[Senate Hearing 112-337]
[From the U.S. Government Publishing Office]
S. Hrg. 112-337
Senate Hearings
Before the Committee on Appropriations
_______________________________________________________________________
Departments of Labor,
Health and Human Services,
and Education, and Related
Agencies Appropriations
Fiscal Year 2012
112th CONGRESS, FIRST SESSION
S. 1599
DEPARTMENT OF EDUCATION
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DEPARTMENT OF LABOR
NONDEPARTMENTAL WITNESSES
SOCIAL SECURITY ADMINISTRATION
S. Hrg. 112-337
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2012
=======================================================================
HEARINGS
before a
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
on
S. 1599
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, 2012, AND FOR OTHER PURPOSES
__________
Department of Education
Department of Health and Human Services
Department of Labor
Nondepartmental Witnesses
Social Security Administration
__________
Printed for the use of the Committee on Appropriations
Available via the World Wide Web: http://www.gpo.gov/fdsys/browse/
committee.action?chamber=senate&committee=appropriations
__________
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COMMITTEE ON APPROPRIATIONS
DANIEL K. INOUYE, Hawaii, Chairman
PATRICK J. LEAHY, Vermont THAD COCHRAN, Mississippi, Ranking
TOM HARKIN, Iowa MITCH MCCONNELL, Kentucky
BARBARA A. MIKULSKI, Maryland RICHARD C. SHELBY, Alabama
HERB KOHL, Wisconsin KAY BAILEY HUTCHISON, Texas
PATTY MURRAY, Washington LAMAR ALEXANDER, Tennessee
DIANNE FEINSTEIN, California SUSAN COLLINS, Maine
RICHARD J. DURBIN, Illinois LISA MURKOWSKI, Alaska
TIM JOHNSON, South Dakota LINDSEY GRAHAM, South Carolina
MARY L. LANDRIEU, Louisiana MARK KIRK, Illinois
JACK REED, Rhode Island DANIEL COATS, Indiana
FRANK R. LAUTENBERG, New Jersey ROY BLUNT, Missouri
BEN NELSON, Nebraska JERRY MORAN, Kansas
MARK PRYOR, Arkansas JOHN HOEVEN, North Dakota
JON TESTER, Montana RON JOHNSON, Wisconsin
SHERROD BROWN, Ohio
Charles J. Houy, Staff Director
Bruce Evans, Minority Staff Director
------
Subcommittee on Departments of Labor, Health and Human Services, and
Education, and Related Agencies
TOM HARKIN, Iowa, Chairman
DANIEL K. INOUYE, Hawaii RICHARD C. SHELBY, Alabama
HERB KOHL, Wisconsin THAD COCHRAN, Mississippi
PATTY MURRAY, Washington KAY BAILEY HUTCHISON, Texas
MARY L. LANDRIEU, Louisiana LAMAR ALEXANDER, Tennessee
RICHARD J. DURBIN, Illinois RON JOHNSON, Wisconsin
JACK REED, Rhode Island MARK KIRK, Illinois
MARK PRYOR, Arkansas LINDSEY GRAHAM, South Carolina
BARBARA A. MIKULSKI, Maryland JERRY MORAN, Kansas
SHERROD BROWN, Ohio
Professional Staff
Erik Fatemi
Mark Laisch
Adrienne Hallett
Lisa Bernhardt
Michael Gentile
Alison Perkins-Cohen
Laura A. Friedel (Minority)
Sara Love Rawlings (Minority)
Jennifer Castagna (Minority)
Administrative Support
Teri Curtin
C O N T E N T S
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Wednesday, March 9, 2011
Page
Social Security Administration................................... 1
Wednesday, March 30, 2011
Department of Health and Human Services.......................... 73
Wednesday, May 4, 2011
Department of Labor: Office of the Secretary..................... 145
Wednesday, May 11, 2011
Department of Health and Human Services: National Institutes of
Health......................................................... 215
Wednesday, July 27, 2011
Department of Education.......................................... 411
Departmental Witnesses........................................... 495
Nondepartmental Witnesses........................................ 489
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2012
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WEDNESDAY, MARCH 9, 2011
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 9:35 a.m., in room SD-124, Dirksen
Senate Office Building, Hon. Tom Harkin (chairman) presiding.
Present: Senators Harkin, Reed, Mikulski, and Shelby.
SOCIAL SECURITY ADMINISTRATION
STATEMENT OF MICHAEL J. ASTRUE, COMMISSIONER
opening statement of senator tom harkin
Senator Harkin. The Subcommittee on Labor, Health and Human
Services, and Education, and Related Agencies will now come to
order.
Our topic today is administrative funding for the Social
Security Administration. Normally, this time of the year, we'd
be talking about the President's budget request for the
upcoming year. However, since this is not a normal year, we're
also here to discuss funding for the rest of fiscal year 2011.
Today's hearing is very timely. Three weeks ago, the House
passed a spending bill for the rest of this year that cuts $102
billion from the President's request. The Senate majority has
offered an alternative that meets the House halfway, cuts $51
billion.
I believe the Senate plan represents a reasonable approach.
But, that's just my own opinion, my own views on this, to
reduce the deficit while protecting programs that help meet the
basic needs of the most vulnerable Americans: seniors,
children, those living in poverty, people with disabilities.
And we're here to discuss one of the most important
programs. And that's Social Security. Created in 1935, Social
Security is the centerpiece of America's social safety net,
providing insurance against poverty from old age, the loss of a
spouse, or a debilitating disability. Today, 58 million
Americans receive Social Security benefits. Eight million will
file, this year. Social Security field offices will receive 45
million visitors. And Social Security's 1-800-number will take
67 million calls this year.
Because of the economic downturn and the aging population,
in the last few years the number of Americans turning to Social
Security and filing for retirement and disability benefits has
increased significantly. You know, as the economy goes down and
unemployment goes up, and it's harder and harder for people at
or near the age of 62, they can't find work; they take early
retirement because they just can't find jobs. So, the number of
people applying has gone up. Also, people who may have had a
minor disability--they've tried to overcome it and work, but
now they're out of work and they simply can't find a job--they
file for disability. So, that's why we've got a huge increase
in an economic downturn.
While the backlogs still persist, the administrative
funding, so far, has largely kept pace with this increased
demand. This, for one thing, has allowed Social Security to
significantly step up its program integrity activities. Social
Security Administration periodically conducts reviews to
determine if beneficiaries are still eligible under the--both
the income and disability guidelines.
Since 2007, the Social Security Administration has
increased the number of continuing disability reviews by over
50 percent, and redeterminations of nonmedical eligibility, by
over 140 percent. Combined, these activities save taxpayers--
save taxpayers--an average of about $8 in future Social
Security, Medicare, and Medicaid benefits for every $1 spent in
administrative funding. So, we spend $1, we save $8.
Today, however, adequate funding for the Social Security
Administration to properly administer these programs is at
risk. The House continuing resolution H.R. 1 would cut
administrative funding for SSA by $125 million below last
year's level--fiscal year 2010 level--even though, as I pointed
out, their workloads on disability claims, hearings, retirement
claims, are staying at record high levels.
Under the House plan, the SSA, the Social Security
Administration, would have to cut its staff by 3,500 by the end
of the year, and may ultimately have to resort to furloughs. As
a result, millions of Americans filing disability claims this
year will have to wait much longer for benefits. Everyone will
have to wait. You probably won't get online, and you probably
won't get your phone call answered right away--and the program
integrity efforts, the one I just mentioned, about making sure
that we save money by making sure that people that are on
disability or filing claims are still eligible--so, delaying
these isn't just bad for the economy, but it's devastating for
the individuals, on both sides.
The Senate majority plan would provide, on net, $600
million more for the Social Security Administration's
administrative expenses. This is less than the President's
request, but it will keep the offices open and allow the agency
to meet its most basic service commitments to the American
public and prevent its backlog of work from growing any bigger
than it is today.
So, that's what this hearing is about. We need to know what
the impact will be on the Social Security Administration, on
their ability to respond to the huge workload, and the effect
it will have on recipients and people who rely upon their
disability or their supplemental security income (SSI) or their
old-age survivors' benefits. So, that's why we're having this
hearing today. We need to know what this means.
So, I look forward to hearing the testimony from our
distinguished panels on this matter. But, first, I yield to
Senator Shelby for any opening remarks.
statement of senator richard c. shelby
Senator Shelby. Thank you, Mr. Chairman.
Thank you for calling this hearing to examine the fiscal
year 2012 Social Security Administration's budget request. I
look forward, as you do, to hearing the panels' testimony and
their views on this critical program.
The greatest obstacle to our Nation's fiscal stability is
ignoring our increasing entitlement obligations. Simply put,
there is no way to control our debt without getting serious
about entitlement reform. And, while we can argue about how to
reform Social Security, we cannot argue about whether it should
be reformed. It's a question of when.
In 2010, for the first time in the history of the Social
Security Program, the system paid out more in benefits than it
received in payroll taxes. This is a critical threshold that
was not expected to be reached until at least 2016. Social
Security is now at the tipping point, the first step of a long,
slow march to insolvency if we don't do something about it.
According to the Social Security Board of Trustees, the
Social Security Trust Fund surplus will be completely exhausted
by 2040. At that juncture, Social Security will have to rely
solely on revenue from the payroll tax, which will not be
sufficient to pay all the promised benefits.
There are currently 50 million Social Security
beneficiaries, and their numbers are increasing faster than the
number of taxpayers. The number of workers per retiree has
fallen from 42 to 1 in 1940 to about 3 to 1 today. Social
Security is unbalanced because contributions are insufficient
to provide the promised benefits. In a sense, it's a classic
Ponzi scheme, with new contributions used to pay off earlier
investors.
I think we must also recognize that the Social Security
Disability Insurance (SSDI) Program contributes more than its
share to Social Security's looming insolvency. During the
economic recession, the unemployment rates soared, as did
applications to the SSDI program. The number of individuals
receiving SSDI benefits has jumped more than 10 percent in the
last two recessionary years. The increase will accelerate the
exhaustion of the SSDI reserves by 2018, and was recently
described by the Congressional Budget Office (CBO) as ``not
financially sustainable.''
And, while the SSDI program faces the same fundamental
issue as the retirement program--that is, there are fewer
workers to pay for an ever-increasing population receiving
benefits--its questionable structure adds complexity. What was
supposed to be a narrowly tailored program to help individuals
who could no longer work grew into a gigantic budgetary burden
that looks more like an unemployment program, to some people.
What makes the problems worse is that, unlike the Federal
Unemployment Program, there is no time limit for how long an
individual can receive SSDI. But, more significantly, among
those receiving SSDI benefits, the incentive to return to work
is very low. In fact, revealing one's ability to go back to the
workforce could result in permanent loss of SSDI benefits. The
strong work disincentives under the SSDI results in workers
never seeking gainful employment, at the risk of losing future
benefits. Clearly, Congress must face the potential fiscal
collapse of the Social Security system in the future.
However, today's hearing focuses on the near-term issues
facing the program and the only aspects of the $817 billion
fiscal year 2012 budget the Appropriations Committee has
control over, $12.5 billion that funds administration costs and
the Office of the Inspector General.
The fiscal year 2012 budget requests an additional $1
billion over the fiscal year 2010 budget to reduce the daunting
744,130 disability claims and 722,872 hearings case backlog. On
top of the significant backlog, the processing time for
disability claims is 112 days, and the wait time for a Social
Security appeal hearing is 371 days.
Interestingly, two-thirds of those who appeal a Social
Security decision win their case on appeal. And, while I
understand the disability process is complex, it's also highly
subjective. With an appeal-over rate so high, why are so many
people winning on appeal. Instead, shouldn't they win at the
beginning?
As the Social Security Administration continues to tackle
the backlogs in their caseload, I think it's important that
funding to pursue continuing disability reviews remains strong.
SSDI benefits are not, and should not be, benefits for life.
Only those who continue to qualify for benefits should receive
them.
We need, I believe, to ensure that fraud and abuse of the
system are rooted out. Those who take advantage of the system
ruin it for those who are genuinely in need. In a program where
there are no fines and virtually no prosecution for those who
attempt to fraudulently collect benefits, we need to examine
ways to stop fraudulent applicants.
The administration of Social Security, while only a small
percentage of the entire system, is a vital component to the
success and the fiscal stability of the overall program. This,
however, does not mean that it can operate without stringent
oversight from this subcommittee. We need to ensure that that
money is being spent wisely and in the best interest of the
U.S. taxpayer.
Mr. Chairman, I look forward to working with you on this
panel, and look forward to the hearing.
Senator Harkin. Thank you very much, Senator Shelby.
I'd like to just ask my colleagues if they have some short
remarks they'd like to make.
Senator Mikulski.
statement of senator barbara a. mikulski
Senator Mikulski. Thank you very much, Mr. Chairman. My
remarks will be brief.
I joined the Labor-HHS Subcommittee at the start of this
Congress, and I'm delighted to be here. As both the chair and
the ranking on the Commerce, Justice, Science Subcommittee,
Senator Shelby and I are used to talking to rocket scientists,
Federal Bureau of Investigation agents, and those in the
Commerce Department who advance the trade for the United
States. But, whether you're a rocket scientist or whether
you're a janitor, Social Security is your program. This is the
one program that the entire United States Government effects.
So, whether you were a Nobel Prize winner, whether you are the
cop protecting the lab where they work, or whether you're the
person who cleans up that lab when everybody goes home, Social
Security is your program.
I'm very proud of the fact that Social Security is
headquartered in my State. Thousands of people work there every
day to make sure that this benefit is a guaranteed benefit, not
a guaranteed gamble for those who want to privatize it, but
they guarantee also that the checks will be delivered on time,
to the right person, with the right actuarial assignment or
payment given to it. I'm very proud of them.
And, quite frankly, Mr. Chairman, I'm deeply troubled about
where we are on the cuts to Social Security, the contemptuous
attack on Social Security as a benefit, and then the even overt
hostile attack on Social Security employees. They're on the
front line every day--some in harm's way, when a disgruntled
person shows up off their meds--but, they're there every day,
every way, serving the people of the United States of America,
and we have to make sure they have the right pay, the right
resources, and the right respect.
Senator Harkin. Thank you, Senator Mikulski.
Senator Reed.
Senator Reed. No, thank you.
introduction of commissioner michael j. astrue
Senator Harkin. Well, thank you all very much.
We'll start with our first panel.
Michael J. Astrue serves as a Commissioner of the United
States Social Security Administration. He was sworn in on
February 12, 2007. Prior to joining Social Security, the
Commissioner served as counsel to the Social Security
Commission, general counsel and Department of Health and Human
Services, and as an associate counsel to the President, in both
the Reagan and George Bush, Sr., administrations. He's a
graduate of Yale University and Harvard Law School.
Mr. Astrue, welcome to the subcommittee. Your testimony
will be made a part of the record in its entirety. And, if you
could sum it up in several minutes or so, we'd be most
appreciative.
Commissioner Astrue. Great.
Senator Harkin. Thank you.
summary statement of michael j. astrue
Commissioner Astrue. Chairman Harkin, Ranking Member
Shelby, and members of the subcommittee, thank you for this
opportunity to discuss the important work of the Social
Security Administration.
For a number of years, going back to the 1990s, we did not
receive full funding, and service deteriorated. When I became
commissioner in 2007, I promised improvements. And Congress has
supported those improvements. With necessary investments,
greater productivity, and new initiatives, we have reversed the
trend of declining service and increasing backlogs.
Our top priority remains eliminating the hearings backlog.
And we've made significant progress 4 years in a row. We have
decided over one-half a million of the oldest, most complex
cases, some as old as 1,400 days. We have cut the waiting time
for a hearing decision, from nearly 18 months in August 2008 to
exactly 1 year in February 2011.
We have made the most progress in some of our most
backlogged offices. For example, our Atlanta downtown office
had an average waiting time of 1,020 days in August 2007. We
have slashed that time by 70 percent. The average waiting there
is now 297 days.
Without your continued support, however, we will not meet
our commitment to eliminate this backlog by 2013. Our staff and
our State disability determination services (DDS) partners kept
our pending level of claims well below our fiscal year 2010
projected level, while achieving the highest level of accuracy
in over a decade, even as they faced furloughs and a huge
influx of claims, due in part to the economic downturn.
In fiscal year 2010, callers to our national 800 number had
the shortest waiting time and lowest busy rates since we began
tracking these measures, nearly a decade ago. We reduced the
average waiting time in our field offices. We have increased
our important program integrity work, which is improving
payment accuracy in the Supplemental Security Income Program.
Every $1 we spend on continuing disability reviews yields
$10 in lifetime program savings. Every $1 spent on SSI
redeterminations yields more than $7. To do this complex work,
we need an adequate number of well-trained employees.
Since 2007, our dedicated employees have averaged nearly a
4-percent annual increase in productivity, which is fueled by
hard work, better business processes, and smart investments in
information technology. Few, if any, organizations can boast
productivity gains of this magnitude.
The fiscal year 2012 President's budget request of $12.5
billion is what we need to reduce our remaining backlogs and to
increase our deficit-reducing program integrity work. But,
achieving that performance depends on receiving the President's
budget request in fiscal year 2011.
Because of the uncertainty of our budget and the length of
the continuing resolution, I've already had to make choices
that will begin to erode service. I cut back on hiring, last
July, and have continued to scale back on hiring and other
areas. We now expect a net loss of 3,500 Federal and State
employees this fiscal year. Most of these employees work in
offices across the Nation, and they will not leave those
offices uniformly. Some offices are already understaffed. Our
employees continue to serve the public as best they can, but
they are disappointed about the prospect of watching what we
have worked so hard to achieve potentially slip away.
I regret that we may not be able to keep our commitments to
the American people because we do not have the necessary
support to move forward. Millions of people we serve cannot
afford to wait. People with disabilities lose their homes,
medical coverage, and dignity. That outcome does not serve
Americans or the economy well.
In addition to other cuts we've made, we are discontinuing
service at over 300 remote sites and are considering field
office consolidations. We will not open eight needed hearing
offices, and we will not be able to staff the new Jackson,
Tennessee, Teleservice Center this year and maybe not next year
or in future years. We're suspending printing and mailing of
annual earnings statements, which will save about $70 million
annually.
If you look at what we have accomplished in just 4 years,
you'll see that we are a good investment. With adequate and
timely resources and the superb efforts of our employees, we
deliver on our promises. Nevertheless, we cannot eliminate our
disability backlogs, provide accurate and responsible service,
and meet our stewardship duties, unless Congress provides us
with the resources to do the job. Suddenly reduced funding
halfway through the fiscal year could eliminate most of the
progress that we have made.
I'm happy to answer any questions that you may have.
prepared statement
Senator Harkin. Mr. Astrue, thank you very much for a very
concise statement. I know you have a longer statement, which I
went over the other evening, and it will be made a part of the
record, as I said, in its entirety.
I thank you for----
Commissioner Astrue. Thank you, Mr. Chairman.
Senator Harkin [continuing]. Summing it up.
[The statement follows:]
Prepared Statement of Michael J. Astrue
Chairman Harkin, Ranking Member Shelby, and Members of the
Subcommittee: Thank you for the opportunity to discuss the President's
fiscal year 2012 budget request for the Social Security Administration.
For over 75 years, Social Security has touched the lives of
virtually every American, whether it is after the loss of a loved one,
at the onset of disability, or during the transition from work to
retirement. Our programs provide a safety net for the public and
contribute to the increased financial security for the elderly and
disabled. Each month, we pay more than $60 billion in benefits to
almost 60 million beneficiaries. These benefits not only provide a
lifeline to our beneficiaries and their families, but also are vital to
the Nation's economy.
Americans request a staggering amount of service from our agency.
We respond to their needs through a network of 1,500 offices that
provide service to local communities across the country. Nearly all of
our employees work in these local offices where they do a wide range of
work including issuing Social Security cards, handling applications for
benefits, maintaining workers' earnings records and the accuracy of our
benefit records, deciding appeals, answering our 800 number, and
assisting with Medicare.
In fiscal year 2010 we:
--Completed 4.7 million retirement and survivors claims;
--Completed 3.2 million initial disability claims;
--Served 45.4 million field office visitors;
--Completed over 67 million transactions over the telephone;
--Verified over 1 billion Social Security numbers;
--Issued 17.2 million new and replacement Social Security cards;
--Conducted 325,000 full medical continuing disability reviews (CDRs)
and 312,000 work CDRs;
--Completed 2.5 million Supplemental Security Income (SSI) non-
disability redeterminations;
--Paid $1.4 billion in attorney fees;
--Completed 738,000 hearings;
--Defended 12,000 new Federal court cases;
--Facilitated over 1,500 data exchanges with Federal, State, local
and foreign government entities as well as some private sector
companies;
--Oversaw approximately 5.6 million representative payees;
--Completed 240 million earnings items for crediting to workers'
earnings records; and
--Mailed out 152 million Social Security statements.
We have a long-standing and well-deserved reputation as a ``can-
do'' agency. Despite years of underfunding, our hard-working and
dedicated employees have done their utmost to maintain the level of
service that the American people expect and deserve. We have been
innovative and proactive in adopting strategies to allow us to meet the
challenges we face. To the extent resources allowed, we have hired and
trained staff to handle our increased workloads, and we have used
technology to complement our traditional work processes and make them
more efficient.
In retrospect, our remarkable successes planted the seeds for many
of our current challenges. Congress, confident that those successes
coupled with our ``can do'' attitude meant that we could always find
ways to adapt, appropriated less than the President requested each year
from 1992-2007. At the same time, requests for our core services rose
as the population grew and baby boomers aged, passing through their
most disability-prone years before retiring. Even with this new and
unavoidable demand, we managed to maintain our high service levels for
some time.
Inevitably, though, we could no longer hold out. Unprecedented
workloads combined with declining budgets damaged our service delivery.
We could not keep up even with a long string of employee productivity
increases. Throughout most of the past decade, the amount of program
integrity work our employees could keep up with while handling other
priority work dropped dramatically, even though we know that program
integrity work saves the taxpayer about $10 for each dollar spent. The
time claimants waited for disability hearings rose to an average of
800-900 days in many cities, and some claimants waited as long as 1,400
days. Waiting times for in-person and telephone service increased, as
did the public's and Congress's frustration with us.
recent accomplishments
In the last 3 years, we have demonstrated the nexus between
adequate funding and our ability to deliver--the Congress increased our
funding, and we made real and measurable progress. We reversed many
negative trends, most notably with the hearings backlog, and
significantly improved service and stewardship efforts. We made these
improvements even though we have had to absorb huge unexpected
increases in workloads due to the worst economic downturn since the
Great Depression.
When I became Commissioner, the Congress made it clear that I had
to reduce the amount of time it takes a claimant to receive a hearing
decision. I recognized their concerns and committed to eliminating the
hearings backlog. Although we have many pressing workloads, we have
never wavered from this top priority, demonstrating what it means to be
a results-driven organization.
With your help, we attacked the backlog and made incredible
progress in the last 4 years. We have cut the national average time
claimants wait for a hearing decision by one-third, from an all-time
high of nearly 18 months in August 2008 to exactly 1 year in February
2011. We have made the most progress in offices that had the largest
backlogs. For example, the Atlanta offices had some of the longest wait
times in the country. In the summer of 2007, the Atlanta Downtown
office had an average waiting time of 1,020 days, and the Atlanta North
office averaged about 900 days. By January 2011, we reduced the wait in
the Atlanta Downtown office to 297 days, a 70 percent reduction, and to
307 days in the Atlanta North office, a two-thirds reduction.
During this time, we focused on the most urgent part of the
backlog--the oldest, most complex cases. In 2007, we had claimants who
waited for a hearing decision for as long as a staggering 1,400 days.
Since 2007, we have decided over a half million of the oldest cases. By
the end of fiscal year 2010, we had virtually no cases pending for more
than 825 days. This year we are focusing on the cases that are 775 days
or older, and through January 2011, we have decided over 60 percent of
these cases.
We expect that once we eliminate the backlog, we will be able to
decide hearings in an average of 270 days. In 2007, 50 percent of the
pending hearing requests were older than 270 days. Today, about 30
percent of our cases are over 270 days, and that percentage continues
to drop.
Another indicator of our progress is the number of our
administrative law judges (ALJ) who are on pace to meet our
productivity expectation to decide between 500-700 cases each year.
When we established the expectation in late 2007, only 47 percent of
the ALJs were achieving it. By the end of fiscal year 2010, 74 percent
of the ALJs met the expectation.
We have made considerable progress, despite the significant
increase in disability claims. More disability applications result in
more appeals. Last year, we received nearly 100,000 more hearing
requests than we received in fiscal year 2009. This trend of increasing
claims has continued. In our highest month for hearing requests last
year, we received approximately 73,800 requests. This year, that number
rose to a record monthly high of about 82,000.
In fiscal year 2010, we handled more than 3,161,000 initial
disability claims--a record number that is 300,000 more than the year
before. Even with this huge increase in determinations, we could not
keep up with the number of disability claims we received. The number of
pending initial disability cases rose to over 842,000. We have begun
working this number down, and as of February 2011, we have reduced the
pending claims to 774,000.
The State disability determination services (DDS), the State
agencies that make initial disability decisions for us, are not
sacrificing quality to gain productivity. The DDSs have steadily
increased the accuracy of their decisions since fiscal year 2007. In
fiscal year 2010, the DDSs achieved an accuracy rate of 98.1 percent,
the highest level in over a decade.
These accomplishments are particularly remarkable considering the
unjustifiable--because we fully fund this work--furloughs of disability
determination services employees in many States.
To help States with mounting disability claims, we created Extended
Service Teams (EST) modeled after our successful National Hearing
Centers. The ESTs are located in State DDSs that have a history of good
quality and high productivity. These centralized DDS teams are helping
us reduce the initial claims backlog as we electronically shift claims
to them from the hardest hit DDSs. We have also expanded our Federal
capacity to decide disability claims. We currently have 12 Federal
units that assist those DDSs most adversely affected by the increase in
initial claims.
Identifying and paying eligible claimants early in the disability
process clearly benefits those with severe disabilities and helps our
backlog reduction efforts. In fiscal year 2010, we used our fast-track
initiatives, Compassionate Allowances and Quick Disability
Determinations, to issue favorable disability determinations to over
100,000 disability claimants within 20 days of filing. We implemented
these initiatives while maintaining a very high accuracy rate.
In fiscal year 2011, we implemented a new regulation to allow
disability examiners to make fully favorable determinations for
claimants with the most severe disabilities without consulting a
medical professional. This change allows us to decide claims even
faster.
Last year, more than 45 million people, a record number, visited
our field offices across the Nation. Despite the increased number of
visitors, we reduced wait times in our field offices more than 10
percent from fiscal year 2009.
We completed more than 67 million transactions over the telephone--
another record number. Callers to our national 800-teleservice centers
had the shortest wait time and lowest busy signal rates since we began
measuring these services over a decade ago. In the last 2 years, we cut
our busy rate by more than half, from 10 percent in fiscal year 2008 to
4.6 percent in fiscal year 2010. We also reduced the time spent waiting
for an agent by over 37 percent, from 326 seconds in fiscal year 2008
to 203 seconds in fiscal year 2010.
Our online applications have been indispensible in helping us keep
up with the enormous growth in retirement claims. For that reason, we
made it easier to file disability claims online. In January 2010, we
released a streamlined disability report, which we use to collect
information about a claimant's disability. This user-friendly report
allows a claimant to complete an application more quickly and improves
the quality of the information we receive.
We continue to expand and improve our online offerings. In March
2010, we introduced an online Medicare-only application. In July 2010,
we introduced our Life Expectancy calculator, which helps people decide
when to start collecting retirement benefits. In December 2010, we
launched a Spanish version of the Retirement Estimator--the first non-
English interactive online application in the Federal Government. We
have the three best electronic services in the Federal Government, as
measured by the University of Michigan public satisfaction survey. Our
Spanish-language retirement estimator is on track to become the fourth.
These easy-to-use online tools encouraged 37 percent of retirees and 27
percent of disability claimants to file online in fiscal year 2010.
We have increased our program integrity work, which saves taxpayers
dollars. In fiscal year 2010, we completed over 700,000 more SSI
nondisability redeterminations than in fiscal year 2009. Completing
more of this important stewardship work, helps us increase the payment
accuracy in the SSI program.
Our employees deserve the credit for these successes. From fiscal
year 2007 to fiscal year 2010, their productivity increased by an
astounding average of nearly 4 percent per year. I am privileged to
lead a workforce dedicated to the highest standards of public service.
Despite the pressures that increased workloads bring, our employees
understand how important our mission is, voting us one of the top ten
best places to work in the Federal Government for the third consecutive
year.
We are proud of the hard-earned progress we have made over the past
3 years. However, demographics, rising workloads, and heightened fiscal
austerity will threaten our recent achievements and make further
progress at this level unlikely.
effects of continuing resolutions
We understand the economic reality that is driving budget
decisions. I have looked for and found ways to cut back. We have
trimmed non-essential travel, training, and even systems enhancements.
By far the largest part of our budget funds payroll. Eighty percent of
our employees work in local offices across the Nation. I have even cut
this critical area--the people we all depend on to get the work done--
by freezing hiring and offering early out.
Beyond payroll costs, most of our remaining costs are mandatory
expenses to maintain our operations. For example, we must pay rent and
maintenance on the 1,500 facilities we occupy; we must pay postage on
more than 390 million notices we send annually; we must pay for medical
and vocational evidence and expertise; and we must pay for armed guards
in our offices to protect our employees and the public. Unfortunately,
these guards are particularly vital now given the increase in threats
against our employees.
A theoretically level-funded continuing resolution does not
consider that our costs do not remain flat--we have to absorb mandatory
cost increases with last year's funding level. In addition, the $350
million Recovery Act funding we used in fiscal year 2010 to handle
claims was not included in our continuing resolution level. Between
having to cover mandatory cost increases and not having Recovery Act
funding, we are operating at a significant loss over last year.
In this modern era, we are completely dependent on information
technology. Not only do we need stable and robust systems to handle our
day-to-day work, technology makes us more efficient. Unfortunately,
under a continuing resolution, our information technology (IT) funds
are severely constrained. Many of our investments in technology to
improve our productivity have been curtailed. If the continuing
resolution reduces our funding further, or the funding reduction
continues into future years, our ability to continue keeping our
technology environment operating smoothly will be threatened.
Our technology to this point has enabled us to implement work
processes that are less costly, more accurate, and require fewer
employees to accomplish the same amount of work. Without our current
investments, we would not have been able to keep pace with the recent
increases in claims. We would not have realized the increases in
productivity that have enabled us to serve the public as we have. IT
investments are critical if we are to continue to improve productivity
and achieve our performance targets. We must maintain and invest in
technology.
Because of the uncertainty of our budget and the length of the
continuing resolution, I have had to make choices that will begin to
erode service. Our employees continue to churn out work, but they are
disappointed and are becoming demoralized about the prospect of
watching what they have worked so hard to achieve slip away. I regret
that we may not be able to keep our commitments to the American people
because we do not have the necessary funding to continue moving
forward.
Our employees come face-to-face with the public every day, and they
are acutely aware of how the public will suffer. As I mentioned
earlier, there is a direct nexus between our funding and our service
level. We want to prepare you for what a deep cut would mean. Our
backlogs will skyrocket, and people will wait considerably longer to
receive decisions. As our backlogs grow, it will become more difficult,
expensive, and time-consuming for us to eliminate them. Waiting times
in field offices and on our 800-number will increase dramatically. Deep
cuts will cause billions of dollars of payment errors that will take
years to address, hardly a wise use of taxpayers' dollars. Even if we
have specific funding for program integrity work, we need the people to
do that work plus all of their other fundamental responsibilities.
A full-year continuing resolution will require us to put on the
brakes, reversing the tremendous progress we have made in the last few
years. Common sense dictates that we need enough skilled employees to
handle mounting workloads. A continued hiring freeze means we will lose
about 2,500 Federal employees and 1,000 DDS State employees this year.
Our field employees will not leave the agency uniformly. Attrition is
random, leaving some offices seriously understaffed.
While we regret the resulting loss in service, we have tried to
prepare for the continuing resolution. In July, we instituted a full
hiring freeze for all headquarters and regional office staff, and then
we further restricted hiring to allow only those components critical to
the backlog reduction effort to replace staffing losses. Under a
continuing resolution, we will continue--and likely expand--the hiring
freeze. We will reduce or eliminate, overtime, which our front line
employees depend on to keep up with their work.
We have decided not to open eight needed hearing offices, and we
will not have staff to open our new Jackson, Tennessee Teleservice
Center this year, and perhaps not even next year. We are discontinuing
service in over 300 remote service sites throughout the United States.
Most of these sites are ``contact stations'' housed in locations like
libraries, senior centers, or other facilities where a Social Security
employee travels, typically once or twice a month, to take applications
for Social Security cards or benefits, as well as answer questions. We
have also begun looking at field office consolidation where that
decision makes fiscal sense.
Each year we send Social Security Statements to non-beneficiaries
who are over age 25. These annual Statements cost us approximately $70
million each year to print and mail. In order to conserve funds, we
will suspend the current contract and stop sending out these
Statements. Individuals contemplating retirement can get real-time
information about the amount of their benefits on our highly regarded
Retirement Estimator, available on-line at www.socialsecurity.gov.
Field offices may also provide Statement data. After we negotiate a new
contract, we will send Statements only to people age 60 and over and
people under age 60 upon request. We also are working on making the
Statements available online.
ongoing funding--fiscal years 2011 and 2012
The President's fiscal year 2012 budget request includes $12.522
billion for our fiscal year 2012 LAE account. This level of funding
will allow us to maintain staffing in our front-line components, fund
ongoing activities, and cover our inflationary increases. It will allow
us to reduce our hearings and initial disability claims backlogs and to
continue to reverse the decline in our program integrity work. Our
fiscal year 2012 request is a very modest increase from our fiscal year
2011 request; the increase of $143 million is primarily to fund
additional program integrity efforts.
However, this level of funding will be sufficient to meet these
goals only if we receive the full amount that the President requested
for fiscal year 2011. While full funding of the President's budget
request will allow us to build on the tremendous progress we achieved
over the past few years, it will not allow us to keep up with some of
the important, statutorily mandated, and less visible work we do, such
as representative payee accountings and benefit recomputations.
Even with full funding, we will not have sufficient resources to do
all that you and America expects us to do. Accordingly, we will use our
fiscal year 2011 and 2012 funding to focus on our three priorities.
--Continuing to reduce the disability backlogs;
--Improving service to the public; and
--Saving taxpayer dollars.
We will continue to operate very efficiently, holding
administrative costs in fiscal year 2012 to just 1.6 percent of benefit
payments.
continuing to reduce the disability backlogs
Hearings Backlog.--Eliminating the hearings backlog continues to be
our number one priority, and we have made real and measurable progress
in reducing both the number of pending hearings and the amount of time
a claimant must wait for a hearing decision.
In fiscal year 2012, with full funding of both the fiscal year 2011
and 2012 President's budget requests, we will continue our progress
toward our goal of eliminating the hearings backlog in 2013. Resources
permitting, we plan to hire an additional 130 ALJs in late fiscal year
2011--particularly if hearing requests remain so high--to ensure that
we can meet our commitment to eliminate the hearings backlog by the end
of fiscal year 2013. We expect to complete a record number of
hearings--over 800,000 in fiscal years 2011 and 2012, which is more
than double the number we handled 10 years ago.
We continue to focus on eliminating our oldest cases. In fiscal
year 2011, we are targeting the 106,715 cases that will be 775 days or
older by the end of the year. In fiscal year 2012, we will lower our
threshold to 725 days.
While we have made significant progress, people still wait too
long. That wait has very real implications--many people with
disabilities lose their homes, medical coverage, and dignity while
waiting for a decision on a hearing. We want to maintain our momentum
and eventually restore an appropriate level of service. Without the
President's budget, it is highly likely that we will miss our goal of
eliminating our hearings backlog in 2013. If that happens, gains that
we have achieved in prior years will vanish.
Initial Claims Backlog.--We remain committed to returning our
initial disability claims pending to its pre-recession level by 2014.
However, in order to meet this commitment, we will need sustained,
adequate funding.
Another significant obstacle to tackling this backlog is the
decisions by a number of States to furlough federally paid State
employees who make our disability determinations. To address that
problem, in July 2010, we submitted a legislative proposal to Congress
that would prohibit States, without our prior authorization, from
reducing the number of State personnel who make disability
determinations for Social Security. I look forward to working with you
on this important issue.
If we receive full funding, we estimate we will complete 3,409,000
disability claims in fiscal year 2011, and 3,268,000 in fiscal year
2012. We have several initiatives planned and underway to help us
achieve our goal.
We are dedicated to fast-tracking disability claims that obviously
meet our disability standards and to providing decisions within 20 days
of filing. With the effective use of screening tools, expanded
technology, and electronic services, we have increased our ability to
identify and quickly complete cases that we are likely to approve. We
continue to refine our methods for identifying these cases so we can
increase the number of fast-tracked claims while maintaining accuracy.
We plan to increase the number of fast-tracked claims to 5.5 percent of
all new claims filed in fiscal year 2012.
improving service to the public
The availability of online services is vital to good and efficient
public service. Increasingly, the public expects to have the option to
conduct business over the Internet at their convenience and at their
own pace. Even though our employees continue to review online benefit
applications and contact applicants to resolve questions or
discrepancies, these online services reduce the average time our
employees spend completing claims, giving them additional time to
address more complex issues.
We plan to continue to expand and improve our online services. We
plan to implement a new, even more secure authentication process to
provide a safe environment for people who are interested in conducting
additional business with us online. This protocol will be the gateway
to allow the public to access their personal information online. We are
also working on an initiative that may provide access to a variety of
personalized online services, such as verifying earnings history,
receiving notices, and requesting certain routine actions.
Investing in online services is critical for providing better and
more efficient service to the public. We will only be able to meet our
budget commitments if we continue to see growth in our online
applications. In fiscal year 2011, we plan to implement a shorter
online application for cases in which a claimant alleges a
Compassionate Allowance condition. In fiscal year 2012, we expect that
50 percent of all retirement applications and 38 percent of all
disability applications will be filed online.
Because calling our 800-number continues to be the option the
public chooses most frequently to access our services, we are committed
to improving our telephone service. In fiscal year 2010, we awarded a
contract to replace our 800-number telecommunications infrastructure.
The new system will include state-of-the-art features such as providing
immediate telephone assistance to people who visit our website. It will
also allow us to redesign our call flow to eliminate lengthy navigation
menus that are frustrating to the public. We plan to implement these
and other enhancements in fiscal year 2011 and fiscal year 2012.
We also recognize the importance of improving our field office
service. Despite a record number of visitors, we reduced wait times in
our field offices for those without an appointment from 23.3 minutes in
fiscal year 2009 to 20.7 minutes in fiscal year 2010. We will continue
improving our field office service in fiscal year 2011 with Social
Security Television (SSTV). SSTV broadcasts to our reception areas
information about our programs and services, such as what documents
visitors need to apply for benefits or to request a Social Security
card. It saves the public and our staff time.
We are improving field office telephone service by continuing to
replace obsolete telephone systems in all of our field offices. Nearly
70 percent of our field offices have the new system, and we are on
schedule to complete the rollout in 2012, although abrupt budget cuts
may slow that rollout. The new system reduces operating costs and
replaces increasingly unreliable outdated telephone systems. It also
will allow us to improve both service and efficiency. For example, with
the new system, we will be able to implement a Dynamic Forward-On-Busy
feature, which will offer field office callers who would otherwise get
a busy signal the option of being transferred to our 800-number during
non-peak times.
Video service can provide an efficient and innovative way to
provide Social Security services to the public. For example, we
negotiated an agreement with the Walter Reed Army Medical Center to
install onsite video service delivery equipment that connects
hospitalized military service members with Social Security claims
representatives to apply for disability benefits. Video service allows
our offices to link together to provide help to busy or understaffed
offices. With adequate funding, we can continue to expand our use of
video services to reach our customers in remote sites such as American
Indian Tribal centers, local community centers, senior centers,
hospitals, and homeless shelters, and end the inefficiency of traveling
to remote sites on a regular basis.
saving taxpayer dollars
We continue to find better ways to conduct our business. We are
committed to minimizing improper payments and protecting program
dollars from waste, fraud, and abuse. We pay over $60 billion in
benefits each month and have a duty to protect taxpayer dollars. We
invested $758 million toward our program integrity efforts in fiscal
year 2010, and our budgets propose to invest even more in fiscal years
2011 and 2012.
We have many stewardship activities that are critical to helping us
prevent and detect improper payments. These include our program
integrity reviews, our initiatives to reduce improper payments, and our
joint Cooperative Disability Investigations effort with our OIG.
We have two types of program integrity reviews for which we receive
special funding: CDRs, which are periodic reevaluations to determine if
beneficiaries are still disabled, and SSI redeterminations, which are
periodic reviews of non-medical factors of SSI eligibility, such as
income and resources. We estimate that every dollar spent on CDRs
yields at least $10 in lifetime program savings. Every dollar spent on
SSI redeterminations yields more than $7 in program savings over 10
years, including savings accruing to Medicaid.
For many years, we had to cut back on these reviews due to
inadequate funding. However, with your support, we have been able to
increase the number of program integrity reviews we complete, saving
billions of program dollars. In fiscal year 2012, we plan to conduct
592,000 full medical CDRs, up from the 360,000 we plan to conduct this
fiscal year. We also plan to conduct 2.6 million redeterminations, up
from an estimated 2.4 million in fiscal year 2011.
The fiscal year 2012 President's budget includes a legislative
proposal to require employers to report wages quarterly. Increasing the
frequency of wage reporting would improve program integrity for a range
of programs by generating more timely information for retrospective
checking and quality control.
We have several initiatives underway to reduce improper payments.
In fiscal year 2009, over 99 percent of all OASDI payments were free of
payment error. Our SSI payment accuracy is improving, but it is still
not acceptable. In fiscal year 2009, 91.6 percent of all SSI payments
were free of overpayments, while 98.4 percent of all SSI payments were
free of underpayments.
To help improve our SSI accuracy rate, we have developed several
program initiatives that are both cost-effective and prevent or
minimize improper payments. These include:
--Access to Financial Institutions (AFI).--In 2004, we began piloting
AFI, which runs data matches with financial institutions that
allow us to quickly and easily identify assets of SSI
applicants and recipients that exceed the statutory limits. In
November 2007, we expanded AFI to California. Currently, 25
States use AFI, and we expect to complete our rollout by the
end of fiscal year 2011. Once we have fully implemented AFI, we
project roughly $900 million in lifetime program savings for
each year that we use the fully implemented process. We are
working with other agencies to see if they would benefit from
this initiative.
--Telephone Wage Reporting.--Wages earned by SSI recipients can
affect their payment amounts. We do not always receive reports
of income timely; in fact, this is a major cause of SSI
improper payments. Using our SSI Telephone Wage Reporting
System (SSITWR), recipients can call a dedicated toll-free
number to report their wages via a voice recognition system. In
fiscal year 2010, we received over 331,000 calls to our SSITWR.
These reports generally require no additional evidence, which
saves time in our field offices. Wages reported using this
method are 92.2 percent accurate, compared to the 75.5 percent
dollar accuracy of wages reported through traditional means.
Based on the positive results of electronic reporting in the
SSI program, we are planning to expand telephone wage reporting
to Social Security disability beneficiaries.
With adequate funding, we plan to continue to modernize our
information technology infrastructure. If our systems are down, we
cannot function. We must continue to provide service that is more
efficient, continually refresh our technology before it becomes
obsolete, and ensure that we can continue to protect our data from
security threats.
We will expand our use of Health Information Technology (HIT). This
promising technology has reduced the amount of time it takes for us to
obtain medical records, which in turn decreases the time it takes to
complete a disability claim. In fiscal year 2010, we funded
technological support for a number of healthcare providers to send us
medical records electronically.
disability work incentives simplification pilot (wisp)
The fiscal year 2010 President's budget request proposes a 5-year
reauthorization of our section 234 demonstration authority for the DI
program, which would allow us to test program innovations. One such
innovation is the WISP program, which would provide beneficiaries with
a simple set of work rules and would no longer terminate benefits based
solely on earnings. Many DI beneficiaries want to return to work but
they do not attempt to because they are worried about losing monthly
benefits and health insurance if their work attempt fails.
Additionally, the current work incentive rules are complex and can
sometimes result in large overpayments.
WISP is intended to address these concerns by replacing complex
rules with a clear, simple, unified process that is both easier to
understand and easier to administer. Work would no longer be a reason
for terminating DI benefits. We would continue to pay cash benefits for
any month in which earnings were below our established threshold, but
would suspend benefits for any month in which earnings were above the
threshold. A beneficiary would maintain an attachment to DI and
Medicare as long as the disabling impairment continues.
Testing WISP under rigorous evaluation protocols would allow us to
analyze the effects of these changes on the behavior of beneficiaries
and potential applicants across the country.
conclusion
I am proud that we have significantly improved the service we
deliver to the American people. Without the additional funding Congress
provided to us since fiscal year 2008, Americans would wait
significantly longer to receive decisions on their claims, speak to a
representative in our field offices or on the phone, and have their
cases heard by an ALJ.
While we hope that the worst of the economic downturn is behind us,
unemployment is predicted to remain high. Since high unemployment rates
usually result in more benefit applications, we expect the number of
new claims, particularly for disability, will continue to remain high.
These additional claims will ultimately result in more hearing
requests.
We have made great progress for the American public, but it will be
jeopardized without full funding of the President's fiscal year 2011
and 2012 budget requests of $12.379 billion and $12.522 billion,
respectively. The American people are still struggling through the
economic crisis. We cannot allow our services to deteriorate. A
reduction in our funding at this time would reverse the progress we
have made over the last few years. Millions of deserving Americans
count on us, and we need your continued support to provide the service
they expect and deserve.
ADMINISTRATIVE FUNDING FOR SOCIAL SECURITY
Senator Harkin. So, we'll begin a round of 5-minute
questions.
First, I just want to reiterate, for everyone here, we're
here today to discuss administrative funding for Social
Security. Issues concerning the solvency of the program are not
in the purview of this subcommittee. I will be limiting my
questions to the very important topic at hand that will impact
millions of Americans this year, and I ask my fellow
subcommittee members to do the same. Debates on solvency and
what needs to be done to ``fix'' Social Security stuff,
that's--as I said, that's not in the purview of this
subcommittee. What's in the purview is the funding for the
administration of the program, and how that program operates
with that funding.
ANNUAL EARNINGS STATEMENTS
So, Commissioner Astrue, just a couple things. One, you
said you're suspending printing and mailing of the annual
earning statements. Is this the statement that people get every
year that says, ``Here's how much you have put in and here's
what you can expect to get''----
Commissioner Astrue. Yes.
Senator Harkin [continuing].``When you retire''?
Commissioner Astrue. Yes, it is, Mr. Chairman.
Senator Harkin. One of the things that, when Social
Security started doing this--I don't know how long ago Social
Security started doing this, but----
Commissioner Astrue. We started doing this, on a pilot
basis, when I was with the agency the last time. So, it would
be more or less around 1987----
Senator Harkin. Somewhere in there.
Commissioner Astrue. Mr. Chairman.
Senator Harkin. Since then, what's happened--correct me if
I'm wrong--is that people get these statements and they then
have a better idea if they need to save more or put more in
some other retirement account or something, because they'll
know what their Social Security is going to be. And now they're
not going to have that information?
Commissioner Astrue. Well, they will substantially have
that information in a different form, Mr. Chairman. So, one of
the things that we have done on my watch is that almost all
Americans can go online now and get an estimate of their
retirement earnings. And it's very accurate. What they used to
do with the old printed statement is take their 35 years, type
those into an online program that was not very accurate, and
try to get the same information. So, for the vast majority of
Americans, they can now get what they're really looking for,
much more accurately.
What we were planning on talking to the Congress about in
the next 6 months, we think that we are close to being able
provide the earning statement information online. We do not
know for sure yet. It's primarily a question of authentication,
and we're still working on that. So, we are in the process of
canceling the contract, which is very expensive. We think, in
the next 6 months, we'll be able to make a decision whether
we're going to be able to provide that information safely and
efficiently online, or whether we have to revert to the old way
of doing things. But, in the meantime, it seemed like it made
sense; given the tradeoffs of all the things that we're
supposed to do that we can't do efficiently, that this is one
of the things that it made sense to take a pause in doing.
PROGRAM INTEGRITY
Senator Harkin. I understand. Very good.
About program integrity: As you say, the continuing
disability reviews save about $10 for every $1 spent.
Redeterminations save about $7 for every $1 spent. What are the
long-term budget implications of cutting administrative funding
for these today, if we do cut them?
Commissioner Astrue. Well, I think the key part of the
issue, Mr. Chairman, is that even if we continue the same level
of program integrity work--and with all the stresses of the
agency, you'll note my commitment to program integrity work,
because that had dropped steadily with the administrative
funding cuts in the beginning of the decade. And they've gone
up, year by year, on my watch, although we're not back to where
we really should be in order to protect the trust funds
appropriately.
But, the issue really is, we are going to make a lot more
mistakes that cost the trust fund money if we're not handling
the cases upfront correctly. And what's going to happen if we
have sudden and severe cuts is, the level of error will
increase dramatically, and we'll need more staff, and it will
take a lot of time, and it will not be a complete recovery
effort, to try to fix that after the fact. As with most things
in life, it's better to do it correctly upfront than try to fix
the problems after the fact.
DISABILITY WAITING TIMES
Senator Harkin. Last--I've only got a few seconds left;
I'll ask my last question. And that has to do with the amount
of time that you have reduced. On your watch, you've reduced
the----
Commissioner Astrue. Yes.
Senator Harkin [continuing]. The waiting time considerably.
I congratulate you on that. That's great leadership. And so,
I've said this to some people, but ``Well, okay, then the time
will go back up again, for people to get their disability
claims.'' And, quite frankly, some people have said, ``Well,
you know, so what? So, they have to wait another half a year or
year. So what?'' Well, what's the response on that?
Commissioner Astrue. Well, you know, my response is, I've
been through this, personally. Very unexpectedly in 1985, I had
to file for disability for my father. And I think that a lot of
people who say things like that just don't appreciate what it's
like to be in that position and how important--even with the 5-
month waiting period for benefits and the 24-month waiting
period for medical benefits--how important it is for the
family, for financial planning, to know what's going to be
available when. And I think anyone who's been through the
process can't possibly say, ``Well, another year, another 2
years, is just fine.''
Senator Harkin. Thank you very much, Commissioner.
Senator Shelby.
RECOVERY ACT FUNDING FOR SSA
Senator Shelby. Thank you, Mr. Chairman.
I'm a little baffled by the assumptions made by the Social
Security Administration, in your testimony, with regard to
fiscal year 2011 and 2012 budgets. You state, and I'll quote,
``The $350 million Recovery Act funding we used in fiscal year
2010 to handle claims was not included in our continuing
resolution level. Between having to recover mandatory cost
increases and not having Recovery Act funding, we're operating
at a significant loss over last year.''
It's my understanding that the Social Security
Administration received $500 million in the stimulus bill to
address workload processing. These were onetime funds that
should not, I believe, be considered in addition to the
administration's baseline. The 2012 budget request is 9.4
percent higher than 2010. This significant request for
additional resources comes, of course, in an austere economic
environment, where we should not be looking at how to throw
money at a problem, but to work smarter.
Instead of spending onetime stimulus funding on personnel,
I believe the Social Security Administration should have been
looking at ways to streamline the claims process. Maybe you
have. The Social Security Administration's use of one-time
funds to build new personnel into its baseline, I think is a
dangerous mismanagement of Federal funds. Using one-time
Recovery Act money, your agency hired 2,405 employees--more
employees--to lower the disability backlog. Your own numbers
show initial disability receipts and hearing receipts will
start to decline in 2012.
Why did you choose a long-term costly hiring strategy for a
short-term problem?
Commissioner Astrue. Well, Mr.----
Senator Shelby. At least that's the way it looks to me.
Commissioner Astrue. Mr. Shelby, in large part, because
that's what the Congress told us to do. We expressed concern to
the committees, at the time, that operating funds were being
put into the Recovery Act instead of into the baseline, that
there might be confusion in subsequent years. But, the
committees of Congress that we talked to were quite clear that
they knew that the only way to reduce the backlog in the short-
term was to address some of the staffing issues, and said it
would be adjusted--we were assured it would be adjusted in the
future years. So, we did----
Senator Shelby. Now, what does that mean, ``adjusted''? You
include it in----
Commissioner Astrue. That, in future authorizations and
appropriations, there would be a recognition that these were
not one-time capital expenditures. These people are different
from a building. So, I agree with you----
Senator Shelby. Who told you that?
Commissioner Astrue. My understanding is that was Members
of the Congress and members of committee staff. I mean----
Senator Shelby. I never heard that.
Commissioner Astrue [continuing]. There was no controversy
at the time that we were going out and doing that hiring. In
fact, I got quite a bit of criticism, from some individual
Members, that we were not moving fast enough on some of the
hiring. But, the civil service process, you know, is a long and
difficult one. So, we did, in my view, exactly what the
Congress told us to do.
Senator Shelby. Well, a lot of people all over America,
realize that this stimulus package, this money was--once it ran
out, it was gone. I think you should have considered that.
Obviously, you didn't.
How will you manage the additional costs, in the future,
when your payroll costs already topped $7 billion, over two-
thirds of your budget?
Commissioner Astrue. Well, most of our----
Senator Shelby. How could you save money? Have you thought
about how could you save?
Commissioner Astrue. Oh, I get up every day----
Senator Shelby. Sure.
Commissioner Astrue [continuing]. And think about how to
save money and how to make the process more efficient. But,
what I think is important for the subcommittee to understand is
that, unlike many other agencies that have discretion in terms
of what kinds of grants they give or prioritization on
enforcement, we have very little that is discretionary. Almost
everything we are doing involves an entitlement to the American
people, where we don't have choice whether we do it or not.
And, at the end of the day, while we have done the best we
can to improve efficiency with information technology and
things like that, people have to do that work. And the people
are very important to that. And, as it is, we're losing people
at a disturbing rate. We're losing 3,500 people this year.
We're expecting, under a continuing resolution, if it extends
to next year, another 4,100 people. So, we're reducing people
at an extremely fast rate.
REVERSAL RATE FOR DISABILITY DECISIONS
Senator Shelby. I want to touch on some other stuff.
We've been told that, after being rejected by the Social
Security Administration for a disability claimant person, two-
thirds of the claimants win their appeal. With such a high
overturn rate, why are claimants not approved on initial
review, if the work was done? And, if so, it would save a lot
of money, it seems to me.
Commissioner Astrue. Yeah. I think that's an arithmetic
confusion, Mr. Shelby, because the numerator and the
denominator are not the same. So, you have to realize that, in
addition to the people--probably last year, if I remember
correctly, over 1 million people who were approved at the
initial level, and there were about 1.2 million people who
received an adverse decision and did not appeal to the next
level. And so, it's a relatively small number of the closer
cases, as a general matter, that go up on appeal. So, the
overall number of denials going from the initial decision to an
appeal is actually very small.
Senator Shelby. And how many--number-wise, what--how many
cases are denied, then appealed nationwide, roughly, per year?
Commissioner Astrue. How many are----
Senator Shelby. Yeah.
Commissioner Astrue. The allowance rate is down, I think,
not even a statistically significant amount. But, it's my
recollection, and we will provide for the record page 103 of
our fiscal year 2012 justification of estimates for
Appropriations Committees, which shows the flow of disability
cases from the initial level all the way to Federal court
appeals.
Senator Shelby. Okay.
[The information follows:]
Figure 1. Fiscal Year 2010 Workload Data: Disability Appeals.
Commissioner Astrue. It's about 62 percent at hearing.
Senator Shelby. And how many cases are there?
Commissioner Astrue. It's about 800,000 hearings a year.
Senator Shelby. Eight-hundred thousand--that's a lot of
cases over the next few years.
Commissioner Astrue. It is a lot of cases, Mr. Shelby.
Senator Shelby. Eight-hundred thousand cases.
Commissioner Astrue. And I would say, you are correct about
the importance of doing things promptly and upfront. So, one of
the things that we've done, in the last couple of years, is
because we have an electronic system, we can now pull out the
cases that should be the easy and automatic cases, and allow
them upfront. And that's part of how we've increased our
accuracy, which had been flat at the first level at about 94
percent. Even with all the influx of cases, we're up to about a
98-percent accuracy rate now.
COST-BENEFIT ANALYSIS OF HEARING VERSUS APPROVING A CASE INITIALLY
Senator Shelby. I know I'm under a time constraint, but if
you'd just----
Commissioner Astrue. I'm sorry.
Senator Shelby [continuing]. Say it for the record. Has the
Social Security Administration performed a cost-benefit
analysis to examine the cost of hearing a case versus approving
a case initially? That is, an appeal. What--the--if someone's
got merit in their initial claim, wouldn't it make sense to do
the work to ascertain that, rather than have 800,000 cases on
appeal?
Commissioner Astrue. Well, we're certainly trying to do
that. And, as I said----
Senator Shelby. Assume it's got merit, you know? And if the
appeal process throws back two-thirds of the cases, there's
something wrong.
Commissioner Astrue. Well, as I said, I think if we were
approving a much lower percentage, then we'd be getting the
complaint from the Congress that the odds are stacked against
the claimants. So, it is a process that has been very carefully
prescribed by the Congress, that we try to follow as closely as
we can. And you have to realize that each decision, if I
remember correctly, at the hearings and appeals level, in terms
of net present value, is about a quarter million dollar
decision. So, these are important decisions.
And I don't think it's the right answer, from a trust fund
point of view, to simply give that money away at the front end
of the process. There are some cases that are very close, where
reasonable people can disagree. It's very hard to tell with
back pain, it's very hard to tell with depression. There are
also cases up on appeal that initially are turned down,
appropriately, because they're diseases that get progressively
worse. And, by the time they get to the appeal, where we look
at it fresh--it's not like a legal appeal, where you----
Senator Shelby. Well, I've known cases where people who
have filed for disability claims and have been denied. And, of
course, to say they're not really that sick or they're not that
disabled, and then they die before the appeal process. You know
'em, too.
Commissioner Astrue. Yes, that's----
Senator Shelby. So, I think----
Commissioner Astrue [continuing]. That does happen.
Senator Shelby [continuing]. What we've got to do is
determine the merits of cases.
Commissioner Astrue. Absolutely. I agree with you, Mr.
Shelby.
Senator Shelby. Thank you.
FUNDING NEED TO RUN AN EFFICIENT, EFFECTIVE SSA
Senator Harkin. Thank you, Senator Shelby.
Senator Mikulski.
Senator Mikulski. Thank you, Mr. Chairman.
Mr. Administrator, I have two questions: one on what you
need to run an efficient, effective Social Security
Administration; and then the other, additional info on the
impact of the continuing resolution.
I believe that demography is destiny. In other words, the
population profile of the United States is predictable. We have
a Census Department that tells us who it is. And what they tell
us is, the Baby Boomer generation is here. If there are
Boomers, there are demands on the application to Social
Security. You have no control over it. Congress doesn't have
any control over it. No political party or subgroup within a
party has it. Tell me, from the standpoint of someone who's
devoted his career to public service, what is it that you think
you need to have for fiscal year 2012. What is the number of
employees you need to have, and what is it that you need to
have in the Federal budget to meet the sheer predictable
population demands, let alone economic downturns or an
unexpected event?
Commissioner Astrue. Sure. That's a very fine question.
As you know, Senator Mikulski, by statute my request to the
President is disclosed to the Congress, and so that you know,
the President's request for 2011 and 2012 was very close to my
request. And we've laid out in the President's budget why we
need----
Senator Mikulski. But, for the record, what amount is it,
and what will that buy?
Commissioner Astrue. Well, what the President's level
would--which is approximately $12.5 billion--would allow us to
do is to meet the ongoing service needs of the country and
continue on track to reduce the existing backlogs, not only at
the hearing level, but at the front level, because we've gotten
about two-thirds of 1 million more disability cases than we
originally projected a few years ago. And we have to process
that work.
EFFECTS OF CONTINUING RESOLUTION
Under the continuing resolution, staff numbers are
declining very rapidly. We are barely above the funding level
where we need to furlough. And, at that point, we start to see
degradation of service. We've been trying to hold the line as
best we can. But, if we go much further with these kinds of
dramatic staff reductions, the numbers that have been improving
so well for the last 4 years----
Senator Mikulski. Let me get----
Commissioner Astrue [continuing]. Rapidly----
Senator Mikulski [continuing]. To the point.
First of all, I'm deeply troubled by the 3,500 employees
that will be lost this year. That's 3,500 nationwide----
Commissioner Astrue. Yes.
Senator Mikulski [continuing]. Not in the headquarters,
the----
Commissioner Astrue. Yes, that's right.
Senator Mikulski [continuing]. The mother ship in
Baltimore----
Commissioner Astrue. Yes, that's right.
Senator Mikulski [continuing]. Is that correct?
Commissioner Astrue. That is correct.
Senator Mikulski. So, that's nationwide, and that's in the
field offices, et cetera.
Commissioner Astrue. Yes. And about 80 percent of the
people, more or less, are in the field.
Senator Mikulski. Now, is it because people now know that
there's both a freeze, an impending furlough, and the serious
threats of reductions in promised retirement benefits that have
been proposed in some deficit reduction plans, such as going to
a high five instead of a high three? Are people also getting
ready, at the Social Security Administration, to retire at a
more increasing rate? So, in addition to that which you need to
replace employees who leave through natural attrition, they're
going to start to bail out?
Commissioner Astrue. Well, I think all those things are
factors, and significant ones. I think if you look at it from a
broad perspective--because we went 14 straight years with
appropriations under the President's request, we did not do
very much hiring for a long time. We had been an agency, at one
point, of as many as 82,000 people. And we dropped, briefly--in
the beginning of my watch, when we were on a continuing
resolution for 15 months, if I remember correctly, to under
60,000. So, we're up a little bit over that now, but we have an
older workforce; we have a lot of people retiring, as a normal
course of business. I think some of the things that have
happened with civil service are accelerating that.
But, I have to be candid with you, too; we also just gave
everyone, without exception, the ability, earlier in the year,
for early out, because we looked at the potential budget
situation and, to Mr. Shelby's point, that the Congress is
telling us that we can't afford those people. So----
Senator Mikulski. Good. Now, let me jump in. We could be
headed to a shutdown.
Commissioner Astrue. Yes.
POSSIBLE EFFECTS OF GOVERNMENT SHUTDOWN
Senator Mikulski. Because, I know that, in my subcommittee,
in Commerce/Justice, I can't cut any more. And Senator Harkin
must also be facing the same stress. So, we're heading to a
showdown.
Now, much has been said about the impact on Social
Security. If there is a shutdown, will Social Security checks
go out?
Commissioner Astrue. So, this answer----
Senator Mikulski. And will field offices----
Commissioner Astrue. Sure.
Senator Mikulski [continuing]. Stay open, or will they be
closed?
Commissioner Astrue. Sure. This answer gets a little bit
complicated, depending on whether the Congress fails to pass a
budget at all or takes deep cuts in our budget. So, it's a
somewhat different answer.
But, if the answer is addressed to a shutdown, where
Congress does not pass a budget, then I think that the White
House has made what will happen clear. Mr. Carney correctly
laid out that, for most existing beneficiaries, checks will go
out and they will not see an interruption of service. If you've
had a change of address, if you're a new applicant, then we
cannot pretend that we will be able to get a timely and
accurate payment out.
Senator Mikulski. And what about the field offices? Are
they open or closed?
Commissioner Astrue. Under a shutdown scenario in the
Government, we have some latitude to keep some essential
services open, but we will be open only on a very partial
basis, for certain types of work, under a Government-wide
shutdown.
Senator Mikulski. I think this is a very severe crisis.
Commissioner Astrue. I agree----
Senator Mikulski. And I----
Commissioner Astrue.--with you, Senator.
Senator Mikulski. And, sir, I appreciate your factual and
candid response. And it's our job to resolve the crisis. Thanks
for being so candid.
Commissioner Astrue. Thank you, Senator Mikulski.
Senator Harkin. Thank you, Senator Mikulski.
Senator Reed.
Senator Reed. Thank you very much, Mr. Chairman.
Thank you, Commissioner, for your testimony and for your
very professional service.
Commissioner Astrue. Thank you.
SSA ADMINISTRATIVE OVERHEAD
Senator Reed. Just as background, sort of contrast, how
would you evaluate your overhead, including all of your
personnel and your systems, versus a comparable insurance
entity in the country?
Commissioner Astrue. I think that we stand up against, not
only any Federal agency, but pretty much any large financial
organization in the country. If I remember correctly--if I'm
making a mistake, we'll correct it for the record--about 1.6
percent, I believe, of our budget is for administrative costs.
And it's been going down steadily, as a percentage of cost, for
a number of years. So, this is, in my book--and I've been a CEO
of publicly traded corporations, which relatively few agency
heads have--an extraordinarily efficient organization. And I
don't think there's a lot of fat left in this organization.
Senator Reed. In fact, I think is--and I'm alluding to what
was suggested by Senator Mikulski--we're reaching the point
where, if we deny effective resources to the Department, this
level of efficiency will be compromised----
Commissioner Astrue. Yes.
Senator Reed [continuing]. That, at some point, you just
can't, you know, continue to maintain this level.
Commissioner Astrue. Exactly, Senator Reed--we've run this
experiment recently. So, we ran down the administrative budget
for most of this decade. And very predictable things happened:
backlogs grew, and program integrity work plummeted, at a long-
term cost to the trust fund. It is only with great difficulty
that we've been able to move the agency back in a positive
direction and increase the program integrity work and bring the
backlogs down.
And what I would say to all of you now is, it's your
choice. We've done everything that we know how to do. And
whether we go backward or whether we go forward depends on what
you decide to choose for funding for the agency.
ADEQUATE RESOURCES NEEDED FOR SSA
Senator Reed. Well, I think it's ironic--I'll use that
term--that you--we have one of the most effective programs in
the history of this country, one of the most efficiently run
programs in the history of this country--in fact, as you
suggest, from your experience as a CEO of a private-sector
country--company--much more effective than most of the vaunted
public companies. And yet, we're at the point of disrupting it
significantly, in terms of how it operates, if we don't provide
adequate resources to you.
So, I think it's clear that, you know, this is one of those
cases--and they're not that frequent in any endeavor,
particularly Government--where we have to reinforce success,
not undercut it. And so, I would hope that we would reject some
of the proposals--particularly the House proposal, it would
have significant cuts, as I understand them--and support you at
a time--and again, to Senator Mikulski's point--where,
demographically, your burden is not going to get lighter, it's
going to get heavier because of the people like me--not yet,
but very soon.
And I want you to be around for my 4-year-old daughter. So,
you--we--I've got a vested interest.
Commissioner Astrue. Well, my term runs pretty soon. So, I
know----
Senator Reed. I know it will.
Commissioner Astrue [continuing]. I won't be there
personally, but the wonderful people behind me will be there.
SERVICE CUTS DUE TO A LACK OF FUNDING
Senator Reed. All right. Well, if that's a promise.
Let me just now go down, sort of, the level--and again,
suggested by Senator Mikulski--these cuts will come, not from
the D.C., Washington, Baltimore, metro area. Most of them are
from the local offices. We had the experience, in 2002, where
adjudication officers in three of my communities in Rhode
Island were consolidated. You know, again, you said, ``When you
cut the budget every year, you start cutting into the--you
know, the efficient operation.'' They were sent up to
Massachusetts. I would assume that if the budget pressure
continues to grow as is, you'll be making those same types of
decisions.
Commissioner Astrue. Exactly right. We are actually moving
more work geographically around the country to take advantage
of wherever places are less busy. So, we've done more of that
than in the past. And, if we go into a crisis, then there'll be
more work moving from one State to another as we try to manage
things as best we can.
Senator Reed. So, you'll have two situations going on:
reductions in force----
Commissioner Astrue. Right.
Senator Reed [continuing]. Consolidations of offices. What
that leaves, though, is big--potentially, big service gaps. I
mean----
Commissioner Astrue. Yes.
Senator Reed [continuing]. It is a difference between a
senior citizen in my State getting on a bus or getting--taking
their car and driving 10 or 15 or 20 minutes to a local office
and the difference of going to Boston, literally----
Commissioner Astrue. Yes.
Senator Reed [continuing]. And with all of the--that
entails.
Commissioner Astrue. Yes. You know, you've said it more
articulately than I could, Senator, but the only thing I would
add is, it's already happening. We're already starting to move
backward because of the staff reductions.
Senator Reed. Let me just--a final point is that we
sometimes focus on the Social Security system as one that deals
with seniors. But, you have families and children that we have
to worry about. In fact, one of the startling statistics that
I've seen recently is that, for the first time, the Great
Depression, 25 percent of children in this country are living
in poverty.
Commissioner Astrue. Right. And----
Senator Reed. That's a very, very shocking and, indeed,
shameful statistic----
Commissioner Astrue. And, in fact----
Senator Reed [continuing]. Given this the----
Commissioner Astrue [continuing]. If you look at----
Senator Reed [continuing]. Wealthiest country.
Commissioner Astrue [continuing]. Where the administrative
effort is spent, we would be even more efficient if we were
just a retirement organization; but we're not. We will take in
about 3.3 million disability claims this year, and that's where
the vast majority of the administrative effort goes. We're the
largest repository of medical records in the world. Sometimes
we have over 1,000 pages of medical records we need to review.
And a lot of these are very difficult, close calls.
That is, in fact, where a lot of the administrative time is
spent, because the retirement process is pretty automatic. We
try to make it even more automatic. We've gone from 10 percent
to 40 percent of the people filing online, because we've
improved--we've made it a much more user-friendly process. And
we're trying to find the efficiencies wherever we can. But, the
lion's share of the administrative effort is on the disability
side. And there are just some limits on how much of that you
can automate. And we'll have to make a lot of those decisions.
Senator Reed. And--but, that has a huge impact on the
quality of life of families and children in this country----
Commissioner Astrue. Absolutely.
Senator Reed [continuing]. Particularly as we see these
growing statistics of childhood poverty. And your agency does
make a difference; but if you don't have the resources, you
can't.
Commissioner Astrue. That's right.
Senator Reed. Thank you.
Senator Harkin. Commissioner, thank you very much for your
great stewardship of a wonderful--or a wonderful part of our
American society. Thank you for your stewardship of it. We have
our work cut out for us, in terms of making sure that you can
do your job well and make sure that people who rely upon Social
Security--as Senator Reed just reminded us, not just elderly, a
lot of kids out there, too, and people with disabilities,
survivors--make sure that they can get timely help.
ADDITIONAL COMMITTEE QUESTIONS
Commissioner Astrue. Thank you very much, Mr. Chairman.
Thank you to everyone on the subcommittee. I appreciate
this opportunity.
Senator Harkin. Thanks, Commissioner.
[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 Richard C. Shelby
Question. You are permitted to transfer unobligated regular
appropriations authority that is considered ``not needed'' to your
information technology (IT) fund. Since fiscal year 2001 you have
transferred $1.3 billion out of the operational Limitation on
Administrative Expenses account into the IT Fund. This is at a time of
record backlogs and wait times. Why were these Limitation on
Administrative Expenses funds considered ``not needed?'' Wouldn't this
funding have been better spent on integrity work, such as, disability
and Supplemental Security Income reviews?
Answer. Our ability to transfer unobligated administrative funds to
our Information Technology Systems (ITS) account is a funding mechanism
that Congress specifically authorized and that the Office of Management
and Budget (OMB) manages closely. Congress included language in our
fiscal year 2001 appropriation that allowed us to carry forward
unobligated Limitation on Administrative Expenses (LAE) funds to invest
in ITS costs. Congress has continued to provide this authority in every
succeeding appropriations act since fiscal year 2001.
We must justify to OMB any transfer of unobligated balances to the
ITS account, and OMB must give us formal approval before we can
transfer and spend any funds. Moreover, available ITS transfer funding
factors into our annual budget request. During the budget process, we
work with OMB to determine how much of our IT needs will be covered
with funding we can transfer into the ITS account, thereby decreasing
the amount of new funding we need to request in any given fiscal year.
We have a long history of sound financial management practices that
avoid Anti-Deficiency Act violations. At the beginning of each fiscal
year, we put in place spending plans to use the full budget. We develop
performance targets (i.e., numbers of completed claims, hearings,
continuing disability review, redeterminations, etc.), estimate related
costs, and negotiate these estimates with OMB. We allocate these annual
resources as soon as we have an appropriation from Congress and
approved apportionments from OMB. We continually monitor our resources
and reallocate them to our highest priorities as the year progresses.
We typically lapse only about 1 percent of our LAE funding each year.
We do not lapse annual funding in order to transfer it to our ITS
account. Nevertheless, with the complexity of our budget, two-thirds of
which is payroll costs, a small amount of lapsed resources is
unavoidable and often necessary to avoid an Anti-Deficiency Act
violation. With nearly 80,000 Federal and State employees, even a small
shift in salary or benefit costs can create a change of millions of
dollars in our administrative budget. We also must be able to address
unanticipated requirements, such as court decisions.
When we receive a budget each year, we determine the level of staff
we can fund and support in future fiscal years. Your suggestion that we
could have better used annual administrative resources to complete more
program integrity work would have required us to hire additional staff.
Uncertainty about future funding makes it difficult to predict how many
employees we can support in future years, and prolonged continuing
resolutions can delay the hiring process. We cannot make long-term
commitments to hire employees when future budgets may not support
retaining them, potentially forcing us to implement furloughs or other
drastic cost saving measures.
ITS transfer authority has allowed us to make technology
improvements that help our employees work more efficiently. Our IT
investments have helped us achieve average annual employee productivity
increases of about 4 percent each of the last 5 years. Most of our
annual ITS funding is necessary for ongoing operational costs such as
our 800 number service and our online services. It also helps us
maintain sufficient capacity to store ever-increasing amounts of data.
Prior year resources have helped us fund essential IT projects such as
making our disability process fully electronic, developing robust and
user-friendly online services, and opening our second data center.
Without these IT investments, we would not have kept pace with the
recent increases in claims. If we did not have the ITS transfer
authority but still invested the same amount of resources in IT
enhancements to improve employee productivity, we would have completed
nearly 1 million fewer disability claims or nearly 500,000 fewer
hearings since fiscal year 2001.
Question. Today, what is the total level of funding in the so-
called ``IT Fund,'' or the carryover funding from previous fiscal years
for information technology and telecommunication activities? Of this
amount, what level of funding did the Social Security Administration's
fiscal year 2011 budget request state would be used in fiscal year
2011? Is it correct that this would still leave a substantial amount of
reserve funding in the IT Fund that would not be spent in this fiscal
year? What level of funding specifically would remain in the IT Fund?
Answer. The fiscal year 2011 column of the fiscal year 2012
President's budget assumed that $480.4 million would be available in
fiscal year 2011 to transfer to the no-year ITS account. Of that total,
our fiscal year 2012 budget assumed that we would use $280 million in
fiscal year 2011 and the remaining $200.4 million in fiscal year 2012
for IT costs. Prior to March 2011, we had transferred $680.4 million
from previous fiscal year unobligated balances to the no-year ITS
account, which was the amount available in prior year accounts that was
not needed for potential upward adjustments to prior year obligations.
On March 18, 2011, the Additional Continuing Appropriations Amendments,
2011 (Public Law 112-6, the sixth CR for fiscal year 2011) rescinded
$200 million of the available $680.4 million. The Department of Defense
and Full-Year Continuing Appropriations Act, 2011 (Public Law 112-10,
enacted on April 15, 2011) rescinded an additional $75 million.
Due to the rescissions in fiscal year 2011, we carried over only
$32.5 million from fiscal year 2011 into the no-year ITS account in
fiscal year 2012. In fiscal year 2012, we transferred $129.6 million
from previous fiscal year unobligated balances to the ITS no-year
account. In total, we have $162.1 million available in the fiscal year
2012 no-year ITS account. This amount is less than the $200.4 million
that we assumed would be available in the fiscal year 2012 no-year ITS
account.
Question. According to the Congressional Research Service, only 3
percent of beneficiaries ever come off Social Security Disability
Insurance (SSDI) rolls. In your testimony, you discussed the pilot Work
Incentives Simplification Program (WISP) that would allow beneficiaries
to return to work and continue to receive SSDI benefits for any month
in which earnings were below the established threshold. I believe it is
critical to the future of SSDI that beneficiaries who are able to work
do. However, I remain concerned that other programs put in place by the
Social Security Administration to incentivize work, such as the Ticket
to Work program, have been failures. How do you implement this program
to ensure those who are able to work in some capacity will do so?
Answer. Congress established the Ticket to Work (Ticket) program in
1999 to expand the universe of service providers to help beneficiaries
obtain the services and supports they need to find and maintain
employment. In 2008, we made regulatory changes to the Ticket program,
which have significantly increased beneficiary and employment network
(EN) participation. Since the change, the number of active ENs
increased by nearly 50 percent and the number of beneficiaries that ENs
placed in a job increased by 319 percent from a little over 4,000
beneficiaries to over 16,895 beneficiaries.
The most important distinction between the Ticket program and the
Work Incentives Simplification Pilot (WISP) is that under the Ticket
program, we must still apply our complex and often confusing work
incentive rules. The Social Security Act (Act) includes a number of
incentives to encourage disability beneficiaries to return to work. In
the Social Security Disability (SSDI) program, the incentives include
the trial work period (TWP) and the extended period of eligibility
(EPE). In addition, there are special rules about impairment-related
work expenses, expedited reinstatement, and medical insurance. Although
we train our field office personnel to explain the work incentives and
we publish information to help people understand the provisions, the
work incentive provisions are complex and difficult to administer and
understand. The work incentive rules are different for SSDI than they
are for Supplemental Security Income (SSI) which make the rules even
more complex if a person is entitled to both types of benefits. The
goal of WISP, which we would first pilot, is to simplify SSDI work
rules to encourage beneficiaries to return to work and reduce our
administrative costs. WISP would eliminate complex rules on the TWP and
the EPE. It would also eliminate performing substantial gainful
activity as a reason to terminate SSDI benefits. If a beneficiary's
earnings fell below a certain threshold, we could reinstate monthly
benefit payments as long as the person remained disabled. WISP would
allow us to replace the complex work continuing disability review
process with a streamlined work review process, which would reduce
improper payments. Finally, our WISP proposal would better align the
SSDI program with the SSI program.
Congress has held hearings to highlight the importance of program
integrity and improved service. Program simplification is an answer to
Congress' questions about how to improve in these areas.
Question. There are no disincentives from fraudulently applying for
Social Security Disability Insurance. Claimants are not fined and
virtually no one is prosecuted for a false claim. How do we implement
specific, targeted fixes to this program when there is no deterrent
mechanism?
Answer. One of our most successful efforts against disability fraud
is the Cooperative Disability Investigations (CDI) program, which links
our Office of Inspector General (OIG) and local law enforcement with
Federal and State workers who handle our disability cases. These units
are highly successful at detecting fraud before we make a disability
decision and identifying overpayments. There are currently 25 CDI units
nationwide.
Since its inception in fiscal year 1998, CDI efforts nationwide
have resulted in nearly $3.1 billion in projected savings: $1.9 billion
to our disability programs and $1.2 billion to other programs, such as
Medicare and Medicaid. Due to the success of the CDI program and our
increased efforts to prevent improper payments, we plan to open
additional units as resources permit.
The Federal Government or States may prosecute an individual for
fraudulently receiving SSDI benefits. The determination as to whether
to proceed criminally rests with the appropriate prosecutor, either
Federal or State. The Department of Justice may also pursue a claim
under the False Claims Act. If a U.S. Attorney's Office declines to
prosecute the case, our OIG may pursue an action for civil monetary
penalties. If the OIG declines the case, we may pursue administrative
penalties.
We train our field employees to alert OIG to any cases of suspected
fraud. We made nearly 19,000 such fraud referrals related to our
disability programs in fiscal year 2011, from which the OIG opened
about 4,600 cases. During this period, our OIG initiated 314 civil
monetary penalty cases, successfully resolving 67 with $2,798,172 in
penalties and assessments imposed.
Additionally, we have nine attorneys assigned to a United States
Attorney's Office as Special Assistants. These attorneys prosecute
possible fraud cases referred by OIG that would not otherwise be
prosecuted in Federal court. From fiscal years 2003 through 2011, our
attorneys secured over $43.7 million in restitution orders and 814
convictions or guilty pleas.
Question. It is my understanding that the Social Security
Administration has implemented two fast-track initiatives, known as
Compassionate Allowances and Quick Disability Determinations, to
improve processing of claims for those with severe disabilities. Please
provide specific data on the decrease in time to approve claims under
these programs compared to past claim processing times.
Answer. The State disability determination services (DDS) render
disability determinations for initial claims. In fiscal year 2011, the
average time from the date the DDS received the claim until the DDS
made a disability determination was approximately 80 days for all
approved claims, 10 days for approved fast-track claims and 88 days for
approved non-fast-track claims.
Question. I am told that Continuing Disability Reviews yield more
than $10 in lifetime program savings for every $1 spent and
Supplemental Security Income redeterminations yield over $7 in lifetime
program savings for every $1 spent. I find it alarming that an Office
of the Inspector General Report recently found from 2005 to 2010 it is
estimated that the Social Security Administration paid between $1.3
billion and $1.6 billion in disability benefits that could have been
avoided with full medical Continuing Disability Reviews. In recent
years, Congress has provided specific funding for program integrity
initiatives. What additional steps would you recommend be taken to
support program integrity efforts that could lead to increased savings?
Answer. For many years, the agency was forced to cut back on
program integrity reviews due to inadequate funding. The same people
who handle initial disability decisions and reconsiderations also
complete medical continuing disability reviews. We must balance the
amount of program integrity work we undertake with our work on incoming
claims. Because of funding cuts, we hit the low point for these reviews
in fiscal year 2007. In fiscal years 2008 through 2010, with additional
funding, we increased our program integrity work, saving billions of
program dollars. However, in fiscal year 2011, we were under a full-
year continuing resolution, which prevented us from further increasing
our program integrity work. We use complex algorithms to select the
most cost-effective cases to review with our limited resources.
Adequate funding is critical to our ability to increase this cost-
effective work, but it is also important to understand that the same
people who handle our program integrity work also handle other work,
such as initial applications for benefits. Without sufficient and
sustained funding, other work suffers as we increase program integrity
work.
Question. Please provide detailed information on the number of
cases each year that are appealed to Federal district courts after
being rejected by Administrative Law Judges at the Social Security
Administration. Of this number, how many claimants win their appeals at
Federal district courts? With regard to cases that are remanded to the
Social Security Administration, how many of these cases are ultimately
decided in favor of a claimant? Please describe possible factors that
may play a role in claimants' success on appeal. What recommendations
would you make to improve the process on the front end so that cases
that win on appeal are approved in the beginning?
Answer. In fiscal year 2010, claimants filed 13,158 complaints in
Federal district courts concerning Social Security program (disability
and non-disability) litigation matters. In fiscal year 2011, this
number increased to 15,644, as we issued more decisions.
In 2010, Federal district courts reversed the agency's decision in
447 cases (or 3.7 percent of the 12,182 district court dispositions
that year). In 2011, this number decreased to 380 cases (or 2.86
percent of the 13,304 district court dispositions that year). District
courts remanded 5,718 cases (46.9 percent) to the agency in 2010 and
6,137 cases (46.12 percent) in 2011.
In 2010, we issued dispositions in 6,028 cases that courts had
previously remanded. We issued fully or partially favorable decisions
in 4,048 of these cases (67.15 percent). In 2011, we issued
dispositions in 6,285 cases that courts had previously remanded. We
issued fully or partially favorable decisions in 4,176 of those cases
(66.44 percent).
The three most common causes of remand in our disability cases,
which represent the vast majority of our program litigation, are: (1)
insufficient reasons provided for rejecting a medical source or
treating source opinion; (2) failure to consider or properly evaluate a
particular impairment at step two of the sequential evaluation process;
and (3) failure to accommodate limitations from all impairments in the
residual functional capacity.
With regard to recommendations on how to improve our decisionmaking
so that we approve claims as early as possible. We hold nationwide
training for our Administrative Law Judges at which attorneys from our
Office of the General Counsel participate to discuss how to best
evaluate medical evidence and draft decisions. In addition, we have
initiatives to improve the quality of the information in a disability
case file. For example, we have an Electronic Claims Analysis Tool, a
web-based tool that automatically prompts an examiner with case-
relevant regulations and instructions and requires the examiner to
enter the necessary documentation before he or she can close a case.
NONDEPARTMENTAL WITNESSES
Senator Harkin. Now we'll turn to our second panel.
Senator Mikulski. Mr. Chairman, I regret, I've to get to
another hearing. But, this was a terrific hearing, and you've
got a great panel, here.
Senator Harkin. We've got a----
Senator Mikulski. I think we're----
Senator Harkin [continuing]. Great panel, yeah.
Senator Mikulski. Yeah. And what we're seeing in this is,
under every rock is another rock.
Senator Harkin. Right, exactly.
Senator Mikulski. And we're now heading to the hard place.
Senator Harkin. This is the----
Senator Mikulski. We don't want a hard landing.
Senator Harkin. These are the hard places. Thank you very
much, Senator Mikulski.
W. Lee Hammond is the president of the AARP and has been a
member of its board of directors since 2002. He is a retired
teacher, who served in the--Wicomico?
Mr. Hammond. Wicomico.
Senator Harkin [continuing]. Wicomico County schools for 30
years. He currently serves on the U.S. Attorney's Healthcare
Fraud Task Force and is a member of the Maryland Commission on
Aging.
Marty Ford is the acting director of the Arc of the United
States and the United Cerebral Palsy Disability Policy
Collaboration. She was previously the chair of the Consortium
for Citizens with Disabilities and has continued to work with
the consortium as a co-chair of the Task Force on Social
Security and Long-term Services and Supports; received her law
degree from the George Washington University National Law
Center and her B.A. from the University of Virginia.
Mr. Joe Dirango was--Dirago or----
Mr. Dirago. Dirago.
Senator Harkin. Dirago.
Mr. Dirago--sorry about that--was elected the president of
the National Council on Social Security Management Associations
in November 2009. He previously served on the New York Region
Management Society, for 13 years, and as chair of the National
Council's Labor Relations Committee for 2 years. Mr. Dirago has
worked for Social Security for 30 years. A graduate of State
University of New York at New Paulz with a bachelor of science
degree in economics.
And, before we start with this panel, I'm also told that
Nancy Shor, who is the executive director of the National
Organization of Social Security Claimants' Representatives, is
also with us here today. She's done great work on behalf of
persons with disabilities. I have spoken and met with NOSSCR in
the past, so I just wanted to take a moment to recognize both
NOSSCR and Nancy Shor. I don't--I can't see where--right there
in front of me.
Nancy, thank you very much. And thank you for the great
work that your organization does on behalf people, especially,
with disabilities.
Now, we'll start with our panel. All your statements will
be made a part of the record in their entirety. I ask you to
sum up, if you can, in 5 minutes or so.
And we'll start Mr. Hammond and work across.
STATEMENT OF W. LEE HAMMOND, PRESIDENT, AMERICAN
ASSOCIATION OF RETIRED PERSONS (AARP)
Mr. Hammond. Chairman Harkin, Ranking Member Shelby, and
members of the subcommittee, good morning to all of you.
And, Mr. Chairman, Wicomico presents a challenge wherever I
go. So.
Senator Harkin. Okay, thank you.
Mr. Hammond. As the largest nonprofit, nonpartisan
organization representing the interests of Americans age 50 and
older, their families, AARP would like to thank the chairman
and ranking member for holding this hearing and giving us the
opportunity to voice our concerns about the ability of the
Social Security Administration to adequately serve current
recipients while responding to the needs of the new Boomer
retirees and other program beneficiaries.
AARP recognizes the budget deficit provides many
challenges, and our members believe that it's important to work
together across party lines to find responsible budget
solutions that consider the health and financial well-being of
all Americans.
We also believe the Federal budget reflects the priorities
of this Nation and her people. First and foremost, we must
always consider the impact each proposed budgetary cut will
have on people. We're not just talking about numbers and
statistics. We're talking about our families, our loved ones,
friends, and neighbors: real people.
The Social Security Administration interacts with millions
of Americans when they retire and seek the benefits that
they've earned over a lifetime of work; with those who, through
sickness or injury, become disabled and cannot longer support
themselves or their families; with orphans of the 9/11
terrorist attack; with families of soldiers killed in Iraq and
Afghanistan; and with countless widows, widowers, and surviving
dependents, who must continue on after the loss of a loved one:
real people.
Now, I'd like to address AARP's major concerns regarding
the funding of the Social Security Administration. SSA was made
an independent agency in 1995 to provide the program with
consistent direction and professional management and to help
insulate it against decisions not based on Social Security-
related issues. However, becoming an independent agency has
also placed added administrative burdens on the Social Security
Administration, and we're very concern with the impact these
additional responsibilities are having on the timely delivery
of services to Social Security beneficiaries.
The Social Security Administration performs this additional
work as it meets the challenges of Boomers reaching the
retirement age at a rate of 1 every 8 seconds by the end of
this decade. Nearly 80 million new beneficiaries will be added
to the Social Security rolls. It's not difficult to understand
the enormity of the administrative task the agency is facing.
With the increases in funding Congress has provided over
the last 3 years, and significant increases in employee
productivity, SSA has been able to make some progress in
customer service. However, the longer-than-foreseen economic
downturn has resulted in a record level of claims for the
retirement and disability benefits. In fiscal year 2010, SSA
received nearly 3.25 million initial disability claims, the
highest in its 75-year history. Yet, at a time when additional
funding is needed to handle the increased workload, the agency
is dealing with the possibility of a Government shutdown as
well as cutbacks resulting from enactment of spending levels
below the current fiscal year. The House passed long-term
continuing resolution H.R. 1, with a result in the aggregate
funding loss of over $1 billion for the Social Security
Administration. That proposal is unacceptable.
As if service reductions were not enough, even the status
quo would prevent program integrity efforts from realizing
their potential. Congress has consistently provided for
separate additional funds for SSA to conduct continuing
disability reviews and SSI eligibility redeterminations. We
believe that not enabling the agency to pursue these
activities, simply because of an artificial barrier like the
discretionary spending caps, would be downright foolish.
Mr. Chairman, AARP strongly urges the subcommittee, and the
Senate as a whole, to reject the deep cuts to SSA funding that
are included in the House-passed resolution. Today, the bottom
line is nothing--is that nothing short of the $11.5 billion,
with no rescission of IT funds for fiscal year 2011, will
ensure the ability of the SSA to adapt to the many critical
challenges that confront them for the balance of this year.
Social Security Administration customers, whether older,
younger, or somewhere in between, are real people. They have
the right to expect better service than they're receiving
today. We sincerely hope that Congress and the President will
not let them down, by providing the funding necessary to enable
SSA to serve them promptly and properly.
On behalf of the millions of AARP members, and of all
Americans who are served by SSA, thank you for the opportunity
to address the subcommittee.
Senator Harkin. Mr. Hammond, thank you very much.
[The statement follows:]
Prepared Statement of W. Lee Hammond
Chairman Harkin, Ranking Member Shelby, and members of the Labor,
Health and Human Services, and Education, and Related Agencies
Subcommittee, good morning.
As the largest nonprofit, nonpartisan organization representing the
interests of Americans age 50 and older and their families, American
Association of Retired Persons (AARP) would like to thank to Chairman
Harkin, and Ranking Member Shelby for holding this hearing. AARP
appreciates this opportunity to appear before the subcommittee to voice
our concerns about the ability of the Social Security Administration
(SSA) to adequately serve current recipients while responding to the
needs of new Boomer retirees and other program beneficiaries. I am here
today to speak to AARP's priorities with respect to funding for the SSA
for fiscal year 2011 and beyond.
While SSA funding is of great importance, we have equal concern for
many other vital healthcare services and economic security programs.
For example, AARP is concerned about sufficient funding for the
Qualified Individual-1 program which helps more than 156,000 seniors
nationwide afford to pay their Medicare premiums that would otherwise
be unaffordable or cause great financial hardship; programs authorized
under the Older Americans Act which provide needed assistance,
including nutrition programs which free hundreds of thousands of our
seniors from hunger, as well as job training and other services; and,
the Low Income Home Energy Assistance that help millions of households
with seniors avoid making that horrible choice between heating and
eating, or paying for all the medicine they need to live healthy lives
in homes, not institutions.
As you complete action on the fiscal year 2011 budget and begin
work on the fiscal year 2012 budget, we ask that you note the framework
we have set forth for our appropriations and budget advocacy:
--AARP recognizes that the Federal budget deficit provides many
challenges, and AARP members believe it is important to work
together across partisan lines to find responsible budget
solutions that consider the health and financial well-being of
all Americans.
--We believe the budget reflects the priorities of this Nation and
any budgetary cuts will impact people, not just programs.
--AARP supports budget proposals that will help make healthcare more
accessible and affordable for all Americans, including
implementation of the Affordable Care Act.
The SSA touches the lives of nearly every American, and was once
known as the standard for Government agency service by which all others
were measured. Over time, however, the agency's mission has been
diluted by additional responsibilities not related to its core mission
while the agency itself has faced a loss of staff and a budget that is
woefully inadequate, especially given the increasing number of
beneficiaries.
The SSA was made an independent agency in 1995 to provide the
program with consistent direction and professional management and help
insulate it against decisions not based on SSA-related issues. However,
in the ensuing years, the agency has been tasked with numerous other
responsibilities that fall outside its core mission of managing the old
age and survivors insurance, disability insurance, and Supplemental
Security Income (SSI) programs. SSA now plays a key role in assessing
the correct premium levels for parts B and D of Medicare. In addition,
SSA processes applications for the Low Income Subsidy of Medicare part
D and conducts outreach to those who may potentially qualify for the
extra help.
In recent years, the agency has also become an important element in
the Nation's homeland security efforts as it conducts millions of
Social Security Number (SSN) verifications for employment purposes and
other immigration-related activities. In light of the added
administrative burden these activities have placed on the agency, and
the impact that burden has on the timely delivery of services to
beneficiaries, AARP has grave concerns about proposals that would
further expand these activities or mandate new ones.
This extra work given to SSA by Congress comes at a time when the
Nation is confronting a significant, long-anticipated demographic
challenge, the coming of retirement age of the Baby Boom generation,
which will add nearly 80 million new beneficiaries to the SSA rolls--
nearly 13 million in the next 10 years alone, and upwards of 16,000 per
working day. At the end of this decade, these Boomers will reach
traditional retirement age at the rate of 1 every 8 seconds. It is not
difficult, then, to understand the enormity of the task the agency
faces in foreseeable work alone.
For the most part, Congress has understood these challenges and has
responded with added resources for SSA to handle this spike in demand.
With the increases in funding Congress has provided over the last 3
years and significant increases in employee productivity, SSA has been
able to make some progress in customer service. However, the
unforeseeably long-lasting economic downturn has caused even more
Americans to turn to the SSA. Claims for retirement and disability
benefits have risen to record levels.
In fiscal year 2010, SSA received nearly 3,225,000 initial
disability claims, the highest in its 75-year history. SSA ended fiscal
year 2010 with initial disability claims pending at an all-time high of
more than 842,000 cases. This year, SSA expects a record number of
visitors to its field offices above the 45.4 million customers that
requested assistance from the field offices in fiscal year 2010. These
field offices are also responsible for processing an additional 1.2
million SSI redeterminations in fiscal year 2011 as compared to fiscal
year 2008, an increase of 100 percent. Furthermore, answer rates on
telephone calls coming into the field offices remain at an unacceptably
low level nationally as the rates of calls answered are less than 65
percent.
SSA field offices also processed more than 18 million requests for
new and replacement SSA cards; field offices served thousands of people
each day needing to report changes of address, changes in direct
deposit information, and other issues that could affect their benefit
payments. Field offices also play a significant role in helping people
with their Medicare benefits and often work with State and local
agencies regarding Medicaid and SNAP (formerly known as food stamps).
Eliminating the hearings backlog continues to be SSA's highest
priority, and one that AARP strongly supports. SSA ended fiscal year
2010 with just more than 700,000 pending hearings nationwide--the
lowest level in 5 years. At its peak, it took an average of 18 months
for a hearing decision. As of January 2011, it took just more than a
year.
At a time when it would additional funding is needed to handle the
incoming and pending workload, the agency is unfortunately dealing with
the possibility of a Government shutdown, as well as cutbacks resulting
from the enactment of spending levels below the current fiscal year.
The House passed long-term continuing resolution, H.R. 1, would
result in an aggregate funding loss of $1.093 billion for the SSA. That
proposal is clearly unacceptable.
SSA is already operating under a partial hiring freeze because of
the current continuing resolution, which is likely to result in nearly
3,500 lost jobs for 2011. These additional cuts could lead to SSA
offices closing their doors, stopping all claims processing, and not
answering the phones for about a month--1 month out of the seven
remaining in 2011. In addition to office closures, many locations are
already seriously understaffed due to employee attrition. Employees who
retire or otherwise leave the agency are not replaced because the
resources are just not available. In fiscal year 2009 staffing reached
its lowest level since 1972, before SSI was established; yet SSA today
has twice the number of beneficiaries it had in 1972.
If the SSA shuts down for a month, it would be devastating to both
the public and to SSA employees. Extended to the national level, it
would mean that about 182,000 visitors would not be seen, about 33,000
claims would not be taken, and almost 10,000 redeterminations would not
be completed. Even 1 furlough day could be devastating to someone in a
dire need situation desperate for a critical or immediate payment, or
for a beneficiary needing verification information to qualify for food
stamps, to obtain housing, or to get Medicaid. Another 70,000 fewer
people will get a disability appeals hearing this year, which means
workers waiting to present an appeal to a judge, who already wait more
than a year, will wait longer. And, SSA would complete 32,000 fewer
continuing disability reviews, which means wasting millions of dollars
on improper payments now.
As if service degradations were not enough, even the status quo
would prevent program integrity efforts from realizing their potential.
Congress has consistently provided for separate, additional funds for
SSA to conduct Continuing Disability Reviews (CDR) and SSI eligibility
redeterminations. When fully utilized, CDR's result in savings of more
than $10 in program costs for every $1 in administrative funding used
to conduct the reviews. SSI redeterminations help save $7 for every $1
spent. Not enabling the agency to pursue these activities simply
because of an artificial barrier like the discretionary spending caps
would be very un-penny wise and grossly pound foolish.
Mr. Chairman, AARP strongly urges the subcommittee and the Senate
as a whole to reject the deep cuts to SSA funding that are included in
the House-passed legislation. Today, the bottom line is that nothing
short of $11.679 billion, with no rescission of IT funds for fiscal
year 2011 will ensure the ability of the SSA to adapt to the many
critical challenges that confront them for the balance of this year.
Additional resources will also be required to fulfill its obligations
in the next fiscal year and beyond. The SSA customers, whether they are
older, younger or anywhere in between, have the right to expect better
service than are receiving today--we sincerely hope that the Congress
and the President will not let them down and provide the funding
necessary to enable its workforce to serve them promptly and properly.
On behalf of the millions of AARP members and all Americans who are
served by SSA, I thank you for the opportunity to address the
subcommittee.
Senator Harkin. And now we'll turn to Ms. Ford.
Ms. Ford.
STATEMENT OF MARTY FORD, CO-CHAIR, CONSORTIUM FOR
CITIZENS WITH DISABILITIES TASK FORCE ON
SOCIAL SECURITY; ACTING DIRECTOR, THE ARC
AND UCP DISABILITY POLICY COLLABORATION
ACCOMPANIED BY NANCY G. SHOR, EXECUTIVE DIRECTOR, NATIONAL ORGANIZATION
OF SOCIAL SECURITY CLAIMANTS' REPRESENTATIVES
Ms. Ford. Chairman Harkin, Ranking Member Shelby, thank you
for this opportunity to testify on behalf of the consumer
advocacy provider and professional organizations working on
behalf of children and adults with disabilities, and their
families, in the United States.
This hearing is extremely important to people with
disabilities who may need the programs administered by SSA: the
Supplemental Security Income Program and the disability
programs in Title II, including the Disability Insurance
Program and Medicare. These are crucial income-support programs
serving disabled workers and their families, and children and
adults with disabilities, who have limited incomes and
resources.
We believe that it is critical to continue to ensure that
SSA provides adequate services to people applying for SSI
entitled to disability benefits. We have worked for many years
with the Congress and the administration to ensure that SSA has
the funding necessary to reduce the huge backlogs in disability
decisions. Just as the agency was bringing down the backlog,
the recession began to have a substantial impact in building a
new backlog in initial claims. Once again, we are facing the
prospect of significantly increasing waiting times for
disability decisions.
Behind the numbers are individuals with disabilities whose
lives are unraveling while waiting for decisions. Families are
torn apart, their homes are lost, claimants' medical conditions
deteriorate, their once-stable financial security crumbles, and
some individuals die. Over the past few years, we have
described extraordinary and unnecessary hardships that people
with disabilities have endured as they wait for decisions on
their claims.
In my written testimony, we have included a very small
sample of what is happening across the country to claimants who
are forced to wait many months for their decisions.
A woman in Oregon has received an eviction notice. Her
husband's paycheck has already been garnished to pay for her
medical bills. She has been waiting for a hearing, and then for
the decision, since August.
A young man in Texas has applied for SSI in February 2010,
more than 1 year ago, due to a combination of intellectual and
mental disabilities. He has just received a notice of denial at
the reconsideration stage, and now will have to wait for a
hearing, and then for a hearing decision.
A man in North Carolina, with a combination of impairments,
who needs a pacemaker, has been waiting for a hearing on his
SSI claim since September. His representative estimates, based
on the claims in that State, that he will have to wait til mid-
to late-summer 2011 for his hearing.
Your own constituent services staff are likely well aware
of similar situations in your States. It is important to note
that these are situations that are current when the processing
times are improving, at least at the hearing level, as
described by the Commissioner earlier.
We are extremely concerned about what might happen if SSA's
budget is further reduced to the level included in H.R. 1.
Under the current continuing resolution, the Social Security
Administration is already operating at a very bare-bones level.
The cuts at the level in H.R. 1 will severely punish people who
most rely on Social Security and SSI. The delivery of services
should be strengthened, not weakened, during economic crisis.
The Senate bill, the continuing resolution for the rest of
2011, in total would provide $600 million more than H.R. 1 for
SSA's operation. While this is not entirely what SSA requires
to continue to meet the needs of the public and to address its
IT needs for fiscal 2011, the Senate amount is certainly better
than the House-passed bill. And we urge its adoption at a
minimum of that amount of $11.8 billion.
PREPARED STATEMENT
Finally, regarding fiscal year 2012, we believe that the
President's budget proposal for SSA for 2012, of $12.5 billion,
is the minimum needed to continue to reduce the backlogs and to
increase the deficit-reducing/program-integrity work.
The speed and quality of the disability process must
continue to improve and should not be allowed to regress into
the longer waiting periods of the recent past. These challenges
can only be addressed if Congress and the administration work
together to ensure that Social Security continues to be the
safety net it was designed to provide for people with
disabilities and their families, as well as retirees and
survivors.
Thank you for this opportunity to testify, and I'm happy to
answer any questions.
Senator Harkin. Thank you, Ms. Ford.
[The statement follows:]
Prepared Statement of Marty Ford
Chairman Harkin, Ranking Member Shelby, members of the
subcommittee, thank you for this opportunity to testify at today's
hearing on the fiscal year 2012 budget request for the Social Security
Administration (SSA) and the impact of possible cuts to the fiscal year
2011 budget.
I am Marty Ford, Acting Director of the Disability Policy
Collaboration of The Arc and United Cerebral Palsy. I am here in my
capacity as a Co-Chair of the Consortium for Citizens with Disabilities
(CCD) Social Security Task Force. CCD is a working coalition of
national consumer, advocacy, provider, and professional organizations
working together with and on behalf of the 54 million children and
adults with disabilities and their families living in the United
States. The CCD Social Security Task Force (hereinafter ``CCD'')
focuses on disability policy issues in the title II disability programs
and the Title XVI Supplemental Security Income (SSI) program.
The focus of this hearing is extremely important to people with
disabilities. The SSA administers the Disability Insurance (SSDI) and
other title II disability benefits and Supplemental Security Income
(SSI), significant crucial income support programs for people with
disabilities. SSDI provides benefits to disabled workers and their
families and SSI provides financial support to aged, blind, and
disabled adults and children who have limited income and resources.
We believe that it is critical to continue to ensure that SSA
provides adequate services to people applying for SSI and title II
disability benefits.
impact of h.r. 1 on remainder of fiscal year 2011
The House-passed H.R. 1, Full-Year Continuing Appropriations Act,
2011, reduces the SSA's administrative spending level to $11.3 billion,
a decrease from the fiscal year 2010 spending levels of $11.4 billion
and leaving an already cash-strapped agency with fewer resources with
which to process claims for people with disabilities and seniors.
Under H.R. 1, the SSA would receive $430 million less than if it
operated the rest of fiscal year 2011 under the current Continuing
Resolution (CR), which is already $1.7 billion less than the
President's proposed fiscal year 2011 budget. If SSA is forced to
furlough employees to address the full $430 million shortfall from the
current CR spending level, it will result in nearly a month of
furloughs, having devastating effects on service to the American
public. In 1 month of furloughs, SSA would complete 400,000 fewer
retirement, survivor, and Medicare claims; 290,000 fewer initial
disability claims (with processing time increasing by a month); 70,000
fewer hearings; and 32,000 fewer continuing disability reviews. In
addition, H.R. 1 severely cuts funds for vital information technology
(IT) improvements and funds to build the critical new National Computer
Center, which must be built to protect SSA electronic information and
infrastructure.
Under the current CR, the SSA is already operating at a very bare
bones level. The proposed cuts in H.R. 1 will punish people who must
rely on SSA and Medicare. We need to remember that there are real
people behind these numbers. The delivery of services must be
strengthened, not weakened, during economic crisis.
impact of senate amendment 149 to h.r. 1
Senate Amendment 149, the full-year fiscal year 2011 continuing
resolution offered by Senator Inouye on March 4, would provide $500
million more for SSA's administrative expenses than would H.R. 1 for
the remainder of fiscal year 2011. In addition, it rescinds $100
million less from the special reserve fund for IT expenses. In total,
the Senate bill provides $600 million more than H.R. 1 for SSA's
operation. While this is not entirely what SSA requires to continue to
meet the needs of the public and to address its IT needs for fiscal
year 2011, the Senate amount is certainly better than the House-passed
bill. We urge the adoption, at a minimum, of the amount included in
Senate Amendment 149, totaling $11,821,500,000.
impact on claimants for social security and ssi benefits
Behind the numbers are individuals with disabilities whose lives
unravel while waiting for decisions--families are torn apart; homes are
lost; medical conditions deteriorate; once-stable financial security
crumbles; and many individuals die. Over the past few years, we have
described the extraordinary and unnecessary hardships endured by people
with severe disabilities as they wait for decisions on their claims.
The following stories are only a sampling of what is happening across
the country to claimants who are forced to wait months and years for
decisions on their appeals. Your own constituent services staff are
likely well aware of similar situations in your State. It is important
to note that these situations are current, when the processing times
are improving, at least at the hearing level. We are extremely
concerned about what will happen if SSA's budget is further reduced to
the level proposed in H.R. 1.
--Ms. C, a 46-year-old woman with fibromyalgia and depression lives
in Omaha, Nebraska. She filed her request for hearing on August
2, 2010. Her utilities were shut off on December 30, 2010, and
she received an eviction notice on January 4, 2011. Although
her husband works, his checks are being garnished for her
medical bills. She cannot afford her medications and does not
qualify for Medicaid because her husband works. Her
representative requested critical case status (for expedited
processing) on December 30, 2010. Her hearing was held on
February 18, 2011, but she has not yet received a decision. The
delay in scheduling a hearing and receiving a decision has been
extremely difficult for her and her family. (From a
representative in Omaha, Nebraska)
--A 19-year-old young man lives with his foster mother in Plano,
Texas; she is his sole source of support. He has a full-scale
IQ of 65 and all of his schooling has been in special education
classes. He also has some mental health diagnoses and has been
in several inpatient psychiatric facilities. He was born
prematurely with a positive drug screening and put into foster
care at 13 months of age. He has chronic encephalopathy with
psychomotor delays. He applied for SSI disability benefits in
February 2010 and, more than 1 year later, he received his
reconsideration denial in February 2011. Now he will have to
wait for a hearing and hearing decision.
--Mr. E is a 52-year-old man who formerly worked as a security guard.
Because he has no income, he lives in a homeless shelter in
eastern North Carolina. He is constantly in and out of the
hospital. He has bipolar disorder and is an insulin-dependent
diabetic with associated neuropathy, which causes burning pain
in his feet and legs. He has a history of two heart attacks for
which he has had stents. He needs a pacemaker for his heart but
cannot get one until he is determined Medicaid eligible. He
cannot get Medicaid until he is found eligible for SSI. He
asked for a hearing on his SSI claim in September 2010, but he
will probably wait until mid to late summer 2011 to get a
hearing--if he lives that long. (From a representative in
Raleigh, North Carolina)
--A homeless woman in Manchester, New Hampshire requested her hearing
in January 2010. After her representative submitted a ``dire
need'' request for expedited processing, her hearing was held 1
year later (January 6, 2011). She has had no access to medical
care for her severe mental impairments (bipolar disorder,
paranoia, and anxiety). She has not yet received a decision.
--The same New Hampshire representative assisted a man who received a
partially favorable decision from an Administrative Law Judge
after a 15-month wait. He now has to wait an additional 90 days
while his case lingers at the Decision Review Board for
possible review. His home is being foreclosed on while he waits
for the board to act on his partially favorable decision.
ssa's limitation on administrative expenses for fiscal year 2012
We believe the President's budget proposal for the SSA for fiscal
year 2012 of $12.522 billion is the minimum needed to continue to
reduce key backlogs and increase deficit-reducing program integrity
work. With your support, SSA could continue to build on the progress
achieved thus far, progress that is vital to millions of people who
depend on their services, including people with disabilities. This
funding level will allow SSA to continue working down disability
backlogs, to implement efficiencies in programs, and to increase
program integrity work.
The budget will provide for the continuance of crucial income
support programs. In fiscal year 2012, SSA expects to provide SSDI
benefits to almost 11 million disabled workers and their family members
and provide SSI benefits to more than 8.3 million beneficiaries.
It is imperative that the SSA continue to reduce its disability
hearings backlog and initial disability claims backlog. This budget
request will allow SSA to reduce hearings and initial disability claims
backlogs and simplify the work incentives in the Disability Insurance
program. With the continued support of Congress, SSA is on track to
meet its commitment to the American public to eliminate the backlog by
fiscal year 2013. However, to reach this goal, it will need to
adjudicate more than 800,000 cases in fiscal years 2011 and 2012, which
is more than double what was handled 10 years ago. Yet, progress
continues to be challenged with the current skyrocketing number of
hearing receipts due to the increased number of people who are applying
for benefits.
We are pleased that SSA has implemented many productivity
improvements which help provide fast and accurate service to the public
at a lower cost, but the administration needs adequate funding to
continue this. Congress and the administration must work together to
ensure that millions of Americans do not experience significant waiting
times for decisions on their claims. To do this, SSA needs full funding
of the President's budget for fiscal year 2012.
The President's proposed fiscal year 2012 budget will aid in
processing mounting disability claims by creating programs such as
Extended Service Teams for more efficiency, and expanding Federal
capacity to decide claims and to assist Disability Determination
Services in handling claims, improving online services, fast-tracking
cases that obviously meet SSA's disability standards, paying medical
consultants per case as opposed to per hour to increase productivity,
and developing a disability case processing system.
The President's budget request proposes a 5-year reauthorization of
section 234 demonstration authority for the Disability Insurance
Program, which would allow SSA to test program innovations. Using this
authority, SSA has proposed a new Disability Work Incentives
Simplification Pilot to provide beneficiaries with a simple set of work
rules that would no longer terminate benefits solely based on earnings.
As a result, beneficiaries would have more flexibility to try working,
without fear of losing their benefits. After years of making similar
recommendations to improve work incentives, we look forward to working
with SSA on the details of this proposal.
The budget request also proposes an extension through 2013 of SSI
eligibility for 9 years for refugees, asylees, and certain other
humanitarian immigrants.
We also support SSA's plans to explore potential improvements to
programs, such as the Disability Research Consortium to address the
shortage of disability policy research and collaboration and to enhance
efforts to expand disability research within and across disability
programs. We would also like to work with SSA on the SSI Children's
Pilot--Promoting Readiness of Minors in SSI (PROMISE)--to improve
outcomes for children and families in the SSI program.
We are also concerned that Amendment 195 to H.R. 1 would make it
more difficult for people whose disability claims have been denied to
take their claims to Federal district court since no funds would be
available for payment of fees or expenses under the Equal Access to
Justice Act. We believe that this could make legal representation
unavailable to claimants who need to pursue their claims in Federal
court. We urge the subcommittee to oppose inclusion of such language in
the fiscal year 2011 and 2012 spending packages.
conclusion
For the remainder of fiscal year 2011, H.R. 1 would have a
devastating impact on administration of the SSA programs and we urge
the subcommittee to reject such drastic cuts. The harmful impact on the
American people, particularly people with disabilities waiting for
decisions on their claims for disability benefits, would be too great.
Instead, we urge the adoption of at least the amount included in Senate
Amendment 149 to H.R. 1.
The President's budget proposal for fiscal year 2012 is the minimum
needed to continue driving down disability backlogs, improve services
to people with disabilities, increase efficiency, and keep pace with
the rising demands of the American public. The speed and quality of the
administration's disability process must continue to improve and should
not be allowed to regress into the longer waiting periods of the recent
past. These challenges can only be addressed if Congress and the
administration work together to ensure that Social Security continues
to be the safety net it was designed to provide for people with
disabilities and their families, as well as retirees and survivors of
workers and retirees.
Thank you for this opportunity to testify. I would be happy to
answer questions or provide you with additional information.
This testimony is submitted on behalf of the undersigned
organizations:
--American Association of People with Disabilities
--American Foundation for the Blind
--Association of University Centers on Disabilities
--Bazelon Center for Mental Health Law
--Children and Adults with Attention-Deficit/Hyperactivity Disorder
--Community Action National Network
--Corporation for Supportive Housing
--Council of State Administrators of Vocational Rehabilitation
--Disability Rights Education and Defense Fund
--Easter Seals
--Epilepsy Foundation
--Health and Disability Advocates
--Lutheran Services of America--Disability Network
--National Alliance on Mental Illness
--National Association of Councils on Developmental Disabilities
--National Association of Disability Representatives
--National Council for Community Behavioral Healthcare
--National Council on Independent Living
--National Disability Rights Network
--National Multiple Sclerosis Society
--National Organization of Social Security Claimants' Representatives
--National Spinal Cord Injury Association
--The Arc of the United States
--United Cerebral Palsy
--United Spinal Association
--VetsFirst, United Spinal Association
--World Institute on Disability
Senator Harkin. And now, Mr. Dirago, please proceed.
STATEMENT OF JOE DIRAGO, PRESIDENT, NATIONAL COUNCIL OF
SOCIAL SECURITY MANAGEMENT ASSOCIATIONS,
INC., NEWBURGH, NEW YORK
Mr. Dirago. Chairman Harkin, Ranking Member Shelby, and
members of the subcommittee, I am the president of the National
Council of Social Security Management Associations, NCSSMA, and
the district manager of the Social Security office in Newburgh,
New York. I appreciate this opportunity to speak on behalf of
3,400 Social Security managers in field offices and teleservice
centers around the country.
NCSSMA's top priority is a strong and stable Social
Security Administration, and we have significant concerns about
funding the agency to maintain service levels vital to millions
of Americans. Workloads are exploding as a result of the
economic downturn and the 80 million Baby Boomers who will file
for benefits by 2030. Even with increases in Internet filing in
2010, over 45 million customers were served in field offices,
and Social Security completed 100 million telephone calls last
year.
Appropriations for SSA are an excellent investment. With
the additional funding Congress has provided, tremendous
progress has been made. Annual productivity has increased an
average of 4 percent, the last 4 years. In 2010, SSA produced
approximately $6 billion in savings from our program integrity
efforts.
However, the repercussions of the current continuing
resolution have already been felt. Feedback from our busy urban
offices indicates many are struggling. The manager of an
Alabama office indicates, ``Our employees are stretched to the
limit, trying to keep up with the increased walk-in and
telephone traffic. I really don't know how much more these
hardworking people can absorb.''
Most of SSA has been under a hiring freeze during the
continuing resolution. If this continues for the rest of the
year, it could result in the loss of 3,500 employees. A
Kentucky manager says, ``The American public does not care that
we are short on staff. They want to be seen quickly, have their
calls answered, and get their issues resolved.''
SSA projects that 50 percent of its employees will be
eligible to retire by 2018. Because it takes 2 years to train a
claims representative, concerns exist about this loss of
institutional knowledge. Geographical staffing imbalances will
occur, leaving some offices severely understaffed. This is
especially problematic for small and rural offices. A manager
in Iowa says, ``Our service area includes several counties.
Last year, we lost two employees, now we find it very difficult
to handle our telephone traffic and other priority workloads.
Although the use of the Internet is rising, this is not the
magic answer.''
SSA offices provide valuable services to many diverse
customers. My Newburgh office delivers assistance to the
Wounded Warrior Transition Unit, at West Point, which has
soldiers from eight States in the Northeast. Without
replacement staff, benefits to these soldiers will be delayed.
We respectfully request Congress consider our
recommendations. For 2011, we urge you to fund SSA at no less
than $350 million above the fiscal year 2010 enacted levels,
with no rescission of funds. This level of funding will cover
increased fixed costs and is essential to keep up with our
workloads. We strongly support the President's fiscal year 2012
budget request, and ask that Congress consider full funding to
sustain the momentum achieved.
NCSSMA also endorses additional funding to address program
integrity workloads. For every $1 invested in medical
continuing disability reviews and SSI redeterminations, $7 to
$10 in program savings is realized.
SSA must also be properly funded so that it may continue to
invest in user-friendly online services and to allow for IT
investments to improve service delivery. Any rescission of
funds could jeopardize initiatives to implement technological
efficiencies.
Social Security is the safety net of America, and must be
maintained as such. If adequate funding is not provided, public
service will suffer, resulting in significant hardship for
millions.
We sincerely appreciate the subcommittee's ongoing support
to ensure that we have the resources necessary to properly
serve the American public.
Thank you for the opportunity to testify at this hearing,
and I respectfully request that you consider our
recommendations.
Senator Harkin. Mr. Dirago, thank you.
[The statement follows:]
Prepared Statement of Joe Dirago
Chairman Harkin, Ranking Member Shelby, and members of the
subcommittee, my name is Joe Dirago and I am president of the National
Council of Social Security Management Associations (NCSSMA). I have
been the manager of the Social Security Administration (SSA) office in
Newburgh, New York for 10 years and have worked for the SSA for 31
years, with 27 years in management. On behalf of our membership, I am
pleased for the opportunity to submit this written testimony to the
subcommittee.
NCSSMA is a membership organization of nearly 3,400 SSA managers
and supervisors who provide leadership in 1,299 community based field
offices and teleservice centers throughout the country. We are the
front-line service providers for SSA in communities all over the
Nation. We are also the Federal employees with whom many of your staff
members work to resolve issues for your constituents who receive SSA
retirement, survivors or disability benefits, or Supplemental Security
Income (SSI). Since the founding of our organization more than 41 years
ago, NCSSMA has considered our top priority to be a strong and stable
SSA, one that delivers quality and prompt service to the American
public. We also consider it a top priority to be good stewards of the
taxpayers' moneys.
Our testimony focuses on the key issues confronting the SSA. We
have critical concerns about the dramatic growth in our workloads and
receiving the necessary funding to maintain service levels vital to
millions of people. Despite agency strategic planning, expansion of
online services, significant productivity gains, and the best efforts
of management and employees, SSA is faced with many challenges to
providing the service that the American public has earned and deserves.
Our testimony also provides our recommendations for addressing the
obstacles confronting the SSA, information on the state of SSA
operations, a review of the funding situation, and our detailed
assessment of the major agency challenges.
recommendations
The NCSSMA offers the following key recommendations to address the
challenges confronting the SSA and to provide the service the American
public has earned and deserves.
--NCSSMA respectfully urges this subcommittee and Congress to
consider funding SSA in fiscal year 2011 at no less than $350
million above the fiscal year 2010 enacted levels with no
rescission of Carryover Information Technology (IT) funds.
Based upon our analysis of the President's proposed budget
request, assessment of the current workload situation, and a
projection of workloads for fiscal year 2012, we believe that
funding SSA below this level would have a devastating impact on
the agency's ability to deliver vital services to millions of
Americans. This level of funding will cover inflationary
increases and is critically necessary to keep up with our
growing claims receipts, maintain the progress achieved on
reducing the disability hearings backlog, process program
integrity workloads, and to meet customer service expectations.
--We strongly support the President's fiscal year 2012 budget request
for the SSA and respectfully request that Congress consider its
full funding to sustain the momentum achieved on our key
priorities, maintain our front-line staffing levels, and to
ensure appropriate levels of service to the American public.
--NCSSMA strongly encourages Congress to consider providing SSA with
additional funding to address program integrity workloads and
other quality initiatives to improve the accuracy of payments.
This would include the elimination of the medical Continuing
Disability Review (CDR) backlog and conducting additional SSI
redeterminations. For every $1 invested in program integrity
initiatives, $7 to $10 in program savings is realized.
Investment in program integrity workloads ensures accurate
payments, saves taxpayers' dollars, and is fiscally prudent.
--SSA must be properly funded so that it may continue to invest in
improved user-friendly online services to allow more Internet
transactions. This would result in fewer visitors and telephone
calls to the field offices and provide relief from increasing
claims and other workloads.
--SSA is confronted with major challenges in managing its IT programs
to keep up with rapidly expanding workloads. NCSSMA believes it
is critical that SSA be adequately funded to allow for IT
investments. This is necessary for SSA to replace our aging
National Computer Center (NCC), to maintain systems continuity
and availability, and improve IT service delivery. Any
rescission of Carryover IT funds could seriously jeopardize
SSA's initiatives to implement automation and technological
efficiencies that address service delivery demands.
--NCSSMA recommends consideration of legislative and/or regulatory
proposals that can improve the effective administration of the
SSA program, with minimal effect on program dollars. We believe
these proposals have the potential to reduce operational costs
and increase administrative efficiency. This includes enacting
the Work Incentives Simplification Program (WISP) pilot,
requiring quarterly reporting of wages, requiring that SSA be
automatically provided with information on workers compensation
cases, and developing an automated system to report State and
local pensions affecting the Windfall Elimination Provision and
Government Pension Offset (WEP/GPO).
current state of ssa operations
Claims Workloads
Over the last 7 years, the SSA has experienced a huge increase in
retirement, survivor, dependent, disability, and SSI claims. The
additional claims receipts are driven by the initial wave of the nearly
80 million baby boomers who will be filing for SSA benefits by 2030--an
average of 10,000 per day. Concurrently, there has been a surge in
claims filed due to the economic downturn, which began in 2008. In
fiscal year 2010 and fiscal year 2011, disability and retirement
receipts alone are expected to exceed 1 million more than in fiscal
year 2008.
Field Office Visitors and Telephone Service
While SSA field offices are processing many more claims, we are
also seeing visitors in much greater numbers. Nationally, visitors to
SSA field offices increased significantly from fiscal year 2007 through
fiscal year 2010. In fiscal year 2010, field offices experienced 5
weeks with more than 1 million visitors.
--SSA visitors in fiscal year 2007--41,900,000.
--SSA visitors in fiscal year 2008--44,457,180.
--SSA visitors in fiscal year 2009--45,082,487.
--SSA visitors in fiscal year 2010--45,430,364.
In addition to the increased visitor traffic, SSA is experiencing
unprecedented telephone call volumes. In fiscal year 2010, SSA
completed 67 million transactions over the 800 number telephone
network--the most ever. NCSSMA estimates that field offices received an
additional 32 million public telephone contacts.
Internet Contacts
SSA's online electronic services, also known as ``eServices,''
offer the public access to SSA services via the Internet. The use of
SSA's Web site is growing and the American public is accessing it more
often to receive information and report changes. eServices has helped
significantly in dealing with the dramatic increases in SSA workloads
resulting from the baby boomers and the economic downturn.
SSA has promoted eServices extensively, including national public
campaigns to promote awareness. The following data illustrates the
volume and growth in SSA eServices.
--Social Security Online had 133.6 million unique visitors in fiscal
year 2010, an increase of more than 52 million from fiscal year
2009. There have been 47 million visitors in the first 4 months
of fiscal year 2011.
--In fiscal year 2010, SSA's Web site had 34.8 million contacts to
the Frequently Asked Questions, 11.6 million to the Field
Office Locator menu, and 3.7 million contacts to the Retirement
Estimator.
--Online retirement claims increased 9.6 percent more than fiscal
year 2009. The percentage of retirement claims filed online in
fiscal year 2010 reached 36.8 percent, with 913,473
applications taken.
--Online disability claims usage increased 34.5 percent in fiscal
year 2010 with 801,060 applications taken. For the first 4
months of fiscal year 2011, 30.3 percent of all disability
claims were filed online.
Disability Workloads
Nationwide, more than 3.2 million new initial disability claims
were filed and sent to the Disability Determination Service in fiscal
year 2010, an increase of more than 600,000 as compared to fiscal year
2008.
SSA's largest backlogs are in hearings to appeal initial decisions,
processed by Administrative Law Judges (ALJs) at the Office of
Disability Adjudication and Review. The chart below illustrates that
hearing receipts continue to rise, and reached 721,841 in fiscal year
2010. However, clearances exceeded receipts beginning in fiscal year
2009, which helped reduce the backlog of SSA hearings to 705,367
pending.
ssa funding fiscal years 2010, 2011, and 2012
SSA Funding Accomplishments Fiscal Year 2010
Appropriations to the SSA are an excellent investment and return on
taxpayer dollars. With the additional funding Congress has provided in
recent fiscal years and significant increases in employee productivity,
tremendous progress has been made to enhance service to the public,
reduce the hearings backlog, and to process additional workloads
received because of the aging of the baby boomers and the economic
downturn. In fiscal year 2010, SSA achieved the following:
--Completed more than 300,000 more initial disability claims than in
fiscal year 2009.
--Served 45 million people who visited our 1,300 field offices.
--Wait times in field offices for those without an appointment were
reduced from 23.3 minutes in fiscal year 2009 to 20.7 minutes
in fiscal year 2010.
--With innovation and automation efforts, along with the hard work
and dedication of our staff, SSA's annual productivity increase
has averaged about 4 percent over the last 4 years.
--In fiscal year 2010, SSA completed 67 million transactions over the
800 number telephone network--the most ever. The telephone busy
rate for the 800 number was reduced by half, from 10 percent in
fiscal year 2008 to 4.6 percent in fiscal year 2010. Time spent
waiting for an agent was reduced by more than 37 percent, from
326 seconds in fiscal year 2008 to 203 seconds in fiscal year
2010. Field office busy rates have also dropped dramatically
from more than 50 percent to nearly 20 percent.
--Program integrity efforts to process 2.4 million SSI
redeterminations and 325,000 medical Continuing Disability
Reviews (CDRs) produced more than $6 billion in estimated
savings.
--SSA expanded the Access to Financial Institutions (AFI) Initiative,
which data matches assets of SSI individuals that exceed
statutory limits. Expansion is to be completed in fiscal year
2011 and SSA projects $900 million in lifetime program savings
for each year the AFI process is used.
--Cooperative Disability Investigation (CDI) units combat disability
fraud. Since their inception in fiscal year 1998, the efforts
of CDI units have resulted in nearly $2.6 billion in savings:
$1.6 billion in disability programs and $967 million in
projected savings in programs such as Medicare and Medicaid.
SSA Funding for Fiscal Year 2011
SSA is facing unprecedented workload challenges due to the economic
downturn and the demand for SSA services from the baby boomers. We
greatly appreciate the increased funding that SSA received for fiscal
year 2009 and fiscal year 2010. This includes the $1 billion SSA
received from the American Recovery and Reinvestment Act (ARRA). About
half of that funding was directed to reducing the backlogs in SSA. Had
SSA not received this funding, the service we provide in SSA would be
much worse and the disability backlog would be unconscionable.
For fiscal year 2011, the President requested $12.379 billion for
SSA's administrative budget. The Limitation on Administrative Expenses
(LAE) account budget request is an increase of $932 million or 8.1
percent more than the fiscal year 2010 enacted level. Much of this
increase is needed to cover inflationary costs for fixed costs such as
rent, guards, postage, periodic step increases, career ladder
promotions, and increased health benefit costs. Funding above current
levels is absolutely necessary to keep up with our growing workloads,
maintain the progress achieved on reducing the disability hearings
backlog, process program integrity workloads, including SSI
redeterminations and medical CDRs, and to meet customer service
expectations.
NCSSMA recognizes that there is no simple way to provide the
necessary resources to SSA. However, we believe that funding SSA for
fiscal year 2011 at the fiscal year 2010 level without covering
inflationary increases would have a devastating impact on the agency's
ability to deliver critical services to millions of Americans. SSA is
the safety net of America and if adequate funding is not provided,
public service will deteriorate, with longer waiting times, unanswered
calls, increased backlogs, and significant hardship on needy
beneficiaries.
Funding SSA at the level passed by the House of Representatives
(H.R. 1) would result in serious negative consequences to public
service. If enacted in its current form, this legislation would reduce
SSA's appropriated funding $125 million from the fiscal year 2010
enacted level, rescind $500 million from the Carryover IT funding, and
rescind $118 million from the NCC funding as part of an overall
reduction in unobligated ARRA funding. This would likely result in an
agency-wide hiring freeze, with no overtime available to address
critical workloads, and employee furloughs. Drastic cutbacks would be
necessary that would have a negative impact on operations and
significant delays in all workloads would result. Disability backlogs
could grow an additional 160,000 cases. Significant financial hardships
could be created because of delays in payments. Agency productivity
would erode significantly. Waiting times and telephone service would
experience major deterioration. This would necessitate cutbacks in
other budget areas, such as supplies and training, and in IT
development expenditures. Spending in these areas would be purely for
maintenance.
NCSSMA is very concerned that the agency will be forced to impose
furloughs if the fiscal year 2011 budget is not adequate. Furloughs
would have a devastating effect on the public that depends on SSA for
vital services, as well as our employees. Nationally, the furloughs
could translate to the following approximate daily impact on SSA's
operations:
--180,000 daily visitors might not be seen in the 1,266 SSA field
offices across the country;
--16,000 retirement and survivors claims might not be taken from
applicants;
--12,600 disability applications might not be processed for
individuals who are unable to work;
--385,000 telephone calls to SSA could go unanswered;
--50,000 individuals could fail to have a SSA card application
processed;
--1,440 medical CDRs, which save $10 for every $1 SSA invests in
processing them, might not be processed;
--10,000 fewer SSI recipients might not have redeterminations of
their benefits completed to make sure payments are accurate.
These reviews save $7 for each $1 SSA spends performing them.
If SSA is funded at the fiscal year 2010 level for fiscal year
2011, without covering inflationary increases of $350 million, this
could reverse the positive progress that has been achieved in the last
few years with all of SSA's workloads. Attempting to address the fiscal
year 2011 workload demands at SSA with fiscal year 2010 resource levels
is not a prudent course of action and would lead to significant
cutbacks that would be devastating for members of the public who rely
on SSA for essential services and assistance.
President's Proposed Fiscal Year 2012 SSA Budget
NCSSMA strongly supports the President's fiscal year 2012 budget
request for the SSA. The total SSA budget request is $12.667 billion,
which includes $12,522,200,000 in administrative funding through the
LAE account. This is an increase of $143.3 million more than the fiscal
year 2011 President's proposed SSA budget request.
The following is a direct quote from the SSA fiscal year 2012
budget overview:
``In fiscal year 2012, we will need a minimum administrative budget
increase of $300 million just to cover our fixed costs, including rent,
guards, postage, and employee salaries and benefits. We will need
funding above that level to keep up with our growing workloads, reduce
existing backlogs, and meet rising customer service expectations.''
We respectfully request that Congress consider full funding of the
President's fiscal year 2012 budget request for SSA to sustain the
momentum achieved on our key priorities, maintain our front-line
staffing levels, and to ensure appropriate levels of service to the
American public. This funding request would allow SSA to do the
following in fiscal year 2012:
--Reduce the initial disability claims backlog to 632,000 by
processing more than 3 million initial disability claims;
--Conduct disability hearings for 822,500 cases in 2012 and reduce
the waiting time for a hearing decision to below a year (to 326
days) for the first time in a decade;
--Reduce pending disability hearings to 597,000 from the fiscal year
2011 level of 668,000 (estimated) and fiscal year 2010 level of
705,367;
--Complete additional program integrity workloads--process 592,000
medical CDRs (up from 325,000 completed in fiscal year 2010)
and 2.6 million SSI redeterminations (up from 2.4 million in
fiscal year 2010). $938 million is dedicated in the fiscal year
2012 budget request to continue these reviews that save
significant program dollars by avoiding improper payments to
beneficiaries. SSA estimates this program integrity funding in
fiscal year 2012 will result in nearly $9.3 billion in savings
over 10 years, including Medicare and Medicaid savings. The
increased funding also improves the savings in fiscal year 2012
over fiscal year 2010 by more than $3 billion.
It is important to note that any backlogs and service deterioration
related to inadequate fiscal year 2011 funding levels would have a
collateral negative impact on fiscal year 2012 and beyond. Backlogs
make SSA much more inefficient. Substantially more dollars are required
to reduce a backlog than to prevent one because of the reworking of
cases. Hiring delays also have long-term effects because of the amount
of time it takes for new employees to gain proficiency.
review and assessment of ssa challenges
Field Office Service Delivery Challenges
Despite staff replacements authorized in recent SSA budgets,
significant overtime hours worked, and increases in the use of Internet
services, field offices are still struggling with tremendous workload
demands. SSA field offices vary in terms of size, demographics, and
location. However, all types of field offices are experiencing
tremendous stress because of our increased workloads and additional
visitor traffic. The effect of funding the SSA in fiscal year 2011 at
fiscal year 2010 levels exacerbates the situation and has already had a
significant impact on local field offices around the country.
Frontline feedback from our busiest urban offices indicates that
some have seen their visitor traffic explode with overflowing reception
areas and increased waiting times. This can result in standing room
only, lack of seating availability for disabled clients, and visitors
waiting in the hallway or even outside. Managers of busy SSA field
offices recently provided these comments:
--We handle close to 2,000 visitors a week in my office. Recent
losses due to retirement are affecting the service we provide,
as we cannot interview the public fast enough. It seems like
the more employees we put up to interview, the more the public
comes in. Pulling employees from the back creates a backlog and
reduction in staffing reduces our ability to handle those
backlogs. If we cannot hire to fill losses, the public will
wait longer and be disadvantaged. In addition, the safety of
the employees becomes at risk as the public becomes frustrated
at the long waits. (California)
--Working in a busy office in Alabama, I can honestly say a yearlong
continuing resolution at fiscal year 2010 funding levels would
be catastrophic. Our employees are stretched to the limit
trying to keep up with the increased walk-in and telephone
traffic and I really do not know how much more these hard-
working people can absorb. They are working at a dangerous
level--working overtime to keep up--stress levels are high and
this is evident if you spend some time in a field office. They
will only be able to continue this pace for so long. Less
funding and staffing will mean a decreased level of service to
our deserving public. We talk about world-class service in our
staff meetings; this will disintegrate into second-class
service if we do not have the staff or the funding to handle
the increasing workloads.
We expect our working Americans to dutifully pay their SSA taxes;
however, this comes with a promise. We promise to safeguard
this money as an investment toward their retirement or the
horrible possibility of a career-ending disability--a reward
for their hard work and contribution to this great country.
Inadequate funding and staffing will mean we have to tell them
we appreciate their contribution, but we cannot fulfill our
promise to provide timely benefits in their time of need, or
when they are eligible for well-deserved retirement. They will
just have to wait until we can ``get to their claim''. This is
unacceptable. We don't give people the option of ``opting out''
of SSA taxes when they experience financial troubles, but isn't
that what we are doing here? We understand budget woes, but
does this give us a valid excuse for punishing hard-working
Americans? We seem to find funding for important causes and I
can't think of a better cause than the public we serve who have
spent their lives making a positive contribution to make
America what it is today--let's take care of them. (Alabama)
--On a daily basis, we average between 400 and 500 telephone calls on
top of claims and postentitlement interviews. We assign six
employees to telephones daily and we cannot handle the calls we
receive. Last October we had 1 day in which we received more
than 1,100 phone calls. How can we be expected to answer so
many phone calls? Because of assignments to phone duty, I am
unable to process approximately 240 SSI redetermination
clearances a week. We are behind by about 20 percent in SSI
redetermination clearances. (Florida)
Most of SSA has been under a hiring freeze because of the current
funding situation. A hiring freeze for all of fiscal year 2011 could
result in a loss of more than 2,500 SSA Federal employees and up to
1,000 State employees in the Disability Determination Services (DDSs).
SSA field office managers recently provided the following frontline
feedback about the effect of the current SSA hiring freeze on their
offices:
--A hiring freeze will be detrimental, especially to the processing
of our disability workloads. Under the Commissioner's
direction, we have made tremendous improvement in the time it
takes to get a decision. Every year the bar is set higher and
every year SSA staff exceeds expectations. However, in the past
6 months alone, our office staff has been reduced from 57 to 53
employees. We are anticipating a minimum of 4 more losses and
will be down to 49 by the end of the year--a 14 percent decline
in staff. SSA employees take pride in their work knowing that
the American public depends on us for their financial security.
Not having the resources to process workloads in a timely
manner undermines the positive morale of the staff as well as
undermining the public's trust in our agency. Meeting the
demands of the public is a struggle every day. We juggle
phones, walk-ins, appointments, and Internet claims daily.
Despite the flexibility of our staff, we consistently have wait
times of more than an hour. Claims Representatives consistently
interview all day and have little time to work through mail or
return phone messages. Not getting to mail or messages daily
directly influences processing time to pay benefits. (Texas)
As in-office visitors increase in already busy offices, there has
also been an increase in the number of reported security incidents.
Tensions escalate when visitors are in crowded reception areas and many
become frustrated because of the extensive wait to be served. The
societal trend of disruptive visitors to offices continues to be a
challenge. The Office of the Inspector General (OIG) issued a report,
Threats against SSA Employees or Property, on November 30, 1010.
According to the report, ``SSA has experienced a dramatic increase in
the number of reported threats against its employees or property. The
number of threats increased by more than 50 percent in fiscal year 2009
and by more than 60 percent in fiscal year 2010.'' This SSA manager
expresses the connection between staff losses, increased workloads,
public dissatisfaction and security concerns.
--A hiring freeze for all of fiscal year 2011 would be devastating.
We lost two employees over the past 8 months and could not
replace them. As a result, we are seeing our visitor waiting
times increase and we are not able to answer telephone calls,
as we would like. By going from a staff of 18 to 16 employees,
we are barely able to hold the line on our workloads and basic
services. Another loss without replacement will undoubtedly
cause the dam to break. We must have the resources to do the
work. We are already seeing much more stress on our staff
members due to assuming the workloads of the employees we lost,
and we are seeing higher frustration levels from our callers
and visitors. The American public does not care that we are
short on staff, they want to be seen quickly, have their call
answered quickly and get their issues resolved. I am concerned
that this type of frustration will lead to more threats and
acts of violence toward our staff members, not only in our own
office, but also in field offices across the country.
(Kentucky)
SSA has a highly skilled, but aging workforce with about two-thirds
of its more than 60,000 employees involved in delivering direct service
to the public. SSA projects 50 percent of its employees, including 66
percent of supervisors, will be eligible to retire by fiscal year 2018.
Serious concerns exist about the agency's ability to sustain service
levels with the tremendous loss of institutional knowledge from SSA's
front-line service personnel. This SSA field office manager relates the
challenges of dealing with staff retirements.
--A recent article provided staggering statistics--by 2025, nearly 1
in 4 Montanans will be older than age 65. This month, a tidal
wave of baby boomers, 7,000 Americans each day reach that
milestone. By 2015, projections rank Montana fourth in the
Nation in percentage of seniors. By 2025, ``mature'' Montanans
will number 240,000--up more than 100,000.
By the end of the month, I will lose two employees--one to
another Federal agency and the other cannot take the stress of
the job. We ask a lot of our public servants in the SSA and
deal daily with people living in stressful times. It is very
difficult to please people living through hard economic times.
As I lose two trained employees, I wonder what the impact will
be on the level of service we provide. I have a very
conscientious staff. They like to go the extra mile, and do
whatever they can to help people. The impact of losing two
staff members in these times of doing more with less will cause
great strain to an already strained staff. The number of people
that walk through our door and the number of phone calls we
answer has risen tremendously. Staff and management alike are
already filling in on the phones and at the counter to provide
the public with the best possible service.
It takes at least 2 years to train an individual to work in one
of our offices. As we lose two individuals, we are already 2
years and two people behind in providing public service to our
aging population with a trained staff. A hiring freeze is not
only demoralizing to our remaining staff members, but causes
more stress to a demoralized public. (Montana)
Geographical staffing disparities will occur with attrition leaving
some offices significantly understaffed, which is especially
problematic for the rural SSA field offices. These offices serve
customers who often live vast distances away, may have no Internet
service, and lack access to public transportation. In some rural areas,
SSA may be one of the only Government agencies with a local office. SSA
is the face of the Federal Government in many communities and the
public expects their local SSA field office to help them with all of
their Government-related issues. This SSA manager relates recent
service delivery issues in their rural office.
--We are a small office in Iowa and our service area includes several
counties, which include some with the highest poverty rates in
the State. For several years, we have had the necessary staff
to handle our workloads and been able to provide some
assistance to other offices. Last year we lost two employees,
leaving us with a depleted staff. Now we are not able to handle
our own workloads. Because we have a potential driving distance
for claimants of 75 miles to come into the office, we have high
telephone traffic. We find it very difficult to handle our
telephone traffic and all of the workloads and priorities that
should be done. Although use of the Internet is rising, this is
not the magic answer. Stress on employees who are dealing with
rising workloads, pending cases, priorities, deadlines, and
unmet expectations (especially from within themselves) affect
their outlook and physical health. (Iowa)
SSA field offices provide valuable services to many diverse
customers throughout the country. The service provided to our disabled
veterans is vitally important. In September 2009, the U.S. Government
Accountability Office (GAO) reported on SSA disability benefits to
wounded warriors. The GAO report indicated that from 2001 to 2008, SSA
processed more than 16,000 applications for disability from wounded
warriors and their approval rate was about 60 percent. As the manager
of the office that serves the USMA at West Point, I have concerns about
our ability to assist our Wounded Warriors.
--My office delivers vital services to the U.S. Army Wounded Warrior
Transition Unit (WWTU) through the Soldier and Family
Assistance Center. We visit this facility regularly and provide
support and SSA services to soldiers from eight States in the
Northeast. There are approximately 150 soldiers in the WWTU on
an ongoing basis and we process more than 200 leads per year
for SSA-related matters. My office staffing has been reduced
from 35 employees in 2005 to 30, despite large increases in
workloads. Without sufficient resources and replacement
staffing, benefits to these members of our Armed Forces will be
delayed or become seriously backlogged (New York)
SSA workloads are expected to grow exponentially as the baby
boomers retire. Reducing resources while work is significantly
increasing is a prescription for substantial service delays and
resulting inefficiencies as SSA tries to cope with the mounting
backlogs and recontacts by the public. SSA is a very productive agency
that efficiently uses the taxpayers' moneys and must be maintained as
such.
Program Integrity Investments
SSA takes great pride in its stewardship responsibilities by
ensuring individuals receive accurate payment of benefits. The agency
is responsible for issuing more than $700 billion in benefit payments
annually to approximately 60 million people. Tax dollars must be
effectively managed to minimize the risk of making improper payments.
Balancing service commitments with stewardship responsibilities is
difficult given the complexity of the programs SSA administers, but the
reduction of improper payments is one of SSA's key strategic
objectives. The two most powerful tools for reducing improper payments
are conducting medical CDRs and SSI redeterminations.
--CDRs are periodic reviews of a disability beneficiary's medical
condition to determine whether an individual is still disabled,
or if benefits should be ceased because of medical improvement.
Medical CDRs yield more than $10 in lifetime program savings
for every $1 spent.
--SSI redeterminations review nonmedical factors of eligibility, such
as income and resources, to identify payment errors. SSI
redeterminations yield a return on investment of more than $7
in program savings over 10 years for each $1 spent, including
Medicaid savings accruals.
Investment in program integrity workloads to ensure accurate
payments and save taxpayers' dollars is necessary and prudent. Adequate
final appropriations from fiscal year 2008-fiscal year 2010 allowed SSA
to address critical program integrity work. SSA invested $759 million
toward program integrity efforts in fiscal year 2010. The 2.4 million
SSI redeterminations and 325,000 medical CDRs completed in fiscal year
2010 produced more than $6 billion in estimated savings (in
overpayments prevented or projected to be collected).
The President's fiscal year 2011 SSA budget request proposes SSA
will accomplish 2.422 million SSI redeterminations and increase the
number of medical CDRs conducted by 31,000 to 360,000 cases. If SSA is
able to fulfill its fiscal year 2011 program integrity targets for
medical CDRs and SSI redeterminations, the estimated program savings
over the next 10 years is nearly $7 billion, including savings to
Medicare and Medicaid.
Program integrity investments have an important impact. Inadequate
SSA funding in fiscal year 2011 may lead to furloughs or cutbacks that
would prevent the completion of SSI redeterminations and medical CDRs.
LOST PROGRAM INTEGRITY DOLLARS IN FISCAL YEAR 2011
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Total cost
SSI Medical Cost savings/loss savings/loss FO/DDS estimated
Fiscal year 2010 workload period redeterminations continuing redeterminations Cost savings/loss redeterminations employee salary Long-term gain/
and limited disability and limited medical CDRs \4\ and limited \6\ loss \7\
issues \1\ reviews \2\ issues \3\ issues \5\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fiscal year 2011............................................... 2,464,684 360,044 $2,708,687,716 $3,931,680,480 $6,640,368,196 $1,809,240,000 $4,831,128,196
1 work day..................................................... 9,859 1,440 $10,834,751 $15,726,722 $26,561,473 $6,935,276 $19,626,197
10 work days................................................... 98,587 14,402 $108,347,509 $157,267,219 $265,614,728 $69,352,755 $196,261,973
15 work days................................................... 147,881 21,603 $162,521,263 $235,900,829 $398,422,092 $104,029,133 $294,392,959
20 work days................................................... 197,715 28,804 $216,695,017 $314,534,438 $531,229,456 $138,705,510 $392,523,945
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ SSI redeterminations and limited issues represent projected 551 redetermination and limited issue cases for fiscal year 2011.
\2\ Medical CDRs are based on fiscal year 2010 projected to fiscal year 2011 (actual number may be higher).
\3\ Cost savings/loss redeterminations and limited issues fiscal year 2011 projections in administrative costs to process this workload for the year; 1, 10, 15, and 20 work days represent long
term program savings of $7 saved to $1 administrative dollars spent.
\4\ Cost savings/loss medical CDRs fiscal year 2011 projections is adminstrative costs to process CDRs for the year; 1, 10, 15, and 20 work days represent long-term program savings of $10
saved to $1 administrative dollars spent.
\5\ Total cost savings/loss redeterminations and medical CDRs is total for this workload.
\6\ FO/DDS estimated employee salary is estimated for FO/DDS employees for fiscal year 2011; 1, 10, 15, and 20 work days.
\7\ Long-term gain/loss is fiscal year 2011 projection of total saved moneys (cost savings by processing SSI redeterminations and limited issues and CDRs minus salary costs); 1, 10, 15, and 20
work days is total dollars lost (total dollars lost minus salary costs).
SSA's OIG issued a report dated December 1, 2010, titled ``Top
Issues Facing Social Security Administration Management--Fiscal Year
2011.'' This report provides OIG's perspectives on the most serious
management challenges facing SSA. The full report is available at
http://www.ssa.gov/oig/ADOBEPDF/mgmt%20challenges%202011.pdf, but in
part, the OIG report indicates there is a significant need to increase
the number of medical CDRs conducted by SSA.
``From CY 2005 through CY 2010, we estimate SSA will make between
$1.3 and $2.6 billion in disability benefit payments that could
potentially have been avoided if full medical CDRs were conducted when
they became due. Furthermore, although SSA plans to conduct an
increased number of full medical CDRs in fiscal year 2011, a backlog of
approximately 1.5 million full medical CDRs will most likely remain.''
SSA budgetary constraints have caused the shortfall between the
number of CDRs due and the number conducted each year. Adequate funding
is needed for SSA to conduct all CDRs when they become due and to save
program dollars. If SSA completes all of the 1.5 million medical CDRs,
the lifetime program savings would be more than $15 billion.
The OIG report also identifies potential cost-savings, which could
be realized by SSA conducting additional SSI redeterminations:
``SSA decreased the number of SSI redeterminations conducted
between fiscal years 2003 and 2009 by more than 40 percent. We
estimated in a July 2009 report, SSI redeterminations, that SSA could
have saved an additional $3.3 billion during fiscal years 2008 and 2009
by conducting redeterminations at the same level it did in fiscal year
2003.''
The President's fiscal year 2012 SSA budget request indicates the
funding recommended would allow SSA to conduct at least 592,000 medical
CDRs and at least 2.6 million SSI redeterminations of eligibility in
2012. SSA estimates that increased program integrity funding in fiscal
year 2012 will result in nearly $9.3 billion in savings over 10 years,
including Medicare and Medicaid savings.
NCSSMA strongly encourages Congress to provide SSA with the
necessary funding to reduce the medical CDR backlog and to conduct
additional SSI redeterminations. Investment in program integrity
workloads ensures accurate payments, saves taxpayers' dollars and is
fiscally prudent. Failure to process these reviews has adverse
consequences on the Federal budget and the ongoing administration of
SSA programs.
Quality Concerns
With the ever-increasing workloads SSA must handle, concerns exist
about the accuracy of work being performed. SSA employees are working
at a high rate of production and their primary focus is on getting work
processed, oftentimes at the expense of quality. Given the significant
overall dollars involved in SSA's payments, even the slightest errors
in the overall process can result in significant improper payments.
Reduced staffing affects not only the number of employees available
to complete production work, but also management and review positions
that ensure quality work is completed. SSA is making efforts to improve
quality of the work product with its new trainees. Most offices are
completing proficiency reviews after new employees complete their
training class. This will help develop a more technically proficient
employee and improve our quality, but resources are necessary for this.
SSA places a high priority on meeting workload goals, but meeting
these goals and maintaining quality requires sufficient resources. The
core problem relative to addressing quality concerns is the time and
pressure to complete workloads. NCSSMA believes that conducting process
reviews of cases is necessary and cannot be sacrificed at the expense
of production.
--The complexity of the SSI program makes the redetermination process
a significant area of concern relative to accuracy of changes.
A targeted assessment review of error-prone areas would be
beneficial to ensuring a quality product.
--Process reviews are necessary to address the accuracy of disability
reports referred to the Disability Determination Services
(DDSs). Improved report accuracy would result in appropriate
decisions rendered in a shorter period of time, a critical
factor given the pressure on our disability program.
--Reviews of retirement and survivor claims are necessary to ensure
that entitlement to benefits is not missed and claimants are
selecting the most advantageous month of election, whether
filing by telephone, in person or via the Internet. Having
sufficient time to review a sample of all our work would allow
managers to provide proper feedback and mentoring to employees
and ensure continuing quality service.
SSA Online eServices To Assist With Service Delivery Challenges
The expansion of services available to the American public via the
Internet has helped to alleviate the number of visitors and telephone
calls to field offices. However, Internet services currently available
represent only a portion of the total workloads accomplished by SSA. In
spite of SSA's efforts to educate the public regarding Internet
services, the willingness and ability of individuals to utilize the
Internet is not keeping pace with the increasing demand for service.
The agency goal for fiscal year 2012 is to process 50 percent of
retirement applications and 38 percent of disability claims via the
Internet. A study of SSA claims indicates that online claims take less
time to process on average, with a timesaving for a retirement claim of
12 minutes and 21 minutes for a disability claim. While eServices has
assisted significantly with the high number of applications received,
field office staff must still spend significant time to adjudicate
these electronically initiated actions.
Many of the high-volume transactions currently processed in field
offices are not available on the Internet or are only being used by the
public to a limited degree. In fiscal year 2010 SSA processed more than
14.7 million SSA card-related actions and 5.4 million benefit
verifications. This represents more than 40 percent of the 45.4 million
visitors to SSA field offices. SSA cards cannot be processed online
because there are security and authentication issues.
NCSSMA believes that SSA must be properly funded in fiscal year
2011 and beyond so that it may continue to invest in improved user-
friendly online services to allow more online transactions. If
individuals were able to successfully transact their request for
services online, this would result in fewer contacts with field
offices, improved efficiencies, and better public service. The agency
requires the necessary funds for finalizing the authentication process
to allow more postentitlement transactions to be processed via the
Internet. With increasing workloads, it is also imperative that SSA
offers a seamless Internet disability application that is easy to use
and fully integrated with the medical portion of the claim.
Disability Workload Processes
Eliminating the disability hearings backlog continues to be SSA's
top priority, and the agency has made a major resource investment to
improve this situation. The agency's goal is to eliminate the backlog
by 2013 and to improve processing time to 270 days. The Commissioner
has implemented several initiatives to achieve this goal, including
improving processes, compassionate allowances, improving efficiency
with automation, and increasing adjudicatory capacity. Achieving these
goals will depend on the available resources provided by SSA funding
and the volume of new hearings received.
It is important to understand that annual appropriated funding
levels for SSA have a critical impact on the hearings backlog. One of
the most significant reasons for the increase in disability hearing
backlogs was the significant underfunding of SSA. From fiscal year 2004
to fiscal year 2007, the final appropriated funding levels approved by
Congress totaled $854 million less than the President's requests and
$3.071 billion less than the Commissioner's requests.
However, as you can see from the chart below, from fiscal year 2008
to fiscal year 2010, the cumulative final appropriation level was $203
million more than the President's requests. In addition, SSA received
nearly $1 billion in ARRA funding. Half of the ARRA funds were
designated to replace the aging SSA NCC. Much of the other ARRA funding
has been utilized to help address the hearings backlog at SSA.
SSA FUNDING REQUESTS AND FINAL APPROPRIATIONS: FISCAL YEAR 2008-FISCAL YEAR 2010
[In billions of dollars]
----------------------------------------------------------------------------------------------------------------
Commissioner's President's Final Final vs. Final vs.
request request appropriation President Commissioner
----------------------------------------------------------------------------------------------------------------
Fiscal year 2008....................... 10.420 9.597 9.745 .148 -.675
Fiscal year 2009....................... 10.395 10.327 10.454 .059 .127
Fiscal year 2010....................... 11.793 11.451 11.447 -.004 -.346
------------------------------------------------------------------------
Total............................ 32.608 31.375 31.646 .203 -.894
----------------------------------------------------------------------------------------------------------------
The increased resources for SSA became even more essential as the
agency's workloads grew at a very rapid pace following the beginning of
the economic downturn. With the increased funding SSA has received in
the last 3 fiscal years, the agency has hired 228 ALJs and 1,300
additional support staff. The agency has also opened or expanded 19
hearing offices, including a fifth National Hearing Center and 8 more
hearing offices are to be opened this year.
SSA's efforts have resulted in significant progress in reducing
both the number of pending hearings and the amount of time a claimant
must wait for a hearing decision. At the end of fiscal year 2010, the
pending hearings were reduced to 705,367 cases nationwide, the lowest
level in 5 years. In February 2010, the average processing time for a
hearing was 365 days, the lowest level since December 2003. At its
peak, it took nearly 18 months for a hearing decision.
Even though this is positive news, the hearing offices are facing a
significant wave of new hearings that are being filed, as seen in the
chart below.
ODAR PERFORMANCE DATA THROUGH FEBRUARY 2011
----------------------------------------------------------------------------------------------------------------
Hearing
Fiscal year Pending SSA processing Yearly hearing Yearly Average ALJ
hearings times receipts dispositions dispositions
----------------------------------------------------------------------------------------------------------------
2011 \1\........................ \2\ 722,872 371 \2\ 829,373 \2\ 784,693 2.44
2010............................ 705,367 426 721,841 737,616 2.38
2009............................ 722,822 491 625,003 660,842 2.37
2008............................ 760,813 514 591,888 550,805 2.3
2007............................ 746,744 512 581,687 547,951 2.19
2006............................ 715,568 483 561,609 558,978 2.2
2005............................ 708,164 443 598,726 519,359 2.2
2004............................ 635,180 391 634,175 561,461 ( \3\ )
2003............................ 556,369 343 662,733 571,928 ( \3\ )
2002............................ 463,052 333 596,959 532,106 ( \3\ )
2001............................ 392,397 307 554,376 465,228 ( \3\ )
----------------------------------------------------------------------------------------------------------------
\1\ Fiscal year 2011 information is from October 2010 through February 2011.
\2\ Fiscal year 2011 data is projected figure based on October 2010 through February 2011 performance.
\3\ Not applicable.
This chart projects that approximately 400,000 additional hearings
will be filed from fiscal year 2009 through fiscal year 2011 than were
filed in fiscal year 2008. This is attributable to the increased number
of disability claims being filed since the economic downturn that began
in 2008.
The Congressional Budget Office (CBO) released a report July 22,
2010: ``Social Security Disability Insurance: Participation Trends and
Fiscal Implications.'' According to this report, disability
beneficiaries tripled from 2.7 million to 9.7 million people from 1970
to 2009. The CBO projects the number of disability beneficiaries will
grow to 11.4 million by 2015. In fiscal year 2010, SSA received 619,306
more initial disability claims than in fiscal year 2008. In fiscal year
2011, SSA anticipates receiving 629,000 more initial disability claims
than in fiscal year 2008.
The rise in disability claims filings has also created backlogs in
the State DDSs. At the end of fiscal year 2010, the number of pending
initial disability claims was at an all-time high of 824,192 cases,
which was 258,522 more than at the end of fiscal year 2008, a 46
percent increase. In the first 5 months of fiscal year 2011, the number
of initial disability claims pending has been reduced to 774,130. This
foreshadows the second wave of cases coming to the hearing offices.
To eliminate the hearings backlog in fiscal year 2013, SSA will
need to adjudicate a record number of cases in fiscal years 2011 and
2012--more than 800,000 each year. Complicating this monumental task is
the furloughing of workers in 10 States, including DDS employees,
despite the fact that SSA provides 100 percent of the funding necessary
for the DDSs to operate. SSA must also deal with an anticipated
retirement wave of ALJs, with 59 percent currently eligible for
optional retirement.
Despite these unprecedented challenges, SSA continues to utilize
the additional resources received in the last 3 fiscal years to clear
more disability claims and hearing cases. Unfortunately, the number of
claims and hearings pending is still not acceptable to the thousands of
Americans who depend on the SSA for SSI for their basic income, meeting
healthcare costs, and support of their families. It is essential that
adequate funding be provided to SSA to replace lost staff and work
overtime to maintain the momentum achieved in reducing the number of
disability cases pending and the time it requires to process these
cases.
Information Technology Investments
SSA is confronted with major challenges in managing its Information
Technology programs to keep up with rapidly expanding workloads. NCSSMA
believes it is critical that SSA receive adequate funding to allow for
much-needed IT investments. This is vitally necessary for SSA to
replace our aging NCC, to maintain systems continuity and availability,
and to improve IT service delivery. Any rescission of Carryover IT
funds could seriously jeopardize SSA's initiatives to implement
automation and technological efficiencies to address service delivery
demands.
The agency is in the process of replacing its NCC and has received
ARRA funding for this purpose. The existing NCC is more than 30 years
old and has significant structural issues that necessitate its
replacement. Additionally, the NCC's capacity is severely strained by
increasing workloads and expanding telecommunication services to
support the agency's business.
In the previously referenced OIG report dated December 1, 2010,
managing the timing of the transition from the existing data center to
a new center has become a concern.
``SSA estimates that by 2012, [its National Computer Center] as a
stand-alone data center will no longer be able to support this
expanding environment.''
SSA has also made a major investment in improving its telephone
service. The agency is in the midst of replacing telephone equipment
with Voice over Internet Protocol (VOIP). The VOIP technology telephone
system integrates SSA's networks and provides faster call routing. The
agency is approximately 74 percent complete with this initiative, with
936 of its 1,266 field offices now have the new VOIP equipment. SSA
anticipates completion of this project by March 2012.
With SSA's volume of telephone calls increasing, successfully
implementing VOIP is essential to address growing public service
demands. While early VOIP installations experienced problems with the
equipment and services, the agency has made significant strides in
addressing those concerns. Voice quality, management information data,
and programming issues are being addressed and resolved, but SSA IT
funding is critical to the successful completion of this major
initiative.
Legislative and/or Regulatory Actions To Improve SSA Program Efficiency
NCSSMA recommends consideration of the following legislative and/or
regulatory proposals that can improve the effective administration of
the Social Security Program, with minimal effect on program dollars.
NCSSMA believes these proposals, which are included in the fiscal year
2012 budget request, have the potential to increase administrative
efficiency and lower operational costs.
--Enact the WISP.--This proposal would replace the complex work
provisions in the Social Security Disability Program, including
the trial work period, substantial gainful activity
determinations, extended period of eligibility and expedited
reinstatement, and replace these provisions with an earnings
test comparable to that of RSI beneficiaries under full
retirement age. This provision would simplify the entire work
incentive process for the beneficiary and SSA. Work years saved
by SSA currently spent in enforcing the prior provision could
be redirected to other priority workloads.
--Federal Wage Reporting.--This proposal would require employers to
report wages quarterly; the proposal would not affect reporting
of self-employment. Increasing the timeliness of wage reporting
would enhance tax administration and improve program integrity
for a range of programs. This program would give SSA more
immediate access to earnings information for the SSI program,
thereby decreasing underpayments.
--Require That SSA be Provided With Information on Workers
Compensation.--Provision of this information in an electronic
fashion would greatly reduce the number of contacts necessary
by SSA personnel to State and local governments, along with
private insurance providers. Having accurate information at the
time of determinations would ensure more accurate decisions,
thereby reducing incorrect payments. This proposal would save
both administrative and program dollars.
--WEP/GPO.--NCSSMA supports the proposal to develop automated data
exchanges for States and localities to submit useful and timely
information on pensions that are based on work not covered by
Social Security. These cases are complex and error-prone.
Availability of this information would allow for more efficient
case processing, as well as prevent future overpayments.
conclusion
The management and staff of the SSA are highly committed to serving
the American public, but we must have the tools and resources to do so.
SSA is the safety net of America and if adequate funding is not
provided, public service will deteriorate, with longer waiting times,
unanswered calls, increased backlogs, and significant hardship on needy
individuals. The appropriated funding levels for fiscal year 2004
through fiscal year 2007 did not adequately fund SSA and contributed to
a degradation of service to the public. We hope there will be a careful
assessment of what may be done to provide adequate funding for the SSA
in fiscal year 2011 and beyond.
In our view, which is shared by many others, Social Security is the
most successful Government program in the world. We are a very proud
and productive agency that efficiently uses the taxpayers' moneys, and
the SSA must be maintained as such for future generations. NCSSMA
sincerely appreciates the subcommittee's interest in the vital services
the SSA provides and the ongoing support to ensure SSA has the
resources necessary to serve the American public. We remain confident
this increased investment in SSA will benefit our entire Nation.
On behalf of the members of NCSSMA, I thank you again for the
opportunity to submit this written testimony to the subcommittee and
state our viewpoints. NCSSMA members are not only dedicated SSA
employees, but are also personally committed to the mission of the
agency and to public service. We respectfully ask that you consider our
comments, and would appreciate any assistance you can provide in
ensuring the American public receives the critical and necessary
service they deserve from the SSA.
Senator Harkin. And thank you all very much for your
testimonies.
We'll start a round of 5-minute questions, here.
Mr. Dirago, we'll start with you. I held a field hearing at
the University of Northern Iowa campus on February 5 this year.
And we discussed these budget cuts like this, including to the
Social Security Administration, on communities in Iowa. Jerry
Nelson, a field office manager from Waterloo field office,
testified. And he presented a pretty stark picture of the
impact that budget cuts on Iowan's filing for disability
benefits and walking through their door for even basic
services.
As a field office manager in Newburgh, New York--again, the
impact--what is the impact of potential cuts like this on those
who walk through your door and call you on the phone? Again,
just give me a good example.
Mr. Dirago. Well, waiting time in our offices is really an
issue. In terms of the number of people walking into our
offices on a daily basis, the average waiting time across the
country is about 21 minutes. If we're not funded properly and
we don't have replacement staff, those waiting times are going
to go up significantly.
The other effect would be the processing of our disability
claims and the backlogs that would occur. If funding is not
provided, there would be delays in that. Potentially, the
hearings backlog progress would be reversed.
Our telephone calls coming into the offices, there's a
tremendous volume. Last year, I mentioned, 100 million
telephone calls that SSA handled. My office alone receives
about 4,000 telephone calls in a month. It's very difficult to
get to those folks, and we try to do the best job that we can--
--
Senator Harkin. Four thousand phone calls. How many
employees?
Mr. Dirago. We have 30 employees in Newburgh.
Senator Harkin. But, not all those would be employees who
would be representatives that could handle a phone interview,
are they?
Mr. Dirago. Well, there's four management employees and the
rest of the folks are on the front lines.
Senator Harkin. So, that's 26, yeah?
Mr. Dirago. Yeah.
Senator Harkin. For----
Mr. Dirago. And we do----
Senator Harkin [continuing]. 3,000 calls.
Mr. Dirago [continuing]. The best job we can. But,
sometimes--you know, it--the resources are very short.
The other impact that I would mention specifically is the
program-integrity workloads. They're tremendously important.
Last year, we did about 2.4 million in the agency. And that has
a huge benefit. We already talked about the potential of $1 to
$7 savings--$1-$7 in savings for every $1 invested. My office
does in excess of 2,000 redeterminations. And again, if we
don't have the resources, and if the staffing is not replaced,
then we're not going to get to those workloads. And then the
long-term effect would be negative.
Senator Harkin. Someone told me also about the phone calls
coming into your offices, that these are not usually 30-second
phone conversations.
Mr. Dirago. No, generally, the phone calls that come in,
that are to the field offices, are often in regards to claims
development, which could be to resolve issues on their
disability applications; could be complex issues in the
Supplemental Security Income Program, where you have to go into
development of income and resources. So, oftentimes those
telephone calls are 5 to 10 minutes, or even more. The
telephone calls that go into the teleservice center sometimes
can be resolved very quickly, where they may be just a request
for location of an office or a request for a benefit
verification. So, generally when folks call the local field
office, they want to speak to someone in the local field office
because they have an issue that needs to be addressed, with a
particular claims representative, about their claim.
Senator Harkin. And, while I'm very supportive of
technology and putting more things online--Commissioner Astrue
talked about that--as I travel around my State of Iowa, and I
go to so many small towns and places, where we have a lot of
elderly people that live by themselves--in many cases, in small
houses, and the only thing they have is Social Security; that's
all they've got--they just aren't too proficient online. And a
lot of them don't even have online services. In rural areas,
they just don't have it. And so, while technology's okay, it
just doesn't reach, I think, a big segment of the population
out there that are elderly. Now, that may change as the Baby
Boomers start to retire and people who are used to using online
services retire. But, I'm saying, for the present generation
out there, I mean, some of them have never used computers
before, have never gone online.
Mr. Dirago. Yes. We've--in terms of the agency, right now
we're at about 34 percent online, in terms of the claims filed,
between a combination of retirement, survivors, and disability,
which is very good. It's a significant improvement over prior
years.
The Commissioner's fiscal year 2012 goal is 50 percent in
retirement and 38 percent in disability. But, you are correct,
there's--rural counties, there's issues, in terms of access to
the Internet; there's issues, oftentimes, with people's ability
to handle the difficult process of processing----
Senator Harkin. Right.
Mr. Dirago [continuing]. A claim online, particularly
disability claims. That's the large challenge.
The one point I'd like to make--the agency is in the
process of improving its disability online application, and
that's an important initiative, and would be very helpful,
because if more claims are taken online the--what we have to
work on, in terms of the offices--we'd be better able to handle
that. Because every one of those online claims still has to be
handled within the office. So, the local field office reviews
the claim, makes the decision, in terms of any entitlement
factors, may pursue other development. In terms of the
disability, they have to basically clean up the entire
application so that the product that's sent to the disability
determination services is accurate and so they can make a good
decision.
Senator Harkin. All right. Thank you. My time's up.
Senator Shelby. Thank you, Mr. Chairman.
Mr. Hammond, I'll direct the first question to you, if I
could.
In your testimony, you note that, while funding for Social
Security Administration administrative expenses is critical,
AARP has equal concern for many other vital programs.
Specifically, you note the importance of sufficient funding to
help seniors afford to pay Medicare premiums, for senior
nutrition, and job-training programs, and the Low-Income Energy
Assistance Program. Funding for these initiatives also falls
within this jurisdiction of this subcommittee.
As we work to craft a bill in these tough economic times,
and to balance funding priorities for programs that serve our
aging population, do you think a 9.4-percent increase for the
Social Security Administration's administrative expenses is the
best use of limited resources, especially, given substantial
buildup of Social Security's reserve funds, which you know that
this funding may take from other programs you believe are vital
to seniors?
Mr. Hammond. Sir, I think--pardon me, I forgot the
microphone again.
Senator Shelby. Go ahead.
Mr. Hammond. I think it's very important for us to
understand that Social Security is a real safety-net program
for this country. We have millions of Americans who are now on
Social Security. We have more millions of Americans who will be
on Social Security within the next 10 to 15 to 20 years. Unless
we provide a viable system that can take applicants, process
their claims, and do it accurately and efficiently and quickly,
we're going to have longer lists than we have now, waiting for
some help. And, as Senator Harkin mentioned, many of those
folks have Social Security as their only means of income. So,
we need to beef up the Social Security Administration program
to the point where it can handle these new applicants and the
other applicants that are coming through SSI and through the
disability claims department, and give them the resources that
they need.
Certainly, those other programs are very important to us.
But, we think there needs to be bipartisan support to find
solutions to those programs, too.
Senator Shelby. Absolutely. What recommendations,
specifically, would you make to the Social Security
Administration to attain its goal of improving service to the
public? That's very important to all of us.
Mr. Hammond. I'm not here with any specific recommendations
this morning, Senator, but I'd be happy to have staff----
Senator Shelby. Could you do----
Mr. Hammond [continuing]. Talk with you about that.
Senator Shelby [continuing]. Some for the record? Would
you----
Mr. Hammond. Yes.
Senator Shelby [continuing]. You or AARP----
Mr. Hammond. Yes, we can do something----
Senator Shelby [continuing]. So we can consider them.
But--because we're interested in spending the money wisely,
being efficient for the people who need assistance. Not to
waste money, but to do it timely; as you are, I'm sure.
Mr. Hammond. We can have staff do something on that regard.
Senator Shelby. Ms. Ford, I've got a question for you, if I
could.
Ms. Ford. Sure.
Senator Shelby. It's my understanding that the majority of
the Social Security Administration's administrative expenses
are attributed to the Disability Insurance Program. Given your
work with the Consortium for Citizens with Disabilities, could
you discuss briefly the impact of the Social Security
Administration's efforts, to date, to fast-track disability
claims? Specifically, has the disability community noted an
improvement in the time to approve claims of those with severe
disabilities through Social Security's fast track initiatives,
known as Compassionate Allowances and Quick Disability
Determinations? Is that program working? And, if it is, good;
if it's not, how can we suggest they improve it, if you have
some suggestions?
Ms. Ford. Yes, Senator, we have been watching that and have
worked with the administration, and note that those two
programs have been working. The Quick Disability Determination,
I believe that they are still able to decide cases in well
under the 20 days. I can't cite, chapter and verse, the exact
number of days. And the Compassionate Allowance Program has
been able to choose certain types of impairments, where they
can determine that the evidence is there and the type of
impairment, and the evidence with it, will lead them to a quick
decision. And they are----
Senator Shelby. The right decision, right?
Ms. Ford. The right decision quickly. And they are moving
slowly, not too quickly. I think it's important not to move too
quickly, so that they do it properly. And we believe that that
is working.
We want that to work well, because we think it's important
that it not--I don't think it would be good to move too fast
and have it work improperly. But, there is good promise there
that the administration can move cases----
Senator Shelby. Is it more----
Ms. Ford [continuing]. Quickly, when the----
Senator Shelby [continuing]. Efficient than it----
Ms. Ford [continuing]. Evidence is there.
Senator Shelby [continuing]. Used to be?
Ms. Ford. Pardon?
Senator Shelby. Is it a lot more----
Ms. Ford. Oh, absolutely.
Senator Shelby [continuing]. Efficient?
Ms. Ford. Much more efficient.
Senator Shelby. That's what I was saying.
Ms. Ford. I wish I could cite you the----
Senator Shelby. Okay.
Ms. Ford [continuing]. The times, but I can't.
Senator Harkin. If you can get some of that for the
record----
Ms. Ford. Yes. I'm sure----
Senator Harkin [continuing]. It would be good.
Ms. Ford [continuing]. And I'm sure the administration will
be able to give that to you----
Senator Harkin. Okay.
Ms. Ford [continuing]. But we can get that for you.
[The information follows:]
Letter From the Consortium for Citizens With Disabilities
July 27, 2011.
Hon. Tom Harkin,
Chairman, Senate Appropriations Subcommittee on Labor, Health and Human
Services, and Education and Related Agencies, Washington, DC.
Hon. Richard C. Shelby,
Ranking Member, Senate Appropriations Subcommittee on Labor, Health and
Human Services, and Education and Related Agencies, Washington,
DC.
RE: Information for the record, Senate Committee on Appropriations,
Labor-HHS Subcommittee hearing on the Social Security
Administration budget, March 9, 2011
Dear Chairman Harkin and Ranking Member Shelby: Thank you for the
opportunity to testify on March 9, 2011 on behalf of the Consortium for
Citizens with Disabilities (CCD) regarding funding for the Social
Security Administration (SSA) in fiscal years 2011 and 2012. At the
hearing, the Committee asked for additional information for the record
regarding three topics.
Compassionate Allowance and Quick Disability Determination
Senator Shelby asked for additional information on efficiencies
under SSA's Compassionate Allowance (CAL) and Quick Disability
Determination (QDD) initiatives. Through CAL and QDD, cases receive
expedited processing within the context of the existing disability
determination process. I testified that these programs are working and
provide an efficient way for SSA to arrive at accurate, timely
determinations for people with some of the most serious impairments in
cases where evidence can be quickly and easily obtained, and there is a
high likelihood that they meet disability eligibility criteria.
In fiscal year 2010, SSA identified 4.6 percent of all initial
disability claims as CAL or QDD; SSA reports that it can ``complete
these disability claims in days compared to months.'' \1\
Unfortunately, statistics that quantify this are unavailable: SSA
collects, but does not report, CAL and QDD processing times. The SSA
Office of the Inspector General recently recommended adding data on CAL
and QDD processing times and allowances to SSA's annual Performance and
Accountability Report, and providing more detailed data on each
program.\2\ Such data would help policymakers and the public better
understand the efficiency and effectiveness of the CAL and QDD
initiatives.
---------------------------------------------------------------------------
\1\ Social Security Administration (November, 2010). Performance
and Accountability Report for FY 2010. http://www.ssa.gov/finance.
\2\ Office of the Inspector General, Social Security Administration
(April, 2011). Performance Indicator Audit: The Social Security
Administration's Fiscal Year 2010 Performance Indicators. A-02-10-
11076.
---------------------------------------------------------------------------
Social Security Beneficiaries With Disabilities
Senator Shelby also asked how many people with disabilities receive
Social Security. As of May, 2011 approximately 15,611,000 people
received Social Security Old Age, Survivors, and Disability Insurance
(OASDI), Supplemental Security Income (SSI), or both, on the basis of
their own disability.\3\
---------------------------------------------------------------------------
\3\ Social Security Administration (May, 2011). Monthly Statistical
Snapshot, May 2011. Accessed July 1, 2011 at http://ssa.gov/policy/
docs/quickfacts/stat_snapshot/index.html.
---------------------------------------------------------------------------
Amendment 195 to H.R. 1
Senator Harkin asked for additional information regarding Amendment
195 to H.R. 1. This amendment would prohibit any Federal funds
appropriated for the rest of fiscal year 2011 from being distributed
under the Equal Access to Justice Act, 28 U.S.C. Sec. 2412 (``EAJA'').
The EAJA was signed into law by President Reagan in 1980 after
receiving broad bipartisan Congressional support. The EAJA provides
attorneys' fees to individuals, small businesses, and nonprofits who
prevail in claims against the Federal Government and who can prove that
the Federal Government was not ``substantially justified'' in bringing
or defending the case.
The EAJA allows low-income and middle-income people who cannot
otherwise afford an attorney to bring their claims. For example, the
EAJA allows people with disabilities and seniors to appeal denials of
Social Security benefits to Federal court, and veterans to appeal
decisions to the Board of Veterans' Appeals and to the Court of Appeals
for Veterans Claims. The fees paid under the EAJA are assessed against
the Federal agency involved and, as a result, do not reduce the past
due benefits received by the plaintiff/claimant.
As discussed in my written testimony, CCD is concerned that by
making legal representation less available, Amendment 195 would make it
more difficult for people whose disability claims have been denied to
pursue their claims in Federal court. For that reason, my testimony
urged the Subcommittee to oppose inclusion of similar language in the
fiscal year 2011 and 2012 spending packages.
On May 25, 2011, legislation that would have a similar effect as
Amendment 195 was introduced in both the House and Senate (Government
Litigation Savings Act; H.R. 1996 and S. 1061). As more information and
analysis on this legislation becomes available, we will forward it to
you. Additionally, for more information about how the legislation may
affect Social Security claimants, you may wish to contact Nancy Shor,
Executive Director of the National Organization of Social Security
Claimants' Representatives, at 201-567-4228 or [email protected].
In closing, thank you for the opportunity to testify and for your
leadership in considering the needs of people with disabilities. Please
do not hesitate to contact me if you require any additional
information.
Sincerely,
Marty Ford,
Consortium for Citizens with Disabilities,
Co-Chair, Social Security Task Force.
Ms. Ford. I think it--they are both good programs. We like
to watch this carefully, because we want to be sure that the
cases are being handled properly. But, yes, there is great
promise there in making----
Senator Shelby. Good.
Ms. Ford [continuing]. Sure that cases can move more
quickly.
Senator Shelby. I also noted in your testimony that you
expressed support for the administration's proposed Disability
Work Incentives Simplification Pilot Program, which would
provide beneficiaries with the flexibility to return to work
without fear of losing their benefits. Could you elaborate on
the concerns that beneficiaries have on trying to return to
work? And what additional recommendations would you make?
Because some people are temporarily disabled, and they might
get better, but they've got to get back in the workforce, and
it's hard.
Ms. Ford. There are a lot of concerns that people with
severe disabilities have about returning to the workforce. One
is the issue of whether or not they're going to be able to
maintain the medical care that they need. Once they become
conditioned to the--you know, their new life with the
impairment that they may have acquired, do they have the
medical treatment and support that they need? And will they be
able to maintain work? Some people find that they will be able
to, and therefore they won't need the program anymore. Some
people find that, in attempting to work, they may not be able
to maintain that. Those experiences are what people are worried
about. Will they be able to get back into the Social Security--
--
Senator Shelby. Sure.
Ms. Ford [continuing]. System if they need it? And----
Senator Shelby. That's very critical, though----
Ms. Ford. Yeah.
Senator Shelby [continuing]. To someone that's been out of
the workforce. They don't want to use--lose their benefits;
yet, if they could take a step toward work, and without losing
them----
Ms. Ford. Right.
Senator Shelby [continuing]. It would be helpful, would it
not?
Ms. Ford. But--it would. But, if it took you 2 to 3 years
to get into the program----
Senator Shelby. I understand.
Ms. Ford [continuing]. That's one of the problems. And so,
if you knew that, once you were in the program, you could
attempt work without having to go back----
Senator Shelby. Sure.
Ms. Ford [continuing]. Through that 2- or 3-year process,
that you could just simply come back in, and that risk of
having to reenter would----
Senator Shelby. Sure.
Ms. Ford [continuing]. Be gone, and you had an easy on-and-
off. You could take those risks and attempt work. And that's
what we would like to----
Senator Shelby. Without fear of----
Ms. Ford [continuing]. See happen.
Senator Shelby [continuing]. Losing everything at once.
Ms. Ford. Yes.
Senator Shelby. To----
Ms. Ford. Yes.
Senator Shelby. In other words, try and see if they can
swim----
Ms. Ford. Right.
Senator Shelby [continuing]. In the water, huh?
Ms. Ford. Have a good connection to the medical--to the
Medicare. And have a good connection to the----
Senator Shelby. Sure.
Ms. Ford [continuing]. Cash benefit, if you need it. And
those are the things that we think could happen in the work
incentive simplification (WIS) program, and that's why we would
like to work with SSA----
Senator Shelby. Well, that would help----
Ms. Ford [continuing]. On that.
Senator Shelby [continuing]. Help the program and help----
Ms. Ford. Yes.
Senator Shelby [continuing]. The people, would it not?
Ms. Ford. I think it would help immensely.
Senator Shelby. We worked on that.
Ms. Ford. Yes.
Senator Shelby. Mr. Dirago--is that right?
Mr. Dirago. Yes.
Senator Shelby. Your administration is the frontline
service provider for the Social Security Administration in
communities all over the Nation. Would you elaborate on the
legislative and regulatory actions that you recommend in your
written testimony, and to--as to simplify the work incentive
process, to improve the Social Security Administration program
efficiencies? That's very important.
Mr. Dirago. Okay.
Senator Shelby [continuing]. Because we've got a lot of
people working at this. The Social Security has been a good
program, but to say we can't improve it, is nonsense. You know?
You just cited how we could improve it.
Mr. Dirago. And I would just elaborate on the work
incentive simplification, as well. That's probably the most
significant legislative change that's included in the fiscal
year 2012 budget request.
The complexity of the--of disability work-incentive
development is just beyond belief. You have trial work period,
you have substantial gainful activity, you have extended period
of eligibility. It's an extremely complex area for our
technicians to resolve when individuals attempt to return to
work. The proposal would greatly simplify that and make it more
of an earnings test, as opposed to these complex decisions.
And, as Ms. Ford just indicated, we would support it
significantly, because it would reduce administrative costs, in
terms of developing these cases.
It would also overcome the fear that individuals have of
returning to work, because, as was stated, individuals once--it
takes them sometimes 2 years to get on the program; and, when
they're on, they just don't want to try to go back to work,
because they're fearful of losing the little economic security
that they have. So, we would strongly encourage that.
We also encourage--there's some wage matching that we
encourage, in terms of windfall elimination provisions in
Government pension offsets, where there could be some kind of
automatic----
Senator Shelby. What do you mean by that?
Mr. Dirago. Well, in terms of if individuals receive some
form of a public benefit, a Government retirement payment, so
that there would be matching with Social Security records so
that we can resolve any payment issues. So, that if there's
more interfaces----
Senator Shelby. Well, that's a question of information
technology, isn't it?
Mr. Dirago. Yes, it is.
Senator Shelby. And the database you have----
Mr. Dirago. Right.
Senator Shelby. And that can be done.
Mr. Dirago. Right. And there's also--Federal wage reporting
would be something else, in terms of reporting wages on a
quarterly basis; that would help us significantly.
Senator Shelby. About how many people, roughly, are on
Social Security disability in the Nation? Just roughly.
Mr. Dirago. I don't want to misstate the number. I will
get----
Senator Shelby. Well, just roughly.
Mr. Dirago [continuing]. It for you.
Senator Shelby. Just give a ballpark figure.
Mr. Dirago. Wow.
Senator Shelby. Is it in the millions?
Mr. Dirago. Oh, definitely in the millions.
Senator Shelby. Is it 5 million, 10 million?
Mr. Dirago. Hold on----
Ms. Ford. Is it approximately 11?
Mr. Dirago [continuing]. One second, here.
Ms. Ford. I'm thinking 11 million. But, I----
Senator Shelby. Eleven million? Could you furnish it for
the record?
Mr. Dirago. Absolutely.
[Clerk's Note.--The information was provided in the July
27, 2011 letter from the Consortium for Citizens With
Disabilities.]
Senator Shelby. Let's assume it's just 10 million--that's a
lot of people.
Now, in going back to what Ms. Ford said, if some of those
people, statistically, will get better--some of them have
different problems; some will never get better, we know that,
and--but, if we could ferret out who is getting better.
Mr. Dirago. Yeah, and that's part----
Senator Shelby [continuing]. Who could work, and would like
to work--and without throwing them in a ditch, to help them to
get out, that would help vitalize this program, would it not?
And for others that maybe are much more in need.
Ms. Ford. Help--to give them the opportunities to----
Senator Shelby. You see what I mean, Ms. Ford?
Ms. Ford [continuing]. To try work and to get a----
Senator Shelby. Absolutely.
Ms. Ford [continuing]. Foothold in the workforce, without
the fear of losing the support system that they've had to
depend on.
Senator Shelby. I know it's not a total analogy, but in
welfare reform, I know, myself, people that were drawing
benefits, especially single mothers, a lot of them, and dropped
out of school and we didn't knock out their benefits. And a lot
of them have gone and finished high school. I know some that
have gone on--I know one that's an electrical engineer right
now. But, if we had knocked out their benefits, their props,
they would never have made that step toward the marketplace.
And I think--isn't that what we want to do, where people are
able and want to work again, Ms. Ford?
Ms. Ford. Yes, absolutely.
Senator Shelby. Okay.
Ms. Ford. We need to give them an opportunity.
Senator Shelby. Absolutely.
Mr. Chairman, I thank you for your indulgence on your time.
Senator Harkin. No, it was a good exchange.
Now, that's what the President's proposal is going to,
hopefully, going to try to do, is to test a new system out on
this. And I'm looking forward to working with the
administration on the implementation of this pilot program,
starting next year. See if it works.
I would hasten to add, though, that a lot of this
information is--mentioned about the information technology, but
I'm quick to point out that, in addition to the cuts in H.R. 1,
it rescinds $500 million in reserves that we have for
information technology upgrades in the Social Security
Administration. So, on the one hand, we want to use information
technology to help us do the work better and more efficiently;
and then we take $500 million from the reserve fund for
information technology upgrades and expenses. So, I just wanted
to point that out, that that's another little whack out there
that might happen.
I just had one follow up question, Ms. Ford. In your
testimony, you mention an amendment--an amendment to H.R. 1, I
guess, was adopted, I guess--that will adversely impact the
ability of disability claimants to obtain legal representation
in Federal court. Could you discuss that a little bit more, and
its impact on people with disabilities?
Ms. Ford. It was the--let me find my copy, here.
Senator Harkin. You said--mentioned amendment 195 or
something? I don't----
Ms. Ford. Yes, it was the--it would make it difficult for
people whose claims have been denied to take their claims to
Federal District Court, since no funds would be available for
payment of fees or expenses, under the Equal Access to Justice
Act. And we are fearful that that could make legal
representation unavailable to claimants who need to pursue
their claims in Federal court. And so, we just wanted to bring
that to the subcommittee's and the full committee's attention
to ensure that no such language would enter into the Senate
bill.
Senator Harkin. Do we have any--if you don't have the
information now, maybe we could get it for the record, about
how many claimants actually seek to take their cases to Federal
court. I don't know if we know that, or not.
Ms. Ford. When you mention Nancy Shor, she might have that.
Do you have any idea?
Ms. Shor. About 20,000.
Ms. Ford. About 20,000 a year.
Senator Harkin. About 20,000 a year actually seek to go to
Federal--actually go to Federal court, or--actually go to
Federal court.
Ms. Ford. Currently, actually go to Federal court, yes.
Senator Harkin. And what you're saying is that there's
something in H.R. 1 that says that we don't provide legal
representation any longer?
Ms. Ford. That this would not allow them to receive--have
their fees paid under the Equal Access to Justice Act, yes.
Senator Shelby. Can I ask a question?
Senator Harkin. We can----
Senator Shelby. Are the fees paid out of the--say, if they
had a back reward, and it depends on their work----
Ms. Ford. As----
Senator Shelby [continuing]. Say, an attorney's work. And
they have to approve a fee?
Ms. Ford. That's the case, as long as you're still in the
administrative----
Senator Shelby. Okay.
Ms. Ford [continuing]. System. As long as you're still
working your way through the Social Security system.
Senator Shelby. Okay.
Ms. Ford. But, once you've finished, at the appeals level
of SSA, and then you head into Federal District Court, you're
no longer working in that----
Senator Shelby. Okay.
Ms. Ford [continuing]. System. Correct?
Ms. Shor. Close.
Ms. Ford. Close.
Nancy knows this better than I do.
Senator Shelby. Okay.
Ms. Ford. Should we submit something that describes that in
more detail?
Senator Harkin. Well, I might want to get more information
on that, because I don't think that we ought to be in the
business of denying access to court for people who have no
money and they have a legitimate--or they feel they have a
legitimate reason to go to Federal court to contest an
administrative decision. I was not aware of that in the--in
H.R. 1--not aware that that provision was in there.
Did you have something?
Senator Shelby. Mr. Chairman, I just want to follow up----
Senator Harkin. Yes.
Senator Shelby [continuing]. On that, if I may.
Senator Harkin. Yes.
Senator Shelby. Do you have some statistics--and, if you
don't have it, I'm sure you could get it and furnish it for the
subcommittee record--on--if 20,000--just roughly, 20,000 cases
are appealed from the----
Senator Harkin. ALJ.
Senator Shelby [continuing]. Is it the--the appeal on the
Supreme----
Senator Harkin. Probably ALJ.
Senator Shelby. Yes.
Senator Harkin. Yes.
Senator Shelby [continuing]. To the Federal court--Federal
District Court--what's the--are the statistics on overturning
the decision and everything? We'd be curious about that, too.
Ms. Ford. I think----
Senator Harkin. Well, you know what?
Ms. Ford [continuing]. We'd have to get that----
Senator Harkin. I think----
Ms. Ford [continuing]. For the record.
Senator Harkin. I think I'm going to call Ms. Shor up to
the table. No reason we can't.
Senator Shelby. Good idea.
Senator Harkin. What the heck.
So, we have a new witness here on this panel. Nancy Shor,
the executive director of the National Organization of Social
Security Claimants' Representatives.
So, Ms. Shor, welcome to the subcommittee.
Ms. Shor. Thank you very much.
I did want to respond to the question you had, Senator
Shelby, about the availability of a claimant's past-due
benefits to pay the attorney's fee. That can be available for
Federal court cases, as well as fees, pursuant to the Equal
Access to Justice Act. And there's an offset so that it's not a
double recovery.
Senator Shelby. Okay.
Ms. Shor. In response to your question about the statistics
for outcome in Federal court, about 40 percent of cases
annually are--the Commissioner's denial is affirmed--a handful
are dismissed, a handful are paid outright, about 50 percent of
the cases go back to the agency on----
Senator Shelby. Are remanded back for a hearing.
Ms. Shor. And about two-thirds of those cases--in about
two-thirds of those cases, the claimant is successful.
Senator Shelby. Okay. A lot of this could be prevented if
you had all the information at the initial hearing, where you'd
save money, but it'd also bring justice if somebody was really
disabled.
Ms. Shor. No question about it.
Senator Shelby. Is that right?
Ms. Shor. You're absolutely correct.
Senator Shelby. That's--looks to me like that's where we
ought to be working.
Ms. Shor. Absolutely correct.
Senator Shelby. Either, somebody's got merit or they don't,
sometimes it's in between. Because the other is costly to the
person who's denied, also costly to the person who--if the
person's rewarded and they're really maybe not that disabled. I
don't--I can't determine that.
Okay.
Senator Harkin. So, why do so many cases, 20,000 a year, go
through this whole system and stuff if--I mean, is it just an
interpretive question, or is it a question of judgment, how
disabled a person is? Why is there so much difficulty, at the
beginning, in ascertaining whether they quality or not, Ms.
Shor?
Ms. Shor. Senator, I think there are a variety of reasons.
Some of it has to do with inadequate development of the case
throughout the process, that there are impairments that this
individual presents with that are never really researched and
never adequately presented.
I think there are also instances where the improper legal
standards are applied throughout the process, and it isn't til
a Federal judge steps in and directs the agency to correct an
error that they've been making.
There are people whose conditions worsen. They've got a
degenerative type of disease so that, at the very beginning of
the process, they are--their prognosis doesn't look so great,
but, the day they apply, there could certainly be a contested
question about whether they're disabled, that day. And, as the
process proceeds, their conditions will deteriorate and
additional evidence will become available.
Senator Harkin. Complicated system.
Ms. Shor. Complicated system.
Senator Harkin. Not every case is the same. They're all
different, and that's why sometimes people have to appeal these
to ALJs and then on to Federal court, I guess. But, I did not
know that there was this provision in H.R. 1 that would take
that away.
But, I just want to be clear that, with that provision in
H.R. 1, are you saying that there are still funds available
through the passthrough?
Ms. Shor. The Equal Access to Justice Act provides an
offset so that a claimant doesn't have to pay the entire fee
that a--that is awarded for the court. In other words, if there
were a $5,000 attorney fee awarded for the attorney's work,
there could easily be a $3,000 or $4,000 fee awarded, under the
Equal Access to Justice Act. That money goes to the claimant,
the now successful beneficiary. And, of course, is desperately
needed, because, almost by definition, this person has been out
of work for probably 5 years, with the pace of processing of
claims at the Social Security Administration. So, the Equal
Access to Justice Act is an extremely important statute that
defrays the cost of legal expenses for claimants who find
themselves having to go to Federal court.
Senator Harkin. I don't understand that. Let me rephrase
it.
If, in fact, $500 million was rescinded--$500 million was
taken from the Special Reserve Fund for--no, no. I'm sorry,
that's not it.
If, in fact, the language, that was in H.R. 1, that says
that these funds cannot be used for appeals to District Court--
I don't have the exact language----
Ms. Shor. No.
Senator Harkin [continuing]. In front of me.
Ms. Shor. Senator, the language in amendment 195----
Senator Harkin. Yes.
Ms. Shor [continuing]. Would stop the payment of Equal
Access to Justice Act fees, Government-wide. So, it includes
Social Security, but it includes all the other Federal agencies
where plaintiffs are potentially eligible for Equal Access to
Justice Act fees.
Senator Harkin. Oh.
Ms. Shor. So, although Social Security cases are the
largest number of cases in which Equal Access to Justice Act
fees are awarded, the per-case fee is tiny, compared to the
amounts of Equal Access to Justice Act fees that are awarded in
litigation having to do with a lot of other Federal agencies.
So, amendment 195 doesn't contain the words, ``Social
Security,'' it only talks about a prohibition on payment of any
fees, in any type of case, pursuant to the Equal Access to
Justice Act.
Senator Harkin. How much money do we--are we talking about,
do we know?
Ms. Shor. I'm sorry, I don't. But, I could certainly supply
it.
Senator Harkin. Well, maybe I can get my staff to get it.
Do we know?
Senator Shelby. Can you get it for the record, then?
Ms. Shor. Certainly.
Senator Shelby. That would be good.
Ms. Shor. Absolutely.
Senator Harkin. Okay. Well, we'll get that for the record.
Senator Shelby. Good.
[Clerk's Note.--The information was provided in the July
27, 2011 letter from the Consortium for Citizens With
Disabilities.]
Senator Harkin. Anything else?
Senator Shelby. No, nothing.
Senator Harkin. Well, listen. Thank you all very much.
Thank you, Ms. Shor, for adding to our deliberations here.
Senator Shelby. Our fourth panelist.
Ms. Shor. Thank you very much.
Senator Harkin. Yeah, yeah. But again, we wanted to have
this hearing, to highlight the problems confronting the Social
Security Administration, that we have jurisdiction over, only
in terms of the administrative aspect of it. We don't have
jurisdiction over policies, we don't have jurisdiction over
solvency, and all that kind of stuff. That's another committee,
that's not this committee. We just have a responsibility to
make sure that the Social Security Administration gets enough
money to fulfill its obligations, and to do so in a timely
manner, to make sure that, you know, it's efficient and
effective.
So, I guess we're going to have votes today, on H.R. 1 and
the alternative, at 3 p.m. today. And again, I just wanted to
have this hearing, again, to highlight what might happen if, in
fact, the H.R. 1 was enacted. And I think we've got some
interesting testimony on the record.
I would just state that, in administrative funding--I just
want to be clear that--here's the data--for fiscal year 2010,
we enacted $11.447 billion, from this subcommittee. The
President's budget for fiscal year 2011 is $12.379 billion. The
House continuing resolution has $11.322 billion. The Senate
continuing resolution has $11.822 billion. And the fiscal year
2012 President's budget is $12.522 billion. I just wanted to
make sure all those figures are out there.
Anybody else--do you have anything else at all?
Senator Shelby. No.
Senator Harkin. Okay.
SUBCOMMITTEE RECESS
Thank you all very much. The subcommittee will stand
recessed.
[Whereupon, at 11:15 a.m., Wednesday, March 9, the
subcommittee was recessed, to reconvene subject to the call of
the Chair.]
MATERIAL SUBMITTED SUBSEQUENT TO THE HEARING
[Clerk's Note.--The following testimonies were received
subsequent to the hearing for inclusion in the record.]
Prepared Statement of the American Federation of Government Employees,
AFL-CIO
Chairman Harkin, Ranking Member Shelby, and members of the Senate
Appropriations Subcommittee on Labor, Health and Human Service,
Education and Related Agencies, I thank you for the opportunity to
present this statement regarding the Limitation on Administrative
Expenses (LAE) for the Social Security Administration.
As the President of the American Federation of Government
Employees, National Council of SSA Field Operations, AFL-CIO, I speak
on behalf of approximately 29,000 Social Security Administration (SSA)
employees in over 1,300 facilities. These employees work in Field
Offices, and Teleservice Centers throughout the country where
retirement and disability benefit applications and appeal requests are
received, processed, and reviewed.
AFGE thanks the Senate Appropriations Committee for calling this
important hearing, at a very critical time, to examine the SSA's budget
needs for this year and next year, in order to support the proper
administration of our programs. Our employees are very concerned about
prospects for furloughs, loss of staff and overtime hours needed to
keep up with rapidly expanding workloads, and general deterioration in
service delivery. They care deeply about the public they serve, and the
continuing uncertainty about future staffing and resources is
generating high levels of stress.
Background
During the past 3 years, with increased staffing and funding, we
have substantially reduced disability hearing backlogs and processing
times, and turned more of our attention to long-neglected program
integrity workloads. However, working without a budget for the past 5
months, we have been struggling to keep up with rapidly growing
requests for face-to-face and telephone service, and we could easily
slip back. We are constrained by continuing resolutions that have been
funding SSA operations at fiscal year 2010 levels, with a freeze on
hiring in most parts of the Agency. Our clients are having more
difficulty accessing service, waiting times are increasing, and
backlogs have developed in initial disability benefit applications.
Field Representatives who serve clients who are mobility-impaired or
live in remote areas have all but disappeared. SSA Spokesman Mark
Hinkle recently acknowledged that budget pressures have slowly done
away with 1,500 of the 2,000 contact stations that existed in the
1980s.\1\ The recession and the aging of the population have created
unprecedented demands upon the employees we represent. We are concerned
that, if there are further cuts in employee work years, we may be
unable to keep up with record numbers of new claims for retirement,
survivor, and auxiliary benefits. No matter how people access service,
whether face-to-face, by telephone, or via the Internet, our employees
need to be on the job to process new applications for benefits, and to
ensure that payments are made to the right people, in the right amount,
and on time.
---------------------------------------------------------------------------
\1\ ``Social Security ends visits to seniors'', Boston Globe,
January 12, 2011.
---------------------------------------------------------------------------
Budget Battles
The President proposed $12.379 billion to fund SSA administrative
expenses for fiscal year 2011, and $12.522 billion for fiscal year
2011. AFGE supports both requests.
The Agency is limited to spending $11.447 billion, the fiscal year
2010 level with a carryover of $480 million for a total of $11.927
billion, under the current continuing resolution.
The House recently passed H.R. 1, which would cut full year funding
to $11.321 billion. Additionally, H.R. 1 also includes rescissions of
$500 million from the SSA reserve fund and from a special IT
appropriation of $118 million for the National Computer Center. This
would provide SSA with $10.7 billion in overall spending for fiscal
year 2011. This represents about a 5.5 percent decrease from fiscal
year 2010 spending levels and would require $743 million in cuts before
October 1, 2011. Such reductions would most likely cease all hiring at
the Office of Disability and Adjudicative Review (ODAR), which is
currently exempt from the present hiring freeze under the continuing
resolution. Backlogs would escalate very rapidly, improper payments
would grow, and furloughs of employees could be implemented for up to a
month per employee. Public service will be devastated.
The Senate has proposed a fiscal year 2011 budget of $11.822
billion, which includes rescissions of $400 million of the agency
reserve fund. This is essentially the same funding level as fiscal year
2010. This budget would most likely prevent the furloughing of Social
Security workers and allow SSA ``to keep the lights on.'' However, SSA
would most likely be forced to operate under an agency wide hiring
freeze for the remainder of fiscal year 2011, which would result in the
loss of approximately 3,500 SSA and DDS employees by the end of the
fiscal year. This will cause understaffing in offices around the
country. Backlogs will continue to grow and decisions on benefit claims
will take longer. Access to field offices and the 800 number would take
much longer and waiting times would be expected to increase.
SSA Commissioner Astrue and President Obama have determined the
funding level that is required to maintain service, and to make needed
improvements. The wide differences between the House and Senate
proposals for fiscal year 2011 domestic discretionary spending have
raised the specter of one or more Government shutdowns and budget-
driven employee furloughs during the rest of this fiscal year. The
adverse impact of a shutdown or furloughs on Social Security's clients,
and on the hard-working employees dedicated to serving them, would be
very serious. One week ago today, during their lunch breaks, Social
Security employees in 96 facilities across the country joined with
members of their communities to make the public aware of these threats.
It is imperative that Congress pass a responsible budget for the rest
of this year that allows SSA workers to continue to provide high
quality service to the public, and avoid any interruption of services
caused by shutdowns and/or furloughs.
Penny Wise is Pound Foolish
Constraints on spending and on front-line staffing have damaged the
integrity of the programs themselves. Continuing disability reviews are
not being conducted on schedule, and Supplemental Security Income (SSI)
eligibility reviews are being done too infrequently. With insufficient
staff to handle the work, SSA is forced to rely too much on self-
reporting by mail, rather than on a full examination of eligibility
factors through an interview by a trained SSA employee. Continuing
disability reviews save about $10 for every $1 spent on them, and SSI
reviews about $8 for every $1 invested in them. The President's
requests for 2011 and 2012 would provide dedicated funds to conduct
more Supplemental Security Income (SSI) eligibility redeterminations,
and more continuing disability reviews for Social Security and SSI
beneficiaries. Both the House and Senate are silent regarding this
targeted funding, and both have rescinded the vast majority of the
Agency reserves, funds that could have been used to support these
critical workloads and others.
Setting the work aside because of insufficient staff and funding is
penny-wise and pound-foolish, but SSA has little choice because the
disability claims and appeals crisis demands attention. These neglected
workloads have contributed to record overpayments, nearly 9 billion in
fiscal year 2007 \2\, and many of the overpayments are uncollectible,
which has captured the interest of the Government Accountability
Office. The last 2 fiscal years, SSA has been successful in reducing
the overall amount of overpayments. However, with congressional
proposals to reduce Government agency budgets and staffing, this
success may be very short lived. Without adequate staff and budget,
AFGE expects to see a new record number of overpayments, which may
actually exceed SSA's annual administrative expense budget within the
next few years. To make matters worse, the amount of funds lost to
overpayments over the last 10 years exceeded $55 billion. These lost
funds would have funded SSA's administrative expenses for at least 4
years.
---------------------------------------------------------------------------
\2\ Source of verification of all overpayments found in each
respective OIG Annual Audit and SSA Performance Plans for each fical
year listed.
---------------------------------------------------------------------------
The Off Budget Solution
The Omnibus Reconciliation Act of 1990 provided that SSA FICA taxes
and benefits payments were ``off budget.'' Congress later interpreted
that SSA's Limitation on Administrative Expenses (LAE) was not covered
by the Omnibus Reconciliation Act of 1990, although the Social Security
Act stipulates that administrative costs for the Social Security
program must be financed by the Social Security Trust Fund. Since the
SSA LAE (e.g., staffing, office space, supplies, technology, etc.) is
``on budget,'' Congress decides on a yearly basis the amount that will
be authorized and appropriated to administer SSA programs. Often SSA is
left with insufficient staff and limited overtime due to a combination
of competing interests within the Labor, Health and Human Services,
Education and Related Agencies appropriation and the congressional
budget scoring system. These circumstances make it next to impossible
to appropriate adequate administrative funds to enable SSA to complete
the tasks assigned by Congress in a timely manner. Such shortages
adversely affect disability appeals processing time and cause severe
integrity problems.
The Social Security Trust Funds, projected to run a $113 billion
surplus this year, and over $128 billion next year, pay for the great
majority of the operating costs for the programs we administer. AFGE
proposes that the Congress take SSA's administrative accounts off
budget now. We are very efficient, spending just 0.9 percent of income
in Social Security program administration. The Agency would still be
required to justify its budget requests to Congress, and receive
approval to spend money, but there is no reason why SSA should have to
compete for funding with the many other agencies in the Labor/HHS
appropriation package, when our source of funding is almost entirely
off budget.
In an ``off budget'' environment Congress would continue to
maintain spending authority but would be unencumbered by artificial
caps and budgetary scoring rules. However, Congress would continue to
appropriate SSA administrative expenses to ensure integrity and
efficiency. Legislation should require SSA's Commissioner to document
(in performance reports mandated under the Government Performance and
Results Act) how funds have been and will be used to effectively carry
out the mission of the Agency, to meet expected levels of performance,
to achieve modern customer-responsive service, and to protect program
integrity.
Most importantly, GAO must annually inform Congress regarding SSA's
progress in achieving stated goals. Congress should also mandate that
SSA's Commissioner submit the proposed budget directly to Congress as
is now only optional in the independent agency legislation (Public Law
103-296, Sec. 101). This requirement to submit the SSA budget directly
to Congress may also be a provision of ``off-budget'' legislation and
would be endorsed by AFGE.
Without sufficient funding of Social Security, the LAE will not go
far enough to put the agency on a clear path to provide its mandated
services at a level expected by the American public. SSA must receive
enough funding to make disability decisions in a timely manner and to
carry out other critical workloads. AFGE strongly urges Congress to
separate SSA's LAE budget authority from the section 302(a) and (b)
allocations for discretionary spending. The size of SSA's LAE is driven
by the number of administrative functions it conducts to serve
beneficiaries and applicants. Congress should remove SSA's
administrative functions from the discretionary budget that supports
other important programs.
AFGE does not believe the American public deserves poor service
from SSA. Some claimants while waiting for a disability hearings
decision lose their homes, declare bankruptcy, and die. Their families
suffer tremendous financial hardships; some lose everything during the
prolonged wait for a decision. The public deserves efficient,
expeditious service. Now is the time to make the correction, so that
there is stability to run SSA programs that are so vital in providing
family insurance and income security to 54 million beneficiaries.
In closing, AFGE urges the Senate to do whatever is necessary to
insure that SSA receives full funding to do the work that Congress
demands from the Agency.
AFGE thanks the Subcommittee for its time and consideration of the
concerns addressed in this statement. AFGE is committed to serve, as we
always have, as the employees' advocate AND a watchdog for clients,
taxpayers, and their elected representatives.
______
Prepared Statement of the National Committee to Preserve Social
Security and Medicare
As President and Chief Executive Officer of the National Committee
to Preserve Social Security and Medicare, I appreciate the opportunity
to submit this statement for the record. With millions of members and
supporters across America, the National Committee is a grassroots
advocacy and education organization devoted to the retirement security
of all citizens.
Chairman Harkin, Ranking Member Shelby and members of the
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies, the National Committee appreciates your holding this
hearing to examine funding for the Social Security Administration in
fiscal year 2011 and fiscal year 2012.
The National Committee is committed to preserving and strengthening
Social Security. This includes ensuring a strong and stable Social
Security Administration that delivers high-quality, prompt service to
the public. We are certainly concerned about the tremendous funding
challenges facing the Social Security Administration for the remainder
of fiscal year 2011 and for fiscal year 2012. It is crucial that SSA be
provided with adequate funding so that they are able to provide the
American people with the level of service they expect and deserve, one
that also prevents workloads from spiraling out of control.
As you know, 54 million Americans receive Social Security benefits
each month. The benefits they receive from this program constitute a
vital lifeline that is critical to their economic well-being. Given the
essential nature of Social Security, and the increasing demands of an
aging population, I believe it is extremely important that the Social
Security Administration be provided sufficient funds for operating
expenses so it can meet the needs of the American people.
In fiscal year 2010, the last time Congress enacted an
appropriation for SSA, a total of $11.5 billion was made available for
administering the Social Security program. The President, in his fiscal
year 2011 budget, requested an appropriation of $12.4 billion. Instead,
Congress has enacted a series of continuing resolutions that
essentially freeze the Agency's funding at the fiscal year 2010 level.
The House of Representatives recently passed a continuing
resolution for the remainder of the fiscal year that proposes
significant reductions in funding, including elimination of funds for
vital systems improvement projects. The fiscal year 2011 continuing
resolution being considered by the Senate increases funding over the
House-passed amount, providing needed resources to this important
Agency. While the President's fiscal year 2011 budget request would
minimize service reductions and continue the Agency's progress toward
reducing processing backlogs in the disability program, the Senate
proposed funding level is a dramatic improvement over the funding cuts
passed by the House.
Staying within the reduced spending levels authorized in previously
enacted continuing resolutions has been challenging for the Social
Security Administration. The hiring freeze imposed on the Agency's
field offices has resulted in significant staffing imbalances that have
stretched the capability of the staff to provide timely and effective
levels of public service.
Further cuts would exacerbate these problems, resulting in longer
waiting times for appointments to file for benefits, or for processing
address changes or direct deposit information, delays in receiving
Agency decisions, and busy signals at the Agency's toll-free 800
number. In addition, we understand that further cuts may mean employee
furloughs or even office closures, resulting in even greater reductions
in service to America's seniors.
While we believe the President's funding request would best serve
the American people, we believe the funding levels proposed in the
Senate's continuing resolution would provide the Agency with sufficient
funding to avoid major service disruptions. We therefore urge all
Senators to show their commitment to Social Security by providing the
SSA with the resources it needs to do its job.
Going forward, in order for SSA to fully meet its multitude of
responsibilities, the agency will require no less than the $12.667
billion recommended in the President's budget for its fiscal year 2012
administrative funding. This level of funding is necessary due to the
increase in requests for assistance from the American public due in
large part to the economic downturn. SSA teleservice centers, hearing
offices, Disability Determination Services (DDSs), and the nearly 1,300
field offices are in critical need of adequate resources to address
their growing workloads. Without this level of funding, SSA will be
unable to cope with the continued increase in demand for services and
maintain the progress it has already made in providing satisfactory
service delivery to senior citizens, people with disabilities and
others who rely on Social Security.
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2012
----------
WEDNESDAY, MARCH 30, 2011
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:03 a.m., in room SD-124, Dirksen
Senate Office Building, Hon. Tom Harkin (chairman) presiding.
Present: Senator Harkin, Reed, Pryor, Mikulski, Brown,
Shelby, Johnson, Kirk, and Moran.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
STATEMENT OF HON. KATHLEEN SEBELIUS, SECRETARY
OPENING STATEMENT OF SENATOR TOM HARKIN
Senator Harkin. The Labor, Health and Human Services
Appropriations Subcommittee will come to order.
We welcome back Madam Secretary to the subcommittee. I want
to first start by commending you for the outstanding work that
you are doing to implement our healthcare reform law. It has
been just 1 year since President Obama signed the Affordable
Care Act into law, and already millions of Americans are
reaping major benefits. Those benefits include very strong
consumer protections. No longer can large health insurers use
technicalities to cancel your policy if you get sick or impose
lifetime limits on your benefits. No longer can children be
denied coverage because of a preexisting health condition.
Americans have greater access to preventative care than ever
before, and of course, young adults can now stay on their
parents' plan until age 26.
In the past year, your Department has also awarded the
first grants from the Prevention and Public Health Fund, a new
fund that will not only improve the health of the American
people but also help bend the cost curve on healthcare. This
fund is already being used to help Americans stop smoking, as
well as to reduce obesity and prevent costly chronic diseases
like diabetes.
Your plan for fiscal year 2011 expands on all of this work
and adds an investment in childhood immunization which data
shows saves about $6.30 for every dollar that we spend.
Your Department is implementing these reforms with great
skill and dedication, and I thank you for your leadership.
I also want to assure you that as chairman of both this
Appropriations subcommittee and the authorizing committee, the
HELP Committee, your Department will continue to receive the
resources you need to implement the Affordable Care Act. The
American people will not allow the hard-earned protections and
benefits in this law to be taken away. And neither will we.
Reforming healthcare is not only the right thing to do, it
will save taxpayers money and reduce the deficit by $210
billion in the first decade and more than $1 trillion in the
next. And those are not my estimates. They are from the
nonpartisan Congressional Budget Office.
I am well aware that some opponents of healthcare reform
say they intend to use the Labor, HHS appropriations bill, our
bill, as a vehicle for defunding the Affordable Care Act. That
will not happen.
Our topic today is the President's fiscal year 2012 budget
request for the Department of Health and Human Services.
Unfortunately, as we all know, Congress still has not closed
the books on fiscal year 2011. That uncertainty makes it harder
than usual to evaluate the President's request. For example,
the House has proposed major reductions to key programs like
community health centers, Head Start, and the National
Institutes of Health. We do not yet know the outcome of
negotiations to complete a budget for fiscal year 2011, but one
of the things I want to cover in this hearing is what the
impact of those potential cuts would be, that is, on community
health centers, Head Start, and the National Institutes of
Health (NIH).
Overall, the President's proposed budget for fiscal year
2012 is a good start. It is a tight budget. Total funding for
the Department is almost flat compared with fiscal year 2010,
but it does include some significant increases for key
priorities like NIH, child care, Head Start, and of course,
rooting out fraud and waste in Medicare and Medicaid.
I also applaud the administration for proposing a new early
learning challenge fund which is intended to improve the
quality of early childhood education programs. The money for
this new fund would go through the Education Department, but
HHS would be a partner in that effort.
However, some provisions in the President's budget are a
cause for concern. I recognize that we are operating under
significant fiscal constraints, but I am greatly disappointed
by the proposed 50 percent cut to the community services block
grant program. This funding is critically important for
community initiatives that provide a safety net for millions of
low-income people across the country, and I will do whatever I
can to oppose that cut in any bill that comes out of this
subcommittee.
I am also concerned by the proposed $2.5 billion cut to the
Low-Income Home Energy Assistance Program, as well as the small
but important $30 million cut--that would be a 72 percent cut--
to the Child Traumatic Stress Network.
But as I said, overall the budget is a good start.
Madam Secretary, I look forward to hearing your testimony.
First, before I yield to Senator Shelby for his opening
remarks, I have received statements from the full committee
chairman, Senator Inouye and the vice chairman, Senator
Cochran. Their statements will be inserted into the record at
this point.
[The statements follow:]
Prepared Statement of Chairman Daniel K. Inouye
Secretary Sebelius, given the unique geographic challenges in
Hawaii it is imperative that we continue to work together to address
the healthcare needs of our population. I would like to take this
opportunity to thank you for your support in addressing the medical
needs of the people in Hawaii. I will provide questions for the record.
______
Prepared Statement of Senator Thad Cochran
Mr. Chairman, thank you for chairing this hearing to review the
President's fiscal year 2012 budget for the Department of Health and
Human Services. We are pleased to welcome the Secretary of Health and
Human Services, Kathleen Sebelius to her third appearance before our
Subcommittee, and we look forward to working with her to support our
Nation's investment in healthcare, social services programs, medical
research and disease prevention.
I am pleased that your budget includes a $745 million increase for
the National Institutes of Health. These additional dollars are
essential if we are to continue to make scientific discoveries in
cancer, autism, heart disease and the many other maladies that plague
so many Americans.
This subcommittee will be challenged to balance the competing needs
of the programs contained in your $79 billion budget. We look forward
to working with you to maintain our commitment to fiscal restraint
while providing much needed increases for high priority programs.
I am very sorry I cannot stay for the duration of this important
hearing due to another hearing that requires my attention, but I am
submitting questions for the record and I look forward to a response.
Senator Harkin. Senator Shelby.
STATEMENT OF SENATOR RICHARD C. SHELBY
Senator Shelby. Thank you, Mr. Chairman.
Welcome, Secretary Sebelius.
I look forward to hearing your testimony today on the 2012
budget request.
In this austere economic environment, Congress is
struggling with difficult budget decisions. We all understand
the valuable role that healthcare plays in the lives of our
citizens, and we all want to make healthcare more affordable,
more accessible, and on the cutting edge of scientific
discoveries.
However, in times of economic uncertainty when every
Department should be exercising fiscal restraint, I am
disappointed that the administration has not significantly
reduced healthcare spending. In fact, on top of the 9 percent
increase in the entire Department of Health and Human Services'
budget request, the 2012 bill includes $4.2 billion in
mandatory spending for the Affordable Care Act, ACA. This is
$4.2 billion that, due to Senate rules, this subcommittee
cannot reduce or rescind. It is simply more spending for
another entitlement program.
One of the most troubling aspects of the ACA is the
Community Living Assistance Services and Supports (CLASS) Act.
The CLASS Act we call it. The CLASS Act is a new voluntary
Federal insurance program. Its goal is twofold: to provide a
cash benefit to individuals with either a functional or
equivalent cognitive limitation that become too disabled to
work and to create a voluntary insurance program for healthy
individuals looking to hedge against the risk of needing long-
term care in the future. However, the CLASS Act's poor design
attempts to accomplish these two incompatible goals with a
single program. The result will be that the cost of serving
disabled workers will push premiums to unacceptably high levels
for those looking to purchase insurance, and they will decline
to buy. I think this will quickly push the program to
insolvency.
The Congressional Budget Office predicts the CLASS Act will
``add to budget deficits by amounts on the order of tens of
billions of dollars.'' The Department of Health and Human
Services actuary states and says, ``There is a very serious
risk that the program will be unsustainable.'' Even you, Madam
Secretary, testified at the Senate Finance Committee hearing
early this year and said, ``The bill as written is totally
unsustainable.''
In addition to the $4.2 billion included in mandatory
spending for the ACA, the budget submission includes $450
million in discretionary funding. Specifically, the budget
proposes to spend $120 million on the financially unsustainable
CLASS Act, $236 million for health insurance exchange
operations, $38 million for healthcare.gov, and $28 million to
help consumers navigate the private insurance market. Secretary
Sebelius, we fundamentally disagree on the implementation of
the ACA. However, one area of the ACA we should agree on is
that $38 million to fund one website is unacceptable.
Further, I am concerned that many important programs, such
as the Community Health Center Fund, are moved to the mandatory
side of the ledger and funded under the ACA. The question is,
what happens if the ACA is repealed and agencies' baseline
funding levels are too low to cover the cost of these programs?
Finally, as we continue to review the 2012 budget, I
believe we need to ensure that our entire Nation, not just
population-rich urban areas, is reaping the benefits of
healthcare programs. There are numerous consolidations in the
budget that eliminate formula-funded grants which will result
in the redirection of critical Federal funds from smaller,
rural States to urban areas. I think we must continue to make
certain that programs that are deemed competitive actually
allow all States to compete on a level playing field.
Mr. Chairman, the level of Federal spending, I believe, is
unsustainable. We must make steps to reduce the deficit that
burdens our Nation today and will continue to in the future.
Every Federal program should be reviewed to ensure it is
working effectively and efficiently and is a valuable use of
taxpayer dollars. However, I remain cautious about arbitrary or
across-the-board cuts to agencies and programs simply to score
a political point. Congress needs to carefully examine programs
to ensure that we are sustaining those that are effective and
cutting those that are not.
In particular, one of the most results-driven aspects of
our entire Federal budget I believe is the National Institutes
of Health. Research conducted at NIH reduces disabilities,
prolongs life, and is an essential component to the health of
all Americans. NIH programs consistently meet their performance
and outcome measures, as well as achieve their overall mission.
For example, in February, NIH research led to the
announcement of a very promising cystic fibrosis therapy that
targets the genetic defect that causes cystic fibrosis as
opposed to only addressing its symptoms. The preliminary
success of this drug, for instance, underscores the importance
of the NIH whose innovative work on human genetics and other
areas of basic science could potentially lead to treatments and
even cures for some of our most devastating diseases.
Mr. Chairman, I look forward to working with you to craft a
bill that balances the needs of our healthcare system with our
fiscal realities.
Senator Harkin. Thank you very much, Senator Shelby.
Now we will turn to our distinguished Secretary of Health
and Human Services. Kathleen Sebelius became the 21st Secretary
of the Department of Health and Human Services on April 29,
2009. Prior to that, of course, in 2003 she was elected as
Governor of Kansas and served in that capacity until her
appointment as the Secretary.
Prior to her election as Governor, the Secretary served as
the Kansas State insurance commissioner.
She is a graduate of Trinity Washington University and the
University of Kansas.
I believe this will make the Secretary's fourth appearance
before this subcommittee since her appointment.
Madam Secretary, we welcome you again. Your statement will
be made a part of the record in its entirety, and please
proceed as you so desire.
SUMMARY STATEMENT OF HON. KATHLEEN SEBELIUS
Secretary Sebelius. Thank you, Mr. Chairman. Chairman
Harkin, Ranking Member Shelby, members of the subcommittee, I
need to do a special shout out to my fellow Kansan, Senator
Moran, who is a new member of your subcommittee, Mr. Chairman.
But I had the privilege of working with the Senator for years
on Kansas business and now look forward to working with him in
his new capacity here in the Senate.
It is good to be with you and discuss the President's 2012
budget for the Department of Health and Human Services.
In the President's State of the Union Address, he outlined
a vision of how the United States can win the future by out-
educating, out-building, and out-innovating the world so we
give every family and business the chance to thrive.
Our 2012 budget is a blueprint for putting that vision into
action. It makes investments for the future that will grow our
economy and create jobs.
But the budget recognizes we cannot build lasting
prosperity on a mountain of debt. Years of deficits have put us
in a position where we need to make some tough choices. In
order to invest for the future, we need to live within our
means.
In developing our budget, we looked closely at every
program in our Department. We cut waste when we found it, and
when programs were not working well enough, we redesigned them
to put a new focus on results. And, in some cases, we cut
programs that would not have been cut in better budget times.
Now, I look forward to answering your questions on the
budget, but first I want to share some of the highlights that
fall under the jurisdiction of this subcommittee which oversees
more than $72 billion of our Department's $80 billion budget.
Last week, as the chairman said, was the 1-year anniversary
of the Affordable Care Act. Over the last 12 months, we have
worked around the clock with partners in Congress and States to
deliver on the promise of the law to the American people.
Thanks to the new law, children are no longer denied
coverage because of their preexisting health conditions.
Families have new protections under the Patient's Bill of
Rights. Businesses are beginning to get some relief from
soaring healthcare costs, and seniors have lower cost access to
prescription drugs and preventive care.
We are building on this first year's progress by supporting
innovative new models of care that will improve patient safety
and quality while reducing the burden of rising health costs on
families, businesses, cities, and States.
We are also making new, important investments in our
healthcare workforce and community health centers to make
quality, affordable care available to millions more Americans
and create hundreds of thousands of new jobs across the
country.
To make sure America continues to lead the world in
innovation, our budget also increases funding for the National
Institutes of Health. New frontiers of research like cell-based
therapies and genomics have the promise to unlock
transformative treatments and cures for diseases ranging from
Alzheimer's to cancer to autism. Our budget will allow the
world's leading scientists to pursue these discoveries while
keeping America at the forefront of biomedical research.
And because we know, Mr. Chairman, there is nothing more
important to our future than the healthy development of our
children, our budget includes significant increases in funding
for child care and Head Start. Science shows that success in
school is significantly enhanced by high quality early learning
opportunities, which makes these some of the wisest investments
we can make in America's future.
But the budget does more than provide additional resources.
We are also aiming to raise the bar on quality by supporting
key reforms to transform the Nation's child care system into
one that fosters healthy development and gets children ready
for school. The budget proposes a new early learning challenge
fund, a partnership with the Department of Education that helps
promote State innovation in early education. These initiatives,
coupled with the quality efforts already underway in Head
Start, are an important part of the education agenda that will
help every child reach their academic potential and make
America more competitive.
Our budget also recognizes that at a time when so many
Americans are making every dollar count, we need to do the
same. That is why we are providing new support for President
Obama's unprecedented push to stamp out waste, fraud, and abuse
in the healthcare system, an effort that well more than pays
for itself. Last year, we returned a record $4 billion to
taxpayers. The key part of this effort is empowering seniors to
recognize and report fraud, and we have appreciated the support
of Congress and especially Senator Harkin for the Senior
Medicare Patrol Program, which is one of our best tools for
doing that.
In addition, the budget includes a robust package of
legislative proposals to root out waste and abuse within
Medicare and Medicaid. These proposals enhance prepayment
scrutiny, expand auditing, increase penalties for improper
actions, and strengthen CMS' ability to implement corrective
actions. We address State activities that increase Federal
spending. Over 10 years, on the conservative side, they will
deliver at least $32 billion in savings.
Across our entire Department, Mr. Chairman, we have made
eliminating waste, fraud, and abuse a top priority, but we know
that is not enough. Over the last few months, we have also gone
through our Department's budget, program by program, to find
additional savings and opportunities where we can make our
resources go further.
The President's 2012 budget makes tough choices and smart,
targeted investments today so that we can have a stronger,
healthy, and more competitive America tomorrow. That is what it
takes to win the future and that is what we are determined to
do.
PREPARED STATEMENT
Again, thank you, Mr. Chairman, for having me here today
and I look forward to our discussion.
[The statement follows:]
Prepared Statement of Kathleen Sebelius
Chairman Harkin, Senator Shelby, and Members of the Subcommittee,
thank you for the invitation to discuss the President's fiscal year
2012 budget for the Department of Health and Human Services (HHS).
In President Obama's State of the Union address he outlined his
vision for how the United States can win the future by out-educating,
out-building and out-innovating the world so that we give every family
and business the chance to thrive. His 2012 budget is the blueprint for
putting that vision into action and making the investments that will
grow our economy and create jobs.
At the Department of Health and Human Services this means giving
families and business owners better access to healthcare and more
freedom from rising health costs and insurance abuses. It means keeping
America at the cutting edge of new cures, treatments and health
information technology. It means helping our children get a healthy
start in life and preparing them for academic success. It means
promoting prevention and wellness to make it easier for families to
make healthy choices. It means building a healthcare workforce that is
ready for the 21st century health needs of our country. And it means
attacking waste and fraud throughout our department to increase
efficiency, transparency and accountability.
Our 2012 budget does all of this.
At the same time, we know that we can't build lasting prosperity on
a mountain of debt. And we can't win the future if we pass on massive
debts to our children and grandchildren. We have a responsibility to
the American people to live within our means so we can invest in our
future.
For every program we invest in, we know we need to cut somewhere
else. So in developing this budget, we took a magnifying glass to every
program in our department and made tough choices. When we found waste,
we cut it. When we found duplication, we eliminated it. When programs
weren't working well enough, we reorganized and streamlined them to put
a new focus on results. When they weren't working at all, we ended
them. In some cases, we cut programs we wouldn't in better fiscal
times.
The President's fiscal year 2012 budget for HHS totals $891.6
billion in outlays. The budget proposes $79.9 billion in discretionary
budget authority for fiscal year 2012, of which $72.4 billion is within
the jurisdiction of the Labor, Health and Human Services, Education,
and Related Agencies Subcommittee.
The Department's discretionary budget is slightly below the 2010
level. Within that total we cover the increasing costs of ensuring the
safety of our food supply, providing medical care to American Indians
and Alaska Natives, managing our entitlement programs, investing in
early childhood, and advancing scientific research. We contribute to
deficit reduction and meet the President's freeze to non-security
programs by offsetting these investments with over $5 billion in
targeted reductions. These reductions are to real programs and reflect
tough choices. In some cases the reductions are to ineffective or
outdated programs and in other areas they are cuts we would not have
made absent the fiscal situation.
The budget proposes a number of reductions and terminations in HHS.
--The budget cuts the Community Services Block Grant in half, a $350
million reduction, and injects competition into grant awards.
--The budget cuts the Low Income Home Energy Assistance Program by
$2.5 billion bringing it back to the 2008 level appropriated
prior to energy price spikes.
--The budget eliminates subsidies to Children's Hospitals Graduate
Medical Education focusing instead on targeted investments to
increase the primary care workforce.
--The budget reduces the Senior Community Services Employment Program
by $375 million, proposes to transfer this program from the
Department of Labor to HHS, and refocuses the program to train
seniors to help other seniors.
The budget also stretches existing resources through better
targeting.
--The budget redirects and increases funding in CDC to reduce chronic
disease. Rather than splitting funding and making separate
grants for heart disease, diabetes, and other chronic diseases,
the budget proposes one comprehensive grant that will allow
States to address chronic disease more effectively.
--The budget redirects prevention resources in SAMHSA to fund
evidence-based interventions and better respond to evolving
needs. States and local communities will benefit from the
additional flexibility while funds will still be competed and
directed toward proven interventions.
These are the two goals that run throughout this budget: making the
smart investments for the future that will help build a stronger,
healthier, more competitive, and more prosperous America, and making
the tough choices to ensure we are building on a solid fiscal
foundation.
The budget documents are available on our website. But for now, I
want to share an outline of the budget, including the areas of most
interest to this Committee, and how it will help our country invest in,
and win, the future.
That starts with giving Americans more freedom in their healthcare
choices, so they can get affordable, high-quality care when they need
it.
transform healthcare
Expanding Access to Coverage and Making Coverage More Secure.--The
Affordable Care Act expands access to affordable coverage to millions
of Americans and strengthens consumer protections to ensure individuals
have coverage when they need it most. These reforms create an important
foundation of patients' rights in the private health insurance market
and put Americans in charge of their own healthcare. As a result, we
have already implemented historic private market reforms including
eliminating pre-existing condition exclusions for children; prohibiting
insurance companies from rescinding coverage and imposing lifetime
dollar limits on coverage; and enabling many adult children to stay on
their parent's insurance plan up to age 26. The Affordable Care Act
also established new programs to lower premiums and support coverage
options, such as the Pre-Existing Condition Insurance Plans Program and
the Early Retiree Reinsurance Program. The Act provides Medicare
beneficiaries and enrollees in most private plans access to certain
covered preventative services free of charge. Medicare beneficiaries
also have increased access to prescription drugs under Medicare Part D
by closing the coverage gap, known as the ``donut hole,'' by 2020 so
that seniors no longer have to fear being unable to afford their
prescriptions. The Act also provides for an annual wellness visit to
all Medicare beneficiaries free of charge.
Beginning in 2014, State-based health insurance Exchanges will
create affordable, quality insurance options for many Americans who
previously did not have health insurance coverage, had inadequate
coverage, or were vulnerable to losing the coverage they had. Exchanges
will make purchasing private health coverage easier by providing
eligible consumers and small businesses with ``one-stop-shopping''
where they can compare a range of plans. New premium tax credits and
cost-sharing reductions will also increase the affordability of
coverage and care. The Affordable Care Act will also extend Medicaid
insurance to millions of low-income individuals who were previously not
eligible for coverage, granting them access to affordable healthcare.
Ensuring Access to Quality, Culturally Competent Care for
Vulnerable Populations.--The budget includes $3.3 billion for the
Health Centers Program, including $1.2 billion in mandatory funding
provided through the Affordable Care Act Community Health Center Fund,
to expand the capacity of existing health center services and create
new access points. The infusion of funding provided through the
Affordable Care Act, combined with the discretionary request for fiscal
year 2012, will enable health centers to serve 900,000 new patients and
increase access to medical, oral, and behavioral health services to a
total of 24 million patients.
Reducing Health Care Costs.--New innovative delivery and payment
approaches will lead to both more efficient and higher quality care.
For example, provisions in the Affordable Care Act designed to reduce
healthcare acquired conditions and preventable readmissions will both
improve patient outcomes and reduce unnecessary health spending. The
Innovation Center, in coordination with private sector partners
whenever possible, will pursue new approaches that not only improve
quality of care, but also lead to cost savings for Medicare, Medicaid,
and CHIP. Rate adjustments for Medicare providers and insurers
participating in Medicare Advantage will promote greater efficiency in
the delivery of care. Meanwhile, new rules for private insurers, such
as medical loss ratio standards and enhanced review of premium
increases, will lead to greater value and affordability for consumers.
Combating Healthcare Associated Infections.--HHS will use measures
related to heathcare-associated infections (HAIs) for hospital value-
based purchasing beginning in fiscal year 2013, as called for in the
Affordable Care Act. The fiscal year 2012 budget includes $86 million--
of which $20 million is funded in the Prevention and Public Health Fund
Prevention Trust Fund--to the Agency for Healthcare Research and
Quality (AHRQ), the Centers for Disease Control and Prevention (CDC),
and the Office of the Secretary to reduce healthcare-associated
infections. In fiscal year 2012, HHS will continue research on health-
care associated infections and tracking infections through the National
Healthcare Safety Network. HHS will also identify and respond to new
healthcare-associated infections by conducting outbreak and
epidemiological investigations. In addition, HHS will implement, and
ensure adherence to, evidence-based prevention practices to eliminate
healthcare-associated infections. HHS activities, including those that
the Innovation Center sponsors, will further the infection reduction
goals of the Department's Action Plan to Prevent Healthcare-Associated
Infections. HHS has made progress in reducing HAIs. For instance, in
2009, an estimated 25,000 fewer central line-associated blood stream
infections (CLABSIs) occurred among patients in ICUs in the United
States than in 2001 (a 58 percent reduction). Progress in reducing
CLABSIs highlights the preventability of these infections, and HHS will
continue to support HAI prevention in collaboration with States and
facility partners.
Health Services for 9/11 Terrorist Attacks.--To implement the James
Zadroga 9/11 Health and Compensation Act, the fiscal year 2012 budget
includes $313 million in mandatory funding to provide medical
monitoring and treatment to responders of the September 11, 2001
terrorist attacks and initial health evaluations, monitoring, and
treatment to others directly affected by the attacks. In addition to
supporting medical monitoring and treatment, HHS will use funds to
establish an outreach program for potentially eligible individuals,
collect health data on individuals receiving benefits, and establish a
research program on health conditions resulting from the terrorist
attacks.
advance scientific knowledge and innovation
Accelerating Scientific Discovery to Improve Patient Care.--The
budget includes $32 billion for the National Institutes of Health
(NIH), an increased investment of $745 million over the fiscal year
2010 enacted level, to support innovative basic and clinical research
that promises to deliver better health and drive future economic
growth. In fiscal year 2012, NIH estimates it will support a total of
36,852 research project grants, including 9,158 new and competing
awards.
Recent advances in the biomedical field, including genomics, high-
throughput biotechnologies, and stem cell biology, are shortening the
pathway from discovery to revolutionary treatments for a wide range of
diseases, such as Alzheimer's, cancer, autism, diabetes, and obesity.
The dramatic acceleration of our basic understanding of hundreds of
diseases; the establishment of NIH-supported centers that can screen
thousands of chemicals for potential drug candidates; and the emergence
of public-private partnerships to aid the movement of drug candidates
into the commercial development pipeline are fueling expectations that
an era of personalized medicine is emerging where prevention,
diagnosis, and treatment of disease can be tailored to the individual
and targeted to be more effective. To help bridge the divide between
basic science and therapeutic applications, NIH plans to establish in
fiscal year 2012 the National Center for Advancing Translational
Sciences (NCATS), of which one component would be the new Cures
Acceleration Network. With the creation of NCATS, the National Center
for Research Resources will be abolished and its programs transferred
to the new Center or other parts of NIH.
Advancing Patient-Centered Health Research.--The Affordable Care
Act created the Patient-Centered Outcomes Research Institute to fund
research and get relevant, high quality information to patients,
clinicians and policy-makers so that they can make informed healthcare
decisions. The Patient-Centered Outcomes Research Trust Fund will fund
this independent Institute, and related activities within HHS. In
fiscal year 2012, the budget includes $620 million in AHRQ, NIH and the
Office of the Secretary, including $30 million from the Trust Fund, to
invest in core patient-centered health research activities and to
disseminate research findings, train the next generation of patient-
centered outcomes researchers, and improve data capacity.
Advancing Health Information Technology.--The budget includes $78
million, an increase of $17 million, for the Office of the National
Coordinator for Health Information Technology (ONC) to accelerate
health information technology (health IT) adoption and promote
electronic health records (EHRs) as tools to improve the health of
individuals and transform the healthcare system. The increase will
allow ONC to assist healthcare providers in becoming meaningful users
of health IT.
advance the health, safety, and well-being of the american people
Enhancing the Quality of Early Care.--The budget provides $6
billion in combined discretionary and mandatory funding for child care.
These resources will enable 1.7 million children to receive child care
services. The Administration also supports reforms to the child care
program to serve more low-income children in safe, healthy, and
nurturing child care settings that are highly effective in promoting
early learning; supports parental employment and choice by providing
information to parents on quality; promotes continuity of care; and
strengthens program integrity and accountability Additionally, the
President's budget includes $8.1 billion for Head Start, which will
allow us to continue to serve 968,000 children in 2012. The
Administration is also working to implement key provisions of the Head
Start Reauthorization, including requiring low-performing programs to
compete for funding, that will improve program quality. These reforms
and investments at HHS, in conjunction with the Administration's
investments in the Early Learning Challenge Fund, are key elements of
the broader education agenda designed to help every child reach his or
her academic potential and improve our Nation's competitiveness.
Preventing and Treating HIV/AIDS.--The budget supports the goals of
the National HIV/AIDS Strategy to reduce HIV incidence, increase access
to care and optimize health outcomes for people living with HIV, and
reduce HIV-related health disparities. The request focuses resources on
high-risk populations and allocates funds to State and local health
departments to align resources to the burden of the epidemic across the
United States. The budget includes $2.4 billion, an increase of $85
million, for HRSA's Ryan White program to expand access to care for
persons living with HIV/AIDS who are otherwise unable to afford
healthcare and related support services. The budget also includes $858
million for domestic HIV/AIDS Prevention in CDC, an increase of $58
million, which will help CDC decrease the HIV transmission rate;
decrease risk behaviors among persons at risk for acquiring HIV;
increase the proportion of HIV infected people who know they are
infected; and integrate services for populations most at risk of HIV,
sexually transmitted diseases, and viral hepatitis. In addition, the
budget proposes that up to one percent of HHS discretionary funds
appropriated for domestic HIV/AIDS activities, or approximately $60
million, be provided to the Office of the Assistant Secretary for
Health to foster collaborations across HHS agencies and finance high
priority initiatives in support of the National HIV/AIDS Strategy. Such
initiatives would focus on improving linkages between prevention and
care, coordinating Federal resources within targeted high-risk
populations, enhancing provider capacity to care for persons living
with HIV/AIDS, and monitoring key Strategy targets.
Addressing the Leading Causes of Death and Disability.--Chronic
diseases and injuries represent the major causes of morbidity,
disability, and premature death and contribute to the growth in
healthcare costs. The budget aims to improve the health of individuals
by focusing on prevention of chronic diseases and injuries rather than
focusing solely on treating conditions that could have been prevented.
Specifically, the budget includes $705 million for a new competitive
grant program in CDC that refocuses disease-specific grants into a
comprehensive program that will enable health departments to implement
the most effective strategies to address the leading causes of death.
Because many chronic disease conditions share common risk factors, the
new program will improve health outcomes by coordinating the
interventions that can reduce the burden of chronic disease. In
addition, the allocation of the $1 billion available in the Prevention
Fund will improve health and restrain the growth of healthcare costs
through a balanced portfolio of investments. The fiscal year 2012
allocation of the Fund builds on existing investments and will align
with the vision and goals of the National Prevention and Health
Promotion Strategy under development. For instance, the CDC Community
Transformation Grants create and sustain communities that support
prevention and wellness where people live, learn, work and play through
the implementation, evaluation, and dissemination of evidence-based
community preventive health activities.
Preventing Substance Abuse and Mental Illness.--The budget includes
$535 million within the Substance Abuse and Mental Health Services
Administration (SAMHSA) for new, expanded, and refocused substance
abuse prevention and mental health promotion grants to States and
Tribes. To maximize the effectiveness and efficiency of its resources,
SAMHSA will deploy mental health and substance abuse prevention and
treatment investments more thoughtfully and strategically. SAMHSA will
use competitive grants to identify and test innovative prevention
practices and will leverage State and Tribal investments to foster the
widespread implementation of evidence-based prevention strategies
through data driven planning and resource dissemination.
Supporting Older Adults and their Caregivers.--The budget includes
$57 million, an increase of $21 million over fiscal year 2010, to help
seniors live in their communities without fear of abuse, and includes
an increase of $96 million for caregiver services, like counseling,
training, and respite care, to enable families to better care for their
relatives in the community. The budget also proposes to transfer an
Older Americans Act program that provides community service
opportunities and job training to unemployed older adults from the
Department of Labor to HHS. As part of this move, a new focus will be
placed on developing professional skills that will enable participants
to provide services that allow fellow seniors to live in their
communities as long as possible.
Pandemic and Emergency Preparedness.--While responding to the H1N1
influenza pandemic has been the focus of the most recent pandemic
investments, the threat of a pandemic caused by H5N1 or other strains
has not diminished. HHS is currently implementing pandemic preparedness
activities in response to lessons learned from the H1N1 pandemic in
order to strengthen the Nation's ability to respond to future health
threats. Balances from the fiscal year 2009 supplemental appropriations
are being used to support recommendations from the HHS Medical
Countermeasure Review and the President's Council of Advisors on
Science and Technology. These multi-year activities include advanced
development of influenza vaccines and the construction of a new cell-
based vaccine facility in order to quickly produce vaccine in the
United States, as well as development of next generation antivirals,
rapid diagnostics, and maintenance of the H5N1 vaccine stockpile.
The HHS Medical Countermeasure Review described a new strategy
focused on forging partnerships, minimizing constraints, modernizing
regulatory oversight, and supporting transformational technologies. The
request includes $665 million for the Biomedical Advanced Research and
Development Authority, to improve existing and develop new next-
generation medical countermeasures and $100 million to establish a
strategic investment corporation that would improve the chances of
successful development of new medical countermeasure technologies and
products by small and new companies. The budget includes $70 million
for FDA to establish teams of public health experts to support the
review of medical countermeasures and novel manufacturing approaches.
Additionally, NIH will dedicate $55 million to individually help
shepherd investigators who have promising, early-stage, medical
countermeasure products. Finally, the budget includes $655 million for
the Strategic National Stockpile to replace expiring products, support
BioShield acquisitions, and fill gaps in the stockpile inventory.
strengthen the nation's health and human service infrastructure and
workforce
Strengthening the Health Workforce.--A strong health workforce is
key to ensuring that more Americans can get the quality care they need
to stay healthy. The budget includes $1.3 billion, including $315
million in mandatory funding, within HRSA, to support a strategy which
aims to promote a sufficient health workforce that is deployed
effectively and efficiently and trained to meet the changing needs of
the American people. The budget will initiate investments that will
expand the capacity of institutions to train over 4,000 new primary
care providers over 5 years.
Health Workforce Diversity.--As part of these health workforce
investments, the budget also includes $163 million at HRSA for Health
Workforce Diversity programs to improve the diversity of the Nation's
health workforce and improve care to vulnerable populations. This
funding will support training programs and scholarship opportunities to
students from disadvantaged backgrounds enrolled in health professions
and nursing programs.
Expanding Public Health Infrastructure.--The fiscal year 2012
budget supports State and local capacity so that health departments are
not left behind. Specifically, the budget requests $73 million, of
which $25 million is funded in the Prevention Fund, for the CDC public
health workforce to increase the number of trained public health
professionals in the field. CDC's experiential fellowships and training
programs create an effective, prepared, and sustainable health
workforce to meet emerging public health challenges. In addition, the
budget requests $40 million in the Prevention Fund to support CDC's
Public Health Infrastructure Program. This program will increase the
capacity and ability of health departments to meet national public
health standards in areas such as information technology and data
systems, workforce training, and regulation and policy development.
increase efficiency, transparency, and accountability of hhs programs
Strengthening Program Integrity.--Strengthening program integrity
is a priority for both the President and myself. The budget includes
$581 million in discretionary funding, a $270 million increase over
fiscal year 2010, to expand prevention-focused, data-driven, and
innovative initiatives to improve CMS program integrity. The budget
request also supports the expansion up to 20 Strike Force cities to
target Medicare fraud in high risk areas and other efforts to achieve
the President's goal of cutting the Medicare fee-for-service error rate
in half by 2012. The proposed 10 year discretionary investment yields
$10.3 billion in Medicare and Medicaid savings, a return of about $1.5
for every dollar spent. In addition, the budget includes a robust
package of program integrity legislative proposals to expand HHS
program integrity tools and produce $32.3 billion in savings over 10
years. We appreciate the support of Congress, particularly Chairman
Harkin, on efforts to fight Medicare fraud. I look forward to working
with the Subcommittee on this issue.
In addition, the Affordable Care Act provides unprecedented tools
to CMS and law enforcement to enhance Medicare, Medicaid, and
Children's Health Insurance Program (CHIP) program integrity. The Act
enhances provider screening to stop fraudsters from participating in
these programs in the first place, gives the Secretary the authority to
implement temporary enrollment moratoria for fraud hot spots, and
increases law enforcement penalties. Additionally, the continued
implementation of the Secretary's Program Integrity Initiative seeks to
ensure that every program and office in HHS prioritizes the
identification of systemic vulnerabilities and opportunities for waste
and abuse, and implements heightened oversight.
Implementing the Recovery Act.--The American Recovery and
Reinvestment Act provides $138 billion to HHS programs as part of a
government-wide response to the economic downturn. HHS-funded projects
around the country are working to achieve the goals of the Recovery Act
by helping State Medicaid programs meet increasing demand for health
services; supporting struggling families through expanded child care
services and subsidized employment opportunities; and by making long-
term investments in health information technology (IT), biomedical
research and prevention and wellness efforts. HHS made available a
total of $118 billion to States and local communities through December
31, 2010; recipients of these funds have in turn spent $100 billion by
the same date. Most of the remaining funds will support a signature
Recovery Act program to provide Medicare and Medicaid incentive
payments to hospitals and eligible healthcare providers as they
demonstrate the adoption and meaningful use of electronic health
records. The first of these Medicaid incentive payments were made
January 5, 2011. More than 23,000 grantees and contractors of HHS
discretionary programs have to submit reports on the status of their
projects each calendar quarter. These reports are available to the
public on Recovery.gov. For the quarter ending December 31, 2010, 99.6
percent of the required recipient reports were filed timely. Recipients
that do not comply with reporting requirements are subject to sanction.
conclusion
This budget is about investing our resources in a way that pays off
again and again. By making smart investments and tough choices today,
we can have a stronger, healthier, more competitive America tomorrow.
This testimony reflects just some of the ways that HHS programs improve
the everyday lives of Americans.
Under this budget, we will continue to work to make sure every
American child, family, and senior has the opportunity to thrive. And
we will take responsibility for our deficits by cutting programs that
were outdated, ineffective, or that we simply could not afford. But, we
need to make sure we're cutting waste and excess, not making across the
board, deep cuts in programs that are helping our economy grow and
making a difference for families and businesses. We need to move
forward responsibly, by investing in what helps us grow and cutting
what doesn't.
My department can't accomplish any of these goals alone. It will
require all of us to work together. I look forward to working with you
to advance the health, safety, and well-being of the American people.
Thank you for this opportunity to speak with you today. I look forward
to our conversation.
Senator Harkin. Thank you very much, Madam Secretary.
We will start a round of 5-minute questions and recognize
people in order of appearance at the subcommittee. So I will
start, and then Senator Shelby, then we will go by order of
appearance at the subcommittee.
HEAD START
Madam Secretary, I want to focus on early childhood
programs, the impact of H.R. 1, the House-proposed bill, which
would cut over $1 billion from Head Start and the child care
programs. This would go well beyond whatever we did in the
Recovery Act. It actually would cut the funding below the level
where they stood prior to the Recovery Act.
I just visited a Head Start center in Iowa, talked to
parents there and the Head Start program people and the
teachers, and the impact in my own State would be pretty
severe. They estimate about 1,800 kids in Iowa would lose their
Head Start program.
Can you just tell us for the subcommittee what do you see
as the impact of H.R. 1 on Head Start, what changes are you
making to Head Start to ensure that children receive high
quality services, and just a little bit about the early
learning challenge fund and the purpose of it?
Secretary Sebelius. Mr. Chairman, I share your interest and
focus on early childhood education as being an investment that
pays huge dividends in the long run. If H.R. 1 were to become
the law, the budget for Head Start would be cut about $1.1
billion below 2010 funding, and we think about 218,000 children
across the country who are currently being served would lose
those slots both in Head Start and in Early Head Start.
The President, by contrast, has proposed an increase in
Head Start, feeling that that is an investment that is
important to make. Even though our budget is flat-lined, he has
chosen to make an increase in that area, or recommend an
increase.
We have looked across the range of programs at Head Start
and since studies have been done to indicate there has not been
enough progress made as children become school-eligible and
continue on in school, we are relooking at all kinds of
features with the Department of Education in terms of school
readiness. The programs are currently being upgraded and
updated in great collaboration and partnership with the
Department of Education.
We are also, Mr. Chairman, recompeting the 25 lowest-
performing quadrant of the programs, feeling that automatic
ongoing funding has not provided an incentive to update and
upgrade the quality.
Senator Harkin. By the way, I commend your Department and
your leadership in that area.
Secretary Sebelius. Well, I think parents need to be
assured that whatever out-of-home placement they choose for
their child, whether it is a child care setting or Head Start
or a school-based early education program, that the same goals
are in place. And that is really what the early learning
challenge grant is about.
States--and I will take some credit for what we did in
Kansas--are frankly a bit ahead in this. A lot of States have
been very innovative in early child care and early education
opportunities, putting all the placement folks at the table and
insisting that the same kind of quality standards be in place.
The early learning challenge grant would be a partnership
with HHS and Department of Education who together run the scope
of the child care programs and make sure that we are putting
incentives in place to drive higher quality because children
who enter school less prepared than their peers, often, by the
third grade, are so far behind that they will never catch up.
We know that having not only developmentally ready children but
educationally ready children is a way to really open those
doorways of opportunity, and that is what the focus has been.
Senator Harkin. Thank you, Madam Secretary.
COMMUNITY HEALTH CENTERS
My last question--I am running out of time--has to do with
community health centers. I happen to think the community
health center has been one of the great underpinnings of our
health system in America, 1,100 of them nationwide providing
the kind of healthcare that low-income people need when they
walk in that door. Could you explain the impact of the proposed
cuts in H.R. 1, what that would do, and how many patients we
might lose?
Secretary Sebelius. The billion dollars that would be,
again, cut from the community health center funding below 2010
would serve--we are calculating that about close to 3 million
of the people currently served in community health centers
would lose that opportunity, and 10 million who are looking
forward to having access to community health centers would also
not have those sites available. Along with the health center
sites themselves are the healthcare providers, doctors, nurses,
nurse practitioners, mental health professionals. So, with the
Recovery Act, the Affordable Care Act, and the budget
investments, the community health center footprint is scheduled
to go from serving about 20 million Americans to serving 40
million Americans in the most underserved areas, rural and
urban, throughout the country.
Senator Harkin. Thank you very much, Madam Secretary.
Senator Shelby.
CLASS ACT
Senator Shelby. Secretary Sebelius, the CLASS Act attempts
to address an important public policy concern, that is, the
need for non-institutional long-term care, but it is viewed by
many experts as financially unsound. The President's Fiscal
Commission recommended reform or repeal of the CLASS Act. You
stated to health advocacy groups--and I will quote you--that
``it would be irresponsible to ignore the concerns about the
CLASS program's long-term sustainability in its current form.''
The President's budget proposal includes a request of $120
million for the CLASS Act which would be the first
discretionary appropriation for the program. If you are unable
to certify that it will be sustainable absent a massive
taxpayer infusion of funds, why should Congress want to
appropriate the requested $120 million in taxpayer funds for a
program that a lot of the experts project will fail? And what
will prevent the Department from subsidizing this alleged self-
sustaining program with taxpayer funds once it is implemented
and then fails? Is that a concern of yours?
Secretary Sebelius. Senator, the law as written has some
pretty clear directions that we have to be able to certify
before benefits would become available to promote to the public
for their voluntary enrollment that the program is not only
sustainable short-term but sustainable long-term. It needs a
20-year and a 75-year actuarial projection of sustainability.
There also is a very clear directive in the law that
prohibits any taxpayer dollars being spent to subsidize what
may be a program that is on shaky financial ground.
So those are the two guardrails that we are looking at very
closely.
We are working with actuaries. In fact, the head actuary
from GenWorth, who has probably the biggest footprint in this
space, has become our chief actuary on the CLASS modeling
program. But looking at the flexibility that we have, frankly,
to look at work requirements, premium indexing, and
enrollment--three of the elements that are really critical to
making sure you have a solvent program in the future, if indeed
only the disabled community enrolls--this program is
immediately insolvent in a fiscal manner because there will not
be enough income to pay for the benefits.
The money that you have referred to in the budget, which is
being requested as an initial outreach and enrollment feature,
is designed to make sure we have a solvent program, which means
you need to reach into a younger, healthier population, market
benefits----
Senator Shelby. In other words, it is taxpayers' money you
are asking for here. Right? $120 million.
Secretary Sebelius. It is budgeted money that could make
the CLASS program sustainable into the future. Yes, sir.
Senator Shelby. The budget proposal for the CLASS Act also
includes $93.5 million in new Federal spending for,
``information and education to ensure that an adequate number
of individuals would enroll in the program.'' While I do not
agree myself with Congress appropriating $120 million for an
insolvent program, it makes even less sense to me to spend
$93.5 million of that funding to promote a program that we know
is structured currently to fail.
How do you justify, Madam Secretary, spending such a large
sum of money on promotion efforts, given you will be promoting
a program that is not quite defined?
Secretary Sebelius. Well, again, Senator, we would not
promote a program that could not be sustained, and I am
prohibited by law from doing that. So it is our intent to--and
we are engaged in extensive outreach to look at the elements of
the program that need to be adjusted in order to make sure it
is sustainable. I have just mentioned three of them: the work
requirements, the premium indexing issues, and the outreach
efforts.
The outreach is absolutely essential to engage the employer
community and engage citizens who right now--frankly, most
think that Medicare provides long-term care, which it does not.
Most think that that is a benefit that they have to look
forward to, and there really is no private market opportunity
right now for the kind of residential assistance that most
people want and need.
Senator Harkin. We will do other rounds.
Senator Shelby. I will come back.
Senator Harkin. We have a lot of people here. I want to
make sure everyone gets a chance.
I will recognize in order now Senator Pryor, Senator
Johnson, Senator Moran, Senator Reed, Senator Brown, and
Senator Mikulski. Senator Pryor.
WASTE, FRAUD AND ABUSE
Senator Pryor. Thank you, Mr. Chairman.
And thank you, Madam Secretary, for being here.
Let me follow up on something that we actually talked about
1 year ago in this subcommittee, and we were talking about
waste, fraud, and abuse. You had a request in I think for $110
million to do a 2-year process, I guess you can say, to try to
get all the Medicare payment data sets in one system. And I
understand we have had some budget issues in the meantime, but
I am curious about where you are in that process. I guess you
got some of the money appropriated, but tell me where you are
in that process?
Secretary Sebelius. Well, Senator, there is a broad-based
effort underway to put together what is called in the private
market ``predictive modeling,'' the kind of data checks that
credit card companies use to find if there is an aberrant
billing pattern. So, if 10 flat screen TVs end up on your
credit card, you are likely to get a call saying did you
purchase 10 flat screen TVs before they actually send the money
out the door. We have never had that ability with Medicare data
in five or six different systems and not integrated.
We are building that database. We are well down the line to
modeling now what we can do, and with the Affordable Care Act,
we were given new tools to actually be much more nimble in
stopping payments before they go out the door. So the
opportunity to go from the old ``pay and chase'' model, where
the money went out and then we tried to put back together the
scheme of the crooks and find them at some point, to actually
stopping that from ever happening in the first place, using the
very effective tools that the private sector has used for
years, is well underway and we hope to be up and running. We do
have a request in the budget that would continue not only that
but the strike force opportunities and building that data
system, enforcing scrutiny as providers come into the system,
all of which we think will be very effective. Last year alone,
Senator, we got about a 7 to 1 return on dollars out/dollars
in, which I think just gives a prelude to what could be
effective in terms of building some firewalls at the very front
end.
Senator Pryor. Great. At one point you had, I think, a
deadline of trying to get this up and running at least in some
measure maybe at the end of 2011. Are you still on track there?
Secretary Sebelius. I think we have been a little bit
frozen in terms of our capabilities of moving ahead. So there
are some new assets in the Affordable Care Act that we are
continuing to mobilize. We are still working on 2010
assumptions in our budget, and as you know, one of the things
that the House continuing resolution would do to our budget is
take an additional $500 million out of CMS administrative
overhead, reducing us to a level that is about 2006. So we are
a little uncertain what the funding would be, but this is
definitely a program that well pays for itself.
CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION
Senator Pryor. In the President's budget, it eliminates
funding to children's hospitals for graduate medical education.
And I am concerned about that because pediatricians really are
the primary care providers for our children. So when I see
something like that, it makes me concerned that, in effect, we
are going to harm the ability to train physicians to be primary
care physicians for children.
So what assurance can you give me today that this budget is
not going to harm our ability to train more qualified
pediatricians?
Secretary Sebelius. Well, I share your concern, Senator,
and can assure you that in rosier budget times this would not
have been a proposal to take that $317 million out of the
budget. There are some exclusive children's hospitals that have
that funding. I would tell you that there is $40 million in our
block grant for maternal and child health that trains
pediatricians and pediatric residents across the country, as
well as Medicaid training of about $3.89 billion, again some of
which comes to pediatricians. So this is not the sole source of
funding for pediatricians. But I share your concerns that
primary care docs and particularly those who deal with children
are critical.
Senator Pryor. And I do not have time to ask the question,
but there is a Government Accountability Office (GAO) report
that came out this month. It is GAO-11-318SP, and it looks for
opportunities to reduce potential duplication in Government
programs, save tax dollars, and enhance revenue. And I notice
that your Department is mentioned in here many, many times on
ways that hopefully we can save money and stop duplication. We
do not have time to really ask because other Senators are
waiting, but I hope you will look at that----
Secretary Sebelius. We are.
Senator Pryor [continuing]. And take their recommendations
to heart.
Secretary Sebelius. Thank you.
Senator Harkin. Thank you, Senator Pryor.
And now we will turn to Senator Johnson. I want to welcome
our new member to the committee and the subcommittee. As a
matter of fact, I was just checking with my staff. This may be
a unique situation where we have two Senators from the same
State on the same subcommittee on the Appropriations Committee.
So welcome to the subcommittee, Senator Johnson.
AFFORDABLE CARE ACT
Senator Johnson. Well, thank you, Mr. Chairman. It is a
privilege to serve on the subcommittee with you.
Madam Secretary, it was a pleasure meeting you earlier.
I want to center on the Affordable Care Act or law I guess.
First of all, obviously your background is pretty impressive,
being a health commissioner and Governor of the State. You
obviously understand health insurance pretty deeply.
Have you ever purchased, though, a healthcare plan for a
group of individuals, other than the State? I mean for 50
employees, 100 employees.
Secretary Sebelius. Yes, sir. I ran the State health
insurance program which was the largest covered group in Kansas
for 90,000 covered lives. We negotiated 10 or 12 various
competitive plans, kind of the exchange that we are looking to
set up in States around the country. It is exactly that model.
Senator Johnson. Again, that is a very large group,
obviously. Just so you understand my background, I am an
accountant by training, a business owner for the last 31 years,
and I have been buying healthcare for the people that work with
me for 31 years. So I understand fee-for-service. I understand
a self-insured plan where you are buying inspector general
coverage and specific coverage. I know about PPO's and HMO's.
Obviously, with the background with my daughter, having to seek
out the best surgical technique for her, I always made sure
that the employees that worked with me had that exact same
freedom in a fee-for-service type of plan to be able to go
anywhere in the country to do that. So basically what I do is I
bring the perspective of a business owner, a business manager
who will be making the kind of decisions on healthcare coverage
under this Affordable Care Act.
So from my standpoint, this is a very complex bill, 2,700
pages. We have another 6,200 pages, what I was reading, in
terms of additional regulations that have been written since
that point in time. So I try and simplify things. I am trying
to look at the bigger picture. And so I would like to start by
just asking some basic questions we can kind of agree on some
figures here because I am a very reality-based guy. I want to
look at facts and figures.
So is it true that about 163 million people in America get
their healthcare through an employer-sponsored plan? Is that
about the correct number?
Secretary Sebelius. I think it is about 180 million.
Senator Johnson. The Congressional Budget Office (CBO) has
issued a study, a report that claims that under the healthcare
law now, that by 2016 the average cost of a family plan will be
in excess of $15,000. Is that pretty much your----
Secretary Sebelius. I assume that is accurate.
Senator Johnson. It is. We will stipulate that.
Is it also true that under the healthcare law now, if an
employer with more than 50 employees does not provide, I guess,
affordable coverage, the penalty to that employer will be
$2,000 per employee?
Secretary Sebelius. It is an employer responsibility. If
that employee qualifies for the taxpayer subsidy that is in the
bill, then there is, yes, a payment into the fund so that that
cost is not shifted on to other taxpayers who are, indeed,
providing coverage for their employees and paying for the
subsidy.
Senator Johnson. So the CBO has also estimated now that
they are thinking--it is starting, I think, at 2.6 million
rising to about 3.6 million employees will lose their coverage,
will be dropped from their employer-sponsored care into the
Government exchange. Is that about the right figure?
Secretary Sebelius. Well, I know there were all sorts of
studies done by all kinds of people, sir, during the course of
the debate, and I think before we have a framing of a plan and
the opportunity to look at how affordable these plans are, one
of the directives, as you know, with the State-based plan is
that it be affordable coverage. So I think there is not at all
a firm number on how many employers will or will not do what
they are voluntarily doing now.
Senator Johnson. But that is how this thing has been scored
dollar-wise in terms of the cost estimate. Around 3 million
people.
The average subsidy, according to CBO, per person in those
exchanges will rise from about $4,500 to over $7,000 by the
year 2021. Is that largely correct?
Secretary Sebelius. The average subsidy--it is based on an
income level to----
Senator Johnson. Per person. I understand, but what has
been budgeted is almost $7,000 by the year 2021. My concern is
taking a look at the big picture here. I think we have grossly
underestimated the number of employees that will lose their
employer coverage plan under this healthcare act, be put in the
exchanges under extremely high subsidy levels. If I am right,
if my fears come true, we could be looking at tens of millions
of people put in the exchanges at the tune of $5,000 to $7,000
in subsidies. We could be doubling, tripling, quadrupling the
cost of this healthcare bill. Rather than $150 billion, it
could be easily one-half a trillion dollars per year. That is
my concern.
Secretary Sebelius. Well, Senator, I think, as you know and
as a business person participating in the market, the market is
entirely voluntary now for employers. I think the most cynical
view is that employers will just dump all their employees,
discontinue employee benefits, and I guess move people into
some other option. I don't share that kind of cynical view. I
think the voluntary marketplace, in fact, is going to be far
more attractive. A lot of small business owners who now are
paying 18 to 20 percent more for identical coverage to large
business owners will have, for the first time, affordable
options within an exchange to purchase coverage. I think that
the opportunity for individuals, entrepreneurs, farm families,
and others who right now are on the edge of the market or often
outside the market will have affordable options. And I think
the large employers who we talked to who will not see much
difference in their choices, except they will stop paying the
approximately $1,000 per policy tax for everyone who is
accessing the healthcare system without affordable coverage
that gets shifted onto everybody who has coverage.
I guess I think that while there is a scenario that says
everybody would voluntarily walk out of the market and dump
their employees, I think just the opposite is going to happen.
We have not seen that in the one State that is really up and
running--in Massachusetts. Employers have not dropped their
coverage, have not dumped employees. They, in fact, are
continuing, and Massachusetts is now at about a 97 percent
coverage rate. So I think that is an encouraging at least
precursor of what may be coming.
Senator Johnson. Thank you.
Senator Harkin. Thank you, Senator.
Senator Moran.
Senator Moran. Mr. Chairman, thank you.
Senator Harkin. Again, welcome to the subcommittee. Senator
Moran and I have done a lot of work in the past on farm issues.
Now we can work on health issues.
RURAL ACCESS HOSPITALS
Senator Moran. I look forward to continuing that working
relationship, and I am honored to serve Kansas in the United
States Senate by the side of my colleagues here today and
honored to have my former Governor with us this afternoon so
that I can ask a few questions.
Secretary, my thoughts for questioning you today really
revolve around some pretty significant Kansas issues related to
healthcare and your role. And they are, of course, related to
the issue of healthcare in a rural setting.
The IPAB at the moment fails to account for critical access
hospitals. Congress carved out exceptions to the payment
mechanism that we have in place but did not carve out critical
access hospitals, and I would like your reaction to that
related to that because I am fearful that if that carve-out
does not occur and decisions are made by those policymakers not
responsible to rural America, those critical access hospitals
could easily be a target for reduced spending which in my view
causes the demise of access to healthcare in rural America.
Related to that is the budget item for providing the doc
fix. In so many instances today, our rural hospitals are now
employing physicians. And they do that out of necessity. The
ability to track a physician to a rural community is
restricted, is limited. And so in many instances, our rural
hospitals pay the salaries of physicians. Their ability to do
that will be greatly damaged if we lose the ability to be
reimbursed as we are currently as critical access hospitals.
But it is compounded by the problem that in the 29.5 percent
reduction in payments to physicians under Medicare, if we do
not put a doc fix in place. So we have the circumstance in
which many hospitals will have declining revenues and
increasing costs. Of course, a hospital has little viability if
there are not physicians in that community admitting patients
to those hospitals.
So my question is--I have only been in the Senate 2 months,
but I have learned that I have to ask more than one question in
the one question in the 5 minutes that I am allowed. But my two
questions that are related to each other is what is the plan
for the carve out for critical access hospitals and what is the
administration's plan in regard to the so-called doc fix, the
sustainable growth rate problem that we face. There is a fix in
the President's budget for the next couple of years, but
nothing beyond that. And it is significant amounts of dollars
that we need to figure out how we are going to pay and I very
much would welcome your input on both those items.
Secretary Sebelius. Well, thank you, Senator, for those
questions. I do want to tell the chairman that you are not only
an expert now on rural agricultural issues but rural health
issues because Senator Moran started when he was a Kansas
senator working on rural health issues and has continued that
interest. So I look forward to the opportunity to work on some
of these enormous challenges.
The rural access hospitals, as you know, Senator, are paid
at a different rate. So they are paid, I think it is now, 101
percent of costs, and that does not change with anything with
IPAB. The other hospitals are negotiated rates. And so I think
that the lack of a carve out was due to the fact that there is
a different payment structure.
But I share your concern that somehow being focused on by
recommendations in the future with the Independent Payment
Advisory Board is precarious territory. And I would look
forward to working with you on how to look at that structure
going forward. But I do think the differential in the payment
rates was one of the areas that the drafters of the Affordable
Care Act looked at.
In terms of the sustainable growth rate and the ability to
pay Medicare providers adequately and commit to that payment
into the future, I think it is one of the most significant
looming issues. As you know, it well predates the Affordable
Care Act. This has been a discussion for the last decade. The
President has, as you said, in his budget proposed about a 2\1/
2\ year offset for the fix going forward.
But there is no doubt that we need, on a very bipartisan
basis, to sit down and look at what is the long-term ability to
make sure that doctors do not have this looming crisis. I have
now been in my job slightly longer than you have been in yours,
but I can tell you that it is certainly the single most raised
topic by physicians dealing with Medicare. And I do think it is
something that while we have proposed offsets for the next
couple of years, we need to at least have a 10-year or
permanent fix which could be part of the ongoing deficit
conversations or into the future. But there is no question that
that has to be solved long term.
I would tell you, though, also that the Affordable Care Act
has a couple of features that are particularly focused on rural
areas where Medicare providers are paid. Starting this year, an
enhanced rate for serving in underserved areas where there are
access issues that are particularly addressed in terms of not
only the health service corps, but nurse practitioners, and
nurse-provided health centers, that are again, targeted for
rural and underserved areas that I think also are going to be
critically important as you look at healthcare delivery because
it is not only affordable, it is available healthcare.
Senator Harkin. Thank you very much, Senator.
Senator Moran. Thank you, Mr. Chairman.
Senator Harkin. And now Senator Reed.
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM
Senator Reed. Thank you very much, Mr. Chairman.
Thank you, Madam Secretary, for your service.
Let me begin also by thanking you for the investment in the
budget for health professions. We had a chance to talk about
the need for primary care physicians and nurse practitioners,
and the budget represents a good step forward. I know we have
to do more, but thank you for what you have done.
I want to focus quickly on two areas. One was alluded to by
the chairman. That is the cuts in LIHEAP. When the budget was
being prepared, prices in the oil markets were a little tamer.
They are now seemingly out of control. I know there have been
some long-term reductions, at least moderation in the natural
gas market, but up our way we depend heavily on heating oil and
together with the 12 percent unemployment rate, we are
anticipating a huge, huge crisis next winter in terms of
heating. And so these LIHEAP cuts are going to be very
difficult to bear.
Can you talk about how you got to this recommendation? And
two, is there any way going forward that you have the
flexibility to adapt to these increased prices?
Secretary Sebelius. Well, again, Senator, you and I have
had this conversation, and I know that you are not only
concerned, but have been a real leader in the low energy
assistance area. What this budget does--and again, I can assure
you this is not an easy choice for anyone--is return the LIHEAP
funding to the historic traditional levels. The LIHEAP budget
more than doubled in fiscal year 2009 and continued that in
2010 and 2011. This goes back to what was the historic rate.
And it cuts $2.5 billion which is a very significant cut in the
LIHEAP funding. I would not say that I have flexibility, if it
is moving money from somewhere else into LIHEAP, probably not
unless the direction of the Congress is aimed in that area.
So again, I do not think there is an easy answer for this.
It was traditionally the level of funding before there was a
dramatic increase, but will it leave a lot of people who have
relied on that help and support for the last couple of years in
much more difficult circumstances? No question.
Senator Reed. Well, just to reemphasize the point, we are
looking at over 11 percent unemployment in my State. That was
one of the reasons I think for the increase, the recognition of
the difficult times. But the new factor is not a stable but
potentially accelerating price for particularly heating oil,
and we will have to revisit this again, unfortunately, I think,
as we go forward, Madam Secretary.
IMMUNIZATION--SECTION 317 FUNDS
Let me switch to a second area in the remaining time I
have, and that is the section 317 funds for immunization.
Immunization is such a critical part of healthcare. We do not
have to state the benefits. When children are immunized, they
are protected and they save tremendous amounts of--billions of
dollars in avoided health care problems.
The 317 funds as proposed--there seems to be a tradeoff now
between the 317 funds and the prevention trust fund which was
incorporated in the new healthcare act. The prevention trust
fund is designed, at least in your proposal, for infrastructure
improvements, but that will take away money from the actual
acquisition of the vaccines that are necessary. Unfortunately,
what we have seen in Rhode Island is a slippage in coverage for
children. We have gone down from almost 90 percent to less than
that. I have less than a moment for you to comment on that.
Secretary Sebelius. Well again, Senator, this is a critical
area, and Chairman Harkin already mentioned it. What the budget
proposes is the same funding level that we have had in the 317
program, and then, as you noted, an additional $100 million
that would be spent out of the prevention fund for what are
more likely to be sort of one-time investments whether it is
school vaccination clinics or outreach efforts that States can
employ.
One of the challenges, as you well know, is that not only
in Rhode Island but in States across the country, the health
staff, the infrastructure to distribute vaccines, to do
outreach to have kids vaccinated across the country has been
severely hampered in cuts. So we are really trying to calibrate
our resources and make them flexible to States, and I think
that additional $100 million for fiscal year 2011 is a critical
component. Up to 50 percent could be used for vaccination
purchase or for actually immunizing kids. And we think States
can use that to really make sure that they are filling the
holes in their own strategies.
Senator Reed. Thank you, Mr. Chairman.
Senator Harkin. Thank you, Senator Reed.
Senator Brown.
CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION
Senator Brown. Thank you, Mr. Chairman.
I wanted to mention that I appreciate Senator Pryor's
concern about children's GME. I also am concerned. I know
Senator Harkin is. For 10 years, he and I have worked on this
issue and it began when I was at Akron Children's Hospital some
years ago and saw that we had no way with the squeeze of
managed care to fund particularly children's pediatric
specialist training. I appreciate your answer. I appreciate
just about everything you do. But I think that these other ways
of funding graduate medical education for children for training
pediatricians is far too inadequate. So I hope that you will
revisit this issue as it comes forward.
Thank you for coming to Columbus on the patient safety
issue. My State has done some remarkable things in patient
safety in hospitals, and I think that is going to bring a lot
of cost savings that I think opponents to the healthcare bill
have not recognized. None of that was scored as we know, the
work that Senator Mikulski did and Senator Harkin and others.
But that kind of preventive care, that kind of patient safety,
everything from the Pronovost checklist to so much else will
clearly help us restrain healthcare costs that the opponents to
healthcare really barely addressed. And I am really proud to
have been part of that.
MAKENA, KV PHARMACEUTICAL
Two issues I want to bring up. One is a conversation that
we had last week on the Makena, KV Pharmaceutical. For my
colleagues who do not know the background, a drug, a
progesterone, that was administered once a week for 20 weeks at
a cost of about $10 a shot for high-risk pregnant women who had
typically had a low birth weight or a preterm birth in their
past, was making such a difference in cutting the rate of low
birth weight babies.
This drug company, KV Pharmaceutical, out of St. Louis that
really spent some money to do the clinical trials, although the
Government had done them 7 or 8 years earlier and paid for it,
raised their price once they got FDA approval from $10 a shot,
$200 for the whole regimen of treatment, to $1,500 a shot, or
$30,000 for the regimen of treatment, which will mean terribly
high costs and burden for those women, for Medicaid, for
insurance companies, for businesses and will also clearly
result in an increased number of low birth weight babies.
So I just wanted you, if not in the hearing today, to
recommend administrative or legislative strategies that we can
employ to do something about this. We have tried, frankly, to
embarrass the company. We have tried to look at the Food and
Drug Administration (FDA) when Dr. Hamburg testified to our
subcommittee not too long ago to another subcommittee here
about that. And we are looking for answers legislatively,
administratively. If you would speak to that.
Secretary Sebelius. Well, Senator, as you know, the FDA is
really prohibited from considering price in terms of drug
approval, which I think is an appropriate policy.
Having said that, one of the things that the company has
done is to actively notify pharmacists that the FDA will be
enforcing a noncompounding rule. We have put out a statement
today saying that is not the case. The FDA will not be
conducting any enforcement action over the opportunity for
pharmacists to continue to do what they have been doing, which
is compounding this treatment and having it available to
patients throughout the country unless there is some specific
safety issue, which has not come to our attention yet. And we
are continuing to work on what other options we may have, but
we wanted pharmacists throughout the country to understand that
in spite of the drug company's warning, that is not really the
policy of the Food and Drug Administration.
PEDIATRIC CANCER
Senator Brown. Thank you. And we will continue on that.
A low birth weight baby in the first year of life costs on
the average $51,000, putting aside the human cost to the child,
to the baby, the family, and everyone else. And we know what
that is going to do to costs of Government, and I would hope
that people very bipartisanly would go to work on this.
Last point, Mr. Chairman, in the brief time I have. There
is no comprehensive pediatric cancer registry, which makes it
difficult to compare State by State statistics. Ohio is,
unfortunately, home to what we think of as five different sorts
of cancer clusters. There is one in Clyde, Ohio where many
children have been afflicted and several died. Caroline Pryce
Walker, named after Ohio Congresswoman Deborah Pryce's
daughter, Childhood Cancer Act was signed into law in 2008. It
authorizes $30 million annually over 5 years for pediatric
cancer clinical trials. I would just ask you to work with us on
this whole Clyde, Ohio cancer cluster. The cause has not been
determined. We are looking to HHS to work with other agencies
to research this and other kinds of cancer clusters around the
country.
Secretary Sebelius. Well, Senator, I would welcome that
opportunity because this question has come up a couple of times
in committee and I know you are trying to parse your way
through. But again, one of the very troubling features of H.R.
1 in the House would have a huge detrimental effect on NIH
trials because not only does it cut a significant amount of
resources, $1.6 billion, but it also has a lot of language that
would micromanage trials. And we feel that many of the clinical
trials now underway dealing with cancer, dealing with autism,
dealing with others would have to stop taking any additional
patients immediately if that language were to be adopted. So
just to put a little warning on the radar screen.
Senator Harkin. Senator Mikulski.
Senator Mikulski. Thank you, Mr. Chairman.
Madam Secretary, I really just want to welcome you to the
subcommittee. Before I go to my questions, I just want you to
know I think you are doing a great job. You have one of the
largest, most complex agencies within our Federal Government,
and we want to salute you on what you are doing and also the
fact that you are even in public service. Someone with your
background could certainly be in the private sector. One of
those insurance companies would snap you up in a minute and
multiply your salary over and over again.
Secretary Sebelius. Maybe not.
IMPACT OF A FEDERAL GOVERNMENT SHUTDOWN
Senator Mikulski. Well, maybe not now.
But anyway, I just wanted to say that, because I think
there is a lot of intensity involved in these hearings.
This is a very quiet hearing, and I am surprised because we
are on the brink of a shutdown. Whether you call it a shutdown
or a slowdown, we are on the brink I think of a catastrophic
situation. And we are only 10 days away from it. My question to
you as Secretary of HHS is the implications and the operational
consequences if we go to a shutdown. With the people who work
at HHS, could you tell me how many work at HHS, and in the
event of a shutdown, how many would be deemed nonessential and
how many would be possibly furloughed?
Secretary Sebelius. Senator, I am not sure I can give you
the precise numbers right now. We do have a look-back to 1995
when a shutdown occurred and have looked at some of the
services and operations that were slowed down or even stopped.
It has a pretty widespread effect on healthcare delivery and
human service availability throughout the country because we do
touch lives each and every day.
Senator Mikulski. Well, let me jump in. I have major iconic
agencies from the Federal Government and beneficiaries in my
State. And they are also globally recognized and globally
envied. They have names like the National Institutes of Health,
the Food and Drug Administration, beneficiaries of HHS funds,
Nobel Prize winning institutions like Johns Hopkins, important
institutions like the University of Maryland.
Let us go to NIH. If there was a shutdown, could you tell
me the consequences on NIH either both in terms of the
employees who would be nonessential, what would be the impact
on clinical trials, what would be the impact on grant
beneficiaries like at Johns Hopkins?
Secretary Sebelius. Well again, Senator, I hesitate to give
you specifics because I do not have them here. I can tell you
there are conversations going on, and our best indication is
the look-back.
But having said that, we know that critical trials are
underway. Research goes on day in and day out. Thousands of
people are affected not only on the campuses that you referred
to but certainly in grant programs throughout this country
which provide jobs and economic opportunity.
Senator Mikulski. If there is a shutdown, would grant
beneficiaries continue to get their funds?
Secretary Sebelius. Dubious. I do not know what the funding
cycle would be.
Senator Mikulski. I think this is really a big deal. So if
you are in the midst of a clinical trial, whether it is cancer
or autism, even if we looked at the ``A'' words, AIDS, autism,
arthritis.
Secretary Sebelius. I can tell you, having met with Dr.
Collins as recently as 3 days ago, he currently, because of the
uncertainty just of the 2011 budget and the numbers he has to
work with, has given information to grantees all over the
country that he cannot assure them that ongoing funding is
available, and has given a very cautionary note about what they
should do in the future. So we are operating under extremely
uncertain territory right now.
Senator Mikulski. Well, how will you proceed?
Secretary Sebelius. We continue to be hopeful that there
will be a resolution which will give us at least a framework
for the remainder of this fiscal year which, as you know, we
are halfway through. But certainly we have given great notice
to all of our 11 agency directors and everyone throughout the
Department that we are operating on 2010 estimates but to
prepare for the possibility of significant differences.
Let me just give you a snapshot outside of NIH.
Senator Mikulski. Go to any agency. I mean, I raised it----
Secretary Sebelius. We are two-thirds of the way through a
school year with Head Start. If indeed there were to be a cut
right now, we are not sure the programs even have enough money
to make that cut. So, there would be programs that would be
shut down immediately across the country because they literally
do not have enough in their budgets to take the possible cuts.
So we are trying to model scenarios that are very difficult to
try and administer.
Senator Mikulski. Well, Madam Secretary, I know my time is
up.
But, Mr. Chairman, you know, there is this belief that
somehow or another a shutdown will only occur in Washington
with people who ostensibly are overpaid or the lights will go
out on the Washington Monument. I am terrified that the lights
will go out at Johns Hopkins, the University of Maryland. I am
concerned that the lights will go out in my Head Start programs
in the rural parts of my State where they are needed. So, Mr.
Chairman, I think we might have to ask Senator Inouye. We need
to have maybe an all-hands-on-deck hearing on what are the
consequences to this.
Anyway, I exceeded my time. Thank you.
Thank you very much, Madam Secretary.
Senator Harkin. Thank you, Senator.
Senator Kirk.
Senator Kirk. Thank you.
CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION
With all respect, I hope we can reject the administration's
proposal to zero out children's graduate medical education. And
you just head about that as well. I think for, obviously, like
Children's Memorial Hospital in Chicago, La Rabida, et cetera,
I hope we go with regular order on this because the current
system--I do not have faith that the proposal would adequately
provide the trained physician needs in pediatrics. And I hope
the subcommittee goes in that direction.
Senator Harkin. I can assure the gentleman that I share his
concern.
Senator Kirk. Thank you.
WASTE, FRAUD, AND ABUSE IN MEDICARE
I would say, Madam Secretary, you have about a $580 million
request to root out Medicare waste, fraud, and abuse, and you
are running around an 8 to 1 ratio of dollars provided to
dollars saved, which is good.
Another thing that with Ranking Member Shelby and the
chairman that we are working on is to upgrade the very outdated
Medicare card. This is the Medicare card as it currently
exists, and it has none of the standard upgrades that is
available on ID's that are available today.
Now, the Department has funded a pilot project for DME
equipment in Indianapolis, but it is totally outdated. It is
only providing a mag swipe which for $30 can be completely
counterfeited and I think does not represent the technology
that is used by the Federal Government.
This is a common access card of the U.S. military, and 20
million of these have been issued at a cost of approximately $8
each. What I just saw, because I was alert and had a lot of
coffee at the time, is Transportation Security Administration
(TSA) agents have common access cards. So that whole 70,000-man
agency now has this. The critical thing is not just the
enhanced bar code, the optical variable ink, the picture, the
signature, and the chip, but it is all on the back as well.
As far as I know, the Department of Defense (DOD) reports
not a single CAC card has been counterfeited, whereas this card
is pretty easy to counterfeit and the Social Security card
being almost no barrier to counterfeit.
We have agreed to team up and look at how we can use what
is commonly available, and I am hoping you take a look at--and
I would ask you to reach out to Secretary Gates and his team
because I think if we had legislation that went forward to say
to seniors, if you want to protect your ID and help root out
waste, fraud, and abuse, for an $8 fee you can get an enhanced
Medicare card. And I hope we do not reinvent the wheel. I hope
that in fact we reinvent nothing. We just expand the CAC card
to 40 million seniors.
But I wonder if you could explore that.
Secretary Sebelius. Well, Senator, I would love to have our
team work with you on this issue. I do know that there has been
concern that DOD's card is generations ahead of what we are
looking at. It is, as you might understand, a slightly
different universe. They have a closed network system. We have
about 1 million providers. So, it is a challenge of different
proportions. But we do have a new administrator who is
specifically charged with program integrity at CMS, a position
never created before. He is helping to build the new system and
look at ways--and I would love to ask him to follow up with you
and your staff because we would love to take a look at what you
are talking about.
Senator Kirk. I am going to be very much in train with the
chairman and ranking minority here. But I think that a lot of
seniors in this age of identity theft would be pretty
reassured.
Secretary Sebelius. Well, and we are trying, among other
things, to establish the fraudulent card database, because it
is not only seniors losing their card, but it is providers. So
we have got the challenge on both fronts. But I agree with you.
Things that could prevent that in the front end are what we are
looking at. So, I will have Dr. Budetti follow up with you
right away. Thank you.
Senator Kirk. Thank you, Mr. Chairman.
Senator Harkin. I will exercise a little chairman's
prerogative here. I will just back up to what Senator Kirk
said. Senator Kirk brought this up when Mr. Budetti testified
here a few weeks ago. So it would be good for you to contact
him and have him start closing this loop. I concur
wholeheartedly with Senator Kirk. I think this is something
that we just have not paid much attention to and we should. I
hope we can close the loop on this this year --
Secretary Sebelius. You bet.
Senator Harkin [continuing]. And move head on it very
aggressively.
Secretary Sebelius. It sounds like a great bipartisan
proposal. All for it.
Senator Harkin. Actually a great proposal.
Madam Secretary, we will start a second round here of
questions for 5 minutes.
CLASS ACT
The CLASS Act was raised by my good friend, Senator Shelby.
I remember when we discussed this in the healthcare debate and
in developing the legislation. I can tell you, as the chief
sponsor of the Americans with Disabilities Act, now in its 21st
year, and the chief sponsor of the Americans with Disabilities
Act amendments which were just signed into law by President
Bush in 2008, I was very concerned about the CLASS Act and how
it would work. Too many people in our country simply have no
recourse, have no way of setting aside some funds really for a
possible disability that could happen to them or for long-term
care as they grow older.
Right now, one out of six people who reach the age of 65
will spend more than $100,000 on long-term care. Yet, only
about 8 to 10 percent of Americans have private long-term care
insurance coverage. Medicaid now pays more than $110 billion--
$110 billion--annually for long-term care for both the elderly
and the disabled.
So I was one of those. I was very cautiously supportive of
the CLASS Act. I was concerned about whether it would work or
not and how viable it would be. That is why we put into the
legislation the language that would give authority to you, to
the Secretary, to change the program to make sure that it is
financially solvent.
So again, I guess my question to you, Madam Secretary, is
simply that. Are you confident enough that under the
legislation you have the authority to make any changes in the
program to make it financially solvent in the long term?
Secretary Sebelius. Yes, Mr. Chairman, I do think that the
concern about actuarial solvency in the future is one that is
very real, and I have stated that on earlier occasions. Both as
an insurance commissioner working on solvency issues but also
setting up the framework for what an HMO has to have in reserve
and how you model that into the future is something that I take
very seriously. And I think the legislation is very clear that
we cannot turn the switch on in this program unless we can
effectively demonstrate through actuarial models that this is a
solvent program.
Part of the challenge--and Senator Shelby referred to this
earlier--is what the outreach looks like and what the take-up
rate is. If the premiums are too high, the take-up rate will be
very low and only accessed by those who desperately need it. If
indeed there is a broader education effort--and I have to tell
you part of the education effort is directly tied to the fact
that most Americans believe that Medicare covers long-term
care. That is a commonly held belief and often not until they
get close to needing long-term care is there a realization that
really the only program covering long-term care is Medicaid and
that is only if your income is eligible.
So part of the outreach which would have to be done early
on and again to younger, healthier workers is the opportunity
to set aside some income. And again, we are not talking about
competing on long-term care insurance policies. That market
would stay in place. This is really for a range of residential
services. What we also know is that people want to age in
place. They want opportunities to have assistance to stay in
their own homes for a longer period of time, to have care
around areas that they may not be able to do as readily as they
could have years ago and not have a nursing home as the only
option.
But it would need a broad take-up rate, competitively
priced policies, and if that cannot be modeled successfully, we
will not turn the switch on.
Senator Harkin. Thank you very much, Madam Secretary.
Senator Shelby.
CHRONIC DISEASE GRANT PROGRAM
Senator Shelby. Madam Secretary, the President's budget
proposes the elimination of the preventative health services
block grant and proposes a new consolidated chronic disease
grant program at the Centers for Disease Control and Prevention
(CDC). The budget justification in my understanding says this
new grant program will not be a formula grant structure but,
rather, it will be competitive. Rural areas and States without
capacity will be, I believe, disproportionately affected by
competition.
I am concerned that the new chronic disease grant program
will create a scenario where the rich get richer and the poor
get poorer. What are your plans to ensure that State health
departments have the capacity to compete for funds at the
Centers for Disease Control?
Secretary Sebelius. Well, Senator, I----
Senator Shelby. Is that a concern of yours?
Secretary Sebelius. I share the concern that often some of
the, I would say, more underserved areas are also those with
the higher levels of chronic disease. So the worst of all
worlds would be to have a situation where the revenue does not
follow the disease patterns.
The new CDC proposal is to consolidate a series of
separately funded disease programs. Not only does the budget
propose an increase in funding--about $72 million above what
the current level is--but I would suggest gives States the
flexibility of really directing these resources to their target
areas. Every State would get resources. Let me make that clear.
This is not 100 percent of the funds are competed for and there
could be losers and winners. So every State would have a level
of funding, and over and above that, there would be some
additional competition, but it would very much tie I think the
disease profiles in often some of the most underserved areas to
the resources.
But we have heard this proposal was greatly informed by
State health officers who asked us--often they are dealing with
heart disease and diabetes and three or four chronic conditions
that have the same underlying causes. And so rather than having
that funding channeled through separate silos, they said give
us the flexibility of really addressing our State profile, our
situations in a more strategic manner. So that information with
the State health officers is part of what informed this
proposal to have a chronic disease program and get rid of the
separate silos.
CONGRESSIONAL REQUESTS FOR INFORMATION
Senator Shelby. On another subject, Madam Secretary. You
have evidenced a commitment to work with Congress--you have
said this before--to implement the Affordable Care Act.
However, some of my colleagues on the HELP authorizing
committee, specifically Senator Enzi and Senator Hatch have
talked to me, and have many outstanding requests for
information from your Department. I know it is a big
Department. It is very important that the Committees on
Appropriations work with their authorizing committees to
conduct oversight and assess the impact that the law is having
on patients, employers, States, and taxpayers.
To ensure that the Congress has the necessary information
to make informed decisions about the implementation of the new
law going forward, Madam Secretary, would you commit--and have
you committed before--to have your Department respond to
congressional requests, including letters and hearing questions
for the record within 30 days of the request? It is my
understanding from Senators Enzi and Hatch there have been 52
requests and 67 percent no response or incomplete response. Is
that a concern to you? It is to them.
Secretary Sebelius. Senator, we are committed to responding
thoroughly and as timely as possible. We have delivered
hundreds of boxes, thousands of pages of materials. I have had
two hearings in the Senate Finance Committee, and I can assure
you we are trying to get the information as quickly as
possible. The level of requests is significant and takes an
enormous amount of time and energy to gather the materials, but
we are working as fast as we possibly can to be responsive and
as timely as possible.
Senator Shelby. So you are basically committing to be
responsive to their requests.
Secretary Sebelius. Yes, sir.
Senator Shelby. Thank you.
Thank you, Mr. Chairman.
Senator Harkin. Thank you, Senator Shelby.
Senator Johnson.
AFFORDABLE CARE ACT
Senator Johnson. Thank you, Mr. Chairman.
Madam Secretary, I would like to kind of go back to the
earlier questions I was asking about what I consider just
really understated cost estimates for the healthcare act. You
know, back in the 1960s when they passed Medicare, they
projected out 25 years and said that Medicare would cost $12
billion in 1990. In fact, it ended up costing $110 billion,
almost 10 times the original estimate. My concern is our
Federal Government has not gotten any better at estimating
costs.
So you had mentioned, when I started talking, a little bit
about the incentives embedded in this bill for not only
employers to drop coverage but now it is for employees to want
to get into the exchanges because there are such high levels of
subsidies. You talked about that being cynical. I am trying to
be realistic, and I am not the only one I think that has that
same viewpoint.
Douglas Holtz-Eakin, a former CBO director, has issued a
pretty good study where he is talking about a very detailed
decision matrix that pretty well shows that it is in the
employer's best interest and the employee's best interest for
about 35 million people to take advantage of those subsidies
and the exchanges.
Yesterday I believe The Hill reported that Joel Ario, I
believe--I am not sure I am pronouncing that right, but he is
the head of the health insurance exchange office within your
agency--was quoted by saying that if exchanges worked pretty
well, then the employer can say this is a great thing. I can
now dump my people into the exchange and it would be good for
them and good for me.
And that is just what I want to explain. The decision that
an employer is going to be going through is I can pay $15,000 a
year to provide healthcare coverage or I can pay a $2,000
penalty, and by doing that, I am making my employee eligible
for, in some cases, in excess of $10,000 in subsidies. Right
now, in 2018, according to the way the healthcare bill is
written, a family that earns $64,000 will be eligible for a
$10,000 subsidy. And you know, let us face it. When the Federal
Government offers subsidies, they are generally taken advantage
of. So I think it is totally unrealistic to expect only 3
million out of 180 million people to take advantage of those
subsidies.
And my question is what happens if I am right. What if
Douglas Eakin is right and it will be at least 35 million or
even higher? For every 10 million additional people, it is
going to cost $50 billion in additional costs, and that is 33
percent higher than the original cost estimate for this
healthcare act.
Secretary Sebelius. Well, Senator, first of all, the
Affordable Care Act has a ban on large employers even
considering exchanges for at least their first 3 years. So your
scenario in 2018 for large employers is not a possibility
because they would not be eligible to enter into an exchange.
And I think the ban is written in such a way that Congress will
reconsider at the end of 3 years whether that should indeed be
extended, and the vast majority right now who have stable
coverage at least in the employer market is in the large
employer area.
Second, I think that while there are a whole variety of
scenarios, what I know about the existing market is that small
employers have been abandoning the market altogether. The trend
rate for the last 10 years has been sharply downward. So
employees who either are self-employed or farm families or who
are working for a small employer are less and less and less
likely to have any affordable options and therefore are
shopping on their own in what is a very fragile individual
market. So the trend rate is not good at all.
I think there are, again, some very optimistic
opportunities in creating State-based exchanges where small
employers for the first time will have the pooling flexibility
that their large competitors have. They will have an
opportunity to essentially shop without a very sophisticated
human resources (HR) department in a predesigned marketplace
and will have the benefit right now of tax credits that we are
seeing for the first time in a very long time bringing some of
those folks back into the market.
So I think the large employee marketplace will stay
relatively stable and stay fairly much the same, although
hopefully their costs will go down as the CBO predicts, and the
small marketplace, which has been disintegrating dramatically
over years, will again be stabilized.
Senator Johnson. What is the definition of a large
employer? What is the definition that will be excluded from
these exchanges?
Secretary Sebelius. I think the large employer is 100 or
more employees.
Senator Johnson. Thank you.
Senator Harkin. Senator Moran.
INDEPENDENT PAYMENT ADVISORY BOARD
Senator Moran. Mr. Chairman, thank you again.
I want to go back to a couple of topics that we visited
about earlier, Secretary, and then add a third one.
Back to the IPAB. I want to make sure I understand that you
indicated that there was a justification for not including
critical access hospitals in the provisions that eliminate the
potential for the independent board's decision. Does something
need to be done now or are they safe for a while?
Secretary Sebelius. All I was suggesting, Senator, is that
I am speculating that the reason that critical access hospitals
were treated differently in the original proposal was that
critical access hospitals are paid differently in the current
system. So their payment protection stays in place. The law
requires that they get paid based on cost. And that is not the
case of other hospitals.
Senator Moran. Do you support exempting critical access
hospitals from the IPAB through 2019 like the other hospitals?
Secretary Sebelius. Well, I would be supportive of taking a
look at what the proposal would look like. I share your concern
that critical access hospitals are vitally important, and I
just need to look at all the framework that protects them right
now.
MEDICARE SUSTAINABLE GROWTH RATE
Senator Moran. I actually think that because they are paid
differently, they may be a greater target. But there is a
justification that apparently you and I share for why they are
paid differently.
On my other question about the so-called ``doc fix,'' is my
understanding that the administration has a plan for 2012-2013,
but no concrete plan beyond that?
Secretary Sebelius. We have not proposed 10 years of
offsets. As you know, up until probably 1 year ago, the doc fix
was done in a limited fashion a year at a time and never paid
for. I think the President has said it is important to pay for
it. He has proposed in this budget to have what amounts to
about 2\1/2\ years of pay-fors going forward and says we look
forward to working with Congress on a permanent fix for this
situation.
Senator Moran. Well, I made my position clear on the
Affordable Care Act, and that is known. But regardless of your
position on that legislation, the system falls apart if we do
not make the doc fix substantial and permanent.
Secretary Sebelius. There is no question and I have said
that since the outset. As you noted, I mean, the Affordable
Care Act is not what caused the gap in payment and it is not
what will fix it. It really is, I think, something that needs
to be discussed in the overall Medicare system.
Senator Moran. I fear that part of the potential demise of
our healthcare delivery system will be related to the
Government's reimbursement of healthcare providers, that it is
inadequacy, and we will potentially have more providers paid
for by the Government under the Affordable Care Act, and if you
add more people, more providers who are paid at a rate less
than what it costs to provide the service, we lose the
physicians who provide those services, we lose the hospitals
that deliver those services. And so this seems to me to be an
overriding consideration that we just have got to get to.
Finally, your successor's successor has asked for a waiver
under the MOE.
Secretary Sebelius. My successor's successor.
Senator Moran. Yes. Is that true?
Secretary Sebelius. Who is my successor's--I do not know
what we are talking about.
Senator Moran. It depends on what position you have got.
That is true. You have held so many positions. The current
Governor of the State of Kansas has asked for a waiver. I am
interested in knowing the status of that request and what
criteria that you have in place or will put in place to make
those determinations.
Secretary Sebelius. Well, it is my understanding, Senator--
and I think this is the most updated information--that while
there has been some suggestion by Governor Brownback that he
would come to our office with some specifics, we do not have
anything other than the notion that maybe a waiver would be a
good idea. As far as I know, we have no paper. We have no
proposal. We have no notion of what it is that he is talking
about.
We are working actively around the country with States
around not only what they can do to lower their pressing
healthcare costs but ways that other States have taken
advantage of the current law to deliver more effective services
at a lower cost and would look forward to working on Kansas or
any other State. But it is my understanding we really do not
have anything other than a letter saying we are going to come
to you with a proposal.
Senator Moran. Thank you, Secretary. Appreciate our
conversation this morning.
Mr. Chairman, thank you.
Senator Harkin. Thank you, Senator.
Secretary Sebelius. My predecessor's predecessor. Okay.
Successor. That is right. I had predecessors too.
Senator Harkin. Do we need a more Kansas----
Secretary Sebelius. No, no, no. I am just sorting that
title out.
Senator Moran. There is very little good news in the Kansas
world these days.
Secretary Sebelius. We are all bemoaning the Jayhawks.
Senator Harkin. I watched that game. That was quite a game.
Secretary Sebelius. Painful for some of us.
Senator Harkin. That is true.
Well, Madam Secretary, thank you again for your appearance
here. Thank you for your stewardship of this vast and complex
Department. Thank you so much for the clarity and the
forthrightness of your responses here today.
ADDITIONAL COMMITTEE QUESTIONS
The record will stay open for 10 days for other statements
or inclusions of questions by other Senators.
[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 Tom Harkin
Question. Madame Secretary, your budget includes $765 million to
fund the advanced development of the drugs and vaccines that we need to
defend against bioterrorism or a public health emergency. The
Department would like to fund this advanced development by means of
transfers from the Project BioShield Special Reserve Fund (SRF). As you
know, the purpose of BioShield is to provide a financial incentive to
pharmaceutical companies by guaranteeing that the Federal Government
will buy these drugs for the national stockpile. Unless adequate
resources remain in BioShield, we may be calling into question the
Federal Government's commitment to buy these products and therefore
making it more risky for the private sector to remain in the
countermeasure business.
Is there a risk of undermining the entire process of developing
drugs and countermeasures for the stockpile if significantly more
Project BioShield balances are used for other purposes? What is the
Department's plan to reauthorize BioShield and replenish the SRF when
it expires at the end of fiscal year 2013?
Answer. Project BioShield and the Special Reserve Fund have
provided a market guarantee to attract the interest of industry to
medical countermeasures development, and in this they have succeeded.
This market guarantee, however, does little to make drug development
easier or faster. We are just beginning to see the fruits of our
decade-long investment in medical countermeasure development.
Initiatives--such as the Strategic Investor, the Centers of Innovation
in Advanced Development and Manufacturing and additional support for
regulatory science at the Food and Drug Administration--planned to be
undertaken following the Medical Countermeasures Enterprise Review of
last year are designed specifically to remove obstacles to success and
to increase the flow of products through the pipeline, so that Project
BioShield can realize its full potential.
The authorities added to the Public Health Service Act by the
Pandemic All Hazards Preparedness Act have supported advancements in
preparedness and response investments and capabilities. They have
proven beneficial to the Project BioShield program by providing
increased flexibility to support a more robust medical countermeasure
pipeline to respond to chemical, biological, radiological, nuclear
(CBRN) and other emerging threats. There are a number of expiring
authorizations and authorities that should be reauthorized to ensure we
can continue to adequately prepare for public health incidents.
In 2004, in the DHS Appropriations Act (Public Law 108-90),
Congress provided advance appropriations of $5.593 billion for CBRN
countermeasures acquisition from fiscal year 2004 to fiscal year 2013.
Congress subsequently passed the Project BioShield Act (Public Law 108-
276) to authorize the use of these funds for this purpose. The Special
Reserve Fund (SRF), as the Project BioShield appropriation is called,
was intended to serve as a statement of the U.S. Government's
commitment to medical countermeasures development and a market
guarantee to industry as it undertook the arduous process of developing
novel medical countermeasures.
Since its inception, eight products have been acquired using
Project BioShield funds and deliveries have been initiated or completed
to the Strategic National Stockpile, at an aggregate expenditure of
$2.192 billion. Additionally, since the creation of the SRF, $25
million has been rescinded, $995 million had been made available for
the support of BARDA medical countermeasure advanced development, and
$441 million has been transferred for NIH basic research and for BARDA
and NIH pandemic influenza preparedness. Of the funds obligated to date
for purposes other than medical countermeasure acquisition, the vast
majority have contributed directly to maintenance and development of
the medical countermeasure pipeline.
In May 2011, HHS anticipates an award of $433 million for the late-
stage development of an antiviral drug to treat individuals infected
with smallpox. The fiscal year 2012 President's budget requests $1.5
billion, including a request that another $665 million be made
available for advanced research and development and that $100 million
be made available to establish the proposed Medical Countermeasure
Strategic Investor Initiative, which if enacted would leave $742
million for acquisitions between now and the end of fiscal year 2013.
Investments at BARDA have focused heavily on supporting advanced
research and development in recent years, and Project BioShield
acquisitions will also continue through the rest of fiscal year 2011
and into fiscal year 2012.
Question. Madame Secretary, there is a critical need to focus on
drug abuse prevention. Specifically, we should provide sufficient
funding for evidence-based programs that address the use and abuse of
alcohol, marijuana and other illegal drugs. Our country is facing what
the Office of National Drug Control Policy has called an ``epidemic''
of prescription drug abuse. Prescription drugs account for the second
most commonly abused category of drugs, behind marijuana. For this
reason I included language in last year's Senate Report 111-243
indicating my concern about efforts by the Substance Abuse and Mental
Health Services Administration (SAMHSA) to blend mental health and
substance abuse prevention funding:
``Given the paucity of resources for bona fide substance use and
underage drinking prevention programs and strategies, the Committee
instructs that money specifically appropriated to CSAP for substance
use prevention purposes shall not be used or reallocated for other
programs or initiatives within SAMHSA. In addition the Committee is
instructing SAMHSA to maintain a specific focus on environmental and
population based strategies to reduce drug use and underage drinking
due to the cost effectiveness of these approaches.''
Your Department recently issued a Request for Applications for the
Strategic Prevention Framework State Prevention Enhancement Grants,
funded through the Centers for Substance Abuse Prevention (CSAP). The
first goal listed for potential grantees is to: ``With primary
prevention as the focus, build emotional health, prevent or delay onset
of, and mitigate symptoms and complications from substance abuse and
mental illness.'' The third goal listed relates to suicide prevention.
Question. While I recognize that there are common risk and
protective factors for substance abuse disorders and mental illness,
substance abuse prevention programs are unique in focusing on the
environmental strategies for preventing drug and alcohol abuse. Will
the grants issued under this RFA be consistent with the intent of the
language included in last year's Senate Committee report?
Answer. There is a critical need to focus on substance abuse
prevention. As you point out, substance abuse prevention requires
unique environmental and population-based approaches, but it also
requires a focus on common risk and protective factors that put all the
Nation's children at risk. SAMHSA has taken a leadership role, along
with colleagues at NIH, CDC, and ACF, to consider the best way to
encourage States and communities to work collaboratively on the
prevention of substance abuse and on ways to build resilience that will
help our young people, their families, and the systems that serve them.
As you note, a common set of risk and protective factors affects
the development of certain mental and substance use disorders in youth.
The scientific evidence supports an approach that addresses both
substance abuse and mental health prevention in tandem. The 2009
Institute of Medicine Report Preventing Mental, Emotional, and
Behavioral Disorders Among Young People provides evidence for these
common factors. In addition, we know that youth with mental illnesses,
such as depression, are much more likely to use/abuse alcohol or use
substances. A high proportion of youth are under the influence of
alcohol, illegal substances, or nonmedical use of prescription drugs
when they attempt or die by suicide. These issues are not disconnected.
For too long, we have focused on the unique aspects of prevention of
mental illness and substance use/abuse when the evidence shows that
both the substance abuse and the mental health fields can benefit from
employing environmental strategies and supporting the emotional health
of youth.
All SAMHSA grants and contracts are aligned with SAMHSA's Strategic
Initiatives. The grants to be issued under the Strategic Prevention
Framework State Prevention Enhancement Grants (SPE) request for
applications (RFA) support SAMHSA's Strategic Initiative #1--Prevention
of Substance Abuse and Mental Illness. These grants are intended to
focus solely on substance abuse prevention and are strictly consistent
with the intent of the language included in the fiscal year 2011 Senate
Committee report. The language you reference in the RFA is a
description of SAMHSA's Strategic Initiative, which addresses both
substance abuse and the development of emotional health.
We have issued this RFA to assist States, Tribes, and U.S.
Territories in conducting one intensive year of capacity building and
strategic planning to strengthen and enhance their substance abuse
prevention infrastructures to better support communities of high need
throughout the Nation. Through stronger, more strategically aligned
substance abuse prevention infrastructures, SPE grantees will be better
positioned to apply the Strategic Prevention Framework (SPF) process to
achieve more collaborative, cost-effective coordination of services and
to implement data-driven, environmental, and population-based
strategies to reduce substance abuse, including underage drinking.
The fiscal year 2012 President's budget for SAMHSA includes two
separate State Prevention Grants, one for substance abuse and one for
mental health, reflecting the highest priority of HHS on prevention
generally and of SAMHSA on the prevention of both substance abuse and
mental illness--with separate approaches for each. These programs will
continue HHS/SAMHSA's priority to promote emotional health as well as
supporting Congress' direction to focus on environmental and
population-based strategies to reduce illicit drug use and underage
drinking. Likewise, the fiscal year 2012 Budget continues separate
funding to implement underage drinking prevention strategies under the
Sober Truth on Preventing (STOP) Underage Drinking Act.
Question. Madame Secretary, since fiscal year 2002 this Committee
has included funding for the embryo adoption public awareness campaign.
The purpose of this program is to educate Americans about the existence
of frozen embryos resulting from in-vitro fertilization and which may
be available for adoption. In total, we've provided over $23 million
for this program throughout its history.
Please provide an indication of how successful this program has
been. For example, how many adoptions have been made since the start of
the program?
Answer. Because it is a health awareness effort, the impact (and
consequently the success) of the Frozen Embryo Donation/Adoption Public
Awareness Campaign is difficult to directly link to the number of
embryos ``adopted'' in a given year. The success is better measured by
the level of public awareness of the issue among the target population
(in this case infertile couples). The first comprehensive and
scientific attempt to assess the overall impact of the Frozen Embryo
Donation/Adoption Public Awareness Campaign will be conducted in 2012
through the National Survey of Family Growth, which will survey a
nationally representative sample of infertile couples about their level
of awareness of the availability of frozen embryos for adoption.
Estimates derived from the CDC's surveillance system of Assisted
Reproductive Technology indicate that about 2,000 frozen embryos are
adopted each year--a number that has been relatively static since 2004.
______
Questions Submitted by Senator Daniel K. Inouye
ninr's role in the national center for advancing translational sciences
(ncats)
Question. Madam Secretary, scientific inquiry, planned and
conducted by nurses, is a vital part of improving the health and
healthcare of Americans. Nursing research has been a long time catalyst
for many of the positive changes that we have seen in patient care over
the years. The National Institute of Nursing Research (NINR) was given
an fiscal year 2010 appropriation of $145.575 million and has requested
$148.114 million for fiscal year 2012. That would be an increase of
$2.539 million (1.7 percent), which is in line with the increases
requested for many of the other NIH Institutes. The overall increase
requested by NIH for fiscal year 2012 is 2.4 percent. About $1.2
million of the requested increase would support additional funding for
NINR's research grants and training awards. About $1 million of the
increase would support NINR's share of Institute contributions to
several trans-NIH initiatives.
NIH has proposed the creation of a new National Center for
Advancing Translational Sciences (NCATS) to provide the infrastructure
and technologies to bring important discoveries from basic research to
fruition through new diagnostics and therapeutics. What role might NINR
have in working with NCATS?
Answer. Nursing science is historically grounded in the translation
of research and science, and is an essential scientific nexus for these
efforts across the United States and around the globe. NINR and its
scientists, intramural and extramural, are leaders in the translation
of research into health and healthcare interventions. NINR supports
preclinical basic and applied research that integrates biological and
behavioral sciences. NINR scientists are employing new scientific
technologies from diverse fields including neuroscience, genetics and
genomics, molecular biology, biochemistry, and physiology in order to
improve quality of life through health promotion, disease prevention,
and management of symptoms. NINR and nursing science invests in the
infrastructure, resources, and scientific capacity building and
training critical for the success of these efforts.
NINR would collaborate with the proposed National Center for
Advancing Translational Sciences (NCATS) to maintain and enhance
translational and interdisciplinary initiatives across the NIH, as well
as with other government and nongovernment organizations. NINR
currently leads and participates in several interdisciplinary
collaborative programs and partnerships that support translational
science including: the NIH Public Trust Initiative; the NIH Pain
Consortium; and the Clinical and Translational Science Awards (CTSAs).
In particular, the Clinical and Translational Science Awards (CTSA)
program is a major trans-NIH initiative that, since its launch in 2006,
has proven to be a critical component in the NIH efforts to accelerate
research translation. CTSA funded projects touch on all aspects of
translational research including community-based participatory studies,
implementation science, and health services research. Central to the
CTSA program are multifaceted team science, broadly supported
collaborations, and the training and mentoring of the next generation
of interdisciplinary translational scientists--all of which are also
central foci of nursing science.
NINR encourages its scientists to become leaders in the CTSAs.
Working with NIH partners and groups such as the CTSA Nurse Scientists
Special Interest Group, NINR co-sponsors CTSA-related workshops and
symposia to identify research opportunities, highlight successful
exemplars, and develop strategies to maximize the diverse disciplinary
strengths of nursing science. While several current CTSA's include
scientists from nursing specialties who are at the leading edge of
translational and interdisciplinary research, NINR supports the goal of
the CTSA Nurse Scientist Special Interest Group to elevate nurse
scientists to leadership roles in future CTSAs.
adoption of best practices by healthcare professionals and their
patients
Question. NINR supports many activities to enhance the evidence
base for healthcare decisions, including assessing the effectiveness of
new therapies and healthcare interventions for individuals and within
diverse populations. What are your successes and frustrations with
seeing measurable changes in the adoption of such best practices by
healthcare professionals and their patients?
Answer. NINR investigators and research efforts emphasize the
development and use of evidence-based interventions with individuals in
diverse, real-world settings. Nurses and nurse scientists play primary
roles in the translation of research findings into standard practice
because of their prominence in front-line health service provision
across clinical settings. Currently, over 90 percent of NINR-supported
projects are clinically focused.
As a science committed to the translation of evidenced-based
research to the clinician, clinic, and community, nursing science
shares the frustration of the translation-gap between research and
clinical practice. Acknowledging this, nurse scientists are overcoming
the barriers to translation and adoption of research findings through
highly collaborative, interdisciplinary scientific efforts. NINR
supports research efforts from a broad spectrum of disciplines,
involving academic and clinical scientists in settings ranging from
bench laboratories to hospital bedsides.
NINR has experienced successful translation and adoption of
evidence-based programs in key areas such as transitional care, and
patient and caregiver interventions. An NINR-supported program
partnered an interdisciplinary group of caregivers with older heart
failure patients to ease their transition from clinical to home care.
In a randomized clinical trial, the program was successful in reducing
re-hospitalization rates for this high-risk group of patients, and in
addition, it reduced total costs by about 38 percent, or $3,500 per
patient. Another NINR-supported program improved the knowledge and
coping mechanisms for parents of premature infants by facilitating
positive parenting behaviors and lowering parental stress. This
intervention also decreased the length of NICU hospitalization by about
4 days and the associated hospital costs by about $4,800 per infant.
NINR has also supported the development of a behavioral intervention
that significantly reduced the incidence of post-stroke depression in
stroke survivors, compared to patients who only received
antidepressants. Immediate benefits, as well as sustainable
improvements, remained for at least 1 year post-intervention. An
intervention such as this one potentially can have a profound impact on
the long term health outcomes of individuals who have survived a
stroke.
NINR will continue supporting the adoption of evidence-based
research into practice through such research programs as the NINR
Centers Program. Across the United States, these Centers function as
translational research hubs within schools of nursing. Promoting
collaboration between disciplines and across institutions through the
use of shared resources and expertise, this program is designed to
increase research capacity, accelerate translational research, enhance
mentorship of doctoral students and early career scientists, and expand
the science of investigators working on multiple projects. NINR Centers
provide the stable base needed to develop broad, interdisciplinary
translational programs of research to speed the application of research
into practice.
ninr's participation in programs to keep up the supply of nurse
researchers
Question. NIH has various grant and training programs that are
meant to encourage young investigators to pursue research careers and
try out innovative ideas. How does NINR participate in those programs
to keep up the supply of nurse researchers?
Answer. NINR is committed to encouraging, supporting, and
developing the next generation of nurse scientists. NINR training
activities are designed to achieve the vision of creating an
innovative, multidisciplinary, and diverse scientific workforce. In
addition to supporting pre- and post-doctoral research fellowships and
career development awards in the extramural community, NINR also leads
and participates in a number of training programs through its
Intramural Research Program (IRP).
NINR training activities support individual and institutional
graduate and post-graduate research fellowships, as well as career
development awards, including awards to trainees from under-represented
and disadvantaged backgrounds. These programs provide the next
generation of scientists with the necessary, interdisciplinary
education and research skills that will enable them to improve clinical
practice, enhance quality of life for those with chronic illness, and
support preventative health. For example, NINR supports investigators
under the NIH K99/R00 Pathway to Independence (PI) program, in which
promising postdoctoral scientists receive both mentored and independent
research support for up to 5 years.
The NINR IRP also supports several research training opportunities
through programs such as the NINR Summer Genetics Institute, a 1-month
program designed to increase the research capability in genetics among
graduate students and faculty in nursing and to develop and expand the
basis for clinical practice in genetics among clinicians. NINR also
participates in the NIH Graduate Partnerships Program (GPP), in which
doctoral students from schools of nursing with established NINR-
supported training programs can complete their dissertation research
within the IRP. NINR also sponsors the Pain Methodologies Boot Camp,
which is a 1-week intensive research training course in pain
methodology at NIH that is aimed at increasing the research
capabilities of graduate students and faculty through distinguished
guest speakers, classroom discussions, and laboratory training.
An expanded scientific workforce with expertise in these areas of
research will significantly contribute to evidence-based improvements
and reforms to the healthcare system in the coming years. Collectively,
NINR training activities address the national shortage of nurses by
contributing to the development of the nursing faculty needed to teach
and mentor individuals entering the field.
ninr's plans in research on autism, cancer and alzeimer's disease
Question. Does NINR have any particular plans that respond to the
Presidential Initiatives in research on autism, cancer, and Alzheimer's
disease?
Answer. NINR is committed to continuing efforts to support research
that informs the provision of quality care and improving quality of
life for persons with autism, cancer and Alzheimer's disease (AD) and
other dementias, as well as supporting their informal caregivers.
Recent efforts in autism at NINR include the examination of the effects
of an intervention based on self-regulation human-animal interaction
theory (e.g. therapeutic horseback riding) on children and adolescents
with autism, as well as the development of a peer-mentored disaster-
preparedness program for adults living with autism and other
developmental disabilities. NINR is also co-sponsoring an NIH funding
opportunity to support research into the origins, causes, diagnosis,
treatment, and optimal service delivery in autism spectrum disorders.
NINR's cancer research focuses on developing the evidence-base for
enhancing the individual's role in managing disease, managing
debilitating symptoms, and improving health outcomes for individuals
and caregivers. Several NINR-supported scientists are examining how
clinicians and patients work through the treatment and support
decisionmaking process, across the trajectory from diagnosis to end-of-
life and palliative care or illness remission. NINR currently supports
numerous projects in the area of cancer pain research, including
studies to investigate the underlying molecular mechanisms that cause
cancer treatment-related pain, as well as a patient-controlled
cognitive-behavioral intervention for cancer symptoms. Another study is
developing and testing a physician-nurse team intervention to provide
clear and timely end-of-life and palliative care communication to
parents of children with brain tumors. NINR-supported research also
focuses on cancer recurrence prevention and improved quality of life
through such scientific efforts as the development of cancer screening
programs for diverse populations, a genetic cancer risk assessment tool
to improve screening efforts, and a psycho-educational telehealth
intervention for rural cancer survivors. NINR also reaches directly to
the public through such efforts as the development and dissemination of
the NINR publication, ``Palliative Care: The Relief You Need when
You're Experiencing the Symptoms of Serious Illness'' which has been
downloaded from the NINR website nearly one million times.
NINR research on interventions for older adults with AD focuses on
areas such as: alleviating symptoms such as pain, discomfort, and
delirium; improving communication for clinicians; and memory support.
For example, NINR is currently supporting a project to test the
effectiveness of an activity-based intervention designed to increase
quality of life by reducing agitation and passivity and increasing
engagement and positive mood in nursing home residents with dementia.
Another NINR-funded study involves an evidence-based, nurse
practitioner-guided intervention for patients with AD or other
dementia, as well as their family caregivers. The intervention is
expected to improve overall quality of life by decreasing depressive
symptoms, reducing burden, and improving self-efficacy for managing
dementia in caregivers. NINR also emphasizes research on interventions
aimed at improving quality of life and reducing burden for caregivers.
Recognizing the challenges often experienced by caregivers, NINR
supports research on strategies to improve the skills caregivers need
to provide in-home care, to reduce stress and burden, and to maintain
and improve their own health and emotional well-being. Together NINR
and the National Institute on Aging are supporting the Resources for
Enhancing Alzheimer's Caregiver Health (REACH) II program, a
comprehensive, multi-site intervention to assist AD caregivers by
providing strategies to manage stress, maintain social support groups,
and enhance their own health. Multiple efforts across the Federal
Government are currently underway to implement REACH II in the
community, such as through the Administration on Aging's Alzheimer's
Disease Supportive Services Program.
Question. What is the current nursing shortage and how are current
initiatives impacting that shortage?
Answer. Strengthening and growing the primary care workforce--
including nurses and nurse practitioners--is critical to reforming the
Nation's healthcare system. In fiscal year 2010, the ACA Prevention and
Public Health Fund supported $31 million for the training of 600 new
nurse practitioners and nurse mid-wives by 2015 and $15 million for
Nurse-Managed Clinics, which provide primary care and wellness services
to underserved and vulnerable populations. The fiscal year 2012 budget
includes $20 million for these Clinics.
The fiscal year 2012 budget includes $333 million, an increase of
$43 million over fiscal year 2010, to support the training of nurses
and advance practice nurses. The fiscal year 2012 budget initiates a 5-
year effort to fund the training of an additional 4,000 new primary
care providers--including 1,400 advance practice nurses.
Question. Is the Department investing in any efforts to assure that
nurses are available in the regions that need them the most?
Answer. The Administration supports several programs that encourage
nurses to practice in underserved areas and facilities throughout our
Nation. Applicants with initiatives benefitting rural and underserved
areas are given preference for all Public Health Service Act Title VIII
nursing workforce funding.
In addition, the Nurse Education Loan Repayment Program and Nursing
Scholarship Program offer financial support for nurses who agree to
serve in healthcare facilities facing critical shortages of nurses.
The Affordable Care Act provides $1.5 billion for the National
Health Service Corps over the next 5 years, which will help bolster the
supply of clinicians--including nurse practitioners--serving at rural
health clinics, community health centers, and other primary care sites
with a shortage of health professionals.
Question. H.R. 1 proposes to reduce funding for the Nurse Education
and Loan Repayment program by two-thirds. Is this a good idea to reduce
funding when there is such a well documented nursing shortage?
Answer. The Nursing Education Loan Repayment and Scholarship
programs provide financial incentives to nurses who agree to work at
healthcare facilities with a critical shortage of nurses. The proposed
reduction in H.R. 1 would support approximately 850 fewer nurses than
would otherwise be supported. The fiscal year 2012 budget includes $94
million, the same level as fiscal year 2010, for this program in
recognition of the key role that it plays in supporting the recruitment
and retention of nurses in underserved areas.
Question. How is it that HHS says we have a nursing shortage when I
hear that graduating nursing can't find jobs?
Answer. While there remains an overall shortage of nurses, nursing
shortages vary geographically and by sector (e.g., hospitals, nursing
homes). More nurses are delaying retirement and increasing their hours
due to the economic downturn, which has allowed for some temporary
easing in the nursing shortage in some parts of the country. However,
the shortage is still substantial in many parts of the country, and
without sustained production of nurses, the situation will worsen.
Question. Will the funds appropriated from the Community Health
Center Fund (Sec. 10503 of the Patient Protection and Affordable Care
Act) be used to expand this program? If yes, what are the planned
program expansions?
Answer. Native Hawaiian Health Care Programs are not eligible for
funding under Section 10503 of the Patient Protection and Affordable
Care Act.
Question. How would proposals to use some or all of the community
health center fund in lieu of the annual health center appropriation
affect: the program in general; the ability to sustain program
investments made using American Recovery and Reinvestment Act (ARRA
Public Law 111-5) funds; the ability to expand the program; and the
Native Hawaiian healthcare system that is funded from the annual health
center appropriation?
Answer. In fiscal year 2011 the combined resources from the
Community Health Center Fund and discretionary appropriations will
enable the program to sustain investments made using American Recovery
and Reinvestment Act funds as well as create new health center sites.
In total, the Health Center Program will receive a nearly $400 million
increase in fiscal year 2011 above fiscal year 2010 levels.
Question. Secretary Sebelius, there are many different departments
and agencies responsible for our Nation's preparedness and response to
a natural or man-made disaster. Can you talk about the unique role EMSC
plays in those efforts?
Answer. The Emergency Medical Services for Children (EMSC) Program
under section 1910 of the Public Health Service Act (42 U.S.C. 300w-9)
is the only Federal program that focuses specifically on improving the
pediatric components of emergency medical care. The program was created
to address gaps in the provision of quality emergency medical care to
children, and to address the specific anatomical, physiological and
developmental needs of children. The program focuses on improving the
everyday pediatric readiness of the Nation's EMS system to provide the
appropriate infrastructure for disaster preparedness. Furthermore, EMSC
focuses on emphasizing pediatric specific issues in disaster care of a
child in a non-pediatric facility, family reunification, surge capacity
due to the increased vulnerability of children in disaster and transfer
to other facilities for higher levels of care.
Question. Are our Nation's hospitals, ambulances, and first
responders better prepared to treat pediatric patients as a result of
the EMSC program?
Answer. During the 2010-11 assessment of performance measures, the
55 funded State Partnership grantees collected data from over 2,600
emergency departments, approximately 6,660 BLS/ALS agencies, and
conducted an assessment of more than 22,000 vehicles that transport
children in emergency situations.
Findings from select measures demonstrate improvement in the
Nation's pre-hospital provider's access to pediatric medical guidance
in the field, more Basic Life Support (BLS) and Advanced Life Support
(ALS) transport vehicles carrying essential pediatric equipment and
States supporting pediatric continuing education for BLS/ALS providers.
Question. How has the EMSC program helped States be better prepared
for the disaster response and recovery of children?
Answer. The EMSC program is funding projects that will guide
practice in the EMS field for which minimal evidence exist to guide
appropriate delivery of care. Findings are translated into tool kits
and resources that are readily available to States and local
communities. The EMSC National resource center is working with multiple
partner-agencies to develop a web-based resource tool with disaster
related products, publications and resources. This will be available to
States and local communities as they developed their disaster plans.
EMSC is also working with States to develop models of regionalized
care where pediatric resources may be limited. State and Territory
grantees in the Pacific Basin are working on an inter-island agreement
for regionalized care for the pediatric patient. This type of model can
be used in disaster planning as well in which specialty care is
limited, geographical boundaries may require coordination of many
agencies and a prior infrastructure will be essential.
EMSC collaborates with all agencies and systems involved in
providing care to the pediatric patient and are active in contributing
to the special situation of disaster. EMSC continues to provide
important insight to disaster planning since issues of special
equipment, surge capacity, regionalized care are integral to everyday
readiness of pediatric emergency care.
Question. What would a cut along the lines of that proposed in H.R.
1 mean for the 127 health center sites that have opened within the past
year and the almost 3.7 million new patients currently receiving care
at a health center because of the investments through the American
Recovery and Reinvestment Act?
Answer. Funding levels provided in H.R. 1 would impact the ability
of the Health Center Program to fully fund the 127 new access point
grants originally supported by the Recovery Act and would also impact
the number of patients currently served at health centers, including
the 3.7 million patients served through the Recovery Act.
Question. Can you tell us how many applications for new health
centers HRSA has received?
Answer. Over 800 applications have been received for the fiscal
year 2011 New Access Point funding opportunity.
Question. How many awards does HRSA intend to fund?
Answer. HRSA is in the process of determining how many Health
Center New Access Points through Affordable Care Act funding in fiscal
year 2011.
Question. How many awards would HRSA make if H.R. 1 is enacted?
Answer. Under H.R. 1, there would have been no new funding
available to support Health Center New Access Points in fiscal year
2011.
Question. Can you describe the overarching impact on the healthcare
system of the continued health center expansion, as outlined in the
President's fiscal year 2012 budget request?
Answer. The President's fiscal year 2012 budget request for health
centers, more high quality, cost-effective, preventive and primary
healthcare services will be made available nationwide.
Question. Madam Secretary, what additional benefits do health
centers bring to their local communities, in addition to the creation
of jobs and generation of economic activity?
Answer. Health centers increase access to healthcare through an
innovative model of community-based, comprehensive primary healthcare
that focus on outreach, disease prevention, and patient education
activities. For example, evaluations have found that:
--Uninsured people living within close proximity to a health center
are less likely to have an unmet medical need, less likely to
have postponed or delayed seeking needed care, and more likely
to have had a general medical visit.\1\
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\1\ Hadley J and Cunningham P. Availability of Safety Net Providers
and Access to Care of Uninsured Persons. Health Services Research
2004;39(5):1527-1546.
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--Health center uninsured patients are more likely to have a usual
source of care than the uninsured nationally (98 percent versus
75 percent).\2\
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\2\ Carlson, BL et al, ``Primary Care of Patients without Health
Insurance by Community Health Centers.'' April 2001 Journal of
Ambulatory Care Management 24(2):47-59.
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Increasing access and reducing disparities in healthcare requires
quality providers who can deliver culturally-competent, accessible, and
integrated care. Health centers recognize this need and support a
multi-disciplinary workforce designed to treat the whole patient. For
example, evaluations have found that:
--Health center patient rates of blood pressure control were better
than rates in hospital-affiliated clinics or in commercial
managed care populations, and racial/ethnic disparities in
quality of care were eliminated after adjusting for insurance
status.\3\
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\3\ Hicks LS, et al. The Quality of Chronic Disease Care in US
Community Health Centers. Health Affairs 2006;25(6):1713-1723.
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--A high proportion of health center patients receive appropriate
diabetes care.\4\
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\4\ Maizlish NA, Shaw B, and Hendry K. Glycemic Control in Diabetic
Patients Served by Community Health Centers. American Journal of
Medical Quality 2004;19(4):172-179.
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--Health center low birthweight rates continue to be lower than
national averages for all infants. In particular, the health
center low birthweight for African-American patients is lower
than the rate observed among African-Americans nationally (10.7
percent versus 14.9 percent respectively).\5\
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\5\ Shi, L., et al. America's health centers: Reducing racial and
ethnic disparities in perinatal care and birth outcomes. Health
Services Research, 2004; 39(6):1881-1901.
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--Health centers play a critical role in providing healthcare
services to rural residents who tend to have higher rates of
chronic diseases, such as the 27 percent of rural residents
suffering from obesity \6\ and nearly 10 percent diagnosed with
diabetes.\7\
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\6\ Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). ``Health
Disparities: A Rural--Urban Chartbook.'' South Carolina Rural Health
Research Center.
\7\ Pleis JR, Lethbridge-Cejku M. Summary health statistics for
U.S. adults: National Health Interview Survey, 2006. National Center
for Health Statistics. Vital Health Stat 10(235). 2007.
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--Over the past 4 years, cost increases at health centers have been
at least 20 percent below national increases.\8\
---------------------------------------------------------------------------
\8\ Centers for Medicare and Medicaid Services, Office of the
Actuary, National Health Statistics Group: National Health
Expenditures: 2002-2005.
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--Rural counties with a community health center site had 33 percent
fewer uninsured emergency room/department visits per 10,000
uninsured population than those without a health center.\9\
---------------------------------------------------------------------------
\9\ Rust George, et al. ``Presence of a Community Health Center and
Uninsured Emergency Department Visit Rates in Rural Counties.'' Journal
of Rural Health Winter 2009 25(1):8-16.
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--The cost of treating patients with diabetes in health center
settings was approximately $400 less than that experienced by
other primary care settings.\10\
---------------------------------------------------------------------------
\10\ Proser M, Deserving the Spotlight: Health Centers Provide
High-Quality and Cost Effective Care. J Ambulatory Care Management,
2005; 28(4): 321-330.
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--In 2009, health centers generated over $11 billion in revenues and
employed over 123,000 full-time equivalents.
Question. I noticed that the fiscal year 2011 Application and
Guidance released in November of 2010 did not include pharmacist as
part of the eligible participants in NHSC loan repayment program. Are
there any plans in the near future to include pharmacists in the NHSC
loan repayment program?
Answer. The National Health Service Corp (NHSC) program is
currently conducting an analysis of the Loan Repayment Program (LRP)
statute and program policies, which includes a review of the
disciplines the NHSC supports.
The inclusion of pharmacists or other disciplines must be
consistent with the statute that established the NHSC to recruit and
retain primary medical, dental and mental healthcare providers to
provide primary health services to underserved populations in health
professional shortage areas. The Public Health Service Act, which
authorized the NHSC, defines ``primary health services'' as ``health
services regarding family medicine, internal medicine, pediatrics,
obstetrics and gynecology, dentistry, or mental health, that are
provided by physicians or other health professionals'' (42 U.S. Code
Sec. 254d(a)(3)(D)). To date, pharmacists have not been considered an
eligible discipline for participation in the NHSC program.
As part of the discipline review, the NHSC has also conducted a
survey of Community Health Centers and other NSHC-approved sites to
determine the demand for additional disciplines in the NHSC. The
results of this survey are currently under review. Any updates to the
eligible disciplines will be announced through program guidance.
Question. Currently, HRSA collects data on healthcare shortage
areas for primary care. Given the poor outcomes in pregnancy in this
country and the shortage of physicians and midwives, are there any
plans to look at identifying maternity care shortage areas?
Answer. Health Professional Shortage Areas (HPSAs) are designated
by the Department as those areas having shortages of primary medical
care, dental or mental health providers. HPSAs may be geographic (e.g.,
a county or service area), demographic (e.g., low-income population) or
institutional (e.g., federally qualified health center). Among the
factors considered in the designation process are the numbers of
healthcare providers in the area. For the primary care HPSA
designation, Obstetricians/Gynecologists (OB/GYNs) are included in the
provider count when the Department evaluates the number of primary care
providers in an area. As you know, the Affordable Care Act required the
establishment of a Negotiated Rulemaking Committee (Committee) to make
recommendations regarding a revised methodology, criteria and process
for making such shortage designations. The Committee is considering the
role of OB/GYNs in the development of revised criteria for primary care
shortage designation. There are not, however, current plans to
separately identify maternity care shortage areas.
Question. In the remote islands of Hawaii women have few options
for giving birth. We know that freestanding birth centers have improved
access to care and made significant impact on disparities for mothers
and babies. What plans, if any, are there to provide funding to develop
more of these freestanding birth centers in underserved communities?
Answer. The Health Center Program does not provide funding
specifically for the development of birthing centers. However, health
centers may choose to address the primary healthcare needs of their
target populations through a variety of services including obstetrics
care and site locations within their approved Health Center Program
grant.
Question. The Maternal and child health services block grant
facilitate in planning, promoting, coordinating and evaluating
healthcare for pregnant women, mothers, infants, and children, children
with special healthcare needs, and families in providing health
services for those populations who do not have access to adequate
healthcare. I am concerned that decreased funding for this important
program may have a negative impact on our Nation. Would you please
describe the rationale behind decreasing funding for Maternal Child
Block Grants in the fiscal year 2012 budget?
Answer. The fiscal year 2012 budget proposes a decrease to the
Maternal and Child Health Block Grant. The proposed budget would reduce
funding for categorical research grants and not from the MCH grants to
States, in order to respond to the priorities in the fiscal year 2011
final appropriations.
Question. In 2000, Congress launched an important national program,
the National Child Traumatic Stress Initiative, which focuses on a
child traumatic stress, a critical public health problem. With over 130
funded and affiliate programs, this SAMHSA program addresses the
specific needs of children and families who are exposed to a wide range
of trauma, including physical and sexual abuse, violence in families
and communities, natural disasters and terrorism, accidental or violent
death of a loved one, refugee and war experiences, and life-threatening
injury and illness. Over the past 10 years, this program has had strong
bipartisan and bicameral support. The program has been shown to be
extraordinarily effective in expediting science to service through a
collaborative and systems change approach that is helping children and
families recover by improving the treatment and services they receive.
In Hawaii, we have a strong program through our Catholic Charities
Center, and have seen firsthand the benefits of this initiative.
Secretary Sebelius, in fiscal year 2010 the funding for this
program was $40,798,000. In fiscal year 2012, the funding drops to
$11,300,000 a 72 percent cut from fiscal year 2010 funding levels.
Would you please describe the rationale behind cutting funding to this
valuable program?
Answer. SAMHSA is committed to developing and disseminating trauma-
informed services by expanding efforts to infuse trauma-informed
related activities and lessons learned from the 10-year history of the
National Child Traumatic Stress Network (NCTSN) across its entire grant
portfolio. SAMHSA's commitment to bring trauma-informed services to
scale will reach beyond individual programs and grantees, build on the
success of the NCTSN, and include a focus on a diverse mix of
communities (e.g., military families) and trauma-related experiences
(e.g., environmental, historic, economic) while allowing States to
focus resources in communities with the greatest needs. SAMHSA is also
working with the Administration on Children and Families (ACF) and the
Department of Justice (DOJ) to provide technical assistance and share
evidence-based practices and products garnered generated from the
NCTSN. The fiscal year 2012 request for NCTSN does not terminate or
reduce any existing grants.
______
Questions Submitted by Senator Herb Kohl
Question. I am concerned about the timeline of implementing the
physician sunshine provisions (section 6002) of the Affordable Care
Act. Shining light on industry payments to physicians will help
demonstrate the importance of proper research relationships, while
exposing and eliminating conflicts of interest and providing important
information to patients about their health choices.
As you know, the Department of Health and Human Services (HHS) has
a deadline of this October to establish the procedures by which
industry must report information. However, it would be helpful to
release guidance as soon as possible. Businesses and industry will need
time to develop their internal systems to comply with the disclosure
deadline of March 31, 2013. As you develop the guidance, I encourage
you to work closely with stakeholder groups to ensure that the data
collected will be useful and consistent with the legislation's intent.
With these deadlines looming, what is HHS's plan for implementation
of the sunshine regulations? Has your staff been meeting regularly with
stakeholder groups? What is your timetable for proposing the scope of
reportable information? Included in your response, please detail which
office will be drafting and finalizing these rules and why that office
was chosen.
Answer. HHS is moving forward with the implementation of the
Affordable Care Act's requirements related to Section 6002,
``Transparency Reports and Reporting of Physician Ownership or
Investment Interests.'' After reviewing the responsibilities this
provision delegates to the Department, I decided that the Centers for
Medicare & Medicaid Services (CMS) would be the most appropriate agency
to implement all of the requirements. CMS is currently in the process
of rulemaking to establish procedures for reporting and more
information will be forthcoming as the process moves forward. CMS'
Center for Strategic Planning and the Center for Program Integrity have
dual responsibility for developing these regulations. To prepare for
rulemaking, they have individually met with at least seven different
industry stakeholders, and consulted with State agencies from Minnesota
and Massachusetts, which already have considerable experience with this
type of data collection. In addition, on March 24, 2011, CMS held an
open door forum to discuss the provision and to solicit feedback from
almost 500 industry participants. CMS is working hard to meet the
requirements and the deadlines of the physician sunshine provision,
including providing industry with the information they will need to
comply with it.
Question. An estimated 75 percent of all pregnant women use 4 to 6
prescriptions or over-the-counter drugs at some time during their
pregnancy. I am concerned that a proposed rule to improve pregnancy
labeling has been pending at the Food and Drug Administration (FDA) for
nearly 3 years after comments were received in August, 2008. I have
corresponded with HHS and Commissioner Hamburg about this rule and have
not received an adequate response regarding a timeline for its
finalization. I ask again, what is the status of this rule? Given the
importance of this issue to safeguarding the health of pregnant women,
I think getting this proposed rule finalized should be a priority. Is
it a priority for HHS and the FDA?
Answer. Publication of the rule regarding drug labeling for
pregnant and lactating women remains a priority within FDA. Earlier
this year, my staff met with your staff to discuss the status of this
rule, and as they made clear, FDA staff is actively working on the
rule. After a rule is prepared, it undergoes a clearance process prior
to publication. Because the timeframes for preparing the regulation and
completing each step of the clearance process could be affected by
various, unpredictable, factors, FDA cannot say for certain when the
final rule will publish. Please be assured that FDA is committed to
finalizing this rule as promptly as possible.
ncats and the effect on ctsas
Question. I am concerned about the reorganization within the
National Institutes of Health (NIH) that will affect the Clinical and
Translational Science Awards (CTSA) program, in which Wisconsin has a
substantial stake. The NIH invested $42 million into the University of
Wisconsin (UW) in a 5-year CTSA commitment. UW has successfully
leveraged an additional $40 million in local resources. Together, over
the past 4 years these dollars have enabled UW to: (1) train young
scientists in clinical and translational research; (2) pursue clinical
and translational research endeavors through a streamlined and more
efficient research infrastructure; (3) create interdisciplinary
research teams that can pursue diversified research more easily; (4)
sustain a multi-disciplinary partnership across the State with other
major Wisconsin institutions, including the Marshfield Clinic; and (5)
partner with more than 100 community organizations to form research
partnerships and perform collaborative research aimed at improving
health in the community and eliminating health inequities.
The CTSA also promoted intrastate collaboration with UW, whose
efforts have been complemented by independent and collaborative
activities at the Medical College of Wisconsin, where a similar CTSA
grant was awarded. These entities have all made major investments of
resources and capital to deliver on their commitments to CTSA--in
infrastructure, faculty, and research initiatives, to name a few.
Given the impact of CTSA in Wisconsin, I request clarity regarding
the future of this program. The President's budget proposed that the
CTSA program become part of the new National Center for Advancing
Translational Sciences (NCATS) at NIH. However, the future of CTSA and
its scope remains in question. With this in mind, I ask that you
provide me with information about plans regarding CTSAs with respect to
the following: (1) potential and/or planned changes in the CTSA mission
or the scope of the CTSA program in 2011 and beyond, particularly the
goal aimed at engaging communities in clinical research efforts; (2)
potential and/or planned changes in the CTSA budget and in the number
of institutions that may or are likely to receive CTSA funding in 2011
and beyond; (3) potential and/or planned changes in eligibility
criteria for participants in the CTSA program; and (4) potential and/or
planned changes in the process or rules for applicants to receive CTSA
funding.
Answer. The Clinical and Translational Science Awards (CTSA) are
slated to be moved into the proposed National Center for Advancing
Translational Sciences (NCATS) in fiscal year 2012. We believe that
this will be a natural fit; it will serve the CTSAs well to be in an
institute that has a complementary mission to their own, which is to
advance translational sciences.
The CTSAs conduct and support a wide range of translational
research, including therapeutics discovery and development, community
engagement, education and training, and regulatory sciences. Their
contributions in these areas are critical to the mission of NCATS and
the NIH as a whole. However, Director Collins understands the
importance of a smooth transition of this program to a new center. His
goal is to ensure that the CTSAs can continue their important work as
we move to stand up NCATS by October 1. To meet that goal, in April
2011, he convened a trans-NIH working group (the NIH CTSA/NCATS
Integration Working Group) to: (a) enumerate the roles and capabilities
of the CTSAs that can support and enhance the mission of NCATS; (b)
identify CTSA needs and priorities that should be understood and
addressed by NIH and NCATS leadership; and (c) propose processes for
ensuring a smooth transition from NCRR to NCATS.
This group, which is chaired by Dr. Stephen Katz, Director of the
National Institute of Arthritis and Musculoskeletal and Skin Disorders
(NIAMS) will consult with a group of CTSA principal investigators, the
CTSA Consortium Executive Committee (CCEC), who have been involved in
many discussions with the NIH working group as they carry out their
charge. The working groups' recommendations will help Dr. Collins and
his senior staff make informed decisions about the CTSAs that will
ensure a smooth transition into NCATS. No decisions regarding the
administration of the currently awarded CTSAs will be made until they
have completed their work.
CTSA investigators who are not part of the CECC can engage with the
NIH in a number of different ways: utilize the CECC as a conduit of
information both from and to NIH; attend CTSA leadership meetings that
will be held this summer; and provide input directly to NIH through
CTSA staff or the website Feedback NIH.
Question. In 2009, I worked to ensure that long-term care
facilities were eligible for health information technology (HIT)
funding included in the American Recovery and Reinvestment Act by
expanding the general definition of ``healthcare provider'' to also
include nursing and other long-term care facilities. What is the status
of providing HIT funds to long-term care providers? What has been done
to help long-term care providers access these funds?
Answer. The Office of the National Coordinator for Health
Information Technology (ONC) administers grant programs that support
health information exchange within the long-term care community. ONC
provided $265 million to Beacon communities across the Nation. For
example, Bangor, Maine's Beacon community is bringing long-term care
facilities together with hospitals and other physicians to coordinate
care by using health IT.
Additionally, through the State HIE Challenge Grant, ONC awarded
$6.8 million to four grantees for work in improving long-term and post-
acute care transitions through health information exchange. Grant
funding supports the following activities:
--Identification of the data elements for health information exchange
that are relevant to acute to long-term care transitions.
--Determination of strategies to meet improved acute to long term
care transition goals.
--Development of consumer friendly language for personal health
records (PHRs), conversion of transfer forms to electronic
format, and dissemination of best processes for ensuring safe
care transitions--all of which will be integrated into health
information exchange for acute to long-term care transitions.
--Implementation of pilot programs at local and/or regional levels to
test health information exchange for acute to long-term care
transitions, which can then be expanded to the State and
national levels.
ONC is also engaging with the long-term care provider community in
its efforts to establish a clinical electronic infrastructure and
engaging long-term care providers in developing the Electronic Health
Record (EHR) Incentive program's ``Meaningful Use'' definition.
Question. This year offers a prime opportunity to reshape and
modernize aging services through the reauthorization of the Older
Americans Act (OAA). As Chairman of the Senate Special Committee on
Aging, I am looking forward to working with Assistant Secretary
Greenlee to reauthorize the OAA. Has the administration set any
priorities for OAA reauthorization? Please provide a timeline for when
we might expect to receive an OAA proposal from the administration.
Answer. Over the past year, the Administration on Aging conducted
the most open system for providing input on recommendations for
reauthorizing the Older Americans Act in its history, convening and
receiving reports from more than 60 reauthorization listening sessions
held throughout the country, and receiving online input from interested
individuals and organizations, as well as from seniors and their
caregivers. This input represented the interests of thousands of
consumers of the OAA's services, and we continue to receive input and
work with advocates on a variety of issues.
Based in part upon this extensive public input process, we think
that reauthorization can strengthen the Older Americans Act and put it
on a solid footing to meet the challenges of a growing population of
seniors. We look forward to working with you and the Special Committee
on Aging on bipartisan reauthorization legislation.
The following are some examples of areas that we would like to
discuss with the Committee as you consider legislation:
--Ensuring that the best evidence-based interventions for helping
older individuals manage chronic diseases are utilized. A
number of evidence-based programs have proven effective in
helping participants adopt healthy behaviors, improve their
health status, and reduce their use of hospital services and
emergency room visits.
--Improving the Senior Community Service Employment Program (SCSEP)
by integrating it with other seniors programs. The President's
budget proposes to move this program from the Department of
Labor to the Administration on Aging within HHS. The goal of
this move is to better integrate this program with other senior
services provided by AoA. We would like to discuss with you
adopting new models of community service for this program,
including programs that engage seniors in providing community
service by assisting other seniors so they can remain
independent in their homes.
--Combating fraud and abuse in Medicare and Medicaid by embedding the
Senior Medicare Patrol Program (SMP) in the OAA as an ongoing
consumer-based fraud prevention and detection program. The SMP
program serves a unique role in the Department's fight to
identify and prevent healthcare fraud by using the skills of
senior volunteers to conduct community outreach and education
so that seniors and families are better able to recognize and
report suspected cases of Medicare and Medicaid fraud and
abuse. In fiscal year 2009, the program educated over 215,000
beneficiaries in over 40,000 group education sessions and one-
on-one counseling sessions, resolving or referring for further
investigation over 4,000 complaints of potential fraud, error,
or abuse.
Question. The Elder Justice Act established the Elder Justice
Coordinating Council to meet and make recommendations relating to elder
abuse, neglect and exploitation. By law, this council is tasked with
meeting twice annually and reporting to Congress by March, 2012. What
is the status of and timetable for implementing the Elder Justice
Coordinating Council?
Answer. As of March 30, 2011, we have accepted nominations to the
Elder Justice Advisory Board, which makes recommendations to the Elder
Justice Coordinating Council. The timetable for further action is under
development.
______
Questions Submitted by Senator Patty Murray
trauma funding
Question. The Administration's fiscal year 2012 budget proposal
includes $765 million ``to enhance the advanced development of next
generation medical countermeasures against chemical, biological,
radiological and nuclear threats.'' The budget proposal also provides
$655 million ``to ensure the availability of medical countermeasures
from the Strategic National Stockpile during a public health
emergency.''
Given this significant investment in biodefense, I am concerned
that the Administration's budget does not similarly support our
Nation's fragile trauma centers and systems, which will most certainly
be called upon in the event of another terrorist attack or public
health emergency. It is very concerning to note that 23 trauma centers
have closed over the past decade and 45 million people lack access to a
trauma center within 1 hour following injury during which definitive
treatment can make the difference between life and death. In addition,
$80 billion annually is attributed to trauma medical expenses and $326
billion is estimated for lifetime productivity losses for almost 50
million injuries that required medical treatment.
While the Administration's fiscal year 2011 budget includes
funding, albeit decreased, for Public Health and Emergency Preparedness
grants and Hospital Preparedness grants, these funds do not fully
address the urgent needs of our trauma centers and systems.
Given these facts, what is the Administration doing to make the
necessary investments in our Nation's trauma centers and systems?
Is the Administration working to fund the National Trauma Center
Stabilization Act and the Trauma Care Systems Planning and Development
Act (Public Health Service Act sections 1201-4, 1211-32, 1241-46 and
1281-2) so that all Americans have access to trauma care during every
day traumatic events or in the event of another terrorist attack?
Answer. While there is no funding for the National Trauma Center
Stabilization Act and the Trauma Care Systems Planning and Development
Act in the HHS 2012 budget, the Secretary of Health and Human Services
delegated to the Assistant Secretary for Preparedness and Response the
authorities vested in the Secretary under sections 1201-1232 of title
12 of the Public Health Service Act, parts A through C of title 12, (42
USC Sec. 300d through 300d-32), as amended, to administer grants and
related authorities for trauma care. This also included the transfer of
authority from the Health Resources and Services Administration to ASPR
the authorities transferred in the affordable care act. These sections
include four grant programs relating to trauma and emergency medical
care. In addition, section 1201 also provides, among other things, the
authority to sponsor workshops and conferences related to trauma and
emergency care and to conduct and support research related to trauma
and emergency care. This was an important first step in implementing
provision of the Affordable Care Act relating to trauma programs. While
these activities have not received funding, ASPR has undertaken a
cooperative venture with CDC's National Center for Injury Prevention
and Control to assist high-profile cities in improving their plans to
respond to mass casualty events caused by major traumatic events such
as terrorist bombing. Additionally, since the establishment of the
Hospital Preparedness Program, over $3.3 billion has been provided to
hospitals to improve overall surge capacity and strengthen the
capability of hospitals and healthcare systems to plan, respond to, and
recover from all hazard events.
title x funding
Question. Title X is the Nation's cornerstone family planning
program for low-income women. Each year approximately 5 million low-
income individuals receive basic healthcare, including cancer
screenings, birth control, and HIV testing, at clinics receiving funds
under this program.
As we consider recommendations for the coming year, we're mindful
that the House-passed fiscal year 2011 continuing resolution eliminates
all $317 million in funding for the Title X program.
Given that 6 in 10 women who receive care at a Title X health
center consider it their primary source of medical care, what would be
the effects of zeroing out the program?
Answer. The Title X Family Planning program is the only Federal
grant program dedicated solely to providing individuals with
comprehensive family planning and related preventive health services.
The program establishes the framework for the delivery of publicly
funded family planning services in the United States, providing funding
to more than 4,500 sites across the United States, including State and
local health departments, freestanding clinics, hospitals, family
planning councils, and Planned Parenthood agencies. At least 90 percent
of Title X program funds are used to provide clinical services. Title X
services include preventive health services such as cervical cancer
screening, contraceptive counseling and supplies, pelvic exams, breast
and cervical cancer screening, basic infertility counseling, clinical
breast exams, HIV and STI tests, and other services related to
reproductive health and family planning. Title X-funded agencies served
an estimated 5 million individuals each year. At least 90 percent of
the Title X clients served each year have family incomes at or below
200 percent of the Federal poverty level. For many, a family planning
clinic is their entry point into the healthcare system and is
considered to be their usual source of care. This is especially true
for women with incomes at or below 100 percent of the Federal poverty
level, who are uninsured, Hispanic, or black. One-quarter of all poor
women who obtain contraceptive services do so at a site that receives
Title X funding, as do 17 percent of poor women obtaining a Pap test or
pelvic exam and 20 percent obtaining services for a sexually
transmitted infection.
In fiscal year 2009, it is estimated that nearly 1 million
unplanned pregnancies were averted by services provided at Title X
agencies, including more than 233,000 among teens. In 2009, 2,035,017
female clients received screenings for cervical cancer. It is estimated
that these screenings contributed to preventing approximately 670 cases
of invasive cervical cancer. In 2009, more than 2.5 million clients
were tested for Chlamydia and Gonorrhea, and nearly 800,000 were tested
for syphilis. In 2009, nearly 1 million HIV tests were conducted.
Services provided at Title X-supported clinics were estimated to
account for $3.4 billion in savings in 2008 alone. Title X is also
cost-effective--Title X-funded centers saved taxpayers an estimated
$3.4 billion in 2008--or $3.74 for every $1 spent on contraceptive
care. Unintended pregnancy has been linked with numerous negative
maternal and child health outcomes. More broadly, contraception can
enable women and couples to plan and space births, allowing them to
invest in higher education and to participate more broadly in the
Nation's workforce. Title X also provides a critical source of funding
for our Nation's public healthcare infrastructure, which would look
quite different in the absence of Title X funds. In short, in the
absence of Title X, rates of unintended pregnancy, infertility and
related morbidity, and abortion would be considerably higher. In
addition, the public health infrastructure would be negatively
impacted, at a considerable cost to the overall healthcare system.
federal funding for planned parenthood
Question. As you know, the House-passed fiscal year 2011 continuing
resolution prohibits Planned Parenthood from receiving any Federal
funds. Planned Parenthood operates approximately 575 health centers
across the country that receive Title X funds to provide non-abortion-
reproductive healthcare like pap smears, birth control, and cancer
screenings.
Could you tell me what the impact of disqualifying Planned
Parenthood from all Federal funds would be on women and families across
the country, were this policy adopted for into next year's budget?
Answer. More than 800 Planned Parenthood clinics receive some
portion of their funding through a variety of federally funded public
health programs, including Title X and Medicaid. Medicaid is by far the
largest source of funding. For some beneficiaries of these public
health programs, Planned Parenthood serves as a critical source of
services and supplies to prevent unplanned pregnancy, screen for
cervical and breast cancer, vaccinate to prevent cervical cancer, and
obtain pelvic exams and patient education and counseling. Barring
Federal funding to Planned Parenthood agencies could create barriers to
these services, many of which are critical to women's health. Planned
Parenthood estimates that it serves 1.8 million clients with Federal
funds, and provides nearly 4 million STI tests and more than 900,000
cervical cancer screening tests. Without access to these basic
services, rates of STIs, unplanned pregnancy, and abortion could
increase.
Question. Can you describe the overarching impact the continued
health center expansion, as outlined in the President's fiscal year
2012 budget request, will have on the healthcare system, in terms of
the cost-effectiveness and quality of services that health centers
provide? And what about other benefits--like jobs generated and
economic impact?
Answer. Through the President's fiscal year 2012 budget request for
health centers, more high quality, cost-effective, preventive and
primary healthcare services will be made available. Through the fiscal
year 2012 budget request, health centers are projected to employ
thousands of additional staff.
Question. As you know, the Balanced Budget Act of 1997 established
that teaching hospitals may count, for the purposes of indirect (IME)
post-graduate physician education payments, resident time spent in non-
hospital settings, so long as certain conditions are met. One of these
conditions set out in the legislation is that the ``hospital must incur
all or substantially all of the costs for the training program in the
nonhospital setting . . .''.
However, CMS, in its final rules for the Inpatient Prospective
Payment System (IPPS) in 2004, interpreted the law to mean that the
resident time is allowed only when one hospital sponsors the resident's
participation in the non-hospital experience. This interpretation puts
many shared residency rotation programs, including family medicine
residency programs, in my State at risk, at a time when we should be
encouraging more residency programs, not less.
Congress made clear that this was not the intention of the original
legislation in Section 5504 of the Patient Protection and Affordable
Care Act. This section modifies rules governing when hospitals can
receive indirect medical education (IME) and direct graduate medical
education (DGME) funding for residents who train in a non-provider
setting so that any time spent by the resident in a non-provider
setting shall be counted toward direct and indirect medical education
if the hospital incurs the costs of the stipends and fringe benefits.
Are there discussions ongoing at HHS to alter the current
interpretation of resident shared rotation and IME payments,
particularly in light of provisions in the Affordable Care Act?
Answer. As you note in your question, section 5504 of the
Affordable Care Act addresses the situation in which more than one
hospital incurs the costs of training programs at non-provider
settings. The provision allows hospitals to count, on a prospective
basis only, a proportional share of the time that a resident spends
training in such settings when more than one hospital incurs the costs.
The Centers for Medicare & Medicaid Services (CMS) finalized its
proposal to implement section 5504 in the CY 2011 Hospital Outpatient
Prospective Payment System final rule, which was published in the
Federal Register on November 24, 2010. The final rule allows hospitals
to share the costs of resident training at non-provider sites, so long
as those hospitals divide the resident time proportionally in
accordance with a written agreement. In doing so, the final rule
requires that hospitals have a reasonable basis for establishing the
proportion and that the hospitals document the amount they are paying
for the salaries and fringe benefits of the residents for the amount of
time the residents are training at that site.
funding for the national institute for occupational safety and health's
education and research centers
Question. The Administration's fiscal year 2012 budget request
zeroed out all funding for the National Institute for Occupational
Safety and Health's (NIOSH) Education and Research Centers.
What was the original programmatic intent for the National
Institute for Occupational Safety and Health (NIOSH)-funded Education
and Research Centers (ERCs)? As part of your reply to this question,
please provide a copy of the original program announcement for the
record.
Has HHS assessed whether this NIOSH program has fulfilled its
statutory mandate under Section 21 of the Occupational Safety and
Health Act of 1970 to provide an adequate supply of safety and health
professionals?
Has HHS assessed the impact on ERCs from zeroing funding for the
program in fiscal year 2012?
Answer. The original programmatic intent of the ERC program, which
was established in 1977 in response to Section 21(a) of the
Occupational Safety and Health Act, was to create ``education programs
to provide an adequate supply of qualified personnel to carry out the
purposes of the Act''. The program was envisioned as a commitment to
training future professionals to work in industry, public health, and
academia. NIOSH has established partnerships with 48 academic
institutions that comprise the academic network responsible for the
Nation's occupational safety and health professional training
infrastructure. Through university-based ERCs, NIOSH supports academic
degree programs and research training opportunities in the core areas
of industrial hygiene, occupational health nursing, occupational
medicine, and occupational safety, plus specialized areas relevant to
the occupational safety and health field. NIOSH also supports ERC
short-term continuing education programs for occupational safety and
health professionals and others with worker safety and health
responsibilities. Please see attached program announcement from 1976.
[ERC Program Announcement, 1976]
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
Public Health Service
center for disease control
grants for occupational safety and health educational resource centers
program guidelines
The National Institute for Occupational Safety and Health is
implementing a new national competition for training project grants to
support a limited number of Occupational Safety and Health Educational
Resource Centers. It is proposed to establish by 1980, subject to the
availability of funds, at least 10 Center's--at least one in each
Department of Health, Education, and Welfare Region.
Authority
Grants for Educational Resource Centers will be awarded under the
Institute's basic training grant authority, the Occupational Safety and
Health Act of 1970 (29 U.S.C. 670a). Except as otherwise indicated in
these guidelines, the basic policies of the Public Health Service
Grants Policy Statement (HEW Publication No. (OS) 77-50.000 (Rev.)
October 1, 1976) are applicable to this program as are the HEW
regulations on Grants for Educational Programs in Occupational Safety
and Health (42 CFR Part 86).
Background and Objectives
In 1971, the Institute established training grant programs to
assist public or private nonprofit educational institutions in
establishing, strengthening or expanding graduate, undergraduate or
special training of persons in the field of occupational safety and
health in order to provide an adequate supply of qualified personnel to
carry out the purposes of the Act. (Catalog of Federal Domestic
Assistance 13.263). Past and current training project grants have
provided support for primarily, single discipline and single level
occupational safety and health training programs, e.g., in occupational
medicine, occupational health nursing, industrial hygiene, safety
engineering, etc., at either the graduate, undergraduate or technical
and paraprofessional level. The multidisciplinary scope of occupational
health and safety has been recognized by many to be diverse and
complex. It has also been realized that special problems arise at the
workplace from which new concepts develop that do not fall within any
single, traditional discipline. Yet, within this framework, increased
numbers of people must be educated to achieve effective prevention of
the many occupational health and safety hazards that occur at the
workplace.
The objective of this competition is to provide a mechanism for
combining and expanding existing activities and arranging for
coordinated multi-discipline and multi-level training and continuing
education in occupational safety and health under a single grant
servicing a geographic region. The program is intended to afford
opportunity for full- and part-time academic career training, for cross
training of occupational safety and health practitioners, for mid-
career training in the field of Occupational Health and Safety, and
access to many different and relevant courses for students pursuing
various degrees. Further, the combination of these should result in
cross-fertilization among the various disciplines and levels of
occupational safety and health practice.
It is anticipated that Centers will form from bases of ongoing
educational, research and training activities in occupational safety
and health. It is not intended to generate these activities de novo as
this would not net the objectives of this program.
Eligibility Requirements
An eligible applicant is any public or private nonprofit
educational or training agency or institution located in a State:
provided that no agency or institution is eligible for assistance for a
separate training project grant in any project period in which it
receives an educational resource center grant. However, this will not
preclude an existing training grant from being incorporated into an
educational resource center grant award.
A Center may be comprised within one educational institution or
agency or within an association of two or more institutions or
agencies. Educational and administrative justification for any joint
arrangement must, however, be fully documented in the application. If
such proposals are made, each institution, proposing to participate in
a joint arrangement must also participate in the application by
delineating the educational and training activities that in totality
constitute the Educational Resource Center and which, through
interaction and proximity, will improve the probability of the success
of the total program, as indicated in the guidelines below. Current
Public Health Service policy covering consortia and collaborative
arrangements must be complied with. A proposal for a Center which is in
effect a collation of unrelated training activities will not be
considered responsive.
Characteristics of an Educational Resource Center
An Occupational Safety and Health Educational Resource Center
should be an identifiable organizational unit within the sponsoring
organization and shall have the following characteristics:
--Cooperative arrangements between a medical school (with
anestablished program in preventive or occupational medicine);
school of nursing and school of public health or its
equivalent, and school of engineering or its equivalent. Other
schools or departments with relevant disciplines and resources
may be expected to be represented and contribute as appropriate
to the conduct of the total program, e.g., toxicology,
biostatistics, environmental health, law, business
administration, education, etc.
--A Director who possesses a demonstrated capacity for sustained
productivity and leadership in occupational health and safety
training, He shall oversee the general operation of the Center
Program and shall, to the extent possible, directly participate
in training activities.
--A full-time professional staff representing various disciplines and
qualifications relevant to occupational safety and health to be
capable of planning, establishing, and carrying out or
administering training projects undertaken by the Center.
--Training and research expertise, appropriate facilities and ongoing
training and research activities in occupational safety and
health areas.
--A program for conducting education and training of occupational
physicians, occupational health nurses, industrial hygienists/
engineers and safety personnel. There shall be full-time
students in each of these core disciplines, with a goal of a
minimum of 30 full-time students. Training may also be
conducted in other occupational safety and health career
categories, e.g., industrial toxicology, biostatistics and
epidemiology, ergonomics, etc. Training programs shall include
appropriate field experience including experience with public
health and safety agencies and labor-management health and
safety activities.
--Impact on the curriculum taught by relevant medical specialties,
including radiology, orthopedics, dermatology, internal
medicine, neurology, perinatal medicine, pathology, etc.
--A program to assist other institutions or agencies located within
their region including schools of medicine, nursing and
engineering, among others, by providing curriculum materials
and consultation for curriculum/course development in
occupational safety and health, and by providing training
opportunities for faculty members.
--A specific plan for preparing, distributing and conducting courses,
seminars and workshops to provide short-term and continuing
education training courses for physicians, nurses, industrial
hygienists, safety engineers and other occupational safety and
health professionals, paraprofessionals and technicians,
including personnel of labor-management health and safety
committees, in the geographical region in which the Center is
located. The goal shall be that the training be made available
each year to a minimum of 200-250 trainees representing all of
the above categories of personnel, on an approximate
proportional basis with emphasis given to providing
Occupational Safety and Health training to physicians in family
practice, as well as industrial practice, and industrial
nurses. Where appropriate, it shall be professionally
acceptable in that Continuing Education Units (as approved, for
example, by the American Medical Association, American Nursing
Association, etc.) may be awarded, These courses should be
structured so that either educational institutions, public
health and safety agencies, professional societies or other
appropriate agencies can utilize them to provide training at
the local level to occupational health and safety personnel
working in the workplace. Further, the Center shall have a
specific plan and demonstrated capability for implementing such
training directly and through other institutions or agencies in
the region, including cooperative efforts with labor unions and
industry trade associations where appropriate, thus serving as
a regional resource for addressing the problems of occupational
safety and health that are faced by State and local
governments, labor and management.
--Specific mechanisms to implement the cooperative arrangements,
e.g., between departments, schools/colleges, universities,
etc., necessary to insure that the comprehensive, multi- or
core-disciplinary training and education that is intended shall
be engendered.
--A Board of Advisors or Consultants, with representation of the user
and affected population, including representation of employers
and employees, of the Center outreach and continuing education
and training programs should be established by the grantee
institution to assist the Director of the Center in periodic
evaluation of the Center activities.
An application for a Center grant must address each of the above
points. The nature and organization of the appropriate administrative
teaching and support staffs and necessary supplies, equipment,
facilities, etc., should be clearly detailed in the proposal and
clearly related to the budget requested. This program cannot provide
funds for new construction or major alterations or renovations, thus
facilities must be available for the primary needs of the proposed
Center activities.
Criteria for Review
The applications for Occupational Safety and Health Educational
Resource Centers solicited in this announcement will be evaluated in
national competition. The review is expected to involve a site visit.
The reviewing applications criteria utilized include:
--The overall potential contribution of the project toward meeting
the needs for qualified personnel to carry out the purposes of
the Occupational Safety and Health Act of 1970, the expressed
purpose of which is to ``assure so far as possible every
working man and woman in the Nation safe and healthful working
conditions and to preserve our human resources--by providing
for training programs to increase the number and competence of
personnel engaged in the field of occupational safety and
health.''
--The need for training in the areas outlined by the application,
including projected enrollment, recruitment, regional needs
both in quality and quantity, similar programs, if any, within
the geographic area.
--The extent to which arrangements for day-to-day management,
allocation of funds and cooperative arrangements are designed
to effectively achieve Characteristics of an Educational
Resource Center, above.
--The extent to which curriculum content and design includes
formalized training objectives, minimal course content to
achieve certificate or degree, course descriptions, course
sequence, related courses open to students, time devoted to
lecture, laboratory and field experience, the nature of the
latter (primarily applicable to academic training).
--Previous record of training in this or related areas, including
placement of graduates.
--Methods proposed to evaluate effectiveness of training.
--The competence, experience and training of the Center Director and
of other professional staff in relation to the type and scope
of training and education involved.
--Institutional commitment to Center goals.
-- Academic and physical environment in which the training will be
conducted, including access to appropriate occupational
settings.
-- Appropriateness of the budget required to support each component
of the program.
Operational Aspects
Although the mechanism for support for the Center will be a
training grant, it will differ from other grants in its emphasis on
priority of occupational safety and health training in the medical and
nursing disciplines and in conducting an outreach program in curriculum
development and continuing education projects designed to increase
admissions to and enrollment in occupational safety and health training
of persons who, by virtue of their background and interest or position,
are likely to engage or participate in the delivery of occupational
health and safety services.
While it is expected that each Center will plan, develop, direct
and execute its own program, it must also be responsive to the
identified needs of the National Institute for Occupational Safety and
Health, both in content and direction. The award of a Center grant will
establish a special collaborative relationship between the National
Institute for Occupational Safety and Health and the grantee
institution. NIOSH staff, with consultation and assistance from
representatives of the kinds of user groups of the Center program
(e.g., academic labor, management and public health and safety
agencies) will provide initial and continuing review and evaluation of
the Center programs.
From 2005 to 2010, the number of trained occupational safety and
health (OSH) professionals has steadily increased. There were 1,191
graduates during the past 5 academic years (from 2005-06 to 2009-10).
Of these 1,191 ERC graduates 978 (82 percent) entered careers in OSH or
entered more advanced degree programs in OSH. This is due to the
increase in awareness of OSH and the comprehensive curriculum which
provides a variety of continuing education opportunities for OSH
professionals. Of the 287 ERC graduates in 2009-2010, 234 (82 percent)
entered careers in OSH or entered more advanced degree programs in OSH.
Within the context of a budget that requires tough choices, we put
forth a proposal to discontinue Federal funding for the ERCs. We
recognize the vital role of occupational safety and health professional
training. This proposal is one of many difficult reductions we proposed
as part of the fiscal year 2012 budget.
funding for the national institute for occupational safety and health's
agriculture, fishing and forestry program
Question. The Administration's fiscal year 2012 budget request also
zeroed out all funding for the National Institute for Occupational
Safety and Health's (NIOSH) Agriculture, Fishing and Forestry Program.
How does the rate of occupational injury and illness and fatalities
in agriculture, fishing and forestry (AgFF) compare with injury rates
in general industry.
Did the 2007 National Academy (NA) review of NIOSH's Agriculture,
Forestry and Fishing research program recommend elimination of the AgFF
program?
Did the NA review recommend relocating AgFF research activities to
the Department of Labor or USDA?
Answer. The fatality rate in the Agriculture, Forestry, and Fishing
industry is more than seven times higher than that of general industry.
Although the data from 2009 are still provisional, based on the Bureau
of Labor Statistics (BLS), Census of Fatal Occupational Injuries,
workers in the Agriculture, Forestry, and Fishing industry had an
average fatality rate of 28.1 per 100,000 full-time equivalent workers
from 2006-2009 while general industry had an average rate of 3.8 per
100,000 full-time equivalent workers during the same time period. The
rate of nonfatal occupational injuries and illnesses in the
Agriculture, Forestry, and Fishing industry is slightly higher at a
rate of 5.6 per 100,000 full-time equivalent workers than that of
general private industry at a rate of 4.1 per 100,000 full-time
equivalent workers from 2005-2009.
While the 2007 National Academy (NA) review of NIOSH's
Agricultural, Forestry and Fishing research program raised some
questions about the impact of this research on workplace injury and
illness, it did not recommend elimination of the AgFF program.
The NA review did not recommend relocating AgFF research activities
to the Department of Labor or USDA. Instead, NA recommended that the
AgFF program continue to partner with appropriate Federal and State
agencies and establish additional interagency partnerships to increase
the capacity for carrying out research and transfer activities.
______
Questions Submitted by Senator Mary L. Landrieu
child welfare finance reform
Question. Could you explain the Administration's vision for foster
care reform, and why the need for reform is so urgent?
Answer. The President's budget proposes $2.5 billion over 10 years
to align financial incentives with improved outcomes for children in
foster care and those who are receiving in-home services or post-
permanency services from the child welfare system, in order to prevent
entry or re-entry into foster care. We envision States that receive
performance-based funding to be able to support activities that can
improve outcomes for children who have been abused or neglected or at
risk of maltreatment. We believe our proposal will keep the focus on
moving child welfare in the right direction, particularly during these
difficult budget times in States. The proposal incentivizes all States
to improve outcomes by allowing them to earn additional funds that can
be invested in activities that can drive further progress for the
children and families served.
We look forward to working with Congress on developing specific
details, guided by the principles outlined in our fiscal year 2012
budget:
--Creating financial incentives to improve child outcomes in key
areas, by reducing the length of stay in foster care,
increasing permanency through reunification, adoption, and
guardianship, decreasing rates of maltreatment recurrence and
any maltreatment while in foster care, and reducing rates of
re-entry into foster care;
--Improving the well-being of children and youth in the foster care
system, transitioning to permanent homes, or transitioning to
adulthood;
--Reducing costly and unnecessary administrative requirements, while
retaining the focus on children in need;
--Using the best research currently available on child welfare
policies and interventions to help the States achieve further
declines in the numbers of children who need to enter or remain
in foster care, to better reach families with more complex
needs, and to improve outcomes for children who are abused,
neglected, or at risk of abuse or neglect; and
--Expanding our knowledge base by allowing States to test innovative
strategies that improve outcomes for children and reward States
for efficient use of Federal and State resources.
chafee foster care independence program
Question. Can you explain why, in light of the rising number of
foster youth who ``age out'' of care, the Administration has not
proposed to increase funding for Chafee?
Answer. In an environment of limited resources, we have chosen to
provide additional funds to align financial incentives with improved
outcomes for children in foster care and those who are receiving in-
home services or post-permanency services from child welfare system, in
order to prevent entry or re-entry into foster care. States may use
these funds to provide services to youth who are in foster care before
they age out as well as provide post-permanency services to those who
age-out of the foster care system. We believe our proposal will keep
the focus on moving child welfare in the right direction, particularly
during these difficult budget times in States.
Question. If Congress does not meet the President's budget request
of $3.3 billion for the Health Centers Program, what will be the impact
on rural and urban underserved populations? Can you also describe the
economic impacts of not adequately funding the Health Centers Program?
Answer. It will reduce to some extent the expansion of the Health
Center Program (and its associated economic impact) into new
underserved rural and urban communities.
Question. Recognizing the vital role School Based Health Centers
play in serving as a safety net provider for our children and
adolescents, why wasn't funding for the operations of School Based
Health Centers included in the fiscal year 2012 budget request? For
fiscal year 2013, do you see putting School Based Health Centers in the
President's budget as an approach that could be utilized to grant
greater access to care for our youth?
Answer. School-Based Health Centers may apply for operational
support under the Community Health Center program. For example,
interested school-based health centers could have applied for the
Affordable Care Act New Access Point opportunity announced last August
to support new healthcare service delivery sites, if Health Center
Program eligibility criteria were met. Previous operational funding for
health center sites serving school-aged populations and/or located in
schools has been awarded under the Community Health Center Program.
Question. HHS, as well as other Federal agencies, has found great
success with telehealth programs in the treatment of high-cost
patients. As these programs advance, where do you see the best
opportunities not only to maximize cost savings but to provide patients
with better care and improve clinical outcomes?
Answer. The Telehealth Network Grant Program (TNGP), grants have
offered underserved populations the opportunity to access a diverse
variety of clinical services to underserved people in rural areas which
include: allergy, asthma control, cardiology, diabetes care and
management, pain management, remote patient monitoring, and a variety
of other services.
For the relatively more mature Telehealth Networks (TNGP-TH)
provisions, one clinical health outcome measure, diabetes case
management, is being collected, as well as several outcome measures
related to improving access and program efficiency. One of the
responsibilities of OAT's Regional Telehealth Resource Centers (TRCs)
is to track evidence-based telehealth practices in their regions, and
share that information through the technical assistance that they
provide to HRSA grantees, rural and other underserved communities. The
TRCs share information about cost savings, improved quality and
increased access through telehealth applications via their websites,
webinars, conference calls, presentations at conferences, and one-on-
one consultations.
Question. What are the other areas within the Department of Health
and Human Services where Federal support for telehealth technology can
be initiated or expanded?
Answer. HRSA's formal telehealth authority is through ORHP's OAT,
as mentioned in the previous question. HRSA's ORHP is not aware of
other areas within the Department of Health and Human Services where
Federal support for telehealth technology can be initiated or expanded.
Question. What areas within HHS, including the Centers for Medicare
and Medicaid Services and the Center for Medicaid and Medicare
Innovation could be used to increase Federal support for telehealth?
Answer. CMS continually looks for ways to expand the use of
telemedicine in our programs to provide high quality healthcare
services in the most efficient manner possible. To that end, CMS
annually considers requests from the public to add to the list of
telehealth services covered by Medicare Part B, and adds new telehealth
services as appropriate as part of the Medicare Physician Fee Schedule
rulemaking process. CMS also recently finalized new rules for
telemedicine services to ensure that patients in rural or remote areas
will continue to receive access to high quality, cutting-edge medical
care through the use of telemedicine from many of their local
hospitals. The new finalized rules streamline the process that
hospitals and critical access hospitals (CAH) use for credentialing and
granting privileges to physicians and practitioners who deliver care
through telemedicine. The new rule will also permit hospitals to more
easily partner with non-hospital telemedicine entities, such as
teleradiology facilities, to deliver specialty care via telemedicine.
______
Questions Submitted by Senator Richard J. Durbin
the effect of reducing nih funding to 5 percent below fiscal year 2010
Question. In February the House passed an appropriations bill for
fiscal year 2011 that proposed cutting the National Institutes of
Health's (NIH's) budget by $1.6 billion or 5 percent compared to NIH's
fiscal year 2010 budget.
Please provide the NIH's perspective on how such a cut would impact
the NIH and our Nation's economic recovery?
Answer. A $1.6 billion decline from NIH's fiscal year 2010 budget
levels could have adverse consequences for the research community and
could delay current research efforts. It could result in lost
opportunities to develop more cost effective diagnostics and treatments
in areas such as developmental disorders, addiction, mental illness,
infectious disease, cancer, heart disease, and neuro-degeneration.
Specifically, in the area of translational research, more than 100
clinical trials and studies for more precise tests and more effective
treatments of common and rare diseases affecting millions of Americans
could be halted or curtailed. Medical practices that could have been
shown obsolete or needlessly expensive would not be fully evaluated.
In the area of basic research, in just the last 2 years, advances
in whole genome sequencing, methods to grow stem cells not derived from
human embryos, automated equipment that can perform thousands of
experiments at the same time, and previously untried drug design
techniques have all become available for the first time, providing
unprecedented opportunities for research advances at relatively low
cost, many of which could be delayed by these budget cuts. Reductions
in funding the pipeline of basic research could slow the discovery of
fundamental knowledge about how we grow, age and become ill. Valuable
research supporting the prevention of a host of costly, debilitating
chronic conditions could suffer setbacks. Some projects could be
difficult to pursue at reduced levels and could be cancelled; others
could require scope modifications that would dramatically alter the
potential research outcomes.
Budget cuts could effect universities and the private-sector.
Grantee personnel budgets may be reduced. Training grants could be
materially impacted and the population of qualified research trainees
and advanced science instructors could diminish. Some universities,
especially those with research programs in earlier stages of
development, may need to prioritize between training new physicians and
scientists and closing laboratories. In the private sector, high-tech
and low-tech small-business suppliers could face order cancellations.
New equipment prototypes and laboratory methods important to private-
sector pharmaceutical and device research could delay development,
leaving fewer product options available for U.S. companies to offer as
exports in response to the expected rapid rise in health spending in
China and the developing world. Supplies of highly-trained technology
workers in America could further diminish.
Question. Approximately how many NIH-funded jobs could be lost as a
result of a 5 percent cut to the agency's budget?
Answer. NIH estimates that 10,500 full-time-equivalent (FTE)
positions could potentially be lost as a result of a $1.6 billion cut
to the agency's budget. This estimate is based on the average number of
FTE per million dollars of funding reported by recipients of research
funds under the Recovery Act.
Question. Congenital Heart Disease (CHD) is one of the most
prevalent birth defects in the United States and a leading cause of
birth defect-associated infant mortality. Due to medical advancements
more individuals with congenital heart defects are living into
adulthood, unfortunately our Nation has lacked a population-
surveillance system for adults with CHD. The healthcare reform law
included a provision, which I authored, that authorizes the CDC to
track the epidemiology of congenital heart disease, with an emphasis on
adults with CHD and expanding surveillance. If adequately funded, what
could be the public health impact of this surveillance system and how
could it advance our understanding of the prevalence or CHD across
subgroups (including age and race/ethnicity).
Answer. Development of population-based surveillance for congenital
heart disease across the lifespan would be a critical first step in
generating information on prevalence across different age groups, race/
ethnicity and socioeconomic groups in the population, as well as
possible determinants of health disparities in neurocognitive outcomes,
disabilities, survival, and quality of life. This population-based
approach to identifying and following affected persons over time would
have a significant public health impact by:
--Estimating the true prevalence of CHD in the United States.--It is
estimated that about 1 million adults are living with CHD in
the United States, and given the improvements in treatment and
decreasing mortality, this number continues to grow. However,
this estimate is imprecise without population-based
surveillance systems to track adolescents and adults with CHD.
Accurately determining national prevalence estimates of CHD
requires high-quality population-based surveillance of a
representative sample of affected individuals using
standardized surveillance methods.
--Estimating the healthcare costs associated with CHD.--All adults
with CHD have significantly higher rates of healthcare
utilization than their peers. Furthermore, if adults with CHD
develop other chronic conditions, such as diabetes, the
interactive effect of the congenital anomaly with the other
diseases remains unknown. Currently, estimates of direct costs
for adults are often specific to inpatient admissions, and do
not include hospitalizations in which CHD was not the primary
reason for admission nor costs associated with outpatient
visits, prescription medications, or other indirect costs for
the affected individuals, their families, and society.
Therefore, information from a population-based surveillance
system would improve planning for the future utilization of
healthcare resources and enhance our understanding of the
economic costs of CHD among adults.
--Identifying factors associated with adverse outcomes across the
lifespan.--Persons with CHD are at risk for adverse health
outcomes such as neurodevelopmental and cognitive outcomes and
premature death, yet little is known about risk factors for
these outcomes and how they differ among subpopulations.
Identifying and following affected persons over time to track
adverse outcomes could help us understand factors such as
health disparities that might predispose to or ameliorate
adverse outcomes, and characterize the health services needs of
this population.
--Providing reliable, evidence-based information to guide diagnosis,
management, and secondary prevention efforts.--Currently, many
adults with CHD in the United States receive inadequate care
because of the lack of information to guide the clinical
management of a child with a congenital heart defect as he or
she ages into adulthood. Adults and their healthcare providers
have become increasingly aware of the need for reliable,
evidence-based information to guide diagnosis, management, and
secondary prevention efforts.
Collecting and analyzing data on outcomes over time could improve
understanding of the long-term course of CHD, the factors that
might influence such course, and the health services needs
across the lifespan. These data could also help inform efforts
to develop effective primary and secondary prevention
strategies directed at reducing the public health impact of
CHD. The data could also be used to develop and evaluate the
effectiveness of interventions such as guidelines for routine
preventable care for children, adolescents, and adults with CHD
designed to reduce poor outcomes and high cost of treating
individuals who otherwise do not seek or receive adequate care
until in a medical crisis.
Question. Currently, when a person enrolls in Medicare, their
Social Security Number (SSN) is used the basis of their Medicare
identification number. The Social Security Inspector General has
indicated that this creates a risk of identity theft and fraud and has
suggested that the SSN be removed from the Medicare card. How do you
think this risk to Medicare beneficiaries and the Federal program could
be reduced?
Answer. CMS is currently investigating the viability and costs of a
range of options for removing the SSN from Medicare beneficiary cards.
There are considerable costs associated with changing the Medicare
beneficiary identifier, not only for CMS but also for our public and
private sector partners. The SSN identifier in the health insurance
claim number (HICN) is the basis of eligibility for Medicare, and is
integrated in more than 50 CMS systems, as well as communications with
our partners in the Social Security Administration, State Medicaid
departments, private Medicare health and drug plans, and over 2 million
healthcare providers and suppliers. The risks of disruptions in
beneficiaries' access to care are considerable.
I want to emphasize, however, that CMS shares your concerns about
the importance of safeguarding and protecting Medicare beneficiaries
from identity theft. We have taken many important steps to minimize the
display of SSNs or HICNs on Medicare cards. We removed the SSN from
various notices and publications sent to beneficiaries, and from
beneficiary reimbursement checks. We prohibited Part C and D Plans from
using the SSN or HICN as a beneficiary identifier. We have also taken
action to educate beneficiaries about steps they should take to prevent
identity theft and fraud, including posting information on the CMS
website, and adding information to the ``Medicare & You'' Handbook.
Question. On December 20, 2010 you sent a response letter entitled
``Concern on Hepatitis'' to Members of Congress, which directed
Assistant Secretary Dr. Howard Koh to convene an interagency working
group tasked with developing an HHS Action Plan on Viral Hepatitis. Can
a specific date be provided for when the Action Plan will be released?
Once the Action Plan is released how will HHS prioritize resources and
give direction to the various Departmental operating divisions to
ensure steps are taken to curtail the escalating costs associated with
viral hepatitis and the costly outcomes such as liver cancer and end-
stage liver disease?
Answer. We anticipate that the HHS Action Plan for the Prevention
and Treatment of Viral Hepatitis will be released on May 12, 2011. The
Action Plan will help HHS improve its current efforts to prevent viral
hepatitis by leveraging opportunities to improve coordination of viral
hepatitis activities across HHS operating divisions and by providing a
framework for HHS to engage other governmental agencies and
nongovernmental organizations in viral hepatitis prevention and care.
For example, the Action Plan calls for the alignment of HHS guidelines
for the diagnosis of Hepatitis B and Hepatitis C infection. Such
alignment will improve provider understanding, thus supporting
screening efforts and promoting earlier diagnosis of viral hepatitis.
Identifying and disseminating best practices regarding prompt linkage
of persons testing positive for viral hepatitis into needed care and
treatment and developing effective medical management models for use in
priority populations, like injection drug users, will improve care
outcomes and reduce the negative health outcomes of chronic hepatitis.
Finally, on the basis of available funding, the NIH will expand
existing clinical trial networks to expand studies of viral hepatitis
treatment. Improving treatment for hepatitis C and other causes of
viral hepatitis will eventually decrease the number of persons with
chronic hepatitis, thus decreasing the costly sequelae of end stage
liver disease.
______
Questions Submitted by Senator Jack Reed
cdc state cancer registries (pediatric cancer surveillance)
Question. The fiscal year 2012 budget for the Centers for Disease
Control and Prevention (CDC) proposes to consolidate a variety of
programs that address chronic disease into a Coordinated Chronic
Disease Prevention and Health Promotion Grant Program. This program
will mix core funding with competitive grants to States and other
entities. CDC's cancer-related efforts are included in this new
program.
As the author of the Conquer Childhood Cancer Act, which authorized
investment in childhood cancer surveillance efforts--among other
provisions--I am particularly concerned that the consolidation will
take attention away from sub-populations. For example, more timely and
accurate data collection of pediatric cancer cases and treatments can
help researchers determine appropriate treatments and interventions. I
helped secure $3 million for this effort last year and it was welcome
news to the entire pediatric cancer community.
It appears that with the new approach, States will allocate funds
to improving outcomes among large populations where very small changes
can make a big difference. While this will help them secure additional,
competitive grant funding, there are smaller populations that will
likely receive less attention.
How will you ensure that States continue to apply the funds they
receive to continue to build their pediatric cancer surveillance
efforts?
Answer. The President's fiscal year 2012 budget proposes to
consolidate eight separate disease-specific budget lines--Heart Disease
and Stroke, Diabetes, Cancer, Arthritis and other Conditions,
Nutrition, Health Promotion, Prevention Centers, and non-HIV/AIDS
adolescent and school health activities including Coordinated School
Health--into a single comprehensive grant program, the Coordinated
Chronic Disease Prevention and Health Promotion Grant Program. This
consolidation is intended to provide integrated services to State and
local health departments by maximizing the reach and impact of every
dollar invested by CDC to prevent chronic diseases and promote health
in a variety of environments, including schools, and to a variety of
sub-populations, including children.
The National Program of Cancer Registries (NPCR) is essential to
CDC's efforts to prevent and control cancer. Representing 96 percent of
the population, data from NPCR are vital to understanding the Nation's
cancer burden and are fundamental to cancer prevention and control
efforts at the national, State, and local level. Information about
cancer cases and cancer deaths is necessary for health agencies to
report on cancer trends, identify populations with the highest cancer
burden in order to target interventions, assess the impact of cancer
prevention and control efforts, participate in research, especially on
small and disparate populations, such as American Indians/Native
Alaskans, and respond to reports of suspected increases in cancer
occurrence. NPCR is the main source of data on rare cancers--including
some pediatric cancers--which can be difficult to study in regional
registries. CDC remains committed to conducting public health
surveillance, monitoring, and tracking trends in chronic disease risk
factors, incidence, and mortality while enhancing access and
utilization of population-based surveillance data at the State and
local level.
Pediatric cancer is an important public health issue, and has far
reaching social, emotional, and physical impacts on children and their
families. CDC has implemented a range of key activities related to the
Caroline Pryce Walker Conquer Childhood Cancer Act. To date, CDC has:
--Hosted an expert panel to identify gaps in pediatric cancer
research and surveillance. This panel helped inform CDC's
decision to build cancer registry infrastructure in ways that
facilitate pediatric cancer research, enhance registry capacity
and reporting speeds, and create new data linkages for research
use.
--Secured contractor support to simplify and streamline the process
for seeking multiple State institutional review board (IRB)
approval for conducting pediatric cancer research. Work is
being done to assess State level barriers to research across
multiple States requiring linkage to registries or patient
contact, and to identify optimal State policies for research.
--Developed a Funding Opportunity Announcement (FOA) to supplement 12
central cancer registries through NPCR to support pediatric
cancer surveillance, including early case capture. Funded
cancer registries will identify, recruit, and train all
potential sources for reporting pediatric and young adult
cancer cases, and develop procedures and mechanism to implement
early case capture. This FOA will be released in summer 2011.
cdc environmental health (healthy homes/lead poisoning prevention)
Question. The President's budget proposes to consolidate and reduce
by 50 percent the funding for CDC's Healthy Homes/Lead Poisoning
Prevention. I am particularly concerned that the budget proposes
reducing funding for a program--designed to ensure safe housing--that
is extremely cost effective particularly for New England.
In Rhode Island, 70 percent of the State's housing stock was build
prior to 1978, when the use of lead paint was prevalent and 10 percent
are still in need of desperate repair. Over the past 10 years, Rhode
Island has received $40 million for lead poisoning prevention
initiatives and, as a result, just 2.3 percent of children are found to
have elevated lead blood levels in 2007, which is down from 8.8 percent
in 1997.
Cuts to this program will fall squarely on the backs of low-income
families and communities of color since they are disproportionately
impacted by environmental health hazards. It will result in a decrease
in blood lead screening rates and efforts to eliminate lead hazards
that still exist today. What are the long-term impacts that reducing
this funding will have on States, healthcare costs, lost school days
for students, and loss of productivity for parents?
Answer. The goal of the new CDC Healthy Environments consolidated
program is to maintain a multi-faceted approach through surveillance,
partnerships, implementation and evaluation of science-based
interventions to address the health impact of environmental exposures
in the home and to reduce the burden of asthma through comprehensive
control efforts. As the Healthy Environments program is implemented,
the number of funded recipients will decrease from 40 to 34 to
implement Healthy Homes programs and only State health departments will
be eligible to apply for funding; this will help save significant
overhead costs as fewer resources will need to be devoted to grantee
management when there are fewer individual grantees. A healthy homes
approach works to mitigate health hazards in homes such as lead
poisoning hazards, secondhand smoke, asthma triggers, radon, mold, safe
drinking water, and the absence of smoke and carbon monoxide detectors.
Findings indicate that multi-component, multi-trigger home-based
environmental interventions are effective at improving overall quality
of life, reducing healthcare costs and improving productivity. By
integrating the National Asthma Control Program (NACP) and the Healthy
Homes/Childhood Lead Poisoning Prevention Program, CDC's aim is to
establish and maintain a more coordinated approach to this multifaceted
public health challenge.
Question. Can you please explain the impact on Rhode Island, and
the country, if discretionary funding were to be reduced from its
current 2010 level, in terms of patients served, patient health status,
and the economy as a whole?
Answer. Reductions in the annual health center appropriation level
will impact the ability of the Health Center Program to meet projected
patient targets nationally and in Rhode Island. Depending on the size
of the reduction, it may limit or eliminate the Program's ability to
expand the program and/or sustain current program investments and
achievements.
______
Questions Submitted by Senator Mark Pryor
Question. I understand that the Health Resources and Services
Administration funding is proposed to be reduced in the
Administration's fiscal year 2012 budget proposal. Further, the
Administration is proposing to eliminate the Public Health Improvements
account based on the fact that this account is entirely earmarked.
What Federal funding streams are available for hospitals to apply
for facilities and equipment grants?
Answer. The Health Resources and Services Administration's (HRSA)
Office of Rural Health Policy (ORHP) published a manual last year,
targeted to critical access hospitals, outlining the various steps
involved in planning, financing and carrying out construction
projects.HRSA also facilitates the funding of equipment for rural
hospitals to provide or receive clinical services at a distance through
the Telehealth Network Grant Program (TNGP) administered by HRSA/ORHP's
Office for the Advancement of Telehealth (OAT). The TNGP supports not-
for-profit organizations and offers up to $250,000 per year in funding
to demonstrate how telehealth programs and networks can improve access
to quality healthcare services in underserved rural and urban
communities. By statute, the TNGP limits equipment expenditures to 40
percent of each grant award. We anticipate that a TNGP funding
opportunity announcement will be released in fiscal year 2012, subject
to appropriations. Although the TNGP funds equipment, its focus is the
funding of telehealth networks that provide clinical services to
underserved populations and the evaluation of telehealth technology's
effectiveness.
Question. Are any of these funding sources targeted at rural
hospitals?
Answer. Rural Hospitals are eligible to apply for the USDA funding
and TNGP funding. The Telehealth Network Grant Program (TNGP),
administered by the Health Resources and Services Administration
(HRSA)/Office of Rural Health Policy's (ORHP) Office for the
Advancement of Telehealth (OAT) is a primary conduit for demonstrating
how telehealth programs and networks can improve access to quality
healthcare services in underserved rural and urban communities. TNGP
grants demonstrate how telehealth networks improve healthcare services
to: (a) expand access to, coordinate, and improve the quality of
healthcare services; (b) improve and expand the training of healthcare
providers; and/or (c) expand and improve the quality of health
information available to healthcare providers, patients, and their
families.
Question. The fiscal year 2012 budget request for LIHEAP totals
$2.569 billion. This is down from an fiscal year 2011 request of $5.3
billion and an fiscal year 2010 enacted level of $5.1 billion.
While I understand the budget constraints that we are facing right
now, I am concerned about families losing this assistance. What
resources are out there to assist families with energy costs in lieu of
LIHEAP assistance?
I know there are several formulas used to calculate how funding is
distributed. In Arkansas, we are put at a disadvantage in the summer
months because most of the funding is spent on heating during the
winter and little is left over for cooling during the summer. Residents
in southern States rely on LIHEAP for cooling as well as heating. How
can the LIHEAP funding be adjusted so that southern States can better
help their citizens during the hot summer weather?
Answer. Several other ACF programs, including TANF and the Social
Services and Community Services Block Grants, provide assistance to low
income people which may be used for home energy costs. Outside of HHS,
assistance for home weatherization is provided by the Department of
Energy. The fiscal year 2012 President's budget requested $320 million
for this purpose, an increase of 52 percent above fiscal year 2010.
States also provide substantial home energy assistance, $2.6 billion in
fiscal year 2009, primarily from rate assistance from publically
regulated utilities and State/local home energy assistance funds.
LIHEAP block funds are distributed to States by statutory formula.
States determine how to distribute their allocation between heating and
cooling assistance. Prior to 1984, funds were allocated to States based
largely on their numbers of low income people and the National Weather
Service's standard measure for the need for heat. In 1984, Congress
enacted the new formula to adjust State allocations to reflect total
home energy costs (heating and cooling) by low income households. This
formula takes effect when the appropriation for the formula grant
exceeds $1.975 billion. Since fiscal year 2009, LIHEAP appropriation
language has capped the amount of funding distributed by the new
formula at $840 million.
Question. Frequently, I hear concerns about the availability of
healthcare providers in rural areas. Many of the rural areas in
Arkansas have an aging community of healthcare providers, and the
citizens of those communities are worried about preserving access to
care. Can you discuss priorities you are working on to ensure we have
enough healthcare providers to deliver quality healthcare in rural
areas?
Answer. The President's budget included funding to support rural
healthcare that focus on improving recruitment and retention of
healthcare providers in rural areas. The Health Resources and Services
Administration's (HRSA) National Health Service Corps (NHSC) serves as
a key resource in this area as 60 percent of the placements for NHSC
practice in rural areas. In addition, HRSA's Office of Rural Health
Policy is funding the Rural Training Track (RTT) Technical Assistance
Center grant to support the existing rural training tracks around the
country and to assist communities in developing new RTT programs. HRSA
also supports the work of the National Rural Recruitment and Retention
Network, a 50 State consortium of clinician recruiters who work to
match doctors, nurses and dentists with an interest in rural practice
with rural communities in need of a practitioner. Last year, the Rural
Recruitment and Retention Network supported the placement of more than
1,030 clinicians in rural areas.
Question. State-based health insurance exchanges will be created to
make affordable, quality insurance options available to every American.
Debates have been taking place in some States about whether or not
States should move forward in setting up exchanges that will be run by
State governments before the Supreme Court rules on the
constitutionality of the individual mandate. Can you briefly describe
the opportunities States have to establish exchanges and what the role
could be for either State governments or the Federal Government
depending on what decisions States make?
Answer. To receive a multi-year Establishment grant, States must
commit to establishing an Exchange. Recognizing that not all States are
far enough along to make this determination, grants for up to 1 year of
funding will not require a State to commit to operating its own
Exchange. By statute, Territories must commit to establishing, and
ultimately establish, an Exchange to receive any Exchange grant
funding.
Through both the Planning and Establishment grants, States are held
to achieving milestones for important Exchange implementation
activities such as insurance market research, stakeholder consultation,
and assessment of current State eligibility and enrollment systems. If
a State ultimately chooses not to implement its own Exchange, or HHS
determines a State is not ready to operate an Exchange by 2014, HHS may
benefit from this work when it establishes a federally operated
Exchange in that State.
______
Questions Submitted by Senator Richard C. Shelby
class act
Question. The CLASS Act attempts to address an important public
policy concern--the need for non-institutional long-term care--but it
is viewed by many experts as financially unsound. The President's
fiscal commission recommended reform or repeal of the CLASS Act. You
stated to health advocacy groups that, ``it would be irresponsible to
ignore the concerns about the CLASS program's long-term sustainability
in its current form.'' The President's budget proposal includes a
request of $120 million for the CLASS Act, which would be the first
discretionary appropriation for the program. If you are unable to
certify that it will be sustainable absent a massive taxpayer infusion
of funds, why would Congress want to appropriate the requested $120
million in taxpayer funds for a program that experts project will fail?
Answer. We share your view that the CLASS Act addresses an
important public policy concern. About 14 million people spend more
than $230 billion a year on long-term services and supports to assist
them with daily living. Four times that many rely solely on unpaid care
provided by family and friends. Despite public misperception that
Medicare and Medicaid will cover their long-term care costs, Medicare
is only available for time-limited coverage of very specific types of
skilled nursing facility services and while Medicaid is the largest
public payer of these services, it is only available for people with
few financial resources, such as those who were forced to spend their
retirement on long-term care and have no place left to turn. The CLASS
program represents a significant new opportunity for all Americans who
work to prepare themselves financially to remain as independent as
possible under a variety of future health circumstances.
The Affordable Care Act requires HHS to develop an actuarially
sound benefit plan that is fiscally sustainable. The discretionary
request will finance the start up costs associated with establishing
the CLASS program. All programs have start up costs, and this one is no
different. This funding will be used to establish a solid benefit plan,
develop an IT system to help consumers enroll, and implement an
information and education plan to ensure participation and fiscal
sustainability. This bridge will enable the program to begin enrolling
individuals and collecting premiums, which will then be used for
benefits once participants are vested and have an eligible claim.
I appreciate your consideration of this request, recognizing that
HHS is still in the process of developing the actuarially sound benefit
plan. We will not implement a program unless it is solvent and
sustainable, as required by the statute. Prior to collecting any
premiums, HHS will publish a notice of proposed rulemaking and present
three actuarially sound benefit plans, as required by statute, to the
CLASS Independence Advisory Council. These transparent processes will
help HHS ensure the CLASS program starts with every expectation of
sustainability; thus, the $120 million request will help the program
with its critical startup activities, such as ensuring a significant
education and outreach effort for broad enrollment.
Question. What will prevent from the Department from subsidizing
this alleged self-sustaining program with taxpayer funds once it is
implemented and then fails?
Answer. The law clearly states that the program must be able to pay
for benefits with the premiums it takes in and that no taxpayer dollars
may be used to pay for CLASS benefits. Section 3208(b) of the CLASS Act
prevents HHS from using taxpayer funds to pay benefits. Specifically,
the Act states ``No Taxpayer Funds Used To Pay Benefits--No taxpayer
funds shall be used for payment of benefits under the CLASS Independent
Benefit Plan. For purposes of this subsection, the term `taxpayer
funds' means any Federal funds from a source other than premiums
deposited by CLASS program participants in the CLASS Independence Fund
and any associated interest earnings.''
Question. The budget proposal for the CLASS Act includes $93.5
million in new Federal spending for ``information and education'' to
ensure that an adequate number of individuals will enroll in the
program. While I do not agree with Congress appropriating $120 million
for an insolvent program, it makes even less sense to spend $93.5
million of that funding to promote a program that we know as currently
structured will fail. How do you justify spending such a large sum of
money on promotion efforts given you will be a promoting a program that
is not yet defined?
Answer. This $93.5 million will be used to educate Americans about
the immense costs of long-term care and their ability to financially
prepare for these costs. While a direct objective of this effort will
be to expand the risk pool of individuals voluntarily enrolling in the
CLASS program, we expect it to also help Americans begin other private
preparations for these costs and ultimately reduce demands on State and
Federal budgets. By October 1, 2012, HHS is required by statute to
designate an actuarially solvent benefit plan that is solvent
throughout a 75-year period. These funds will be used to promote this
benefit plan, which will have been made available for comment before
final designation.
Question. Given the significant actuarial concerns raised about the
solvency of the CLASS program, will you agree that all education and
outreach materials about the CLASS program will be vetted by
independent actuaries who can attest to their completeness and
accuracy? I am concerned because it is my understanding that the
Medicare actuary did not sign off on the 2010 Medicare mailer that
stated, ``keep Medicare strong and solvent.'' Clearly, that statement
was not entirely accurate and CMS spent $18 million to distribute these
false claims.
Answer. HHS is required to designate an actuarially sound benefit
plan that is solvent throughout a 75-year period. By law, the methods
and assumptions used to determine the actuarial status of the CLASS
Independence Fund will be reviewed and certified by the Chief Actuary
of the Centers for Medicare & Medicaid Services and the financial
solvency of the program will be documented in an annual report to
Congress. The education and outreach materials will be consistent with
these reviews.
Question. Modeling suggests that if you have a 2-3 percent
participation rate the program is not sustainable. Absent massive media
campaigns, how do you know that there will be greater participation?
How do you know the market will receive this concept?
Answer. Broad participation is necessary to mitigate adverse
selection and ensure the solvency and sustainability of the CLASS
program. The proposed $93.5 million information and education effort
will help inform eligible Americans about enrolling in the program. In
addition, HHS will focus on recruiting employers to participate in the
program, further improving enrollment. We also intend to conduct
research to determine the best ways to communicate with consumers about
the program and their options, and we will discuss the findings from
this research with the CLASS Independence Advisory Council to help
inform our estimates of participation in the program.
Question. On March 22, the Wall Street Journal highlighted the
problems with the Social Security Disability Insurance system,
including the inconsistent standards used by State offices that
adjudicate claims. As an example, the article pointed to one
administrative law judge in Puerto Rico that approved 98 percent of the
Social Security disability claims he heard during fiscal year 2010. I
am concerned that the inconsistent standards across States in the
Social Security Disability Insurance system could apply to the CLASS
Act. Secretary Sebelius, will the CLASS Act require a new State-based
system to process claims and if so, how will you ensure standards
remain consistent across States?
Answer. Section 3205 of the statute precludes use by the CLASS
program of the State determination system for Social Security
disability claims. At this time, we are considering how to implement
the eligibility assessment process through which participants will
claim benefits. Considering the voluntary, self-funded nature of this
national program, we believe the eligibility assessment system should
be consistent across the Nation. Thus, one possible approach that we
are considering is contracting with a neutral third-party
administrator, like the type servicing private long-term care insurance
carriers, to ensure standardization of assessments consistent with the
CLASS Act and its regulations.
prevention and public health fund
Question. If the Prevention and Public Health Fund is repealed, how
will agencies fund the programs you have moved?
Answer. The Administration strongly opposes legislation that
attempts to erode the important provisions of the Affordable Health
Care that are making healthcare more accessible and affordable for all
Americans. The Prevention and Public Health Fund is central to reducing
the burden of chronic disease and reducing the healthcare costs
associated with treating these diseases. Repeal of the Prevention and
Public Health Fund would affect current year plans and have a direct
programmatic impact. The Prevention Fund is central to reducing the
burden of chronic disease and reducing the healthcare costs associated
with treating these diseases. HHS has not replaced the entire base of
program funding with Prevention and Public Health resources. Rather,
the fiscal year 2011 allocation primarily builds on the prevention
activities underway at HHS.
Question. The Affordable Care Act gives the Committee on
Appropriations transfer authority for the mandatory funding provided
through the Prevention and Public Health Fund. In fiscal year 2010, the
Prevention Fund transferred $500 million toward prevention efforts, and
in fiscal year 2011 $750 million should be transferred. Each fiscal
year 2011 continuing resolution that has passed has included the
transfer of these funds. Clearly it is the intent of the Committees on
Appropriations to direct the transfer of this funding. Yet, you
announced a spending plan for these funds on February 9, 2011, without
the enactment of a full year appropriations bill. This means those
dollars will be obligated without any congressional input or oversight.
Is it the Department's intention to obligate these funds without
Congressional transfer authority?
Answer. The Affordable Care Act in section 4002 gives the Committee
on Appropriations transfer authority for the mandatory funding provided
through the Prevention and Public Health Fund. If Congress had directed
the transfer of fiscal year 2011 Prevention and Public Health Fund
resources, the Department would have followed the transfer provided in
law. The full-year appropriations bill for fiscal year 2011, however,
did not direct the transfer of these funds, and section 4002 of the
Affordable Care Act gives the Secretary authority to transfer resources
from the appropriated amount within HHS.
Question. OMB claims that the ``Education Research Centers overlap
activities offered by the Department of Labor's Occupational Safety and
Health Bureau.'' However, the mandate of the two agencies is different.
The National Institute for Occupational Safety and Health is mandated
to conduct research and provide professional training in occupational
safety and health, while OSHA is mandated to regulate occupational
safety and health conditions in the workplace and provide worker
training. Therefore, Madam Secretary, where is the overlap?
Answer. OSHA's Outreach Training Program (OTP), OSHA Training
Institute (OTI) Education Center, and Resource Center Loan Program all
focus on employee training. OTP provides employee training in basic
occupational safety and health courses in construction or general
industry safety and health hazard recognition and prevention while the
Resource Center Loan Program offers a collection of training videos to
help increase employee knowledge of workplace safety. The OSHA Training
Institute (OTI) Education Center program was initiated as an extension
of the OSHA Training Institute, which is the primary training provider
of the Occupational Safety and Health Administration. OTI targets
Federal and State compliance officers and State consultants, other
Federal agency personnel, and the private sector. While these programs
focus on employee training, the ERCs support professional training and
provide academic programs and research training in the core areas of
industrial hygiene, occupational health nursing, occupational medicine,
and occupational safety.
Question. The OMB justification for elimination of Education
Research Center's is that the original programmatic plan was to provide
funding for institutions to develop and expand existing occupational
health and safety training programs and that this goal has been met.
However, the statutory goal of the Education Research Centers is ``to
provide an adequate supply'' of qualified occupational safety and
health professionals. Has this goal been met? Before you answer, Madam
Secretary, I would like to point out that according to the Bureau of
Labor Statistics, employment of occupational health and safety
specialist and technicians is expected to increase 11 percent during
the timeframe of 2008-2018.
Answer. No. The establishment of a set of high quality training
programs was the necessary first phase of the original long-range plan.
The subsequent and critical steps for providing an adequate supply of
qualified safety and health practitioners and researchers require
ongoing resources to provide trainee support (for example, stipends,
tuition and fee reimbursement, and research supplies), and to maintain
the training program infrastructure, which includes a high-quality
faculty and training environment. Within the context of a budget that
requires tough choices, we put forth a proposal to discontinue Federal
funding for the ERCs. We recognize the vital role of occupational
safety and health professional training. This proposal is one of many
difficult reductions we proposed as part of the fiscal year 2012
budget.
Question. In the fiscal year 2012 budget request, the President
eliminates funding for the Children's Hospitals Graduate Medical
Education program. In explaining the elimination, the Administration
said it ``prefers to focus on targeted investments to increase the
primary care workforce.'' Although they represent 1 percent of all
hospitals, children's hospitals train more than 40 percent of general
pediatricians. Since the inception of the program, children's hospitals
have increased their training by 35 percent, helped address workforce
shortages, and improved access to care. When there is a need for an
expanded physician workforce nationwide, why are you supporting the
elimination of a program that trains the primary care workforce for
children?
Answer. Within the context of a budget that requires tough choices,
we put forth a proposal to discontinue these general subsidies. This
proposal is one of many difficult reductions we would not have put
forth under different fiscal circumstances. We recognize the vital role
that children's hospitals and pediatric providers play in providing
quality healthcare to our Nation's children.
Children's hospitals would continue to be able to compete for
funding through the competitive grant programs for which they are
eligible. For example, six children's hospitals received over $16
million in fiscal year 2010 from the Primary Care Residency Expansion
program funded by the Affordable Care Act. Pediatric residencies can
also be supported through the new Teaching Health Center Graduate
Medical Education Program created by the Affordable Care Act, which
supports primary care medical residents in community-based ambulatory
care settings.
______
Questions Submitted by Senator Thad Cochran
Question. The President's fiscal year 2012 budget for the
Department of Health and Human Services proposes the elimination of the
Delta Health Alliance at the Health Resources and Services
Administration and also proposes the elimination of the Delta Chronic
Disease Assessment and the Centers for Disease Control and Prevention.
Mississippi has the highest obesity rate in the nation. What are your
plans to address the health problems in the Mississippi Delta region?
Answer. The Health Resources and Services Administration (HRSA)
currently supports 21 Health Centers in Mississippi and they focus on
providing access to quality healthcare for underserved populations. In
addition, HRSA's Office of Rural Health Policy (ORHP) has several grant
programs which are available to address health disparities in the
Mississippi Delta Region.
mississippi state department of health funding
Question. The President's budget proposes the elimination of the
Preventive Health and Health Services Block Grant and proposes a new
consolidated chronic disease grant program at the Centers for Disease
Control and Prevention. The budget justification says this new grant
program will not be a formula grant structure, but rather it will be
competitive. Rural areas and States without capacity will be
disproportionately affected by competitions. I am concerned that the
new chronic disease grant program will create a scenario where the rich
get richer and the poor get poorer. What are your plans to ensure that
State health departments have the capacity to compete for funds at the
Centers for Disease Control?
Answer. Chronic diseases--such as heart disease, stroke, cancer,
diabetes, and arthritis--are among the most common, costly, and
preventable of all health problems in the United States. Historically,
CDC has funded categorical programs in State health departments to
address these diseases as well as their common risk factors of obesity,
poor nutrition and/or inadequate physical activity. Under the current
structure, not all States are funded for these programs.
Because of the inter-relatedness of many common chronic diseases
and their risk factors, the Coordinated Chronic Disease Prevention and
Health Promotion Grant Program will support essential public health
functions at the State level including epidemiology, evaluation,
policy, communications and program management. Such an approach will
strengthen State based coordination and therefore improve program
efficiencies, provide leadership and support for cross-cutting
activities and enhance the effectiveness of chronic disease prevention
and risk factor reduction efforts across the included categorical
programs.
State health departments are eligible to receive funding through
the Coordinated Chronic Disease Prevention Program. State health
departments are required to deliver programming that reaches across the
State and reduces specific disparities within the State, including
rural areas. In addition, recognizing the importance of supporting all
States, including rural areas, $115 million of the $528 million
available is intended to support all State health departments,
territories, and some Tribes to establish or strengthen leadership,
expertise, coordination of chronic disease prevention programming,
surveillance and evaluation. In addition, health departments will be
eligible to apply for competitive awards to strengthen coordination of
chronic disease prevention programs and implement evidence-based
prevention strategies. These competitive grants to State health
departments, territories, some tribes and other entities will support
activities addressing:
--Policy and environmental approaches to improve nutrition and
physical activity in schools, worksites and communities;
--Interventions to improve delivery and use of selected clinical
preventive services; and
--Community programs to support chronic disease self management to
improve quality of life for people with chronic disease and to
prevent diabetes, heart disease and cancer among those at high
risk.
______
Questions Submitted by Senator Lamar Alexander
Question. As a former Governor, I am deeply concerned with the
Medicaid expansion in the new health law. Tennessee's previous Governor
Bredesen, a Democrat, has called it ``the mother of all unfunded
mandates'' and estimated that it will cost Tennessee and additional
$1.1 billion for 2014-2019, and that is even with the Federal
Government is paying 100 percent of the expansion population from 2014-
2016. CBO recently estimated that it will cost States $60 billion
through 2021.
The new law also mandates that Medicaid primary care physicians be
reimbursed at 100 percent of Medicare rates in 2013-2014, for which the
Federal Government will pay for those 2 years. But this creates a
funding cliff for 2015. To keep doctors in their programs, States will
either be forced to continue to pay Medicaid primary care physicians
100 percent of Medicare rates, or these physicians will effectively see
a 40-50 percent cut for in 2015. According to the TennCare Director,
the requirement to increase provider reimbursement to 100 percent of
Medicare would cost Tennessee roughly an additional $324 million per
year.
How are States going to shoulder these additional burdens in the
current budget crises most of them are experiencing? Is the
administration considering any kind of flexibility options to offer to
States in order to avoid being crushed by all the mandates and
maintenance of effort requirements?
Answer. We recognize that the economic downturn has forced States
to make hard choices to control State spending, and that there are no
easy answers. Recognizing the challenges facing States, I sent a letter
to Governors in early February outlining existing flexibility and
reaffirming the Department of Health and Human Services'--and the
Center for Medicare & Medicaid Services'--commitment to working with
States to improve care and manage costs in the Medicaid program. As
part of that effort, CMS has undertaken an unprecedented level of
outreach to States to help them strategize on ways to improve the
efficiency of their Medicaid programs in light of current State budget
challenges. To accomplish this task, CMS has created Medicaid State
Technical Assistance Teams (MSTATs) that are ready to provide intensive
and tailored assistance to States on day-to-day operations as well as
on new initiatives. As of mid April, CMS has been contacted by 22
States for technical assistance. We are ready to continue working with
States to explore new ways to manage their programs that will increase
efficiency, reduce spending, and improve health for Medicaid
beneficiaries.
Question. One of the problems with the Medicaid expansion is that
there is an access problem for patients in the program being unable to
see a doctor willing to treat them. There are varying reports on
providers not willing to see Medicaid patients, like the 2006 report
from the Center for Studying Health System Change Only stating that
only about one-half of U.S. physicians accept new Medicaid patients.
Even the CMS chief actuary stated in an analysis done in April, ``.
. . it is reasonable to expect that a significant portion of the
increased demand for Medicaid would be difficult to meet, particularly
over the first few years.''
By adding 16-18 million more people into the program, what is your
administration doing to address access issues for all these new
beneficiaries?
Answer. I am committed to ensuring access for Medicaid
beneficiaries. The Affordable Care Act provision which helps States
boost their payment rates to Medicare levels for 2 years is a good
first step, as are all of the provisions that reform our healthcare
delivery system to align payments with higher quality care. Federal
funding will be available to cover 100 percent of the initial cost of
the mandated increases in provider payment for primary care services.
The newly formed Medicaid and CHIP Payment and Access Commission
(MACPAC) will play an important role by providing research and analysis
on provider payment rates and access in the Medicaid program. In the
initial MACPAC report, issued in March 2011, there was extensive
discussion about the difficulties in analyzing access issues, and the
need to develop additional data sources and new analytic approaches. On
May 6, 2011, we published a proposed rule that integrated the MACPAC
approach into a strategy to develop a transparent process for States to
collect and analyze access issues. We anticipate working closely with
MACPAC to learn about best practices and approaches in sustaining
access in 2014 and beyond.
Question. Has HHS done an analysis of how many providers are not
seeing new or any Medicaid patients? If not, can CMS look into this?
Answer. Access to providers by Medicaid recipients is of paramount
importance. As a requirement for States' participation in the Medicaid
program, they must ensure that ``payments are consistent with
efficiency, economy, and quality of care and are sufficient to enlist
enough providers so that care and services are available to the general
population in the geographic area.'' As noted above, CMS is currently
undertaking rulemaking to provide guidance to States on compliance with
this requirement, which includes a framework for State and Federal
review. Through the rulemaking process, we are welcoming public notice
and comment on our proposed approach, which provides for States to
review access through a three-part framework, focusing on beneficiary
needs, provider enrollment, and service utilization.
Because States have primary responsibility for managing data on
eligible beneficiaries and for enrolling and reimbursing Medicaid
providers, States have the most accurate and up to date information on
the number of providers participating in each State's Medicaid program,
the percent of those accepting new Medicaid patients, and whether those
numbers are comparable to the availability of providers for the general
population in the area. Our proposed strategy is to require States to
perform the initial analysis of available data and issue access reports
for both Federal and public scrutiny.
Question. In your January testimony to the HELP Committee, you
mentioned tax credits as a way that the law will keep down premiums. I
realize that people who receive the tax credits or subsidies will pay
less out of their own pocket for premiums, but are you saying that
these tax credits/subsidies will bring down the underlying premiums and
or the underlying cost of healthcare?
Answer. Many provisions of the Affordable Care Act make healthcare
more affordable for American families and businesses, including tax
credits and premium assistance, new oversight of private insurance
premiums growth, delivery systems reforms that will bend the healthcare
cost curve, and larger purchasing pools through Exchanges.
Insurers often raise premiums to protect themselves against
unpredictable market conditions. Premium tax-credits offered through
Exchanges make health insurance coverage attainable for individuals who
have not previously been able to afford the costs of health insurance
and will enable wider participation in the health insurance market.
Keeping more people in the insurance market at all times, and not just
when they get sick, will lead to greater predictability and stability
in the individual market.
Question. According to estimates from Senate Finance minority tax
staff last year, only 7 percent of Americans would qualify for
subsidies and would see these cost savings. What about everyone else?
Even CBO has said premiums for families buying coverage on the
individual market would see premiums increase by $2,100 a year.
Answer. Even after full implementation of health reform, most
Americans will continue to receive insurance through their employers,
as has traditionally been the case. CBO estimates that nearly 20
million Americans without access to affordable or adequate coverage
through their employers or other sources will receive premium tax
credits or cost-sharing subsidies through the Exchanges.
Question. You also stated in your HELP testimony that the new law
``is bringing down premiums for consumers by limiting the amount of
premiums insurers may spend on administrative costs and by giving
States resources to beef up their review process.''
How do you square this statement with recent news articles that
some insurers are raising premiums as a result of the new law?
Answer. According to our analysis and those of some industry and
academic experts, any potential premium impact from the new consumer
protections and increased quality provisions under the Affordable Care
Act will be minimal. We estimate that the effect will be no more than 1
to 2 percent. This is consistent with estimates from the Urban
Institute (1 to 2 percent) and Mercer consultants (2.3 percent).
Insurers themselves have also reached a similar conclusion.
Pennsylvania's Highmark, for example, estimates the effect of the
legislation on premiums from 1.14 to 2 percent.
Any premium increases will be moderated by out-of-pocket savings
resulting from the law. These savings include a reduction in the
``hidden tax'' on insured Americans that subsidizes care for the
uninsured. By making sure that high-risk individuals have insurance and
emphasizing healthcare that prevents illnesses from becoming serious,
long-term health problems, the law will begin to reduce costs resulting
from the treatment of patients at the acute stage of illness. The law
prioritizes prevention, making many services available without cost-
sharing, invests in prevention in communities across the country, and
contains a series of provisions designed to improve the way we pay for
care.
In addition to the coverage and delivery system changes that will
begin to bend the cost curve, the law provides valuable new tools to
ensure that consumers are getting value for their premium dollar.
Already, we have provided 44 States and the District of Columbia with
resources to strengthen the review and transparency of proposed
premiums. CMS is making up to $250 million available for States to
improve their rate review infrastructure and to fight unreasonable
rates. Rate review allows States to examine and in some cases reject or
modify the insurance rate before implementation. At the end of the
year, the new medical loss ratio standard requires carriers to rebate
premiums back to consumers if they fail to meet the standard. Rate
review and medical loss ratios work together to help consumers. We will
also keep track of insurers with a record of unjustified rate
increases; those plans may be excluded from health insurance Exchanges
in 2014.
Question. There has been a lot of news coverage lately about the
more than 1,100 annual limit waivers granted by your administration.
Additionally, several States have applied for waivers from the medical
loss ratio (MLR) requirement.
Would it not make more sense for HHS to consider a blanket waiver
of annual benefit limits and MLR standards until 2014?
Answer. The Center for Consumer Information and Insurance Oversight
(CCIIO)'s waiver policy represents a transition to 2014, when annual
limits will be eliminated and limited medical benefit plans will be a
thing of the past. Until 2014, the transition ensures that insurance
plans that can remove annual limits do so. Those that cannot remove
annual limits without significantly raising premiums or reducing access
to benefits can receive waivers. This transition assures that Americans
can keep this limited coverage until more comprehensive coverage
options are available to all in 2014. CCIIO is approving 1 year waivers
and collecting data on limited benefits plans that will inform our
approach for future years.
The medical loss ratio provision allows CCIIO to adjust the
percentage if the potential exists to destabilize the individual market
in a State. To date, one State, Maine, has received a reduced loss
ratio. Each State market is different and CCIIO has established a
process by which a State may apply, if they believe the potential
exists for disruption. CCIIO will evaluate each application against the
criteria set forth in regulation and guidance.
Question. Does the HHS have contingency plans for larger than
expected expenditures for subsidies if more employers drop coverage
than expected?
Answer. The reforms in the Affordable Care Act are intended to
complement and strengthen the existing employer-based insurance system,
not to replace it. We believe that the MLR requirements, review of
annual rate increases, and delivery system reforms will help slow the
growth of insurance costs to businesses so they can continue to provide
the insurance their employees and families need and depend on.
The Congressional Budget Office has found that any decrease in
employer-sponsored coverage because of the Affordable Care Act would be
minimal. On the contrary, the Affordable Care Act provides tremendous
benefits for employers that will encourage them to continue to offer
health insurance coverage to their employees. In the coming years, the
Congressional Budget Office estimates that health insurance premiums
could decrease by up to 3 percent for employers. The new law also
provides $40 billion in tax credits to help small businesses purchase
coverage for their employees. In 2014, small businesses will be able to
purchase private insurance through the Exchanges, which will provide
them with the same purchasing power as large businesses.
Question. In the last Congress, HHS received enormous
appropriations of tax dollars with very little Congressional direction
on the use of those funds going forward. HHS received $1 billion as
part of the Federal stimulus program and approximately $2 billion more
per year in the future as part of the new healthcare law, all for the
Mobilizing for Action through Planning and Partnerships (MAPP)
intervention grants. HHS was given these enormous streams of taxpayer
dollars without clear direction on the specifics of how those funds
should be used.
CDC appears to be using these taxpayer dollars to fund advocacy
organizations at the State and local level who engage in legislative
advocacy for higher taxes and restrictions focused on consumer goods,
which raises a number of serious concerns. Using Federal tax dollars
for legislative advocacy is against the law, as the appropriation
itself is subject to a restriction clearly prohibiting that the agency
from using Federal funds to engage in direct or grassroots lobbying for
changes in State or local laws. There also is a Federal criminal
statute--the Anti-Lobbying Act--making it a criminal offense to
``influence in any manner . . . an official of any government, to
favor, adopt, or oppose, by vote or otherwise, any legislation, law,
ratification, policy or appropriation.''
As a former Governor, I think it is totally inappropriate for the
executive branch to unilaterally decide what is or isn't a good State
or local law worthy of financial support. If the Administration has a
legislative agenda, it should work with the Congress to enact it
through the legislative process.
In response to questions about the use of these funds during
congressional hearings last year, CDC Associate Director Pechachek,
stated that, ``The prohibition against lobbying does not mean that
communities are prohibited from interacting with policy makers such as
legislators in order to promote the goals of the Communities Putting
Prevention to Work Program.''
How can a program have as a main, underlying objective to seek
changes in State and local laws when the Federal Government
specifically prohibits the use of Federal grant moneys to engage in
direct or grassroots lobbying? Do you agree with this concern?
How much of the billions of dollars in spending under the stimulus
and new healthcare law has been used to support efforts to change local
and State laws? Would you provide this Committee with the details of
that information?
Answer. As part of the American Recovery and Reinvestment Act
(ARRA), Congress provided $650 million in funding for CDC to implement
the Communities Putting Prevention to Work (CPPW) program. In addition,
approximately $44 million from the Prevention and Public Health Fund
supported quality but unfunded CPPW grantees, as well as media and
evaluation, in fiscal year 2010. CPPW grantees are tackling important
health problems, focusing on tobacco, nutrition and physical activity.
Addressing these health challenges requires action at the community
level, often to make changes that give individuals greater
opportunities to make healthy choices.
CDC strictly adheres to all Federal laws prohibiting the use of
Federal funds to lobby, and even goes beyond statutory requirements to
restrict the activities of grantees at the local level when Federal
funds are involved. CDC regularly educates all grantees on Federal laws
related to funding awards, including anti-lobbying provisions. CDC
references Additional Requirement (AR)-12 ``Lobbying Restrictions'' in
all of its Funding Opportunity Announcements (FOAs), and all
prospective recipients must agree to these restrictions prior to
receiving funds. The AR states, in part, ``Any activity designed to
influence action in regard to a particular piece of pending legislation
would be considered `lobbying.' That is, lobbying for or against
pending legislation, as well as indirect or `grass roots' lobbying
efforts by award recipients that are directed at inducing members of
the public to contact their elected representatives at the Federal or
State levels to urge support of, or opposition to, pending legislative
proposals is prohibited. As a matter of policy, CDC extends the
prohibitions to lobbying with respect to local legislation and local
legislative bodies.''
CDC is careful to monitor the use of Federal funding, and to ensure
that grantees comply with Federal law and the specific guidance of the
Funding Opportunity Announcement and conditions outlined in the AR-12.
However, anti-lobbying provisions do not prohibit communities from
interacting with policymakers through proper official channels, in
order to educate them about the burden of chronic diseases and their
associated risk factors, as well as evidence-based strategies to
promote health. There are many activities that are allowable under
Federal law which community leaders may decide to pursue; moreover,
policy change does not have to include formal legislative action. For
example, health departments may choose to work with local
transportation and planning departments to ensure that urban design
policies include opportunities for people to be active. Local
businesses may voluntarily decide to change their food procurement
policies and to provide a greater selection of healthy food options for
employees in vending machines and cafeterias. Transit systems may
determine on their own to make their trains and buses smoke-free. Each
of these is an example of a type of policy change that impacts people
in their daily lives, without requiring legislative action at the
local, State, or Federal levels.
CDC supports community efforts to foster these types of linkages
between health departments and key stakeholders from multiple sectors
across a community, while strictly adhering to all Federal laws
prohibiting the use of Federal funds to lobby. CDC carefully monitors
the activities of grantees and the use of Federal funds to ensure
compliance with Federal law, the specific guidance of the Funding
Opportunity Announcement, and conditions outlined in AR-12.
Question. One of the major concerns I have heard from constituents
about the new health law is that it will lead to government control and
rationing. Treatment choices should be made between doctors and
patients, rather than by folks in Washington, DC.
While the FDA has announced its decision to withdraw its approval
for Avastin for breast cancer treatment, the European equivalent (the
EMEA) has confirmed the use of Avastin for breast cancer. Shouldn't
American women on Medicare have access to this drug as well?
Answer. I recognize the critical importance of the physician-
patient relationship, especially in deciding an appropriate drug
therapy treatment. The Medicare statute authorizes coverage of items
and services that are reasonable and necessary for the diagnosis or
treatment of illness or injury in the Medicare population.
At this time, CMS is not making any changes to its coverage or
reimbursement policies for Avastin and is waiting until the resolution
of the FDA process before deciding whether to make any changes. While
we do periodically consider new evidence about Medicare-covered drugs
or treatments to evaluate whether changes in coverage decisions are
warranted, it would be premature to speculate on possible changes in
Medicare coverage of Avastin, if any, that may be made in response to
future FDA actions.
Question. Avastin is an expensive treatment option. Can you affirm
that the FDA was looking purely at science rather than the cost of the
drug when making its decision?
Answer. The Food and Drug Administration (FDA) is responsible for
protecting the public health by ensuring that drugs and biologics are
safe and effective. In determining whether a product should be labeled
for a particular indication, FDA takes seriously our obligation to
carefully weigh the risks and benefits for the patient. Specifically,
FDA considers whether the benefits of the drug, including the magnitude
of those benefits, outweigh the product's potential toxicities for the
indicated use. The Food and Drug Administration does not factor costs
into its drug approvals or safety related decisions. FDA's Center for
Drug Evaluation and Research has proposed to remove Avastin's
indication for metastatic breast cancer based on the Center's
evaluation of efficacy and safety data available from clinical trials,
without considering the cost of the drug. FDA has not yet reached a
final decision on this proposal, and this matter will be the subject of
a hearing in June 2011.
Question. More than 40 States have laws in place to ensure those on
private insurance have access to cancer drugs even if they are ``off-
label.'' Shouldn't women on Medicare have the same guarantee?
Answer. At this time, CMS is not making any changes to its coverage
or reimbursement policies for Avastin and is waiting until the
resolution of the FDA process before deciding whether to make any
changes. While we do periodically consider new evidence about Medicare-
covered drugs or treatments to evaluate whether changes in coverage
decisions are warranted, it would be premature to speculate on possible
changes in Medicare coverage of Avastin, if any, that may be made in
response to future FDA actions. I would note, however, that, generally,
Medicaid coverage of a drug is contingent upon that drug having FDA
approval. I cannot speak to the process behind the coverage decisions
of other insurance providers.
Question. If many of the roughly 18,000 women using Avastin for
metastatic breast cancer find it effective, and scientific experts at
the National Comprehensive Cancer Network, the leading cancer
compendia, support its use, can you assure me that Medicare will not
restrict coverage of this product?
Answer. I recognize the critical importance of the physician-
patient relationship, especially in deciding an appropriate drug
therapy treatment. The Medicare statute authorizes coverage of items
and services that are reasonable and necessary for the diagnosis or
treatment of illness or injury in the Medicare population.
At this time, CMS is not making any changes to its coverage or
reimbursement policies for Avastin and is waiting until the resolution
of the FDA process before deciding whether to make any changes. While
we do periodically consider new evidence about Medicare-covered drugs
or treatments to evaluate whether changes in coverage decisions are
warranted, it would be premature to speculate on possible changes in
Medicare coverage of Avastin, if any, that may be made in response to
future FDA actions.
______
Questions Submitted by Senator Lindsey Graham
Question. Can you explain FDA's process for approving drugs for new
indications?
Answer. Secretary Sebelius: In order for a new indication for a
drug or biologic product to be marketed in the United States, it must
be shown to be safe and effective for its intended new use.
In 1998, FDA published guidance for manufacturers planning to file
applications for new indications of approved drugs or biologic
products. In this guidance, FDA articulated its thinking on the
quantity of evidence needed in particular circumstances to establish
substantial evidence of effectiveness. The guidance discussed the
standards and data requirements for approval of new indications so that
duplication of data previously submitted in the original application
could be avoided. In particular, FDA addressed situations in which a
single adequate and well-controlled trial of a specific new use could
be supported by information from other adequate and well-controlled
trials, such as trials in other stages of a disease, or in closely
related diseases.
The new drug or biologics licensing application that is submitted
by the manufacturer in support of a new indication must include the
requisite clinical trial information demonstrating safety and
effectiveness, and supportive clinical pharmacology, preclinical and
product quality information, as needed. FDA scientists review the
submitted information and determine whether or not the product may be
approved for the new use if the benefits of treatment are found to
outweigh the risks for the intended population.
Question. Am I correct in my understanding that FDA does not
consider the cost of a drug during its approval process? If cost is
considered, how does that cost factor into FDA's decision to approve
drugs for certain indications?
Answer. Yes, you are correct. In deciding whether to approve a
drug, FDA cannot and does not take price into account.
Question. I am aware that Avastin is a very expensive drug, and I
have been made aware of concerns that cost could have been a factor in
FDA's decision to remove the breast cancer indication from Avastin's
label. Did Avastin's cost play any role in FDA's decision regarding the
drug?
Answer. The Food and Drug Administration is responsible for
protecting the public health by ensuring that drugs and biologics are
safe and effective. In determining whether a product should be labeled
for a particular indication, FDA takes seriously its obligation to
carefully weigh the risks and benefits for the patient. Specifically,
FDA considers whether the benefits of the drug, including the magnitude
of those benefits, outweigh the product's potential toxicities for the
indicated use. The Food and Drug Administration does not factor costs
into its drug approvals or safety related decisions. FDA's Center for
Drug Evaluation and Research has proposed to remove Avastin's
indication for metastatic breast cancer based on the Center's
evaluation of efficacy and safety data available from clinical trials,
without considering the cost of the drug. FDA has not yet reached a
final decision on this proposal, and this matter will be the subject of
a hearing in June, 2011.
Question. What is HHS's policy for awarding grants to organizations
that advocate for specific policy positions?
I have heard concerns that Federal stimulus dollars targeted to
public health were awarded to advocacy organizations who lobby State
and local governments for specific policy changes regarding food and
beverages. Can you provide details regarding the grant-making process
for public health programs including the information required for
proposal when submitted and how often HHS audits grant recipients to be
sure they are complying with the aims of the HHS' grant programs?
Answer. Applicants for (and recipients of) Federal grants,
cooperative agreements, contracts, and loans are prohibited by 31
U.S.C. 1352, ``Limitation on use of appropriated funds to influence
certain Federal contracting and financial transactions,'' from using
appropriated Federal funds to pay any person for influencing or
attempting to influence any officer or employee of an agency, a member
of Congress, an officer or employee of Congress, or an employee of a
Member of Congress with respect to the award, extension, continuation,
renewal, amendment, or modification of any of these instruments. These
requirements are implemented for HHS in 45 CFR part 93, which also
describes types of activities, such as legislative liaison activities
and professional and technical services that are not subject to this
prohibition. Applicants for HHS grants with total costs expected to
exceed $100,000 are required to certify that they: have not made, and
will not make, such a prohibited payment; will be responsible for
reporting the use of non-appropriated funds for such purposes; and will
include these requirements in consortium agreements, other subawards,
and contracts under grants that will exceed $100,000 and will obtain
necessary certifications from those consortium participants and
contractors.
Disclosure reporting is required after award as indicated and must
be certified annually either through providing submitting disclosure
statements by doing so on the SF-LLL, Disclosure of Lobbying
Activities. Where there are no disclosures to report the grantee
certifies this fact by signing the face page of the application without
the need to submit the forms. The grantee certifies that there are no
lobbying activities to report when they sign the face page of the
application.
Consistent with Federal law, in its grant programs, CDC references
Additional Requirement (AR)-12 ``Lobbying Restrictions'' in all of its
Funding Opportunity Announcements (FOAs), and all prospective
recipients must agree to these restrictions prior to receiving funds.
The AR states, in part, ``Any activity designed to influence action in
regard to a particular piece of pending legislation would be considered
`lobbying.' That is, lobbying for or against pending legislation, as
well as indirect or `grass roots' lobbying efforts by award recipients
that are directed at inducing members of the public to contact their
elected representatives at the Federal or State levels to urge support
of, or opposition to, pending legislative proposals is prohibited. As a
matter of policy, CDC extends the prohibitions to lobbying with respect
to local legislation and local legislative bodies.''
CDC is careful to monitor the use of Federal funding, and to ensure
that grantees comply with Federal law, the specific guidance of the
FOAs, and conditions outlined in AR-12. Grants or cooperative
agreements funded by the American Recovery and Reinvestment Act are
also subject to this policy. We note, however, that many organizations
engage in advocacy using funding from other sources, and that this does
not bar them from applying for and receiving funding from CDC.
Recipients are permitted to use their own funds to lobby, so long as it
can be demonstrated or shown that the funds that were used for lobbying
were entirely separate from any appropriated funds they received from
the Federal Government. Recipients are required to disclose all
lobbying activities along with their application. CDC only provides
funds to undertake activities outlined in the FOA.
CDC's Procurement and Grants Office (PGO) provides specific
budgetary oversight to ensure the appropriate use of Federal funds. CDC
grants management specialists and program staff are significantly
involved in the planning and monitoring of recipient activities, review
and approval of spending details, and tracking of grantee drawdown of
funds. PGO staff participate in annual site visits to all funded
communities. One example is the Communities Putting Prevention to Work
(CPPW) program, which has a robust plan for performance monitoring in
order to ensure that Federal funds are used effectively and
appropriately. The plan positions CDC staff to identify early warning
signs that a program is using Federal funds for unauthorized and
inappropriate activities. Furthermore, an electronic performance
monitoring system provides a central repository for collecting
information from a number of program monitoring sources. CDC also
complies with other mandatory directives, such as OMB Circular A-133,
which requires every organization receiving $500,000 in aggregate
Federal grants to submit to annual financial audit. The results of
these audits are used in periodic grantee reviews to identify grantees
that may present a risk to the control or integrity of fund use.
Question. I have heard concerns that Federal stimulus dollars
targeted to public health were awarded to advocacy organizations who
lobby State and local governments for specific policy changes regarding
food and beverages. Can you provide details regarding the grant-making
process for public health programs including the information required
for proposal when submitted and how often HHS audits grant recipients
to be sure they are complying with the aims of the HHS' grant programs?
Answer. Applicants for (and recipients of) Federal grants,
cooperative agreements, contracts, and loans are prohibited by 31
U.S.C. 1352, ``Limitation on use of appropriated funds to influence
certain Federal contracting and financial transactions,'' from using
appropriated Federal funds to pay any person for influencing or
attempting to influence any officer or employee of an agency, a Member
of Congress, an officer or employee of Congress, or an employee of a
Member of Congress with respect to the award, extension, continuation,
renewal, amendment, or modification of any of these instruments. These
requirements are implemented for HHS in 45 CFR part 93, which also
describes types of activities, such as legislative liaison activities
and professional and technical services that are not subject to this
prohibition. Applicants for HHS grants with total costs expected to
exceed $100,000 are required to certify that they: have not made, and
will not make, such a prohibited payment; will be responsible for
reporting the use of non-appropriated funds for such purposes; and will
include these requirements in consortium agreements, other subawards,
and contracts under grants that will exceed $100,000 and will obtain
necessary certifications from those consortium participants and
contractors.
Disclosure reporting is required after award as indicated and must
be certified annually either through providing submitting disclosure
statements by doing so on the SF-LLL, Disclosure of Lobbying
Activities. Where there are no disclosures to report the grantee
certifies this fact by signing the face page of the application without
the need to submit the forms. The grantee certifies that there are no
lobbying activities to report when they sign the face page of the
application.
Consistent with Federal law, in its grant programs, CDC references
Additional Requirement (AR)-12 ``Lobbying Restrictions'' in all of its
Funding Opportunity Announcements (FOAs), and all prospective
recipients must agree to these restrictions prior to receiving funds.
The AR states, in part, ``Any activity designed to influence action in
regard to a particular piece of pending legislation would be considered
`lobbying.' That is, lobbying for or against pending legislation, as
well as indirect or `grass roots' lobbying efforts by award recipients
that are directed at inducing members of the public to contact their
elected representatives at the Federal or State levels to urge support
of, or opposition to, pending legislative proposals is prohibited. As a
matter of policy, CDC extends the prohibitions to lobbying with respect
to local legislation and local legislative bodies.''
CDC is careful to monitor the use of Federal funding, and to ensure
that grantees comply with Federal law, the specific guidance of the
FOAs, and conditions outlined in AR-12. Grants or cooperative
agreements funded by the American Recovery and Reinvestment Act are
also subject to this policy. We note, however, that many organizations
engage in advocacy using funding from other sources, and that this does
not bar them from applying for and receiving funding from CDC.
Recipients are permitted to use their own funds to lobby, so long as it
can be demonstrated or shown that the funds that were used for lobbying
were entirely separate from any appropriated funds they received from
the Federal Government. Recipients are required to disclose all
lobbying activities along with their application. CDC only provides
funds to undertake activities outlined in the FOA.
CDC's Procurement and Grants Office (PGO) provides specific
budgetary oversight to ensure the appropriate use of Federal funds. CDC
grants management specialists and program staff are significantly
involved in the planning and monitoring of recipient activities, review
and approval of spending details, and tracking of grantee drawdown of
funds. PGO staff participate in annual site visits to all funded
communities. One example is the Communities Putting Prevention to Work
(CPPW) program, which has a robust plan for performance monitoring in
order to ensure that Federal funds are used effectively and
appropriately. The plan positions CDC staff to identify early warning
signs that a program is using Federal funds for unauthorized and
inappropriate activities. Furthermore, an electronic performance
monitoring system provides a central repository for collecting
information from a number of program monitoring sources. CDC also
complies with other mandatory directives, such as OMB Circular A-133,
which requires every organization receiving $500,000 in aggregate
Federal grants to submit to annual financial audit. The results of
these audits are used in periodic grantee reviews to identify grantees
that may present a risk to the control or integrity of fund use.
SUBCOMMITTEE RECESS
Senator Harkin. And with that, again, Madam Secretary,
thank you and the subcommittee will stand recessed.
[Whereupon, at 11:37 a.m., Wednesday, March 30, 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 2012
----------
WEDNESDAY, MAY 4, 2011
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10 a.m., in room SD-124, Dirksen
Senate Office Building, Hon. Tom Harkin (chairman) presiding.
Present: Senators Harkin, Brown, Shelby, and Cochran.
DEPARTMENT OF LABOR
Office of the Secretary
STATEMENT OF HON. HILDA L. SOLIS, SECRETARY
OPENING STATEMENT OF SENATOR TOM HARKIN
Senator Harkin. The Subcommittee of Labor, Health and Human
Services, and Education, and Related Agencies will now come to
order.
First of all, welcome back to the subcommittee, Madam
Secretary. Your appearance today comes at a critical point for
your Department and for our Nation's workforce.
After a long and difficult recession, our economy is slowly
recovering, but too many workers are unemployed or
underemployed, and more needs to be done to ensure that all
Americans benefit from economic growth, not just the few at the
top. At the same time, Congress and the administration must
work together to reduce our budget deficits and restore fiscal
discipline.
FISCAL YEAR 2011 APPROPRIATIONS BILL
A first step was taken last month when we completed action
on the fiscal year 2011 appropriations bill. This bill made
significant cuts to the Department of Labor, more than $800
million, or 6 percent below the fiscal year 2010 level. And
yet, we maintained important investments in employment and
training programs, worker protections, and the fight against
the worst forms of child labor. The cuts could have been more
damaging. The House alternative, H.R. 1, targeted programs that
serve the most vulnerable Americans, including drastically
cutting job training for people who have lost their jobs as a
result of layoffs. It's hard to see the wisdom of a cut like
that when the real unemployment rate really is close to 16
percent in this country. Thankfully, the fiscal year 2011 bill
rejected that approach.
FISCAL YEAR 2012
Now we turn to fiscal year 2012. Regrettably, we already
know that programs that benefit American workers are once again
being targeted for draconian cuts. The budget passed by the
House last month takes the approach that the deficit should be
addressed by enacting yet another tax cut bonanza for those at
the top while ripping the social safety net for seniors, people
with disabilities, and low income, and slashing funding for
education and training. In fact, the House budget would cut
education and training programs by 15 percent in fiscal year
2012.
I believe there's a better way, and history offers a guide.
When President Clinton took office in 1993, he faced a similar
situation in terms of the budget. He proposed a balanced
approach that included spending cuts and necessary revenue
increases while continuing to make crucial investments in
education, infrastructure, and research, areas that are
absolutely essential if we're going to create jobs and stay
competitive in the global economy. The plan worked, and worked
brilliantly. It created large budget surpluses, 22 million new
jobs, and 116 consecutive months of economic expansion, the
longest in American history. I believe we need that same
balanced approach today.
Madam Secretary, there is no question that the fiscal year
2012 budget for the Department of Labor will remain tight. But,
the President rightly puts a high priority on programs that are
critical to our long-term fiscal health, especially in the
areas of employment and training, as well as a new workforce
innovation fund that Congress created in the fiscal year 2011
bill.
I'm also pleased to see that the budget request continues
the Disability Employment Initiative that Congress started in
fiscal year 2010. With almost 80 percent of Americans with
disabilities not currently in the labor force, we need to do
much better, and I believe this initiative will help.
Your budget also proposes important investments that will
help address mine safety and health, worker misclassification,
and workplace safety and health activities. I was particularly
pleased to see a proposed increase for Bureau of International
Labor Affairs (ILAB), which leads our fight against the worst
forms of child labor around the world. And I thank you for
that, Madam Secretary.
On a related note, I'd like to thank you for your efforts
on the framework of action to support the implementation of the
Harkin-Engle Protocol targeted at child labor in the cocoa
sectors of Ghana and the Ivory Coast.
Madam Secretary, I know you are well aware of the many
important priorities competing for resources in our Labor-HHS
appropriations bill. Your testimony in this hearing will help
inform us as we do that work.
And before we hear from you, Madam Secretary, I would yield
to Senator Shelby for his opening statement.
STATEMENT OF SENATOR RICHARD C. SHELBY
Senator Shelby. Thank you, Mr. Chairman.
Madam Secretary, I look forward to hearing your testimony
today on the 2012 budget request. As the chairman has said,
we're in difficult economic times. The unemployment rate is 8.8
percent. When you consider the underemployed and those who have
stopped looking for work, which the Department of Labor does
not incorporate in the unemployment statistics, the real
unemployment rate is actually much higher, at 16.2 percent.
The Federal deficit is $1.65 trillion. In fiscal year 2012,
I believe we need to make cuts to our discretionary budget. I
don't think we have any choice. The Department of Labor's
fiscal year 2012 budget request reduces Federal spending by 5
percent, compared to fiscal year 2010 levels. And while the
Department of Labor should be recognized for cutting spending,
a feat not accomplished by every Department in the year 2012, I
do not believe, myself, a 5-percent reduction within the
Department of Labor goes far enough. In this difficult economic
environment we need to cut spending today.
DUPLICATION IN DEPARTMENT OF LABOR TRAINING PROGRAMS
To get Federal spending under control in the long term, we
must reduce spending in the short term. The first place to
begin to reduce expenditure is by eliminating duplication among
Department of Labor training programs. On March 1, the
Government Accountability Office, GAO, released a report on
duplication within Federal programs. I'm concerned that 44 of
the 47 Federal employment and training programs that the GAO
identified overlap with at least one other program. I would
think we could all agree that providing the same services to
the same population but through separate administrative
structures does not make sense. Many Federal workforce programs
meet important skill needs. But, the workforce system could be
better aligned across agencies and streamlined to ease access
for both workers and employers. And while I understand the
implementation could be challenging, collocating services and
consolidating administrative structures would increase
efficiencies, and it would certainly reduce costs.
GOVERNMENT ACCOUNTABILITY OFFICE REPORT
To the greatest extent possible, we should not have
duplication within the Federal Government, and certainly not
within one Department. The GAO report makes a number of
recommendations that would move the system in that direction.
And I think our subcommittee needs to seriously consider them.
Second, as the GAO report pointed out, we do not know the
effectiveness of most of the Department of Labor programs. In
last year's testimony before this subcommittee, Madam
Secretary, you stated that you understand the importance of
evaluating the Department of Labor workforce programs, and you
have, quoting you, ``a new commitment to program evaluation.''
Those were your words. A year later, I see few results. Job
Corps has not had a rigorous evaluation since 2003--8 years
ago. The program's funding, under the Workforce Investment Act
was supposed to be evaluated in 2005, and now we will not have
results until 2013. How can this subcommittee make funding
decisions without having thorough reviews of programs? I
believe we should have clear metrics and a results-driven
evaluation process to ensure that we fund only the most
successful programs.
Finally, over the past 10 years, the Federal Government's
regulatory reach has greatly expanded. The administration
continues to want to extend that reach, even though costly new
regulations, I believe, are oppressing economic growth in the
business community. According to the Center for the Study of
American Business at Washington University, $1.3 trillion is
lost each year in total U.S. economic activity due to Federal
regulations throughout our Government. We need to work together
to reduce excessive burdens on businesses and job creation
while still maintaining workplace health, safety, and basic
employment protections.
I'm particularly concerned regarding draft rule proposals
on welfare benefit plan disclosures and on the definition of a
fiduciary. I will have questions for the record on both of
these topics.
Mr. Chairman, I thank you for holding this hearing. I look
forward to continuing to work with you as we move toward the
2012 appropriation process.
Senator Harkin. Thank you very much, Senator Shelby.
Senator Cochran. Mr. Chairman, may I ask unanimous consent
to join you and Senator Shelby in welcoming the witness----
Senator Harkin. Absolutely.
Senator Cochran [continuing]. And having my statement be
included at this point in the hearing record?
Senator Harkin. Absolutely. Absolutely----
Senator Cochran. Thank----
Senator Harkin. [continuing]. Senator Cochran.
Senator Cochran. Thank you. Welcome.
[The statement follows:]
Prepared Statement of Senator Thad Cochran
Mr. Chairman, thank you for calling this hearing to discuss
funding for the Department of Labor for fiscal year 2012. I
appreciate Secretary Solis attending today and look forward to
her testimony.
Madame Secretary, I want to thank you for your continued
support of Job Corps and the YouthBuild program within the
fiscal year 2012 budget. Workforce development programs
targeted at youth are critical to developing occupational
skills as they work toward their chosen career field.
Mississippi has three Job Corps centers that serve over 1,400
students each year and six YouthBuild programs throughout the
State. These programs have given numerous out-of-school, out-
of-work Mississippi youth the opportunity to obtain their
General Equivalency Diploma (GED) or high school diploma and
gain critical vocational training. I look forward to continuing
to work with you on these important programs.
Thank you, Mr. Chairman.
Senator Harkin. And any other Senators who are not here, or
may come later, their written statements will be made a part of
the record.
Secretary Solis was confirmed as the 25th Secretary of
Labor on February 24, 2009. First elected to public office in
1985, as a member of the Rio Hondo Community College board of
trustees, Secretary Solis also served in the California State
Assembly from 1992 to 1994; in 1994, made history by becoming
the first Latina elected to the California State Senate. As the
chairwoman of the California Senate Industrial Relations
Committee, she led the battle to increase the State's minimum
wage. She also authored a record 17 State laws aimed at
combating domestic violence. Secretary Solis also was a
management analyst with the Office of Management and Budget
(OMB) in the Civil Rights Division and, as we know, also served
as a U.S. Representative from the 32d congressional district in
California from 2001 to 2009. Secretary Solis graduated from
the California State Polytechnic University, in Pomona, and
earned her master's degree at the University of Southern
California.
So, Madam Secretary, you have a sterling background, and a
background that fits in very well with your job and your
leadership at the Department of Labor. And let me, again, just
thank you for that great leadership that you've provided over
the last couple of years. We have seen, I think, dramatic
improvement in the morale. And we've see a lot of good things
happening out there, especially in areas of worker safety and
worker health protections. And I just want to compliment you
for that and welcome you back to the subcommittee.
Your statement will be made a part of the record in its
entirety. And you can please proceed as you so desire.
Thank you.
SUMMARY STATEMENT OF HON. HILDA L. SOLIS
Secretary Solis. Thank you so much, Chairman Harkin and
Vice Chairman Shelby and, obviously, Senator Cochran, for being
here. It's a pleasure to come back here before you, to the
subcommittee, and provide my testimony to you.
Since I came before you last year, there have been a lot of
changes in our economy, as you well know, and throughout our
country. But, what has not changed is the desire of the
American public, and that is for us to work together to address
the challenges facing working-class people and especially those
people that are underemployed or unemployed. While there is
broad agreement that the Government has to start living within
its means, I hope we can also agree that we have to make those
investments that will allow our future to prosper by out-
innovating out-competing, out-educating, and making sure that
everyone here has a fighting chance to be successful. For the
Department of Labor, that means preparing Americans for jobs of
tomorrow as well as ensuring that those jobs are both safe and
that they are fair.
The President's 2012 budget reflects difficult choices but
retains the critical investments needed to get America back to
work and in safe jobs. It also does so in a way that shows our
commitment to innovation. I want to thank you, Mr. Chairman,
for supporting the Workforce Innovation Fund within this recent
budget agreement. I look forward to working together with you
to build on the initial investment in a way that will make the
public workforce investment system more efficient, more
streamlined, more targeted to best serve our Nation's workers.
This is an example of where we did make a tough choice in the
budget. Instead of adding funds on top of existing programs, we
redirected funding from a slower spending statewide set-aside
to create a competitive grant program. Some of the concerns
that Senator Shelby has raised I believe will be addressed in
this Innovation Fund.
WORKFORCE INVESTMENT ACT
There was a similar choice that we had to make that you had
to make, as well: recent cuts that were made in the Workforce
Investment Act, overall. In crafting the future of WIA, the
Workforce Investment, I hope that we can find a way to strike a
good balance between local service dollars, statewide
activities, and competitive grants that don't replicate or
duplicate programs. I'm looking for ideas to provide new areas
and innovative pursuits, as also--and looking, also, for a
system that will help provide those reforms that we're talking
about here today.
I know that you've also faced tough choices in eliminating,
in fiscal year 2011, funding for green job training programs.
As the economy recovers, however, I strongly believe that green
jobs still will remain a growing segment of this economy and
will take us further, in the 21st century, to cut our
dependence on foreign oil and as well as relying on those
countries that may not be supportive of our goals, overall.
Preparing workers for these jobs will be a vital component
of winning the future, and restoring the investment will allow
us to continue to work with industry to ensure that American
workers have the opportunity to gain the skills and credentials
to move into better and high-paying jobs. And hopefully those
jobs will stay here on our shores.
I also want to emphasize that our budget maintains our
commitment to helping the most vulnerable populations, those
that are veterans, women, and other people that serve us well,
here in our country. We focus our resources and our Nation's--
on our Nation's veterans, including additional funds to help
veterans in transition to civilian employment, and for homeless
veterans, as well.
One of my priorities in that program is targeting women
veterans, many who are coming home have served us abroad and
are finding it very, very difficult to find employment, but
also, to help their families. We maintain the funding, in both
ETA and ODEP, for the Disability Employment Initiative that
you, Mr. Chairman, have championed. We recognize, also, that
young people need skills to qualify for the jobs of the future,
and request additional funds for the YouthBuild Program and the
Job Corps operations.
WORKER PROTECTION
At the Department of Labor, we take very seriously our
obligation to both protect workers and to protect those
businesses that play by the rules and provide their workers a
safe and fair workplace. No worker should have to worry about
whether they are going to come home safely at the end of a
shift or get paid for the work that they do. And no employer
should have to compete against companies that cut corners on
safety or evade the law.
The fiscal year 2012 budget builds on recent gains from our
worker protection agencies. As an example, the Occupational
Safety and Health Administration, OSHA, must ensure that all
employers live up to their obligation to provide a safe
workplace. Fiscal year 2012 budget provides the enforcement and
regulatory staff and resources we believe are necessary to meet
that challenge. It also maintains and expands on our commitment
on compliance assistance programs, including the Voluntary
Protection Program and the free Onsite Consultation Program
that focuses on small businesses.
Also within OSHA, we include additional funds to respond to
the challenge of implementing a greatly expanded Whistleblower
Protection Program that the Congress enacted.
The Upper Big Branch mine disaster, as you recall, 1 year
ago, resulted in the needless loss of 29 miners, and the worst
mining disaster since the creation of the Mine Safety and
Health Administration. In light of this tragedy, the budget
request includes additional resources so necessary to ensure
that the Department has the right tools needed to best protect
our miners. The request includes funding to continue to reduce
the backlog of contested citations at the Federal Mine Safety
and Health Review Commission. And I thank you for your
attention that you have paid to this problem in the recent
budget agreement. We must also continue our efforts in this
area to ensure that we're holding accountable mine operators
who fail to meet their legal and moral obligation and
responsibility to provide safe mines.
I also wanted to highlight a few other priority areas at
DOL. The budget request contains an increase for EBSA, the
Employment Benefit Security Administration, that protects
employee benefits for more than 149 million people by
safeguarding the integrity of 718,000 pension plans and 2.6
million health plans. Our recent request also includes
resources in the Wage and Hour Division and other agency
partners to prevent misclassification which is often misused by
employers by classifying workers as independent contractors in
order to avoid their legal obligation to pay taxes or follow
employment laws.
One of my goals as Secretary has been to build upon a
balanced pattern of global trade. Unless workers' rights,
wages, and working conditions are respected in countries abroad
that we trade with, workers will be at a disadvantage in the
global economy, particularly U.S. workers. The budget includes
an increase of this work by our Bureau of International Labor
Affairs while maintaining resources in ILAB's effort to combat
child labor. Again, I want to thank the chairman for his
tireless effort on our behalf and those many millions of
children.
Before closing, I want to emphasize our commitment to
improving how we deliver services. We're constantly
scrutinizing ourselves and looking for opportunities to improve
and to do things much smarter. I'm particularly proud of our
adoption of a rigorous self-evaluation program. We have a new
chief evaluation officer who is helping us measure our impact
of our programs to find out what works and what does not work.
And I welcome the opportunity for her to have a discussion with
each of you.
And I also want to note that the budget includes a proposal
to strengthen the integrity of unemployment insurance. And we
look forward to working with Congress on that matter.
Again, I want to thank you for the opportunity to present
our budget. I look forward to working with all of you. And I
hope that we'll continue to make headway in the coming year.
Thank you for the opportunity to be here.
[The statement follows:]
Prepared Statement of Hilda L. Solis
Chairman Harkin, Ranking Member Shelby, and members of the
Subcommittee, thank you for the invitation to testify today. I
appreciate the opportunity to discuss the fiscal year 2012 budget
request for the Department of Labor.
There is broad agreement that the Federal Government has to start
living within its means. Now that our economic recovery is gaining
strength, we must come together, reduce our deficit, and get back on a
path that will allow us to pay down our debt. But we must do it in a
way that protects the recovery, protects the investments we need to
grow, create jobs, and helps us win the future. Building on the 2012
budget and borrowing from the recommendations of the bipartisan Fiscal
Commission, the President recently proposed a balanced approach to
achieve $4 trillion in deficit reduction over 12 years. Part of this
plan is to keep annual domestic spending low by building on the savings
reflected in our 2011 budget agreement. That step alone will save us
about $750 billion over 12 years. The administration is committed to
making the tough cuts necessary to achieve these savings--including to
programs we care about--but will not sacrifice the core investments we
need to grow and create jobs.
The 2012 budget request for the Department of Labor includes a
number of these difficult cuts, but it also includes key investments
that would allow us to win the future by out-innovating, out-educating,
and out-building our global competitors. Getting America back to work
is a top administration priority as we seek to spur growth in the U.S.
economy. It is important to promote the creation of ``good jobs,'' and
the Department of Labor plays a vital role in this goal by helping
workers find and prepare for new jobs, helping employers find skilled
workers, and enforcing statutory obligations that keep workers safe and
help them keep what they earn.
investing in the future
The Department of Labor fiscal year 2012 budget invests in the
future by working toward my vision, Good Jobs for Everyone. The
Department's budget focuses on this vision in a fiscally responsible
manner by:
--Getting America Back to Work;
--Keeping Workers Safe; and
--Helping Workers Provide for Their Families and Keep What They Earn.
getting america back to work
To get America back to work and win the future, the Department will
prepare workers with the tools they need to succeed in the 21st century
economy, help workers and firms find each other, and support innovative
strategies to promote economic recovery. The budget documents have been
provided to the Committee and are available on our website, but for
now, I want to share the key investments with you:
--Workforce Innovation Fund.--The public workforce investment system
is more important now than ever, but we need to make it more
efficient, streamlined, and targeted to serve our growing
customer base. To ensure that our investments in employment and
training are focused on reform, the Departments of Labor and
Education will invest in a Workforce Innovation Fund that will
drive innovation and reinvigorate America's workforce
development system. The Fund represents a small but crucial
investment in innovative, evidence-based, and cost-saving
workforce investment strategies that will significantly impact
formula-funded activities well into the future. We were pleased
that the final 2011 budget agreement included funding for the
Fund. Our commitment to innovation is also reflected in
requests for green jobs innovation activities and, of course,
for evaluation so that we can improve our knowledge of what
works.
--YouthBuild.--Developing the skills of our Nation's youth is
critical to ensuring that our workforce is ready to succeed in
the future. The 2012 budget requests additional funds for the
YouthBuild program, which provides disadvantaged youth,
including youth with disabilities, with a pathway to employment
or post-secondary education. In fiscal year 2012, we will
continue to implement the YouthBuild random assignment
evaluation--the first rigorous impact evaluation ever conducted
of the program--to measure the program's impacts on
participants' post-program employment and earnings and to build
knowledge of what works.
--Unemployment Insurance Solvency and Integrity.--This administration
is committed to protecting the financial integrity of the UI
system and helping unemployed workers return to work as swiftly
as possible. Two major legislative proposals would strengthen
the unemployment insurance safety net. One would help States
improve the solvency of their unemployment accounts in the
Unemployment Trust Fund (UTF), while providing temporary tax
relief for employers. The other would create incentives for
States to adopt Short-Time Compensation programs and expand
their use nationally through implementation grants and a
temporary Federal program in order to help avert layoffs.
Another legislative proposal would focus on reducing UI
improper payments by giving the States new tools and resources
that will strengthen the fiscal integrity of the UI system
--Job Corps.--Our Job Corps program has a long history of preparing
disadvantaged youth for a successful transition into the
workforce. The 2012 budget would request additional funds for
the program, and continues an ambitious agenda to improve the
program's performance.
--Veterans' Employment and Training Service.--We know returning
veterans can contribute greatly to our economy. The request for
the Department's Veterans' Employment and Training Service
includes additional funds for the Homeless Veterans
Reintegration Program to provide employment and training
assistance to almost 27,000 homeless veterans, including
continuing our outreach to homeless women veterans. In
addition, the budget request funds the Transition Assistance
Program for service members and their spouses, including
expansion of services to retiring Reserve and National Guard
members. Transition Assistance Program workshops play a key
role in helping service members transition swiftly and
successfully to civilian employment.
--Disability Employment Initiative.--It is also important to continue
our efforts to ensure that our workforce system effectively
serves persons with disabilities. To accomplish this, the
Department's budget includes funding for the Employment and
Training Administration and the Office of Disability Employment
Policy to continue the Disability Employment Initiative begun
in fiscal year 2010. This initiative works to build the
capacity of the WIA One-Stop Career Center system to serve job
seekers with disabilities by improving coordination across
programs, leveraging resources, and prioritizing the provision
of service to job seekers with disabilities (adults and youth)
through the Social Security Administration's Ticket to Work
program.
keeping workers safe
Winning the future requires a successful competitive market where
all firms are playing by the rules to keep workers safe. Workers should
be safe in their jobs and we need to ensure that our worker protection
efforts keep up with the changing economy. The fiscal year 2012 budget
builds on recent gains for our Worker Protection agencies. Some of the
highlights of our worker protection request include:
--Occupational Safety and Health Administration.--The Occupational
Safety and Health Administration (OSHA) must ensure that all
employers are able to provide safe workplaces to their
employees. The request would expand OSHA's commitment to
preventing injuries, illnesses and fatalities by deterring
employers in the most hazardous workplaces who exhibit a
profound disregard for worker safety and health. The fiscal
year 2012 budget also includes funds to support OSHA's work
with the 21 whistleblower programs it administers in order to
reduce the backlog in whistleblower claims, expedite the
handling of received complaints, and prepare for a high volume
of complex cases resulting from recently passed laws.
--Mine Safety.--The Upper Big Branch mine disaster just over 1 year
ago resulted in the needless loss of 29 miners' lives and was
the worst mining disaster in the last 40 years. To prevent
future such tragedies, the budget request includes additional
resources for the Mine Safety and Health Administration (MSHA)
to ensure that the Department has the tools we need to best
protect miners. The Budget also requests funding for the Office
of the Solicitor (SOL) to reduce the enforcement backlog of
contested citations at the Federal Mine Safety and Health
Review Commission (FMSHRC). Funds would also support
Administrative Law Judges processing Mine Safety and Health
citation cases at FMSHRC. We must continue our efforts in this
area to ensure that we are holding accountable mine operators
who fail to meet their legal and moral responsibility to
operate safe mines.
helping workers provide for their families and keep what they earn
Employee Benefits Security Administration.--The Department's
Employee Benefits Security Administration (EBSA) protects the employee
benefits for more than 149 million people by safeguarding the integrity
of 718,000 pension plans, including 401(k) plans, 2.6 million health
plans, and a similar number of other employee benefit plans. The
additional requested resources will support the significant increase in
congressional action aimed at strengthening benefit security for
working Americans and their families. The Department's efforts will
make plans more secure and help ensure that workers and their families
receive the benefits to which they are entitled from their plan and
under the law.
Pension Benefit Guaranty Corporation.--The Budget proposes to
strengthen the defined benefit pension system for the millions of
Americans who rely on it by giving the PBGC Board the authority to
adjust premiums and directing PBGC to take into account the risks that
different sponsors pose to their retirees and to the pension insurance
program. In order to ensure that these reforms are undertaken
responsibly, the budget would require 2 years of study and public
comment before any implementation and the gradual phasing-in of any
increases.
Employee Misclassification Prevention and Detection Initiative.--
The budget re-proposes a multi-agency Misclassification Initiative that
would coordinate Federal and State efforts to remedy violations that
may result from the misclassification of employees as ``independent
contractors'' and mitigate future violations.
Other priorities from the budget submitted by the President in
February include additional funds for the Bureau of International Labor
Affairs. The fiscal year 2012 budget includes funds to allow ILAB to
collect additional information for its responsibilities for reporting
on labor rights in countries that have free trade agreements and trade
preference programs with the United States. The budget will also
continue the Bureau's longstanding commitment to combating child labor
internationally and to building international relationships that
improve global working conditions and strengthen labor standards around
the world.
conclusion
To summarize, the 2012 budget provides targeted investments to help
workers and firms better find each other, prepare Americans with the
skills needed for the jobs of today and the jobs of the future, and
ensure that we have a fair and equitable labor market for firms and
workers. Our efforts will help to get America back to work, foster safe
workplaces that respect workers' rights, provide a level-playing field
for all businesses, and help American workers provide for their
families and keep the pay and benefits they earn. I am committed to
achieving the goal of Good Jobs for Everyone while the administration
focuses on our shared long-term goal of reducing the Federal deficit. I
believe it is possible to do both and stand ready to work with you in
the weeks and months ahead on a responsible way forward.
Mr. Chairman, thank you for inviting me today. I am happy to
respond to any questions that you may have.
Senator Harkin. Thank you very much, Madam Secretary.
We'll start a round of 5-minute questions.
EMPLOYMENT OF PEOPLE WITH DISABILITIES
Madam Secretary, I know you share my deep concern about
what happened in a situation in Iowa a couple of years ago. It
was uncovered in April 2009. Again, for your benefit, and
others, here's what happened. We found people with
disabilities, 21 men, were working in a turkey processing
plant. They had been employed by Henry's Turkey Service, out of
Goldthwaite, Texas--shipped up to Iowa--and had been working in
this turkey processing plant, some for as long as almost 20
years. They were living in an old bunkhouse, an old
schoolhouse--106-year-old schoolhouse--where the boilers didn't
work. It was cold. Cockroaches were everywhere. And these men
were bused from there to the workplace and back again. They
were making 41 cents an hour--subminimum wage--41 cents an
hour. And they were working right next to people making $12 an
hour, doing the same job. I mean, it's not that they were
picking up after them, they were doing the exact same work. And
so, this was uncovered. It became quite a scandal.
I have since visited--now, those men have been taken out of
there. I've since visited with some of those employees in
Waterloo, but some went back to Texas. Some are still in Iowa,
and they're working. And they're working not at subminimum wage
jobs, but at regular integrated employment. In fact, one even
started his own business, which is a lawn care business in
Waterloo.
WAGE HOUR DIVISION
Now, why do I raise this issue? I raise it because, from
2000 to 2008, the Wage and Hour Division lost 20 percent of its
staff. John McKeon, Deputy Administrator of the Department of
Labor's Wage and Hour Division, told me, before I held the
hearing that we held on this subject in the HELP Committee,
that there are many employers in the United States who pay less
than the minimum wage and, ``have never seen a Wage and Hour
investigator.'' And that's sort of what happened in Iowa.
As I understand it, they were visited, years ago, and then,
every year, all they have to do is just send in a piece of
paper. They just send in a piece of paper saying that, ``We're
complying,'' and that's the end of it. The turkey place was
called Atalissa--Atalissa. And so, we refer to it as the
Atalissa case, which raises, in my mind, if that happens in
Iowa, how many more Atalissas are there out there? And as you
know, I am taking the opportunity in the HELP Committee and
with the Workforce Investment Act, to take a look at this area
of subminimum wage, and how people with disabilities are
funneled into subminimum wage jobs. They're never given any
training, never any upgrading of skills, never tested to see,
can they do something else? Obviously, if these men were doing
the same job as nondisabled people, they should have been paid
the same rates. There should have been integrated employment.
So, I guess I just wanted to bring that to your mind and to
your attention and just ask you, again, what actions your
Department's taking to prevent this sort of situation from
happening again, and to find out how many other places like
this exist in our country?
Secretary Solis. Mr. Chairman, I also am appalled by this
particular case. And I know the last time that I came before
this subcommittee, I think you brought it up at that time, as
well. Since that time, I'm happy to report that our Wage and
Hour Division, because of the support that we received, we're
able to bring back the enforcement capability that we lost in
the last 10 years.
And what we have done, in this particular case, is to look
at those individuals that are working with the 14(c) program,
particularly identifying this population, and looking through a
survey, a compliance survey, to see where we have gaps, where
we have found problems. And I can tell you that I will make
sure that you get the results of our survey that will be due to
us in about 4 to 6 weeks.
And with that, I would say that we have made sure--and this
one particular case that you're talking about--at the time,
they were not certified under the 14(c) program, but we did
have our Wage and Hour personnel take action, as well as our
solicitor. That particular situation is being litigated in
courts right now. And we're finding that there were some major,
major violations of the Fair Labor Standards Act. And these
individuals, I believe----
Senator Harkin. Yeah.
Secretary Solis [continuing]. Will find justice.
And I would tell that we're going to continue to look at
these kinds of abuses, because we know that if it happened
there, it could very well be happening somewhere else. And we
want to get to the bottom of that.
Senator Harkin. I thank you for that. And I also--I just
might say, they got initial summary judgment for $1.76 million.
But, then again, that doesn't--that helps, but that doesn't
take care of the losses they've had in Social Security, for
example, payments that they're going to need when they get
older. And some are on the verge of retirement right now. So,
thank you.
Secretary Solis. I'd be happy to work with you on that----
Senator Harkin. I appreciate it.
Secretary Solis [continuing]. On strengthening----
Senator Harkin. I appreciate it.
Secretary Solis [continuing]. This program.
Senator Harkin. This case just shocks the conscience. Just
shocks the conscience. Thank you very much, Madam Secretary.
Senator Shelby.
RECOVERY EFFORTS IN ALABAMA
Senator Shelby. Thank you, Mr. Chairman.
Madam Secretary, last week, tornados devastated my home
State of Alabama. It was the worst that we've experienced in my
lifetime, and probably in most people's lifetime in the whole
South. I toured the damage, last Friday, with the President.
And we've had a number of Cabinet Secretaries who were down
there Saturday and Sunday. I'm going back down there next week
with the HUD Secretary, who's already been there.
Could you tell me what the Department of Labor is doing to
assist the people of Alabama in their recovery efforts? I know
you're doing some things. But, you know, we're facing dire
circumstances.
Secretary Solis. Right. Senator, also I want to convey my
condolences to the families there, as well as to the other
States that are affected, and tell you that this is a constant
reminder of my role at the Department of Labor, because we have
a special funding that is made available. Fortunately, we have
some funds for them. In fact, this morning, before I came to
this hearing, I signed off on what we call the National
Emergency Grant, the NEG, that will be going to Alabama, to
those, I believe, 67 counties that are eligible, under FEMA----
Senator Shelby. That's fine.
Secretary Solis [continuing]. To receive funding. The
amount is for about $10 million to help provide temporary jobs
for those individuals, whether they work for private or public
sector, if they've lost their homes. They'll be hired. They can
help provide with cleanup. They'll also be able to help provide
with any repair, renovation, reconstruction for low-income
housing, as well as provide assistance for weatherization. And
particularly, people that are eligible for other types of
Federal aid, they will be able to help those individual
households repair.
I know this is a small amount, given the catastrophe there.
And I would imagine that the Governor and yourself will be
working with my staff, my Assistant Secretary----
Senator Shelby. Sure.
Secretary Solis [continuing]. Jane Oates, who was contacted
very early on, and had our staff out in the field. In this
tornado, unfortunately, we lost some State staff from----
Senator Shelby. We did.
Secretary Solis [continuing]. Various WIA programs, that
lost their homes and lost their lives, as well.
So, we know this is tragic. And I am also prepared, once we
have more notification from the other States that have not yet
completed their applications, to make a visit out there myself,
as I did a year ago, when we heard about the BP oilspill. We
have a necessity to be on top of safety and protection for
workers, as well.
Thank you.
NATIONAL LABOR RELATIONS BOARD
Senator Shelby. Well, thank you very much. And I know there
are other States, including the State of Mississippi that
Senator Cochran represents, that were affected here.
I want to turn to another area. On April 20 of this year,
the acting General Counsel of the National Labor Relations
Board issued a complaint against the Boeing Company, alleging
that it violated Federal law by deciding to transfer a second
airplane production line from a union facility in the State of
Washington to a nonunion facility in the State of South
Carolina. The complaint said this was discrimination. It's
interesting that the National Labor Relations Board used the
word ``transfer,'' as its production line does not, and never
did, exist in Washington State. I make this point because, if
the production line never existed in Washington and was not
planned or committed there, there were no jobs lost there.
Madam Secretary, I understand that the National Labor
Relations Board is an independent agency. But, I'd like to hear
your thoughts on the underlying issue here, that private U.S.
business cannot freely open new facilities in right-to-work
States without fear of retaliation by the U.S. Government and
this administration. Is that the policy of this administration?
Secretary Solis. Senator, I would just say to you--and you
just emphasized that--that this in an independent agency, the
NLRB. And while they are currently going through their decision
or--I can't really comment on what they are--on what the
counsel there is----
Senator Shelby. I know it's not directly under you. You
have an opinion on it, or you'd just rather not----
Secretary Solis. No. No, I don't have, other than to tell
you that this administration strongly supports the efforts of
those that want to associate with unions and collectively
bargain.
Senator Shelby. And what if they don't want to associate
with them?
Secretary Solis. They have those rights, as well.
Senator Shelby. Do they support that, too?
Secretary Solis. I believe so.
Senator Shelby. I hope so.
Secretary Solis. I believe so. Yes.
JOB CORPS PROGRAM
Senator Shelby. I want to get into the Job Corps, if I
could, in my limited time. Job Corps is the Nation's largest
vocationally focused education and training program for
disadvantaged youths. For the year 2012, the administration
included $1.7 billion for Job Corps. I'm concerned about the
lack of clear metrics within the Department for evaluating Job
Corps. It's my understanding the Job Corps Program has not had
a rigorous evaluation since the Mathematica administrative data
study concluded in 2003, 8 years ago. And that study concluded
that the program's cost exceed its benefits.
Further, according to a study published in the American
Economic Review in 2008 entitled, ``Does Job Corps Work?'', Job
Corps participants were less likely to earn high school
diplomas, according to this study, and earned an average of
only 22 cents more an hour than nonparticipants. The study even
showed that the program had no effect on college attendance or
completion.
These are disturbing statistics, given that the Federal
Government spends an average of $27,000 per Job Corps
participant over a 9-month period. As we all know, for $27,000,
a person could earn their associate's degree or attend several
years at a university somewhere in America.
Madam Secretary, what are your thoughts on the
justification for spending $1.7 billion on a workforce training
program that has few, that I see, published results, and clear
problems with management of taxpayer funds? What's your defense
of that?
Secretary Solis. Senator, first of all, I'd like to tell
you that I am a strong believer of the Job Corps Program. And
since I have been in charge of the program in the last 2 years,
we have made, I think, some tremendous strides in trying to
make sure that we do provide the metrics and evaluation. And I
would tell you that, yes, that last review that you talk about
that was done in 2001, it's unfortunate that, in the past 10
years, or so, that there wasn't a closer look at what the
metrics are.
But, I would tell you that what we are doing now is
instituting more evaluation from within our own program. And I
would tell you that, in program year 2009 through June 2010,
20,000 students attained high school diplomas in--and their
general equivalency diploma (GED), 30,000 students completed
career and technical training in 11 high-growth areas.
Senator Shelby. What's the percentage of that? That's good,
but----
Secretary Solis. Seventy-six percent of--in 2009, were--
graduates were placed in employment, or some chose to go in the
military.
Senator Shelby. Okay.
Secretary Solis. So, we are doing a better job. But, I
realize that one of the goals that we have to look at here is,
What career are these folks going into?--not just a job, not
just a part time, or not just a minimum wage job, but also a
career. So, we've instituted, I think, a whole platform to have
them look at renewable energy--green jobs. We can transition
from construction into a new hybrid technological area.
And it's hard, because these students are the ones that--
our society, or maybe their families, have failed them. And I
would tell you that, in many instances--and I know Senator
Cochran might agree--that these students--young people--not all
of them are young, some of them are 21, 24 years old--have
stepped up, in many ways, when there's disasters. When Katrina
happened, I know some of them were out there helping to rebuild
homes----
Senator Shelby. Yeah.
Secretary Solis [continuing]. For even people who were less
fortunate than themselves. And I look to these students as our
future leaders, many who have transformed their lives, many who
have served--even in my own office, have come and have shared
their talent and skills with us. And I think that, in many
cases, it's a well-kept secret. Yes, we could make improvement
with Job Corps. But, we should not somehow push aside the
enormous resource that we have with these young people. We only
have 124 centers. And, at best, there hasn't been sufficient
funding to help make them more effective and more, how could I
say, directed toward those good careers that we all know that
they can be a part of.
Senator Shelby. Well, I want to--I'm not proposing we
abolish Job Corps. I'm thinking, in trying to work with you and
Senator Cochran and others, to improve it. Because, I know it
does do some good. And I know, for a lot of people, it's their
last hope. But, we can always improve it.
Secretary Solis. Absolutely.
Senator Shelby. I hope you're committed to that.
Secretary Solis. I am. I am, sir. And I would love to be
able to visit with you----
Senator Shelby. Absolutely.
Secretary Solis [continuing]. And one of our Jobs Corps
centers----
Senator Shelby. Thank you.
Secretary Solis [continuing]. So that we can look at those
things together.
Senator Shelby. Thank you, Mr. Chairman.
Secretary Solis. Thank you.
Senator Harkin. Thanks, Senator Shelby.
Senator Cochran.
Senator Cochran. Mr. Chairman, thank you.
Madam Secretary, welcome to our subcommittee. We appreciate
your being here to discuss the budget request for the programs
under the jurisdiction of your Department.
JOB CORPS CENTER, GULFPORT, MISSISSIPPI
Mentioning the Job Corps center reminds me that, in
Hurricane Katrina, we had a devastating hurricane, as you
recall, and everybody does, that struck the gulf coast area of
the country. And our Job Corps center in Gulfport, Mississippi,
was totally destroyed. And so, we had a lot of displaced people
who had been working there and living there. Progress has been
made, but I wonder whether or not you can give us some idea
about when the construction, or reconstruction, of that center
might be completed. We had heard 2012. Now we're hearing it
might be delayed well over into 2013 or 2014. What is the
latest information you can provide the subcommittee with on
that subject?
Secretary Solis. Yes, thank you, Senator Cochran. I would
just say that, at the Gulfport center, students, as you know,
have already been enrolled. So, we have about one-half the
number of students that we could handle there. That's about, I
believe, 145 that are currently there and enrolled. We know
that we have to continue to build out the rest of the facility,
which is going to take us some time. We believe that we're
making progress on the permanent construction. That's what
you're talking about. And I can see--possibly by mid-August of
this year, we should be able to see that permanent dormitory
established there that I know you're concerned about. The rest
of the center, the design will probably be complete in another
2 years--2 to 3 years, unfortunately. But, it remains a focus
of what our efforts are there. And believe me, I will keep you
up to date, and my staff will. And I'm just excited that we're
able to serve with those 145 students that are currently on
campus.
Senator Cochran. We appreciate your personal attention to
that and the leadership that the Department is providing to get
that back into operation as soon as possible. Thank you.
YOUTHBUILD PROGRAM
There's another program, that I was curious about your
assessment of it, called ``YouthBuild.'' And it's targeted to
younger workers. It's a training program but a workforce
development program all at the same time. It gives high-risk
youth opportunities to develop occupational skills with
vocational training as they work. Could you tell us what the
program is achieving, if it's working? Do we continue to
support it under your budget request?
Secretary Solis. Thank you, Senator Cochran. I am delighted
that, through the YouthBuild Program, and especially the
funding that we received in the last two cycles, have been able
to help us focus better on providing better certificates and
measurements for student success. And one of the highlights, I
think, of our effort has been to really infuse technology. So,
whether it's healthcare, IT, or whether it's renewable energy,
changing the focus, in some ways, from construction to
renewable energies. And I've actually been able to see this on
the ground, where young men and women--and I'm delighted to say
``women''--are getting enrolled in these programs and really
learning the crafts, the crafts that will help provide them
with better training, better skills, and giving them a job. And
most students that enroll in the program are tied in, typically
with either an apprenticeship program, in some cases, and in
some cases, with a business developer in construction, that
will hire those individuals up as rapidly as they're trained.
So, I would say to you that the program--actually, I would
love to see it expanded, because I think it is well worth our
investment there. And I know that many people, again, that come
into that program sometimes are the hardest ones to serve,
because they may not have completed their high school
education. Some may not be as motivated as others. And once
they find collegiality amongst their other peers, they then
become competitive with themselves. And I've seen them develop
leadership skills and actually work in new industries that are
actually going to help to bring back our economy, especially
when it comes to conservation and restructuring and
retrofitting of some of our aged housing and commercial
buildings. I see a lot of them that are very enthusiastic about
the program.
Senator Cochran. Thank you. I'm also advised there's other
good news from my State. One program, in particular, the on-
the-job training provided under the Workforce Investment Act,
has been particularly successful in Mississippi. And I wanted
to pass that assessment from my staff on to you, and thank you
for the leadership on that.
OFFICE OF DISABILITY EMPLOYMENT POLICY
And Disability Employment Service is another area where I
think the Department is making important contributions. That's
a well coordinated effort, I'm told, providing those with
disabilities rehabilitation services, encouraging them,
monitoring their progress. Some of the highest rates of
rehabilitation in the country, at over 70 percent, are being
observed under that program. It's the Disability Employment
Initiative.
Secretary Solis. Yes.
Senator Cochran. And I thank you for your leadership in
that area, as well. Are you familiar with those reports?
Secretary Solis. Yes, I am. Yes, I am. And I want to thank
the chairman and this subcommittee for supporting the funding
for that program. And it continues, I think, to be something
that really is refreshing, because it helps to shine a light on
the fact that the disabled community has been underrated. In
fact, what we're finding, from our own assessments, is that
they tend to perform better in the workplace. And we are losing
out, as a country, if we don't utilize the skills and talents
that they have.
So, we know that good models exist in Iowa and other
States, and we want to continue to build that out. Under the
leadership of my Director for ODEP, Kathy Martinez, she has
been tremendous. You know, she is--I call her one my Charlie's
Angels, who's been out there, really helping to fight, and
really parlay the importance of providing the disabled
community with the tools that they need. They're not asking for
a handout. They're asking for a hand up, an ability to be able
to work in different employment situations. And when we find
employers that are willing to do that, they are going to make
those businesses shine. And we've seen it already evidence. And
I'm very delighted that, through the leadership of this
chairman, that we're looking at expanding this effort, also, to
include our one stops. So, there are one-stop centers. We have
3,000 of them. We'll also start looking at how we can better
serve that population and address their issues, up front.
Senator Cochran. Thank you.
Thanks, Mr. Chairman.
Senator Harkin. Thanks.
Senator Brown.
Senator Brown. Yeah. Thanks, Mr. Chairman.
Welcome, Madam Secretary.
AFRICAN-AMERICAN UNEMPLOYMENT
Talk to me about African-American unemployment. African-
American unemployment is 16 percent--official unemployment. We
know it's higher than that, almost twice the white unemployment
rate of 8.7 percent. What is DOL doing specifically to address
the endemic, long-term very serious problem of black
unemployment?
Secretary Solis. It's a very serious problem, Senator. And
I know it's one that we care a lot about.
I recently visited Ohio and several States there, and met
with several faith-based leaders to talk about how we can
begin, in a better way, to target our funding and our
proposals. One thing I will tell you is that we, under the ARRA
Program, were able to target about $150 million in career
pathways out of poverty, targeting communities that have
unemployment rates above, say, 50 percent. Those went into
particular communities of color. We continue to also provide
reintegration programs for ex-offenders. It's something very
important. And with our YouthBuild Program and our Job Corps
Program, I think it's safe to say that about 40 percent to 60
percent are African-American.
We need to do more, obviously. And we do need to have
assistance, in terms of providing them with the job training
opportunities that will put them into good careers that won't
just lead to a paycheck, but a career. And I think that's what
we're trying to do in some of our new rollout of programs.
We just announced, for example, in the H1B Program, through
fees that we received, $240 million in grants that will go out
to help dislocated workers, but also working with industry to
help provide new technical training to their current incumbent
workers, hopefully open up that slot to allow for a dislocated
worker. Hopefully, it will be those in those communities most
distressed. So, that is going to be our focus for that
particular program.
But, we continue to work with our community colleges, our
workforce investment boards, and with the faith-based community
to see how we can better improve the status of African-
Americans.
But, again, one of the things I have to tell you--and you
know this better than I--is that one of the things we have to
do is aspire for higher education. That's why the President has
talked a lot about providing opportunities for Pell grants, for
assistance, for financial aid, so that individuals can receive
a community college degree and hopefully get better training,
because it is a more competitive workforce.
2012 BUDGET RESOLUTION PASSED BY HOUSE
Senator Brown. Thank you. You mentioned Federal job
training programs, WIA, and other things. The--I'm concerned,
with the 2012 budget resolution that passed the House, the
consolidation of multiple programs serving a range of
populations--minorities, veterans, individuals with
disabilities, dislocated workers, at-risk youth--into a single,
one-size-fits-all voucher program, and squeezing those programs
to the point of tens of billions of dollars, over the next 10
years. Does the administration share the view approved by the
House, that now is the time to significantly reduce investments
in workforce training? Is that something that you oppose? Would
you talk to us about, you know, sort of a critique of that, and
what direction you think we should go in, if you disagree?
Secretary Solis. Well, Senator, as you know, the President
and the debate right now is about working within our means. And
that obviously is something that we do take serious. And we did
take that step in this budget.
And I would say to you that we have attempted to keep the
integrity of our programs in place. As the President said, we
don't want to hurt the innovation, the ability to not be able
to compete, and the fact that we have to keep our vulnerable
communities front and center.
So, I would say to you that my personal commitment is to
try to keep the integrity of these programs in place. I
realize, as a former member, like yourself, that we don't have
the luxury of being able to cut back on these very vital
programs that help provide people the ability to get back to
work. There are so many people that are, how could I say,
feeling let down, that they don't have an opportunity to get a
job right away. And those are the very folks that we have to
keep in place. Those are the very folks that we have to make
sure that they receive training, that they go to our one-stop
centers and they keep engaged. Because, the farther they are
away from that ability, an employer, chances are, will not want
to hire them up. And we've seen that evidenced already in the
workplace, where actually employers are saying, if someone's
been out of work more than 6 months or 1 year, they may not be
the first person that they're going to look at, in terms of
their resume. So, I'm very concerned about this.
Senator Brown. My last--thank you--my last question, Mr.
Chair.
EXPANSION OF TRADE ADJUSTMENT ASSISTANCE
Madam Secretary, the administration did something very
important, many things very important, in the Recovery Act.
Specifically what I want to talk about, just for a moment, is
the expansion of trade adjustment assistance to expand it, not
just to the service industry, but to--I mean, not just to
manufacturing, but service and those job layoffs and retraining
in--where not only--not exclusively with countries with whom we
had a free trade agreement. That--you know, we were able--it
was in effect til the end of December of this past year; we
were able to get a 6-week extension with--you know, the--late
in December, as you know. And you helped us with that. But,
this--the expanded TAA eligibility lapse for service workers
and workers who lost their jobs in--as a result of----
Secretary Solis. Right.
Senator Brown [continuing]. Of job loss in countries with
whom we didn't have a free trade agreement, that--so, what's
the Department doing? Is the Department, now that that's
lapsed--I--number one, I'd like the administration to take a
stronger position on TAA. You know, some people have called TAA
``funeral expenses'' for these trade agreements, frankly. But,
at least TAA is something. And now we don't even have TAA for
these workers that have lost their jobs because of trade
agreements that were wrong-headed. I remember your work in the
House against some of them--CAFTA and some others. What--is the
administration going to speak more forcibly--forcefully on the
extending of TAA and extending of the health credit--the HCTC,
health care tax credit? And what are you doing, in terms of
processing these applications, when the program--the expansion
of the program is expired on TAA?
Secretary Solis. Well, Senator, we are very concerned that
there was not a decision to extend the TAA Program. And it is
of great concern. And it is affecting many dislocated workers
at this time. And I do believe that the program is worthy of
being reinstituted, because I know it does make a difference,
especially for people from the Midwest, in your case, your
State, and other places where we've seen industries leave our
country and go to other places, where it has made a difference
to help provide as a safety net for people to transition into
new jobs. I saw it happening, time and time again, these last 2
years, especially in the automobile industry. We saw a lot of
dislocated workers that received this assistance and were able
to make the transition quickly to get higher skills or
healthcare coverage and be able to make that transition.
And as you know, that story, I think, is a good story,
especially with the automobile recovery, where we've seen that
now GM, Chrysler, and those folks have been able to put back
some lines of assembly and also put people back, and they've
paid back their loans.
But, TAA is very important. That discussion has to go on. I
understand there are individuals that still have questions
about it and are trying to tie that in with other trade
agreements. I would hope that the--that this body would do the
right thing and extend it on its own, if possible. But again,
that is not something that I can determine.
Senator Brown. Well, but we----
Secretary Solis. But, I wholeheartedly support it.
Senator Brown. Thank you. But, we need the administration
to speak much more forcefully than they have on the importance
of TAA. You weren't absent, as an administration--and I know
your personal feelings on this--you weren't absent, last
December, on this, but you weren't nearly as vocal as an
administration that stands for workers and stands for
retraining and stands for an industrial moving forward that we
have not done so well, in the last few years, on. So, that's a
plea to you.
Thank you, Madam Secretary.
Senator Harkin. Thank you very much, Senator Brown.
Senator Shelby.
Senator Shelby. Mr. Chairman, I have a couple of questions,
and then I have a number for the record. If I can ask the rest
of them, after I ask these two, for the record, I'd appreciate
it very much.
GAO REPORT
Madam Secretary, I want to go back into some of the GAO
reports. In January, the GAO released a report on multiple
employment and training programs, and the report stated, and
I'll quote, ``Little is known about the effectiveness of the
employment and training programs we identified because only
five reported demonstrating whether outcomes can be attributed
to the program through an impact study, and about one-half of
all the programs have not had a performance review since
2004.'' That was the GAO.
Despite unemployment being at 8.8 percent, officially, the
Department of Labor, it's my understanding, has not taken
action to address its ineffective programs. In fact, based on
the GAO survey of Department of Labor officials, only 5 of 47
programs have studies that assess whether the program is
improving employment outcomes.
Madam Secretary, how do you respond to these troubling
issues identified in the GAO report? And, if you want to, you
can answer that for the record.
Secretary Solis. Thank you, Senator. I would just say to
you, as I mentioned earlier, that the report that was--that
you're citing was done in the previous administration, was
supposed to be completed, I believe, at that time. That's why I
signed a contract so that we could continue to do our own
evaluation and have that done, which began in 2009.
[The information follows:]
Department of Labor's Performance Measures
Nearly all of the Department of Labor's two dozen
employment and training programs include strong accountability
features and performance metrics on employment, retention and
earnings measures. We are strengthening our accountability
further, as demonstrated by the Departmental 2011-2016
strategic plan, which places an increased focus on performance-
based management. Performance measures are being reassessed for
consistency across programs throughout the workforce system to
promote better outcomes for individuals of all skill and need
levels, particularly those who are not yet ready and able to
move quickly into a good job. We believe that workers and
employers should have ease of access to information about past
participants' outcomes, to make informed decisions about which
programs are most likely to meet their needs.
In addition to the annual employment and training
performance reviews conducted at the Federal, State, local and
training provider levels, the Department has been working
diligently over the past 2 years to restore the rigor of our
evaluation studies. Specifically, I established the Chief
Evaluation Office (CEO), which was staffed in May 2010. The
purpose of this office is to coordinate the Department's
research and evaluation agenda in order to increase its
capacity to conduct high quality, rigorous evaluations.
Further, the GAO has noted in a recent March 2011 report
the marked improvement in the dissemination of research reports
by the Employment and Training Administration under my
leadership at the Department of Labor. The GAO noted that,
``The 34 research reports published by ETA in 2008 took, on
average, 804 days from the time the report was submitted to ETA
until the time it was posted to ETA's research database. By
contrast, from 2009 through the first quarter of 2010, the
average time between submission and public release was 76 days,
which represents a more than 90 percent improvement in
dissemination time compared with 2008.'' \1\
---------------------------------------------------------------------------
\1\ U.S. Government Accountability Office, ``Employment and
Training Administration: More Actions Needed to Improve Transparency
and Accountability of Its Research Program,'' March 2011, p. 26.
---------------------------------------------------------------------------
Also, since 2009, approximately half the evaluations the
Employment and Training Administration (ETA) has funded have
been rigorous, random assignment impact evaluations. These
include the Workforce Investment Act (WIA) Gold Standard
Evaluation of the Adult and Dislocated Worker Programs (WGSE),
the YouthBuild Impact Evaluation, the Reintegrating of Ex-
Offenders Random Assignment Evaluation, the Impact Evaluation
of Green Jobs, Health Care and High Growth Training Grants and
the Transitional Jobs Impact Evaluation, all of which will
examine net impacts on employment, retention and earnings, and
include benefit-cost analyses. ETA was able to fund these
evaluations through an increase in fiscal year 2010
appropriations and the large one-time infusion of funds made
available to the Department through the American Recovery and
Reinvestment Act of 2009.
While rigorous random assignment impact studies, such as
the WGSE, provide the most credible information on program
effectiveness, these are also highly resource intensive and
take a range of 3 to 7 years to implement and complete. Mindful
of the statutory responsibility for evaluation, and to address
the knowledge gap until the WGSE results are available, in 2009
the ETA released the results of a quasi-experimental net impact
evaluation of the WIA Adult and Dislocated Worker programs.\2\
This study uses the next-best methodology when random
assignment is not available. This evaluation found positive
long-term earnings impact for both programs, though the impacts
were more substantial for the Adult program than for Dislocated
Workers. ETA plans to publish interim findings of the WGSE in
2013, and the final report will be available in 2016, although
this schedule is dependent upon continued appropriations for
the evaluation of WIA programs.
---------------------------------------------------------------------------
\2\ The Workforce Investment Act Non-Experimental Net Impact
Evaluation: Final Report may be found at ETA's Research Publication
Database Web site.
Secretary Solis. The results of that study----
Senator Shelby. Is this ongoing?
Secretary Solis. Yes. And that will become available in
2013. It does take time, because----
Senator Shelby. It does.
Secretary Solis [continuing]. You're looking at different
factors. But, nevertheless, since I've been here, we have begun
this evaluation.
Senator Shelby. Have you seen some of the preliminary work?
Secretary Solis. Not necessarily----
Senator Shelby. Not yet?
Secretary Solis. No. But, as I said earlier, that some of
the results that we have seen from our own evaluation, our in-
house, shows that during the program year June 2009 to June
2010, 76 percent of our workers exiting the WIA dislocated
program, and 69 percent of the workers exiting the adult worker
training, found a job within 3 months. And after that--and
that--and I think those are good statistics----
Senator Shelby. That's good.
Secretary Solis [continuing]. Considering a bad economy,
when you're finding four----
Senator Shelby. It's tough.
Secretary Solis [continuing]. To five people are competing
for one----
Senator Shelby. It's tough out there with skills, right
now.
Secretary Solis. Yes.
Senator Shelby. We understand that. But, my interest is
probably--coincides with yours, that we want these programs to
work. And we have to measure them. And if they don't work, we
figure out something that will work. Because, the end game is
to get people back to in the employment. Is that right?
Secretary Solis. Yes. And, Senator, I would say that one of
the things that we need to focus on is reauthorizing WIA,
because that's really going to help us. What I've heard, time
and time again, is that this is an old system that has to be
restructured. It has to look at new segments, regional issues,
and really look from the bottom up, not from the top down.
Senator Shelby. I think we know somebody that deals with
authorization close to us today.
TRANSITION ASSISTANCE PROGRAM
If I could, I'd like to get into another program, the
Transition Assistance Program. The unemployment rate for
veterans of the wars in Iraq and Afghanistan rose to 15.2
percent in January 2011 which is well above the official
national rate of 8.8 percent. This is the highest rate recorded
since the Bureau of Labor Statistics began tracking this data
in 2006. And these are our veterans, recent veterans.
Madam Secretary, are we doing all we can to assist our
veterans, particularly as they attend the Transition Assistance
Program classes prior to discharge from the military service?
It's my understanding that the Transition Assistance Program,
which the Labor Department administers for the Department of
Defense, was recently revised; its first substantive revision
since the first gulf war. Is there data or any information yet
on whether the revised program is actually helping veterans
find jobs, particularly 21st century jobs that will sustain
them--in information technology, health-related professions,
and the energy industry--jobs that are meaningful?
I believe we owe our veterans a lot. And I'm sure you'd
share this.
Secretary Solis. I couldn't agree with you more, Senator.
And, as a former House member, this was one area--while I
didn't sit on that committee--I was very concerned with the
training and the TAP program. That's why I asked my Assistant
Secretary, Ray Jefferson, who runs that division, to take a
keen look at what was going on there. And what we found was
that, yes, there hadn't been evaluations. There weren't any
metrics to really identify the people that went through the
process, if they really found employment.
We're doing a better job. We're investing money. We have a
whole evaluation and a request for proposal to look at how we
can improve the program. We have new partners. And I'm happy to
report that we even have engaged outside entities like the U.S.
Chamber of Commerce, who has agreed to help us identify
opportunities for employment, something that should have
happened 10 years ago. This program was neglected for the last
8 years. I admit that. I wasn't here----
Senator Shelby. I know you weren't.
Secretary Solis [continuing]. For all that time. But, I can
tell you that one of the concerns that this administration has
is making sure that we don't just help that soldier, male or
female, but we also help the family. Because, the family can
also help provide assistance----
Senator Shelby. Absolutely.
Secretary Solis [continuing]. If they're given the right
tools and information. Training, especially for wounded
warriors--very important. I've seen some tremendous programs
that have come out of efforts, that identify good careers. For
example, helmets to hardhats, where actually an individual can
go in through a training and apprenticeship program, and then,
after they leave and are discharged, can actually continue in
that program in their State, and then be hired up almost
immediately, making a six-figure salary. And that, to me, is
something that we ought to be expanding and looking more at.
I'm looking forward to working with the Department of
Defense (DOD)--and we have, with the Veterans Administration
(VA)--to improve upon these services. This couldn't be one of
the most, if not one of the most important areas that I often
look at.
WOMEN VETS
And I'm particularly concerned about returning women vets.
We've had a number of women, young women who've gone in, who
are also faced with a lot of challenges, one that isn't easily
identified when they come back home. Many have been through
different posttraumatic stress and also need our help. Many are
not apt to identify, in many cases, that they are veterans, as
well. Because, when you find them, in some cases, homeless or
in a shelter, they won't say that they were a vet, because they
feel ashamed. And we have to remedy that. And we have to let
everyone know that----
Senator Shelby. They should be proud.
Secretary Solis [continuing]. They're needed, that they're
needed.
Senator Shelby. They should be proud of what they've done.
And you're absolutely right that if we can get them back in the
workforce, it will help them readjust to civilian life, because
they've gone through a heck of a lot.
Secretary Solis. Absolutely.
Senator Shelby. Thank you, Mr. Chairman.
Senator Harkin. Thank you, Senator Shelby.
JOB CORPS EVALUATION
Madam Secretary, I don't have any other questions, just,
again, a follow up on what Senator Cochran talked about
earlier. You had an exchange with him on the Job Corps, I
believe. And I think Senator Shelby asked a question about the
efficiency and effectiveness of Job Corps. Yes, it does cost
$27,000 per person. But, let me give you one example of a young
woman that I know that was in our Job Corps center in Dennison,
Iowa.
Our Job Corps center in Dennison, Iowa, was the first in
the Nation, by the way--oh, this has been 20-some years ago--
that actually added a facility whereby young single mothers
could come and bring one or two children with them, and be
housed there in a safe environment. They have a Head Start
program right there for these kids, plus the healthcare
benefits and things like that, that accrue to them.
You take a young single mother who dropped out of high
school when she was about a sophomore, had some unfortunate
things happen to her, is now 18, 19 years old, two children and
no hope, no family, no structure, and headed toward a life of
drugs and crime. She gets sent to the Job Corps center. Her
kids have a great place to stay. They're in a Head Start
program and she's in a program where she's going to get her
GED, and then she's being trained for a career. She sees a
future ahead of her now. She has all the hope and all of the
kind of internal support mechanisms she needs to go out there
and do something.
Does that cost $27,000 a year? You bet it does. But, the
cost to society of not doing that, I submit to you, will be 10,
20, 30 times that much--the cost to society--if we don't do
that.
RETURN ON INVESTMENT
So, I know Job Corps. You look at it and you wonder about
the rate of return on investment, as they say, and things like
that. But, I don't mind an indepth look. I think we should have
it evaluated. I agree with you on that. If there's places that
can be tightened up, it should be done. But, in certain cases,
this is just going to be--it's not a quick fix. Some of these
young people are just not a quick fix. And it takes some time.
But, it's been my experience, with the Job Corps centers
over the last 30 years, as a Congressman before this, that
sure, there are obviously those that don't make it. There are
those that drop out, and don't make it. But, I would say, the
success rate that I have been able to see has been tremendous.
And what they do in the local community and the local
businesses and the synergism, the inner workings with these
kids and young people in the Job Corps centers with the local
business community, and how they work things out, it's just
been for a rural area, it's been quite a thing to see.
So, I just--again, count me as a great supporter of Job
Corps. I don't want to turn a blind eye to things that need to
be done to make it more effective. And I hope we can work
together, and work in a bipartisan----
Senator Shelby. Absolutely.
Senator Harkin [continuing]. Fashion to do that.
Senator Shelby. We want the end result, don't we?
Senator Harkin. And we want the end result. Exactly right.
Exactly right.
So, Madam Chairman, thank--or, Madam Secretary, thank you.
Secretary Solis. Thank you both. Thank you. I thank the
subcommittee.
And I do want to work with you on evaluation. I think that,
yes, we are in hard budget times. We realize that. But, I
think, again, if we can preserve the quality of the intent of
these services, and help those people that really deserve the
help, I think----
Senator Harkin. Yeah.
Secretary Solis [continuing]. We're on the same page.
Senator Harkin. I'll just add one other thing to my good
friend--and he is a great friend of mine--Senator Shelby--is
that we are working on WIA. We've been working on it for a long
time, even before I was chairman. And hopefully, we're going to
have a bill this year.
Secretary Solis. Good.
Senator Shelby. If I could, Mr. Chairman, I just want to
reemphasize that we all--Senator Harkin was relating some
examples of where Job Corps really works with people and
everything--that's what we all want. We want to help these
people, because if we don't help them, as he's pointed out,
they will be--a lot of them will be in trouble. They will be on
welfare for most of their life, if not in prison. I won't say
everybody, but so many of them. And this is a chance to help
them. We just want to make sure that the programs are working.
Let's pump them up. If they're not working, let's find out why
they're not working.
Secretary Solis. Right.
Senator Shelby. Because, the need for people--and the help
is going to be there--we just want the program to work.
Senator Harkin. Absolutely.
Secretary Solis. Thank you.
Senator Shelby. Okay.
Senator Harkin. Amen.
ADDITIONAL COMMITTEE QUESTIONS
Secretary Solis. Thank you both. Thank you. It's a
pleasure. 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 Tom Harkin
employee benefits security administration
Question. Since fiscal year 2009, the Employee Benefits Security
Administration has created efficiencies in its programs, eliminated
lower-priority spending and realized other cost savings. What
additional steps will EBSA complete in fiscal year 2011? What is
proposed in the fiscal year 2012 budget request?
Answer. Our new paperless participant complaint intake system is
scheduled to become fully operational by the end of fiscal year 2011.
Currently 92 percent of inquiries and complaints handled by our Benefit
Advisors (BAs) are received by phone. We will encourage the use of our
new electronic intake process which will be more efficient for the BAs
and will be more user friendly for the public. When the paperless
system is operational, all participant inquiries/complaints regardless
of how they are received will be managed electronically. Currently,
participants can submit inquiries electronically; however, the
submission does not auto-populate the inquiry database and make
assignments to the appropriate office for handling. The new system will
more efficiently direct electronic inquires to a Benefit Advisor in the
appropriate office and transmit the response for electronic approval
and clearance. The system will provide basic contact information for
the participant and the subject of the inquiry/complaint that will
auto-populate our tracking system. The new paperless system will
include standard language paragraphs to be used in correspondence when
responding to all types of participant inquiries and will include an e-
mail wizard that will allow us to more efficiently contact the
participants and plan sponsors to resolve complaints. This will
substantially improve the efficiency of the overall Participant
Assistance Program.
By the end of fiscal year 2011, EBSA will have implemented a new
call management system and web-based reporting tool throughout its
regional offices. This system helps EBSA to achieve performance measure
targets through more efficient workload management. Also, it allows
EBSA to handle more live calls, reduces hold times and dropped calls,
and provides managers with real time performance data in order to
adjust duty roster schedules. Answering calls live ensures contact with
the participant and is more efficient by eliminating call-backs, voice
mail messages, and customer service complaints to Congressional
offices, DOL managers and other officials.
The EBSA reporting compliance program is continuing to adapt to the
new EFAST2, wholly electronic, Form 5500 processing system which became
operational in fiscal year 2010. The new EFAST2 makes Form 5500 data
available faster--within 24 hours of a filing being made. Consequently,
EBSA is able to analyze and review data on a ``real time'' basis and
then apply a customized approach in targeting filings with significant
errors.
Question. What will the Employee Benefits Security Administration
achieve in terms of workload and performance in fiscal year 2011?
Answer. The fiscal year 2011 information and data provided in the
fiscal year 2012 congressional budget justification was based on an
annualized continuing resolution at fiscal year 2010 enacted
appropriations. While the final fiscal year 2011 appropriation
approximated these funding levels, the delay in appropriations creates
challenges in achieving workload and performance goals. At this point,
we expect the performance for the Employee Benefits Security
Administration (EBSA) to differ from the fiscal year 2011 information
in the fiscal year 2012 congressional budget justification as follows:
----------------------------------------------------------------------------------------------------------------
Original
fiscal year
Workload measure 2011 workload Fiscal year Difference
in fiscal year 2011 revised
2012 CBJ
----------------------------------------------------------------------------------------------------------------
Civil Investigations Processed.................................. 3,282 2,900 -382
Criminal Cases Processed........................................ 247 200 -47
Participant Inquiries (Field)................................... 246,000 233,000 -13,000
Participant Inquiries (NO)...................................... 10,000 12,000 +2,000
Indictments..................................................... 84 82 -2
Compliance Seminars............................................. 10 6 -4
Regulatory Projects............................................. 237 250 +13
Individual Exemptions........................................... 122 130 +8
Section 502(I) Waivers.......................................... 15 6 -9
Exemption Processing Time....................................... 301 430 +129
----------------------------------------------------------------------------------------------------------------
All remaining fiscal year 2011 workload estimates remain as
presented in the fiscal year 2012 CBJ.
Question. The Department has proposed a new regulation defining
``fiduciary'' under the Employee Retirement Income Security Act of
1974. What benefits would the proposed regulation have for employers--
especially small employers--that sponsor retirement plans?
Answer. Investment advisers have assumed an increasingly important
role in helping employers, especially small employers, choose an
appropriate menu of investments choices for 401(k) plans and in
advising employees and IRA holders on how to allocate their individual
account balances. Although ERISA specifically provides that investment
advisers may be fiduciaries, and employers and employees often rely
heavily on their advice, advisers often have no accountability for
their recommendations because the Department's current regulation
stipulates a five-part test which makes it easy for these advisers to
avoid fiduciary status.
The Department's proposal would address this problem by providing
that those who purport to give impartial investment advice for a fee
will be held to ERISA's fiduciary standards of prudence and loyalty,
and preventing them from using compensation arrangements that conflict
with these duties. Small business owners, in particular, are often not
equipped to make plan investment decisions on their own. In selecting
appropriate plan investments and investment options for their
employees, small businesses depend on impartial expert advice. The
Department's proposed regulation will give these employers recourse
against advisers who fail to uphold the standards of a plan fiduciary.
wage and hour division (whd)
Question. The fiscal year 2012 budget identifies savings related to
the operation of a toll-free employer compliance assistance call
center. Please describe how this proposal will achieve the identified
savings with at least the same level of services currently provided.
What steps will WHD complete in fiscal year 2011 that create
efficiencies and realize other cost savings?
Answer. In order to improve the ability to provide timely and
accurate customer service at each of the more than 200 offices
nationwide, the Wage and Hour Division (WHD) is in the process of
implementing a telephone system with automated call distribution and
integrated voice response technology. Once all new hardware and
software are fully deployed in fiscal year 2011, WHD will be better
able to route calls for more efficient transfers and referrals, manage
staffing needs to be more responsive to callers, record and monitor
calls for quality and training purposes, and collect and analyze
telephone usage statistics.
With the full implementation of the new computer telephony system,
WHD will be able to provide better and timelier service to the public,
and at lower cost than it did with the call center.
Question. What additional cost savings are proposed in the fiscal
year 2012 budget request?
Answer. The fiscal year 2012 budget request indicates program
decreases for Employment Compliance Assistance and the Call Center of
$2,290,000 and 12 FTE. Over the last 2 years WHD has hired additional
in-house technicians who can answer calls more effectively and
accurately and as noted above, WHD is already in the process of
upgrading its own telephone infrastructure in order to improve the
ability to provide timely and accurate customer service at each of the
more than 200 offices nationwide.
Question. What will the WHD achieve in terms of workload and
performance in fiscal year 2011?
Answer. The fiscal year 2011 information and data provided in the
fiscal year 2012 congressional budget justification was based on an
annualized continuing resolution at fiscal year 2010 enacted
appropriations. At this point, we expect the performance for the Wage
and Hour Division (WHD) to be consistent with the fiscal year 2011
information in the fiscal year 2012 congressional budget justification.
With the additional investigative resources added to the agency
over the past 2 years, the WHD expects an increase in the number of
compliance actions that it is able to complete in a fiscal year. For
example, WHD estimated a 20 percent increase in the number of concluded
compliance actions for fiscal year 2011, or approximately 5,400
additional cases above the 26,500 completed in fiscal year 2010. The
newly hired investigators have now completed much of their basic
training requirements, and as a result, are contributing to the
agency's investigation production numbers.
WHD also expects to see an increase in the number of directed
investigations that it completes in fiscal year 2011--particularly in
high risk industries, i.e., those industries with high minimum wage and
overtime violations and among vulnerable worker populations where
complaints are not common. WHD's fiscal year 2011 directed
investigations are being concentrated in the agricultural,
construction, and hotel/motel industries and in specific program areas.
The program areas include the FLSA Section 14(c) program in which
employers are certified to employ disabled workers at wages below the
Federal minimum wage and the Davis-Bacon and related Acts and Service
Contract Act government contract programs. WHD offices are also
conducting directed investigations in industries in which young workers
are employed and at risk of injury. In fiscal year 2011, WHD will
complete a pilot study related to H-2B compliance in the resort segment
of the hotel/motel industry. The agency will also examine compliance in
the residential construction sector.
Finally, WHD has revised its Davis-Bacon wage survey processes to
improve the quality and timeliness of wage determinations published by
the agency. WHD, for example, is now utilizing State prevailing wage
determinations as the basis for issuing more current highway wage
rates. This change, coupled with improvements to the survey process,
has positioned the agency to complete during fiscal year 2011 all 26
surveys that were initiated in 2010.
Question. According to the preliminary results from the WHD's 2010
review of the authority established under 14(c) of the Fair Labor
Standards Act, 23 percent of Section 14(c) certificate holders were
found in compliance with only 57 percent of consumers paid in
compliance with this section of the law. What specific steps will WHD
take in fiscal year 2011 and under the fiscal year 2012 budget request
to improve these unacceptably low compliance rates?
Answer. We agree that the 2010 evaluation of employer compliance
with Section 14(c) of the Fair Labor Standards Act produced
disappointing results. In response to the evaluation findings, WHD
conducted investigation-based evaluations of a randomly selected sample
of 154 community rehabilitation programs (CRPs) that were certified to
employ individuals with disabilities at less than the minimum wage. The
agency conducted full investigations of randomly selected CRPs from
three employer groups: all certified CRPs, CRPs with prior violations,
and CRPs that had conducted a self audit as part of the certification
process.
In the baseline evaluation, 65 percent of the cases, which
represent approximately 3 percent of the nationwide population of
community rehabilitation programs (CRP), were randomly selected for
investigation. Twenty-three percent of the investigated CRP's were in
compliance with all laws enforced by Wage and Hour for both Section
14(c) workers and other staff workers. Seventy-two percent had monetary
violations.
With respect to the evaluation of prior violators, 42 cases
representing 49 percent of the nationwide population of CRP's with
prior investigations were selected. Nineteen percent of the
investigated CRP's were in compliance with all laws enforced by WHD for
both Section 14(c) workers and other staff workers, and 69 percent had
monetary violations.
For CRPs that conducted a self-audit as part of the certification
process, 47 cases, representing 24 percent of the CRP's with prior
self-audits, were randomly selected for investigation. Fifteen percent
of the investigated CRP's were in compliance with all laws enforced by
WHD for both Section 14(c) workers and other staff workers, and 83
percent had monetary violations.
Despite the low compliance rates found in all three evaluations,
the data appear to be more nuanced than the rates suggest. The majority
of the violations resulted from incorrect or untimely prevailing wage
and commensurate wage determinations. Other violations were caused by
confusion about the appropriate minimum wage, owing to the fact that
between 2007 and 2010, the Federal minimum wage increased three times
followed by further minimum wage increases at the State level. Keeping
pace with these minimum wage adjustments produced many of the
violations during the survey period.
WHD has identified a number of internal and external strategies to
address these types of violations, including changes to the
certification process. Given the high turnover among CRP staff who
conduct these wage determinations, WHD is considering additional
training requirements for CRPs. WHD is also analyzing the certification
process as a potential means for routinely and broadly disseminating
information on making wage determinations and other compliance issues
to certification applicants. Given the geographic distribution of CRPs,
along with their staffing and resource constraints, Web-based training
could reach a wider audience with less investment for both WHD and
CRPs. Exploring the use of technology in training and maintaining the
emphasis on improving wage determinations may address many of the
violations found.
office of federal contract compliance programs
Question. OFCCP recently secured a contract to conduct a program
level organizational assessment. What were the findings and related
costs savings implemented or planned to be implemented? What additional
steps will OFCCP complete in fiscal year 2011 that create efficiencies
and realize other cost savings? What additional actions are proposed in
the fiscal year 2012 budget request?
Answer. To ensure that it is appropriately staffed and resourced to
implement its enhanced enforcement, compliance, regulatory and outreach
efforts, OFCCP undertook an independent management and organizational
assessment. The goal of the organizational assessment was to evaluate
the agency's current structure, staff capabilities, resource
allocation, and business process efficiency. The assessment was broken
into two distinct parts; the former focusing on the National Office and
the latter focusing on the regions. In response to the findings of the
first part of the assessment, OFCCP reorganized its National Office and
created a Governance Board to address systemic issues and break down
organizational barriers. OFCCP is still in the process of evaluating
the findings of the regional assessment.
The reorganization involved making the following changes to the
structure of the National Office, which were aimed at improving
organizational effectiveness and efficiency: (1) create a
Communications Team within the Office of the Director; (2) make the
Division of Statistical Analysis a unit reporting to the Division of
Program Operations; (3) create a separate Testing Unit within the
Division of Program Operations; (4) create a separate Data Integrity
Team within the Division of Program Operations; and divide the Branch
of Budget, Finance and Administrative Services into three specialized
parts (the Branch of Budget and Finance, the Branch of Human Resources
Liaison and Information Management, and the Administrative Services
Unit).
The purpose of the OFCCP Governance Board is to transform the way
the agency addresses select operational issues. The independent
organizational assessment found that too often, identification and
development of solutions to operational issues occurs among functional
groups on an ad-hoc basis. This approach is not systematic; nor does it
provide a consistent mechanism for divisions and regions to work across
organizational boundaries. It encourages stove piping and thus limits
the agency's ability to achieve desired outcomes. Additionally, it was
suggested that many projects would benefit from broader input from the
various segments of the OFCCP workforce.
The OFCCP Governance Board will provide a transparent and
sustainable means to address appropriate operational issues across
organizational boundaries. Once fully implemented, the OFCCP Governance
Board will improve vertical and horizontal communication within OFCCP,
strengthen the workforce, create a healthier work environment, and
provide better ways to identify issues and solve problems, as well as
enable the agency to more effectively achieve output targets, outcome
goals as described in the Department's Strategic Plan, as well as other
organizational goals. In addition, the OFCCP Governance Board will
improve employee morale by sending a message to staff that we are
committed to including them in the decisionmaking process.
The Governance Board is designed to augment existing approaches. To
ensure success, the process will be developed carefully, beginning with
a few high priority projects and expanded over time.
In addition to improvements made as a result of the organizational
assessment, OFCCP expects to realize significant savings from its new
IT system, the Federal Contractor Compliance System (FCCS), a modern
cloud-computing based integrated case and content management
information technology solution, which is slated to replace the
agency's 20 year old case tracking system, the OFCCP Information System
(OFIS), in fiscal year 2012. In fiscal year 2011, OFCCP devoted $3.815
million to the development of system requirements for FCCS. The agency
plans to allocate an additional $2 million to the project in fiscal
year 2012.
At present, the compliance review process is completely manual. The
FCCS will significantly increase the agency's productivity by fully
automating this process. Concurrently, FCCS will eliminate
inconsistencies across OFCCP's regions by imbedding business rules in
the automated environment, thereby preventing deviations from standard
operating procedures. Stand alone functionalities such as word
processing, spread sheets, statistical software, and e-mail will be
integrated into the FCCS, eliminating the need to exit one system to
invoke the other. This will create additional efficiencies in
completing and tracking cases. For example, compliance officers must
enter case related status updates manually into OFIS. This leads to
delays and input errors, and is extremely inefficient. By eliminating
the need to manually enter status updates and providing the capability
to capture, store, search, retrieve and reference case file
documentation, the FCCS will save time spent in reconciling
information.
The FCCS will also improve information security. Currently, OFCCP
case files are in hard copy and lack advanced safeguards to protect the
personally identifiable information and commercial data provided to
OFCCP by Federal contractors. The FCCS will enable the agency to
create, analyze, generate, schedule, and track cases in a secure
electronic environment.
We estimate the FCCS will cost about $23 million over a 10 year
period, in contrast to a benefit of about $39 million for that same
period. The system is designed to allow the agency to add enhancements
and improvements over time. Under OFIS, the agency would not be able to
add value in the upcoming years. On the contrary, OFIS would become
more obsolete every year, and more expensive to maintain over the same
time period. In fact, the overall cost to operate the OFIS system for
the next 10 years is estimated to be greater than for FCCS, even when
the FCCS acquisition and planning cost, front loaded in the first 2\1/
2\ years, is factored in. For years 3 to 10, we estimate it would cost
twice as much for OFIS to operate as it would for FCCS. Thus,
implementing the FCCS will enable OFCCP to realize significant savings
over time in addition to large gains in productivity.
Question. What will the OFCCP achieve in terms of workload and
performance in fiscal year 2011?
Answer. In fiscal year 2011, OFCCP is implementing the following
strategic goals to achieve the Secretary's vision of good jobs for
everyone: (1) prepare workers for good jobs and ensure fair
compensation by increasing workers' incomes and narrowing wage and
income inequality, and assisting low wage and the unemployed with
gaining access into the labor market and the middle income bracket; and
(2) assure fair and high quality work-life environments by eliminating
barriers to a fair and diverse workforce. OFCCP has also developed new
outcome measures that are being baselined in fiscal year 2011. These
measures will be used to target OFCCP's performance in fiscal year 2012
and beyond. The measures are: Compliance rate for Federal contractors;
discrimination rate for Federal contractors; and impact of an OFCCP
evaluation on future contractor compliance.
To measure and assess workload enforcement efforts, OFCCP has
several workload measures that are assessed quarterly. These include
completion of 3,500 compliance evaluations in fiscal year 2011, which
includes a target of 3,225 supply and service reviews and 275
construction reviews. The agency exceeded its compliance review goals
by 18 percent through the first and second quarters of fiscal year
2011. OFCCP also has workload measures for its outreach and compliance
assistance work, and has also implemented a new quality control measure
that will look at the quality of cases worked on by compliance
officers.
To further enhance the effectiveness of the compliance review
process, OFCCP focuses its investigative efforts on enforcement
priorities once desk audits are completed. The objective is to modify
how and where case investigation decisions are determined to ensure
efficient use of resources. Specifically, the agency identifies cases
for priority review based on the potential and type indicators of
discrimination and uses a new concept called Triaging of Cases, to
identify similar issues and patterns among corporate-wide
establishments and within industries. The agency's focus centers on
compensation cases, hiring investigations, veterans and disability
investigations, and other investigations including promotions,
terminations, and good faith efforts. This concept allows the agency to
focus enforcement efforts toward complex investigations, which renders
more in-depth, detailed and thorough investigations, including
additional onsite verifications.
In addition, OFCCP is using performance accountability measures
that assist the agency's enforcement efforts, as well as provide the
agency with the ability to make proactive adjustments that will ensure
the agency reaches its goal. The performance accountability efforts
include: (1) ongoing monitoring and reporting of field enforcement
operations by national and regional office activities; (2) quality
assurance and quality Investigations of contractors that assist the
agency in achieving its goal to conduct more comprehensive audits; (3)
improving the identification of adverse impact indicators in the audit
process; (4) identifying compensation disparities; and (5) bringing
more Federal contractors into compliance. The agency will also enhance
the training of its Compliance Officers with an objective to expand and
increase the effectiveness of the agency's enforcement. The training
will provide staff with introductory, intermediate, and advanced level
training in line with national priorities.
Question. Secretary Solis, as you know, I am supportive of your
efforts to strengthen the affirmative action requirements of 41 CFR
part 60-741, the regulations implementing Section 503 of the
Rehabilitation Act of 1973, as amended (Section 503). You issued an
Advance Notice of Proposed Rulemaking (ANPRM) last July with a
September deadline for comments. Can you please provide an update on
where things stand with that proposed rule, and when we can expect to
see a final rule? I strongly believe that Federal contractors can play
a big role in helping to improve employment outcomes for qualified
workers with disabilities, and I am eager to see the Section 503
regulations strengthened as part of a broader effort to increase the
number of people with disabilities participating in the U.S. labor
force.
Answer. I share your belief that strengthening the Section 503
regulations is an important part of the broader effort to increase the
number of people with disabilities in the U.S. labor force. The ANPRM
we published last year resulted in 127 comments from disability and
veteran advocacy organizations, trade and professional associations,
employers, and other interested groups and individuals. All comments we
received were considered as we drafted a Notice of Proposed Rulemaking
(NPRM), which was submitted to OMB for interagency review under
Executive Orders 12866 and 13563 on May 24.
office of labor-management standards (olms)
Question. In fiscal year 2011, OLMS will eliminate a unit dedicated
to audits of international unions. OLMS has determined that these
expenses will be better used in core mission work. Please provide
supporting data for this conclusion, including how OLMS will enforce
relevant laws with respect to international unions.
What additional steps will OLMS complete in fiscal year 2011 that
create efficiencies and realize other cost savings?
Answer. In fiscal year 2011, OLMS plans to eliminate the
International Compliance Audit Program (I-CAP), which on average,
resulted in seven or eight audits per year. Savings will be applied to
maintaining FTE levels in OLMS' core mission, compliance assistance and
enforcement of employer/consultant reporting. It is important to note
that OLMS is continuing to conduct criminal investigations involving
international unions based on information of financial improprieties.
Criminal investigations are part of OLMS' core mission work and OLMS
projects to have sufficient resources to conduct approximately 300
criminal investigations in fiscal year 2011. OLMS is also continuing to
conduct union officer election investigations (over 130 cases
projected) including investigations of international union officer
elections. OLMS will also continue to conduct audits of intermediate
body and local unions under the compliance audit program (CAP). OLMS
will create efficiencies in the CAP program by improving its audit
targeting methods to more effectively identify fraud and embezzlement
while conducting fewer audits. Despite fewer audits, OLMS' enforcement
program will remain viable and effective. OLMS will also realize
efficiencies and cost savings in the election program by working to
reduce the number of days it takes to resolve union officer election
complaints and, in the reports and disclosure program, by increasing
the number of LMRDA reports filed electronically.
Question. What additional actions are proposed in the fiscal year
2012 budget request?
Answer. OLMS proposed the following initiatives in the fiscal year
2012 budget request:
--Increase effectiveness of audits by focusing resources on labor
unions most likely to be in violation of the law.
--Improve timeliness in resolving union member election complaints.
--Improve the Internet public disclosure service and public access to
information reported by unions, union officers, union
employees, employers, labor consultants and surety companies
under the Act.
--Increase provision of compliance assistance to national and
international labor organizations to increase their affiliates'
LMRDA compliance by developing, implementing, and extending the
number of voluntary compliance agreements (VCA) to establish
goals, baselines, and measures for improving recordkeeping,
reporting, and internal controls.
--Improve compliance with minimum bonding requirements of local and
intermediate union affiliates by working closely with their
parent national and international unions, including those who
are not party to a VCA.
--Increase the number of national and international unions whose
affiliates conduct audits of their own financial records in
accordance with a partnership that develops, delivers, and
evaluates a customized local union audit training curriculum
for each parent union.
--Increase the number of reports filed by employer-consultant
persuaders.
--Reduce delinquency rate of filers of Labor Organization Annual
Financial Reports.
--Reduce delinquency rate of chronically delinquent filers of Labor
Organization Annual Financial Reports.
Question. What will the OLMS achieve in terms of workload and
performance in fiscal year 2011?
Answer. The fiscal year 2011 workload and performance data provided
in the fiscal year 2012 congressional budget justification was based on
an annualized continuing resolution at the fiscal year 2010 enacted
level. At this point, however, we expect the performance for the Office
of Labor-Management Standards to differ from the fiscal year 2011
information in the fiscal year 2012 congressional budget justification
as follows:
OLMS expects that the number of election cases will exceed the
projected total of 130. Election cases are predicated on member
complaints and during fiscal year 2011, OLMS has received an inordinate
number of these cases.
OLMS projects fewer supervised elections (projected 35). The number
of supervised elections is a demand-driven measure in that OLMS cannot
predict changes in annual numbers, and historically the number of
supervised elections has fluctuated greatly (based upon the number of
election investigations, ability to reach voluntary agreements, etc.)
OLMS expects to exceed the predicted number of 200 compliance
audits and complete at least 350 during fiscal year 2011.
As noted above (SSEC10), OLMS expects to continue to seek increased
program efficiencies for the remainder of fiscal year 2011 and into
fiscal year 2012.
office of workers' compensation programs (owcp)
Question. Since fiscal year 2009, the OWCP has created efficiencies
in its programs, eliminated lower-priority spending and realized other
cost savings. What additional steps will OWCP complete in fiscal year
2011?
Answer. OWCP continues to modernize its technology systems to
automate claims processing and provide greater accessibility and
services to customers. Expanded use of teleconferencing has reduced
travel costs to conduct informal hearings and conferences and training
costs. Technology tools also enable centralization of functions and
increases flexibility in workforce assignments and workload
organization and management. In fiscal year 2011, OWCP will:
Consolidate Division of Federal Employees' Compensation (DFEC)
claims intake and case creation activities from 12 District Office
locations to two central sites. Consolidation will improve consistency
in the quality of case creation as well as provide operational
efficiencies such as reduced contract staff and equipment requirements.
Deploy the Employees' Compensation Operations and Management Portal
(ECOMP) to allow electronic filing of Federal Employees' Compensation
Act (FECA) claim forms, submission of other documents, and the
uploading of documents directly through a secure web-based application.
Deploy DFEC's new interactive voice response (IVR) system that will
offer self-help features to callers, greatly improve call routing, and
provide greater access to information and assistance services.
DEEOIC continues to actively look for ways to improve customer
service and speed benefit delivery. In response to a customer service
satisfaction survey conducted last year, new pamphlets and brochures
are being developed to be posted online and given out at the Resource
Centers. These informational pamphlets will provide clear guidance to
the claimant population concerning key benefit and program issues.
Continue, on a monthly basis, the Black Lung program assessment of
each district office's workload and the rebalancing of caseloads so as
to prioritize the adjudication of new claims filed under the Patient
Protection and Affordable Care Act (PPACA).
Question. What is proposed in the fiscal year 2012 budget request?
Answer. Requests for additional resources in fiscal year 2012,
through which OWCP will continue to create efficiencies in its
programs, eliminate lower-priority spending, and realize other cost
savings include:
--$1,200,000 in Special Benefits (FECA) to provide for policy review
and conversion of the iFECS Case Management System to the new
HIPPA International Classification of Diseases standard, ICD-10
mandated by the Department of Health and Human Services. The
ICD coding scheme is used by OWCP to identify medical
conditions accepted in workers' compensation claims and by the
healthcare industry for delivery of services to our claimants.
--$3,200,000 and 9 FTE in Longshore Salaries & Expenses for resources
to address the numbers and complexity of Defense Base Act (DBA)
claims and reduce processing timeframes. DBA injury and death
cases in connection with the wars in Iraq and Afghanistan have
increased dramatically, rising from 347 cases in fiscal year
2002 to nearly 15,000 cases in fiscal year 2010, while
Longshore resources have remained static.
In addition, OWCP continues to pursue legislative reform of the
Federal Employees' Compensation Act (FECA). We estimate that our reform
proposal will save the Government (conservatively) between $400 and
$500 million in its first 10 years. In addition, the proposal contains
several provisions that will improve administration of FECA operations.
These include creating a lower benefit level, or ``conversion''
benefit, once an injured employee reaches Social Security Retirement
age or after 1 year of FECA compensation (whichever is later);
establishing a uniform compensation rate of 70 percent for all
claimants, including schedule awards, and removing benefit augmentation
for dependents; moving the 3-day waiting period for benefits from after
the 45-day continuation of pay period to the first 3 days following the
filing of a traumatic claim; and authority to match Social Security
records with FECA claims records without prior claimant approval to
ensure continued FECA benefit eligibility.
Fiscal year 2012 funding will enable OWCP to introduce additional
customer service improvements and business process and organizational
design enhancements, as well as workload management innovations such as
Telework and Flexiplace expansion.
Question. The congressional budget justification indicates that the
Division of Federal Employees' Compensation will take a series of steps
related to the recruitment, placement, and accommodations of workers
with disabilities. Please provide more specifics on current and
proposed actions under existing law.
Answer. Subsequent to last year's kick-off of the new Federal
workplace safety and return-to-work (RTW) initiative--``Protecting Our
Workers and Ensuring Reemployment'' (POWER)--DFEC met with the 14
larger agencies to discuss their current performance levels and actions
they will take to meet their POWER targets. The meetings also included
discussions about those agencies' organizational and other RTW
challenges, opportunities for DFEC to provide assistance, and the
agencies' potential for improvement.
Extending those latter topics, DFEC and DOL's Office of Disability
Employment Policy (ODEP) are developing a research project to be
completed by the end of fiscal year 2012 to document the obstacles that
exist in Federal agencies relating to return to work, job
accommodations, and placement and the best practices used by agencies
to reduce or eliminate these obstacles and increase opportunities for
success. This research project also supports the objectives of
Executive Order 13548, Increasing Federal Employment of Individuals
with Disabilities, which specifically directs the Secretary of Labor to
take steps that will foster improved return-to-work outcomes. DFEC and
ODEP will utilize the results to offer tailored technical assistance to
Federal agencies regarding the adoption and implementation of
successful return-to-work practices and related disability employment
practices.
To provide an incentive to Federal employers to reemploy injured
Federal workers with permanent disabilities, DFEC has begun a program
to identify and certify FECA claimants for job placement using Office
of Personnel Management (OPM) Schedule A hiring authority.
Qualification for Schedule A authority, found at 5 CFR
Sec. 213.3102(u), provides an avenue to enhance and expedite hiring of
individuals with disabilities (as well as other categories of
individuals) for Federal service by removing barriers and increasing
employment opportunities. Participation in the program is voluntary on
the part of the claimant; however, if they volunteer they must self-
identify the nature of their disability. With Schedule A, qualified
candidates who meet the OPM guidelines can be hired non-competitively:
without the typical recruitment headaches; without posting and
publicizing the position; and without going through the certificate
process.
Question. What will the OWCP achieve in terms of workload and
performance in fiscal year 2011?
Answer. Following enactment of the fiscal year 2011 appropriation,
OWCP reprioritized workload and activities to support the targets and
goals addressed in the fiscal year 2011 congressional budget
justification. It is expected that the Federal Employees' Compensation
Division, the Coal Mine Workers' Compensation Division, and the Energy
Employees Occupational Illness Compensation Division achievements will
be close to the established targets. The possible exception is the
Longshore and Harbor Workers' Compensation Division which is currently
not achieving the GPRA goal of 58 percent of First Payment of
Compensation Issued Within 30 days for Defense Base Act cases. The
performance for the DBA First Payment measure through the second
quarter is 54 percent. The performance targets were based on requested
additional funding for nine additional FTE and information technology
investments that was not enacted. Longshore's resources have been
severely taxed by both the numbers and the complexity of Defense Base
Act claims arising from increased activity by civilian contractors
supporting the military overseas.
occupational safety and health administration (osha)
Question. What steps will OSHA complete in fiscal year 2011 and
does it propose in fiscal year 2012 to create efficiencies and realize
other cost savings in pursuing the agency's mission?
Answer. OSHA has been carefully controlling its Full-Time
Equivalent (FTE) ceiling and hiring in fiscal year 2011 to ensure that
priority, mission-critical positions are filled. The agency has also
been granted Voluntary Early Retirement Authority (VERA) by the Office
of Personnel Management for the remainder of fiscal year 2011, which
extends to agency operations outside of Washington, DC for the first
time in well over a decade. In addition, the agency has reduced funding
for discretionary purchases, including travel, contracts and printing.
As an example, the agency is starting to utilize video conferencing
technology for training, meetings and screening of egregious cases to
reduce travel expenses. OSHA is also pursuing technology efficiencies,
including the elimination of outdated and redundant equipment, to
realize cost savings.
Question. How will the modest increase available to OSHA be
targeted to carrying out the highest priority activities in fiscal year
2011 and achieving the core mission of the agency?
Answer. OSHA did not receive an increase to its budget in fiscal
year 2011. The continuing resolution provided the Department with the
authority to move funds from the Departmental Management appropriation
to other accounts for the purposes of program evaluation, initiatives
related to the identification and prevention of worker
misclassification, and other worker protection activities. With this
authority, funding was restored to OSHA in the amount of the 0.2
percent rescission for standards development, State program enforcement
efforts, and training on identifying worker misclassification.
Question. What will the OSHA achieve in terms of workload and
performance in fiscal year 2011?
Answer. The fiscal year 2011 information and data provided in the
fiscal year 2012 congressional budget justification was based on an
annualized continuing resolution at fiscal year 2010 enacted
appropriations. At this point, we expect the performance for OSHA to
not differ significantly from the information in the fiscal year 2012
congressional budget justification.
mine safety and health administration (msha)
Question. What steps will MSHA complete in fiscal year 2011 to
create efficiencies and realize other cost savings in pursuing the
agency's mission?
The fiscal year 2012 budget identifies savings related to the
elimination of the small mines office and the SAVE proposal related to
the use of postcards reminders for certain information requests.
Answer. With respect to the Small Mines Office, MSHA is not going
to close or eliminate it, but will transfer and integrate the function
into the Metal and Nonmetal program. MSHA intended to replace the
narrative in the justification during the drafting phase to reflect
this, but unfortunately that did not occur.
MSHA will begin mailing the first post card reminders in lieu of
the multi-part 7000-2 forms for the CY 2011 second quarter reporting
period (April-June). This transition will reflect the beginning of the
savings outlined in the SAVE proposal.
Question. Please describe how this proposal will achieve the
identified savings with at least the same level of services currently
provided.
Answer. Implementing the SAVE proposals to move to the mailing of
post cards will significantly reduce MSHA's printing and postage costs.
MSHA will continue to mail the multi-part form when requested; however,
MSHA is encouraging stakeholders to take advantage of the on-line
filing capability.
MSHA believes the transfer of the Small Mines Office function will
increase the effectiveness of the program by allowing the managers to
focus on areas where their expertise is needed. This will provide more
meaningful compliance assistance, leading to lower overall fatality and
accident rates at all mines.
Question. What additional cost savings are proposed in the fiscal
year 2012 budget request?
Answer. The fiscal year 2012 request includes two reductions
totaling $3,250,000 reflecting the elimination of a project previously
funded through an earmark.
Question. How will the modest increase available to MSHA be
targeted to carrying out the highest priority activities in fiscal year
2011, including those previously addressed in MSHA reports to the
Committee on Appropriations and Office of Accountability reports, and
achieving the core mission of the agency?
Answer. In the Department of Defense and Full-Year Continuing
Appropriations Act, 2011, Congress appropriated to MSHA an additional
$7.27 million (post rescission) above the revised fiscal year 2010
continuing resolution (CR) level. MSHA allocated this funding to
address critical projects and needs within its core programs and comply
with known congressional interest. Below is a summary of the
allocations:
Federal Mine Safety and Health Review Commission (FMSHRC) Backlog
Reduction (SOL): $2,000,000
Transfer of funds necessary to continue the backlog reduction
project for the last 2 months of the fiscal year.
Federal Mine Safety and Health Review Commission (FMSHRC) Backlog
Reduction (MSHA): $750,000
Funds necessary to continue the backlog reduction project for the
last 2 months of the fiscal year.
Metal and Non/Metal Inspections: $1,300,000
Funds for overtime and travel to ensure the Metal and Nonmetal
enforcement program have the necessary resources to complete its
mandated inspections.
Upper Big Branch Investigation Costs: $550,000
Funds to offset costs associated with MSHA's investigations into
the Upper Big Branch mine disaster above those that were supported
through the 2010 supplemental appropriation.
Coal District 4 Split: $250,000
In response to concern about the sheer size and responsibility of
the District 4 office, whose area of jurisdiction in southwest West
Virginia encompassed nearly 400 mines and mine facilities or roughly 20
percent of the Nation's coal mines, MSHA is splitting the District into
two more manageable organizations, creating a new District office, D12.
This action will better serve MSHA and the mining industry. The
creation of two districts to cover southern West Virginia will provide
for more effective enforcement oversight and improved management of
this significant portion of MSHA's workload. The allocation reflects
funding to support the infrastructure of a temporary space while GSA
secures a permanent location for the new District 12 office. All items
purchased or leased will convey to the permanent location.
Brookwood-Sago Grants Increase: $500,000
Increase the Miner Act-established Brookwood-Sago Grants program by
$500,000. The program provides funding for the development of
educational and training programs and training materials for mine
emergency preparedness by providing funding for education and training
programs to help identify, avoid, and prevent unsafe working conditions
in and around underground mines, and focuses on training materials and
training programs for mine rescue and mine emergency preparedness in
underground coal mines.
Enforcement Programs Computer IT support: $1,100,000
Funding to provide replacement laptop and desktop computer
equipment for enforcement staff. Current laptops and desktops are 3-4
years old and only have one-half GB of memory which causes all programs
to run very slowly. Some machines are taking as long as 8 minutes to
start up. This substantially and negatively impacts productivity by
reducing mine site time for the inspectors. These machines will not be
able to support Office 2010 if and when DOL/MSHA upgrades to this
version. Additionally, Windows 7 would not be able to be supported as
the operating system due to inadequate hardware and memory on current
machines. MSHA and DOL have already begun migrating to Windows 7 where
the hardware is able to support the move.
Health Samples Reengineering: $900,000
Funding to replace MSHA's current obsolete 31-year old COBOL system
and provide an application that is fully integrated with MSHA's
enterprise database. The new system will significantly reduce
maintenance costs and improve processing speed. Reengineering the
system will allow for:
--Consistent management of samples data.
--Establish consistent integration of samples monitoring with
enforcement activities.
--Provide consistent reporting mechanisms.
--Maintain the ability to perform unique validations based on sample
type.
--Provide a consistent mechanism for tracking sample history.
--Provide the capability to create a consistent advisory mechanism
for reporting violations to MSHA enforcement personnel.
Mine Emergency Equipment: $750,000
Provides funding for the purchase of Mine Emergency Operations
(MEO) response equipment. MSHA will purchase:
--Communications vehicle, wireless mesh points and supporting
equipment.
--Satellite dish for improved communications.
--Engineering vehicle, trailer and equipment.
Base Funding Reallocations: -$1,080,000
MSHA will re-direct lapsed compensation funding to offset increases
in the Metal and NonMetal enforcement, which will allow MSHA to ensure
that Metal and Nonmetal completes 100 percent of its mandated
inspections. Additionally, MSHA is reallocating resources to increase
the Brookwood-Sago Mine Safety Grants programs, transfer management of
the Mount Hope Lab from Technical Support to the Coal activity, and
support MSHA's expanded regulatory program.
Question. What will MSHA achieve in terms of workload and
performance in fiscal year 2011?
Answer. We expect MSHA to continue its enhanced enforcement
efforts, i.e. impact inspections, maintain 100 percent of the mandated
inspections, and conduct other inspections/investigations. Although the
delay in fiscal year 2011 appropriations created some challenges in
achieving workload and performance goals, MSHA expects its workload and
performance levels to coincide very closely with the fiscal year 2011
information in the fiscal year 2012 congressional budget justification.
The fiscal year 2011 information and data provided in the fiscal year
2012 congressional budget justification was based on an annualized
continuing resolution at the fiscal year 2010 enacted appropriation
level.
bureau of labor statistics (bls)
Question. BLS has taken steps in recent years to reduce travel
costs by expanding the use of videoconferencing and web-based services.
What additional steps will BLS complete in fiscal year 2011 to create
efficiencies and realize other cost savings in pursuing the agency's
mission?
Answer. The Bureau of Labor Statistics (BLS) has continued to
increase the use of its videoconferencing system, web-based services,
and telephone and Internet data collection to mitigate travel costs.
The videoconferencing system provides high-quality audio and video for
meetings between the BLS national office and its regional locations. In
addition, the BLS uses videoconferencing to meet with organizations
located outside the United States, where international travel would
have been required previously. The BLS has increased its use of WebEx,
a web-based service that combines real-time desktop sharing with phone
conferencing to conduct some work activities with State and regional
staff, rather than traveling to conduct business on site. The BLS has
also increased its use of telephone and Internet data collection,
thereby reducing the travel costs associated with collecting data. In
addition to reducing travel costs, the BLS has been working to identify
and, where possible, reallocate unused/unneeded IT equipment
(computers, servers, printers, and cellphones) using the Asset
Management Application (AMA). The AMA enables the BLS to transfer
surplus IT equipment that is still serviceable to offices where it will
be used. These strategies have proven to be an effective means to avoid
rising costs. The BLS is committed to continuing such practices.
Question. In addition to the elongating of the fielding schedules
for National Longitudinal Surveys and the elimination of the
International Labor Comparisons program, what additional cost savings
and efficiencies are proposed in the fiscal year 2012 budget request?
Answer. In 2012, the BLS will continue efforts to implement online
forms within the Producer Prices and Price Indexes (PPI) program, a
survey that currently collects monthly price data by mail and fax. In
fiscal year 2011, PPI began work with the centralized Internet Data
Collection Facility within the BLS to offer online data collection to
select respondents. By the end of fiscal year 2012, the BLS will
realize cost savings of approximately $10,000. Offering modern,
electronic options to respondents, including use of online data
collection, will improve the accuracy, timeliness, and efficiency of
data collection for both respondents and the BLS and be more
environmentally friendly.
Question. BLS also has taken steps to change the relationship with
State labor market information agencies, most recently with the
centralization of the current employment statistics (CES) program. The
Nation requires current, accurate, detailed labor statistics for
Federal and non-Federal data users. Please comment on the accuracy of
the data being produced through the centralized CES program.
How are DOL agencies and State labor market information agencies
interacting with each other and with other Federal and non-Federal
entities to address the goals of relevant Federal legislation and the
Federal-State cooperative statistics system?
Answer. In March 2011, the BLS assumed responsibility for producing
CES State and metropolitan area estimates. The transition went smoothly
and, as of early June, the BLS has produced 2 months of estimates under
the new protocol. State agencies have cooperated fully with the BLS
during the transition. States continue to relay information to the BLS
about any local events not captured by the CES sample, and provide
analysis and dissemination of the estimates to local data users. Data
accuracy remains high as the sample size remains unchanged and is
supplemented by local information provided by States. In addition, the
centralization will permit the BLS to implement program enhancements in
the CES program to improve survey response rates, thereby reducing the
statistical error on the estimates. Centralizing operations at the BLS
also improves the consistency and transparency of the estimation
process, which are important dimensions of quality.
In terms of the overall Federal-State cooperative system for
producing Labor Market Information (LMI), the BLS and States continue
to work together through the annual cooperative agreement process to
produce, analyze, and disseminate data from the CES, Local Area
Unemployment Statistics, Occupational Employment Statistics, Mass
Layoff Statistics, and Quarterly Census of Employment and Wages
programs. Consistent with Section 309 of the Workforce Investment Act
of 1998, BLS senior management and 10 State LMI Directors elected by
their peers continue to hold regular formal consultations.
Representatives of other Federal agencies involved in producing labor
market information regularly participate in these consultations as
well.
Question. Last, the National Research Council held a workshop last
year on facilitating innovation in the Federal statistical system.
Please comment on DOL agencies' innovation activities and plans.
Answer. To foster innovation at the agency and program level, the
BLS has included a number of budget initiatives in the President's
budget in recent years. For example, in 2010, the BLS received
resources to provide new series on ``green'' jobs, addressing the need
for detailed data on these rapidly evolving industries and occupations.
As another example, in 2012, the BLS is requesting resources to
modernize its Consumer Expenditure (CE) survey. The CE survey is a
critical input for the Consumer Price Index. This initiative will allow
for continuous research to incorporate multiple data collection modes
to take advantage of new technologies, use new sample and statistical
modeling methods to increase cost effectiveness, and assess the
feasibility of implementing further improvements.
The BLS also continuously improves its current data products to the
extent possible within existing resource levels. For example, in 2010,
the BLS released official all-employee hours and earnings data, which
provide more comprehensive information for the Bureau of Economic
Analysis' National Income Accounts and for analyzing economic trends.
Also in 2010, the BLS began publishing, for the first time, national
estimates of workplace injuries and illnesses incurred by State and
local government workers.
In addition, the National Research Council report highlighted the
importance of interagency work in fostering innovation within the
Federal statistical system. One current example is the Joint Program in
Survey Methodology, which is intended to address the critical and
growing need of Federal agencies for highly trained personnel in
mathematical statistics and survey methodology.
Question. What will the BLS achieve in terms of workload and
performance in fiscal year 2011?
Answer. The BLS does not expect the workload and performance goals
to differ from the fiscal year 2011 information in the fiscal year 2012
congressional budget justification.
office of the solicitor (sol)
Question. What steps will the Office of the Solicitor (SOL)
complete in fiscal year 2011 to create efficiencies and realize other
cost savings in pursuing the agency's mission?
Answer. In fiscal year 2011, SOL continues to develop critically
needed Legal Technology infrastructure improvements. This initiative
began with an evaluation in fiscal year 2009. In fiscal year 2011, we
are projected to complete the first of three phases of development.
SOL's IT modernization initiative addresses important improvements in
SOL's IT/Litigation Support infrastructure, including: replacing SOL's
failing case management and time reporting systems (SOLAR/TD), as well
as developing capacities in the critical areas of legal document
management, document review tools, transcript and evidence management,
trial presentation and case analysis. In addition, in fiscal year 2011,
SOL continues to build its FTE-related program support capacity,
including its professional development and training necessary to ensure
that SOL's legal skills are competitive with those of its adversaries
and other stakeholders that influence the working conditions and
security of America's working women and men.
Question. The fiscal year 2012 budget identifies savings related to
the elimination of resources for compliance assistance and outreach,
longshore litigation, and review of Uniformed Services Employment and
Reemployment Rights Act case referrals to the Department of Justice.
Please describe how these proposals will achieve the identified savings
without compromising SOL's core mission.
Answer. SOL's budget request for fiscal year 2012 was constructed
in close coordination with the budget priorities for its DOL client
agencies, enabling SOL to forcefully and decisively support the
Secretary's vision of ``good jobs for everyone.'' The fiscal year 2012
budget includes three program reductions as follows.
Eliminate SOL's Compliance Assistance and Public Outreach
Activities.--SOL proposes to cease performing the wide variety of
compliance assistance and public outreach activities in which it
currently engages, including speeches, presentations, responding to
inquiries from and providing training to the public, and supporting the
clients' compliance assistance activities.
Eliminate SOL review of the Veterans Employment and Training
Service's (VETS) USERRA case referrals to DOJ.--The Department of
Justice bears the primary authority for litigating cases in this
program and engages in a de novo review of the merits of each case.
This proposal eliminates SOL's review of the recommendations to DOJ
from VETS.
Eliminate Non-participation memos.--DOL should discontinue its
practice of drafting legal memos to support its decision not to
participate in cases under the Longshore and Harbor Workers
Compensation Act and Mine Act in the courts of appeals, and should
communicate those recommendations orally to OWCP and MSHA.
Question. What additional cost savings are proposed in the fiscal
year 2012 budget request?
Answer. As described in the response to SSEC24, SOL is in the midst
of an IT Modernization initiative that began in fiscal year 2009 and
the fiscal year 2012 budget request includes funding to continue this
project in fiscal year 2012.
Question. What will the SOL achieve in terms of workload and
performance in fiscal year 2011?
Answer. The fiscal year 2011 information and data provided in the
fiscal year 2012 congressional budget justification (CBJ) were based on
an assumed annualized funding level based on the continuing resolution
at fiscal year 2010 enacted appropriations. While the final fiscal year
2011 full year continuing resolution approximated these funding levels,
the delay in appropriations has created challenges in achieving
workload and performance goals. Consistent with the performance and
workload information in SOL's fiscal year 2012 CBJ, SOL expects its
fiscal year 2011 workload and performance projections to be consistent
with fiscal year 2011 information in the fiscal year 2012 CBJ, with the
increased production from the temporary and term FTE funded by the
fiscal year 2010 supplemental appropriation (and the $2 million
transfer from MSHA's fiscal year 2011 appropriations to SOL) to reduce
the backlog of mine safety and health cases pending before the Federal
Mine Safety and Health Review Commission. At this point, we expect the
performance for SOL to differ from the fiscal year 2011 information in
the fiscal year 2012 CBJ as follows:
Historically, including in the fiscal year 2012 CBJ, SOL aggregated
its Pre-Litigation Matters and Litigation Matters together as
``Litigation Matters'' when reporting. Now that SOL has revised its
production measures to separate out Pre-Litigation Matters from
Litigation Matters, we have revised targets and results for Litigation
Matters Opened (formerly referred to as Litigation Matters Received)
and Litigation Matters Concluded to exclude Pre-Litigation Matters from
the tabulations, and we have included separate figures for Pre-
Litigation.
The projected number of Mine Safety and Health litigation backlog
matters to be concluded in fiscal year 2011 projection for Litigation
Matters Concluded, as reflected in SOL's workload projects, has been
revised. The original target was based on a projection from the MSH
litigation matters concluded in the first quarter of the backlog
project, but based on current trending, that rate is not sustainable as
a constant rate over the full project. While we expect this SOL
workload measure to trend downward, the MSH litigation backlog project
remains on track to exceed our expectations for disposition of cases
and citations. It is important to note that the SOL workload
projections are not directly comparable to data and projections
reported in the Quarterly Reports to Congress for the Targeted Caseload
Backlog Reduction Project. This is because SOL's projections are based
on SOLAR, which tracks only Litigation Matters Concluded by SOL, and
the reports to Congress are based on data provided by the Federal Mine
Safety and Health Review Commission, including matters handled by
MSHA's CLRs (and not SOL) as well. In addition, these two data sets are
based on different time periods.
bureau of international affairs (ilab)
Question. What actions will the Bureau of International Affairs
take in fiscal year 2011 to create efficiencies and realize other cost
savings in pursuing the agency's mission?
Answer. The President's fiscal year 2011 budget request included
additional resources for ILAB to improve its monitoring and enforcement
of trade agreements and expand its worker rights technical assistance
program. The United States has trade agreements with 13 developing
countries and provides trade preferences to approximately 140 other
developing countries. These agreements and programs include labor
rights obligations. Without the additional requested resources, ILAB
has shifted staff from lower priority activities, such as participation
in inter-agency processes, to higher priority activities such as labor
monitoring and the enforcement. However, we anticipate that monitoring
activities will increase as the U.S. negotiates additional trade
agreements and ILAB continues to strive for the robust enforcement of
trade agreements.
ILAB will continue to coordinate its efforts to address the root
causes of child labor and forced labor with those of the International
Labor Organization (ILO). ILAB will also continue to search for ways to
improve the effectiveness of its programs to advance its goal of
improving the livelihoods of exploited laborers and at-risk youth.
ILAB is using research and technology to improve the efficiency of
ILAB's operations. Systematic research and analysis on the status of
labor rights in trade partner countries allows ILAB to coherently
target policy engagement--including trade enforcement actions and
technical cooperation activities--to specific countries and issues
where the maximum impact may be achieved. ILAB has made substantial
progress on developing a system for tracking and sharing information
internally and with other agencies. This helps utilize scarce resources
as efficiently as possible.
Question. What additional steps are proposed in the fiscal year
2012 budget?
Answer. The ILAB budget proposal for fiscal year 2012 included
expanded resources (1) for additional staff in the area of monitoring
and enforcement of the labor provisions of trade agreements and (2) for
expanded worker rights grants. The budget proposal did not call for
specific additional steps to create efficiencies and realize other cost
savings in pursuing the agency's mission beyond those proposed in the
fiscal year 2010 budget and cost savings realized to comply with the
constraints of the continuing resolutions covering fiscal year 2011.
However ILAB intends to continue to pursue efficiencies and cost
savings from measures that have been put in place during the current
fiscal year, including prioritization of activities, targeted
engagement with those governments that offer greatest promise of
progress, limitations on staff travel and cautious hiring and
replacement policies.
In addition, in fiscal year 2012 ILAB intends to undertake more
assignment of staff across its offices in order to accomplish all high
priority and mandated work without addition staff resources, in case
the fiscal year 2012 budget does not allow additional hiring. ILAB will
also identify and eliminate additional lower priority activities,
beyond those curtailed in fiscal year 2011, as needed to accomplish its
mission with constrained resources. ILAB has started to identify such
lower priority activities for possible elimination in fiscal year 2012.
These measures will mean that ILAB is not able to sustain the current
level of effort on all programs.
Question. Please describe the impact of not receiving the increase
proposed in the fiscal year 2011 budget, particularly on activities
related monitoring and enforcement of labor provisions of trade
agreements.
Answer. Not receiving the increase proposed in the fiscal year 2011
budget has significantly reduced ILAB's intended impact on improving
worker rights around the world. Without the fiscal year 2011 request
for resources to monitor and enforce labor provisions of trade
agreements, ILAB will be unable to increase its monitoring efforts. In
fiscal year 2011, ILAB has been monitoring less than half the number of
trade partner countries it would have monitored under the requested
level of funding. It has also been impossible to establish and expand
high priority trade related worker rights technical assistance,
especially Better Work programs. A lower level of resources will lead
to a reduction in ILAB's planned activities, particularly monitoring
and enforcement, in the following specific ways:
Monitoring.--ILAB will not have the resources to systematically
review, analyze and track labor problems in all FTA countries. ILAB has
developed a set of standards and a systematized method for tracking
progress on labor issues, but has only been able to apply this in-
depth, systematic monitoring to six FTA countries. For the other 11 FTA
partners, ILAB has been conducting ad hoc monitoring as problems arise.
ILAB's responsibilities related to the labor provisions of FTAs are
expected to rise significantly in the next year. The recently
negotiated Colombia Action Plan Related to Labor Rights will require
significant ILAB resources to monitor in the near future. In addition,
the United States is currently negotiating the Trans-Pacific
Partnership FTA (TPP) with seven countries. ILAB has not been able to
invest the staff resources to engage the developing countries that are
party to the TPP negotiations on labor issues to the extent we consider
desirable. Negotiating new FTAs offers the best leverage for the
necessary changes in labor regimes and institutions. Without the
additional resources, ILAB's capacity to bring current and detailed
knowledge to the negotiating process will be seriously constrained. TPP
countries include Vietnam, Malaysia, and Brunei Darussalam, which have
significant labor challenges.
Enforcement.--ILAB will not have the resources to expand
enforcement beyond 2010 levels of the labor obligations of countries
that benefit from U.S. trade agreements and preference programs. ILAB
monitors and engages countries on labor rights law and practice if a
labor petition is filed under GSP, free trade agreements, or as part of
the annual review process of AGOA. ILAB had planned to expand its
engagement to additional countries of concern to address areas where
there were concerns they had not met their obligations. While ILAB has
identified potential labor rights issues in trade partner countries, it
has been unable to proactively initiate new labor consultations or
reviews under trade agreements and preference programs because of the
significant staff resources they would entail.
ILAB must divert resources from other functions. ILAB has already
been compelled to re-assign staff from technical assistance and
research functions to mandated monitoring and enforcement of FTA labor
provisions. If monitoring activities increase, we will have to draw
resources from other priorities.
ILAB also has not received requested resources to expand its worker
rights technical assistance programs. These programs aim to create a
level playing field for U.S. workers in the global economy and improve
worker rights in U.S. trade partner countries. As part of this
initiative, ILAB has established Better Work programs in Haiti, Lesotho
and Nicaragua, and provided initial funding in fiscal year 2010 to
establish a program in Bangladesh and support modest expansions in
Vietnam and Cambodia. In fiscal year 2011, we plan to initiate a
program in Egypt modeled on Better Work. However, without additional
resources, these programs will not be able to be fully scaled up.
Question. What will the ILAB achieve in terms of workload and
performance in fiscal year 2011?
Answer. The fiscal year 2011 information and data provided in the
fiscal year 2012 congressional budget justification was based on an
annualized continuing resolution at fiscal year 2010 enacted
appropriations. While the final fiscal year 2011 appropriation
approximated these funding levels, the delay in appropriations creates
challenges in achieving workload and performance goals. At this point,
we do not expect the performance for ILAB to differ from the fiscal
year 2011 information in the fiscal year 2012 congressional budget
justification.
women's bureau (wb)
Question. What actions will the Women's Bureau take in fiscal year
2011 to create efficiencies and realize other cost savings in pursuing
the agency's mission, beyond replacing staff with lower-paid employees?
Answer. The Women's Bureau works diligently to make the most
effective use of its resources. Over 85 percent of the Bureau's budget
is spent on salaries and benefits, rent and working capital fund,
leaving very little discretionary funding. However, the Bureau
continues to look for ways to create efficiencies in the way it does
business. One way is by utilizing the Federal Strategic Sourcing
Initiative to lower cost for supplies. Both the national and regional
offices use this initiative to purchase supplies whenever possible.
In addition, the Bureau is attempting to reduce copying and
printing costs and find ``greener'' alternatives when disseminating
outreach and technical assistance materials. As part of our strategic
outreach activities, the Bureau provides attendees with research
papers, guides, manuals, and other materials. At meetings or events
that require such extensive resource material, the Bureau has moved
away from printing the documents to providing them on flash drives. The
use of flash drives also allows the Bureau to include additional
Departmental and governmental information and resources to the attendee
at no additional cost. These flash drives also serve as a
communications tool, as they are imprinted with Bureau's name and
website.
Question. What additional steps are proposed in the fiscal year
2012 budget?
Answer. The Bureau will continue to look for efficiencies including
use of technology to reduce travel costs. The Bureau is working with
the Department for cost effective ways to implement video conferencing
with our regional offices, which will reduce travel costs over the near
future. Additionally we are looking to use social media tools to
promote our message, products and programs and increase the turnout and
impact of our initiatives.
Question. The budget proposes appropriations language to enable the
Women's Bureau to make grants. How much funding and what purposes would
this authority be used to support?
Answer. The Bureau anticipates that approximately $500,000 to
$750,000 of funds currently spent on contracts will be spent on grants.
The Bureau typically works closely with nonprofits, community and
faith-based organizations, and educational institutions to meet its
mission of helping women achieve economic security, providing them with
the necessary tools to ensure their advancement in the labor force, and
promoting fair and high-quality work-life environments. These informal
partnerships have been productive, but grants and cooperative
agreements would give the Bureau the tools to better achieve its public
policy and programmatic goals and objectives. This authorization would
allow the Bureau to fund research, publications, and educational
efforts that will directly contribute to the Bureau's mission.
Question. What will the Women's Bureau achieve in terms of workload
and performance in fiscal year 2011?
Answer. The fiscal year 2011 information and data provided in the
fiscal year 2012 congressional budget justification was based on an
annualized continuing resolution at fiscal year 2010 enacted
appropriations. While the final fiscal year 2011 appropriation
approximated these funding levels, the delay in appropriations creates
challenges in achieving workload and performance goals. At this point,
we expect the performance for the Women's Bureau to differ only
slightly from the fiscal year 2011 information in the fiscal year 2012
congressional budget.
office of disability employment policy (odep)
Question. What actions will the Office of Disability Employment
Policy (ODEP) take in fiscal year 2011 to create efficiencies and
realize other cost savings in pursuing the agency's mission? What
additional steps are proposed in the fiscal year 2012 budget?
Answer. In fiscal year 2011 ODEP will create efficiencies and
realize costs savings by focusing on the priority activities that we
believe will yield the greatest impact on low labor force participation
and high unemployment rates. This will allow ODEP to shift resources to
key problem areas and, in some cases, increase resources to conduct
policy development and expand technical assistance and dissemination
efforts. For example, we plan to transition some programs and
initiatives to other Federal agencies who are better positioned to
administer them. For example, ODEP efforts related to two initiatives--
United We Ride and America's Heroes at Work--will be reduced as other
agencies assume greater responsibility for these.
ODEP is proposing additional steps in fiscal year 2012 to
concentrate its efforts on those key factors most likely to yield
significant results. By utilizing proven strategies focused on our
priority areas, ODEP will direct and redirect its resources to maximize
impact. Also, in fiscal year 2012, ODEP intends to increase its
reliance on the National Employer Technical Assistance Center (NETAC)
which has knowledge of ODEP's policy products and utilizes a consortium
approach to leverage access of national organizations to employers and
stakeholders. By relying on NETAC and its partners, ODEP can extend its
reach and ability to rapidly disseminate information and provide
technical assistance. ODEP expects to realize operational efficiency
and cost savings by tapping into NETAC's existing knowledge,
infrastructure and capacity to reach more than 4,000 employers
(including the Federal Government and its contractors), service
providers, and other stakeholders likely to adopt and implement
effective practices.
dol's civil rights center (crc)
Question. Please provide information on the findings from the new
review process of State Methods of Administration and the assistance
that will be provided to help States and the One Stop System meet the
needs of all customers or potential customers, including individuals
with disabilities.
Answer. The WIA nondiscrimination regulations require each Governor
(or his/her designee) to prepare and submit to DOL's Civil Rights
Center (CRC) a document known as a Methods of Administration (MOA) plan
for ensuring that all WIA Title I financially assisted State programs
comply with the civil rights laws enforced by CRC, including the laws
protecting individuals with disabilities. Additionally, every 2 years,
the Governor is required to review the MOA to determine whether it
needs to be updated in order for the State to be in full compliance. If
updates are necessary, the Governor must make and submit them; if no
updates are necessary, the Governor must certify in writing that the
previous MOA remains in effect.
Until recently, review of the MOA documents was CRC's primary
method of assessing whether each Governor was satisfying his/her
oversight responsibilities. Within the past 2 years, CRC has shifted
the emphasis of its reviews to determining whether the actions
described in the plans are actually being implemented.
CRC offers recipients a number of different types of technical
assistance and training. The agency's website, which underwent a major
reorganization in fiscal year 2010, contains compliance assistance
tools and training courses on a number of nondiscrimination-related
topics, including disability issues. CRC staff members provide
individualized compliance assistance and information, upon request, to
congressional staff, State- and local-level Equal Opportunity Officers,
Disability Program Navigators, Job Corps administrators and staff,
other DOL managers and employees, representatives from other Federal
departments and agencies, members of the public seeking information
about civil rights laws, and a host of other persons from CRC's
internal and external customer base. This assistance and information is
generally provided by phone or e-mail, and occasionally in person.
(Note: The majority of technical assistance requests CRC receives are
with regard to disability issues, such as the lawfulness of disability-
related inquiries.)
With regard to training, CRC continues its policy of delivering
training courses and workshops at State- or Local Area-sponsored
training events, tailored to the specific issues of concern to the
audience. In recent months, the agency has leveraged limited resources
by providing these courses and workshops remotely, via webinar and
audio conference; live delivery will take place as budgets permit. In
addition, CRC will offer its 22nd Annual National Equal Opportunity
Training Symposium from August 30 through September 2 in Crystal City,
Virginia. The 2010 event drew approximately 350 State- and local-level
EO Officers and staff, as well as administrators and staff of the One-
Stop workforce development system; Job Corps staff and contractors; and
other stakeholders.
Question. What will the ODEP achieve in terms of workload and
performance in fiscal year 2011?
Answer. The fiscal year 2011 information and data provided in the
fiscal year 2012 congressional budget justification was based on an
annualized continuing resolution at fiscal year 2010 enacted
appropriations. Since the final fiscal year 2011 appropriation closely
approximated these funding levels, the delay in appropriations is not
expected to create any significant challenges in achieving workload and
performance goals. At this point, we do not expect the performance for
the Office of Disability Employment Policy (ODEP) to differ
significantly from the fiscal year 2011 information in the fiscal year
2012 congressional budget justification.
emerging industries and high growth occupations
Question. The prediction of emerging industries and high growth
occupations is essential to effective workforce development. What are
the current ways that ETA is using labor market information to improve
workforce services such as job search, career counseling and training?
Answer. We agree that labor market information (LMI) including
information about emerging industries and high growth occupations is
necessary to ensure that job seekers, career changers, and strategic
planners have the labor market intelligence they need to make sound
training, education, and economic development investments. This past
year, ETA launched two new creative and useful electronic tools:
mynextmove.org which is a career exploration site for individuals
entering the labor market and myskillsmyfuture.org which quickly shows
unemployed workers what other jobs need their skill sets.
ETA takes several actions to assure that State and local workforce
investment boards, One-Stop Career Centers, partner agencies, job
seekers, and businesses have a wide variety of reliable and comparable
labor market data and information. ETA provides annual funding from the
Workforce Information-National E-Tools and Capacity Building budget
line to the States and territories and consortia of States to support
the collection and dissemination of state and local labor market
information, including:
--Production at the State and local levels of 2- and 10-year industry
and occupational employment projections;
--Population of the Workforce Information Database that facilitates
the sharing among the States of comparable data sets on wages,
licenses, credentials, military to civilian occupational cross
walks, employer location and contact information, etc.;
--Maintenance and expansion of the occupational information network
(O*NET) that documents occupational skills, competencies, and
detailed work activities including new, emerging, or evolving
occupations such as green jobs; and
--Universal access to the LMI data described above and a variety of
other data through state LMI web sites and via national
electronic tools including the Career One Stop portal at
www.CareerOneStop.org and ONET Online at http://
www.onetonline.org/. These websites and portals receive more
than 38,000,000 customer visits per year.
In addition, in 2009, ETA provided nearly $50,000,000 in ARRA
competitive grants for State LMI Improvement grants to 24 States and
six consortia. While most projects continue to operate, to date the
States have:
--Conducted numerous State- and local-level surveys to measure green
jobs and the impact green jobs are having on their States'
economies, and to identify education and training programs that
support skills acquisition for emerging industries and
occupations;
--Researched the use of ``Real Time'' LMI (job openings data
collected daily and aggregated from the Internet job banks and
corporate websites) to enhance 2-year and 10-year projections
and to make more job opportunity data available to job seekers;
--Conducted research on green jobs skills with the goal of aiding
dislocated workers' transition from declining to transforming
and emerging industries; and
--Developed new tools and improved access to workforce and LMI data
in the labor exchange operations within the One-Stop Career
Centers.
Question. How is the Department working to improve the use or
availability of this information to make quality and timely
predictions?
Answer. One of the State LMI Improvement grants, noted in the
response to SSEC 37, was awarded to the Projections Managing
Partnership consortia of States to re-write and enhance the State and
local industry and occupational short-term (2 years) and long-term (10
years) software suite that States use to inform training, education,
and economic development investment decisionmaking. This is now
available to all States to produce the occupational projections. In
addition, the consortia made enhancements to add the skills that will
be in demand by combining the projected occupational growth and O*NET-
defined skills.
In September 2010, the Department released a new skill
transferability tool specifically designed for direct use by dislocated
workers who have skills and work experience but need to change jobs to
adapt to the changes in their local economy. Called
myskillsmyfuture.org, this site uses simplified navigation, language,
and integrated information resources to provide a seamless experience
for dislocated workers. Similarly, for individuals who are exploring
careers, the Department released a site in February 2011 with
simplified language, and an online 60-question interest assessment tool
that makes the O*NET occupational profiles easier to access and use,
while ultimately still linking to the additional detail available
through O*NET OnLine. This tool is found at mynextmove.org.
adult employment and training activities
Question. The fiscal year 2012 budget request indicates that the
Department will increase the rate of industry-recognized credential
attainment among customers receiving training. What is the strategy for
increasing credential attainment and how will the Department measure
its progress on this goal?
Answer. The Secretary of Labor has set a high priority performance
goal of increasing by 10 percent the number of workforce program
participants who attain industry-recognized credentials. To support
this goal, the Employment and Training Administration has issued
guidance to the system (Training and Employment Guidance Letter 15-10),
provided technical assistance through webinars and other means, and
invested in promising program models. A summary of this activity
follows:
ETA, with its partner agencies in Education and Health and Human
Services, supports the increase of credential attainment through the
development of career pathway systems. Through strong alignment of
education, training and employment services among public agencies and
with employers, career pathway approaches better enable low-skilled
adults and other hard-to-serve populations, students, and workers, to
succeed in postsecondary education and earn in-demand, industry-
recognized credentials that place them on a career ladder. Through
discretionary grants and technical assistance efforts, ETA is working
with community colleges, State workforce systems and others to develop
career pathway models that link education and training to advancement
along a specific track. For example, one career pathway includes bridge
programs to assist Certified Nursing Assistants to become Licensed
Practical Nurses.
ETA also focuses on strengthening programs like Job Corps and
YouthBuild that help young people earn valuable occupational
credentials while completing high school and Registered Apprenticeship
programs that provide participants a valuable credential while earning
wages on the job.
Through the Trade Adjustment Assistance Community College and
Career Training Initiative, the Department of Labor will make a large
investment in building the capacity of community colleges and other
eligible higher education institutions to design programs that meet the
needs of trade-impacted workers. These programs will be designed to
meet the needs of non-traditional, eligible students for flexible
scheduling, easy entry and exit from programs, accelerated remediation
through contextualization, integrated academic and occupational
training, on-line courses, and more. They will reflect evidence-based
strategies that have proven effective, or test strategies that have
promise.
dislocated worker employment and training activities
Question. Dislocated Worker National Emergency Grants (NEGs) are
sometimes used to create employment opportunities for dislocated
workers to assist with clean up from natural disasters. What portion of
fiscal year 2010 NEGs was used for these purposes and how many
dislocated workers received employment opportunities through these
grants?
Has the use of NEGs for this function increased over time?
Answer. As fiscal year 2010 appropriations fund Program Year (PY)
2010 activity for National Emergency Grants (NEGs), we are providing
responses based on disaster NEG activity thus far in PY 2010 (PY 2010
began July 1, 2010 and ends June 30, 2011).
Within the National Reserve, the fiscal year 2010 appropriation
provided $190,919,666 for NEGs. As the table below shows, the
Department has awarded 18 disaster NEGs and funded two increments for
prior year disaster NEGs, for a total $79,893,327. Of the amount
awarded, $69,041,816 was funded, which is about 36 percent of the
almost $191 million available for NEGs in PY 2010 and 55 percent of the
$126,544,605 awarded to date. An estimated 6,180 individuals will
receive temporary employment opportunities and reemployment services
through these NEGs. A number of these NEGs are too recent to have
completed their final planning/hiring, so we have presented their
participant estimates in italics.
Disaster NEG funds provide funding to create temporary jobs to
support clean-up and recovery efforts. These efforts can fluctuate
widely depending on the number, severity, and type of natural disasters
that occur in any given year. Activity in PY 2010 is slightly above
average. However, it doesn't compare to Hurricane Katrina/Rita efforts,
where Louisiana alone spent $43,599,160 to provide 7,502 disaster
affected workers temporary employment and reemployment services.
As indicated, we are still within the program year, and it is
customary for State applications to come in late in the program year as
formula funds are depleted. As a result of this practice, together with
recent weather emergencies, the Department currently has applications
that exceed the remaining funds for NEGs and we expect the entire
appropriation to be awarded.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Amount
State Project New or incremental Approval date approved (up Amount funded Participants
funding to award)
--------------------------------------------------------------------------------------------------------------------------------------------------------
KYKY-Severe Storms, Tornadoes, and Flooding New................... 6/6/2011............. $4,276,514 $4,276,514 317
OKOklahoma Severe Storms and Tornadoes New................... 6/1/2011............. $471,150 $471,150 26
MOMO Severe Storms, Tornadoes and Flooding 2011 New................... 5/27/2011............ $5,822,352 $5,822,352 404
ARSevere Storms, Tornadoes and Associated Flooding New................... 5/26/2011............ $3,758,327 $3,758,327 249
TNTN-Disaster-Storms, Tornadoes, Flooding New................... 5/23/2011............ $3,589,704 $3,589,704 480
CACalifornia Tsunami Waves New................... 5/11/2011............ $6,498,100 $6,498,100 271
GAGeorgia Tornado and Storm Disaster New................... 5/11/2011............ $5,000,000 $5,000,000 300
MSMS-Disaster-Severe Storms, Tornadoes, Straight- New................... 5/9/2011............. $7,000,000 $7,000,000 525
line Winds, and Associated Flooding
ALSevere Storms, Tornadoes, Winds, & Flooding New................... 5/4/2011............. $10,000,000 $10,000,000 800
Disaster
OROregon Tsunami Wave Surge 2011 New................... 4/15/2011............ $284,023 $94,674 15
ORSTORMS 2011 New................... 3/18/2011............ $176,904 $176,904 10
CA2010 California Severe Storms New................... 2/23/2011............ $11,267,940 $3,755,980 252
ARStorms October 2009 Increment............. 12/10/2010........... .............. $8,494 119
PRTropical Storm Otto New................... 11/23/2010........... $4,000,000 $4,000,000 607
MNSouthern MN 2010 Flood New................... 11/8/2010............ $1,160,391 $580,195 29
IASevere Storms/Flooding/Tornadoes 2010 New................... 9/22/2010............ $5,800,000 $2,000,000 126
TNSevere Storms and Flooding Increment............. 9/14/2010............ .............. $2,921,500 670
TXHurricane Alex Flooding New................... 9/14/2010............ $5,849,481 $5,849,481 416
KYEastern Kentucky Severe Storms, Flooding and New................... 8/27/2010............ $938,441 $938,441 57
Mudslides
PRSevere Storms and Flooding New................... 7/22/2010............ $4,000,000 $2,300,000 507
------------------------------------------------------------------------------------------------
Totals ...................... ..................... $79,893,327 $69,041,816 6,180
--------------------------------------------------------------------------------------------------------------------------------------------------------
youthbuild
Question. As you know, as a result of the significant funding
constraints on the fiscal year 2011 continuing resolution, the 2011
funding level for YouthBuild represents a significant reduction to the
program. Specifically, the program was funded at $80 million--a $23
million or 22 percent reduction. On May 17, 2011, the Department
announced 74 grantees that will receive funding under the fiscal year
2011 appropriation for YouthBuild. How many existing YouthBuild
grantees have lost funding as a result of the reduction and how many of
the 74 awards are going to new grantees not previously funded by the
Department?
Answer. With fiscal year 2009 and American Recovery and
Reinvestment Act Funds (ARRA), a total of 183 grants were funded by the
Department of Labor (DOL). In fiscal year 2011, a total of 74 grants
were awarded, of which two went to organizations not previously awarded
grants by DOL. This means that 72 previously funded grantees were
refunded through the 2011 competition. Therefore, 111 grantees were not
refunded in the most recent competition.
Question. In the past the Department has tended to fund YouthBuild
grants on a 2-year basis. Has that approach changed as a result of the
lower funding level in fiscal year 2011?
Answer. With fiscal year 2011 funds, the Department of Labor (DOL)
awarded 74 YouthBuild grants that are for 2 full years of program
services. These grants were provided the full amount from the fiscal
year 2011 funds. This plan was outlined in Solicitation for Grant
Application announced in October, 2010 and was not a result of the
lower funding level.
job corps
Question. The fiscal year 2011 continuing resolution included a $75
million rescission to Job Corps construction and renovation funds. How
will Job Corps implement that rescission?
What projects will it impact and will Job Corps go forward with the
planned construction of centers in Wyoming and New Hampshire?
Answer. Job Corps had preliminarily identified $75 million from
previously budgeted, but not obligated, projects. These projects have
now been placed on hold, subject to available resources, and may be
designated to receive funding in future Program Years. These projects
are in one of three categories: (1) projects in which the budgeted
amount includes the construction phase of the project, (2) projects in
which the budgeted amount includes the design phase of the project, and
(3) projects in which the budgeted amount was only partially rescinded.
The new centers in Wyoming and New Hampshire are still under
consideration in light of the available funding. Final decisions will
be made after the Department thoroughly assesses the impact of the
rescission and concludes a re-evaluation of Job Corps' inventory of
construction projects.
workforce innovation fund
Question. The fiscal year 2011 continuing resolution included $125
million for a new Workforce Innovation Fund to support innovative new
strategies or expand evidence-based strategies that align programs and
strengthen the workforce development system to improve the education
and employment outcomes for job seekers and workers, youth, and
employers. What are the Department's plans for these awards in terms of
the timing of the solicitation and awards and the likely number of
awards?
What benefits do you see these grants having for the workforce
investment system and how would these initial grants tie to the
President's fiscal year 2012 request for Workforce Innovation Funds?
Answer. While the precise timeline is still being discussed, ETA is
pursuing an aggressive timeline to prepare for publication of the first
Workforce Innovation Fund (WIF) Solicitation for Grant Applications. To
ensure that our final product draws fully on the experience and
knowledge of stakeholders and is capturing the most innovative and
promising approaches, the Department has commenced an intensive
stakeholder engagement strategy which includes outreach to Federal
partners, including the Departments of Education and Health and Human
Services and the Office of Management and Budget; State and local
workforce organizations; intergovernmental organizations and
associations; Senate and House Committees (Authorizing and
Appropriations); and foundations and the research community. ETA is
using a mix of face-to-face discussions and webinars to encourage broad
participation; it has established a general e-mail account
([email protected]) where stakeholders can post ideas and
feedback. ETA will determine the size and scope of grants after
analyzing information from the consultations.
The WIF offers a unique opportunity to test innovative workforce
strategies that lead to system change. While the fiscal year 2011
budget provides only a brief description of the WIF, the fiscal year
2012 budget request provides additional information and outlines the
intent and purpose. Specifically, the administration intends that the
Fund:
--invest in projects that deliver services more efficiently and
achieve better outcomes, particularly for vulnerable
populations and dislocated workers;
--support both structural reforms and the delivery of services;
--emphasize building knowledge about effective practices through
evaluation;
--translate into improved labor market outcomes and increased cost
efficiency and other measures in the regular formula programs;
and
--facilitate the use of waivers where necessary to achieve better
outcomes and facilitate cooperation across programs and funding
streams.
In fiscal year 2011, the Department is the sole contributor to the
fiscal year 2011 Workforce Innovation Fund. Therefore, the first year
of funding on innovation strategies will directly benefit Title I and
III (Workforce Investment System and Wagner-Peyser Employment Service)
programs, although proposals to improve coordination with Title II and
IV, and other Federal programs would be in line with goals for system
reform. If joint funding with the Department of Education is achieved
in fiscal year 2012, the Department will have a solid framework from
which to expand to the other WIA title programs.
community service employment for older americans (cseoa)
Question. The President's fiscal year 2012 budget proposes the
transfer of CSEOA to the Department of Health and Human Services'
Administration on Aging. What has been the reaction to this proposal of
the national nonprofit agencies who administer the majority of these
grant funds?
Have you received a lot of comments from those entities, what are
their concerns and how are you addressing their concerns in your
transition planning?
Answer. The Department has received very few direct comments from
grantees. However, we have arranged two conference calls for the
Assistant Secretaries of the Department of Health and Human Services
(HHS) Administration on Aging (AoA) and the Department of Labor
Employment and Training Administration to speak with the national
grantee directors and with all grantees to address any concerns.
Questions in advance of and during the calls largely centered on how
the program would work if it went to AoA, and what kind of changes AoA
anticipated making in how the program is structured and funds are
allocated. Both Assistant Secretaries assured grantees that the
Departments would work collaboratively to ensure that the proposed
transfer would be as seamless as possible, with collaboration and
consultation at the staff level already underway. This would include
coordination on the statutorily required national grantee competition
planned for late 2011, with operations under these new grants effective
in 2012.
Question. Also, as the budget notes, the majority of State CSEOA
programs are housed within offices on aging, senior services or health
and human services departments. What will the transfer of this program
mean for the 17 States where that is not the case, where CSEOA programs
are housed in labor departments and how will DOL and HHS ensure a
smooth transition for those grantees?
Answer. Under the Older Americans Act, Governors have complete
discretion on where within the State bureaucracy the CSEOA program is
housed. Program services, performance goals, program structure,
coordination requirements, etc., are not dependent on whether the
program is administered at the State level by either a Labor or HHS
State agency. Because CSEOA has a dual focus on job training and
community service, it can be effectively run by either the Labor or HHS
State agency.
______
Questions Submitted by Chairman Daniel K. Inouye
workforce investment act (wia) workforce innovation fund
Question. Are the innovation grants proposed in the fiscal year
2012 budget intended to inform the Employment and Training
Administration's (ETA's) reauthorization efforts or are they a
component of ETA's ongoing efforts to improve program functioning?
Answer. This Fund represents a small but crucial investment in
innovative, evidence-based and cost-saving workforce strategies to
strengthen outcomes for both workers and employers. This Fund will
benefit future WIA formula-funded activities by moving the public
workforce system toward better results and more cost effective delivery
that can be replicated broadly across the workforce system. In
addition, while evidence developed over the next few years may not be
available in time to inform an imminent WIA reauthorization, it would
inform future WIA reauthorizations and administrative guidance issued
by the Department.
Question. Are the proposed innovation grants multi-year grants and
would they require funding in subsequent years? If these proposed
innovation grants are intended as multi-year grants, what are the
proposed periods (e.g., 3 years, 5 years)?
Answer. Grant funds are available for Federal obligation through
September 30, 2012; the appropriation remains available for recording,
adjusting, and liquidating obligations properly chargeable to the WIF
account until September 30, 2017. Assuming a 1 year close out period,
grants could be provided for a period of up to 5 years. Senators Harkin
and Murray have recommended a 2-3 year period of performance. While
this aligns with our typical grant award period, and will adequately
accommodate front-line service delivery reforms, such a time period may
not be sufficient for a State or regional partnership to make
structural or systemic changes at the State or local level and observe
how those changes increase efficiency or quality in service delivery.
Currently, the Department is engaged in intensive stakeholder
consultations for the WIF which will provide more information around a
practical timeframe of grant availability.
Question. Will the proposed reduction in the Governors Reserve from
15 percent to 7.5 percent of State formula grant allocations affect the
ability of Governors to carry out required statewide activities within
the WIA system?
Answer. It is possible that the reduction in the Governor's Reserve
will cause States to scale back on some statewide activities, including
performance incentives to local areas. The fiscal year 2011 Full-Year
Continuing Appropriations Act reduced the Governor's Reserve from 15
percent to 5 percent, which will provide a test case to determine how
States prioritize their statewide activities with fewer available
resources. For the fiscal year 2011 funds, the Department has advised
States to consider investments in statewide activities central to State
management such as reporting or those that provide direct services to
participants ahead of other required activities. States that are unable
to carry out all required activities due to a lack of funds may apply
for a waiver to allow for a temporary exemption from the requirement to
carry out some of the required statewide activities, such as
performance incentives and evaluations.
unemployment compensation (uc)
Question. What has DOL done to discourage States from reducing the
number of weeks that unemployed workers can receive regular
unemployment compensation (UC) benefits?
Answer. The Federal-State UC program is a cooperative arrangement
between the Federal Government and the States providing income support
to individuals who meet the eligibility requirements of State law.
Federal UC law establishes broad requirements that State laws must
meet. Otherwise, States are free to establish the requirements of their
own UC laws. Federal law has never included any requirements concerning
weeks of benefits payable. Thus, DOL has no official role in mandating
the number of weeks of benefits that States provide; we implement laws
passed by Congress. Additionally, we note that until the American
Recovery and Reinvestment Act, Federal law had never included any
requirements concerning weekly benefit amounts. Currently States that
have agreed to operate the Emergency Unemployment Compensation (EUC)
program on behalf of the Federal Government (and all States currently
do) are prohibited from reducing their weekly benefit amounts. The EUC
program is currently set to expire December 31, 2011, with phase out
completed by June 9, 2012.
There are potential consequences if States reduce the number of
weeks of benefits available. Specifically, the benefit amounts
available under the permanent extended benefits (EB) program and the
temporary emergency unemployment compensation (EUC) program are reduced
if individuals received fewer than 26 weeks of regular UC. DOL has
informed States considering such benefit reductions of the impact on
EUC and EB benefit amounts that would be available to eligible
individuals in their States.
Question. Will the administration support the reauthorization of
the Emergency Unemployment Compensation (EUC08) program before it
expires in January 2012? Would the administration support an extension
of 100 percent Federal financing for Extended Benefits (EB) beyond
January 4, 2012?
Answer. When people lose their jobs our Unemployment Insurance
system provides crucial support for both the recipients and their
communities. We've seen in every recession how important these benefits
are not just in helping to keep food on the table and roofs over
peoples' heads, but they provide an automatic stabilizer for our
economy. Each dollar paid out in UI benefits generates $2 in economic
activity, which means that helping the jobless prevents joblessness.
The extension of Emergency Unemployment Compensation (EUC) and 100
percent Federal financing of Extended Benefits--that we pushed for and
passed as part of the broadly supported tax agreement in December--have
been very important for our economy. They are helping 7 million
Americans support themselves while looking for work who would otherwise
have seen their benefits expire and supporting the businesses in their
community. The Council of Economic Advisers estimates that these
extensions of Federal support for unemployment insurance will create
600,000 jobs this year.
As we continue to work every day to put Americans back to work, we
are looking at a wide variety of options. The extension of Unemployment
Insurance benefits is also one of the ideas that should be analyzed
economically and discussed with all Members of Congress as we go
forward.
Question. Does the administration favor adding another Tier of
emergency UC benefits to the Emergency Unemployment Compensation
program (EUC08)?
Answer. Whether Unemployment Insurance benefits should be expanded
is worth both analyzing economically and discussing with all members of
Congress as we go forward.
davis-bacon act
Question. What are Department of Labor's plans to improve
implementation of the Davis-Bacon Act?
Answer. In fiscal year 2010, the Wage and Hour Division (WHD) re-
engineered its Davis-Bacon wage survey processes to improve the quality
and timeliness of wage determinations published by the agency. For
example, we are now utilizing State prevailing wage determinations as
the basis for issuing more current highway wage rates. This change,
coupled with improvements to the survey process, has positioned the
agency to complete during fiscal year 2011 all surveys that are
currently in the pipeline.
WHD continues to improve the IT system used for Davis-Bacon wage
determinations and to re-engineer its wage determinations processes in
order to improve the timeliness and accuracy of wage determinations. We
are also building upon previous efforts to revamp and enhance
performance measures and goals, as well as increase our numbers of
trained and experienced survey staff. We believe all these efforts will
produce more responsive and representative survey results that will
lead to more accurate and timely wage determinations.
Question. What resources would DOL need to ensure that Davis-Bacon
wage determinations are accurate and up-to-date?
Answer. The Department's budget does not include a request for
additional resources for Davis-Bacon wage determinations. Process
changes in conducting wage surveys are currently being implemented.
These changes should enable the Wage and Hour Division to update and to
keep current wage determinations nationwide.
Question. How will the administration's proposed cut to the
Community Service Employment for Older Americans program affect
services to older, low-income Americans?
Answer. The fiscal year 2011 budget allocation has already reduced
program funding to the level proposed in the fiscal year 2012 budget.
It will mean an approximate 25 percent reduction in funding and
services to unemployed, low-income seniors starting in PY 2011, as
compared to PY 2010 regular funding. However, grantees are already
implementing management strategies to help ensure that the impact of
the severe funding reductions on current CSEOA participants is
minimized in so far as possible. Grantee strategies include eliminating
new enrollments, cutting back on hours of paid community service
training for individual participants, and restricting any time
extensions for current participants beyond the new statutory 48 month
participation limit that starts on July 1, 2011.
______
Questions Submitted by Senator Patty Murray
evaluations and performance
Question. Duplicity and ineffectiveness are two claims that have
been levied against Federal job training programs recently, mostly in
response to the release of a GAO report earlier this year. However,
most of the inquiries I've heard into these claims never got to the
heart of the matter. I believe that accountability and performance are
too important not to address the issue fully.
I'd like to ask about the evaluation required under Sec. 172 of the
law. To your knowledge, why, under the Bush administration, didn't the
Department complete the multisite control group evaluation of WIA
formula programs by fiscal year 2005 as required by statute?
Has the Obama administration made such an evaluation a priority?
Answer. While rigorous random assignment impact studies provide the
most credible information on program effectiveness, these also are
highly resource intensive and take a minimum of 5 years to implement
and complete. The Bush administration had several policy proposals to
change WIA, and while we cannot answer with certainty why decisions
were made, it is our understanding that the Bush administration viewed
the WIA program as a program undergoing a transition. It generally is
advisable not to conduct an evaluation of a program undergoing
transition, as it could result in incorrect conclusions.
While it is unfortunate that we do not have evaluation results from
that period in time, in 2008, the Department commissioned the rigorous
WIA Gold Standard Evaluation of the Adult and Dislocated Worker
Programs (WGSE). This study will use a control group to measure the
impact of the WIA adult and dislocated worker formula programs at
nearly 30 randomly selected sites. The study's results will be
available in 2016, although this schedule is dependent upon continued
appropriations for the evaluation of WIA programs.
Question. I'd like to ask about the other evaluations that the
Department has undertaken under the authority of Sec. 172. Another
recently released GAO report noted that ETA released 34 reports to the
public in 2008, 20 of which had waited between 2 and 5 years to be
approved for public release. GAO goes on to note that several of those
reports would have been useful for the workforce system.
To your knowledge, why didn't the Bush administration release those
findings and reports earlier?
How has the Obama administration worked to address the criticisms
leveled by GAO concerning it research and evaluation activities for WIA
programs?
Answer. As I understand it, the Bush administration argued that
those studies were flawed. What I can tell you is that the GAO's March
2011 report discussed the marked improvement in the dissemination of
research reports by the Employment and Training Administration under my
leadership at the Department of Labor. The GAO noted that, ``The 34
research reports published by ETA in 2008 took, on average, 804 days
from the time the report was submitted to ETA until the time it was
posted to ETA's research database. By, contrast, from 2009 through the
first quarter of 2010, the average time between submission and public
release was 76 days, which represents a more than 90 percent
improvement in dissemination time compared with 2008.''
The Department has also worked diligently over the past 2 years to
increase the rigor of its evaluation studies. For example, I created
the Chief Evaluation Office (CEO), which was staffed in May 2010. The
purpose of this office is to coordinate the Department's research and
evaluation agenda in order to increase its capacity to conduct high
quality, rigorous evaluations.
In addition, since 2009, about half the evaluations the Employment
and Training Administration (ETA) has funded have been rigorous, random
assignment impact evaluations. These include: (a) the Workforce
Investment Act (WIA) Gold Standard Evaluation of the Adult and
Dislocated Worker Programs (WGSE); (b) the YouthBuild Impact
Evaluation; (c) the Reintegrating of Ex-Offenders Random Assignment
Evaluation; (d) the Impact Evaluation of Green Jobs, Health Care and
High Growth Training Grants; and (e) the Transitional Jobs Impact
Evaluation. Each of these evaluations will examine net impacts on
employment, retention and earnings, and include benefit-cost analyses.
ETA was able to fund these evaluations through an increase in fiscal
year 2010 appropriations and the large one-time infusion of funds made
available to the Department through the American Recovery and
Reinvestment Act of 2009.
While rigorous random assignment impact studies, such as the WGSE,
provide the most credible information on program effectiveness, they
also are highly resource intensive. Mindful of the statutory
responsibility and to address the knowledge gap until the WGSE results
are available, in 2009 the ETA released the results of a quasi-
experimental net impact evaluation of the WIA Adult and Dislocated
Worker programs.\1\ This study uses the next-best methodology when
random assignment is not available. This evaluation found positive
long-term earnings impact for both programs. ETA plans to publish
interim findings of the WGSE in 2013, and the final report will be
available in 2016.
---------------------------------------------------------------------------
\1\ The Workforce Investment Act Non-Experimental Net Impact
Evaluation: Final Report may be found at ETA's Research Publication
Database Web site.
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In addition, random assignment evaluations may not always be
possible when the law requires that people receive services as is the
case in many entitlement programs such as the Unemployment Insurance
(UI) program. In November 2010, ETA released a study which used
nationally representative tax and benefit data in a prominent
macroeconomic model, which provided new evidence reaffirming the value
of UI as an automatic economic stabilizer during the latest
recession.\2\
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\2\ The Role of Unemployment Insurance As an Automatic Stabilizer
During a Recession may be found at ETA's Research Publication Database
Web site.
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Question. I'd like to address the lack of performance information
argument. Does the Department collect performance data on WIA formula
programs? If so, how long has such data been collected and what does it
reveal about the value of WIA programs?
Answer. The Department has collected performance information on WIA
formula programs since its inception. The principal data set, known as
the Workforce Investment Act Standardized Record Data (WIASRD), records
a wide range of information about individual program participants,
including program outcomes for participants after they have exited from
the program. The outcomes recorded include employment, job retention,
and earnings, as well as attainment of education, credentials, and
skills.
Other information collected includes individual demographic
information and data about participation in and services or other
assistance received through WIA or partner programs. The full list of
data elements collected by WIASRD is posted on-line at http://
www.doleta.gov/performance/guidance/WIA/Appendix-A-WIASRD-
Specifications-Expires-02282009.xls.
Since WIA's inception, the Department has used this information to
produce and disseminate quarterly and annual performance reports. These
reports provide aggregate summary information on program exiters and
their outcomes with respect to the given time periods. These reports
are available to the public on-line at http://www.doleta.gov/
performance/results/Reports.cfm?#etaqr.
While this information is highly useful for monitoring program
performance, it cannot directly provide information regarding the value
of the programs. However, this information is the primary source of
data on which program evaluations, cost-benefit analyses and/or impact
studies are based. On the whole, these studies have provided evidence
that WIA programs enhance both the employment prospects and future
earnings of WIA participants.
As with any performance accountability system, WIA data systems and
performance metrics could always be improved or expanded. However, WIA
is certainly not lacking performance information as the WIASRD is a
rich dataset.
investment compared to need
Question. A recent GAO report noted $18 billion was invested in
Federal employment and training programs in fiscal year 2009, an
increase of $5 billion since an analysis in 2003. The same report goes
on to note that after adjusting for inflation, the increase in funds
equals $2 billion, which is approximately the same amount Congress
invested in these programs in the American Recovery and Reinvestment
Act to help address the impact of the Great Recession. I've seen some
reports that public financing for our workforce development programs
has actually fallen by 90 percent since the 1970s while our workforce
has grown by 50 percent.
However, just looking at recent years, it's my understanding that
the one-stop delivery system saw a marked increase in use over the last
several years due to the downturn in the economy. In fact, it
experienced nearly 234 percent increase in participants. Do you believe
that Federal investments have matched the increasing need for services
since 2003?
Answer. In calendar year 2010, ETA programs served more than 39.1
million people. The Wagner-Peyser Employment Services (ES) and
Unemployment Insurance (UI) served 74.6 percent of this total, and 63
percent of those receiving Unemployment Insurance also received Wagner-
Peyser funded Employment Services. ETA's other programs provided more
comprehensive services to over 9.9 million people in 2010. The high
level of participants reflects the continued demand for temporary
income support, training and employment services including job search
assistance, and the impact of the American Recovery Act and
Reinvestment Act funding.
While many of ETA's current workforce programs existed in 2003, we
are not able to make a direct comparison between the number of
individuals served in 2010 with those served in 2003 due to a changing
number of workforce investment programs authorized and appropriated by
the Congress. It also is important to note that the $18 billion
invested in Federal employment and training cited by the Government
Accountability Office includes the one-time $2 billion infusion of
funding from the American Recovery and Reinvestment Act. Without these
funds, there will be a significant decrease in individuals who receive
WIA services.
Adequate funding is important; there are many individuals eligible
for WIA services that the system could serve with additional funding.
In addition, increasing the number of participants who acquire
industry-recognized credentials through longer-term training means
higher cost services; and funding evaluations to assess the
effectiveness of alternative approaches requires significant resources.
However, these needs must be balanced with the current economic
environment, and the acknowledgment that the Federal Government must
live within its means. This requires that investments be strategic and
focus on increasing efficiency and alignment with existing Federal
resources. For example, the new Workforce Innovation Fund supports the
identification and replication of innovative, evidence-based and cost-
saving workforce strategies.
The range of such investments can build on technological advances
(e.g., using online resources to reach more people), system flexibility
measures such as waivers, partnerships, and guidance on aligning or
leveraging resources to help State and local workforce investment
programs deliver cost effective and high quality services to job
seekers and worker and employers.
administrative structures
Question. Another claim we often hear about job training programs
is multiple administrative structures and lack of strategic approach to
planning at the State level. To help address this issue, we've heard
about the value of unified planning and common performance measures as
ways to reduce administrative burden while promoting a better
understanding about the value of these programs. How does the
Department propose to address these concerns?
What value do you see in unified planning and the use of common
measures?
Answer. The Workforce Investment Act of 1998, Section 501 allows
States to submit a single Unified Plan to satisfy the planning
requirements of multiple employment and training programs. ETA
currently is redesigning and streamlining the Unified State Plan
requirements in order to improve strategy-focused planning and promote
improved alignment and integration of workforce and other relevant
programs. ETA is working with States to gather ideas and feedback on
how the current State planning process could be improved without any
changes in law. We hope that encouraging more strategic and joint
planning among States will prepare the states for any reauthorized WIA
that enhances planning provisions. ETA will encourage more States to
engage in unified planning leading to improved outcomes across programs
(as captured by the common measures) and resource utilization. Common
measures and unified planning are complementary tools that can support
State and Federal efforts to better align planning with performance
measurement and make each process more effective and efficient.
ETA anticipates sending revised planning guidance to States in
December 2011 that will facilitate the inclusion of multiple partners
in the planning process and in the State plan submitted to the
Department.
The goals of the effort to redesign State plans are to:
--Focus State planning on strategy instead of operations and
compliance;
--Better align and integrate workforce programs and strategies with
each other and other relevant programs (e.g., training
providers, education, and economic development);
--Streamline various paperwork processes;
--Encourage strategic thinking and creating workforce strategies that
focus on skills training and credential attainment; and
--Use current labor market information and economic indicators to
place newly trained individuals into career pathway employment
opportunities and track retention through wage record
information.
______
Questions Submitted by Senator Mary L. Landrieu
Question. Your testimony this morning reflects the administration's
commitment to keep annual domestic spending low by building on the
recently enacted continuing resolution that defined spending levels for
the remainder of fiscal year 2011 and to make the tough cuts necessary
to achieve these savings. Can you identify the additional cuts that
would be needed to make the fiscal year 2012 DOL budget request before
us consistent with the deficit reduction framework President Obama
announced last month?
Answer. The President's fiscal year 2012 budget was transmitted
before enactment of the final fiscal year 2011 appropriations bill. I
am aware that there are ongoing bicameral, bipartisan discussions
between the administration and congressional leadership on the Nation's
long-term fiscal picture. These conversations, along with the enacted
fiscal year 2011 appropriations, could impact eventual funding levels.
The implications of both on the fiscal year 2012 request will be
evaluated. Nonetheless, the fiscal year 2012 budget request reflects
the administration's policy priorities and remains a good starting
point for developing funding levels. We look forward to working closely
with you as the process moves forward.
But while the administration is committed to making the tough cuts
necessary to achieve these savings--including to programs we care
about--we will not sacrifice the core investments we need to grow and
create jobs and protect our workforce. We still believe that the fiscal
year 2012 budget request is a disciplined approach, representing
responsible spending that supports the most critical investments
necessary to keep our workforce system moving forward to assist our
country's businesses and workers. The budget includes key investments
that are an essential part of the President's commitment to out-
innovate, out-educate and out-build our global competitors, and to
assure that our workplaces are safe and fair. In short, getting America
back to work is a top administration priority. As you formulate your
appropriations bill, I hope we can work together to ensure adequate
funding for the programs that help us reach that goal.
voluntary protection programs (vpp)
Question. Currently, there are approximately 96 Voluntary
Protection Programs (VPP) sites in the State of Louisiana that are
actively pursuing VPP status in the State of Louisiana. Collectively,
these sites employ approximately 28,871 workers. The fiscal year 2012
budget request includes $4 million for Department of Labor's
Occupational Safety and Health Administration (OSHA) to administer the
VPP for 2012. How will President Obama's proposed deficit reduction
framework impact the resources terms of their ability to administer the
VPP?
Answer. The fiscal year 2012 request level includes sufficient
resources to maintain the VPP program, which is included in the Federal
Compliance Assistance budget activity.
Question. According to Government Accountability Office report on
the VPP published in May 2009, approximately 80 percent of VPP
worksites have fewer than 500 employees. Has OSHA studied and concluded
separately on the impact on small businesses?
Answer. The 80 percent figure does not accurately capture the true
number of actual small businesses because GAO was looking at the size
of the worksite and not the size of the company owning the worksite.
For example, many participating U.S. Postal Service worksites have been
classified as small businesses because they employ 250 or fewer
employees.
OSHA has not concluded a separate analysis of the impact of VPP on
small business because only 99 out of the 1,644 Federal VPP sites (6
percent) of the total number of VPP sites meet the small business
definition (250 or fewer employees and are not part of a corporation/
organization with 500 or more employees.)
Question. What are OSHA's plans to review the impact on small
businesses that participate in the VPP?
Answer. While at this time, there are no plans to review the impact
on small businesses that participate in the VPP, OSHA has formed a VPP
Workgroup to conduct a comprehensive evaluation of OSHA's VPP in
response to the May 2009 GAO report. Comprised of Regional and National
Office VPP personnel, the Workgroup will review such subject areas as
consistency in VPP administration, response to fatalities and
documentation following fatalities, effective use of limited resources,
recertification of current VPP sites, and training, communication, and
cost of administering the VPP. The review process will involve
interviews of OSHA VPP staff (Region and National Office), VPP
stakeholders (e.g., VPPPA, labor unions, VPP corporate participants,
and congressional staff), and review of policy and procedure manuals. A
first draft of the Workgroup's evaluation/report is to be completed by
the end of September 2011. Small business participation in VPP will be
addressed as part of this comprehensive VPP evaluation.
Small businesses with exemplary safety and health management
systems are more likely to be recognized under OSHA's Safety and Health
Recognition Program (SHARP). These small employers have had a full On-
site Consultation visit and meet other requirements. Upon receiving
SHARP recognition, OSHA exempts worksites from OSHA programmed
inspections during the period that the SHARP certification is valid.
Question. What is the current status of implementing the
recommendations from the GAO report for assessing the performance of
the VPP?
Answer. OSHA is continuing to evaluate and develop ways to improve
internal controls and measurement of program performance and
effectiveness as part of the ongoing VPP continuous improvement
process. The Assistant Secretary's series of VPP policy memoranda (five
to date, the earliest signed August 3, 2009, and the most recent, April
22, 2011) include instructions to strengthen nationwide consistency in
OSHA's administration of VPP; improve the quality and documentation of
OSHA actions following a fatality at a VPP site; strengthen internal
controls, audit procedures, tracking, and proper documentation of OSHA
actions; and improve annual data submissions required of all VPP
participants and OSHA's review of the submissions and follow-up
actions. And as mentioned above, in order to ensure successful
implementation of these improvements, OSHA has formed a VPP Workgroup
to conduct a comprehensive evaluation of OSHA's VPP.
Question. Some of my constituents have contacted me regarding the
Department of Labor's (DOL) proposed rule for expanding the definition
of the term ``fiduciary'' to include Employee Stock Ownership Plan
(ESOP) annual appraisers. See 75 Fed. Reg. 65263 (Oct. 22, 2011).
According to testimony submitted by the American Society of Appraisers
at a hearing on this proposed fiduciary rule held last month, the
proposed rule would impose ``significant financial burdens'' on ESOP
appraisers because it would require ESOP appraisers to purchase special
high-cost fiduciary insurance in addition to the standard errors and
omissions insurance required under current law. These increased
insurance costs will result in increases to the cost of ESOP
valuations--costs that would be then transferred to the ESOP and
inevitably to the customer. Has the DOL made a determination as to
whether it will exempt annual ESOP appraisals from the new fiduciary
rules?
Answer. Some stakeholders have asserted that the proposal would
cause some appraisers to discontinue ESOP valuations and would
significantly increase costs of appraisals for small businesses that
sponsor ESOPs. The Department is carefully reviewing these and other
comments with a view to avoiding unwarranted costs for ESOPs. In so
doing, we must also keep in mind that ESOPs often use annual appraisals
to calculate the dollar amount that participants who are leaving the
employer will receive for their shares. Thus, such appraisals should be
conducted in a prudent and impartial manner.
Question. Some constituents have also raised questions as to how
the above-referenced proposed fiduciary duty rule will impact broker-
dealers servicing individual retirement accounts. Constituents have
expressed concern about the proposed rule having the effect of
restricting affordable access to services for initiating and managing
IRAs. Recent studies have illustrated that IRAs are the fastest growing
accounts holding retirement savings. Specifically, IRAs are widely held
by small investors. Small investors prefer brokerage relationships over
advisory relationships. Ninety-eight percent of investor accounts with
less than $25,000 are in brokerage relationships. The proposed rule
would practically make every investment-related conversation with a
client subject to fiduciary duty. Consequently, under this proposed
rule firms and their associated representatives may not receive
different levels of compensation based on the investment choices made
by retail investors in protected IRA accounts. The current fee
structure accommodates the needs of small investors by allowing firms
to provide them with affordable investment services commensurate with
their risk profile. Under the proposed rule, brokerage firms would be
forced to offer investment services and guidance to IRA investors
through fee based advisory accounts--which frequently require much
higher fees. These higher fees make it uneconomical and unaffordable
for the majority of IRA investors. What is DOL going to do to ensure
small IRA accounts can continue to be served by broker-dealers in the
same way they are being served now?
Answer. Today, the advice provided to workers, employers, and
retirees about their retirement plans is too often tainted by conflicts
of interest and therefore potentially harmful. There is strong evidence
that unmitigated conflicts of interest cause substantial harm, and
therefore the Department is confident that amending the fiduciary
regulation to combat such conflicts will deliver significant benefits
to plan participants and IRA holders. This evidence is found in
academic research, IRA underperformance, SEC examinations, and EBSA's
own enforcement experience. Taken together, the available evidence more
than establishes that such negative impacts are present and often times
large. When the fiduciary proposal is finalized, plans, plan
participants and IRA holders will be able to more readily access and
benefit from impartial advice that puts their interests first.
The Department has received comments that the proposed fiduciary
regulation would force brokers to convert their existing commission-
based accounts into fee based advisory accounts, which would result in
higher fees and widespread distributions from smaller account, as these
advisory accounts would require higher minimum balances. The Department
is carefully considering these comments. To be clear however, the
proposal does not, by its terms, require brokers to restructure their
compensation as wrap fees or to convert brokerage accounts to advisory
accounts. Moreover, under already existing administrative exemptions
broker-dealers that are fiduciaries can receive commissions for trading
securities, insurance products, and mutual funds--which are the types
of investments that make up the large majority of IRA assets today.
These and other existing exemptions already create substantial space
for brokers to provide fiduciary advice as fiduciaries under ERISA and
the tax code while continuing to operate as brokers under the 1934
Securities Exchange Act. In addition, we have ample authority to grant
additional exemptions if there are legitimate concerns that beneficial
practices would be needlessly prohibited. We will attempt to provide
this clarification in a more formal manner as we proceed in this
process.
Further, the tax code itself treats IRAs differently from other
retail accounts, bestowing favorable tax treatment, and prohibiting
self-dealing by persons providing investment advice for a fee. In these
respects, and in terms of societal purpose, IRAs are more like plans
than like other retail accounts. Most IRA assets today are attributable
to rollovers from plans.\3\ The statutory definition of fiduciary
investment advice is the same for IRAs and plans. It therefore makes
sense to establish a single consistent definition for both by
regulation, and then deal with the practical differences between the
two by tailoring exemptions accordingly. In addition, while IRA holders
have more choice, they may nonetheless require more protection. Unlike
plan participants, IRA holders do not have the benefit of a plan
fiduciary to represent their interests in selecting or compensating
investment advisers. Compared to those with plan accounts, IRA holders
have larger account balances and are more likely to be elderly. For all
of these reasons, combating conflicts among advisers to IRAs is at
least as important as combating those among advisers to plans.
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\3\ Peter Brady, Sarah Holden, and Erin Shon, The U.S. Retirement
Market, 2009, Investment Company Institute, Research Fundamentals, Vol.
19, No. 3, May 2010, at http://www.ici.org/pdf/fm-v19n3.pdf.
---------------------------------------------------------------------------
______
Questions Submitted by Senator Jack Reed
workshare
Question. As you know, I introduced legislation last year to expand
work sharing, which just over 20 States have adopted or implemented. I
was pleased to see the administration include a work sharing proposal
in its budget this year that builds off of my legislation. What can we
do to encourage the remaining States to adopt work sharing and for more
businesses to participate in work sharing as a means to avoid layoffs
and help workers stay attached to the workforce?
Answer. The Department currently is limited in what it can do to
actively encourage the adoption of worksharing or short-time
compensation (STC) programs. Current legislative authority for STC does
not authorize certain State practices, such as making the payment of
STC contingent on the employer entering into a plan with its employees
and making such plan subject to approval by the State UC agency.
Amending Federal law would address these issues and allow the
Department to more actively promote STC. The Department's Unemployment
Compensation Integrity Act of 2011 that was recently sent to the
Congress includes language that would provide the necessary legislative
authority for the Department to more actively promote STC. The
Department welcomes the opportunity to work with the Congress to
develop additional strategies to encourage more states to adopt STC and
more businesses to participate.
workforce investment act reauthorization
Question. Public libraries are key access points in the workforce
investment system. How can we strengthen these linkages in the
Workforce Investment Act? Do you see the Innovation Fund that was
included in the fiscal year 2011 CR as an avenue for supporting
library-workforce partnerships?
Answer. We agree that public libraries are an important access
point for all jobseekers to access workforce services. Under current
law, libraries may serve as affiliate One-Stop Career Centers and this
feature should be preserved in a reauthorized Workforce Investment Act.
The Department has an agreement with the Institute of Museum and
Library Services (IMLS) to support strong linkages between public
libraries and the workforce investment system. Under this agreement,
the Department has provided technical assistance and guidance
specifically targeted to library workers on how to use the workforce
electronic tools such as career exploration, resume writer, job banks,
etc. The Workforce Innovation Fund will test and support innovative
practices and strategies in the workforce system and will contribute to
the ongoing work of the Department to disseminate and replicate
innovative, successful, and proven practices, which may include those
supported by partnerships between the workforce system and other
partners such as libraries. The Department has launched a broad
consultation process regarding the WIF with the public workforce system
and its stakeholders and partners, such as libraries, and this input
will help shape the grant solicitation.
______
Questions Submitted by Senator Sherrod Brown
unemployment rate for african americans
Question. In 2010, the overall unemployment rate in the United
States was 9.6 percent. However, the unemployment rate for African-
Americans was 16 percent, which is nearly twice as much as the 8.7
percent unemployment rate for white Americans. We also know African-
Americans are among highest of the long-term unemployed.
The numbers we use only include people who the Bureau of Labor
Statistics considers officially unemployed; still more Americans want
jobs and can't find one, yet they aren't considered unemployed. Many of
these Americans, like discouraged workers, have likely been unemployed
for a very long period of time as well.
Please explain what DOL is doing to address the especially high
long-term unemployment rates among African-Americans?
Are there any programs geared specifically toward lowering the high
unemployment rates among African-Americans?
Answer. DOL recently released a comprehensive report looking at the
labor market situation for African-Americans since the 2007-2009
recession. Although most of the Department's programs are not
specifically targeted to any one demographic, our programs are serving
African-Americans who are unemployed and underemployed in significant
numbers. The following provides an overview of how these programs have
benefitted millions of African-Americans during these challenging
economic times:
--Ensuring that training and employment services are serving African
Americans and are providing a host of support services to hard-
to-place workers.
--Between October 2009 and September 2010, more than 4.3 million
participants served by the Department's Wagner-Peyser
program, employment services administered by the
Department, were African-American. This figure represents
over 19 percent of total participants served by this
program.
--The Workforce Investment Act (WIA) served 570,000 self-indentified
African-American Adult and Dislocated Worker participants who
received staff-assisted services from July 2009 to June 2010.
For PY 2009 (July 2009-June 2010), after receiving counseling
or counseling and training services, over 330,000 Adult and
Dislocated African-American workers exited their respective
programs. In addition, of those being served by WIA, over
140,000 African-Americans found jobs during the corresponding
timeframe.
--As of September 30, 2010, 28,392 African-Americans have been
served by the Department's Community Based Job Training
grants and 13,060 African-Americans have been served
through the Department's High Growth and Emerging Industry
grants.
--Between October 2009 and September 2010, 11,835 African-American
workers impacted by trade were served by the Department's
Trade Adjustment Assistance program.
--In January 2011, the Department of Labor announced the
availability of approximately $500 million for the first
round of Trade Adjustment Assistance Community College and
Career Training Grants. The program will enable eligible
institutions of higher education, including but not limited
to community colleges, to expand their capacity to provide
quality education and training services suitable for Trade
Adjustment Assistance program participants and other
individuals. The overarching goals of these grants are to
increase attainment of degrees, certificates, and other
industry-recognized credentials and better prepare workers,
for high-wage, high-skill employment.
--The National Farm-Worker Jobs Program provides funding to
community-based organizations and public agencies to assist
migrant and seasonal farm-workers and their families attain
greater economic stability. Between October 2009 and September
2010, nearly 1,000 individuals who exited the program after
receiving core, intensive, and training services were African-
American.
--Since its inception in spring 2006, the Reintegration of Ex-
Offenders programs have assisted over 26,000 participants.
Of these, 15,530 (60 percent) are African-Americans.
--The Federal-State Unemployment Insurance system (UI) served over
2,377,000 African-Americans from October 2009 to September
2010.
--Providing training opportunities for African-American workers to be
involved in the clean energy economy. In 2010, DOL funded the
following Recovery Act grant competitions designed to advance
training and employment in these industries.
--``Pathways Out of Poverty'' grants provided $150 million to support
programs that help disadvantaged populations find ways out of
poverty and into economic self-sufficiency through employment
in energy efficiency and renewable energy industries.
--Among the awardees was the East Harlem Employment Services, which
will work with foundations, unions, educational
institutions, and minority contractors to provide education
and training to 1,819 people and unsubsidized employment to
881 people in Flint, Michigan and Baltimore, Maryland.
--MDC, Inc. was awarded funds to train more than 700 persons,
including 400 who will be placed into employment, in
Orangeburg, Calhoun and Bamberg Counties in South Carolina.
The Los Angeles Community College District will use funds
to provide training to more than 925 persons, including 667
who will receive on the job training.
--``Energy Training Partnership'' grants provided $100 million for
job training in energy efficiency and clean energy industries,
of which approximately $50 million reached communities of
color. The grants support job training programs to help
dislocated workers and other target populations, including
communities of color, find jobs in expanding green industries
and related occupations.
--Transitioning more African-American youth to employment through
programs targeting individuals affected by high poverty and
high unemployment.
Job Cops and Youthbuild
--Programs such as Job Cops and YouthBuild provide job training and
educational opportunities for low-income or at-risk youth aged
16 to 24. As of September 2010, there are 8,380 African-
American youth enrolled in YouthBuild, representing nearly 60
percent of the participants served in the program.
--African-American youth represented approximately 50 percent of
Job Corps students. In addition, VETS and ETA recently
announced a pilot for 300 veterans to participate in Job
Corps.
``Skills for America's Future'' Initiative
--Increasing college attendance and graduation rates among African-
American youth and encouraging more African-American students
to pursue careers in science, engineering and technology. The
President's ``Skills for America's Future'' initiative seeks to
increase the number of college graduates in science,
technology, engineering, and mathematics (STEM), as well as
improve industry partnerships with community colleges and other
training providers by matching classroom curricula with
industry standards and employer needs.
--Assisting workers interested in starting their own businesses.
Entrepreneurship training is available to dislocated workers
and other adults and youth through the public workforce system
overseen by DOL. DOL is also currently conducting an
experimental training program called Growing America Through
Entrepreneurship (GATE). Project GATE connects individuals with
entrepreneurship training and education to help them realize
their dreams of business ownership. Project GATE, which is now
in its second phase, has been shown to increase the number of
hours of business training participants receive, the speed of
business opening among participants, and the longevity of their
businesses.
--In eight States--Delaware, Maine, Maryland, New Jersey, New York,
Oregon, Pennsylvania, and Washington--certain unemployed
workers who participate in entrepreneurship training or
business counseling but would otherwise be eligible for
unemployment insurance can obtain weekly benefits through a
program called Self Employment Assistance.
Supporting Family-Friendly Workplace Policies
--Examples of such policies include flexible work schedules and on-
site child care, along with the Department's Wage and Hour
Division's implementation of the break time for the nursing
mothers' law, which became effective when the Patient
Protection and Affordable Care Act was signed by the President
in March 2010. This new law requires employers to provide
reasonable break time and a place--other than a bathroom that
is shielded from view and free from intrusion by coworkers or
the public--to express breast milk while at work. The
Department's role in this effort will undoubtedly help nursing
moms achieve balance between their job and care for their
children.
--Additionally, the Department has taken steps to ensure more workers
can take advantage of the Family and Medical Leave Act (FMLA)
by issuing an Administrator Interpretation clarifying that the
definition of son and daughter includes someone who stands or
stood ``in loco parentis'' to the child. This interpretation
ensures that an employee who assumes the role of caring for a
child receives parental rights to family leave regardless of
the legal or biological relationship.
--Protecting workers through enhancing the Department's Wage and Hour
Division and Office of Federal Contract Compliance Programs
enforcement
--The WHD is working to prevent employee misclassification.
Misclassification often results in the failure of employers
to pay employees the proper minimum wage or overtime pay.
Employers may also evade payroll taxes and often do not pay
for workers' compensation or other employment benefits. As
a result of misclassification, employees are denied the
protections and benefits of this Nation's most important
employment laws--protections to which they are legally
entitled. Misclassification tends to be a pervasive problem
in industries that employ a large number of vulnerable
workers, such as construction, janitorial, staffing firms,
restaurants, and trucking. The President requested funding
in fiscal year 2012 for DOL to lead a multi-agency
initiative to strengthen and coordinate Federal and State
efforts to enforce statutory protections, and identify and
deter employee misclassification. This initiative will help
provide employees with their rightful pay and benefits.
--The Department recovered more than $176 million in African-
American wages for nearly 210,000 workers in fiscal year
2010. Through the direct leadership of Secretary Solis, the
Wage and Hour Division hired more than 300 new
investigators--a staff increase of more than one-third.
These increased staffing levels will help improve complaint
investigations and more targeted enforcement.
--In 2010, the Office of Federal Contract Compliance Programs
(OFCCP) completed 80 compliance evaluations where it
identified discriminatory practices under Executive Order
11246, which bars race, gender, religious, and national
origin discrimination by Federal contractors impacting
minorities, which included African-Americans. One case of
compensation discrimination against an African-American
male resulted in an award of $24,894 in back pay. Overall,
OFCCP also entered into more than 96 Conciliation
Agreements with discrimination findings on behalf of more
than 12,000 affected workers, resulting in back pay awards
of more than $9 million, and more than 1,400 potential job
offers to provide relief for affected workers who have been
discriminated against under the Executive Order. Of these,
14 discrimination cases impacted 1,414 African-Americans.
workforce training strategies
Question. As we've discussed on several occasions, I've been
working on sector partnership workforce training strategies for 4
years, along with Senator Olympia Snowe. This is the strategy of
bringing multiple industry players together, along with labor,
community colleges, and WIBs, to design a training curriculum and
pipeline for future workers within that industry. It's a proven
strategy many Governors have taken up, and we're seeing success in
Ohio, especially in biosciences and healthcare.
I've introduced legislation--the SECTORS Act--that would amend WIA
to create dedicated capacity for sector partnerships, and many States
have used their 15 percent set-aside for statewide activities under WIA
to support these strategies.
The fiscal year 2011 CR created a new Workforce Innovation Fund
that will be used to support demonstration and replication projects
that test innovative workforce service delivery strategies, and the
fiscal year 2012 budget request proposed $380 million for the Fund.
Given the reduction in State-level funding under the recent CR, and
while Congress continues to consider WIA reauthorization, can you
assure me that new and existing sector partnerships will be eligible to
receive support from the new Workforce Innovation Fund?
Answer. Eligible applicants for these competitive grants are
States, State agencies eligible for assistance under Title I and III of
the Workforce Investment Act, consortia of States, or partnerships,
including regional partnerships (which ETA interprets to include
partnerships of local Workforce Investment Boards). Applications
submitted by an eligible entity should demonstrate appropriate and
engaged partnerships that support the proposed innovation that leads to
better employment outcomes for individuals, meets the skill needs of
employers, accelerates learning and credential attainment, and
increases efficiencies in the delivery of services. Depending on the
relationship and types of activity, sector partners may be eligible to
receive funding in support of the overall goals of the proposed
innovation.
ETA is engaged in a consultation process with key stakeholders
including the Federal partners, Congress, intergovernmental
organizations, and the public workforce system in support of the SGA
development. Your comment and others received through both formal and
informal discussions will be taken under advisement as the Department
refines the WIF.
payroll fraud prevention act
Question. I recently introduced, with Senators Harkin, Blumenthal,
and Franken, the Payroll Fraud Prevention Act (S. 770) which would
protect workers from being misclassified as independent contractors,
thereby ensuring access to fair labor standards, health and safety
protections, and workers compensation. The President's budget includes
$46 million to combat worker misclassification.
What is DOL's plan for cracking down on worker misclassification
and payroll fraud? How does making misclassification a violation of the
Fair Labor Standards Act (FLSA) helpful to your efforts?
Answer. The administration recognizes that misclassification is a
serious problem--it often deprives workers of rights and benefits to
which they are entitled under the law; it results in a loss to Federal
and State revenue, and underfunded unemployment insurance and workers
compensation funds; and it creates an uneven playing field for those
employers who obey the law. This is why the Department is participating
in a multi-agency Misclassification Initiative, headed by the Vice
President's Middle Class Task Force, that aims to coordinate the
administration's efforts to enforce statutory protections, identify and
deter employee misclassification, and mitigate future violations.
Internally, the Department's Initiative is headed by the Wage and
Hour Division (WHD), which is working with the Department's Solicitor's
Office to increase information sharing and coordination between DOL
agencies, with other Federal agencies, and with State agencies that
also enforce laws where employee misclassification is a significant
issue. When WHD finds cases where misclassification has occurred, it
will be referring those cases to the appropriate Federal and State
agencies, such as the IRS and State agencies that oversee Unemployment
Insurance and Workers Compensation programs.
WHD is also focusing its enforcement and compliance assistance
resources on those industries with large numbers of vulnerable and low
wage workers where misclassification is particularly prevalent. WHD is
working on ensuring that employers, employees, and the public fully
understand that misclassification, whether deliberate or as an
unintended consequence of a business practice that seeks to reduce
labor costs, frequently leads to violations of the laws we enforce, and
effectively communicating to employers the risks of being found in
violation. As part of this effort, WHD is actively seeking to work with
local and national businesses and trade associations to make sure that
our compliance assistance reaches their members.
Currently, misclassification is not a violation of any Federal
labor or employment law, but the practice often leads to violations of
those laws. We believe that, by making misclassification a violation of
the FLSA, requiring notice to workers informing them whether they are
classified as employees or not, and providing civil money penalties for
violating the act's recordkeeping provision, the Payroll Fraud
Prevention Act would provide employers with important additional
incentives to make the correct call when determining whether a worker
is an employee and keep accurate records of how they treat those
employees, which could reduce the number of violations that occur
without WHD having to get involved.
Question. The administration is soon likely to submit to Congress
the pending trade agreements with South Korea, Colombia, and Panama.
The administration recently announced a ``labor action plan'' with
Colombia.
The Colombian government, however, continues to fail at effectively
prosecuting those responsible for anti-union violence. The United
Steelworkers claim the Colombian government has prosecuted only 4 to
5.6 percent of the nearly 2,800 killings of trade unionists since 1986.
And, it has not initiated investigations into more than two-thirds of
these killings. What is your view of the labor action plan with
Colombia? Has Colombia so far met obligations set forth in the labor
action plan, including its April 22 commitments? How is the Bureau of
International Labor Affairs at DOL involved in the implementation of
the action plan?
Answer. The Colombian Action Plan Related to Labor Rights (Action
Plan) and our partnership with the new administration of President
Santos provide a concrete way forward to address the problems of
violence and impunity as a matter of urgency and to improve protections
for internationally recognized labor rights in Colombia.
Yes, Colombia has met the April 22 commitments and is on track to
meet the additional commitments in the Action Plan. We are continuing
to work with the Government of Colombia to ensure that Colombia
continues to make the needed progress.
For example, the Action Plan includes strong and specific steps to
increase investigation and prosecution of the perpetrators of earlier
violence against union activists because the Santos administration
recognizes that ending impunity is a major factor in deterring future
crimes. In accordance with the Action Plan, President Santos has issued
a directive to the National Police, which has already assigned 100
additional full-time judicial police investigators to support the
investigation of violence against trade unionists. The Prosecutor
General's office has issued directives, consistent with the Action
Plan, to improve the investigation and prosecution of labor cases. It
is also undertaking an analysis of past homicide cases of union members
and activists, in order to extract lessons that can help improve the
investigation and prosecution of future cases. Moreover, the Prosecutor
General's office has analyzed its needs for additional investigators
and prosecutors and submitted its plan and 2012 budget request to the
Santos administration, which has committed to provide funding for the
expanded staffing, including to strengthen capacity in regional
offices. In addition, the Prosecutor General's office is working with
the Colombian labor unions and the National Labor School (ENS) to
reconcile the Government's and ENS' lists of union homicides since 1986
with that of the unions.
DOL's Bureau of International Labor Affairs (ILAB) has been closely
involved in both the negotiation and implementation of the Action Plan.
An interagency team comprised of DOL, the Office of the United States
Trade Representative, and the Departments of State and Justice are
working closely with the Colombian government to ensure that each
commitment under the Action Plan is fulfilled.
national longitudinal youth survey
Question. For the past 32 years, the Center for Human Resource
Research at the Ohio State University has been tasked with conducting
the National Longitudinal Youth Survey. This survey measures an array
of important issues ranging from how families handle their financial
affairs, the impact of training and education programs for reentry into
the workforce, and what Federal programs are most effective over
multiple decades.
As the Nation continues to recover from the 2008 economic downturn,
this survey can help us better understand how long unemployment, high
rates of youth unemployment term and foreclosure can impact youth in
future decades.
How does the Department of Labor plan to utilize the National
Longitudinal Youth Survey to best gauge the impact of the current
recession?
Answer. The NLS records the labor force experiences of two cohorts
of American men and women. The older cohort is the 1979 National
Longitudinal Survey of Youth (NLSY79) that provides information on the
``baby boomer'' generation. The younger 1997 cohort is composed of
individuals currently in their late 20s and early 30s. The NLS captures
long-run changes in individual labor force behavior by interviewing the
same individuals over extended time periods. As a result, it is
uniquely designed to enable researchers and policymakers to examine how
changing economic conditions, such as a recession, affect labor force
experiences.
Policymakers can utilize information from past recessions to
understand the effect of the recent recession. For example, a study
using the NLSY79 measured the wage effects for people who graduated
from college in a recession (Kahn, 2010). Another study used the NLSY79
from the years 1978 to 2006 to examine how State and national
unemployment rates affected the likelihood of divorce (Arkes and Shen,
2010).
Another use of these data can be to study the recent recession and
recovery. As the recession began, the nearly 10,000 members of the
NLSY79 were aged 43 to 51 and had been followed for almost 30 years.
Analysts will be able to examine how the recession affected this
generation's retirement plans, health, ability to pay for their
children's college education, and many other aspects of their lives.
The 9,000 members of the NLSY97 were 23 to 28 when the recent recession
started and had been reporting about their lives for over 10 years.
This survey includes many veterans of the wars in Iraq and Afghanistan,
and the Department's Veterans' Employment and Training Service already
has used the survey to examine the challenges these young veterans have
faced as they transition back to civilian life. Analysts will continue
to use the NLSY97 to examine how the recession affected the career
trajectories, educational attainment, health, families, and other
aspects of the lives of veterans and nonveterans, both in the short-
term and across the rest of their working lives.
international labor comparisons (ilc)
Question. I was pleased that Congress saw fit in the fiscal year
2011 continuing resolution to maintain the International Labor
Comparisons (ILC) office of the Bureau of Labor Statistics. I'm
concerned, however, by the administration's proposal to eliminate this
important office in its fiscal year 2012 budget.
As you know, the ILC program provides the only systematic data
comparing labor costs in the United States with major trading partners,
including China. As the volume of trade expands, particularly with
developing countries, having reliable information on the
competitiveness of our workers with those overseas is more important
than ever before. While other agencies produce international data, none
has the mission and expertise like the ILC to compare data across key
countries on labor costs, GDP, unemployment, wages, and inflation.
Therefore, it is disturbing that the administration would seek to
eliminate this source of information.
If, as the President and you have stated, we are going to out-
educate, out-innovate, out-compete in the global economy, it is
imperative we do not sacrifice this source for effective policy making
and analysis. I request that you share with me your views on
maintaining the ILC in the fiscal year 2012 budget, and beyond.
Answer. The 2012 President's budget carries forward the proposal
from the 2011 budget to eliminate the International Labor Comparisons
(ILC) program. The BLS proposes to eliminate this program to fund
other, more critical needs. In developing the 2012 budget, the
administration committed to make tough choices that prioritize our
Nation's most pressing needs during its economic recovery. As a result,
programs that were funded in the 2011 budget were identified for
reduction in the 2012 President's budget. The proposal to redirect ILC
funding does not reflect on the quality and usefulness of the ILC data,
but rather the administration's commitment to maintaining the quality
and quantity of some of our Nation's most important economic
indicators.
______
Questions Submitted by Senator Richard C. Shelby
dol fiduciary rules
Question. The Department of Labor's recent proposal to amend its
fiduciary duty rule has raised many questions about potential
unintended consequences of the rule. For example, a recent study by
Oliver Wyman found that ``the proposed rule will disproportionately
negatively affect small balance IRA investors.'' What types of economic
analyses does the Department intend to conduct to shed more light on
how the proposal would affect small and large entities, including
retirement plans, their sponsors and service providers, and individual
retirement accountholders?
Answer. The proposed regulation included a regulatory impact
analysis (RIA) that assessed the potential costs and benefits
associated with the proposal. The Department's RIA satisfied applicable
requirements and provided an appropriate economic basis for the
proposal. The Department acknowledged in the RIA that its assessment
was subject to uncertainty and solicited public comment to help it
address areas of uncertainty. As we move forward with finalizing the
proposed rule and developing an expanded RIA, the Department will take
into account input received from stakeholders and consultations with
other Federal agencies. The economic impact of the final rule on both
ERISA plans and IRAs will be carefully considered during this process.
Some private studies--including several have been commissioned by
organizations opposed to the proposal--purport to demonstrate that the
Department's proposal will hurt the very investors and workers that the
Department is seeking to help. However, these studies are predicated on
several deeply flawed assumptions. For example, one widely cited study
builds its entire cost analysis on the assumption that commission-based
compensation for servicing IRA's would no longer be allowed even though
there are exemptions already in place that allow broker-dealers acting
as fiduciaries to receive commissions for the sale of securities,
mutual funds and insurance products.
The Department is always mindful of the impact its regulatory
actions may have on the availability of investment products and
services to employee benefit plans, IRAs, and to workers and retirees
covered by those plans. For example, some commenter's have suggested
that we consider the possible exercise of the Department's authority to
issue additional administrative exemptions from certain prohibited
transaction provisions of ERISA as a way of ensuring the continued
availability of certain types of transactions that they say clearly
benefit plan participants, beneficiaries, and IRA owners. Other
commenter's urged that the effective date of the final regulation allow
service providers transition time to adjust their business practices
and systems for compliance. We will also be considering these comments
and suggestions.
cftc
Question. The CFTC has proposed rules under the Dodd-Frank Act
that, when read together with the Department's proposed rule on
fiduciary duty, may make it impossible for pension plans to find
counterparties willing to engage in swap transactions with them. Does
the Department of Labor plan to weigh in on the CFTC rulemaking or take
steps in its own rules to ensure that pension plans are able to
continue to use swaps in managing plan risks?
Answer. The Department has recently weighed in with the CFTC on the
interaction between the fiduciary proposal and the CFTC rules proposed
under Dodd-Frank by sending a letter from EBSA Assistant Secretary
Phyllis Borzi to CFTC Chair Gary Gensler. As this letter says, it is
the Department's view that ``a swap dealer or major swap participant
acting as a plan's counterparty in an arm's length bilateral
transaction with a plan represented by a knowledgeable independent
fiduciary would not fail to meet the terms of the proposed regulation's
counterparty exceptions solely because it complied with the business
conduct standards set forth in the CFTC's proposed regulation.'' The
Department does not seek to impose ERISA fiduciary obligations on
persons who are merely counterparties to plans in arm's length
commercial transactions. Parties to such transactions routinely make
representations to their counterparties about the value and benefits of
proposed deals, without purporting to be impartial investment advisers
or giving their counterparties a reasonable expectation of a
relationship of trust. Accordingly, the Department's proposed
regulation provides that a counterparty will not be treated as a
fiduciary if it can demonstrate that the recipient of advice knows or
should know that the counterparty is providing recommendations in its
capacity as a purchaser or seller.
As we evaluate the comments we have received, we will continue to
evaluate the particular terms used to define the scope of any exception
to ensure that the regulation is as clear and effective as possible,
and to avoid any unintended consequences.
Finally, the Department and the CFTC are actively consulting with
each other and coordinating our efforts relating to the DOL fiduciary
regulation and the CFTC business conduct standard. Our shared joint
goal is to harmonize these initiatives to ensure that the regulated
community has clear and sensible pathways to compliance. We are
confident that this goal will be achieved.
Question. The Department of Labor is considering issuing a
transparency rule under ERISA that would require service providers to
disclose detailed financial information to health plans. If so,
pharmacy benefit managers (PBMs) may be required to provide detailed
disclosure of their proprietary cost structures (e.g., pharmacy
discounts and drug manufacturer rebates) to thousands of PBM clients
without sufficient confidentiality protections to safeguard against the
anti-competitive effects repeatedly pointed out by the Federal Trade
Commission in the context of state PBM transparency laws. As the
Department is undertaking rule promulgation to require the disclosure
of proprietary data of service providers of ERISA plans, what has the
Department done to reconcile its proposal with the FTC's seemingly
contrary position? Has the Department had high level, in-depth
discussions with the FTC's Bureau of Competition?
Answer. Yes, the Department has met with senior policymakers at the
FTC and had very productive and informative discussions. We will
continue to work closely with our colleagues at the FTC on this
regulatory initiative.
In March, the FTC's decided in a 5-0 vote to write Mississippi
lawmakers about the anticompetitive effects of competitors learning
each other's pricing information:
``These provisions could result in sharing competitively sensitive
cost information among competing pharmacies and pharmaceutical
manufacturers. In particular, such information sharing could undermine
competition between pharmacies to be included in PBM networks and
between pharmaceutical manufacturers to offer discounts to PBMs. Both
outcomes could raise prescription drug prices for consumers. We note,
however, that if there are appropriate confidentiality safeguards in
place, health plan sponsors (and their consultants) may find specific
cost information helpful as they seek to select among PBMs, understand
their enrollees' prescription drug use, and ensure that they are
receiving appropriate rebates from PBMs.''
Question. How has the Labor Department calculated the additional
costs of service provider disclosure in the absence of confidentiality?
Answer. The Department is aware of the FTC's March 2011 letter. We
are still gathering information in advance of considering policy
options for this rulemaking at this time and have not yet calculated
the potential costs and benefits of service provider disclosure in the
absence of confidentiality. The Department will take into account the
FTC's concerns regarding competition, collusion, and appropriate
confidentiality safeguards in developing the regulatory impact analysis
for any rule that is promulgated in this area.
The FTC's March, 2011, letter also noted how certain disclosure
could increase collusion.
``In some circumstances, sharing information among competitors may
increase the likelihood of collusion or coordination on matters such as
price or output. The antitrust agencies have explained how coordinated
interaction harms consumers: coordinated interaction `can blunt a
firm's incentive to offer customers better deals by undercutting the
extent to which such a move would win business away from rivals' and
`also can enhance a firm's incentive to raise prices by assuaging the
fear that such a move would lose customers to rivals.' ''
Question. What action is the Labor Department pursuing to mitigate
collusion or price coordination among corporations?
Answer. The Department's objective in this area is to ensure that
ERISA plan fiduciaries have sufficient information to fulfill their
fiduciary responsibility of determining whether their contracts or
arrangements with service providers, such as PBMs, are reasonable. We
will consult closely with the FTC as we develop a regulatory framework
that addresses concerns regarding collusion or price coordination.
trade adjustment assistance community college training grants
Question. Could you explain why the Trade Adjustment Assistance
Community College Training Grants program (TAACCCT) calls for the
development of Open Education Resources to meet the immediate training
needs of students?
The National Center for Academic Transformation indicates that
``high-quality course materials [are already available] at a reasonable
cost,'' ``reasonably priced software . . . is a non-problem,'' and that
available software enables ``faculty to focus on pedagogy rather than
materials creation.'' Therefore, why do you believe the Federal
Government should spend develop materials that appear to already exist
in the marketplace?
Answer. The Department expects the Federal funding from the Trade
Adjustment Assistance Community College and Career Training (TAACCCT)
grant program to provide quality education and training services to
Trade Adjustment Assistance (TAA) for Workers program participants as
well as other individuals to improve their knowledge and skills,
enabling them to obtain good, sustaining jobs. The program allows for
development of materials, and it also can improve on existing courses
that can be completed in 2 years or less. Ultimately, the goal of
adoption and adaptation of courses is to increase industry-recognized
credential or degree completion rates of participants through four key
priorities and strategies including: (1) accelerating progress for low-
skilled and other workers, (2) improving retention and achievement
rates to reduce time to completion, (3) building programs that meet
industry needs including the development of career pathways, and, (4)
strengthening online and technology-enabled learning.
Across these strategies, DOL recognizes that grantees may use
existing courses or programs when they are well suited to meet the
project's objective. However, training and education needs vary by
region and can change quickly. The marketplace does not support courses
that meet every project need. In some cases courses may need to be
tailored or augmented, and in other cases new materials altogether, not
currently supported by the marketplace, may be developed.
As one of four strategies, community colleges and other education
organizations have an opportunity to harness technology in their
classrooms and modernize their curriculum. These projects are
encouraged to improve or develop online or technology-enabled learning
programs and courses that can be taken to scale beyond a community
level to reach a national audience of diverse students over a larger
geographic area. The programs and courses developed with these funds,
particularly those developed by consortia of eligible institutions,
will be produced to maximize interoperability and exchange, and made
freely available for reuse and improvement by others. Online and
technology-enabled learning courses not only ensure widespread usage
but encourage continuous improvement of courses and learning materials.
Most importantly, online learning allows for rapid deployment and the
ability to meet employers' skilled workforce needs as they arise.
budget deficit
Question. Unemployment in our Nation is 8.8 percent. Madam
Secretary, what is your Department doing to ensure that we are
providing our workers with the type of assistance necessary to help our
small businesses and entrepreneurs create well paying jobs?
Answer. While the Department's resources do not directly create
jobs, they can help ensure workers acquire the skills that employers
need to successfully compete in the global economy. The public
workforce system focuses workforce development resources on the
expressed needs of employers, both small and large, in the following
ways:
Local and State workforce boards oversee WIA programs; they are
required to be business-led and have majority business membership to
connect the One-Stop service delivery system directly to the local
employers to ensure workers and training providers are knowledgeable
about what jobs/skills are needed in the regional or local economy.
The Department has strengthened connections between the public
workforce system and local employers through initiatives such as:
Awarding $75,000,000 in competitive On-the-Job Training (OJT) where
small businesses can be reimbursed up to 90 percent of the trainees'
wages for up to 6 months to cover the extraordinary costs of training;
Requiring many of ETA's competitive grants to focus on employers'
skill needs or require a partnership with employers, for example, H-1B
technical skills training grants that may be competitively awarded to
partnerships of private and public sector entities that may include
business-related nonprofit organizations, such as trade associations;
Providing technical assistance such as training Business Service
Representatives from the One-Stop Career Centers and Workforce
Investment Boards to better address business needs and issuing guidance
about Entrepreneurship (TEGL No.12-10).
The Department worked closely with businesses and trade
associations to develop 19 competency models in such industry sectors
as energy, advanced manufacturing, allied health and long-term care and
supports, and entrepreneurship. These competency models document the
foundational and technical skills and competencies required for
workplace success in economically important industries and are
available at www.careeronestop.org/competencymodel. Industry competency
models provide a resource for the development of curricula,
certifications, and the tests that assess work-related competencies.
Most importantly, competency models support worker progression along
career pathways.
workforce investment act
Question. Under the Workforce Investment Act (WIA--pronounced WEE-
a), all WIA funded initiatives were to be evaluated in 2005. It is now
2011 and we do not have any significant, concrete updates on WIA
programs. Given the fiscal restraints in the fiscal year 2012 budget,
unless we know that workforce programs are working, I do not think we
should continue to fund them. It is my understanding the Department has
started a comprehensive evaluation of WIA funded programs and interim
results will be available in 2013. Secretary Solis, in the meantime,
can you address ways this subcommittee can effectively evaluate these
programs?
Answer. The value of training is illustrated by the entered
employment rate, or how many individuals found jobs. For the 12-month
period ending June 30, 2010, individuals receiving WIA Dislocated
Worker program training found employment 1.6 times faster than those
who did not receive training. Adults at program exit who participated
in On-the-Job Training (OJT) found employment at a rate of 86 percent,
while dislocated workers receiving OJT found jobs at 90.3 percent
rate.\4\ In the 6-month period after finding jobs, individuals who
completed the WIA Adult program and Dislocated Worker program, and who
were unemployed at program entry, helped stimulate the economy by
earning just under $7.2 billion.\5\
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\4\ Workforce Investment Act Standardized Record Data (WIASRD)
records from Program Year 2009 (July 1, 2009-June 30, 2010).
\5\ Workforce Investment Act Standardized Record Data (WIASRD)
records from April 1, 2008 to March 31, 2009.
---------------------------------------------------------------------------
However, such outcome data do not take into account what
participants could accomplish without WIA. To do so, in 2008 the
Department released the WIA Non-Experimental Study.\6\ This study found
that, although differences across States are substantial, participation
in the WIA Adult program is associated with an increase in quarterly
earnings of several hundred dollars. The analysis of participants who
receive only core and intensive services suggests that their benefits
may be as great as $100 or $200 per quarter over the period of study,
which is substantial compared to the small costs of those services. The
marginal benefits of training may exceed $400 in earnings each quarter.
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\6\ http://wdr.doleta.gov/research/FullText_Documents/
Workforce%20Investment%20Act%
20Non%2DExperimental%20Net%20Impact%20Evaluation%20%2D%
20Final%20Report%2Epdf.
---------------------------------------------------------------------------
The study also found that following entry into WIA, Dislocated
Workers experience several quarters for which earnings are depressed
relative to comparison group workers. However, their earnings do
ultimately overtake the comparison group. The return they experience
from training appears to be smaller than that obtained by Adult program
participants. The study further found that women appear to obtain
greater benefits than men for participation in both the Adult and
Dislocated Worker programs.
The estimated effects for various subgroups examined--nonwhite non-
Hispanics, Hispanics, those under 26 years of age, those 50 years of
age or above, and veterans--are similar to the estimated effects for
all WIA participants. In other words, there is essentially no evidence
that any of the subgroups considered have experiences that differ from
the average in important ways.
Because of serious concerns about the limitations of the
methodology and data used in the non-experimental study, in 2008 the
Department commissioned the WIA Gold Standard Evaluation (WGSE). This
study will address the limitations of the 2008 study as shown in the
table below and includes a cost-benefit component. The study's results
will be available in 2016, although this schedule is dependent upon
continued appropriations for the evaluation of WIA programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
WIA Non-Experimental Impact Study (aka 2008 Impact Study) WIA gold standard evaluation
--------------------------------------------------------------------------------------------------------------------------------------------------------
Evaluation Methodology........ Quasi-experimental methods (propensity score matching)..... Random assignment
Sample........................ Consisted of 12 purposively selected States................ Will use a nationally representative sample of
approximately 30 randomly-selected local workforce
investment areas
Comparison Groups............. Drawn from Unemployment Insurance claimants and Wagner- Will randomly assign from WIA applicants
Peyser participants.
Data Sources.................. Used administrative data (UI wage records) which limited In addition to administrative data, will use survey data
the outcomes looked at to quarterly earnings and which will allow a full range of educational, employment,
employment. earnings, and self-sufficiency outcomes to be examined
Services Examined............. Looked at three levels of services: Core, Intensive, and Will look only at Intensive and Training compared to Core
Training compared to persons not receiving WIA services.
Study Dates................... Looked at participants who entered WIA between July 2003 Will look at entrants between approximately September 2011
and June 2005. and December 2012
--------------------------------------------------------------------------------------------------------------------------------------------------------
program effectiveness
Question. In March, GAO stated that the Employment and Training
Administration's research and evaluation programs have ``failed to
conduct research that can answer urgent workforce policy questions and
lead to an understanding of what works and what does not.'' What are
the Department of Labor's plans to improve the efficiency and
effectiveness of programs administered by the Department?
Answer. The Department of Labor is taking action in virtually all
aspects of its operations to ensure that our programs will operate at
the optimal levels of effectiveness and efficiency. We strongly believe
in the importance of Federal fiscal responsibility and that part of
this responsibility is identifying which programs and strategies
efficiently provide the greatest benefit to participants.
The Department recently undertook a significant strategic planning
process, publishing the U.S. Department of Labor Strategic Plan Fiscal
Years 2011-2016 on September 30, 2010. The strategic planning process
was highly inclusive, including formal opportunities for public
comment. Further, each agency, including ETA, has formal Operating
Plans that are used to guide and monitor its performance. Together,
these plans harness and direct the Department's resources toward
achieving five goals, which include: (1) preparing workers for good
jobs and fair compensation, and (2) for those not working, provide
income security. These planning processes are designed to maximize the
use of evidence and results.
The Department relies on performance data and evaluations. In
addition to our efforts to reassess performance measures to promote
better outcomes for individuals of all skill and need levels, we
believe that workers and employers should have easy access to
information about program outcomes for past participants, so they can
make informed decisions about which programs are most likely to meet
their needs.
The Department has worked diligently over the past 2 years to
increase the rigor of its evaluations. I established the Chief
Evaluation Office (CEO) to coordinate the Department's research and
evaluation agenda and increase its capacity to conduct high quality,
rigorous evaluations. The CEO is working closely with all Departmental
agencies, including ETA, to ensure that Departmental evaluations are
appropriately rigorous and designed to yield clear and actionable
information for policymaking purposes.
Since 2009, about half the evaluations the ETA has funded have been
rigorous, random assignment impact evaluations. These include: (1) the
Workforce Investment Act (WIA) Gold Standard Evaluation of the Adult
and Dislocated Worker Programs (WGSE); (2) the YouthBuild Impact
Evaluation; (3) the Reintegration of Ex-Offenders Random Assignment
Evaluation; (4) the Impact Evaluation of Green Jobs, Health Care and
High Growth Training Grants; and (5) the Transitional Jobs
Demonstration Impact Evaluation. Each of these evaluations examines net
impacts on employment, retention and earnings, and include benefit-cost
analyses. ETA was able to fund these evaluations through an increase in
fiscal year 2010 appropriations for evaluations and the funds made
available to DOL by the American Recovery and Reinvestment Act of 2009.
Random assignment evaluations are highly resource intensive and
typically take a range of 3 to 7 years to implement. In addition,
random assignment evaluations of our programs may not always be
possible when the law requires that people receive services. Therefore,
it is necessary at times to conduct other types of evaluations to gain
as much information as possible with available resources.
Another key investment that the Department will maximize is the
Workforce Innovation Fund (Fund). The Full-Year Continuing
Appropriations Act of 2011 provides $124.7 (post rescission) for the
Workforce Innovation Fund that will support competitively awarded
grants to States; State agencies that are eligible for assistance under
any program authorized under WIA; consortia of States; or partnerships,
including regional partnerships. This Fund represents a small but
crucial investment in innovative, evidence-based and cost-saving
workforce strategies. This Fund will significantly benefit WIA formula-
funded activities well into the future by obtaining results that can be
replicated broadly throughout the workforce system. These results will
inform administrative guidance issued by the Department and future
workforce related legislative initiatives.
In addition, the Department has developed effective partnerships
with other Federal agencies that encourage State and local synergies to
improve the delivery of quality, cost effective services across
programs and evaluate their performance. Finally, we look forward to
continuing to work with Congress in support of a WIA reauthorization
bill that meets the administration goals of streamlined service
delivery, better meeting the needs of employers and regional economies,
improving accountability, and promoting innovation.
SUBCOMMITTEE RECESS
Senator Harkin. The subcommittee will stand recessed.
[Whereupon, at 11:03 a.m., Wednesday, May 4, 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 2012
----------
WEDNESDAY, MAY 11, 2011
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 9:59 a.m., in room SD-124, Dirksen
Senate Office Building, Hon. Tom Harkin (chairman) presiding.
Present: Senators Harkin, Reed, Mikulski, Brown, Shelby,
Kirk and Moran.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
STATEMENT OF DR. FRANCIS S. COLLINS, DIRECTOR
ACCOMPANIED BY:
HAROLD VARMUS, M.D., DIRECTOR, NATIONAL CANCER INSTITUTE
ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY
AND INFECTIOUS DISEASES
SUSAN B. SHURIN, M.D., ACTING DIRECTOR, NATIONAL HEART, LUNG,
AND BLOOD INSTITUTE
DR. GRIFFIN RODGERS, DIRECTOR, NATIONAL INSTITUTE OF DIABETES,
DIGESTIVE AND KIDNEY DISEASES
OPENING STATEMENT OF SENATOR TOM HARKIN
Senator Harkin. The Senate Subcommittee on Labor, Health
and Human Services, and Education will now come to order.
First of all, Dr. Collins, welcome back to the
subcommittee. We welcome also Dr. Harold Varmus, Director of
the National Cancer Institute; Dr. Tony Fauci, Director of the
National Institute of Allergy and Infectious Diseases; Dr.
Griffin Rodgers, Director of the National Institute of
Diabetes, Digestive and Kidney Diseases; and Dr. Susan Shurin,
Director of the National Heart, Lung, and Blood Institute.
This subcommittee holds an appropriations hearing on the
NIH budget every year, and every year I am both inspired by the
dedication of the scientists who testify before us and proud
that their accomplishments have made America the world leader
in biomedical research. But in recent years, our Nation's
status in that regard has been threatened. While China and
Singapore make massive investments in research, here in the
United States we're pulling back.
The fiscal year 2011 appropriations bill that Congress
passed last month cut NIH funding by $322 million below the
fiscal year 2010 level. When you consider how much funding was
needed to keep up with inflation, the cut was more like $1.3
billion, taking inflation into account.
We should be thankful that the result wasn't significantly
worse. H.R. 1, the spending bill passed by the House majority,
would have cut NIH funding by $1.6 billion or $2.6 billion if
you counted inflation. Fortunately, the Senate rejected that
plan.
But even the compromise bill that was ultimately signed in
law will result in a success rate for NIH research grants, I'm
told, of just 17 or 18 percent, meaning just one out of every
six peer-reviewed application will be approved. And, again, I
am informed that that is the lowest success rate on record for
NIH.
What a dismal downturn from what Senator Specter and I, and
others did back in the late 1900s and early 2000 when we
doubled the funding of NIH and we got the success rate up, I
think--if I'm not mistaken. You correct me, Dr. Collins--up in
the 20-30 percent range, somewhere in there. And we thought we
were on a path to continue that kind of a success rate. Now,
it's down lowest on record.
And there is cause to fear even bigger cuts next year. The
budget plan approved by the House last month would cut health
funding by 9 percent in fiscal year 2012. If that plan were
approved, severe reductions to NIH research would be
unavoidable.
That doesn't make sense. Let's set aside for a moment any
thoughts about the moral value of trying to improve people's
health, and just look at the issue from a purely economic
standpoint. NIH research is one of the best investments this
country can make.
A study released yesterday by United for Medical Research
concluded that in fiscal year 2010, NIH funding supported
almost 500,000 jobs across country. And I always have to remind
people that only a small percentage of that goes to NIH in
Bethesda, Maryland. I want Senator Mikulski to know that. Most
is awarded to researchers at academic institutions all over the
United States.
Another study by Battelle examined the specific impact of
the Human Genome Project, which was overseen, again, by Dr.
Collins and completed in 2003. The Federal Government spent a
total of $3.8 billion on this historic initiative. A lot of
money, but the return on the investment is staggering.
According to the Battelle study that $3.8 billion translated
into an economic output of $796 billion between 1988 and 2010.
And, of course, we'll be seeing benefits from the Human Genome
Project for many more decades to come. In fact, when I was
reading all of your testimonies last night, what struck me in
each one of them there were references made back to genomic
research in every single case of the institutes who are
represented here.
So the lesson is clear. Biomedical research is one of the
engines that drive our economy. If we want our economy to grow,
both immediately and in the long term, that engine needs fuel.
Drastically cutting NIH, as the House budget would force us to
do, would be a classic case of penny wise and pound foolish
thinking. That, again, is just on the economic side.
On the human side, though, the great advances that have
been made in cancer research and what we have done to lessen
the threat of cancer--young kids now with leukemia are being
cured at an almost 100 percent rate. Maybe that's not quite
right, but pretty darn close, things that were unheard of just
a few years ago. The advances that we're making in infectious
diseases, unheard of 20 years ago when I first came on this
subcommittee. Well, that's been 25 years ago, but great
advances have been made. Just stark.
So, from the human standpoint, in helping people have
better lives and overcoming some of the dreaded diseases that
have plagued mankind for so long, on both fronts, biomedical
research is the place to go and we ought not to be penny wise
and pound foolish on that.
And so now I'll recognize my ranking member, Senator
Shelby, for an opening statement.
STATEMENT OF SENATOR RICHARD C. SHELBY
Senator Shelby. Thank you, Mr. Chairman. I appreciate you
holding this hearing today to discuss the vital mission carried
out by the National Institutes of Health.
We live in a world where there are thousands of
debilitating and life-threatening diseases, all that could use
additional funding for research and clinical trials.
I support Federal investment in basic biomedical research
and development. Research carried out by the NIH and its
network of 325,000 researchers at 3,000 institutions across the
country serves the Nation with the goal of improving human
health. As research becomes more expensive and private capital
dries up, I believe it's critical to ensure support for
translational research; that is, research that moves a
potential therapy from development to the market.
The NIH has developed an interesting proposal with the
establishment of the National Center for Advancing
Translational Sciences, NCATS. NCATS is intended to fill the
gap between advances in scientific understanding of disease and
the process to turn new scientific insights into products. I
believe the need for an entity to straddle the world's research
and industry is clear.
In the private market, pharmaceutical companies will
abandon drug development projects that are not initially
successful, become too complex or do not provide a lucrative
path forward.
For example, since 1949, there have only been two major
drug discoveries in mental health--lithium and Thorazine. Sixty
years later, researchers still do not know why these drugs
actually work. Hundreds of genes have been shown to play roles
in mental illness, too many for focused efforts by drug
developers.
Therefore, many drug manufacturers have dropped out of the
mental-health field. In particular, pharmaceuticals for rare
and neglected disease are often ignored because private
companies avoid this small market with little profit appeal
leaving patients with no treatment options.
Even promising new drugs discovered through basic research
often struggle during the translational stage of the process
because it's expensive, time consuming and prone to failure.
These barriers inhibit both the scientists dedicated to
improving health and the patients who ultimately need improved
cures and care.
The question remains, however, as to whether NCATS is the
right approach to solving the issue. Will NCATS be the right
mechanism for taking valuable discoveries that the taxpayer has
funded and giving it a greater opportunity to make it in the
marketplace? As we review this proposal, we need to consider
the fact that NIH is not a drug developer or an expert in the
therapeutics world.
Dr. Collins, I would like to continue to work with you to
make a thoughtful, informed decision regarding the NCATS.
Unfortunately, the fiscal year 2012 budget request, I believe,
does not provide adequate details on the reorganization.
It is May 11 and we've not received a budget amendment or
specific structural details of an NCATS, a program NIH wants to
implement by October 1. How can the subcommittee be expected to
support a program that does not yet exist in budget documents?
I understand that the transition from basic research to
clinical application requires interdisciplinary and
multidisciplinary expertise. Research that aims to transform
science is inherently difficult. If it were easy, the need for
transformation would not exist.
NCATS may be the answer to solve this complex issue, but it
also may not be. We don't know. Dr. Collins, I believe that
NCATS is a matter that we should contemplate, but we must
ensure that the steps forward are measured and in the best
interests of all stakeholders, especially those who are in need
of treatment and care.
I look forward to working with you and the chairman on this
very important issue. Thank you.
INTRODUCTION OF WITNESS
Senator Harkin. Thank you very much, Senator Shelby.
Now, welcome back to Dr. Collins.
Francis Collins was sworn in as the 16th Director of the
National Institutes of Health in August 2009 after being
unanimously confirmed by the Senate.
He is a physician geneticist noted for his discoveries of
diseased genes and leadership, of course, of the Human Genome
Project. Prior to becoming Director, he served as Director of
the National Human Genome Research Institute at NIH.
Dr. Collins received his bachelor's degree from the
University of Virginia, his Ph.D. from Yale and his M.D. from
the University of North Carolina at Chapel Hill.
Dr. Collins, again, welcome, and first I want to say that
your testimony, and all of the testimony of the Directors who
are here, will be made a part of the record in their entirety.
Again, due to time, Dr. Collins, we ask you to make a
fairly comprehensive statement. I'm not going to get the clock
going here, but if it goes too long and people start looking at
me funny, then I'll probably ask you to close it out. But
please take whatever time you need to give us an update on NIH
and a concise summation of your written testimony.
SUMMARY STATEMENT OF DR. FRANCIS S. COLLINS
Dr. Collins. Well, thank you, Senator, and, Mr. Chairman,
and distinguished members of the subcommittee, it's an honor to
appear before you this morning, together with my colleagues, on
behalf of NIH.
And I'll try not to talk so long that people start looking
at you or looking at me, but I do have some things I really
wanted to put in front of this distinguished subcommittee,
because this is a very exciting time for biomedical research.
NIH is the largest supporter of biomedical research in the
world, and we're here to present the President's budget request
of $31.987 billion for fiscal year 2012.
NIH--Turning Discovery Into Health
Global Competitiveness--The Importance of U.S. Leadership in Science
and Innovation for the Future of Our Economy and Our Health
The National Science Board's 2010 Key Science and Engineering
Indicators, provide insight into how crucial decisions on R&D funding
may affect our Nation's ability to thrive in an increasingly
competitive and knowledge-driven global economy. While these trends
apply not just to bimoedical reserch, but also to research in
chemistry, physics, engineering, computer science, and many other
fields, the conclusion of most observers is that the 21st century will
be dominated by the life sciences, and the country that leads in this
area will have much to gain. Unfortunatley, the United States,
traditionally the dominant Nation in scientific resarch, has been
slipping in leadership recently.
Losing Ground.--R&D investment growth rates are rising sharply in
Asia.
For example, China's growth rate is 4 times higher than the U.S.
rate.
While the U.S. remains among the nations with the highest actual
R&D expenditures, Asia is rapidly closing the gap.
Employment Impact: The number of people engaged in scientific
research in China has increased dramatically. In 2007, China had 1.42
million researchers, while the US had 1.47 million. In 2010, it is
likely that China has surpassed the U.S. research workforce.
Knowledge Generation: The number of scientific articles published
is a common measure of scientific productivity. The average increase in
U.S. publications is significantly lower than for other key countries
and also below the world average. Meanwhile, China, Thailand, South
Korea, and others show impressive growth rates.
As a result of the previously mentioned trends, it is not
surprising that the U.S. share of world publications has significantly
decreased, and that China's share has grown.
------------------------------------------------------------------------
Share of world
articles (Percent) Percent
Country/Region ---------------------- Change
1998 2008
------------------------------------------------------------------------
United States.......................... 34 28.9 -5.1
EU..................................... 34.6 33.1 -1.5
China.................................. 1.6 5.9 4.3
Japan.................................. 8.5 7.8 -0.7
Asia-8................................. 3.6 6.8 3.2
------------------------------------------------------------------------
Source: SEI 2010
The number of times a scientific article is cited indicates its
scientific impact. One could argue that emerging countries are
publishing articles with limited impact. While this may be the case
from certain perspectives, the aggregate number of citations indicates
a worrisome plunge in the U.S. share of worldwide citations, which fell
8.6 percent from 1998 to 2008. In contrast, China and Asia-8 countries
displayed a noticeable increase in their share of citations, rising 3.7
percent and 3.1 percent respectively over the same time period.
Economic consequences: Reducing R&D investments when other nations
are rapidly increasing them has already had significant consequences on
exports, which are an important component of the U.S. economy and well
being of Americans.
IMPACTS ON U.S. ECONOMY
NIH is the largest funder and conductor of biomedical research in
the world.
The NIH fiscal year 2011 budget is $31 billion--84 percent of which
is awarded to the Nation's finest universities, institutes, and small
businesses through a rigorous peer review process. Every State, along
with almost every Congressional district, benefits.
NIH extramural program supports more than 40,000 competitive
research grants and 325,000 research personnel at more than 3,000
universities, medical schools, and other research institutions in all
50 states, U.S. territories, and around the world.
Approximately 10 percent of the NIH budget funds nearly 6,000
scientists working at the NIH campus in Bethesda, in laboratories in
Rockville and Frederick, Maryland, at Research Triangle Park in
Raleigh, North Carolina, and at the Rocky Mountain Laboratories in
Hamilton, Montana.
NIH spending increases business activity directly and indirectly:
According to Families USA, each dollar of NIH award money generates
about $2.21 of new business activity within 1 year, while each grant
awarded by NIH generates about 7 jobs.
NIH-driven advances have not only had profound effects on the
health and quality of life for all Americans, but also yielded economic
gains. The percentage of elderly with chronic disabilities has declined
(from 27 percent in 1982 to 19 percent in 2005). Since 1970, life
expectancy in the United States has risen from 71 to 78 years.
Economists estimate that these gains in life expectancy have been worth
approximately $95 trillion.
The economic potential of NIH-fueled advances in improved
treatments for disease is also clear in this projection: a reduction in
cancer deaths by one percent has a present value to current and future
generations of Americans of nearly $500 billion. A full cure would be
worth approximately $50 trillion--more than three times today's GDP.
Advances in disease diagnosis also illustrate the health-related
and economic benefits of NIH research: approximately $100 million in
health care costs annually are being saved through the use of a genomic
test that determines whether a particular type of breast cancer is
likely to be cured by surgery and radiation or by chemotherapy. As a
result of this test, thousands of women are being spared needless
exposure to toxic therapies--and millions of dollars are being saved.
NIH is an engine of innovation--and a crucial support for the
global competitive stature of the United States. In fiscal year 2010,
NIH filed 289 U.S. patent applications (of which 141 were new
applications). These are now included in a total of 3,186 NIH patent
applications in the United States and abroad that were pending
approval.
Key Facts on U.S. Competitiveness in the Global Research Arena
The United States still is the world leader in science and
engineering research. But that leadership role is being challenged by
China, India, and other nations as they recognize the economic, health,
and social benefits of investing in R&D.
Over the past decade, R&D intensity has grown in Asia, but remained
flat in the United States.
Growth of R&D expenditures in the United States averaged 5-6
percent annually from 1996-2007, lagging behind the worldwide average
of 7 percent per year. In contrast, growth in most Asian nations
exceeded the worldwide average, and China's R&D expenditures grew more
than 20 percent annually from 1996-2007.
The United States share of high technology exports fell by one-
third from 1996-2007. China's share more than tripled.
India exported $8.3 billion in pharmaceutical products and services
in fiscal year 2009, up 25 percent from the previous year.
About 277,000 people, ranging from scientists and to production
workers, are currently employed by pharmaceutical companies in the
United States, a decline of 5 percent from 2008. More than 340,000
people work in India's pharmaceutical manufacturing industry in 2009--
and the industry is projected to grow by 13 percent in 2010.
Between 1995 and 2007, the worldwide share of researchers working
in China, Singapore, South Korea, or Taiwan rose from 16 percent to 31
percent.
In 2007, the United States had 1.47 million people engaged in
scientific research; China had 1.42 million--and it was generating R&D
jobs at three times the rate of the U.S.
In the United States, the percentage of undergraduate students who
major in science and engineering is 15 percent; in China, it is 50
percent.
In 1995, China ranked 14th in the world in the production of
research publications. In 2008, it ranked second.
China's leading genome sequencing institute, BGI, is on track to
sequence more than 10,000 human genomes a year. That would surpass the
entire DNA sequencing output of the United States.
For more on how shifts in global research capacity are challenging
the United States to actively focus on maintaining its competitive
strength, go to http://www.nsf.gov/statistics/nsb1003/.
Health Improvements
In the last 25 years, NIH-supported biomedical research has
directly led to human health benefits that both extend lifespan and
reduce illnesses:
--Prolonging Life and Reducing Disability.--Our Nation has gained
about 1 year of longevity every 6 years since 1990. A baby born
today can look forward to an average lifespan of nearly 78
years--nearly three decades longer than a baby born in 1900.
Not only are people living longer, they are staying active
longer. From 1982 through 2005, the proportion of older people
with chronic disabilities dropped by almost a third.
--Heart Disease.--NIH research has generated new techniques for heart
attack prevention, effective drugs for lowering cholesterol and
controlling blood pressure, and strategies for dissolving blood
clots. As a result, the death rate for coronary disease is 60
percent lower--and for stroke, more than 70 percent lower--than
during the era of World War II. Better treatment of acute
conditions, better medications, and improved health-related
behaviors--all made possible by NIH research--account for as
much as two-thirds of this reduction.
--Chronic Disability.--From 1982-2004, the reported chronic
disability among American seniors dropped nearly 30 percent.
Health improvements from NIH research played a major role in
this, including better prevention and treatment of heart
attacks and strokes, advances in treatment of arthritis, and
improved technologies for cataract surgery.
--Age-Related Macular Degeneration (AMD).--Forty years ago there was
little or nothing one could do to prevent or treat advanced AMD
and blindness. Because of new treatments and procedures based
on NIH research, 750,000 Americans who would have gone blind
over the next 5 years instead will continue to have useful
vision.
--Breast Cancer.--The 5-year survival rate for women diagnosed with
breast cancer was 75 percent in the mid-1970s. Because of NIH-
supported research, the 5-year survival rate has risen to over
90 percent.
--Cervical Cancer.--Cervical cancer is a deadly cancer in women. Due
to groundbreaking NIH research, an FDA-approved vaccine
(Gardasil) now is available to prevent the development of
cervical cancer.
--Colon Cancer.--From 1974-1976, in an NIH-sponsored study, the 5-
year survival for patients with colon cancer was 50 percent. In
2009, based on NIH-supported clinical trials using new
diagnostics and treatments, a comparable patient group has a 5-
year survival rate of over 70 percent.
--Cochlear Implants.--Because of NIH-supported research, children who
are profoundly deaf but receive a cochlear implant within the
first 2 years of life now have the same skills, opportunities,
and potential as their normal-hearing classmates.
--Type 1 Diabetes.--Thirty to forty years ago, 30 percent of patients
died within 25 years of a diagnosis of type 1 diabetes. Today,
due to tight blood glucose control, heart disease and stroke in
patient with type 1 diabetes have been reduced by over 50
percent.
--Hepatitis B.--In the mid-1980s, hepatitis B infection caused
untreatable and fatal illness. Due to intensive vaccination
programs based on NIH research, the rate of acute hepatitis B
has fallen by more than 80 percent.
--HIV/AIDS.--In the 1980s, the diagnosis of HIV infection was a
virtual death sentence. Due to antiviral drugs developed by
NIH, today an HIV-positive 20-year-old can be expected to reach
the age of 70.
--Infant Health.--In 1976, the infant mortality rate was 15.2 infant
deaths per 1,000 live births. By 2006, that rate had fallen to
6.7 deaths per 1,000 live births. Much of this progress can be
attributed to NIH research in the areas of neonatal care unit
procedures and new drugs administered to women at risk for
premature birth.
--Childhood Leukemia.--Survival rates for children with the most
common childhood leukemia (acute lymphocytic leukemia) is now
90 percent.
Advances In Knowledge
NIH-funded research leads to thousands of new findings every year.
These incremental advances and technological developments are the
building blocks that ultimately yield significant improvements in
health. Highlighted below are just a few of the many recent advances
from NIH-supported research:
--Studies find possible new genetic risk factors for Alzheimer's
disease.--Scientists have confirmed one gene variant and have
identified several others that may be risk factors for late-
onset Alzheimer's disease, the most common form of the
disorder. In the largest genome-wide study, or GWAS, ever
conducted in Alzheimer's research, NIH-supported investigators
studied DNA samples from more than 56,000 study participants
and analyzed shared data sets to detect gene variations that
may have subtle effects on the risk for developing Alzheimer's.
Until recently, only one gene variant, Apolipoprotein E-e4
(APOE-e4), had been confirmed as a significant risk factor gene
for the common form of late-onset Alzheimer's disease, which
typically occurs after age 60. In 2009 and 2010, researchers
confirmed additional gene variants of CR1, CLU, and PICALM as
possible risk factors for late-onset Alzheimer's. This newest
GWAS confirms the fifth gene variant, BIN1, affects development
of late-onset Alzheimer's. The genes identified by this study
may implicate pathways involved in inflammation, movement of
proteins within cells, and lipid transport as being important
in the disease process.
--NIH scientist advance universal flu vaccine.--Significant progress
was made toward the development of a universal flu vaccine that
would confer longer term protection against multiple influenza
virus strains. NIH-supported researchers have identified the
regions of influenza viral proteins that remain unchanged among
seasonal and pandemic strains. These findings will inform the
development of influenza vaccines that might one day provide
universal protection against the broad range of influenza
strains. Such a universal influenza vaccine would provide
broader protection against multiple flu strains and make yearly
flu shots a thing of the past.
--Early detection of cancer is critical to provide effective
therapy.--NIH-supported investigators recently reported the
detection of a single metastatic cell from lung cancer in one
billion normal blood cells. These circulating tumor cells
(CTCs) may also be released into the bloodstream of patients
with invasive but localized cancers. The presence of CTCs may
be an early indicator of tumor invasion into the bloodstream
long before distant metastases are detected. Identifying CTCs
may be viewed as performing liquid biopsies, which can be
especially advantageous for prostate cancer. Researchers plan
to extend their work to develop a point-of-care microchip that
would allow non-invasive isolation of CTCs from patients with
many different types of cancer, to improve the management and
treatment of this devastating disease.
--Prenatal surgery reduces complications of spina bifida.--NIH-
supported scientists reported that a surgical procedure to
repair a common birth defect of the spine, if undertaken while
a baby is still in the uterus, greatly reduces the need to
divert, or shunt, fluid away from the brain. The fetal surgical
procedure also increases the chances that a child will be able
to walk without crutches or other devices. The birth defect,
myelomeningocele, is the most serious form of spina bifida, a
condition in which the spinal column fails to close around the
cord. The study, the Management of Myelomeningocele Study
(MOMS), was stopped after the enrollment of 183 women, because
of the benefits demonstrated in the children who underwent
prenatal surgery. In spite of an increased risk for preterm
birth, children who underwent surgery while in the uterus did
much better, on balance, than those who had surgery after
birth.
--Progesterone reduces rate of early preterm birth in at risk
women.--Preterm infants are at high risk of early death and
long term health and developmental problems including,
breathing difficulties, cerebral palsy, learning disabilities,
blindness and deafness. An NIH study found that progesterone
gel reduces the rate of preterm birth before the 33rd week of
pregnancy by 45 percent among women with a short cervix, which
is known to increase the risk of preterm birth. Women with a
short cervix can be identified through routine ultrasound
screening, and once identified could be offered treatment with
progesterone. In addition, infants born to women who received
progesterone had a lower rate of respiratory distress syndrome
than those in the placebo group.
--Daily dose of HIV drug reduces risk of HIV infection.--A daily dose
of an oral antiretroviral drug, currently approved to treat HIV
infection, was shown to reduce the risk of acquiring HIV
infection by 43.8 percent among men who have sex with men. The
findings, a major advance in HIV prevention research, came from
a large international clinical trial supported by NIH. The
study, titled ``Chemoprophylaxis for HIV Prevention in Men''
found even higher rates of effectiveness, up to 72.8 percent,
among those participants who adhered most closely to the daily
drug regimen. These new findings provide strong evidence that
pre-exposure prophylaxis with an antiretroviral drug, a
strategy widely referred to as PrEP, can reduce the risk of HIV
acquisition among men who have sex with men, a segment of the
population disproportionately affected by HIV/AIDS.
Prophylactic antiretroviral therapy has already been proven to
significantly reduce the transmission of HIV from a mother to a
child during childbirth through breastfeeding.
--Pocket-sized device makes medical ultrasound more accessible.--NIH-
supported research at General Electric supported the
development of a low-cost, portable, high-quality ultrasonic
imager. In the last year, this advance was extended even
further with GE's production of ``Vscan.'' This pocket-sized
device makes medical ultrasound even more accessible and has
enabled wireless imaging, patient monitoring, and prenatal care
applications.
--Lung cancer screening with CT scan reduces deaths.--The National
Lung Screening Trial found that screening with low-dose
computed tomography (CT) can decrease lung-cancer deaths among
current and former heavy smokers by 20 percent. Because of
earlier identification of cancerous tumors, screening was found
to reduce mortality from lung cancer, the most common cause of
cancer deaths.
--Nicotine vaccine shows promise in preventing tobacco addiction.--
Vaccines developed to combat drug addictions work by generating
drug-specific antibodies that bind the drug while in the
bloodstream and prevent its entry into the brain. A nicotine
vaccine recently found to improve smoking quit rates is now in
phase III trials to evaluate continued abstinence at 12 months.
--Nanotechnology demonstrates advances in the realm of materials
technologies.--Carbon nanotubes have been used to deliver
chemotherapeutic agents specifically to head and neck cancer
cells, causing rapid death of the cancer cells, but leaving
non-cancerous cells unharmed.
--Certain lipid molecules that show promise in controlling pain could
result in new treatments.--Researchers have demonstrated in
animal models that certain lipids called resolvins, which shut
down inflammation, are more potent than morphine in controlling
pain. Since these resolvins are normally found in the body,
they are likely to be safe and non-addictive when used
therapeutically. Additional research is under way to explore
these compounds further and translate into new analgesics for
pain management.
--Combined treatment improves vision in patients with diabetic
macular edema.--A comparative effectiveness study for diabetic
macular edema found that combined treatment with the drug
ranibizumab and laser therapy was substantially better at
improving vision in patients with diabetes than laser therapy
alone, and better than laser therapy with a different drug
(triamcinolone).
--Scientists develop a system for making functional hair cells from
stem cells, offering possible new treatment of deafness.--In
mammals, mechanically-sensitive ``hair cells'' in the inner
ear, which are essential for both hearing and balance cannot
regenerate when they die or are damaged. NIH supported
scientists have used mouse embryonic stem cells as well as
induced pluripotent stem cells and generated hair cells that
respond to mechanical stimulation, offering a new avenue for
the treatment of deafness.
--Experimental medication lifts depression symptoms in people with
bipolar disorder.--NIH intramural researchers discovered that
ketamine, an anesthetic medication, provides rapid and
effective treatment for depressive symptoms among patients with
bipolar disorders. While ketamine's side effects make it
impractical for long-term use, this class of drugs may be
invaluable for treating severe depressive symptoms in these
patients during the weeks it usually takes for typical
antidepressants to take full effect.
Proposed National Center for Advancing Translational Sciences
National Institutes of Health
Rationale
The development of new diagnostics and therapeutics is widely
recognized as a complex, costly, and risk-laden endeavor. Only a few of
the thousands of compounds that enter the drug development pipeline
will ultimately make it into the medicine chest.
----------------------------------------------------------------
Mission
To advance the discipline of translational science and catalyze
development and testing of novel diagnostics and therapeutics across a
wide range of human diseases and conditions.
----------------------------------------------------------------
In recent years, there has been a deluge of new discoveries of
potential drug targets, yet we still lack effective therapeutics for
many conditions, especially rare and neglected diseases. A major
problem is that the drug development pipeline is full of bottlenecks
that slow the speed of development and add expense to the process. To
address these challenges, the National Institutes of Health (NIH) has
proposed establishing the National Center for Advancing Translational
Sciences (NCATS).
NCATS will study various steps in the drug development pipeline,
identify bottlenecks amenable to re-engineering, and experiment with
innovative methods to streamline the process. Promising therapeutic
projects will be used to evaluate pipeline innovations.
NCATS will complement--not compete with-- translational research
being carried out elsewhere at NIH and in the private sector. In fact,
through its mission to use the power of science to advance the entire
discipline, NCATS will benefit all stakeholders, including academia,
biotechnology firms, pharmaceutical companies, the Food and Drug
Administration, and--most importantly--patients and their families.
Functions
NCATS will aim to improve the processes in the drug development
pipeline by:
--experimenting with innovative approaches in an open-access model;
--choosing therapeutic projects to evaluate these innovative
approaches; and
--promoting interactions to advance the field of regulatory science.
NCATS also will strive to catalyze the development of new drugs and
diagnostic tests by:
--encouraging collaborations across all sectors;
--providing resources to enable therapeutic development; and
--enhancing training in relevant disciplines.
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NCATS will:
--facilitate--not duplicate--other translational research activities
supported by NIH;
--complement--not compete with--the private sector; and
--reinforce--not reduce--NIH's commitment to basic research.
----------------------------------------------------------------
Programs
NCATS will be formed by pulling together these existing NIH
programs: components of the Molecular Libraries initiative,
Therapeutics for Rare and Neglected Diseases, Office of Rare Diseases
Research, Rapid Access to Interventional Development, Clinical and
Translational Science Awards, and FDANIH Regulatory Science. In
addition, the Cures Acceleration Network will be part of NCATS if funds
are appropriated for fiscal year 2012. Relocated programs will have
their respective budgets transferred to the new center.
Background
On May 19, 2010, the NIH Director asked the NIH Scientific
Management Review Board (SMRB) to:
--identify the attributes, activities, and functional capabilities of
a translational medicine program for advancing therapeutics
development; and
--broadly assess the NIH landscape for existing programs, networks,
and centers for inclusion; and recommend their optimal
organization.
On Dec. 7, 2010, the SMRB recommended the creation of a new
translational medicine and therapeutics center. It also urged NIH to
undertake a detailed analysis, through a transparent process, to
evaluate the new center's impact on existing NIH programs.
Informed by the SMRB's recommendations, NIH initiated a planning
process to establish NCATS. The NIH Director established three panels
to guide and inform the process: the Institute and Center Directors'
(ICD) NCATS working group, the Advisory Committee to the Director (ACD)
NCATS working group, and the NIH Clinical and Translational Science
Awards (CTSA) Integration working group.
On Jan. 4, 2011, Dr. Collins charged the ICD working group with
making recommendations on the mission, functions, and organizational
design of NCATS. This panel presented its recommendations to Dr.
Collins on Feb. 17, 2011. The ACD working group, which has been asked
to provide high-level advice on how NCATS can best engage the private
sector in translational science, met for the first time on Feb. 4,
2011. This distinguished panel of outside experts will report its
findings to the ACD later this year.
The final working group, composed of leaders from across NIH, was
formed in mid-March to ensure a smooth transition of the CTSA program
into NCATS.
Next Steps
At every point along the way, NIH has sought input on NCATS from a
broad and diverse array of stakeholders. In addition, NIH will continue
to inform all stakeholders on new developments and seek their comments
through our interactive web site Feedback NIH.
Pending approval from the Health and Human Services Secretary, the
Office of Management and Budget, and the Congress, NCATS will be
included in the fiscal year 2012 budget and be formally established on
Oct. 1, 2011.
So in this brief statement today, I'd like to tell you
about four innovative areas, and I'm going to show some
pictures up on the screen in which NIH is investing in order to
carry out its mission of turning discovery into health.
First, dramatic advances in technologies, including
imaging, nanotechnology, computational biology, and, yes,
genomics, have recently made it possible for scientists to
understand the details of health and disease in breathtaking
new ways.
Consider this curve, the cost to sequence a human genome.
Look at the profound reduction over the past decade. In 2001,
it cost about $100 million to sequence a single human genome.
That cost now stands at about $10,000, and we anticipate it
will be less than $1,000 within the next few years.
That advance will give many Americans access to far more
personalized strategies for detecting, treating and preventing
disease than are now available.
Those new technologies not only reduce the cost of doing
science, but open up whole new frontiers in medicine. I'll tell
you about one of those later in a story about a 6-year-old boy
named Nic that I think you'll find quite compelling.
But, first, let's turn to the effects that this technology
has had on our understanding of cancer. Cancer is a disease of
the genome, comes about because of mutations in DNA.
Through a bold initiative, called the Cancer Genome Atlas,
or TCGA, my colleague, Harold Varmus, and others are analyzing
the DNA of tumors of hundreds of patients to identify
comprehensively the genetic mutations associated with the
specific cancers.
Brain and ovarian cancers were the first ones selected for
study through TCGA and the results have been stunning. Knowing
the molecular drivers of cancer gives us a chance to make much
more accurate diagnoses, prognoses, and predictions of response
to therapy. And in the longer run, this approach will lead to
development of a new generation of targeted therapies, those
magic bullets so dreamed of to treat this disease.
The plan for the next few years is ambitious. TCGA will
sequence, characterize, and understand the genomes of 20
different types of tumors.
New treatments are wonderful. Effective prevention can be
even better. NIH is dedicated to use the latest science to
improve America's health today by identifying effective new
strategies for disease prevention. The grave threat of diabetes
is a compelling example of how we are doing this.
This map shows the prevalence of diabetes in the United
States in 1995. As you can see from the color code, in most
States, less than 5 percent of adults were affected, but watch
what happened over just 15 years. Prevalence of diabetes has
gone up rapidly in every State, and it now stands at 9 percent
or more in many parts of the country.
The total costs of the disease, including medical care,
disability and premature death, were an estimated $174 billion
in the United States in 2007. If current trends continue, one
in three U.S. adults will have diabetes by 2020, just 9 years
from now, and the annual cost of care alone will have risen to
a breathtaking $500 billion.
But my colleague, Grif Rodgers, and I can offer some hope.
NIH spearheaded a landmark clinical trial on how to prevent
type 2 diabetes. The Diabetes Prevention Program, or DPP,
involved adults with pre-diabetes. That refers to a modest
elevation of glucose in the blood foreshadowing much worse to
come if nothing is done, but not yet frank diabetes.
The study participants were assigned personal coaches who
encouraged them to exercise about 30 minutes a day and to make
modest dietary changes resulting in an average weight loss of
just 7 percent. This simple approach lowered the chance of
full-blown diabetes by a whopping 58 percent, and that has been
sustained for more than 10 years.
Building on these results, NIH has joined with the Centers
for Disease Control and Prevention (CDC), the YMCA, Walgreens,
United Health Care and other partners to bring this program to
communities in 10 States. And we are now working with
colleagues at CMS to explore how a similar program could be
used to great advantage in Medicare and Medicaid.
Now, I'd like to turn your attention to another important
contribution of NIH research already mentioned by the chairman,
enhancing the economy and U.S. competitiveness worldwide.
NIH will be a key engine driving the U.S. economy in the
21st century. Many call this the century of biology. As
mentioned, just yesterday, a new economic impact study
published by United for Medical Research suggests that in
fiscal year 2010 NIH research funding supported an estimated
487,900 American jobs at 3,000 institutions and small
businesses across all 50 States of this Nation.
More than that, nearly 1 million U.S. citizens are employed
by the industries and companies that make up this sector of the
economy, earning $84 billion in wages and salary and exporting
$90 billion of goods and services annually. But despite this
impressive track record, our Nation today is at serious risk of
losing its position as the world's research leader.
As you can see in this slide, which shows the percent
growth of R&D expenditures on an annual basis, China and India
and other countries have been steadily increasing their R&D
expenditures by 10 percent or more per year, highlighting China
and India there. Whereas, the United States has been at a
substantially lower level. China's growth rate is now four
times greater than ours.
Let me give you a personal example of what this means. Last
fall, when I visited the BGI Genome Center in Shenzhen, China,
I saw an amazing facility built in just 3 years from an
abandoned shoe factory that is capable of sequencing more than
10,000 human genomes a year.
The capacity of that one Chinese institution now surpasses
the combined capacity of all genome sequencing centers in the
United States. This critical area of scientific innovation,
stimulated by the U.S.-led Human Genome Project, is now being
developed more aggressively in China than it is here, a
sobering story indeed, and one that I hope would inspire our
Nation to redouble its efforts on the research front.
A final area I wish to highlight in which our Nation faces
exceptional challenges, as well as exceptional opportunities,
is this field of translational science which Senator Shelby has
specifically highlighted in his opening statement. As a result
of years of steadfast support of NIH research by Congress and
the American people, we find ourselves in a paradoxical
situation.
This graph shows we've seen a deluge of discoveries about
the molecular basis of disease, both rare and common, which
provide us with the power to identify more therapeutic targets
than ever before; more than 4,000 diseases now having their
molecular basis discovered, much of that in the last decade.
But there's a serious problem. The process of taking those
basic discoveries to the point of clinical advances, as here
demonstrated by a diagram showing you what happens in the
development of new therapeutics, is far too slow--14 years on
the average--and the failure rate is far too high--more than 98
percent. We clearly need a new approach to therapeutic
development and a new partnership with the private sector.
So to meet this need, NIH is proposing the establishment of
a new national center for advancing translational sciences or
NCATS. NCATS will allow us to study the various steps in the
development of diagnostics, devices and therapeutics, identify
bottlenecks that might be reengineered and experiment with
innovative methods to streamline this process.
Through this new center, we can work in an open-access
model that will allow stakeholders, including industry and
academia, to access and apply the innovations that are
developed. NCATS will also advance the field of regulatory
science by promoting interactions among the NIH, FDA, patient
advocates, and pharmaceutical and biotechnology companies.
Importantly, NCATS will complement, not compete with, the
private sector. This is not Bethesda Pharm. It will facilitate
translational research being carried out elsewhere at the NIH,
extensive translational work already going on by many of the 27
Institutes, including those represented at this table. And it
will reinforce, not reduce, NIH's commitment to basic science,
a foundational part of our mission.
Most importantly, though, by advancing discipline of
translational sciences, NCATS will benefit patients and their
families.
So, Mr. Chairman, members of the subcommittee, I've spoken
today about the great promise of new technologies, how we're
applying science to prevention, NIH's role in maintaining U.S.
economy--world leadership, and the unique opportunity to pursue
a new paradigm in translation.
Let me close by sharing the story of one little boy to show
you what NIH research advances now allow us to do. So meet Nic
Volker, a brave boy from Monona, Wisconsin.
Starting about the age of two, Nic developed a mysterious
life-threatening disease that ravaged his body, making it
impossible for him to eat normally and causing unimaginable
pain and suffering.
At a loss to explain Nic's terrible affliction, researchers
at the Medical College of Wisconsin decided to sequence Nic's
DNA instruction book hoping to find an answer. After exacting
work over several months, the researchers identified a
misspelling of just one single letter in a little-studied gene
called XIAP. Now, glitches in this gene had been associated
with rare blood disorders, but not with intestinal symptoms.
Based on this new insight, the research team had an idea that,
as with the rare blood disorders, Nic's disease might be
curable with a bone-marrow transplant.
Transplantation of cord blood cells from--stem cells from a
matched donor occurred in July of last year. Although Nic is
still receiving some immunosuppressant drugs to prevent
rejection of the donated cells, his symptoms have largely
disappeared, and, today, as you can see here, he can eat
normally and vigorously.
What's more, he's now attending kindergarten, enjoying
outings with his family and friends, signing up for a T-Ball
team, and, this past Sunday, presenting his mother with a
flower for Mother's Day. Nic has given us all a glimpse of the
future.
PREPARED STATEMENTS
Thank you, Mr. Chairman. This concludes my formal remarks.
[The statements follow:]
Prepared Statement of Francis S. Collins, M.D., Ph.D.
introduction
Good morning, Mr. Chairman and distinguished Members of the
Subcommittee. I am Francis S. Collins, M.D., Ph.D. and I am Director of
the National Institutes of Health (NIH).
It is a great honor to appear before you today to present the
administration's program level request of $31.987 billion for NIH in
fiscal year 2012, and to discuss the contributions that NIH-funded
biomedical research has made in improving human health. NIH is the
largest supporter of biomedical research in the world, providing funds
for more than 40,000 competitive research grants and more than 325,000
research personnel at more than 3,000 research institutions and small
businesses across our Nation's 50 States. I also want to offer a vision
of how NIH will catalyze innovation in basic and translational
sciences, and will ensure future U.S. economic strength and global
competitiveness.
On behalf of NIH and the biomedical research enterprise, I want to
thank you as Members of the Senate for sparing NIH from deeper cuts in
the final fiscal year 2011 continuing resolution (CR). We know that,
even as Congress and the administration wrestled with cuts of more than
3 percent to the Labor-HHS portion of the CR, NIH received a 1 percent,
or $321.7 million, cut from the fiscal year 2010 level, while other
programs and functions were cut more deeply.
NIH's mission is to seek fundamental knowledge about the nature and
behavior of living systems and to apply that knowledge to enhance human
health, lengthen life, and reduce the burdens of illness and
disability. I can report to you that NIH continues to believe
passionately in that mission and works tirelessly to achieve it.
Due in large measure to NIH research, our Nation has gained about 1
year of longevity every 6 years since 1990. A child born today can look
forward to an average lifespan of nearly 78 years--nearly three decades
longer than a baby born in 1900. And not only are people living longer,
but their quality of life is improving: in the last 25 years, the
proportion of older people with chronic disabilities has dropped by
almost one-third.
NIH research has enabled new techniques to prevent heart attacks,
newer and more effective drugs for lowering cholesterol and controlling
blood pressure, and innovative strategies for dissolving blood clots
and preventing strokes. As a result, the U.S. death rate for coronary
disease is 60 percent lower--and for stroke, more than 70 percent
lower--than three generations ago. Better treatment of acute heart
disease, better medications, and improved health-related behaviors--all
underpinned by NIH research--account for as much as two-thirds of these
reductions.
In recent years, largely as a result of NIH research, we have
succeeded in driving down mortality rates for cancer in the United
States. This progress comes despite the fact that cancer is largely a
disease of aging and our population is growing older. Over the 15-year
period from 1992 to 2007, cancer death rates dropped 13.5 percent for
women and 21.2 percent for men. According to an American Cancer Society
report released in July 2010, the continued drop in overall mortality
rates over the last 20 years has saved more than three-quarters of a
million lives.\1\ And in cancers that strike children we have made
near-miraculous progress--the 5-year survival rate for children with
the most common childhood cancer, acute lymphocytic leukemia, is now 90
percent.\2\
---------------------------------------------------------------------------
\1\ http://pressroom.cancer.org/index.php?s=43&item=252.
\2\ http://seer.cancer.gov/csr/1975_2008/
browse_csr.php?section=28&page=sect_28_table.08.html.
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I would also like to offer a shining example of the Senate's strong
and consistent support of biomedical research at NIH by note that we
are celebrating a significant anniversary. This year marks the 10th
anniversary of the establishment of the Dale and Betty Bumpers Vaccine
Research Center (VRC) at NIH. Groundbreaking research performed at the
VRC is making great progress toward developing a universal flu vaccine
that confers longer-term protection against seasonal and pandemic
influenza strains.
Today, scientists have to make an educated guess about the make-up
of the coming winter's influenza viruses. These educated guesses become
the basis for the manufacture of each year's flu shot and mean that
everyone has to be re-immunized in anticipation of next year's strain
of flu. Recently, NIH scientists have identified pieces of influenza
viral proteins that consistently appear among seasonal and pandemic flu
strains. These findings raise the possibility that we might soon
develop an influenza vaccine that provides near-universal protection
against a broad range of current and future strains of influenza,\3\ as
well as make yearly flu shots a thing of the past. Most of this
exciting work was performed at the VRC. Scientists at that same center
are making important strides toward the development of the long-hoped-
for vaccine against the human immunodeficiency virus (HIV), the cause
of acquired immune deficiency syndrome (AIDS). While after so many
frustrations, no one would want to predict success just yet, recent
discoveries of VRC scientists about how to encourage production of
neutralizing antibodies against HIV have provided renewed hope that
this pressing problem may ultimately be solved.
---------------------------------------------------------------------------
\3\ http://www.niaid.nih.gov/news/newsreleases/2010/Pages/
UniversalFluVax.aspx.
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nih and economic growth
Mr. Chairman and Members of the Subcommittee, I recognize that,
given our Nation's fiscal situation, and the extraordinarily tough
decisions that you will have to make about our Nation's finances, you
need to be assured that NIH remains a worthwhile national investment.
Even as you make these decisions and even as our country recovers from
financial recession, I want to offer evidence that NIH and its research
provide two strong and ongoing benefits to our economy.
First, NIH research spending has an impact on job creation and
economic growth. A new economic impact study by United for Medical
Research suggests that in fiscal year 2010, NIH research funding
supported an estimated 487,900 American jobs, including researchers and
spin-off employment.
Second, NIH research funding has a longer term impact in its role
as the foundation for the medical innovation sector. Nearly 1 million
U.S. citizens are employed by the industries and companies that make up
this sector of the economy, earning $84 billion in wages and salary in
2008, and exporting $90 billion of goods and services in 2010. NIH
support for biomedical research institutions catalyzes business
activity in other ways as well. Such institutions constitute reservoirs
of skilled, knowledgeable individuals and, thereby, attract companies
that wish to locate their operations within such ``knowledge hubs.''
For example, in the 1990s, Federal funding through research grants
and the Small Business Innovation Research (SBIR) and the Small
Business Technology Transfer (STTR) programs transformed the academic
research environment and helped to launch new industrial sectors in
Silicon Valley and elsewhere that are flourishing today. Federal
funding has been crucial in stimulating the formation of start-up
companies and collaborations among academia and the private sector in
the development of innovative technology. A prime example is the
company Affymetrix.
In the late 1980s, a team of scientists led by Stephen P.A. Fodor,
Ph.D., developed methods for fabricating DNA microarrays, called
GeneChips, using semiconductor manufacturing techniques, melded with
advances in combinatorial chemistry to capture vast amount of
biological data on a small glass chip. In 1992, the first of several
NIH grants was awarded to Affymetrix; with this and an SBIR grant from
the Department of Energy, Dr. Fodor was able to demonstrate proof of
principle of using large arrays of DNA probes in genetic analysis.
Affymetrix and similar companies are building the machine tools of the
genomic revolution. In 2009, Affymetrix had annual revenue of $327
million and employed more than 1,100 people.
Furthermore, NIH research leads to better health outcomes that not
only ease human suffering, but also produce an economic return. A 2006
study by Kevin Murphy and Robert Topel of the University of Chicago
shows that a permanent reduction of 1 percent in cancer deaths has a
present value to current and future generations of Americans of nearly
$500 billion. The article states that if we were able to defeat cancer
completely, such cures would be worth approximately $50 trillion--more
than three times today's Gross Domestic Product.\4\
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\4\ Murphy, K.M., & Topel, R.H. (2006), The value of health and
longevity. Journal of Political Economy, 114(5), 871-904.
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We face a similar economic threat from diabetes. If current trends
continue, by 2050 as many as one in three U.S. adults will be diagnosed
with diabetes.\5\ Total costs of diabetes, including medical care,
disability, and premature death, reached an estimated $174 billion in
the United States in 2007.\6\ According to analysis from the
UnitedHealth Center for Health Reform & Modernization, more than 50
percent of Americans could have diabetes or pre-diabetes by 2020.\7\
Furthermore, the center's analysis predicts diabetes and pre-diabetes
will account for an estimated 10 percent of total healthcare spending
by the end of this decade, at an annual cost of almost $500 billion.
---------------------------------------------------------------------------
\5\ http://www.cdc.gov/media/pressrel/2010/r101022.html.
\6\ CDC National Diabetes Fact Sheet. http://www.cdc.gov/diabetes/
pubs/pdf/ndfs_2011.pdf.
\7\ http://www.unitedhealthgroup.com/hrm/UNH_WorkingPaper5.pdf.
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But I can offer some hope. NIH spearheaded a landmark clinical
trial on type 2 diabetes prevention that showed that people at high-
risk for diabetes can dramatically reduce their risk of developing type
2 diabetes through modest exercise and dietary changes that achieve
modest weight loss. Called the Diabetes Prevention Program (DPP), the
clinical trial included 3,234 adults at high risk for developing type 2
diabetes, including those with a family history of diabetes, as well as
other risk factors. One-third of these individuals participated in a
lifestyle program that included exercise training and dietary change
implemented under the guidance of lifestyle coaches. The DPP research
team found that this approach lowered risk of diabetes by 58
percent.\8\ The DPP trial also demonstrated that the cost of the
lifestyle intervention was $3,540 per participant over 3 years, which
was significantly offset by the lowering of other healthcare costs as
lifestyle participants became healthier.\9\ The cost effectiveness of
the DPP has continued to be followed and 10-year results will be
published in the near future. Building on these critically important
results, NIH partnered with the Centers for Disease Control and
Prevention (CDC) and more than 200 private partners, including the
YMCA, Walgreens, and UnitedHealthcare, to bring these evidence-based
lifestyle interventions to communities in Ohio, Indiana, Minnesota,
Arizona, Oklahoma, New Mexico, New York, New Jersey, Connecticut, and
Georgia. In addition, the DPP Lifestyle Intervention is being used by
the Indian Health Service in a large demonstration project on many
American Indian reservations.
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\8\ Knowler WC, et al. Reduction in the incidence of type 2
diabetes with lifestyle intervention or metiformin. N. Engl J Med
346:393-403, 2002.
\9\ Diabetes Care. 2003 Jan;26(1):36-47.
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investing in basic science
At NIH, we have always put our greatest percentage of our resources
into basic research. This is because the fundamental observations made
today become the building blocks of tomorrow's knowledge, therapies,
and cures. NIH's history has repeatedly demonstrated that significant
scientific advances occur when new basic research findings, often
completely unexpected, open up new experimental possibilities and
therapeutic pathways. Historically, NIH has put more than 50 percent of
its budget into basic research and the research discoveries that led to
the 132 Nobel prizes won by our intramural and university scientists
are evidence of the wisdom of this investment.
Basic research is precisely the type of work that the private
sector, which must see a rapid return on invested capital, cannot
afford to support. NIH provides the fundamental observations that
pharmaceutical and biotechnology companies can turn into diagnostics,
therapies, and devices that eventually reach patients. As the
Congressional Budget Office put it, ``Federal funding of basic research
directly stimulates the drug industry's spending . . . by making
scientific discoveries that expand the industry's opportunities for
research and development.'' \10\
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\10\ Congressional Budget Office, Research and Development in the
Pharmaceutical Industry, October, 2006, p. 3.
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Because we simply cannot predict the next scientific revelation or
anticipate the next opportunity, our basic research portfolio must be
diverse. We set scientific priorities by considering a wide array of
biomedical questions that we might try to answer. It is rather like
facing a series of doors, some of which lead to vast treasures and
others to much more modest payouts, without any sure way of knowing
what lies behind any particular door. To improve our odds of striking
scientific gold, we need a broad basic research portfolio that enables
our Nation to open as many doors as our resources allow.
Not all disease or scientific problems are equally ripe for new
advances, nor do such advances come at the same rate across the
portfolio, no matter how pressing today's public health challenges are.
We can only be sure that without a strong commitment to basic research
today, the new knowledge of tomorrow will remain hidden behind those
unopened doors and future therapies and cures will remain out of our
reach.
Let me offer a few of the exciting insights that NIH's support of
basic research have provided. On April 3, 2011, the online issue of
Nature Genetics presented the findings by a team of NIH-supported
scientists who had identified five new genetic variants that are risk
factors for late-onset Alzheimer's disease, which is the most common
form of the disorder. These findings doubled from 5 to 10 the number of
gene variants that we know are associated with Alzheimer's disease.\11\
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\11\ Naj, A.C. et al. Common Variants of MS4A4/MSA6E, CD2AP, CD33
and EPHA 1 are associated with late-onset Alzheimer's Disease. Nature
Genetics, EPUB April 3, 2011, and Holligworth, P., et al. Common
variants at ABCA7, MS4A/MS4A4E, EPHA 1, CD33 and CD2Ap are associated
with Alzheimer's disease. Nature Genetics. Epub April 3, 2011.S
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What is even more compelling is that these newly identified genes
strongly implicate inflammation and high cholesterol as risk factors in
the development of Alzheimer's disease. Although each of these newly
identified genes increases a given individual's risk of developing the
disease by no more than 10 to 15 percent, the unanticipated insight
that cholesterol and inflammation are contributing factors opens up new
research avenues to understand the disease process, and increases the
likelihood that we can glimpse potential preventions or therapies.
NIH's commitment to basic research has also provided us with one of
the most promising therapeutic strategies we have seen to date for the
deadliest form of skin cancer, melanoma. Since 2002, we have known that
many melanoma tumors exhibit a mutation in the BRAF gene and that this
mutation might provide a target for therapeutic intervention. A team
that included NIH-supported investigators used high-throughput
screening in combination with structural biology, to identify compounds
that inhibit the activity of the mutant form of the BRAF gene found in
most melanomas, but have little effect on the BRAF gene found in normal
cells. This basic cancer research supported by NIH contributed to the
development of the drug PLX4032, a drug designed to inhibit the
activity of a mutant form of the protein called BRAF. This is a
powerful example of how support for basic research can be translated
into therapeutic potential. In August 2010, Plexxikon, a small drug
development company, announced that PLX4032, had elicited a positive
response in more than 80 percent of melanoma patients in early phase
clinical trials. PLX4032 caused the tumors in 24 of the 30 trial
participants to shrink by at least 30 percent, while the tumors of two
patients disappeared. Another clinical trial involving hundreds of
participants across many institutions demonstrated that metastatic
melanoma patients treated with PLX4032 lived 6 to 8 months longer than
those who had been given the chemotherapy drug dacarbazine, which is
the current standard of care.
Whether it is with the hope of finding new ways to treat cancer,
prevent Alzheimer's disease, or help people suffering from countless
other rare and common conditions, we at NIH invest in basic research
because of our conviction that it will benefit our Nation in the long
term.
advancing translational science
NIH also has a longstanding commitment to translating fundamental
knowledge into cures and therapies for human disease. It should not be
surprising that NIH-supported science underpins many of the most
transformative drugs and therapies that have benefited millions of
Americans and people around the world, including statins to lower
cholesterol and drugs to treat depression. In 2010, we conducted a
trans-NIH inventory of therapeutics development activities and found
more than 550 such projects, of which approximately 65 percent were
pre-clinical and 35 percent were clinical research.
An analysis published in the February 10, 2011 issue of the New
England Journal of Medicine (NEJM) underscores the depth and breadth of
NIH's support for translational science that benefits patients.\12\ The
article's authors describe a new emphasis on ``public sector research''
that is almost exclusively supported or conducted by NIH, noting ``the
boundaries between the roles of the public and private sectors have
shifted substantially since the dawn of the biotechnology era, and the
public sector now has a much more direct role in the applied-research
phase of drug discovery.''
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\12\ Stevens, Ashley J. et al. The role of public-sector research
in the discovery of drugs and vaccines. New England Journal of
Medicine, 364,:6, February 10, 2011.
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Drugs that represent a major advance in treatment or offer
treatments for diseases for which no adequate therapy currently exists
are granted ``priority review'' by FDA. According to the NEJM article,
between 1990 and 2007, 20 percent of the FDA approvals of novel
compounds granted priority review were given to drugs discovered by
NIH. Examples include AZT for HIV/AIDS and the targeted leukemia
therapy Gleevec. Over the past 40 years, 153 new FDA-approved drugs,
vaccines, or new indications for existing drugs were discovered through
work carried out by NIH-supported biomedical research institutions.
Despite NIH's historic and growing commitment to translational
sciences, far more remains to be done. Millions of people still suffer
from diseases, such as cancers and diabetes, for which we have no
adequate treatments. There are nearly 7,000 rare diseases, yet we have
therapies for fewer than 200 of them. This staggering public health
need and attendant human suffering continues even as the pharmaceutical
industry, beset by economic stress, is investing less in research and
development, and the pool of venture capital needed by the biotech
industry is drying up.
At the same time, a deluge of discoveries about the molecular basis
of disease has been made possible by the sequencing of the human and
many other genomes, as well as breathtaking advances in research
technologies, such as high-throughput screening and bioinformatics.
These discoveries reveal hundreds of tantalizing potential therapeutic
targets. As the result of years of steadfast support of NIH research by
Congress and the American people, we find ourselves in a paradoxical
situation: we can uncover the molecular basis of common and rare
diseases better than ever before and we can more readily identify
therapeutic opportunities than at any point in history, but the
pipeline through which these new therapeutic agents must pass is
crimped and, in some places completely blocked.
Consequently, a new approach to therapeutic development, and a new
partnership with the private sector, is needed. That is why we have
proposed the establishment of NIH's new National Center for Advancing
Translational Sciences beginning in fiscal year 2012.
national center for advancing translational sciences
As previously noted, NIH has a long and rich history of significant
contributions to therapeutic development. In particular, the National
Cancer Institute (NCI) and the National Institute for Allergy and
Infectious Diseases (NIAID) have made major contributions over many
years to the discovery of new treatments. However, now is the time to
consider the therapeutic development process itself as a scientific
problem that is ripe for innovation. The mission of the National Center
for Advancing Translational Sciences (NCATS) will be to advance the
discipline of translational science and catalyze the development and
testing of novel diagnostics and therapeutics across a wide range of
human diseases and conditions. NIH has no intention of entering the
drug development arena that is rightly the province of private sector
companies. Indeed, given that it costs in the range of $ 1.3 billion to
$1.8 billion to bring one drug to market, it is clear that it would be
impossible for NIH to compete with private industry.\13\ What NCATS
intends to do is advance the science of therapeutic development and
determine if there are ways we can re-engineer the drug development
pipeline; creating new approaches and methods that will benefit
everyone interested in speeding the delivery of new medicines.
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\13\ DiMasi, JA, Hansen RW, Grabowski HG. Extraordinary claims
require extraordinary evidence. Journal of Health Economics
2005;24(5):1034-1044. Tonkens, R. An Overview of the Drug Development
Process. The Physician Executive May-June 2005.
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Today, the development of new diagnostics and therapeutics is a
complex, costly, and risky endeavor. Only a few of the thousands of
compounds that enter the drug development pipeline will ultimately make
it into the medicine chest or to the patient's bedside. NCATS will
study the various steps in the drug development pipeline, consult with
the private sector to identify bottlenecks amenable to re-engineering,
and experiment with innovative methods to streamline the process.
To offer one example of the kind of pipeline challenge we might
address, new ideas about assessing the toxic potential of drug
candidates using sophisticated cell-based methods, instead of animal
toxicology testing, hold out the promise of revolutionizing this step
in validating a new therapeutic agent--and such research can be
catalyzed by NIH in ways that might otherwise not be possible.
NCATS will attack the bottlenecks in the drug development pipeline
by experimenting with innovative approaches in an open-access model so
that all stakeholders, ranging from industry to patients, will be able
to access and apply its innovations. NCATS's open access operating
framework will also advance the field of regulatory science by
promoting interactions among the Food and Drug Administration (FDA),
NIH, patient advocates, and pharmaceutical and biotechnology companies.
NCATS will encourage collaboration across all sectors, provide
resources to enable therapeutic development, and support and enhance
training in the relevant translational science disciplines.
NCATS will complement--not compete with--translational research
being carried out elsewhere at NIH and in the private sector. In fact,
in pursuing its mission of using the power of science to advance the
entire discipline of translational science, NCATS will benefit all
stakeholders, including academia, biotechnology firms, pharmaceutical
companies, the FDA, and--most importantly--patients and their families.
NCATS will pull together existing NIH programs such as the
Therapeutics for Rare and Neglected Diseases program, the Office of
Rare Diseases Research, the Rapid Access to Interventional Development
program, the Clinical and Translational Science Awards, the FDA-NIH
Regulatory Science grants program, and components of the Molecular
Libraries initiative. These relocated programs will have their
respective budgets transferred to or implemented by the new center. In
addition, we are hopeful that funding for the new Cures Acceleration
Network will be provided within the NCATS appropriation in fiscal year
2012. The intent of this innovative program and its exceptional DARPA-
like flexibilities for supporting projects are a natural fit with
NCATS.
Aside from the new funding requested in fiscal year 2012 for the
Cures Acceleration Network, resources for NCATS will come from the
combination of already existing and appropriated programs and so be
budget neutral.
NCATS will bring the scientific method to bear on today's drug
development process and aim to improve and speed the therapeutic
development process of tomorrow.
conclusion
This statement has provided you with a brief overview of NIH's past
successes and future commitment to basic and translational sciences,
along with a quick look at the important role that NIH plays in our
domestic economy and U.S. global economic and scientific leadership.
But I would like to close my testimony today with an example that
demonstrates the benefits to be reaped from our continuing pursuit of
``personalized medicine.'' It is the story of one individual, 6-year-
old Nic Volker of Monona, Wisconsin. Starting about the age of 2, Nic
developed a mysterious, life-threatening disease that ravaged his
intestines, making it impossible for him to eat normally and causing
unimaginable pain and suffering. At a loss to explain this terrible,
inflammatory condition, researchers and clinicians at the Medical
College of Wisconsin decided to sequence Nic's entire exome, that is,
all the parts of the genome that code for the proteins that become
life's building blocks. After exhaustive work over a period of months,
the researchers identified a mutation in Nic's XIAP gene. Such
mutations had been associated with rare blood disorders, but not with
bowel symptoms. Based on this new insight, the research team had an
idea that, as with the rare blood disorders, Nic's disease might be
curable with a bone marrow transplant.
NIH investment over the years in the sequencing of genomes--and the
technologies associated with such sequencing--has put us at the
threshold of ``personalized medicine.'' Young Nic Volker is one of a
handful of individuals who has crossed that threshold, and it was made
possible because of years of research and development supported and
performed by NIH.
Transplantation of cord-blood stem cells from a matched donor
occurred in July of last year and, although Nic is still on
immunosuppressant drugs to prevent rejection of the donated cells, his
symptoms have largely disappeared and today he can eat normally. Hot
dogs are his favorite!
The local newspaper, the Milwaukee Journal Sentinel, was so struck
by the saga of Nic and his family that they devoted a series of
articles to the little boy's struggles and therapy, coverage that
included posting photos, videos, blogs, and many other resources to the
web. The five Journal Sentinel journalists did such a good job that
they were awarded the Pulitzer Prize for Explanatory Reporting on April
18. Now, that is truly putting a face on the promise of today's
biomedical research, tomorrow's personalized medicine, and NIH's role
in making this promise possible.
Thank you Mr. Chairman. This concludes my formal remarks.
______
Prepared Statement of Harold Varmus, M.D.
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National Cancer
Institute (NCI) of the National Institutes of Health (NIH). The fiscal
year 2012 request includes $5,196,136,000 for NCI, which reflects an
increase of $141,899,000 over the comparable fiscal year 2011 level of
$5,054,237,000.
We now know that cancer is a collection of diseases reflecting
changes in a cell's genetic makeup and thus its programmed behavior.
Sometimes the genetic changes occur spontaneously or are inherited;
sometimes they are caused by environmental triggers, such as chemicals
in tobacco smoke, ultraviolet radiation from sunlight, or viruses.
While cancers constitute an incredibly diverse and bewilderingly
complex set of diseases, we have at hand the methods to identify
essentially all of the genetic changes in a cell and to use that
knowledge to rework the landscape of cancer research and cancer care,
from basic science to prevention, diagnosis, and treatment. The funds
in the President's budget for NCI represent a bold investment strategy
critical for realizing that goal.
The emerging scientific landscape offers the promise of significant
advances for current and future cancer patients, and for preventing
cancer so that many never become cancer patients. And it offers
scientists at the National Cancer Institute--and in the thousands of
laboratories across the United States that receive NCI support--the
opportunity to increase the pace of lifesaving discoveries
dramatically.
In the past year alone, we have seen powerful examples of how
research dollars have translated into concrete advances against cancer
through basic science, prevention and early detection, and treatment.
Basic science.--In collaboration with NHGRI, the NCI is leading The
Cancer Genome Atlas (TCGA), the largest and most comprehensive analysis
of the molecular basis of cancer ever undertaken. TCGA aims to identify
and catalog all of the relevant genetic alterations in many types of
cancer. For instance, building on their recent reclassification of
glioblastoma multiforme (GBM), an aggressive form of brain cancer, this
year TCGA investigators discovered that about 10 percent of patients
with one of the four subtypes of GBM are younger at diagnosis and live
longer than patients with other subtypes of the disease, but their
tumors are unresponsive to current intensive therapies. The molecular
profile of this subtype offers new targets for developing drugs to
treat this form of the disease more effectively. TCGA scientists are
also preparing to publish similarly important findings about the major
form of ovarian cancer in mid-2011 and are in the midst of analyzing
nearly 20 other types of cancer.
Prevention and early detection.--NCI's intensive efforts to study
and reduce the use of tobacco products have contributed to a sustained
annual reduction in age-adjusted cancer mortality rates over the past
decade and more. But current and former heavy smokers remain at high
risk of developing lethal lung cancers, which are the leading cause of
cancer mortality. In late 2010, NCI announced initial results from the
National Lung Screening Trial, a large, multi-year randomized trial
that enrolled more than 53,000 subjects. Because early detection
provides the potential to intervene at the earliest, most treatable
stages of disease, thus reducing potentially difficult to treat
outcomes seen in more advanced disease, current and former smokers who
were screened with low-dose helical computed tomography were 20 percent
less likely to die of lung cancer than were peers who received standard
chest x-rays. These results provide the first clear demonstration that
a screening procedure can be effective in reducing mortality from lung
cancer--a finding that could save many lives among those at greatest
risk. Over the course of the $240 million study, NLST investigators
collected samples of early and advanced lung cancers from enrolled
subjects, and these specimens will be invaluable for determining
genetic alterations that may be used to predict which tumors are likely
to progress to an advanced stage.
Cancer treatment.--The potential therapeutic impact of basic
discoveries made by TCGA and other efforts in cancer genomics has been
dramatically illustrated this year by the development of effective
drugs against the most deadly form of skin cancer, melanoma. Almost a
decade ago, studies of cancer genomes first uncovered a common mutation
in a gene that encodes an enzyme called BRAF. Last year, early stage
clinical trials at NCI-designated Cancer Centers of drugs targeted
against the mutant BRAF enzyme showed that most melanomas with the
relevant mutation regressed dramatically. Although tumor regression
generally lasted less than a year, NCI-supported investigators have
already pinpointed some causes of resistance to BRAF inhibitors,
outlining a pathway to more sustained control of this lethal disease.
Another benefit of a prolonged and broad-based investment in cancer
research has also been realized in the context of malignant melanoma
this year, with the recent approval by the FDA of an antibody,
ipilimumab, which extends the lives of patients with metastatic
melanoma. Ipilimumab stimulates the immune system to act against cancer
by blocking natural inhibitors of the immune response, an approach that
would not be possible without a profound understanding of the immune
system and one that promises to harness immunological tools against
other cancers.
These examples of NCI's progress in understanding, treating, and
detecting different forms of cancer illustrate what can be achieved at
an accelerated pace with sustained investments across the cancer
research spectrum, such as proposed under the President's budget. While
those perspectives are only beginning to inform the American public's
perception about cancer and its treatment, the downward trajectory of
cancer deaths--reported by NCI and its partners in March--reflects real
and sustained reductions over more than a decade for numerous cancers,
including the four most common: breast, colorectal, lung, and prostate.
We have identified proteins and pathways that different cancers may
have in common and represent targets for new drugs for these and many
other cancers--since so often research in one cancer creates potential
benefits across others.
Additional progress against cancer also will require building these
research advances into clinical treatments and diagnostic tools for
better patient care and by our many connections with public and private
sector partners. The Institute's investments in translational research
are broad and deep, and will receive NCI's full energies, recognizing
that the publicly announced proposal for reorganizing services that
support translational science in general could give NIH additional
focus in this important area.
revitalizing the cancer clinical trials system
For today's new understandings of cancer biology to benefit cancer
patients on a broad scale, they must be coupled with a modernized
system for conducting cancer clinical trials. This system must enable
clinical researchers across the Nation to acquire tumor specimens and
conduct genetic tests on each patient, to efficiently analyze molecular
changes in those samples, to manage and secure vast quantities of
genetic and clinical data, and to identify subsets of patients with
tumors that demonstrate changes in specific molecular pathways--
pathways that can be targeted by a new generation of cancer therapies.
As part of its effort to transform the cancer clinical trials
system, NCI asked the Institute of Medicine (IOM) in 2009 to review the
Clinical Trials Cooperative Group Program. This program involves a
national network of 14,000 investigators currently organized into nine
U.S. adult Cooperative Groups and one pediatric cooperative group that
conduct large-scale cancer clinical trials at 3,100 sites across the
United States. The IOM report, issued in April 2010, noted that the
current trials system--established a half-century ago--is inefficient,
cumbersome, underfunded, and overly complex. Among a series of
recommendations, the report urged that the existing adult cooperative
groups be consolidated into a smaller number of groups, each with
greater individual capabilities and with new means to function with the
others in a more integrated manner.
In December 2010, NCI announced its intent to begin consolidating
the current nine adult cooperative groups into four state-of-the-art
entities that will design and perform improved trials of cancer
treatments, as well as explore methods of cancer prevention and early
detection, enhance the ability of the cooperative groups to assess the
molecular characteristics of individual patients' tumors, and study
quality-of-life issues and rehabilitation during and after treatment.
The sole pediatric cooperative group was created by consolidating four
pediatric cooperative groups almost a decade ago, and that group will
not be affected by the current consolidation effort.
provocative questions
This has been a challenging and hopeful time for NCI to lead the
Nation's cancer research program. Over the past two decades researchers
have unraveled some of the damage that occurs in the genome of a cancer
cell and how a cancer cell behaves in its local environment as a result
of those changes. With this better understanding of cancer and recent
technological advances in many fields, such as genomics, molecular
biology, biochemistry, and computational sciences, progress has been
made on many fronts, and a portrait has emerged for several cancers.
With sustained and accelerated funding, and NCI's strong leadership in
defining cancer research priorities, we can build upon today's cancer
advances with provocative thinking by asking better questions.
To that end, NCI is asking researchers in various disciplines to
pose and articulate ``provocative questions'' that can help guide the
Nation's investment in cancer. Provocative questions may be built on
older, neglected observations that have never been adequately explored,
or on recent findings that are perplexing, or on problems that were
traditionally thought to be intractable but now might be vulnerable to
attack with new methods.
Many of these provocative questions are being asked--and answered--
by young scientists who are early in their careers. The 2012 budget
will support NCI's commitment to ensuring that an equitable share of
our research grants will go to the young men and women, who are at the
forefront of understanding cancer.
We are now reaping the rewards of investments in cancer research
made over the past 40 years or more, even as we stake out an investment
strategy to realize the potential we see so clearly for the future. The
public has benefitted from past generous congressional stewardship of
biomedical research funding; cancer research over the past four decades
has provided the evidence required to lower the incidence and mortality
of many kinds of cancer, to improve the care of cancer patients, and to
establish the new understanding of cancer that is now beginning to
revolutionize control of cancer throughout the world.
No matter what the fiscal climate, NCI will strive to commit the
resources necessary to bring about a new era of cancer research,
diagnosis, prevention, treatment, and survivorship.
Thank you for the opportunity to provide you this testimony, and I
would be pleased to answer any questions you might have.
______
Prepared Statement of Susan B. Shurin, M.D.
Mr. Chairman and Members of the Committee: I am pleased to present
the President's budget request for the National Heart, Lung, and Blood
Institute (NHLBI) of the National Institutes of Health (NIH). The
fiscal year 2012 budget of $3,147,992,000 includes an increase of
$80,903,000 over the comparable fiscal year 2011 level of
$3,067,089,000.
The NHLBI provides global leadership for a research and education
program to promote prevention and treatment of heart, lung, and blood
diseases. Our vision is to enhance the health of all individuals and
thereby enable them to enjoy longer and more productive lives. The
Institute advances its objectives through an innovative program of
excellent science that addresses urgent public health needs,
capitalizes upon extraordinary opportunities, leverages strategic
assets, balances and integrates basic and clinical research approaches,
and calls upon the creativity, expertise, and dedication of thousands
of scientists here and abroad. The American people have generously
supported this work for many years, and tremendous progress has
resulted.
This testimony highlights three areas of particular current
emphasis: (1) genetics and genomics; (2) regenerative medicine; and (3)
translational medicine.
genetics and genomics
NHLBI-funded gene-sequencing projects and genome-wide association
studies have been extraordinarily productive. Scanning the genomes of
more than 100,000 people from all over the world, scientists recently
reported the largest set of genes yet discovered that underlie blood
lipid variations known to be major risk factors for coronary heart
disease. Altogether, the gene variants explain between one-quarter and
one-third of the inherited portions of cholesterol and triglyceride
measured in the blood. Of the variants, 59 had not been previously
identified and thus provide new clues for developing effective
medicines to combat heart disease. This exciting discovery follows upon
similar research, reported in 2009, regarding another heart disease
risk factor--hypertension. Using genomic analysis of over 29,000
participants from the Framingham Heart Study and other cohorts, an
international research team identified a number of unsuspected genetic
variants associated with systolic and diastolic blood pressure.
Although hypertension has long been known to run in families and have a
substantial genetic component, previous attempts to identify genes
associated with blood pressure had met with only limited success. The
new findings from both the lipid and the blood pressure studies
illustrate the potential of large-scale genome-wide scans to identify
genes that play roles in a complex disease of widespread public health
importance.
Smaller-scale genome-wide scans are also providing valuable new
information about less common disorders, such as thoracic aortic
aneurysm and dissection--a condition that is often asymptomatic until
an unpredictable catastrophic cardiovascular event occurs. Researchers
comparing 418 patients with non-familial thoracic aneurysms to normal
controls identified a number of genetic variants that appeared more
frequently in the patients. Many of the variants exist in genes that
are in some manner involved in contraction of smooth-muscle cells,
suggesting that genetic variants governing smooth-muscle cell function
are a potential target of predictive tests that could be developed in
the future.
Although genome-wide scans and sequencing have identified many
genetic variations that contribute to disease risk, much more research
is needed to understand the mechanisms underlying gene disease
associations. NHLBI is advancing this area by supporting a new program,
Next Generation Genetic Association Studies, to investigate cells that
have been reprogrammed into induced pluripotent stem cells to model
heart, lung, and blood diseases and explore the functional consequences
of genetic variation.
Another initiative, Getting from Genes to Function in Lung Disease,
will support characterization of the function of lung-disease
associated genes and their variants that have been identified through
GWAS or other genetic approaches. Multidisciplinary teams will use a
variety of experimental methods and tools to elucidate the mechanisms
that contribute to diseases such as asthma, chronic obstructive
pulmonary disease (COPD), sarcoidosis, and idiopathic pulmonary
fibrosis and thereby generate knowledge that may lead to more effective
ways to prevent and treat them. In fiscal year 2012, the Institute
plans to solicit research projects to study two severe and poorly
understood conditions that affect the lungs: The Genomic Research in
Alpha-1 Antitrypsin Deficiency and Sarcoidosis program will conduct
state-of-the-art genomic, microbiomic, and phenotypic studies with the
goals of understanding the molecular and cellular bases of the
diseases, facilitating classification of sub-types, and developing new
drug therapies.
Because genome-wide scans are not well suited to discovery of
extremely uncommon genetic variants, the Institute is pursuing other
avenues to explore the contributions of infrequent variants to both
common and rare diseases. A program planned for fiscal year 2012 in
collaboration with the National Human Genome Research Institute, Life
After Linkage: The Future of Family Studies, will use data from
existing family studies to identify and characterize genes, including
rare variants, that influence complex diseases. The potential success
of such an approach is illustrated by a recent breakthrough resulting
from a collaboration between the NHLBI intramural program and the NIH
Undiagnosed Diseases Program. Researchers identified the genetic cause
of a rare and debilitating vascular disorder, not previously explained
in the medical literature, that involves severe arterial calcification.
Analysis of DNA from members of three affected families revealed that
the variant is in a gene responsible for a product that protects
arteries from calcifying. It is hoped that this understanding of the
underlying defect will enable discovery of improved treatment for the
patients.
regenerative medicine
Body components can malfunction because of inherent defects,
catastrophic or accumulated damage, or senescence, and chronic disease
is often the result. Restoring healthy function via delivery of
``replacement parts'' and helping organs repair injury with functional
tissue instead of scarring are high priorities of NHLBI. Recent
progress gives much reason for optimism. For example, heart attacks
cause permanent damage to heart muscle cells (cardiomyocytes) that
renders them useless for pumping blood. Although cardiomyocytes cannot
themselves be rejuvenated, NHLBI-supported scientists were able to
induce other heart cells (fibroblasts) to become pluripotent stem cells
that, in turn, were induced to become cells that looked and behaved
much like cardiomyocytes. The finding suggests the possibility that
fibroblasts--cells widely available throughout the body--could be
directly reprogrammed into functional cells to treat or prevent heart
failure and other adverse consequences of cell damage. Other NHLBI-
supported researchers recently reported progress toward engineering
lung tissue in a rat model, creating a scaffold populated with
multipotent neonatal rat cells to produce a transplantable organ
capable performing the fundamental lung function of gas exchange. The
success of this study and others using cadaveric human lung tissue and
immortalized cell lines suggests that such an approach might one day be
beneficial for patients who are awaiting lung transplant.
NHLBI is making considerable investments to advance regenerative
medicine research for cardiovascular, lung, and blood diseases. A
collaborative solicitation with the National Institute of Biomedical
Imaging and Bioengineering, New Strategies for Growing 3D Tissues, will
support highly integrated, multidisciplinary research to improve
understanding of how cells respond to their environment and how cell-
communication systems that enable blood-vessel and organ development
can be used to engineer 3D human cellular aggregates. Translation of
Pluripotent Stem Cell Therapy for Blood Diseases will promote the
development of technologies for translation of recent stem cell
advances into treatments for sickle cell disease and other blood
disorders. This new program will build upon the expertise, resources,
and infrastructure of the ongoing NHLBI Progenitor Cell Biology
Consortium, and it will encourage collaboration with two other
Institute initiatives--Production Assistance for Cellular Therapies and
the Gene Therapy Resource Program, which is slated for renewal in
fiscal year 2012.
A major initiative planned for fiscal year 2012, Consortium of Lung
Repair and Regeneration: Building the Foundation, will establish an
interactive group of multidisciplinary teams to formulate and test
innovative hypotheses about the mechanisms that control lung repair and
regeneration. The program will seek to leverage innovative technologies
such as tissue engineering, biomaterials and scaffolds, induced
pluripotent stem-cell technology, cell-directed therapy, and humanized
animal models that are not used widely in lung-regeneration research
but are being applied to investigate regeneration and repair in other
organ systems.
translational medicine
NHLBI continues to place strong emphasis on translating basic
science findings into better diagnostic, therapeutic, and preventive
approaches and fostering their use in real-world clinical practice. A
number of initiatives are supporting these efforts. For example, a
program called Science Moving Towards Research Translation and Therapy
(SMARTT) has been launched to facilitate transition of potential new
therapies for heart, lung, and blood diseases from discovery in the lab
to the testing needed to establish their safety and effectiveness in
people. Pre-clinical development--that is, readying products for
testing in humans--is the first step in turning discoveries into cures,
but the processes involved can be expensive and baffling to academic
scientists. Connecting academic researchers with industry, the SMARTT
program will offer help with manufacturing, pharmacology and toxicology
testing, pre-clinical and early-phase clinical study design, and
administrative and regulatory matters.
The Translational Research Implementation Program, or TRIP, is
intended to facilitate well-designed clinical trials in heart, lung, or
blood diseases to demonstrate the safety and efficacy of promising
interventions that have emerged from fundamental studies. Its initial
phase, which began in fiscal year 2010, supported the planning of
trials; the second phase will fund the most promising of them beginning
in fiscal year 2012. A second new program will provide planning grants
to establish the feasibility of pivotal clinical trials with a major
focus on hemoglobinopathies such as sickle cell disease and
thalassemia. Another solicitation, planned for fiscal year 2012, would
provide an innovative mechanism for the development of clinical trials
for hemostatic and thrombotic disorders, including access to expertise
in clinical trial methodology and design through existing institutional
resources.
Several exceptionally promising new translational efforts in lung
diseases are also under way. Research Education in Sleep and Circadian
Biology is promoting the use of innovative educational tools and
programs to accelerate the transfer of recent scientific advances and
health knowledge in sleep and circadian biology into clinical and
public-health practice. Renewal of a solicitation titled Utilization of
a Human Lung Tissue Resource for Vascular Research will advance
translational efforts in lung vascular disease, using previously
collected biospecimens from patients with pulmonary hypertension. An
initiative slated for fiscal year 2012 would support dosing and
efficacy trials of promising but untested therapies for lung diseases,
including agents that have already been approved for use in treating
other diseases and combinations of common drugs with low toxicities,
neither of which would be likely candidates for testing by industry.
Such small proof-of-concept trials are vitally important for
translating basic research advances into clinical research, providing a
foundation for larger efficacy trials, and advancing understanding of
disease processes.
______
Prepared Statement of Griffin P. Rodgers, M.D., M.A.C.P.
I am pleased to present the President's fiscal year 2012 budget
request for the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK) of the National Institutes of Health (NIH). The fiscal
year 2012 budget includes $1,837,957,000, which is $47,272,000 more
than the comparable fiscal year 2011 level. Complementing these funds
is an additional $150,000,000 also available in fiscal year 2012 from
the Special Statutory Funding Program for Type 1 Diabetes Research. The
NIDDK supports research on a wide range of common, chronic, costly, and
consequential diseases and health problems that affect millions of
Americans. These include diabetes and other endocrine and metabolic
diseases; digestive and liver diseases; kidney and urologic diseases;
blood diseases; obesity; and nutrition disorders.
uncovering the genetic and environmental causes of disease to inform
therapy and prevention
Unprecedented discoveries in genetics continue to lead the way
toward the development of personalized treatments and prevention of
devastating diseases and disorders. Scientists revealed that certain
variants in the APOL1 gene may be responsible for the differential risk
of developing kidney disease for African Americans. These variants also
provide a degree of protection against African sleeping sickness, a
degenerative and potentially fatal condition caused by a parasite that
is endemic to Africa. This could explain why these variants are more
commonly found in individuals of African descent, despite the increased
risk of kidney disease they confer.
Many of the diseases within the NIDDK research mission result from
the interaction between multiple genetic and environmental factors.
Research on the human microbiome--the microorganisms associated with
the body--has demonstrated that the composition of bacterial
communities is determined mostly by their location on or in the body
and varied between people. In a separate study, scientists reported
that bacteria in the mouse gut contributed to changes in appetite and
metabolism. Therefore, excess calorie composition and obesity may be
affected by these bacterial populations. Researchers in The
Environmental Determinants of Diabetes in Youth are using newly
developed technologies to study the microbiome of children at high risk
for developing type 1 diabetes and explore whether viral or bacterial-
based treatments could be used to prevent or treat the disease. NIDDK
will continue to capitalize on recent genetics and environment
discoveries to transform prediction, prevention, diagnosis, and
treatment of diseases within the Institute's mission.
improving patient care through research
Obesity is a major health epidemic in the United States, and it
increases the risk for type 2 diabetes; kidney, heart, and liver
disease; and other health issues. Therefore, efforts to curb this
rising trend are vitally important. The NIDDK's HEALTHY study revealed
that while a middle school-based intervention did not reduce obesity
school-wide, it lowered the obesity rate in students with the highest
risk for type 2 diabetes. This important result will inform future
school-based efforts to reduce overweight and obesity in children.
Research also shows that weight loss can improve the health of people
with diabetes. NIDDK's Look AHEAD study showed that weight loss in
overweight and obese people with type 2 diabetes can lead, with lower
medication requirements, to long-term favorable effects on diabetes
control and cardiovascular risk factors.
NIDDK continues to support efforts to test potential treatments for
NIDDK-related diseases and disorders. Investigators demonstrated in a
preliminary trial that salsalate, an anti-inflammatory drug used for
years to manage arthritis pain, can help people with type 2 diabetes
control blood glucose levels. If the expanded trial is successful, it
could lead to a safe and inexpensive way to treat the disease. Non-
alcoholic steatohepatitis (NASH) is a form of fatty liver disease
associated with overweight and can lead to liver cirrhosis and liver
failure requiring a transplant. Currently, there are no specific, FDA-
approved treatments for NASH. NIDDK scientists compared vitamin E, the
insulin-sensitizing drug pioglitazone, and placebo for treatment of
adult NASH, and reported promising improvements in response to 2-year
therapy, especially for vitamin E.
It is important to compare available, effective treatments and
combine this knowledge with a patient's history to identify the best
option for treating an individual. A recent NIDDK study demonstrated
that, on average, a lower blood pressure goal was no better than the
standard goal at slowing progression of kidney disease among African
Americans who had chronic kidney disease resulting from high blood
pressure. However, the lower blood pressure goal did benefit patients
who had protein in their urine, a sign of kidney damage. In light of
the APOL1 results I described earlier, this and other findings suggest
that genetic traits more common in African Americans may subtly alter
the pathogenesis of kidney disease in this population, and new classes
of drugs that target these pathways might be more effective in
preventing the onset and progression of chronic kidney disease in these
patients.
Millions of American women suffer from stress urinary incontinence,
an underdiagnosed public health problem that is associated with
diminished quality of life. An NIDDK trial demonstrated that two
different surgical approaches were equally effective--although they had
different side effects--in treatment for stress urinary incontinence, a
major milestone in treatment for this condition. This information will
enable women and their doctors to weigh more accurately the benefits
and risks of available treatment options. In concert with identifying
the best treatment options, NIDDK research aims to ensure that patients
are able to take advantage of these results to improve their health and
care.
disseminating research results to improve public health
It is critical that the results of research reach the American
public quickly and clearly to translate to real improvements in health.
NIDDK supports a number of public health campaigns such as the National
Kidney Disease Education Program, the Weight-control Information
Network, a Celiac Disease Awareness Campaign, and the National Diabetes
Education Program (NDEP).
Diabetes continues to be a growing worldwide public health concern;
rising rates of obesity and an aging populance are driving the
increasing prevalence of type 2 diabetes. There is hope, however:
research has shown that it is possible to delay--or even prevent--the
disease. The NIDDK's landmark Diabetes Prevention Program (DPP) was a
tremendous success, demonstrating that loss of 5-7 percent of an
individual's body weight--or treatment with the drug metformin--can
delay type 2 diabetes. By eating less fat and fewer calories and doing
moderate exercise, such as brisk walking, DPP participants were able to
lose body weight and maintain the loss. These lifestyle changes worked
particularly well for participants age 60 and older, and were equally
effective for all participating ethnic groups and for both men and
women.
To transfer the lessons of the DPP to the community level, NIDDK
supports translational research, which included a trial of less costly
delivery of the DPP intervention in YMCAs in group settings. The
results have led CDC and private organizations to fund the intervention
at more Ys and United Health Group to cover the cost for plan
participants to use the intervention at Ys. Additionally, the NDEP is
disseminating the good news from the DPP follow-up study that
development of type 2 diabetes continued to be reduced 10 years after
the intensive lifestyle change or treatment with metformin. NDEP has
partnered with NIH's Office of Research on Women's Health to also raise
awareness of the increased risk of type 2 diabetes for women who have a
history of gestational diabetes.
generating research opportunities
The future of public health depends critically on the development
of the next generation of scientists and the pursuit of scientific
opportunities. NIDDK continues to vigorously support new investigators,
and training and mentorship in biomedical research. NIDDK held its
second annual New Investigators' meeting to enhance their ongoing
research and spur future success. NIDDK also held its eighth annual
workshop for the Network of Minority Research Investigators to
encourage and facilitate participation of members of underrepresented
racial and ethnic minority groups in the conduct of biomedical research
in NIDDK-relevant fields. These new investigators will be poised to
take advantage of a wealth of opportunities to improve the health of
Americans; such opportunities have been identified by a number of
recent strategic planning efforts undertaken by the NIDDK.
The development and application of new technologies will also
improve patient care. Through support for small business innovation
research grants and other efforts, NIDDK will foster cutting-edge
research in this area. New technologies could facilitate analysis of
organs, tissues and biological molecules, and, with mobile
communication, help convey critical information quickly to patients and
healthcare providers. This research would enhance our ability to
monitor disease progression or how a therapy is working and would
improve diagnosis of disease or risk, to enable earlier intervention.
In closing, Mr. Chairman, NIDDK will continue to emphasize my
guiding principles: support a robust portfolio of investigator-
initiated research; vigorously support clinical trials to identify
better ways to prevent and treat disease; preserve a stable pool of new
investigators; disseminate science-based knowledge from research
through education programs; and foster research training and mentoring.
Thank you Mr. Chairman and members of the Committee for the
opportunity to share with you a few highlights of NIDDK's research and
outreach efforts to improve the health of Americans. I will be pleased
to answer any questions you may have.
______
Prepared Statement of Anthony S. Fauci, M.D.
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Institute of Allergy and Infectious Diseases (NIAID), a component of
the National Institutes of Health (NIH). The fiscal year 2012 budget
includes $4,915,970,000, which is $144,100,000 more than the comparable
fiscal year 2011 level of $4,771,870,000.
NIAID conducts and supports biomedical research to understand,
treat, and prevent infectious and immune-mediated diseases, including
HIV/AIDS; tuberculosis; malaria; influenza; emerging and re-emerging
infectious diseases; asthma and allergies; autoimmune diseases; and the
rejection of transplanted organs. NIAID makes a major investment in
translational research, which seeks to accelerate the findings from
basic research into healthcare practice. This decades-long commitment,
together with NIAID's multidisciplinary collaborations with experienced
as well as new investigators at academic centers, the private sector,
and other governmental and non-governmental partners, continues to help
improve domestic and global health through the development of
diagnostics, therapeutics, and vaccines for infectious and immune-
mediated diseases. I appreciate the opportunity to highlight just a few
of our research successes and to describe some of our most promising
research programs aimed at improving public health and quality of life.
global health
NIAID has been a leader in both basic and clinical HIV/AIDS
research ever since the disease emerged as a devastating public health
crisis 30 years ago. In 2010, NIAID support for HIV/AIDS research
resulted in landmark scientific advances in HIV prevention. The NIAID-
supported iPrEx study demonstrated that a daily dose of an oral
antiretroviral medication, a strategy known as pre-exposure prophylaxis
or PrEP, was effective at reducing the risk of HIV acquisition among
men who have sex with men. This finding was selected by the prestigious
journal The Lancet as one of the top six medical discoveries in the
world in 2010 and was named by Time magazine as the number one medical
breakthrough in 2010. A second important study, and another of The
Lancet's selections, CAPRISA 004, showed that a vaginal microbicide gel
of an antiretroviral drug could give women a measure of protection
against HIV infection. This important trial was funded by the U.S.
Agency for International Development and carried out using a research
infrastructure developed with NIAID support. In the area of HIV vaccine
development, researchers in NIAID's intramural Vaccine Research Center
and NIAID-funded extramural investigators discovered human antibodies
that can block a wide range of HIV strains from infecting human cells
in the laboratory and are now zeroing in on their precise mechanisms of
action. Coupled with last year's success from the RV 144 HIV vaccine
clinical trial conducted in Thailand, which found a ``prime-boost''
vaccine candidate to be safe and modestly effective in preventing HIV
infection, NIAID is making important strides in developing a robust
package of prevention modalities that can be used in combination. In
addition, research supported under NIAID's new initiative, the Martin
Delaney Collaboratory: Towards an HIV Cure, will provide insights into
how HIV hiding places in the body--so-called ``reservoirs''--are
formed, where they are located, how they are maintained despite
effective antiretroviral therapy, and how they might be eliminated.
NIAID makes a significant investment in research on the co-
infections and co-morbidities that often accompany HIV infection.
Tuberculosis (TB) occurs in about one-third of HIV-infected individuals
and is the leading cause of death in this group. The NIAID-sponsored
CAMELIA study demonstrated that survival of untreated HIV-infected
adults with weak immune systems and newly diagnosed TB can be prolonged
by starting antiretroviral therapy 2 weeks after beginning TB
treatment, rather than waiting the standard 8 weeks. This finding will
help to optimize treatment strategies for people co-infected with HIV
and TB and promises to save many lives in the developing world. A
significant number of adults at risk for HIV infection are also at risk
for hepatitis B and C infection. NIAID supports a robust research
program to understand the pathogenesis of and immune response to
hepatitis viruses and to develop novel therapeutics and vaccines
against the diseases caused by these viruses.
In 2009, there were approximately 9.4 million TB cases and 1.7
million TB deaths globally according to the World Health Organization
(WHO). NIAID has accelerated its TB research activities and is applying
21st century technology to a field that has lagged behind the study of
other infectious diseases. NIAID supports the development of several
promising TB vaccine candidates, and basic and clinical research has
contributed to both new and repurposed therapeutic approaches and
candidates. With NIAID support, researchers also have developed a tool
for diagnosing TB that provides more specific, sensitive, and rapid
results than currently available diagnostics.
In 2009, approximately 225 million cases of malaria resulted in
more than 780,000 deaths, 90 percent of which occurred in Africa,
according to WHO. More than a decade has passed since the newest class
of antimalarial drugs, artemisinins, entered widespread use worldwide;
unfortunately, malaria parasites are becoming increasingly resistant to
these medications. There is a pressing need for new malaria therapies
due to the constant threat of the emergence of drug resistance, which
NIAID is addressing by supporting domestic and international research.
For example, NIAID-supported researchers identified NITD609 as a
promising antimalarial drug with a mode of action that differs from the
current drugs used to treat malaria. NIAID-supported scientists also
discovered a novel metabolic pathway of the malaria parasite Plasmodium
falciparum that could lead to new drug targets. In 2010, NIAID
established ten International Centers of Excellence for Malaria
Research in malaria-endemic regions. In addition to research on HIV/
AIDS, TB, and malaria, NIAID supports research devoted to better
understanding, preventing, and treating other important diseases that
cause a significant burden of illness and death globally, including
neglected tropical diseases such as lymphatic filariasis, trachoma, and
leishmaniasis.
emerging and re-emerging infectious diseases
NIAID continues its critical focus on advancing drugs, vaccines,
and diagnostics from concept to product development to fight emerging
and re-emerging infectious diseases. In response to the 2009 H1N1
influenza pandemic, NIAID played a key role in developing and testing
the 2009 H1N1 influenza vaccines, and in assessing their safety and
potential effectiveness in a variety of populations. NIAID researchers
also made important strides in the development of broadly protective
influenza vaccines. NIH intramural researchers in the Vaccine Research
Center demonstrated that a ``prime-boost'' vaccine strategy could
protect animals from infection with multiple strains of influenza.
NIAID-supported scientists also determined that individuals infected
with pandemic 2009 H1N1 influenza generated antibodies that neutralized
many different influenza virus strains. This adds to the evidence base
that a universal influenza vaccine may be possible, which would obviate
the need to modify the influenza vaccine each season. NIAID-supported
investigators also showed that vaccinating children against influenza
protects the wider community, underscoring the public health importance
of widespread vaccination with current and improved vaccines. The
Lancet chose this study as its top scientific advance of 2010.
Building on the experience and challenges of the 2009 H1N1
influenza pandemic, the Department of Health and Human Services
conducted a review of the Federal Government's efforts to develop
medical countermeasures (MCMs) such as drugs and vaccines for public
health emergencies, including bioterror attacks, culminating in a new
vision for MCM development. As part of this vision, NIAID--in
coordination with the Biomedical Advanced Research and Development
Authority and the Department of Defense--will lead the Concept
Acceleration Program to stimulate the translation of new scientific
concepts and discoveries to the development of MCMs for biodefense and
emerging infectious diseases.
The dengue epidemic in Puerto Rico and dengue cases in Florida and
Hawaii, as well as the cholera outbreak in earthquake-ravaged Haiti,
demonstrate the importance of understanding the factors that contribute
to disease emergence and re-emergence. NIAID dengue research includes
basic research, vector biology, translational research, as well as the
development of research tools, resources, and services. With NIAID
support, scientists are developing several vaccine approaches for
dengue. NIAID research on cholera spans basic research, genomics,
studies of environmental and climactic factors, and the development of
vaccines and therapeutics. An NIAID-supported study pinpointed the
genetic lineage of the cholera microbe that is causing the epidemic in
Haiti.
NIAID continues to support a robust basic, translational, and
clinical research portfolio to address the public health issue of
antibiotic resistance for key pathogens, including methicillin-
resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria. For
example, NIAID scientists recently identified a toxin from a community-
acquired strain of MRSA that could be a factor in the severity of MRSA
infections. NIAID also supports research to preserve the effectiveness
of currently used antibiotics, including studies to examine optimal
treatment of community-acquired pneumonia and infections caused by
Gram-negative bacteria such as Pseudomonas and Acinetobacter. NIAID-
supported researchers settled a medical controversy by recently showing
that antibiotics clearly reduce the severity and duration of acute
middle-ear infections in toddlers that were diagnosed using consistent
criteria.
immune-mediated disorders
NIAID is committed to furthering our understanding of the
immunologic mechanisms underlying autoimmune diseases, asthma and
allergic diseases, rejection of transplanted organs, and other immune-
mediated disorders; and to translating this knowledge into new
approaches for diagnosis, prevention, and treatment. In 2010, an NIAID-
sponsored expert panel produced much-needed comprehensive guidelines
for medical practitioners for the diagnosis and management of food
allergy that will be helpful to clinicians across a range of medical
specialties. NIAID also launched the Human Immunology Project
Consortium to better understand the human immune system and how it
reacts to infection or vaccination. The information gained from this
effort will provide insights into the development of safer and more
effective vaccines, including those for young children and the elderly.
In addition, researchers in the NIAID Immune Tolerance Network
demonstrated that Rituxan is a safe and effective therapy for two
forms of severe vasculitis, a rare and devastating disease of the blood
vessels. These data were instrumental in the recent Food and Drug
Administration-approval of Rituxan for this indication, representing
the first licensed treatment for this disorder in 40 years. Also, the
NIAID Inner-City Asthma Consortium determined that the addition of
Xolair to NIH guidelines-based asthma therapy for young children and
adolescents resulted in fewer asthma symptoms and severe asthma
attacks.
conclusion
For more than 60 years, NIAID has conducted and supported basic and
clinical research on infectious and immune-mediated diseases leading to
the development of vaccines, therapeutics, and diagnostics that have
significantly improved the health and saved the lives of millions
around the world. NIAID will continue to support the highest quality
research with the aim of translating fundamental discoveries into
improved public health.
______
Prepared Statement of Josephine P. Briggs, M.D., Director, National
Center for Complementary and Alternative Medicine
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National Center
for Complementary and Alternative Medicine (NCCAM) of the National
Institutes of Health. The fiscal year 2012 budget includes
$131,002,000, which is $3,399,000 more than the comparable fiscal year
2011 appropriation of $127,603,000.
The National Center for Complementary and Alternative Medicine
(NCCAM) is the Federal Government's lead agency for scientific research
on complementary and alternative medicine (CAM). CAM includes a group
of diverse medical and healthcare interventions, practices, products,
or disciplines that are not generally considered part of conventional
medicine (sometimes called Western or allopathic medicine). The
boundaries between CAM and conventional medicine are not absolute;
instead, they are constantly evolving: interventions such as hospice
care or relaxation and breathing techniques in childbirth that were
once considered unconventional are now widely accepted. Furthermore,
there is growing interest in more integrative approaches that use both
CAM and conventional interventions. For example, both the Departments
of Defense \1\ and Veterans Affairs are integrating select CAM
modalities into treatments for pain, stress, and sleep disorders.
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\1\ Pain Management Task Force Final Report: Providing a
Standardized DOD and VHA Vision and Approach to Pain Management to
Optimize the Care for Warriors and Their Families, Office of the Army
Surgeon General, Department of Defense, May 2010.
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CAM is used by many in the United States, both in treating health
problems and in promoting better health and well-being. Data from the
2007 National Health Interview Survey \2\ (NHIS), developed under NCCAM
leadership in collaboration with the National Center for Health
Statistics at the Centers for Disease Control and Prevention (CDC),
show that nearly 40 percent of adult Americans and 12 percent of
children are using some form of CAM. The data also show that in 2007
out-of-pocket expenditures for CAM totaled $33.9 billion. While this
amount accounted for only 1.5 percent of total healthcare expenditures,
it was more than 11 percent of out-of-pocket expenditures. Finally,
NHIS data indicate that a large portion of CAM use is best described as
``self-care'' in that it occurs outside of the framework of a
relationship with a healthcare professional. The scope, associated
costs, and self-care nature of CAM use in the United States reinforce
the need to develop reliable, objective scientific evidence concerning
the usefulness and safety--or lack thereof--of CAM interventions, and
to ensure the public has access to accurate and timely evidence-based
information.
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\2\ Nahin RL, Barnes PM, Stussman BA, et al. Costs of complementary
and alternative medicine (CAM) and frequency of visits to CAM
practitioners: United States, 2007. CDC National Health Statistics
Report #18. 2009.
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NCCAM is shaping its research directions through our third
strategic plan, which was developed with considerable input from our
diverse stakeholder community and released in February 2011. The
strategic plan, Exploring the Science of Complementary and Alternative
Medicine (available at www.nccam.nih.gov), was built around three long-
range goals aimed at improving the state and use of scientific evidence
regarding the two major reasons for use of CAM in the United States--
treating health problems and supporting or promoting better health and
well-being. The three goals are to (1) advance the science and practice
of symptom management; (2) develop effective, practical, personalized
strategies for promoting health and well-being; and (3) enable better
evidence-based decisionmaking regarding CAM use and its integration
into healthcare and health promotion.
pain and symptom mangement
CAM approaches, as treatments for health problems, are used most
often to manage symptoms such back or neck pain, arthritic or other
musculoskeletal pain, headache, and insomnia. These are all difficult
problems and there is broad agreement that existing options are less
than fully satisfactory for many patients. For example, chronic back
pain is, by far, the most frequent health problem for which Americans
turn to CAM. They might try CAM approaches after exhausting other
options such as opioids, injections, surgery, or physical therapy. More
often, however, they pursue CAM treatment options, including spinal
manipulation, yoga, acupuncture, and massage, in conjunction with
conventional approaches. Individuals suffering from chronic pain
conditions, their healthcare providers, and health policymakers all
need better evidence regarding the value and safety of these
complementary and integrative approaches in alleviating pain, and in
improving quality of life.
To address this critical need, NCCAM is intensifying its focus on
determining whether and how CAM interventions add value to existing
approaches and on understanding their biological mechanisms. In order
to advance the science and practice of symptom management, NCCAM plans
to support Centers of Excellence for Research on CAM for Pain in fiscal
year 2011. NCCAM is also working with our colleagues at the Department
of Defense to explore ways that CAM mind and body approaches can be
used in integrative approaches to treat pain, stress disorders, and
other symptoms. For example, we recently sponsored a joint workshop on
acupuncture for the treatment of acute pain. We are also investigating
potential collaborations with the Department of Veterans Affairs to
advance CAM research and to maximize our investments in bringing relief
to our wounded warriors.
strategies for promoting health and well-being
It is generally accepted and well established that sustaining
healthy behaviors (e.g., good eating habits and regular physical
exercise) and modifying unhealthy behaviors (e.g., smoking) reduce
risks of major chronic diseases. Many CAM and integrative medicine
practitioners and disciplines employ various interventions (e.g.,
meditation or yoga) to help motivate people to adopt and sustain
health-seeking behaviors, or to encourage dietary practices (sometimes
grounded in traditional medical systems) that incorporate a healthy
food philosophy. Newly emerging evidence suggests that CAM use may be
associated with greater degrees of health-seeking behavior. While
causal relationships between CAM use and healthy behavior have not been
established, the claims and preliminary data deserve investigation
given the formidable public health challenges in motivating behavior
change. Research is needed to explore, clarify, and examine the
hypothesis that certain CAM approaches or practices can, in fact, be
useful in encouraging better self-care, an improved personal sense of
well-being, and a greater commitment to a healthy lifestyle.
cam research challenges
Given the scope and self-care nature of CAM use by Americans, NCCAM
remains committed to supporting rigorous research that will address the
need for scientific evidence to help the public and their healthcare
providers make better-informed decisions about CAM use. For example,
herbal medicines, dietary supplements, and other CAM natural products
are readily available to and purchased by consumers, but evidence
regarding usefulness of many does not exist. In addition, some people
believe that herbal medicines, dietary supplements, and other CAM
natural products are inherently healthier or safer than drugs. In fact,
there are ongoing concerns about safety, including the presence of
contaminants or adulterants (e.g., conventional drugs) in some CAM
natural products, and the potential of toxic interactions with drugs or
other natural products.
Clinical research to address these needs will remain a cornerstone
of the CAM research enterprise, but these studies are complex,
expensive, and time-consuming. NCCAM's strategic approach is to ensure
that clinical trials of CAM natural products are based on a
scientifically sound hypotheses and methods that are grounded in basic
mechanistic and translational research. This foundation facilitates
design of maximally informative clinical trials that include measures
of biological effect relevant to the hypothesis (e.g., biomarkers or
surrogate markers), as well as measures of clinical outcomes.
Investigators studying mind and body interventions face other
scientific challenges in designing rigorous research that will address
the questions of greatest importance to consumers, providers, and
healthcare policymakers. These include identifying relevant study
endpoints and defining appropriate experimental designs to test
interventions. To address such challenges, NCCAM recently collaborated
with several NIH ICs to sponsor a workshop on control and comparison
groups for studies of non-pharmacological interventions.\3\
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\3\ NCCAM Workshop on Control/Comparison Groups for Trials of Non-
Pharmacologic Interventions, April 26, 2010.
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conclusion
As established in its third strategic plan, NCCAM is focusing the
Center's efforts and resources on two compelling areas of public health
need: better strategies for managing symptoms such as chronic pain, and
better strategies for promoting health and well-being. In both areas
there exist promising scientific opportunities for research on CAM
interventions to contribute to real and meaningful progress in
addressing common and vexing individual and social problems, and in
developing more integrative approaches to healthcare and the support of
healthy behaviors and lifestyles.
Finally, NCCAM's plan looks to a vision in which scientific
evidence informs decisionmaking by the public, by healthcare
professionals, and by health policymakers regarding CAM use. NCCAM will
continue its multi-pronged efforts to provide world-class information
about the safety and usefulness of CAM interventions to consumers, and
to foster dialogue about CAM use between patients and their healthcare
providers. In addition, a new online resource, tailored to the needs of
healthcare professionals, is being launched on the NCCAM website. It
includes information on the safety and efficacy of a range of CAM
practices, and was developed in response to providers' needs for an
evidence-based, one-stop resource to help answer their patients'
questions on CAM.
______
Prepared Statement of Barbara M. Alving, M.D., Director, National
Center for Research Resources
Mr. Chairman and Members of the Committee: It is a privilege to
present to you the President's budget request for the National Center
for Research Resources (NCRR) programs for fiscal year 2012. The fiscal
year 2012 budget of $1,297,900,000 includes an increase of $41,225,000
over the comparable fiscal year 2011 level of $1,256,675,000. Funding
priorities for fiscal year 2012 include the continued support and
refinement of the Clinical and Translational Science Award program,
which will reach its targeted number of 60 consortium members later
this year. Funds will also sustain the range of activities supported by
the Center's other major programs, including the Research Centers in
Minority Institutions, the Institutional Development Awards, the
National Primate Research Centers, and the Biomedical Technology
Research Centers.
By uniting innovative research teams with the power of shared
resources across the Nation, NCRR programs provide laboratory
scientists and clinical researchers with the tools and training they
need to understand, detect, treat, and prevent a wide range of diseases
through clinical and translational research. NCRR's diverse yet
interconnected NCRR programs enable the research of more than 30,000
NIH-funded investigators nationwide by providing the resources, tools,
and networking connections.
This statement is submitted with the recognition of a publically
announced proposal for reorganization that would result in dissolution
of NCRR and the transfer of programs to other NIH ICs and Offices.
building clinical and translational research capabilities
NCRR's Clinical and Translational Science Award (CTSA) program is
transforming biomedical research by building national clinical and
translational research capacity to speed the translation of laboratory
discoveries into better treatments for patients. Launched in 2006, the
CTSA program is a national clinical and translational research
consortium which now includes 55 medical research institutions in 28
States and the District of Columbia. The consortium supports research
by disseminating clinical research informatics tools, forging new
partnerships with healthcare organizations, and expanding outreach to
minority and medically underserved communities. The first cohort of
CTSAs, now re-competing for their next 5 years of funding, have pushed
scientific discoveries toward novel and promising treatments that
enable healthcare reform and more cost-effective treatments. For
instance, research conducted at the University of California, San
Francisco's CTSA found that reducing salt intake by just a half
teaspoon per day could help Americans significantly improve their heart
health, reduce a number of heart-related deaths and potentially save
millions in healthcare costs. The findings influenced the Food and Drug
Administration's decision to limit the amount of salt in prepared foods
and helped support the CDC's salt reduction campaign.
Importantly, the CTSA consortium serves as a communications hub
that ensures sharing among sites and accelerates adoption of best
practices for clinical and translational research. The CTSAs are
building biomedical research capability by generating new tools and
resources, such as ResearchMatch.org, a Web-based national recruitment
registry which matches volunteers with clinical studies seeking
participants, and the CTSA Pharmaceutical Assets Portal, a public-
private collaboration enabling scientists to learn more about existing
compounds that are not being actively developed and might be repurposed
to treat other types of diseases.
energizing research communities
NCRR programs support new investigators and promote new ideas
through innovative networking collaborations, partnerships, training,
and career development for clinical and translational scientists.
Members of the Institutional Development Award (IDeA) program, which
supports rural and underserved communities, developed the Network of
IDeA-funded Core Laboratories (NICL) to address common challenges of
NCRR-funded core laboratories. NICL addresses, develops and
disseminates sustainable business models for efficient core operations
and expands access to advanced core resources and expertise. Now
extended to other NCRR programs, NICL supports, encourages, and
facilitates resource sharing and collaboration among NCRR-funded cores
and shared-resource facilities. NCRR programs are also energizing the
research community with the world's first physician-scholar training
program on wireless healthcare research, launched through a partnership
between The Scripps Translational Science Institute (STSI) CTSA and the
wireless telecommunications company Qualcomm. STSI is positioned to
become an invaluable resource for this emerging, high-impact field of
research.
advancing innovative biomedical technologies
The Biomedical Technology Research Centers (BTRCs) program is
producing leading edge technologies to accelerate discoveries that help
researchers who are studying virtually every human disease. At the
Resource for Magnetic Resonance and Optical Imaging at the University
of Pennsylvania, researchers are working closely with clinicians to
improve patient care by developing and promoting ready access to
imaging tools with the goal of translating novel approaches for imaging
blood flow through brain tissue and other organs.
new and better treatments through animal models
The National Primate Research Center (NPRC) program advances
research and knowledge in HIV and AIDS, as well as in numerous other
diseases. The NPRCs have a close relationship with the CTSAs; one
example is the collaboration between the New England NPRC and the
Harvard CTSA. The two are jointly examining the observation that
insulin resistance appears to be a predictor of dementia utilizing a
monkey model of insulin resistance and an analysis of high-field MRI
scans in the monkey model conducted by the Harvard CTSA investigators
who have expertise with MRI in humans. NCRR continues to supply the
research community with animal models and resources. Through the Link
Animal Models to Human Disease Initiative (LAMHDI), a Web-based
resource, investigators can identify and locate useful animal models
that are essential to their research in treatments for human disease.
expanding research capabilities to address human health
Through the IDeA and Research Centers in Minority Institutions
(RCMI) programs, biomedical research capacities across the Nation are
expanding into States with historically low NIH funding and are having
a direct impact on human health. One example is from the National
Center for Genome Resources in New Mexico, home of the DNA sequencing
and bioinformatics core for the New Mexico IDeA Networks of Biomedical
Research Excellence (INBRE). Scientists used innovative whole-genome
sequencing and expression analyses to study Multiple Sclerosis (MS) in
identical twins resulting in the first published genome sequences of
female twins or individuals with autoimmune disease. It is also the
first systematic comparison of genomes in identical twins, including
epigenetic markers and expression profiles. Another study from the New
Mexico INBRE used next-generation sequencing methods to develop a pre-
conception genetic test for 500+ mutations known to increase the risk
of numerous rare diseases in children of carriers.
Another illustrative example is a pilot study, initiated by the
RCMI Translational Research Network, to study the effect of Vitamin D
on cardiovascular disease risk factors in African Americans. This study
is important because racial/ethnic minorities, especially African
Americans, continue to suffer a disproportionate burden of
cardiovascular disease. African Americans also tend to have low levels
of Vitamin D and these low levels have been associated with
cardiovascular disease risk. Supplementation with Vitamin D may be an
accessible and affordable intervention.
providing a catalyst for research collaboration
Grantee institutions are adopting research networking tools as a
step toward national networking of people, resources, and data on the
web. The VIVO project, which is an initiative to enable national
networking of scientists and resource discovery, is driving the network
with availability of linked open data about scientists and their work.
The potential will be realized through their commitment to publish data
on the web so the information is more easily discoverable and
connections with other open linked data can be made. VIVO is an open
source semantic web application linking information automatically from
institutional and public systems of record to provide detailed profiles
of scholars and researchers. The power of this semantic web approach is
the ability for creative visualization of connections not previously
possible between diverse types of information and data.
This brief overview of NCRR's programs demonstrates our continuing
commitment to accelerating clinical and translational research. NCRR
will continue to advance research through partnerships among its
programs, other Institutes and Centers at the NIH, and with other
Federal and non-Federal agencies to advance training and translational
research opportunities.
______
Prepared Statement of Paul A. Sieving, M.D., Ph.D., Director, National
Eye Institute
Mr. Chairman and Members of the Committee:I am pleased to present
the President's budget request for the National Eye Institute (NEI).
The fiscal year 2012 budget of $719,059,000 includes an increase of
$18,832,000 over the fiscal year 2011 appropriation level of
$700,227,000. As the director of the NEI, it is my privilege to report
on the many research opportunities that exist to reduce the burden of
eye disease.
technologies to accelerate discovery
The causes of common diseases are complex in that there are
potentially many different environmental factors and genetic variants
that can contribute to disease. New technologies such as genome-wide
association studies (GWAS) allow investigators to scan the genomes of
patients to identify genetic risk variants for common diseases.
Individually, each of these variants may only contribute to a small
percentage of cases, so GWAS require many subjects to identify low
frequency risk variants. In the largest GWAS study in vision research
to date, NEI investigators recently sequenced DNA from over 18,000
patients and control subjects and identified three new genes associated
with age-related macular degeneration (AMD), the most common cause of
vision loss in older Americans. Two of these genes are involved with
high-density lipoprotein cholesterol metabolism, implicating a new
biochemical pathway involved in the pathogenesis of AMD. These findings
will allow researchers to better understand the disease mechanisms
underlying AMD and develop therapies that address the root cause of
vision loss. Glaucoma is another heritable blinding disease where the
genetic underpinnings are poorly understood. The NEI Glaucoma Human
Genetics Collaboration, a consortium of clinicians and geneticists at
12 institutions throughout the United States dedicated to identifying
the genetic factors associated with glaucoma is conducting a large-
scale GWAS that involves scanning 5,000 DNA samples. The consortium is
using state-of-the-science technology to sequence the exome, the full
complement of protein coding regions in the human genome, in a subset
of patients. The data from these DNA samples are expected to be
available to the vision research community in 2011.
translational sciences and therapeutics development
Positive results of ongoing, pioneering clinical trials of gene
therapy for Leber congenital amaurosis, a severe, early onset retinal
disease, have encouraged applications of this approach to many other
eye diseases. In the past year, NEI investigators demonstrated proof-
of-concept of gene therapy using animal models of AMD, achromatopsia,
Leber's hereditary optic neuropathy, retinitis pigmentosa, and red-
green color blindness. Previous work with animal models established the
utility of gene therapy in juvenile retinoschisis, optic neuritis, and
Stargardt disease. These studies now allow investigators to conduct the
pre-clinical work necessary to pursue regulatory approval for clinical
trials. In addition, novel gene delivery systems, such as the use of
nanoparticles, have shown promise in animal models. Such vectors will
be helpful in expanding the reach of gene therapy to target a variety
of ocular tissues such as retinal ganglion cells and the light-
sensitive photoreceptor cells.
enhancement of evidence-base for health care decisions
For treating the blinding (``wet'') form of advanced AMD, monthly
ocular injections of a drug, Lucentis, was approved in 2007 by the FDA.
This was the first effective treatment that not only stopped
progression of the disease, but also improved vision for many patients.
Lucentis blocks formation of new, but abnormal blood vessels that leak
fluid into the central part of the retina that is responsible for keen
vision. It was developed from another inhibitor of blood vessels,
Avastin, which since its approval in 2004, has been used to block new
vessels that form to nourish growth of some cancers. Even before final
FDA approval of Lucentis, ophthalmologists began using Avastin ``off-
label'' for treating AMD, and today, most AMD patients receive Avastin.
Given the lack of data regarding the effectiveness of Avastin for AMD
treatment, in 2007, the NEI had an obligation to patients and
clinicians to compare the two drugs and to evaluate whether the drugs
could be used less frequently as needed--called PRN--rather than
monthly as originally approved for Lucentis. Visual acuity improvement
was virtually identical (within one letter difference on an eye chart)
for either drug when given monthly. When each drug was given PRN, there
also was no difference between drugs. For PRN dosing, patients required
four to five fewer injections per year compared to monthly treatment
and still had substantial gains in vision.
Lucentis was also studied in a comparative effectiveness trial for
diabetic macular edema (DME), a common sight-threatening complication
of diabetes in which fluid from leaky blood vessels causes the retina
to swell. For the past 25 years, DME has been treated with a laser to
destroy abnormal blood vessels. Although laser therapy slows disease
progression, the effects are temporary, and repeated treatments can
damage healthy retinal tissue and impair vision. In recent years,
ophthalmologists have been supplementing laser treatment with ocular
injections of either Lucentis, a drug that prevents blood vessel
growth, or triamcinolone, a corticosteroid to reduce inflammatory
complications. An ongoing clinical trial comparing the safety and
efficacy of these two drugs is being conducted by the Diabetic
Retinopathy Clinical Research Network (DRCR.net), a public-private
partnership funded by NEI, the Type 1 Diabetes Funding Program, and
industry collaborators. After 1 year, Lucentis plus laser treatment was
superior in both safety and efficacy compared to triamcinolone plus
laser or to laser alone. This landmark clinical trial identified the
first new safe and effective treatment regimen for DME in more than two
decades. In addition, the study demonstrated that intravitreal
triamcinolone, which had been used in 60 percent of patients with DME,
had significant side effects (cataract and glaucoma) and was not better
than laser alone. These results are already being used by community
ophthalmologists to greatly improve the vision and quality of life for
people living with diabetes.
Treatment of cataracts in infants is challenging for pediatric
ophthalmologists and parents. Replacing the opaque lens with an
artificial lens is critical to prevent permanent loss of vision in the
eye. After removing the cataract, contact lenses have been the
preferred method to overcome the loss of the natural lens. However, it
is difficult and stressful for parents to insert a contact lens into an
infant's eye. Removing the cataract and surgically implanting a
transparent intraocular lens (IOL) in adults is common but had not been
fully characterized in infants. An NEI-supported clinical trial found
no difference in visual acuity with contact lenses compared to IOLs 1
year after cataract removal. However, IOLs caused significant numbers
of surgical complications. Based on these results, the use of contact
lenses is considered the safest effective treatment for infants with
cataract.
new investigators, new ideas
The increasingly quantitative nature of the biomedical sciences and
the explosive growth of genomic, transcriptomic, proteomic,
metabolomic, neurophysiological and clinical data require that
investigators work at the interface of biology and computational
sciences. The NEI is committed to developing the next generation of
vision researchers and has expanded its institutional training grant
program with a program in ocular statistical genetics at several
universities. This program will partner researchers with expertise in
mathematics, modeling, and computation, fields that are not usually
affiliated with ocular research, with researchers in all areas of
vision science to provide state-of-the-art training for a new breed of
researchers.
______
Prepared Statement of Eric D. Green, M.D., Ph.D., Director, National
Human Genome Research Institute
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 President's budget request for the National Human
Genome Research Institute (NHGRI). The proposed fiscal year 2012 budget
is $524,807,000, an increase of $13,749,000 from the comparable fiscal
year 2011 level of $511,058,000.
This is an exciting time for biomedical research in general and for
genomics research in particular. NHGRI investments in the development
of genomic technologies and their application are generating innovative
and powerful approaches to address a diverse array of biological and
biomedical questions. In early 2011, after 2-plus years of rigorous
consultation and planning, NHGRI published a new strategic plan for the
field of genomics in the premiere scientific journal Nature. This
comprehensive strategic vision describes the next key steps in the
herculean journey to decipher the secrets within our genetic code and
to use those discoveries to empower health practitioners and patients
in a fashion that leads to improved human health. The strategic plan
also challenges the broader biomedical community to anticipate the
scientific and non-scientific achievements that will be necessary to
implement cost-effective and accessible genomics-based medical care
(i.e., genomic medicine).
enabling research
Basic research lays the foundation for understanding the functional
features within our genome and how disruptions in them can lead to
disease. In fact, the knowledge gained from basic genomic
investigations enables scientists and clinical investigators from other
disciplines to pursue translational research programs to understand
particular biological pathways or address disease-specific questions.
The ENCyclopedia of DNA Elements (ENCODE) project and the related model
organism ENCODE (modENCODE) project are moving forward effectively
toward their goals of finding all the functional elements in the human
genome, as well as in the genomes of organisms that serve as important
models for human biology.
To stimulate and accelerate multi-disciplinary research, NHGRI has
funded several Centers of Excellence in Genomic Science (CEGS). In
addition to pursuing cutting-edge genomics research questions, these
centers are associated with rigorous training programs that focus on
groups under-represented in biomedical research. Such efforts aim to
reinvigorate the biomedical research community by engaging diverse
expertise and fostering the development of versatile young scientists.
The unprecedented decreases in the cost of DNA sequencing resulting
from the NHGRI-stimulated technology development efforts are moving us
steadily closer to the reality of using genome sequencing as a routine
part of clinical care. However, even with the three-to-four orders-of-
magnitude drop in DNA sequencing costs that has occurred, sequencing an
entire human genome remains too expensive for the kind of human
research studies needed to dissect the small genetic differences
between individuals that contribute to increased risk for common
diseases, such as cancer, heart disease, and asthma, because such work
often requires the study of thousands or tens of thousands of
individuals. To this end, NHGRI continues to push forward technology-
development initiatives, such as the $1,000 Genome program, to develop
novel and even more cost-effective DNA sequencing methods.
Concurrently, the NHGRI-funded large-scale sequencing centers continue
to use innovative approaches for improving available DNA sequencing
technologies. These efforts are projected to result in a substantial
drop in the cost of generating a human genome sequence--to less than
$25,000 by the end of fiscal year 2011 and less than or equal to
$15,000 by the end of fiscal year 2012.
To develop an appropriately broad catalog of information about the
variation within the genomes of different individuals across the world,
NHGRI continues to contribute substantially to the international 1000
Genomes Project. In addition, on behalf of NIH, NHGRI led the effort to
launch a research partnership with the Wellcome Trust, called the Human
Heredity and Health in Africa (H\3\Africa) Initiative. This new effort
seeks to stimulate research within African laboratories to enable
leading-edge genomic studies to be conducted across the continent. The
knowledge gained through a deeper understanding of genomic variation in
African populations will not only lead to improved abilities to study
genetic diseases in those populations, but will enhance our
understanding of the complex interplay between environmental and
genetic factors that influence disease susceptibility and drug
responses in many diverse populations.
building a framework for translation
Building on the tools and knowledge created by these and other
basic research programs, the joint NHGRI-National Cancer Institute
(NCI) project, The Cancer Genome Atlas (TCGA), is providing important
new insights into some of the most vexing forms of malignancy,
including brain cancer and, more recently, acute myeloid leukemia and
ovarian cancer. Results from TCGA and associated cancer genomics
studies by NHGRI-funded investigators point to new therapeutic targets
and, as recently reported in the Journal of the American Medical
Association, demonstrate the potential for more precise modes of cancer
diagnosis and treatment. As a flagship program for NIH translational
research activities, TCGA is expanding its efforts and will focus on an
additional 20 major cancers over the next 5 years.
Beginning in fiscal year 2012, NHGRI will expand its large-scale
genome sequencing and analysis portfolio to include centers that target
the study of rare, single-gene (Mendelian) disorders using cutting-edge
genomic technologies. Rare disease research already is benefiting from
the new genomic technologies. For example, the causative genes for a
pair of developmental disorders were discovered recently: Miller
syndrome, which affects the development of the face and limbs, and
Kabuki syndrome, which affects facial and cognitive development. These
two discoveries represent the ``tip of the iceberg'' with respect to
the identification of altered genes that result in rare diseases, as
reports of such discoveries are published in the scientific literature
almost weekly. Another new NHGRI initiative in fiscal year 2012 will
pilot the use of genome sequencing in clinical care settings, an
important step towards implementing genomic medicine.
Complementing the genome sequencing initiatives, the NIH
Therapeutics for Rare and Neglected Diseases (TRND) program, which is
currently administered by NHGRI, aims to innovate and accelerate the
drug development pathway for rare and neglected diseases. As the TRND
pilot projects move toward their initial milestones, the first full-
scale project portfolio will be launched in collaboration with external
and internal partners. Likewise, the NIH Chemical Genomics Center
(NCGC) continues to serve as a national resource for the generation of
novel chemical ``leads'' to spur inventive directions in candidate drug
and biological assay identification. This statement is submitted with
the recognition of the Department's notification to the Congress of an
NIH reorganization that would establish a new National Center for
Advancing Translational Sciences (NCATS).
early opportunities for genomic medicine
The clinical promise of genomics requires strong foundational
knowledge about the structure and biology of genomes as well as the
biology of disease. Increasingly, genomics will be used to advance
medical science and to improve the practice of medicine.
Cancer genomics (as previously discussed) and pharmacogenomics (or
genomically guided medication prescription) are anticipated to be
leading-edge examples of genomic medicine. Successes of the latter
include the use of genomic information for making decisions about
administering the antiretroviral drug abacavir, now the standard of
care for HIV-infected patients. Other promising examples of
pharmacogenomics involve the use of patient genomic information to
target the application and dose of tamoxifen to treat breast cancer,
clopidogrel to treat cardiovascular disease, and the blood-thinner
warfarin. For cancer genomics, it is expected that genomic profiling of
tumors will become increasingly routine for making decisions about
treatment strategies.
Major advances in the study of common, genetically complex diseases
also have been seen recently. Over the past 5 years, more than 4,000
validated associations have been made between a genomic region and a
common disease (or another specific trait). Studies that identify and
provide evidence to support the value-added connections between genetic
factors and observed phenotype (physical traits, clinical symptoms,
etc.) require substantial investments in time, funding, and resources,
but are fundamental to translating genomics investments into clinical
applications. One such initiative, the Electronic Medical Records and
Genomics (eMERGE) Network, aims to advance the efficiency of this
scientific approach. This program will enter its second phase in late
fiscal year 2011, during which it will not only link patients' DNA to
their electronic medical record information, but also will explore the
challenges of using the information to inform clinical care in a
respectful, responsible manner.
The new NHGRI strategic plan identified several critical cross-
cutting elements that are integral to navigating successfully the path
to genomic medicine: bioinformatics and computational biology,
education and training, and the continued study of the societal
implications of genomics. The major bottleneck in genome science is no
longer data generation; rather, it is the computational analysis of
data. Beyond the research setting, the public, and especially
healthcare providers, need to become much more conversant in genomics.
To help address the needs of healthcare professionals, NHGRI has
launched online tools to support genetic and genomic training in health
professional education programs, including bilingual case studies.
Moving forward, translating basic genomic knowledge to improve
human health will continue to rely on innovative technology
development, large-scale collaborative and, increasingly, multi-
disciplinary efforts, and robust attention to the societal implications
of genomic advances. Demonstrating utility and feasibility will be
critical for widespread adoption of genomic medicine; the thresholds
for defining benefit and harm will vary across stakeholders and
cultural perspectives. However, overcoming the challenges that
accompany such a paradigm-changing venture is within reach. The
research and related programs that NHGRI will pursue over the next year
will continue to lay the groundwork for an era where individualized
genomic medicine will become a reality, and the original promise of the
Human Genome Project will be fulfilled.
______
Prepared Statement of Richard Hodes, M.D., Director, National Institute
on Aging
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Institute on Aging (NIA) of the National Institutes of Health (NIH).
The fiscal year 2012 budget includes $1,129,987,000 which is
$30,450,000 more than the comparable fiscal year 2011 appropriation of
$1,099,537,000.
The National Institute on Aging leads the national effort to
understand aging and to identify and develop interventions that will
help older adults enjoy robust health and independence, remain
physically active, and continue to make positive contributions to their
families and communities. We support a comprehensive portfolio of
genetic, biological, clinical, behavioral, and social research related
to the aging process, healthy aging, and diseases and conditions that
often increase with age. We also carry out the crucial task of training
the next generation of researchers who specialize in understanding and
addressing the issues of aging and old age.
Approximately 39 million people age 65 and older live in the United
States, and data from the Federal Interagency Forum on Aging-Related
Statistics indicate that their numbers will double within 25 years. In
less than 50 years, the number of ``oldest old''--people ages 85 and
older--may quadruple. As record numbers of Americans reach retirement
age and beyond, profound changes will occur in our economic,
healthcare, and social systems.
translational sciences and therapeutics development
NIA supports a comprehensive portfolio of research that builds upon
basic discovery to develop new preventive, diagnostic, and therapeutic
interventions for age-related diseases and conditions. For example,
investigators with the Alzheimer's Disease Neuroimaging Initiative
(ADNI) have found that changes in the structure of the hippocampus, a
brain area important to learning and memory, may reflect disease
progression and effectiveness of potential treatments, and have
established biomarker and imaging measures that may predict risk for
cognitive decline and conversion to dementia. Clinical, imaging, and
biological data from ADNI are available to qualified investigators
around the world; over 1,700 researchers have signed up for access to
the ADNI database, and global collaborations have resulted in over 170
published scientific papers since 2004.
NIA-supported research to identify Alzheimer's disease (AD)
biomarkers and gain a deeper understanding of the disease's pathology
and clinical course has made possible the first revision of the
clinical diagnostic criteria for AD in 27 years through a joint effort
of the NIA and the Alzheimer's Association. Unlike the criteria that
doctors and researchers have been using since 1984, the updated
guidelines cover the full spectrum of the disease as it gradually
changes over many years, from the earliest preclinical stages before
symptoms are apparent through mild cognitive impairment (MCI) and
advanced dementia. The new guidelines also address the use of imaging
and biomarkers to determine whether changes in the brain and body
fluids are due to AD.
Even under the new guidelines, however, diagnosis of AD remains
complex. NIA intramural investigators are working toward development of
an accurate, noninvasive, inexpensive blood test for AD. Last year,
they found that the amount of a protein called clusterin in the blood
of AD patients reflected the severity of disease, predicted the
progression of memory impairment, and may predict brain amyloid burden
long before the patient develops memory problems. These findings were
recently replicated by independent researchers, and research is ongoing
in this promising area.
A continuing translational research success story for NIH is the
ongoing development of the compound exendin-4. NIA intramural
investigators originally developed exendin-4 as a treatment for type 2
diabetes, but have since found that exendin-4 may act as a
neuroprotective agent in animal models, and they are now conducting a
phase II/III clinical trial of the compound in patients with MCI and
early AD. NIA also supports over 40 drug discovery and development
projects through our AD Translational and Drug Discovery Initiative,
including a number of AD pilot clinical trials.
Other NIA-supported researchers are pursuing the development of
interventions that will delay disease and dysfunction and even extend
lifespan. Investigators with the innovative Interventions Testing
Program found that the drug rapamycin, used to help prevent rejection
of transplanted organs in humans, extended life span in middle-aged
mice, and more recently demonstrated that the drug exerts beneficial
effects early in life. Rapamycin inhibits the mTOR pathway, which helps
regulate cell growth and proliferation. Building upon these findings,
in 2010 NIA began soliciting research to identify and characterize
molecular targets within the mTOR pathway with potential to impact
health span and lifespan.
NIA also partners with other agencies and organizations on
translational initiatives. For example, with the Administration on
Aging, NIA has established an initiative to support development of
evidence-based interventions, programs, policies, practices, and tools
that can be used by community-based organizations to help elderly
individuals remain healthy and independent in their own homes and
communities. NIA is also joining ``ambassadors'' from organizations
interested in the health and well-being of older people to promote
Go4Life, our new exercise and physical activity website
(www.nia.nih.gov/Go4Life.)
technologies to accelerate discovery
New GWAS (genome-wide association study) technologies are
transforming our understanding of the origins of disease and disability
by facilitating rapid comparisons of the full genomes of thousands of
individuals. This research may lead to the identification of novel
disease pathways that can be targeted to develop new treatments. In the
largest GWAS ever conducted in AD research, scientists with the AD
Genetics Consortium found that a previously unconfirmed gene variant,
BIN 1, affects development of late-onset AD and identified four
additional genetic variants significant for the disease. The genes
identified by this study may implicate pathways involved in
inflammation and the movement of proteins and lipids both within and
between cells as being important in the disease process. In a another
large GWAS, NIA intramural researchers joined an international research
consortium to confirm six previously identified genes for Parkinson's
disease and identify five new genes or loci (an area on the chromosome
where a gene is thought to be located).
A new NIA-supported initiative is underway to develop technologies
to better understand the life span and fate of cells in various tissues
of aged mammals. In these studies, cells are permanently marked at a
specific point in the organism's life and those marked cells are
followed to determine their fate and traits over time. These studies
will provide important insights into aging at the cell and tissue
levels.
using science to inform health care reform
Research that will lead to the identification of more effective and
less expensive clinical interventions is a high priority for NIA,
particularly through a broad portfolio of comparative effectiveness
research (CER). A major CER effort has been NIA's administration, on
behalf of the Agency for Health Care Research and Quality and the
Office of the DHHS Secretary, of an initiative identifying ways that
principles of behavioral economics could be used to encourage
healthcare providers to incorporate findings from CER studies into
their practices. Other ongoing CER studies include a randomized trial
of behavioral economic interventions to reduce risk of cardiovascular
disease; a study comparing various motivators to increase HIV
screening; and a study comparing the effects of an intensive exercise
program vs. stretching and range of motion exercises on ambulation in
hip fracture patients.
Surprisingly little definitive evidence exists on the impact
insuring the uninsured has on their health-related behaviors (including
healthcare usage) and outcomes. However, NIA-supported investigators
are currently taking advantage of a remarkable opportunity to develop
such evidence. For a brief period in 2008, Oregon opened a waiting list
for enrollment in its previously closed public health insurance program
for certain low income adults, and then offered randomly selected
people the opportunity to enroll. By comparing individuals who obtained
health insurance through this program with otherwise eligible
individuals who were not selected in the ``insurance lottery,'' the
investigators are assessing the impact of insurance on healthcare usage
and health outcomes, including the differing impacts on different
groups. Understanding the consequences of health insurance coverage
will be central to evaluating proposals to expand or modify health
insurance coverage in the United States.
Recently, NIA-supported investigators studying older populations in
the United States, England, and 11 European countries found that
retirement prior to age 65 was associated with a significant decline in
cognitive performance. The investigators suggest that this may be in
part because for many people retirement leads to a less stimulating
daily environment, and the prospect of retirement reduces the incentive
to engage in mentally stimulating activities on the job. It is possible
(although not yet proven) that the recent trend of American workers
delaying retirement may eventually lead to improved cognitive
performance in this group.
new investigators, new ideas
As the American population grows older, the need for healthcare
professionals who specialize in the unique needs of older individuals
is becoming ever more urgent. To address this increase in demand
effectively, we must foster the development of physician-scientists
whose research will lead to improved care and more effective treatment
options for older patients with complex medical conditions. Recently,
NIA established the Grants for Early Medical/Surgical Subspecialists'
Transition to Aging Research (GEMSSTAR) program to support physicians
who seek to become clinician-scientists in geriatric aspects of their
subspecialty. We anticipate supporting 18 to 20 emerging physician-
scientists in this program.
Once again, thank you. I welcome your questions.
______
Prepared Statement of Roger I. Glass, M.D., Ph.D., Director, Fogarty
International Center
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 President's budget for the Fogarty International
Center (FIC). The fiscal year 2012 budget of $71,211,000 reflects an
increase of $1,835,000 over the comparable fiscal year 2011
appropriation of $69,376,000.
When it comes to global health, there is no ``them''--only ``us.''
\1\ In an increasingly interdependent world, the United States and
nations around the globe share diseases, as well as the burden that
these diseases inflict on healthy people. In fact, the interests of the
American people are well-served when the United States promotes global
health, as healthy nations are more likely to succeed in economic
development and enjoy political stability. In addition, Americans have
a strong humanitarian tradition and have long supported efforts to
improve the health of people around the world. The U.S. Government
(USG) has recognized these realities, and has made global health a
national priority. For these investments to yield the maximum benefit
however, U.S. and foreign scientists must work together to generate the
scientific evidence that will inform how best to allocate resources.
These researchers will contribute the necessary local expertise and
knowledge to thwart pandemics and fight diseases that prevent societies
from achieving their full potential. They will also empower nations to
more effectively improve the health of their own populations. The
Fogarty International Center plays a unique role at the National
Institutes of Health (NIH) and in the USG by supporting the development
of global health research expertise in the United States and abroad.
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\1\ Global Health Council, Washington, DC.
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new investigators, new ideas
Research advances are more likely occur when investigators study
diseases onsite to develop health interventions that are responsive to
local and international priorities. Therefore, Fogarty supports long-
term research and training partnerships between United States and low-
and middle-income country (LMIC) research institutions, which has
resulted in the training of more than 5,000 researchers--many of whom
contribute to major scientific advances. For example, the first results
from a large clinical trial testing candidate microbicides that use
anti-retrovirals (ARVs) found that the incorporation of an ARV into a
vaginal gel was more than 50 percent protective against HIV infection
when used as directed. This advance is a key step toward empowering
women with a safe and effective HIV prevention tool. Notably, six of
the study's authors are current or former Fogarty-sponsored trainees.
To increase the pool of physicians who have the necessary skills to
conduct robust and critical health research, and to support country-
driven efforts that enhance the sustainability of gains made under
PEPFAR, Fogarty is also administering a major new program called the
Medical Education Partnership Initiative (MEPI)--a joint effort of the
Office of the Global AIDS Coordinator, HRSA, DOD, USAID, CDC, and NIH.
MEPI supports institutions in Sub-Saharan African countries and their
U.S. partners to develop new models of medical education, and to
strengthen the ability of medical students and faculty to conduct
research that responds to the health needs of their countries.
Non-communicable diseases--such as heart disease, stroke, cancer,
and diabetes--are in fact the leading causes of worldwide mortality,
accounting for 60 percent of all deaths. According to the World Health
Organization, 80 percent of this burden is in LMICs, where these
diseases affect people disproportionately during their most
economically productive years. Fogarty is addressing this challenge
through its expanded program on Chronic, Non-Communicable Diseases and
Disorders across the Lifespan, which will support training of in-
country scientists to conduct research on these diseases. Given the
high burden of non-communicable diseases in the United States,
knowledge gained from these research activities can inform domestic
efforts to prevent and treat these diseases--particularly in low-
resource settings.
Fogarty also supports the training of U.S. investigators to conduct
global health research and actively engage in international scientific
collaborations. These investments directly respond to the overwhelming
demand for global health opportunities on university campuses across
the United States, and are helping early career scientists to build
long-term relationships and acquire skills that will help to ensure
that the United States continues to be a global leader in health
innovation.
enhancement of evidence base for health care decisions
There is a tremendous gap between scientific advances and health
outcomes in the developing world. Therefore, there is an urgent need to
bridge the gap between what we know and what we do. Fogarty has
expanded support for research training in implementation science, which
generates knowledge and methods to better integrate research findings
and proven health interventions into health policy and practice.
For example without a significant shift in global prevalence
patterns, smoking is projected to cause roughly 8 million deaths
annually by 2030; notably, more than 80 percent of these deaths will
occur in LMICs. Fogarty's International Tobacco and Health Research and
Capacity Building Program addresses the critical role of research and
local research capacity in reducing the global burden of tobacco
consumption and the need to generate a solid evidence base that can
inform effective local tobacco control strategies and health policies.
The program supports epidemiological and behavioral research, as well
as prevention, treatment, communications, implementation, health
services and policy research. In Delhi, India, researchers are testing
the efficacy and cost-effectiveness of a community-based behavioral
intervention for tobacco cessation among youth living in low-income
communities. Such studies can inform efforts to curb adolescent smoking
in the United States--particularly in resource-poor settings.
Another example is Fogarty's International Implementation,
Clinical, Operational, and Health Services Research Training Award for
AIDS and Tuberculosis program, which supports training of scientists
and health professionals in developing countries to conduct research-
related to implementation of prevention, care and treatment
interventions for HIV and/or TB. Researchers supported by this program
recently made a significant discovery regarding the treatment of
patients with both HIV/AIDS and TB. In these resource-limited settings,
a high proportion of patients begin antiretroviral therapy (ART) while
on TB treatment, and paradoxical tuberculosis-associated immune
reconstitution inflammatory syndrome (TB-IRIS) is a frequent
complication of the ART. To address this disease management challenge,
investigators in South Africa found that a 4-week course of prednisone
reduced the need for hospitalization and therapeutic procedures, and
hastened improvements in symptoms, performance, and quality of life--
all without excess adverse events.
Fogarty has also partnered with the Bill and Melinda Gates
Foundation and the Foundation for NIH on a study that examines the
relationship between malnutrition and intestinal infections, and also
the consequences of these conditions on various aspects of child health
and development. Investigators across multiple international research
sites seek to facilitate the design of more targeted, cost-effective
interventions that will reduce the burden of child morbidity and
mortality from diarrheal diseases. One area of focus is the impact of
malnutrition, along with damage to the gut (from repeated and
persistent episodes of diarrheal disease), on the effectiveness of
childhood vaccines. In many low-resource settings, the immunity
conferred by various vaccines is significantly lower than in high-
income countries. A better understanding of the links between nutrients
and the health and function of the intestinal immune system will likely
lead to the development of targeted and modified vaccine formulations
and delivery strategies (e.g., dosing, schedules) for improved control
of intestinal infections.
technologies to accelerate discovery
With increasing globalization, the need to monitor, diagnose and
respond to epidemics has risen dramatically. Since 1998, Fogarty has
supported partnerships between the United States and LMIC research
institutions to increase the capacity of biomedical scientists to
design, access and use modern information technology in support of
health sciences research. These partnerships are training biomedical
and behavioral scientists, engineers, clinicians, librarians, and other
health professionals to access, manage, analyze, and share biomedical
information electronically. They are also training individuals who will
be capable of developing new informatics applications. This will
increase the ability of local scientists and institutions to conduct
multi-site clinical trials and perform international disease
surveillance and prevention programs. Several Fogarty-supported
informatics projects have now reached new levels of maturity, expanding
to form regional networks and leveraging tools and lessons learned to
benefit more researchers. For example, a program in Brazil is sharing
its materials with Mozambique, where Portuguese is also the national
language. Researchers in Peru are building a Latin American training
network, and a university in South Africa is forming a consortium to
strengthen biomedical informatics throughout Africa.
translational sciences and therapeutics development
Fogarty's International Cooperative Biodiversity Groups program
supports natural products drug discovery and ethnomedical and
botanicals research. Investigators supported by this program are
generating new and exciting leads from natural products that may result
in new therapeutics for a range of diseases. For example, a promising
new weapon in the war against malaria may come from seaweed found in
Fiji, as discovered by Fogarty grantee Dr. Julia Kubanek, a chemical
ecologist at the Georgia Institute of Technology. She and her team
discovered that a type of red algae in Fiji has strong anti-malarial
properties. Animal studies have begun to further explore the compound's
potential as a new therapeutic.
In conclusion, to effectively confront complex health issues that
transcend national boundaries, more scientific collaborations must be
developed and strengthened. Deep regional expertise enables Fogarty to
facilitate these scientific collaborations. In the context of advancing
science and health, Fogarty seeks opportunities to bridge differences
between countries that might otherwise not engage and to build trust by
encouraging scientists from around the world to work together to
address shared health challenges. These partnerships promote goodwill,
stability and peace, and effectively harness science for diplomacy. As
the world continues to become more interdependent, international
scientific partnerships will play a critical role in building bridges
and in improving health for people worldwide. Working in partnership
with rest of the NIH, Fogarty's unique programs will continue to enable
scientists in the United States and abroad to work together to tackle
the most pressing and complex health challenges of our time.
______
Prepared Statement of Dr. Kenneth Warren, Ph.D., Director, National
Institute on Alcohol Abuse and Alcoholism
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Institute on Alcohol Abuse and Alcoholism (NIAAA), of the National
Institutes of Health (NIH). The fiscal year 2012 budget includes
$469,197,000 for the NIAAA, which reflects an increase of $11,304,000
over the fiscal year 2011 level of $457,893,000, comparable for
transfers proposed in the President's request.
alcohol and healthcare--transforming the landscape
NIAAA-supported research is leading to dramatic changes in the
understanding of alcohol-related problems and their prevention and
treatment across the lifespan. By translating this research into new
and better prevention and treatment approaches we have the ability to
reduce the heathcare burden due to alcohol and enhance the well-being
of individuals, their families, and society-at-large.
scope of the problem
According to the World Health Organization, alcohol is among the
ten leading causes of death and disability worldwide; and according to
the Centers for Disease Control and Prevention (CDC), alcohol is also a
major cause of preventable death and disability in the United States.
As the United States. implements healthcare reform, it is important to
recognize that alcohol misuse costs our Nation an estimated $235
billion annually.\1\
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\1\ Rehm J, et al. The Lancet 373(9682): 2223-2233, June 27, 2009-
July 3, 2009.
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The consequences of alcohol misuse can affect both drinkers and
those around them at all stages of life. NIAAA's National Epidemiologic
Survey on Alcohol and Related Conditions (NESARC) estimates that almost
18 million people in the United States. ages 18 and older suffer from
alcohol abuse or dependence (collectively known as alcohol use
disorders, AUDs). The highest prevalence of alcohol dependence, which
encompasses a broad spectrum of disease ranging from a single episode
of a few years duration to a chronic relapsing disorder, occurs among
18-24 year olds. Of note, more than 85 percent of individuals with an
AUD do not have another drug use disorder. Returning war veterans
represent a particularly vulnerable population for developing AUDs that
co-occur with Post Traumatic Stress Disorder (PTSD) and other mental
health problems. Chronic, heavy alcohol use can damage tissues and
organs, most notably in the brain, liver, heart, pancreas, and
esophagus. According to the CDC, in 2007, alcoholic liver disease
accounted for over 14,000 deaths and in 2008 was responsible for nearly
20 percent of U.S. liver transplants.
Alcohol misuse can also have second hand effects, both direct
effects of alcohol exposure such as damage to the developing embryo due
to drinking by the pregnant mother, as well as indirect effects
experienced by individuals other than the drinker such as car crashes,
sexual assault, and violence. According to an analysis of NIAAA's
NESARC, one in four children grow up in a household where alcohol is a
problem, putting them at risk for short and long-term adverse physical
and psychological health outcomes.
Research to Practice
NIAAA-supported research is increasing our understanding of how to
identify and address alcohol-related problems across the lifespan.
Research shows that early identification and intervention are key to
reducing future health problems and can dramatically reduce healthcare
and other costs for individuals who misuse alcohol and those around
them.
The Value of Screening and Brief Intervention
The medical and economic value of screening and brief intervention
(SBI) to identify and address high risk drinking behavior early has
been well documented. In fact, according to an analysis in the American
Journal of Preventive Medicine, SBI for alcohol misuse was ranked
similarly in cost-effectiveness to screening for colorectal cancer and
hypertension, and to influenza immunization. Using NIAAA's A
Clinician's Guide: Helping Patients Who Drink Too Much, SBI can be
performed efficiently and effectively by primary care clinicians. By
intervening early, providers are able to offer their patients more
appealing, accessible options to address their alcohol problems,
options that are less resource intensive and less expensive than those
needed to treat more severe forms of dependence. For individuals who
want to assess and address their drinking behavior on their own, NIAAA
has developed an interactive Web site and booklet, Rethinking Drinking,
http://rethinkingdrinking.niaaa.nih.gov. These tools offer evidence-
based information about risky drinking patterns, the alcohol content of
drinks, and the signs of an alcohol problem, along with other resources
to help people who choose to cut back or stop drinking. Tools such as
Rethinking Drinking may benefit those who could ultimately recover from
dependence without treatment by decreasing the severity and duration of
dependence. For others it may provide the motivation to seek
professional help.
Underage and College Drinking
According to the Substance Abuse and Mental Health Services
Administration, more than one-fourth of 16-17 year olds drank in the
past 30 days, and 17 percent engaged in binge drinking, i.e. drinking
more than five drinks on an occasion. For 18-20 year olds, over one-
third engaged in binge drinking in the past 30 days. According to The
Surgeon General's Call to Action to Prevent and Reduce Underage
Drinking, each year underage drinking results in the death of about
5,000 people under the age of 21 from alcohol-related injuries. This
number is equivalent to the incoming freshman class at Virginia Tech,
and greater than the total student body at the United States Naval
Academy. Given the widespread use of alcohol and high prevalence of
binge drinking by children and adolescents, and the link between early
alcohol use and later problems including alcohol dependence, it is
important to identify children and adolescents who are at high risk for
alcohol use and/or alcohol use disorders. NIAAA will soon release an
easy to use two question screener and guide for pediatricians and other
clinicians who provide medical care to children and adolescents. This
empirically based screening instrument is devised to identify children
at elevated risk for using alcohol as well as those who have already
begun to experiment or are more heavily involved with alcohol. In
addition to identifying individuals who need any level of intervention,
health practitioners can also use the screening process to provide
information to patients and their parents about alcohol's effects on
the developing body and brain. In collaboration with other Federal and
non-Federal partners NIAAA will implement and evaluate the new guide.
Alcohol use is also a serious public health and safety problem
among college students with adverse consequences that range from poor
academic performance to alcohol poisoning. NIAAA has an ongoing
research focus on reducing college drinking and its consequences.
Research encompasses both individual approaches, such as screening and
brief intervention in college health centers, and environmental
approaches including studies on college and community policies. NIAAA
has also established a College Presidents Working Group to advise the
Institute.
Exploiting Technology to Improve Treatment
For those who need treatment, NIAAA seeks to provide more and
improved options. Individuals experience alcohol differently, for some
it provides almost immediate euphoria, others can drink much higher
quantities yet feel relatively little effect. Both types may be at risk
for developing alcohol dependence. Clinical trials with alcohol
dependent patients testing a variety of medications suggest that, just
as their physiological response to alcohol differs, so too does their
response to a specific treatment; and genes appear to be responsible,
at least in part, for these differences. Given that alcohol dependence
is a complex disorder influenced by multiple genes, along with the
evidence that specific treatments only work for subsets of individuals,
NIAAA continues to seek additional medications that target different
molecules and pathways in the brain. A number of medications currently
prescribed for other indications are being evaluated as
pharmacotherapies to reduce heavy drinking including: the mood
stabilizing drug quetiapine, the antiepileptic drug levetiracetum, the
smoking cessation drug varenicline and the anti-nausea drug
ondansetron. Recently, clinical trials with ondansetron revealed that
individuals with specific variations in a gene which encodes the
serotonin transporter respond better to treatment than individuals
without these variants. Similarly, individuals with a specific variant
in the mu opioid gene respond better to the FDA-approved alcohol
dependence treatment naltrexone than those lacking the variant. The
identification of additional medications, along with the knowledge of
what works for whom, will soon make personalized treatment for alcohol
dependence a reality. NIAAA's efforts to make testing of compounds more
efficient, its active role in engaging the pharmaceutical industry in
concert with its willingness to test novel compounds, and its work with
the FDA to improve guidelines and methodology for alcohol clinical
trials have greatly accelerated the pace of medications development for
alcohol dependence.
In parallel, NIAAA is exploiting technological advances in genomics
to determine the multiple underlying genetic signatures that contribute
to the range and severity of alcohol use disorders. As part of the next
NIAAA NESARC, DNA samples will be collected from an estimated 46,000
people for use in genome-wide association analyses. The level and
complexity of information derived from new, large-scale, comprehensive
genomic studies will facilitate our ability to correlate genetic make-
up with subtypes of alcohol dependence improving our ability to match
patients with treatments.
Treating the medical consequences of heavy chronic drinking is also
a priority. For example, currently liver transplantation is often the
only viable option for treating advanced liver disease but it is a
prolonged, expensive and risky process only available to patients who
maintain abstinence. To expand treatment options, NIAAA is supporting
studies to test a number of compounds that target progressive stages of
liver disease including fatty liver and liver fibrosis. In addition,
seminal research is providing a better understanding of why some
individuals develop liver cirrhosis whereas others who consume similar
amounts of alcohol do not. Over-activation of the body's natural repair
mechanisms may actually promote liver disease, suggesting new targets
for prevention and treatment of alcoholic and non-alcoholic liver
disease.
______
Prepared Statement of Stephen I. Katz, M.D., Ph.D., Director, National
Institute of Arthritis and Musculoskeletal and Skin Diseases
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget for the National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National
Institutes of Health (NIH). The fiscal year 2012 budget includes
$547,891,000 which is $14,002,000 more than the comparable fiscal year
2011 appropriation of $533,889,000.
introduction
NIAMS addresses diseases that affect individuals of all ages, of
all racial and ethnic backgrounds, and across all economic strata; many
disproportionately affect women and minorities. Some are rare
disorders, but many are very common, and all have a major impact on the
quality of people's lives. Twenty-five years of NIAMS-funded research
has contributed greatly to a variety of new treatment and prevention
strategies that are reducing the burden the diseases place on
individuals, their families, and society.
leveraging basic science to improve patient care
NIAMS research has been the basis for the development and testing
of many new medications, including biologic therapies for autoimmune
diseases. The newly approved drug belimumab, the first lupus treatment
to receive U.S. Food and Drug Administration approval in over 50 years,
interferes with a molecule that NIAMS-funded researchers showed to be
involved in the immune dysfunction that characterizes this disorder.
Other, more recent basic research results suggest another existing
drug, omalizumab, may prevent lupus-associated kidney damage. NIAMS
investigators in Bethesda, Maryland, are planning to start testing the
drug's safety for lupus patients soon.
Basic research into disease mechanisms also is explaining why some
therapies do not work as well as expected. In 2003, investigators were
baffled when two NIAMS-funded clinical trials showed that combining two
medications (a bisphosphonate and parathyroid hormone) that each
improve bone mass and prevent fractures did not help people any more
than either drug did individually. Eight years later, research into the
mechanisms by which bisphosphonates preserve bone revealed that they
interfere with parathyroid hormone's bone-forming activity. This
discovery can help physicians choose drug regimens that are best for
their patients.
developing tools to diagnose and monitor disease
Improvements in bone health have underscored the importance of
identifying which of the 40 million Americans \1\ who have low bone
mass are most likely to break a bone. Several large, NIAMS-funded
studies have indicated that spine fractures predict both future spine
fractures and debilitating hip fractures. Researchers recently
published evidence that women who have mild spine defects may also be
at risk of hip fractures and could benefit from lifestyle changes or
drugs that prevent bone deterioration. However, the ability to
distinguish between deformities related to fragile bones and those from
other causes is critical. If imaging tools that are under development
can make this distinction, clinicians will be better able to predict
patients' risk and monitor responses to therapies. Also, the new tools
potentially could reduce the cost of clinical trials by allowing
investigators to assess a medication's effects relatively quickly.
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\1\ Looker AC, et al. J Bone Miner Res. 2010 Jan;25(1):64-71. PMID:
19580459.
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Other researchers are testing whether a specific type of magnetic
resonance imaging can predict worsening of knee arthritis. Preliminary
work--using images that are available to the research community through
a public-private partnership supported by the NIH and various
companies--is promising. If confirmed, clinicians could use the
technology to identify patients whose knee cartilage is likely to
rapidly deteriorate due to osteoarthritis. Moreover, like the imaging
tools mentioned above, the discovery and validation of structural
changes that researchers can visualize could lead to shorter, more
efficient trials of promising disease-modifying agents that may help
the more than 27 million Americans \2\ who have osteoarthritis pain in
their knees or other joints.
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\1\*Lawrence RC, et al. Arthritis Rheum. 2008 Jan;58(1):26-35.
PMID: 18163497.
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Many diseases within the NIAMS mission involve pain, fatigue, and
other difficult-to-measure symptoms. A test to quantify changes in
these parameters could enhance clinical outcomes research and,
ultimately, clinical practice. NIAMS is one of several NIH components
engaged in the Patient-Reported Outcomes Measurement Information System
(PROMIS) initiative to develop such a tool. In addition to managing
PROMIS on behalf of the NIH, NIAMS encourages researchers to use the
resource. For example, NIAMS is funding a study to test questions for
fibromyalgia patients, along with information collected through PROMIS,
for development of disease-specific measures that allow investigators
and healthcare providers to monitor patients more effectively.
applying genetics, genomics, and other cutting-edge research to new
treatments
Researchers have been trying to determine for decades if pain and
itch send different signals to the brain. Difficulties distinguishing
the two symptoms at molecular and cellular levels had hindered this
effort, but a group of NIAMS investigators finally identified an itch-
specific molecule. Their work also illuminated a previously elusive
mechanism by which the itch message travels through the spinal cord to
be perceived by the brain. Such a discovery should pave the way for
studies into how chronic itch develops, and make it possible, for the
first time, to design better treatments.
Research is providing hope to patients with epidermolysis bullosa
(EB), a group of rare, inherited blistering skin conditions. When
investigators repaired the genetic defect in an EB patient, NIAMS-
funded scientists wondered if gene therapy might also work for another
form of the disease. The strategy seemed promising in a mouse model of
recessive dystrophic EB (characterized by large, painful blisters, open
wounds, and early death due to cancer). A first-in-human clinical trial
will begin this year.
NIAMS also is funding a Phase I clinical trial that suggests that a
different gene transfer approach may correct the molecular defect
underlying type-2 limb-girdle muscular dystrophy (LGMD-2D). The study,
supported through one of the Senator Paul D. Wellstone Muscular
Dystrophy Cooperative Research Centers, demonstrated that the procedure
could safely produce the corrected protein for at least 6 months. The
data provide a framework that investigators can use when designing
subsequent LGMD-2D clinical trials. Furthermore, researchers can
leverage the study's findings about immune responses as they develop
gene-based therapies for other diseases.
In the past 12 months, muscular dystrophy researchers also have
made considerable progress toward understanding the genetic
underpinnings of facioscapulohumeral muscular dystrophy (FSHD). Prior
findings from an NIH-funded FSHD patient registry showed that the
disease is associated with a shorter-than-normal series of repeated
genetic sequences. Recent technologic advances enabled researchers to
identify a genetic pattern within these sequences in FSHD patients.
This discovery, combined with findings that the defects cause FSHD by
activating a gene and allowing its product to accumulate in muscle, are
enabling new directions that will accelerate progress. For example,
researchers can now engineer animal models of the disease, something
that they could not do without a basic understanding of the genes
involved.
Like FSHD, many health problems are influenced by complex genetic
factors. Over the last few years, the ability of genome-wide
association (GWAS) approaches to identify gene variants related to
disease risk has matured from an intriguing concept to a widely used
scientific tool. These analyses can require thousands of patients, and
often entail data sharing among NIAMS-funded researchers and scientists
around the globe.
An international GWAS team including researchers at the NIH
Clinical Center showed that a gene involved in the body's immune
response underlies a person's susceptibility to a painful, inflammatory
condition called Behcet's disease, which primarily affects people of
Asian, Middle Eastern, Turkish, or European descent. The gene linked to
Behcet's disease is associated with other conditions for which
treatments exist or are being developed. Because of this connection,
therapies might be available sooner than if the investigators had found
a completely new disease mechanism.
In the past year, other genetic studies uncovered additional,
shared links among diseases. Investigators discovered that rare
variants of a gene encoding the enzyme sialic acid acetylesterase are
associated with rheumatoid arthritis and type 1 diabetes, and may play
a role in other autoimmune diseases. Likewise, researchers leveraging
the NIAMS-sponsored National Alopecia Areata Registry found that genes
associated with rheumatoid arthritis and type 1 diabetes are linked to
the development of alopecia areata, a disease in which the body's
immune system attacks the hair follicles and causes hair loss. As with
Behcet's disease, the possibility of a common mechanism is particularly
exciting because drugs under development for other diseases might also
be effective against alopecia areata.
GWAS also holds promise for understanding the genetic differences
that give rise to more common diseases, such as osteoporosis. The NIAMS
dedicated funds from the American Recovery and Reinvestment Act of 2009
toward developing a resource that investigators can use to identify
molecular changes that influence bone health. The discovery of gene
variants that protect against osteoporosis or increase a person's risk
of having low bone mass is likely to suggest targets that researchers
can pursue when exploring new ways to prevent fragility fractures.
Moreover, investigators could use genetic markers to identify
appropriate participants for clinical trials. Data from this effort is
likely to be available to the wider research community at the end of
this year.
conclusion
Twenty-five years ago, a few months after Congress passed the
Health Research Extension Act of 1985 (Public Law 99-158), the NIH
established the NIAMS. Over the past two and one-half decades, the
increased emphasis on research on arthritis and musculoskeletal and
skin disorders has benefited nearly every household in our Nation. We
are proud of the scientific advances that our researchers have made
toward helping people who have diseases of the bones, joints, muscles,
and skin, and are excitedly looking forward to the discoveries they
will make in the future.
______
Prepared Statement of Roderic I. Pettigrew, Ph.D., M.D., Director,
National Institute of Biomedical Imaging and Bioengineering
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Institute of Biomedical Imaging and Bioengineering (NIBIB) of the
National Institutes of Health (NIH). The fiscal year 2012 budget is
$322,106,000, which is $8,573,000 more than the fiscal year 2011
appropriation of $313,533,000. This statement is submitted with the
recognition of the Department's notification to the Congress of an NIH
reorganization that would establish a new National Center for Advancing
Translational Sciences and reallocate the remaining portions of the
National Center for Research Resources to other parts of NIH, including
NIBIB.
The mission of NIBIB is to improve human health by leading the
development and accelerating the application of biomedical
technologies. NIBIB invests resources in scientific and technological
research opportunities at the convergence of the quantitative and life
sciences, and in training the next generation of researchers. The
Institute is at the forefront of translating scientific advances into
engineered medical solutions. Ultimately, NIBIB seeks to realize
innovations that address healthcare challenges, reduce disease
mortality and morbidity, and enhance quality of life. To accomplish
this goal, NIBIB continues to fund bold and far-reaching projects that
facilitate discovery and translate basic science into new and better
healthcare.
translational science and therapeutics development
Biodegradable Home-Based Vaccination System.--Influenza is a major
cause of morbidity and mortality worldwide. Despite vaccination
campaigns, the CDC attributes 36,000 deaths and 226,000
hospitalizations per year in the United States to influenza, with an
associated cost of approximately $100 billion per year. The number of
cases could be greatly reduced if more people were vaccinated and if
the vaccine was more effective. Researchers at the Georgia Institute of
Technology are addressing both issues by developing a bio-dissolvable
micro-patch that will allow people to vaccinate themselves. The patch
is painless, has an application time of just seconds, has no
biohazardous waste, does not require refrigeration for storage, and
develops an enhanced immune response to flu. The patch combines cutting
edge technology and user-friendly simplicity to address this
significant public health problem.
Noninvasive Image-Guided Therapy: Focused Ultrasound.--NIBIB
supports research to develop and promote innovative image-guided
therapies. One of these technologies is High-Intensity Focused
Ultrasound (HIFU). HIFU is a non-invasive, image-guided and controlled
new therapy delivery system which consists of a highly focused beam of
high-intensity ultrasound that is capable of ablating tissue in a
targeted region of the body, without harming surrounding tissues.
Researchers are combining magnetic resonance imaging and HIFU to form
an image-guided therapy delivery system for non-invasive tumor
ablation, which can either replace or complement surgery or radiation
therapy. In addition, transcranial transmission of HIFU can also induce
the opening of the blood-brain barrier, which allows delivery of drugs
directly to specific locations in the brain. HIFU for treatment of
uterine fibroids is now an FDA-approved clinical procedure. These
developments could revolutionize surgery, cancer therapy and the
delivery of therapeutic agents in new targeted approaches.
Regenerative Medicine for Wounded Warriors.--The NIBIB is the lead
NIH institute for participation in the U.S. Military's signature Armed
Forces Institute for Regenerative Medicine (AFIRM), now in its third
year. AFIRM is a multi-institutional, interdisciplinary network to
develop advanced treatment options for our wounded servicemen and
women. Researchers are addressing many severe medical conditions
including burns, compartment syndrome, complex craniofacial injuries,
limb/digit salvage, and wound healing.
technologies to accelerate discoveries
Monitoring Tumor Cells and Cancer Biology.--NIBIB Quantum Grant
investigators have successfully developed a test capable of detecting a
single cancer cell among the billions of normal cells in a blood
sample. The microchip device, known as the HB-Chip (after the micro
herringbone pattern on the chip surface), enables the isolation of rare
circulating tumor cells that may be the source of cancer metastasis.
Subsequent molecular characterizations of these cells have led to the
discovery of several subtypes of prostate, breast, and lung cancer.
These subtypes serve as the basis for customized cancer treatments that
are tailored to specific patients. The isolation and characterization
of circulating tumor cells has the potential to revolutionize the
management of care in cancer patients. Recently, Johnson & Johnson
announced a partnership with the researchers at Massachusetts General
Hospital to further develop and market this blood test. ``Stand Up to
Cancer,'' an organization focused on translational cancer research, is
supporting four leading cancer centers to launch clinical trials using
the HB-Chip to determine the sensitivity and specificity of the device
for various cancers.
Global Technologies for Disease at the Point of Care.--NIBIB has
partnered with the Department of Biotechnology and the Ministry of
Science and Technology in India to support the development of low-cost
diagnostic and therapeutic technologies that will be used in
underserved communities worldwide. As the prevalence of chronic
diseases in low-resource settings increases, PATH (Program for
Appropriate Technology in Health, a nonprofit organization that
improves the health of people around the world) is working on new
initiatives to tackle diabetes. NIBIB-supported researchers are
evaluating cost-effective technologies to monitor and screen for
gestational and type 2 diabetes in India. These technologies are also
applicable to rural and low resource settings in the United States and
can lead to more effective interventions and therapies.
In the United States, about 500 mothers die every year during
childbirth, and in Africa, childbirth-related deaths are nearly 300,000
annually. Many of these deaths could be prevented if these populations
had ready access to ultrasound exams, which identify mothers at high
risk for birth complications. In addition, cardiovascular disease and
abdominal illnesses could be broadly monitored and managed with wide
access to ultrasound exams. NIBIB has supported the successful
development by GE of a hand-held battery powered portable ultrasound
system (VSCANTM) that costs approximately $8,000 but has the
features of a conventional hospital or office based system costing
approximately $200,000. The broad goal is to make ultrasound imaging as
available as stethoscopes, to facilitate earlier detection and
monitoring response to therapies.
technologies to improve evidence-based clinical decisions
Patients routinely receive their healthcare at multiple locations
ranging from physician's offices to major medical centers. For optimal
care, medical records and medical imaging studies must be readily
available at different sites. To address the need for sharing of images
and to enhance the adoption of evidence and comparative effectiveness
in clinical decisions, NIBIB has funded several coordinated projects.
Patient Controlled Web-Based Access and Sharing of Medical
Images.--A contract with the Radiological Society of North America
(RSNA) includes five academic institutions: UCSF, University of
Maryland, Mayo Clinic, University of Chicago, and Mount Sinai. Two
additional grants provide support to Wake Forest University and the
University of Alabama at Birmingham. Each of these projects is
developing an approach to patient-controlled medical image sharing
systems for secured image sharing among radiologists and clinicians
across organizational boundaries. The project at Wake Forest University
has a special focus on image sharing in rural and under-served areas.
Validation testing of patient health records that can accept images
with the appropriate controls and privacy safeguards has begun and will
start enrolling patients in the near future.
On Line Decision Support Systems.--NIBIB is providing resources to
the Brigham and Women's Hospital and the Massachusetts General Hospital
to implement information technology systems that include clinical
decision support capability. These systems enable the care providers to
make clinical decisions that are based on the best available evidence
and the patient's comprehensive medical data set, including clinical
images.
new investigators, new ideas
Nanoparticles for Improved Drug Delivery: Overcoming the Mucus
Barrier.--The delivery of bioactive molecules to target tissues can
significantly improve drug effectiveness while reducing side effects by
concentrating medicine at selected sites in the body. While the barrier
properties of mucus provide protection against infection and other
potentially toxic particles, they also have thwarted efforts to achieve
uniform and sustained drug delivery to mucosal surfaces, and have
likely prevented successful delivery of genes that could potentially
treat fatal diseases, such as cystic fibrosis. The work of NIBIB
grantee Dr. Justin Hanes at Johns Hopkins University seeks to
understand the properties of mucosal barriers and use this knowledge to
guide the development of polymeric nanoparticulate carriers capable of
more efficient drug and gene delivery to the respiratory tract, female
reproductive tract, gastrointestinal tract, surface of the eye, and
other mucosal tissues for improved therapies. The delivery of bioactive
molecules to target tissues can significantly improve drug
effectiveness while reducing side effects by concentrating medicine at
selected sites in the body.
Robotic Prostheses for Amputees.--Despite significant technological
advances over the past decade, state-of-the-art transfemoral prostheses
are unable to provide power for joint motion. The absence of joint
power significantly impairs the ability of these prostheses to restore
many locomotive functions, including walking upstairs and up slopes,
running, and jumping, all of which require significant net positive
power at the knee joint, ankle joint, or both. Dr. Michael Goldfarb, an
NIBIB Edward C. Nagy Young Investigator, recently reported the
development of the first robotic transfemoral prosthesis with fully
powered knee and ankle joints. The device allows above-the-knee
amputees to walk 25 percent faster with less energy than is expended
with conventional prosthetics and provides increased balance, agility,
and recovery reflexes to prevent falls. In April, Freedom Innovations
announced a worldwide licensing agreement for exclusive rights to
commercialize this device.
The Institute's emphasis on interdisciplinary approaches to
biomedical research has provided unprecedented opportunities for
collaborations among the life and physical scientists leading to
advances in biology and medicine through the quantitative, physical
sciences, and engineering perspective, as well as the development of
technologies that reflect the translation of biological mechanisms.
These advances will produce remarkable improvements in the health of
individuals around the world.
______
Prepared Statement of Alan E. Guttmacher, M.D., Director, Eunice
Kennedy Shriver National Institute of Child Health and Human
Development
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 President's budget request for the Eunice Kennedy
Shriver National Institute of Child Health and Human Development
(NICHD) of $1,352,189,000. This reflects an increase of $35,466,000
over the fiscal year 2011 level of $1,316,723,000.
In my short time as NICHD Director, the breadth and importance of
the Institute's mission have already impressed me. Our research changes
clinical practice and improves health for many people, particularly
those who may be under-represented in medical research--pregnant women
and their offspring; adolescents; and people with intellectual,
developmental, and physical disabilities. Our research shows that even
simple approaches can have significant impact. For example, a recent
study found that an inexpensive program teaching newborn care to
Zambian midwives reduced deaths in the first week of life by 40
percent. Today, I would like to highlight a few other examples of
NICHD's recent progress toward improving health, and describe a new
effort to position our research to continue to contribute to a
healthier Nation and world.
improving healthcare for women and children
Thanks partly to NICHD research, Centers for Disease Control and
Prevention (CDC) data show that the preterm birth rate in the United
States declined for the second year in a row in 2008. Still, 12 percent
of all pregnancies end in preterm birth, a leading cause of infant
death in our country. Preterm infants have greater risk for breathing
problems, life-threatening infections, cerebral palsy, and
developmental disabilities. In recent years, NICHD research showed that
treating pregnant women with a prior history of preterm birth with a
type of progesterone reduced their risk of another preterm delivery.
Now, a new study shows that a vaginal gel containing another type of
progesterone substantially reduces the risk of premature delivery in
women with a short cervix. With adoption of such treatments, the
preterm birth rate should drop further.
Spina bifida, which occurs when the fetal spinal column does not
close properly, affects nearly 1,500 U.S. infants a year, according to
the CDC. The most common and severe form of spina bifida,
myelomeningocele, can cause paralysis, problems with nerve function,
and brain damage. Recently, the NICHD reported an important trial, the
Management of Myelomeningocele Study (MOMS). MOMS researchers compared
standard surgical repair of the spinal cord after birth to repair while
the fetus is in utero. They found that repairing the spinal cord in the
womb greatly reduced risk of death and the need to divert fluid from
the brain. It also doubled the chance of walking and improved later
motor and cognitive development. Infants undergoing prenatal surgery,
however, were also more likely to be born preterm, and their mothers
more likely to experience a uterine tear in childbirth. While
researchers continue to study this specialized surgery, the initial
findings promise to improve the quality of life for thousands of
children.
New findings also can improve healthcare for women: NICHD
researchers recently showed that women's cholesterol levels correspond
with monthly changes in estrogen levels. On average, the total
cholesterol level of the women studied varied 19 percent over the
course of the menstrual cycle. Although previous data showed that
estrogen-containing oral contraceptives or menopausal hormone therapy
could affect cholesterol levels, this was the first study to show
conclusively that the cyclical levels of naturally occurring hormones
have similar effects. This natural variation suggests that clinicians
should consider the phases of a woman's monthly cycle when evaluating
her cholesterol levels and before prescribing treatment to help protect
women against heart disease.
new technoliges advance hope for autism and parkinson's
Autism spectrum disorder (ASD) encompasses a range of conditions
involving impaired social interactions and communication, atypical
behaviors, and health problems. While ASD is known to have genetic
components, researchers have not identified a consistent pattern of
variant genes. In fact, dozens of gene variants, along with other
factors, are now linked with ASD, complicating, but also advancing, our
understanding of the condition and ability to develop new treatments.
Using advanced imaging technology, NICHD-supported researchers
identified a gene that impairs communication between parts of the
brain. Additional genetic studies may reveal ASD subtypes and how
certain genes function and interact with each other. This research
could help individualize treatments based on a child's genetic profile.
New technologies also hold promise for other neurologic conditions,
such as Parkinson's disease, which results from a loss of brain cells
that help coordinate movement. NICHD-supported researchers injected
stem cells from the endometrium (lining of the uterus) into the brains
of mice with a laboratory-induced form of the disease. These new cells
took over the function of the brain cells eradicated by Parkinson's.
This is the first time that scientists showed endometrial stem cells
could assume the properties of the tissue into which they were
transplanted. Since endometrial stem cells are widely available, this
suggests that women with Parkinson's disease might serve as their own
stem cell donors, or healthy endometrial stem cells might be stored and
later matched to individuals with the disease.
translating science to advance rehabilation
Applying basic scientific findings to clinical problems can help
scientists develop new diagnostics or therapeutics for many conditions.
For instance, NICHD researchers seeking to understand how the vitamin
folate is metabolized found that the vitamin appears to promote healing
in rats with damaged spinal cord tissue. Up to 20,000 people yearly
suffer a spinal cord injury, and about 200,000 people currently live
with such injuries, according to the National Center for Injury
Prevention and Control. Folate, a B vitamin that naturally occurs in
leafy green vegetables and other foods, plays an important role in
early embryonic brain and spinal cord development. Further
translational studies on folate could lead to new techniques to help
regenerate nerve fibers and heal damaged nervous system tissue.
the national children's study (ncs)
The NCS is designed to examine the effects of genetic factors and a
broad range of environmental factors such as physical environment and
family, community, and cultural influences on the development and
health of children in the United States over time. The NCS will yield a
rich repository of environmental and genetic/genomic data and
biospecimens that can be mined by scientists for years to come and help
answer questions concerning the earliest origins of health and disease.
Over the past year, the NCS has been in a pilot phase, known as the
``Vanguard Study,'' enrolling about 650 children in 37 sites as of
February 2011. Three separate recruitment strategies are being tested
to optimize participation and cost management. During the coming year,
a range of experts will review ongoing findings, allowing staff to
develop, by late summer 2011, evidence-based cost-estimates and
recommendations for the initial phase of the Main Study.
vision for the future
The NICHD has embarked on crafting a vision for the future that
inspires the institute and its partners to achieve critical scientific
goals and meet pressing public health needs. In early 2011, in a series
of workshops, we asked leading scientific and health experts to
identify what the scientific future should look like in 10 years and
what knowledge must be obtained to reach these new frontiers. We
focused on such areas as plasticity, development, cognition, behavior,
reproduction, pregnancy and pregnancy outcomes, developmental origins
of health and disease, environment, and diagnostics and therapeutics.
Resultant white papers are posted on our website for additional public
comment. In June, we will assemble another diverse group of experts to
refine these concepts and identify those that are most promising. We
will publish the final vision document by early 2012, helping to ensure
that NICHD addresses the most important science for the Nation's women,
children, families, and individuals with special needs.
Mr. Chairman and members of the Committee, thank you for your
continued support of NICHD's important work. I would be pleased to
respond to any questions.
______
Prepared Statement of Nora Volkow, M.D., Director, National Institute
on Drug Abuse
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Institute on Drug Abuse (NIDA). The fiscal year 2012 budget of
$1,080,018,000 includes an increase of $30,377,000 over the comparable
fiscal year 2011 level. The following statement updates NIDA's
scientific progress in addressing drug abuse and addiction. These
public health problems cost our society more than $600 billion annually
in health- and crime-related costs and losses in productivity, not to
mention incalculable personal and social devastation (ONDCP 2004; Rehm
et al. 2009; CDC 2007). NIDA has crossed a threshold into a new
research era, unprecedented in its scope, and transformative in its
prevention, treatment, and policy implications for substance use
disorders (SUDs).
return on investment: technologies to speed discovery
New technologies and scientific breakthroughs continue to generate
actionable information about the genetics, chemistry, and circuitry of
the human brain. This knowledge has dramatically enhanced our
understanding of the underlying vulnerabilities and the long-term
effects of addiction on neurophysiology and behavior. Continuing
advances in DNA sequencing and analytical tools have transformed the
landscape of genomic exploration. For example, we can now engage in
high resolution and accurate sequencing of vast genomic tracts, from
many different individuals, to systematically search for and identify
addiction risk variants, which may open up new targets for medications.
Also, we are dissecting the epigenetic processes that can affect gene
expression through persistent but reversible changes. Epigenetics
research has started to help explain the deleterious impact of known
environmental risk factors, like poverty or chronic stress, on
vulnerability for SUDs. The burgeoning availability of genetic,
epigenetic, and environmental data heralds new opportunities for
translational applications. NIDA is committed to optimizing this
potential through harmonization efforts that help ensure the
comparability of pooled data.
Harmonized databases are crucial for individualized medicine. This
is clear in the genomics field, but also in the emerging field of
globally connected biomarkers, or the ``human connectome,'' and for
brain imaging. NIDA is supporting research to develop biomarkers to
screen for drug exposure and addiction vulnerability that would be more
accurate, reliable, and sensitive than current tests (i.e. bodily
fluids, hair, questionnaires) and would help transform the way SUDs are
identified and treated.
Other innovations, such as wireless remote sensing and virtual
technologies, offer opportunities for transforming how prevention
messages, real-time monitoring, and even some treatment modalities are
delivered to the public. Having real-time, objective measures of drug
use could have a huge impact on SUD treatments. One example is remote
physiological monitoring (RPM), a rapidly evolving form of telemedicine
that can track patients' health status (e.g., heart rate, blood
pressure, skin temperature, and glucose levels) remotely, using devices
that can store and transmit the results in real-time. NIDA is
supplementing studies on the use of RPM for monitoring drug use to
evaluate the effects of treatment interventions and their relationship
to clinical outcomes. Such data could support the establishment of non-
abstinence endpoints, which in turn could inform the Food and Drug
Administration (FDA) addiction medications approval process.
emerging psychoactive threats to public health
The past few years have witnessed several alarming trends,
particularly prescription drug abuse. Although opioid analgesics are
among the most effective medications for pain management, they are also
associated with serious and growing public health problems, including
drug abuse, addiction, and overdose deaths. The Substance Abuse and
Mental Health Services Administration reports a six-fold increase in
treatment admissions for opioid analgesics, from nearly 20,000 in 1998
to about 120,000 in 2008, while the Centers for Disease Control and
Prevention acknowledge that unintentional poisonings involving opioid
analgesics have more than tripled from 1999 through 2007, exceeding the
total number of deaths involving heroin and cocaine. These trends
illustrate the challenge of balancing access to critical medications
for those who need them and preventing their abuse, particularly when
the public does not perceive their dangers and has much greater access
to them from a decade-long surge in availability. In 2009, 202 million
opioid prescriptions were dispensed in the United States making opioids
the most prescribed class of medications. NIDA is committed to helping
reverse this trend by providing information on the patterns and
motivations behind their abuse, sponsoring research on developing pain
medications with less abuse potential, and creating curricula to
minimize diversion through better prescribing practices.
Lingering public misperceptions, particularly among youth, continue
to hinder our marijuana prevention efforts. The latest Monitoring the
Future survey of 8th, 10th, and 12th graders reveals that daily
marijuana use is up for all grades. These teens are not only at higher
risk of becoming addicted, but they are functioning below optimal level
at a time when their future depends on peak cognitive performance. Why
is this happening now? We do not know for sure, but it is reasonable to
infer that the public debates surrounding medical marijuana have
increased confusion and lowered the perception of risk, an important
factor in curtailing use.
Meanwhile, new drugs routinely emerge and gain rapid notoriety
thanks to the Internet. Recent examples include ``bath salts'' and
``spice,'' which are synthetic stimulants and cannabinoids,
respectively.
improving public healthcare--delivery and performance
NIDA will continue to leverage our knowledge base into better
strategies for battling addiction. To further this goal, NIDA takes
advantage of collaborative research infrastructures designed to deploy
proven strategies rapidly and effectively. For example, NIDA's Drug
Abuse Treatment Clinical Trials Network (CTN) tests evidence-based
treatments in community settings with diverse patient populations,
optimizing the utility and cost-effectiveness of treatments and
fostering their adoption. Similarly, NIDA's Criminal Justice-Drug Abuse
Treatment Studies (CJ-DATS) network promotes multilevel collaborations
to bring proven treatment models into the criminal justice system,
disproportionately affected by both drug abuse and HIV. These
infrastructures allow for the broad testing of promising new
strategies. One example, called ``Seek, Test, and Treat,'' has great
potential to improve the public health by expanding access to HIV
testing and treatment, and ultimately reducing HIV spread.
Another cornerstone of our strategy is to engage physicians as
``frontline'' responders to patient substance abuse, providing the
science-based tools they need to identify potential substance abuse in
their patients and offering better options for treatment. Recent
research shows, for example, that compared with methadone,
buprenorphine results in fewer neonatal abstinence symptoms among
babies born to opioid-addicted mothers, and is associated with
decreased hospital stays and thus, costs. To bolster education in the
treatment of pain, NIDA is leading a multi-Institute effort to create
Centers of Excellence (CoEs) to develop curricula for medical students,
nurses, resident physicians, and others. Part of our NIDAMED physician
outreach initiative, CoEs have also developed and are helping to
disseminate substance abuse training curricula, woefully neglected in
most medical training. NIDA continues to encourage physician screening
of drug abuse with the help of a Web-based interactive screening tool
that generates clinical recommendations. The broad availability of
these resources is an important step toward integrating substance abuse
screening, brief intervention, and referral to treatment (SBIRT) into
medical care, which will enable better healthcare decisions and
outcomes.
translation--therapeutics development
To help those affected by the disease of addiction, we need to
expand the pharmacological and behavioral tools available to treat
SUDs. Thus, medications development is one of the main areas that
benefits from new discoveries. For example, the century-old practice of
vaccination has recently been found to be a viable approach for
treating addiction. In this case, the body itself is coaxed to produce
antibodies that bind a drug while still in the bloodstream, blocking
its psychoactive effects in the brain. Already, a nicotine vaccine that
reduces craving and withdrawal symptoms is in advanced stages of
development and will be market-ready following approval by the FDA.
Another strategy has been the development of long-acting, or depot,
formulations of medications that serve to overcome poor compliance. One
example is Vivitrol, an extended-release opioid antagonist
(naltrexone), recently FDA-approved for treating opioid addiction. NIDA
is now testing the use of depot medications in high-risk groups, such
as criminal justice offenders, and in regions of the world that have
high rates of HIV infection and are resistant to treatment with opioid
agonist medications.
In parallel, NIDA is supporting research on drug combinations, an
effective strategy for treating many diseases (e.g., HIV/AIDS, cancer)
and one starting to show success with addiction. For example, the
combination of lofexidine (a hypertension medication) and marinol (a
synthetic form of marijuana's THC) shows promise in treating withdrawal
symptoms among marijuana-addicted individuals. Early results also
suggest that a buprenorphine-naltrexone combination could be effective
in treating cocaine addiction.
new investigators, new ideas
To help sustain our commitment to the next generation of biomedical
research scientists, NIDA supports multiple training initiatives at
various career levels and areas of need (e.g., physician scientists,
computational neuroscience, and medicinal chemists). Examples include
efforts aimed at mentoring minority investigators and international
HIV/AIDS researchers, as well as multi-Institute training programs. To
identify and encourage the next generation of addiction scientists,
NIDA also awards special prizes at the annual Intel International
Science and Engineering Fair to high school students whose projects
exemplify excellent achievement in addiction science.
In closing, NIDA pledges to continue to tackle the emerging and
significant public health needs related to drug abuse and addiction,
taking advantage of unprecedented scientific opportunities to close the
gaps in our knowledge base and develop and disseminate more effective
strategies to prevent and treat drug abuse and addiction.
______
Prepared Statement of James F. Battey, Jr., M.D., Ph.D., Director,
National Institute on Deafness and Other Communication Disorders
Mr. Chairman and Members of the Subcommittee: I am pleased to
present the President's budget request for the National Institute on
Deafness and Other Communication Disorders (NIDCD) of the National
Institutes of Health (NIH). The fiscal year 2012 NIDCD budget of
$426,043,000 includes an increase of $11,244,000 over the comparable
fiscal year 2011 appropriation of $414,799,000. This statement is
submitted with the recognition of the Department's notification to the
Congress of an NIH reorganization that would establish a new National
Center for Advancing Translational Sciences (NCATS).
The NIDCD conducts and supports research and research training in
the normal and disordered processes of hearing, balance, smell, taste,
voice, speech, and language. Our Institute focuses on disorders that
affect the quality of life of millions of Americans in their homes,
workplaces, and communities. The physical, emotional, and economic
impact for individuals living with these disorders is tremendous. NIDCD
continues to make investments to improve our understanding of the
underlying causes of communication disorders, as well as their
treatment and prevention. It is a time of extraordinary promise, and I
am excited to be able to share with you some of NIDCD's ongoing
research and planned activities on communication disorders.
affordable hearing healthcare
Hearing loss is a serious public health issue and has significant
social and economic impacts. Approximately 17 percent of American
adults, or 36 million individuals, report a hearing loss, and only
about one in five of those individuals who could benefit from a hearing
aid wears one. Additionally, hearing healthcare and hearing aids are
only rarely covered by health insurance, and are not covered by
Medicare. A recent industry survey found that the average cost per
hearing aid to an individual is $1,600, and for many, the cost is much
higher. Hearing aids are also consumable devices, often requiring
replacement every 4-6 years, and frequent battery replacement. This
makes hearing aids potentially the third highest cost item for an
individual, following just behind the purchase of a home and car. In
2009, NIDCD sponsored a workshop, Accessible and Affordable Hearing
Health Care for Adults with Mild to Moderate Hearing Loss, to examine
the factors that contribute to hearing healthcare access,
affordability, and usage; and to develop a set of research objectives
which could be explored in the future. Based on the recommendations,
NIDCD published several targeted research initiatives for hearing
healthcare: to explore new approaches that could lead to improved
access, assessment, and intervention; to develop methods to determine
the success of new or improved approaches; and to create small business
technologies to improve access for underserved patients. The research
supported through these and other NIDCD-sponsored efforts will enhance
the evidence-base for hearing healthcare decisions, and provide a
strong research base for future policy decisions related to affordable
hearing healthcare.
tinnitus
Tinnitus--a perceived ringing, buzzing or roaring in the ears--is a
major public health concern, affecting more than 25 million American
adults. It can range in severity from a mild condition, requiring no
medical intervention, to a severe debilitating disease with significant
physical, emotional, and economic impacts. The Department of Veterans
Affairs reports tinnitus as the most prevalent service-connected
disability for veterans receiving disability compensation. More than
744,000 veterans received service-connected disability compensation for
tinnitus in fiscal year 2010, presenting a significant cost burden for
the Nation. Past research has shown that tinnitus is often associated
with hearing loss; however, little is known about the specific neural
dysfunctions that lead to the disorder. There are also limited
treatment options available, and their effectiveness varies widely. In
response to this need, NIDCD is supporting a strong research portfolio
on tinnitus. In 2009, NIDCD sponsored a research symposium, Brain
Stimulation for the Treatment of Tinnitus, to explore the potential
translation of existing brain stimulation technologies for the
treatment of tinnitus. Recently, NIDCD supported scientists have
demonstrated that stimulation of the vagus nerve (a large nerve that
runs from the head to the abdomen) with an implantable electrode, in
combination with the playing of tones, is able to ``reset'' the brain,
eliminating tinnitus in a rat model of the disease. (Vagus nerve
stimulation is already in use for the treatment of epilepsy and
depression in more than 50,000 individuals). By varying the tones
played and the co-stimulation of the vagus nerve, scientists were able
to abolish the tinnitus sensation and restore the normal function of
the brain. These exciting findings are the first demonstration of a
treatment that specifically erases the tinnitus, rather than simply
masking the sound or providing coping mechanisms for the individual.
Scientists are now working to translate these findings from the animal
model into a novel therapeutic strategy for people with severe
tinnitus.
vestibular prosthesis
Based on the recent 2008 National Health Inventory Survey, Balance
and Dizziness Supplement, about 15.5 percent of U.S. adults, or about
33.6 million individuals, reported they had a problem with dizziness or
balance in the past 12 months. Balance disorders are one of the reasons
older people fall, and falls and fall-related injuries, such as hip
fracture, can have a serious impact on an older person's life. One
balance disorder which has been particularly difficult to treat is
Meniere's disease. This disorder causes severe dizziness (vertigo),
tinnitus, hearing loss, and a feeling of fullness or congestion in the
ear. NIDCD estimates that approximately 615,000 individuals in the
United States are currently diagnosed with Meniere's disease and that
45,500 cases are newly diagnosed each year. While many individuals are
able to manage the symptoms associated with Meniere's disease through
diet, drugs, or surgery, up to 2 in 10 do not find adequate relief from
their symptoms after exhausting all treatment options. NIDCD-supported
scientists are working to adopt cochlear implant technologies to
produce a vestibular implant that could counteract vertigo attacks that
persist despite other treatments. Scientists have already demonstrated
the ability of a vestibular implant to induce, and provide recovery
from, vertigo attacks in animal models of Meniere's. Most recently,
scientists have translated this technology to humans and performed
their first implantation into an individual. While clinical trials are
still several years away, this recent breakthrough provides hope to
many for whom traditional treatments have failed.
stuttering
The popularity of the recent Academy Award winning movie, ``The
King's Speech,'' has brought to light the communication challenges
faced by approximately 3 million Americans each day. Stuttering can
affect individuals of all ages, but occurs most frequently in young
children between the ages of 2 and 6, with boys 3 times more likely
than girls to stutter. Most children, however, outgrow their
stuttering, and it is estimated that less than 1 percent of adults
stutter. For those individuals who continue to stutter into adolescence
and adulthood, there are limited treatment options. NIDCD supports a
research portfolio on stuttering to understand the underlying genetic,
neurologic, and physiologic causes of stuttering, to predict which
children will continue to stutter, and to develop novel and effective
therapies for treatment of stuttering. Recently, NIDCD intramural
scientists pinpointed the first specific genes that underlie
stuttering. Building on previous studies which identified a genetic
region linked to stuttering, and harnessing new technologies in genetic
sequencing, the researchers found mutations in three genes important in
the recycling of cellular breakdown products inside cells. Different
mutations in two of these genes are related to severe metabolic
disorders, called mucolipidosis II and III, which cause joint,
skeletal, heart, liver, and other health problems, including speech
problems. The findings may result in the development of new drug
therapies for individuals who stutter.
olfactory deficits early warning of alzheimer's disease
For several years, it has been know that individuals with
Alzheimer's disease (AD) often exhibit an impaired sense of smell
(olfaction), making a smell screening test an attractive opportunity
for development as a biomarker of disease. However, it was not known
why AD impacts olfaction. Recently, NIDCD-supported scientists used a
mouse model of AD to identify pathological changes in the olfactory
system very early in the animals' lives, indicating a sensitivity of
the olfactory system to this type of damage. These changes manifested
well in advance of the onset of changes in other areas of the brain
involved in memory, and were predicted by the animals' performance on a
smell discrimination task. In addition, NIDCD-supported scientists have
used brain imaging of humans to examine changes in brain activity
during smell discrimination tasks. These imaging studies have
identified a significant blunting of response in individuals with AD.
Both of these discoveries could lead to new, non-invasive tools to
enhance the early diagnosis of AD, and better inform healthcare
decisions for affected individuals.
new strategic plan for nidcd
NIDCD has initiated the development process for a new Strategic
Plan. In March 2011, NIDCD convened a series of working groups of
scientific experts in the smell and taste; voice, speech, and language;
and hearing and balance fields to advise us on emerging scientific
opportunities in four priority areas: understanding normal function of
communication systems; understanding diseases and disorders of
communication systems; improving diagnosis, treatment, and prevention
of communication disorders; and accelerating translation of research
findings into practice. In addition, we remain committed to continuing
our leadership in fostering the development of new investigators in the
communication sciences. Our staff is currently working to compile these
priority areas into a document that will guide our research investments
from fiscal year 2012 through 2016. A draft will be made available for
public comment later this year and we anticipate publication of our new
Strategic Plan in January 2012.
Mr. Chairman, I would like to thank you and Members of this
Subcommittee for giving me the opportunity to present examples of
recent research progress and to highlight some programs made possible
through your support of the NIDCD.
______
Prepared Statement of Dr. A. Isabel Garcia, D.D.S., M.P.H., 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) of the National Institutes of Health
(NIH). The fiscal year 2012 budget request for NIDCR is $420,369,000,
which reflects an increase of $11,113,000 over the fiscal year 2011
enacted level of $409,256,000 comparable for transfers proposed in the
President's request.
The NIDCR goal of improving the Nation's dental, oral, and
craniofacial health is an ambitious one. It demands that we address the
wide array of diseases and conditions that affect the oral cavity and
craniofacial structures, including diseases such as dental caries
(tooth decay) and periodontal diseases that are endemic in the United
States, as well as birth defects such as cleft lip and palate, chronic
oral-facial pain conditions, oral and pharyngeal cancers, and oral
manifestations of systemic diseases, such as Sjogren's syndrome,
diabetes, and HIV infection. NIDCR is committed to identifying
effective preventive, diagnostic, and treatment approaches for these
diseases and conditions. Today, I will describe how we are investing in
basic discovery and preclinical studies across these myriad areas and
applying new knowledge to the development of clinical trials and
studies in humans.
accelerating basic discovery
Joshua Lederberg, who shared the 1958 Nobel prize for discovering
that bacteria can mate and exchange genes, once quipped about microbes
that ``you know one when you see it.'' The problem, he explained, is
that microbes were largely ``invisible'' and noticed only after their
damage had been wrought. NIDCR-supported researchers and others
recently identified--made ``visible''--more than 600 distinct microbial
species as residents of the human mouth. NICDR scientists are also
systematically exploring how the individual bacterial species assemble
into biofilms. Biofilms are the living, mat-like microbial communities
found on many parts of the human body, including our teeth and gums,
and play a major role in the development of dental and oral disease.
Microbial biofilms can form on any surface, including on medical
devices, and are implicated in more than 80 percent of human
infections. The oral cavity offers tremendous potential both as a
diagnostic window and an easily accessible model for research aimed at
understanding the host of bacteria associated with biofilm-mediated
disease throughout the body. Researchers now possess the tools to
extract a biofilm sample and determine the identities of most of its
microbial inhabitants.
Recently, NIDCR grantees devised a new fluorescent imaging system
that successfully distinguished among 28 oral microbes within a single
field of view and that soon will be able to distinguish among at least
100, providing spatial analysis in three dimensions. Enhanced imaging
of the oral biofilm will accelerate discovery in studies of biofilm
formation, organization, and composition and thus the keys to their
control. This structural understanding will form the basis for research
aimed at development of tools to combat oral and other infectious
diseases and improve health.
An NIDCR grantee and colleagues recently performed a novel type of
systematic genetic analysis to better elucidate microbial behavior. The
researchers collected over 4,000 mutant bacterial strains and tested
them in 324 different environmental conditions. Pulling all the data
together, the scientists gained a fuller understanding of the
functional molecular networks governing bacterial response. They also
gleaned new information about a gene involved in antibiotic resistance
and the synergy of three common antibiotic drugs.
Both of the exciting advances described above were spearheaded by
young investigators on NIDCR training grants, offering prime examples
of the vital importance of continuing to support new investigators and
new ideas. NIDCR is committed to developing and strengthening the
workforce of researchers that can leverage the latest tools of
discovery and are dedicated to solving urgent problems in oral, dental
and craniofacial health. To enhance this critical pipeline further,
NIDCR continues to create innovative new training and career programs,
such as a new transition path for clinical researchers, as well as an
initiative to catalyze the formation of multidisciplinary teams led by
new investigators researching temporomandibular disorders and orofacial
pain.
translating basic science into improved public health
Advances in studying oral microbial communities have the potential
for rapid impact on research for new, more personally targeted,
clinical treatment. A team of NIDCR-supported scientists recently
reported that a microbe called Scardovia wiggsiae appears to be linked
with severe forms of early childhood caries (ECC), the most prevalent
chronic childhood disease in the United States. For decades, the oral
bacterium Streptococcus mutans has been singled out as the primary
pathogen involved in ECC. The scientists found that S. wiggsiae often
was present in children with decayed teeth in the absence of S. mutans.
The discovery of this bacterium's role in ECC offers a future target in
efforts to identify children at risk and to prevent or stop progression
of this disease before it leads to destruction of the teeth.
The burden of craniofacial, oral, and dental disease, particularly
untreated disease, falls heaviest on lower socioeconomic status (SES)
groups, which include disproportionately large numbers of racial and
ethnic minorities. Researchers, including those at the five NIDCR-
supported Centers for Research to Reduce Disparities in Oral Health,
continue working to identify creative, practical approaches to deal
with pressing oral health issues, including ECC and oral and pharyngeal
cancer. These approaches must be inexpensive, easily applied, and
readily tailored to meet individual and community needs. Three of these
Centers recently initiated clinical trials to test new interventions to
prevent ECC among American Indian and Hispanic children and in
residents of public housing. Children in low SES families are
particularly vulnerable to ECC's painful and costly impact. Three
additional trials will launch in fiscal year 2012.
enhancing the evidence base for oral health care
Tackling real-world clinical issues and generating evidence that
will be of immediate value to practitioners and patients is the central
goal of the NIDCR-supported dental Practice-based Research Networks
(PBRNs). Conducting research in dental practices draws on the
experience and insight of practicing clinicians to help identify and
frame research questions. Because PBRN studies address practice-based
problems, their results tend to be more quickly translated into daily
clinical care.
Leveraging the infrastructure of established dental practices for
conducting PBRN studies also can be a powerful and cost-effective means
to conduct clinical research. For example, the past decade brought
reports that people who take bisphosphonates, a class of drug
prescribed for osteoporosis or to treat the bone-wasting effects of
cancer, can develop osteonecrosis (bone death) of the jaw, or ONJ. To
address the problem, the three regional PBRNs, taking advantage of
their presence in practices spanning multiple States, teamed up to
carry out a collaborative study on ONJ. The study results, published in
2010, confirmed that bisphosphonate use is a risk factor for ONJ, and
provided additional important evidence to guide clinicians in their
treatment of this challenging condition.
In fiscal year 2012, NIDCR will launch a new National Dental PBRN.
This single network, more national in scope and more representative of
a greater variety of practice settings, will provide a framework to
study and improve the delivery of oral care and will build upon the
collaboration among the regional networks that was crucial to the
successes to date. Critical to this effort is an improved capacity to
collect data electronically. Using an adaptable electronic platform for
enhanced connectivity, data sharing, and communication within and
between networks will help providers conduct research effectively and
efficiently and strengthen the PBRN enterprise.
developing new clinical treatments
Each year, about 400,000 people worldwide are diagnosed with cancer
in the head and neck region. In an effort to identify new treatments
and improve the stagnant 5-year survival rate that hovers only slightly
above 50 percent, NIDCR scientists focused their research on the
immunosuppressive drug rapamycin. This research is now moving from the
basic and preclinical phases, which included studies in an NIDCR-
developed mouse model, to clinical studies. By fiscal year 2012,
scientists will be recruiting subjects for a clinical trial to assess
rapamycin's safety and efficacy in humans.
Research is also needed to combat harmful treatment side effects
for head and neck cancers. Many patients with head and neck cancers
will receive radiation therapy, which has the significant long-term
side effect of xerostomia (dry mouth). The salivary glands, damaged by
the radiation used to kill nearby tumor cells, can become less
permeable to the fluid that naturally flows through them and yield less
saliva, or stop working altogether. Many functional and quality-of-life
problems occur when oral tissues are deprived of saliva's protective
properties, including difficulty chewing and swallowing, burning mouth,
and greater risk of dental caries and oral fungal infections. Despite
continuing efforts to eliminate this problem, many patients continue to
suffer.
Moving from bench to bedside, NIDCR scientists began the first
gene-transfer study in people with radiation-induced xerostomia. The
transferred gene, Aquaporin-1, encodes a protein that conveys fluid by
forming pores, or water channels, in the cell membrane. The study
assesses whether the transferred gene will open water channels in the
duct cells, allowing the rapid movement of water through the duct. In
fiscal year 2012, NIDCR will issue an initiative to stimulate
additional research on restoring damaged salivary gland structure and
function to complement this important clinical advance.
As these highlights illustrate, NIDCR has made a strong commitment
to advancing oral health science through efforts in the laboratory, in
training sites, in dental practices, and in the community. This
investment is providing new tools and scientific approaches that may
greatly accelerate the next breakthroughs in oral health research.
NIDCR will continue to support research that provides new and exciting
leads that can translate into better ways to prevent, diagnose, and
manage oral, dental, and craniofacial diseases and disorders. In so
doing, NIDCR seeks to improve the oral health of the Nation.
______
Prepared Statement of Linda S. Birnbaum Ph.D., D.A.B.T., A.T.S.,
Director, National Institute of Environmental Health Sciences and
Health Services
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Institute of Environmental Health Sciences (NIEHS) of the National
Institutes of Health (NIH). The fiscal year 2012 budget includes
$700,537,000; an increase of $17,400,000 over the comparable fiscal
year 2011 enacted level of $683,137,000, comparable for transfers
proposed in the President's request.
introduction
Good health is vitally important for all Americans, and it depends
on a clean and safe environment. Currently, our healthcare system
expends huge resources controlling a variety of diseases and
dysfunctions that are known to be at least partially connected with
environmental exposures: asthma, cancer, developmental disabilities,
neurological/cognitive deficits, heart attack, and many others.
Preventing these diseases through prevention of adverse environmental
exposures could make an enormous difference in reducing healthcare
costs. At NIEHS, and through NIEHS-funded projects in research
institutions across the United States, we are bringing all the tools of
biomedical science to bear on the fundamental questions of the effects
of environmental exposures to toxic substances on biological systems.
Environmental health science is advancing at a tremendous rate and new
tools--genetics, genomics, proteomics, metabolomics, informatics, and
computational biology, just to name some of these new disciplines--give
us new insights on how environmental effects happen in our bodies. They
also point the way toward technologies and testing procedures to
provide better and more timely information for the use of our agency
partners who are responsible for policy decisions and regulations.
advances in toxicology and exposure assessment
With our rapidly increasing understanding of the subtleties of
biological effects of environmental exposures, we are moving toward a
new kind of toxicological testing that is less expensive and time-
consuming than our current methods, and also gives us an improved
understanding of the actual effects on humans. Toxicology is becoming a
more powerful predictive science focused on making target-specific,
mechanism-based, biological observations. Alternative assays are
targeting the key pathways, molecular events, and processes linked to
disease or injury and incorporating them into a research and testing
framework. Our National Toxicology Program (NTP) at NIEHS is laying the
foundation for this new testing paradigm in partnership with the
National Human Genome Research Institute, the Environmental Protection
Agency, and the Food and Drug Administration. We are using quantitative
high-throughput screening assays to test a large number of chemicals.
The resulting data are being deposited into publicly accessible
relational databases. Analyses of these results will set the stage for
a new framework for toxicity testing.
The NIEHS-led Exposure Biology Program (EBP), part of the NIH
Genes, Environment and Health Initiative, has resulted in the
development of dozens of new technological advances for personalized
measurement of environmental exposures. At a recent workshop, EBP
investigators presented their prototypes: miniaturized personal
monitors for black carbon and other air pollutants; a wearable
nanosensor array for real-time monitoring of exposure to diesel and
gasoline exhaust; a personal aerosol sensor platform to link children's
exposures to asthma severity; personal exposure assessment systems for
chemical toxicants; gene expression biomarkers of airway response to
tobacco exposure; and biomarkers of organophosphate-linked proteins.
One prototype of a continuously operating wearable badge that provides
real-time measurements of chemical toxicants has attracted subsequent
R&D funding from the Department of Defense to develop this model for
use by military personnel. Others are being moved into validation
studies as a next step toward their deployment in environmental health
research.
epigenetics, endocrine disrupters, and environmental health
Our understanding of chemical toxicity has been challenged by the
new science of epigenetics, which is the study of changes to the
packaging of the DNA molecules that influence the expression of genes,
and hence the risks of diseases and altered development. Studies
indicate that exposures that cause epigenetic changes can affect
several generations.\1\ This new understanding heightens the need to
protect people at critical times in their development when they are
most vulnerable. NIEHS is making key investments in understanding basic
epigenetic processes and how they are influenced by environmental
factors. Recently, some of this work has provided a critical resource
for understanding and characterizing properties of human induced
pluripotent stem cells.\2\ The development of pluripotent stem cells
shows promise for research and clinical applications in lieu of
embryonic stem cells, but many questions remain to be answered about
their structure, utility, and safety. NIEHS-funded investigators have
established genome-wide reference maps of DNA methylation (an
epigenetic marker) and gene expression in previously derived human
embryonic cell lines and human iPS cell lines, to assess their
epigenetic and transcriptional similarity and predict their
differentiation efficiency. A separate report by another NIEHS-funded
group reported ``hotspots'' of aberrant epigenomic reprogramming in
human iPS cells.\3\ There are still many questions about the role of
these important epigenetic processes which will need to be answered
before iPS cells can be confidently used in research and therapy.
---------------------------------------------------------------------------
\1\ Anway MD, Cupp AS, Uzumcu M, Skinner MK (2005) Epigenetic
transgenerational actions of endocrine disruptors and male fertility.
Science 308:1466-1469.
\2\ Bock C, Kiskinis E, Verstappen G, et al. (2011) Reference maps
of human ES and iPS cell variation enable high-throughpu
characterization of pluripotent cell lines. Cell 144(3):439-52.
\3\ Lister R, Pelizzola M, Kida YS, et al. (2011) Hotspots of
aberrant epigenomic reprogramming in human induced pluripotent stem
cells. Nature 471(7336):68-73.
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Related to the field of epigenetics is the key concept of ``windows
of susceptibility.'' Research shows that the developmental processes
that occur at fetal and early life stages are especially vulnerable to
disruption from relatively low doses of certain chemicals.\4\ \5\ \6\
We first saw this in the case of lead and other metals, such as mercury
and arsenic, which we learned decades ago could harm neurological
development as a result of fetal and childhood exposures. This concept
also applies to hormonally active agents which disrupt the endocrine
system. This is an active area of our research program. For example,
NIEHS and NTP are funding important studies to fill the gaps in our
knowledge about bisphenol A (BPA), a widely distributed compound used
in plastics, can linings, thermal paper, and more. NTP's Center for
Evaluation of Risks to Human Reproduction determined that there was
``some concern'' about effects to the brain, behavior, and prostate
gland in fetuses, infants, and children exposed to BPA.\7\ NIEHS is now
supporting an aggressive research effort to fill the research gaps in
this area, especially concerning BPA effects on behavior, obesity,
diabetes, reproductive disorders, development of prostate, breast and
uterine cancer, asthma, cardiovascular diseases and transgenerational
or epigenetic effects.
---------------------------------------------------------------------------
\4\ Rogan WR, Ragan NB (2003) Evidence of effects of environmental
chemicals on the endocrine system in children. Pediatrics 112:247-252.
\5\ Dolinoy DC, Weidman JR, Jirtle RL (2007) Epigenetic gene
regulation: Linking early developmental environment to adult disease.
Reproductive Toxicology 23:297-307.
\6\ Committee on Environmental Health, American Academy of
Pediatrics (1999) Pediatric environmental health, 2nd edition, pp 9-23.
\7\ http://www.niehs.nih.gov/news/media/questions/sya-bpa.cfm See
``What does some concern mean?''.
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Any consideration of important public health issues in the United
States. has to include obesity. Environmental exposures are beginning
to be implicated in the obesity epidemic.\8\ \9\ NIEHS is supporting
research on the developmental origins of obesity and the theory that
environmental exposures during development play an important role in
the current epidemic of obesity, diabetes, and metabolic syndrome.
There are data showing weight gain in adult rats and mice following
developmental exposure to a number of different chemicals, such as
tributyltin compounds,\10\ which have been termed ``obesogens'' by some
researchers. A groundbreaking workshop on environmental factors in
obesity and diabetes was sponsored by NIEHS in January 2011. Many
research gaps still need to be filled, but if these early research
results are confirmed, we may find it more useful to expand our
approach to fighting obesity to include not just educating about diet
and lifestyle but also reducing early life exposure to these
``obesogenic'' chemicals that might be setting the stage for us to gain
weight later in life.
---------------------------------------------------------------------------
\8\ Grun F, Blumberg B (2009) Endocrine disrupters as obesogens.
Mol Cell Endocrinol 304:19-29.
\9\ Verhulst SL, Nelen V, Hond ED, Koppen G, Beunckens C, Vael C,
Schoeters G, Desager K (2009) Intrauterine exposure to environmental
pollutants and body mass index during the first 3 years of life.
Environ Health Perspect 117:122-126.
\10\ Iguchi T, Watanabe H, Ohta Y, Blumberg B (2008) Developmental
effects: oestrogen-induced vaginal changes and organotin-induced
adipogenesis. Int J Androl 31:263-268.
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planning for the future
NIEHS recently began work on the development of a new Strategic
Plan to set goals for guiding our research investments over the next 5
years. Our process is designed to bring in information and perspectives
from a wide variety of sources: community members, advocacy groups,
agency partners, and scientists from all disciplines.
In summary, understanding the connection between our health and our
environment, with its mixture of chemicals, diet and lifestyle
stressors, is a complex and intricate scientific endeavor. At NIEHS, we
remain committed to leading the evolution of the field of environmental
health sciences to meet emerging public health challenges.
______
Prepared Statement of Thomas R. Insel, M.D., Director, National
Institute of Mental Health
Mr. Chairman and Members of the Committee: I am pleased to present
the President's budget request for the National Institute of Mental
Health (NIMH) of the National Institutes of Health (NIH). The fiscal
year 2012 NIMH request of $1,517,006,000 includes an increase of
$40,981,000 over the fiscal year 2011 appropriated level of
$1,476,025,000. In my statement, I will underscore the impact that
mental disorders have on public health in the United States; outline
examples of NIMH's strategies for reducing the burden associated with
mental disorders; and, highlight examples of research activities that
are advancing us toward this goal. I submit this statement with the
recognition of the Department's notification to the Congress of an NIH
reorganization that would establish a new National Center for Advancing
Translational Sciences.
public health burden of mental illness
NIMH's mission is to transform the understanding and treatment of
mental illnesses through basic and clinical research, paving the way
for prevention, recovery, and cure. The burden of mental illness is
enormous. In 2009, an estimated 11 million American adults
(approximately 1 in 20) suffer from serious mental illness.\1\
According to the World Health Organization, mental disorders are the
leading cause of medical disability in the United States and Canada.\2\
In contrast to many other chronic medical conditions, mental disorders
typically begin at an early age, usually before the age of 30. Mental
disorders, such as schizophrenia, depression, and bipolar disorder, are
increasingly recognized as the chronic medical illnesses of young
people.
---------------------------------------------------------------------------
\1\ SAMHSA. Results from the 2009 National Survey on Drug Use and
Health: Mental Health Findings (Office of Applied Studies, NSDUH Series
H-39, HHS Publication No. SMA 10-4609). Rockville, MD; 2010.
\2\ The World Health Organization. The global burden of disease:
2004 update, Table A2: Burden of disease in DALYs by cause, sex and
income group in WHO regions, estimates for 2004. Geneva, Switzerland:
WHO, 2008.
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The annual economic costs of mental illness in the United States
are enormous. The direct costs of mental health treatment represent an
estimated 6.2 percent of all healthcare spending,\3\ which, according
to the Centers for Medicare and Medicaid Services, totals 15.8 percent
of the gross domestic product. Indirect costs, which include all non-
treatment-related costs such as Social Security disability payments,
lost earnings, and incarceration, account for an even greater expense
than the direct costs associated with mental healthcare. A conservative
estimate places the total direct and indirect costs of mental illness
at well over $300 billion annually.\4\
---------------------------------------------------------------------------
\3\ Mark TL, et al. National Expenditures for Mental Health
Services and Substance Abuse Treatment, 1993-2003. SAMHSA Publication
No. SMA 07-4227. Rockville, MD: SAMHSA, 2007.
\4\ Insel TR. Assessing the economic cost of serious mental
illness. Am J Psychiatry. 2008 Jun;165(6):663-5.
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NIMH's mission is not merely to reduce the symptoms and disability
associated with mental disorders, but to promote recovery, to extend
healthy life, and ultimately, to discover preventive interventions. In
the year ahead, NIMH will work toward this mission by fostering and
facilitating a collaborative approach across the spectrum of mental
health research approaches--from discovery to dissemination--to make a
positive change in the lives of people with mental disorders and their
families.
technologies to accelerate discovery
Funding from the American Recovery and Reinvestment Act of 2009 has
enabled NIMH to support infrastructure development that will provide a
framework for future discoveries. One large, collaborative project that
promises to provide researchers with an invaluable reference tool is
the Transcriptional Atlas of Human Brain Development. This atlas is
mapping when and where genes are switched on and off during normal
brain development, because to understand disorders, scientists must
first understand what the normal patterns of gene expression are during
development. The atlas will contain data from 16 brain regions at 11
developmental stages--ranging from embryonic development to mid-
adulthood. These maps will highlight differences between prenatal and
postnatal brains, changes across adolescence, and unique patterns of
gene expression that only occur during development. The first maps from
the atlas were released this year and will form the foundation for
future maps and releases.
translational sciences and therapeutics development
NIMH-funded researchers are working to translate discoveries from
basic science into targeted, rapidly acting therapeutics. Current
antidepressant medications and cognitive behavioral therapies often
require 6 to 8 weeks to have an effect. Previous NIMH research has
shown that the drug ketamine can reduce depression, including thoughts
of suicide, within 6 hours. However, long-term use is associated with
side effects, and the mechanism by which ketamine works remained
unclear, until NIMH-funded researchers made a significant discovery in
2010. They identified how the brain responds to ketamine, as well as
the molecular mechanism for this rapid response--the rapid activation
of an enzyme, mTOR, which regulates cell growth, proliferation, and
survival. The discovery of this cellular mechanism today helps point
the way to developing practical, rapid-acting treatments for depression
tomorrow.
In tandem with this cutting-edge discovery-to-treatment research,
NIMH is looking into ways to personalize and optimize current
treatments for depression. While effective interventions do exist,
there is considerable variation in individual treatment outcomes. The
Establishing Moderators/Mediators for a Biosignature of Antidepressant
Response in Clinical Care (EMBARC) study is working to develop a
collaborative approach among researchers who are focusing on biological
indicators (biomarkers) of depression. EMBARC researchers hope to
identify a standard set of biomarkers and other measures that can be
used to predict which interventions will produce the best treatment
outcomes for an individual. Taken together with our advancing knowledge
of ketamine, we can say with confidence that rapid, personalized, and
effective treatments for depression are close at hand.
enhancement of evidence-base for healthcare decisions
NIMH's basic and translational research will improve U.S. public
health only when they lead to improved mental healthcare. To improve
the outcomes for people suffering from schizophrenia, NIMH is funding
the Recovery After an Initial Schizophrenia Episode (RAISE) project--a
large-scale clinical trial designed to alleviate the long-term
disability associated with schizophrenia by intervening as early as
possible after the first onset of symptoms, so that people with the
disorder can lead more productive, independent lives. RAISE addresses
the effectiveness of providing early, sustained, and integrated care to
improve health and life functioning outcomes, and develops strategies
to facilitate implementation of successful, cost-effective early
interventions in the U.S. healthcare system. RAISE incorporates
features necessary for rapid dissemination into community settings,
thus accelerating the transition from research to practice.
NIMH has also launched the Mental Health Research Network to
encourage scientific collaboration among nine established research
centers that are based in integrated, not-for-profit healthcare
systems. These systems provide care coverage to a diverse population of
10 million people in 11 States, and they share rich and compatible data
resources to support a range of effectiveness research. Researchers
have begun to use this network to address vital issues, including the
development of a geographically and ethnically diverse autism research
registry; a pilot study for a new type of therapy for postpartum
depression; and, a longitudinal analysis of how suicide warning labels
on antidepressants affect later suicidality among youth.
new investigators, new ideas
The future of discovery and translational research lies in the next
generation of mental health researchers. NIMH's Biobehavioral Research
Awards for Innovative New Scientists (BRAINS) program provides support
to early stage investigators to foster innovative research aimed at
critical gaps identified by the NIMH Strategic Plan. NIMH also
recognizes the importance of ensuring that our workforce reflects the
diversity of backgrounds and perspectives that has made the United
States a source of innovation. NIMH is leading an NIH Blueprint for
Neuroscience initiative to enhance diversity in neuroscience through
undergraduate research education experiences, and has established a
supplemental funding program to provide underrepresented minority
scholars with mentored research training in strong institutional
training programs.
working collaboratively to combat suicide
NIMH is committed to collaborating with other Federal agencies and
private partners to hasten the development of interventions and to
facilitate their widespread use by those most in need. As an example,
NIMH has been concerned by the high rate of suicide among our Nation's
military personnel, and has partnered with the Army to conduct the
Study to Assess Risk and Resilience of Service Members (Army STARRS)--
the largest mental health study of military personnel ever conducted.
Early examination of Army STARRS data has begun to reveal potential
predictors of risk for suicide among soldiers. Researchers plan to
analyze additional historical data and new survey data collected by
Army STARRS to confirm and expand upon these findings.
Suicide among civilians is also of significant concern.
Approximately 34,500 American lives are lost to suicide each year,
nearly twice the number lost due to homicide, making it the 10th
leading cause of death in the United States.\5\ \6\ To combat this
issue, under the leadership of the Substance Abuse and Mental Health
Services Administration, NIMH joined the Army, the Centers for Disease
Control and Prevention, other NIH Institutes, and private partners to
form the National Action Alliance for Suicide Prevention. NIMH is
spearheading a Research Prioritization Taskforce on behalf of the
Action Alliance to develop a strategic research agenda that could
reduce suicide-related mortality by 20 percent in 5 years, or 50
percent in 10 years, if fully implemented.
---------------------------------------------------------------------------
\5\ CDC, National Center for Injury Prevention and Control. Web-
based Injury Statistics Query and Reporting System.
\6\ U.S. Department of Justice, Federal Bureau of Investigation.
(September 2009). Crime in the United States, 2008.
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Successfully combating mental disorders requires collaboration
across multiple levels of society; Federal agencies, the research
community, private industry, and the individuals and families affected
each day. Despite the tremendous burden of mental disorders, NIMH is up
to the challenge of bringing all stakeholders to the table, harnessing
scientific advances, and directing the next generation of research to
improve the lives of people affected by mental disorders.
______
Prepared Statement of John Ruffin, Ph.D., Director, National Institute
on Minority Health and Health Disparities
Mr. Chairman and Members of the Committee: I am pleased to present
the President's budget request for the National Institute on Minority
Health and Health Disparities (NIMHD) of the National Institutes of
Health (NIH). The fiscal year 2012 budget of $214,608,000 includes an
increase of $5,073,000 over the fiscal year 2011 comparable
appropriation level of $209,535,000.
This statement is submitted with the recognition of the
Department's notification to the Congress of an NIH reorganization that
would establish a new National Center for Advancing Translational
Sciences and reallocate the remaining portions of the National Center
for Research Resources to other parts of NIH, including NIMHD.
introduction
Health disparity is an issue of immense proportions with health,
economic, social and environmental impact for the Nation. Disparities
in the burden of illness and premature death experienced by racial and
ethnic minorities, low-income, and rural populations, apply to a broad
spectrum of disease types. Evidence-based research reveals that health
disparities are the result of interacting factors that may be genetic,
biological, environmental, social, economic, or psychological in
nature. The causes of and solutions to health disparities are
multidimensional and require multidimensional approaches to improve
health and eliminate the disparities.
Health disparities have had a longstanding economic burden on the
healthcare system. The Affordable Care Act (ACA) included several
provisions aimed at mobilizing the Nation around actions to confront
health disparities in order to overcome the multiple barriers faced by
underserved communities in obtaining quality healthcare. One provision
in the ACA re-designated the National Center on Minority Health and
Health Disparities (NCMHD) at the NIH to an Institute--named the
National Institute on Minority Health and Health Disparities. The NIMHD
was created to strengthen the base for the acceleration of scientific
discovery already initiated by the predecessor organization, the NCMHD,
to understand health disparities and to identify and implement
strategies to eradicate them across the Nation. In accordance with the
Affordable Care Act, NIMHD is charged to plan, review, coordinate, and
evaluate minority health and health disparities research activities
conducted by the NIH Institutes and Centers (ICs). As health
disparities transcend many diverse areas of biomedical science and
public health, this work must involve all of the NIH ICs, and numerous
Federal Government and non-Federal Government partners.
building on a decade of progress
During the past decade, under the aegis of the NCMHD, the NIMHD
launched its congressional mandates, and established new programmatic
initiatives and partnerships, allowing it to create the infrastructure
required to be at the cutting edge of scientific discovery through its
independent programs and support for collaborative research, research
infrastructure development, and outreach projects with partners within
the NIH, HHS, and beyond.
The foundation of the NIMHD's research portfolio is the NIMHD
Exploratory and Comprehensive Centers of Excellence (COE) programs.
Research in the COEs spans the wide array of diseases, health
conditions, and complex non-biological factors contributing to health
disparities. Translational research and the development of appropriate
health interventions is a particular strength of the NIMHD COEs. The
NIMHD University of Puerto Rico-Cambridge Health Alliance Research
Center of Excellence has focused its research on Latino health and
healthcare disparities, specifically mental disorders, substance abuse
and asthma. This COE has generated and tested models aimed to improve
health service delivery to eliminate these disparities. This includes
multi-level interventions at the provider, individual/family and policy
levels to reduce health services disparities and has provided
invaluable data to understand the magnitude of substance abuse
treatment disparities and the social and economic burden of these
disparities.
In addition, NIMHD COEs have assisted in emergency response to
disasters with health disparities implications such as Hurricane
Katrina in 2005, and the Haiti earthquake in 2010. NIMHD COEs responded
to the Haitian earthquake crisis with assistance to Haitian communities
in south Florida and beyond the borders of the country. These efforts
have improved the understanding of the global nature of health
disparities.
To effectively conduct research, individuals, institutions and
organizations must have the capacity and access to the resources that
are necessary to conduct research. NIMHD is a leader in advancing the
NIH efforts to increase the number of underserved populations
represented in science and medicine. The NIMHD Health Disparities
Research and the Clinical Research for Individuals from Disadvantaged
Backgrounds Loan Repayment Programs (LRP) have supported more than
2,300 individuals representing multiple disciplines through loan
repayment of educational loans. More than 60 percent of the LRP
scholars represent racial/ethnic minority populations. The program has
incentivized the pursuit of a scientific or health disparities research
career and many former LRP recipients have been successful in competing
for other NIH grants. Also, NIMHD offers the opportunity for LRP
recipients to transition into becoming independent investigators
through its Disparities Research and Education Advancing our Mission
(DREAM) program in its Intramural Research Program (IRP). During their
2-year appointment at the NIH conducting research on health
disparities, the DREAM fellows work with mentors within the NIH
Intramural Research Program across different NIH Institutes and
Centers. After the 2-year period, the DREAM fellows have the option of
returning to their originating academic institution or to a health
disparity community to further hone their research skills and complete
the final 3 years of the program.
In addition, programs such as the Research Centers in Minority
Institutions and the new NIMHD Science Education Initiative which
focuses on promoting science education and increasing the pool of
individuals from health disparity populations in the science field
starting from kindergarten through the post-doctoral level, will play a
key role in advancing the NIMHD's activities in this area.
There is growing interest in scientific research including health
disparities research at academic institutions throughout the Nation.
However, many institutions have limited or no current capacity to
conduct scientific research. Recognizing the variance in capacity among
institutions of higher education, the NIMHD has invested considerable
resources in the enhancement of research infrastructure and capacity of
less research-intensive institutions through programs such as the NIMHD
Building Research Infrastructure and Capacity (BRIC) program. Over
time, the BRIC awards have been instrumental in transforming the
abilities of some institutions to conduct health disparity research.
For example, San Francisco State University (SFSU) through the
development of shared research facilities has resulted in the
publication of approximately 70 research articles on a variety of
scientific topics, 76 SFSU students have entered highly competitive
Ph.D. programs, and BRIC-supported faculty have received more than $13
million in support to conduct health disparity research. Importantly,
BRIC support has provided a strong base for institutions to expand
their graduate level educational programs to include new doctorate
opportunities to advance health disparities research, as well as the
development of NIMHD Centers of Excellence.
a new era in the fight against health disparities
The next decade will focus on bridging persistent gaps in health
disparities, sustaining effective investments, and developing and
adapting innovative approaches to health disparities. NIMHD will lead
the development, implementation and evaluation of the agency's health
disparities research agenda in collaboration with the other NIH
Institutes and Centers. Research on minority health and health
disparities, research capacity-building and outreach/information
dissemination priorities across the NIH will emphasize areas such as:
translational research, genetics and biological factors, global health,
social determinants of health, behavioral and social sciences,
innovative health technologies, developing a diverse scientific
workforce, health informatics capacity, public-private partnerships,
social networking, and diverse participation in clinical trials.
NIMHD will advance this health disparities research agenda through
translational research and dissemination of research findings for the
benefit of clinical practice and health disparity communities.
Community and population health intervention studies that map social,
economic and environmental determinants will provide greater insight
into the underlying causes of health disparities. In addition, primary
care and prevention research to inform healthcare reform, improve
healthcare quality, reduce costs and ultimately improve health outcomes
for health disparity populations will be examined.
In today's culturally diverse and technologically advanced society,
the construction of health messages that do not consider culture,
history, environments, or literacy levels of certain health disparity
communities can result in the inability of those communities to receive
health information. NIMHD is committed to supporting and developing
vehicles to translate and deliver research findings and health
information to health disparity communities in a culturally and
linguistically appropriate manner.
conclusion
While many health disparities concerns of the past decade remain
pervasive, the NIMHD sees opportunities to accelerate the pace of
scientific discovery and translation. Within the context of the NIH and
HHS priorities for eliminating health disparities, the NIMHD will
intensify and diversify its research focus to elucidate the Nation's
understanding of health disparities. Research strategies must continue
to be innovative and the results of this research must reach the
community at a faster pace. The NIMHD is committed to strengthening its
research efforts to realize these goals.
______
Prepared Statement of Story C. Landis, Ph.D., Director, National
Institute of Neurological Disorders and Stroke
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 President's budget request for NINDS. The fiscal
year 2012 budget is $1,664,253,000. Our mission is to reduce the burden
of neurological disorders through research. NINDS research has improved
diagnosis, prevention, and treatment, but the best of medical science
is still far from optimal for most nervous system disorders.
Fortunately, advances in understanding the brain and its disorders are
providing extraordinary opportunities for progress.
enhancing the evidence base for medical decisions
U.S. Centers for Disease Control and Prevention statistics show
that from 1997 to 2007 the stroke death rate in the United States
decreased 34.3 percent, and the number of stroke deaths declined 18.8
percent, which translates to thousands of lives saved and thousands
with reduced disability every year. For decades, NINDS clinical trials
have contributed to this trend by providing evidence that enables
physicians to choose the best stroke prevention interventions according
to each person's risk factors. In April, NINDS stopped a stroke
prevention clinical trial early because the results were already clear
\1\. The trial included patients at high risk because of a prior non-
disabling stroke and severe narrowing of arteries to the brain.
Angioplasty combined with stenting, which opens clogged arteries with a
tiny balloon and inserts a device to prop them open, plus aggressive
medical therapy led to a higher risk of stroke than the medical therapy
alone. Another recent NINDS clinical trial showed that a procedure
using stents is as safe and effective in preventing stroke as carotid
endartarectomy, a more invasive surgical procedure to clear arteries,
in people with certain risk factors.\2\ Follow up to monitor longer
term results is continuing for both trials. NINDS clinical trials are
similarly guiding treatment for other diseases. A recent clinical trial
showed that an older drug, ethosuximide, may be the best first drug to
test to prevent seizures with minimum side effects in children with
absence epilepsy, providing much needed guidance for treating this
common disorder \3\. An NINDS-Department of Veterans' Affairs trial
showed that surgical implantation of deep brain stimulators (DBS) can
yield better movement and quality of life than drug treatment for
people with advanced Parkinson's disease, and more recent results of
this trial provided information about choosing the best site in the
brain to implant electrodes for each patient \4\. NINDS currently
supports 32 multi-site clinical trials to test the safety and
effectiveness of interventions in stroke, epilepsy, traumatic brain
injury, multiple sclerosis, muscular dystrophy, and other diseases, and
more than 120 earlier phase trials that are essential steps toward
large efficacy trials.
---------------------------------------------------------------------------
\1\ http://www.nlm.nih.gov/databases/alerts/
intracranial_arterial_stenosis.html.
\2\ Brott TG et al. Stenting Compared to Endarterectomy for
Treatment of Carotid Artery Stenosis, New England Journal of Medicine
363:11-23 2010.
\3\ Glauser et al. Ethosuximide, Valproic Acid, and Lamotrigine in
Childhood Absence Epilepsy. New England Journal of Medicine. 362:790-
799 2010.
\4\ Weaver F. et al. Best Medical Therapy versus Bilateral Deep
Brain Stimulation for Patients with Advanced Parkinson's Disease: A
Randomized Controlled Trial. JAMA 301:63-73 2009; Follett et al.
Pallidal versus Subthalamic Deep Brain Stimulation for Parkinson's
Disease. New England Journal of Medicine 362:2077-91 2010.
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advancing translational science
Since long before the term ``translational'' became common, NINDS
has pushed development of basic science advances into drug, biologic,
and device therapies. The first enzyme therapy for inherited metabolic
diseases, several drugs for epilepsy, the first emergency treatment for
stroke, and pioneering technology for devices that replace lost nervous
system function are among advances that NINDS translational research
made possible. Often, industry capitalizes on NIH basic science
findings to develop a new therapy. However, rare diseases, bold new
therapeutic strategies, and new uses for existing drugs are all
challenges that NINDS is more likely than industry to take on. This is
especially so now because drug companies, citing the extraordinary
challenges of brain research, are reducing programs to develop nervous
system drugs \5\.
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\5\ ``R&D Cuts Curb Brain-Drug Pipeline,'' The Wall Street Jounal,
March 27, 2011.
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NINDS launched the Cooperative Program in Translational Research in
2003 to exploit increasing opportunities from neuroscience research.
This program supports teams of academic and small business
investigators to carry out milestone-driven, preclinical therapy
development for a broad range of neurological disorders. The first
candidate therapies from this program have moved into clinical testing
for disorders including stroke, Batten disease, and muscular dystrophy.
Several NINDS programs meet special translational needs for
particular diseases. Among these are the Anticonvulsant Screening
Program, the Specialized Centers of Translational Research in Stroke
(SPOTRIAS), the Udall Centers of Excellence in Parkinson's Disease, and
the Wellstone Centers for Muscular Dystrophy Research. NINDS chose
spinal muscular atrophy (SMA) as the disease to pilot another
innovative approach to drug development. With experts from academia,
industry, and FDA, the SMA Project designed a drug development plan and
is implementing the plan through a ``virtual pharma'' organization that
engages resources via contracts. Promising drug candidates are now in
advanced pre-clinical testing, and the Project is working toward
certification for a clinical trial in 2012. Building on the SMA Project
strategy, NINDS is leading the NIH Blueprint for Neuroscience in a
larger scale Grand Challenge on Neurotherapeutics. The challenge goal
is to develop truly novel drugs that will transform the treatment of
nervous system diseases. The NINDS Intramural Research Program, which
has a long record of therapy development, is also accelerating
translational research under a new Clinical Director. NINDS
translational programs work closely with all of the NIH-wide programs
and resources that will become part of the National Center for
Advancing Translational Sciences (NCATS), and will certainly benefit
from NCATS programs to catalyze translational research.
Because novel therapies for several neurological diseases are
moving toward readiness for clinical testing, NINDS is developing a
multi-site clinical network to improve the speed and effectiveness of
the early steps in clinical testing of novel therapies for neurological
disorders. Better early phase testing will increase the likelihood of
success in larger and more expensive phase III clinical trials of
effectiveness. This network will test promising interventions, whether
they arise from academia, foundations, or industry, and will engage
expertise much greater than the Institute could dedicate to separate
networks for each of the many neurological diseases. This is especially
important for rare disorders, including pediatric diseases. A project
to validate biomarkers for SMA will be among the network's first
studies.
Another major clinical initiative will develop and validate
biomarkers for Parkinson's disease, that is, measurable indicators of
the disease process. Biomarkers research, which NINDS supports for many
disorders, exemplifies another way that NINDS programs can catalyze
both NIH and industry therapy development efforts. With biomarkers for
neurodegenerative disorders, clinical trials can determine in months,
rather than years, whether drugs are slowing the progression of disease
and understand why a new treatment worked or did not. Better biomarkers
can reduce the cost of research and speed the development of better
treatments in NIH and industry.
accelerating progress through technology
An extraordinary array of technologies has accelerated progress in
neuroscience. These range in scale from imaging activity of the
thinking human brain as people carry out complex tasks, to
understanding atom by atom how molecules control electrical activity in
brain cells. This year research demonstrated the power of whole genome
sequencing to understand Charcot-Marie-Tooth disorder, a peripheral
nerve disease \6\. This is a harbinger of personalized genomics for
many diseases. Next generation genomics research is underway for
several neurological disorders. A ``Center without Walls'' will bring
together the best possible team, regardless of geography, to apply
advanced genomics to epilepsy. On another technological frontier, ARRA
enabled NINDS to accelerate research on induced pluripotent stem cells
(iPSC's) that can be derived from patients with Parkinson's,
Huntington's, ALS, epilepsy, and other disorders. A spate of new
technologies, from methods that label nerve cells with more than a
hundred different colors, to computerized three-dimensional
reconstruction of intricate nerve cell circuits, to techniques that
control the activity of individual nerve cells with light, are arming
neuroscientists to meet the longstanding challenge of understanding how
circuits of nerve cells underlie memory, perception, complex movement,
and other higher brain functions. This has implications for
understanding autism, epilepsy, Parkinson's, Alzheimer's, and many
other diseases.
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\6\ Lupski JR et al. Whole-genome sequencing in a patient with
Charcot-Marie-Tooth neuropathy. New England Journal of Medicine
362:1181-91 2010.
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encouraging new investigators and new ideas
When progress against disease is not forthcoming, a gap in basic
understanding of the normal brain or the disease process is often the
cause. Physicians and scientists across academia and industry agree
that basic research propels long-term progress against disease. The
insight and ingenuity of the research community is the key. Supporting
a vigorous scientific community and investigator-initiated research are
thus high priorities throughout NINDS programs and policies. To
encourage innovative research, for example, the EUREKA (Exceptional
Unconventional Research Enabling Knowledge Acceleration) program
complements the NIH Pioneer Awards, New Innovator Awards, and
Transformative R01's, all of which support neuroscientists. To prepare
the next generation of neuroscientists, NINDS training and career
development programs are tailored to the needs of basic and clinical
researchers, and funding policies favor early stage investigators.
NINDS encourages cooperative research and promotes sharing through
several programs. Examples include the Common Data Elements program,
Human Genetics Resource Center, consortia on induced pluripotent stem
cells, disease centers programs, and other grants to multi-investigator
teams. NINDS is improving programs on workforce diversity and health
disparities based on guidance from an external review and planning
process that was completed in 2011.
concluding remarks
Neurological disorders present formidable challenges. Nonetheless,
prospects for progress have never been more encouraging because of
progress in understanding the nervous system and its diseases at every
level from molecules through the working human brain. NINDS is
aggressively pursuing better prevention and treatment with a balance of
basic, translational, and clinical research, supported through
investigator-initiated and priority-targeted programs.
______
Prepared Statement of Patricia A. Grady, Ph.D., RN, FAAN, Director,
National Institute of Nursing Research
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Institute of Nursing Research (NINR) of the National Institutes of
Health (NIH). The fiscal year 2012 budget includes $148,114,000 which
is $3,857,000 more than the comparable fiscal year 2011 appropriation
of $144,257,000.
introduction
I appreciate the opportunity to share with you some of the exciting
areas of research that we support at the National Institute of Nursing
Research (NINR). As you know, a unique combination of societal trends
challenges our Nation's health, including an aging population,
increased chronic illness and obesity rates, and shortages in the
healthcare workforce. At NINR, we address these issues by supporting
research across the life span that: builds the scientific foundation
for clinical practice; improves quality of life through managing and
easing symptoms of illness; promotes health and prevents disease
through biological and behavioral interventions; and enhances end-of-
life and palliative care. We also seek to ensure future discoveries by
training the next generation of nurse scientists. NINR's emphasis on
clinical research and training places NINR in a position to make major
contributions to trans-NIH initiatives to enhance the evidence-base for
healthcare decisions, promote translational research, and support new
investigators and new ideas. NINR was established 25 years ago, in
1986, as the National Center for Nursing Research. This year, we are
commemorating our 25th anniversary through a series of scientific
outreach events to celebrate our longstanding emphasis on translating
science to improve health and clinical practice. In our first event, a
scientific symposium entitled ``Bringing Science to Life,'' some of our
distinguished scientists presented cutting edge research on topics as
varied as: the role of sleep in health and safety; managing chronic
illness in racially/ethnically diverse groups; testing interventions to
educate and support parents with premature infants; and understanding
the biological underpinnings of muscular dystrophy. This Anniversary is
an opportunity to review what NINR science has accomplished, and more
importantly, to envision and plan the next phase of evidence-based
research to meet future health and healthcare needs, challenges, and
priorities. As we look forward to the next 25 years, we are confident
that NINR-supported science will play an ever-increasing role in
addressing the most pressing issues facing our Nation's health. I
would, next, like to share with you some examples of the research that
we support and how it improves quality of life.
childhood and adolescence: risk and resilience
From birth through young adulthood, children and adolescents face
many health challenges and also demonstrate incredible resilience. NINR
supports research to promote positive outcomes for children and
families facing a myriad of challenges. For example, chronic health
conditions in children, such as diabetes, arthritis, and obesity, pose
challenges for the entire family and require sustained attention to
treatment adherence and health assessment. NINR-funded scientists have
made advances both in understanding the family's role in children's
health and in improving assessment strategies. One study found that
although parents detected significant pain in their child following the
child's surgery, they tended to under-treat it, suggesting that
educating parents about pain management may be beneficial. Another
study found that screening children's waist circumference, which can be
easily implemented in schools, identifies more cases of high blood
pressure than the usual measure of body mass index alone. A current
initiative led by NINR aims to improve self-management of chronic
illness in children. An increasing challenge later in childhood comes
from HIV, with adolescents and young adults comprising one-third to
one-half of new infections in the United States,\1\ despite numerous
prevention campaigns. Moreover, adolescents from racial/ethnic minority
groups are disproportionately affected.\2\ A new NINR initiative
supports projects to examine psychosocial, cognitive, and neurological
predictors of HIV/AIDS risk decisionmaking in adolescents. This
research will provide an evidence-base to guide future culturally and
developmentally relevant interventions to prevent HIV/AIDS.
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\1\ National Institute for Child Health and Human Development.
AIDS/HIV. 2008.
\2\ Centers for Disease Control and Prevention. 2008. HIV/AIDS
among youth.
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challenges and changes in an aging population
The population of our Nation is aging rapidly, due in large part to
increased longevity and the aging of the baby boomers. These changes
are giving rise to significant challenges, resulting in a need for:
improved strategies to manage co-occurring chronic illnesses; better
interventions to support family caregivers; and new ways to address
health disparities and meet the needs of an elderly population that is
more racially and ethnically diverse than ever before. One pressing
challenge is the increase in the number of older adults with multiple
chronic illnesses, such as heart disease, diabetes, and arthritis. Such
older adults have complex care needs, face long-term self-management of
illness, and may experience poor coordination of care in the community.
In a recent NINR-supported Nurse Coordinated Care Intervention,
advanced practice nurses developed individualized care plans for older
adults, which included family members and ongoing follow-up care. The
intervention improved health outcomes and reduced costs of care for
Medicare patients. A new NINR initiative, that benefits not only older
adults but individuals across the life span, supports research that
translates basic genomic science to clinical practice with the goal of
preventing and alleviating symptoms of chronic illness. Such efforts
have the potential to improve quality of life for older adults and
families. Another challenge is Alzheimer's disease (AD), which is
incurable, affects up to 5.1 million Americans, and is expected to
dramatically increase in incidence by the year 2030.\3\ NINR is
addressing the quality of care for AD patients, and the quality of life
of, and burden on, family caregivers. For example, researchers funded
by NINR and the National Institute on Aging (NIA) developed an
intervention to teach caregivers about AD, stress management, and
maintaining their own health. The intervention showed promising
improvements in emotional, mental, and physical health in racially
diverse groups.
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\3\ National Institute on Aging. 2009 Progress report on
Alzheimer's disease: Translating new knowledge.
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end of life: supporting individuals and families
As a society we are living longer lives than ever before; however,
we are also more likely to die from chronic and sometimes painful
illnesses \4\ that require families to make complex decisions about
life and death issues, often without adequate support and information.
As the lead NIH Institute on issues related to end-of-life research,
NINR supports research leading to evidence-based end-of-life and
palliative care that ultimately assists individuals, families, and
healthcare professionals in alleviating symptoms, planning for end-of-
life decisions, and promoting psychological, social, spiritual, and
physical well-being. NINR's Office of Research on End-of-Life Science
and Palliative Care, Investigator Training, and Education coordinates
research, training, and educational efforts in end-of-life and
palliative care science. One NINR-supported study recently examined the
effectiveness of a program to communicate patient preferences for end-
of-life decisions to clinicians. Compared to traditional practices such
as Do-Not-Resuscitate orders, the program led to fewer unwanted life-
sustaining treatments without affecting quality of remaining life. In
addition, a new NINR initiative begun in 2011 will support research to
address issues related to end-of-life and palliative care for
individuals with chronic illness who also experience life-threatening
acute illness. Finally, on August 10-12, 2011, NINR, with support from
partners across the NIH, will convene a forum entitled ``The Science of
Compassion: Future Directions in End-of-Life and Palliative Care.''
This forum is intended to energize and mobilize end-of-life and
palliative care research and to draw attention to the end-of-life and
palliative care processes, the care options available to patients and
their families, and the obligations of health service communities to
address these complex needs.
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\4\ Centers for Disease Control and Prevention and The Merck
Company Foundation. The state of aging and health in America 2007.
Whitehouse Station, NJ: The Merck Company Foundation; 2007.
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training the next generation of scientists
NINR places strong emphasis on equipping the next generation of
scientists with the necessary skills to conduct research that improves
the Nation's health. In light of the societal trends that will
characterize the coming decades, NINR recognizes that tomorrow's nurse
scientists need to be trained in rigorous, innovative, and
interdisciplinary research that reaches diverse individuals, families,
and communities. NINR supports young scientists and junior and senior
scholars through grant funding, fellowships, and career development
awards. NINR also offers an intensive summer training program, the
Summer Genetics Institute, to improve research and clinical practice
among graduate students and faculty by providing a foundation in
molecular genetics. Additionally, our Pain Boot Camp, held for the
first time in 2010, is a 1-week research intensive program where
participants learn innovative pain research methodology from nationally
and internationally known scientists. NINR's efforts to invest in new
investigators and new ideas are critical investments in preparing a
nursing workforce to address the healthcare challenges of the coming
years.
future directions in nursing science
Nursing science is at the forefront of efforts to improve health
and healthcare practice. NINR is currently formulating its new
strategic plan and will continue its focus on the unique social,
cultural, societal, genetic, and biological factors that contribute to
disease prevention, health promotion, and self-management of illness.
We look forward to the next 25 years in which nursing science, focused
on individuals, patients and families, will make critical contributions
to improving healthcare practice and quality of life across the disease
spectrum and across the lifespan. Thank you, Mr. Chairman. I will be
happy to answer any questions that the Committee might have.
______
Prepared Statement of Donald A.B. Lindberg, M.D., Director, National
Library of Medicine
Mr. Chairman and Members of the Committee: I am pleased to present
the President's fiscal year 2012 budget request for the National
Library of Medicine (NLM) of the National Institutes of Health (NIH).
The fiscal year 2012 NIH request includes $387,153,000 for NLM, which
is $24,420,000 more than the comparable fiscal year 2011 NLM
appropriation of $362,733,000.
As the world's largest biomedical library and the producer of
internationally trusted electronic information services, NLM delivers
trillions of bytes of data to millions of users every day. Many who
begin a search in Google, another search engine, or a mobile ``app''
actually receive health information from an NLM website. Now in its
175th year, NLM is a key link in the chain that makes the results of
biomedical research--DNA sequences, clinical trials data, toxicology
and environmental health data, published scientific articles, and
consumer health information--readily available to scientists, health
professionals, and the public worldwide. A leader in biomedical
informatics and information technology, NLM also conducts and supports
leading-edge informatics research and development in electronic health
records, clinical decision support, information retrieval, advanced
imaging, computational biology, telecommunications, and disaster
response.
NLM's programs and services directly support NIH's four key
initiatives. The Library organizes and provides access to massive
amounts of scientific data from high throughput sequencing; assembles
data about small molecules to support research and therapeutic
discovery; provides the world's largest clinical trials registry and
results database; and is the definitive source of published evidence
for healthcare decisions. Research supported or conducted by NLM
underpins today's electronic health record systems. The Library has
been the principal funder of university-based informatics research
training for 40 years, supporting the development of today's leaders in
informatics research and health information technology. NLM's databases
and its partnership with the Nation's health sciences libraries deliver
research results wherever they can fuel discovery and support health
decisionmaking.
research information resources
NLM's PubMed/MEDLINE database is the world's gateway to research
results published in the biomedical literature, linking to full-text
articles in PubMed Central, including those deposited under the NIH
Public Access Policy, and on publishers' websites, as well as
connecting to vast collections of scientific data. Through its National
Center for Biotechnology Information (NCBI), NLM is a hub for the
international exchange and use of molecular biology and genomic
information, with databases accessed by more than 2 million users
daily. NCBI meets the challenge of organizing, analyzing, and
disseminating scientific research data with more than 40 integrated
databases and analysis tools that enable genomic discoveries in the
21st century. These databases are fundamental to the identification of
important associations between genes and disease and to the translation
of new knowledge into better diagnoses and treatments. Resources such
as dbGAP and the upcoming Genetic Testing Registry (GTR) create a
bridge between basic research and clinical applications. dbGaP links
genotype and phenotype information from clinical studies to identify
genetic factors that influence health and serves as the public
repository for data from genome wide association studies (GWAS)
supported by NIH and other research funders. The GTR will be a central
source for healthcare providers and patients to find detailed
information about genetic tests and the laboratories that offer them.
NLM also stands at the center of international exchange of data
about clinical research studies. NLM's Lister Hill National Center for
Biomedical Communications builds ClinicalTrials.gov, the world's
largest clinical trials database, including registration data for more
than 106,000 clinical studies with sites in 174 countries.
ClinicalTrials.gov has novel and flexible mechanisms that enable
submission of summary results data for clinical trials subject to the
Food and Drug Administration Amendments Act of 2007. To date, summary
results are available for about 3,400 completed trials of FDA-approved
drugs, biological products, and devices--providing a new and growing
source of evidence on efficacy and comparative effectiveness.
health data standards and electronic health records
Electronic health records with advanced decision-support
capabilities and connections to relevant health information will be
essential to achieving personalized medicine and will help Americans to
manage their own health. For 40 years, NLM has supported seminal
research on electronic health records, clinical decision support, and
health information exchange, including concepts and methods now used by
MicroSoft Health Vault and Google Health. As the central coordinating
body for clinical terminology standards within HHS, NLM works closely
with the Office of the National Coordinator for Health Information
Technology (ONC) to facilitate adoption and ``meaningful use'' of
electronic health records (EHRs). NLM supports, develops, and
disseminates key data standards for U.S. health information exchange in
ONC's criteria for certification of electronic health records. NLM is
actively engaged in research on Next Generation EHRs, while also
developing tools and frequently used subsets of large terminologies to
help EHR developers and users implement health data standards right
now. Most recently, NLM released MedlinePlus Connect, which allows
application developers to establish direct links from a patient's view
of his or her EHR to high quality health information relevant to that
person's specific health conditions, medications, and (coming soon)
recent tests.
information services for the public
This new EHR connection builds upon NLM's extensive information
services for patients, families and the public. The Library's
MedlinePlus website provides integrated access to high quality consumer
health information produced by all NIH components and HHS agencies,
other Federal departments, and authoritative private organizations and
serves as a gateway to specialized NLM information sources for
consumers, such as the Genetic Home Reference and the Household
Products database. Available in English and Spanish, with selected
information in 40 other languages, MedlinePlus averages well over
600,000 visits per day. Covering nearly 900 health topics, MedlinePlus
has interactive tutorials for persons with low literacy, an illustrated
medical encyclopedia, surgical videos and links to the scientific
literature in PubMed. Mobile MedlinePlus, also in both English and
Spanish, reaches the large and rapidly growing mobile Internet
audience.
The NIH MedlinePlus quarterly magazine is an outreach effort made
possible with support from many parts of NIH and the Friends of the
NLM. Like MedlinePlus itself, the magazine is free and contains no
advertising. It is distributed to the public via physician offices,
community health centers, libraries and other locations and has a
readership of up to 5 million nationwide. Each issue focuses on the
latest research results, clinical trials and new or updated guidelines
from the 27 NIH Institutes and Centers. A Spanish/English version, NIH
MedlinePlus Salud, launched with support from the National Alliance for
Hispanic Health and the National Hispanic Medical Association,
addresses the specific health needs of the growing Hispanic population
and showcases the many Hispanic outreach efforts and relevant research
results funded by the NIH.
To be of greatest use to the widest audience, NLM's information
services must be known and readily accessible. The Library's outreach
program, with a special emphasis on reaching underserved populations,
relies heavily on the more than 6,300-member National Network of
Libraries of Medicine (NN/LM). The NN/LM is a network of academic
health sciences libraries, hospital libraries, public libraries and
community-based organizations working to bring the message about NLM's
free, high-quality health information resources to communities across
the Nation.
disaster information management
Events of the past year, such as the Deepwater Horizon oil spill
and the earthquake, tsunami, and radiation event in Japan, demonstrated
yet again the importance of rapid, organized response to natural
disasters and other emergencies. NLM has a long history of providing
health information to prepare for, respond to, and recover from
disasters and has tools and advanced information services designed for
use by emergency planners, responders and managers. Through its
Disaster Information Management Resource Center, NLM builds on proven
emergency backup and response mechanisms within the National Network of
Libraries of Medicine to promote effective use of libraries and
disaster information specialists in disaster preparedness and response.
NLM also conducts research on new methods for sharing health
information in emergencies as its contribution to the Bethesda Hospital
Emergency Preparedness Partnership, a model of private-public hospital
collaboration for coordinated disaster planning. NLM partners with the
Pan American Health Organization (PAHO) and other bodies in the Latin
American Network for Disaster and Health Information to promote
capacity-building in the area of disaster information management.
Within 2 days of the gulf oil spill, NLM launched a web page
focused on the potential effects of oil on human health, which quickly
became a highly regarded resource for evidence-based information by
Federal, State, and local agencies and communities. NLM continued to
support information needs in Haiti, including onsite assistance to PAHO
in setting up a system for collecting information from cholera
treatment centers. The Radiation Emergency Medical Management (REMM)
tool, previously developed by NLM, the HHS Office of the Assistant
Secretary for Preparedness and Response, CDC and NCI, was deployed in
Japan, via the web and on mobile devices, to assist with assessing and
managing the health effects of radiation. NLM also activated the
Emergency Access Initiative, a partnership with publishers and medical
libraries which provides free temporary access to key electronic
medical journals and books when disasters interrupt regular health
information services, and provided practical advice to Japanese
libraries and archives on rescuing water-damaged books and documents.
In summary, NLM's information services and research programs serve
the Nation and the world by supporting scientific discovery, clinical
research, education, healthcare delivery, public health response, and
the empowerment of people to improve personal health. The Library is
committed to the innovative use of computing and communications to
enhance public access to the results of biomedical research.
______
Prepared Statement of Jack Whitescarver, Ph.D., Director, Office of
AIDS Research
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 President's budget request for the trans-NIH AIDS
research program, which is $3,159,531,000. This amount is an increase
of $100,254,000 over the fiscal year 2011 enacted level. It includes
the total NIH funding for research on HIV/AIDS and the wide spectrum of
AIDS-associated malignancies, opportunistic infections, co-infections,
and clinical complications; intramural and extramural research;
research management support; research centers; and training. It also
includes a transfer of approximately $27 million to the HHS Office of
the Assistant Secretary of Health to foster collaborations across HHS
agencies and finance high priority initiatives in support of the
President's National HIV/AIDS Strategy.
the aids pandemic
Nearly 30 years since the recognition of AIDS and the
identification of HIV as its causative agent, the HIV/AIDS pandemic
remains a global scourge. UNAIDS reports that in 2009, more than 33
million people were estimated to be living with HIV/AIDS; 2.6 million
were newly infected; and 1.8 million people died of AIDS-related
illnesses. The majority of cases worldwide are the result of
heterosexual transmission, and women represent more than 50 percent of
HIV infections worldwide. More than 1,000 children become infected each
day, most of them as newborns. More than 25 million men, women, and
children worldwide have already died.
In the United States, CDC reports that more than 1.1 million people
are estimated to be HIV-infected; approximately 56,300 new infections
occur each year; and someone is infected with HIV every 9\1/2\ minutes.
HIV/AIDS continues to be an unrelenting public health crisis,
disproportionately affecting racial and ethnic populations, women of
color, young adults, and men who have sex with men. The number of
individuals aged 50 years and older living with HIV/AIDS is increasing,
due in part to antiretroviral therapy, which has made it possible for
many HIV-infected persons to live longer, but also due to new
infections in individuals over the age of 50.
nih aids research program
To address this pandemic, NIH has established the most significant
AIDS research program in the world, a comprehensive program of basic,
clinical, translational, and behavioral research in domestic and
international settings--a multi-disciplinary, global research program
carried out by every NIH institute and center in accordance with their
mission. This diverse research portfolio requires an unprecedented
level of trans-NIH planning, scientific priority-setting, and resource
management. The Office of AIDS Research (OAR) was authorized to plan,
coordinate, evaluate, and budget all NIH AIDS research, functioning as
an ``institute without walls,'' to identify the highest priority areas
of scientific opportunity, enhance collaboration, minimize duplication,
and ensure that precious research dollars are invested effectively and
efficiently.
new scientific advances and opportunities
The past year has been a significant one for AIDS research. The NIH
investment in the priority areas of HIV prevention research and in
basic science over the past several years has resulted in important
progress in critical areas of the NIH AIDS research program. Recent
research advances by NIH intramural and extramural investigators have
opened doors for new and exciting research opportunities in the search
for strategies to prevent, treat, and ultimately cure HIV infection.
These advances include:
Technologies to accelerate discovery--
--Vaccines.--A team of scientists led by researchers at the NIAID
Vaccine Research Center discovered two potent human antibodies
that can stop more than 90 percent of known global HIV strains
from infecting human cells in the laboratory and determined the
structural analysis of how they work. The novel techniques used
in this research may accelerate HIV vaccine research as well as
the development of vaccines for other infectious diseases. An
HIV vaccine clinical trial conducted in Thailand by NIH and the
Department of Defense demonstrated the first indication of a
modest but positive effect in preventing HIV infection. The
trial marked the first step in proving the concept that a
vaccine to prevent HIV infection is feasible.
--Microbicides.--For the first time in nearly 15 years of research,
scientists discovered a vaginal microbicide gel that gives
women a level of protection against HIV infection. The study,
sponsored by USAID and conducted by the Centre for the AIDS
Programme of Research in South Africa (CAPRISA), found that the
use of a microbicide gel containing the antiretroviral drug
tenofovir resulted in 39 percent fewer HIV infections compared
with a placebo gel. NIH provided substantial support and
resources to establish the infrastructure and training for
CAPRISA. Ongoing and future NIH clinical trials will build on
these study results with the goal of bringing a safe and
effective microbicide to licensure.
--Basic Science.--This past year, using genome-wide association
studies, NIH-sponsored researchers made an important discovery
related to the genetics of an individual's immune system. These
genes appear to be involved in the control of HIV disease
progression among a group of individuals considered ``elite
controllers,'' who have been exposed to HIV over an extended
period, but whose immune systems have controlled the infection
without therapy and without symptoms. These findings will
contribute to the development of potential HIV prevention
strategies.
Translational sciences and therapeutic development.--New lymphoma
regimens have been developed that can be tailored to specific tumor
types. This development has markedly improved the therapeutic outcome
and survival of patients with AIDS-related lymphoma. In addition,
progress in both basic science and treatment research aimed at
eliminating viral reservoirs has been significant enough that
scientists are now, for the first time, planning to conduct research
aimed at a cure. NIH has announced several initiatives to generate new
ideas for curing HIV infection through domestic and international
partnerships among government, industry, and academia.
Enhancement of evidence-base for healthcare decisions.--In the
critical area of treatment as prevention, two recent studies have
demonstrated the effectiveness of new multi-drug antiretroviral
regimens for the prevention of mother-to-child-transmission of HIV
during pregnancy and breastfeeding. In addition, a large international
NIH clinical trial provided strong evidence that the use of pre-
exposure prophylaxis (PrEP), that is, the use of antiretroviral
treatment before exposure to prevent infection, can reduce risk of HIV
acquisition in men who have sex with men. Additional and continued
research is needed to determine whether PrEP will be similarly
effective at preventing HIV infection in other at-risk populations and
assist healthcare workers in providing these potential options.
trans-nih plan and budget
These advances, while preliminary and incremental, provide the
groundwork for further scientific investigation and the building blocks
for the development of the trans-NIH AIDS strategic Plan, developed by
OAR in collaboration with both government and non-government experts.
The priorities of the strategic Plan guide the development of the
trans-NIH AIDS research budget. OAR develops each IC's AIDS research
allocation based on the Plan, scientific opportunities, and the IC's
capacity to absorb and expend resources for the most meritorious
science--not on a formula. This process reduces redundancy, promotes
harmonization, and assures cross-Institute collaboration. The
priorities of the Plan will establish the biomedical and behavioral
research foundation necessary to implement the major goals of the
President's National HIV/AIDS Strategy and to implement the NIH
Director's themes.
fiscal year 2012 scientific priorities
A growing proportion of patients receiving long-term antiretroviral
therapy (ART) are demonstrating treatment failure, experiencing serious
drug toxicities and side effects, and developing drug resistance.
Recent studies have shown an increased incidence of malignancies, as
well as cardiovascular and metabolic complications, and premature aging
associated with long-term HIV disease and ART. NIH research will
address the need to develop better, less toxic treatments and to
investigate how genetic determinants, sex, gender, race, age, pregnancy
status, nutritional status, and other factors interact to affect
treatment success or failure and/or disease progression.
NIH-funded research is needed to address the causes of HIV-related
health disparities, their role in disease transmission and acquisition,
and their impact on treatment access and effectiveness. These include
disparities among racial and ethnic populations in the United States;
between developed and resource-constrained nations; between men and
women; between youth and older individuals; and disparities based on
sexual identity. In addition, specific fiscal year 2012 research
priorities include: biomedical and behavioral research focused on the
domestic AIDS epidemic, particularly in racial and ethnic populations
of the United States; research to build on important research advances
in prevention research in the past year in the areas of microbicides,
vaccines, and treatment as prevention; research to prevent and treat
HIV-associated co-morbidities, malignancies, and clinical
complications; research to address the complex issues around AIDS and
aging; research to better understand the issues of adolescents and
AIDS; basic and therapeutic research focused on elimination of viral
reservoirs leading toward a cure; genetic studies to delineate the
genetic basis for immune responses to HIV and to sequence HIV-
associated tumors; and research on feasibility, effectiveness, and
sustainability required for the scale-up and implementation of
interventions in communities at risk.
summary
The OAR has utilized its authorities to shift AIDS research program
priorities and resources to meet the changing epidemic and scientific
opportunities. This investment in AIDS research has produced
groundbreaking scientific advances. AIDS research also is helping to
unravel the mysteries surrounding many other cardiovascular, malignant,
neurologic, autoimmune, metabolic, and infectious diseases as well as
the complex issues of aging and dementia. Despite these advances,
however, AIDS has not been conquered, and serious challenges lie ahead.
The HIV/AIDS pandemic will remain the most serious public health crisis
of our time until better, more effective, and affordable prevention and
treatment regimens are developed and universally available. NIH will
continue its efforts to prevent, treat, and eventually cure AIDS.
Thank you for your continuing support for our efforts.
______
Prepared Statement of Lawrence A. Tabak, D.D.S., Ph.D., Principal
Deputy Director, National Institutes of Health
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 President's budget request for the Office of the
Director (OD). The fiscal year 2012 budget includes $1,298,412,000; an
increase of $132,451,000 over the comparable fiscal year 2011 enacted
level of $1,165,961,000, comparable for transfers proposed in the
President's request.
The OD promotes and fosters NIH research and research training
efforts in the prevention and treatment of disease through the
oversight of the Intramural Research program and through coordination
of program offices responsible for stimulating specific areas of
research throughout NIH to complement the ongoing efforts of the
Institutes and Centers. The OD also develops policies in response to
emerging scientific opportunities employing ethical and legal
considerations; maintains peer review policies; provides oversight of
grant and contract award functions; coordinates information technology
across the Agency; and coordinates the communication of health
information to the public and scientific community. Moreover, the OD
provides the core management and administrative services, such as
budget and financial management, personnel, property, and procurement
services, ethics oversight, and the administration of equal employment
policies and practices.
The principal OD offices providing these activities include the
Offices of Extramural Research, Intramural Research, Science Policy,
Communications and Public Liaison, Legislative Policy and Analysis,
Equal Opportunity and Diversity Management, Financial Management,
Budget, Management, Human Resources, Chief Information Office, and the
Executive Office. This request contains funds to support the functions
of these offices as will be outlined in the Program, Project and
Activities Table which follows.
The statement is submitted with the recognition of the Department's
notification to the Congress of an NIH reorganization that would
establish a new National Center for Advancing Translational Sciences
and reallocate the remaining portions of the National Center for
Research Resources to other parts of NIH, including the OD.
division of program coordination, planning, and strategic initiatives
(dpcpsi)
The DPCPSI mission includes identifying the most compelling
scientific opportunities, emerging public health challenges, and
scientific knowledge gaps that merit further research or would
otherwise benefit from strategic coordination and planning across the
Agency. DPCPSI provides key support of research that is consistent with
the NIH Director's Themes. The Division is comprised of the Office of
AIDS Research, Office of Research on Women's Health, Office of
Behavioral and Social Sciences Research, Office of Disease Prevention,
Office of Medical Applications of Research, Office of Dietary
Supplements, Office of Rare Diseases Research, and the Office of
Strategic Coordination (OSC). The OSC is responsible for the oversight
and management of the NIH Common Fund. The Division is responsible for
agency-wide effort in portfolio analysis and also manages NIH-wide
evaluation and performance activities, including the Evaluation Set-
Aside program and the Government Performance and Results Act plans and
reports. The fiscal year 2012 budget for DPCPSI/Office of the Director
is $8,401,000. Descriptions of the eight programmatic offices within
DPCPSI, and their separate budgets, follow.
the office of aids research
The Office of AIDS Research (OAR) plays a unique role at NIH,
establishing a plan for the AIDS research program. OAR coordinates the
scientific, budgetary, legislative, and policy elements of the NIH AIDS
research program. OAR's response to the AIDS epidemic requires a unique
and complex multi-institute, multi-disciplinary, global research
program. 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. The
fiscal year 2012 budget for OAR is $65,760,000.
the office of research on women's health
The Office of Research on Women's Health (ORWH) mission is to
enhance and expand research supported by the NIH to adequately address
women's health. This is done by identifying gaps in knowledge, and
collaborating with the ICs to stimulate and support innovative research
including interdisciplinary scientific approaches to women's health and
studies of sex and gender differences in health and diseases. ORWH
continues to lead efforts to ensure adherence to policies for the
inclusion of women and minorities in clinical research The fiscal year
2012 budget for ORWH is $43,811,000.
the office of behavioral and social sciences research
The Office of Behavioral and Social Sciences Research (OBSSR) was
established by Congress to stimulate behavioral and social science
research at NIH and to integrate it more fully into the NIH research
enterprise. The Office furthers the NIH mission by emphasizing the
critical role that behavioral and social factors play in health,
healthcare, and well-being. The Office supports the activities of the
NIH Basic Behavioral and Social Science Opportunity Network, a trans-
NIH initiative to expand the agency's funding of basic behavioral and
social sciences research. The fiscal year 2012 budget for OBSSR is
$27,949,000.
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. The fiscal year 2012 budget for ODP is
$1,400,000. The Office of Medical Applications of Research (OMAR),
Office of Dietary Supplements (ODS), and Office of Rare Diseases
Research (ORDR) are within the ODP organizational structure.
The Office of Medical Applications of Research (OMAR) mission is 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 fiscal
year 2012 budget for OMAR is $4,877,000.
The Office of Dietary Supplements (ODS) promotes study of the use
of dietary supplements by supporting investigator-initiated research,
and through other major mechanisms. The fiscal year 2012 budget for ODS
is $28,691,000.
The Office of Rare Diseases Research (ORDR) supports activities
that stimulate research on rare diseases by collaborating with the
research institutes, research investigators, patient advocacy groups,
the pharmaceutical industry, and Federal regulatory and research
agencies. The fiscal year 2012 budget for ORDR is $18,423,000.
the office of strategic coordination and the common fund
The Office of Strategic Coordination (OSC) facilitates strategic
planning and management of Common Fund-supported programs by working
with groups of staff from across the NIH to develop and implement each
individual program while providing central management for the Common
Fund as a whole. The NIH Common Fund was enacted into law by Congress
through the 2006 NIH Reform Act to support cross-cutting, trans-NIH
programs that require participation by at least two NIH Institutes or
Centers (ICs) or would otherwise benefit from strategic planning and
coordination. The Common Fund provides limited-term funding for new
programs that are intended to catalyze research in the ICs through the
development of cross-cutting resources, technologies, and data sets.
Common Fund programs do not address any particular disease or
condition, but rather, are designed to be broadly relevant. The fiscal
year 2012 budget for the Common Fund is $556,890,000.
the office of science education
The Office of Science Education (OSE) develops science education
programs, instructional materials, and career resources that serve our
Nation's science teachers, their students (kindergarten through
college), and the public. OSE's activities are an important component
to the overall Agency effort to achieve the NIH Director's goal to
reinvigorate and empower the biomedical research community and enhance
America's competitiveness in the global economy. The OSE creates
programs to improve science education in schools (the NIH Curriculum
Supplement Series) that stimulate interest in health and medical
science careers (LifeWorks Web site); and advance public understanding
of medical science, research, and careers; and advises NIH leadership
about science education issues. The OSE website is a central source of
information about available education resources and programs. http://
science.education.nih.gov. The fiscal year 2012 budget for OSE is
$4,120,000.
loan repayment and scholarship programs
The Office of Intramural Training and Education administers the NIH
Intramural Loan Repayment and Undergraduate Scholarship Programs
(UGSP). The Loan Repayment Programs (LRPs) seek to recruit and retain
highly qualified physicians, dentists, and other health professionals
with doctoral-level degrees. These programs offer financial incentives
and other benefits to attract highly qualified physicians, nurses, and
scientists into careers in biomedical, behavioral, and clinical
research as employees of the NIH. The NIH UGSP offers competitive
scholarships to exceptional college students from disadvantaged
backgrounds that are committed to biomedical, behavioral, and social
science health-related research careers at the NIH. The fiscal year
2012 budget is $7,653,000 for the Intramural Loan Repayment and
Undergraduate Scholarship Programs.
I am happy to answer any questions you may have about the OD's
programs and activities as well as our plans for the upcoming year.
______
Prepared Statement of Jeremy M. Berg, Ph.D., Director, National
Institute of General Medical Sciences
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 President's budget request for the National
Institute of General Medical Sciences (NIGMS). The fiscal year 2012
budget request includes $2,102,300,000, an increase of $70,263,000
above the fiscal year 2011 appropriation of $2,032,037,000, which has
been adjusted comparably to reflect NIH proposed transfers. This
statement is submitted with the recognition of the Department's
notification to the Congress of an NIH reorganization that would
establish a new National Center for Advancing Translational Sciences
and reallocate the remaining portions of the National Center for
Research Resources to other parts of NIH.
Since the mid-20th century, NIGMS has played a leading role as
NIH's ``basic research institute.'' Spanning a broad spectrum, the
Institute's mission supports discovery ranging from how cells work to
how diseases affect communities across towns, nations, and countries.
NIGMS-supported scientists probe the unknown to solve mysteries about
fundamental life processes. This effort goes well beyond the need to
satisfy innate curiosity; answering basic research questions such as
how bacterial and human cells divide, move, and communicate has
increased our knowledge about infections, cancer, birth defects, and
heart disease in ways that would have been difficult to achieve with
more directed studies. Other ongoing NIGMS research investments, such
as in chemistry, continue to provide tangible benefits to society and
our economy. This past year, an NIGMS-supported scientist shared a
Nobel Prize for his discovery of a ground-breaking chemistry method
that is used routinely in the pharmaceutical, electronic and
agricultural industries.
Continued investment in basic research is vital because many of
today's therapies, although effective, nevertheless have significant
limitations. Treatments that are applied after the onset of serious
illness--kidney transplants and dialysis, bypass surgery for coronary
artery disease, surgical removal of tumors--though often lifesaving,
are still not optimal. Treating disease before such interventions are
needed would likely improve both outcomes and quality of life. Basic
biomedical and behavioral research has the power to move treatments in
this direction, and in the coming years, emerging biotechnology and
nanotechnology tools will give researchers unprecedented precision to
detect and derail disease at its earliest stages.
technologies to accelerate discovery
Basic research on stem cells remains one of the most rapidly
advancing areas of biomedicine, in large part because of the knowledge
base scientists already have about how cells behave and change. NIGMS-
supported research on stem cells continues to provide hope that these
multitalented cells will find use in customized therapies for a range
of conditions. In the near term, stem cells are providing researchers
powerful tools for understanding diseases and developing drugs to treat
them. This past year, NIGMS-funded researchers made important progress
on several fronts:
--Stem cell research pioneer James Thomson, D.V.M., Ph.D., created a
powerful tool to trace the individual steps in a deadly cancer
by turning the clock back on blood cells from a person with
leukemia.
--Chemist Laura Kiessling, Ph.D., developed an inexpensive and simple
synthetic culture system for growing embryonic stem cells in
the laboratory.
--NIH Director's New Innovator Awardee Alysson Muotri, Ph.D., used
cells from a person with Rett syndrome to create a cellular
model of autism.
Another area showing great promise is molecular diagnosis. This
past year, NIH Director's Pioneer Awardee Thomas Kodadek, Ph.D.,
applied a unique and creative strategy that conducts an ``immune
surveillance'' of human blood to look for early signs of disease before
symptoms appear. To date, he has obtained exciting evidence that
Alzheimer's disease may be detectable by this approach, and he has
licensed the technology to further its development and application.
The study of systems--of cells, organs, and diseases--is an
important area of basic discovery within the NIGMS mission. In 2010,
the Institute grew its support of systems biology by adding two new
National Centers for Systems Biology. All 12 centers integrate
approaches from engineering, genomics, and systems and synthetic
biology to identify principles and architectural features involved in
common cellular behaviors, including the response to disease-causing
microorganisms, poisons, and metabolic imbalances.
Computer modeling is a key element of all systems biology, and a
central aspect of the NIGMS-led Models of Infectious Disease Agent
Study (MIDAS). This international effort continues to add new research
expertise to increase its capacity to simulate disease spread, evaluate
different intervention strategies, and help inform public health
officials and policymakers. This past year, two MIDAS findings are
worth highlighting:
--One MIDAS study used computer modeling to analyze the spread of
H1N1 flu in a Pennsylvania elementary school. The researchers
collected extensive data from seating charts, school
timetables, bus schedules, nurse logs, attendance records and
questionnaires. The findings indicated that transmission occurs
mostly through girl-to-girl and boy-to-boy interactions and
that sitting directly next to a child with the flu does not
raise a child's risk of getting it.
--In another MIDAS study, researchers learned that the Haiti cholera
outbreak that followed that Nation's colossal earthquake in
2010 could have been blunted with the use of a mobile stockpile
of oral cholera vaccine.
translational sciences and therapeutics development
Since the landmark discovery of the structure of DNA in the 1950s,
our increasing knowledge of how all living things share a basic set of
working parts has catalyzed progress in biomedicine. Large-scale
efforts to scan and compare genomes are teaching scientists about
individual differences in DNA scripts that predispose us to disease.
However, such sequence information is only useful if it can be properly
interpreted. NIGMS has been at the forefront of supporting research
that facilitates this interpretation, leading to numerous discoveries
that have revealed new, unforeseen mechanisms by which DNA information
is made operational.
As one example, the NIGMS Protein Structure Initiative (PSI) has
been creating knowledge and providing tools to researchers for more
than 10 years. This past year, NIGMS enhanced this signature effort by
launching PSI:Biology, a new program that supports research
partnerships between groups of biologists and high-throughput structure
determination centers to solve medically important problems. Already
this investment is bearing fruit, yielding new structures that show how
the largest class of drug receptors functions.
Another example is a pilot study by an individual scientist that
searched systematically for environmental factors--nutrients, chemicals
and toxins--that may be linked to diabetes. Based conceptually on the
Genome-Wide Association Studies approach, Atul Butte, M.D., Ph.D.,
developed a new technique he calls Environment-Wide Association
Studies. In this method, he considered many different factors at once,
using health survey data from the U.S. Centers for Disease Control and
Prevention, which led him to identify 266 environmental factors linked
to type 2 diabetes. This example highlights the tremendous potential
benefits of integrating existing data sources and asking the right
questions.
enhancement of evidence base for healthcare decisions
Although medicines have been revolutionary in humankind's ability
to stay healthy, we now know that people having widely varying
responses to the drugs they take to heal their various ills. NIGMS has
been a long-time supporter of pharmacogenomics, the study of how our
DNA influences the way we respond to medications. This area of research
is an especially important focus in our country today, as the baby-boom
generation gets older and is more likely to take multiple medicines
routinely. NIGMS leads the trans-NIH Pharmacogenomics Research Network
(PGRN), a nationwide collaborative of scientists looking for clues to
inherited variability in the response to medicines used to treat heart
disease, asthma, cancer, depression and addiction.
This past year, two new groups joined the network, adding
rheumatoid arthritis and bipolar disorder as new focus areas. Over the
next 5 years, the PGRN plans to expand to pursue cutting-edge DNA
sequencing methods and statistical analysis, as well as to perform
pilot studies to learn about medication response from de-identified
medical records in healthcare systems. Furthermore, previous PGRN-based
discoveries are now moving further into clinical application with
evidence accumulating on improved outcomes and lower costs.
new investigators, new ideas
Biomedical and behavioral research is a human endeavor, and NIGMS
has a long-standing commitment to supporting and sustaining the people
behind the research. Creativity comes from the sparks of individual
minds, and thus the Institute has always adhered to the principle that
a healthy workforce is an essential ingredient for good science that
leads to better health for all.
Science and the conduct of research continue to evolve, though, as
do workforce needs. It is our responsibility to stay attuned to these
new needs and opportunities. In 2010, NIGMS launched a process to
examine its activities and general philosophy of research training--to
assure that all of the Institute's activities related to the training
of scientists are aligned with our commitment to build an excellent,
diverse research workforce to help achieve the NIH mission, now and in
the long term.
NIGMS gathered data and input from the scientific community through
a series of regional meetings across the country, as well as through
other means of electronic communication including a webinar, online
postings, and comment submissions via e-mail. The resulting plan,
Investing in the Future, the NIGMS Strategic Plan for Biomedical and
Behavioral Research Training, was released in early 2011.
A key focus of this plan is the importance of putting the needs of
trainees first--by focusing on mentoring, career guidance, and
diversity. The plan also affirms the Institute's strong assertion that
there are multiple avenues in which a well-trained scientist can make
meaningful contributions to society. These include research careers in
academia, Government, or the private sector, as well as careers
centered on teaching, science policy, patent law, communicating science
to the public, and other areas.
In closing, and on the cusp of my departure from Federal service, I
want to note how proud I have been to play a role in furthering the
basic research that has had such a profound effect on the health and
well-being of our Nation. I will treasure the time and effort spent
leading the fine institution that is NIGMS.
AVERAGE COST OF RESEARCH PROJECT GRANTS
Senator Harkin. Well, thank you, Dr. Collins. Very poignant
ending for your testimony.
We will now begin a round of 5-minute questions.
Dr. Collins, in addition to drastically cutting NIH
funding, the House Appropriations bill would have required NIH
to fund a minimum number of new competing research grants and
put a ceiling on the average cost to them.
I have a letter here from a number of different entities--
American Association for Cancer Research, American Medical
Colleges, American University--a whole list of different people
who've written us a letter saying that this would really hamper
the ability of NIH to fund the best, the most innovative, the
brightest by putting a cap on it. Now, you have to fund so many
and you have to--I think it was 9,000--and then they put a cap
on it of, I think, $400,000, if I'm not mistaken.
Again, I'd like you to speak to that. We've been down this
road before over the last 25 or 30 years that I've been on this
subcommittee, in saying that NIH really ought to do this on a
peer-reviewed basis. Some of the projects cost more, some cost
less, but to limit it and then to say you have to do so many,
takes away the ability to really do a good peer-reviewed
systematic approach to this.
I would like you to respond to that and what that would
mean to NIH if, in fact, we were to set a limit on how much and
to mandate that you have to fund at least so many grants.
Dr. Collins. Senator, I appreciate the question. This is a
very serious issue and you've set it up quite well in terms of
what the risks might he here.
Certainly, that feature of the language that was part of
H.R. 1 was deeply troubling to those of us at NIH, because, as
you have just said, the goal of all of us who tried to carry
out our responsibilities to support the very best biomedical
research is to utilize the tools of peer review, to seek advice
from the scientific community and our advisory councils about
how best to utilize the resources that the taxpayers, through
this Congress gives to us.
The idea that we would have to manage that enterprise in an
arbitrary way to try to hit a certain number of grants, and
particularly to try to hit some average cost of a new and
competing grant could potentially seriously interfere with the
flexibility that we believe is necessary for the best science
to be supported.
For instance, clinical trials tend to be more expensive.
Would this kind of a limit on the average costs of a new and
competing grant find its way into conversations about, well,
maybe we should do fewer clinical trials and more grants that
happen to be inexpensive, like conference grants? That would
be, I think, a serious intrusion into the ways in which,
really, scientific decisions should be made.
So I agree with you that that particular kind of way of
tying NIH's hands would be very unfortunate. Given all of the
scientific opportunities that we have right now, we should be
able to pursue them in a way that represents the best decisions
and not managed in this sort of arbitrary way by trying to hit
certain numerical grant limits.
DIABETES
Senator Harkin. I appreciate that.
Dr. Rodgers, on diabetes, I think we saw that chart there
about moderate changes in diet and exercise resulting in a huge
decrease in the incidence of the disease. I had 71 percent and
the chart said 58 percent, so I have to figure out why there's
a difference here. When you testified a few years ago on this,
you said you would be undertaking a follow-up study to see
whether these could be sustained over time. What's happened?
Dr. Rodgers. That's correct, Senator, and thanks for the
question.
First of all, the 71 percent, even though the average
improvement in terms of a reduction with that intensive
lifestyle modification was 58 percent for all comers, among the
people over 60 years of age, it was 71 percent. So they really
enjoyed the best benefit of all of the subsets of the patients
studied.
Now, the initial trial, the diabetes prevention trial, was
published in 2002, and, at that point, the reduction was 58
percent for intensive lifestyle, 31 percent for a drug,
metformin.
But, more recently, the 10-year follow-up, which is what I
was referring to at that hearing, was just published in the
Lancet in 2009, and that shows, as Dr. Collins mentioned, a
durable effect out 10 years. These patients who engaged in the
intensive lifestyle still showed a reduction of their going on
to develop diabetes, and the patients, in fact, who were on the
metformin also continued to show an improvement.
Senator Harkin. Very good.
Now, my 5 minutes is up, but I have other questions for
other people here. I'll do that on my second round.
Senator Shelby.
NCATS BUDGET AMENDMENT
Senator Shelby. Thank you, Mr. Chairman.
Dr. Collins, I'm going to get back into NCATS for a minute.
I think it's very important, and I think it has great promise.
I think that NCATS proposal requires thoughtful
consideration to the effect that it will have on NIH, the
extramural research community and the private pharmaceutical
market. You've alluded to this a little.
As I stated, I remain concerned that this announcement was
made in December, yet we don't have some details before the
subcommittee yet.
The reorganization will impact all of NIH's 27 Institutes
and Centers and will shift at least $1.3 billion. I believe the
subcommittee needs to review such a proposal, especially one
that has such a potential impact on the NIH community.
My question is when will we receive some more details that
we can renew--for the staff and the subcommittee--or do you
have a timeline? I know it's a difficult transition.
Dr. Collins. Senator, it's a very fair question, and I had
certainly hoped that by the time of this hearing we would have
been able to provide the full details about the budgetary
consequences of standing up this new and exciting new center.
It is a complicated process. The recommendation to do this
came forward from my Scientific Management Review Board last
December 7.
Rather than putting this off until fiscal year 2013, which
I thought would really have wasted an opportunity, we decided
we would try to move as quickly as possible. Although some
people said, ``Hey, this is the Government. You can't possibly
do that by October'', well, they used to say that about the
Genome Project. So I decided that we could, and we should,
because this is the best way to move the science forward.
But, of course, what this means is taking a number of
components that already exist in various institutes and in the
common funded NIH and moving them together into this new
synergistic entity. That's important to point out.
Actually, what we're talking about is not to create new
budgetary implications, with the one exception of the Cures
Acceleration Network, which is in the President's fiscal year
2012 budget at $100 million, and which we hope this
subcommittee and others will see fit to support, because it'll
give us some flexibilities in terms of how we manage the budget
that we would dearly love to have.
But the other pieces of NCATS are basically derived from
existing programs that are moved together in a way that are
going to be highly complementary and synergistic.
We needed, of course, to consult with our communities, with
our constituencies, and, as we figured out how to do the
shifting right down to every employee to make sure that the
programs were encouraged and nurtured, we had to be sure we had
that right.
We are at the point now where we believe we have that
together. It needs, of course, to be reviewed by the Department
of Health and Human Services (HHS) and Office of Management and
Budget (OMB) experts. We hope to get that to you, Senator, in
the fairly near future, within, certainly, the next few weeks
and, hopefully, a very few weeks.
COST OF DE-RISKING PHARMACEUTICALS
Senator Shelby. Dr. Collins, you've also described the
NCATS mission as one of what you call de-risk--that moves basic
scientific discoveries beyond the lab to a point where the
private pharmaceutical market feels confident enough to jump
in.
What is the policy or what would you think the policy would
be if a selected project is successfully de-risked, but no
companies produce the drug or medical product? I know you've
thought about that.
Dr. Collins. And, indeed, I should point out that this is
an activity which NIH has been engaged in for some long periods
of time, and my colleagues, particularly from the National
Cancer Institute (NCI) and National Institute of Allergy and
Infectious Diseases (NIAID), have been supporting this kind of
translational effort in always looking for a commercial partner
at the earliest moment in order to be able to carry a project
through to completion and limit the amount of dollars that the
taxpayers have to cover.
I would say projects that get undertaken at this point need
to think about that from the very beginning. There will be
instances perhaps where no commercial partner can be found,
even all the way through to the end of a phase III trial, but
they will be rare indeed, because those are very expensive
enterprises.
But for very rare diseases, where the economic incentives
are simply going to be very limited, and especially if one is
in a circumstance where you could conduct such a clinical trial
by repurposing a drug that's already been approved for
something else, then NIH may very well find it worthwhile to
undertake that effort.
But you're quite right to point this out. We have to get
the balance----
HEALTH PREPAREDNESS AND OBESITY
Senator Shelby. Absolutely.
Just want to touch on health disparities. You got into it a
little. Health disparities most often associated with the ethic
population persist in rural United States. Stroke, diabetes,
kidney disease and cancer are all more prevalent in both the
African-American community as well as the South.
One of the root causes to health disparity is the obesity
epidemic that is rampant in our Nation. You pointed it out in
your slides. Southern States have the highest rates in the
Nation.
My question is should we be looking for a new paradigm that
broadly addresses this critical national issue at multiple
levels for molecules to behavior to policy? You touched on it
with your slide. And how can NIH help the American people meet
that challenge?
Dr. Collins. So, Senator, I really appreciate the question
because this is an enormous public-health challenge for all
communities, but particularly so for certain underserved
communities.
I'm going to turn to my colleagues, Dr. Rodgers and Dr.
Shurin, who lead the Obesity Task Force at NIH, who are just
putting forward a new research plan that's quite exciting.
Dr. Rodgers. Thank you, Senator.
Because of the extreme importance of this project, and
particularly the recognition that obesity is occurring much
more frequently in children in this country, we've also asked
Dr. Collins for his permission to have the Director of the
Child Health Institute on board as a co-chair of this obesity
research task force.
As Dr. Collins indicated, we just put out this last month a
strategic plan which highlights a blueprint for research in
these critical areas related to prevention and potential
treatment of obesity, particularly in health disparities or in
certain ethnic and racial groups, in older adults, in young
children.
And it recognizes the fact that obesity is a multifaceted
problem, and, therefore, you need multifaceted solutions,
including behavioral, medical, surgical and others.
Senator Shelby. How important is behavioral here----
Dr. Rodgers. Behavioral research is extremely important.
For example, we know that for childhood obesity just decreasing
screen time, the amount of time kids are in front of the
television, the computer, video games can greatly reduce the
risk. Increasing physical activity is another important
component to this.
Let me turn to my colleague, Dr. Shurin, who actually has a
very active program involving children.
Dr. Shurin. Thank you, Senator. We share your very deep
concerns about this.
One of the things that Dr. Rodgers and I have done is to
convene a group, a collaborative on obesity with the CDC and
the Department of Agriculture with the support of the Robert
Wood Johnson Foundation, which has a particular interest in
childhood obesity.
So we have a multifaceted research program. Much of it is
community-based research, but it also ties in to many
biologically and behaviorally oriented research programs really
looking at the factors that impact obesity.
As Dr. Rodgers has said, we've got several studies now
which show a very profound influence of screen time. Physical
activity is at least as important as diet, but dietary issues
are obviously of major importance. And we have a very rich
portfolio of research projects looking at what are the most
effective interventional strategies.
Many of these are site-based, worksite-based and school-
based programs. I think one of the things that's particularly
important is that many of the projects that we get into which
look very promising don't actually pan out. It's very helpful
for us to know what doesn't work, so we can really be fairly
aggressive in pursuing the ones that do.
The impact of policy changes, the engagement of the food
industry and of preventive health services we think are
particularly important. We initiated a program called We Can,
which is ways of enhancing childhood activity and nutrition,
which we have now several thousand community partners aimed
very heavily at reducing screen time and increasing physical
activity and focusing very heavily on dietary activities.
We have several collaborations with the food industry, with
several partners in the food industry which have become
increasingly responsive, but we think that there are probably
going to have to be some policy approaches that will have an
impact on this, that simply relying on individual choices is
not going to be sufficient.
Senator Shelby. Thank you. Thank you, Mr. Chairman.
Senator Harkin. Thank you. In keeping with the
subcommittee's policy in order of appearance here at the
subcommittee be Senator Reed, Senator Moran, Senator Mikulski,
Senator Brown.
Senator Reed.
GLOBAL COMPETITIVENESS
Senator Reed. Thank you very much, Mr. Chairman, and thank
you, doctors.
Dr. Collins, just a quick point, that Chinese facility that
you mentioned to is supported by the Chinese Government or do
we know?
Dr. Collins. Interesting. It is partly supported by the
Government, but they actually have put this in place by taking
out a bank-supported loan to allow them to purchase 128 of
these----
Senator Mikulski. They didn't get it here.
Dr. Collins. Senator Mikulski is correct. It was not at an
American bank. And they have purchased 128 of these sequencing
machines, the largest collection in the world, and they are
quite confident that the value economically will fully justify
the cost of buying the machines.
They've also hired about 4,000 of the smartest young
scientists that I've ever seen in one place from all over China
who are in their 20s and who are prepared to change the world
and probably are going to.
And we should celebrate that. I don't mean in any way to
say I think this is a bad thing, but it worries me to see that
China has taken that kind of initiative and we have not.
Senator Reed. But the financing might be considered quasi
private and public together, but this is clearly an initiative
at the highest levels of the Chinese Government to get this
done.
Dr. Collins. Yes.
Senator Reed. And we are at this debate here in the United
States about what we will commit as a Government to not only
the genome sequencing, but so many of the innovative proposals
you've talked about.
Dr. Collins. That's correct----
NIC VOLKER TREATMENT DETAILS
Senator Reed. Just want to clarify that.
I thought also, joining the chairman, that the poignant
story of Nic--I wonder did he or his doctors avail themselves
to the National Cord Blood Registry, CDC's the MATCH? Was that
a----
Dr. Collins. I don't know in terms of where his stem cell
transplant came from. I can find that out for you, Senator.
PEDIATRIC RESEARCH
Senator Reed. But that's an initiative that Senator Hatch
and I worked on and I hope it contributed to that great story.
[The information follows:]
Nic and the National Blood Cord Registry
David A. Margolis, M.D., professor of pediatrics and director of
the Bone Marrow Transplant Program at the Children's Hospital of
Wisconsin, said, ``Our donor coordinator says `Yes. If it were not for
the National Marrow Donor Program, and the single access that it
provides, the search (for Nic's cord blood stem cell donor) would have
been more difficult, time consuming, and may not have yielded the same
results.' ''
Senator Reed. But this raises a larger question, then, in
terms--that I have with respect to the amount of resources
going to pediatric research. You've cited several examples. Dr.
Rodgers, Dr. Shurin have talked about, you know, the research
you're doing in children's obesity, et cetera.
For example, I'm told that only about 4 percent of the
funds in the National Cancer Institute are for pediatric
cancers. That might be good news, because it might represent
that it's a relatively healthy population, but just generally a
sense do you think we're making the right allocation of
resources to pediatric research?
If we're not, are there structural issues; that is, is the
peer-based review tilted toward adult experts rather than
pediatric experts? Any comments I'd appreciate.
Dr. Collins. Well, quickly, and then I'll ask Dr. Varmus to
address the pediatric oncology issue, but we have an entire
Institute at NIH, the National Institute of Child Health and
Human Development, which has as its major focus pediatric
research and which certainly is a place of a great deal of
interest and excitement right now because there are so many
promising developments in childhood illness.
We also are investing in a very large national project, an
unprecedented one, the National Children's Study, which will
enroll 100,000 kids beginning even before conception through
pregnancy and up to age 21 in order to comprehensively collect
the kind of information about environmental exposures and
genetics that may shed light on diseases like autism and
diabetes that have continued to vex us.
I would say, yes, there's a lot of investment. Could there
be more? You bet there could, but that would probably be true
in virtually every area that we're looking at. With these 17 to
18 percent success rates that were mentioned by the chairman,
we are clearly not able to support a lot of great science that
we'd like to support.
Senator Reed. Before Dr. Varmus, I must say that Brown
University Medical School is participating along with Women and
Infants Hospital, and Dr. Rodgers is their commencement
speaker, because he's one of the most illustrious Brown
University medical graduates in the history of the program. I
had to put that in the record. Forgive me, Dr. Collins.
Dr. Varmus.
Dr. Varmus. Senator Reed, thank you very much, and I
appreciate your honoring my colleague, Dr. Rodgers.
You're correct that the amount of money we specifically
identify as being devoted to pediatric cancer research is about
4 percent of our budget, which is about $200 million a year,
but, of course, a great deal of other funding that we're
involved in addresses cancer more generally and is applicable
to pediatric problems.
Let me say a few words more broadly about pediatric cancer.
Chairman Harkin alluded to the fact that we do cure most
patients with leukemia. Pediatric cancers, in general, are much
more effectively treated, whether they're brain tumors or
neuroblastomas or Wilms tumor or leukemias, but, nevertheless,
there still is an increased incidence of childhood cancers over
the last several years by about 30 percent, but a continuing
decline in mortality.
Nevertheless, mortality figures do not tell us the whole
story. There are severe consequences of being treated for
cancer at an early age--developmental defects, loss of mental
capacity in some individuals, and, of course, a very high
incidence of second tumors, particularly in survivors' 20s and
30s.
We're trying to address these problems in a variety of
ways. We're trying to understand the cancers more profoundly
with some of the genomic-sequencing techniques that Dr. Collins
alluded to.
We, in fact, have spent Recovery Act money on a new project
to study pediatric cancers in great detail. And we have new
therapeutic maneuvers that are based on more targeted, bullet-
specific drugs and antibodies that have been very effective in
reducing mortality rates in neuroblastoma and leukemias with
therapies that are less toxic.
We have paid a lot of attention to the survivors of
pediatric cancer. We have a nationwide survivors study for
pediatric cancer that has enrolled over 20,000 patients in
roughly 37 different centers. So with these and other projects,
we think we're making a pretty good effort to control the
consequences of treatment of pediatric cancer and to do a
better job in treating pediatric cancers in a less toxic
manner.
But you're correct, we could do more, but, as you know, we
have budget constraints this year. It's unlikely that we'll see
a very significant increase in that domain or any other in the
coming year.
BIOMEDICAL RESEARCH RESOURCES AND WORKFORCE
Senator Reed. Thank you very much. Thank you, gentlemen.
Thank you, Dr. Shurin. Thank you, Mr. Chairman.
Senator Moran. Chairman Harkin, thank you.
Dr. Collins and your colleagues, fellow doctors, I
appreciate the opportunity to have this conversation with you
this morning.
This is a beginning course for me. I have 4 months of being
a United States Senator and being a member of this
subcommittee, but I'm excited about joining Senator Harkin and
Senator Shelby and my colleagues here.
I think medical research is a huge component of the future
of our country. I think it matters greatly, and I commend you
for your efforts to date.
In my healthcare reform bill, we would support medical
research in a dramatic way. I think it's a cost-saving measure.
It's about saving people's lives, improving the quality of
their life. And so from an economic--as you point out--but also
from a personal, humanitarian point of view, what we do here in
this subcommittee and what you do at NIH matters greatly.
And I would welcome the opportunity to become better
acquainted with NIH, its personnel, its mission. Maybe the
people in the rows behind you--I want my doctors out there
doing the research, but I'm happy to have others at NIH devote
some time to educating me so that I can better understand how
we can advance the cause of medical research here in the United
States.
I would ask first if there is something missing. We're here
in an appropriations subcommittee, but other than money, is
there something missing at NIH or here in our country, in the
United States, that makes it much more difficult or makes it
difficult for you to reach the goals that you outlined for us
today or is this just a financial issue, how many dollars do we
devote? What are the other, if any, impediments toward success?
Dr. Collins. Well, Senator, I appreciate the question and
certainly appreciate your strong statement of support, and you
are most welcome to come and visit us at NIH. We'd love to host
you for a visit and show you some of the things that are going
on in the laboratories and in the clinical center, the largest
research hospital in the world, that's up there in Bethesda.
Senator Moran. Thank you.
Dr. Collins. But as you know, most of the money that NIH
sends out in grants goes to the 50 States, including Kansas,
and we're very proud of the research that's going on there in
your State.
Senator Moran. Thank you.
Dr. Collins. In terms of other things that potentially are
barriers, certainly we do not have what I would call a vigorous
pipeline of young scientists coming into our field, and part of
that is the sad state of K through 12 science education in this
country, which has certainly, by any measure, slipped badly
over where it used to be back in the--30 or 40 years ago in the
sort of post-Sputnik arena where science education was really
emphasized.
Now, in many schools, it is unfortunately quite
rudimentary, and I think we lose, therefore, the chance to
capture young people's imagination that science would be a
place they wanted to spend their own careers. And that means we
have fewer American-born individuals who are clamoring to come
in to our laboratories and make the next great discoveries.
We have lots of interest from individuals born in other
countries to do that, but that interest has actually declined a
bit as more opportunities are present in their own countries.
Some of them, certainly in large numbers, still come to
train in our universities, but they often now go back to their
original homes and carry out research instead of staying in the
United States. And some of our visa practices have not helped
in that regard in terms of making such talented scientists from
other countries feel less welcome than we wish they were.
It seems to me that would be a very important area for us
to, again, try to get right, because it is to our advantage to
recruit such individuals--and our universities are still seen
as the very best in the world--to come and do their research,
but then for us to also be able to capture their talents in an
ongoing way I think would be a great advantage. That is just
one of the areas.
But, frankly, the major concern that I think we have is
just the lack of sufficient resources to chase down all of the
great ideas that are now potentially possible.
INTERDISCIPLINARY RESEARCH
Senator Moran. I appreciate that answer and look forward to
finding solutions in that regard and understand now the
importance you place upon the resources.
I did visit the University of Kansas last week and one of
the research facilities there, the Molecular Libraries Program,
and I'm very interested in what the ranking member pursued in
regard to NCATS.
And when I heard your testimony today, my assumption is
that this will take a lot of different kinds of scientists
engaged in this effort, and I guess an initial question would
be what steps would you anticipate being taken to ensure that
the best of American science in as many areas will have that
opportunity to contribute to this new program?
Dr. Collins. Well, a very appropriate point. It will take
an interdisciplinary effort of a considerably revolutionary
sort.
It means bringing together biologists and chemists--as no
doubt you saw at the Molecular Libraries Program in Kansas--
along with computational experts, structural biologists who can
actually figure out the shape of molecules and figure out which
shapes fit together in a way that might make a particular drug
work, immunologists who can help us with monoclonal antibody
development, engineers who can work on devices that will be the
next generation of what we need for all manner of medical
applications, and those disciplines traditionally haven't had
such an easy time talking to each other, and one of our goals
through this program and many others is to do that.
Maybe this is also partly in answer to your first question
about what are some of the barriers. In some way our own
traditional disciplines have presented some of that problem,
although I think those barriers are coming down.
Clearly, there's a lot of excitement--and I suspect you
perceived that in your visit to the Kansas center--about the
potential here of bringing those disciplines together with
these new comprehensive sciences to enable academic
investigators to play a larger role in reengineering this
broken pipeline to try to make it possible to come up with
therapeutics and devices and diagnostics in a shorter time
period.
This resonates with me for the same kind of feeling I had
about the Genome Project 20 years ago. It was controversial
then, too, of course. A lot of people wondered whether this was
biting off more than the Government could chew, but it
recruited into the effort some of the best and brightest minds
of that generation because they could see the potential.
I think that same atmosphere is beginning to appear in
translational science, and I suspect once we have the programs
in place it will not be hard to recruit some really brilliant
minds to play a role in this.
Harold, did you want to add to that?
Dr. Varmus. I think it might be important to reassure you,
Mr. Moran, about the effort that's being made in translational
research across the institutes.
As Francis alluded to in his testimony, a great deal of
work--interdisciplinary work, indeed--has gone on in the
Institutes and will continue to go on, while NCATS provides a
catalytic advantage to the efforts that we're making by
providing new methodologies, ways to analyze how translational
research is done, some core facilities.
But, as you probably know from going to your cancer center
at the University of Kansas, that there is a lot of
translational research going on there, and that's done by
interdisciplinary teams.
So all of us at the NIH are engaged in this process and
we've had a lot of experience in gathering multidisciplinary
teams over the last decade or so to do this kind of work.
Senator Moran. So it's not new and we know it can be done.
It's being done today.
Dr. Varmus. But we're all engaged in the process, and it's
not going to fall solely on the head of NCATS.
Senator Moran. And, unfortunately, I'm on the social
science in my education and I detect that the same thing may be
there between chemistry and biology as there is between history
and political science.
Dr. Varmus. Well, there could well be. Yes----
Senator Moran. But I appreciate that, and I did see the
enthusiasm. That was perhaps the takeaway of my visit is the
excitement that is there and the belief in the potential of
what can be accomplished.
Dr. Varmus. Yes.
Senator Moran. It's very appealing to me.
Dr. Collins. Dr. Fauci wants to add something.
Dr. Fauci. There is one other thing that sometimes gets
misunderstood. We mention--and Dr. Varmus mentioned also that
there's a lot of translational research going on.
What the center is going to be directing itself at is to
really advance what we call the discipline of translational
research, in other words, to help us to do more innovative ways
of approaching translational research. So translational
research goes on to the tune of many billions of dollars at the
NIH, mostly in the big Institutes, but some of the smaller
Institutes also.
What we want to do is advance the discipline of how it's
done, making it a 21st century approach toward translational
research as opposed to relying on many of the methodologies
that have been good, but that we think we can do better on.
That's what it's really all about, putting forth the discipline
and improving the discipline of translational research.
Senator Harkin. Thank you. Thank you, Senator Moran.
Senator Mikulski.
SUPPORT OF NIH
Senator Mikulski. Thank you very much, Mr. Chairman. I'm
very proud of the fact that NIH is located in the State of
Maryland. And for more than 25 years, I've visited NIH
regularly, and every time I come, my eyes pop with wonder, my
heart beats with excitement and I just--one of the reasons I
wanted to be here today was to tell you and all of the people
who work at NIH how proud I am of you, and how America ought to
be proud of you.
Dr. Collins, you did path-breaking pioneering work when
mapping the genome. And we were in a race. You had another
competitor down the street. You broke the code and we
invented--not only mapped the code, but came up with new fields
called computational biology, bioinformatics, new exciting
careers that help both us in particularly the private sector be
able to come up with new products.
And, Dr. Fauci, you, what you've done. You were the guy who
broke the AIDS code. You were the guy that came here when we
were gripped in fear and near panic when we were shut down due
to anthrax and we had no place to turn in our United States
Government for information, but we turned to you and you kept
us on the right path, so that we could keep the doors of the
Capitol----
Dr. Varmus, a former head of NIH. You know, NIH Directors
don't leave. They leave legacies, and then they come back to
create new ones, and we're so glad to see you. And we note that
when you were at Sloan-Kettering you had a lot of other zeros
behind your compensation package, which says something about
why you came back.
And to Dr. Rodgers and Dr. Shurin, who also was educated at
Hopkins, we're just glad to see you.
And, Mr. Chairman, and what they do is the work that helps
us manage the biggest budget busters in our healthcare budget--
diabetes, heart disease, the chronic conditions that lead to
chronic problems in the way we live, in the way we have to fund
healthcare.
So I wanted to be here today to say for all the people work
at the institutes, all the people work at the various offices,
all the lab techs, the security guards, the fire department,
we're really proud of you.
So having said that, I want to make sure we help NIH be
NIH. So I want to stick to the basic mission in addition to
these exciting new ideas.
Dr. Collins, how many research grants did NIH fund last
year, and how many requests did you get for funding? In other
words, what is the funding gap, and particularly not only with
the tried and true research, but also with those promising
young, maybe more upstart type thinking?
Dr. Collins. So in fiscal year 2010, we funded
approximately 9,300 research grants. The success rate in fiscal
year 2010 came out at just about 20 percent; that is, one out
of five that were able to be supported.
With the fiscal year 2011 budget now in front of us, now
that it's been decided, we won't do that well, because, of
course, as you know, after the dust all settled, we ended up
with a 1-percent cut of $320 million, although I really want to
express my appreciation----
Senator Mikulski. So that's what one percent means, $320
million?
Dr. Collins. That's correct. But I do want to express my
appreciation to members of this subcommittee, because I know
there was a great deal of debate about exactly where the dust
would all settle out, and certainly many of the proposals were
vastly worse than this, and I know many people really went to
bat for NIH, and we appreciate that enormously.
But we do believe that in fiscal year 2011--with some
uncertainty in the number, because we don't actually know how
many grants we will receive, and, of course, we're talking
about a proportionality here--that the success rate will fall
to approximately 17 to 18 percent, and that will be the lowest
in history.
We will do our best to try to manage the resources that
we've got, and we've made a number of adjustments to try to
keep that number----
Senator Mikulski. But for every one grant that you can
fund, let's even go to before fiscal 2011, how many are
unfunded?
Dr. Collins. So it would be five out of the six. If you
have six grants in front of you, we're going to fund one of
them and five of them are going to go begging.
WORKFORCE PIPELINE
Senator Mikulski. All of which are quite promising.
Now, let's go to much is made about recruiting young people
into science, and we want a lot of initiatives in that, but
young people follow opportunity. So when we look at your
internship, your fellowship program, both for high school,
undergraduates and so on, again, how many students can you have
come in to NIH? And how many--In other words, how many can you
take and how many apply? What's the enthusiasm gap here?
Dr. Collins. Well, there is enormous enthusiasm. Certainly,
we run a number of internship programs on the NIH campus. We
have a program for high school students and college students
who come and spend 10 weeks in the summer. That is always
oversubscribed by at least a factor of five in terms of the
number of slots that we have available and the space that's in
the labs.
We also have a program for individuals who are finishing
college, who are really interested in science, but they're not
sure whether they want to go to graduate school or medical
school. They come and spend 1 year, sometimes 2 years doing
full-time research in the lab.
I have three of those students in my lab right now. They're
enormously energized, excited about what they're doing, and
they go on to do great things. This is a really important
program.
But there again, the number of applications we have for
that so-called post bac program is at least four or five times
greater than the number of slots that we have available to
offer.
Senator Mikulski. So while we're busy--You know, we like to
pound our chest and come up with all kinds of things in
education to encourage people for science, but our young people
are going in it, but they need opportunity, both in the public
as well as in the private sector.
Dr. Collins. So, Senator, I've just set up, as part of my
advisory committee to the Director, a working group to look at
our workforce issues, and I've asked Dr. Shirley Tilghman, the
president of Princeton, to co-chair that, because I think we
need a better handle on what the supply-and-demand issues are
in terms of the biomedical research workforce.
We want to be sure that we're looking forward with a clear
eye toward all of the different pathways that are going to need
well-trained, doctoral-level biomedical researchers and that
we, NIH, as a major source of training support are
appropriately tuning our programs so that we have the numbers
right in terms of how many people we are bringing in and what
kinds of careers we're preparing them for.
EFFECTS OF A GOVERNMENT SHUTDOWN
Senator Mikulski. Well, I think this would be enormously
useful to this subcommittee, Mr. Chairman, because, as you
know, this is a topic--a big public-policy topic they ponder
all of the time.
My last just comment or question is with all the talk of
the shutdown and during H.R. 1, a cut to the National Cancer
Institute, which was stunning to many people, including me,
what is the morale at NIH now that they thought that they might
be sent home and told that they were non-essential and the cuts
might be coming?
I mean, I must say both the chairman and the ranking member
were enormously supported to minimize the disaster, but it was
not a victory.
Dr. Collins. So I would say this was a very difficult
period to go through. We were required, of course, in
preparation for what appeared to be a very high likelihood of a
shutdown, to define how we would manage that, and that meant
defining which particular employees were considered essential
and which were excepted, was the term that was used, and which
were non-excepted.
And, of course, those who were involved in patient care or
management of animals couldn't very well just not come to work,
but others were told, ``I'm sorry. If there is a shutdown, you
can't come to work.''
Think about how that feels if you're a post-doctoral fellow
who's in the middle of an experiment that you've been working
on for 2 or 3 weeks and has another couple of weeks to go and
you're being told, ``I'm sorry. You're not allowed to come to
work tomorrow if the Government shuts down.'' It did have a
very significant effect. People were quite shaken up by that.
I think people are--in the aftermath of that--feeling a
little uncertain about what it's like to work in this
environment and hoping that we won't face that again. But,
again, I think everybody understands these are terribly,
terribly difficult times for our country.
INFLATION EFFECTS ON PURCHASING POWER
I just want to show you one image because I think it might
be actually useful.
[The information follows:]
Senator Mikulski. Okay. I'm going to just--chairman
regulate the time, but I'm fine with it, but if that's okay
with the chairman.
Dr. Collins. It'll take 1 second. This is basically why we
are in such a crunch.
Senator Mikulski. Well this is a terrific slide.
Dr. Collins. So this is--this shows----
Senator Mikulski. It's more like the way my heart went up
during the shutdown mode.
Dr. Collins. So in blue, you see the appropriations for NIH
going back to 1998. You see the doubling that happened between
1998 and 2003, and then you see that since 2003 the NIH budget
has been much more in a flat trajectory.
But in yellow, you see the effects of inflation, the
biomedical research and development index, which has been
eating away at our buying power since 2003, placing us now,
even with the President's budget, in the range of what we were
at 2001. So we're sort of where we were 10 years ago.
You see the Recovery Act dollars there in 2009 and 2010,
which were a wonderful boost to the scientific community, but,
of course, that was 2-year money.
That is why the success rates are now dropping to where
they are. It's all pretty much clear what the consequences
would be once one considers what's happened to buying power for
research.
Senator Mikulski. Thank you. Mr. Chairman, thank you.
Senator Harkin. Senator Mikulski.
Senator Mikulski. You are the genius club. I mean, you
really are. So thank you.
Dr. Collins. Thanks.
Senator Harkin. Senator Brown.
NEW INVESTIGATORS
Senator Brown. Thank you, Mr. Chairman. And I've always so
enjoyed having panels from NIH, some of the smartest people in
the country, especially those who used to teach in Cleveland,
Dr. Shurin.
But thank you. I mean, it really is illuminating and we
thank you so much for your service. This is such an example of
public service and why government matters.
And when I hear some of the know-nothings that hold jobs
like we hold say that the Government is broke and that
Government can't function and Government doesn't contribute
anything and Government doesn't create jobs, you know, I think
about the special forces. Those were Government employees that
were in Abbottabad, but I think primarily of what NIH does and
what you contribute to public health and to wealth of our
country.
I want to take up on what Senator Mikulski said, and Dr.
Collins' response, on the one out of five grants. I was in the
House, ranking Democrat on the subcommittee back when we
actually wanted to fund public health bipartisanly in this
country 15 years ago, doubled the budget at NIH.
And I remember in those days those numbers that some of
your predecessors--well, some of you and some of your
predecessors--would cite, now that we fund one out of five
grants or one out of six grants. It's gotten a bit worse than
what Senator Mikulski said.
The other part of that story that I remember is the young
researchers that you are always looking to attract when you
teach at med schools and you counsel people and you mentor
people, those are the least likely to be the one out of five
that gets the grants--or the one out of six--because my
understanding is that people that have done these grants over
time kind of know how to win the grants better than the young,
bright researcher also applying for the grant. So the numbers,
in some sense, among younger, hungry researchers are even
worse, the ratios, and too many of these young people leave the
field.
And I think that's, to me, the most compelling reason that
this fervor to cut budgets as--we need to address our budget
deficit, but we're creating terrible deficits in young
scientists and terrible deficits in the public body of
knowledge, I just want to say.
COST OF PHARMACEUTICALS
Let me go--two issues I want to talk briefly about. One is
the issue of the Makena drug, the progesterone that was
developed over time into a--produced by compounding pharmacies
as you know, has made a huge difference, provable huge
difference, clinically trialed--if that's a verb or adverb--
huge difference in preventing early birth, pre-term births.
We know what this KV Pharmaceuticals in St. Louis did. We
also know that you at NIH have invested $21 million on now four
clinical trials, in the midst of the fourth one and still
investing in this and finding, I think, more indications,
perhaps, to use this drug, this progesterone, this compounded
pharmacy drug.
Well, just give me your thoughts, briefly, if you would,
how do we prevent this from happening? The Food and Drug
Administration (FDA) has stepped in and done something pretty
unusual and pretty gutsy by saying they're not going to enforce
the cease-and-desist order on compounding pharmacies.
So when I talk to obgyns and visit hospitals--I was at
University Hospitals yesterday in Cleveland--2 days ago--
talking about they're still compounding it, still producing
this.
When taxpayers invest in this and it's clearly a drug in
the public interest and one company can get exclusivity for 7
years, while you continue to do these clinical trials
expanding--in a sense expanding their market on this fourth
clinical trial you're doing--and I know this cuts across FDA,
HHS as a whole and you and CDC and all, but what do we do about
this?
Dr. Collins. Well, Senator, I think you spoke out quite
strongly about the Makena situation and I think brought a lot
of attention to a circumstance that really was deeply
troubling, that a drug--let's just call it 17P--that was
previously available and compounded by pharmacists and then was
put into a clinical trial, ultimately ended up, after FDA
approval and orphan-drug status, going up in cost from
something that cost $10 or $20 to something that costs $1,500.
We were also deeply alarmed to see that and quite pleased
to see FDA step in and say they were not going to go after
pharmacists that continued to provide the compounded material.
And that, by the way, also, and along with your strong
statements and that from some of the professional groups, did
cause KV Pharmaceuticals to drop their costs, but still at a
much higher level than they were in the old days.
NIH has its hands a bit tied in this situation. Back in the
1990s, when Harold Varmus was NIH Director, we had a big
discussion about whether drugs that NIH plays a role in
developing should have some sort of reasonable pricing clause
attached to any kind of licensing that we would do to a
company.
And while that might have seemed like a way to avoid
another kind of Makena outcome, it was a poison pill for any
serious relationship that NIH would have with a company. No
company in this country or elsewhere would be interested in a
partnership with NIH under those circumstances.
What we can do is to make sure that if profits ensue and
NIH has made a contribution to that, in terms of genuine
intellectual property discoveries, that there should be royalty
sharing on that basis.
But when it comes to setting the price, as KV did, even
though we supported the clinical research, we are probably not
the agency in a position to be able to do something to step in
and interfere with their pricing decision.
It was the public outcry, your outcry, Representative
DeLauro, the professional societies that I think actually
turned the tide.
Senator Brown. But that outcry only brought the price from
$1,500 multiplied times 20, with 20 weeks of treatment, as you
know----
Dr. Collins. Yes.
Senator Brown [continuing]. $1,500, $30,000, when it was 20
times $10 or $20--depending on the compounded pharmacy's
charge--down to $690. So the outcry worked with FDA. The outcry
barely worked with KV.
But is there a way to sort of cross the--I understand that
you don't want to engage in partnering and price-setting and
all that, but--or maybe you do--but when a company so
overreaches like this, it was such an affront to the public
interest, if there's a way, sort of across help agencies we
could find some solutions or----
I mean, Dr. Hamburg was in here and she said, well, you
know, FDA didn't do this. She wasn't defensive at all, but then
FDA did something. This was before they made that decision.
But I just will follow up with you, but I'd like to see if
there's a way to----
CANCER CLUSTERS
My other question--I'm sorry to go over the 5 minutes, Mr.
Chairman--Dr. Varmus, you had talked about pediatric cancers
and Senator Reed had asked you about that.
There's a cancer cluster in Clyde, Ohio, where many, many
children, under 12 in most cases, have developed cancer, and I
know you see these. There are four or five believed to be
cancer clusters. I don't know if that's a particular medical
term, but is certainly what we talk about.
What is NIH's role in sort of examining these, exploring
these, finding out the environmental cause, if it is that, as I
presume--I guess I presume it is. What is your role in that?
Dr. Varmus. Well, we do investigate that. We have a
Division of Epidemiological Cancer Research that will look at
these clusters to ascertain whether or not the cluster is real.
Because, as you might expect, if cancers are distributed in
their frequency across the country, there are going to be some
places that just, by chance, have a particularly high or
particularly low incidence, and there are several classical
examples of clusters that turned out only to be arithmetic
aberrations, but without any clear indication of causes.
On the other hand, there have been clusters of cancers that
are linked to certain practices or to exposure to industrial
mutagens, and we would go in with collaboration with the
National Institute of Environmental Health Sciences and try to
ascertain what might be a precipitating cause.
So we do have a role and we would--I don't know about the
one you're citing, but we can certainly look into it and report
back to you on what----
Senator Brown. We have talked to NIH overall, but we will
specifically talk to you.
Thank you, Mr. Chairman.
[The information follows:]
Clyde, Ohio Cancer Cluster
State and Federal Responses to Cancer Cluster Reports.--State and
local health departments respond to cancer cluster reports and provide
the first level of response and review of the most current local data
for the area. If needed, these local health departments can request
assistance from Federal agencies, including the National Center for
Chronic Disease Prevention and Health Promotion (NCCDPHP) of the
Centers for Disease Control and Prevention (CDC), the Agency for Toxic
Substances and Disease Registry (ATSDR), and the U.S. Environmental
Protection Agency (EPA). CDC's role in investigating potential cancer
clusters is to provide technical assistance to States at their request
as they conduct their investigations. In State cancer registries,
States have the data needed to determine whether a cluster exists.
National Cancer Institute (NCI).--NCI does not investigate
anecdotal clusters of individual cancer cases in neighborhoods, but
rather clusters of counties with elevated rates as part of the
geographic mapping strategy to identify and investigate high-risk
populations for etiologic insights. However, upon occasion NCI's
Division of Cancer Epidemiology and Genetics (DCEG) may be called upon
to consult with local and State health officials and CDC experts as
they investigate purported cancer clusters.
DCEG's research portfolio includes analysis of cancer treands in
human populations, and DCEG investigators conduct studies both within
the U.S. and around the world where the incidence of certain cancers is
significantly higher than might be expected. Examples of such
investigations include lung cancer in coastal communities in the U.S.,
which was linked to asbestos exposure in ship yards, and oral cancer in
women in the rural south, which was linked to smokeless tobacco use.
DCEG researchers are currently investigating the reasons for the very
high rates of bladder cancer in northern New England; they will soon be
reporting data from this effort. They are also conducting a study to
explore the elevated rates of Burkitt's lymphoma in regions in Africa.
Regarding the Clyde, Ohio Investigations.--It is our understanding
that there was a multi-year analysis of a suspected cancer cluster in
Clyde, Ohio by the Ohio Department of Health (ODH). Both CDC and ATSDR
provided technical assistance to the State officials over the course of
the multi-year assessment. While NCI has not received any reports or
conclusions, it is our understanding that the assessment's final
conclusion was that the data were inconclusive and there was no cancer
cluster identified. These Federal public health agencies are continuing
their collaboration with ODH and are available to provide support as
needed.
FLU VACCINE
Senator Harkin. Thank you, Senator Brown.
Dr. Fauci, for years, you've been here, year after year,
and we've talked about flu vaccines, and, some time ago, I
remember you talked about progress being made toward a--perhaps
a universal type flu vaccine. You mentioned it in your written
statement, which I read last night. Again, how close are we?
Dr. Fauci. Well, I can't give you an exact time in years,
because every time a vaccinologist does that, he or she gets
burned. So I'll refrain from that, but I can tell you that we
clearly are considerably closer than when I spoke to you last
time at a hearing when we were talking about the possibility of
getting away from that very frustrating situation where each
year you have to hopefully guess right, and we do most of the
time, but not all the time.
But even more importantly, when we're faced with a pandemic
flu like we were with the 2009 H1N1, when we made a vaccine
after isolating the virus, but the production issues were such
that by the time we got enough to distribute, unfortunately,
the pandemic had already peaked. Fortunately for us, it was a
relatively mild one, but that's not going to happen all the
time.
So what's happened in the last year since we spoke, Mr.
Chairman, is that there have been a number of experiments that
have been conducted both at the NIH and by our grantees and
contractors, which have really identified components of the
influenza virus that the body generally does not make a very
good response to readily, and that part of the virus is the one
that would give you protection against virtually all strains.
And one of the reasons is is that it's sort of hidden from
the view of the immune system. The thing that the immune system
sees really clearly is the part of the virus that changes from
season to season, and that really changes a lot when you get a
pandemic. There's a part of the virus that the body can make an
immune response to that it doesn't usually see very well.
So what investigators have done, in a very simple way, is
that to put that particular component of the virus in a form
that the body would see it much more sharply and clearly. This
has been done in animal models and proven to be inducing
responses that are good against decades of changes of
influenza.
And, now, those studies are being done in what we call
phase I trials in humans, and the early work indicates that,
clearly, it looks quite safe, and, second, it is inducing
responses that span multiple years.
So I believe it's really just a matter of time. As you
know, clinical trials, when you want to prove safety and
efficacy over a period of time, naturally would take years, but
it's on a track that I believe it's going to happen. I don't
think it's going to be a question of if. It's going to be a
question of when. So we're really quite excited about it.
And that's a very good example of that transition from
fundamental basic research observations on molecules and their
confirmation and how that ultimately gets translated into
something that, if successful, is going to have enormous public
health benefit.
Senator Harkin. Well it would. I mean, the amount of just
savings alone on annual flu shots would be incredible, aside
from the fact that you wouldn't--I would, from what I
understand is if this was really developed, the threat of
pandemics would not be as large as they are now either.
Dr. Fauci. The ultimate goal is to have on the shelf, ready
for utilization a vaccine that does have the universal
characteristics to it, so that if you do get a change with a
pandemic, that you can actually have that particular virus be
covered by it.
So we'd like to get it to the form--I don't think it's
going to be perfectly this way, Mr. Chairman, but it's going to
be close. I don't think it's going to be one flu vaccine and
that's it for the rest of your life.
It'll probably be having to be given every several years to
continue to boost the immune system, but we would like to be
the way we are, for example, with measles or hepatitis or
polio, where you just make a lot of it, you have it available
and when you need it, you deploy it, as opposed to having to
play catch up every single time a new virus emerges.
MEDICAL MILESTONES
Senator Harkin. Very good.
Dr. Varmus, in 2001, Gleevec was on the cover of all our
national news magazines, talked about it being the magic bullet
that would herald in a new age in the war against cancer. For
the first time, we had a drug that specifically targeted a
known cancer gene. It took this deadly blood disease, turned it
into a chronic, but survivable condition.
We were told that Gleevec was the promise of the future. We
talked about it in our subcommittee hearings at that time, but
that was 10 years ago. We haven't had any other Gleevecs.
What's happened? How come no more Gleevecs?
Dr. Varmus. Well, I wouldn't characterize it quite that
way, Senator. Gleevec remains the poster child for targeted
therapy.
Senator Harkin. Yes.
Dr. Varmus. And just to give you a brief update, it's used
not only for the treatment of chronic myeloid leukemia, the
leukemia you heard about, it's used for the treatment of
several other diseases in which potential targets for the drug
are mutated, and that includes gastrointestinal stromal tumors,
a number of other blood diseases, and, indeed, a few other
diseases in a few cases in which certain genes are known to be
mutated as a result of analysis of the genome of those cancers.
Moreover, it's recently been shown that we can deal with
drug resistance, a common problem in cancer therapy, by using
drugs closely related to Gleevec but not identical to it and to
treat patients who become resistant to Gleevec.
Second, it's been shown recently that a person in their 40s
or 50s who develop--leukemia now have a normal life expectancy,
which was previously 5 years. That's a dramatic change and it
shows that the efficacy of Gleevec has been sustained over the
last 10 years, and, actually, the evidence that it's effective
is only strengthened.
There are a number of other targeted therapies. They tend
to work quite well initially. Patients become--their tumors
become resistant to therapy. Let me give you a couple of
examples.
One happens to involve my own work on lung cancer, which is
a significant percentage, perhaps 10 percent, of cancers have
mutations in some specific genes against which we have
effective inhibitors, but, generally speaking, within 1 year or
so, on average, patients become resistant to those drugs. We
don't have good therapies to counter the tumors that are
resistant.
Recently, in the case of a disease called metastatic
melanoma, a disease that is secondary to finding a skin tumor,
but the tumor has spread to the liver, bones, and other sites,
it's been found as recently as 7 or 8 years ago, that about 60
percent of those cancers have a mutation in a specific gene
against which an inhibitor has been developed.
It's extremely effective, again, in inducing remissions in
a fairly non-toxic way. This is, again, an orally available
drug that promotes a dramatic regression in the size of tumors.
There are two drugs that do this. They are very likely soon
to be approved by the FDA. They don't cause persistent
regressions, but there's every reason to hope that additional
drugs will be on the way to help counter drug resistance.
So I would say that we've had a number of other targeted
therapies. They have not, in general, been quite as dramatic as
Gleevec, but most of us who are working in this area are quite
optimistic about a number of new drugs, some of which I haven't
mentioned, that are in the pipeline.
Senator Harkin. That drug you mentioned about metastatic
melanoma, you mentioned it in your written testimony.
Dr. Varmus. Correct.
Senator Harkin. What's the name of the drug? I forget----
Dr. Varmus. Well, there are two things that I mentioned in
my testimony, Senator, first was these so-called inhibitors of
BRAF. These drugs are not yet on the market. One comes from
Flexicon, one from GlaxoSmithKline (GSK).
Senator Harkin. Yes.
Dr. Varmus. There's also a new immunotherapy called
ipilimumab, which has been approved by the FDA. That's not the
same kind of targeted therapy, but it's a dramatic development,
because it's one of the first immunological approaches.
There are others, but this is one of the first that
actually displays how we can manipulate our understanding of
the immune system to galvanize the response of the immune
system against a variety of cancers, including melanoma.
Senator Harkin. But I can't even pronounce that word,
ipilimumab?
Dr. Varmus. Ipilimumab.
Senator Harkin. Thank you very much.
Dr. Varmus. Yes, I'm not responsible for that, Senator. It
would not have been my choice. Ipi for short.
Senator Harkin. It seems to me this is about as important
as Gleevec. I mean, this attacks metastatic melanoma in later
stages.
Dr. Varmus. Correct.
Senator Harkin. And this has always been a death sentence
before.
Dr. Varmus. As does the drug that inhibits the BRAF
mutation. But ipilimumab does not work in all cases, but does
prolong life significantly in a very substantial 15 to 30
percent of patients who have metastatic melanoma. It is a major
development, no question about it.
One of the open questions is why do a certain subset of
patients with this disease respond and others not respond.
There are other inhibitors of the so-called brakes on the
immune system that are in development, and I think may be
combined with ipilimumab or used as an alternative when
ipilimumab doesn't work.
So we're quite optimistic after many years of trying to
manipulate the immune system that we have some very serious
handles on how the immune system works that we can use in
cancer therapies.
Senator Harkin. Very good. Thanks, Dr. Varmus.
Recognize Senator Shelby, then I see Senator Kirk has
joined us. I'll go to Senator Kirk next.
ACADEMIA-INDUSTRY COLLABORATION TO REPURPOSE DRUG COMPOUND
Senator Shelby. Thank you.
Dr. Collins, repurposing drugs, you alluded to that
earlier. As we have searched for treatments, as you do, and
others, investigators, to the healthcare challenges, one of the
clear ways that some people believe we can continue drug
development is by finding new uses for drugs that were
discontinued or halted mid-development. By leveraging existing
compounds, researchers in industry can develop and have new,
novel treatments for patients.
It's my understanding that the NIH recently held a
roundtable discussion regarding rescuing and repurposing
compounds. Seems like that's an ideal opportunity for academia
to team with industry to bring treatments to patients faster.
Could you expand on that? What are you doing here and how?
Dr. Collins. I'd be happy to, Senator, because this is a
really exciting potential area to speed up the process of
developing new treatments for diseases that currently lack
effective interventions, and it's another example of the kind
of thing that NCATS will be able to catalyze just by its
convening power.
Yes, we did have this meeting just about 10 days ago. We
invited major leaders from pharmaceutical and biotech
industries to meet with NIH investigators, with academic
experts and to ask the question: Are there in fact, already
sitting in medicine bottles or in freezers of companies that
have tried various compounds and abandoned them along the way
opportunities to take molecules about which we already know a
lot and find a new use for them?
Senator Shelby. Do you have any examples or is it too
early?
Dr. Collins. We have some very striking examples. Maybe
I'll even ask Dr. Shurin to tell the example of Marfan
syndrome. So let me set this up.
Marfan syndrome is a genetic condition caused by a single
glitch in a gene called fibrillin and is characterized by very
tall stature, and, unfortunately, by a high risk of an aortic
dissection, which is often fatal. So Flo Hyman, the volleyball
star, died suddenly because of that condition, and it's not
that rare.
And many of us thought, well, we'll never come up with a
therapy for that in the next 50 years, because it's too rare
for there to be much economic interest, but something pretty
interesting happened. Do you want to tell that story?
Dr. Shurin. One of our investigators at Johns Hopkins, Dr.
Hal Dietz, discovered that a drug, losartan, which is used for
blood pressure--it's an approved drug--actually cures Marfan
syndrome, not only in the test tube, but also in mice.
And so we were able, using our existing Pediatric Heart
Network, to rapidly launch a clinical trial. We had the first
patient enrolled about 5 months after we had opened the trial
and, working very closely with the Marfan Foundation, have been
able to complete enrollment.
The results are not yet fully available. The trends are
looking very good, and we've been very excited by this. But the
ability to do this with the cooperation of the drug
manufacturer and the patient advocacy groups has been really
quite spectacular.
Dr. Collins. So that's an example.
My own lab works on a disease called Progeria, the most
dramatic form of premature aging. These kids age about seven
times the normal rate and usually die by age 12 or 13 of heart
attack or stroke.
By discovering the genetic cause of that disease,
understanding the pathway that's involved, it became clear that
a drug class developed for cancer might actually turn out to be
beneficial in this premature-aging disease.
They've just completed a 2-year clinical trial on kids with
Progeria using this supposed cancer drug, and while the results
are not yet published, I'm hearing very encouraging noises. So
it's repurposing a very different idea of what that drug would
be used for for a new application.
I am sure that if we had a systematic way of trolling the
landscape to identify other such opportunities there would be
lots more.
INTER-AGENCY COLLABORATIONS
Senator Shelby. Dr. Collins, dealing with NIH-FDA
collaboration, which is, I think, is very important, what do
you think would be the best results to come from increased NIH-
FDA collaboration? Are there topics in particular that you're
working on with the NIH and partnering there to move--I assume
moving drugs to market and getting them approved safely is very
important.
Dr. Collins. Commissioner Margaret Hamburg and I have been
meeting for now almost 2 years to talk about ways that our
agencies could work more closely together. And she is a strong
advocate, and I share that same view with her, that regulatory
science--that is, applying science to how reviews are done of
drugs and devices--is very much a possible solution to the
current logjam of trying to get products through that pipeline.
Senator Shelby. We would all benefit from that, wouldn't
we?
Dr. Collins. We would, indeed.
And so she and I have together started a regulatory science
research program. We formed a leadership council between the
two of us which involves the senior leadership of both of our
agencies. We've identified six areas that we think are
particularly ripe for progress, such things as how do you do
toxicology more efficiently? How do you deal with combination
therapies like Dr. Varmus was mentioning may be necessary for
cancer when, in fact, that's hard to review. You have to come
up with new ways to look at that.
And I think together, working as sister agencies, we can
make progress that neither of us could have done alone, and
we're totally committed to making that happen.
Senator Shelby. How do you collaborate with CDC?
Dr. Collins. Oh, quite intensively.
Senator Shelby. I know you do.
Dr. Collins. Tom Frieden, the head of CDC, and I were on
the phone yesterday, and that happens regularly, about areas of
shared interest, and that includes global health as well as
domestic issues.
He and I have exchanged people by going back and forth to
look at shared projects. We obviously work very closely in the
area of infectious disease.
Maybe Dr. Fauci would want to make a comment about your
relationship with CDC, because it's so important.
Dr. Fauci. Yes. We have very strong and long-standing
collaborations, particularly in the arena of global health with
the emphasis on infectious diseases, even though global health
certainly encompasses more than just infectious diseases.
An example of that is we share some of our sites. The CDC
has epidemiological sites and posts for surveillance of
disease. We are now incorporating many of those sites in our
clinical trials of drugs, so many of the trials that take place
are really strong collaborations between the CDC and the NIH,
and that's worked very well.
CYSTIC FIBROSIS
Senator Shelby. Dr. Collins, I enjoyed seeing you last
night, and you know better than anybody that they've come out
with a new drug in the treatment of lupus for many things.
That's a breakthrough of many, many years.
What about cystic fibrosis? Where are you in this area? I
know you've done a lot of research in that area, too.
Dr. Collins. Senator, I appreciate the question. I enjoyed
the experience of chatting with you last night at the Lupus
Foundation of America event. And they are very excited, and
justifiably so, at the approval of Benlysta, this first drug
for lupus in a long time.
Cystic fibrosis is an area of intense interest for me,
because I was part of the team that found the cause of that in
1989, and that has now, finally, after many years of struggle,
led to a very exciting time therapeutically.
So just in the last few months, a drug developed using this
same approach to try to identify small molecules, the same kind
of thing that Senator Moran was seeing in Kansas, this, in this
case, done as a partnership with a company called Vertex, found
a molecule which goes by a not terribly friendly name, VX-770,
which, in fact, for that category of patients with cystic
fibrosis who have a particular mutation in the gene, appears to
be highly effective, and taken over the course of just a month
improves lung function. It reduces the sweat chloride, which
has been the diagnostic hallmark of cystic fibrosis----
Senator Shelby. This has been out how long now?
Dr. Collins. This is still in clinical trials. It hasn't
yet been approved by the FDA, but the phase III trial results
look extremely promising.
Senator Shelby. That would herald, if it were approved by
FDA--It's in clinical trials now.
Dr. Collins. That would be an enormous step forward.
Senator Shelby. A huge breakthrough, hopefully, for cystic
fibrosis.
Dr. Collins. Now, the down side is that this particular
drug is only likely to be effective in that subset of patients
with cystic fibrosis who have a particular mutation in the
cystic fibrosis gene. The common mutation would not necessarily
respond to this drug. You wouldn't expect it would.
There is another drug in the pipeline a few steps behind,
VX-809, which is targeted toward the common mutation. We all
have high hopes that that will turn out to be just as
effective, but we have to wait and see what the clinical trials
show.
Senator Shelby. But it holds promise for the people with
cystic fibrosis and their families.
Dr. Collins. I've been in this field for 25 years. I've not
seen more excitement and hope about a therapeutic intervention
in that whole time until now.
Senator Shelby. Thank you.
Senator Harkin. Thank you.
Senator Kirk.
HEALTHCARE SPENDING POLICY OPTIONS
Senator Kirk. Thank you, Mr. Chairman, and I'm sort of
overawed to see this group here. I followed in the Congress
Congressman John Porter, very much a supporter of NIH and
Research!America.
And, to me, it's interesting, in these times of deficits
and debt in which the largest bond purchaser in America, Pimco,
has now divested itself of all U.S. Treasury securities,
because he's worried about the long-term future of us being
able to borrow money.
I just met with one of the Chinese top officials in meeting
Secretary Clinton, and they also talked about how they were
making moves to leave U.S. debt.
And so it's--over the long term, I wonder how we might be
able to borrow the kind of monies that are being thought of.
With these kind of limitations, you wonder, then, what
direction you take with regard to healthcare policy. And there
are obviously two main directions, if the Government is to
support it, and that is to subsidize care or to subsidize
research.
Now, in subsidizing care, I guess the rough numbers are
Medicare is now $370 billion and Medicaid is $300 billion. So
that's very, very expensive now and growing quite rapidly, but
$670 billion in the subsidizing care path.
In the subsidizing research, NIH comes in at $26 billion,
and yet I think offers a much brighter future of a virtuous
cycle of better and better patient outcomes, faster and faster
innovation and dramatic reversals in disease outcomes, as we've
seen in several cancers or, for example, in juvenile diabetes.
And so in a resource-constrained area--and I think either
the Congress is going to make budget cuts or the bond market is
going to make budget cuts to the Federal budget--you then say
do we double down on subsidizing care or do we continue on the
funding research side, and because this also has a huge
economic benefit to the United States, I very much favor NIH,
where I worry about the long-term sustainability of other parts
of the budget.
So let me ask you somewhat of a theological question on
how we move forward in this environment, which is the
President's healthcare bill set up an independent payment
advisory board to ration care and basically to deny care in
several areas. Its goal, I think, over time will be to
replicate the power and authority of the British NIH's NICE
rationing board.
Have we thought about NIH's relationship to IPAB and how we
would advise the people who would be denying care under
Medicare how they would keep up with medical research and
technology?
Dr. Collins. So these are difficult questions indeed,
Senator. NIH's role as the prime supporter of biomedical
research is to provide the evidence that is necessary for
making wise healthcare decisions, but, obviously, those
decisions depend on more than just the scientific evidence.
They also depend on how society wants to expend its resources.
But I think we can help in substantial ways with the very
frightening cost curve that otherwise faces us. If you'll
permit me, I'd just like to show you one example of the kind of
looming problem that we have in front of us if nothing is done.
This curve shows you for one disease, Alzheimer's disease,
what we are currently spending, which in 2010 is about $180
billion, and which by the projections that many people have
made, if nothing is done, if research is unsuccessful or not
supported, will rise to more than $1 trillion just for that one
disease in 2050, and the number of effected individuals at that
point will be in the neighborhood of 13 million. One disease.
And, yet, at the present time, our investments in research
on Alzheimer's disease fall somewhat less than $1 billion. So,
clearly, we feel a great responsibility to move that curve in a
different direction. If we could even come up with a
therapeutic approach that would slow the onset of disease,
delay it by 5 years, you could cut these costs almost in half,
and, obviously, something more dramatic would have an even more
beneficial effect. That's what we see as our mission----
Senator Kirk. I'm just wondering--My time has run out, but
if we--I think IPAB's future depends on the presidential
election. Should the President prevail, then IPAB and the
healthcare bill is with us. Should the President be defeated, I
think that much of the healthcare bill will be wiped out and
IPAB with it.
But on the potential that the President is reelected, have
you thought about--because what I'm worried about is IPAB will
become an incredibly bureaucratic, stultified organization. It
will review diseases and protocols, but the danger is that they
will be working on heart disease and a breakthrough comes in
cancer that revolutionizes research and they will not have the
bureaucratic means to switch and then advise for a new payment.
And we have such a pace of innovation that a huge state
bureaucracy inevitably will slow down and be unable to keep
pace with medical innovation.
In fact, I would actually argue it probably will kill a lot
of medical innovation as it locks in payment methodologies the
way Medicare has.
But have you begun to think about how you might relate to
this new bureaucracy?
Dr. Collins. Well, again, Senator, I think our best answer
to that is to do the rigorous research that actually not only
tries new therapeutic approaches, but also does comparisons,
when there's more than one alternative, to see what works, and
then to do what we do routinely, and which we believe is a
strong part of our job, is to make that data immediately
available, publish it, make sure it's propagated so that nobody
is left in the dark about knowing what the results have been.
And then I guess I'm just enough of an optimist to think if
the data is there and if it's compelling, it'll be hard to
ignore. But I hear your concern.
Senator Kirk. I would just simply finish up by saying
should IPAB not survive--I hope it doesn't, but should it
survive I think we might want to think about a more formal data
transmission between NIH and IPAB, because, otherwise, IPAB, I
think, will rapidly cause Medicare to fall behind technology
and innovation.
Thank you, Mr. Chairman.
Senator Harkin. Senator Moran.
EFFECTS OF RESEACH ON HEALTHCARE COSTS
Senator Moran. Mr. Chairman, thank you again.
Dr. Collins, perhaps my question is in ways related to the
Alzheimer's chart you just showed, which was a request that do
you have information to substantiate my suggestion or a belief
that money spent on biomedical research results in cost savings
in healthcare? Is there that kind of science-based fact that
substantiates my feelings?
Dr. Collins. So those are complex economic analyses, and
even economists will tend to disagree with each other about the
right way to do it. Let me just cite a couple of figures,
though.
If you look, for instance, at heart disease, what's
happened in the last 40 years, Dr. Shurin will tell you we've
seen a 60-percent drop in mortality from heart attack during
those 40 years. The cost of that, if you average it out per
American per year, in terms of the research that led to those
advances, beginning with the Framingham Study, going through
with the development of understanding about cholesterol and
ultimately the development of statins, was about $3.70 per
American per year, the cost of a latte, and not even a grande
latte, that would be a tall, I think.
So and if you add up the economic benefits that have
resulted from the increase in longevity that have occurred
between 1970 and 2000, I am told credible economists believe
that adds up to $91 trillion. Michael Milken, in a recent
editorial in The Wall Street Journal runs through a lot of
those figures and they seem to be cited by reasonable experts.
If we were to diminish the frequency of cancer by just one
percent--and that's actually happening each year. Each time the
frequency of cancer goes down by 1 percent, economists say
that's saving our country $500 billion in terms of economy that
is sustained as a result of having those people with us. So the
return is enormous.
I could cite you specific examples of new technologies, but
the big picture is quite compelling.
RARE AND NEGLECTED DISEASES
Senator Moran. Well, I'm not surprised by that. It would be
very helpful to have that--I don't like the word sound byte,
but that phrase that says for every dollar spent, here's what
we're able to save in otherwise spending on healthcare.
Let me go back to something more specific and just ask you
to elaborate upon the value of academic and nonprofit research
institutions' role in developing therapies and treatments for
rare and neglected diseases through NCATS, as you propose, and
through your therapeutic and rare neglected disease program
that you already have.
I mean, is this something that you envision as having a
significant role in the future as you develop NCATS are these
neglected diseases?
Dr. Collins. Indeed. And, in fact, the 27 Institutes and
Centers at NIH have been engaged in such efforts for rare and
neglected diseases for some time.
We expect that the advent of NCATS serving as a hub of this
activity will further encourage that and hopefully contribute
innovations that will result in more rapid progress and also a
lower failure rate.
The TRND Program, Therapeutics for Rare and Neglected
Diseases, which the Congress authorized 2 years ago, is
specifically devoted to identifying projects that might
otherwise sit there untouched, where there's a real promise in
taking a therapeutic and moving it into the preclinical space,
which is often called the Valley of Death, because that's where
often good projects go to die.
Take example sickle-cell disease. There's a TRND Program
right now pursuing an interesting therapeutic for sickle-cell
disease originally identified at a university, Virginia
Commonwealth University, then licensed out to a biotech
company, AESRX.
The biotech company carried it to a certain level and then
ran out of money, and venture capital is hard to find these
days unless you have something that's going to result in
profits within a couple of years.
So the company has now partnered with the NIH to move this
forward. The preclinical studies look very good. This will, as
I understand it, be submitted to the FDA for an IND application
later this year, and clinical trials may well get under way
within 1 year at our NIH Clinical Center.
If this were successful, this would be a radical new
approach to sickle-cell disease. The way this molecule works is
unlike anything that's been tried for this disease before.
And while this is certainly a neglected and relatively rare
disease, it still affects tens of thousands, hundreds of
thousands of individuals in this United States and many more
across the world. So it's a good example of a way in which NIH
may be able to assist in the current scientific environment to
move projects forward that otherwise would have languished.
Senator Moran. Thank you very much. Mr. Chairman, thank
you. And let me express my gratitude to all of you for your
public service.
Senator Harkin. Well, I want to thank you all for being
here, again, for another enlightening session.
ADDITIONAL COMMITTEE QUESTIONS
I have some other questions I won't propound now, but I'll
submit those in writing, and the record will remain open for a
week for other Senators to submit further questions or
statements.
[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 Tom Harkin
national center for complementary and alternative medicine (nccam)
advisory council
Question. The statute for the NCCAM stipulates that of the 18
appointed members of the Center's Advisory Council, 9 must be
practitioners licensed in one or more of the major systems with which
the Center is concerned, and at least three shall represent the
interests of individual consumers of complementary and alternative
medicine. Is the NCCAM meeting this requirement? Of the four new
members announced on June 6, 2011, how many meet one of the two
categories described above?
Answer. The composition of the National Advisory Council for
Complementary and Alternative Medicine meets the statutory requirements
concerning membership. Collectively, its membership includes the
expertise required for it to carry out its requirements to provide
second level peer review and other advice across the broad and varied
spectrum of clinical practice and scientific disciplines which fall
under the Center's mandate.
On Friday, June 3, 2011, four new members joined the NCCAM Advisory
Council. Brian M. Berman, MD, LAC, is a licensed physician and
acupuncturist. James Lloyd Michener, MD, is professor and chairman of
the Department of Community and Family Medicine and Director of the
Duke Center for Community Research. Dr. Michener also represents the
interests of individual consumers of complementary and alternative
medicine (CAM). Daniel C. Cherkin, Ph.D., is an epidemiologist and
highly experienced clinical researcher who has conducted a number of
major studies that have provided evidence for benefit of CAM therapies
(including chiropractic manipulation, acupuncture, and massage) for low
back pain. David G.I. Kingston, Ph.D., is a widely respected natural
products chemist whose research focuses on the chemistry of
biologically active natural products and the discovery of new therapies
for cancer and malaria from plants.
the nccam research successes
Question. Under the statute that created the NCCAM, the general
purposes of the Center include ``identifying, investigating, and
validating complementary and alternative treatment, diagnostic and
prevention modalities, disciplines and systems.'' Please identify all
instances in the past 10 years in which the NCCAM-supported research
has validated complementary and alternative treatment, diagnostic and
prevention modalities, disciplines and systems.
Answer. The NCCAM is strongly committed to the highest standards of
evidence-based medicine. Validating health interventions is a process
that begins with evidence developed in peer-reviewed basic and clinical
research. Next, the evidence from multiple studies is collectively
assessed through formal systematic review methods. Finally, if these
earlier steps indicate sufficient usefulness and safety, professional
organizations and health policy makers undertake the development of
guidelines and recommendations regarding use and clinical practice.
This process, collectively referred to as evidence-based medicine,
entails assimilation of the body of scientific evidence; almost never
does a single study result in consensus that an intervention is valid.
Eleven years ago, when the NCCAM was created, there was no
significant evidence-base on the biological properties, safety, and
efficacy of the vast majority of CAM modalities. The Center's first
decade was therefore focused on the conduct and support of basic and
applied research that addressed this lack of scientific information.
The results of that investment now include an emerging evidence base
that is dramatically stronger in terms of both quality and quantity.
Basic research and clinical trials, large and small, have yielded
results--both ``positive'' and ``negative''--regarding the effects,
efficacy, safety, and in some cases, promise regarding CAM
interventions.
Critically, sufficient evidence regarding some CAM interventions
has now been developed to permit informative evidence-based analyses
and systematic reviews by independent organizations (e.g., the Cochrane
Collaboration) using the rigorous standards of evidence-based medicine.
Indeed, such analyses now point increasingly toward clinically helpful
conclusions regarding usefulness and safety--or lack thereof--of
specific CAM interventions and practices.
Notably, the expanding evidence base now includes a large body of
science that points toward specific, very promising opportunities to
improve healthcare and health promotion using CAM-inclusive strategies.
These opportunities are reflected directly in the NCCAM's recently-
released third strategic plan. Important examples include the
following:
Mind and Body Practices
--Developing better, comprehensive strategies for management of
chronic back pain and defining the roles of acupuncture, spinal
manipulation, and massage in those strategies
--Exploring the role of specific promising CAM practices or
disciplines (e.g., meditation, yoga, or acupuncture) in
developing better strategies for alleviating symptoms (e.g.,
chronic pain, stress) or in promoting healthier lifestyles
--Exploring the associations between well-characterized pathways of
pain processing and acupuncture analgesia or the placebo
response
--Exploring the associations of major pathways of cognitive
processing and emotion regulation by meditative practices
--Studying the influence of the provider-patient/client interaction,
context effects, and the placebo response on outcomes of CAM
interventions
Natural Products
--Studying the molecular targets and biological effects of
potentially beneficial small molecules that are constituents of
natural products or diet (e.g., quercetin, curcumin, or other
polyphenols and flavonoids)
--Defining the anti-inflammatory actions of omega-3 fatty acids
--Employing state-of-the-art tools and technologies to study the
effects of probiotics on the human microbiome
--Developing evidence regarding the safety profile of certain widely
used natural products, including interactions with drugs and
other herbals or dietary supplements
The growing evidence base is clearly influencing professional
practice guidelines of mainstream professional medical societies, and
the practice of integrative medicine. Complementary and alternative
therapies are increasingly being accepted and integrated into
conventional healthcare systems. For example, recent data show that
approximately half the hospices in the United States and 9 out of 10
Department of Veterans Affairs facilities offer some complementary or
alternative therapies. The Consortium of Academic Health Centers in
Integrative Medicine, an organization of integrative medicine
departments at academic medical centers, has grown from 11 members in
2002 to 43 members in 2011. Medical societies such as the American
College of Physicians, the American Academy of Pediatrics and the
American Academy of Family Physicians have formulated policies
regarding complementary therapies and offer educational material about
these forms of treatment. The Departments of Defense and Veterans
Affairs are also actively pursuing care and research initiatives that
include various CAM interventions in treatment and prevention of
problems such as chronic pain and post-traumatic stress disorder
afflicting our wounded warriors.
In the appendices, we have included a status report on the process
of validation of selected interventions. In Appendix A, we present
examples of specific complementary and alternative interventions for
which a sufficient number of individual studies exist for systematic
reviews to conclude the interventions appear to offer benefit. In
Appendix B, we list numerous additional examples of individual NCCAM-
supported studies that provide preliminary evidence of benefit in other
indications. We feel it important to provide both types of information
in addressing the subcommittee's specific questions because the
processes of evidence-based validation of health practices and
decisionmaking regarding their use are iterative, and draw on a variety
of such sources rather than merely single studies.
appendix a: the status of the evidence based reviews and professional
guidelines for select complementary and alternative therapies
The examples of systematic reviews and professional assessments
cited here all include evidence derived from clinical and mechanistic
research supported by the NCCAM. As is true with the evidence in most
areas of healthcare, there continues to be controversy about some of
these conclusions, and not all systematic reviews come to the same
conclusions.
Role of Complementary Therapies in the Management of Chronic Low Back
Pain
Management of chronic low back pain is a critical challenge for our
healthcare system and a major driver of healthcare costs. Complementary
interventions are increasingly being integrated into the care of
chronic back pain patients, and there is substantial recognition,
supported by findings from the NCCAM research, that complementary
therapies, particularly chiropractic and osteopathic spinal
manipulation, massage, acupuncture, and meditative exercise forms such
as yoga, can make important contributions to improved outcomes for
patients. Many systematic reviews have assessed these therapeutic
approaches. The Joint Clinical Practice Guideline for low back pain,
developed by the American College of Physicians and the American Pain
Society, reflects the strength of this evidence base and the emerging
professional consensus for the value of the incorporation of
complementary approaches. To quote directly from the summary:
``For patients who do not improve with self-care options,
clinicians should consider the addition of nonpharmacologic therapy
with proven benefits-for acute low back pain, spinal manipulation; for
chronic or sub-acute low back pain, intensive interdisciplinary
rehabilitation, exercise therapy, acupuncture, massage therapy, spinal
manipulation, yoga, cognitive-behavioral therapy, or progressive
relaxation.''--Joint Clinical Practice Guideline, American College of
Physicians and American Pain Society. Annals of Internal Medicine,
2007: 147,478.
Nevertheless, there is also a consensus among healthcare providers,
both conventional and complementary, that, current approaches are not
satisfactory for many patients suffering with back pain. Moving
forward, a major area of emphasis for the NCCAM, as described in the
NCCAM's 2011 Strategic Plan, will be improving management of chronic
back pain. Research is needed to optimize complementary therapies, to
understand better who benefits from them, and to develop better systems
of integrated care that improve real world application of these helpful
therapeutic techniques.
Role of Natural Products in Promotion of Health and Wellness
The NCCAM's natural product research portfolio, carefully assessed
during our strategic planning process, has yielded many important
lessons that will guide us moving forward. Fundamental scientific
understanding of potential beneficial mechanisms of many dietary
supplements and natural products has increased markedly, with some
notable examples described below. New high-throughput technologies and
modern genomic tools have created important new scientific
opportunities. We have learned much about the challenges of translation
of these findings to clinical efficacy research. The future emphasis,
as described in our strategic plan and strongly supported by both
academic investigators and leaders of the botanical and dietary
supplement industry, is on the development of strong biological
mechanistic hypotheses, sensitive biological signatures of effect, and
carefully optimized trial designs.
A few examples of the independent systematic reviews that have
provided validation of the potential value of natural products or other
dietary supplements are as follows:
--Fish Oil for the Prevention of Cardiovascular Disease.--``Dietary
supplementation with omega-3 fatty acids should be considered
in the secondary prevention of cardiovascular events.''--
Clinical Cardiol. 2009: 32, 365.
--Melatonin for the Prevention and Treatment of Jet Lag.--``Melatonin
is remarkably effective in preventing or reducing jet lag, and
occasional short-term use appears to be safe.''--Cochrane
Database Syst Rev 2002: 1520.
--Probiotics for Prevention of Necrotizing Enterocolitis in Preterm
Infants.--``Enteral supplementation of probiotics prevents
severe necrotizing enterocolitis and all cause mortality in
preterm infants.''--Cochrane Database Syst Rev 2008: 5496.
--Prebiotics and Probiotics for Hepatic Encephalopathy.--``The use of
prebiotics, probiotics and synbiotics was associated with
significant improvement in minimal hepatic encephalopathy.''--
Ailment Pharmacol Ther 2011: 33.
--Probiotics for Acute Infectious Diarrhea.--``Used alongside
rehydration therapy, probiotics appear to be safe and have
clear beneficial effects in shortening the duration and
reducing stool frequency in acute infectious diarrhea.''--
Cochrane Database Syst Rev 2010: 3048.
--Zinc for the Common Cold.--``Zinc administered within 24 hours of
onset of symptoms reduces the duration and severity of the
common cold in healthy people.''--Cochrane Database Syst Rev
2006: 1364.
Role of Complementary Therapies in the Management of Pain and Other
Troublesome Symptoms
Concern is often voiced that the processes of evidence-based
medicine could not accommodate the evidence emerging from research on
many complementary therapies. In fact, this is a challenge common to
evaluation of the evidence of many nonpharmacological interventions,
including psychotherapy and surgery. The NCCAM's strategic plan
addresses this challenge by calling for increased use of outcomes and
effectiveness research methodology, and collaboration with experts who
work in other fields facing similar challenges. Nonetheless, several
examples are provided below which illustrate that rigorous research on
these complicated therapies is possible and can meet the exacting
standards of evidence-based review.
--The Cochrane Collaborative has reviewed the evidence that
acupuncture may provide benefit for migraine prophylaxis and
for treatment of tension-type headache, and concluded that it
has value in both situations.--Cochrane Database Syst Rev 2009:
1218, Cochrane Database Syst Rev 2009: 7587.
--The Cochrane Collaborative has reviewed the evidence that
acupuncture may be useful for postoperative nausea and
vomiting, as well as for nausea and vomiting which has been
induced by cancer chemotherapy. Systematic reviews conclude
benefit in both cases.--Cochrane Database Syst Rev 2009, 3281,
National Cancer Institute, PDQ summary.
--A systematic review published in the British Journal of Anesthesia
concluded that perioperative acupuncture is a useful adjunct
for acute postoperative pain management.--Br. J Anaesth 2008:
101, 151.
appendix b: the nccam-supported studies that contain evidence of value
of cam
Listed below are the NCCAM-supported studies, which contain
evidence of the value of CAM. Consistent with the priorities of the
NCCAM's strategic plan, these findings are grouped into three major
categories: Mind and Body Interventions; Natural Products
Interventions; and Population-Based Research. Within each category, the
findings are listed in reverse chronological order by the publication
date.
Mind and Body Interventions
Chronic Pain
Review of CAM Practices for Back and Neck Pain Shows Modest
Benefit.--According to a recent review published by the Agency for
Healthcare Research and Quality, the benefits of complementary and
alternative therapies for back and neck pain--such as acupuncture,
massage, and spinal manipulation--are modest in size but provide more
benefit than usual medical care. While these effects are most evident
following the end of treatment, the authors of the report noted that
very few studies looked at long-term outcomes. Back and neck pain are
important health problems that affect millions of Americans, and back
pain is the most common medical condition for which people use
complementary and alternative medicine (CAM). They noted that more
well-designed studies are needed to draw more definitive conclusions
regarding the benefits of CAM therapies for pain. http://nccam.nih.gov/
research/results/spotlight/100110.htm.--AHRQ Publication No.
10(11)E007. Rockville, MD: Agency for Healthcare Research and Quality.
October 2010.
Tai Chi May Benefit Patients With Fibromyalgia.--Fibromyalgia is a
disorder characterized by muscle pain, fatigue, and other symptoms.
Researchers, funded in part by the NCCAM, evaluated the physical and
psychological benefits of tai chi (which combines meditation, slow
movements, deep breathing, and relaxation) in 66 people with
fibromyalgia. The participants were assigned to one of two groups: an
attention control group that received wellness education and practiced
stretching exercises, or a tai chi group that received instruction in
tai chi principles and techniques and practiced 10 forms of Yang-style
tai chi. Compared with the attention control group, the tai chi group
had a significantly greater decrease in total score on the Fibromyalgia
Impact Questionnaire at 12 weeks. In addition, the tai chi group
demonstrated greater improvement in sleep quality, mood, and quality of
life. Improvements were still present at 24 weeks. No adverse events
were reported. The researchers concluded that these findings support
previous research indicating benefits of tai chi for musculoskeletal
pain, depression, and quality of life. The underlying mechanisms are
unknown, and the researchers noted that larger, longer term studies are
needed to evaluate the potential benefits of tai chi for patients with
fibromyalgia. http://nccam.nih.gov/research/results/spotlight/
081810.htm.--New England Journal of Medicine. 2010;363(8):743-754 and
783-784.
Analysis of National Survey Reveals Perceived Benefit of CAM for
Back Pain.--According to an analysis of the 2002 National Health
Interview Survey, approximately 6 percent of U.S. adults used
complementary and alternative medicine (CAM) to treat their back pain
during the previous year. The data from this analysis also revealed
that a majority (60 percent) of survey respondents who used the most
common CAM therapies for back pain perceived ``a great deal'' of
benefit. The most common CAM therapies used for back pain--in
descending order of perceived benefit--were chiropractic (66 percent),
massage (56 percent), yoga/tai chi/qi gong (56 percent), acupuncture
(42 percent), herbal therapies (32 percent), and relaxation techniques
(28 percent). The specific factors associated with a greater perception
of benefit from CAM use were having an improved self-reported health
status, and using CAM because ``conventional medical treatment would
not help.'' Back pain is the most common medical condition for which
people use CAM, and these data give more insight into the use and
perceived benefit of CAM therapies for this condition. The researchers
suggested that this analysis demonstrates the need for future studies
that include both self-reported outcomes and observer-based performance
measures of patients using CAM therapies for back pain. http://
nccam.nih.gov/research/results/spotlight/060110.htm.--Journal of the
American Board of Family Medicine. 2010;23(3):354-362.
Study of Spinal Manipulative Therapy for Neck-related Headaches
Reports Findings on Dose and Efficacy.--Previous research suggests that
spinal manipulative therapy (SMT) may be helpful for various types of
chronic headaches, including cervicogenic headache (CGH), which is
associated with neck pain and dysfunction. This randomized controlled
trial evaluated the dose (number of treatments) and relative efficacy
of SMT in a group of 80 patients with chronic CGH. Compared with
massage, participants receiving SMT had greater improvements in CGH-
related pain and disability, lasting to 24 weeks. These differences
were clinically important and statistically significant. The dose
effects of SMT treatments (i.e., differences between 8 and 16
treatments) were small but significant. The mean number of headaches
reported by SMT subjects decreased by more than half during the study.
The researchers concluded that their findings support SMT as a viable
option for treating CGH, but also point out that these findings should
be considered preliminary. They suggest additional research to
determine whether SMT results for patients with CGH are affected by
treatment intensity and duration, use of other therapies, lifestyle
changes, and an integrative care approach. http://nccam.nih.gov/
research/results/spotlight/041310.htm.--Spine Journal. 2010;10(2):117-
128.
Preliminary Trial Finds Possible Benefits of Osteopathic Treatment
for Back Pain During the Third Trimester of Pregnancy.--Most pregnant
women experience low-back pain, which often is associated with sleep
disturbance and can affect daily activities. Researchers investigated
the effects of osteopathic manipulative treatment on back pain during
the third trimester of pregnancy. They found that back-specific
functioning deteriorated significantly less in the osteopathic
manipulative treatment group than in the usual care or usual care with
sham treatment groups. Although the results of this preliminary study
suggest that osteopathic manipulation may have benefits for back-
specific functioning, but not pain, in the third trimester of
pregnancy, larger trials are needed before definitive conclusions can
be drawn about its efficacy or effectiveness for this purpose. http://
nccam.nih.gov/research/results/spotlight/032210.htm.--American Journal
of Obstetrics and Gynecology. 2010;202(1):43.e1-43.e8.
Tai Chi May Benefit Older Adults With Knee Osteoarthritis.--Knee
osteoarthritis (OA) is an increasing problem among older adults,
causing pain, functional limitations, and reduced quality of life.
Researchers conducted a long-term, randomized, controlled trial
comparing tai chi and conventional exercise in a group of 40 adults
(mean age 65) with symptomatic knee OA. The tai chi group learned and
practiced Yang-style tai chi, modified slightly to eliminate excess
stress on the knees. The control group received wellness education and
did stretching exercises. Compared with the control group, tai chi
patients had greater improvement in measures of pain, physical
function, self-efficacy (belief in one's own abilities), depression,
and health-related quality of life. Although most differences between
the two groups were statistically significant only at 12 weeks, the
differences for self-efficacy and depression remained statistically
significant at 24 and 48 weeks. No serious adverse events were
reported. The researchers recommend additional studies of biologic
mechanisms and approaches of tai chi, so its benefits can be extended
to a broader population. http://nccam.nih.gov/research/results/
spotlight/011510.htm.--Arthritis & Rheumatism. 2009;61(11):1545-1553.
Iyengar Yoga for Chronic Low-back Pain Shows Promising Results.--
Researchers conducted a clinical trial to evaluate the effects of
Iyengar yoga (a popular style of yoga that uses props to help support
the body during postures) on chronic low-back pain. They found that
compared with the control group, the yoga group had significantly
greater reductions in functional disability, pain, and depression, at
weeks 12 and 24 and at the 6-month followup. There were no significant
differences in pain medication usage between the groups; however, there
appeared to be a trend toward decreased usage in the yoga group. The
researchers concluded from their results that yoga decreases functional
disability, pain, and depression in people with chronic low-back pain.
However, they noted potential limitations of their study (e.g., heavy
reliance on self-report instruments, and differential demands on yoga
vs. control groups in terms of attention and group support) and suggest
design considerations for future research. http://nccam.nih.gov/
research/results/spotlight/112409.htm.--Spine. 2009;34(19):2066-2076.
Managing Low-Back Pain: an Evidence-Based Approach for Primary Care
Physicians.--A physician's response to a patient with low-back pain
(LBP) should take into account psychological and social factors as well
as physical symptoms, according to an article that looked at two case
studies in light of evidence-based clinical guidelines developed by
Roger Chou et al. for the American Pain Society and the American
College of Physicians. The article's authors, recommend a measured
approach to the use of imaging (x-rays and MRI/CT scans) and
medication. The authors outline considerations in evaluating each
patient and choosing action steps. The authors also noted that most
people with chronic LBP will not become pain free. Physicians can help
patients have a realistic outlook that focuses on improving functioning
in addition to reducing pain. http://nccam.nih.gov/research/results/
spotlight/040209.htm.--Journal of Family Practice. 2009;58(4):180-186.
Study Finds Benefits of Therapeutic Massage for Chronic Neck
Pain.--In a research study, 64 adults with neck pain persisting for at
least 12 weeks were randomly assigned to receive either massage or a
self-care book. The massage group had up to 10 treatments over a 10-
week period, provided by licensed practitioners who used a variety of
common Swedish and clinical massage techniques and also made typical
self-care suggestions. After 10 weeks, the massage group was more
likely than the self-care-book group to have clinically significant
improvement in function and symptoms. At 26 weeks, the massage group
tended to be more likely to report improvement in function but not in
specific symptoms. For both function and symptoms, mean differences
between the two groups were strongest at 4 weeks and not evident by 26
weeks. At all followup points, the massage group was more likely than
the self-care-book group to report global improvement ratings of
``better'' or ``much better.'' At 26 weeks, medication use had
increased 14 percent for the self-care-book group but had not changed
for the massage group. The researchers concluded that therapeutic
massage is safe and may have benefits for treating chronic neck pain,
at least in the short term. They recommended studies to determine
optimal massage treatment, as well as larger, more comprehensive
studies to follow patients for at least 1 year. http://nccam.nih.gov/
research/results/spotlight/051809.htm.--Clinical Journal of Pain.
2009;25(3):233-238.
Massage Therapy May Ease Pain and Improve Mood in Advanced Cancer
Patients.--Researchers investigated the benefits of massage versus
simple touch therapy (placing both hands on specific body sites) in
patients with advanced cancer. This multisite study--conducted at 15
U.S. hospices in the Population-based Palliative Care Research
Network--included 380 participants with advanced cancer who were
experiencing moderate-to-severe pain. Results of the study showed that
both the massage and simple touch therapy groups experienced
statistically significant improvements in pain relief, physical and
emotional distress, and quality of life. Immediate improvement in pain
and mood was greater with massage than with simple touch; however,
sustained effects of these therapies were not observed. The researchers
concluded that massage therapy may provide some immediate relief for
patients with advanced cancer. They also suggest that simple touch,
which can be provided by family members and volunteers, may benefit
these patients. http://nccam.nih.gov/research/results/spotlight/
110608.htm.--Annals of Internal Medicine. 2008;149(6):369-379.
Study Points to Cost-effectiveness of Naturopathic Care for Low-
Back Pain.--Researchers who studied treatment alternatives for low-back
pain in a group of 70 warehouse workers found that a naturopathic
approach (incorporating a range of treatment options--acupuncture,
exercise and dietary advice, relaxation training, and a back-care
booklet) was more cost-effective than the employer's usual patient
education program. Both the workers and the employer benefited from the
naturopathic approach, which was associated with better health-related
quality of life, less absenteeism, and lower costs for other treatments
and pain medication. The study consisted of workers ages 18 to 65 who
had experienced low-back pain for at least 6 weeks. The workers were
randomly assigned to receive naturopathic care or patient education
visits over a 3-month period. The 30-minute, onsite visits were
conducted semiweekly (naturopathic) or biweekly (patient education).
The researchers conclude that naturopathic care is more cost-effective
than a patient education program in treating low-back pain. They also
recommend further studies of the economic impact of naturopathic
medicine, particularly to address the limitations of their evaluation.
http://nccam.nih.gov/research/results/spotlight/070708.htm.--
Alternative Therapies in Health and Medicine. 2008;14(2):32-39.
Acupuncture Relieves Pain and Improves Function in Knee
Osteoarthritis.--Acupuncture provides pain relief and improves function
for people with osteoarthritis of the knee and serves as an effective
addition to standard care, according to a landmark study. The
researchers enrolled 570 patients with osteoarthritis of the knee, aged
50 and older, to receive one of three treatments: acupuncture,
simulated acupuncture (procedures that mimic acupuncture, sometimes
also referred to as ``placebo'' or ``sham''), or participation in a
control group. The control group followed the Arthritis Foundation's
self-help course for managing their condition over 12 weeks.
Participants in the actual and simulated acupuncture groups received 23
treatment sessions over 26 weeks. All study participants continued to
receive standard medical care from their primary physicians, including
anti-inflammatory medications and opioid pain relievers. At the start
of the study, participants' pain and knee function were assessed using
standard arthritis research survey instruments and measurement tools.
After 26 weeks participants in the acupuncture group had a 40 percent
decrease in pain and a nearly 40 percent improvement in function
compared to their assessments at the start of the study. Findings from
this study begin to shed more light on acupuncture's possible
mechanisms and potential benefits, especially in treating painful
conditions such as arthritis. http://nccam.nih.gov/research/results/
spotlight/052504.htm.--Annals of Internal Medicine. 2004;141(12):901-
910.
Stress/Anxiety
Long-term Yoga Practice May Decrease Women's Stress.--Research has
shown that women who practice hatha yoga (a common type of yoga
involving body postures, breath control, and meditation) regularly
recover from stress faster than women who are considered yoga
``novices.'' The research also showed that yoga may boost the mood of
both yoga experts and novices. The researchers found that the novices'
blood had 41 percent higher levels of the cytokine interleukin-6 (IL-6)
than those of the experts. IL-6 is a stress-related compound that is
thought to play a role in certain conditions such as cardiovascular
disease and type 2 diabetes. In addition, the novices' levels of C-
reactive protein, which serves as a general marker for inflammation,
were nearly five times that of the yoga experts. Experts had lower
heart rates in response to stress events than novices. The researchers
suggested that this study offers insight into how yoga and its related
practices may affect health. Regularly performing yoga could have
health benefits, which may only become evident after years of practice.
http://nccam.nih.gov/research/results/spotlight/051510.htm.--
Psychosomatic Medicine. Feb 2010;72(2):113-121.
A Form of Acupuncture May Help in Opioid Addiction.--Transcutaneous
electric acupoint stimulation (TEAS), a form of acupuncture that uses
skin electrodes to apply electrical stimulation at different points on
the body, may help people addicted to opioid drugs. This study,
supported in part by the NCCAM, also suggests that combining this
technique with prescribed drugs that ease withdrawal symptoms may
improve other outcomes for people addicted to opioids. Further,
participants who received active TEAS were more than two times less
likely to have used any drugs than those who received simulated TEAS.
In addition, patients in the active TEAS group reported they were less
bothered by pain and that they experienced greater improvements in
overall health. However, the researchers noted that drug abstinence may
have contributed to these improvements. The researchers noted several
limitations of this study, including a small number of participants and
brief duration of treatment. Despite these limitations, they suggested
that additional studies with larger, more diverse populations and
longer treatment durations are needed. http://nccam.nih.gov/research/
results/spotlight/010410.htm.--Journal of Substance Abuse Treatment.
2010;38(1):12-21.
Transcendental Meditation Helps Young Adults Cope With Stress.--A
study found that Transcendental Meditation (TM) helped college students
decrease psychological distress and increase coping ability. For a
group of students at high risk for developing hypertension, these
changes also were associated with decreases in blood pressure. Compared
with controls, the TM group had significant improvement in total
psychological distress, anxiety, depression, anger/hostility, and
coping ability. Changes in psychological distress and coping paralleled
changes in blood pressure. According to the researchers, these findings
suggest that young adults at risk of developing hypertension may be
able to reduce that risk by practicing TM. The researchers recommend
that future studies of TM in college students evaluate long-term
effects on blood pressure and psychological distress. http://
nccam.nih.gov/research/results/spotlight/051410.htm.--American Journal
of Hypertension. Dec 2009;22(12):1326-1331.
Mantram Instruction May Help HIV-positive Individuals Handle
Stress.--Repeating a mantram (also known as a mantra--the practice of
silently focusing on a spiritual word or phrase frequently throughout
the day)--may help HIV-positive individuals develop coping skills and
reduce anger. Researchers analyzed the effects of a group-based mantram
training program, based on data from a study involving 93 HIV-positive
individuals. After the 5-week intervention, the mantram group reported
a significant increase (25 percent on average) in use of positive
reappraisal coping (handling stressful situations by focusing on
positive aspects), while the control group reported a significant
decrease. At a 22-week followup, anger levels had decreased in the
mantram group (13 percent on average) but not in the control group.
According to the researchers, these findings suggest that repeating a
mantram may help HIV-positive individuals examine stressful situations
in a more nonjudgmental and accepting way, reducing the likelihood of
an angry response. This is significant because reducing reactive anger
may help individuals preserve supportive social relationships as well
as maintain adherence to antiretroviral treatments. The researchers
suggested additional studies to explore the effects of mantram on
attention, cognitive processing, and acceptance-based responding.
http://nccam.nih.gov/research/results/spotlight/010609.htm.--
International Journal of Behavioral Medicine. 2009;16(1):74-80.
Stress Management Interventions May Enhance Immune Function in
People With HIV.--Stress management interventions may help to improve
immune function and coping skills in HIV-positive individuals.
Researchers assessed three interventions: cognitive-behavioral
relaxation training (physical and mental relaxation techniques and
active coping skills); focused tai chi training (exercises for balance,
breathing, posturing and movement, and relaxation); and spiritual
growth (discussions and personal journals to enhance spiritual
awareness). None of the intervention groups differed from controls on
measures of HIV-related psychological distress, quality of life, and
health status, or on physiological stress response (cortisol levels).
However, compared with controls, all three treatment groups had
significant increases in lymphocyte proliferation (production of white
blood cells), indicating enhanced immune function. The researchers
noted the potentially important clinical implications of this finding.
They recommend additional research to examine specific effects of
stress management interventions in people with HIV. http://
nccam.nih.gov/research/results/spotlight/060208.htm.--Journal of
Consulting and Clinical Psychology. 2008;76(3):431-441.
Acupuncture May Help Symptoms of Post-traumatic Stress Disorder.--A
pilot study shows that acupuncture may help people with post-traumatic
stress disorder. Post-traumatic stress disorder (PTSD) is an anxiety
disorder that can develop after exposure to a terrifying event or
ordeal in which grave physical harm occurred or was threatened.
Traumatic events that may trigger PTSD include violent personal
assaults, natural or human-caused disasters, accidents, or military
combat. Researchers conducted a clinical trial examining the effect of
acupuncture on the symptoms of PTSD. The researchers analyzed
depression, anxiety, and impairment in 73 people with a diagnosis of
PTSD. The participants were assigned to receive either acupuncture,
group cognitive-behavioral therapy, or were put on the wait list as a
control group. The people in the control group were offered treatment
or referral for treatment at the end of their participation. The
researchers found that acupuncture provided treatment effects similar
to group cognitive-behavioral therapy; both interventions were superior
to the control group. Additionally, treatment effects of both the
acupuncture and the group therapy were maintained for 3 months after
the end of treatment. The limitations are that the study consisted of a
small group of participants that lacked diversity and that the results
do not account for outside factors that may have affected the
treatments' results. http://nccam.nih.gov/research/results/spotlight/
092107.htm.--The Journal of Nervous and Mental Disease, June 2007.
Self-hypnosis Beneficial for Women Undergoing Breast Biopsy.--
Researchers have found that women who used self-hypnosis during a type
of core needle breast biopsy experienced anxiety relief and reduced
pain when compared with standard care. A large core needle breast
biopsy is usually an outpatient procedure that limits the use of
anesthetic. Women having this procedure often experience anxiety
because of the possibility of a cancer diagnosis in addition to the
anxiety that patients typically experience during a medical procedure.
In this randomized, controlled trial researchers recruited 236 women
who were randomly assigned to receive standard care, structured
empathic attention from a research assistant, or guided self-hypnotic
relaxation during the biopsy. The study found that both self-hypnosis
and empathic attention reduced pain and anxiety during the procedure.
Self-hypnosis provided greater anxiety relief than empathic attention.
Neither intervention increased procedure time or significantly
increased cost. As a result, the researchers suggest that self-hypnosis
appears attractive for outpatient pain management. http://
nccam.nih.gov/research/results/spotlight/122606.htm.--Pain, December
2006.
Basic and Translational Research
Basic and translational research provides important insights into
how CAM interventions can benefit human health. For example, animal
studies help to identify biomarkers or signatures of biological effects
that can be applied to future studies in humans.
Mindfulness Meditation is Associated With Structural Changes in the
Brain.--Practicing mindfulness meditation appears to be associated with
measurable changes in the brain regions involved in memory, learning,
and emotion, according to a research study that compared brain images
of participants who participated in a mindfulness-based stress
reduction program with those who did not. Specifically brain images in
the meditation group revealed increases in gray matter concentration in
the left hippocampus, which is an area of the brain involved in
learning, memory, and emotional control, and is suspected of playing a
role in producing some of the positive effects of meditation. The
researchers concluded that these findings may represent an underlying
brain mechanism associated with mindfulness-based improvements in
mental health. Additional studies are needed to determine the
associations between specific types of brain change and behavioral
mechanisms thought to improve a variety of disorders. http://
nccam.nih.gov/research/results/spotlight/012311.htm.--Psychiatry
Research: Neuroimaging. 2011;191(1):36-43.
Study Examines the Effects of Swedish Massage Therapy on Hormones,
Immune Function.--Massage is used for many health purposes, but little
is known about how it works on a biological level. This study examined
the effects of one session of Swedish massage therapy--a form of
massage using long strokes, kneading, deep circular movements,
vibration, and tapping--on the body's hormonal response and immune
function. Researchers randomly assigned 53 healthy adults to receive
one session of either Swedish massage or light touch (in which the
therapist used only a light touch with the back of the hand). The
researchers found that participants who received Swedish massage had a
significant decrease in the hormone arginine-vasopressin (which plays a
role in regulating blood pressure and water retention) compared with
those who were treated with light touch. Study data, although
preliminary data, led the researchers to conclude that a single session
of Swedish massage produces measurable biological effects and may have
an effect on the immune system. However, more research is needed to
determine the specific mechanisms and pathways behind these changes.
http://nccam.nih.gov/research/results/spotlight/090110.htm.--The
Journal of Alternative and Complementary Medicine. 2010;16(10):1-10.
Electroacupuncture Relieves Cancer Pain in Laboratory Rats.--
Electroacupuncture (acupuncture combined with electrical stimulation)
has been used to treat cancer pain; however, the existing data on its
efficacy and how it works are unclear. Researchers investigated the
effects of electroacupuncture on cancer pain in rats and also looked at
the underlying biomechanisms. The results showed that compared with the
sham control, electroacupuncture significantly reduced cancer-induced
bone pain. The researchers also examined the rats spinal cords to see
whether electroacupuncture affected chemical processes thought to play
a role in pain. They found that compared with the sham control,
electroacupuncture inhibited up-regulation of two substances involved
in these processes: spinal cord preprodynorphin mRNA and dynorphin. In
a separate experiment, they found that injection of an antiserum
against dynorphin also inhibited cancer-induced pain in the rats. The
researchers concluded that electroacupuncture eases cancer pain in
rats, at least in part by inhibiting spinal dynorphin. They note that
their findings support the clinical use of electroacupuncture in the
treatment of cancer pain. http://nccam.nih.gov/research/results/
spotlight/040109.htm.--European Journal of Pain. 2008;12(7):870-878.
Brain-Imaging Study Explores Analgesic Effect of Acupuncture.--
Researchers used two imaging technologies--functional magnetic
resonance imaging (fMRI) and positron emission tomography (PET)--to
investigate how specific areas of the brain might be involved in
acupuncture analgesia. The imaging results showed acupuncture-related
changes in both of the brain's pain networks: the lateral network,
which is associated with sensory aspects of pain perception, and the
medial network, which is associated with affective aspects. However,
the fMRI and PET results pointed to different areas in these networks,
with one exception: both imaging technologies showed changes in the
right medial orbitofrontal cortex--an indication that this area of the
brain may be important in acupuncture analgesia. The researchers note
that their preliminary findings demonstrate that imaging studies using
more than one imaging technique have potential for clarifying the
neural mechanisms of acupuncture. They point out that similar studies
with much larger samples might reveal other areas of the brain where
fMRI and PET results converge. http://nccam.nih.gov/research/results/
spotlight/121208.htm.--Behavioural Brain Research. 2008;193(1):63-68.
Green Tea May Help Protect Against Rheumatoid Arthritis.--
Investigators examined the effects of green tea polyphenols on
rheumatoid arthritis (RA) by using an animal (rat) model. The animals
consumed green tea in their drinking water (controls drank water only)
for 1 to 3 weeks before being injected with heat-killed Mycobacterium
tuberculosis H37Ra to induce arthritis. The researchers found that
green tea significantly reduced the severity of arthritis. They suggest
that green tea affects arthritis by causing changes in various
arthritis-related immune responses--it suppresses both cytokine IL-17
(an inflammatory substance) and antibodies to Bhsp65 (a disease-related
antigen), and increases cytokine IL-10 (an anti-inflammatory
substance). Therefore, they recommend that green tea be further
explored as a dietary therapy for use together with conventional
treatment for managing RA. http://nccam.nih.gov/research/results/
spotlight/120808.htm.--The Journal of Nutrition. 2008:138(11):2111-
2116.
Electroacupuncture May Help Alcohol Addiction.--Researchers
examined the effects of electroacupuncture on alcohol intake by
alcohol-preferring rats. After being trained to drink alcohol
voluntarily and then subjected to alcohol deprivation, the rats
received either electroacupuncture or sham electroacupuncture, and
their alcohol intake was monitored after the intervention. Some rats
were also pretreated with naltrexone (a drug that blocks the effects of
opiates), so researchers could look for evidence that opiate mechanisms
are involved in electroacupuncture's effects. The results showed that
electroacupuncture reduced the rats' alcohol intake. The researchers
also found that injecting the rats with naltrexone blocked the effect
of electroacupuncture on alcohol intake-an indication that this effect
may be through the brain's opiate system. On the basis of their
findings, the researchers recommend rigorous clinical trials to study
the effects of electroacupuncture in alcohol-addicted people. They also
recommend further investigation of how electroacupuncture affects the
brain. http://nccam.nih.gov/research/results/spotlight/022609.htm.--
Neurochemical Research. 2008;33(10):2166-2170.
Lifestyle Changes May Affect Cell-level Processes Related to
Disease.--Disease risk, progression, and premature mortality--in many
types of cancer and in cardiovascular and infectious diseases--have
been linked to telomeres, which are protective DNA-protein complexes
that keep cells genetically stable. The cellular enzyme telomerase is
an important part of the body's maintenance system for these essential
complexes. In a pilot study researchers investigated the effects of
lifestyle changes on telomerase levels in 24 men with low-risk prostate
cancer. The participants underwent a comprehensive lifestyle
modification that included: improved nutrition, moderate aerobic
exercise, stress management, and increased social support. After 3
months, the study participants' telomerase activity had increased 29.8
percent. Decreases in psychological distress and low-density
lipoprotein (LDL) cholesterol were associated with the increase in
telomerase activity. This is the first longitudinal study to suggest
that lifestyle modifications (or any intervention) might significantly
increase telomerase activity. The researchers emphasize that additional
research is needed and recommend larger randomized controlled trials to
confirm the findings. http://nccam.nih.gov/research/results/spotlight/
100908.htm. The Lancet Oncology. Published online September 16, 2008.--
Journal of Immunology. 2007;179(6):4249-4254.
New Research Gives Insight Into How Acupuncture May Relieve Pain.--
In the first study of its kind, researchers evaluated the effects of
acupuncture on brain activity following active stimulation. The
researchers used functional magnetic resonance imagery (fMRI) to
monitor brain activity in 15 healthy adults before and after true
acupuncture and sham acupuncture. The procedure lasted 150 seconds, and
the rest period was 5.5 minutes. Analysis of the fMRI images showed
that following true acupuncture--but not sham--there were increased
connections among the parts of the brain involved in the perception and
memory of pain. The subjects also reported stronger sensations with
true acupuncture than with sham. The researchers concluded that
acupuncture changes resting-state brain activity in ways that may
account for its analgesic and other therapeutic effects. http://
nccam.nih.gov/research/results/spotlight/111408.htm.--Pain.
2008;136(3):407-418.
Prostate Genes Altered by Intensive Diet and Lifestyle Changes.--A
pilot study suggests that intensive lifestyle and diet changes may
alter gene expression (the way a gene acts) in the prostate--possibly
affecting the progression of prostate cancer. This pilot study included
a group of 31 men with low-risk prostate cancer. These men declined
immediate surgery, hormonal therapy, or radiation, and participated in
an intensive 3-month nutritional and lifestyle intervention while
researchers monitored their tumor progression. The men stuck to a low-
fat, plant-based diet and took dietary supplements including fish oil,
selenium, and vitamins C and E. They also participated in stress
management activities, did moderate aerobic exercise, and attended
group support sessions. The researchers found that there were changes
in the men's RNA following the lifestyle and diet modifications.
Certain RNA transcripts that play a critical role in tumor formation
had ``up-regulated'' (increased) and others ``down-regulated''
(decreased). The researchers concluded that intensive nutrition and
lifestyle changes may alter gene expression in the prostate. They
believe that understanding how these changes affect the prostate may
lead to more effective prevention and treatment for prostate cancer,
and recommend larger, randomized controlled trials to confirm the
results of this pilot study. http://nccam.nih.gov/research/results/
spotlight/100808.htm.--Proceedings of the National Academy of Sciences
of the United States of America. 2008;105(24):8369-8374.
Meditation May Increase Empathy.--Previous brain studies have shown
that when a person witnesses someone else in an emotional state--such
as disgust or pain--similar activity is seen in both people's brains.
This shows a physiological base for empathy, defined as the ability to
understand and share another person's experience. Now, research using
advanced brain images (functional magnetic resonance imaging) have
shown that compassion meditation--a specific form of Buddhist
meditation--may increase the human capacity for empathy. In the study,
researchers compared brain activity in meditation experts with that of
subjects just learning the technique (16 in each group). They measured
brain activity during meditation and at rest, in response to sounds
designed to evoke a negative, positive, or neutral emotional response.
The researchers found that both the novice and the expert meditators
showed an increased empathy reaction when in a meditative state.
However, the expert meditators showed a much greater reaction,
especially to the negative sound, which may indicate a greater capacity
for empathy as a result of their extensive meditation training. An
increased capacity for empathy, the authors say, may have clinical and
social importance. The next step, they add, is to investigate whether
compassion meditation results in more altruistic behavior or other
changes in social interaction. http://nccam.nih.gov/research/results/
spotlight/060608.htm.--PLoS ONE [online journal], 2008.
Meditation May Make Information Processing in the Brain More
Efficient.--``Attentional-blink'' occurs when two pieces of information
are presented to a person in very close succession, and the brain
doesn't perceive the second piece of information because it is still
processing the first. Researchers attempted to determine if intensive
mental training through meditation could extend the brain's limits on
information processing, reducing ``attentional-blink.'' Two groups of
people--17 expert meditators and 23 novices--were compared to see if
either was better at recognizing two pieces of information shown in
quick succession. The participants were tested at the beginning and end
of a 3-month period. For the intervening 3 months, the meditation
practitioners participated in a retreat, during which they meditated
for 10-12 hours a day. The novices participated in a 1-hour meditation
class, and were asked to meditate for 20 minutes a day for the week
before each test. The researchers found that intensive training did
reduce ``attentional-blink.'' The participants who had gone through the
mental training were more likely to perceive both pieces of information
instead of just the first because the brain used fewer resources to
detect the first piece of information--leaving more resources available
to detect the second. The researchers also note that this study
supports the idea that brain plasticity, or the ability of the brain to
adapt, exists throughout life. http://nccam.nih.gov/research/results/
spotlight/082307.htm.--PLOS Biology, June 2007.
Quality of Life and Other Factors
Quality of Life and Safety of Tai Chi and Green Tea Extracts in
Postmenopausal Women.--For postmenopausal women with osteopenia (low
bone mineral density), practicing tai chi and/or taking green tea
polyphenols appears to be safe. Further, practicing tai chi by itself
or in combination with green tea polyphenol supplements may improve
quality of life; however, taking green tea supplements by themselves
has no significant improvement in quality of life. The researchers
noted that this is the first placebo-controlled, randomized study to
evaluate the safety of long-term use of green tea supplements in
postmenopausal women. Based on these findings, the researchers
concluded that green tea polyphenols at a dose of 500 mg daily for 24
weeks, alone or in combination with tai chi, appears to be safe in
postmenopausal women with low bone mineral density. http://
nccam.nih.gov/research/results/spotlight/121410.htm.--BMC Complementary
and Alternative Medicine. 2010;10(1):76. [Epub ahead of print]
Tai Chi and Qi Gong Show Some Beneficial Health Effects.--A review
of scientific literature suggests that there is strong evidence of
beneficial health effects of tai chi and qi gong, including for bone
health, cardiopulmonary fitness, balance, and quality of life. Both tai
chi and qi gong (also known as qigong) have origins in China and
involve physical movement, mental focus, and deep breathing.
Researchers analyzed 77 articles reporting the results of 66 randomized
controlled trials of tai chi and qi gong. The studies involved a total
of 6,410 participants. Of the many outcomes identified by the
reviewers, current research suggests that the strongest and most
consistent evidence of health benefits for tai chi or qi gong is for
bone health, cardiopulmonary fitness, balance and factors associated
with preventing falls, quality of life, and self-efficacy (the
confidence in and perceived ability to perform a behavior). The
reviewers concluded that the evidence is sufficient to suggest that tai
chi and qi gong are a viable alternative to conventional forms of
exercise. http://nccam.nih.gov/research/results/spotlight/071910.htm.--
American Journal of Health Promotion. 2010;24(6):e1-e25.
Hypnosis May Reduce Hot Flashes in Breast Cancer Survivors.--
Researchers investigated the effects of hypnosis on hot flashes among
women with a history of primary breast cancer, no current evidence of
detectable disease, and at least 14 hot flashes per week over a 1-month
period. Sixty women were assigned to receive either hypnosis (weekly
50-minute sessions, plus instructions for at-home self-hypnosis) or no
treatment. The women who received hypnosis had a 68-percent reduction
in self-reported hot flash frequency/severity and experienced an
average of 4.39 fewer hot flashes per day. Compared with controls, they
also had significant improvements in self-reported anxiety, depression,
interference with daily activities, and sleep. The researchers
concluded that hypnosis appears to reduce perceived hot flashes in
breast cancer survivors and may have additional benefits such as
improved mood and sleep. They recommend long-term, randomized, placebo-
controlled studies to further explore the benefits of hypnosis for
breast cancer survivors. The researchers are currently conducting a
randomized clinical trial with 200 participants. http://nccam.nih.gov/
research/results/spotlight/102308.htm.--Journal of Clinical Oncology.
Published online September 22, 2008.
Tai Chi May Help Heart Failure Patients Sleep Better.--People with
heart failure may benefit from practicing tai chi, according to
researchers who analyzed sleep in 18 patients with chronic heart
failure. All patients were on maximal medical therapy. The patients
were assigned into one of two groups: a usual care group (the control)
that received medication and diet/exercise counseling, or a tai chi
group that received usual care plus 12 weeks of tai chi training.
Compared with the usual care group, the tai chi group had significant
improvements in sleep stability. The tai chi group also demonstrated
significant quality-of-life improvements over the usual care group. The
researchers concluded that a 12-week tai chi exercise program may help
heart failure patients sleep better. They noted that it remains to be
determined if any single component of tai chi--meditation, relaxation,
or physical activity--may be responsible for the observed benefit. They
suggested further research to better understand the mechanisms of tai
chi's effects on sleep should include more conventional sleep testing
to document sleep stages and patterns of sleep disruption. http://
nccam.nih.gov/research/results/spotlight/072508.htm.--Sleep Medicine.
2008;9(5):527-536.
Tai Chi Chih Improves Sleep Quality in Older Adults.--Researchers
conducted a randomized controlled trial to determine whether tai chi
chih could improve sleep quality in healthy, older adults with moderate
sleep complaints. In the study, 112 individuals aged 59 to 86
participated in either tai chi chih training or health education
classes for 25 weeks. Participants rated their sleep quality based on
the Pittsburgh Sleep Quality Index, a self-rate questionnaire that
assesses sleep quality, duration, and disturbances. The results of the
study showed that the people who participated in tai chi chih sessions
experienced slightly greater improvements in self-reported sleep
quality. The researchers concluded that tai chi chih can be a useful
nonpharmacologic approach to improving sleep quality in older adults
with moderate sleep complaints, and may help to prevent the onset of
insomnia. http://nccam.nih.gov/research/results/spotlight/031109.htm.--
Sleep. 2008;31(7):1001-1008.
Acupuncture Shows Promise in Improving Rates of Pregnancy Following
IVF.--A review of seven clinical trials of acupuncture given with
embryo transfer in women undergoing in vitro fertilization (IVF)
suggests that acupuncture may improve rates of pregnancy. An estimated
10 to 15 percent of couples experience reproductive difficulty and seek
specialist fertility treatments, such as IVF. According to researchers
who conducted the systematic review, acupuncture has been used in China
for centuries to regulate the female reproductive system. With this in
mind, the reviewers analyzed results from seven clinical trials of
acupuncture in women who underwent IVF to see if rates of pregnancy
were improved with acupuncture. The studies encompassed data on over
1,366 women and compared acupuncture, given within 1 day of embryo
transfer, with sham acupuncture, or no additional treatment. The
reviewers found that acupuncture given as a complement to IVF increased
the odds of achieving pregnancy. According to the researchers, the
results indicate that 10 women undergoing IVF would need to be treated
with acupuncture to bring about one additional pregnancy. The results,
considered preliminary, point to a potential complementary treatment
that may improve the success of IVF and the need to conduct additional
clinical trials to confirm these findings. http://nccam.nih.gov/
research/results/spotlight/020808.htm.--British Medical Journal.
Published online February 2008.
Tai Chi May Help Maintain Bone Mineral Density in Postmenopausal
Women.--Tai chi may be a safe alternative to conventional exercise for
maintaining bone mineral density (BMD) in postmenopausal women. Bone
mineral density is one of the key indicators of bone strength and low
BMD is associated with osteoporosis. Exercise is an important component
of osteoporosis prevention and treatment. Researchers conducted a
systematic review of research looking at the effect of tai chi, a mind-
body practice that originated in China, on BMD. They found that tai chi
may be an effective, safe, and practical intervention for maintaining
BMD in postmenopausal women. The authors further note that the benefits
of tai chi appeared similar to those of conventional exercise. However,
tai chi may also improve balance, reduce fall frequency, and increase
musculoskeletal strength. They note that the evidence is preliminary
because the research they reviewed was of limited scope and quality,
but enough evidence of effectiveness exists to warrant further
research. http://nccam.nih.gov/research/results/spotlight/081407.htm.
Archives of Physical Medicine and Rehabilitation, May 2007.
Tai Chi Boosts Immunity to Shingles Virus in Older Adults.--Tai
chi, a traditional Chinese form of exercise, may help older adults
avoid getting shingles by increasing immunity to varicella-zoster virus
and boosting the immune response to varicella vaccine. The study is the
first rigorous clinical trial to suggest that a behavioral
intervention, alone or together with a vaccine, can help protect older
adults from the varicella virus, which causes both chickenpox and
shingles. The randomized, controlled trial included 112 healthy adults
ages 59 to 86. Each person took part in a 16-week program of either tai
chi or health education with 120 minutes of instruction weekly. After
the tai chi and health education programs, with periodic blood tests to
determine levels of varicella virus immunity, people in both groups
received a single injection of the chickenpox vaccine, VARIVAX. Nine
weeks later, the investigators assessed each participant's level of
varicella immunity and compared it to immunity at the start of the
study. Tai chi alone was found to increase participants' immunity to
varicella, and tai chi combined with the vaccine produced a
significantly higher level of immunity, about a 40 percent increase,
over the vaccine alone. The study also showed that the tai chi group's
rate of increase in immunity over the course of the study was double
that of the health education group. Finally, the tai chi group reported
significant improvements in physical functioning, bodily pain, vitality
and mental health. http://nccam.nih.gov/research/results/spotlight/
040607.htm.--Journal of the American Geriatrics Society, April 2007.
Study Compares Year-long Effectiveness of Four Weight-loss Plans.--
The very low carbohydrate diet known as the Atkins diet may contribute
to greater weight loss than higher carbohydrate plans without negative
effects such as increased cholesterol. The study consisted of 311
premenopausal women, all of whom were overweight or obese who were
randomly assigned to 1 of 4 diets. Each of the diets used were selected
for their different levels of carbohydrate consumption: the Atkins
diet, the Zone diet, the LEARN diet and the Ornish diet. Participants
in each group received books that accompanied their assigned diet plan,
and attended hour-long classes with a registered dietitian once a week
for the first 8 weeks. The researchers recorded body mass index (BMI);
percent body fat; waist-hip ratio; as well as metabolic measures such
as, insulin, cholesterol, glucose, triglyceride, and blood pressure
levels. The Atkins diet group reported the most weight loss at 12
months with an average loss of just over 10 pounds. They also had more
favorable overall metabolic effects. Average weight loss across all
four groups ranged from 3.5 to 10.4 pounds. The authors note that
``even modest reductions in excess weight have clinically significant
effects on risk factors such as triglycerides and blood pressure.''
http://nccam.nih.gov/research/results/spotlight/030607.htm.--Journal of
the American Medical Association. March 2007.
Natural Products Interventions
Treatment or Enhancement of Treatment
New Approach for Peanut Allergy in Children Holds Promise.--
Currently, there are no treatments available for people with peanut
allergy. A new treatment may be a safe and effective form of
immunotherapy for those children. The double-blind, placebo-controlled
study investigated the safety, clinical effectiveness, and immunologic
changes with sublingual immunotherapy--a treatment that involves
administering very small amounts of the allergen extract under a
person's tongue. Though these findings are promising, more study is
needed to determine whether sublingual immunotherapy can increase long-
term tolerance to peanuts in children with peanut allergy. http://
nccam.nih.gov/research/results/spotlight/022011.htm.--The Journal of
Allergy and Clinical Immunology. 2011.
Magnesium Supplements May Benefit People With Asthma.--Some
previous studies have reported associations between low magnesium
consumption and the development of asthma. This study provides
additional evidence that adults with mild-to-moderate asthma may
benefit from taking magnesium supplements. Researchers found that
participants who took magnesium experienced significant improvement in
lung activity and the ability to move air in and out of their lungs.
Those taking magnesium also reported other improvements in asthma
control and quality of life compared with people who received placebo.
The researchers noted that this study adds to the body of research that
shows subjective and objective benefits of magnesium supplements in
people with mild-to-moderate asthma. http://nccam.nih.gov/research/
results/spotlight/021110.htm.--Journal of Asthma. 2010;47(1):83-92.
Study Shows Chamomile Capsules Ease Anxiety Symptoms.--Researchers
conducted a randomized, double-blind, placebo-controlled trial to test
the effects of chamomile extract in patients diagnosed with mild to
moderate generalized anxiety disorder (GAD). Researchers used the
Hamilton Anxiety Rating (HAM-A) and other tests to measure changes in
anxiety symptoms over the course of the study; dosage adjustments were
based on HAM-A scores. Compared with placebo, chamomile was associated
with a greater reduction in mean HAM-A scores--the study's primary
outcome measure. The difference was clinically meaningful and
statistically significant. Chamomile also compared favorably with
placebo on other outcome measures (although the differences were not
statistically significant), and was well tolerated by participants.
These results suggest that chamomile may have modest benefits for some
people with mild to moderate GAD. As this was the first controlled
trial of chamomile extract for anxiety, the researchers note that
additional studies using larger samples and studying effects for longer
periods of time would be helpful. They also point out that other
chamomile species, preparations (e.g., extracts standardized to
constituents other than apigenin), and formulations (e.g., oil or tea)
might produce different results. http://nccam.nih.gov/research/results/
spotlight/040310.htm.--Journal of Clinical Psychopharmacology. 2009
Aug;29(4):378-382.
Study Indicates Cranberry Juice Does Not Interfere With Two
Antibiotics Women Take for Recurrent Urinary Tract Infections.--
Cranberry juice, a popular home remedy for urinary tract infections
(UT), is often taken along with low-dose antibiotics as a preventive
measure. Because little is known about the potential of cranberry juice
to interact with drugs, researchers studied cranberry's effects on two
antibiotics frequently prescribed for UTI: amoxicillin and cefaclor.
The data showed that cranberry juice did not significantly affect
either antibiotic's oral absorption or renal clearance (i.e., how
completely the body processed the drugs in the intestine and kidneys).
Absorption took somewhat longer with cranberry juice, but the delay was
small, and the total amount of antibiotic absorbed was not affected.
Based on these results, the researchers concluded that cranberry juice
cocktail, consumed in usual quantities, is unlikely to change the
effects of these two antibiotics on UTIs. They noted that the same may
or may not be true of other antibiotics, or when people who take
antibiotics also drink a large quantity of concentrated cranberry
juice. http://nccam.nih.gov/research/results/spotlight/081009.htm.--
Antimicrobial Agents and Chemotherapy. 2009 Jul;53(7):2725-32.
Traditional Chinese Herbs May Benefit People With Asthma.--
Scientists reviewed research evidence on traditional Chinese medicine
(TCM) herbs for asthma, focusing on studies reported since 2005. They
determined that preliminary clinical trials of formulas containing
Radix glycyrrhizae in combination with various other TCM herbs have had
positive results. Laboratory findings on TCM herbal remedies suggest
several possible mechanisms of action against asthma, including an
anti-inflammatory effect, inhibition of smooth-muscle contraction in
the airway, and modulation of immune system responses. http://
nccam.nih.gov/research/results/spotlight/061609.htm.--Journal of
Allergy and Clinical Immunology. 2009;123(2):297-306.
A Review of St. John's Wort Extracts for Major Depression.--
Researchers reviewed the scientific literature on St. John's wort for
major depression and analyzed findings from randomized, double-blind
studies comparing St. John's wort extracts with placebo and standard
antidepressants. The researchers reviewed a total of 29 studies in
5,489 people. The studies came from a variety of countries, tested
several different St. John's wort extracts, and mainly included people
with minor to moderately severe symptoms of depression. According to
this literature review, St. John's wort extracts appeared to be
superior to placebo, were as effective as standard antidepressants, and
had fewer side effects than antidepressants. However, the findings from
studies in German-speaking countries were disproportionately favorable,
possibly because some subjects had slightly different types of
depression, or because some of the small studies were flawed and overly
optimistic in reporting their results. The authors noted the need to
investigate the reasons for the differences between study findings from
German-speaking countries and those from other countries. http://
nccam.nih.gov/research/results/spotlight/120908.htm.--Cochrane Database
of Systematic Reviews. 2008 8;(4):CD000448.
Study Suggests Vitamin E May Help People With Asthma.--A form of
vitamin E (gamma-tocopherol) commonly found in foods may be a useful
additional treatment for asthma, according to preliminary research.
Researchers investigated the biological activity of a gamma-tocopherol
supplement in asthma patients. The researchers gave a daily dose of a
vitamin E preparation rich in gamma-tocopherol to 16 volunteers. Eight
healthy volunteers and eight volunteers with allergic asthma received
one supplement daily during the first week, followed by a week with no
treatment, and then two supplements daily for another week. They found
similar results for both doses--the vitamin E supplements prevented
inflammation and decreased oxidative stress without any adverse health
effects. This research was an initial step in extending previous
findings of gamma-tocopherol's anti-inflammatory effects in animals.
Further research on vitamin E in patients with asthma is under way.
http://nccam.nih.gov/research/results/spotlight/070208.htm.--Free
Radical Biology & Medicine. 2008;45(1):40-49.
Omega-3 Fatty Acids May Be Helpful in Psychiatric Care.--Omega-3
fatty acids may hold promise for use in psychiatry, particularly for
depression and bipolar disorder. Researchers conducted a meta-analysis
of research looking at omega-3 fatty acid supplements as treatments for
psychiatric conditions, such as depression, bipolar disorder,
schizophrenia, dementia, and attention-deficit hyperactivity disorder.
Omega-3 fatty acids are essential nutrients that the body cannot make
on its own, so they must come from food sources. The richest source of
these fatty acids is fish and seafood, but they can also be found in
flaxseeds and some eggs. The authors suggest that omega-3 supplements
may be helpful for people with depression or bipolar disorder as a
complement to standard care. However, they were unable to determine
benefits for other conditions such as schizophrenia and dementia. They
also ``strongly recommend that patients with psychiatric disorders
should not elect supplementation with omega-3 fatty acids in lieu of
established psychiatric treatment options.'' They further recommend
studies to look at how the nutrient may work, and large trials to
conclusively determine the utility of omega-3 fatty acids in
psychiatric care. http://nccam.nih.gov/research/results/spotlight/
121506.htm.--Journal of Clinical Psychiatry, December 2006.
Polyunsaturated Fatty Acids for Depression.--Omega-6 and omega-3
fatty acids (also called PUFAs, short for polyunsaturated fatty acids)
are among the CAM therapies used with the intent to help symptoms of
depression. A team reviewing the evidence found five randomized
controlled trials to be of sufficient quality for review, although all
were small and of short duration. All but one of these trials found
some improvement from using PUFAs for symptoms of depression,
particularly from omega-3 fatty acids. The authors concluded that while
the evidence to support using PUFA supplements as a treatment for
depression is not strong, enough potential exists to merit further
research. http://nccam.nih.gov/research/results/spotlight/050106.htm.--
Journal of Affective Disorders, May 2006.
Disease Prevention
Ginkgo Does Not Shield Seniors' Hearts, But It May Protect Their
Leg Arteries.--While findings from the Ginkgo Evaluation of Memory
(GEM) study show that the herbal supplement Ginkgo biloba did not
prevent heart attack, stroke, or death in a group of older adults, the
herb may reduce the risk of developing peripheral arterial disease
(also known as peripheral vascular disease), a painful and potentially
life-threatening condition affecting blood circulation in the legs,
arms, stomach, and kidneys. Of the 35 cases of peripheral arterial
disease observed in the study, 23 patients received placebo and 12
patients received ginkgo, a difference that was statistically
significant. The researchers reported that this finding was consistent
with European studies that reported improvements in patients with
peripheral arterial disease who received ginkgo versus placebo. But,
due to the small number of patients in whom this was seen, the
researchers suggest larger trials to evaluate the herb before they
would recommend it as a treatment for peripheral arterial disease. This
study was a planned secondary outcome of the GEM study. http://
nccam.nih.gov/research/results/spotlight/052110.htm.--Circulation:
Cardiovascular Quality and Outcomes. 2010;3(1):41-47.
Chinese Herbal Medicine May Benefit People With Pre-Diabetes.--In
China and other Asian countries, Chinese herbal medicines have long
been used to prevent or delay the onset of diabetes, and there is
anecdotal evidence regarding efficacy for this purpose. A recent
review, funded in part by the NCCAM, examined related clinical trials
to see whether scientific evidence supports recommending Chinese herbal
medicine as a treatment option for people with pre-diabetes. The review
looked at 16 clinical trials involving 1,391 participants with pre-
diabetes, 15 different herbal formulations, and various comparisons
(i.e., lifestyle modification, drug interventions, placebo). Analysis
of data from eight trials that included lifestyle modification as a
comparison found that lifestyle modification combined with Chinese
herbs was twice as effective as lifestyle modification alone in
normalizing blood sugar levels. Participants who received herbal
formulations were also less likely to develop full-blown diabetes
during the study period. Due to limitations among the studies reviewed,
the reviewers concluded that while their findings are promising,
further, well-designed trials are needed to clarify the potential role
of Chinese herbal medicines in glucose control and diabetes prevention.
http://nccam.nih.gov/research/results/spotlight/110309.htm.--Cochrane
Database of Systematic Reviews. 2009(4):CD00066690.
Red Yeast Rice May Help Patients With High Cholesterol Who Cannot
Take Statin Drugs.--In light of previous findings that red yeast rice
can reduce levels of low-density lipoprotein (LDL, or ``bad''
cholesterol), researchers investigated the effects of this supplement
in patients with high cholesterol and a history of statin-associated
myalgia (SAM). Compared with placebo, red yeast rice significantly
decreased blood levels of LDL and total cholesterol over a 24-week
period, without increasing the incidence of myalgia. Red yeast rice did
not significantly affect levels of high-density lipoprotein (HDL, or
``good'' cholesterol), triglycerides, weight loss, or pain severity.
This was the first randomized, double-blind, placebo-controlled trial
to evaluate red yeast rice in patients who cannot take statin drugs
because of muscle pain. The results suggest that red yeast rice may be
a cholesterol-lowering alternative for these patients, but additional,
larger studies are needed to establish long-term safety and efficacy.
The researchers also suggest studies to compare red yeast rice directly
with statins and to explore the role of lifestyle change therapy.
http://nccam.nih.gov/research/results/spotlight/071709.htm.--Annals of
Internal Medicine. 2009;150(12):830-839.
Flaxseed Reduces Some Risk Factors of Cardiovascular Disease.--
Flaxseed is rich in alpha linolenic acid (ALA), a plant-based omega-3
fatty acid, as well as fiber and lignans (phytoestrogens), making it a
possible functional food for reducing cardiovascular risk factors. A
double blind, randomized, controlled clinical trial by researchers
explored the effects of flaxseed on various cardiovascular risk factors
in adults. Researchers found that flaxseed positively affected
lipoprotein A and insulin sensitivity. They also found a modest but
short-lived lowering effect in participants' LDL (``bad'') cholesterol
levels. However, the researchers also noted that flaxseed significantly
lowers HDL (``good'') cholesterol levels in men, although not in women.
There were no changes noted in markers of inflammation or oxidative
stress. The authors suggest that additional investigation of the HDL
lowering effect among men may be warranted. http://nccam.nih.gov/
research/results/spotlight/062308.htm.--Nutrition, 2008.
Basic and Translational Research
Basic and translational research provides important insights into
how CAM interventions can benefit human health. For example, animal
studies help to identify biomarkers or signatures of biological effects
that can be applied to future studies in humans.
Laboratory Study Suggests Potential Anti-cancer Benefit of White
Tea Extract.--White tea extract increased a specific type of cell death
in laboratory cultures of two different types of nonsmall cell lung
cancer cells, indicating that the tea may have an anti-cancer effect.
Although white tea comes from the same plant as green and black teas
(Camellia sinensis), white tea goes through much less processing,
resulting in a higher concentration of polyphenols. This study, for the
first time, showed the roles of the PPAR-gamma and 15-LOX signaling
pathways in white tea-induced apoptosis. (A reduction in PPAR-gamma in
a tumor is linked to poor prognosis in patients with lung cancer.) The
researchers also compared green tea extract with white tea extract and
found that white tea extract was significantly more effective in
increasing certain RNA transcripts (e.g., PPAR-gamma) that play a
critical role in cell death. They noted, however, that the components
in white tea extract that may be responsible for this outcome are not
yet known. They noted that the findings from this preliminary study
provide an important basis for more investigation of the anti-cancer
properties of white tea extract and whether it may help prevent the
development of lung cancer. http://nccam.nih.gov/research/results/
spotlight/092110.htm.--Cancer Prevention Research. 2010;3(9):1132-1140.
Laboratory Study Shows Turmeric May Have Bone-Protective Effects.--
Turmeric--an herb commonly used in curry powders, mustards, and
cheeses--may protect bones against osteoporosis. This study, which used
an animal (rat) model of postmenopausal osteoporosis, builds on
previous laboratory research examining turmeric's anti-arthritic
properties. Funded in part by the NCCAM, the study tested two turmeric
extracts containing different amounts of curcuminoids--(components of
the herb) in female rats whose ovaries had been surgically removed
(ovariectomy--a procedure that causes changes associated with
menopause, including bone loss). Tests showed that while nonenriched
turmeric extract did not have bone-protective effects, curcuminoid-
enriched turmeric extract prevented up to 50 percent of bone loss, and
also preserved bone structure and connectivity. Other physiological
changes associated with ovariectomy (weight gain and shrinking of the
uterus) were unaffected--an indication that the bone-protective effects
did not involve an estrogen-based chemical pathway. The researchers
concluded that turmeric may protect bones, but that the effect depends
on the amount of curcuminoids present. However, they emphasized that
clinical research is needed to evaluate the use of turmeric-derived
curcuminoid products to guard against osteoporosis in humans. http://
nccam.nih.gov/research/results/spotlight/093010.htm.--Journal of
Agricultural and Food Chemistry. 2010;58(17):9498-9504.
Effects of Milk Thistle Extract on the Hepatitis C Virus
Lifecycle.--A laboratory study suggests that silymarin--an extract from
the milk thistle plant--has multiple effects against the lifecycle of
the hepatitis C virus. Hepatitis C is a chronic (long lasting) disease
that primarily affects the liver and is often difficult to cure. This
study examined the antiviral properties and mechanisms of silymarin on
cultured (grown in a lab) human liver cells infected with the virus. By
analyzing the interactions between silymarin and the virus, the
researchers observed that silymarin prevented the entry and fusion of
the hepatitis C virus into the target liver cells. They also found that
silymarin inhibited the ability of the virus to produce RNA (a chemical
that plays an important role in protein synthesis and other chemical
activities of the cell), interfering with a portion of the virus's
lifecycle. These findings build on previous research of silymarin's
antiviral and anti-inflammatory properties and provide more information
about the potential mechanisms involved in silymarin's antiviral
actions. Further research, particularly in clinical trials, is needed
to determine if silymarin could be a safe and effective supplement for
treating hepatitis C in humans. http://nccam.nih.gov/research/results/
spotlight/061610.htm.--Hepatology. 2010;51(6):1912-1921.
Fish Oil Enhances Effects of Green Tea on Alzheimer's Disease in
Mice.--Fish oil, when combined with epigallocatechin-3-gallate (EGCG--a
polyphenol and antioxidant found in green tea), may affect chemical
processes in the brain associated with Alzheimer's disease. This study,
which used an animal (mouse) model of Alzheimer's disease, builds on
previous research linking the disease to peptides (amino acid chains)
called beta-amyloids and laboratory studies suggesting that EGCG
decreases memory problems and beta-amyloid deposits in mice.
Researchers found that the mice fed the combination of fish oil and
EGCG had a significant reduction in amyloid deposits that have been
linked with Alzheimer's disease. Upon examination of blood and brain
tissues of the mice, the researchers found high levels of EGCG in the
mice that were fed the combination of fish oil and low-dose EGCG
compared with those fed low-dose EGCG alone. A possible explanation,
according to the researchers, is that fish oil enhances the
bioavailability of EGCG--that is, the degree to which EGCG was absorbed
into the body and made available to the brain. This effect, in turn,
may contribute to the increased effectiveness of this combination.
Further research is necessary, however, to determine if the combination
of fish oil and EGCG affects memory or cognition, and whether it might
have potential as an option for people at risk of developing
Alzheimer's disease. http://nccam.nih.gov/research/results/spotlight/
031610.htm.--Neuroscience Letters. 2010;471(3):134-138.
Laboratory Study Suggests Potential Anti-Cancer Benefit of
Ginseng.--American ginseng (Panax quinquefolius) extract caused
laboratory cultures of colorectal cancer cells to die, indicating that
the herb may have an anti-cancer effect. Although results from the
study suggest that combining ginseng with antioxidants such as vitamin
C may potentially enhance this effect, there is no evidence yet that
this laboratory research can be extended to treatments in people.
Researchers treated two types of colorectal cancer cells with steamed
American ginseng root extract. This caused damage to the cells'
mitochondria, the internal structures that are involved with energy
production, and led to apoptosis (cell death). It also increased levels
of reactive oxygen species (ROS)--a byproduct of the processes in which
cells use and break down oxygen (increased levels of ROS can either
bring on cell death or activate the survival pathways that protect
against it). Whether ROS acts to induce cell death or survival in
response to ginseng depends on the specific biochemical pathways that
are activated, and how this happens remains unknown. Further studies
are needed. The researchers also noted the need for additional
investigations to test whether combining ginseng and antioxidants might
help prevent the development of colorectal cancers. http://
nccam.nih.gov/research/results/spotlight/032510.htm.--Cancer Letters.
2010;289(1):62-70.
Mouse Study Shows Green Tea Polyphenols May Repair DNA Damage
Caused by Ultraviolet (UV) Radiation.--Antioxidants found in green tea
may help repair DNA damage caused by sun exposure, according to a
recent study in mice. Exposure to UV radiation can damage DNA and, in
turn, trigger suppression of the immune system--a risk factor for
developing skin cancer. The study, funded in part by the NCCAM,
examined the effects of polyphenols from the leaves of the green tea
plant, which are thought to fight free radicals (highly unstable
molecules that can damage cells) and have anticarcinogenic activity.
Compared with the control group, the mice treated with green tea
polyphenols had reduced immunosuppression from the UV radiation. This
same group of mice also showed more rapid repair of DNA damaged by UV
radiation. Further, the study showed that green tea polyphenols
increased the levels of some nucleotide excision repair genes, which
allow for DNA repair. The researchers noted that this study is the
first to show that preventing skin cancer with green tea polyphenols in
water may be due to the blocking of UV-induced immunosuppression in
mice. More studies are needed to determine if green tea has any
potential chemopreventive effect on skin cancer in people. http://
nccam.nih.gov/research/results/spotlight/022110.htm.--Cancer Prevention
Research. 2010;3(2):179-189.
Cinnamon Bark and Ginseng in Herbal Formulas Increase Life Span of
Roundworms.--Researchers used a roundworm that has some genetic and
biochemical similarities to humans to examine complex herbal
preparations thought to combat adverse effects of aging. The worms,
called Caenorhabditis elegans, or C. elegans, have a brief life span
(about 20 days). The researchers assessed two traditional Chinese
multiherbal formulas--Huo Luo Xiao Ling Dan (HLXL), taken for chronic
inflammatory pain (e.g., joint pain from arthritis); and Shi Quan Da Bu
Tang (SQDB), taken to reduce fatigue and improve general wellness. They
found that cinnamon bark, a component of both formulas, increased the
worms' life span. Of all the individual components tested, two
significantly prolonged life span: Cinnamomum cassia bark (present in
both formulas) and Panax ginseng root (present in SQDB only). In light
of these findings, the researchers concluded that C. elegans is a valid
model for evaluating complex herbal preparations and may provide
insight for future studies on longevity-promoting herbs. http://
nccam.nih.gov/research/results/spotlight/052510.htm.--PLoS ONE [online
journal]. 2010;5(2):9339.
Laboratory Study Explores Anti-HIV Potential of Palmitic Acid.--In
a laboratory study, a fatty acid from seaweed reduced the ability of
HIV-1 viruses to enter immune system cells. Researchers evaluated
palmitic acid (from Sargassum fusiforme, a type of seaweed that grows
off the coasts of Japan and China) to see if palmitic acid reduced the
ability of HIV-1 viruses to enter CD4+ T-cells (white blood cells that
are HIV-1's main target). Palmitic acid blocked both X4-tropic and R5-
tropic viruses, the HIV viruses that use a particular receptor (X4 or
R5) to enter a cell. In addition, the study's findings showed that
palmitic acid protected other cells against HIV-1, reducing X4
infection in primary peripheral blood lymphocytes and R5 infection in
primary macrophages (white blood cells). In all cases, the extent of
the blocking effect depended on the concentration of palmitic acid, and
most cells remained viable (alive) after treatment. The researchers
noted that understanding the relationship between palmitic acid and CD4
may lead to development of an effective microbicide product for
preventing sexual transmission of HIV. http://nccam.nih.gov/research/
results/spotlight/121409.htm.--AIDS Research and Human Retroviruses.
2009;25(12):1231-1241.
Study Uses Rat Liver Cells To Explore Cholesterol-Lowering
Mechanisms of Tea.--There is evidence that tea consumption can reduce
the risk of cardiovascular disease, apparently by lowering cholesterol
levels in the blood. Researchers examined extracts from both green tea
and black tea, as well as some components of green tea, for their
effects on the synthesis of cholesterol in liver cells from rats. The
study's finding that black tea was more effective than green tea in
decreasing cholesterol synthesis in rat liver cells was unexpected, as
was the finding that EGCG alone was less effective than whole green
tea. Additional research may reveal more about the cholesterol-lowering
mechanisms of both kinds of tea. http://nccam.nih.gov/research/results/
spotlight/040510.htm.--Journal of Nutritional Biochemistry. 2009
Oct;20(10):816-822.
Evidence in Mice May Spur More Research on Fish Oil and Curcumin
for Alzheimer's Disease.--A popular dietary supplement and a curry
spice may affect Alzheimer's disease--related chemical processes in the
brain, according to research findings. This study, which used an animal
(mouse) model of Alzheimer's disease, builds on previous research
linking the disease to peptides (amino acid chains) called b-amyloids
and to defective insulin-processing by the brain. A particular b-
amyloid, Ab-42, is associated with Alzheimer's disease. Funded in part
by the NCCAM, the study looked at two dietary supplements: fish oil
rich in the omega-3 fatty acid docosahexaenoic acid (DHA); and
curcumin, a component of turmeric. Researchers fed the Alzheimer's
disease--model mice a regular or fatty diet; some of the mice also
received fish oil and/or curcumin. They found that the high-fat diet
increased Alzheimer's disease--related chemical processes in the brain,
and that fish oil and curcumin, alone or in combination, counteracted
this effect. DHA and curcumin also protected cognitive performance for
mice on the high-fat diet--i.e., how well the mice remembered a maze.
http://nccam.nih.gov/research/results/spotlight/070109.htm.--Journal of
Neuroscience. 2009;29(28):9078-9089.
Animal Study Shows Connection Between Vitamin E, Lung Inflammation,
and Asthma.--Citing study results in mice, researchers reported for the
first time that the form of vitamin E found primarily in food (gamma-
tocopherol) increased lung inflammation in induced asthma, while the
form of vitamin E found primarily in dietary supplements (alpha-
tocopherol) reduced inflammation. The researchers found that compared
with placebo, alpha-tocopherol significantly reduced inflammation while
gamma-tocopherol significantly increased inflammation. The researchers
also found that the mechanism by which both forms of vitamin E work
involves the regulation of endothelial cell signals during leukocyte
(white blood cell) recruitment--a process that occurs during
inflammation. Endothelial cells line the inner walls of blood vessels.
The researchers concluded that the opposing activities of the two
common forms of vitamin E on inflammation found in this study are
consistent with the contradictory outcomes of vitamin E on asthma in
previous clinical trials. They also noted that the information gained
from this study could have a significant impact on designing and
interpreting future clinical studies on vitamin E. http://
nccam.nih.gov/research/results/spotlight/041109.htm.--The Journal of
Immunology. 2009;182(7):4395-4405.
Researchers Investigate Anti-inflammatory Effects of Pineapple
Extract.--Previous research indicates that bromelain--an enzyme
extracted from pineapple stems--may help inflammatory conditions such
as allergic airway disease. Bromelain's anti-inflammatory effects have
been attributed to its ability to alter the activation and expansion of
the immune system's CD4+ T cells (a type of lymphocyte). To better
understand the processes involved, the NCCAM-funded researchers
conducted in vitro experiments with mouse cells, using bromelain
derived from a commercially available, quality-tested product. The
results show that bromelain reduces CD25 (a protein involved in
inflammation) expression via proteolytic (enzymatic) action, in a dose-
and time-dependent manner. The researchers' analysis of the mechanism
involved found that bromelain apparently splits CD25 from the CD4+ T
cells, and that the T cells remain functional--i.e., they can still
divide--after bromelain treatment. The researchers concluded that the
novel mechanism of action demonstrated in their experiment explains how
bromelain may exert its therapeutic benefits in inflammatory
conditions. http://nccam.nih.gov/research/results/spotlight/
080309.htm.--International Immunopharmacology. 2009;9(3):340-346.
Grape Seed Extract May Help Neurodegenerative Diseases.--In light
of previous studies indicating that grape-derived polyphenols may
inhibit protein misfolding, researchers examined the potential role of
a particular grape seed polyphenol extract (GSPE) in preventing and
treating tau-associated neurodegenerative disorders. The results of
their in vitro study showed that GSPE is capable of interfering with
the generation of tau protein aggregates and also disassociating
preformed aggregates, suggesting that GSPE may affect processes
critical to the onset and progression of neurodegeneration and
cognitive dysfunctions in tauopathies. The researchers concluded that
their laboratory findings, together with indications that this GSPE is
likely to be safe and well-tolerated in people, support its development
and testing as a therapy for Alzheimer's disease. http://nccam.nih.gov/
research/results/spotlight/031209.htm.--Journal of Alzheimer's Disease.
2009;16(2):433-439.
Chinese Herbal Formula Shows Anti-Arthritis Effects in Animal
Study.--Researchers analyzed the effects of a modified version of the
classic Chinese formula Huo Luo Xiao Ling Dan (HLXL) in an animal (rat)
model of adjuvant arthritis, which shares some features with human
rheumatoid arthritis. The researchers induced adjuvant arthritis in
male rats by injecting them with a complete Freund's adjuvant solution
containing heat-killed Mycobacterium tuberculosis. On days 16 to 25,
the rats were given a daily oral dose of either a quality controlled,
11-herb HLXL preparation or liquid only. Compared with controls, the
HLXL-treated rats had significantly decreased arthritis symptom scores;
reduced paw edema; and lower TNF-a and IL-1b levels. No adverse effects
were observed. Based on their results, the researchers concluded that
this HLXL formula may have benefits for treating arthritis and related
inflammatory disorders. http://nccam.nih.gov/research/results/
spotlight/071609.htm.--Journal of Ethnopharmacology. 2009;121(3):366-
371.
Echium Oil Reduces Triglyceride Levels in Mice.--In light of
previous research indicating that oil from the seeds of the Echium
plantagineum plant can lower triglycerides in people, researchers used
an animal model--mice with mildly elevated triglyceride levels--to
investigate how echium oil achieves this effect. The researchers fed
the mice diets supplemented with either echium oil, fish oil, or (as a
control) palm oil. They found that both echium and fish oils had the
following effects: reduced triglycerides in blood plasma and the liver;
enriched EPA in plasma and the liver--echium less so than fish oil; and
``down-regulated'' (decreased the expression of) several genes involved
in synthesis of triglycerides in the liver. The researchers concluded
that echium oil may provide a botanical alternative to fish oil for
reducing triglycerides. http://nccam.nih.gov/research/results/
spotlight/022509.htm.--Journal of Nutritional Biochemistry.
2008;19(10):655-663.
Laboratory Study Shows Black Cohosh Promotes Bone Formation in
Mouse Cells.--Results of laboratory research are the first to indicate
that extracts of the herb black cohosh (Actaea racemosa) may stimulate
bone formation. Researchers added an extract of black cohosh to a
culture of bone-forming mouse cells. The researchers observed that a
high dose (1,000 ng/mL) of the extract suppressed the production of
these bone-forming cells, yet a lower dose (500 ng/mL) significantly
increased the formation of bone nodules. When the cells were treated
with a protein whose molecules attach to estrogen receptors in place of
estrogen, this effect on bone nodule formation disappeared. Thus, the
researchers suggest that ingredients within black cohosh contain a
component that acts through estrogen receptors. The researchers
concluded that their results provide a scientific explanation at the
molecular level for claims that black cohosh may protect against
postmenopausal osteoporosis. They also noted that studying extraction
methods and identifying black cohosh's active components may make it
possible to develop new ways to prevent and treat this condition.
Although results from the study suggest that black cohosh may have
potential implications for the prevention or treatment of
postmenopausal bone loss, there is no evidence yet that this laboratory
research can be extended to treatments in people. http://nccam.nih.gov/
research/results/spotlight/090408.htm.--Bone. 2008;43(3):567-573.
Pomegranate Extract May Be Helpful for Rheumatoid Arthritis (RA).--
RA is an autoimmune disease characterized by joint pain, stiffness,
inflammation, swelling, and sometimes joint destruction. The
pomegranate has been used for centuries to treat inflammatory diseases,
and people with RA sometimes take dietary supplements containing a
pomegranate extract called POMx. However, little is known about the
efficacy of POMx in suppressing joint problems associated with RA.
Researchers used an animal model of RA--collagen-induced arthritis
(CIA) in mice--to evaluate the effects of POMx. They found that POMx
significantly reduced the incidence and severity of CIA in the mice.
The arthritic joints of the POMx-fed mice had less inflammation, and
destruction of bone and cartilage were alleviated. Consumption of POMx,
the researchers also concluded, selectively inhibited signal
transduction pathways and cytokines critical to development and
maintenance of inflammation in RA. Although previous studies of POMx
found cartilage-protective effects in human cell cultures, this is the
first study to observe positive effects in a live model. The
researchers note that the data from this study suggest the potential
efficacy of POMx for arthritis prevention, but not for treatment in the
presence of active inflammation; future studies will address disease-
modifying effects of POMx. They also note that clinical trials are
needed before POMx can be recommended as safe and effective for RA-
related use in people. http://nccam.nih.gov/research/results/spotlight/
120508.htm.--Nutrition. 2008;24(7--8):733-743.
Two Studies Explore the Potential Health Benefits of Probiotics.--
In two studies, researchers investigated how probiotics may have a role
in treating gastrointestinal illnesses, boosting immunity, and
preventing or slowing the development of certain types of cancer. In
one study, researchers investigated how Lactobacillus reuteri ATCC PTA
6475 might work to slow the growth of certain cancerous tumors. Their
study documented the molecular mechanisms of the probiotic's effects in
human myeloid leukemia-derived cells--i.e., how it regulates the
proliferation of cancer cells and promotes cancer cell death. The
researchers noted that a better understanding of these effects may lead
to development of probiotic-based regimens for preventing colorectal
cancer and inflammatory bowel disease. In another study, researchers
looked at whether Lactobacillus acidophilus might enhance the immune-
potentiating effects of an attenuated vaccine (a vaccine prepared from
a weakened live virus) against human rotavirus infection--the most
common cause of severe dehydrating diarrhea in infants and children
worldwide. The investigators' tests on newborn pigs found that animals
given both a vaccine and the probiotic had a better immune response
than the animals given the vaccine alone. The researchers concluded
that probiotics may offer a safe way to increase the effectiveness of
rotavirus vaccine in humans. In both studies, the investigators called
for additional research into the mechanisms behind the health-related
effects of probiotics. http://nccam.nih.gov/research/results/spotlight/
110508.htm.--Cellular Microbiology. 2008;10(7):1442-1452.--Vaccine.
2008;26(29--30):3655-3661.
Research Shows Promise of Pineapple Extract for Inflammatory Bowel
Disease (IBD).--IBD, including Crohn's Disease (CD) and ulcerative
colitis (UC), are characterized by inflammation of the gastrointestinal
tract. Researchers have found that bromelain--an enzyme derived from
pineapple stems--might be able to reduce inflammation in IBD.
Researchers recruited patients with a confirmed diagnosis of CD or UC
as well as a normal, non-IBD control group. In total, this pilot study
recruited 51 participants: 8 controls, 20 with UC, and 23 with CD. To
assess the effect of a bromelain preparation on the production of
cytokines, colon biopsies obtained from patients with UC, CD, and
normal controls were treated in the lab (in vitro) with bromelain. The
researchers report that bromelain reduced production of several pro-
inflammatory cytokines and chemokines that are elevated in IBD and play
a role in the progression of IBD. The authors conclude that bromelain
treatment could potentially benefit IBD patients if similar changes
also occur when colon tissues are exposed to bromelain inside the body.
The researchers also suggest that additional research is needed to
understand how bromelain influences chemokine and cytokine production.
http://nccam.nih.gov/research/results/spotlight/070108.htm.--Clinical
Immunology (2008) 126, 345-352.
Grape Seed Extract May Help Prevent and Treat Alzheimer's.--
Emerging research shows a correlation between red wine consumption and
reduced risk of Alzheimer's disease-type cognitive decline. Researchers
found that grape seed-derived polyphenolics--similar to that in red
wine--significantly reduced Alzheimer's disease-type cognitive
deterioration in mice. Researchers conducted experiments in mice with
Alzheimer's disease to see if a highly purified polyphenolic extract
from Vitis vinifera (cabernet sauvignon) grape seeds, could affect
Alzheimer's disease-type cognitive deterioration. The mice received 5
months of either water containing grape seed extract or water alone as
a placebo treatment. The mice were then given behavioral maze tests to
determine cognitive function and brain tissue samples were tested to
determine evidence of disease. The researchers found that mice treated
with grape seed extract had significantly reduced Alzheimer's disease-
type cognitive deterioration compared to the control mice. This is due
to the prevention of a molecule called amyloid forming in the brain
that has been shown to cause Alzheimer's disease-type cognitive
impairment. http://nccam.nih.gov/research/results/spotlight/
062408.htm.--The Journal of Neuroscience. 2008. 28(25);6388-6392.
Chinese Herbal Formula May Be Helpful for Peanut Allergies.--A
study in mice shows that a Chinese herbal formula may help prevent
dangerous reactions to peanuts. Peanut allergies affect as many as 6
percent of young children and are a major cause of anaphylaxis--a
severe allergic reaction with respiratory symptoms that can be fatal.
Researchers conducted experiments in mice with established peanut
allergies to see if a formula of nine Chinese herbs, called FAHF-2,
could reduce sensitivity to peanuts. The peanut-sensitive mice received
7 weeks of oral treatment with FAHF-2 or water as a placebo treatment.
The mice were then exposed to peanuts at 2 different times to see if
they would have anaphylactic reactions. The researchers found that
FAHF-2 completely protected the mice from a dangerous reaction on both
occasions--showing that protection lasted at least 4 weeks after the
treatment finished. The mice treated with the placebo (water) had
anaphylactic reactions. The researchers note that the protection of
FAHF-2 may result from a shift in the immune balance away from the
allergic response. http://nccam.nih.gov/research/results/spotlight/
012908.htm.--Clinical and Experimental Allergy, June 2007.
Turmeric and Rheumatoid Arthritis Symptoms.--More than 2 million
Americans suffer from rheumatoid arthritis (RA), a condition in which
the body's immune system attacks the joints, causing pain, swelling,
stiffness, and loss of function. The herb turmeric has been used for
centuries in Ayurvedic medicine (a whole medical system that originated
in India) as a treatment for inflammatory disorders, including RA. To
study the effects of turmeric, researchers created symptoms in rats
that mimic those of RA in humans. In a series of experiments, they
treated the rats with different preparations and dosages of turmeric
extracts. The results, measured in terms of joint swelling, suggested
that an extract containing only curcuminoids (a family of chemicals
that is the major component of turmeric) may be more effective for
preventing RA symptoms than a more complex extract containing
curcuminoids plus other turmeric compounds. They also noted that the
curcuminoids-only formulas appeared safer and more effective at lower
doses. Also, the researchers found that the compounds had greater
effectiveness when the rats were treated before instead of after the
onset of inflammation. The authors identified a need for well-designed
preclinical and clinical studies to look further into turmeric for
anti-inflammatory use. http://nccam.nih.gov/research/results/spotlight/
030106.htm.--Journal of Natural Products, March 2006.
Other Research
Botanicals May Help Conditions Associated With Aging.--To evaluate
the effectiveness of botanicals in relation to conditions such as high
blood pressure, cardiovascular disease, cognitive decline, insulin
resistance, and excess fats in the blood, researchers conducted a
literature review and examined studies from their own laboratory. The
researchers looked at effects of dietary soy; soy isoflavones (daidzein
and genistein); grape seed extract, which has a high concentration of
polyphenols; and puerarin, an isoflavone found in kudzu. The literature
review found that soy seemed to lower blood pressure in men and
postmenopausal women, help protect against cardiovascular diseases
(including heart disease and atherosclerosis), and benefit people with
diabetes. The researchers' own animal studies found that soy
isoflavones protected against salt-sensitive hypertension in male rats
and in female rats whose ovaries had been removed (OVX); grape seed
extract reduced blood pressure and improved cognitive functioning in
OVX female rats; and puerarin improved glucose control in male mice.
The researchers concluded that the botanical compounds reviewed appear
to have beneficial effects in animal models of disease (soy also has
shown benefits in humans), and that the compounds may be more effective
in relation to cardiovascular, metabolic, and cognitive function than
for menopausal symptoms. They recommended that the compounds' safety
and mechanisms of action should be carefully tested in the context of
the disease status of potential users. http://nccam.nih.gov/research/
results/spotlight/121008.htm.--Gender Medicine. 2008;
5(suppl A):76S-90S.
Botanical Research Centers Featured in American Journal of Clinical
Nutrition.--The February 2008 issue of the American Journal of Clinical
Nutrition features eight articles from the NIH Botanical Research
Centers Program, which is co-funded by the NIH Office of Dietary
Supplements and the NCCAM. The articles highlight different areas
related to the Centers' research into botanical use, safety, and
efficacy. They include evaluation of botanicals for improving health;
technologies and experimental approaches to evaluating botanicals;
botanicals and metabolic syndrome; echinacea in infection; botanicals
for age-related diseases; ways in which botanical lipids affect
inflammatory disorders; botanicals to improve women's health; and
ensuring botanical dietary supplement safety. The Botanical Centers are
intended to advance research activities in plant identification, as
well as preclinical research and early phase clinical studies. Each
Center has a broad interdisciplinary research program that focuses on
collaborative activities. Each of the Centers was created with a high
potential for translating findings into public health benefits. http://
nccam.nih.gov/research/results/spotlight/042308.htm.--American Journal
of Clinical Nutrition, 2008. Volume 87, Number 2, 463.
Population-based Research
Cancer Survivors Are More Likely Than General Population To
Use CAM, According to National Survey Analysis
A recent analysis of the 2007 National Health Interview Survey
revealed that cancer survivors are more likely to use complementary and
alternative medicine (CAM) compared with the general population. Cancer
survivors are also more likely to use CAM based on a recommendation by
their healthcare providers and to talk to their healthcare providers
about their CAM use. Although cancer survivors communicated more about
their CAM use than the general population, the study authors emphasized
the overall need for improving communication between patients and
providers about CAM use to help ensure coordinated care. http://
nccam.nih.gov/research/results/spotlight/032011.htm.--Journal of Cancer
Survivorship: Research and Practice. 2011;5(1):8-17.
Analysis of National Survey Shows CAM Use in People With
Pain or Neurological Conditions
According to an analysis of the 2007 National Health Interview
Survey, approximately 44 percent of American adults with pain or
neurological conditions, compared to about 33 percent of people without
those conditions, used complementary and alternative medicine (CAM)
during the previous year. The most common CAM therapies used by people
with these conditions were mind-body therapies (25 percent), such as
deep breathing exercises, meditation, and yoga; biologically based
therapies (21 percent), such as herbal therapies; manipulative and
body-based therapies (19 percent), such as massage and chiropractic
care; and alternative medical systems (4 percent). In addition,
respondents with pain or neurological conditions indicated that they
used CAM because conventional treatment did not work (20 percent vs. 10
percent) and was too expensive (9 percent vs. 4 percent). The
researchers noted that this analysis demonstrates the need for more
robust studies on the efficacy of CAM therapies for people with these
conditions. http://nccam.nih.gov/research/results/spotlight/
111010.htm.--Journal of Neurology. 2010;257:1822-1831.
Study Asks Adolescents With Inflammatory Bowel Disease
About Use of Complementary and Alternative Medicine
(CAM) Mind-body Therapies
This study found that many adolescents with inflammatory bowel
disease are currently using or would consider using CAM--specifically
mind-body therapies such as relaxation and guided imagery--to help
manage their symptoms. This disease is actually a group of disorders
(including Crohn's disease and ulcerative colitis) that cause
inflammation of the intestines. The physical and emotional problems
associated with irritable bowel disease in adolescents often affect
quality of life. The researchers noted that their findings provide
groundwork for future studies to determine the effect of CAM therapies
on health outcomes in adolescents with inflammatory bowel disease.
http://nccam.nih.gov/research/results/spotlight/031110.htm.--
Inflammatory Bowel Disease. 2010;16(3):501-506.
Certain Categories of Complementary Therapies Appear To
Benefit Older Adults
According to a recent analysis of data from the 2002 National
Health Interview Survey and the 2003 Medical Expenditure Panel Survey,
use of biologically based therapies (e.g., herbs or megavitamins) and
manipulative/body-based therapies (e.g., chiropractic or massage) may
be associated with better health outcomes among individuals age 55
years and older. The analysis showed a statistical association between
ability to function and use of biologically based therapies and
manipulative/body-based therapies. The researchers concluded that some
categories of complementary therapies may be more beneficial than
others for older adults. They cautioned that these findings should not
be interpreted as evidence for the efficacy of specific therapies.
Although the findings indicate that the use of certain kinds of CAM
therapies is associated with better health outcomes for older adults,
only clinical trials can determine the efficacy of specific therapies.
The researchers also noted that this is the first longitudinal
assessment (analysis of data collected from the same people at
different points in time) of possible connections between complementary
therapy use and health outcomes in a national sample of older adults.
They recommended additional population-based research in this area.
http://nccam.nih.gov/research/results/spotlight/070810.htm.--Journal of
Alternative and Complementary Medicine. 2010;16(7):701-706.
Many Older People Use Both Prescription Drugs and Dietary
Supplements
Researchers analyzed the use of prescription drugs and dietary
supplements in a sample of 3,070 people aged 75 and older. The data had
been gathered during the Gingko for the Evaluation of Memory (GEM)
study, a clinical trial that examined the effects of Gingko biloba on
the development of dementia. Nearly 75 percent of the GEM study
participants took at least one prescription drug and one dietary
supplement. Approximately 33 percent used three or more prescription
drugs and three or more supplements. Furthermore, 10 percent of the
participants combined five or more prescription drugs with five or more
dietary supplements. Although supplements were taken along with all
types of prescription drugs, individuals using prescribed nonsteroidal
anti-inflammatory drugs (NSAIDs), thyroid drugs, and estrogens were
more likely to use dietary supplements. Individuals who used
prescription drugs for high blood pressure and diabetes were less
likely to use dietary supplements. Based on these data, they recommend
that patients discuss dietary supplement use with their healthcare
providers. In addition, the researchers emphasized the need for further
investigations to better define the clinical importance of interactions
between drugs and supplements. http://nccam.nih.gov/research/results/
spotlight/071509.htm.--Journal of the American Geriatric Society.
2009;57(7):1197-1205.
Translating CAM Research Results Into Clinical Practice:
Results From a National Survey of Physicians and
CAM Providers
In an initial investigation of the potential for information from
CAM research to influence clinical practice, a 2007 national survey
asked acupuncturists, naturopaths, internists, and rheumatologists
about their awareness of CAM clinical trials, their ability to
interpret research results, and their use of research evidence in
decisionmaking. The survey focused on awareness of two major NCCAM-
funded clinical trials that studied acupuncture or glucosamine/
chondroitin for osteoarthritis of the knee. Fifty-nine percent of the
1,561 respondents were aware of at least one of the two clinical trials
but only 23 percent were aware of both trials. The acupuncture trial
was most familiar to acupuncturists and rheumatologists, the
glucosamine/chondroitin trial to internists and rheumatologists.
Overall, awareness was greatest among rheumatologists and those
practicing in institutional or academic settings. All groups regarded
clinical experience as ``very important'' in their decisionmaking,
although CAM providers were more likely to rate it ``most important.''
Physicians were much more likely than CAM providers to consider
research results very important or ``very useful'' in their clinical
decisionmaking. The survey team concluded that CAM research has the
potential to make a difference in both conventional and alternative
medicine clinical practice. They recommend concerted efforts to better
train all clinicians in interpretation and use of evidence from
research studies, and to improve the dissemination of research results.
http://nccam.nih.gov/research/results/spotlight/041309.htm.--Archives
of Internal Medicine. 2009;169(7): 670-677.
National Survey Reports on CAM Use by Adults and Children
The 2007 The National Health Interview Survey (NHIS) found that
approximately 38 percent of adults and 12 percent of children use some
form of CAM. Among both adults and children, the most commonly used CAM
therapy is nonvitamin/nonmineral natural products; fish oil/omega-3 is
the most popular natural product for adults, while echinacea is the
most popular for children. Back pain is by far the most common
condition prompting adults to use CAM. Among children, back or neck
pain is the most common reason for using CAM, followed closely by head/
chest colds. The 2002 NHIS also included a supplement on CAM use by
adults. Overall usage among adults in 2002 (36 percent) was about the
same as in 2007. Since 2002, usage has increased for some therapies,
including deep breathing, meditation, massage, and yoga. Adult use of
CAM for head/chest colds showed a marked decrease between 2002 and
2007. The 2007 survey was the first to ask about CAM use by children.
http://nccam.nih.gov/research/results/spotlight/123108.htm.--CDC
National Health Statistics Report #12. 2008.
New Findings on Sleep Disorders and CAM
Based on a national survey, the NCCAM scientists found that over
1.6 million American adults use some form of CAM to treat insomnia or
trouble sleeping. The authors key findings are:
--More than 17 percent of adults reported insomnia or trouble
sleeping in the past 12 months. In this group, 4.5 percent used
some form of CAM to treat these problems.
--The CAM users were most likely to use biologically based therapies
(nearly 65 percent), such as herbal therapies, or mind-body
therapies (more than 39 percent), such as relaxation
techniques. Most who used these two types of therapies said
they were at least somewhat helpful for insomnia or trouble
sleeping.
http://nccam.nih.gov/research/results/spotlight/090106.htm.--Archives
of Internal Medicine, September 2006.
CAM Use High Among Adolescents
Researchers conducting the first national survey of CAM use among
adolescents in the United States analyzed responses from 1,280
adolescents aged 14 to 19. They found that 79 percent had used at least
one form of CAM during their lifetime and that females used CAM more
than males. Among all participants, almost 30 percent had used one or
more dietary supplements, and almost 10 percent had used supplements
along with prescription medications in the preceding month. Many of the
supplements the teens reported using were related to attempts to change
body shape (e.g., creatine and weight-loss products). The authors urged
that healthcare providers be aware of CAM and dietary supplement use by
their adolescent patients, because of the lack of standardization in
supplements, as well as their potential for safety risks and
interactions with prescription medications.http://nccam.nih.gov/
research/results/spotlight/040106.htm.--Journal of Adolescent Health
April 2006.
More Than One-third of U.S. Adults Use Complementary and
Alternative Medicine, According to a 2002
Government Survey
According to the 2002 National Health Interview Survey (NHIS), 36
percent of U.S. adults use some form of CAM. The most commonly used
form of CAM was natural products (such as herbs and other botanicals).
Other popular CAM therapies included deep breathing, meditation,
chiropractic care, yoga, massage, and special diets. Echinacea was the
most commonly used natural product. CAM was most often used to treat
back pain, colds, neck pain, joint pain, and anxiety or depression. The
survey also revealed variations in CAM use by population subgroups. For
example, CAM use overall was more common among women, people with
higher education, people who had been hospitalized in the past year,
and former smokers (compared to current smokers or those who had never
smoked). The authors noted that the information from this survey is a
foundation for future studies of CAM as it relates to health and
disease among population subgroups. http://nccam.nih.gov/research/
results/spotlight/050810.htm.--CDC Advance Data Report #343. 2004.
the nccam research approaches
Question. Individualized therapies that involve multiple approaches
often do not lend themselves to traditional double-blind studies but
are frequently used in integrative medicine. Please describe work that
the NCCAM is doing to support research on these kinds of treatments.
Answer. The NCCAM recognizes that assessing some of the
individualized therapies used in integrative medicine in double-blind
studies is challenging. Similar challenges confront other disciplines
of healthcare research that employ individualized or multifaceted
interventions, complex procedures, or system approaches (e.g.
cognitive-behavioral therapy, surgery, or behavior change strategies).
There is broad interest within the biomedical and behavioral research
communities in applying effectiveness and outcomes approaches and
pragmatic trial designs to such questions.
Addressing this challenge is a high priority for the NCCAM as
evidenced by its inclusion as one of our strategic plan objectives: to
``develop research examining the contributions of specific promising
CAM approaches to better treatment and health promotion using the real-
world methods and tools of the disciplines of observational, outcomes,
health services, and effectiveness research.'' These methods and
approaches also offer potential to address the challenges of conducting
CAM research that reflects practice in the real world.
Health provider networks, practice-based clinical research
networks, and integrative medicine practices provide important venues
in which to develop real-world evidence across a broad array of outcome
measures regarding the effects and effectiveness of CAM approaches and
their integration into strategies for treatment and health promotion.
Practice-based research provides an important setting in which to study
the complex interplay of intervention, the patient-provider
relationship, and other important contextual and environmental factors
involved in healthcare and health promotion. Indeed, many CAM and
integrative care practices actively seek to employ these factors.
Population-based and practice-based research strategies also offer
great potential for developing evidence regarding the effectiveness of
CAM-related interventions in engaging individuals in health-promoting
behaviors and practices.
The NCCAM is pursuing these approaches in the context of CAM and
integrative medicine practice through collaboration with experts who
confront similar challenges and opportunities. For example, the NCCAM
is working with our colleagues at the Departments of Defense and
Veterans Affairs to explore ways that CAM mind and body approaches can
be used in integrative approaches to treat pain, stress disorders, and
other symptoms. Further, the NCCAM has released a funding opportunity
announcement to foster development of CAM research methodology titled,
``Translational Tools for Clinical Studies of Mind/Body and Manual
Therapy CAM Interventions.'' It will ``encourage the development of
improved research methodology to study safety, efficacy, and clinical
effectiveness of mind-body interventions.''
Additionally, the NCCAM has substantially increased its investment
in research which advances our understanding of the usefulness of CAM
interventions in real world settings. For example, in one promising
study being funded by the NCCAM at the Mount Sinai School of Medicine,
researchers are studying methods to utilize all available information
regarding CAM treatments in patients with HIV. By utilizing randomized
controlled trials along with observational studies, expert judgment and
other types of data, they seek to develop a clinical prediction model
to determine which CAM interventions are beneficial. Another study,
this one at Brigham and Women's Hospital, is looking at the
effectiveness of an integrative healthcare team at improving outcomes
for chronic low back pain by focusing on observational data. These are
just two examples of studies funded by the NCCAM that go beyond
traditional double-blind studies by using real world data to support
CAM research.
national center for advancing translational sciences (ncats) and
preventative medicine
Question. One goal of the NCATS is to accelerate the process by
which scientific discoveries are turned into treatments and cures--
moving discoveries more quickly through the ``valley of death'' or the
time between discovery and available cures. In particular, the NIH has
indicated that the NCATS would focus on the drug development pipeline
with a hope of understanding and addressing the reasons that so many
drugs fail in development. Meanwhile, research has increasingly shown
how a healthy lifestyle, exercise or better nutrition can help prevent
the onset of disease or the use of expensive medicines or treatments.
Will translational research that focuses on prevention or disease
control through lifestyle changes be incorporated into the new vision
for the NCATS? If so, how? Or will the NCATS focus exclusively on drug
development?
Answer. As you point out, the prevention of diseases as well as
their successful treatment may often require behavioral and lifestyle
interventions or strategies. As such, a clear understanding of, and
further research into, the role of behavioral and lifestyle factors in
human health will be critical to the NCATS' success in catalyzing the
development of new strategies to address human health and disease. The
NCATS will support research to generate new methods and approaches
aimed at accelerating the development, testing, and implementation of
diagnostics, therapeutics, and prevention strategies. The NCATS
prevention and behavioral research will be coordinated with the related
work of the other NIH Institutes and Centers as well as with the Office
of Disease Prevention and the Office of Behavioral and Social Sciences
Research and carried out in part through the 60 institutions with
Clinical and Translational Science Awards.
budgetary constraints on universal flu vaccine
Question. The NIH-supported scientists are making significant
progress toward developing a universal flu vaccine that would confer
longer term protection against multiple influenza virus strains and
make yearly flu shots a thing of the past. What would be the impact on
public health if research on the universal flu vaccine were delayed or
scaled back due to budget constraints at the NIH?
Answer. The costly and time-consuming annual process of
manufacturing, distributing, and administering millions of doses of
seasonal influenza vaccine would become obsolete if researchers could
design a vaccine that provides protection against a broad range of
influenza strains over multiple influenza seasons. One strategy to
overcome the need for a yearly influenza vaccine is to develop a
vaccine against the common components of the influenza virus that do
not change from year to year or from strain to strain. Recently,
researchers supported by the National Institute of Allergy and
Infectious Diseases (NIAID) have made significant breakthroughs in
identifying the specific parts of influenza viral proteins that are
unchanged among both seasonal and pandemic strains. So-called
``universal'' influenza vaccines that capitalize on these findings
might one day provide protection against the broad range of viruses
arising from seasonal antigenic drift (minor changes) and pandemic
antigenic shift (major changes) that are the hallmark of influenza
viruses.
The NIAID is supporting a number of research projects to develop a
vaccine that induces a potent immune response to the common elements of
the influenza A virus that undergo very few changes from season to
season and from strain to strain. Conserved internal proteins of the
virus such as the M2 protein and conserved regions of the influenza
envelope protein hemagglutinin (HA) have been identified as promising
vaccine targets. For example, the NIAID-supported researchers found
that a vaccine based on the M2 protein of H5N1 avian influenza virus
elicited strong immune responses in mice. The HA protein of influenza
virus, which is the protective antigen of the virus, has both a
``head'' region and a ``stem'' region. The NIAID-funded researchers
recently generated a novel form of HA that elicited broadly cross-
reactive antibodies against the stem region of a number of divergent
seasonal and pandemic influenza subtypes and provided protection
against disease in mouse challenge studies. In addition, the NIAID
intramural researchers in the Vaccine Research Center demonstrated that
a ``prime-boost'' vaccine strategy based on conserved regions of the HA
protein could protect animals from infection with multiple strains of
influenza that had been prevalent over many years. This ``prime-boost''
vaccine strategy involves first priming the immune system with a
vaccine containing the DNA of an influenza surface protein (HA) and
then administering a second vaccine made from a seasonal influenza
virus or from a weakened cold virus, to amplify the immune response
generated by the first vaccine.
Budget reductions could adversely affect the NIAID's ability to
continue support of these activities in a robust and timely manner.
Funding cuts could delay the development of new candidate vaccines for
universal influenza and improved vaccines for seasonal influenza, as
well as delay initiation of clinical trials necessary to test these
vaccines. However, if budget reductions do materialize, the NIH would
have to reevaluate its research priorities, and thus, the specific
research areas to be impacted by such reductions would be determined at
that time.
budgetary constraints on vaccine research
Question. What other types of vaccine research underway at the NIH
might also have to be delayed or scaled back due to budget constraints?
Answer. Vaccines provide a safe, cost-effective, and efficient
means of preventing illness, disability, and death from infectious
diseases. The NIH is recognized as a worldwide leader in basic
immunology research that underpins all vaccine development, and
conducts or supports preclinical and clinical research on a broad
spectrum of new and improved vaccine candidates. Recent progress in
global vaccine research--from the RV 144 trial in Thailand that
demonstrated that an HIV vaccine regimen provided a modest preventive
effect, to the NIH-sponsored research advances that may unlock
neutralizing antibody targets for a range of infectious diseases--
highlights the need for a robust vaccine research portfolio at the NIH
to pursue these and other advances in the field. A reduction in vaccine
research funding at the NIH could slow the pace of ongoing efforts to
develop new tools to prevent infectious diseases and could erode our
ability to capitalize on scientific progress toward the development of
vaccines.
HIV vaccine research activities that could be slowed by reduced
funding levels include the conduct of additional and important Phase
IIb trials that are planned to further assess and improve upon the
results of the RV144 HIV vaccine trial, especially in other risk groups
and in countries other than Thailand. Reduced funding could also
undermine other important HIV vaccine trials. For example,
investigators conducting the HIV Vaccine Trials Network (HVTN) 505
trial would likely be unable to expand the study to include 2,200
participants at 21 sites in 18 U.S. cities in order to assess whether
the candidate vaccine regimen can prevent HIV infection and/or reduce
viral load. Decreased funding could also limit the NIH's ability to
support efforts to identify other promising HIV vaccine candidates, and
curtail our ability to test those candidates that hold the most promise
and advance them into clinical trials. Again, however, specific
research areas that may be impacted by budget reductions are subject to
priority assessments and cannot be precisely predetermined.
In addition to research to develop an HIV vaccine, the NIH is also
supporting vaccine research across a range of other globally important
diseases, including dengue, pandemic influenza, malaria, and
tuberculosis, as well as diseases that might occur as a result of acts
of bioterrorism. A reduction in funding could force the NIH to scale
back efforts across many of its infectious disease research programs.
Potential adverse effects include a reduced ability to support
preclinical product development, which is intended to assist companies
and academic investigators in developing essential products to prevent
and treat infectious diseases. Reduced funding levels could limit the
development of new and improved preclinical products required to
confront and keep pace with emerging and re-emerging infectious
diseases, including a planned array of vaccine-related product
development services. Funding constraints could also adversely affect
clinical research efforts at the NIH, limiting our ability to support
clinical trials designed to assess influenza and malaria vaccines, and
slowing the progress of trials. Finally, budget constraints could
result in significant delays in advancing research projects focused on
the development of next-generation vaccines for biodefense purposes.
guidance for use of class b cats
Question. On March 18, the NIH released guidance on its plan to
transition from the use of USDA Class B dogs to other legal sources
(Notice NOT-OD-11-055). Why is there no mention of cats? The transition
plan, as the NIH notes, is in accordance with the National Academy of
Sciences report, Scientific and Humane Issues in the Use of Random
Source Dogs and Cats in Research. The NIH notice also quotes from
Senate report language regarding research on both dogs and cats, but
the mention of cats was excised from the quotation. Does the NIH plan
to issue a separate guidance dealing with cats?
Answer. The NIH believes that sufficient numbers of cats currently
are available through Class A vendors to support the needs of the NIH-
supported research. Therefore, no plan for phase out is needed nor a
plan for developing sufficient animals from Class A vendors. At
present, the NIH has no plans to issue separate guidance dealing with
cats.
lupus research
Question. How are the different NIH Institutes NIAID, National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS),
National Heart, Lung, and Blood Institute (NHLBI), National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK), General
Medicine, among others) working together to increase support for
research on lupus? How will the new Translational Center work to
address diseases like Lupus that cross multiple Institutes?
Answer. Lupus is an autoimmune disease that affects the lives of
many Americans. Ninety percent of Americans with lupus are women. Lupus
can affect many parts of the body, including the joints, skin, kidneys,
heart, lungs, blood vessels, and brain. Although people with the
disease may have different symptoms, some of the most common ones
include extreme fatigue, painful or swollen joints (arthritis),
unexplained fever, skin rashes, and kidney problems.
A wide range of basic, translational, and clinical research on
lupus is being supported by many of the Institutes, Centers, and
Offices at the NIH. Highlights of collaborative efforts include:
--The Lupus Federal Working Group, established on behalf of the
Department of Health and Human Services (HHS) Secretary by the
NIH, facilitates collaboration among the NIH components, other
Federal agencies, voluntary and professional organizations, and
industry groups with an interest in lupus. The group is
coordinated by the NIAMS and includes participation from nine
other NIH Institutes and Centers.
--The NIAID chairs the NIH Autoimmune Diseases Coordinating
Committee, established by the Congress in fiscal year 1998 to
increase collaboration and facilitate coordination of
autoimmune diseases research among 21 NIH Institutes and
Centers (ICs), other Federal agencies, and private health and
patient advocacy groups.
--In September 2010, the NIAMS, the National Cancer Institute (NCI),
the NIAID, and the NIH Office of Research on Women's Health
(ORWH) hosted a 2-day scientific meeting in Bethesda, Maryland,
``Systemic Lupus Erythematosus: From Mouse Models to Human
Disease and Treatment.'' Clinicians and basic scientists from a
variety of disciplines came together to discuss the clinical
and molecular similarities and differences seen in human
disease and animal models. Participants also discussed advances
in lupus genetics, challenges and advances in the treatment of
lupus, and emerging areas warranting further study.
--The Autoimmunity Centers of Excellence (ACEs), sponsored by the
NIAID, the NIDDK, the NIAMS, the National Institute of
Neurological Disorders and Stroke (NINDS), and the ORWH,
conduct collaborative research on autoimmune diseases,
including lupus. This research includes clinical trials of
immunomodulatory therapies and associated studies to understand
the mechanism of disease and therapeutic effects.
--The Human Leukocyte Antigen (HLA) Region Genomics in Immune-
Mediated Diseases Consortium, a cooperative research group
sponsored by the NIAID and the NINDS, focuses on defining the
association between variations in the HLA genetic region and
immune-mediated diseases, including lupus.
--The Cooperative Study Group for Autoimmune Disease Prevention,
sponsored by the NIAID, the NIDDK, and the Juvenile Diabetes
Research Foundation International, focuses on research for the
prevention of human autoimmune diseases, including lupus.
Projects include the creation of improved models of disease
pathogenesis and therapy to better understand immune mechanisms
that will provide opportunities for prevention strategies.
--The NIDDK and the NIAMS organized an April 2010 meeting, ``Novel
Therapies to Enhance ESRD (End Stage Renal Disease) Patient
Survival,'' which included a session on ``Lessons for
Nephrologists from Lupus.'' The NIDDK is planning a meeting in
mid-2012 that will focus on glomerular disease, including that
arising from lupus.
--The NIDDK-supported Chronic Kidney Disease Biomarkers Consortium--
which seeks to discover and validate biomarkers for chronic
kidney disease--is assessing inflammatory mediators as
biomarkers for progression of kidney disease in patients with
lupus who have had kidney biopsies. The Consortium will cross-
validate its findings using a variety of patient cohorts,
including those funded by the NIDDK (such as the Chronic Renal
Insufficiency Cohort) and other ICs (such as the
Atherosclerosis Risk in Communities Study, funded by the
NHLBI).
The proposed NIH NCATS has been designed to catalyze the
development of innovative methods and technologies that will enhance
the development, testing, and implementation of diagnostics and
therapeutics across a wide range of conditions, including diseases such
as lupus. The NCATS will encourage collaborations across all sectors,
provide resources to enable therapeutics development, and support and
enhance training in the relevant translational science disciplines.
chronic obstructive pulmonary disease (copd) research
Question. COPD is the third leading cause of death in the United
States, killing approximately 141,075 Americans annually. Despite the
growing burden of COPD, the United States does not currently have a
comprehensive public health action plan on the disease. What activities
are the NIH currently conducting on COPD and what is missing from the
Federal response? Would a Federal action plan on COPD provide insights
on how we could better address this leading killer?
Answer. The NHLBI--the NIH component with primary responsibility
for lung diseases--supports a wide range of research and education
activities on COPD. Its programs include basic science and animal
studies of underlying disease mechanisms; clinical studies of COPD risk
factors, genetics, molecular and cellular defects, disease progression,
and co-morbidities; translational studies of pathways and drugs that
may lead to better treatments; clinical trials; comparative
effectiveness research; and public and professional educational
programs to increase awareness of COPD and knowledge about its
symptoms, diagnosis, and treatment. Several other NIH components,
including the NCI, the National Institute on Aging (NIA), the National
Institute on Drug Abuse (NIDA), the National Institute of Environmental
Health Sciences (NIEHS), the National Institute of General Medical
Sciences (NIGMS), and the National Institute of Nursing Research
(NINR), also support research relevant to COPD. For example, the NCI
and the NHLBI are collaborating on an investigation of lung cancer and
COPD. The NHLBI also cooperates with a number of other Federal agencies
on this disease. The NHLBI Long Term Oxygen Treatment Trial is carried
out in collaboration with CMS. The FDA collaborates with the NHLBI in a
program called SPIROMICS, which is performing extensive molecular and
clinical phenotyping of subjects with COPD to indentify biomarkers and
characterize the heterogeneity in the patient population. VA Medical
Centers participate in a number of the NHLBI clinical trials in COPD.
The CDC is a partner in the NHLBI's COPD Learn More Breathe Better
national public health education campaign. The NHLBI--CDC collaboration
has led to the introduction of a module on COPD in the Behavioral Risk
Factor Surveillance System Survey and to a recently released public
health strategic framework for COPD prevention. Investigators supported
jointly by the NHLBI and the AHRQ are setting up a large registry for
comparative effectiveness research. Finally, the reports of the Surgeon
General on the health effects of smoking are a constant guide for the
NHLBI programmatic directions for COPD.
These examples illustrate the extent and diversity of existing
Government programs related to COPD, the cooperative and complementary
interactions among Federal agencies in this area, and the central role
that the NHLBI plays in the Government's efforts to control this
disease. The NHLBI will continue to provide strong leadership for
research and education activities to address this growing public health
epidemic in collaboration with other components of the Federal
Government. In particular, the NHLBI plans to host a forum of
representatives from Federal Government agencies in fiscal year 2012 to
share information regarding current activities related to COPD and to
discuss opportunities for increasing cooperation among stakeholders and
enhancing effectiveness of the Federal response to this debilitating
and deadly disease. Whether a Federal action plan should be developed
will almost certainly be a topic of discussion at the forum.
clinical trials cooperative group program reorganization impact on the
gynecological cooperative group
Question. The Institute of Medicine (IOM) of the National Academies
was asked by the National Cancer Institute (NCI) to review the
Institute's Clinical Trials Cooperative Group Program. One of the
recommendations from that report is a reorganization of the Cooperative
Group Structure that would entail restructuring and consolidating some
of the cooperative groups. We understand that the reorganization may
merge the Gynecological Cooperative Group (GOG) with the NSABP
(National Surgical Adjuvant Breast and Bowel Project) and the RTOG
(Radiation Therapy Oncology Group). Gynecological cancers are generally
diagnosed by gynecologists and the GOG is the only cooperative group
that studies gynecological cancers. Is our understanding of the
reorganization plan for the GOG correct and, if so, what is the
rationale for the planned merger of the GOG with these other groups?
What is the scientific basis for it? If not, what is the current plan
for the GOG? In general, what has been the process for making these
reorganization decisions, what are the primary considerations and what
is the timeframe and next steps for finalizing the reorganization
decisions?
Answer. For more than 50 years, the NCI has supported a standing
infrastructure--the NCI Cooperative Group Program--to conduct large
scale cancer clinical trials across the Nation, with successful
completion of many important trials that have led to new treatments for
cancer patients. Over time, however, oncology has evolved into a more
molecularly based discipline including genetic sub-classification of
tumors and individualized treatments. Accordingly, the NCI must ensure
that the Cooperative Groups are optimally situated and well-prepared to
continue to design, enroll and complete state-of-the-art trials for
cancer patients.
In 2009, the NCI commissioned the Institute of Medicine to review
the Cooperative Group Program in order to gather independent and expert
perspectives on the state of cancer clinical trials and to obtain
advice about improvements in the NCI Cooperative Group Program. The IOM
report ``A National Cancer Trials System for the 21st Century:
Reinvigorating the NCI Cooperative Group Program'' was issued in April
2010. The report called for a series of changes to the clinical trials
program, including restructuring and consolidation of the adult
Cooperative Groups.
Transforming the NCI's Cooperative Group System into a highly
integrated National Clinical Trials Network is one of the Institute's
major initiatives. Enhancing the scientific basis for the clinical
trials that the NCI supports is essential if marked improvements in
cancer diagnosis, prevention, and therapy are to continue unabated. The
increasing need for molecular screening of large patient populations to
define categories appropriate for intervention provides an important
rationale for consolidating the NCI-supported clinical research groups
into a coordinated network. Furthermore, the NCI's commitment to
strategic consolidation includes the requirement for a shared, and
standardized, clinical trials data management IT infrastructure, for a
facile process by which the phase III clinical trials portfolio is
prioritized, and for the conduct of clinical investigations that are
multimodal in nature, and involve understudied and underserved patient
populations. The NCI's restructured clinical trials network, as
envisioned, will be organized to move such studies forward both
efficiently and with the necessary resources to conduct correlative
scientific investigations capable of increasing the potential of these
trials to change current medical practice.
In addition to the ability to screen large patient populations, a
coordinated network of a smaller number of consolidated Cooperative
Groups will be better able to prioritize specific trials across all
disease areas and to efficiently develop and complete multicenter
trials. Consolidation will also enable optimal use of crucial
biospecimens from the NCI-supported clinical trials. Finally,
consolidation will address current disincentives to study less common
diseases or to enroll patients to another Cooperative Group's trials.
The NCI began a discussion with the Cooperative Group Chairs in
November 2010 about changes to the Group structure and has participated
in multiple discussions with the public. Throughout the process, the
NCI has been--and remains--committed to having an open dialogue about
changes to the Cooperative Group Program. The NCI has not dictated
mergers among groups and instead has encouraged groups to voluntarily
consolidate on their own. The Gynecological Oncology Group (GOG), the
National Surgical Adjuvant Breast and Bowel Project (NSABP), and the
Radiation Therapy Oncology Group (RTOG) have entered negotiations about
consolidation, and as background for those discussions, the NCI program
leadership met with the GOG Chair in May 2011 to discuss GOG concerns
and to provide assurances that funding for gynecological cancers will
be protected. The NCI expects that consolidation will greatly
strengthen the overall program and will provide each of the
consolidated Cooperative Groups with unique capabilities and a greatly
expanded network of clinical sites to recruit patients for trials
across the entire program.
Since December 2010, the NCI has been gathering input from
stakeholders and the cancer community about the plans to restructure
the program. The comment period will close in July 2011, at which point
the NCI will develop a concept proposal about the new structure and
proceed with the NCI leadership review and presentation to the Board of
Scientific Advisors in November 2011. The Funding Opportunity
Announcement for the new Clinical Trials Program will be developed over
the next several months, and released in July 2012. Applications will
be accepted in November 2012 and reviewed over the next few months,
with the consolidated Cooperative Groups being funded in fiscal year
2014.
creation of suaa
Question. Based on recommendations from the Scientific Management
Review Board, the NIH has been considering the formation of a single
institute that would be devoted to research related to substance use,
abuse and addiction. The focus at the NIH seems to have turned away
from this reorganization as attention has shifted to the creation of
the NCATS. Is the NIH still considering the formation of this institute
and, if so, what is the latest thinking on the creation of such an
institute? What is the process and timeframe for making a decision and
developing a plan?
Answer. The NIH is actively considering the formation of a single
Institute that will focus on substance use, abuse, and addiction-
related research. After receiving the SMRB recommendations, Dr. Collins
formed a Task Force of scientific experts to begin a comprehensive
review of the NIH substance use, abuse, and addiction research
portfolio. The Task Force has met with subject matter experts from
across the NIH to gain a better understanding of the breadth and
diversity of NIH's substance use, abuse, and addiction portfolio. This
review has made it clear that this portfolio is very complex and taken
together with the administrative steps that would be required to
implement a reorganization of this magnitude, we determined that
additional time would be advantageous. Additionally, during the last
few months, many stakeholders have requested additional input into the
development of the scientific plan for the new Institute.
The NIH will continue to analyze our substance use, abuse, and
addiction portfolio to provide a framework for a new proposed
Institute. We will also develop a new scientific strategic plan to
provide a framework for substance, use, abuse, and addiction-related
research at NIH. This scientific strategic plan will be directed by the
relevant Institute or Center Directors and will include extensive
consultation with stakeholders, including scientists, patients, and the
community, in addition to soliciting information from the Advisory
Councils of the potentially affected Institutes and Centers. It is our
intent to release the portfolio integration plan and the scientific
strategic plan in the fall of 2012 for public comment, obtaining the
Secretary's formal approval in December 2012 with the ultimate goal of
notifying Congress through inclusion in the proposed reorganization in
the fiscal year 2014 President's budget and standing up the new
Institute at the beginning of fiscal year 2014 (October 1, 2013).
use of chimpanzees in biomedical research
Question. In response to a request from the NIH, the Institute of
Medicine (IOM) is conducting a study on the use of chimpanzees in
biomedical and behavioral research. The study will assess the current
and anticipated uses of chimpanzees in the NIH research and determine
whether chimpanzees are and will be necessary for research needed to
advance public health. The IOM is expected to release the report by the
end of this year, in December 2011. Some interest groups have suggested
that a moratorium be put in place on new funding for invasive research
using chimpanzees pending the release of the IOM report. What would be
the impacts of this type of temporary moratorium on the NIH research?
Answer. NIH appreciates the Senator's continued interest in the use
of chimpanzees in research. As you know, chimpanzees have been used in
important research such as key studies on hepatitis, malaria, and
vaccine research. The Senator wisely requested that NIH initiate an in-
depth analysis to be performed by the Institute of Medicine (IOM) to
assess the scientific need for the continued use of chimpanzees in
biomedical research. The NIH has followed this advice and anticipates a
thoughtful analysis and rigorous review that will be a valuable input
as NIH charts the future course for the use of chimpanzees in research.
In the interim, while the IOM study is ongoing, we believe it would
be unwise to make any abrupt changes in our primate research programs.
Therefore, we think it best to await the IOM report before making
decisions that could have potentially far reaching implications.
______
Questions Submitted by Senator Daniel K. Inouye
the national institutes of health (nih) research support to hawaii
academic institutions
Question. Over the years the subcommittee has urged the NIH to pay
particular attention to developing a cadre of scientific investigators
from rural America and in the case of Hawaii, from the neighbor
islands. This month the College of Pharmacy at the University of Hawaii
at Hilo will graduate its first class and I appreciate the ongoing
efforts by the leadership of several of your Institutes to ensure that
basic research infrastructure will be made available for their faculty
and students. In order to attract the next generation of scientists, it
is absolutely necessary that they be exposed to caring mentors and the
joy of scientific inquiry in their early academic years. Those of us
who represent rural America appreciate how difficult it can be to
provide this critical nurturing experience, especially when bright high
school students and undergraduate students have to face significant
transportation barriers, such as exist in an island State. At this
time, I would appreciate receiving a report detailing the extent to
which your Institutes have been able to provide scientific resources to
Hawaii, and particularly to the educational campuses on the various
islands.
Answer. The NIH has provided considerable support to Hawaii in an
effort to ensure that Native Hawaiian and other Pacific Islanders have
access to the clinical benefits of the NIH research. While research and
training investments represent the majority of the NIH support to
institutions in Hawaii, technical assistance to Hawaiian institutions
has also been important. Periodically over the past decade, the NIH
through the Office of Policy for Extramural Research Administration
(OPERA) has provided workshops in Hawaii on the topics of the NIH
policies, grant writing skills, and human subjects research issues
including adverse event reporting, vulnerabilities of pediatric
populations, and cultural issues involving Native Hawaiians
participating in research studies. Also, the Office of Laboratory
Animal Welfare (OLAW) presented several comprehensive overviews of the
laws, regulations, and policies that govern the humane care and use of
laboratory animals.
The breadth of the research enterprise in Hawaii is quite
impressive. In fiscal year 2010, more than 17 of the 27 NIH Institutes
and Centers have provided support for academic institutions to conduct
research activities ranging from basic biomedical science to behavioral
interventions. For example, Chaminade University has a National
Institute on Minority Health and Health Disparities (NIMHD) Building
Research Infrastructure and Capacity grant which supports renovations,
research training, student academic enrichment programs, and junior
faculty career development activities. The University of Hawaii Hilo
has received funding from the National Institute on Drug Abuse (NIDA)
for the mentoring of clinical investigators and to conduct patient-
oriented mental health services research, including post-traumatic
stress disorder. The National Institute on Alcohol Abuse and Alcoholism
(NIAAA) is supporting a project to develop research capabilities in the
area of substance use and indigenous youth populations (e.g., Native
Hawaiian) at Hawaii Pacific University.
The University of Hawaii Manoa plays a pivotal role since it has
the most robust research enterprise of all the Hawaiian institutions of
higher education. They have received over 70 NIH awards over the past
year. The NIMHD Center of Excellence, Partnerships for Cardiometabolic
Disparities in Native and Pacific Peoples, has a focus on
cardiometabolic health and eliminating health disparities among Native
Hawaiians and other Pacific Islanders including Filipinos, Samoans, and
Tongans. The Cancer Research Center of Hawaii is an NCI-designated
Clinical Cancer Center and is the only such institution in the State of
Hawaii. Moreover, the University of Hawaii Manoa Research Centers in
Minority Institutions (RCMI) Multidisciplinary and Translational
Research Infrastructure Expansion in Hawaii serves as the integrated
``home'' for clinical and translational science in the State of Hawaii.
In addition, Hawaiian small business concerns have received NIH support
for innovative ideas to improve health through the NIH Small Business
Innovative Research and Small Business Technology Transfer programs.
For example, Hawaii Biotech is taking the knowledge gained through its
dengue fever and West Nile virus vaccine programs and applying it to
tick-borne encephalitis. This project, Recombinant Subunit Vaccine for
Tick-Borne Encephalitis, addresses an important unmet biodefense need
within the United States since there is no registered tick-borne
encephalitis vaccine.
The NIH is pleased to be able to support biomedical research and
student training programs to help further the health of Native
Hawaiians and other Pacific Islanders. Recent discussions between the
NIH Deputy Director and several faculity at the University of Hawaii
Hilo may help identify additional gaps that could be filled through the
NIH-University partnerships.
Below is a list of all the NIH awards to Hawaiian institutions in
fiscal year 2010.
FISCAL YEAR 2010 HAWAII NIH AWARDS
----------------------------------------------------------------------------------------------------------------
Organization name Grant number Institute/center Project title
----------------------------------------------------------------------------------------------------------------
CARDAX PHARMACEUTICALS, INC...... 4R44AA018922-02..... NIAAA.............. Heptax for Alcoholic Liver Disease
CHAMINADE UNIVERSITY OF HONOLULU. 1P20MD006084-01..... NIMHD.............. Chaminade University BRIC Project
EAST-WEST CENTER................. 5R01HD042474-06..... NICHD.............. Innovations in Early Life Course
Transitions
HAWAII BIOTECH, INC.............. 5R44AI055225-04..... NIAID.............. Recombinant Subunit Vaccine For
Tick-Borne Encephalitis
HAWAII PACIFIC UNIVERSITY........ 3K01DA019884-04S1... NIDA............... Ecological Factors and Drug Use of
Native Hawaiian Youth
HAWAII PACIFIC UNIVERSITY........ 5K01DA019884-05..... NIDA............... Ecological Factors and Drug Use of
Native Hawaiian Youth
KUAKINI MEDICAL CENTER........... 5U01AG017155-10..... NIA................ Epidemiology of Aging and
Dementia--Autopsy Research
KUAKINI MEDICAL CENTER........... 5U01AG019349-09..... NIA................ Epidemiology of Brain Aging in the
Very Old
KUAKINI MEDICAL CENTER........... 3R01AG027060-04S1... NIA................ Defining the Healthy Aging
Phenotype
NEUROBEHAVIORAL RESEARCH, INC.... 5R01AA013659-08..... NIAAA.............. Brain Morbidity in Treatment--
Naive Alcoholics
NEUROBEHAVIORAL RESEARCH, INC.... 5R01AA016944-03..... NIAAA.............. Long-Term Abstinence Clinical
Issues and CNS Disinhibition
NEUROBEHAVIORAL RESEARCH, INC.... 5R01AA016303-04..... NIAAA.............. Effects of heavy alcohol abuse on
adolescent brain structure and
function
PACIFIC HEALTH RESEARCH INSTITUTE 5U10NS044448-08..... NINDS.............. Parkinson's Disease
Neuroprotection Trial: Hawaii
Center
PACIFIC HEALTH RESEARCH/EDUCATION 3U10NS044448-09S1... NINDS.............. Parkinson's Disease
INST. Neuroprotection Trial: Hawaii
Center
PACIFIC HEALTH RESEARCH/EDUCATION 3R01NS041265-10S1... NINDS.............. Risk Factors for Pathologic
INST. Markers of Parkinson Disease
PACIFIC HEALTH RESEARCH/EDUCATION 6U10NS044448-09..... NINDS.............. Parkinson's Disease
INST. Neuroprotection Trial: Hawaii
Center
PACIFIC HEALTH RESEARCH/EDUCATION 1R01DK089347-01..... NIDDK.............. Reducing Cost-Related Medication
INST. Nonadherence in Persons with
Diabetes
PANTHERA BIOPHARMA, LLC.......... 5U01AI078067-03..... NIAID.............. Antidotes to Anthrax Lethal Factor
Intoxication
PAPA OLA LOKAHI.................. 3U01CA114630-05S3... NCI................ IMI HALE NATIVE HAWAIIAN CANCER
NETWORK
PAPA OLA LOKAHI.................. 1U54CA153459-01..... NCI................ IMI HALE NATIVE HAWAIIAN CANCER
NETWORK
PAPA OLA LOKAHI.................. 3U01CA114630-05S4... NCI................ IMI HALE NATIVE HAWAIIAN CANCER
NETWORK
QUEEN'S MEDICAL CENTER........... 5R01GM063954-08..... NIGMS.............. Molecular and functional
properties of the TRPM2 catioin
channel
QUEEN'S MEDICAL CENTER........... 5R21CA139687-02..... NCI................ Treatment Effects on Tumor 18F-
Choline Metabolism in Advanced
Prostate Cancer
QUEEN'S MEDICAL CENTER........... 5R01GM080555-03..... NIGMS.............. Molecular components of the store-
operated CRAC channel
UNIVERSITY OF HAWAII AT HILO..... 5K24MH074468-05..... NIMHD.............. Mentoring/Career Development in
PTSD Services Research
UNIVERSITY OF HAWAII AT MANOA.... 2P20RR016467-09A1... NCRR............... INBRE II: Hawaii Statewide
Research & Education Partnership
(HSREP)
UNIVERSITY OF HAWAII AT MANOA.... 3R01NS063932-03S1... NINDS.............. HIV and Global Drug Therapies:
Peripheral Neuropathy
Complications and Mechanisms
UNIVERSITY OF HAWAII AT MANOA.... 5R01NS053345-05..... NINDS.............. HIV-1 Proviral DNA and Monocyte
Phenotype in Relation to
Neurocognitive Function
UNIVERSITY OF HAWAII AT MANOA.... 5U54NS056883-04..... NINDS.............. Imaging Studies in Neurotoxicity
and Neurodevelopment
UNIVERSITY OF HAWAII AT MANOA.... 5R01NS063932-03..... NINDS.............. HIV and Global Drug Therapies:
Peripheral Neuropathy
Complications and Mechanisms
UNIVERSITY OF HAWAII AT MANOA.... 5R01NS053359-04..... NINDS.............. HIV-1 Specific Immune Responses in
Thai Individuals with HIV
Dementia
UNIVERSITY OF HAWAII AT MANOA.... 5P20NR010671-04..... NINR............... Center for 'Ohana Self-Management
of Chronic Illnesses Hawaii
(COSMCI0): Building
UNIVERSITY OF HAWAII AT MANOA.... 5R01MH081845-02..... NIMH............... The Genetic Control of Social
Behavior in the Mouse
UNIVERSITY OF HAWAII AT MANOA.... 5R01MH079717-02..... NIMH............... Modeling monocyte and macrophage
based gene therapy for neuroAIDS
UNIVERSITY OF HAWAII AT MANOA.... 1R01EB011517-01..... NIBIB.............. Spectral Spatial RF Pulses for
Gradient Echo fMRI
UNIVERSITY OF HAWAII AT MANOA.... 5R24MD001660-06..... NIMHD.............. PILI 'Ohana Project: Partnerships
to Overcome Obesity Disparities
in Hawai'i
UNIVERSITY OF HAWAII AT MANOA.... 5R01CA115614-04..... NCI................ Physical Activity in Women with
Infants
UNIVERSITY OF HAWAII AT MANOA.... 1U13HD063139-01..... NICHD.............. Community-Based Capacity Building:
Academic-Community Partnerships
Using Partici
UNIVERSITY OF HAWAII AT MANOA.... 5G11HD054969-04..... NICHD.............. Office of Research Development
(EARDA)
UNIVERSITY OF HAWAII AT MANOA.... 5F32HD055000-03..... NICHD.............. Origins of neuronal patterning in
animal development
UNIVERSITY OF HAWAII AT MANOA.... 2T34GM007684-29A1... NIGMS.............. Minority Access to Research
Careers
UNIVERSITY OF HAWAII AT MANOA.... 1R01GM093116-01..... NIGMS.............. Gene regulatory network evolution
and the origin of biological
novelties
UNIVERSITY OF HAWAII AT MANOA.... 1P41GM094091-01..... NIGMS.............. Accessing Cyanobacterial Chemical
Diversity: A Unique Natural
Product Library
UNIVERSITY OF HAWAII AT MANOA.... 5R01GM083158-03..... NIGMS.............. Transposon Based Mammalian
Transgenesis and Transfection
UNIVERSITY OF HAWAII AT MANOA.... 1R01GM088266-01A1... NIGMS.............. RSK-2 regulates integrin-mediated
adhesion and migration
UNIVERSITY OF HAWAII AT MANOA.... 1K01DK090091-01..... NIDDK.............. Neighborhood Characteristics and
Diabetes Incidence in the
Multiethnic Cohort Stu
UNIVERSITY OF HAWAII AT MANOA.... 5R25DK078386-04..... NIDDK.............. High School Students STEP-UP To
Biomedical Research
UNIVERSITY OF HAWAII AT MANOA.... 5R01DK079684-04..... NIDDK.............. Multimedia intervention to
motivate ethnic teens to be
designated donors
UNIVERSITY OF HAWAII AT MANOA.... 3U10CA063844-17S1... NCI................ Hawaii Minority-Based Clinical
Community Oncology Program
UNIVERSITY OF HAWAII AT MANOA.... 5P01CA114047-05..... NCI................ Pathogenesis of mesothelioma
UNIVERSITY OF HAWAII AT MANOA.... 5R01CA058598-12..... NCI................ Collaborative Genetic Study of
Ovarian Cancer Risk
UNIVERSITY OF HAWAII AT MANOA.... 5R01CA120799-04..... NCI................ Testing Alternative Stage Models
of Smoking Cessation: An
Intervention Study
UNIVERSITY OF HAWAII AT MANOA.... 5R37CA054281-18..... NCI................ Multiethnic Cohort Study of Diet
and Cancer
UNIVERSITY OF HAWAII AT MANOA.... 1R03CA150041-01..... NCI................ Urinary Estrogen Metabolites in a
2-year Soy Trial Among
Premenopausal Women
UNIVERSITY OF HAWAII AT MANOA.... 3U54CA143727-02S1... NCI................ University of Guam/Cancer Research
Center of Hawaii Partnership (1
of 2)
UNIVERSITY OF HAWAII AT MANOA.... 3P30CA071789-12S9... NCI................ Cancer Research Center of Hawaii
UNIVERSITY OF HAWAII AT MANOA.... 3P30CA071789-12S8... NCI................ Cancer Research Center of Hawaii
UNIVERSITY OF HAWAII AT MANOA.... 5U24CA074806-12..... NCI................ The Colon Cancer Family Registry:
Hawaii
UNIVERSITY OF HAWAII AT MANOA.... 1R01CA153154-01..... NCI................ Self-Control as a Moderator for
Effects of Mass Media on
Adolescent Substance Use
UNIVERSITY OF HAWAII AT MANOA.... 3U24CA074806-11S1... NCI................ The Colon Cancer Family Registry:
Hawaii
UNIVERSITY OF HAWAII AT MANOA.... 7R01CA124687-03..... NCI................ The Sphingolipid Pathway in Colon
Cancer Chemoprevention
UNIVERSITY OF HAWAII AT MANOA.... 2U10CA063844-17..... NCI................ Hawaii Minority-Based Clinical
Community Oncology Program
UNIVERSITY OF HAWAII AT MANOA.... 5R21AT004844-02..... NCCAM.............. Mechanisms by which selenium
influences T helper cells during
immune responses
UNIVERSITY OF HAWAII AT MANOA.... 5R21AT005139-02..... NCCAM.............. Exploratory Studies on the Anti-
Breast Cancer Function of Bamboo
Extract
UNIVERSITY OF HAWAII AT MANOA.... 7R01AI054128-06..... NIAID.............. Mechansim of activation of innate
immunity by ISS-DNA
UNIVERSITY OF HAWAII AT MANOA.... 5R01AI075057-03..... NIAID.............. Intraspecies Transmission and
Infectivity of Insectivore-Borne
Hantaviruses
UNIVERSITY OF HAWAII AT MANOA.... 5R01AI071160-04..... NIAID.............. Malarial Immunity in Pregnant
Cameroonian Women
UNIVERSITY OF HAWAII AT MANOA.... 1R01AI089999-01..... NIAID.............. Selenoprotein K modulates calcium-
dependent signaling in immune
cells
UNIVERSITY OF HAWAII AT MANOA.... 5R01AI074554-03..... NIAID.............. Global HIV Drug Therapies and
Mitochondrial Complications and
Mechanisms
UNIVERSITY OF HAWAII AT MANOA.... 5U01HG004802-03..... NHGRI.............. Epidemiology of Putative Causal
Variants in the Multiethnic
Cohort
UNIVERSITY OF HAWAII AT MANOA.... 5R01DA021146-04..... NIDA............... RGR-based motion tracking for real-
time adaptive MR imaging and
spectroscopy
UNIVERSITY OF HAWAII AT MANOA.... 5R01DA021856-04..... NIDA............... The Project Success Model:
Evaluation of a Tiered
Intervention
UNIVERSITY OF HAWAII AT MANOA.... 5K02DA020569-05..... NIDA............... Parallel MRI for Substance Abuse
Research
UNIVERSITY OF HAWAII AT MANOA.... 5K23DA020801-05..... NIDA............... Neurodevelopment of
Methamphetamine Exposed Children
UNIVERSITY OF HAWAII AT MANOA.... 5R01DA019912-04..... NIDA............... Parallel MRI for High Field
Neuroimaging
UNIVERSITY OF HAWAII AT MANOA.... 5K24DA016170-07..... NIDA............... Neuroimaging and Mentoring in Drug
Abuse Research
UNIVERSITY OF HAWAII AT MANOA.... 1R24DA027318-01..... NIDA............... Factors for enhanced neurotoxicity
in methamphetamine abuse in HIV
infection
UNIVERSITY OF HAWAII AT MANOA.... 5K01DA021203-04..... NIDA............... Impact of Marijuana Exposure on
Brain Maturation
UNIVERSITY OF HAWAII AT MANOA.... 3R25RR024281-03S1... NCRR............... Pacific Education and Research for
Leadership in Science (PEARLS)
UNIVERSITY OF HAWAII AT MANOA.... 5P20RR024206-03..... NCRR............... Institute for Biogenesis Research:
COBRE
UNIVERSITY OF HAWAII AT MANOA.... 5P20RR016453-09..... NCRR............... COBRE: Center for Cardiovascular
Research
UNIVERSITY OF HAWAII AT MANOA.... 5R25CA090956-08..... NCI................ Nutritional & Behavioral Cancer
Prevention in a Multiethnic
Population
UNIVERSITY OF HAWAII AT MANOA.... 5R01CA126895-03..... NCI................ Whole Genome Scan for Modifier
Genes in Colorectal Cancer
UNIVERSITY OF HAWAII AT MANOA.... 5R01CA129063-03..... NCI................ Inflammation and Innate Immunity
Genes and Colorectal Cancer Risk
UNIVERSITY OF HAWAII AT MANOA.... 5R03CA135699-02..... NCI................ A pooled analysis of mammographic
density and breast cancer risk
UNIVERSITY OF HAWAII AT MANOA.... 5R01CA140636-02..... NCI................ Characterizing Mitochondrial DNA
Susceptibility to Breast,
Colorectal, and Prosta
UNIVERSITY OF HAWAII AT MANOA.... 5R01CA080843-09..... NCI................ Effects of Soy on Estrogens in
Breast Fluid and Urine
UNIVERSITY OF HAWAII AT MANOA.... 5U54CA143727-02..... NCI................ University of Guam/Cancer Research
Center of Hawaii Partnership (1
of 2)
UNIVERSITY OF HAWAII AT MANOA.... 5K23HL088981-03..... NHLBI.............. Cardiovascular autonomic function
in HIV virologic failure
UNIVERSITY OF HAWAII AT MANOA.... 5R01HL095135-03..... NHLBI.............. Role of Oxidative Stress and
Inflammation in HIV
Cardiovascular Risk
UNIVERSITY OF HAWAII AT MANOA.... 1R01HL098423-01A1... NHLBI.............. Role of mTOR in the diabetic heart
UNIVERSITY OF HAWAII AT MANOA.... 5UH1HL073449-07..... NHLBI.............. University of Hawaii Research
Scientist Award in Molecular
Cardiology
UNIVERSITY OF HAWAII AT MANOA.... 5R21HL087289-02..... NHLBI.............. Pseudoxanthoma elasticum: Elastic
fibers alterations and
characterization of seru
UNIVERSITY OF HAWAII AT MANOA.... 5R01HL081863-05..... NHLBI.............. Rho kinase in immune-mediated
atherosclerosis
UNIVERSITY OF HAWAII AT MANOA.... 5R01AI068525-05..... NIAID.............. Role of macrophages in HIV
Lipoatrophy
UNIVERSITY OF HAWAII AT MANOA.... 5G12RR003061-25..... NCRR............... Research Outcomes Accelerating
Discoveries for Medical
Applications and Practice
UNIVERSITY OF HAWAII AT MANOA.... 1R01HD060722-01A1... NICHD.............. Contribution of Sperm Nucleus to
Paternal DNA Replication
UNIVERSITY OF HAWAII AT MANOA.... 5R21AG032405-02..... NIA................ A Needle in a Haystack: New
approaches to Alzheimer's Drug
Discovery from Natural
UNIVERSITY OF HAWAII AT MANOA.... 2P20RR018727-06A1... NCRR............... Pacific Center for Emerging
Infectious Diseases Research
UNIVERSITY OF HAWAII AT MANOA.... 5P20MD000173-09..... NIMHD.............. Partnerships for Cardiometabolic
Disparities in Native and Pacific
Peoples
UNIVERSITY OF HAWAII AT MANOA.... 5R01GM057873-11..... NIGMS.............. Cyclopentannelation in Total
Synthesis
UNIVERSITY OF HAWAII AT MANOA.... 1U54RR026136-01A1... NCRR............... RCMI Multidisciplinary And
Translational Research
Infrastructure EXpansion Hawaii
UNIVERSITY OF HAWAII AT MANOA.... 5R25RR024281-03..... NCRR............... Pacific Education and Research for
Leadership in Science (PEARLS)
----------------------------------------------------------------------------------------------------------------
the national institute of nursing research (ninr) support for end-of-
life care and health disparities research
Question. The NINR will soon be celebrating its 25th anniversary.
The late Senator Quentin Burdick and I were active in establishing the
original Center and I am confident he would share my enthusiasm for how
nicely it has matured over the years. At this time I would appreciate
an update on the extent to which the NINR has been able to co-fund
various initiatives with other NIH Institutes, particularly in the
areas of end-of-life issues and racial and geographical disparities.
Answer. Improving palliative and end-of-life care and eliminating
health disparities are critical components of the NINR's research
mission. Consistent with this mission, as well as the Institute's
longstanding practice of extensive collaboration with other NIH ICs,
the NINR co-funds numerous scientific efforts with other ICs focused on
these two important topics.
As the lead NIH Institute on issues related to end-of-life care
research, the NINR, with support from partners across the NIH, will
convene a forum on August 10-12, 2011, entitled ``The Science of
Compassion: Future Directions in End-of-Life and Palliative Care.'' A
part of the NINR's 25th Anniversary commemoration, this forum is
intended to energize and mobilize palliative and end-of-life care
research and to draw attention to palliative and end-of-life care
processes, options available to patients and their families, and the
healthcare community's obligation to address these complex needs. This
event is co-sponsored by the following NIH partners: National Institute
on Aging (NIA), Office of Rare Diseases Research, Office of Research on
Women's Health, National Center for Complementary and Alternative
Medicine, and the NIH Clinical Center Department of Bioethics.
In addition, the NINR and the NIH Common Fund recently awarded $7.1
million in funding provided by the American Recovery and Reinvestment
Act to support a Palliative Care Research Cooperative (PCRC), a multi-
institution effort to conduct collaborative research on palliative and
end-of-life care. The PCRC will bring together experienced,
multidisciplinary investigators to facilitate innovative, high-impact,
clinically useful palliative care research to inform practice and
health policy. The PCRC will address challenges associated with
conducting research with individuals with life-limiting conditions, and
could lead to significant improvements in the evidence base for
palliative and end-of-life care.
NINR also collaborates with other ICs to support basic, clinical,
and translational research to address health disparities across the
life span. The NINR currently co-funds an initiative focused on
reducing health disparities in minority and underserved children,
including children from: racial/ethnic minority groups; rural and low-
income populations; and geographically isolated locations. The NINR,
and other Institutes, have supported various important projects under
this initiative. For example, the NINR-supported investigators are
testing interventions to improve the well-being of African American,
Hispanic, and White families where grandmothers are raising
grandchildren. These custodial grand-families are at high risk for
psychological difficulties and limited access to needed services. This
initiative is co-funded with the following NIH Institutes: National
Institute of Child Health and Human Development; National Heart, Lung,
and Blood Institute; National Institute on Alcohol Abuse and
Alcoholism; and the National Institute on Deafness and Other
Communication Disorders.
Additionally, researchers funded by the NINR and the NIA developed
the Resources for Enhancing Alzheimer's Caregivers Health (REACH) II
program which teaches caregivers about Alzheimer's disease, managing
stress, and maintaining their own health. In a large sample of African
American and White caregivers for Alzheimer's patients, those in the
REACH II intervention reported better physical, emotional, and overall
health and had lower scores for depression which contributed to
reducing caregiving burden. To address the need for support of
caregivers, particularly in racially/ethnically diverse families,
multiple efforts across the Federal Government are currently underway
to implement REACH in the community.
health messages for the native hawaiian population
Question. According to the fiscal year 2012 NIH CJ, the National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
``supports a robust information dissemination and outreach program to
distribute research-based information to the public, patients, and
their healthcare providers.'' The NIAMS supported National
Multicultural Outreach Initiative ``is creating a sustainable network
of partners to assist in the development and dissemination of health
messages and materials for racial and ethnic minority populations.''
The Initiative will focus its efforts on reaching many different
minority/ethnic populations including Native Hawaiians. ``Working with
existing NIAMS partners, the Institute will develop research-based
self-care messages and products, and ensure their distribution through
trusted health and multicultural community channels. The NIAMS
implemented critical phases of the Initiative in fiscal year 2011,
namely, the development and pretesting of culturally and linguistically
appropriate health messages and materials through audience research.''
The NIAMS and its National Multicultural Outreach Initiative are
supporting the development of health messages for racial and ethnic
minority populations. What types of health messages are being developed
and tested for the Native Hawaiian population?
Answer. In fiscal year 2011, the NIAMS completed qualitative
research with members of multicultural communities, including Native
Hawaiians, to help inform the development of culturally appropriate and
useful health education products for adults with medical conditions
affecting the bones, joints, muscles, and skin. The NIAMS conducted a
total of 18 focus groups (2 with Native Hawaiians), and 20 in-depth
interviews (2 with Native Hawaiians) to gather feedback from
individuals on preferences for different message concepts and formats
for communicating health messages. The information gleaned from this
audience research will enable the development of tailored products that
raise awareness about the availability of reliable, research-based
health information and resources from the NIAMS and partner
organizations to help patients and their families manage their
conditions.
The NIAMS National Multicultural Outreach Initiative relies on the
guidance and input from its working groups for the development and
dissemination of health messages and products. These groups are
comprised of national experts from multicultural communities, and
include representation from the Native Hawaiian community.
the national institute on minority health and health disparities
(nimhd) centers of excellence (coe) in hawaii
Question. The fiscal year 2012 congressional justification states
that the NIMHD has supported 91 COE sites in 35 States, the District of
Columbia, Puerto Rico, and the U.S. Virgin Islands. According to the
CJ, the ``types of institutions are diverse and include Historically
Black Colleges and Universities, Hispanic-Serving Institutions, Tribal
Colleges and Universities, Alaskan Native, and Native Hawaiian Serving
Institutions.'' In fiscal year 2010, the 51 active COEs conducted
transdisciplinary research on high priority diseases/conditions
including ``cardiovascular disease, stroke, cancer, diabetes, HIV/AIDS,
infant mortality, mental health, and obesity that disproportionately
affect racial/ethnic minority and other health disparity populations.''
Is the NIMHD currently supporting a COE at a Native Hawaiian
Serving Institution? What high priority diseases or conditions are the
focus of research at a COE in a Native Hawaiian Serving Institution?
Answer. The NIMHD COE represent a scientific platform for
innovative research projects, research training, and effective
community engagement to address the health status of health disparity
populations. The NIMHD has provided funding for a COE at the University
of Hawaii Manoa since September 2002. This COE, Partnerships for
Cardiometabolic Disparities in Native and Pacific Peoples, is a
regional focal point for improving cardiometabolic health and
eliminating health disparities among Native Hawaiians and other Pacific
Islanders, including Filipinos, Samoans, and Tongans.
The primary focus of the COE is obesity and diabetes which are
known risk factors for cardiovascular disease. Eighty-two percent of
Native Hawaiians are overweight or obese, which is considerably higher
than the national average of 53 percent. Pacific Islander women with
diabetes have a higher risk of myocardial infarction. Through dedicated
efforts over the years, Partnerships for Cardiometabolic Disparities in
Native and Pacific Peoples has made significant contributions to the
improvements in the health of Native Hawaiians and other Pacific
Islanders.
In addition, supplemental funding was provided in July 2010 to
support the establishment of the Comparative Effectiveness Research
Approaches to Eliminate Cardiometabolic Disparities initiative as part
of the COE. The intent of the project is to train researchers in
comparative effectiveness research, to conduct innovative research, to
establish diabetes and cardiometabolic disease registries, and to
disseminate research results to communities with health disparities in
Hawaii.
hereditary angiodema research support
Question. Dr. Collins, I would like to thank you for your
leadership of the National Institutes of Health, including its
continuing emphasis on rare diseases. As you are aware, the NIH
provides critical opportunities for research surrounding orphan
conditions which otherwise may not have an opportunity for significant
research. Recently, constituents and members of the U.S. Hereditary
Angioedema Association (USHAEA), based in Honolulu, brought to my
attention the absence of Federal support since 2009 for hereditary
angioedema (HAE) research. I would appreciate receiving a report on why
funding for this disease was eliminated and what your efforts are
toward reinvigorating hereditary angioedema research support.
Answer. HAE is a rare genetic disorder. HAE patients suffer from
swelling of the hands, feet, abdomen, face and/or throat. Especially
the latter is a major medical emergency that may be fatal. Estimates
for the prevalence of HAE range from 1 in 10,000 to 1 in 50,000 people
in the United States.
In 2009, a number of research projects focusing on hereditary
angioedema came to a natural end. For example, the most extensive
project, sponsored by the Eunice Kennedy Shriver National Institute of
Child Health and Human Development, C1 Inhibitor Gene and Hereditary
Angioneurotic Edema, was last funded in 2008 after 23 years of research
and concluded in 2010. The Principal Investigator did not apply for
renewed funding for this project.
The National Center of Research Resources (NCRR) funded Mount Sinai
General Clinical Research Center project: CHANGE Trial (C1-Inhibitor in
Hereditary Angioedema Nanofiltration Generation Evaluating Efficacy):
Open-Label Safety/Efficacy Repeat Exposure Study of C1 Esterase
Inhibitor (Human) in the Treatment of Acute Hereditary Angioedema (HAE)
Attacks participant visits ended in March 2009 and closed in September
2009. The results were published in the NEJM in August 2010 (PMID
20818886). Currently, the NCRR-funded Mount Sinai Clinical and
Translational Science Award supports the Phase III Randomized Double
Blind, Placebo controlled Multicenter Study of Icatibant for
Subcutaneous Injection in Patients with Acute Attacks of Hereditary
Angioedema.
The NCRR General Clinical Research Center at the University of
Texas Medical Branch at Galveston (UTMB) conducted the Randomized,
Placebo-Controlled, Double-blind Phase II Study of the Safety and
Efficacy of Recombinant Human C1 Inhibitor for the Treatments of Acute
Attacks in Patients with Hereditary Angioedema. The study ended in May
2009.
The NCRR-funded University of Texas Medical Branch at Galveston
(UTMB) Clinical and Translational Science Award represents an
additional site which conducted the Phase III Randomized Double-Blind,
Placebo-Controlled Multicenter Study of Icatibant for Subcutaneous
Injection in Patients with Acute Attacks of Hereditary Angioedema
(HAE). This study was completed in May 2011.
Currently, we also are supporting three training grants with
projects investigating HAE, two from National Institute of Allergies
and Infectious Diseases and one from the National Heart, Lung, and
Blood Institute. These training grants are critical since they train
the next generation of investigators. The trainees are expected to
continue their careers with a research emphasis on HAE. The NIH would
welcome the opportunity to support meritorious research studies
focusing on hereditary angioedema (HAE).
To stimulate future research activities and applications we would
encourage investigators and advocates of HAE research to submit an
application for a scientific conference grant. In addition to helping
to identify research opportunities and needs and develop a research
agenda and research priorities for HAE, such a conference could create
significant research interest in this particular rare disease. The
Office of Rare Diseases Research (ORDR), collaborating with other NIH
research institutes, would be pleased to confer with the U.S.
Hereditary Angioedema Association (U.S. HAEA) and interested research
investigators about your concerns.
cancer prevelance and research in hawaii
Question. Over the years the NCI has systematically invested in
research activities targeting the unfortunately high incidence of
cancer among my State's Native Hawaiian population. At one point the
NCI researchers reported that Native Hawaiian women had the highest
incidence of breast cancer in the world. I am confident that progress
has been made and would appreciate a report describing the NCI's future
plans for targeting the special needs of these indigenous people.
Answer. The NCI funds research that focuses on Native Hawaiian,
other Pacific Islander, and Asian American populations. These studies
are supported to illuminate the causes of cancer in these populations;
to improve screening rates so that when cancer appears, it can be
treated at an early stage; to increase knowledge about treatment
options so that patients and their physicians can make more informed
choices about their care; to fund registries, surveys, and reports that
generate the latest statistics and inform researchers, policy makers,
and the public; to support cohorts that provide a population base from
which to conduct important future research, and ultimately to prevent
cancers in these populations.
Current Efforts
The NCI's Prostate, Lung, Colorectal, and Ovarian Cancer Screening
Trial (PLCO) and National Lung Screening Trial (NLST) studies, with
more than 200,000 participants, include programs in Hawaii and from
diverse ethnic populations. At the Pacific Health Research and
Education Institute in Honolulu, of the 13,200 study participants in
Hawaii, approximately half were Asians (5,553) and Native Hawaiians and
other Pacific Islanders (1,053).
In the area of clinical trial recruitment of minorities, the
University of Hawaii Minority-Based Community Clinical Oncology Program
(MB-CCOP), funded since 1994, provides access to the NCI clinical
trials in cancer prevention, treatment, and control to both children
and adults.
The NCI Community Network Program (CNP) Centers address disparities
at the community level with outreach, research, and training. Two CNPs
are oriented to Pacific Islanders (Imi Hale and Weaving an Islander
Network for Cancer Awareness, Research and Training, or WINCART) and
two other CNPs are focused on underserved Asians (Asian American
Network for Cancer Awareness, Research, and Training, or AANCART, and
the Asian Community Cancer Health Disparities Center, or ACCHD).
National Outreach Program (NOP) supported by the Imi Hale Native
Hawaiian Cancer Network is designed to reduce cancer incidence and
mortality among Native Hawaiians by maintaining and expanding an
infrastructure that:
--Promotes cancer awareness within Native Hawaiian communities;
--Provides education and training to develop Native Hawaiian
researchers; and
--Facilitates research that aims to reduce cancer health disparities
experienced by Native Hawaiians.
The Imi Hale Native Hawaiian Cancer Network made progress toward
reducing cancer incidence and mortality among Native Hawaiians through
a project, ``Woman to Woman-Micronesians United Lay Educator Program''
for Native Hawaiians focused on increasing breast and cervical cancer
screening. Six months of outreach activities resulted in screening of
150 women. CNP-Southern California developed culturally tailored
educational resources specifically for Native Hawaiians and the
Marshallese, in colorectal cancer screening, which resulted in a
library of culturally relevant resources. In addition to these primary
efforts, the CNP Native Hawaiian trainees have submitted 40 grant
applications and a total of 12 were ranked high enough for funding.
Imi Hale has a dedicated Community Health Educator, who seeks to
bridge the gap between the community and the research community by
developing culturally tailored cancer information. For instance, to
help women learn to do self-breast exams to detect lumps early, Imi
published Breast Health Shower Cards in nine languages. In terms of
breast cancer education, Imi Hale has produced a DVD entitled ``A
Journey of Hope: When a Young Woman Gets Cancer.'' Seeking creative
ways to educate women about breast cancer, Imi Hale created a breast
cancer computer game (http://imihale.org/game/click_to_start.html). In
addition, a series of brochures for Native Hawaiian breast cancer
survivors called ``Talking Story Booklets'' has been developed. The
outreach component works closely with such partners as the five Native
Hawaiian healthcare Systems positioned on five islands.
--Imi Hale Clinical partners include: Community Health Centers
serving Native Hawaiian clients, the Queen`s Cancer Center and
other hospitals, and the State-contracted Breast and Cervical
Cancer Control Programs; and
--Imi Hale Community partners include: Association of Hawaiian Civic
Clubs, Hawaii State Tobacco Coalition, Office of Hawaiian
Affairs, and other community agencies.
A Comprehensive Partnership to Reduce Cancer Health Disparities
Program between the University of Hawaii Cancer Center (UHCC) and the
University of Guam (UOG) have an NCI-funded partnership with the aim of
enhancing the awareness of cancer and cancer prevention and ultimately
reducing the impact of cancer on the population in Hawaii, the
Territory of Guam and the other U.S.-associated Pacific Island
territories. The partnership supports projects designed to develop
culturally appropriate guidelines for tobacco use prevention and
cessation in youth with the underlying hypothesis that interventions to
prevent tobacco use are more likely to succeed if they conform to
culturally relevant guidelines developed with the active participation
of the target youth themselves. The long-term goal of the community-
based participatory outreach program is to engage the community as
equal partners in tobacco control and cancer prevention research. The
partnership also supports investigator-initiated cancer research
projects that address different aspects of cancers in Hawaii and Guam
including the development of protocols for studying oral precancerous
lesions and other health risks among betel nut users in Hawaii, the
Territory of Guam and the other U.S.-associated Pacific Island
territories.
The NCI Community Cancer Centers Program (NCCCP) is designed to
create a community-based cancer center network to support basic,
clinical and population-based research initiatives, addressing the full
cancer care continuum--from prevention, screening, diagnosis,
treatment, and survivorship through end-of-life care. The NCCCP pilot
has added the Queen's Medical Center, Honolulu, Hawaii (The Queen's
Cancer Center) to its 30 hospital network.
Future Research
The NCI will be launching a program to foster evidence-based
research, data collection, and analysis within Asian American and
Pacific Islander (AAPI) populations and subpopulations through a unique
collaboration with the University of Guam, the University of Hawaii,
the Pacific Regional Central Cancer Registry, and the Pacific Island
Cancer Council. The NCI developed the Health Information National
Trends Survey (HINTS) to monitor changes in the rapidly evolving field
of health communication by collecting data across the Nation. The
HINTS-Guam program will pilot test a localized survey instrument geared
specifically to AAPI populations and subpopulations, including
Chamorros and other Pacific Islanders living on Guam. Data collected
from this survey will increase understanding of cancer information
seeking, experiences, and behaviors (prevention, screening, treatment,
etc.) among AAPI populations. Discussions have also begun on a HINTS
pilot project to be conducted in Hawaii.
kidney disease and diabetes research in hawaii
Question. It has recently come to my attention that my State's
Filipino population has an extraordinarily high incidence of kidney
disease. Similarly, several ethnic groups in Hawaii (including Native
Hawaiians) have been found to have high incidences of diabetes.
Accordingly, I would appreciate receiving a report on your efforts to
develop initiatives targeting these populations, and particularly those
which would stress prevention and perhaps diet.
Answer. Data show that Filipinos in Hawaii seem to have a
disproportionate burden of kidney disease. The NIDDK is naturally very
concerned about kidney disease in Hawaiians, including the health
disparity in the Filipino population, and has several initiatives in
place to address the problem. First, our National Kidney Disease
Education Program (NKDEP) provides materials that can be used in
Hawaii's high risk populations. The NKDEP's materials aim to raise
awareness of the seriousness of kidney disease, the importance of
testing those at high risk (those with diabetes, high blood pressure,
or a family history of kidney failure), and the availability of
treatment to prevent or slow kidney failure. NKDEP's extensive new
offerings on dietary intervention in chronic kidney disease for
providers and patients would be particularly useful.
The National Diabetes Education Program (NDEP) is sponsored by the
NIDDK and Centers for Disease Control and Prevention (CDC) and includes
more than 200 partners working together to improve the treatment and
outcomes for people with diabetes, promote early diagnosis, and prevent
or delay the onset of type 2 diabetes, a leading cause of kidney
disease. The NDEP has a major focus on Asian Pacific Islanders; it has
translated educational materials into Tagalog, one of the languages
spoken in the Fillipino population. These materials address both
prevention of diabetes and prevention of complications such as kidney
disease. The University of Hawaii is a site for the Diabetes Prevention
Program Outcomes Study, which recently reported data showing durability
of effect of lifestyle intervention and the drug metformin at
preventing or delaying onset of type 2 diabetes at 10 years follow-up.
People whose disease progresses to kidney failure can be treated
with a kidney transplant, though limitations on available donor organs
is a chronic problem. The NIDDK's ``Minority Organ Donation Program''
initiative supports an investigator at the University of Hawaii, Dr.
Cheryl Albright, whose research focuses on educating Filipino high
school students about signing up (on drivers' licenses) to donate
organs. Students from Honolulu and other smaller Islands (including
rural areas) are participants. The grant is in the fourth year and
results are quite encouraging. The Filipino community is very
interested in kidney transplants, and participated in the original
National Minority Organ and Tissue Transplant Education Program (http:/
/mottep.org/) to rally the community around kidney donation from
relatives and friends.
In another initiative, the NIDDK, in collaboration with the CDC and
the Indian Health Service, has funded eight Tribal Colleges and
Universities in the initiative ``Diabetes Education in Tribal
Schools.'' This effort developed supplemental curricula, to be used in
K-12 schools in American Indian and Alaska Native communities, about
prevention and better management of diabetes, the most common cause of
kidney failure. Although the cultural content is directed primarily
toward American Indians, some Hawaiian schools participated in piloting
the curricula. The project is completed and the curricula are being
fielded in tribal schools. Also, the curricula were distributed to and
currently are being used in Hawaiian schools, primarily on the Big
Island of Hawaii.
stroke disparities in the united states
Question. I am concerned that stroke apparently remains the number
two killer in the United States and a major cause of disability. In
addition, stroke affects some segments and regions of our population
more than others. I understand that the State of Hawaii ranks 20 out of
52 highest in our Nation for age-adjusted stroke deaths. Death rates
from a certain type of stroke (intracerebral hemorrhage) are higher
among Asians/Pacific Islanders than among Whites. More than 20 percent
of Native Hawaiians or other Pacific Islanders have high blood
pressure, a leading risk factor for stroke. Yet, the NIH invests only 1
percent of its budget on stroke research. What is your Institute doing
to address the disparities that exist in stroke burden among different
cultural and racial populations in the United States?
Answer. Stroke research at the NIH is comprehensive and includes
research on basic disease mechanisms; epidemiology studies to assess
stroke risk, occurrence and outcomes in the population; clinical
research to develop effective prevention and acute treatment
approaches; and development of strategies for improving recovery and
rehabilitation in stroke patients. Clinical research in stroke is
particularly a high priority at the National Institute of Neurological
Disorders and Stroke (NINDS)--approximately 50 percent of its large
Phase III trials are on stroke.
The NINDS also supports major research initiatives aimed at better
defining stroke risk, incidence and outcomes in the United States and
among different subpopulations. Collections of population-based data
help identify and explain health disparities in stroke, and inform the
development of preventive interventions that target high risk
populations.
--In the Reasons for Geographic and Racial Differences in Stroke
(REGARDS) study, investigators are exploring the geographical
and racial influences on stroke risk in a cohort of about
30,000 individuals, about half of whom live in the ``stroke
belt'' region of the Southeastern United States. This large
study has produced over 70 publications that have led to a
better understanding of disparities in stroke in the United
States. Data generated from this study continue to help
researchers pinpoint why the stroke rate is higher in this
region, and among African Americans, and to develop targeted
strategies for intervention. Recent data from REGARDS indicated
that overall time spent in the stroke belt is more predictive
of hypertension--a powerful risk factor for stroke--than is
current residence in the stroke belt. Data from the REGARDS
study have also revealed that stroke survivors were more likely
to have unrecognized hypertension and diabetes.
--The Stroke Disparities Program is a multi-component program to
address major stroke challenges in the African American
community. The three projects in this program include:
--an intervention strategy to increase stroke knowledge and reduce
the time from symptom onset to hospital arrival (ASPIRE);
--an intervention utilizing navigators for secondary stroke
prevention that targets adherence to poststroke care
(PROTECT DC); and
--an observational imaging study to better understand racial and
ethnic differences in risk, occurrence and outcomes of
small brain hemorrhages (DECIPHER).
--The NOrthern MAnhattan Study (NOMAS) investigators have been
following a cohort of stroke-free adults, including whites,
African Americans and Caribbean Hispanics in a Northern
Manhattan community. Researchers are collecting imaging,
biological and neuropsychological data to evaluate the
relationship between biological and imaging predictors for
stroke, heart attack and death, as well as cognitive decline.
Using these markers in combination with other factors such as
diet, alcohol use, smoking, and history of peripheral vessel
disease, investigators are developing risk factor and cognitive
ability assessment tools. Genetic studies involving this and
other cohorts, have suggested that there may be genetic
susceptibilities underlying left atrium size and
atherosclerosis of the carotid arteries that contribute to
stroke.
--BASIC (Brain Attack Surveillance in Corpus Christi) investigators
are comparing trends in recurrent stroke, as well as functional
and cognitive outcomes following stroke, in 5,000 non-Hispanic
whites and Mexican Americans in Corpus Christi, Texas. Data
from this study have shown that Mexican Americans with atrial
fibrillation are more likely to have recurrent strokes than
whites, and the strokes are more likely to be severe. The
investigators are also exploring associations between
biological and social stroke risk factors, and recently found,
for example, that the density of fast food restaurants was
associated with neighborhood stroke risk.
--Ethnic and Racial variation in Intracerebral Hemorrhage (ERICH), a
study that was initiated in 2010, will identify differences in
intracerebral hemorrhage (ICH) risk factor distribution and
outcomes by race and ethnicity. This project will compare 3,000
cases of ICH, among African Americans, Hispanics and non-
Hispanic whites, to 3,000 demographically matched controls in
order to identify differences in risk factor distribution and
ICH outcome by race, ethnicity and location of ICH and to
determine differences in imaging characteristics among African
Americans and Hispanics compared to whites. The investigators
will also collect DNA in order to combine with other cohorts to
perform a genome-wide association study (GWAS) to identify
genes that affect risk of ICH in whites, African Americans and
Hispanics.
--The Alaska Native Stroke Registry (ANSR) is a population-based
surveillance study on the epidemiology of stroke in Alaska
Natives. Comprehensive assessment of the stroke epidemiology,
vascular risk factors, cultural understandings of vascular
health and lifestyle, and structural barriers to risk reduction
strategies has informed the development of a community level
prevention intervention pilot program that aims to reduce the
burden of stroke in the Alaska Native population.
______
Questions Submitted by Senator Herb Kohl
comparison of age-related macular degeneration treatments trials
Question. The National Institutes of Health (NIH) recently released
results of the Comparison of Age-Related Macular Degeneration
Treatments Trials (CATT), which found that Lucentis and off-label
Avastin are similarly efficacious at treating neovascular age-related
macular degeneration (wet AMD). Now that the CATT study is released,
what is the NIH going to do with the results? The taxpayers spent
millions of dollars on the CATT study to determine the comparative
effectiveness of the drugs. I believe the trial results ought to be
actionable.
Answer. The National Eye Institute (NEI) recognizes its
responsibility to fund and conduct scientifically valid clinical
research and to disseminate the study results to the professional
clinical community and the public.
We collaborate extensively with ophthalmic organizations to apprise
their members of CATT results. In particular, outreach to professional
groups was the most effective and efficient means of reaching the
clinical ophthalmic community regarding CATT findings. For example, the
American Academy of Ophthalmology (AAO) has 30,000 member
ophthalmologists who are the primary eye care professionals that treat
wet AMD. The NEI worked with AAO to disseminate CATT results through
the AAO's Website, newsletters, press releases, and its upcoming annual
meeting. Additionally, the AAO Executive Director has written
extensively to the membership in support of CATT. We will continue to
work with AAO as they develop ``preferred practice plans'' for the
treatment of wet AMD. The Association for Research in Vision and
Ophthalmology (ARVO) is a 12,500 member eye research organization
comprised of clinicians and investigators. CATT investigators presented
their results at ARVO's annual meeting in May 2011. These two
organizations will continue to provide information and guidance to
their members about CATT so that the results can inform clinical care
decisions.
The NEI is also working to inform the public about the CATT
findings. The release of the study was accompanied by an extensive
media outreach campaign. For example, the NEI hosted a news briefing
for journalists where the NEI Director and CATT investigators presented
study findings and fielded questions from more than 60 media outlets.
Supplemental background video footage was made available to broadcast
outlets. A press release was also distributed widely to media outlets.
The NEI generated robust media coverage for CATT, coverage that has
been intense and more widespread than for other recent studies (see
accompanying table), despite media competition from the royal wedding
and the death of Osama Bin Laden. As follow-up to the initial media
coverage, the NEI distributed CATT results to members of the National
Eye Health Education Program (NEHEP), a partnership of 60 public and
private organizations dedicated to eye health education. This program
provides the NEI with direct access to community-based public health
education efforts, and we are preparing an NEI webpage devoted to CATT
along with a brochure including public health information about CATT.
Of note, the May publication of CATT reported on first year
results. The second year results will be published in the spring of
2012. At that time, the NEI will repeat its efforts with professional
organizations and the media to disseminate CATT results.
NEI CLINICAL TRIAL MEDIA COVERAGE
----------------------------------------------------------------------------------------------------------------
Number of Pick-up of
Study name Impressions original news original news
(millions) \1\ stories stories \2\
----------------------------------------------------------------------------------------------------------------
CATT.--Comparison of AMD Treatment Trials (2011)................ 296 157 234
ETROP.--Early Treatment for Retinopathy of Prematurity Study 257 20 138
(2010).........................................................
DRCR-DME.--Ranibizumab plus laser therapy for diabetic macular 232 42 29
edema (2010)...................................................
ACCORD.--Action to Control Cardiovascular Risk in Diabetes Eye 8 9 ( \3\ )
Study (2010)...................................................
GWAS-AMD.--Genome-wide association study genes associated with 16 13 6
AMD (2010).....................................................
LALES.--Los Angeles Latino Eye Study (2010)..................... 3 7 ( \3\ )
Myopia.--Increased pevalence of myopia in United States (2009).. 158 76 ( \3\ )
SCORE.--Standard Care vs. Corticosteroid for Retinal Vein 150 27 79
Occlusion (2009)...............................................
LCA.--Leber Congenital Amaurosis (2009)......................... 155 32 37
CITT.--Convergence Insufficiency Treatment Trial (2008)......... 44 117 183
CDS.--Cornea Donor Study (2008)................................. 63 118 74
AREDS2.--Age Related Eye Disease Study 2 (2006)................. 17 92 ( \3\ )
----------------------------------------------------------------------------------------------------------------
\1\ Impressions.--Number of people exposed to the news story in print, online, or on television based on
expected readership or viewers.
\2\ Pick-up.--When an original story is reprinted in another outlet (i.e., an Associated Press article is
printed in The Washington Post), it is counted as a pick-up.
\3\ Not applicable.
Question. How does the NIH share this information with other
agencies within the Federal Government?
Answer. In the preparation for the release of CATT, the NEI held a
teleconference with relevant Department of Health and Human Services
(HHS) agencies (FDA, CMS, CDC, and AHRQ) to inform them of CATT results
and to coordinate the HHS response to media. In accordance with
standard HHS and NIH operating procedures, the NEI distributed a draft
press release for clearance within DHHS and responded to various issues
prior to approval for release. This effort helped ensure a coordinated
HHS response to CATT. Since this initial interaction, both the NEI
staff and CATT leadership have been contacted by CMS staff to discuss
the implications of the CATT study results.
Question. Has the NIH's National Eye Institute considered what
effect, if any, the CATT study might have on future physician
prescribing behavior regarding Lucentis vs. off-label Avastin to treat
wet AMD?
Answer. Avastin, which inhibits the formation of new blood vessels,
was approved by the FDA in 2004 for the treatment of colon cancer.
Avastin is effective as an anti-cancer agent because inhibiting the
blood supply to tumors inhibits their growth. Since wet AMD is due to
leakage from new, abnormal blood vessels, ophthalmologists began trying
Avastin off-label to treat this form of AMD in 2006 on the basis of
both the cancer data and clinical trial results for Lucentis during the
FDA approval process. At that time, Avastin off-label was the only
available treatment for wet AMD that led to improvement in vision.
The vast majority of patients treated for wet AMD participate in
Medicare. After Lucentis was FDA-approved in 2007, most
ophthalmologists continued to use Avastin because the cost was
significantly lower than for Lucentis and because a number of reported
cases demonstrated Avastin efficacy that appeared similar to that
reported in the Lucentis clinical trials. Last May, Dr. Ross Brechner
and colleagues (Centers for Medicare and Medicaid Services) and Dr.
Phillip Rosenfeld (Bascom Palmer Eye Institute, University of Miami)
published an analysis of Medicare claims for wet AMD during 2008.\1\
They found that 64.4 percent of patients received Avastin and 35.6
percent received Lucentis and concluded that despite its off-label
designation, intravitreal Avastin is currently standard-of-care
treatment for wet AMD. Medicare payments totaled $536.6 million for
Lucentis and $20.3 million for Avastin.
---------------------------------------------------------------------------
\1\ Brechner, R. J, P. J. Rosenfeld, J. D. Babish, and S. Caplan.
Pharmacotherapy for Neovascular Age-Related Macular Degeneration: An
Analysis of the 100 percent Medicare Fee-For-Service Part B Claims
File. American Journal Ophthalmology 151:887-895, 2011.
---------------------------------------------------------------------------
CATT was a very tightly controlled, well-designed study, which
compared the two drugs in more than 1,100 patients. The exceptionally
wide dissemination of CATT results means that the retinal specialists
who treat AMD and the patients they care for are undoubtedly well aware
of the equivalence. As such, an increase in the number of patients
receiving Avastin as first line therapy is to be expected. Careful
monitoring of use of the drugs by CMS is expected.
Importantly, some patients with wet AMD respond better to Avastin,
while others to Lucentis. In practice, if one is ineffective, the other
may be tried. The fact that more than one drug is available is
beneficial and allows ophthalmologists and patients treatment choices.
______
Questions Submitted by Senator Mary L. Landrieu
interim status of idea program
Question. Scientists have expressed their concern about programs
that have been placed before under ``interim'' status and tend to lose
direction and in some cases have disappeared. I am particularly
concerned about the Institutional Development Award (IDeA) Program,
which is so important to Louisiana. What is the reason for placing a
program that serves 23 States and Puerto Rico on an interim status?
Answer. The IDeA Program has not been placed in an interim status.
Under the proposed creation of the National Center for Advancing
Translational Sciences (NCATS), we considered moving the program to a
new unit called the Office of Research Infrastructure Programs within
the Office of the Director, Division of Program Coordination, Planning,
and Strategic Initiatives. However, following extensive consultation
and feedback from multiple stakeholders, including grantees,
professional organizations, and the public, we concluded that the IDeA
program is most closely aligned scientifically and programmatically
with the mission and goals of the National Institute of General Medical
Sciences (NIGMS). Therefore, the National Institutes of Health (NIH)
intends on moving the IDeA program and the IDeA program staff to the
NIGMS. We are confident the program will flourish as a vital component
of the NIGMS.
placement of national center for research resources (ncrr) programs
Question. For many years the programs housed at the NCRR have
worked synergistically to serve the IDeA community. Can this synergy
continue by placing these programs under a single NIH institute?
Answer. There is no reason why synergies established between IDeA
and other NCRR programs will not continue to flourish at both the
national level through programmatic communication and collaboration
across institutes and centers and at the local level through
institutional collaborations and interactions. Fostering collaborative
research networks is an inherent part of the IDeA mission, and it
excels at establishing connections and linkages. IDeA institutions
currently collaborate with grantees of the Research Centers in Minority
Institutions (RCMI) program as well as the Science Education
Partnership Award Program (SEPA). The NIH encourages such
collaborations, and they will continue.
placement of idea within the national institute of minority health
disparities (nimhd)
Question. It has been made public that some institute directors who
have been approached to house IDeA programs have voiced reservations
about housing these programs in their institutes based on their
programmatic mission and staffing needs. We also know that the Advisory
Council for the NIMHD has enthusiastically endorsed the idea of placing
these programs in the NIMHD. Have you considered the possibility of
placing these programs under the management of the NIMHD?
Answer. An NIH National Center for Research Resources (NCRR) Task
Force, charged with identifying the optimal new home for the IDeA
program, considered a range of options, including its placement within
the NIMHD. After careful analysis, fact-finding, and consultation, the
Task Force recommended that this program be transferred to the National
Institute of General Medical Sciences (NIGMS). The IDeA program fosters
health-related research and enhances competitiveness of investigators
at institutions located in States in which the aggregate success rate
for applications to the NIH has been historically low. By its nature,
the program extends beyond traditional capacity building in supporting
research projects that are designed to strengthen future investigator-
initiated research applications, most of which are focused on
addressing basic science questions. The NIGMS has a basic science focus
as well as a longstanding focus on institutional capacity building and
career development. Given these synergies, the Task Force determined
that the mission of the IDeA program is most closely aligned with the
mission of the NIGMS and that the NIGMS would be the optimal new home
for the IDeA Program.
the clinical and translational science awards (ctsas) and the national
center for advancing translational sciences (ncats)
Question. With the final five CTSAs expected to be announced in the
near future, I have a couple of questions for Dr. Collins on this
program's future direction now that it is being moved to the new NCATS.
Because the NCATS is primarily focused on drug development, what
will become of the community research and integration aspect of the
CTSAs' mission? Will community involvement continue to be a central
focus of this program?
The CTSAs represent translational research across the country, but
there are no centers in the gulf south--an area with significant health
needs that would benefit greatly from a CTSA and could contribute much
to the network of centers. Is geographic distribution considered as
CTSA sites are being selected?
Answer. The mission of the NCATS will be to catalyze the
development of innovative methods and technologies that will enhance
the development, testing, and implementation of diagnostics and
therapeutics across a wide range of human diseases and conditions. In
addition to strengthening and streamlining the therapeutics development
process, the NCATS will support research aimed at accelerating the
development, testing, and implementation of products and techniques,
including diagnostics, drugs, biologics, medical devices, and
behavioral interventions, for the diagnosis, treatment, and prevention
of disease. The CTSAs possess the requisite expertise across the full
spectrum of translational research, and they will be integral to the
success of the NCATS. The involvement of research sites across the
Nation and the study of the integration of research findings at the
community level will continue to be an important focus of the CTSA
program.
Institutions with CTSAs that are either close to or interact with
communities and populations along the Gulf include the University of
Texas Medical Branch in Galveston and the University of Alabama in
Birmingham. The CTSA at the University of Texas Health Sciences Center
at Houston serves gulf communities through its strong connections to
UT's Brownsville campus.
With regard to the selection of the CTSA sites, NCRR has used the
peer review process to establish priority scores to guide funding
decisions. All applications, together with their priority scores, were
then reviewed by the National Advisory Research Resources Council,
which is able to make recommendations, where needed, concerning
geographic distribution. Going forward, scientific merit will continue
to be the principal selection criterion, and considerations of program
relevance and public health need will be factored in at subsequent
levels of review.
geographic distribution of small business innovative research (sbir)
grants
Question. As one of the largest funders of SBIR grants, can you
tell me what the NIH is doing to ensure that there is a more balanced
portfolio and increased participation from States that have
traditionally received a small number of SBIR grants?
Answer. The NIH prioritizes SBIR and Small Business Technology
Transfer (STTR) outreach to States that historically have submitted a
small number of SBIR applications and/or have lower success rates than
the overall SBIR/STTR success rates. Each year, we hold an annual SBIR/
STTR conference, this year on the NIH's campus in Maryland, but in past
years in Ohio, Nebraska, Nevada, Georgia, and North Carolina. We also
participate in direct one-on-one contact with current and potential
applicants/grantees in several national, State, and regional SBIR
events per year. Currently in fiscal year 2011, the NIH staff have
already attended, presented, or participated on the SBIR program in
Arizona, California, Florida, Kansas (via webinar), Kentucky, Maine,
Maryland, Michigan, Missouri, Nebraska, New York, Virginia, Washington,
DC, and Wisconsin. On the horizon is an event in Louisiana. These
conferences attract attendees from across the country, and offers
attendees an opportunity for one-on-one consultations with the NIH
SBIR/STTR program, review and grants management staff. In addition,
there are a number of other conferences/meetings in which the NIH
offers consultation to SBIR/STTR applicants and similar outreach is
conducted by the individual NIH Institutes and Centers. In all venues,
the NIH educates as many current and potential applicants/grantees as
possible about the SBIR program.
In addition to these in-person opportunities, the NIH staff are
available to provide assistance to all applicants from concept
development through grant life-cycle by phone, email, webinars, and our
Web sites. SBIR funding decisions ultimately are made at the NIH
Institute level and are based on scientific merit (as determined by our
two level peer-review system), available funding, and programmatic
priority. Information about all NIH grant awards, including State
location, can be accessed through our RePORTER Web site at http://
projectreporter.nih.gov/reporter.cfm.
antiviral development for flu
Question. Discussions regarding the prevention of a flu pandemic
frequently focus on vaccine development, but it is my understanding
that effective management of influenza will require the continued
development of new antiviral drugs. I was pleased to learn that the
National Institute of Allergy and Infectious Diseases (NIAID) recently
held a workshop on the influenza antiviral research pipeline. Are we
making progress in the development of antiviral drugs for influenza and
does the NIAID have plans for any new initiatives in this area?
Answer. In March 2011, the NIAID held the Influenza Antiviral
Research Pipeline Workshop, which brought together stakeholders from a
variety of sectors including academia, business, and government.
Discussions focused on the state of influenza antiviral research and
spanned all aspects from discovery to advanced clinical development.
Workshop proceedings will be posted on the NIAID Web site in the near
future.
Currently, there are four drugs licensed to treat influenza:
oseltamivir (Tamiflu), zanamivir (Relenza), rimantadine (Flumadine),
and amantadine (Symmetrel). Ongoing NIAID efforts in influenza drug
development include combination studies with licensed and experimental
drugs, studies of the safety of antiviral drugs in infants and
children, studies of broad-spectrum antivirals, studies of antibody
therapeutics, and evaluation of novel drug targets. For example, the
NIAID also supports in vitro and in vivo antiviral screening and other
preclinical services to identify new antiviral candidates. In fiscal
year 2010, more than 100,000 compounds were evaluated by high-
throughput screening assays against multiple influenza A strains, and
several hundred compounds were tested for their efficacy against
influenza in animal models. Also, the NIAID is supporting the
preclinical and clinical development of a novel antiviral drug
candidate; a safety study has been completed and a Phase II clinical
trial is ongoing.
To meet the need for effective influenza management strategies, the
NIAID will continue to support a robust influenza antiviral research
portfolio, including discovery of drug targets, identification of
compounds with novel mechanisms of action, and clinical studies to
evaluate promising drug candidates.
stroke in women
Question. My State of Louisiana lays in the Stroke Belt, a group of
Southeastern States where stroke death rates are the highest in our
Nation. I am concerned about the seriousness of stroke, particularly
among women who account for 61 percent of stroke fatalities. Please
tell this subcommittee what studies the NIH is conducting to combat
stroke in women, including prevention and rehabilitation efforts. In
addition, please highlight planned activities in these areas.
Answer. The National Institute of Neurological Disorders and Stroke
(NINDS) supports a large and broad portfolio of stroke research that
includes numerous efforts to better understand and address the
substantial burden that stroke places on women.
The NINDS supports multiple research studies on the physiological
basis for gender-related differences in stroke risk and outcomes. One
study funded by the NINDS and the National Heart, Lung, and Blood
Institute (NHLBI) will follow a cohort of women to identify biological
and physiological markers associated with ischemic stroke, and to
establish which of those are influenced by sex hormones or menopausal
status. This study will inform future development of gender-specific
predictors for stroke risk. In another study, investigators will
explore how biological functions programmed by sex-specific chromosomes
are related to gender differences observed in cell death pathways
activated by a stroke. The NINDS also funds a study to investigate the
role of estrogen receptors in gender-related differences in incidence
of stroke associated with cardiovascular surgical procedures.
The NINDS supports a number of surveillance studies that aim to
illuminate differences in stroke knowledge, risk and outcomes among
different sub-populations, including women, in order to inform
development of tailored prevention intervention strategies. For
example, the Reasons for Geographical and Racial Differences in Stroke
Study (REGARDS) is a large cohort of more than 30,000 participants,
more than half of whom are women. This comprehensive assessment of
disparities in stroke risk and incidence is one of the largest
longitudinal cohort studies of African Americans and the only national
study of the epidemiology of cognitive change. The large representation
of women in this important population-based study is significant as it
allows for data analyses of gender-specific differences, as well as
among different racial populations. For example, a recent publication
from this study revealed that markers for inflammation led to more
accurate vascular disease risk stratification, particularly in blacks
and women, since they are at higher risk for increased levels of this
marker. Studies from REGARDS will continue to improve our understanding
of differences in stroke risk among a diverse U.S. population.
The NINDS supports a large number of clinical studies to improve
acute management and long-term outcomes in stroke. All of the NIH-
funded clinical trials are required to set and justify target
enrollment by race, ethnicity, and gender and to report on enrollment
progress. Approximately half of the participants in all of the NINDS-
supported stroke clinical trials are women so that data can be analyzed
for gender-specific differences. These trials are investigating new
approaches to treat acute stroke and brain hemorrhage, to reduce brain
damage due to stroke and to improve rehabilitation strategies, which
will provide all patients, including women, and their physicians with
more therapy options and a better chance of survival and recovery after
a stroke.
The NINDS is embarking on a new stroke planning effort in 2011 to
update research progress and activities in response to prior research
recommendations, and to identify a specific set of high priority areas
for advancing stroke research over the next 5-10 years. The planning
effort will specifically address stroke prevention, treatment, and
recovery in subpopulations, with a special emphasis on women and gender
differences. Recommendations from this planning effort will inform
future NINDS research investment and activities related to stroke in
women.
nci priorities
Question. Dr. Varmus, you have stated a desire for the NCI to
continue to fund as many grants as in previous years, even if this
means cuts in other areas, such as the Cancer Center program. Could you
tell us a bit more about your plans and priorities for the institute
and possible changes on the horizon?
Answer. Cancer is a complex disease requiring many approaches to
make progress. It is important to fund as many meritorious grants as we
possibly can within the resources we are given, because individual
grants allow us to pursue new ideas effectively. We will be finding
savings across the Institute by taking money away from routine
administrative expenses, making cuts to the intramural and Cancer
Centers programs, and by conducting reviews of large programs and
cutting where possible. This will allow us to achieve acceptable grant
levels and to protect certain imperatives.
In addition, realignment of the clinical trial cooperative groups,
as recommended by the Institute of Medicine report in 2010, will
improve the efficiency of the overall system and enable the cooperative
groups to conduct state of the art oncology research more consistently.
Funding for this effort is a priority for the NCI. A second imperative
is maintaining the pace of work on cancer genomics. The Cancer Genome
Atlas (TCGA), a project undertaken by the National Cancer Institute and
the National Human Genome Research Institute to gain an understanding
of the molecular basis of cancer, has already produced results in brain
cancer and ovarian cancer. The rate of discovery is dependent on the
level of funding. Therefore, we place a high priority on protecting
funding for this project and other meritorious efforts in cancer
genomics. As TCGA is expanded to include many cancer types, the
ultimate goal is to ensure that genetic information is applied to
prevention, diagnosis, and treatment of cancer in clinical practice.
______
Questions Submitted by Senator Richard J. Durbin
economic benefits of biomedical research
Question. According to a recent Families USA report, every $1
investment in medical research stimulates $2.43 in business activity--
such as support staff, supplies, food services, and building
development. Are you aware of other studies that attempt to quantify
the local impact of the Federal investment in medical research? Are
there any efforts underway at the NIH to capture the return-on-
investment that taxpayers receive as a result of the Federal commitment
to research?
Answer. To the best of our knowledge, there are two comprehensive
published studies that attempt a quantification of the economic effects
of the NIH spending at the State level, both supported by research
advocacy groups. Both studies rely on the Regional Input-Output
Modeling System (RIMS II), developed by the Bureau of Economic Analysis
at the Department of Commerce. RIMS II measures, at a State level, the
economic multiplier effect generated by local demand. National
aggregate averages are extrapolated from State data.
The first report was released in June 2008 by Families USA and was
titled ``In your own backyard.'' \1\ The report found, among other
things, that in fiscal year 2007, the NIH funding supported more than
350,000 jobs that generated wages in excess of $18 billion in the 50
States. The average wage for these jobs was $52,000. It also found that
$1 spent by the NIH funding generates $2.21 of business activity at the
State level. This $2.21 figure is an average; individual States may
vary (e.g., in Illinois, the figure is $2.43.)
---------------------------------------------------------------------------
\1\ FamiliesUSA. (2008). In Your Own Backyard: How NIH Funding
Helps Your State's Economy. Washington, DC. Retrieved December, 2008
from http://www.familiesusa.org/issues/global-health/publications/in-
your-own-backyard.html.
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More recently, in May 2011, the organization ``United for Medical
Research'' released a report, titled: ``An Economic Engine. NIH
Research, Employment and the Future of the Medical Innovation Sector.''
\2\ The report draws three conclusions: the NIH extramural research is
an important source of income and employment around the country; the
complementary relationship between public NIH investment and private
industry development is critical to the health and well-being of our
Nation; and the U.S. medical innovation sector is facing increasing
challenges in maintaining America's competitiveness and position as the
world leader in medical research. The report found that in fiscal year
2010, the NIH directly and indirectly supported nearly 488,000 jobs and
produced $68 billion in new economic activity and that $1 of the NIH
investments generated, on average, $2.60 of business activity, at the
national level.
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\2\ Ehrlich, E. (2011). United for Medical Research from http://
www.unitedformedicalresearch.com/wp-content/uploads/2011/05/
UMR_Economic-Engine.pdf.
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The NIH has worked closely with experts in the field of labor and
health economics and R&D evaluation on several projects. One of the
studies found that a one dollar increase in the NIH funding leverages
an additional 35 cents in funding from non-Federal sources.\3\
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\3\ Blume-Kohut, M., Kumar, K. B., & Sood, N. (2008). The Impact of
Federal Funding on University R&D. Retrieved November 7, 2009 from
http://www.rand.org/labor/seminars/brown_bag/pdfs/2008_sood.pdf
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Another study determined that 33 percent of all drugs approved by
FDA and 58 percent of approved priority review new molecular entities
(which tend to be the most innovative drugs) cite an NIH-funded
publication or an NIH patent.\4\
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\4\ Lichtenberg, F. R., & Sampat, B. (2011). What are the
respective roles of the public and private sectors in pharmaceutical
innovation? Health Affairs, 30(2), 332-338.
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Another study showed that multinational companies in the
pharmaceutical sector tend to locate their R&D facilities next to hubs
of skilled workers. This finding underscores the importance of the NIH
investments in sustaining a strong research infrastructure system in
the United States and avoiding the loss of private sector investments
in R&D that could be moved abroad.\5\
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\5\ Thursby, J. G., & Thursby, M. C. (2009). Is the US a Target of
R&D Globalization? Location, Type and Purpose of Biomedical Industry
R&D in New Locations: NBER. Report prepared for the NIH Office of
Science Policy Analysis.
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Another study, Economic Impact of the Human Genome Project (http://
www.battelle.org/publications/humangenomeproject.pdf), which was
commissioned by the Life Technologies Foundation and prepared by the
Battelle Technology Practice Foundation, assessed the benefits of the
Federal investment of the Human Genome Project (HGP). Finding that the
benefits are widespread and increasing over time, the report cites
among other factors, the production of 3.8 million job-years of
employment (one job-year for each $1,000 invested) and the generation
of personal income (wages and benefits) exceeding $244 billion over the
last 7 years, an average of $63,700 per job-year.
With regard to whether there are other efforts underway at the NIH
to capture the return-on-investment that taxpayers receive as a result
of the Federal commitment to research, the NIH is also participating in
the STAR METRICS Project.\6\ \7\ STAR METRICS is a collaboration
between Federal science agencies and research institutions to document
how Federal science investments support knowledge creation, economic
growth, workforce development and a broad range of societal outcomes.
The program's goal is to build a data infrastructure that will bring
together inputs, outputs, and outcomes from a variety of sources in as
open a fashion as possible.
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\6\ https://www.starmetrics.nih.gov/.
\7\ Lane, J., & Bertuzzi, S. (2011). Research funding. Measuring
the results of science investments. Science, 331(6018), 678-680.
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STAR METRICS has two levels and the NIH participates in both. Level
I documents the initial effect of S&T investments on employment using
administrative records from research institutions. This approach goes
beyond the RIMSII model, capturing the actual, rather than estimated,
number of jobs supported. Level II builds on Level I by connecting
sources of funding, recipients of funding, interactions among
scientists (in both the public and private sector) and the products of
research over time ranging from the most proximal (such as meeting
presentations and publications) to more distal (such as the development
of a new drug).
congenital heart disease (chd)
Question. Congenital Heart Disease (CHD) is one of the most
prevalent birth defects in the United States and a leading cause of
birth defect-associated infant mortality. Due to medical advancements
more individuals with congenital heart defects are living into
adulthood. Please provide an update of research within the NIH,
particularly the National Heart, Lung, and Blood Institute (NHLBI)
related to congenital heart defects across the life-span. The
healthcare reform law included a provision, which I authored, that
authorizes the CDC to track the epidemiology of congenital heart
disease, with an emphasis on adults with CHD and expanding
surveillance. If adequately funded, how could a population-surveillance
system for adults with CHD support the NIH's ability to investigate CHD
across the life-course and across subgroups?
Answer. The NIH supports research on CHD across the lifespan. For
example, as part of its Pediatric Heart Network, the NHLBI is following
participants in an earlier study of the Fontan surgical procedure to
assess functional health status, neurocognitive performance, and
transitions from pediatric care to adult care for CHD. Through its
Bench-to-Bassinet program, the NHLBI is examining the genetic causes of
CHD and the effects of genetic variation on the long-term clinical
outcomes of affected children as they grow older. The NHLBI also funds
a research partnership between the Adult Congenital Heart Association
and the Alliance of Adult Research in Congenital Cardiology that seeks
to improve care delivery and long-term outcomes for adults with CHD and
also to inform research designs for studies in adults. Through its
Pumps for Kids, Infants, and Neonates (PumpKIN) program the NHLBI
supports development of pediatric devices for congenital heart disease.
In addition, an investigator-initiated project seeks to develop a blood
pump for patients who have undergone the Fontan surgery. Patients who
have had the surgery experience significant morbidity due to diminished
blood flow, especially as they grow into adulthood, and a device to
assist blood flow could dramatically improve care.
An adequately funded population-surveillance system for adults with
CHD could facilitate the NIH research. The surveillance data would help
the NIH ensure that its research efforts address the full range of
heart conditions, risk factors, and complications across the lifespan;
provide the potential to link genetic and other biological information;
permit monitoring of the effectiveness of new preventive and
therapeutic strategies; and identify a potential pool of patients who
could benefit from participation in various research activities.
However, funding was not provided for this provision in the Affordable
Care Act, and no funds have been requested within the budget for the
Centers for Disease Control and Prevention to implement it.
the cancer genome atlas
Question. The National Cancer Institute is making tremendous
progress with the Cancer Genome Atlas (TCGA) in sequencing cancer
genomes and then using scientific discoveries to further specific
fields of cancer research. What is the status of the TCGA gastric
cancer project? Specifically, the pilot project to utilize contiguous
biopsies to sequence the genome for the diffuse gastric cancer subtype?
How will the NCI utilize these groundbreaking discoveries to further
the field of gastric cancer research? What other initiatives and steps
is the NCI taking to investigate gastric cancer?
Answer. TCGA staff and extramural researchers have been steadily
working on identifying, collecting, and assessing the quality of
gastric cancer biospecimens for inclusion into TCGA's genotyping and
molecular characterization pipeline. However, due to the difficulty in
obtaining qualifying biospecimens from patients with diffuse gastric
cancer, the NCI began to explore a pilot project for collection of
diffuse gastric cancer biospecimens. The challenges involved in this
pilot project of multiple gastric biopsies was discussed in detail in
May 2011 when the NCI hosted a workshop on gastric and esophageal
cancer, bringing together a group of international experts to explore
and discuss the basic biology, epidemiology, and clinical research
aspects of these cancers across the world. There was tremendous
interest in the pilot study from the gastric cancer researchers, and in
June 2011 the NCI approved TCGA to proceed with the pilot study to
collect biospecimens on a small number of diffuse gastric cancers from
the United States. The extent of the project will depend on the cost
per case and the number of centers willing to participate. We are
hopeful that analysis of these biospecimens will yield valuable
information that will stimulate novel research approaches for this
challenging disease and will lead to advances in the prevention,
diagnosis, and treatment of diffuse gastric cancer.
In addition to the TCGA-related efforts, an NCI Genome-Wide
Association Study (GWAS) on gastric adenocarcinoma and esophageal
squamous cell carcinoma has already revealed a common cancer
susceptibility region at PLCE1, and the NCI is funding follow-up
mechanistic studies on the effect of the gene variations in this
location. A second GWAS will be conducted in a mostly Caucasian cohort
to provide further clues about susceptibility regions and whether they
differ between populations that experience different rates of gastric
cancer. The NCI also funds broad based research at four
Gastrointestinal Cancer Specialized Programs of Research Excellence
(SPOREs), two of which include a focus on esophageal cancers.
eosinophilic-associated disorders research
Question. Eosinophilic-associated disorders were identified in the
last decade. Consequently many people go undiagnosed for years, due to
lack of information and awareness about these diseases. Please describe
current efforts at the NIH, particularly the National Institute for
Allergy and Infectious Diseases (NIAID) to investigate eosinophilic-
associated disorders. Last year, the Senate budget included report
language urging the NIAID to convene a working group to develop a
research agenda aimed at improving the diagnosis and treatment of
eosinophilic-associated disorders. What strides are the NIH and the
NIAID making to develop a research agenda focused on these conditions?
Answer. As the lead institute at the NIH responsible for research
on immunologic and allergic disorders, the NIAID is committed to
research to better understand the mechanisms that mediate tissue injury
when eosinophils accumulate, including eosinophilic gastrointestinal
disorders, a group of recently recognized allergic diseases associated
with the production of IgE antibodies and other immune responses to
food. The NIAID works closely with other NIH Institutes and Centers
supporting research on eosinophilic disorders. Although these
collaborations and communications do not occur through a formal working
group or a predetermined research agenda, they have led to jointly
sponsored workshops and research initiatives on eosinophilic disorders.
In fiscal year 2012, the NIH, with the NIAID as the lead, will
establish a working group with participation by relevant NIH Institutes
and Centers, to develop a trans-NIH strategy to improve the diagnosis
and treatment of eosinophilic disorders.
As part of its overall research agenda on immunologic and allergic
diseases, the NIAID pursues research on eosinophilic disorders through
a variety of efforts and collaborations. For example, the Consortium of
Food Allergy Research (CoFAR), co-funded with the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK), and renewed in
fiscal year 2010, develops new approaches to treat and prevent food
allergy. A new CoFAR project is examining the genetic aspects of
eosinophilic esophagitis. The NIAID Asthma and Allergic Diseases
Cooperative Research Centers (AADCRC) support basic and clinical
research on the mechanisms, diagnosis, treatment, and prevention of
asthma and allergic diseases, including food allergy and anaphylaxis.
Many of these disorders are associated with eosinophilia. In addition,
the NIAID-supported investigators are conducting a pilot clinical trial
to determine the efficacy of swallowed glucocorticoids for the
treatment of eosinophilic esophagitis, and developing novel noninvasive
diagnostic tools for eosinophilic gastrointestinal diseases to reduce
the number of endoscopies and biopsies that are currently performed.
Also, on behalf of more than 30 professional organizations, Federal
agencies, and patient advocacy groups, including the American
Partnership for Eosinophilic Disorders, the NIAID coordinated the
development of Guidelines for the Diagnosis and Treatment of Food
Allergy in the United States. This document includes clinical practice
guidelines for the diagnosis and management of eosinophilic esophagitis
associated with food allergy. The guidelines were published in the
December 2010 issue of the Journal of Allergy and Clinical Immunology
and can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/21134576.
The NIAID will continue its commitment to research and trans-NIH
research collaborations on eosinophilic disorders to understand the
mechanisms that mediate tissue injury when eosinophils accumulate. As
part of this effort, in fiscal year 2011, the NIAID will recompete the
AADCRC program.
______
Questions Submitted by Senator Mark Pryor
extramural research budget
Question. What percentage of the NIH's funding leaves the greater
Washington, DC area and goes to medical research in States and local
communities?
Answer. In fiscal year 2010, the NIH awarded 82 percent ($25.6
billion of $31.2 billion) of its budget to more than 3,000 institutions
and organizations across the United States, as well as several other
countries throughout the world, 71 percent ($22.1 billion) in grants
and 11 percent ($3.5 billion) in research and development contracts.
The percentage of the fiscal year 2011 budget devoted to extramural
research is also expected to be approximately 82 percent. An overview
of the NIH funding allocations by Institute and Center in fiscal year
2010, fiscal year 2011, and the fiscal year 2012 budget is available
at: http://officeofbudget.od.nih.gov/pdfs/FY12/
COPY%20of%20NIH%20BIB%20Chapter%202-9-11-%20FINAL.PDF.
personalized medicine as a priority
Question. As you well know, we are currently in a very difficult
economic time. The Congress is in the process of making many decisions
related to addressing the Nation's budget problems. We are considering
many ways to control our costs and minimize additional debt, but at the
same time, we have to prioritize and ensure that important programs are
adequately funded. Having said that, do you believe advances in
personalized medicine could be threatened should the Congress enact
cuts to the NIH's budget?
Answer. Through the application of genomic research and high-
throughput technologies, breakthroughs in our understanding of the
causes of many diseases and the identification of new targets and
pathways for the development of new therapeutics are within reach. For
example, a decade ago, diagnosis of cancer was based on the organ
involved and treatment depended on broadly aimed therapies that often
greatly diminished a patient's quality of life. Today, research in
cancer biology is moving treatment toward more effective and less toxic
therapies tailored to the genetic profile of each patient's cancer. The
NIH research is also identifying genetic markers that can predict
whether an individual will respond well to a particular medication or
will be at risk of having an adverse reaction. The NIH-funded
researchers are also uncovering information about genes and the
environment that will help point the way toward more personalized,
targeted treatments for other diseases. The new National Center for
Advancing Translational Sciences (NCATS) will provide the
infrastructure and technologies to bring these critical basic
discoveries to fruition through new diagnostics and therapeutics.
Significant budget cuts could threaten the NIH's ability to continue to
support these advances. However, the specific research areas that would
be affected in the event that budget cuts materialize cannot be
determined now since the NIH would need to re-evaluate its research
priorities.
______
Questions Submitted by Senator Richard C. Shelby
reorganization of ncrr programs
Question. There remain concerns within the Congress and the
research community with the decision to eliminate the National Center
for Research Resources (NCRR). Can you explain the rationale behind
this decision and where the National Center for Research Resources'
assets will be moved?
Answer. With the decision to move the Clinical And Translational
Science Awards (CTSAs) into the proposed National Center for Advancing
Translational Sciences (NCATS), it was necessary to consider the impact
of its transfer on NCRR and whether there were long-range benefits that
could be achieved by relocating its remaining programs within other NIH
components. A task force was formed to determine if the remaining
programs should be kept in a separate organization or if there was an
opportunity for greater scientific synergies by moving the remaining
programs to other NIH components. The task force was guided by the
following considerations and principles in developing its
recommendations:
--The scientific synergies that could be achieved by placing the NCRR
program in adjacency to existing (or in the case of the NCATS,
proposed) portfolio/mission of the recipient IC versus the
existing synergies among the NCRR programs.
--The ``goodness of fit'' for the NCRR program within the recipient
IC versus the negative effects of adding a program that is
disproportionately large and/or not well aligned to the
recipient IC's current (or in the case of the NCATS, proposed)
mission.
--The level of disruption to long-standing NCRR programs led by
dedicated NCRR staff versus the disruptive innovation from
reassigning NCRR staff to enable interactions with new
colleagues and/or new programs.
The Task Force agreed with the SMRB recommendation that the CTSAs
be placed in the proposed Center. The Task Force then determined that
the greatest scientific synergies could be achieved by placement of the
remaining programs to other components of the NIH. The Research Centers
in Minority Institutions (RCMI) program was proposed for placement in
the National Institute for Minority Health and Health Disparities; the
Institutional Development Award (IDeA) program was proposed for
placement in the National Institute for General Medical Sciences
(NIGMS); the Imaging and Point-of-Care Biomedical Technology Research
Center (BTRC) grants, and Biomedical Imaging, and Point-of-Care
research grants for Technology Research and Development were proposed
for placement in the National Institute of Biomedical Imaging and
Bioengineering; the remaining BTRCs and all other research grants for
Technology Research and Development, and the BIRN network grants were
proposed for placement in the NIGMS; the Gene Vector Repository was
proposed for placement in the National Heart, Lung, and Blood
Institute; and the Comparative Medicine Program, Extramural
Construction and Animal Facilities Improvement, Shared and High-End
Instrumentation, and Science Education Partnership Awards (SEPA) were
proposed for placement in a new Office of Research Infrastructure
Programs in the Division of Program Coordination, Planning, and
Strategic Initiatives in the Office of the Director.
The Task Force implemented a transparent process to collect and
consider input from a wide range of internal and external experts, as
well as stakeholders ranging from members of the public to members of
the extramural research community. As the deliberations progressed, the
NIH made information available to the public through a feedback page
available on its website. The final Task Force recommendations were
accepted by the NIH Director and the Secretary, and transmitted to the
House and Senate Appropriations Committees in a letter dated June 6,
2011. Additional budget details on the reorganization were provided to
the subcommittees on June 23, 2011.
basic and applied research balance
Question. How do you balance the NIH's goals in research aimed at
knowledge generation (basic research) versus translation of that
knowledge toward cures and improving human health (applied research)?
Will the NCATS help to achieve a better balance?
Answer. Basic research advances knowledge of fundamental biological
processes and elucidates the molecular underpinnings of human health
and disease. Basic research makes it possible to understand the causes
of disease onset and progression and opens up new avenues for
developing new and improved diagnostics, therapeutics, and preventive
strategies. Realizing the benefits of fundamental biomedical
discoveries depends on the translation of that knowledge into
strategies and products that treat disease and sustain and improve
health. It is important to understand that ``basic'' and
``translational'' research are inherently interrelated and comprise a
cyclical process. There are important feedback loops between the fields
so that advances in one ultimately yield new avenues for scientific
inquiry and discovery in the other. Breakthroughs in our understanding
of therapeutic targets and pathways also stimulate new avenues for
basic scientific inquiry. By studying the process of developing new
therapeutics and diagnostics in an open access environment, the NCATS
will ultimately catalyze the cycle of discovery in order to advance
public health.
From a funding standpoint, 54 percent of the NIH budget is devoted
to basic research and 46 percent to applied research, a ratio that has
not varied appreciably for decades. The NIH does not intend to shift
resources currently devoted to basic research to fund translational
research. The NCATS will be formed through the realignment of existing
translational research programs and, as such, will not affect the
balance of basic and applied research supported by the NIH. It will
certainly use discoveries made through basic research to advance its
work while also providing important insights for basic scientists to
pursue.
molecular libraries program as part of the ncats
Question. Dr. Collins, can you discuss the NIH Roadmap Molecular
Libraries Probe Production Center Network component of the NCATS. I
understand that this national network of centers provides for the first
time a sophisticated infrastructure for drug discovery to the academic
and nonprofit research community. What role will this program play in
the NCATS going forward?
Answer. The NIH Molecular Libraries Probe Production Center Network
(MLPCN), a component of the NIH Molecular Libraries Program (MLP), is a
collaborative research network that enables the generation of effective
and useful small molecule chemical probes for the entire biomedical
research community. Through support from the NIH Common Fund, the MLPCN
offers biomedical researchers access to large-scale screening capacity,
along with medicinal chemistry and informatics needed to convert the
large number of active compounds identified by high-throughput
screening into useful probes for studying the functions of genes,
cells, and biochemical pathways. Traditionally, these resources and
associated expertise have resided exclusively within the private
sector.
By providing early stage chemical compounds to the biomedical
research community, the NIH anticipates that the components of the MLP
can further enable researchers in both the public and private sectors
to validate new drug targets, which could then move into the drug-
development pipeline. This is particularly true for rare diseases,
which may not be attractive for development by the private sector. For
this reason, several components of the Common Fund's MLP are
transitioning to be funded and managed through the NCATS. These include
the Small Molecule Repository, Cheminformatics/PubChem, and the NIH
Chemical Genomics Center (NCGC), an intramural high-throughput
screening Center. The Common Fund will continue to provide support for
the Chemical Diversity technology development program, the Imaging
Probe Database, and the extramural Specialized Screening Centers.
the nih, academia, and industy relationship
Question. Much of the country's translational research has been
within the pharmaceutical industry and the biotechnology community. Can
you elaborate on the relationship between the NCATS and these entities?
Is there a change in roles in academia and the commercial world?
Answer. The process of translating fundamental knowledge into new
or better clinical applications is an exceedingly complex, costly, and
risk-laden endeavor. Moreover, the average length of time from target
discovery to FDA approval of a new drug is 14 years and the failure
rate exceeds 95 percent, i.e., fewer than one out of twenty projects
that enter the drug development pipeline will result in a new FDA-
approved product. At the same time, recent progress in genomics,
biotechnology, and other fields of biomedical research has advanced the
potential for development of new diagnostics and treatments for a wide
range of diseases, opening a wide door of opportunity in translational
science.
There is a growing recognition on the part of all those involved in
translational medicine that the current model for development is not
sustainable and that novel partnerships and collaborations are critical
to progress. The NIH is uniquely positioned to help bring about the
changes by complementing the translational efforts of each sector. To
achieve this goal, the NCATS will bring together resources and skilled
scientists to study the steps in the therapeutics development and
implementation process, consult with experts in academia and the
biotechnology and pharmaceutical industries to identify bottlenecks in
the processes that are amenable to re-engineering, and develop new
technologies and innovative methods for streamlining the processes.
Cross-sector collaborations will be an essential part of how the NCATS
operates.
future of r01 funds
Question. Will the establishment of the NCATS result in the loss of
R01 funds?
Answer. No. Funds for research project grants will not be affected
by the establishment of the NCATS, which is being created by realigning
several existing NIH translational research programs. The NCATS will
stimulate the pursuit of new avenues of scientific inquiry by
facilitating and complementing translational research efforts carried
out elsewhere at the NIH. It will not diminish the agency's commitment
to basic science. Moreover, the NIH requested an additional $100
million for the operation of the Cures Acceleration Network within the
NCATS, some of which would be used for research project grants.
process innovation and the ncats
Question. Dr. Collins, you have stated that ``process innovation''
is an important component of the NCATS. Can you explain what this is
and why it is important? How will process innovation relate to
individual disease-focused projects the NCATS may do?
Answer. Process innovation involves studying the therapeutics
development process with the goal of developing new approaches and
technologies that can strengthen and streamline the development
pipeline itself. By approaching the development pipeline as a
scientific question, the NCATS will identify bottlenecks in the
processes that are amenable to re-engineering and develop new
technologies and innovative methods for improving and advancing the
discovery, testing, and implementation of new therapeutics. Among the
specific developmental steps that may be addressed are target
validation, preclinical toxicology testing, clinical trial design, and
drug rescue and repurposing. In order to evaluate these innovations and
new approaches, the NCATS will undertake targeted therapeutics
development and implementation projects that may have relevance to
individual disease-focused projects.
reorganization of the comparative medicine program
Question. I have heard from several elite schools of medicine,
including Stanford, MIT, UAB, and Auburn that splitting the components
of the National Center for Research Resources' Comparative Medicine
program into different administrative entities would have a negative
impact on the NIH's critical scientific infrastructure. Dr. Collins,
can you address their concerns and share with the subcommittee a
solution to ensure components of the Comparative Medicine program
remains intact and together within the new organizational structure?
Answer. Initially, we had considered a number of options with
regard to the placement of the programs within the Division of
Comparative Medicine, including dividing them among relevant institutes
and centers. However, following extensive consultation with multiple
stakeholders, including grantees, professional organizations, and the
public, we concluded that it was important to keep the programs within
the Division of Comparative Medicine together because of their
intrinsic uniqueness and synergies. As such, the Division of
Comparative Medicine is to be transferred in its entirety to the new
Office of Research Infrastructure Programs in the Division of Program
Coordination, Planning, and Strategic Initiatives within the Office of
the Director.
broadening the idea program
Question. The National Center for Research Resources' Institutional
Development Award program broadens the geographic distribution of the
NIH funding for biomedical and behavioral research. It is my
understanding that the goal of the program is to expand biomedical
research capabilities to areas that currently lack it through research
and infrastructure funding opportunities and faculty development.
In its entirety, Alabama is a significant recipient of the NIH
funding, mainly due to the research funding received by its two medical
schools. While they provide great benefit to my State and Nation
through medical breakthroughs and economic investment, I am concerned
that their success puts other Alabama institutions at a competitive
disadvantage with similar institutions in IDeA-eligible States.
Has the NIH considered ways to include institutions in this program
from non-IDeA eligible States? If not, are there other avenues within
the NIH that could serve a similar role to IDeA for schools in States
where one or two universities' significant NIH funding limits their
access to preliminary support?
Answer. The current authorization language for the IDeA program
limits participation in the program to institutions located in States
with low aggregate success rates for obtaining NIH funding or States
that do not attain a particular level of support from the NIH. It does
not allow for participation by institutions from States with high
success rates or States that receive substantial support from the NIH.
In 2008, a working group of NCRR's advisory council, which was formed
to review the eligibility criteria for the IDeA program, explored
whether it would be possible to base eligibility on institutional or
regional success rates. The group was unable to identify an alterative
approach that met the intent of the law.
In States that are not eligible for IDeA, institutions with limited
NIH funding are encouraged to participate in are encouraged to apply
for Academic Research Enhancement Awards (AREA) http://grants.nih.gov/
grants/funding/area.htm which supports projects in the biomedical and
behavioral sciences conducted by faculty and students in health
professional schools, and other academic components that have not been
major recipients of the NIH research grant funds. In addition,
institutions could try to increase the NIH grant support by partnering
with institutions with more significant NIH funding. Such partnerships
can help build the experience and capacity necessary to successfully
compete independently for the NIH funding in the future.
gulf oil spill health effects research
Question. According to the NIH press statement, of the 40 known oil
spills in the past 50 years, the health effects have been studied from
only eight of those spills. I am pleased to see the NIH will begin to
review health effects of people impacted by the Deepwater Horizon oil
spill in the Gulf of Mexico. It is critical to understand how being
exposed to the oil and the dispersants may have affected the health of
cleanup workers and volunteers. Could you discuss how this study will
be conducted and what you are hoping the GULF Study will help us learn?
Answer. The Gulf Long-term Follow-up Study (GuLF STUDY) will help
determine if oil spills and exposure to crude oil and dispersants
affect physical and mental health. The National Institute of
Environmental Health Sciences (NIEHS) is leading this research. A major
facet of the study is to compare the health of clean-up workers and
others who did not do clean-up work to learn if health problems are
more common in workers. GuLF STUDY researchers will also examine other
factors that may explain why some people are more likely than others to
get sick and how stress affects health. The NIEHS will send
approximately 90,000 invitation letters to people to be included in the
study. Of this group it is expected that 55,000 will be enrolled and
complete telephone interviews. Participants will be interviewed about
their oil-spill clean-up jobs, demographic and socioeconomic factors,
occupation and health histories, and current health, including stress
and mental health. About half of the cohort will be asked to complete a
brief clinical examination in their home. The home exam will include
additional health questionnaires and collection of biological samples,
such as blood and urine, and environmental samples, e.g., house dust.
The exam will include basic clinical measurements such as height,
weight, blood pressure and tests of lung function. The home exams will
largely target workers residing in the four most affected Gulf States--
Louisiana, Mississippi, Alabama, and Florida). All cohort members will
be followed for development of a range of health outcomes. Follow-up of
the entire cohort is initially planned for 10 years, with extended
follow-up possible depending upon scientific and public health needs
and the availability of funds.
GuLF STUDY researchers are hoping to learn if exposure to
constituents of oil, dispersants, and oil-dispersant mixtures during
oil spill clean-up is associated with adverse health effects,
particularly respiratory, neurological, hematologic, and mental health.
In addition, this research is anticipated to reveal biomarkers of
potentially adverse biologic effects associated with oil spill-related
exposures. Results of the study will provide further insight into how
stress and job loss can affect health, including mental health.
Overall, the findings may influence long-term public health responses
in Gulf communities or responses to other oil spills in the future.
cystic fibrosis research
Question. In February, the NIH announced that federally funded
research led to the development of a very promising therapy that
targets the genetic defect that causes Cystic Fibrosis. How will the
fiscal year 2012 NIH budget request support additional research on
Cystic Fibrosis?
Answer. Cystic fibrosis (CF) research continues to be a high-
priority area. The NIH estimates the fiscal year 2012 budget request
would support about $88 million for CF research, ranging from basic
science studies through clinical trials. The results of our prior
investments have provided enormous benefit to affected patients.
Whereas years of life expectancy for children born with CF could once
be counted on the fingers of one hand, today average survival is 37
years and some patients live into their 50s and beyond. Evidence-based
improvements in nutrition, infection control, and symptom management
have substantially enhanced the quality of life of affected persons.
Newborn screening for cystic fibrosis, now universal in the United
States, is not only enabling early interventions but also providing
unprecedented opportunities for effective translation of new research
advances into clinical practice.
With improved understanding of CF biology, advances in experimental
methods, and growing availability of new targets for interventions, we
anticipate that CF research will be especially productive in the next
few years and that tangible improvement in patient outcomes will
follow. The recent NHLBI workshop ``Future Research Directions in the
Pathogenesis, Treatment, and Prevention of Early Cystic Fibrosis Lung
Disease'' identified a number of important topics for future research
that can be pursued as funding permits. They include work with animal
models to understand how early lung disease develops, identification of
genetic and environmental factors that modify the manifestations and
course of CF, examination of the role of mutant CFTR (the defective
gene product in CF) in airway growth and development, and exploration
of the mechanisms that underlie CF-related diabetes and liver disease.
The NIH will continue to adjust its research portfolio in CF to ensure
that needs and opportunities for advancing research are addressed.
the nih-fda collaborations
Question. The development of treatments for diseases, especially
rare diseases, is an expensive and lengthy process. A very small
percentage of potential medicines even make it to the clinical research
stage, let alone to FDA review. What can the NIH do to reduce some of
the regulatory requirements that both slow the pace and increase the
cost of medical research, but that add little meaningful
accountability?
Answer. The NIH is taking a multi-pronged approach to promote
efforts to address unnecessary, inconsistent, and duplicative
regulatory requirements. We work closely with FDA and the Office for
Human Research Protections to enhance the consistency of regulations
governing clinical research. Through the NIH-FDA Joint Leadership
Council, we are working with FDA to help ensure that regulatory
considerations are a component of scientific research at all phases of
development and they are informed by the most current science and
technologies. Such efficiencies along with targeted support for the
development of novel technologies including new and improved
preclinical toxicology approaches for testing safety should quicken the
pace and reduce the human-related costs of medical research. The
proposed National Center for Advancing Translational Sciences will be
focused on studying diagnostics and therapeutics development, testing,
and implementation; identifying bottlenecks amenable to re-engineering;
and formulating innovative methods to streamline the process.
clinical trial process
Question. One of the priorities of the Joint NIH-FDA Leadership
Council is to optimize and maximize data from clinical trials. Would
you consider working with the FDA to grant greater flexibility
regarding the approval of orphan drug therapies on the basis of a
single, well-designed trial?
Answer. The FDA and the NIH have complementary roles and
functions--the NIH supports and conducts biomedical and behavioral
research and the FDA ensures the safety and effectiveness of medical
and other products. The NIH does not share regulatory authorities with
the FDA, i.e., we do not make decisions about regulatory pathways or
the approvability of investigational products. However, we certainly
have common goals and are working closely in a number of ways to
address issues related to therapeutics development and regulatory
science. As you noted, the agencies are working at the leadership level
through the NIH-FDA Leadership Council, formed in 2010, to help ensure
that regulatory considerations form an integral component of biomedical
research planning and that the latest science is integrated into the
regulatory review process. The challenges associated with the
development and review of therapies for rare and neglected diseases,
such as the availability of alternative regulatory pathways for trials
of rare diseases and the level of scientific evidence needed for
approval of a new orphan therapy, are among the specific topics of
mutual interest. We also collaborate closely on issues associated with
the development of new cancer diagnostics and therapeutics through an
interagency oncology task force and, in accord with the provisions the
Best Pharmaceuticals for Children Act, to advance the development of
preclinical and clinical methodologies that provide optimal approaches
for treating diseases in childhood. We believe all of these efforts can
go a long way toward achieving our common goal of advancing public
health by promoting the translation of basic and clinical research
findings into medical products and therapies.
______
Questions Submitted by Senator Thad Cochran
transfer of the idea program to the national institute of general
medical sciences (nigms)
Question. The NIH has proposed the elimination of the National
Center for Research Resources (NCRR). I am particularly concerned that
this elimination will affect the Institutional Development Award
(IDeA), which has benefitted my home State of Mississippi. Under the
proposal, the IDeA program will be moved to the National Institute of
General Medical Sciences. There have been concerns expressed that the
IDeA program should not be placed in an Institute with a defined
constituency. Dr. Collins, can you elaborate on the decision process
for moving IDeA to the National Institute of General Medical Sciences?
Why do you think this is the best Institute to house the IDeA program?
Answer. The IDeA program fosters research and enhances the
competitiveness of investigators at institutions located in States in
which the aggregate success rate for applications to the NIH has
historically been low. By its nature, the IDeA program extends beyond
traditional capacity building in supporting research projects that are
designed to strengthen future investigator-initiated research
applications, most of which are aimed at addressing basic science
questions. The National Institute of General Medical Sciences (NIGMS)
has a basic science mission as well as a longstanding focus on
institutional capacity building and career development. Given these
synergies, the NIGMS was determined to be the optimal new home for the
IDeA program. The NIH reached this conclusion based on a careful
analysis of existing NCRR programs as well as extensive consultation
with stakeholders across the scientific community and input from the
NIH Institutes and Centers, including NCRR leadership and staff.
jackson heart study impacts
Question. African Americans are more likely to be diagnosed with
coronary heart disease, and they are more likely to die from heart
disease. Due to this greater prevalence, the Jackson Heart Study is
exploring the reasons for this disparity and uncovering new approaches
to reduce it. Can you discuss the impacts this study will have?
Answer. The goals of the Jackson Heart Study (JHS) are to determine
the roles of established risk factors such as obesity, dyslipidemia,
and high blood pressure in the development and progression of
cardiovascular disease (CVD) and to identify factors related to the
emergence of such risk factors. Moreover, the study seeks to shed light
on the contributions of sociocultural factors (e.g., stress, racism,
discrimination, and coping strategies) and familial/hereditary factors,
genetic variants, and gene--environment interactions to the development
of CVD and its risk factors. Based on our experience with other NHLBI-
funded epidemiological studies of CVD such as the Framingham Heart
study, we expect the JHS to provide important information that will
help researchers to generate new hypotheses and design studies to test
interventions to prevent CVD. Ultimately, we expect the results of the
JHS to benefit not only Mississippians but also African Americans
beyond the participants in the study.
The JHS also seeks to build research capabilities in minority
institutions, address the critical shortage of minority investigators
in epidemiology and prevention, and reduce barriers to dissemination
and use of health information in a minority population. The JHS
educational and community outreach components are very strong;
consequently, the research findings will be efficiently disseminated
among participants. The JHS training component continues to provide
outstanding opportunities to inspire, motivate, and educate students to
become research leaders and to study and disseminate important findings
on prevention of CHD.
staffing the jackson heart study
Question. The Jackson Heart Study is the largest epidemiologic
investigation of Cardiovascular Disease among African Americans in the
United States. The National Heart Lung and Blood Institute opened a
field office in Jackson to provide scientific investigators and support
staff to the study. It is my understanding that this one-person office
will soon have no staff due to the staffer leaving Jackson. I am
concerned that the National Heart Lung and Blood Institute may not fill
the position quickly which would result in an adverse effect on the
Jackson Heart Study. It is vital that the field site maintain strength
to support scientific research at the Jackson Heart Study. Dr. Collins,
can I have your assurance that the National Heart Lung and Blood
Institute will replace this position in a timely manner?
Answer. At present, the National Heart, Lung, and Blood Institute
(NHLBI) medical officer stationed at the Jackson Heart Study site plans
to remain there indefinitely. Should the position become vacant in the
future, the NHLBI would promptly pursue recruitment via standard
competitive procedures.
geographic health disparities for stroke and obesity
Question. Health disparities are persistent across ethnic
populations as well as geographically. Geographic isolation,
socioeconomic status, and health risk behaviors contribute to health
disparities in these rural communities. Mississippi is part of the
``Stroke Belt'' and has the highest rate of obesity in the Nation. Both
of these issues are persistent problems in the rural South, with 10 out
of 11 States with the highest rates of obesity being in the South. Dr.
Collins, how is the NIH addressing the geographic issues associated
with many of the most serious diseases affecting our Nation?
Answer. The NIH supports a broad portfolio of research to
understand the complex factors that contribute to obesity, stroke, and
related health problems, and to develop and evaluate prevention and
treatment strategies for diverse populations.
The Look AHEAD clinical trial, supported by the National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK) and other NIH
components, is determining whether lifestyle intervention improves
health in overweight/obese people with type 2 diabetes, and in
particular the impact of the intervention on the incidence of
cardiovascular events, including stroke, heart attack, hospitalized
angina, and cardiovascular-related death. For the first four years of
this long-term study, participants in the lifestyle intervention group
lost more weight and improved their blood pressure, fitness, glucose
control, and good cholesterol, with less use of medication, compared
with those in the control group. Look AHEAD includes sites across the
country, including in Alabama, Louisiana, and Tennessee.
A major National Institute of Neurological Disorders and Stroke
(NINDS)-funded epidemiological study related to the ``Stroke Belt'' is
the REGARDS study (REasons for Geographic and Racial Differences in
Stroke) in which investigators are exploring the geographical and
racial differences in stroke risk in a cohort of about 30,000
individuals, about half of whom reside in the Stroke Belt region of the
United States. This study also includes measures of functional
cognitive decline, which may be a risk factor for stroke as well as a
marker for unrecognized stroke. Data generated from this study has led
to more than 70 publications, and will continue to help researchers
pinpoint the reasons that the stroke death rate is higher in this
region, and among African Americans, and to develop targeted strategies
for intervention. Recent data from REGARDS indicated that overall time
spent in the Stroke Belt is more predictive of hypertension--a powerful
risk factor for stroke--than is current residence in the Stroke Belt.
Data from the REGARDS study have also revealed that stroke survivors
were more likely to have unrecognized hypertension and diabetes.
To improve stroke care utilization and patient outcomes among
vulnerable populations, the NINDS also invests in research to increase
stroke awareness and reduce the time from symptom onset to hospital
arrival, so that patients can be evaluated and treated in a timely
manner.
In one such study, a novel behavioral intervention will be tested
in which children in high risk, minority communities are taught through
Hip Hop Stroke (stroke rap songs and animated musical cartoons) to
recognize and act on the five cardinal stroke symptoms and the
importance of early treatment, with the hopes that they will
communicate this information to their parents. Preliminary pilot data
indicated that 74 percent of children communicated the material to
their parents, which significantly improved their stroke knowledge.
In the SWIFT (Stroke Warning Information and Faster Treatment)
study, a culturally sensitive educational intervention focused on
improving knowledge retention and time of arrival to the emergency
department has been tested in minority communities. The outcome and
results of this study are currently under review in a major medical
journal.
The ASPIRE program (Acute Stroke Program of Interventions
addressing Racial and Ethnic disparities) is currently testing
strategies to overcome community/socio-cultural and system barriers to
stroke treatment with the goal of increasing the number of stroke
patients treated with the clot-busting drug, tissue plasminogen
activator (tPA), in six Washington, DC, hospitals.
Ten years ago, the NINDS convened a Stroke Progress Review Group
(SPRG) to identify and prioritize scientific opportunities in stroke
research. In 2011, the NINDS will embark on a new stroke planning and
evaluation effort, which will identify a specific set of high priority
areas for advancing stroke research over the next 5-10 years. The topic
of health disparities in stroke will be included as a cross cutting
topic in this effort.
cardiovascular disease research
Question. Cardiovascular Disease is the leading cause of death in
Mississippi, accounting for more than 40 percent of all deaths. In
2004, the State of Mississippi implemented a 10-year plan to address
Cardiovascular Disease risk factors in a two-fold approach: prevention
of potential risk factors and management of existing risk factors. In
addition, the Jackson Heart Study is the largest investigation of
causes of Cardiovascular Disease in an African-American population.
While both initiatives are good starts to addressing this health issue
in my home State, Cardiovascular Disease is the number one killer in
the United States and we need comprehensive research to fight the
disease nationwide. What plans do you have to increase research in the
area of Cardiovascular Disease?
Answer. The NHLBI is committed to supporting a comprehensive
research program on the causes, prevention, diagnosis, treatment,
monitoring, and management of cardiovascular disease (CVD). We invest
63 percent of the NHLBI extramural budget in CVD research, and we
intend to continue that high level of support. This year, the Institute
has launched a number of new projects, including two major clinical
trials:
--The International Study of Comparative Health Effectiveness with
Medical and Invasive Approaches (ISCHEMIA) addresses management
of patients with stable coronary heart disease who have
substantial ischemia on a cardiac stress test. The trial will
evaluate whether an invasive approach (performing an angiogram
and then opening or bypassing any blockages with stents or
surgery) plus optimal medical therapy is better than optimal
medical therapy alone in forestalling CVD events. Quality of
life and cost-effectiveness will also be assessed.
--The Cardiovascular Inflammation Reduction Trial (CIRT) addresses
cardiovascular disease risk reduction in heart-attack survivors
with persistently high levels of C-reactive protein, an
indicator of inflammation. The trial will evaluate whether a
very low dose of the anti-inflammatory drug methotrexate
reduces rates of recurrent heart attack, stroke, and
cardiovascular death. Several other conditions that have an
inflammatory basis, such as diabetes, venous thromboembolism,
and atrial fibrillation, will also be assessed.
The NHLBI has responsibility for cardiovascular, lung, and blood
diseases that affect millions of people worldwide. We will continue our
longstanding emphasis on the support of a balanced research portfolio
that addresses the many public health needs and scientific
opportunities that fall within our mandate.
______
Questions Submitted by Senator Lamar Alexander
reorganization of national center for research resources (ncrr)
programs
Question. In my State of Tennessee, the largest single Federal
grant at one of the State's largest medical research institutions is a
Clinical and Translational Science Award (CTSA), for $40 million. How
will this program and others like it be affected by the dissolution of
the NCRR, and the creation of the National Center for Advancing
Translational Sciences (NCATS)?
Answer. The NIH is committed to supporting each program currently
housed within the NCRR; the proposed reorganization will not adversely
affect the individual programs. Indeed, a careful programmatic
evaluation concluded that important scientific synergies could be
gained by moving NCRR programs to other NIH components with adjacent
scientific missions. Staff responsible for administering and directing
these programs will transfer with their respective programs to ensure
continuity and oversight. With regard to the Clinical and Translation
Science Awards (CTSA) program specifically, it is to be transferred to
the proposed National Center for Advancing Translational Sciences
(NCATS). The transfer was recommended by the NIH Scientific Management
Review Board, a congressionally-mandated advisory committee to the NIH
Director, and further supported by an internal NIH task force charged
with assessing the optimal location for NCRR programs. The task force's
analysis confirmed that the goals of the CTSA program were in close
alignment with those of the new center. Decisions regarding the
selection of individual CTSAs will continue to be made based upon each
proposal's scientific merit and program relevance.
ctsa program mission
Question. Given the established focus of the NCATS on drug
development, will the CTSA's continue to be able to build on the
programs of training, career development for young investigators,
research informatics, community engagement and clinical research
infrastructure?
Answer. The focus of the NCATS is to develop new and innovative
approaches to conducting research across the therapeutic development
pipeline, in the context of strengthening and streamlining the process
itself. The CTSAs have the infrastructure and diverse expertise that
supports translational research, including training and career
development for the next generation of clinical investigators,
informatics, and community engagement, and they will be integral to
fulfilling the NCATS mission. The CTSAs are making important
contributions in transforming translational research across the
country, and the NIH is committed to building upon the program's
successful efforts. Ensuring that the pipeline of new investigators is
sufficiently equipped to tackle the challenges associated with
translational science through training and mentoring is an inherent
part of the NCATS mission and will continue to be an essential
component of the CTSAs.
personalized medicine
Question. Physicians and researchers in Tennessee are investing a
great deal in the science of personalized medicine. Can you tell us
what the term ``personalized medicine'' means to you, and what role you
see for the NIH?
Answer. The concept of ``personalized medicine'' is based on the
idea that one size does not fit all when it comes to the practice of
medicine. Knowledge gathered from basic research and clinical studies
have demonstrated that individuals are highly unique in their
susceptibility to disease, reaction to medical treatments, and response
to environmental and social factors. More than ever before, and largely
thanks to research supported by the NIH, we now have the tools to
understand, describe, and quantify these biological differences as well
as the power to better predict which available treatments are optimal
for certain patients and to design rationale-based new targeted-based
therapies.
The NIH will continue to play a pivotal role in the advancement of
personalized medicine. For example, our support for pharmacogenomics
research will advance understanding of the predictive roles and
influences of genes in drug response. Findings from such research can
help identify the right drug for the right patient at the right time.
Increasingly, this information will help doctors calculate dosages that
match a person's unique physiology. Pharmacogenomic information already
is contained in approximately 10 percent of FDA-approved drug labels,
helping to prevent the inappropriate use of diagnostics and therapies.
Pharmacogenomic knowledge can also reduce the financial, emotional, and
physical costs associated with the current trial-and-error based
approach to treatment. Knowing each patient's DNA sequence is expected
to add efficiencies and new research capabilities to current endeavors.
As such, we are also fostering technological advances that are expected
to bring down the cost of sequencing an individual genome to under
$1,000. These advances will help make genetic analysis a routine part
of medical care and a revolutionary factor in approaches to basic
research and practice.
dna databanks
Question. Several major research institutions are creating
databanks that allows researchers to access a large collection of human
DNA. How does the NIH also plan to build on the mapping of the human
genome by optimizing unique resources such as this?
Answer. In support of its mission to improve public health through
research, the NIH has a longstanding policy of making data publicly
available from the research that it funds. The NIH recognizes that data
sets are not only valuable for addressing the questions that the
experiments that generated them were designed to ask, but also can be
powerful resources when combined with other data sets or used to answer
other scientific questions. This is particularly true of DNA data sets
that consist of information across the full sequence of the human
genome. Consequently, building on the data sharing practices that
characterized the Human Genome Project, the NIH launched research
programs to stimulate the creation of genomic resources and created
policies and tools for facilitating the sharing of genomic data to
capitalize on the databanks created by other institutions with or
without the NIH funding.
For example, under the leadership of the National Human Genome
Research Institute (NHGRI) the International HapMap Project used the
reference human genome sequence to build a comprehensive map (database)
of the variation within human DNA sequences, so that ``spelling''
differences in the DNA code of those with disease and those without
disease could be identified and studied. The 1000 Genomes Project is
now capitalizing on technological advances to extend and deepen the
HapMap data. All data from each of these projects are publicly
available to any investigator through the web with regular updates as
new data are generated.
In addition, to leverage the infrastructure and databank resources
created at other research institutions, the NIH has introduced funding
programs, such as the NHGRI-supported Electronic Medical Records and
Genomics (eMERGE) Network. This consortium of U.S. medical research
institutions has the primary goal of developing, disseminating, and
applying approaches to research that combine existing DNA
biorepositories with electronic medical record (EMR) systems for large-
scale, high-throughput genomic research. eMERGE Network institutions
use their own databanks (e.g., Vanderbilt University's BioVU DNA
databank) for this program, but all data are shared through an NIH
database, the database of Genotypes and Phenotypes (dbGaP), which
provides centralized and consistent access to researchers around the
globe. Importantly, dbGaP includes not only eMERGE data, but data from
studies across the disease spectrum. Extremely rich databanks from
studies such as the Framingham Heart Study, The Cancer Genome Atlas,
and many other projects reside within dbGaP, enabling many more
investigators to analyze the data as independent or combined data sets.
The standardization of access supported by the NIH facilitates cross-
study analyses, enables expansion of the study design beyond the
initial research focus of the individual databanks, and increases the
statistical power to identify the genetic contributors to common
diseases that create substantial public health burden. And,
importantly, all of these benefits are achieved through robust data
sharing policies intended to protect the interests of the research
participants who contribute their personal information to the
individual databanks.
industry investment in genome sequencing
Question. How does private investment in genome sequencing help to
leverage the Federal investment of genomic research through the NIH
funding?
Answer. The sequencing of the human genome has rightly been
regarded as one of the most important scientific undertakings of the
modern era. The NIH's investment in genomics has been, and continues to
be wide-ranging, from basic research to uncover and understand the
structure of our genome to translational science aimed at using a
patient's DNA code to tailor treatment. Enabling all of this research
are innovative new tools for DNA sequencing that have precipitated a
drop in the cost of sequencing an individual genome from hundreds of
millions of dollars to $15,000 or less.\2\ In the process, an entire
industry of genomics-focused companies has been created, one that,
according to a recent study conducted by Battelle Technology
Partnership Practice, has generated an economic contribution of almost
$800 billion since the start of the Human Genome Project.\3\ \4\
---------------------------------------------------------------------------
\2\ Additional information on sequencing costs is available at
http://www.genome.gov/27541954.
\3\ http://www.battelle.org/publications/humangenomeproject.pdf.
\4\ Additional information on the economic impact of the human
genome project is available at http://www.genome.gov/27544383.
---------------------------------------------------------------------------
The field of genomics has benefited from a combination of public
and private investment. During the course of the last 10 years, the
National Human Genome Research Institute's Genome Technology Program
has provided support for the development of almost all of the currently
commercialized, as well as several yet-to-be-commercialized or
emerging, sequencing technologies. Private investment during and since
that initial period of the NIH support has and will continue to bring
these innovative advances to the market. Newer and increasingly cheaper
sequencing machines and reagents have increased both capacity and
productivity, enabling the NIH grantees to answer more research
questions in the same period of time and for the same cost as
previously. Illumina and Life Technologies, for example, have now
developed smaller and less expensive sequencing machines that are
bringing DNA sequencing within reach of single-investigator research
labs. Affordable access to these technologies will greatly amplify the
number of researchers that can employ genomic sequencing within their
research plans, expanding the benefit of the Federal investment in
genomic sequencing into yet more basic, translational, and clinical
research domains. Companies like Illumina and Complete Genomics are
also offering sequencing services that the NIH-funded researchers have
used to great effect, such as the discovery last year of the causative
genes behind rare disorders like Miller syndrome, something that had
eluded science until now.\5\
---------------------------------------------------------------------------
\5\ http://www.sciencemag.org/content/328/5978/636.
---------------------------------------------------------------------------
______
Questions Submitted by Senator Lindsey Graham
eosinophilic disorders working group
Question. I have heard from individuals in my State about the
enormous challenges to children with eosinophilic disorders and their
families. I understand that these conditions are often misdiagnosed and
there is no cure for these children, many of whom suffer from extreme
pain and are unable to eat normal food. This subcommittee has asked
that the NIH convene a working group on this topic. When will this
group meet and when can we expect to have a report of the group's
recommendations?
Answer. Eosinophilic gastrointestinal disorders (EGID) are a group
of diseases characterized by a wide variety of gastrointestinal
symptoms including abdominal pain, swallowing problems, food impaction
(food lodged or wedged in the esophagus), vomiting, diarrhea, growth
impairment and bleeding. EGIDs are associated with increased numbers of
eosinophils, a type of white blood cell, in the gastrointestinal
lining. The most common EGID, eosinophilic esophagitis, is
characterized by inflammation and accumulation of eosinophils in the
lining of the esophagus. This disease and other EGIDs are diagnosed by
a patient's clinical history plus endoscopy with biopsy.
As the lead Institute at the National Institutes of Health (NIH)
responsible for research on immunologic and allergic disorders, the
National Institute of Allergy and Infectious Diseases (NIAID) works
closely with other NIH Institutes and Centers supporting research on
eosinophilic disorders. Although these collaborations and
communications do not occur through a formal working group or a
predetermined research agenda, they have led to jointly sponsored
workshops and research initiatives on eosinophilic disorders. In fiscal
year 2012, the NIH, with the NIAID as the lead, will establish a
working group with participation by relevant NIH Institutes and
Centers, to develop a trans-NIH strategy to improve the diagnosis and
treatment of eosinophilic disorders.
As part of its overall research agenda on immunologic and allergic
diseases, the NIAID pursues research on eosinophilic disorders through
a variety of efforts and collaborations. For example, the Consortium of
Food Allergy Research (CoFAR), co-funded with the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK), and renewed in
fiscal year 2010, develops new approaches to treat and prevent food
allergy. A new CoFAR project is examining the genetic aspects of
eosinophilic esophagitis. The NIAID Asthma and Allergic Diseases
Cooperative Research Centers (AADCRC) support basic and clinical
research on the mechanisms, diagnosis, treatment, and prevention of
asthma and allergic diseases, including food allergy and anaphylaxis.
Many of these disorders are associated with eosinophilia. In addition,
the NIAID-supported investigators are conducting a pilot clinical trial
to determine the efficacy of swallowed glucocorticoids for the
treatment of eosinophilic esophagitis, and developing novel noninvasive
diagnostic tools for eosinophilic gastrointestinal diseases to reduce
the number of endoscopies and biopsies that are currently performed.
Also, on behalf of more than 30 professional organizations, Federal
agencies, and patient advocacy groups, including the American
Partnership for Eosinophilic Disorders, the NIAID coordinated the
development of Guidelines for the Diagnosis and Treatment of Food
Allergy in the United States. This document includes clinical practice
guidelines for the diagnosis and management of eosinophilic esophagitis
associated with food allergy. The guidelines were published in the
December 2010 issue of the Journal of Allergy and Clinical Immunology
and can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/21134576.
The NIAID will continue its commitment to research and trans-NIH
research collaborations on eosinophilic disorders to understand the
mechanisms that mediate tissue injury when eosinophils accumulate. As
part of this effort, in fiscal year 2011, the NIAID will recompete the
AADCRC program.
______
Question Submitted by Senator Jerry Moran
budgetary effects on the nci programs
Question. Dr. Collins, I recently visited the University of Kansas
and was given a tour of the University's drug discovery, delivery, and
development operation. This visit helped demonstrate to me not only the
many elements that will become part of the application by the
University for National Cancer Institute (NCI) comprehensive cancer
center designation, but also the impressive role that the NCI's cancer
centers play across the Nation. This network of centers drives basic
research, brings individuals into clinical trials, and, most
importantly, leads to the development of new treatment advances that
will change the course of cancer for all Americans and individuals
across the globe.
While I understand that the University of Kansas' application for
the NCI designation will be determined on its scientific merits, can
you please explain how the NCI cancer center program will be affected
by the proposed budgets of the NIH and the NCI?
Additionally, considering possible scenarios for the fiscal year
2012 budget, what will the effects of such scenarios be on current NCI
programs and on the prospect for funding the review of new
applications?
Answer. The the NCI-designated Cancer Centers are an important part
of the NCI's research portfolio, and they play a unique and valuable
role in providing cutting-edge cancer care and access to the NCI-
sponsored clinical trials across the country. The final fiscal year
2011 appropriation has already necessitated a 5 percent reduction in
funding below fiscal year 2010 for the cancer centers, and it is
difficult to predict how they will be affected by the resolution of the
fiscal year 2012 budget.
The NCI's first priority must be to preserve funding for Research
Project Grants (RPGs). Ensuring support for as many new RPGs as
possible will enable investigators, especially new investigators, to
pursue novel ideas that will preserve the pipeline of innovative cancer
research. This year, nearly every NCI program budget has had to be
trimmed in order to award adequate, though reduced, number of new RPGs.
SUBCOMMITTEE RECESS
Senator Harkin. Is there anything else that any one of you
would like to state for the record now? If not--Yes.
Dr. Collins. Well, Senator, I'd just like to thank you and
this subcommittee for your steadfast support for biomedical
research.
All of us involved in this enterprise sitting here at this
table, and many others who are not at the table, but who are
engaged every day in this effort to try to find interventions
for people with disease appreciate your support and your strong
voice that, even in difficult times, medical research is
basically a societal good.
I think a society ultimately will be judged by the ways in
which, even in difficult times, priorities are chosen.
We think, in terms of alleviating suffering as well as
encouraging our American competitiveness and our economic
growth, that what we are able to do through NIH is a very good
story indeed, but we appreciate the fact that you have convened
this hearing and given us a chance to tell some of that story.
Senator Harkin. Well, thank you very much, Dr. Collins, and
I can just reciprocate then I'll join all my colleagues in
thanking you and all of you and all your colleagues at the NIH,
all the Directors, the people who work there, and through you
the whole network of researchers, young and old, some of who
have just come on, some who have been there for many years, to
thank you for your outstanding public service. All of you,
every single person engaged in NIH, thank you.
The subcommittee will stand recessed.
[Whereupon, at 11:45 a.m., Wednesday, May 11, 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 2012
----------
WEDNESDAY, JULY 27, 2011
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:05 a.m., in room SD-124, Dirksen
Senate Office Building, Hon. Tom Harkin (chairman) presiding.
Present: Senators Harkin, Durbin, Landrieu, Reed, Pryor,
Brown, Shelby, Cochran, Alexander, Moran, and Kirk.
DEPARTMENT OF EDUCATION
Office of the Secretary
STATEMENT OF HON. ARNE DUNCAN, SECRETARY
OPENING STATEMENT OF SENATOR TOM HARKIN
Senator Harkin. The Senate Appropriations Subcommittee on
Labor, Health and Human Services, and Education will please
come to order.
Secretary Duncan, welcome back to the subcommittee. This is
obviously a critical moment to be talking about education
funding. The Nation will default on its loans in just 6 days
unless Congress raises the debt ceiling; we all know that. I
believe that to bring Federal deficits under control, we must
be willing to make some tough, but necessary, budget choices.
But we must be just as willing to say no to foolish and
destructive choices. And this is especially true when it comes
to funding for the education of our children.
2011 CONTINUING RESOLUTION IMPACT ON EDUCATION BUDGET
The fiscal year 2011 continuing resolution eliminated 37
education programs totaling more than $900 million. Those cuts
included the successful Striving Readers initiative, the
Federal Government's only comprehensive literacy program.
Meanwhile, cash strapped State and local governments are
slashing school budgets and firing tens of thousands of
teachers. Los Angeles public schools cut their budget for
summer classes from $18 million last year to $3 million this
year. Philadelphia recently issued layoff notices to more than
1,500 of its 11,000 teachers. Many districts are shortening
their academic calendar despite growing evidence that students
should be spending more time in school, not less.
From my perspective, as chairman of both this subcommittee
and also the authorizing committee, I believe the combined
Federal, State, and local budget cuts pose a grave threat--let
me repeat that--pose a grave threat to education reform efforts
across the country just as those efforts are reaching critical
mass.
Forty-eight States and the District of Columbia have
collaborated to create high-quality, common education
standards. Mr. Secretary, your Race to the Top initiative has
jump started ambitious State-level reforms on teacher
accountability, academic standards, and the better use of data
in tracking student performance.
In the HELP Committee, the authorizing committee, we hope
to mark up the reauthorization of the Elementary and Secondary
Education Act this year. However, it is wishful thinking--
wishful thinking--to expect improvements in school quality when
we are laying off teachers, increasing class sizes, and
reducing instructional time. To demand reform without resources
is to set up students and teachers to fail.
INVESTING IN EDUCATION
Other countries understand this. China, for example, has
tripled its investment in education. It is building hundreds of
new universities. Even in times of austerity and shrinking
budgets, smart countries do not just turn a chainsaw on
themselves. They continue to invest in the future.
A good case in point is early childhood education. Experts
agree that high quality pre-kindergarten education gives a
critical boost to students' long-term academic success. But the
quality of early childhood education programs varies widely.
Many States lack any coordination.
The fiscal year 2011 appropriations bill addresses these
challenges head on. And, Mr. Secretary, I applaud your efforts
on this. We have provided $700 million for your Race to the Top
initiative, and working together, you very wisely, I believe,
have put $500 million of that into an early learning challenge
grant program, in a competition. Studies have shown that high
quality pre-school returns $7 for every $1 invested, but we
will not be able to continue that investment if overall funding
for domestic discretionary spending is slashed.
At the other end of the learning continuum, we must do
everything we can to preserve the fiscal integrity of the Pell
Grant program. The 9 million students who rely on Pell grants
to earn a postsecondary education each year need to be assured
that this aid will not vanish in the middle of their college
careers. So, I was very pleased that Senator Reid's plan would
virtually close the Pell shortfall for the next 2 years. I want
to engage with you on that aspect also in the question period.
This will greatly improve our prospects of maintaining the
maximum Pell grant at its current level of $5,550 per year.
Mr. Secretary, I appreciate the work that you are doing not
only to protect our Nation's investments in education, but to
challenge the States to do better, and to make sure the money
is spent in ways that will truly improve student learning.
I also want to thank you for coming out to Iowa this last
weekend, both for an event on Sunday regarding early childhood
learning and also for Governor Branstad's education summit for
Iowa. I could not be there because I had to come back here, but
I read your remarks, and from all I hear, your presentation was
both well received and challenging to the lawmakers and the
policymakers in the State of Iowa.
With that, I will yield to my ranking member, Senator
Shelby.
STATEMENT OF SENATOR RICHARD C. SHELBY
Senator Shelby. Thank you, Mr. Chairman. Thank you for
calling this hearing.
Mr. Secretary, I look forward to hearing your testimony
today on the fiscal year 2012 budget request for the Department
of Education.
BUDGET SAVINGS
But as we convene today's hearing, I am gravely concerned
that the Department of Education has delayed some of the tough
choices that are necessary to ensure national economic
stability. We all understand the critical role of education in
our society and its impact on our Nation's ability to compete
in a global economic environment. However, our Nation is $14
trillion in debt, and I think we must rein in spending.
FISCAL YEAR 2012 DEPARTMENT OF EDUCATION BUDGET REQUEST
In times of economic uncertainty, while every Department
should be looking for savings and efficiencies within the
budget, the Department of Education has requested a 13.3
percent increase from 2011. In comparison to 2010, the 2012
budget request is a 20.7 percent increase. Let me repeat that--
20.7 percent increase since 2010.
The Department of Education has requested 20.7 percent more
funding in 2012 than it received 2 years ago. However, in your
written statement, Mr. Secretary, you state, and I quote, ``Our
request is a responsible budget that emphasizes both fiscal
constraint and investment in education reforms that will
deliver results.'' Mr. Secretary, how can you consider an over
20 percent increase since 2010 a responsible budget that
emphasizes fiscal restraints?
RACE TO THE TOP BUDGET REQUEST
One of the key investments proposed by the Department of
Education in 2012 is Race to the Top. The budget includes $900
million for the program, an increase of $200 million or 28.6
percent above 2011. According to the Department, Race to the
Top funds are awarded to States that are leading education
reform with ambitious, yet achievable plans. Specifically, Race
to the Top creates incentives for State and local reforms that
produce improvements in student achievement, while reducing
achievement gaps.
ALABAMA AND RACE TO THE TOP COMPETITION
I understand that education reform is never easy. However,
it is made significantly more difficult when States must meet
prescriptive requirements, in this case a de facto requirement
for charter school legislation, to even compete for available
funding. My State of Alabama has been a leader in innovative
science, technology, engineering, and mathematics (STEM)
initiatives. The Alabama math, science, and technology
initiative has earned nationwide recognition as a model for
increasing the math and science achievements of students, the
very achievement that Race to the Top states it supports. Yet,
Race to the Top only awarded STEM programming 15 points out of
500. That is troubling, Mr. Secretary.
Instead, the Department chose only States with charter
schools as awardees. Despite its nationally recognized STEM
program, a key component to our future workforce competing in a
global economy, Alabama finished dead last in the latest round
for Race to the Top funding. And although the Department of
Education often states its objectives to be loose on means and
tight on ends, the experience of the State--my State--clearly
illustrates this is not the case.
STATE FLEXIBILITY TO INNOVATE
As the United States continues to fall behind other
developed countries in reading, math, and science, States
should be given the flexibility, I believe, to implement
critical reforms as identified on the State and local level.
The Federal Government should not mandate initiatives, but
assist States in implementing programs that they deem most
important to improving their students' achievement.
PELL GRANTS--GROWTH IN COST
A key component to this achievement is improving access to
education. As a Nation, we are on the brink of breaking our
commitment to students who wish to attend college because the
Pell Grant program is on a fiscally unsustainable path. Since
2008, the cost of the Pell Grant program more than doubled.
Legislative changes that expanded eligibility, combined with
the dramatic rise in the number of students seeking further
education due to the economic recession, have caused costs to
skyrocket.
And while the 2012 budget request offers proposals to
address the growth in costs, the administration also proposes a
$5.6 billion increase in discretionary Pell Grant funding. We
cannot continue to throw money at this problem. Access to
higher education must be protected and immediate reforms are
necessary to ensure the Pell Grant program continues as the
basis of our commitment to helping low income students attend
college.
DISTANCE LEARNING AND STATE AUTHORIZATIONS
Finally, Mr. Secretary, I am concerned about State
authorization provisions related to distance learning under the
proposed program integrity regulations. While I understand the
Department of Education has delayed the enforcement date
related to distance learning until July 2014, as long as an
institution is making a good faith effort to obtain the
necessary State authorizations, I do not believe that this
adequately addresses the underlying issue. Simply extending the
deadline does not take into account the burdensome impact of
these regulations on colleges and universities.
In addition, the definition of what ``good faith'' means--
good faith effort is vague, and the Department's proposed
guidelines will prove costly and time-consuming.
I hope, Mr. Chairman, that we can work together to find the
appropriate balance between fiscal responsibility and
meaningful education investments because we need this in
America.
Senator Harkin. Thank you very much.
OPENING STATEMENT OF SECRETARY DUNCAN
Again, Mr. Secretary, welcome, and your statement will be
made a part of the record in its entirety. Please proceed as
you so desire.
Secretary Duncan. Thank you so much, and good morning,
Chairman Harkin and Ranking Member Shelby. Thank you very much
for having me here today to talk about education, the economy,
and the need to continue investing in our future, even as
Congress and the administration work together to reduce overall
spending and manage our Nation's deficit.
KEY INVESTMENTS IN FISCAL YEAR 2012 BUDGET REQUEST
Our Department of Education has submitted a formal
statement on our 2012 budget proposal outlining our request to
boost investments in education in order to secure America's
future. Key investments include closing the Pell Grant
shortfall both through efficiencies and more resources,
protecting desperately needed title I and Individuals with
Disabilities Education Act (IDEA) formula funds for students
most at risk, expanding reform programs, including Race to the
Top and Investing in Innovation, or i3, and our early learning
and college completion programs. These programs support State
and local policies to accelerate achievement for all students,
particularly for students most at risk, and provide adequate
funding for student aid administration, now that all Federal
student loans are originated through the direct loan program.
BUDGET REQUEST IN CURRENT ECONOMIC CONDITIONS
Recognizing the real fiscal challenges facing the country,
we also propose efficiencies, consolidations, and cuts in
programs that are not as effective as they should be. We
understand that just as every family is doing more with less,
so should we. But like America's hardworking families, we also
understand that you cannot sacrifice the future to pay for the
present, and nothing is more important to a family's future and
to our future as a Nation than education.
INVESTING IN PROGRAMS THAT WORK
Mr. Chairman, I was in Iowa earlier this week where I
talked about the fact that your State had gone from being a
national leader in education to being frankly in the middle of
the pack. I know that was a difficult message for citizens in
Iowa to hear, but I didn't want to sugarcoat the message
because that would not be doing any favors to Iowa's children.
And your State is not unique. In fact, America as a whole
has gone from being a world leader in education to being in the
middle of the pack. In this new century, the middle of the pack
is simply not what we want for our children or for our country.
We all have to get better, and in order to get better, we must
continue to invest in programs that are working.
PELL GRANT PROGRAM
The Pell Grant program is helping millions of young people
and adults get new skills for the jobs of tomorrow. Demand has
skyrocketed from 6 million to 9 million grants in 4 years.
College has never been more necessary for success in the global
economy, but it has also never been more expensive and out of
reach for an increasing number of Americans. We cannot afford
to go backward. We must once again lead the world in college
graduates.
WELL-ROUNDED CLASSROOM AND AFTER SCHOOL PROGRAMS
We must continue to invest in programs like title I and
IDEA, and programs that help support literacy, science, and
mathematics, and other subjects necessary for a well-rounded
education, and provide a rich offering of high quality after-
school activities. They give struggling students the extra help
they need to succeed. They promote equity and safety in
schools, strengthen the teaching profession, and support
English language learners, students with disabilities, rural
students, and other special populations.
TEACHER PREPARATION AND CLASSROOM INNOVATION
We also have to give States and districts the flexible
dollars that allow for innovation and reform. Today in America,
thanks to programs like Race to the Top and Investing in
Innovation, States and districts are preparing teachers to
teach to higher standards. They are integrating technology into
classrooms, expanding arts programs for students with
disabilities, and producing a new generation of teachers in
science, technology, engineering, and math, the STEM fields.
SCHOOL TURNAROUND PROGRAM
Today, thanks to our School Turnaround Program, low-
performing schools across the country are undergoing dramatic
changes--new leadership, new staff, new curriculum, longer
school days, and fresh approaches to educating students at risk
of failure.
NEED TO KEEP EDUCATION SUPPORT IN TOUGH ECONOMY
From big cities like New Orleans and Chicago to small towns
in Tennessee and Kansas, educators are tackling our toughest
challenges, exploring new approaches to education, and building
new partnerships that are making a difference in the lives of
our children. At the same time, we all know States and
districts are facing more fiscal pressure than ever before.
Recovery Act funding has largely dried up, and local and State
revenues have yet to recover from the recession. The harsh
result is that too many students are losing out--losing out on
music, drama, sports, science, field trips, exchange programs,
summer school, and many other unique and wonderful things that
make education so worthwhile. Their generation, our children,
are being cheated out of a world-class education because our
generation is unable or unwilling to make the tough choices
necessary to protect them.
The current debate about the debt ceiling and the deficit
is not just about budgets and numbers. It is really about the
fundamental promise at the heart of the middle class American
dream. For much of the last century, America was a country
where if you worked hard, you and your family could enjoy the
basic benefits of a secure and comfortable life--a job, a home,
affordable healthcare, quality education, and a secure
retirement. Today, for too many Americans, these building
blocks of middle class life are increasingly beyond their
reach, and that is creating uncertainty and anxiety. This is
not good for the country, it is not good for our families, it
is not good for children and for education.
PREPARED STATEMENT
So, while I absolutely appreciate the hard work underway to
cut spending and get our debt under control, I want all of us
to work together to do this in a way that does not undermine
the education of our Nation and the education of our children.
They are counting--our children are counting on us to prepare
them for the future. Business owners are counting on us to
produce the workforce they need to compete in the new economy.
Families are counting on us to open the doors to opportunity
for every child, regardless of background, income, ability or
disability. We cannot let them down. We cannot let ourselves
down. The path to a strong future starts in our Nation's
classrooms.
Thank you.
[The statement follows:]
Prepared Statement of Arne Duncan
Chairman Harkin, Ranking Member Shelby, and Members of the
Committee: Thank you for this opportunity to talk about President
Obama's fiscal year 2012 budget to help America out-educate the rest of
the world. While the President's overall request for 2012 reflects
broad agreement that the Federal Government has to start living within
its means, we believe it is absolutely essential to keep investing in
education so that, as the President put it, ``every American is
equipped to compete with any worker, anywhere in the world.''
final fiscal year 2011 appropriation
I want to begin by thanking the Chairman, the Ranking Member, and
other Members of this Subcommittee for your work on the fiscal year
2011 appropriation for education. I know that you faced some tough
decisions in reaching agreement on the 2011 budget, but I believe the
final appropriation reflected a responsible mix of continued investment
in high-priority activities as well as reductions in programs and
activities based in large part on the recommendations in the
President's 2012 budget.
In particular, I want to thank you for your renewed support of the
Race to the Top program, which now includes the Early Learning
Challenge competition. In May, I was pleased to share the podium with
Secretary of Health and Human Services Kathleen Sebelius to announce a
$500 million competition that will reward States that create
comprehensive plans to transform their early learning systems by
coordinating services, raising standards, and increasing the
effectiveness of pre-K teachers. I also announced separately that we
will use the remaining $200 million in fiscal year 2011 Race to the Top
funding to support a competition involving the nine States that were
high-scoring finalists but did not receive funding in the first two
rounds of Race to the Top.
I'm also grateful that Congress provided $150 million for a second
Investing in Innovation (i3) competition, as well as $30 million to
keep moving forward with our Promise Neighborhoods initiative. In
addition, Congress did the right thing by providing the significant
funding and programmatic changes needed to maintain the $5,550 maximum
Pell Grant award, as well as essential funding for the continued
effective and efficient administration of the Department's
postsecondary student financial aid programs.
president obama's 2012 budget request
Turning to 2012, we recognize that the final 2011 appropriations
bill will have an impact on the levels provided in fiscal year 2012,
and we are aware of the ongoing bicameral, bipartisan discussions
between the Administration and congressional leadership on the Nation's
long-term fiscal picture, which may result in further adjustments to
funding levels for 2012. Nonetheless, the 2012 budget request for the
Department of Education reflects the Administration's policy priorities
and remains a good starting point for developing these funding levels.
The request represents both fiscal constraint and investment in
education reforms that will deliver results. The overall discretionary
request for the Department of Education, excluding Pell Grants, is
$48.8 billion.
As you know, financing the Pell Grant program, which is funded
through a combination of discretionary and mandatory appropriations and
has faced growing demand in recent years as more and more students and
working adults seek to improve their knowledge and skills, has been a
real challenge for the Department and for the Congress. The President's
budget responds to this challenge by proposing a combination of tough
choices to generate savings from Pell Grants and student loan programs
and increased discretionary funding. The overall goal of our Pell Grant
proposals is to protect the $5,550 maximum Pell Grant award, put the
program on more sustainable financial footing in 2012 and beyond, and
ensure that more than 9 million low-income students can continue to
rely on Pell Grants to enter and complete a college education.
Our 2012 request included a Pell Grant Protection Act that was
designed to rein in Pell costs and place the program on more solid
financial footing by eliminating the extra Pell Grant, ending the
interest subsidy for graduate student loans, and allowing the
conversion of guaranteed student loans to the Department. This
proposal, combined with administrative action to implement enhanced
income verification procedures for Pell Grant applicants as part of
improvements in the processing of the Free Application for Federal
Student Aid (FAFSA), would have produced an estimated $100 billion in
discretionary Pell Grant savings over the next 10 years. The final 2011
appropriations act ended the extra Pell Grant, achieving a significant
portion of the savings proposed in our 2012 request, and we will be
working with the Subcommittee to build on those savings in negotiations
over the 2012 appropriation.
making tough choices
Before I describe some of the key investments we are proposing for
2012, I want to emphasize that our overall strategy for supporting
effective education reform is fully consistent with the current fiscal
environment. From the beginning, this Administration has envisioned a
smaller Federal role focused on key priorities and structured to ensure
the most productive use of the resources entrusted to us by taxpayers
and the Congress. This is why, for example, our reauthorization
proposal for the Elementary and Secondary Education Act (ESEA) would
consolidate 38 existing programs into 11 more flexible authorities that
would give communities more choices to implement their own research-
based reform strategies.
We also have worked hard to identify and eliminate duplicative,
unnecessary, or ineffective programs, and Congress accepted many of
these recommendations in its final action on the fiscal year 2011
appropriation. Key eliminations included Even Start, Smaller Learning
Communities, Educational Technology State Grants, Tech Prep Education
State Grants, and Leveraging Educational Assistance Partnerships, as
well as a number of smaller programs. While each of these programs
undoubtedly provided meaningful benefits to students and schools over
the years, we recognize that all levels of government are challenged to
do more with less in these times of financial constraint. That's why
our 2012 budget places a priority on spending smarter through cost-
effective reforms that improve student outcomes, including by
consolidating and, where appropriate, eliminating programs.
But make no mistake; the President's request for education is about
investing in our Nation's future. President Obama has said that to win
the future, we have to win the education race, and his 2012 budget
reflects what is needed to educate our way to a better economy. More
specifically, the 2012 request for education is designed to promote
reform, reward success, and support innovation at the State and local
levels while maintaining strong support for students most at risk of
educational failure. To meet these goals, our 2012 investments in
education are divided into four significant priorities.
sustaining reform momentum
First, our request includes an additional $900 million for Race to
the Top, which already has demonstrated how competitive rewards create
powerful incentives for State and local leaders to make groundbreaking
education reforms. In the first two RTT competitions, 46 States created
bold comprehensive reform plans that have buy-in from Governors,
legislators, local educators, union leaders, business leaders and
parents. As noted earlier, we will use 2011 Race to the Top funds to
make awards to high-scoring but unfunded finalists from the first two
rounds of Race to the Top. The 2012 request would focus on supporting
district-level reform plans while also emphasizing cost-effective
strategies that improve student achievement in a time of tight budgets.
The Department would also carve out a portion of funds for rural school
districts to ensure that communities of all sizes and from all
geographic areas are able to compete for a fair share of Race to the
Top funds.
While we are very pleased that we will be able to launch the Early
Learning Challenge Fund with fiscal year 2011 Race to the Top funds, we
are seeking additional funding in 2012 to continue critical investments
in early learning that will support model systems of high-quality early
learning supports and services for children from birth to kindergarten
entry. These investments would complement proposed 2012 increases for
programs in the Department of Health and Human Services, including
increases for Head Start and for quality child care.
The 2012 request also would encourage reform and innovation through
a $300 million request for the Investing in Innovation (i3) program to
develop, evaluate, and scale up promising and effective models and
interventions with the potential to improve educational outcomes for
hundreds of thousands of students. The request includes priorities for
science, technology, engineering, and mathematics (STEM) education and
early learning, as well as an overall focus on increasing productivity
to achieve better student outcomes more cost-effectively. The
Department would include a refined rural priority in the i3 competition
to ensure geographic diversity in the communities served by recipients,
and would fund applications from providers and other entities proposing
evidence-based approaches to address the unique needs and priorities of
rural districts and schools. We also would take a page from the
Department of Defense by creating a new Advanced Research Projects
Agency: Education (ARPA-ED) that would use both discretionary and
mandatory funds to pursue breakthrough developments in educational
technology and learning systems, support systems for educators, and
tools that improve outcomes from early learning through postsecondary
education. We see this as a natural complement to the innovations found
in the field through the i3 program.
In addition, our request would significantly boost funding for the
Promise Neighborhoods program to $150 million to support comprehensive,
innovative and cost effective approaches to meeting the full range of
student needs, drawing on the contributions of schools, community-based
organizations, local agencies, foundations, and private businesses.
Also, the request would maintain funding for safe school programming
designed to reduce substance use, violence, and bullying while
providing States with greater ability to adapt interventions to school
needs and drive resources to the most unsafe schools.
great teachers and leaders
Our second priority is teachers and school leaders. I think we can
all agree that nothing is more important, or more likely to improve
student achievement and other key educational outcomes, than putting a
great teacher in every classroom and a great principal in every school.
Our 2012 request, together with a proposed restructuring of teacher and
leader recruitment and preparation programs as part of our ESEA
reauthorization plan, is designed to support State and local reforms of
systems for recruiting, preparing, supporting, rewarding, and retaining
effective teachers and school leaders. For example, the budget includes
funding for a Teacher and Leader Innovation Fund to support ambitious
reforms, including innovative teacher evaluation and compensation
systems, to encourage effective teachers, principals, and school
leadership teams to work in high-need schools. We also are seeking
funds for Teacher and Leader Pathways to expand high-quality
traditional and alternative pathways into teaching, with an emphasis on
recruiting, preparing, placing, and supporting promising teacher
candidates for high-need (including rural) schools, subject areas, and
fields. Included in this request is a set-aside to help prepare 10,000
new STEM teachers over the next 2 years, as part of the President's
plan to prepare 100,000 new STEM teachers over the next decade. In
addition, the Presidential Teaching Fellows program (formerly the TEACH
program), paid for with mandatory funds, would award $10,000
scholarships to the best students attending our most effective teacher
preparation programs who agree to work in high-need schools.
college completion
Our third priority is college completion. I've already talked about
the Pell Grant program, which is the foundation of Federal efforts to
support both increased college access and completion for low-income
students. Unfortunately, we know that far too many students who enroll
in college drop out and never earn a degree. Currently, one-third of
postsecondary students leave school without earning a degree and only
one-half finish after 6 years. Clearly, access isn't enough, and we
need a much stronger emphasis on attainment in postsecondary education.
Through the $123 million ``First in the World'' competition, we'll
provide venture capital to develop innovative approaches to increase
college completion rates and improve educational outcomes while
lowering costs and time to degree for students in higher education. And
through our proposed College Completion Incentive Grants program, we
would provide mandatory funding over the next 5 years in grants to
States to reward institutions with exemplary college completion
outcomes.
The President's budget also would continue support for key existing
programs supporting college access and completion, particularly for
minority and disadvantaged students. The request includes funding for
the Federal TRIO programs and the GEAR UP program, which helps an
estimated 756,000 middle and high school students prepare for and
enroll in college. The 2012 budget also provides discretionary and
mandatory funding for the Aid for Institutional Development programs,
which support institutions that enroll a large proportion of minority
and disadvantaged students, and discretionary and mandatory funding for
the Aid for Hispanic-Serving Institutions programs, which help ensure
that Hispanic students have access to high-quality postsecondary
education opportunities.
We also look forward to working with Congress to strengthen the
Perkins Act, which shapes the Career and Technical Education program,
and improve its alignment with the education reform efforts at the core
of our ESEA reauthorization proposal, so that the Perkins Act is a
stronger vehicle for supporting the President's 2020 college completion
goal and the Department's efforts to improve secondary schools.
support for at-risk students and adults
Finally, the President's 2012 budget for education would maintain,
and in some cases expand, the Federal Government's commitment to
formula programs for students most at risk of educational failure. For
example, our request for the reauthorized Title I College- and Career-
Ready Students program (currently Title I Grants to Local Educational
Agencies) includes increased funding to recognize and reward high-
poverty districts and schools where disadvantaged students are making
the most progress. The $600 million request for a reauthorized School
Turnaround Grants program would expand support for school districts
undertaking fundamental reforms in their persistently lowest-achieving
schools, while the budget also provides funding to help English
Learners meet the same college- and career-ready standards as other
students.
In Special Education, our request for Individuals with Disabilities
Education Act Grants to States would help States and school districts
pay the additional costs of educating students with disabilities, while
our request for Grants for Infants and Families program would
complement the proposed Early Learning Challenge Fund.
The 2012 request also provides significant resources to help adults
pursue educational and employment opportunities, including funding for
Adult Basic and Literacy Education State Grants to help adults without
a high school diploma or equivalent to become literate and obtain the
knowledge and skills necessary for postsecondary education, employment,
and self-sufficiency, and mandatory and discretionary funds for
Vocational Rehabilitation (VR) State Grants to help States and tribal
governments to increase the participation of individuals with
disabilities in the workforce.
We are looking forward to the reauthorization of the Workforce
Investment Act (WIA) so that low-skilled adults and individuals with
disabilities have access to the education and training they need to be
successful in the 21st century economy. A reauthorized WIA would
provide opportunities to upgrade the skills of our Nation's workers so
that they are able to compete in this new economy. One of those
opportunities includes a new Workforce Investment Fund, which we are
proposing in partnership with the Department of Labor, to help provide
flexibility for the connections necessary to get people into good jobs
or the education needed for a better job. The Fund will also provide
resources to evaluate and replicate best practices so that we better
serve those who have the hardest time finding work--those with limited
basic skills and individuals with disabilities.
conclusion
In conclusion, President Obama's 2012 budget for education is part
of a comprehensive and responsible plan that will put us on the path
toward fiscal sustainability in the next few years. Like every other
agency across the Government, we are working hard to more efficiently
steward the Department's resources. At the same time, education remains
a priority for the Administration due to the critical importance of our
education system for our continued economic prosperity. The
Department's budget includes a responsible mix of savings and
investments that will promote reform and innovation, support a
comprehensive ESEA reauthorization, and encourage improved
postsecondary outcomes. I look forward to working with the Committee to
build support for the President's 2012 budget for education and to
secure the best possible future for America by providing the best
possible education for all of our children.
Thank you. I would be happy to answer any questions you may have.
PELL GRANTS AND TOTAL EDUCATION BUDGET REQUEST
Senator Harkin. Thank you very much, Mr. Secretary. We will
start a round of 5-minute questions.
Mr. Secretary, I want to talk about this 20 percent
increase. I was quite surprised to hear that this budget had
gone up 20 percent since 2010. So, I started looking at it, and
when you look at the figures, excluding Pell grants, in fiscal
year 2010, it was $46.64 billion, fiscal year 2012, the
President's budget is $48.8 billion, which is about a 4 percent
increase. So, why do we have a 20 percent increase that I heard
my ranking member talk about? Is that not because of the
increase in the Pell grants--the number of Pell grant money? Is
that right, Mr. Secretary?
Secretary Duncan. Yes, sir.
UNEMPLOYMENT IMPACT ON PELL GRANT PROGRAM
Senator Harkin. Well, I would point out, of the $77.4
billion request for fiscal year 2012, $28.6 billion is for Pell
grants. Now, we might say, well, gee, what is going on here?
Maybe we have got to cut back on Pell grants. What is going on
is we have got over 20 million out of work. We've got an 18
percent--not 9--almost 18 percent unemployment rate in this
country.
So, I guess what we are going to do is penalize the kids
because their parents are out of work, and they have now fallen
into the classification where they qualify for Pell grants,
where before they probably would not have qualified for Pell
grants.
INCREASED DEMAND FOR PELL GRANTS
So, I hope we keep our eye on exactly what is happening
here. Most of this increase is because of the increased use of
Pell grants. We have an increased use of Pell grants because we
have more poor people in this country, and we have more poor
people because 18 percent of people are out of work and they
are not working.
So, I guess we have a choice to make. Do we cut these kids
off at the knees?--Say, no, you qualify, but you are not going
to get the money because we have to keep our budget down, you
see, and our spending down. Well, as I said in my opening
statement, that is like turning a chainsaw on yourself. Or up
my way, we say, it is like eating your seed corn, when you are
cutting education.
PELL MAXIMUM GRANT
I can tell you, Mr. Secretary, this subcommittee and our
committee, and I hope the Congress, will continue to be fully
supportive of the maximum Pell grant.
PELL SHORTFALL AFTER ELIMINATION OF YEAR ROUND PELL
Now, again, we in the fiscal year 2011 continuing
resolution, in order to free up money to make sure we had money
for the basic Pell grant, we--Congress ended the year-round
Pell Grant program known as ``two Pells'', which allowed
students to receive two Pell grants in a single year. Well,
that cut into some students, but it brought down the costs of
the Pell Grant program. But even with that change, the
shortfall for fiscal year 2012 is about $11 billion.
MAXIMUM PELL GRANT
So, the other proposal that Senator Reid came up with--that
we worked with him on--was to eliminate the in-school interest
subsidy for graduate loans as another way of making sure we
could keep the maximum Pell grant for the poorest students.
This proposal was also in the President's budget.
So, when you look at the options, why, Mr. Secretary, do we
choose this one? Why do we choose eliminating the in-school
interest subsidy for graduate loans? Why--could you just
enlighten us why that is better than other options we might
have?
Secretary Duncan. Yes, Mr. Chairman. These are all very
tough choices. In an ideal world, you know, better economic
times, maybe you would not make any of these choices. But at
the end of the day, we desperately want to preserve that
maximum Pell grant.
ELIMINATION OF TWO PELLS AND IN-SCHOOL SUBSIDIES
And I think there are two factors at work here. One, as you
said, is we simply have more young people around the country
who qualify, who have need. Second, what is so critically
important, I think, that we all understand is that our economy
is changing. And to get the jobs of the future--there was a
recent study that came out from the Georgetown University
Center on Education and the Workforce. They estimate that going
forward, we are going to be about 3 million college graduates
short of what the economy needs--what the market is asking for.
And so, at a time of increasing need, there is also increasing
demand. And so, we have to keep that maximum Pell Grant at
$5,550. We have had to make tough calls. Eliminating the two
Pells in one year--in an ideal world, I would never want to do
that. Eliminating in-school subsidies for graduate students,
again, in an ideal world we'd never want to do that. But we are
trying to be fiscally responsible and share the pain and make
these tough choices. We think those are the lesser of the
evils, and we want to at all costs maintain that Pell maximum
award at $5,550.
Senator Harkin. I appreciate that. And when we looked at
that, the interest subsidy for graduate students, I mean, let
us face it. If you are a graduate student, you are probably
going to get a pretty good job when you get out. And so, in the
whole spectrum of things, they could probably afford that
interest payment--we hope so anyway, with all the unemployment.
But hopefully our graduate students will lead us--help lead us
out of this mess. But I can see where we would take on that
rather than the poorer students in undergraduate school.
Secretary Duncan. Yes, sir.
Senator Harkin. So, it is a tough choice, but one that we
supported.
My time is up. Senator Shelby.
STRONG EDUCATION SUPPORT NEEDED DESPITE TOUGH ECONOMY
Senator Shelby. Thank you, Mr. Chairman.
Mr. Secretary, I do not think any of us want to take a
chainsaw to any program that is going to sustain our
educational system and hope for our young people at all. But we
are all taking a chainsaw to our budget right now to a certain
extent because of our failure to act. We have a $14 trillion
debt. You probably, in putting your budget together, made some
tough choices.
What we have got to do, I believe, is make some wise
choices, and then carry them through. And what those all are, I
am not sure, but I know that we cannot, as Senator Harkin said,
we cannot starve the future. We cannot starve our children of
food and sustenance. We cannot starve them of an education.
JOB AND EDUCATION REQUIREMENTS OF NEXT DECADE
Where are the jobs going to be, in your judgment, in the
next, say, 10 years? Where are the jobs in America going to be,
and what kind of education process do we need to get there, to
have our people ready for the workforce jobs that are needed?
Because at the end of the day, we've got millions of people
unemployed, and a lot of them are losing hope every day.
INADEQUACY OF EDUCATION FOR CURRENT HIGH SKILL JOBS
Secretary Duncan. Let me give you four different statistics
that sort of get at this. One is that even in this tough
economic climate, we have 3 million unfilled jobs in this
country. Many of those are high-skilled, high-wage jobs, and we
are simply not preparing the workforce for those jobs.
EDUCATION AND JOB DEMANDS OF NEXT DECADE
Going forward, up until about 2018, we are going to need to
fill 2.6 million job openings in the STEM fields--science,
technology, engineering, and math. Going forward, there is an
estimate that by 2018, if we stay on the current course, if we
do not improve, we are going to be 3 million college graduates
short of what the market demands.
And then finally, by 2018, between now and then, 63 percent
of job openings will require at least some college-level
education. And these are not our facts; these are all facts
from outside groups, the Bureau of Labor Statistics, and the
Georgetown University Center on Education and the Workforce.
So, we need an increasingly educated, high-skilled workforce
with this particular emphasis on the STEM fields.
PELL GRANTS--INTEGRAL TO EDUCATION BUDGET AND GOALS
Senator Shelby. Mr. Secretary, as we think of Pell grants,
do we not have to think of them in the overall budget process
of the Department of Education? In other words, they are not
separate from; they are part--an integral part of the budget.
Is that correct?
Secretary Duncan. I think, again, all of our work from, you
know, early childhood education, which we will talk about----
Senator Shelby. Everything----
Secretary Duncan [continuing]. K to 12 reform, all of that
is to what goal? The goal, as the President has laid out, is to
lead the world in college graduates by 2020. We think that--we
have to educate our way to a better economy. So, the Pell
grants are absolutely vital, integral, critical to getting us
as a country----
Senator Shelby. But they are not the only part of the
education part.
Secretary Duncan. No, sir.
Senator Shelby. An important part, yes.
Secretary Duncan. Yes, sir.
PELL GRANTS--HOW DO WE PAY FOR THEM?
Senator Shelby. Now, how are we going to pay for it? That
is the bottom line. In other words, the growth--we have a lot
of people unemployed. We know this, which we hate. But how are
we going to pay for this, because that is going to be the
bottom line up here this year and in the future. What are our
priorities? What are our priorities in education? What are your
priorities in the Department of Education? Could you list, say,
the top three or four? You are going to have to make some
decisions. So do we.
SAVINGS FROM ELIMINATING TWO PELLS AND IN-SCHOOL SUBSIDY
Secretary Duncan. So, we are making very tough decisions.
We have talked about eliminating the grad school subsidies.
That is going to save the country $18 billion over the next 10
years.
Senator Shelby. Eighteen billion dollars.
Secretary Duncan. Over the next 10 years.
Senator Shelby. Would that pay for the Pell Grant increase,
for the, say, the undergraduates?
Secretary Duncan. Short term, it helps. I mean, this is $18
billion with a B, this is real money.
Senator Shelby. Okay.
Secretary Duncan. So, eliminating the second Pell----
Senator Shelby. That is $1 billion here and $8 billion
there, and it is real money?
Secretary Duncan. Exactly. I am learning that here in
Washington.
Senator Shelby. Okay.
Secretary Duncan. Eliminating the second Pell Grant each
year, which again was a tough, tough call, that is $5 billion
every single year. So, over 10 years that is $50 billion. So,
these are very real savings. You know, tough calls, not calls
we wanted to make, but we had to make, we think, to preserve
that maximum funding for Pell grants.
EDUCATION PRIORITIES--CRADLE-TO-CAREER CONTINUUM
To answer your question, our priorities are continuing to
strengthen early childhood education, to continue to drive K to
12 reform, and to continue to invest in--to increase access to
higher education. So, this is a cradle-to-career continuum, and
those are the three steps along that pathway.
Senator Shelby. But if you cannot have it all, and you
cannot--I wish you could, and I wish that I were here when we
owed no money as a Nation, because I think a lot of us could
get together and have a lot of good ideas including investment
in education. We are going to have to make tough decisions.
And thank you. My time is up.
Senator Harkin. Senator Reed.
EDUCATION REFORM
Senator Reed. Thank you very much, Mr. Chairman, and thank
you, Mr. Secretary. And certainly you have an extraordinarily
challenging job, given the budget pressures. I think you
rightly point out the central need to fundamentally reform our
education system at the elementary and secondary level, and
also support it at the higher education level.
LARGE-SCALE COMPETITIVE VS. FORMULA-BASED GRANT PROGRAMS
But let me take a moment because I am concerned that the
overarching strategy at the Department has been to focus almost
exclusively on these untested, large-scale competitive grant
programs at the expense of some proven research-based programs
that have a track record of success. Race to the Top is
probably the signature program. That is a novel, and I think
bold, way to sort of rethink education. But it has displaced
programs, for example, like the school library program.
NEED FOR LIBRARY PROGRAMS
And the Department's own evaluation has found these library
programs to be extraordinarily effective over many decades. In
fact, since 1965, more than 60 educational library studies have
produced clear evidence that school libraries staffed by
qualified librarians have a positive impact on student
achievement. And I think it just follows that someone who knows
about how to use the library and wants to use the library, is
probably prepared for learning the rest of his or her life.
There is no plan that I have seen or has been shared with
me for the Department to replace either through Race to the Top
or any other program the support that we have given to school
libraries. So, frankly, those programs are not only on hold,
but they very well might be lost. And I do not have to remind
anyone around here, the first thing to go at the local school
committee meeting is, well, we will not buy any library books
this year. In fact, back in the 1990s when I got involved in
this issue, librarians would come to me with books stamped
ESEA, 1965, and that was 25 years after the legislation was
passed. So, I am concerned about that.
TEACHER QUALITY PARTNERSHIPS
Another example, too, is the Department has a program that
is trying to develop support for teachers, but there is already
a teacher quality partnership grant program that was included
in the Higher Education Opportunity Act. This program has high
bars for reform. You are consolidating that program into a
broader, more flexible funding stream, which could water down
reforms.
NEED FOR FULL RANGE OF STUDENT AID PROGRAMS
And then we all are committed to maintaining student
financial aid. And the President, I must admit, and your
leadership has been instrumental in increasing the maximum Pell
grant. However, the strength and resilience of our Federal aid
programs comes through a combination of Pell, State grants,
institutional aid, and student loans. And as we try to work the
Pell Grant, it seems that we have done a lot to undermine the
other programs. In fact, we have eliminated some of them
effectively.
And so, I do not know. They are not easy questions--with
easy answers. I have specific questions I will submit to you in
writing. But I would just in the remaining minute ask you to
comment.
FORMULA GRANT PROGRAMS FORM MAJORITY OF ED BUDGET
Secretary Duncan. Sure. I will try and respond succinctly.
So, the vast majority--let me be very clear--the vast
majority of our funding has been, continues to be, and will be
going forward, formula-based, not competitive-based. And in
fact, 84 percent of our money is formula-based funding, the
large--absolute large majority being title I and IDEA.
SUPPORT FOR INNOVATION AND ACHIEVEMENT
We have asked for a small percentage of money to reward
excellence and courage. And what has been so interesting to me
in programs like to Race to the Top is it is not just within
the States that won money, like your State, but it is in a
State like Chairman Harkin's, where they did not receive a dime
from us, that we have seen a massive amount of change. For the
first time, States are raising standards, and that benefits
disadvantaged children, and rural children more than anyone. We
have dummied down standards in far too many places.
And so, at the end of the day, it was not just about who
received money; it was creating a climate in this country where
folks started to do the right thing, started to think about
high standards, or working together on better assessments, or
finally turning around chronically under-performing schools
that they hesitated to do before. And so, that work is going on
nationwide whether States receive money or not.
SUPPORT FOR LITERACY PROGRAMS
In terms of the literacy funding and school libraries, and
you have been a strong advocate there, we were very
disappointed that in our fiscal year 2011 budget, funding for
literacy basically got decimated, went to zero in the
continuing resolution. And so, we are asking for a very
substantial increase in literacy funding because that is so
fundamental, so foundational to student learning. And if
students cannot read, if they cannot express their ideas
verbally and on paper, frankly however much else we do does not
matter. And so, we are, again, in tough economic times, asking
for a significant boost in that funding.
INCREASING COLLEGE COMPLETION RATES
And then again, just finally on the need for access to
higher education. We want to continue, as I have said
repeatedly, we want to continue to maintain that commitment.
One thing we have not talked about is we are asking for some
i3-like money, some creative money, to really reward
institutions and States, and nonprofits that can increase
college completion rates, and increase productivity, and do a
better job of helping students with disabilities to graduate.
So for me, access is desperately important, but it has got to
be about more than access. It has got to be about attainment.
It is about getting that college diploma. And we want to really
invest in places that are going to build cultures around not
just access, but around completion.
Senator Reed. Mr. Secretary, I have specific questions I
will submit to you. But I thank you again for your presence
today and for your service. Thank you.
Secretary Duncan. Thank you.
STRENGTHENING LITERACY IN THE EARLY GRADES
Senator Cochran. Mr. Chairman. Mr. Secretary, thank you
very much for your cooperation and participation in this
hearing. I am pleased to be a co-sponsor with my friend from
Rhode Island of S. 1328, The Strengthening Kids' Interest in
Learning and Libraries Act. And that question that he put to
you is one that I identify with.
In our State, we have a financial problem because we do not
have enough tax money coming into the State government
agencies, and in county and local agencies that fund education
programs to take care of all of our needs. So, we were really
excited when the Elementary and Secondary Education Act was
approved and funding under the various titles began coming to
our State, and have provided some needed financial benefits
that have been used to involve students who were not learning
at the rates they should have been in innovative programs,
literacy programs. And the school libraries played an active
role in this.
I was just curious to know what your assessment of the
Department of Education's Learning and Libraries Act is having
on that challenge.
MISSISSIPPI'S GAINS IN LITERACY IN EARLY GRADES
Secretary Duncan. Again, we want to do everything we can to
enhance literacy through libraries, the classroom, and
technology. That is just fundamental. And I have to tell you, I
have been recently studying, Senator Cochran, Mississippi's
results on increasing literacy in the early grades. And I think
Mississippi is making as fast, if not faster, progress than any
State in the country. And so, I am spending a lot of time
talking to folks from your State, looking at what they have
done right there.
And Mississippi, as you know, historically has really been
maybe 50th in so many indicators. And particularly in the early
grade literacy, I think you have gone from 50th as a State to
43rd. That is remarkable progress in a short amount of time.
So, I think there are a lot of lessons to be learned about what
you guys are doing as a State to create a culture of literacy,
to better support teachers, to raise expectations.
And, again, I am always looking not at just where you rank,
but rates of progress. And the progress your State is making is
very significant, very encouraging, and I think has national
implications. So, I thank you for the leadership there. And I
thank the State for taking on such a foundational issue and
making remarkable progress in a short amount of time.
FEDERAL ROLE IN EDUCATION
Senator Cochran. I am very proud of the fact that my
parents were both involved in education. And my father was a
school superintendent, and my mother was a mathematics teacher.
And they both were very strong advocates for Federal assistance
to education at a time in Mississippi when some people thought
there were strings attached, and there were--it would
strengthen the Federal role in education--and not necessarily
to the benefit of the children, but to the control of the
Federal Government over local decisionmaking.
I think all of that has gotten sorted out, and there is not
as much suspicion now as there used to be with Federal money
coming into the State, and with it, strings being attached that
might not be consistent with what was really best for the
children and the atmosphere they were growing up in.
LITERACY THROUGH SCHOOL LIBRARIES
But we want to continue to monitor the use of Federal
dollars. And there is one program, I think it is called the
Second Evaluation of the Improving Literacy Through School
Libraries Program. What effect do you think this has had on the
ability of school districts that do not have adequate resources
for furnishing libraries? Has that provided meaningful benefits
in your opinion?
Secretary Duncan. I would have to look at the details of
that. But, again, whatever we can do to support literacy, to
support early literacy, in the classroom, after school, through
print, and more and more going forward, digital resources, we
want to do that, and we want to give students and communities
who historically have been under-served or under-resourced--
disadvantaged communities--we want to give them more
opportunity.
TITLE I REWARDS PROGRAM
Senator Cochran. Well, one area that has been brought to my
attention is the title I program and a new--under new authority
called Title I Rewards. I was going to ask you if you could
submit for the hearing record your assessment of how that
program is working.
While Mississippi has the country's highest concentration
of children in poverty, it received only $1,318 per title I
eligible student. And we were looking at some comparisons with
other States that had student populations about our size, and
Wyoming received--and I am not fussing about the higher level,
but three times as much funding for that program as our State
did. I am just curious to know why is that, and if that is a
disparity?
Secretary Duncan. We would have to look at that and look at
how States are allocating title I dollars. But to answer your
question directly, our Title I Rewards Program hasn't been
funded yet; that is a request, so there is nothing to evaluate.
But our goal is very, very clear. There are certain high
poverty, often high minority districts that do an amazing job
of increasing student achievement. And we want to shine a
spotlight on that, we want to recognize that, we want to learn
from that, and we want to incentivize that, give them more
resources.
And so, I think, again, with everything we are doing, we
are trying to put a spotlight on excellence. We spend billions
and billions of dollars, you know, well over $10 billion a year
on title I. I want to know which districts are doing an amazing
job of helping disadvantaged students be successful, and give
them additional resources and learn from them. That is the
purpose of that program, but it has not been funded yet, so
there is nothing to evaluate. That is part of our request.
Senator Cochran. All right. Thank you very much. Mr.
Chairman.
FIRST GENERATION STUDENTS--COLLEGE DROPOUT RATE
Senator Brown. Thank you very much, Chairman Harkin, and,
Mr. Secretary, nice to see you again.
Eighty-nine percent of first generation students--89
percent leave college without a degree after 6 years, a
terrible waste of human talent, a terrible waste of the future
potentially, and a terrible waste of dollars.
The Gates Foundation said 54 percent of students that leave
during that 6 years cite the need to work and make money; 31
percent cite an inability to afford the tuition and fees. And
this is a direct result of Government not investing the way
that we should. I appreciate the President's efforts there.
You came a couple of years ago to speak to an annual--I
have done it four times in my 5 years now in the Senate--annual
presidents' conference. We bring in 50, 55 college presidents
in Ohio, 2-year, 4-year, private, public. And you spoke 1\1/2\
years ago, 1 year plus ago there. And trying to figure this
whole issue out.
What--talk to me--give me 2 or 3 minutes--what the
Department is doing to target and eliminate barriers faced by
first-generation students, especially community colleges.
My wife was a first-generation. Her dad carried a union
card for 35 years. She was one--the oldest of four children
that went to college. She graduated with very little debt. It
was--I guess I can say this--30 plus years ago. And she--but
she talks about calling home those first 2 years, and her
parents never had any real substantive useful advice for her
about how to navigate their way through college.
So, give me a couple of minutes of very specific, what this
Department is doing to rescue--give those young people
opportunities that they need.
HELPING FIRST GENERATION STUDENTS GRADUATE
Secretary Duncan. First of all, thanks so much for your
passionate leadership in this area. And as we become an
increasingly diverse country, as the minority population
becomes the majority, our ability to help those first-
generation students, not just graduate from high school, but
graduate from high school truly college- and career-ready, and
then to graduate from college is critical. The fate of our
Nation hangs on our ability to do that well, so I cannot
overstate the importance.
MAINTAINING ACCESS THROUGH PELL GRANTS
Three very specific things we are trying to do. One of the
big emphases today is our desperate fight to maintain access
for poor students to Pell grants, which by definition are
students you are talking about. And if we scale back on Pell
access based upon the research that the Gateses and many others
have done, we will simply have a lot less people going on to
college. And they are going to be at a huge disadvantage in
this knowledge-based, globally competitive economy. So, we have
to maintain that commitment and help more and more people have
access.
INVESTING IN COMMUNITY COLLEGES
Second, we have not talked enough today about community
colleges. We think community colleges have been this unpolished
gem along the education continuum. Many are doing a magnificent
job, whether it is with 18-year-olds or 38-year-olds, or 58-
year-olds, folks going back to retrain and retool, in areas
like green energy jobs, healthcare jobs, technology jobs. We
are making an unprecedented investment--$2 billion along with
the Labor Department, to invest in community colleges that are
building strong partnerships with the private sector. And,
again, their work and their courses are leading to real jobs in
the community.
It has been a great partnership with Labor. My Under
Secretary of Education, Martha Kanter, is a former president of
a community college. We have never had someone at that level
with that background. We did that very strategically because we
thought that was so important.
FIRST IN THE WORLD--BUILDING A COLLEGE COMPLETION CULTURE
Finally, we want to invest in the fiscal year 2012 budget
in what we are calling the First in the World Competition, and
to really again put significant money, over $100 million behind
States and universities and nonprofits that can show us what
they are doing to build cultures around completion,
particularly for first generation college goers, folks with
disabilities, those who have been denied opportunities
historically. So, those three, Pell access, a huge play in the
community colleges in trying to invest in place, building
cultures around completion would be the three I would give to
you this morning.
Senator Brown. Thank you, Mr. Secretary.
Two other issues, one a comment, and then a last question.
FEDERAL DIRECT STUDENT LOAN ORIGINATION FEES
It is my understanding that Speaker Boehner's latest
deficit reduction plan proposes to eliminate the Department of
Education's ability to offer incentives to borrowers who pay
their loans on time. The Federal direct student loan program,
which makes so much sense in terms of students dealing with
interest rates, cost, debt all of that. I know that my
colleagues do not--they think it is another big Government
program. It is one that saves money and helps students, and
kind of throws the middle man out, if you will, the banks, and
has made such a difference. But under their deficit reduction
plan, college students would have to pay a higher origination
fee for their Federal direct loan. I would just like you to
continue to do the right thing on the Federal direct loan
program. It matters so much.
TITLE VI CULTURE AND FOREIGN LANGUAGE PROGRAMS
My last question is this. The title VI international
education and foreign language studies programs are, I think,
especially important for us to enhance our capacity to
understand foreign languages and cultures and people--
increasingly important in both a globalized economy and in an
uncertain world.
For 50 years, the United States has invested in building
this national capacity, which is vital to our economic and
diplomatic efforts around the world. I was disappointed that
fiscal year 2011 appropriations contained severe reductions to
international programs.
I think we--and my question is this. I would like more
specifics about how you are measuring the effectiveness of this
program, because I think if you really do measure it, including
implementing the recommendations made by the 2007 National
Academies report, the more accurately you measure this, the
less likely you are going to want to, from my experience with
this, be making any cuts to this program. So, if you would give
me your thoughts on that.
Secretary Duncan. No, I really appreciate you pushing on
that. And we were disappointed those funds got cut
substantially in fiscal year 2011. We are looking to restore
funding for that program that we think is very important. And,
again, in a smaller world and a more globalized world, in order
to give young people those kinds of opportunities, we want to
restore funding in fiscal year 2012. That is part of our
request.
Senator Brown. Thank you.
Thank you, Mr. Chairman.
Senator Moran. Mr. Chairman, thank you.
TEACHER AND STUDENT CLASSROOM EXPERIENCE
Secretary, I appreciate the conversation you and I had last
week, and look forward to working with you to see that good
things happen in education, in our country, and particularly in
Kansas.
STATE AND LOCAL FLEXIBILITY
I voted against No Child Left Behind in its early creation
back when I was a member of the House of Representatives for a
number of reasons. I have genuine concern about what is
happening in regard to teachers. And I am concerned that
education becomes more of a bureaucracy as compared to a
profession. I worry that the classroom experience is being
diminished with focus on in-service teachers' meetings
preparation as compared to that opportunity for teachers to do
what they do best, teach our students in a classroom, in my
view, as students learn with a teacher who loves to teach, with
a student who wants to learn, and parents who encourage that
through discipline and encouragement.
And I want to make sure that the programs we create here in
Washington, DC, do not impede upon that educational opportunity
in the classroom.
FEDERAL FUNDS AS PERCENT OF KANSAS EDUCATION BUDGET
In Kansas, we receive just over 7 percent of our education
funding from the Federal Government, and yet as I talk to
educators--teachers, school administrators, superintendents,
board members--the amount of time, effort, energy, and cost
associated with trying to figure out what the Department of
Education, what the Federal Government is doing in education
consumes a much more substantive amount of their time than the
7 percent of funding that is received. And I suppose one could
answer, well, let us provide more money. I doubt that that is a
realistic option.
STATE FLEXIBILITY AND WAIVERS
I would love to hear from you the efforts that you are--
your Department is pursuing to make sure that schools have the
flexibility, that the focus is on the classroom, that it is not
upon paperwork and bureaucracy. And in particular, you
indicated that if we do not have ESEA reauthorized by
September, that you had plans to offer waivers. And I am
interested in knowing what those--what you would require--what
those waivers would be and what you would require of States to
actually receive a waiver. And also your thoughts about the
growth model, which seems to be educators' kind of solution to
AYP is changing the model, and what efforts in that regard do
you see beneficial?
Secretary Duncan. So, lots there, and I appreciate your
leadership and thoughtfulness on these issues.
IMPROVING PARTNERSHIPS WITH STATES AND LEAS
First of all, one of the biggest things I am trying to do,
and I want you collectively to hold me accountable, is we want
our Department to be a better partner. I was a school
superintendent for 7\1/2\ years, and frankly, I often chafed at
the restrictions of the Federal Government--I tell the story
frequently that I had to have a huge battle with my Department
of Education here for the right to tutor poor children after
school in Chicago. I won that battle, but it made no sense that
we had to fight the Federal Government to do the right thing by
children.
So, I am acutely aware of the history there. I cannot say
we are doing it perfectly every day, but I just want to assure
you we are trying. And I would encourage you to talk to supes
and State school chief officers, and teachers to find out if we
are being more receptive and doing a better job of listening.
INCREASED EFFICIENCY THROUGH PROGRAM CONSOLIDATION
We have tried to consolidate programs, to cut from 38 to
11, to become more efficient and effective, but also just to
have less points of contact, make it simpler for folks to deal
with us.
FLEXIBILITY IN EXCHANGE FOR RESULTS
And then for me, the tradeoff in all of this, whether it is
in our education plans, Race to the Top, i3, Promise
Neighborhoods, whether it is in, hopefully, reauthorization of
ESEA, and if not, potentially waivers--to me, the real tradeoff
is where States and districts are raising the bar, setting
higher standards, and holding themselves accountable. I am a
big believer in growth rather than absolute test scores. I want
to know how much students are improving each year, not whether
they are at some artificial cut point.
Where States are doing the right thing, we want to provide
a lot more resources and a lot more flexibility. Where folks
are backing down, reducing standards, showing an unwillingness
to close the achievement gap, we are going to challenge them
very, very hard.
NO CHILD LEFT BEHIND
But for me, the grand trade off philosophically in all
these things is, if we can hold folks accountable to a high
bar, then we should give them a lot more room to move. I think
the current law, I have said repeatedly, is far too punitive.
It is far too prescriptive. It led to a narrowing of the
curriculum, and it led to a dumbing down of standards. None of
those things are good for children or teachers or education in
our country, and we want to fix the law in a common sense way.
Chairman Harkin is working extraordinarily hard in a bipartisan
manner. We are working very, very closely with Senator Enzi,
and with the gentleman to your left, Senator Alexander, someone
I have great, great respect for, who held my position. I listen
very closely when he speaks.
BIPARTISANSHIP APPROACH TO EDUCATION BILL
And we just hope, despite some of the dysfunction, frankly,
that we see coming from our Congress, that we can think about
education, while putting politics to the side, putting ideology
to the side, to come up with a common sense, bipartisan bill.
It is the right thing to do. And I desperately hope that will
still happen.
Senator Moran. I thank you for your answer, and I will
follow up with questions in writing.
WAIVER FOR MC PHERSON USD SCHOOL DISTRICT 418
But in that regard, as I indicated to you, I am very
grateful for the waiver you provided McPherson USD School
District 418. They have created their own set of tests and
standards, and you granted the first waiver nationwide. It is
an example of what is going on in Kansas. It is very
beneficial.
Secretary Duncan. And let me be very clear on that. That
was not a gift; that was something McPherson earned. They
basically said they were raising the bar above State standards.
And whenever anyone is holding themselves to a higher level of
accountability and challenging both adults and students to do
more, we want to do everything we can to support that, and,
frankly, to get out of the way. So, I appreciate their courage.
That is tough, tough work. But if we had more districts and
more States doing that, today education would be in a much
better place. So, that was not a gift; that was something they
absolutely earned. And I appreciate the example they are
setting for the country.
Senator Moran. I do criticize you for using my time to
compliment Senator Alexander.
Do that when he asks his questions, I would appreciate it.
Thank you, Mr. Secretary.
Secretary Duncan. I will use his time to compliment you.
Senator Harkin. Senator Landrieu.
Senator Landrieu. Mr. Secretary, let me begin by using some
of my time to compliment Senator Alexander. I have worked with
him on many issues.
And I appreciate his continued support for our bipartisan
reform efforts.
I want to thank you, Mr. Secretary, for your passionate
leadership and your inspirational leadership. I think you are
exactly the right Secretary for the challenges before this
Nation. And I thank you for being tough and not backing up and
pushing this all forward.
TEACH FOR AMERICA
But I wanted to raise just a couple of questions that are
concerning to me.
First, is because of the zeroing out of several critical
and, in my view, superior programs, one of which, not the only
one, but one of which is Teach for America. This subcommittee
rallied in a bipartisan way because that program was zeroed out
both by the President's budget and by a missed definition, in
my view, of earmark. This subcommittee rallied, the chairman
helped us, to identify 1 percent of title II-A funds last year
so that some funding could move to Teach for America and other
programs that were, in my view, in a very shortsighted way
zeroed out.
We have a plan--90 Members of Congress have sent a letter
to you and the President, urging you to set aside 5 percent
this year for these high-performing, effective programs. I am
going to ask you this question in a minute. But I want to put
on the record, Teach for America last year, there were 48,000
applicants. Now, these applicants are the top 1 and 2 percent
of students graduating from all of our universities. From 1,500
colleges they applied. They only selected 5,000. Again, 48,000
applied, 5,280 were selected by limits of budget.
LEVERAGING POWER OF TEACH FOR AMERICA
TFA, for every $7 in non-Federal funding, they leverage $7
in the private sector for every $1 that we fund them.
TEACH FOR AMERICA AND STEM INSTRUCTION
In addition, TFA is the largest single provider of STEM--
science, technology, engineering, and math--teachers in the
country, so science, technology, engineering, math, STEM. They
are providing more teachers, so we cut this program out
entirely. It makes no sense to me.
TEACH FOR AMERICA FUNDING
We have tried to say collectively, how do we get our best
and brightest in the classroom? So, Teach for America comes up
with a plan, mostly private sector driven, nonprofit driven. We
put up a little money, they put up a lot of money, the public
benefits.
I am very confused as to how we zero out a program like
this. So, we want to solve this problem.
Are you committed to increasing 5 percent so that at least
Teach for America has an opportunity to compete for decent
enough money to get them back on track to continue to provide
the technology, engineering, and math teachers this country
desperately needs? If so, why? And if not, why not?
TEACH FOR AMERICA--LEADERSHIP DEVELOPMENT BENEFITS
Secretary Duncan. First of all, obviously I think Teach for
America has done a remarkable job, not just at producing
teachers and teachers in STEM areas and teachers in
disadvantaged communities, but one of the huge residual
benefits of the program is it has been an amazing leadership
program. And many innovative superintendents, many leaders of
nonprofits, many education entrepreneurs are Teach for America
alums. And I think that is a benefit. When I ran Chicago Public
Schools, I worked to bring TFA in. What I did not realize--I
was not smart enough at the time, when we started opening
really innovative new schools in disadvantaged communities--a
wildly disproportionate number of the principals leading those
efforts were Teach for America alumni. So, it was a really
important lesson for me.
FUNDING INCREASE FOR TEACH FOR AMERICA
Senator Landrieu. So, do you support the 5 percent----
Secretary Duncan. So, we are adding--I am getting to that.
We are right now, as you know, TFA successfully competed,
again, not a gift, won, a $50 million grant to invest in
innovation. Had great evidence, great data on effectiveness. We
were happy to do the 1 percent set-aside. I would need to sort
of sit down with my staff and think about the 5 percent set
aside as we move forward. I understand the need, and to give
more folks the chance to compete would be interesting to me.
So, I am not willing to commit to it today, but----
Senator Landrieu. Well, the nine of us are going to push
you very hard to do that. And there are other programs, not
just Teach for America, that are superior, effective, and
extraordinary in their results. We should not be eliminating
them.
RACE TO THE TOP ACCOUNTABILITY
And my second question, Race to the Top----
Secretary Duncan. I could not agree with that more.
RACE TO THE TOP AMENDMENTS
Senator Landrieu. Okay. My second is, every State except
Georgia that won Race to the Top in the first two rounds has
now amended its State reform plan in some way, usually to push
back timetables or scaling, you know, scale back initiatives.
According to the list of approved amendments, there were 12
winners that changed their plans 25 times.
My question is, the administration has requested an
additional $900 million for the Race to the Top, but before
approving additional funding, are you going to continue to give
out funding to States just to see their timelines, which they
promise to meet, push back, or there are promises made, then
modified, and not reach the goals that we all hope for them to
do?
Secretary Duncan. No, we are absolutely holding them
accountable for outcomes, and we are never giving waivers for
material changes in applications. We have asked them to take on
very, very ambitious work. If it takes a little bit longer to
get that work done well, we are happy to support that. If it is
bypassing that work or avoiding it, we will never grant that
waiver. And to be very clear, we will withhold funding if they
take that step.
I am not, frankly, seeing that. I am seeing huge amounts of
courage. I am seeing extraordinarily hard work going on.
Sometimes it takes a little longer, but I am interested in the
outcome, in quality. And the second we see a State back away
from that, we will stop funding them immediately. I want to let
you know that, absolutely.
Senator Landrieu. Okay. And I know my time is up, Mr.
Chairman, but I do have other questions. I will just submit
them for the record on the TRIO program and emergency
preparedness for schools. And I thank you very much.
Secretary Duncan. Thank you.
TEACH FOR AMERICA FUNDING
Senator Harkin. I might just say to my friend from
Louisiana that I have always been a big supporter of Teach for
America. It was one of those earmarks that we used to do.
Senator Landrieu. But it is a federally authorized program,
so I am very confused about that definition.
Senator Harkin. Well, we put a set-aside in there for
everything at 1 percent. I would be delighted to visit with you
about whether that should be increased at this level or not on
that set-aside.
Senator Landrieu. Thank you, Mr. Chairman, for your
leadership.
Senator Harkin. Well, for the competition.
Senator Landrieu. And it is not just for Teach for America,
but there are several effective programs out there. I mean, I
understand eliminating programs that do not work, but when we
start eliminating the best programs that are working at even a
public/private partnership, I think we have gone way off the
cliff.
Senator Harkin. Well, I could not agree more. Thank you
very much.
Senator Pryor.
Senator Pryor. Thank you, Mr. Chairman, and I want to thank
the Secretary for being here today. It is great to see you. I
think the last time you and I saw each other face to face was
in Little Rock when you were at Little Rock Central High School
doing your Courage in the Classroom kick off. I hope that was
successful. We loved having you in Arkansas. Thank you very
much for coming down.
PROMISE NEIGHBORHOOD PROGRAM
I want to ask about the Promise Neighborhoods program. This
is a program under which the University of Arkansas at Little
Rock was successful in getting a planning grant for fiscal year
2010. I am curious about your view of how the Promise
Neighborhood projects are going. What kind of results you are
seeing out there? What kind of end results you are looking for?
Secretary Duncan. This is a hugely important initiative to
me, particularly in our Nation's most distressed, most
disadvantaged communities. The only way we strengthen those
communities is by increasing the quality of education and
building community support for that work, and building the kind
of wrap-around services and nonprofit partnerships that help
schools to be successful in very tough communities.
PROMISE NEIGHBORHOODS FUNDING
We were fortunate to be able to fund 20 planning grants,
that being one of them, around the country. We had 300
applicants, and we had many more highly creative, thoughtful
proposals that I would love to have funded that we simply did
not have the money for. Fiscal year 2011, we have $30 million
that we are going to use for a combination of purposes--
starting to fund some programs, some communities for
implementation and others to develop a plan. But we would like
to see a significant increase in the investment in Promise
Neighborhoods for fiscal year 2012 to really start to move to
implementation across the country.
And the grants are in very poor rural communities. We have
one planning grant on an Indian reservation, Native American
reservation, and others in distressed inner-city communities
where we can get the kind of results that Geoffrey Canada has
done in the Harlem children zone in New York, dramatically
transforming the life chances of young people there.
NEED FOR RECOGNIZING, FUNDING MORE PROMISING PROGRAMS
We can prove, demonstrate, that communities can come
together to help the most challenged children and families be
very successful academically. So, we think this is the right
investment. It is early on. There is much greater need and
capacity out there than we are able to fund, and that is what
is heartbreaking to me. There are people doing amazingly
thoughtful work, collaborating, partnering in ways that they
never would have done before. We support that effort to not
scale back. And so we would respectfully ask for a significant
increase in funding to move toward implementation to a wide
variety of communities around the country.
Senator Pryor. I think that is great. So, you are seeing
what you would hope to see out there, which is communities
coming together and really getting great things done. And now
you are getting to the implementation stage.
PROMISE NEIGHBORHOOD APPLICANTS AND AWARDS
Secretary Duncan. And we were blown away by the number of
applicants, the quality of applicants. And, again, we were able
to fund 20 or 21. There were probably over 100 that I would
have felt great about investing in, and I was thrilled to do
the ones we did. I would love to have had the chance to invest
in many other communities.
SCIENCE, TECHNOLOGY, ENGINEERING AND MATHEMATICS
Senator Pryor. Well, thank you for that answer. Now let me
also ask about STEM. This is an area that is very important.
You have prioritized STEM education in your budget. My view is
that focusing on STEM will absolutely translate into better
jobs, better opportunities for many, many, many Americans
around the country. Could you comment on that and talk about
your vision for STEM education and how that impacts the future
workforce?
Secretary Duncan. So, at its heart as we go forward, we
simply have to produce a lot more young people with skills,
with competency, with a passion for the STEM disciplines. That
is where the jobs of the future are. That is going to be the
future creators, the innovators, the entrepreneurs who are
going to create jobs in fields that do not even exist today.
STEM TEACHER SHORTAGE
Right now, we have a shortage of teachers who are strong in
STEM. We have had that shortage in this country probably for
20, 25, 30 years, and I want to stop admitting the problem. I
want to try and fix it. And we need teachers with great
passion, great interest in the STEM fields, not just for AP
calculus and physics, but in third, and fourth, and fifth grade
where too often students start to turn away from that, lose
interest because their teachers do not know the content area,
and they start to back away.
So, we have to invest significantly to get that next
generation of teachers to come in to the STEM fields. The
President has challenged us to recruit 100,000 new teachers in
the STEM areas. We have to make sure that students in
elementary school, eighth grade have access to classes like
algebra I. We have to make sure that students--sophomores,
juniors, and seniors--in high school have access to AP classes
and college-level classes in the STEM fields.
I think we--I am a little controversial on this but, I
think particularly in disadvantaged communities, in rural and
remote areas, we should be thinking about where there is a
scarcity of great STEM teachers, and I think we should pay
those teachers more money to take on those assignments in
communities that just haven't had access. And we see across the
Nation far too many young people--we just did a recent data
survey--data collection with the Office of Civil Rights. There
are far too many--hundreds of thousands of young people who do
not have access to a class like algebra I in eighth grade. And
if you want them taking, you know, AP physics or calculus down
the road, you have to start them in that trajectory.
So, we have a lot of hard work here. I do not want to keep
admitting the problem. I want to try to fix it.
Senator Pryor. Right. Mr. Chairman, thank you. Before I
close, I would like to say to Secretary Duncan that I know we
have picked on Senator Alexander today. But I know that Senator
Alexander has great respect for you because the other day he
was telling me that he thinks you are the second best secretary
of education we have ever had.
Thank you.
Senator Harkin. Thank you, Senator Pryor. I must just add
on the STEM stuff, Mr. Secretary, you pointed out it is so
important to get down to first-, second-, third-graders who
have a natural instinct and interest in science, and to
encourage that at that level.
Senator Kirk.
EDUCATION SUPPORT FOR CHILDREN OF MILITARY FAMILIES
Senator Kirk. Thank you. And, Mr. Secretary, it is great to
see you in this job after what you did for the Chicago Public
Schools.
And I want to talk to you about--Senator Durbin and I are
working on making sure that we are supporting the military
families, especially around Great Lakes. We have a unique
arrangement there. We are working with the chairman to make
sure that we do not see a couple of school districts implode
that support the military families there.
CHARTER SCHOOLS
Then there is a unique charter school initiative that we
are rolling, which I think will look a little bit like a DOD
school, and further support military families that may be
replicable throughout the rest of the country. I wonder if you
could comment on those two initiatives.
Secretary Duncan. Yeah. I do not know the details. I think
you are working in the North Chicago community.
Senator Kirk. Right.
Secretary Duncan. And I will just say simply, we cannot do
enough to support our military families. And as I talk to
troops who are serving and who have come back from service in
Iraq and Afghanistan, when I ask what can we do to help you,
they consistently say, take care of my children. Educate my
children. That is the least we can do.
And so, I do not know the details of the proposal. Whatever
I can do to support getting high quality options, strengthening
education for the children of adults who are serving our
country, I want to do everything I can to help that. I have
tried to travel to as many bases and schools around military
communities to really understand the challenges.
COMMON STANDARDS BENEFIT MILITARY FAMILIES
This is a little bit off topic. There are huge benefits of
the common standards that folks are doing, higher standards,
for as you know, military families move very frequently, and
they get devastated by those moves to different States doing
different things, and children finding out they are far behind.
So, they have been extraordinarily supportive of the work we
have done to have college- and career-readiness common
standards in the vast majority of States around the country.
So, at the local level, nationally, whatever I can do to help
support these children, please count me in.
EXPANDING CHARTER SCHOOL OPPORTUNITIES
Senator Kirk. Thank you. Senator Durbin and I are also
working on the Durbin-Kirk ALL-STAR legislation to expand
charter school opportunities for kids. Right now, for example,
in a community you know well, Chicago, only about 10 percent of
families even have the ability to send their kids to a charter
school. So, we would change the Federal funding law to allow us
not just to start new charter schools, which is allowed under
Federal law, but to expand current ones. And I think that would
allow us to pick the winning charter systems. But can you
comment on that?
Secretary Duncan. I think, again, that is where I have been
very, very clear. I am not pro-charter; I am pro great schools.
And where you have great charters, giving them the chance to
replicate, to serve more students, it is silly not to do that.
I have also challenged the charter community, when schools are
not working, we need to hold them accountable and close them
down. But where you have high-performing charters, particularly
in disadvantaged communities, to give them the chance to serve
more children makes absolute sense to me.
And where you have now not just sort of mom and pop charter
models, you have some national models. You have folks that are
replicating at a pretty significant scale in many communities
and demonstrating this is not one amazing principal or one
charismatic teacher, but systemically they are closing
achievement gaps in very significant ways.
And where we are seeing that, I just want every child in
this country to have a chance to go to a great school.
ACADEMIC YEAR CALANDAR
Senator Kirk. Yeah. Can I have you talk about a big picture
item? Our basic school calendar was established two centuries
ago, in the 19th century, to provide a summer break to bring in
the harvest, which I think is particularly inappropriate for
the now 80 percent of Americans who live in an urban or
suburban area.
We generally see in school performance that the summer
break will set kids back at least 1 month if not more. Give me
your views on all-year school in the 21st century.
LONGER SCHOOL YEAR NEEDED
Secretary Duncan. I usually get booed by children when I
talk about this, and adults usually--most adults cheer, not
everyone.
But I think we are crazy on this as a country. The fact
that our school calendar is based upon an agrarian economy
makes no sense to me whatsoever. And other countries that are
out-educating us today--I do not think they are any smarter
than us but, a lot of them are just going to school 30, 40, 50
more days a year than we are.
Senator Kirk. Right.
Secretary Duncan. And they are just working a little bit
harder and we need to work a little bit harder. All of you guys
are in your positions because you work pretty hard. And we are
just denying that opportunity to our young people. So, I am
advocating everywhere I can, passionately, for longer days,
longer weeks, and longer years.
And let me be clear. Particularly in the summer, not that
every child needs to do that. If you have a middle class
child--a child that has access to libraries and summer camps
and museums, that is okay. But if that child is going to be in
the street or is going to sit in front of a TV all summer, that
is a devastating loss. We are trying to close achievement gaps,
not expand them.
And so, to not give those students those kinds of
opportunities makes no sense. So we can be, you know,
thoughtful, we can be creative here, you can differentiate, you
know, on what students need. But to just say we are going to
stop learning in June and just hope for the best, particularly
in disadvantaged communities, just makes no sense to me
whatsoever.
And, Senator, I have gone too long on this. But what really
troubles me is you see some districts being really creative
around the use of time and technology and doing some great
things. You see other districts retrenching, going to 4-day
weeks, shortening the school calendar. And I understand these
are tough economic times, but those are horrendous decisions,
and we need more time, not less. Our children need more
structure, more opportunities to learn. And if we want them to
compete and to compete successfully in a global economy, right
now we are putting them at a competitive disadvantage from
children in India and China who are going to school 30 to 50
days more each year than children in the U.S. I do not know why
we would want to put our children at a competitive
disadvantage.
Senator Kirk. And, Mr. Chairman, I know there are
difficulties and we have to work out payer work arrangements,
but the country, I think, should begin a debate on moving to
all-year school. I think that would help our performance.
And I would say the very controversial thing of joining
Senator Landrieu on praising Secretary Alexander and his work.
Senator Harkin. Thank you very much.
Senator Alexander.
Senator Alexander. Well, thanks. If I had known all these
compliments were going to flow, I would have come on time.
That gives me a chance to restate what I have said many
times. I really compliment President Obama for his appointment
of Secretary Duncan, who has a real heart for the job and a lot
of experience, and is willing to challenge a lot of
conventions. And despite the fact he is more of a basketball
player than a politician, he is a better politician than most
cabinet members and than most senators. So, all of us, I
included, really respect your work.
EDUCATION ACCOUNTABILITY
Let me use my time to talk with you for a few minutes about
what we call accountability in the education business. And I
want to read a letter--not a whole letter. I want to read a
sentence from a letter or two and see whether you agree with
it. I think you are generally familiar with the letter. This is
a letter that the chief counsel of Chief State School Officers
wrote to me and cc'd Senator Harkin, and Senator Enzi, and
Senator Bingaman in May, talking about the work they have been
doing, which you have been very much involved with. And I have
asked, Mr. Chairman, this letter be included in the record.
Senator Harkin. It will be.
[The information follows:]
Council of Chief State School Officers,
Washington, DC, May 19, 2011.
The Honorable Lamar Alexander,
455 Dirksen Senate Office Building,
United State Senate, Washington, D.C. 20510.
Dear Senator Alexander: In anticipation of our meeting, I wanted to
share with you some information regarding the important work currently
being led by the States on behalf of our Nation's students. We look
forward to discussing our work with you in greater detail in hopes that
we might be able to partner with you and work with the Senate Health,
Education, Labor and Pensions Committee to inform reauthorization of
the Elementary and Secondary Education Act (ESEA).
Over the course of the past several years, and in the face of
outdated and burdensome Federal requirements, States have led in
developing policies and systems designed to ensure that all students
graduate from high school ready for college and career. This is
evidenced by myriad State-led reforms, including:
--The development and adoption of college- and career-ready,
internationally benchmarked standards, including the Common
Core State Standards in reading/language arts and math that
have been adopted by 45 States and territories;
--The ongoing development of robust, internationally benchmarked,
assessments aligned to rigorous standards, including through
the two national assessment consortia (PARCC and SMARTER
Balanced);
--The design and implementation of growth models for accountability,
which focus schools on ensuring that students meet the goal of
college- and career-readiness; and
--The development of improved standards for teacher and principal
effectiveness, and teacher and principal evaluation systems
focused on student achievement.
In the light of this State leadership, CCSSO spearheaded a task
force of chiefs in developing a roadmap for States in looking at next-
generation accountability systems. Coming out of this task force are
principles that would guide new models of school and district
accountability designed to better drive school performance toward
college- and career-readiness; more accurately and meaningfully
identify and support the range of schools; and better provide
actionable data to support districts, schools, principals, teachers,
parents, students, and policymakers to dramatically improve student
achievement. Beyond these core requirements, States may and will
develop proposals that approach these issues in different ways. Each
state's proposal would be guided by the following principles:
--Fully align accountability expectations and measures to the goal of
all students graduating from high school ready for college and
career;
--Make annual accountability determinations for all schools based on
the performance of all students;
--Base accountability determinations on student outcomes, including
but not necessarily limited to improved, rigorous statewide
assessments in reading and math (grades 3-8 and high school)
and accurate graduation rates;
--Base accountability determinations in part on disaggregated data of
student performance across relevant subgroups;
--Provide timely, transparent, disaggregated data and reports that
can meaningfully inform policy and practice;
--Include, as appropriate, deeper diagnostic reviews of school and
district performance, particularly for low-performing schools,
to create a tighter link between initial accountability
determinations and appropriate supports and interventions;
--Focus on building district and school capacity for significant and
sustained improvement in student achievement toward college-
and career-ready performance goals; and
--Focus significant interventions on the lowest performing 5 percent
of schools (elementary and middle, and high schools) and their
districts (in addition to targeted interventions to address the
lowest performing subgroups and/or schools with the greatest
achievement gaps).
A critical number of States are committed to moving forward in the
design of accountability systems aligned to these principles and we
expect a number of additional States to join in the next couple of
weeks. States seek a reauthorization that supports this State
leadership and innovation, and does not remain a barrier or seek to
codify a single ``right'' answer for national education reform. We want
to work with you in this effort and hope that our work helps to inform
your conversations going forward. I look forward to meeting with you to
discuss these issues in greater detail.
Sincerely,
Gene Wilhoit.
NO CHILD LEFT BEHIND--FLEXIBILITY AND ACCOUNTABILITY
Senator Alexander. Thank you. Thank you.
In this letter, it talks about the work that the different
States have done in creating common core standards, in creating
a test to see where children are meeting that standard, and
creating what we call growth models, which have been discussed
in this hearing before, and especially in working in there that
you, and I, and others care a lot about, which is finding a way
to measure teacher and principal effectiveness, and especially
relating that to student achievement. And it is a very
impressive record.
And they go on to say this. And I had a conversation about
this with one of your predecessors, Secretary Dick Riley, the
former Governor of South Carolina, who supports this idea. The
last--this is the sentence in the letter, it says, ``States
seek a reauthorization of the Elementary and Secondary
Education Act that supports this State leadership and
innovation, and does not remain a barrier or seek to codify a
single right answer for national education reform.'' Do you
agree with that?
Secretary Duncan. Yes.
FEDERAL ROLE IN EDUCATION
Senator Alexander. Well, good. Then as we go down through
these, one of the difficult issues that we have as we think
about fixing No Child Left Behind is this accountability
section. And to what extent should the Federal Government write
anything about tests, write anything about a growth model,
write anything about how to measure teacher performance,
because whenever we put it in law, then the Department of
Education, which you and I know something about, then goes
through a process of rulemaking, establishes ``parameters,''
which are what people in Washington think Chicago
superintendents or Governors of Tennessee ought to be doing.
And it all sounds good. By the time you get it all done, you
have a superintendent flying in from Denver, Chicago, or
Nashville seeking the Secretary's approval for some specific
growth model, which is a big waste of everybody's time.
So, what I am trying to get at--and let us take a specific
example. Let us take the idea of relating student performance
to teacher pay. I am a big advocate of rewarding outstanding
teaching, master teachers. I think it is the Holy Grail of
education. How do we reward outstanding school leaders and
teachers with more pay, more honor?
TEACHER INCENTIVE FUND
And I think many of us agree on that. But my fear is that
if we put it into the law, and we write a rule about it, then
suddenly we will be defining what 100,000 schools will be
trying to do, and I do not think it works well that way. I
think what has worked well is your teacher incentive fund where
you give grants and money to local school districts who then
work with their teachers or work with their community and come
up with different models for rewarding outstanding teaching.
So, what would your advice be as we work on fixing No Child
Left Behind about how we accomplish this goal, which there is
broad bipartisan support for, without running into the problem
of violating what the Chief State School Officers have told us
they do not want done.
Secretary Duncan. Yeah. These are really, really thoughtful
questions, and you and I have talked about this a multitude of
times.
STATE FLEXIBILITY
There is a balance we are trying to strike and where I
think we are all trying to get to the same point and trying to
figure out how to do that. The last thing we want to be is to
be prescriptive or top down. We think the teacher incentive
fund has been very effective. We think Race to the Top,
frankly, was very effective. We said that student achievement
had to be a significant part of teacher evaluations, but we did
not say a number, and, frankly, we do not know that number. We
have seen a huge amount of very creative and very, very hard
work going on at the State level because we incentivize that in
the right way.
So, the Council of Chief State School Officers, Gene
Wilhoit, has been an amazing profile in courage. All this work
of higher standards, better assessments we talk about, that is
not coming from you or I. That is coming from Governors and
chief State school officers having the courage to do the right
thing. And I cannot overstate what a great partner they have
been.
ENSURING ACHIEVEMENT GAINS WITHIN FLEXIBILITY
I think the vast majority of States are moving in the right
direction now. My only concern is I do not want to give a pass
to a State that somehow goes in the wrong direction. And we
have a history of Governors, both Republican and Democrat, who
dummied standards under No Child Left Behind, who did exactly
the wrong thing for children for their State, because it was
politically expedient, because it made them look good
politically, but it hurt their children, hurt their education,
ultimately hurt their State's economy. And nobody said anything
about it. It was like they all got a great pass.
So, I want to continue to reward courage, to incentivize
that. But I also think as the Federal Government, we have an
obligation to make sure if a State says, you know, we are not
going to do accountability, we do not care about achievement
gaps, we think poor children, black or brown children cannot
learn--we have to think about what the Federal responsibility
is there. And I think that is--we are trying to get that fine
line worked out and, again, we continue to look to your advice
and guidance of how best to do that.
Senator Harkin. And, Senator Durbin.
Senator Durbin. Thank you very much, Mr. Chairman.
Secretary Duncan, Mr. Skelly, thank you for being with us.
Mr. Secretary, thanks for the good job you are doing.
GROWTH IN RATE OF STUDENT INDEBTEDNESS
In October of last year, we reached a milestone in America
that most people did not know and did not hear about. For the
first time in the history of our country, student loan debt
exceeded credit card debt in America.
The rate of growth of student indebtedness in our country
is alarming. The indebtedness that students are incurring to go
to school is holding them back in terms of their own personal
ambitions and career goals, and creating a problem for us
because should they default, ultimately the taxpayers will be
the losers.
I and many others have voted consistently for student
assistance because that is why I am sitting here today. Were it
not for the National Defense Education Act enacted by this
Congress out of fear of Sputnik and the Russians, I do not know
if I would have gone to college or to law school. So, I have
always felt that I owed it to the next generation to give them
the same chance.
PELL GRANTS VERSUS STUDENT LOANS
And I have always felt the same way about Pell grants
because, rather than loans, this is money that a student does
not have to repay. The Pell Grant now is in the range of
$5,500. The administration believes it is important and had
made it part of our budget negotiations.
And notwithstanding that, the next time I vote on Pell
grants, I am going to have a very difficult time voting for
them and looking at student loans the same way. And you know,
because we have discussed it at length.
FOR-PROFIT SCHOOLS
And the chairman of this committee has looked at a problem
that we are facing that I think many Members of Congress are
ignoring; that is the growth of for-profit schools.
For-profit postsecondary education trains or educates 10
percent of the students, claims 25 percent of all Federal aid
to education, and accounts for 44 percent of all student loan
defaults.
What is going on is nothing short of scandalous. There are
private companies that have found a way to game our system, to
bring students out of high school into a so-called learning
environment to burden them heavily with debt, to hand them
worthless diplomas, and then watch while they fail.
We have got to do something about this, Mr. Secretary.
I cannot vote blindly for Pell grants and college student
loans knowing that this Ponzi scheme is going on in the name of
for-profit colleges. Now let me add, there are good ones, and I
could name a few and you could, too. But there are so many bad
ones, terrible schools, that are exploiting students these
days.
You looked at this. You have come up with a proposal. I
think it moves in the right direction, but I think it moves too
slowly.
How can we in good conscience extend Pell grants and
student loans knowing that this kind of predatory lending is
going on, this kind of subprime mortgage pyramid is being
created in the name of higher education?
WORKING TO ENSURE EFFICACY OF FEDERAL STUDENT AID
Secretary Duncan. Sir, your leadership in this issue and
Chairman Harkin's absolute passion and leadership I think has
changed the national conversation.
And what we tried to do is very simple, and I think it is a
significant step in the right direction. Is it perfect?
Absolutely not, and we have had those conversations. But what
we want to do is where you have good actors, as you said, we
think that is a good investment. We think that is good for
young people and folks who have not had those kinds of
opportunities before to have the chance to increase their
skills, if it is leading to meaningful work, if those skills
and what they are learning are real. If it is not, we simply
cannot continue to invest taxpayer money anytime, but
particularly in tough economic times, in those places.
So, we put in place some pretty significant rules and
guidance that has been heavily challenged by many in the
industry. Some of the good actors are actually supporting it,
which has been interesting. But basically, trying to eliminate
those programs that were not leading to good outcomes, where
there is, you know, false advertising, where there are no jobs
available, where you are under a mountain of debt that you
cannot pay back. That is a horrendous investment. So, we have
tried to move in the right direction.
I would also add, I think we have seen pretty significant
changes in behavior. We have seen a number of CEOs lose jobs.
You have seen institutions start to behave in some very
different ways. And so, I think this is going in the right way,
and I feel much more comfortable about our investment in grants
and loans, more comfortable today than I did before our
regulation.
ACCREDITATION AND TRANSPARENCY OF FOR-PROFIT SCHOOLS
Senator Durbin. I have only a few seconds left. Here is
what I think we have to do. You cannot expect a student or that
student's family to know whether a school is worth investing
in. There is no way they can tell whether the claims made by
the school are true or not. It starts with the accreditation.
I have been disappointed, sadly disappointed, by the
limited, if negligible, standards for accreditation. Schools
that are a laughing matter end up being accredited. How is a
student supposed to know? How is a family supposed to know?
They assume that if they are accredited and our Federal
Government will send Pell grants and college student loans
through those schools, that it is a good education. Why would
they not assume that?
Do we not have an additional obligation when it comes to
evaluating these schools?
Secretary Duncan. No, I think that is a great, great point.
Absolutely. And we need to look at that. You have been very,
very clear on that.
I would only add one thing; what we are trying to do now is
to really increase transparency so that young people and their
parents can have a much better understanding of outcomes. And
we think that transparency--we think there are lots of choices
out there, and that transparency will hopefully drive behavior
in the right way.
But your basic question about accreditation is an
absolutely real one, and I will take that to heart.
REPAYMENT OF STUDENT LOAN DEBT
Senator Durbin. And the last point I will make, if you will
bear with me for 5 seconds. Student loans are different than
other debts. They are not dischargeable in bankruptcy. A
student loan you will carry to the grave, and that is something
we ought to remember and students should be advised of before
they make these decisions.
Thank you.
[The statement follows:]
Prepared Statement of Senator Richard J. Durbin
I want to thank the Chairman for convening this hearing to review
the fiscal year 2012 budget request for the Department of Education.
We are engaged in a debate this week about our Nation's long-term
fiscal outlook as we consider proposals to raise the debt ceiling. We
can deal with our debt responsibly and in a balanced way.
We have to reduce the debt and deficit. But investing in education
and retraining is the best way to ensure our economic recovery now and
our economic growth well into the future.
President's Budget for Fiscal Year 2012
The President's fiscal year 2012 budget recognizes the importance
of education to sustained economic recovery by investing in key areas:
--Early childhood education.--The President's budget includes $8.1
billion for Head Start to serve an additional 1 million
children and families.
The budget also includes an additional $1.3 billion to support
1.7 million children and families through the Child Care
Development Block Grant Program.
--High-quality schools.--The President's budget includes $26.8
billion, an increase of 6.9 percent, for a reformed Elementary
and Secondary Education Act that is focused on raising
standards, encouraging innovation, and rewarding success.
--Innovation and reform.--The budget would invest $1.4 billion in
competitive programs that leverage scarce Federal dollars to
bring about systemic reform in education.
--The Early Learning Challenge Fund would spur States to improve
the quality of early childhood programs.
--A new Race to the Top program would bring resources to school
districts willing to make needed reforms.
--A new ``First in the World'' competition would encourage colleges
and universities to demonstrate success in graduating more
high-need students and preparing them for employment.
These are the kinds of programs that use limited resources to
inspire meaningful improvements. And it's the students who win.
Pell Grants and For-Profit Colleges
I would like to say a word about Pell Grant funding.
The Department of Education expects demand for Pell grants to reach
9.6 million students next year, up from 6 million in 2008.
The President's budget would maintain a maximum Pell Grant award of
$5,550 per year for these students.
As a beneficiary of Federal investment in higher education, I have
always voted to support Pell Grants and Federal student loans.
But I have become deeply troubled by what I see happening in higher
education today. The Federal financial aid system is in serious peril,
largely because of the actions of many for-profit colleges.
For-profit colleges educate less than 10 percent of students, take
in 25 percent of all Federal financial aid, and account for 44 percent
of all student loan defaults.
We can't afford to see taxpayer dollars wasted by sending billions
of dollars of Pell Grants to for-profit schools, many of which aren't
providing a good return on that investment.
If we want our economy to grow, we should help low-income students
attend colleges that put them on a path to success.
But it is irresponsible for us not to question whether the
taxpayers are getting their money's worth at many for-profit colleges.
And as we consider increasing funding for the Pell Grant program to
meet our commitments to students, I think we should also have a serious
conversation about how to ensure the value of that investment.
Taxpayers deserve some assurance that a Pell Grant invested in a
student is leading to a better career, a higher salary, and a greater
potential to contribute to the economy--not wasted at a for-profit
college that leads to little except debt.
Conclusion
Chairman Harkin, we can invest in education in a way that's
fiscally responsible and will lead to stronger economic growth long
into the future.
The Administration has provided us a good start to that
conversation, and I look forward to hearing from Secretary Duncan this
morning.
MISUSE OF STUDENT AID BY FOR-PROFIT INSTITUTIONS
Senator Harkin. Well, thank you, Senator Durbin. And,
again, I thank you for your great leadership in this area. You
are the one who first started getting me focused on this a year
and a half ago. And as you know, our authorizing committee has
had a series of hearings and investigations into this going
back 18 months. And what we have uncovered is just about what
you just talked about. It is an invasion into the programs that
we have developed to help poor kids get a decent education to
prepare them for a career.
And it has turned into almost an open spigot of taxpayers'
dollars being siphoned off to hedge funds, Wall Street. You
would be surprised how many of these for-profit schools are
owned by Wall Street entities. And they are most interested--
their interest is in the bottom line, not on education.
Well, we do not mean to get into that, but thank you for
your leadership.
SPECIAL EDUCATION MAINTENANCE OF EFFORT WAIVERS
Mr. Secretary, I do not mean to hold you any longer, but
just one issue I wanted to raise with you relates to special
education. Obviously you know this is a long-standing interest
of mine. We have discussed this many times.
Tight budgets are leading some States to ask for waivers
for their maintenance of effort requirements under IDEA. I want
to thank you for your close scrutiny of those requests, which
should be granted only under exceptional circumstances. I also
would encourage you to continue to take a close look at any
additional requests and use all of the resources available to
you to make sure a free and appropriate public education is not
denied students with disabilities.
SPECIAL EDUCATION--FREE, APPROPRIATE PUBLIC EDUCATION
Whenever this issue comes up, I always take the opportunity
for a little teachable moment perhaps and a little history
lesson. I was here at the beginning of this when we did IDEA.
And many States I know and some people think that IDEA, the
Individuals with Disabilities Education Act, which superseded
the Education of All Handicapped Children Act, was somehow a
Federal mandate on States, requiring them to give a free,
appropriate education to kids with disabilities.
FAPE--A CONSTITUTIONAL REQUIREMENT
Well, that is absolutely wrong. The mandate on States to
have a free, appropriate public education for kids with
disabilities is a constitutional mandate--constitutional. PARC
v. Board of Education, Pennsylvania Association of Retired
Citizens v. Board of Education. That established the principle
that if a State--first of all, as we all know, States do not
have to provide free education. There is no constitutional
requirement for any State--Alabama, Mississippi, or Iowa, or
any other State to provide a free public education. What the
Constitution does say is if a State--if a State decides to
provide a free public education--or FAPE, it cannot then
discriminate on the basis of race, or sex, or national origin,
and PARC v. Pennsylvania--I am sorry, it was PARC v.
Pennsylvania--that case said that a State cannot then
discriminate either on the basis of disability.
FEDERAL ASSISTANCE TO STATES IN PROVISION OF FAPE
The Federal Government came along and said, okay, if that
is the case, we will try to help States with IDEA to provide
some help and support. And if you want this money, if a State
wants to partake in IDEA, well, here are certain requirements.
No State has to take one dime of IDEA money. But if they do,
they have to meet certain requirements in terms of a free and
appropriate public education.
So, this is a constitutional matter. Even if we provided
not one dime of IDEA money, States would still have to provide
a free, appropriate public education to every kid with a
disability.
Now, I say all this, Mr. Secretary, I know you understand
that, but I always like to take that time to reaffirm the fact
that we have constitutional obligations to provide this kind of
education to our kids. And when States ask for waivers from
their constitutional obligation, that ought to be looked upon
with very close scrutiny as to whether or not they need that
kind of waiver.
So, again, I say this in a way of thank you because I know
you have looked at that with close scrutiny, and to make sure
that you have continued to look at those waivers very, very
closely in the future. So, I thank you for that.
And I will turn to Senator Shelby.
Senator Shelby. Secretary, you have been very patient, but
I have three quick areas I would like to get into.
RACE TO THE TOP APPLICATION SCORING PROCESS
I am concerned that the scoring process for the Race to the
Top applications essentially mandates which interventions
should be used by States and local school districts to improve
student achievement and reduce achievement gaps. The Federal
Government, I believe, should give States the flexibility to
implement critical reforms as identified on the State and local
level.
If Race to the Top receives funding in 2012, can I have
your commitment to review the scoring process for the Race to
the Top applications, and specifically reevaluate the scoring
measures on science, technology, engineering, and mathematics
reform efforts? And will the Department consider changes to the
Race to the Top program that allow States to be evaluated on
their statewide vision and reform efforts identified at the
State and local level? And if not, why not?
Secretary Duncan. No, absolutely happy to continue to learn
every single year----
Senator Shelby. Okay.
Secretary Duncan [continuing]. And to get that feedback. I
thought we did a very, very good job. Did we do it perfectly?
Of course not. And, you know, this is a work in progress, and
I'm happy to have that conversation going forward.
Senator Shelby. Do you disagree with some of my concerns
here?
Secretary Duncan. I do not know if I disagree. I welcome
that conversation.
Senator Shelby. Okay.
Secretary Duncan. We want to continue in everything we do
to emphasize STEM. We did it as a competitive priority on i3
and Promise Neighborhoods and other things. So, STEM is a
consistent thing there, and I think it is a fair, you know,
question, and we will look at it very closely.
Senator Shelby. So, you would review the scoring process.
Secretary Duncan. Yeah, absolutely, no question, not just
in that area, across the board. Again, we will take what worked
and what did not, and learn from it, and try and get better.
IMPACT OF COMPETITIVE-BASED FUNDING ON RURAL AREAS
Senator Shelby. Mr. Secretary, formula versus competitive
funding. The President's budget, your budget, proposal includes
a substantial increase in the amount of discretionary funding
that would be competitively awarded. This is a significant
policy shift from the current formula grant structure. I am
concerned that replacing formula-funded programs with so-called
competitive programs will result in the redirection of critical
Federal funds from smaller rural States or urban areas because
they will not be able to compete for funding on a level playing
field.
RACE TO THE TOP COMPETITION
For example, Mr. Secretary, my State of Alabama, Iowa, and
Mississippi, were all shut out from the competitive Race to the
Top grants. These three States did not receive any funding in
round one or in round two.
Are you concerned at all that a shift from formula funding
to competitive funding may not allow many high-need States and
districts to receive Federal funding as illustrated in the Race
to the Top?
Secretary Duncan. Yeah. So, we have thought about that
very, very carefully. Two answers just to think about. Again,
to be very, very clear, the overwhelming majority of our money
will continue to be, will always be, formula-based. So, in this
budget, 84 percent is formula-based.
Senator Shelby. You see my concern here?
Secretary Duncan. Yes, I do.
Senator Shelby. And I am sure it is a concern of the two
colleagues of mine.
Secretary Duncan. Yes, sir. And so, what we have tried to
do in the Investing in Innovation fund, in the Promise
Neighborhoods initiative, is to really make sure that rural
States and communities could compete, and we think we did that
better. So, we will continue to learn. And in all of these
competitions, the goal is not a fancy PowerPoint presentation.
We want to invest in places that have the courage and the
capacity to do some things very, very differently.
So, I am acutely aware of that, and we want to continue to
strike that balance. We think in some of the other
competitions, that went very well. And we want to continue to
learn across the board in this area.
MATHEMATICS AND SCIENCE PARTNERSHIPS
Senator Shelby. In the area of mathematics and science
partnerships, the United States continues to fall behind, as we
know, other developed countries in reading, math, and science
education.
According to the 2009 Performance Reporting Ranking, the 34
countries of the Organization for Economic Cooperation and
Development, the United States ranks 25th in math, 17th in
science, and 14th in reading. It is unacceptable to all of us.
I am concerned, and I am sure you are, that the 2012 budget
proposal does not request funding for the mathematics and
science partnership program. In Alabama, my State, funds from
this formula program have helped finance the highly successful
Alabama math, science, and technology initiative, a leading
model for math and science education reform nationwide.
In the place of the mathematics and science partnerships,
the Department--your Department--proposes to create a new
competitive grant program for science, technology, engineering,
and math.
How does the Department intend to ensure that all States
will be able to compete for math and science funding when it is
no longer distributed by a formula, as my understanding? And
how will this program close the growing achievement gap between
the United States and our global competition?
WELL-ROUNDED EDUCATION
Secretary Duncan. We have talked about--a lot about STEM.
Let me even broaden it a little bit further. One of my greatest
concerns is that due to the current law and sometimes due to
budget issues, we have seen a narrowing of the curriculum
around the country. And that is probably the biggest complaint
I hear as I travel, urban, rural, suburban, from students, from
teachers, from parents across the board.
So, we are asking for significant investment, not just in
STEM, but in literacy, in arts, in PE, in all those things to
give children what we call a world-class, well-rounded
education. So, we want to invest at a different level there,
getting behind those States and districts, again, whatever they
look like, those that are committed to giving their children a
well-rounded, world-class education. And this is not just at
the high school level; this has to be for first and second and
third and fourth graders----
Senator Shelby. Absolutely.
Secretary Duncan [continuing]. To give them a chance to
build their skills. So, we are absolutely committed there, and
want to put significant resources behind that effort.
Senator Shelby. If we do not do this, where are the jobs
going to come from in the future?
Secretary Duncan. Well, the jobs will continue to migrate.
Senator Shelby. Thank you.
Thank you, Mr. Chairman.
Senator Harkin. Senator Cochran. No other questions.
There are no other questions, Mr. Secretary. Thank you very
much. You have been very generous with your time, and we
appreciate your appearance here.
ADDITIONAL COMMITTEE QUESTIONS
And we will keep the record open for 10 days for any other
questions that the Senators may have.
[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 Tom Harkin
pell grants
Question. Congress continues to make a significant investment in
the Pell Grant program, in order to help make college more affordable
for low-income students. The number of Pell Grant recipients has grown
from 6.2 million in 2008 and is projected to reach 9.6 million in 2011.
At the same time, 56 percent of all bachelor degree students graduated
within 6 years and 28 percent of all associate degree students
graduated within 3 years. For low-income students, these rates are even
lower. Taking into account the difficult budget decisions Congress is
facing in fiscal year 2012, what can be done to ensure that Congress'
investment in Pell Grants is fully realized and low-income students
complete their degrees at higher rates?
Answer. The Department agrees that certain cost-cutting measures
are necessary, but does not believe sacrificing the Pell Grant maximum
award--especially considering current financial conditions--should be
one of them. As evidenced in its fiscal year 2012 budget request, the
Department has made maintaining the Pell Grant at its current $5,550
maximum a priority. The Pell Grant will be an important piece of 9.6
million students' financial aid packages in the 2012-2013 academic
year. Ensuring these students have sufficient financial aid to remain
in school is an important first step in helping lead them to college
completion.
Increasing college completion rates is another priority for the
administration, and the fiscal year 2012 President's budget included a
number of new programs--including College Completion Incentive Grants,
First in the World, and College Access Challenge Grants--designed to
help States and institutions focus on and adopt activities that are
likely to contribute to higher completion rates. Some of the activities
endorsed by these programs are: aligning high school graduation
requirements with institutions' expectations for academic preparation;
reducing a program's net price or time to degree; and providing low-
income students assistance such as financial literacy training, need-
based grant aid, or educational or career preparation.
workload of direct loan program
Question. Since Congress passed the Student Aid and Fiscal
Responsibility Act (SAFRA) of 2010, new volume in the Direct Loan
program has increased to an estimated $124 billion in 2012, up from $29
billion in 2009. What have been the implications of the increased
workload on the Department's administration of the Direct Loan program
and what has been the impact on customer service?
Answer.
Impact of SAFRA on Direct Loans Administration
The Department has undertaken a number of administrative
initiatives to manage increased workload resulting from SAFRA:
--expansion of origination and disbursement capacity,
--expansion of servicing capacity, and
--addition of Government personnel to manage the increased workload.
Each of these initiatives has driven increases in Department
administrative costs. However, these initiatives have enabled
over 2,500 domestic schools and 380 foreign institutions to
smoothly transition to Direct Loans for the 2010-2011 award
year, and millions of new Direct Loan borrowers to be
successfully brought on by the Department's five private-sector
loan servicers.
Origination and Disbursement
In anticipation of increased Direct Loan volume, in February 2010,
the Department revised its Common Origination and Disbursement (COD)
system contract to accommodate projected increases in Direct Loan
originations. The Department further revised the COD contract in June
2011 based on updated projections of Direct Loan volume. A Final
Management Information Report issued on September 16, 2010, by the
Department's Office of Inspector General, ``Federal Student Aid's
Efforts to Ensure the Effective Processing of Student Loans Under the
Direct Loan Program,'' notes that Federal Student Aid took all
necessary actions to ensure processing of student loans as a result of
SAFRA, and credits COD with successfully providing the capacity to
transition to 100 percent Direct lending.
Loan Servicing
In order to accommodate expected increases in loan volume, foster
improved performance through competition, and prepare for the eventual
expiration of the existing loan servicing contract, the Department
awarded four new servicing contracts in June 2009, known collectively
as the Title IV Additional Servicers (TIVAS). The four vendors
receiving awards were American Education Services/Pennsylvania Higher
Education Assistance Agency (AES/PHEAA); Great Lakes Education Loan
Services; Nelnet, Inc.; and Sallie Mae Corporation (SLM). These vendors
began servicing FFEL loans purchased by the Department in September
2009 and new Direct Loans starting June 2010. Together, these vendors
provided a broad base of servicing capacity well equipped to handle the
dramatic increase in workload post-SAFRA. As of June 2011, these four
vendors held 50.4 percent of the total loan volume managed by the
Department. In accordance with SAFRA, the Department is currently
working on awarding additional performance-based Not-For-Profit loan
servicer contracts, which will further expand loan servicing capacity.
Government Personnel
In order to properly manage the increased loan portfolio, the
Department increased its FTE from fiscal year 2010 through fiscal year
2011 after undergoing a 4 percent decrease in FTE from fiscal year 2008
to fiscal year 2009. In response to SAFRA, over 100 new Federal staff
have been added to handle an increased level of contract oversight,
school reconciliation support, school training, and call center
management. The increase represents a 9 percent rise from fiscal year
2009 level; over the same period, the number of Direct Loan schools
nearly doubled; the number of new Direct Loan originations grew by 158
percent, and the Government-held servicing portfolio grew by 132
percent.
Additional Federal staff are needed in fiscal year 2012 to
effectively manage up to 30 or more new Not-For-Profit contracts during
fiscal year 2012 through fiscal year 2013.
Budget Impact
In order to meet the demands of the increased portfolio, the
Student Aid Administration Account has required a budgetary increase of
74 percent for COD and 198 percent in total servicing, including Not-
For-Profit and For-Profit servicers, from 2009 to 2012. As the number
of borrowers serviced continues to grow, servicing costs will continue
to rise. These costs are not only necessary to manage effectively the
student loan portfolio and provide quality customer service; they are
essential for achieving approximately $67 billion in savings over the
next 10 years, according to CBO estimates, for the transition of all
Federal student loan originations to the Direct Loan program.
Impact on Consumer Service
There were no negative impacts to customer service during the
transition. Schools have generally been highly satisfied with the
Direct Loan process and the Department is aware of no students who have
been unable to receive Federal Student Aid due to the transition. In
fact, by uniting all Department-held loans for a single borrower with a
single servicer, the Department has improved customer service for 1.6
million student loan borrowers.
In addition, increased workload stemming from SAFRA has not
prevented the Department from continuing efforts to improve its service
to students and borrowers who have been traditionally under-represented
in postsecondary education. For example, the Free Application for
Federal Student Aid (FAFSA) Completion program has allowed the
Department to work with State and local education agencies and
secondary schools to increase the number of completed FAFSA
applications. Also, by reducing the number of questions an applicant
must answer and streamlining financial information through the IRS Data
Retrieval tool, FAFSA simplification efforts have made it much easier
for applicants to apply successfully for Federal student aid.
teacher incentive fund--vanderbilt and rand studies on performance-
based pay
Question. Last year, the Center for Performance Incentives at
Vanderbilt University found little evidence to support a primary goal
of the Teacher Incentive Fund (TIF)--that rewarding teachers for
improved student test scores would cause scores to rise. This rigorous
evaluation funded by the Department raises serious questions about the
idea behind this program. And, just last week a RAND evaluation of New
York City's program came to similar conclusions about performance-based
pay. New York permanently canceled its program after the study's
release.
I understand that the Vanderbilt and RAND studies didn't examine
all of the performance-based pay systems across the country. However,
they raise the question whether we should continue to provide $400
million per year for TIF given the need to reduce deficits and the
significant amount of funding for these grants already.
Mr. Secretary, what is your view of these evaluations of
performance-based pay programs, and how will they shape your
Department's thinking and priorities in fiscal year 2012?
Answer. These evaluations provide important information about some
of the challenges schools, districts, and States face when reforming
human capital systems to focus on improving student outcomes. But the
Teacher Incentive Fund (TIF) differs in important ways from the
performance-pay programs studied by Vanderbilt and RAND. In addition,
the Department plans to significantly strengthen TIF as part of the
2012 new grant competition.
Performance-based Compensation Systems
While all of the 2010 TIF grant cohort projects include as one
statutorily required element the development and implementation of
performance-based compensation systems (PBCSs), these TIF projects
support broader activities than just making performance-related
payments to effective (as measured by student achievement gains and
observations) teachers and principals. As you mentioned, the Vanderbilt
study focused on awards to teachers based solely on increases in
student achievement. Teachers received no additional support, such as
mentoring or professional development, and the awards were not
permanent or incorporated into district-wide human capital management
systems. Finally, although about two-thirds of teachers participating
in the study expressed support for the general notion that teachers
should receive additional compensation if their students show
outstanding achievement gains, a similar proportion felt that the
program in which they participated did not do a good job of
distinguishing effective and ineffective teachers. Likewise, large
majorities agreed that the program ignored important aspects of
performance not measured by test scores.
In the 2010 TIF competition, on the other hand, in order to be
eligible for a grant, applicants had to provide evidence that the
proposed PBCS is aligned with a coherent and integrated strategy for
strengthening the educator workforce, including the use of data and
evaluations for professional development and retention and tenure
decisions in the LEA or LEAs participating in the project during and
after the end of the TIF project period. In addition, applicants could
receive a competitive priority by demonstrating that their proposed
PBCS is designed to assist high-need schools in:
--serving high-need students,
--retaining effective teachers in teaching positions in hard-to-staff
subjects and specialty areas, such as mathematics, science,
special education, and English language acquisition, and
--filling vacancies with teachers of those subjects or specialty
areas who are effective or likely to be effective.
Applicants also had to provide an explanation for how they would
determine that a teacher filling a vacancy is effective or likely to be
effective, and demonstrate the extent to which the subjects or
specialty areas they propose to target are hard-to-staff. Lastly,
applicants had to demonstrate that they would implement a process for
effectively communicating to teachers which of the LEA's schools are
high-need and which subjects and specialty areas are considered hard to
staff.
New York City's Schoolwide Performance Bonus Program
The RAND study similarly found that New York City's Schoolwide
Performance Bonus Program had limited impact. The New York City
Department of Education set annual performance targets for each
participating school's ``Progress Reports,'' which are based in part on
student growth. Schools meeting or exceeding those targets were
eligible to receive a school-wide award of up to $3,000 per union-
represented staff member. A committee at each school determined how to
distribute the funds. However, the study noted that over one-third of
teachers did not understand basic aspects of the program, ``including
the target their school needed to reach, the amount of money their
school would receive if they met their target, the source of the
funding, and how committees decide on distribution plans.'' In
addition, teachers reported that the bonus was too small to provide any
incentive for changing behavior. Also, most compensation committees
chose to distribute bonuses equally across all school staff members,
further limiting the potential for such a policy to reward and motivate
improved performance. Research suggests that performance-based
incentive plans work best when participating individuals have a strong
understanding of the program, when participants expect that their own
effort can control the outcome, and when rewards are sufficient enough
to drive action. New York City's teacher bonus program was not strong
in these areas. Even the RAND report's authors question whether the NYC
system was sufficiently designed to motivate or effect change.
Teacher Incentive Fund Performance-based Compensation Systems
In contrast, under TIF, a grantee must show that it has a plan for
effectively communicating to teachers, administrators, other school
personnel, and the community at-large the components of its PBCS.
Grantees must also provide evidence of the involvement and support of
teachers and principals and the involvement and support of unions in
participating school districts (where they are the designated exclusive
representatives for the purpose of collective bargaining) that is
needed to carry out the grant. Finally, TIF emphasizes performance-
based compensation systems that include compensation that is
differentiated and substantial. The RAND study authors noted that these
characteristics were integral to successful implementation of
performance-based compensation reforms.
Creating Innovative Human Capital and Evaluation Systems
In the 2012 TIF competition, the Department will provide support
for State and school district efforts to develop and implement
innovative approaches to creating human capital and evaluation systems
that improve teacher and leader effectiveness and student outcomes.
This new competition would emphasize supporting, retaining, and
rewarding teachers and principals who raise student achievement. The
Department would continue to require TIF grantees to develop and
implement these human capital and evaluation systems with meaningful
input and support of teachers and school leaders.
promise neighborhoods
Question. Promise Neighborhood grantees have been fully engaged and
supported by State and city public officials, as well as private
players. In fact, all 21 of the federally funded Promise Neighborhoods
planning grantees have leveraged nearly $7 million in matching funds
from public and private sources--including investment from foundations.
Their planning efforts are progressing and generating a ground swell of
local support.
How are the current grantees planning to leverage existing
resources to achieve the goals of their local communities?
Answer. There are a number of examples where the 2010 Promise
Neighborhoods grantees are leveraging existing resources to help meet
the objectives of their planning grants. In Worcester, Massachusetts,
the Main South Promise Neighborhood is partnering with Clark University
in several ways. Clark is developing the longitudinal data system
required by the program, and its students serve as formal and informal
mentors to young residents in the neighborhood. Developed as a
partnership between Clark and Worcester Public Schools, University Park
School is an effective, comprehensive high school within the Main South
neighborhood. Clark also waives tuition for any resident of Main South
who has lived in the neighborhood for at least 5 years and who meets
the university's entrance requirements.
In the rural Mississippi Delta, the Indianola Promise Community is
partnering with Mississippi State's National Strategic Planning and
Analysis Research Center, a grantee of the Department's State
Longitudinal Data Systems program. Mississippi is one of the few States
with a data system that links K-12 and postsecondary data through the
use of a unique identifier. The partnership with the Data Center,
specifically the opportunity to leverage the Department's investment in
the State's longitudinal data system, creates an opportunity for the
Indianola Promise Community to manage outcomes at the student level
from preschool through college.
maximizing public and private partnerships
Question. Additionally, how can we maximize this public/private
partnership moving forward?
Answer. Peer reviewers of Promise Neighborhoods applications
evaluate the extent to which applicants would leverage and integrate
high-quality programs and related public and private investments into
their work. We can maximize these types of partnerships by placing a
similar priority in other Department grant programs. Moreover, guidance
on productivity \1\ released by the Department's Office of Innovation
and Improvement early this year identified additional opportunities for
supporting such partnerships. State and local health and human services
agencies, departments of public safety and parks and recreation,
community-based organizations, businesses, and other entities have a
significant stake in the success of our children and youth. Many have
long provided academic and enrichment opportunities in the form of
before- and after-school programming, apprenticeships, nursing, or
counseling support. Breaking down barriers and better aligning and
using community resources may also help school systems identify and
access low-cost services or facilities. Governors, working with policy-
makers and educators, can put in place State-level policies addressing
these issues or issue guidance to districts, schools, nonprofits, and
institutions of higher education that encourages collaboration and
leverages public-private investments as part of school reform
strategies.
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\1\ http://www.ed.gov/oii-news/increasing-educational-productivity.
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recovery act of 2009 and the education jobs fund of 2010
Question. Mr. Secretary, I know that you share my concern about the
state of the economy and the continuing challenges that many families
are facing, especially when it comes to finding jobs. In my opinion,
the best way to solve our debt crisis is to get more people working,
because when people are working they pay more taxes, buy more goods,
and keep our economy growing.
Jobs are a particular concern in our Nation's schools, where we're
hearing more reports every day of possible teacher layoffs. It's
timely, therefore, to take a look back at the Recovery Act of 2009 and
the Education Jobs Fund of 2010. Some have said that today's
unemployment figures prove those investments were a waste of money.
However, in my home State of Iowa, these bills have helped save or
create almost 4,000 education-related jobs (960 Ed Jobs through March
2011 plus almost 2,800 education-related jobs through the Recovery
Act).
That's the story in Iowa. What is your assessment of these bills
from a national perspective?
Answer. I share your concern about our economy and how it affects
our Nation's families and children. To do our part to minimize the
effects of these difficult times on students, we worked with you to
provide States and school districts with unprecedented resources in the
Recovery Act and through the Education Jobs Fund to save and create
education jobs. Based on State-reported data, we estimate that the
Recovery Act and the Education Jobs Fund have funded over 400,000
educator jobs since February 2009. We know that the strain of the
economy continues to force States and school districts to make
difficult choices, and we know that these two efforts helped to save
our students from an even heavier burden that would have been felt in
our Nation's schools.
cost savings and efficiencies initiated by the department of education
in fiscal year 2009 and fiscal year 2010
Question. The fiscal year 2012 budget request identifies savings in
program administration related to decreased travel costs generated by a
greater use of teleconferencing. In fiscal years 2009 and 2010, what
actions did the Department take to create efficiencies in its programs,
eliminate lower-priority spending and realize other cost savings?
Answer. The Department took a variety of actions in 2009 and 2010
to create efficiencies in its programs, eliminate lower-priority
spending, and realize other cost savings. These included the following
items:
--In 2009, the Department closed its office at the U.S. Mission to
the United Nations Educational, Scientific, and Cultural
Organization in Paris, France and eliminated its attache
position.
--In 2009, the Department closed the National Institute for Literacy,
which provided national leadership on issues related to
literacy, and coordinated literacy services and policy. Funding
for the Institute ended in fiscal year 2009. The Institute's
broad mission and lack of clear management oversight led to a
diffuse and incoherent system of delivery, as well as
duplication of efforts with other Department of Education and
Federal offices. The functions of the Institute are more
efficiently being carried out by other Department offices,
primarily the Office of Vocational and Adult Education.
--The Department eliminated the Secretary's Regional and Deputy
Regional Representatives in the Department's 10 regional
offices. These positions were primarily used for communication
and outreach, which may be done as effectively by other
personnel.
--The Department undertook two steps to reduce the cost of
information technology equipment it leases. The number of
computers used per person was reduced from 1.5 to 1.1, with a
total reduction of 1,600 computers. In addition, the number of
printers on employees' desktops was reduced from 5,700 to
1,400.
--Starting in fiscal year 2010, the Department required any
conference or meeting occurring in Washington, DC with an
attendance of 250 or less to take place in either of the
Department's two large capacity auditorium facilities.
--In fiscal year 2010, the Department negotiated with one of its
Direct Loan servicing vendors to eliminate transfer fees for
migrating servicing accounts between this vendor and any other
Direct Loan servicing vendor.
cost savings planned for fiscal year 2011 and fiscal year 2012
Question. What additional steps will be completed in fiscal year
2011, and what other steps are proposed in the fiscal year 2012 budget
request?
Answer. The Department will complete additional cost savings
actions in 2011 and is planning more in 2012, as follows:
--The Department plans to save 7 percent of contract spending by the
end of 2011, using 2008 acquisition expenditures as a base.
Some actions already taken have been described in the response
for fiscal year 2009 and fiscal year 2010. The Department will
continue to achieve contract savings by ending contracts that
do not meet program needs or projects that are no longer
needed, restructuring high-risk cost reimbursement contracts as
fixed price contracts, improving contract terms and conditions,
improving the procurement process, and investing in a highly
skilled acquisition workforce.
--In 2011, the Department partially implemented an initiative to use
double-sided printing as the default printing option.
Currently, 25 percent of printing is two-sided. The Department
is moving towards using double-sided printing 50 percent of the
time.
--Due to the elimination of several programs administered by the
Office of Safe and Drug-Free Schools (OSDFS), and to maximize
limited resources, the Department is planning to move the
remaining programs administered by OSDFS programs into the
Office of Elementary and Secondary Education (OESE). This
change will provide new opportunities for staff from OESE and
OSDFS to work together to improve school environments and
support children's learning, health, and well-being.
--The Grant Award Notification (GAN) process provides the
Department's grantees with official documentation of their
Federal grant award and instructions for grants management.
This process is currently paper-based, requiring a traditional
signature from the Department's representative and mailing the
2 copies of the signed GAN to the grantee. In fiscal year 2012,
the Department will provide mechanisms for:
--Electronically signing the GAN documentation sent from the
Department to grantees;
--Electronically transmitting the GAN documentation from the
Department to grantees; and
--Electronically filing and retrieving the GAN documentation.
______
Questions Submitted by Senator Daniel K. Inouye
ethnic and immigrant student performance
Question. In Hawaii, Filipino Americans represent the second
largest ethnic group in the public school systems but are consistently
ranked second to last in the Hawaii State Assessments. These tests, in
which Filipino students in 2010 scored only 69 percent in reading and
51 percent in math proficiencies, indicate that these students are in
need of additional assistance throughout their primary, K-12,
education. Furthermore, a study conducted by the John A. Burns School
of Medicine, in Honolulu, indicated a significant connection between
low Filipino cultural identification and low family support with
delinquency. What new creative efforts are being considered by your
administration to improve student performance within large ethnic and
recently immigrated communities, such as the Filipinos, while
maintaining the integrity of their cultural values?
Answer. The Department is focusing much of its current efforts on
improving student performance, as detailed below. Most of these efforts
are not focused on particular ethnic or recently immigrated
communities, but are designed to improve performance in a wider range
of student populations.
Many of the top priorities of the Department are found in A
Blueprint for Reform, which proposes a reauthorized Elementary and
Secondary Education Act intended to help give all children the world-
class education that they deserve and that America needs to ensure
future economic prosperity. The Blueprint focuses on key priorities
aimed at improving educational outcomes for all students, including:
--recognizing and rewarding student academic growth and school
progress;
--ensuring that students complete high school prepared for college
and a career, based on rigorous, State-developed standards;
--putting a great teacher in every classroom and a great principal in
every school; and
--focusing intensive support and interventions on our lowest-
performing schools that serve our neediest students and
communities, including the ``dropout factories'' that account
for one-half of the estimated 1 million students who leave
school each year without a high school diploma.
Together, these changes support the goal of ensuring that, by 2020,
the United States will once again have the highest proportion of
college graduates in the world--a key goal not only for restoring and
increasing our economic prosperity, but also for securing the more
equal, fair, and just society envisioned by our Nation's founders.
More specifically, the Department is emphasizing the following
goals:
Sustaining Reform Momentum.--The Department will reform America's
public schools to deliver a 21st century education that will prepare
all children for success in the new global workplace, building on the
achievements already gained by the Race to the Top and Investing in
Innovation (i3) programs. Race to the Top will focus on supporting
district-level reform plans while also emphasizing cost-effective
strategies that improve student achievement in a time of tight budgets.
The i3 program will prioritize science, technology, engineering, and
mathematics (STEM) education and early learning, as well as focus
overall on increasing productivity to achieve better student outcomes
more cost-effectively. The Department also will place high priority on
Promise Neighborhoods to support comprehensive, innovative and cost
effective approaches to meeting the full range of student needs,
drawing on the contributions of schools, community-based organizations,
local agencies, foundations, and private businesses.
Great Teachers and Leaders.--Nothing is more important, or more
likely to improve student achievement and other key educational
outcomes, than putting a great teacher in every classroom and a great
principal in every school. To help achieve this goal, the Department
will support ambitious reforms, including innovative teacher evaluation
and compensation systems, to encourage effective teachers, principals,
and school leadership teams to work in high-need schools. Emphasis will
also be placed on expanding high-quality traditional and alternative
pathways into teaching and preparing 10,000 new STEM teachers over the
next 2 years, as part of the President's plan to prepare 100,000 new
STEM teachers over the next decade.
College Completion.--The Department is committed to ensuring that
America will once again lead the world in college completion by 2020.
Regardless of their intended educational path after high school, all
Americans should be prepared to enroll in at least 1 year of higher
education or job training to ensure we have a better prepared workforce
for a 21st century economy.
access to 4-year institutions
Question. Super rural and isolated communities, such as those
existing on some of the neighboring islands of Hawaii, face many
obstacles when it comes to accessing higher education. On the Hawaiian
island of Kauai, for example, residents have access to a local 2-year
community college but would have to relocate to another island to be
able to attend a 4-year institution. How is the Department of Education
improving access to 4-year higher education programs for potential
university students residing in super rural and isolated areas, such as
Kauai, without diverting funds from existing local community colleges?
Answer. The Department provides aid to students based on their
estimated family contribution, not their location. If a student chooses
to attend a more expensive school, attend a degree or certificate
program that would keep him in school for a longer period of time, or
attend a school in a different location, the total Federal and State
financial aid he would be able to receive would be influenced by these
circumstances.
Additionally, a student may find useful the net price calculator on
his desired institution's website, to see the potential costs of
attending that school. In accordance with the Higher Education
Opportunity Act of 2008, all postsecondary institutions are required to
have a version of this calculator on their websites by October 29,
2011. The net price number produced from the calculator will be able to
help the student see the full cost of attending that school, and help
him evaluate and make a more informed decision about whether it is
financially possible for him to attend that institution.
student health initiatives
Question. Nurses in schools provide a vital service to the
educational system. As your Department has established, proper health
and nutrition are key to students being considered ``ready to learn''
and maximizing their educational opportunities. How is your Department
supporting and funding initiatives in States, such as Hawaii, that lack
a robust school health nursing infrastructure and what other creative
initiatives have been put forward to provide access to school-based
nurse managed health centers in these targeted States?
Answer. The administration's Elementary and Secondary Education Act
reauthorization proposal includes the Successful, Safe, and Healthy
Students program. This new program would provide resources and
increased flexibility for States and districts to design and implement
strategies that best reflect the needs of their students and
communities, which may include programs that support student physical
health. Depending on the activity, projects that support the efforts of
school-based nurses could be funded. Additionally, the administration
is working to improve student health outside of the Department of
Education. Under the Affordable Care Act, the Department of Health and
Human Services awarded $95 million in July 2011 to school-based health
center programs across the country. These grants will help improve the
health and wellness of children through screenings, health promotion,
and disease prevention activities.
carol m. white physical educaton program
Question. Your Department has found that students who come to
school ready to learn perform better in their classes and on
standardized tests. Good health is a vital component of being
considered ``Ready to Learn.'' In light of the increasing prevalence of
chronic conditions, how is the Department of Education supporting
health screening, prevention and treatment of obesity, and support for
students with diabetes, asthma, and other increasingly prevalent,
chronic conditions so that they may be best prepared to get the most
out of their education?
Answer. Currently, the Department's primary contribution to the
physical wellness of students is the Carol M. White Physical Education
program. Through rulemaking in fiscal year 2010, the Department
established a competitive priority for the Physical Education program
for projects that incorporate the collection of body mass index data as
part of a comprehensive assessment of health and fitness for the
purposes of monitoring the weight status of their student population
across time. In addition, the administration's ESEA proposal for the
Successful, Safe, and Health Students program would provide funding for
States and districts to design and implement strategies that best
reflect the needs of their students and communities, which may include
programs that support student physical health.
21st century community learning centers
Question. How would changing the 21st Century Community Learning
Centers (CCLC) program to a competitive grant program affect Hawaii? If
Hawaii can no longer rely on a consistent funding formula for the 21st
CCLC program, program administration and planning for future years may
become more difficult for the State.
Answer. We believe that transforming the 21st CCLC program from a
formula to a competitive grant program will improve program quality.
States developing high-quality plans to compete for the 21st CCLC funds
would lead to more of a focus on improved outcomes for students. If we
encourage all States to submit high-quality applications, we believe
that would drive more improvements in the field in general.
Additionally, we believe that numerous States would continue to receive
funding under a competitive 21st CCLC program.
Question. How can States maintain consistent program administration
without formula funds?
Answer. Those States that would not receive funding under a
competitive 21st CCLC program would be in the best position to
determine whether local programs that had received 21st CCLC formula
funds are worth investing in if 21st CCLC funds are not available.
States could, for example, choose to invest more State funds in
programs currently funded by the 21st CCLC program. Another option
could be that States could encourage school districts to dedicate more
title I funds to lengthening the school day and providing services
outside of regular school hours.
teach grants and proposed presidential teaching fellows program
Question. The Education Department's fiscal year 2012 budget
proposal would replace the TEACH Grant program for institutions of
higher education (IHEs) with a new Presidential Teaching Fellows grant
program for States. Under the TEACH Grant program, many eligible
students do not receive grants either because the schools they attend
do not participate in the program or they anticipate being unable to
fulfill the program's employment requirements. Did these shortcomings
prompt the administration to propose replacing the program with its new
proposal; are there other reasons why the administration wants to
effectively end the TEACH Grant program?
Answer. Yes, based on preliminary data, it does not appear that the
program is fulfilling its intended purpose of encouraging students to
enter, and remain in, the teaching profession. As many as 75 percent of
students receiving a TEACH Grant fail to fulfill its requirements.
Additionally, many of the students receiving a TEACH Grant may be doing
so in lieu of other institutional aid, which often does not need to be
repaid.
The Presidential Teaching Fellows program is designed specifically
to target students who demonstrate an interest in teaching later in
their undergraduate career, as well as those individuals in programs
that have a proven ability to produce quality teaching candidates.
institutional participation in the teach program
Question. According to the Education Department, five institutions
for higher education (IHE) in Hawaii are TEACH Grant eligible. Can you
explain why some IHEs did not participate?
Answer. There are many reasons why an institution may not
participate in this program, but it would be reasonable to say their
decision is likely based, at least in part, on the decision that
nonparticipation is in the best interest of their students and
institution. Many of the problems with the nature of the TEACH Grant
program, as described earlier, may be contributing factors into an
institutions' reasoning when choosing whether or not to participate.
presidential teaching fellows
Question. How many of Hawaii's institutions will be considered
eligible for the Presidential Teaching Fellows program?
Answer. Any Hawaiian institution's participation would be dependent
upon if the State chose to participate in the program. In order for the
institutions in a State to be eligible, the State must first agree to
embrace certain reforms, including making licensure and certification
systems more rigorous, measuring the effectiveness of teacher
preparation programs based on multiple outcomes, including their
graduates' success in improving student achievement, and to be willing
to shut down persistently low-performing programs.
career and technical education
Question. The President has set a goal of having the United States
improve college completion rates and become the Nation with the highest
percentage of college graduates among its adults by 2020. The Carl D.
Perkins Career and Technical Education Improvement Act of 2006 is the
principal source of Federal funding to the States for the improvement
of secondary and postsecondary career and technical education programs.
The Department of Education's (ED's) fiscal year 2012 budget proposes
reducing Federal funding to States under the act from $1.124 billion in
fiscal year 2011 to $1 billion in fiscal year 2012, following a $140
million reduction from fiscal year 2010 to fiscal year 2011. Hawaii's
$6.121 million allocation in fiscal year 2010 will be reduced an
estimated $595,000 in fiscal year 2011 and an additional $608,000 in
fiscal year 2012. How will this proposal support the administration's
goal and the Nation's projected employment needs?
Answer. While career and technical education (CTE) is vitally
important to America's future, the Perkins CTE program as it is
currently structured is not operating in a way that produces optimal
results for students. ED is currently engaged in developing our
reauthorization proposal for the Carl D. Perkins Career and Technical
Education Act. Our intent is to develop a proposal that will improve
the statute by ensuring that all CTE programs become viable and
rigorous pathways to postsecondary and career success, providing
students with the career skills necessary to compete in a global
marketplace, and collecting better program performance data.
career and technical education in hawaii
Question. What effect will this funding decrease have for Hawaii,
in particular?
Answer. While the State of Hawaii would receive a reduced grant
award under the administration's $1 billion request for the CTE State
Grants program, the State would still continue to benefit from the .25
percent set aside under section 116(h) of the Perkins Act for programs
that benefit Native Hawaiian individuals. The State could also
supplement the funds distributed to local agencies and institutions of
higher education by taking advantage of the authority in section 112(c)
of the Act that allows it to reserve State funds for awards in rural
areas or areas with high percentages or numbers of CTE students.
distance education regulations
Question. Mr. Secretary, Hawaii has a large number of military
members assigned to bases throughout our State. I am concerned that the
new regulations on distance education may have potential negative
impacts on the ability of our military members to access distance
learning opportunities, particularly since they frequently change duty
location. What effect will this regulation have on military members?
Answer. The Department's regulations governing State authorization
of distance education programs simply required institutions to comply
with State laws where they exist. It imposed no additional requirements
beyond being able to demonstrate that they complied with State law
where those State laws exist. A Federal court recently took action to
strike the provision of the Department's regulation, but did not
overturn State law.
______
Questions Submitted by Senator Patty Murray
early childhood education
Question. I was pleased with the investment in early childhood
education you decided to make with the fiscal year 2011 Continuing
Resolution Race to the Top funding. However, I think we both know there
is much more that should be done. Early childhood education is one of
the most important investments we can make in a child's education. Can
you tell me your thoughts and plans for continued funding and
investments to improve the quality of early childhood education for
children in Washington State and across the country?
Answer. The administration wants to ensure that there continues to
be funding to support the important work of improving the quality of
early learning programs and services. We are excited about the RTT-ELC
competition, which is focused on improving the early learning and
development of young children by supporting States' efforts to increase
the number and percentage of low-income and disadvantaged children in
each age group of infants, toddlers, and preschoolers enrolled in high-
quality early learning and development programs, and on States' efforts
to design and implement an integrated system of high-quality early
learning and development programs and services. We expect that the
States that win these grants will serve as models for others, leading
to improved quality of early learning and development programs across
the Nation.
literacy funding
Question. I am very troubled by the elimination of almost all
Federal aid for literacy programs and what it could mean for the future
of the Federal commitment to literacy. Providing high-quality literacy
programs for children across the country has always been a priority for
me. How does the Department plan to support further investments in
literacy, given its importance in the educational success of students?
Answer. The fiscal year 2011 compromise agreement included many
painful cuts, and the reductions for literacy programs were
particularly difficult. The administration requested increased funding
for literacy in fiscal years 2011 and 2012, so we are very concerned
about the cuts to literacy programs. We want to work with you to find a
way to restore funding for literacy programs.
The President's fiscal year 2012 budget request included funding
for the proposed Effective Teaching and Learning: Literacy program,
which would replace the previously fragmented literacy programs to
support States in carrying out a comprehensive, pre-kindergarten
through grade 12 literacy strategy. States would target funds to high-
need districts to implement high-quality evidence-based literacy
instruction. States and districts would have the flexibility to target
funds on the activities and grade spans where local need and the
potential impact on student learning are greatest. In addition, the
Department just made awards under the Striving Readers Comprehensive
Literacy (SRCL) program using fiscal year 2010 funds. That competition
is aligned in many ways with the proposed Effective Teaching and
Learning: Literacy program. The President's budget request includes
continuation funds for the SRCL grants in the request for the new
literacy program.
21st century community learning centers
Question. The budget proposal you submitted proposes adding new
purposes and programs to the existing 21st Century Community Learning
Centers initiative, including summer school and longer school days. In
this budget environment, I am very concerned that diverting afterschool
funds to schools to extend the regular school day will inevitably mean
fewer afterschool programs and fewer communities being served. How can
you guarantee that these proposed changes will not result in fewer
children being served by afterschool programs that keep our students
safe and give them enriching educational activities?
Answer. The fiscal year 2012 request for the 21st Century Community
Learning Centers program, which is aligned with the administration's
proposal to reauthorize the Elementary and Secondary Education Act
(ESEA), would allow local recipients to use program funds to expand
learning time by significantly increasing the number of hours in a
regular school schedule and comprehensively redesigning the school
schedule for all students in a school. The administration's ESEA
reauthorization proposal would continue to allow funds to be used for
before- and after-school programs, summer enrichment programs, and
summer school programs, and, additionally, would permit States and
eligible local entities to use funds to support expanded-learning-time
programs and full-service community schools. This enhanced flexibility
would allow communities to determine the best strategies for enabling
their students and teachers to get the time and support they need.
extended-day and after-school programs
Question. Many extended-day programs only keep students in school
until 4 PM, or earlier. And, since the majority of afterschool programs
end between 5 pm and 7 pm and sometimes later, how is extending the
school day going to fill that gap, ensuring students are off the
streets, until their working parents get home?
Answer. I agree that it is critically important that children have
a safe, enriching place to go between the time that they are dismissed
from school and when they are supervised at home. The administration's
reauthorization proposal assumes that local communities are best suited
to determine how best to provide such support for children and their
families, whether through afterschool programs, expanding the regular
school day, week, or year, or a combination of these strategies. Under
our reauthorization proposal, all of these options would be allowed,
including afterschool programs.
initiatives and investment in educational technology
Question. As you know, the first round of Race to the Top
Assessments are scheduled to be performed online in 2014. Many States
and districts are unprepared technologically and in terms of training
people to administer them and yet funding for classroom technology was
cut from this and last year's budget proposals. Can you explain the
Department's rationale for failing to invest in classroom technology,
and, are there any plans to assist States and districts in ramping up
to meet the technology challenges of implementing the Common Core
assessments?
Answer. The administration believes that technology is integral in
improving educational quality for students, and that technology can be
a valuable tool for enhancing student learning and better supporting
teachers. For that reason, instead of continuing to fund a separate,
narrowly defined formula program for education technology, the
administration is proposing, through the Elementary and Secondary
Education Act (ESEA) reauthorization and fiscal year 2012 budget
request, new ways of investing and integrating technology across ESEA
programs. We believe that this new approach would offer more
flexibility and provide greater support to States, districts, and
schools in their efforts to integrate technology into curricula and
instruction and also would encourage the replication of effective
technology-based practices.
Educational Technology in the Fiscal Year 2012 Budget Request
As you are aware, the President's fiscal year 2012 budget request
includes $835 million for the proposed Effective Teaching and Learning
for a Complete Education initiative, which would address the need to
strengthen instruction and increase student achievement, especially in
high-need local educational agencies, through three programs focused on
literacy; science, technology, engineering, and math; and ensuring a
well-rounded education. Under this proposed initiative, the Department
would support States and districts in developing strategies and
practices to meet the needs of their students and teachers across
subject areas, including through innovative uses of technology in
classroom instruction and professional development. The initiative's
national activities authority also would support States in
strengthening their use of technology in the core academic subjects,
including the development and implementation of technology-enabled
curriculum, assessments, professional development, and tools and
resources.
The fiscal year 2012 budget request also includes $300 million for
a reauthorized Investing in Innovation Fund and $90 million for the new
Advanced Research Projects Agency--Education (ARPA-ED). The Investing
in Innovation Fund would support the use of technology to drive
improvements in educational quality and productivity. The ARPA-ED
initiative would pursue breakthrough developments in educational
technology and learning systems, support systems for educators, and
tools that result in improvements in student outcomes. Other programs
that would encourage the integrated use of technology in classrooms
include Expanding Educational Options, College Pathways and Accelerated
Learning, Effective Teachers and Leaders State Grants, Teacher and
Leader Pathways, Assessing Achievement, and English Learner Education.
The administration is also proposing to allow States and districts to
set aside a sizable percentage of the $14.8 billion request for Title
I, Part A, College- and Career-Ready Students program to support
capacity-building activities, including for technology.
Computer-based Assessments
In addition to these new ways of investing and emphasis on the
integration of technology across programs, the administration is
committed to supporting States and districts as they begin to make
greater use of computer-based assessments. Under the Race to the Top
Assessments competition, the Department awarded grants to consortia of
States to develop reading-English language arts and mathematics
assessments that are aligned with standards that are held in common by
participating States. The administration's ESEA reauthorization
proposal and fiscal year 2012 budget request include support for the
Assessing Achievement program (currently titled State Assessments),
which would allow States to use program funds to administer assessments
that are aligned with college- and career-ready standards, as well as
for other activities relating to implementation of such assessments and
reporting of assessment data. The administration believes that these
resources would increase the number of States implementing assessment
systems that measure whether students are on track to being college-
and career-ready by the time they graduate from high school, and they
also would help States align their standards and high school graduation
requirements with college and career expectations.
career and technical education
Question. Across America, unemployment levels remain high, but we
know there are jobs available for individuals who have the right skill
sets. Career and Technical Education (CTE) programs work to ensure that
students have the academic, technical and employability skills
necessary for real career readiness. And at the Federal level, it is
important that we support programs that help our workforce gain the
skills necessary to be successful. Can you discuss how schools can
offer CTE programs to help students attain these skills without Perkins
funding?
Answer. The Perkins Act funding assists States in expanding and
implementing CTE education in high schools, technical schools, and
community colleges. While it constitutes a small percentage of the
total funding used by States, districts, and institutions of higher
education for CTE programs, targeted Federal funding can continue to
spur reform and innovation.
The majority of the funding for CTE programs comes from State and
local sources. Therefore, as long as students, school systems, and
business leaders find that these programs are valuable and provide
students with relevant and useful skills, these programs are likely to
continue to exist.
reauthorization of perkins act--career and technical education
Question. The Department has mentioned that one reason for cutting
Perkins funding is an inconsistency in the quality of programs across
the country. However, I think that cutting funding for Perkins will
likely exacerbate program quality inconsistencies. Furthermore, due to
the nature of this formula grant, even high-quality programs will lose
a significant amount of funding. Can you discuss how the Department
expects CTE programs to succeed under this loss of funding?
Answer. The administration's intent is to work with Congress during
the upcoming reauthorization of the Perkins Act to improve the program
and ensure that it provides students with the career and technical
skills necessary to compete in a global marketplace. The current
accountability system under the act cannot effectively differentiate
between low- and high-quality CTE programs, nor does it provide
incentives to distribute funds to schools and postsecondary
institutions based on performance. We need to ensure that we invest in
high-quality CTE programs, those that provide multiple pathways to
success in careers and postsecondary education or training and align
academic and technical coursework with challenging postsecondary
expectations, industry needs, and certifications, and respond to the
changing needs of the global economy.
impact aid funding
Question. Impact Aid is an important education program for many
schools around the country and, specifically, in my home State of
Washington. Impact Aid remains a bipartisan priority of the United
States Senate. Could you please explain for me your plan for continued
investment in the Impact Aid program?
Answer. The Department is committed to maintaining funding for the
Impact Aid program. Since 2001, funding for the Impact Aid program has
increased by over 28 percent. The administration's budget request would
maintain the current level of funding and provide over $1.2 billion in
financial assistance to school districts affected by Federal
activities. Our request would maintain the Department's commitment to
over 937,000 federally connected students and ensure that sufficient
funding remains available for Basic Support Payments, Payments for
Children with Disabilities, Facilities Maintenance, Construction, and
Payments for Federal Property.
impact aid payment process
Question. Additionally, how does the Department plan to rectify
ongoing, consistently late Impact Aid payments to districts?
Answer. With regard to late payments to districts, as you may know,
the Impact Aid program is not fully funded and as a result we follow
payment proration rules that are set by statute. In order to make final
payments for any fiscal year, all data for all applicants must be
complete and approved. When we begin making payments for any fiscal
year, this is not the case. There are a number of reasons why this
happens, such as amendments submitted by some applicants in September,
incomplete field reviews (the monitoring process), pending property or
Indian policy and procedure reviews, eligibility determinations that
are not final, data questions regarding total current expenditures,
attendance or local contribution rate figures, and submissions for
military base housing undergoing renovation that have not been
approved. As a result of these pending questions, we have to set the
payment level at a lower level for the first year to avoid making
overpayments to a large number of districts. In addition, we must set
an initial payment rate in our system in May or June in order to be
prepared to begin making payments on October 1, when funds become
available for the new fiscal year. As this is well before an
appropriation is enacted, we must consider the possibility that the
program will not receive an increase or even be level funded for the
next fiscal year. When we operate under a continuing resolution for
part of the fiscal year, as we have for many recent years, we have
limited funds to distribute and try to provide funding to as many
applicants as possible, which is another reason for setting the initial
payments at a lower rate. Once we have an appropriation for the full
fiscal year, we raise that rate and issue another set of payments.
Under the Impact Aid statute, we actually have 6 years to complete
payments, the year of the appropriation and 5 more. However, our goal
is to get this down to only 2 years so that we can get our funds out to
the LEAs as soon as possible. What generally happens during a fiscal
year is that we make initial and interim payments for the current year
and the prior year, and final payments for the second prior year.
Together these payments are usually equal to approximately the full
amount of the payments for the current year. The LEAs with the highest
percentages of federally connected students in their enrollments have
received the highest proportions of their final payments in the first
year, which we feel is an appropriate outcome. We continually strive to
improve and expedite our payment processing while ensuring that our
payments to all applicants are accurate.
______
Questions Submitted by Senator Mary L. Landrieu
teach for america
Question. Because of the zeroing out of several critical education
programs, worthwhile organizations like Teach For America have been
struggling to find alternative sources of Federal funding. To support
this effort, this subcommittee recently approved a competitive funding
stream to be set aside for national programs that recruit, train, and
professionally develop teachers at an amount of 1 percent of title IIa
funds. Meanwhile, the programs eligible to compete for these funds were
awarded over $100 million last year, and they will be left to vie for a
slice of merely $25 million if this set aside is left at 1 percent.
Nearly 90 Members of Congress--from both parties and chambers--have
written in support of increasing this competitive funding pot to 5
percent of title IIa.
Mr. Secretary, do you support this increase; if so, why, and if
not, why not?
Answer. Under the President's fiscal year 2012 budget request,
Teach For America, along with other nonprofit organizations, States,
local educational organizations, and institutions of higher education,
would be eligible to apply for $250 million in competitive grant awards
under the Teacher and Leader Pathways program, for which the creation
or expansion of high-quality alternative pathways into the teaching
profession would be an authorized activity. In addition, Teach For
America would also be eligible to compete for funding under the
Investing in Innovation program, through which Teach For America
received $50 million in 2010 and for which $300 million was requested
for 2012. Finally, Teach For America could partner with States and
districts to use funds awarded under the Effective Teachers and Leaders
State grants program to support Teach For America projects. The
Department believes that the funds requested for these programs would
significantly expand the resources available for Teach For America and
other States, local educational agencies, nonprofit organizations, and
institutions of higher education to compete for funding to support
their efforts to recruit, prepare, and develop, and retain effective
and highly effective teachers.
race to the top funding competition
Question. Every State (except Georgia) that won Race to the Top in
the first two rounds has now amended its State reform plan in some
way--usually to push back a timeline or scale back an initiative.
According to the list of approved amendments listed on the U.S.
Department of Education's Web site, 12 winners have changed their plans
25 times, overall.
Delaware, the District of Columbia, Florida, Georgia, Hawaii,
Maryland, Massachusetts, New York, North Carolina, Ohio, Rhode Island,
and Tennessee won Race to the Top funding based on their ambitious
plans for reform. Now, nearly all of these States and the District of
Columbia are making changes to their plans.
The administration has requested an additional $900 million for
Race to the Top. Before appropriating additional funding to this
competition, it's worth asking if the Department of Education is
learning any lessons from the first two rounds.
Could you address any improvements the Department of Education
intends to make to Race to the Top to ensure that only the States truly
committed to their bold reform plans win the funds?
Answer. We are working closely with States to ensure that the only
changes they make to the plans in their winning applications are those
that preserve the ambitious work they set out to do. We are open to
revisions so long as they preserve the long-term trajectory of the work
while addressing short-term implementation challenges. If a State fails
to follow through on the commitment in their application, we will
freeze or take back its grant award.
Question. Additionally, can you please discuss the specifics of the
administration's proposal to expand the Race to the Top competition to
regions and cities, not just States?
Answer. We still have details to work out, but it is our intention
that districts in States that received Race to the Top grants, as well
as those in all the other States, would be eligible to compete in the
district competition. In States that won Race to the Top grants last
year, we do not want to get in the way of the great work these States
are already doing. District plans should be aligned with the State's
plans, and we would seek input from the field on how best to ensure
that alignment. We also recognize the concern that districts in Race to
the Top States may be further ahead in developing comprehensive reform
plans. We would explore the best way to ensure a level playing field
for all districts, whether they are in Race to the Top States or not.
race to the top phase 3
Question. Finally, could you also provide a status update on the
$200 million fiscal year 2011 Race to the Top competition for the nine
high-scoring finalists that did not receive funds in the first two
rounds of the competition?
Answer. The Department will dedicate (for what we are calling
``Race to the Top Phase 3'') approximately $200 million for the nine
highest-ranked but unfunded finalist States from the 2010 Race to the
Top Phase 2 competition. The grant application for Race to the Top
Phase 3 will be available in early fall for the nine eligible States:
Arizona, California, Colorado, Illinois, Kentucky, Louisiana,
Pennsylvania, New Jersey, and South Carolina. We are working on the
final details of the grant opportunity, but the focus will be on
supporting the States' 2010 Race to the Top applications in order to
drive continued education reform in those States. The Department plans
to make awards in December 2011.
emergency preparedness in schools
Question. According to the National Commission on Children and
Disasters, in its October 2010 Report to the President and Congress, a
major concern is the lack of comprehensive disaster planning and
preparedness for schools across the country. The Commission echoes a
2007 GAO Report that identified many gaps in aligning school emergency
plans with federally-recommended practices.
The U.S. Department of Education manages the Readiness and
Emergency Management for Schools (REMS) grant competition to improve
emergency preparedness in schools. It is the only Federal grant program
solely dedicated for this purpose. In fiscal year 2010, the Department
received $30 million and awarded grants to about 120 school districts
(local educational agencies). The fiscal year 2011 budget request was
again $30 million.
The Commission noted that $30 million is insufficient to improve
emergency preparedness for over 130,000 public and private schools in
our country. For fiscal year 2011, the Department intends to spend just
$4 million and provides only $6 million in its fiscal year 2012 budget
request.
Given the concerns of the Commission and GAO, why isn't improving
emergency preparedness for schools a higher priority to the Department,
and worthy of greater investment?
Answer. The Department remains committed to emergency preparedness
planning, and believes that a more cost-effective and efficient
strategy is to build State-level capacity for emergency preparedness
planning. Instead of funding grants for Readiness and Emergency
Management for Schools (REMS) to school districts, the Department plans
to award grants in 2012 to States to provide support to districts and
schools, including those that face unique challenges in implementing
emergency management activities, that will help them prepare to address
a variety of potential hazards and crises.
REMS currently does not enable the Department to achieve meaningful
progress towards sustainable, continuous improvement in K-12 emergency
management. The REMS grants program has served a small fraction of all
school districts and is too small to have a significant impact on
emergency preparedness nationally. Since 2003, the Department has
distributed 823 grants to districts, a small proportion of the 14,200
public school districts nationwide.
State Grants for Emergency Management
Supporting statewide efforts will ultimately allow the Department
to reach more districts. Also, moving to this new approach will allow
the Department to support State efforts to develop best practices and
innovative models that can be shared with and adapted or adopted by
other States.
Further, the National Commission on Children and Disasters 2010
Report to the President and Congress recommended the approach we have
proposed, stating, ``the Commission recommends that competitive
disaster preparedness grants be awarded to States through the REMS
program as an initial step toward developing innovative models designed
to ensure a higher level of school preparedness statewide.'' This
approach also would align our emergency preparedness efforts with the
Department's overall priority to build the capacity of State
educational agencies across the country.
We had hoped to initiate the State Grants for School Emergency
Management in 2011 but, due to the $98 million cut in funding for Safe
and Drug-Free Schools and Communities (SDFSC) National Activities under
the fiscal year 2011 full-year continuing resolution, the Department
did not have enough 2011 funds to make any new SDFSC grant awards.
Also, in 2012 under SDFSC National Activities the Department plans
to award additional Safe and Supportive Schools grants to States to
support statewide measurement of, and targeted programmatic
interventions to improve, conditions for learning in order to help
schools improve safety and reduce substance use. Promoting readiness
and emergency management for schools would be among the programmatic
interventions supported with those grants.
federal trio programs
Question. Over the last 5 years, Federal TRIO programs have lost
37,000 participants as a result of stagnant funding. The $26.6 million
cut in fiscal year 2011 may result in as many as 107,000 fewer
participants. The administration has requested $920 million for TRIO in
fiscal year 2012. This funding is critical to growing the capacity of
TRIO and thereby increasing the rate of college completion for students
from lower socioeconomic backgrounds. Could you discuss how the
administration will support and defend its recommended funding level
for TRIO in fiscal year 2012?
Answer. The administration believes that the Federal TRIO programs
play an important role in assisting low-income students and students
whose parents never completed college with support and preparation to
enter and complete postsecondary education programs. In designing the
TRIO competitions for 2012, particularly Upward Bound, the Department
is focused on ensuring that grantees pursue strategies and activities
that will maximize the number of students to which they can provide
high-quality services. The Department also believes that the TRIO
programs can play an important role in ensuring that our investment in
Pell Grants results in more students persisting and completing because
they enroll in postsecondary education better prepared to succeed.
The administration remains committed to increasing college
enrollment and completion rates among traditionally underrepresented
populations. In demonstration of this commitment, we have prioritized
protecting the $5,550 maximum Pell Grant award in fiscal year 2012 and
beyond, with the goal of ensuring that more than 9 million low-income
students can continue to rely on Pell Grants to enter into, and
complete, a postsecondary education. However, low-income students need
more than just financial support to enter and complete college; they
also need supportive services like those provided by our Federal TRIO
programs.
educational stability for foster youth
Question. Children in the foster care system face unique challenges
on their path to high school graduation and college success. On
average, foster children move one to two times per year, and often
change schools when they move. When students change schools, they lose
4 to 6 months of educational progress. Only about half of foster
children graduate from high school, and a mere 3 percent earn
bachelor's degrees. As the Co-Chair of the Senate Caucus on Foster
Youth and an advocate for foster youth, I am concerned that children in
the foster care system do not have the educational stability they need
to graduate from high school--on time and with the strong educational
foundation they need to access and complete college.
Mr. Secretary, do you believe the U.S. Department of Education
should invest in promoting educational stability for the nearly 450,000
children in foster care, and, if so, what would that investment look
like? Might this investment include school vouchers for youth in care
over 18 months; stronger collaboration between State Educational
Agencies and State child welfare agencies; Federal funding for the
transportation needed to keep foster youth in their school of choice;
or other solutions?
Answer. All students, especially those in foster care, need
educational stability in order to succeed in school. We certainly need
to do more for youth in foster care, who are more likely to repeat a
grade, and score lower on standardized tests, than youth who are not in
foster care. Between one-quarter and almost one-half of all children in
foster care are also in special education, well above the average for
the general population.
Collaboration among State educational agencies (SEAs), State child
welfare agencies, local educational agencies (LEAs) and schools is key
to tackling these challenges. In letters to Chief State School Officers
and State Child Welfare Directors, we are planning to encourage States
and LEAs to develop or review and, if appropriate, revise their
policies and guidelines for serving children in foster care, in order
to minimize the disruptions to education that can come from being
placed in foster care. We have encouraged SEAs, LEAs, and child welfare
agencies to collaborate during this process and to publicize these
policies and guidelines so that school administrators, teachers, social
workers, and parents understand and can replicate and reinforce their
efforts to increase the educational success of foster children. ED has
also urged child welfare agencies to collaborate with LEAs on policies
and procedures to ensure that foster children remain in and receive
transportation to their school of origin in cases where this is in the
best interest of the foster child, using funding under title IV, part E
of the Social Security Act and other available resources for such
purposes. We have pushed for all States and LEAs to have any revised
policies and guidelines in place prior to the start of the 2011-2012
school year.
ED is also collaborating with the Department of Health and Human
Services (HHS) on this issue, by providing HHS with the information and
technical assistance needed to successfully carry out that agency's
work under the Fostering Connections to Success and Increasing
Adoptions Act of 2008 (FCA). For example, we have worked closely with
HHS in providing input and assistance as it develops guidance and other
material on the FCA. ED has also shared with HHS resources developed by
the National Center for Homeless Education (NCHE), our technical
assistance contractor for the McKinney-Vento Education for Homeless
Children and Youth program. NCHE provides technical assistance to ED on
issues related to homeless students, but it has also put together
information and recommendations on the education of students who are
eligible for homeless services while they are awaiting foster care
placement.
Foster Care and Education National Meeting in 2011
Finally, ED and HHS will co-host a Foster Care and Education
National Meeting on November 3 and 4 of 2011 to bring together State
teams, representing each State's educational, child welfare, and court
systems, to discuss how to promote educational stability and improve
educational outcomes for children in foster care. Our goals for this
meeting are to expand participants' understanding of each system and of
the individual and collective opportunities that can contribute to
improving educational outcomes for children in foster care; gain
insight into foster youths' perspectives on what supports have aided in
their educational success; familiarize participants with the
educational provisions of the FCA; and showcase meaningful
collaborative initiatives that have demonstrated positive educational
outcomes. During the meeting, each State team will also create an
action plan for cross-system collaboration to be implemented following
the conference. All conference attendees will have access to additional
technical assistance, such as webinars, on topics related to the FCA
leading up to this national meeting.
high school dropout recovery/prevention programs
Question. A June 2011 MDRC report, ``Staying on Course: Three-Year
Results of the National Guard Youth ChalleNGe Evaluation,'' shows that
the National Guard Youth ChalleNGe program is effectively reducing our
Nation's high school dropout rate. According to the report, 3 years
after entering the program, Youth ChalleNGe graduates were more likely
to earn their high school diploma or GED, obtain college credits, be
employed, and have substantially higher earnings than high school
dropouts who were eligible, but did not participate in the ChalleNGe
Program.
Are you aware of any comparable high school dropout recovery/
prevention programs, and if so, how is the U.S. Department of Education
investing in these programs?
Answer.
Dropout Prevention Guidance
Reducing our Nation's high school dropout rates is a key Department
goal, and we have been actively engaged in identifying and
disseminating information on effective dropout prevention and recovery
practices. In fall 2008, the Institute of Education Sciences (IES)
released Dropout Prevention: A Practice Guide, which provides
recommendations for dropout interventions using evidence from
previously implemented programs that positively affected students'
progress and persistence in school. Using material from this guide, the
Department developed a Dropout Prevention section for the Doing What
Works Web site, which provides practitioners with research-based
information and tools for improving outcomes. The Office of Elementary
and Secondary Education has also recently initiated an effort to
identify a set of promising dropout prevention and recovery models. In
addition, IES continues to fund research on dropout prevention
programs, currently including a study of the Check & Connect dropout
prevention model.
Departmental Dropout Prevention and Reentry Programs
The Department has invested in dropout prevention and reentry
efforts through the High School Graduation Initiative (HSGI, formerly
School Dropout Prevention) program, which received $48.9 million in
fiscal year 2011 and provides competitive grants to States and local
school districts to implement, at schools with below-average graduation
rates, effective, sustainable dropout prevention and reentry
activities, including activities similar to those of the National Guard
Youth ChalleNGe program. In our proposal to reauthorize the Elementary
and Secondary Education Act, we propose to consolidate this and two
other programs that seek to improve outcomes for high school students
or offer accelerated learning opportunities into a single authority,
the College Pathways and Accelerated Learning program. This program
would support comprehensive efforts to increase high school graduation
rates and preparation for college matriculation and success by
providing college-level and other accelerated courses and instruction
in middle and high schools with concentrations of students from low-
income families and in high schools with low graduation rates. It would
also allow considerable local flexibility for activities including
efforts to prevent students from dropping out and to reengage out-of-
school youth, including early warning systems and comprehensive
prevention and reentry plans. The President's fiscal year 2012 request
includes $86 million for this program.
In addition, high schools with high dropout rates receive
significant assistance through the Title I School Turnaround Grants
(formerly School Improvement Grants) program. Under the
administration's recent program regulations and ESEA reauthorization
proposal, Title I secondary schools with a graduation rate below 60
percent may receive priority for School Turnaround funds. These school
turnaround grants will provide hundreds of millions of dollars to help
restructure significant numbers of the Nation's ``dropout factories.''
Also, the Department will continue to invest in efforts to keep
students in school and on the path to college through programs
authorized under the Higher Education Act, including the TRIO-Talent
Search and GEAR UP programs.
______
Question Submitted by Senator Richard J. Durbin
study abroad and foreign language instruction
Question. Currently, only about 1 percent of college students study
abroad each year, few of whom are minority students, community college
students, or students studying in the STEM fields or to be teachers.
Less than 10 percent of students enrolled in higher education
institutions in the U.S. are taking foreign languages. Given the
increasingly global nature of our economy, what plans does the
Department have to help more students graduate college with the global
mindset and foreign language skills necessary to be successful in
today's global economy?
Answer. The Department agrees that a world-class education must
integrate global competencies and is committed to increasing the global
competency of all U.S. students, including those from traditionally
disadvantaged groups. The Department expects these objectives to be
reflected in a strategy it is currently developing that would govern
all its international activities. The Department currently administers
18 discretionary grant programs authorized under the Higher Education
Act and the Mutual Educational and Cultural Exchange Act of 1961 that
are designed to strengthen the capability and performance of American
education in foreign languages and in area and international studies,
and to improve secondary and postsecondary teaching and research
concerning other cultures and languages, as well as the training of
specialists, and the American public's general understanding of the
peoples of other countries. The Department intends to further align
activities to be supported in fiscal year 2012 under these programs
with the Department's goals to advance global educational competency
for American citizens and to increase access and quality in
postsecondary education.
______
Questions Submitted by Senator Jack Reed
school libraries
Question. Given that more than 60 education and library studies
have shown evidence that effective school libraries are linked to
increased student achievement and knowing that digital literacy skills
are essential to being college and career ready, what is the
administration's plan to ensure that students in title I schools have
access to effective school library programs?
Answer. The administration's proposed Effective Teaching and
Learning: Literacy program would address the need to comprehensively
strengthen instruction and increase student achievement in literacy in
high-need districts and schools. The administration believes that this
new program would help ensure that States and high-need districts have
in place a solid infrastructure across the grade levels to support
high-need schools in implementing high-quality, developmentally
appropriate, and systematic literacy instruction (which may include
programs that support school libraries).
Question. What changes does the administration plan to make to
competitions such as Race to the Top to encourage States and school
districts to provide effective school library programs?
Answer. Race to the Top provides significant flexibility to States
and encourages them to pursue approaches that improve student outcomes
and best meet State and local needs. Depending on the strategies
adopted by individual States (and by local educational agencies, if we
are able to hold a district-level RTT competition), the approaches may
include activities to strengthen school libraries. In addition, the
proposed Effective Teaching and Learning: Literacy program would
encourage States and LEAs to implement high-quality literacy
instruction, which could include support for school libraries.
teacher quality partnership grants
Question. The President's fiscal year 2012 budget calls for the
Teacher Quality Partnership program to be consolidated, along with four
others, into a new authority called Teacher and Leader Pathways.
Teacher Quality Partnership Grants are currently the Federal
Government's only investment in reforming teacher preparation at
institutions of higher education, which prepare nearly 90 percent of
all teachers. Why is the administration planning to switch course
before full implementation of the Teacher Quality Partnership Grants?
Answer. In its March 2011 report entitled ``Opportunities to Reduce
Potential Duplication in Government Programs, Save Tax Dollars, and
Enhance Revenue,'' the Government Accountability Office (GAO)
specifically identified the Teacher Quality Partnerships Grants program
as a current teacher quality program that overlaps with another program
in the Department based on its allowable activities or shared
objectives and target groups. The GAO report noted that the
administration had already proposed to reform the current fragmented
approach to improving teacher quality through its Blueprint for the
reauthorization of the Elementary and Secondary Education Act.
By consolidating several overlapping and sometimes narrowly
targeted programs, the administration has proposed an integrated
approach to recruiting, preparing, developing, rewarding, and retaining
effective teachers and school leaders that builds on the best elements
of existing programs and approaches at the Federal, State, and local
level. The President's fiscal year 2012 budget requests $250 million
for the Teacher and Leader Pathways program to support the preparation
of new teachers, with particular emphasis on the preparation of
science, technology, engineering, and mathematics, or STEM, teachers.
Institutions of higher education, along with States, local educational
agencies, and nonprofit organizations, would be eligible for
competitive grants to support the creation or expansion of high-quality
traditional and alternative pathways into the teaching profession.
projects funded under teacher quality partnership grants
Question. What are the preliminary results from the current Teacher
Quality Partnership Grants?
Answer. The Department is currently administering 40 grants under
the Teacher Quality Partnership Grants program, including 19 teacher
residency projects, 12 pre-baccalaureate teacher preparation projects,
and 9 projects that support both a teacher residency project and pre-
baccalaureate teacher preparation. Although it is too early to know if
these teacher preparation programs are producing more effective
teachers as a result of the reforms they are implementing through these
grants, the annual performance reports for the second year of these
grants indicate that most projects are implementing their projects as
planned.
The grants supporting teacher residency projects prepared 620
teacher candidates last year. These projects focused on preparing
candidates who will be certified to teach elementary education,
mathematics, science, or special education. The graduates of these
residency projects will be teaching in high-need schools in high-need
districts in the 2011-2012 school year. Due to reductions in State and
local funding, some of the partnering high-need districts for the
residency projects have been unable to meet their original commitments
to hire as many residents to teach in high-need schools. Since grantees
are required to place successful graduates of residency projects in
teaching positions in high-need schools, these grantees have had to
reduce the number of candidates they admitted. The Department is
hopeful that the partnering districts will be able to commit to hiring
more teacher residents in the remaining years of these grants and will
continue to work with grantees to ensure that these projects are as
successful as possible despite the challenging economic conditions.
For the pre-baccalaureate teacher preparation grants, six
institutions of higher education have incorporated information into
their traditional course offerings to ensure that their teacher
preparation candidates are prepared to teach students in urban, high-
need schools more effectively. Four pre-baccalaureate projects are
focused on preparing candidates to teach students in high-need rural
schools and rural education is an area of emphasis for several other
projects. Both pre-baccalaureate and residency projects reported that
they are establishing or expanding clinical experience requirements for
teacher candidates. In addition to preparing teachers to enter the
classroom, six projects also have reported that they are offering
professional development for teachers in partnering schools.
federal partnerships and need-based student grant aid
Question. Does the administration see a need for a Federal-State
partnership to support need-based grant aid for students? What are the
administration's plans to rebuild such a partnership now that the
Leveraging Educational Assistance Partnerships, or LEAP, program has
been defunded?
Answer. Cooperation between the Department and States is vital to
achieve good educational outcomes. This is why the 2012 President's
budget included proposals for new Federal-State partnerships in the
form of the College Completion Incentive Grant (CCIG) program, and the
College Access Challenge Grant program. CCIG is designed for twofold
activity: to encourage States to engage in reforms to increase college
completion rates (and ensure these students are well-prepared), and to
reward institutions that are successful at achieving these goals.
States must apply to receive funding, and include with their
application a plan of how they will make certain reforms.
The College Access Challenge Grant Program, as proposed, would
provide formula aid to States to bolster access, persistence, and
completion activities, specifically targeted toward low-income
students. This program would fund activities to ensure low-income
students are prepared to enter and succeed in postsecondary education,
such as providing them need-based grant aid, promoting financial
literacy and debt management, and providing postsecondary education and
career preparation for students and their families.
Question. Does the administration see a need for a Federal-
institutional partnership to provide need-based grant aid for students?
How can we strengthen the current aid programs to improve these
partnerships?
Answer. Besides the funding that is able to be granted to
institutions from States via the College Completion Incentive Grants
and College Access Challenge Grant programs, the First in the World
program, included in the 2012 President's budget request, would go
directly to programs that are evidence-based and willing to undergo
rigorous evaluation. This would be a competitive grant program, and
would place priority in the first year on projects that could reduce
net price, improve outcomes, reduce time to degree or instructional
costs; and/or improve access and completion rates.
race to the top funding and vendors
Question. With billions of dollars awarded, Race to the Top is the
largest competitive grant program at the Department of Education. It is
essential that the use of these funds is fully transparent. Please
provide information on which vendors States are using to implement
their grants and the amount of Race to the Top dollars that are being
awarded to the top vendors across the States.
Answer. We have not aggregated the information about the vendors
with whom the Race to the Top States are working to implement their
plans. All of the States and school districts that received Race to the
Top funds must meet the reporting requirements set forth in section
1512 of the Recovery Act. Those requirements include identifying any
vendors that receive payment of $25,000 or more in a given quarter, and
that information is publicly available on Recovery.gov. In addition,
States must follow State procurement laws, which may require the public
release of the names of entities that are awarded contracts and other
awards under the program.
______
Questions Submitted by Senator Mark Pryor
level playing field for rural areas in grant competitions
Question. You testified that over 80 percent of the Department of
Education's funding allocations remain formula based. However, I have
heard from many of my constituents that are concerned that they do not
have the ability or the resources necessary to effectively compete for
the remaining 20 percent of funding in competitive grants. What steps
is the Department of Education taking to ensure that poor and rural
school districts are able to apply for competitive grants and compete
on a level playing field?
Answer. The Department recognizes that capacity constraints in
remote and rural areas can make applying for competitive grants
difficult. To help level the playing field for rural districts, the
Department is using absolute and competitive priorities to award
additional points to applications from these districts or other
applicants serving rural areas. For example, the Department included a
rural priority and a tribal priority in the Promise Neighborhoods grant
competition. The Department also has proposed structuring new
competitions for the Race to the Top and i3 programs to reflect the
needs of rural districts. Our goal would be to ensure that rural
districts are able to compete for Race to the Top funds in our proposed
district-level competition, and that i3 recipients serve geographically
diverse communities. Under i3, for example, we hope to fund providers
proposing evidence-based approaches to addressing the unique needs of
rural districts and schools. Also under i3, we plan to recruit peer
reviewers experienced in working with rural students and schools, and
to improve our training methods so that all peer reviewers are aware of
the unique needs of students and schools in rural communities and our
expectations for applications that respond effectively to the rural
priority.
The Department also is using its Comprehensive Centers to provide
technical assistance designed to increase the capacity of rural
districts, working with Rural Education Achievement Program (REAP)
State coordinators to increase awareness of competitive grant
opportunities for rural areas, and encouraging the development and
expansion of consortia and partnerships to help make rural districts
more competitive. Finally, the Department's recent experience with the
School Improvement Grants (SIG) program suggests that rural districts
can hold their own in properly structured competitive grant
competitions. Rural schools made up just under 20 percent of all
schools eligible for SIG funds in the fiscal year 2009 State SIG
competitions, but totaled 23 percent of grant recipients in that year.
race to the top application process and rural district applicants
Question. The President has requested $900 million for fiscal year
2012 for Race to the Top. Can you take me through the process of
selecting applications for award?
Answer. We have not yet developed the specific process for the
district-level competition, but would do so with input from
stakeholders in a diverse array of districts.
Question. Additionally, what metrics or criteria do you have in
place to ensure that rural and underserved States and school districts
will be evaluated on a level playing field with States and school
districts that may have more resources?
Answer. While we do not have specific metrics or criteria in place,
we would develop the competition with rural districts in mind. If a
single set of criteria are not appropriate for both rural and non-rural
districts, we may develop different criteria. We have not yet decided
what approach we would use.
education and employment
Question. I am increasingly concerned about the ability of students
with a degree or certification from a high school, technical or
vocational school, or community college to find gainful employment. How
can we make sure these students graduate with the knowledge and skills
that employers are looking for?
Answer.
Ensuring All Students Graduate College- and Career-Ready
President Obama and I share your commitment to ensuring that all
students graduate college- and career-ready, both to expand individual
opportunity for further education and success in the job market and to
ensure our Nation's continued competitiveness in the global economy. We
recognized early on that one of the unintended consequences of No Child
Left Behind was that it encouraged States to lower the quality of their
K-12 academic standards, primarily to avoid the law's overly
prescriptive school improvement requirements. This is why all of our
key initiatives in elementary and secondary education have emphasized
the development and adoption of more rigorous college- and career-ready
academic standards and aligned assessments. In particular, the Race to
the Top program has had a tremendous impact in this area, encouraging
the vast majority of States to adopt a common set of State-developed
college- and career-ready standards and supporting State consortia as
they develop the next generation of high-quality assessments aligned
with these standards.
The development and implementation of college- and career-ready
standards is also at the core of our proposal to reauthorize title I of
the Elementary and Secondary Education Act (ESEA), which would provide
resources to States and school districts for this purpose. It is
important to recognize, however, that the Department cannot prescribe
or impose particular standards or curricula on America's schools, and
that the States bear the primary responsibility for developing,
adopting, and successfully implementing high-quality academic standards
linked to success in college and careers. Our role is to highlight the
need for such standards and, wherever possible, create the incentives
for States to do the right thing for their students and for our Nation.
College Pathways and Accelerated Learning Program
Our ESEA reauthorization proposal would create other new programs
that aim to improve student college and career readiness including the
College Pathways and Accelerated Learning program, which would
consolidate several current ESEA programs into a single, more
comprehensive and flexible authority that supports State and local
efforts to better prepare students for college and the workforce by
providing college-level and other accelerated courses and instruction,
including dual enrollment and early college high school programs, in
secondary schools with concentrations of students from low-income
families and with low graduation rates. The President's fiscal year
2012 request includes $86 million for this program.
Carl D. Perkins Career and Technical Education Act
The Department is also in the process of developing a
reauthorization proposal for programs under the under the Carl D.
Perkins Career and Technical Education Act (Perkins Act). We are
looking at options for making the Perkins Act a better vehicle for
ensuring that all career and technical education programs are viable
and rigorous pathways to postsecondary and career success. College and
career pathways provide multiple pathways to the same destination:
achievement of both success in college and an upwardly mobile career.
These pathways must align academic and technical coursework with
challenging postsecondary expectations, as well as industry needs and
certifications, and be designed and implemented in close collaboration
with employers in order to respond to the changing needs of the global
economy. The President's fiscal year 2012 request includes $1 billion
for this program.
public-private partnerships as tool in ensuring college- and
career-readiness
Question. In your opinion, would public-private partnerships be an
effective tool? If so, how can we incentivize educational institutions
to create partnerships with businesses to develop effective programs?
Answer. Public-private partnerships can definitely be a valuable
tool for helping young people acquire the knowledge and skills that
employers are looking for. Surveys of business leaders show that,
despite the high unemployment rate, they are having difficulty finding
sufficiently skilled workers to fill many job openings. However, few
business leaders report that they are working with postsecondary
institutions to help them improve programs that prepare individuals for
careers.
The Department is currently developing its reauthorization proposal
for the Carl D. Perkins Career and Technical Education Act. One of the
issues we are considering is how to create incentives for educational
institutions and businesses to work together to ensure that students
acquire the knowledge and skills they need to get good jobs and succeed
in high-wage, high-skill careers.
supplemental educational services oversight
Question. Many educators in my State have voiced concern about the
lack of proper oversight of title I funds for supplemental educational
services (SES). How can we ensure that these valuable funds are being
used effectively and in the best interest of students?
Answer. Under the ESEA, States are responsible for approving SES
providers and monitoring provider performance in providing tutoring and
other academic enrichment services to eligible students. To help States
carry out these responsibilities, the Department in recent years has
provided extensive technical assistance to States on questions and
issues related to the provision of SES, including questions regarding
the allowable use of title I funds by providers for specific activities
and incentives. The Department also monitors the implementation of SES,
sometimes including the delivery of services by particular providers,
as part of the title I monitoring process.
supplemental educational services evaluation
Question. What level of evaluation of the impact of SES on student
achievement is currently underway?
Answer. The Department is currently completing a rigorous
evaluation of the impact of supplemental educational services on
individual student achievement in six school districts with
approximately 24,000 students eligible for SES. The study also will
examine whether the impact of SES on student achievement is associated
with particular characteristics of services, providers, students, or
practices in the school district. This study currently is undergoing
peer review and is expected to be released by the end of 2011.
common core state standards
Question. What do you think about the new Common Core State
Standards and the corresponding Partnership for Assessment of Readiness
for College and Careers assessment system?
Answer. The administration believes the adoption of State-
developed, college- and career-ready academic standards is an essential
first step toward developing next generation accountability systems
that will help students prepare more effectively for college and
careers and ensure that our Nation is able to compete successfully in
the global economy of the 21st century. As a result of the leadership
of our Governors and Chief State School Officers, the vast majority of
States have now voluntarily adopted common, college- and career-ready
standards. The administration also believes that the development and
implementation of new State assessments linked to these standards,
including the work currently under way by the Partnership for
Assessment of Readiness for College and Careers, will be a game-changer
in public education. These new assessments will, for the first time,
effectively measure whether America's students are on track for college
and careers while providing teachers with timely, high-quality
formative assessments that measure student academic growth and help to
improve teaching and learning.
funds for implementing academic standards and assessments
Question. Are you concerned about resources for teachers and
schools to implement these Common Core State standards?
Answer. The Department, as enunciated in both its budget requests
and in our proposal for reauthorizing the ESEA, intends to continue
providing State formula grant funding to help States implement high-
quality standards and assessments, as well as competitive grants for
States and LEAs to support instruction aligned with college- and
career-ready standards. For fiscal year 2012, the President's request
includes $420 million under a reauthorized Assessing Achievement
program, as well as $835 million under a reauthorized Effective
Teaching and Learning for a Complete Education program. In addition,
the Department believes that the near-universal voluntary adoption of
common academic standards by the States is evidence of a commitment to
make available the State and local resources required to implement
these standards as well as aligned assessments.
ayp waiver request
Question. In March 2011, Arkansas requested that you waive a
requirement of NCLB to allow its AYP targets to be held at the 2011-
2012 levels until it fully implements the Common Core State Standards
(2014-2015 school year). I understand that their request was denied.
Did you grant any AYP waivers?
Answer. No, we have not granted any waivers of adequate yearly
progress (AYP) targets. Several States have submitted amendments to
their Accountability Workbooks that are consistent with the ESEA
statute and regulations, but these are not waivers.
no child left behind requirements flexibility plan
Question. The reason given for the waiver denial was that these
issues should be addressed in an Elementary and Secondary Education
Authorization bill. As we all know, it is highly unlikely that we will
see such a bill this year. Based on that information, will you take a
second look at Arkansas's request for a waiver?
Answer. The Department is developing a plan to provide flexibility
regarding NCLB requirements for those States that are moving forward
with reforms that will increase the quality of instruction and improve
student achievement. Final details on the flexibility package will be
available in mid-September, and we encourage all interested States,
including Arkansas, to request it.
______
Questions Submitted by Senator Sherrod Brown
elimination of in-school subsidy for undergraduate students
Question. Last year, the Deficit Reduction panel proposed the
elimination of the in-school subsidy for undergraduates as a way to
find savings. It is my understanding that this was on the table during
debt ceiling recent negotiations. Eliminating the in-school subsidy for
undergraduates would have an extremely negative impact on students. How
does the administration plan to balance the needs of middle class
students who may qualify for the in-school subsidy, but not the Pell
Grant?
Answer. While the Budget Control Act of 2011 eliminated subsidized
loans for graduate and professional students--which the administration
endorsed as part of its 2012 budget proposal--undergraduate students
still retain the ability to take out subsidized loans. Students who are
not interested in a Stafford loan, and are not otherwise Pell-eligible,
should consider the campus-based aid programs--Supplemental Educational
Opportunity Grants (SEOG), Work-Study grants, and Perkins loans--as a
good source of aid. Part of the 2012 budget request was to maintain the
current level of funding for SEOG and Work-Study, and to reform the
Perkins program with $8.5 billion in volume--eight and one-half times
the current volume--which could enable it to reach over 3 million
students at over 2,700 institutions.
student loan conversion
Question. In May, I introduced the Student Loan Simplification and
Opportunity Act which was a part of the Presidents' Pell Grant
Protection Act. This legislation would allow students with both Federal
Family Education Loan Program (FFELP) loans and Direct Loans to
simplify their loan repayment process and provide borrowers with 2
percent off of their FFELP principal for converting their loans, while
saving the Government $1.8 billion. Does the administration support
this policy included in the bill?
Answer. The administration supports the policy as presented in its
fiscal year 2012 budget proposal to Congress. The administration
believes this policy will make loan repayment simpler for the estimated
6 million split borrowers--those with loans both in the Direct Loan and
FFEL programs--and make it less likely they will default as a result.
race to the top--early learning challenge program
Question. In July, Senator Hagan and I introduced the Ready Schools
Act of 2011. This legislation is based off of the great work of the
Spark Partnership in Ohio and the North Carolina Ready Schools
Initiative. This legislation focuses on the importance of school
readiness in addition to the student readiness. Early childhood
education plays an important role in the short- and long-term success
of students. I appreciate your efforts in establishing the Early
Learning Challenge Grant Program but am concerned that this funding
will only benefit a limited number of children. As childhood poverty
rates continue to grow, it is important that we invest in all young
children. Why did the Department decide to spend $500 million for this
program when the success of the Race to the Top model is still unknown?
What is included in the budget to improve the systematic alignment and
delivery of early childhood education?
Answer. The Race to the Top--Early Learning Challenge program will
support States that demonstrate their commitment to integrating and
aligning resources and policies across all of the State agencies that
administer public funds related to early learning and development.
Winning States will serve as models of how to build a more unified
approach to supporting young children and their families--an approach
that increases access to high-quality early learning and development
programs and services, and helps ensure that children enter
kindergarten with the skills, knowledge, and dispositions toward
learning they need to be successful.
All States can undertake this work by using existing funds that
support early learning and development from Federal, State, private,
and local sources, such as the Child Care and Development Fund, title I
and II of the ESEA, the Individuals with Disabilities Act, State-funded
preschool programs, and Head Start.
federal trio programs
Question. In your fiscal year 2012 budget request, you recommend a
$67 million increase to the TRIO programs. As you know, this is not
really an ``increase'' but rather it provides funding to ensure that
the 180 Upward Bound programs funded by the College Cost Reduction and
Access Act--including three programs in Ohio--would not have to close
their doors in December 2011. In light of recent funding cuts to TRIO
in fiscal year 2011, could you reaffirm your commitment to TRIO,
particularly the administration's fiscal year 2012 funding request for
the program?
Answer. The administration believes that the Federal TRIO programs
play an important role in assisting low-income students and students
whose parents never completed college with support and preparation to
enter and complete postsecondary education programs. In designing the
TRIO competitions for 2012, particularly Upward Bound, the Department
is focused on ensuring that grantees pursue strategies and activities
that will maximize the number of students to which they can provide
high-quality services. The Department also believes that the TRIO
programs can play an important role in ensuring that our investment in
Pell Grants results in more students persisting and completing because
they enroll in postsecondary education better prepared to succeed.
The administration remains committed to increasing college
enrollment and completion rates among traditionally underrepresented
populations. In demonstration of this commitment, we have prioritized
protecting the $5,550 maximum Pell Grant award in fiscal year 2012 and
beyond, with the goal of ensuring that more than 9 million low-income
students can continue to rely on Pell Grants to enter into, and
complete, a postsecondary education. However, low-income students need
more than just financial support to enter and complete college; they
also need supportive services like those provided by our Federal TRIO
programs.
tech prep program
Question. The Tech Prep program provides college and career
training for students beginning in high school so that they are
prepared for success in business and industry. This program also helps
to ensure more students are on the path to complete higher education
and thus the United States is on the path to compete in a global
economy. Why did the administration choose to merge the Tech Prep State
Grant with the title I basic State grant and then reduce the overall
appropriation?
Answer. The Tech Prep program duplicates activities authorized
under the Career and Technical Education (CTE) State Grants program.
The purpose of the Tech Prep program is to support development and
implementation of programs of non-duplicative, sequential courses of
study that incorporate secondary education and postsecondary education
with work-based learning experiences. However, the CTE State Grants
program also requires States to develop these types of programs, and to
do so within the larger context of CTE programs within the State. In
addition, 28 States consolidated at least a portion, and generally all,
of their Tech Prep funds into State Grants during school year 2010-
2011.
In order to maintain fiscal discipline by placing a priority on
programs that are most aligned with the President's reform agenda and
most likely to demonstrate results, the Department did request a
reduction in funding for CTE for fiscal year 2012. While CTE is vitally
important to America's future, the Perkins CTE program as it is
currently structured is not operating in a way that produces optimal
results for students. The Department is currently engaged in developing
our reauthorization proposal for the Carl D. Perkins Career and
Technical Education Act. Our intent is to develop a proposal that will
improve the statute by ensuring that all CTE programs become viable and
rigorous pathways to postsecondary and career success, providing
students with the career skills necessary to compete in a global
marketplace, and collecting better program performance data.
family engagement in educational outcomes for children
Question. I have heard a lot of discussion about family engagement
in education from the administration, which is a step in the right
direction. In your blueprint for ESEA reauthorization, you propose the
establishment of a Family Engagement and Responsibility Fund, along
with an increase in the title I set-aside for family engagement
initiatives. However, the Parent Information Resource Center (PIRC)
funds are consolidated in the Department 2012 budget. Parental
Information and Resource Centers exist to work in partnership with, and
build the capacity of, State and local educational agencies and provide
technical assistance on implementing research-based and effective
family engagement strategies.
How does the administration plan to ensure that districts and
States build their capacity to carry out this work without the PIRC
program?
Answer. Enhancing family engagement is crucial to improving
educational outcomes for children, and the administration's budget and
Elementary and Secondary Education Act (ESEA) reauthorization proposals
reflect our commitment to making sure that families are informed of and
better involved in the educational opportunities available in their
community. The Department is also committed to pursuing actions that
will help build the capacity of States, school districts, and schools
to effectively leverage resources for strengthening family engagement
in education. As you mentioned, the administration's ESEA
reauthorization proposal for the renamed College- and Career-Ready
Students (CCRS) program (currently title I grants to local educational
agencies) would significantly increase State and local spending on
parent and family engagement activities, ensuring that every district
receiving title I funds is developing and implementing a family
engagement plan focused on raising student achievement and developing
promising new strategies to engage parents and families. States would
be permitted to reserve up to 5 percent of their title I, part A
allocations to carry out activities to build State and local capacity
to improve student achievement, including by improving capacity to
carry out effective family engagement strategies.
Family Engagement and Responsibility Fund
States also would be permitted to set aside up to 1 percent of
their title I, part A allocations to fund programs that support family
engagement and to identify and disseminate best practices in this area.
This Family Engagement and Responsibility Fund would support and expand
district-level best practices, with a priority for evidence-based
parental involvement activities. PIRCs, along with districts,
community-based organizations, and other nonprofit organizations, would
be eligible to compete for these funds.
Title I Set-aside and Family Engagement
Our reauthorization proposal would also double the local title I
set-aside for parent and family engagement, from 1 to 2 percent,
increasing the total from about $145 million to approximately $270
million. PIRCs would be eligible to partner with school districts or
consortia of school districts in implementing activities funded under
this set-aside. Additional elements of the administration
reauthorization proposal (including our proposals for Safe and Healthy
Students, Promise Neighborhoods, and Expanding Educational Options)
would also focus specifically on issues related to family engagement.
Capacity Building and Technical Assistance for Family Engagement
Activities
Finally, you asked about the Department's plan to provide capacity-
building and technical assistance to States and districts on family
engagement in education. We will continue to support these goals
through our new Implementation and Support Unit (ISU), in the Office of
the Deputy Secretary, and through programs like the Comprehensive
Centers. The ISU provides technical assistance directly to States
implementing comprehensive reforms under the Education Jobs Fund, Race
to the Top, Race to the Top Assessment, and State Fiscal Stabilization
Fund programs. The Comprehensive Centers also help increase State
capacity to assist districts and schools in meeting their student
achievement goals. In fiscal year 2012, the Department will make
approximately 21 new competitive grant awards to support the first year
of a second cohort of Comprehensive Centers. Because family engagement
is a priority for the administration and for the Secretary, it will be
one of the key issues addressed through these efforts.
school-based counseling programs
Question. School counselors, school psychologists, and school
social workers provide counseling and other learning support services
to students who are struggling with issues that create barriers to
learning. The Elementary and Secondary School Counseling Program is the
only Federal grant specifically targeted to providing assistance to
school districts to establish and enhance school counseling programs,
including ensuring access to these highly trained professionals to
address students' social and emotional needs. Given the serious impact
on students' academic success that children can face because of anxiety
related to a parent's military deployment, issues related to
homelessness, or other types of mental illness, as well as the need for
prevention and early intervention to avoid more serious problems, how
will the priorities of the Elementary and Secondary School Counseling
Program be preserved under the proposed consolidation program?
Answer. The administration is committed to addressing student
mental health issues and believes that school-based counseling programs
offer great promise for improving prevention, diagnosis, and access to
treatment for children and adolescents.
Successful, Safe, and Healthy Students Program
Under the proposed Successful, Safe, and Healthy Students program,
State educational agencies (SEAs), high-need local educational agencies
(LEAs), and their partners, that are interested in establishing or
expanding elementary and secondary school counseling programs would be
eligible to apply for competitive grant funding to develop and
implement programs that measure and improve conditions for learning
based on local needs. The administration believes that this broader,
more flexible approach, through which grantees could address students'
mental health and related social needs comprehensively, rather than a
narrowly focused program, would be more successful in building State,
district, and school capacity and in providing the resources necessary
to design and implement strategies for promoting healthy development
and successful students.
promise neighborhoods applications
Question. There were 339 communities who applied for $10 million in
Promise Neighborhoods funding in fiscal year 2010. More than 80 of
these communities scored 80 or higher on the application process. Nine
of these communities were in Ohio. Many of these communities would have
been awarded planning grants if additional funding were available. I am
pleased that for fiscal year 2011, there is $30 million available for
Promise Neighborhoods, and that ED is offering implementation grants,
in addition to a second round of planning grants. I understand that the
notice of intent for this second round was due last week; do you have a
sense of how many communities applied for the new implementation?
Specifically, do you know how many communities are seeking
implementation verse planning grants?
Answer. As of the July 22 deadline for Intents to Apply in the
fiscal year 2011 competition, 501 entities had submitted their intent
for the planning grant competition and 161 entities had submitted their
intent for the implementation grant competition. The deadline to submit
a full application for both the planning and implementation grant
competitions is September 6, 2011.
promise neighborhoods funding
Question. What is the Department of Education doing to meet the
national need and demand for Promise Neighborhoods?
Answer. The President's fiscal year 2012 budget request includes
$150 million to provide continued funding to fiscal year 2011
implementation grantees in addition to funding a new round of planning
and implementation grants. We consider this a priority within our 2012
budget request. In addition, as part of the White House Neighborhood
Revitalization Initiative (NRI), the Department is partnering with
other Federal agencies to provide comprehensive technical assistance to
additional communities, many of which have expressed interest in the
Promise Neighborhoods program, as part of the NRI's Building
Neighborhood Capacity program. This program will support organizations
with limited capacity, but serving high-poverty neighborhoods, through
hands-on technical assistance. Designed to serve an initial cohort of
five neighborhoods, the program will provide an online resource center
and leverage assistance from multiple Federal agencies and other
sources in support of local neighborhood revitalization initiatives.
technical assistance to promise neighborhoods grantees
Question. For those communities who did receive planning grants,
how is the Department providing the necessary coaching and technical
assistance needed to ensure success?
Answer. The fiscal year 2010 appropriation did not provide Federal
resources to support coaching or technical assistance for the planning
grantees. Nevertheless, the Promise Neighborhoods Institute (PNI), an
independent, foundation-supported nonprofit resource, is meeting many
of the needs of the communities. PNI offers tools, information, and
strategies to assist any community interested in participating in the
Promise Neighborhoods program. In addition, PNI provides technical
support directly to the program's grantees for planning, identifying
quality approaches, building partnerships, assessing needs, and many
more essentials for successfully building a Promise Neighborhood. The
$30 million fiscal year 2011 appropriation will support national
activities, including technical assistance for the first cohort of
Promise Neighborhood implementation grantees.
______
Questions Submitted by Senator Richard C. Shelby
pell grants funding
Question. The unsustainable growth in the costs of the Pell Grant
program continues to be an anchor dragging down the entire budget for
the Department of Education. While the fiscal year 2012 budget request
does propose some policy changes to address the growth in Pell Grant
costs, the administration also proposes a $5.6 billion increase in
discretionary funding. How will the fiscal year 2012 budget request
address the fiscally unsustainable path of the Pell Grant program?
Answer. The President's budget for fiscal year 2012 seeks to
protect the $5,550 maximum award for those students with the greatest
need, while also finding ways to reduce the overall cost impact of the
Pell Grant program. One way the request does this is by not seeking to
raise the maximum award, instead keeping it level with the prior 2
years. Additionally, in the President's budget, the administration
outlined a comprehensive plan to cover rising Pell Grant costs and help
close the program's shortfall through changes to other student aid
programs, and changes to the administration of Pell itself. In total,
these changes are estimated to save $100 billion over 10 years.
reducing pell grants costs
Question. Specifically, how is the administration proposing to
reduce the overall rapid cost growth in the Pell Grant program?
Answer. The Department's plan for reducing Pell Grant costs
specifically includes eliminating the availability of a second Pell
Grant in an award year, FAFSA simplification, creating easier student
repayment through a debt conversion plan, expanding and modernizing the
Perkins Loan program so it can assist more students, replacing the
TEACH Grants program with Presidential Teaching Fellows, creating the
College Completion Incentive Grants program to achieve better outcomes
for students, and eliminating subsidized loans for graduate and
professional students. Two of these policy proposals--the elimination
of the second Pell Grant in an award year, and the elimination of
subsidized loans to graduate and professional students--have already
been adopted by Congress. In total, the Department estimates these
changes will reduce Pell's discretionary appropriations need by $13.2
billion in 2012 alone.
state authorization of distance education programs
Question. There continues to be concerns raised by colleges and
universities regarding State authorization provisions under the
proposed Program Integrity regulations and the potential impact on
access to distance education at higher education institutions. At the
risk of losing Federal financial aid, colleges and universities will be
required to request permission to offer their distance education
programs in every State in which a student is located while receiving
instruction. Many States already have legislation that requires
registration. Why is the Department of Education moving forward with
regulations where States already have efficient and equitable policies
in place regarding distance learning?
Answer. The Department's regulations governing State authorization
of distance education programs simply required institutions to comply
with State laws where they exist; it imposed no additional requirements
beyond being able to demonstrate that they complied with State law
where those laws exist. A Federal court recently took action to strike
the provision of the Department's regulation but did not overturn State
law. The United States is still evaluating whether to appeal.
With that said, Alabama has set high standards and imposed
significant charges on institutions that offer distance learning in the
State. While we do not endorse these requirements, we do acknowledge
that each State has the ability to regulate higher education
institutions operating in the State.
Question. How will the Department ensure universities that have
already been approved by their home State's Higher Education Commission
and accredited by the relevant regional accrediting authority that they
will not be unduly burdened by duplicative, costly, time consuming, and
academically unnecessary regulations?
Answer. The Department's regulations governing State authorization
of distance education programs simply required institutions to comply
with State laws where they exist; it imposed no additional requirements
beyond being able to demonstrate that they complied with State law
where those laws exist. A Federal court recently took action to strike
the provision of the Department's regulation but did not overturn State
law. The United States is still evaluating whether to appeal.
With that said, Alabama has set high standards and imposed
significant charges on institutions that offer distance learning in the
State. While we do not endorse these requirements, we do acknowledge
that each State has the ability to regulate higher education
institutions operating in the State. So, States, including Alabama, can
take steps to reduce the burden imposed on institutions of higher
education if they believe those burdens are duplicative, costly, time
consuming, and academically unnecessary. The Federal Government ought
not to limit the authority of States but if that were to be done it
would involve preempting State laws. Such preemption would require
either congressional action or a regulatory action. Such regulations
would need to be developed consistent with the Executive Order of
Federalism signed by President Reagan.
high school graduation initiative and the college pathways and
accelerated learning program
Question. The fiscal year 2012 Department of Education budget
request proposes to consolidate 38 programs into 11 new authorities in
line with the administration's Elementary and Secondary Education Act
reauthorization proposal. Beginning in 2010, the Mobile County School
System will receive nearly $9 million over 5 years under the High
School Graduation Initiative to support the implementation of
effective, sustainable, and coordinated dropout prevention and reentry
efforts in high schools. However, the fiscal year 2012 budget request
would eliminate the High School Graduation Initiative and replace the
program with a new College Pathways and Accelerated Learning program.
How will the Department of Education ensure that schools who have been
awarded funding under the High School Graduation Initiative continue to
receive their promised funding under the budget request?
Answer. The administration's proposal for the College Pathways and
Accelerated Learning program would require the Secretary to reserve
funds to pay for grants made under the High School Graduation
Initiative and Advanced Placement programs through the grants'
completion.
______
Questions Submitted by Senator Thad Cochran
targeting of title i funds to local educational agencies
Question. It is clear that the funds appropriated for title I could
be distributed in a more equitable manner that targets those for whom
the program is intended: children in concentrated poverty. Is the
Department of Education actively pursuing potential changes to title I
distribution formulas to ensure Federal education funding better
reaches disadvantaged children?
Answer. The administration is strongly committed to ensuring that
title I funds are targeted to high-poverty schools, regardless of
geographic location, and stands ready to work with the Congress,
through the reauthorization process, on ways to improve the targeting
of title I funds.
national not-for-profit organizations and the improving teacher quality
state grants program
Question. There continues to be concern with the consolidation of
existing programs into 11 new authorities in the administration's
reauthorization proposal for the Elementary and Secondary Education
Act. Specifically, the Department of Education budget appears to direct
funding to programs for States and localities without a path for
national not-for-profit organizations with a proven track record to
compete. In fiscal year 2011 Congress addressed this concern by
including a 1 percent set aside under the Improving Teacher Quality
State Grants program for a competition for national not-for-profit
organizations that provide teacher training or professional development
activities. When does the Department of Education intend to have a
competition for national not-for-profit (NFP) organizations under the
Improving Teacher Quality State Grants program?
Answer. A notice inviting applications for new awards under this
set-aside was published in the Federal Register on September 8, 2011.
Our goal is to make awards in early 2012, well before the period of
availability ends on September 30, 2012.
national nfp organizations set-aside competition
Question. Can you please provide details to this subcommittee on
how the Department intends to conduct a competition for these funds,
including any expected priorities for the competition?
Answer. Through the new Supporting Effective Educator Development
competition, the Department will make grants to national non-profit
organizations to support projects that are supported by at least
moderate evidence, as defined in the notice inviting applications.
Grantees will use the funds to recruit, select, and prepare or provide
professional enhancement activities for teachers or for teachers and
principals.
Supporting Effective Educator Development Competition Absolute
Priorities
An applicant may apply under any of three absolute priorities:
--Under Absolute Priority 1, the Department will support the creation
or reform of practices, strategies, or programs that are
designed to increase the number or percentage of teachers (or
teachers and principals) who are highly effective, especially
teachers (or teachers and principals) who serve concentrations
of high-need students, by identifying, recruiting, and
preparing highly effective teachers or teachers and principals.
To meet this priority, an applicant must propose a plan
demonstrating that teacher or principal participation in the
applicant's proposed activities will be determined through a
rigorous, competitive selection process.
--Under Absolute Priority 2, we will support projects that will
increase the quality of student literacy and writing by
creating or reforming practices, strategies, or programs that
improve teachers' knowledge, understanding, and teaching of
English language arts with a specific focus on writing through
high-quality professional development or professional
enhancement programs.
--Under Absolute Priority 3, the Department will fund projects that
encourage and support teachers or teachers and principals
seeking advanced certification or advanced credentialing
through high-quality professional enhancement programs designed
to improve teaching and learning for teachers or for teachers
and principals. To meet this priority, an applicant must
demonstrate or propose a plan to demonstrate that the award of
the advanced certification or advanced credential will be
determined on the basis of a rigorous evaluation with multiple
measures that include measures of student academic growth.
The Department will also award points in this competition based on
two competitive preference priorities. An applicant may receive
additional points by proposing:
--a project that is supported by strong evidence of effectiveness (as
defined in the notice inviting applications), or
--a project that is designed to significantly increase efficiency in
the use of time, staff, money, or other resources while
improving student learning or other educational outcomes.
Projects that receive points under the second competitive
preference priority may include innovative and sustainable uses
of technology, modification of school schedules and teacher
compensation systems, use of open educational resources, or
other strategies.
national nonprofit competitions and esea reauthorization
Question. Will the Department of Education commit to supporting a
dedicated funding stream for the same purpose in fiscal year 2012?
Answer. Our proposal for ESEA reauthorization includes several
competitions in which many national nonprofit organizations would be
eligible to participate. For example, organizations such as Teach for
America, the National Writing Project, and the National Board for
Professional Teaching Standards, the organizations no longer receiving
earmarked assistance, could partner with schools to apply for an
Investing in Innovation grant. In addition, Teach for America could
compete for funds under the proposed new Teacher and Leader Pathways
program. The National Board for Professional Teaching Standards could
partner with States in the Teacher and Leader Innovation Fund to
strengthen State standards for certification and licensure. The
National Writing Project could receive funding under the national
activities set-aside in the new Effective Teaching and Learning
initiative and could also partner with States on comprehensive literacy
strategies.
promise neighborhoods competition--absolute priority for rural
communities
Question. The fiscal year 2012 budget request includes $150 million
for the Promise Neighborhoods program, which supports projects designed
to improve education and life outcomes for children and youth within a
distressed geographic area. The Indianola Promise Community in
Mississippi was awarded one of the first Promise Neighborhood grants in
fiscal year 2010. However, there are concerns that as the process moves
forward the Indianola Promise Community will have to compete on a
national scale with large, urban school districts for implementation
grant funding. Please provide details on the steps that the Department
has taken under the Promise Neighborhoods program to ensure rural
communities can compete for grant funding to implement reform efforts.
Answer. In fiscal year 2010, the Department included an absolute
priority for rural communities applying for Promise Neighborhood
grants. The Delta Health Alliance in Indianola applied for and received
a planning grant under this rural community priority. The fiscal year
2011 competition again includes an absolute priority for rural
communities as well as tribal communities, for both planning and
implementation grants, in order to ensure that communities such as
Indianola are able to compete on a national scale for Promise
Neighborhood funding.
improving competitive stance of rural communities for education funding
Question. Does the Department plan to take similar steps in the
future to ensure that rural communities are less disadvantaged under
competitive grant opportunities, as it has with the Promise
Neighborhoods and Investing in Innovation programs?
Answer. Through the rulemaking process, the Secretary has created
supplemental priorities to target funds to high-priority areas. These
priorities include a priority for improving the achievement and high
school graduation rates of students in rural school districts. The
Department is considering applying this priority in competitions for
absolute or competitive preference in a number of programs for fiscal
year 2012.
innovative strategies in early learning
Question. The Department recently announced that $500 million of
the fiscal year 2011 funding for the Race to the Top program will be
awarded to States to help build comprehensive early learning systems.
For fiscal year 2012, the administration requested an additional $900
million for the Race to the Top program and $350 million for a new
Early Learning Challenge Fund. What plan does the Department have in
place to ensure that funding awarded through Race to the Top or the
Early Learning Challenge Fund prioritizes innovative strategies for
early learning, including the implementation and expansion of full-day
kindergarten?
Answer. We want to provide funding to support the important work of
transforming early learning programs and services from a patchwork of
disconnected programs with uneven quality into a coordinated system
that prepares children for success in school and in life. The purpose
of the Race to the Top-Early Learning Challenge (RTT-ELC) program,
which we are implementing with about $500 million of the fiscal year
2011 appropriation for Race to the Top, is to improve the quality of
early learning and development and close the achievement gap for
children with high needs. The overarching goal is to make sure that
many more children, especially children with high-needs, enter
kindergarten ready to succeed. The competition for RTT-ELC grants also
includes an invitational priority to encourage States to sustain
positive early learning program effects in the early elementary grades.
geography education
Question. According to results from the National Assessment of
Educational Progress that were released on July 19, 2011, fewer than
one-third of the Nation's students achieve at or above the proficient
level in geography. As the sponsor of S. 434, the ``Teaching Geography
Is Fundamental Act,'' which would create a dedicated program to improve
geographic literacy, these recent results are gravely concerning. Will
the Department of Education commit to do more to ensure that funding is
directed to geographic education activities?
Answer. The Department is committed to ensuring that our Nation's
students have access to high-quality instruction across academic
content areas. Our proposal to reauthorize the Elementary and Secondary
Education Act (ESEA) includes the Effective Teaching and Learning for a
Well-Rounded Education program, which would support efforts to improve
instruction in a wide range of subjects, including geography, while
providing States and local school districts with greater flexibility to
meet the needs of their students and teachers. The President's fiscal
year 2012 request includes $246 million for this new program.
Although geography is included among the subjects in the current
ESEA definition of ``core academic subjects,'' geography education is
not the focus of any current ESEA program and, thus, most likely does
not receive significant Federal support under current law. Enactment of
the Effective Teaching and Learning for a Well-Rounded Education
program would give the Department and grantees a better vehicle for
supporting the evaluation and expansion of geography education programs
as well as efforts to integrate geography more prominently in
instruction in other subject areas.
career and technical education
Question. Across the country, unemployment levels are still high,
but there are jobs available for individuals with the right skill sets.
The Career and Technical Education program works to ensure that
students have the academic, technical and employability skills
necessary for career readiness in the current workforce. In fiscal year
2012, the Department of Education budget request proposes an almost
$125 million reduction to the Career and Technical Education State
Grants. How will the Department of Education ensure that schools can
continue to offer Career and Technical Education programs to help
students attain these skills with a decrease in funding?
Answer. While CTE is vitally important to America's future, the
Perkins CTE program as it is currently structured is not operating in a
way that produces optimal results for students. The Department is
currently engaged in developing our reauthorization proposal for the
Carl D. Perkins Career and Technical Education Act. Our intent is to
develop a proposal that will improve the statute by ensuring that all
CTE programs become viable and rigorous pathways to postsecondary and
career success, providing students with the career skills necessary to
compete in a global marketplace, and collecting better program
performance data.
______
Questions Submitted by Senator Lindsey Graham
incentive compensation regulations
Question. It is my understanding that recent sub-regulatory
language related to incentive compensation rules issued by your
Department would prohibit one or two entities from providing support
services to other colleges and universities, services that other
companies can provide without reservation. If this is accurate, this
regulation would be arbitrarily picking winners and losers. It is
difficult to comprehend either the statutory grounds or rationale for
interfering with the provision of services to educational institutions.
In order to better understand the intent of the regulation, I
respectfully request clarity on the statutory grounds and why the
Department would choose to include some institutions under the
regulation while leaving others out.
Answer. On March 17, 2011, the Department issued guidance related
to several areas of program integrity, including the issue of incentive
compensation. This guidance was designed to assist institutions in
understanding the regulations and provide examples of permissible
activities. The guidance provided in this letter, and the regulations
in general, seek to ensure title IV aid at all institutions is used to
successfully train students.
Please be aware that there is no prohibition upon any entity
providing support services to another entity. The only prohibition is
upon the manner in which compensation may be provided should one of
those services involve student recruitment. Pursuant to section
487(a)(20) of the HEA an ``institution will not provide any commission,
bonus, or other incentive payment based directly or indirectly on
success in securing enrollments or financial aid to any persons or
entities engaged in any student recruiting or admission activities or
in making decisions regarding the award of student financial
assistance.'' It is that statutory provision which the Department is
enforcing when it monitors the manner in which student recruitment
activities are compensated.
title vi centers for international business education (ciber) program
Question. For fiscal year 2011, your Department cut the title VI
Centers for International Business Education and Research (CIBER)
program by 55 percent. Over two decades, CIBERs have been engaged in
cutting-edge activities to strengthen the Nation's global economic
competitiveness on many levels.
I respectfully request detailed information on CIBERs' recent role
in supporting an increase in our country's exports, including
collaboration with business and government on the President's National
Export Initiative. I also request information on how CIBERs have
enhanced institutes of higher education, including underrepresented
institutions such as HBCUs, MSIs, and community colleges, in meeting
global demand for a competitive workforce.
Answer. In response to President Obama's recent announcement of the
National Export Initiative, which calls for increased resources to
expand international trade, the U.S. Commercial Service--the trade
promotion arm of the U.S. Department of Commerce's International Trade
Administration--plans to increase its efforts to move U.S. companies
into new and emerging markets. The CIBERs have a good track record with
the U.S. Department of Commerce and will work with President Obama's
National Export Initiative, either directly or indirectly, by holding
conferences and assisting businesses to improve their export
strategies.
In the 2010 CIBER competition, the Department encouraged the
applicants to help improve internationalization at minority-serving
institutions (MSIs). Many applicants responded to the priority by
incorporating activities into their 2010-2013 CIBER projects. For
example, Michigan State University hosts a bi-annual training program
for community colleges where the Commerce Department's teaching
materials are featured.
As outreach to other constituencies, a number of CIBERs have
developed 4-year training programs for faculty from HBCUs. The program
includes mentoring institutions as well as individual faculty and
providing for faculty study abroad. The program will be extended to
Hispanic-Serving Institutions, and three CIBERS--Colorado, Hawaii, and
Washington--will work with Alaska Native, Native Hawaiian, and Native
American students and faculty during the 2010-2014 cycle.
In partnership with the University of Memphis, CIBERs and the
Institute of International Public Policy, which is operated by the
United Negro College Fund Special Programs Corporation, have been
working with 46 Historically Black Colleges and Universities (HBCUs) to
enhance understanding of interdisciplinary international business
education. The consortium has been engaged in equipping HBCU faculty
with discipline specific international knowledge, pedagogical tools,
research methodologies, and study abroad experiences to incorporate
international content into existing business courses and/or develop new
courses, and to increase international business research. An integral
component of the program is one-on-one assistance provided by the
sponsoring CIBERs to their respective HBCUs in the implementation of
international business education programs on HBCU campuses and in
acquiring Federal grants to support these efforts.
CIBERs at Brigham Young University and the University of Colorado
at Denver support a consortium of 36 community colleges and
universities across 10 western States to provide CIBER programs to the
region's small and medium-sized rural institutions and to facilitate
the sharing of resources among regional schools with developing
international business expertise. The consortium is now reaching out to
Tribal Colleges and Universities (TCUs) recognized by the American
Indian Higher Education Consortium, as 23 TCUs are located in 10 States
with a significant number of Native American students.
national impact of fiscal year 2011 budget cuts on cibers
Question. Lastly, what has been the impact of the cuts on CIBERs
nationally and their ability to continue their legislative mandates?
Answer. Besides producing the majority of internationally prepared
business students and entrepreneurs, CIBERs are designed to serve as
regional and national resources to businesses, students, and academics.
The CIBERs are the equivalent of the National Resource Centers (NRCs)
in Schools of Business. Most are located at major U.S. universities.
The most recent competition for new awards was held in fiscal year
2010 and 33 grants averaging $386,576 were awarded. The CIBER
allocation in 2011 is $5.7 million, a reduction of $7 million or 55
percent, below the 2010 funding. The reduced funding in 2011 will
likely hamper activities supported by the CIBER program. Outreach to
business, including export development; business language training and
other interdisciplinary programs; outreach and faculty development to
minority-serving institutions, community colleges, other colleges and
universities, and K-12 schools in the 50 States; practical, policy-
oriented international business research; and study abroad and
international internships could be eliminated or reduced.
plan for ciber program funding in fiscal year 2012
Question. What is your plan for CIBER program funding in fiscal
year 2012?
Answer. The Department is currently supporting 33 universities,
designated as CIBERS, who were awarded multi-year grants in fiscal year
2010. Fiscal year 2012 funds would be used to cover, to the extent
possible, funding for the third year of the 4-year grants.
Currently funded CIBERS institutions are: Brigham Young University,
Columbia University, Duke University, Florida International University,
George Washington University, Georgia Institute of Technology, Georgia
State University, Indiana University, Michigan State University, Ohio
State University, Purdue University, San Diego State University, Temple
University, Texas A&M University, University of California, LA,
University of Colorado at Denver, University of Connecticut, University
of Florida, University of Hawaii at Manoa, University of Illinois at
Urbana-Champaign, University of Maryland, University of Memphis,
University of Miami, University of Michigan, University of Minnesota,
University of North Carolina--Chapel Hill, University of Pennsylvania,
University of Pittsburgh, University of South Carolina, University of
Southern California, University of Texas--Austin, University of
Washington, and University of Wisconsin--Madison.
______
Questions Submitted by Senator Jerry Moran
possible waivers of esea requirements
Question. Secretary Duncan, you have stated recently that if
reauthorization of the Elementary and Secondary Education Act (ESEA) is
not completed by this September, you will look to issue States
conditional waivers from No Child Left Behind's most troublesome
requirements provided that States agree to make certain changes to
their education systems. Specifically, what No Child Left Behind
requirements would you waive for States and what changes would you
require of States to receive such waivers?
Answer. The Department is still working out the details of possible
flexibility from ESEA requirements pending the completion of
reauthorization, and expects to announce the specifics in mid-
September.
measuring student academic growth
Question. Mr. Secretary, last March, your Department released its
Blueprint for the Reauthorization of ESEA, which outlined in broad
terms proposed changes to the current law, including the development of
new assessments of student growth. What do you see as the ideal
``growth models'' for States to measure individual student performance
and how will these models be different from current ``adequate yearly
progress'' (AYP) standards?
Answer. The Department believes that there are a number of valid
and reliable methods for measuring student academic growth that States
would be able to choose from to meet the requirements of our
reauthorization proposal. The key benefit of growth models is that they
will track the academic progress of individual students over time, as
opposed to simply measuring the percentage of students who have reached
grade-level proficiency in a particular subject at a particular point
in time, as under most assessment and accountability systems used by
States under current law. The Department's reauthorization proposal
would continue to require States to set performance targets for
schools, similar to current AYP requirements, but schools would be able
to meet such targets either by demonstrating that students are ``on
track'' to college- and career-readiness or making adequate progress
toward being on track to college- and career-readiness.
impact of the esea on student achievement
Question. We all know that education is a primary key to increasing
our country's global competitiveness. Knowledge and human capital are
what drive innovation, entrepreneurship, and growth. We talk a lot
about holding our schools and teachers accountable for creating our
leaders of tomorrow, but we also need to hold ourselves accountable.
Since the ESEA was enacted more than 45 years ago, Federal per-pupil
spending has nearly tripled. However, our national graduation rates and
other academic achievement measures have remained relatively flat and
we have fallen in international education ranking. Considering these
measures, why have we failed to improve and what are some examples you
have seen in your travels across the country that represent a fresh
approach where schools are raising the bar for student achievement?
Answer. I believe a number of factors have been holding us back
educationally despite decades of effort to improve academic and other
outcomes at the Federal, State, and local levels. First, I believe we
have set the bar too low. We all know that young people tend to perform
up to expectations, and our expectations for academic achievement in
core subjects, as reflected in State standards and assessments, have
simply been lower than many of our strongest economic competitors have
for their students. In part this ``dumbing down'' of standards and
assessments has been due to flawed and overly prescriptive
accountability requirements, such as those we have experienced over the
past decade under No Child Left Behind. The administration's response
to these problems has been to encourage and create incentives for
States to raise their standards, and thanks to the leadership of our
Nation's Governors and Chief State School Officers, we have seen great
success in this area with the voluntary adoption of common, State-
developed, college- and career-ready standards by the vast majority of
States over the past 2 years. And we are proposing to create, through
the reauthorization of the ESEA, more nuanced accountability systems
that ask States and school districts to focus their attention and
support on the lowest-performing schools and schools with the largest
achievement gaps, while also giving them considerable flexibility to
develop and implement their own improvement strategies for most
schools.
Teacher Recognition and Academic Achievement
Another issue is that we have not treated our teachers like the
professionals that they are: we must provide needed support, reward
excellence, and create incentives for our best teachers to work in our
toughest schools. A key first step toward elevating the teaching
profession is the development and implementation of rigorous and fair
teacher evaluation systems that will help us identify, support, learn
from, and reward effective teachers. We have been promoting the
creation of those systems in several of our key initiatives, including
Race to the Top, the Teacher Incentive Fund, School Improvement Grants,
and our ESEA reauthorization proposal.
Examples of Innovative Approaches to Ensuring Academic Success
Despite these challenges to excellence in our education system,
many districts and schools are finding innovative ways to make
extraordinary progress in preparing their students for success in
college and careers as well as for lifelong and active participation in
our democracy. For example, Mooresville Graded School District in North
Carolina has launched a Digital Conversion Initiative to promote the
use of technology to improve teaching and learning. The district has
provided laptops to every 4th to 12th grade student and interactive
SMART Boards and Slates and Response Devices have been employed in
every K-3 classroom. In addition to the use of computers as
instructional tools, the Digital Conversion Initiative has resulted in
a shift to digital textbooks with content that is aligned with State
standards. Traditional textbooks may still be used, but generally as
supplemental materials. The use of digital textbooks and other
technology can increase student achievement and enhance the learning of
21st century skills.
In Florida, the Florida Virtual School also taps into technology to
provide online learning options for students in grades K-12. The school
has modified the way most traditional public school systems work by
moving to a completely results-based funding model in which a school
receives funding only for students who successfully complete courses.
It allows students to progress at their own pace--usually faster than
normal seat-time classes would allow--and provides many traditional
schools economical options for providing courses they would have
difficulty staffing locally.
And in Mobile, Alabama, George Hall Elementary School underwent a
restructuring plan that involved hiring a new principal and replacing a
majority of school staff. The new staff signed contracts to stay at the
school for at least 5 years. The principal focused on developing staff
cohesion, a positive culture, and a curriculum that was aligned with
State standards and connected from one grade level to the next. Since
then student achievement has risen sharply. In reading, the percentage
of students scoring at or above the proficient level almost doubled
from 24 percent in 2003-2004 to 43 percent in 2004-2005; math gains
were even larger, rising from 34 percent to 69 percent. By 2008-2009,
the percentage of students who scored proficient or above reached 90
percent in reading and 94 percent in math.
career and technical education
Question. In Kansas and many other States, career and technical
education is critical to economic growth and expansion of a competitive
workforce. Your Department's Blueprint for the Reauthorization of ESEA
references developing and implementing new statewide assessments for
career and technical subjects. Specifically, what role do you see
career and technical education playing in a reauthorized ESEA?
Answer. For too long, career and technical education (CTE) has been
a neglected part of the education reform movement. That neglect must
end, and CTE must change its mission to play a key role in the goal of
ensuring that all students graduate high school ready for college and
careers. President Obama has suggested that every American earn both a
high school diploma and a degree or an industry-recognized
certification. CTE can and must help ensure that young adults receive
those two credentials, both of which are essential to securing a good
job.
esea title i accountability structure
Question. Also, how do we successfully incorporate career and
technical education and other learning that may take place outside the
traditional classroom into ESEA's accountability structure?
Answer. The ESEA title I accountability structure is based on
student performance on assessments in reading/language arts and
mathematics, as well as additional academic indicators such as high
school graduation rates. Students who participate in career and
technical education are included in those assessments, but they
typically are assessed in the 10th grade, before they begin taking CTE
coursework, and the assessments do not measure their progress in CTE.
Many observers of the current title I accountability structure have
criticized it as being too focused on reading/language arts and
mathematics, which may have resulted in a narrowing of the curriculum.
The administration's ESEA reauthorization blueprint includes a number
of proposals that would seek to ensure that students have access to a
broad, well-rounded curriculum that is not dominated by the tested
subjects.
Accountability in Career and Technical Education Programs
In addition, in the context of the upcoming reauthorization of the
Carl D. Perkins Career and Technical Education Act, we are seeking to
develop mechanisms for holding career and technical education programs
appropriately accountable for results-- mechanisms that would track
student programs in CTE as well as in the academic subjects. We believe
that this type of strategy is likely to be more successful than trying
to incorporate CTE skill and knowledge acquisition within the title I
framework.
CONCLUSON OF HEARINGS
Senator Harkin. And with that, the--we are done. The
subcommittee will stand in recess.
[Whereupon, at 11:40 a.m., Wednesday, July 27, 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 2012
----------
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
[Clerk's note.--The subcommittee was unable to hold
hearings on departmental and nondepartmental witnesses. The
statements and letters of those submitting written testimony
are as follows:]
DEPARTMENTAL WITNESSES
Prepared Statement of the Corporation for Public Broadcasting
Chairman Harkin, Ranking Member Shelby, and members of the
subcommittee, thank you for allowing me to submit testimony on behalf
of our Nation's public media system.
Every day across the country, people turn to public radio and
television for programs that inform and inspire; for lifelong
education; for local news and information; for arts and cultural
content, and for a variety of other services. Public broadcasting, or
what should more accurately be called ``public media,'' has many faces,
and employs around 24,000 people, but is best-known by the 1,300 local
public radio and television stations across the country that provide
unique local service to their communities. These stations collectively
reach more than 98 percent of the U.S. population with free, over-the-
air television and radio programming and other services. When Congress
appropriates money to the Corporation for Public Broadcasting (CPB), it
is benefitting the 170 million Americans who use public broadcasting
each month by supporting the stations that serve them.
CPB distributes Federal funds in accordance with a statutory
formula contained in the Public Broadcasting Act of 1967, under which
more than 70 percent of our funds go directly to local public
television and radio stations. CPB also supports the creation of
programming for radio, television, and digital media. The statute
ensures diversity in this programming by requiring CPB to fund
independent and minority producers. CPB fulfills these obligations by
funding the Independent Television Service and the five Minority
Consortia in television (which represent African American, Latino,
Asian American, Native American, and Pacific Islander producers) and
similar organizations in radio. CPB funds the National Program Service
at PBS, which supports signature programs like ``PBS NewsHour'',
``NOVA'' and ``American Experience''; as well as educational,
scientifically researched, impactful and trusted children's programming
like ``Sesame Street'', ``Curious George'', and ``Word Girl''.
In addition, CPB spends 6 percent of its funds on projects that
benefit the entire public broadcasting community, befitting its role as
the only entity responsible for and answerable to the entirety of the
public media system. CPB negotiates and pays music royalties for all of
public broadcasting, for example, and funds research to explore
audience needs and technological opportunities. Added together, these
efforts account for 95 percent of the funds appropriated to CPB (which
is limited by law to an administrative budget of no more than 5
percent).
Some have suggested that public broadcasting can easily do without
Federal funding. Let me briefly explain the critical importance of
Federal funding to public media as it exists today, and what the impact
would be if it were to go away. Congress designed the public media
system in this country as a public-private partnership, where minimal
Federal dollars are leveraged to the maximum extent to ensure universal
service to every American and every community. While CPB's
appropriation accounts for around 15 percent of the entire cost of
public broadcasting, this ``lifeblood'' funding leverages critical
investments from State and local governments, universities, businesses,
foundations and from viewers and listeners of local stations. Put
simply, CPB funding is the foundation on which the entire system is
built. Undermining the foundation puts the entire structure in
jeopardy.
CPB funding is particularly important to minority-owned public
stations and stations in rural areas, which are more challenging to
operate due to low population density of viewers and listeners; the
need to operate multiple transmitters to reach far-flung populations;
and the limited disposable incomes and potential for private support
often found in rural America. In fiscal year 2009, individual donations
represented 17 percent of an average rural station's total revenue,
versus almost 28 percent for the industry as a whole. The
disproportional importance of Federal funding to stations in rural
areas is clear--in fiscal year 2009, 108 rural stations relied on CPB
for at least 25 percent of their revenue; while 22 rural stations, many
on Native American reservations, relied on CPB funding for at least 50
percent of their revenue.
Finally, CPB funding is also the only funding source without a
station cost associated with it--all other fundraising costs money (for
stations and for any nonprofit). For example, in fiscal year 2008 it
costs the average station 40 cents on the dollar to raise funds from
individuals and local businesses.
Numerous studies, including one conducted by the Government
Accountability Office (GAO), have shown that the loss of Federal
funding would create a void not easily filled by other sources of
funding. For the vast majority of stations, this would mean a drastic
and immediate cutback in service, local programming and personnel, and
in many cases stations would ``go dark.'' Further, the loss of Federal
funding would have a severe impact on a station's ability to acquire
national programming, such as ``The Electric Company'', ``Super Why!'',
``NOVA'', ``American Experience'', ``Frontline'', ``PBS NewsHour'',
Marketplace and many others, from PBS, NPR, American Public Media and
other sources. Federal funding has been the basis for this highly
successful public media model since CPB was created nearly 45 years
ago. Without it, public media ceases to exist as its creators intended.
Core System Support
One of CPB's core responsibilities is to preserve, protect, and
advance public media. Public television and radio stations are facing
an unprecedented array of challenges. These include the challenging
economy, reductions in Federal and State support, shifting community
demographics, fracturing audiences and emerging patterns in the way
content is delivered and consumed. Public television has been hit
especially hard. Over the past two years, the public television economy
has declined by $250 million, and CPB projects a further $250 million
decline over the next two years. In addition, while the digital
conversion in public television has provided exciting new opportunities
for service, digital equipment becomes obsolete much more quickly than
the analog equipment it replaced. The more or less constant cost of
equipment replacement is further affecting public television. To cope
with declining revenue and increasing equipment expenses, many stations
have been forced to cut local service. As a result, the need to
maintain infrastructure is draining resources from content and local
service at stations.
CPB is working in two areas to help the system begin to facilitate
collaboration and operational efficiencies: mergers and consolidations,
and joint master control operations.
Mergers and Consolidation.--Most communities are served by one or
more stand-alone public broadcasting stations. While independent local
stations theoretically have a great deal of flexibility in choosing how
to serve their community, the limited scale of many stand-alone
operations drives up operating costs and constrains stations' ability
to offer local service.
State networks like Iowa Public Television and Alabama Public
Television have demonstrated the advantage of taking an alternative
approach. Combining management and back office operations to serve
multiple communities can increase efficiency and free resources for
additional local service. CPB plans to continue to work with stations
to explore operating models that bring multiple stations together as an
important focus of our work. Our efforts include offering informal
advice to stations considering mergers and, once stations issue a
formal intent to merge, providing some financial assistance with
merger-related costs.
Central Master Control.--A master control room is the central hub
of a television station's technical operation, the point where content
sources come together to be routed to the station transmitter. In the
past, each television station has needed a master control room. Digital
technology now allows the master control function to be provided from a
remote location. A single master control facility can now serve
multiple stations. This is important because master controls are
expensive; they are both capital- and people-intensive. Combining
master control operations can yield significant cost savings, increase
productivity, and encourage station collaboration in other back-office
areas.
CPB is supporting the design and construction of multi-station
master control facilities. We are also exploring the practicality of
creating a nationwide ``master plan'' for master control facilities. As
the specifics of a new consolidated master control function evolve,
there is an opportunity to realize cost savings, reduce the capital
burden on stations, and improve efficiency for public television.
American Graduate
In the words of our statute, ``[I]t is in the public interest to
encourage . . . the use of [public] media for instructional,
educational, and cultural purposes.'' Education continues to be a core
value of the public broadcasting community, as it has been since its
inception. For over 40 years, public broadcasting stations have made a
robust and vital contribution to education and an informed and
strengthened civil society, and these contributions are reflected in
CPB's recently-launched American Graduate initiative.
American Graduate is a significant new public media initiative to
help improve our Nation's high school graduation rates. Every year,
more than 1 million students drop out of high school. If that trend
continues, over the next 10 years, it will cost the Nation more than $3
trillion in lost wages, productivity and taxes. American Graduate
expands on public media's record of success in early childhood
education to reach students in middle school--a critical point when the
disengagement that leads to dropping out in high school often begins.
Local public radio and television stations are at the core of this
initiative and are uniquely positioned to educate and engage various
stakeholders on the dropout problem, rally support and help coordinate
efforts in communities, something experts say is crucial to a solution.
CPB's Requests for Appropriations
Public media stations continue to evolve, both operationally and
more importantly in the myriad ways they serve their communities.
Stations are committed to reaching viewers and listeners on whatever
platform they use--from smart phones to iPads to radios to television
sets. While stations can and will continue to adapt and thrive in the
digital age, without sufficient support they cannot provide service on
evolving platforms. As the Federal Communications Commission's National
Broadband Plan noted, ``Today, public media is at a crossroads . . .
[it] must continue expanding beyond its original broadcast-based
mission to form the core of a broader new public media network that
better serves the new multi-platform information needs of America. To
achieve these important expansions, public media will require
additional funding.''
CPB Base Appropriation (Fiscal Year 2014).--CPB has requested a
$495 million advance appropriation for fiscal year 2014, to be spent in
accordance with the Public Broadcasting Act's funding formula. The two-
year advance appropriation for public broadcasting, in place since
1976, is the most important part of the ``firewall'' that Congress
constructed between Federal funding and the programs that appear on
public television and radio. President Gerald Ford, who initially
proposed a 5-year advance appropriation for CPB, said it best when he
said that advance funding ``is a constructive approach to the sensitive
relationship between Federal funding and freedom of expression. It
would eliminate the scrutiny of programming that could be associated
with the normal budgetary and appropriations processes of the
government.''
Our fiscal year 2014 request balances the fiscal reality facing our
Nation with the stark fact that stations are struggling to maintain
service to their communities in the face of shrinking non-Federal
revenues--a $218 million, or 9.2 percent, drop between fiscal year 2008
and 2009 alone. Even with these challenges, public broadcasting
contributes to American society in many ways that are worthy of greater
Federal investment. In fiscal year 2014, CPB will continue to support a
range of programming and initiatives through which stations provide a
valuable and trusted service to millions of Americans.
CPB Digital Funding (Fiscal Year 2012).--CPB requests $48 million
for CPB Digital for fiscal year 2012, $11.5 million less than requested
in fiscal year 2011. The digital conversion of public media is a much
more extensive process than simply replacing analog with digital
equipment. Digital conversion requires the development of new
organizational models optimized for the digital environment, with new
workflows, multi-channel services, and multi-platform distribution. CPB
Digital funding, which can fund a wider range of projects than our
formula-governed main account, has led to some of the most important
innovation in public broadcasting's history. The continuing
availability of this funding is critical to public broadcasting's
progress toward a true, digital public service media.
Ready To Learn (Fiscal Year 2012).--CPB requests that the U.S.
Department of Education's Ready To Learn (RTL) program be funded at
$27.3 million, the same level as fiscal year 2011. A partnership
between the Department, CPB, PBS and local public television stations,
RTL leverages the power of digital television technology, the Internet,
gaming platforms and other media to help millions of young children
learn the reading and math skills they need to succeed in school. The
partnership's work over the past few years has demonstrably increased
reading scores particularly among low-income children and has erased
the performance gap between children from low-income households and
their more affluent peers. An appropriation of $27.3 million in fiscal
year 2012 will enable RTL to develop tools to improve children's
performance in math as well as reading and bring on-the-ground,
station-convened early learning activities to more communities.
All told, the Federal contribution to public media through CPB
amounts to $1.39 per American per year and, in a model private-public
partnership, the public media system takes each of these dollars and
raises six dollars more. The returns for taxpayers are exponential.
They include in-depth news and public affairs programming on the local,
State, national and international level; unmatched, commercial-free
children's programming; formal and informal educational instruction for
all ages; and inspiring arts and cultural content.
Mr. Chairman and Ranking Member, thank you again for allowing CPB
to submit this testimony. We are under no illusions about the pressures
you face on a daily basis as Congress works to address our country's
perilous fiscal situation. As such, on behalf of the public
broadcasting community, including the stations in your states and those
they serve, we sincerely appreciate your support.
______
Prepared Statement of the Railroad Retirement Board
We are pleased to present the following information to support the
Railroad Retirement Board's (RRB) fiscal year 2012 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 the past 2
years, the RRB has also administered special economic recovery payments
and extended unemployment benefits under the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5). More recently, we have
administered extended unemployment benefits under the Worker,
Homeownership, and Business Assistance Act of 2009 (Public Law 111-92),
and the Tax Relief, Unemployment Insurance Reauthorization, and Job
Creation Act of 2010 (Public Law 111-312).
During fiscal year 2010, the RRB paid $10.8 billion, net of
recoveries, in retirement/survivor benefits to about 582,000
beneficiaries. We also paid $156.3 million in net unemployment/sickness
insurance benefits to some 38,000 claimants. Unemployment benefits
included $19.4 million under Public Law 111-92, and about $0.8 million
under Public Law 111-5. In addition, the RRB paid benefits on behalf of
the Social Security Administration amounting to $1.3 billion to about
116,000 beneficiaries.
proposed funding for agency administration
The President's proposed budget would provide $112,239,000 for
agency operations, which would enable us to maintain a staffing level
of 902 full-time equivalent staff years (FTEs) in 2012. The proposed
budget would also provide $1,810,000 for information technology (IT)
investments. This includes $700,000 for costs related to systems
modernization and e-Government, and $654,000 for improvements related
to cyber security and continuity of operations. The remaining $456,000
would be used for network operations, infrastructure replacement and
emergency restoration services.
agency staffing
The RRB's dedicated and experienced workforce is the foundation for
our tradition of excellence in customer service and satisfaction. Like
many Federal agencies, however, the RRB has a number of employees at or
near retirement age. Nearly 70 percent of our employees have 20 or more
years of service at the agency, and about 40 percent of our current
workforce will be eligible for retirement by January 1, 2013. To help
prepare for the expected staff turnover in the near future, we are
placing increased emphasis on strategic management of human capital.
Our human capital plans provide for employee support and knowledge
transfer, which will enable the RRB to continue achieving its mission.
In addition, with the agency's formal human capital plan, succession
plan and various action plans in place, we are ensuring that succession
management supports a systematic approach to ensuring a continuous
supply of the best talent through helping individuals develop to their
full potential.
In connection with these workforce planning efforts, our budget
request includes a legislative proposal to enable the RRB to utilize
various hiring authorities available to other Federal agencies. Section
7(b)(9) of the Railroad Retirement Act contains language requiring that
all employees of the RRB, except for one assistant for each Board
Member, must be hired under the competitive civil service. We propose
to eliminate this requirement, thereby enabling the RRB to use various
hiring authorities offered by the Office of Personnel Management.
information technology improvements
We are actively pursuing further automation and modernization of
the RRB's various processing systems to support the agency's mission to
administer benefit programs for railroad workers and their families.
Key capital initiatives for fiscal year 2012 include projects to add
new reporting services to our Employer Reporting System, and to
continue with long-term system modernization efforts. In recent years,
the agency has moved to a relational database environment and optimized
the data that reside in the legacy databases. In fiscal year 2012, our
staff will work with an experienced DB2 Database Administrator to
ensure that the master database remains platform independent and to
develop stored procedures that will be used by reengineered mainframe
programs that access the master database. We also plan to move forward
with reengineering the applications to the agency's LAN enterprise
program platform, several of which are programmed in outdated,
commercially unsupported technologies.
Our budget request also provides for cyber security improvements to
ensure that the RRB continues to control the risks that threaten the
agency's critical assets and to meet the security requirements set
forth in the Federal Information Security Management Act (FISMA) of
2002, and infrastructure investments to maintain our operational
readiness and provide a firm foundation for our target enterprise
architecture.
other requested funding
The President's proposed budget includes $51 million to fund the
continuing phase-out of vested dual benefits, plus a 2 percent
contingency reserve, $1,020,000, which ``shall be available
proportional to the amount by which the product of recipients and the
average benefit received exceeds the amount available for payment of
vested dual benefits.'' In addition, the President's proposed budget
includes $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
(Trust), which was established by the Railroad Retirement and
Survivors' Improvement Act of 2001 (RRSIA) to manage and invest
railroad retirement assets. Pursuant to the RRSIA, the RRB has
transferred a total of $21.276 billion to the Trust. All of these
transfers were made in fiscal years 2002 through 2004. The Trust has
invested the transferred funds, and the results of these investments
are reported to the RRB and posted periodically on the RRB's website.
The net asset value of Trust-managed assets on September 30, 2010, was
approximately $23.8 billion, an increase of $0.5 billion from the
previous year. As of April 2011, the Trust had transferred
approximately $11 billion to the Railroad Retirement Board for payment
of railroad retirement benefits.
In June 2010, 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 addressed the 25-year period 2010-2034, and included
projections of the status of the retirement trust funds under three
employment assumptions. These indicated that barring a sudden,
unanticipated, large decrease in railroad employment or substantial
investment losses, the railroad retirement system would experience no
cash flow problems for the next 23 years. Even under the most
pessimistic assumption, the cash flow problems would not occur until
the year 2033. The report did not recommend any change in the rate of
tax imposed by current law on employers and employees.
Railroad Unemployment Insurance Account.--The RRB's latest annual
report on the financial status of the railroad unemployment insurance
system was issued in June 2010. The report indicated that even as
maximum daily benefit rates rise 39 percent (from $64 to $89) from 2009
to 2020, experience-based contribution rates are expected to keep the
unemployment insurance system solvent, except for small, short-term
cash-flow problems in 2010 and 2011. Projections show a quick repayment
of loans even under the most pessimistic assumption.
Unemployment levels are the single most significant factor
affecting the financial status of the railroad unemployment insurance
system. However, the system's experience-rating provisions, which
adjust contribution rates for changing benefit levels, and its
surcharge trigger for maintaining a minimum balance, help to ensure
financial stability in the event of adverse economic conditions. No
financing changes were recommended at this time by the report.
Due to the increased level of unemployment insurance payments
during fiscal years 2009 and 2010, loans from the Railroad Retirement
(RR) Account to the RUI Account became necessary beginning in December
2009. The balance of loans from the RR Account was $47.4 million at the
end of fiscal year 2010, including $0.9 million in accrued interest.
The estimated loan balance at the end of fiscal year 2011, is $3.0
million, and full repayment of the loans is expected during fiscal year
2012.
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 the Inspector General, Railroad Retirement Board
My name is Martin J. Dickman and I am the Inspector General for the
Railroad Retirement Board. I would like to thank you, Mr. Chairman, and
the members of the Subcommittee for your continued support of the
Office of Inspector General.
budget request
I wish to inform you of our fiscal year 2012 appropriations request
and describe our planned activities. The Office of Inspector General
(OIG) respectfully requests funding in the amount of $9,259,000 to
ensure the continuation of its independent oversight of the Railroad
Retirement Board (RRB). During fiscal year 2012, the OIG will focus on
areas affecting program performance; the efficiency and effectiveness
of agency operations; and areas of potential fraud, waste and abuse.
operational components
The OIG has three operational components: the immediate Office of
the Inspector General, the Office of Audit (OA), and the Office of
Investigations (OI). The OIG conducts operations from several
locations: the RRB's headquarters in Chicago, Illinois; an
investigative field office in Philadelphia, Pennsylvania; and five
domicile investigative offices located in Arlington, Virginia; Houston,
Texas; San Diego, California; Miami, Florida; and New York, New York.
These domicile offices provide more effective and efficient
coordination with other Inspector General offices and traditional law
enforcement agencies with which the OIG works joint investigations.
office of audit
The mission of the Office of Audit is to promote economy,
efficiency, and effectiveness in the administration of RRB programs and
detect and prevent fraud and abuse in such programs. To accomplish its
mission, OA conducts financial, performance, and compliance audits and
evaluations of RRB programs. In addition, OA develops the OIG's
response to audit-related requirements and requests for information.
During fiscal year 2012, OA will focus on areas affecting program
performance; the efficiency and effectiveness of agency operations; and
areas of potential fraud, waste, and abuse. OA will continue its
emphasis on long-term systemic problems and solutions, and will address
major issues that affect the RRB's service to rail beneficiaries and
their families. OA has identified four broad areas of potential audit
coverage: Financial Accountability; Railroad Retirement Act & Railroad
Unemployment Insurance Act Benefit Program Operations; Railroad
Medicare Program Operations; and Security, Privacy, and Information
Management.
During fiscal year 2012, OA must accomplish the following mandated
activities with its own staff: Audit of the RRB's financial statements
pursuant to the requirements of the Accountability of Tax Dollars Act
of 2002 and evaluation of information security pursuant to the Federal
Information Security Management Act (FISMA).
During fiscal year 2012, OA will complete the audit of the RRB's
fiscal year 2011 financial statements and begin its audit of the
agency's fiscal year 2012 financial statements. OA contracts with a
consulting actuary for technical assistance in auditing the RRB's
``Statement of Social Insurance'', which became basic financial
information effective in fiscal year 2006. In addition to performing
the annual evaluation of information security, OA also conducts audits
of individual computer application systems which are required to
support the annual FISMA evaluation. Our work in this area is targeted
toward the identification and elimination of security deficiencies and
system vulnerabilities, including controls over sensitive personally
identifiable information. OA will also conduct an audit of employer
compliance with the provisions of the Railroad Retirement and Railroad
Unemployment Insurance Acts. Our work in this area is designed to
verify the completeness and accuracy of the external reviews performed
by the RRB's compliance group.
OA undertakes additional projects with the objective of allocating
available audit resources to areas in which they will have the greatest
value. In making that determination, OA considers staff availability,
current trends in management, Congressional and Presidential concerns.
office of investigations
The Office of Investigations (OI) focuses its efforts on
identifying, investigating, and presenting cases for prosecution,
throughout the United States, concerning fraud in RRB benefit programs.
OI conducts investigations relating to the fraudulent receipt of RRB
disability, unemployment, sickness, and retirement/survivor benefits.
OI investigates railroad employers and unions when there is an
indication that they have submitted false reports to the RRB. OI also
conducts investigations involving fraudulent claims submitted to the
Railroad Medicare Program. These investigative efforts can result in
criminal convictions, administrative sanctions, civil penalties, and
the recovery of program benefit funds.
OI INVESTIGATIVE RESULTS FOR FISCAL YEAR 2010
------------------------------------------------------------------------
------------------------------------------------------------------------
Civil Judgments......................................... 19
Indictments/Informations................................ 47
Convictions............................................. 50
Recoveries/Receivables.................................. $29,296,188
------------------------------------------------------------------------
OI anticipates an ongoing caseload of about 450 investigations in
fiscal year 2012. During fiscal year 2010, OI opened 244 new cases and
closed 210. To date in fiscal year 2011, OI has opened 188 new cases
and closed 135. At present, OI has cases open in 47 States, the
District of Columbia, and Canada with estimated fraud losses of over
$37 million. Disability fraud cases represent the largest portion of
Ol's total caseload. These cases involve more complicated schemes and
often result in the recovery of substantial amounts for the RRB's trust
funds. They also require considerable resources such as travel by
special agents to conduct surveillance, numerous witness interviews,
and more sophisticated investigative techniques. Additionally, these
fraud investigations are extremely document-intensive and require
forensic financial analysis.
During fiscal year 2012, OI will continue to coordinate its efforts
with agency program managers to address vulnerabilities in benefit
programs that allow fraudulent activity to occur and will recommend
changes to ensure program integrity. OI plans to continue proactive
projects to identify fraud matters that are not detected through the
agency's program policing mechanisms.
conclusion
In fiscal year 2012, the OIG will continue to focus its resources
on the review and improvement of RRB operations and will conduct
activities to ensure the integrity of the agency's trust funds. This
office will continue to work with agency officials to ensure the agency
is providing quality service to railroad workers and their families.
The OIG will also aggressively pursue all individuals who engage in
activities to fraudulently receive RRB funds. The OIG will continue to
keep the Subcommittee and other members of Congress informed of any
agency operational problems or deficiencies.
The OIG sincerely appreciates its cooperative relationship with the
agency and the ongoing assistance extended to its staff during the
performance of their audits and investigations. Thank you for your
consideration.
______
NONDEPARTMENTAL WITNESSES
Prepared Statement of the ADAP Advocacy Association
Thank you on behalf of the ADAP Advocacy Association (aaa+) and its
board of directors for the opportunity to submit our written testimony
to the Senate Committee on Appropriations, Subcommittee on Labor,
Health and Human Services and Education (LHHSE) about the AIDS Drug
Assistance Programs (ADAPs). aaa+ is a national 501(c)(3) nonprofit
organization incorporated in the District of Columbia to promote and
enhance the AIDS Drug Assistance Programs and improve access to care
for persons living with HIV/AIDS. We appreciate the opportunity to
share our testimony on fiscal year 2010 appropriations.
State ADAPs are primarily federally funded under Part B of the Ryan
White Comprehensive AIDS Resources Emergency (CARE) Act. ADAPs provide
medications to treat HIV disease and prevent and treat AIDS-related
opportunistic infections to low income, uninsured and underinsured
individuals living with HIV/AIDS in the 50 States, District of
Columbia, Puerto Rico, Guam, U.S. Virgin Islands, American Samoa,
Marshall, and Northern Marianas Islands. Additional funding is directed
toward State ADAPs from other Ryan White CARE Act funds, including Part
A Eligible Metropolitan Area (EMA) funds. Many States also directly
contribute funding. ADAPs represent the ``access to treatment'' window
for the community-based continuum of HIV/AIDS healthcare so carefully
built and supported by all the parts of the Ryan White CARE Act, which
was reauthorized for 4 years by both Houses of Congress and signed into
law by President Barack Obama on October 30, 2009. The law in general
has enjoyed strong bipartisan support since it was first passed in the
1990s, and ADAPs specifically have been a Return on Investment (ROI)
model since the Federal Government began pumping money into them when
President Bill Clinton and Speaker Newt Gingrich were in office.
At the time when our testimony is being submitted to the
subcommittee for its consideration, there are 7,553 people living with
HIV/AIDS in 11 States on ADAP waiting lists--including 31 people in
Arkansas, 3,848 people in Florida, 1,221 people in Georgia, 11 people
in Idaho, 816 people in Louisiana, 21 people in Montana, 177 people in
North Carolina, 303 people in Ohio, 560 people in South Carolina, 563
people in Virginia and 2 people in Wyoming. Overall, 95.54 percent of
these people reside in the South. Additionally, it is being submitted
for the people living with HIV/AIDS who are the ``invisible'' waiting
lists because they have been kicked-off the program due to changes in
eligibility requirements--including 99 people in Arkansas, 257 people
in Ohio, and 89 people in Utah, as well as the 6,500+ people in Florida
who have been transitioned off the program.
Faced with the ``Perfect Storm'' that is being fueled by high
unemployment, record number of uninsured, State budgetary cutbacks,
high cost of medications and inadequate Federal funding, there are a
historic number of people being denied access to treatment. Without the
subcommittee's leadership and fortitude to recognize the ROI from
ADAPs, several thousand people living with HIV/AIDS will be at risk of
developing Opportunistic Infections (OIs), and thousands of others who
are HIV-negative will be at greater risk of contracting the virus
because their HIV-positive counterparts are more infectious when not
taking Highly Active Anti-Retroviral Therapy (HAART).
Each year a sophisticated pharmacoeconomic model is employed by the
ADAP Coalition--a unique coalition of AIDS advocates, community-based
organizations and representatives of research-based pharmaceutical and
biotechnology companies--referencing the data collected from ADAPs from
the previous 2 years to forecast the dollar resources that will be
needed for the coming 2 years to enable ADAPs to provide HAART
(combination antiretroviral therapy) to Americans living with HIV
disease.
Many are familiar with this process and its remarkable accuracy
over the past 12 years. The Congress and White House have provided us
with support very close to the amounts we projected in fiscal year
1996, 1997, 1998, 1999, 2000, always in amounts above the original
Administration budget requests; funding in subsequent fiscal year 2001-
05 was sustainable, but often short of the necessary amounts needed to
avert waiting lists. Between 2000 and 2008, States increased their
share of the ADAP budget by 155 percent while the Federal Government
increased its share by only 46 percent overall. The chart shows the
increase by each party each year over the previous fiscal year in
percentage points. States have basically increased--as well as
pharmaceutical rebates--while the Federal commitment has gone down!
The ongoing ADAP crisis is being fueled, by in large, because
Federal spending has been inadequate--despite small budget increases
under both President George W. Bush and President Obama since 2005. The
Federal share of ADAP funding has fallen steadily over the last several
years. In fiscal year 2003 the Federal earmark was 72 percent of the
overall ADAP budget. In fiscal year 2009, the Federal share had fallen
to 49 percent of the ADAP budget. ADAPs have long had a strong State-
Federal partnership; however despite the economic downturn many States
have increased funding in fiscal year 2010 by an additional $121
million for a total of $346.2 million. Pharmaceutical manufacturers
have also helped to alleviate fiscal challenges for ADAP by agreeing to
lower drug prices and enhance rebates, which amounted to $259 million
in saving for fiscal year 2009. Supplemental agreements will save an
additional $160 million per year starting in July 2010.\1\
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\1\ The ADAP Coalition, ADAP Need Fiscal Year 2012, January 2011.
---------------------------------------------------------------------------
ADAPs truly need an increase of $410 million in fiscal year 2012 to
maintain their programs and fill the structural deficits that have
built up over the last several years. In fiscal year 2012, the HIV/AIDS
community is asking for an increase of $131 million to continue to
serve an average of 1,312 new clients per month. The funding level of
$991 million is the authorized level in the Ryan White reauthorization
of 2009.\2\
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\2\ The ADAP Coalition, ADAP Need Fiscal Year 2012, January 2011.
---------------------------------------------------------------------------
A large gap remains for ADAPs in fiscal year 2010. Included in the
fiscal year 2011 need number was a revised estimate for the ADAP
Federal need number for fiscal year 2010 of $961 million, an increase
of $126 million over the current funding level. The fiscal year 2010
need number was revised based upon new survey data. Coupled with
estimated State funding, this funding will provide continued services
to a total of 153,875 clients in fiscal year 2010, including the
ability to enroll 15,760 new clients and eliminate waiting lists. This
includes individuals who are fully covered by ADAP and those who
receive assistance with Medicare Part D cost sharing requirements or
private insurance continuation. The fiscal year 2010 need number has
been adjusted from the previous level to account for the $20 million
already received through the fiscal year 2010 Congressional
appropriations process.\3\ This problem is only worsens moving into
fiscal year 2012.
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\3\ The ADAP Coalition, ADAP Need Fiscal Year 2010 & Fiscal Year
2011, January 2010.
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The problem of growing ADAP waiting lists is exacerbated because we
are facing an American HIV/AIDS epidemic of devastating proportion.
According to some estimates, the number of people living with HIV/AIDS
in the United States was approximately 2 million by the end of 2010.
These numbers are not due to decrease in the near future. In 2006
alone, the Centers for Disease Control and Prevention (CDC) estimated
that there have been more than 56,000 new HIV infections per year for
the last decade. If this was not severe enough, the disease is far from
color blind. Currently, the incidence rate of new HIV infection among
African American men and women is seven times that of the Caucasian
population. Furthermore, racial disparities are echoed regionally as
the epidemic has seen its most recent unfettered growth in southern
States, which often times have smaller State budgets and fewer access
points to comprehensive care.
The ADAP need is being driven by simple factors. As we all know
HAART AIDS treatments has dropped U.S. death rates from AIDS by about
75 percent starting in 1996. Whereas annual AIDS deaths use to run
about 40,000 a year, now 15,000 to 17,000, even less in areas of very
good medical care.
While dramatic improvements in lifespan and quality of life are
almost miraculous, HAART treatments must continue for ADAP patients.
Therefore patients living longer will likely require ADAP services for
medications longer. There are 200,000 to 300,000 Americans who are
unaware that they are HIV+. Extensive multi-million dollar efforts for
outreach and HIV testing are going on all over the country, and the CDC
now urges routine testing for those at risk for HIV. Funded by
churches, foundations, Minority Health Initiatives, pharmaceutical
companies and AIDS service groups, these efforts are identifying ``hard
to reach'' populations many of whom lack adequate health insurance.
These individuals, when identified, must look to ADAP to cover the
costs of their drugs. For most, access to Medicaid is limited. State
Medicaid programs typically require disease progression to full-blown
AIDS to meet the Social Security definition of disabled. U.S.
Government treatment guidelines consider progression to full-blown AIDS
to be months and years too late for optimum treatments. As we decided
in Congress to allow timely early treatment of breast and cervical
cancers in women, so too should we allow States the option to provide
early treatments for HIV through Medicaid to both men and women.
While we hope that Congress will pass the Early Treatment for HIV
Act (ETHA) to allow States the option to provide HIV care and
treatments through Medicaid early in the disease process when health
benefits are greater and costs are less, for now we are stuck with
folks who can't qualify for Medicaid looking to ADAP for basic
coverage. Increases in private sector health insurance costs forces
steady streams of HIV+ patients from private health insurance programs
to State ADAPs. This is a result of rising costs in premiums and co-
payments that become unaffordable, and in some instances by HMO-type
providers with drug benefits leaving the market for more profitable
locations. These factors together, ensure need for State ADAPs for the
coming years. The increasing rate of need will be substantial until key
provisions of the Patient Protection and Affordable Care Act (PPACA)
can provide adequate benefits to our entire senior, elderly and
disabled populations. As the profile of the American AIDS epidemic has
expanded further into communities of color, marginalized populations,
rural areas, and particularly to women of color in their child bearing
years, ADAPs feel these additional strains from groups which
traditionally may work low-paying jobs with inadequate health insurance
or no healthcare benefits.
In the past 12 months, 20 State ADAPs have instituted other cost-
containment strategies. ADAPs with other cost-containment strategies
instituted since April 1, 2009, as of February 2, 2011) include:
Arizona: Reduced formulary, Arkansas: Reduced formulary, lowered
financial eligibility to 200 percent of FPL, (disenrolled 99 clients in
September 2009), Colorado: Reduced formulary, Florida: Reduced
formulary, lower financial eligibility to 300 percent FPL, transition
clients to Welvista from 2/14-3/31/11, Georgia: Reduced formulary,
implemented medical criteria, continued participation in the
Alternative Method Demonstration Project (AMDP), Idaho: Capped
enrollment, Illinois: Reduced formulary, instituted monthly expenditure
cap, Kentucky: Reduced formulary, Louisiana: Discontinued reimbursement
of laboratory assays, North Carolina: Reduced formulary, North Dakota:
Capped enrollment, instituted annual expenditure cap, lowered financial
eligibility to 300 percent FPL, Ohio: Reduced formulary, lowered
financial eligibility to 300 percent of FPL (disenrolled 257 clients),
Puerto Rico: reduced formulary, South Carolina: Lowered financial
eligibility to 300 percent FPL, Utah: Reduced formulary, lowered
financial eligibility to 250 percent of FPL (disenrolled 89 clients),
Virginia: Reduced formulary, only distribute 30-day prescription
refills, Washington: Instituted client cost sharing, reduced formulary
(for uninsured clients only), only pay insurance premium for clients
currently on antiretrovirals, and Wyoming: Reduced formulary,
instituted client cost sharing.
As previously stated, ADAP waiting lists--as well as the
aforementioned cost-containment strategies put the lives of people
living with HIV/AIDS at risk (e.g., developing OIs), as well as put
HIV-negative people at higher risk of becoming infected (e.g., HIV-
positive people are more infectious when not properly treated with
HAART). Without congressional leadership and adequate Federal funding,
current circumstances could easily lead to a public health emergency
that will only cost the taxpayers much more.
In hindsight, it becomes easy to argue that ADAPs have historically
been underfunded. In reality however, it is the emergence of highly
active anti-retroviral therapy over the past 7 years and the successes
of these treatment options that have made dramatic changes in people's
lives; that have made access to HIV treatment and care such a dramatic
national policy concern. We now understand how HIV replicates in the
body, beginning its destructive impact on the immune system from the
moment of infection. Where in the recent past we divided people into
categories such as asymptomatic and symptomatic in order to make
treatment decisions, current treatments dictates that we no longer make
these distinctions in our approach to therapy. The latter simply
reflects a more advanced state of immune damage.
The standard of care today recommends that patients start on
antiretroviral therapy with a combination of drugs earlier in the
disease in order to preserve immune function. It also presumes the
earliest possible knowledge of HIV status and informed medical care to
decide the exact timing of treatment commencement and treatment type
selection. Improved immune function has a direct impact on those topics
you are most likely interested in today, saving and improving the
quality of lives and cost savings to the healthcare system.
By now it is really not necessary to explain the benefits of
antiretroviral treatments or even its cost effectiveness. Everyone
knows these things. In fact thousands of people are dedicated to seeing
that the ``AIDS miracles'' of the last few years available in the
United States are delivered to the rest of the world before societal
damage in excess of the plagues of the Middle Ages is inflicted upon
whole countries in the Caribbean, Africa, Asia and parts of the former
Soviet Union. In sharing the wealth of the medical knowledge and
expertise, which the United States have lead in developing we must not,
and should not forget the homeland. We must make sure that no American
with HIV is forgotten and allowed to fall through the cracks. The time
has come to end the wait for people living with HIV/AIDS.
In closing the following two hypothetical examples demonstrate the
ROI of the AIDS Drug Assistance Program:
--Charlie is a 29-year old black single father living in Gadsden
County Florida. He and his wife found out they were infected
with HIV when she died from complications of AIDS related
pneumonia the previous year. Charlie is on a waiting list to
receive AIDS drugs but between his depression and efforts to
care for his children he is unable to access the help he needs
to navigate the Patient Assistance Programs. He himself gets
sick. He enters an emergency room in Tallahassee, Florida and
is subsequently admitted for a 5-day stay. His emergency room
visit is near the average for this hospital at $2,783 (source
Florida Heath Finder.org.) The hospital stay is near the
national average of $24,000. He receives additional bills from
doctors, radiologists and therapists for $750. You can compare
this total to the cost of the AIDS drug he would need for an
entire year. Charlie is what is known as therapy naive so the
most inexpensive combination therapy drugs would be effective
in reducing the virus to undetectable levels. The annual drug
cost would be around $15,000 per year. Compare that to $33,830
in 6 days for hospitalization.
--Now consider Patricia. She has had AIDS for 20 years and the AIDS
virus she carries is resistant to all but the most expensive
AIDS drugs. She has fallen out of care and is now getting
progressively sicker. She goes to ADAP at the nearest county
health department which is 20 miles away only to be told that
she has been wait listed due to budget shortfalls. Patricia
falls ill while trying to navigate assistance programs and is
hospitalized. Her ER costs are similar to that of Charlie's but
she stays in the hospital for 20 days and then dies. Her costs
are well over $100,000 not including funeral and burial costs.
Her drugs would have cost $30,000 per year.
We urge to you fully fund the ADAP program in fiscal year 2012 with
an increase of $131 million. No one need be denied the new standard of
care for HIV disease. We have come too far as a Nation to turn our
backs on HIV/AIDS now. Please make sure that the resources are there
for every HIV-positive American to be treated regardless of their
financial resources or ability to access adequate health insurance
coverage.
______
Prepared Statement of the Ad Hoc Group for Medical Research
The Ad Hoc Group for Medical Research is a coalition of more than
300 patient and voluntary health groups, medical and scientific
societies, academic and research organizations, and industry. The Ad
Hoc Group appreciates the opportunity to submit this statement in
support of enhancing the Federal investment in biomedical, behavioral,
and population-based research supported by the National Institutes of
Health (NIH).
We are deeply grateful to the Subcommittee for its long-standing,
bipartisan leadership in support of NIH. These are difficult times for
our Nation and for people all around the globe, but the affirmation of
science is the key to a better future. To improve Americans' health and
strengthen America's innovation economy, the Ad Hoc Group for Medical
Research recommends $35 billion for NIH in fiscal year 2012.
The partnership between NIH and America's scientists, medical
schools, teaching hospitals, universities, and research institutions
continues to serve as the driving force in this Nation's search for
ever-greater understanding of the mechanisms of human health and
disease. More than 83 percent of NIH research funding is awarded to
more than 3,000 research institutions located in every State. These are
funded through almost 50,000 competitive, peer-reviewed grants and
contracts to more than 350,000 researchers.
The foundation of scientific knowledge built through NIH-funded
research drives medical innovation that improves health and quality of
life through new and better diagnostics, improved prevention
strategies, and more effective treatments. NIH research has contributed
to dramatically increased and improved life expectancy over the past
century. A baby born today can look forward to an average life span of
nearly 78 years--almost three decades longer than a baby born in 1900,
and life expectancy continues to increase. People are staying active
longer, too: the proportion of older people with chronic disabilities
dropped by nearly a third between 1982 and 2005. Thanks to insights
from NIH-funded studies, the death rate for coronary heart disease is
more than 60 percent lower--and the death rate for stroke, 70 percent
lower--than in the World War II era.
NIH research continues to create dramatic new research
opportunities, offering hope to the millions of patients awaiting the
possibility of a healthier tomorrow. For example, a new ability to
comprehend the genetic mechanisms responsible for disease already is
providing insights into diagnostics and identifying a new array of drug
targets. We are entering an era of personalized medicine, where
prevention, diagnosis, and treatment of disease can be individualized,
instead of using the standardized approach that all too often wastes
healthcare resources and potentially subjects patients to unnecessary
and ineffective medical treatments and diagnostic procedures.
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. 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 also often provides important
insights and leads to further basic research opportunities. Additional
funding is needed to sustain and enhance basic and clinical research
activities, including increasing support for current researchers and
promoting opportunities for new investigators and in those areas of
science that historically have been underfunded.
Ongoing efforts to reinvigorate research training, including
developing expanded medical research opportunities for minority and
disadvantaged students, continue to gain importance. For example, the
volume of data being generated by genomics research, 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.
To move forward, it will be essential to maintain the talent base
and infrastructure that has been created to date. Large fluctuations in
funding will be disruptive to training, to careers, long range projects
and ultimately to progress. The research engine needs a predictable,
sustained investment in science to maximize our return.
Further, NIH-supported research contributes to the Nation's
economic strength by catalyzing private sector growth and creating
skilled, high-paying jobs; new products and industries; and improved
technologies. Industries and sectors that benefit include the high-
technology and high value-added pharmaceutical and biotechnology
industries, among others. In particular, the NIH funds ``enabling
science'' that explores and identifies discoveries at a point earlier
than businesses often invest, stoking and sustaining the discovery
pipeline.
The investment in NIH not only is an essential element in restoring
and sustaining both national and local economic growth and vitality,
but also is essential to maintaining this Nation's prominence as the
world leader in medical research. As Raymond Orbach, former Under
Secretary for Science at the Department of Energy for President George
W. Bush, noted in a recent editorial in Science, ``Other countries,
such as China and India, are increasing their funding of scientific
research because they understand its critical role in spurring
technological advances and other innovations. If the United States is
to compete in the global economy, it too must continue to invest in
research programs.'' To succeed in the information-based, innovation
driven world-wide economy of the 21st century, we must recommit to
long-term sustained growth in medical research funding.
The ravages of disease are many, and the opportunities for progress
across all fields of medical science to address these needs are
profound. In this challenging budget environment, we recognize the
painful decisions Congress must make. The community appreciates that
this subcommittee always has recognized that discoveries gained through
basic research yield the medical advances that improve the fiscal and
physical health of the country. Strengthening the Nation's commitment
to medical research is the key to ensuring the future of America's
medical research enterprise and the health of her citizens.
The Ad Hoc Group for Medical Research respectfully requests that
NIH be recognized as an urgent national priority as the subcommittee
prepares the fiscal year 2012 appropriations bills.
______
Prepared Statement of the AIDS Healthcare Foundation
On behalf of the over 1 million Americans with HIV/AIDS, and the
over 56,000 Americans who will become infected with HIV this year, AIDS
Healthcare Foundation (AHF) submits the following recommendations and
proposals for funding domestic HIV/AIDS programs for fiscal year 2012.
AHF is the largest HIV/AIDS nonprofit in the United States. For
over 20 years, it has delivered high quality medical care, pharmacy
services, research, and HIV prevention and testing services throughout
the country. It currently provides medical care to over 150,000 people
with HIV/AIDS in 22 countries around the world.
Based on this experience, it is clear to AHF that the battle
against HIV/AIDS is winnable, and that the keys to winning this fight
are:
Find those Americans who have HIV, but don't know it.
It is estimated that approximately 20 percent of all Americans who
have HIV do not know they are infected. It is not surprising that this
group unwittingly is the source of up to 70 percent of all HIV
infections in the United States--if you don't know you have HIV, you
don't take steps to protect others, and you don't get treatment.
Provide AIDS drug treatment to all Americans with HIV/AIDS who need
it.
It cannot be stressed enough--treatment is prevention. AIDS
treatment is one of the most effective tools we have to prevent new
infections. The point of treatment is to reduce the amount of the HIV
virus in a person. People with HIV/AIDS who are on treatment are less
infectious, and simply are far less able to transmit the virus. AIDS
treatment is 92 percent effective in preventing new infections.
If we could find those who don't know they have HIV, and get them
treatment, new HIV infections would plummet. Not only would these
people be healthier and able to work and care for their families, but
we would save tens of billions per year in future medical costs.
Currently, there are approximately 56,000 new HIV infections in the
United States every year. As the lifetime medical cost (the majority of
which will be borne by the Federal Government via Medicare, Medicaid,
or the Ryan White CARE Act) for each HIV infection is over $600,000,
the United States accrues over $36 billion in future medical costs
every year due to new HIV infections.
Therefore, effectively battling the AIDS epidemic requires
prioritizing scarce funds into two main areas: Testing (to find those
who are unaware they have HIV) and treating (providing AIDS drugs and
medical care to the newly diagnosed, to prevent new infections).
AHF recognizes the prevailing economic and budget climate, and
understands that finding new money to pay for these necessary programs
is extremely challenging. AHF therefore makes the following
recommendations that would free up existing funding to focus more on
testing and treatment:
Re-prioritize AIDS prevention funding within the Centers for
Disease Control toward HIV testing.
Yearly new HIV infections have not declined for well over a decade.
As a result, it is time to re-think the CDC's approach to HIV
prevention. In recent times CDC has spent approximately 30 percent of
its HIV prevention budget on HIV testing. AHF recommends that, for
fiscal year 2012 and beyond, the CDC be required to spend at least 50
percent of its prevention budget on testing. The more tests the CDC
performs, the more people who are unaware of their HIV status will be
found, which is the first step in preventing new infections.
Increase funding for the AIDS Drug Assistance Program (ADAP) by
$108 million.
ADAP is a lifeline for thousands of Americans who cannot afford
AIDS treatment, which can cost well in excess of $12,000 per year.
Nationwide, ADAP serves over 165,000 people, approximately one-third of
all people on AIDS treatment in the United States.
Ensuring access to treatment is the backbone in our fight against
HIV/AIDS. Without treatment, people with AIDS become sicker. Without
treatment, new infections will increase, and every new infection
carries with over $600,000 in lifetime medical costs. For these
reasons, it is of grave concern that access to care for thousands of
Americans is now at risk.
Currently, there are over 7,800 Americans on ADAP waiting lists
across the country--7,800 people who cannot get access to these drugs
due to budgetary constraints. This list continues to grow as infections
continue, State financial support is reduced, and drug prices increase.
To reverse this trend, AHF supports the consensus of the AIDS
community that ADAP funding should be increased by $108 million for a
total of $991 million. In the absence of new money, AHF proposes
funding this increase via the following means:
Implement administrative and overhead caps within CDC, HRSA, and
NIH AIDS programs, and redirect the savings to ADAP.
In tight budgetary times, Government must become more cost
effective. Currently, Government agencies like HRSA require that
contractors spend no more than 10 percent of grants on administrative
overhead. These agencies, which are tasked with implementing ADAP and
other AIDS programs, spend a combined $2.3 billion on administration
and overhead. As a recipient of Government funds that has operated
under these requirements, AHF submits that these caps should be applied
to these agencies as well. Controlling administrative costs will free
up money that can be spent on services, not bureaucracy.
Secure additional drug price discounts/rebates from AIDS drug
manufacturers.
Drug price increases are one of the main causes of the current ADAP
crisis. Additional discounts would mean ADAPs could serve everyone who
needs it without new funding. Moreover, given the unique nature of
ADAP, these discounts would not have any significant impact on drug
company profitability, as they would not impact price calculations for
other drug programs or reduce drug company revenues.
AIDS Healthcare Foundation (AHF) supports increasing Federal
funding for ADAP. However, additional funding must go hand in hand with
changes to ADAP that protect the program from high drug prices. To
achieve this, AHF proposes that for every dollar of additional Federal
funding drug companies contribute $2 in additional rebates or price
cuts. This would effectively triple the purchasing power of each
additional ADAP dollar, and ensure the sustainability of this vital
program. Congress can implement this solution by directing the
Secretary of Health and Human Services to negotiate the drug company
contribution as a condition of receiving new money for ADAP.
Call for the National Institutes of Health to make an independent
review of prevention interventions being supported by CDC to determine
their effectiveness.
Even though the AIDS epidemic is over 25 years old, there is still
very little evidence concerning what prevention programs work, and are
cost effective. In order to better target scarce resources to the most
effective interventions, AHF recommends that $1 million of NIH's fiscal
year 2012 AIDS research budget be spent on determining which HIV
prevention methods are in fact cost-effective ways of reducing HIV
infections.
The implementation of the recommendations would forcefully re-
orient America's AIDS response in a way that would significantly reduce
new infections, save billions of dollars, and improve the health of
hundreds of thousands of Americans.
______
Prepared Statement of AIDS United
On behalf of AIDS United and our diverse partner organizations I am
pleased to submit this testimony to the Members of this Subcommittee on
the urgency of needed funding for the fiscal year 2012 domestic HIV/
AIDS portfolio. AIDS United is a national organization that seeks to
end the AIDS epidemic in the United States by combining private-sector
fundraising, philanthropy, coalition building, public policy expertise,
and advocacy--as well as a network of passionate local and State
partners--to effectively and efficiently respond to the HIV/AIDS
epidemic in the communities most impacted by it. Through its unique
Community Partnerships program, Public Policy Committee and targeted
special grant-making initiatives, AIDS United represents over 400
grassroots organizations. These organizations provide HIV prevention,
care, treatment, and support services to underserved individuals and
populations most impacted by the HIV/AIDS epidemic including
communities of color, women and people living with HIV/AIDS in the
United States as well as education and training to providers of
treatment services.
June 5, 2011 marks the 30th year since the Centers for Disease
Control and Prevention (CDC) reported the first cases of what later
became identified as HIV disease. Sadly, the HIV/AIDS epidemic in the
United States is characterized by needless mortality, inadequate access
to care, persistent levels of new infection, and stark population and
regional disparities. Although improved treatment has made it possible
for people with HIV disease to lead longer and healthier lives, these
stark realities remain.
HIV Remains a Major Public Health Danger
More than 1.2 people are living with HIV or AIDS; nearly one-half
living with HIV/AIDS are not in care.
56,300 people are estimated to have been newly infected with HIV in
the United States in 2006, the year for which the most recent data is
available--one new infection every 9\1/2\ minutes. According to the
Centers for Disease Control and Prevention (CDC) the HIV infection rate
has not fallen in 16 years.
There is neither a cure nor a vaccine for HIV and current
treatments do not work for everyone.
HIV Severely Affects African Americans, Latinos, Women and Gay Men
African Americans represent 13 percent of the United States
population but nearly 50 percent of all newly reported HIV infections.
Hispanics/Latinos represent 13 percent of the United States
population but account for 18 percent of newly reported cases of HIV.
The percentage of newly reported HIV/AIDS cases in the United
States among women tripled from 8 percent to 27 percent between 1985
and 2007. AIDS is a leading cause of death among black women aged 15-
54.
Gay, bisexual, and other men who have sex with men, especially in
communities of color, are the population most severely affected by HIV.
AIDS United Supports the Goals of the National HIV/AIDS Strategy
The Federal Government has created a first ever National HIV/AIDS
Strategy that commits to four basic goals: reducing the number of
people who become infected with HIV; increasing access to care and
optimizing health outcomes for people living with HIV; reducing HIV-
related health disparities; and achieving a more coordinated national
response to the HIV Epidemic.
AIDS United strongly supports achievement of these goals and
strongly urges the Labor, Health and Human Services, and Education
Subcommittee of the Senate Appropriations Committee to ensure that
meeting these goals is a top priority. Unfortunately given the growth
in the epidemic, meeting these goals, particularly lowering the new HIV
infection rate, will require greater funding than has been made
available. The Federal Government's commitment to HIV domestic funding
is even more important this year as we see many States lowering their
State funding contributions due to the economic realities States are
facing. AIDS United strongly urges Congress to meet this challenge
through the good work of this subcommittee and to recognize and address
the true funding needs of the programs in the HIV/AIDS portfolio.
AIDS Budget and Appropriations Coalition HIV Community Fiscal Year 2012
Request (Increases Over Fiscal Year 2010)
The HIV community has come together under the umbrella of the AIDS
Budget and Appropriations Coalition with the community funding request
for the HIV/AIDS domestic portfolio for fiscal year 2012, the
comparisons are based on fiscal year 2010 finals. We fully understand
the budgetary constraints that are impacting this time, but we feel it
is imperative to let this subcommittee know of the true needs in the
HIV community.
HIV Prevention.--According to CDC estimates contained in the
agency's 2009 HIV/AIDS Surveillance Report, since the beginning of the
epidemic there have been 1,142,714 AIDS cases reported with a total of
617,025 deaths in the United States. Based on previous CDC estimates
more than 1.2 million people are living with HIV/AIDS and that an
estimated 21 percent of people living with HIV are unaware of their HIV
status and could unknowingly transmit the virus to another person.
Prior to fiscal year 2010 funding had remained flat for more than 8
years. As a result, grants to States and local communities have
decreased significantly even as the United States seeks to increase
prevention and testing services. To begin to reach the goals of the
National HIV/AIDS Strategy the Congress must give the CDC the necessary
funding to invest in meaningful prevention. AIDS United requests an
increase of at least $57.2 million to $857.6 million in fiscal year
2012 to address the true need of $1,324.6 billion.
Education.--The National HIV/AIDS Strategy acknowledges the need to
educate all Americans about the threat of HIV and how to prevent it.
The United States must invest in programs that provide our young people
with complete, accurate, and age-appropriate sex education that helps
them reduce their risk of HIV, other STDs, and unintended pregnancy.
AIDS United supports the Administration's teen pregnancy prevention
initiative but urges Congress to find opportunities to fund true,
comprehensive sex education that promotes healthy behaviors and
relationships for all young people, including LGBT youth. Negative
health outcomes are related to lack of knowledge and we must provide
youth with the information and services they need to make responsible
decisions about their sexual health. AIDS United requests that the teen
pregnancy prevention initiative funding increase by $6.7 million to a
level of $161.4 million. AIDS United also requests an increase of $10
million, for a total of $50 million, for the Division of Adolescent and
School Health's HIV Prevention Education at the CDC. AIDS United is
pleased that the President's budget includes zero funding for failed
abstinence-only-until-marriage programs and urges the subcommittee also
to ensure that funding is not included for these ineffective programs.
Policy Rider, Syringe Exchange.--CDC estimates that approximately
13 percent of all HIV cases and 60 percent of all hepatitis C cases in
the United States are related to intravenous drug use. Eight Federal
studies and numerous scientific peer reviewed papers have conclusively
established that syringe exchange programs reduce the incidence of HIV
among people who inject drugs and their sexual partners and that
syringe exchange reduces drug abuse. Syringe exchange programs connect
people who use drugs to healthcare services including substance abuse
treatment, HIV and viral hepatitis prevention services and testing,
counseling, education, and support. AIDS United recommends that the
Subcommittee maintain the current compromise language letting local
jurisdictions make their own decision about using Federal funds to
prevent HIV and viral hepatitis through the use of proven syringe
exchange programs.
HIV/AIDS Treatment.--The Ryan White HIV/AIDS Treatment Extension
Act, administered by the Health Resources and Services Administration
(HRSA) provides services to more than 529,000 people living with and
affected by HIV throughout the United States and its territories. It is
the largest source of Federal funding solely focused on the delivery of
HIV services and has provided the framework for our national response
to the HIV epidemic. In recent years, funding for the Ryan White
Program has not kept pace with the growing epidemic leading to waiting
lists and other cost containment measures for the AIDS Drug Assistance
Program (ADAP), increasing wait times to receive medical appointments
and loss of some support services. Ryan White Programs are designed to
compliment each other. As such, all parts of the Ryan White Program
require substantial increased funding to address the true needs of the
hundreds of thousands of people living with HIV who are uninsured,
underinsured, or who lack financial resources for healthcare and
require Ryan White Program services. AIDS United recommends that the
Ryan White Program funding level be increased by $369.7 million to a
total of $2.686 billion in fiscal year 2012.
Ryan White Programs, Part A.--This Part of the Ryan White Programs
provides physician visits, laboratory services, case management, home-
based and hospice care, and substance abuse and mental health services
in the jurisdictions most affected by HIV/AIDS. These core medical and
supportive services are critical to ensuring patients have access to
and can effectively utilize life-saving therapies. AIDS United
recommends funding for Part A at $751.9 million, an increase of $73.8
million in fiscal year 2012.
Ryan White Programs, Part B (base).--This program ensures a
foundation for HIV related healthcare services in each State and
territory, including the critically important ADAP. Part B base grants
(excluding ADAP). AIDS United recommends funding for Part B base grants
at $495.0 million, an increase of $76.2 million in fiscal year 2012.
Ryan White Programs, Part B (ADAP).--The AIDS Drug Assistance
Program provides medications for treating people with HIV who cannot
access Medicaid or private health insurance. According to the 2011
National ADAP Monitoring Project, ADAP provided drugs to about 190,936
clients in fiscal year 2009, including 33,672 new clients. As of April
15, 2011, 11 State ADAPs had waiting lists of 7,885 individuals and an
additional 8 States had taken or were considering taking cost-
containment measures. According to a respected pharmacoeconomic study
that measures the funds needed to let State ADAPs provide a minimum
clinical standard formulary the actual need for increases last year was
more than $370.1 million. The community recognizes the difficult budget
environment and asks for a much lower amount. AIDS United recommends
$991 million, the authorized amount for ADAP, an increase of $131
million, in fiscal year 2012.
Ryan White Programs, Part C.--This Part awards grants to community-
based clinics and medical centers, hospitals, public health
departments, and universities in 22 States and the District of Columbia
under the Early Intervention Services program. These grants are
targeted toward new and emerging sub-populations impacted by the HIV
epidemic. Part C funds are particularly needed in rural areas where the
availability of HIV care and treatment is still relatively new. AIDS
United requests $272.2 million, the authorized amount for Part C an
increase of $65.8 million, in fiscal year 2012.
Ryan White Programs, Part D.--Part D awards grants under the
Comprehensive Family Services Program to provide comprehensive care for
HIV positive women, infants, children, and youth and 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. AIDS United
requests $83.1 million, an increase of $5.5 million, for Part D.
Ryan White Programs, Part F, the AIDS Education and Training
Centers (AETCs).--The AETCs train Ryan White program doctors, advanced
practice nurses, physicians' assistants, nurses, oral health
professionals, and pharmacists about HIV treatment, testing, viral
hepatitis and more. The AETCs also ensure that education is available
to primary healthcare providers who do not specialize in HIV but are
asked to treat the increasing numbers of HIV positive patients who
depend on them for care. AIDS United requests a total of $50 million, a
$15.2 million increase in fiscal year 2012.
Ryan White Programs, Part F, Dental Care.--Dental care is a crucial
service needed by people living with HIV disease. Oral health problems
are often an early manifestation of HIV disease. Unfortunately oral
health is often neglected by those who cannot afford, or do not have
access to, proper medical care creating missed opportunities to find
early HIV infections. AIDS United request $19 million, a $5.4 million
increase, for this program in fiscal year 2012.
Department of Health and Human Services, Minority AIDS
Initiative.--The Minority AIDS Initiative directly benefits racial and
ethnic minority communities that are the most deeply affected by HIV/
AIDS infection rates with grants to provide technical assistance,
infrastructure support and strengthen the capacity of minority
community based organizations to deliver high-quality HIV healthcare
and supportive services. Communities of color are deeply affected by
the HIV epidemic. The Minority AIDS Initiative funds needed programs
throughout HHS agencies and is included in every Part of the CARE Act.
It was authorized within the Ryan White Program for the first time in
2006. AIDS United requests a total of $610 million for the Minority
AIDS Initiative.
HIV/AIDS Research.--Research to prevent, treat and ultimately cure
HIV is vital to the domestic and global control of the disease. The
United States through the National Institute of Health (NIH) must
continue to take the lead in the research and development of new
medicines to treat current and future strains of HIV. The NIH's Office
of AIDS Research must continue its groundbreaking research in both
basic and clinical science to develop a preventative vaccine,
microbicides, and other scientific, behavioral, and structural HIV
prevention interventions. Commitment to research will ultimately help
to bring the epidemic under control decreasing the funds that must be
spent on care and treatment of HIV. AIDS United requests that the NIH
be funded at $35 billion in fiscal year 2012 and the AIDS portfolio be
funded at $3.5 billion, a $410 million increase.
The HIV epidemic is a continuing health crisis in the United
States. We must expand resources for our domestic HIV prevention,
treatment and care, and research efforts to meet the goals of the
National HIV/AIDS Strategy. On behalf of our more than 400
participating organizations, HIV positive Americans and those affected
by this disease, AIDS United urges the subcommittee help us save lives
by to fully funding the domestic response to the ongoing, tragic, HIV
epidemic in the United States.
______
Prepared Statement of the Adult Congenital Heart Association
Introduction
The Adult Congenital Heart Association (ACHA)--a national non-for-
profit organization dedicated to improving the quality of life and
extending the lives of adults with congenital heart disease (CHD)--is
grateful for the opportunity to submit written testimony regarding
fiscal year 2012 funding for congenital heart research and
surveillance. We respectfully request $3 million for CHD surveillance
at the Centers for Disease Control and Prevention (CDC) as well as
additional CHD research at the National Heart, Lung and Blood Institute
(NHLBI).
Adult Congenital Heart Disease
Congenital heart defects are the most common group of birth defects
occurring in approximately 1 percent of all live births, or 40,000
babies a year. These malformations of the heart and structures
connected to the heart either obstruct blood flow or cause it to flow
in an abnormal pattern. This abnormal heart function can be fatal if
left untreated. In fact, congenital heart defects remain the leading
cause of birth defect related infant deaths.
Many infants born with congenital heart problems require
intervention in order to survive. Intervention often includes one or
multiple open-heart surgeries; however, surgery is rarely a long-term
cure. The success of childhood cardiac intervention has created a new
chronic disease--CHD. Thanks to the increase in survival, of the nearly
2 million people alive today with CHD, more than half are adults,
increasing at an estimated rate of 5 percent each year. Few congenital
heart survivors are aware of their high risk of additional problems as
they age, facing high rates of neuro-cognitive deficits, heart failure,
rhythm disorders, stroke, and sudden cardiac death, and many survivors
require multiple operations throughout their lifetime. 50 percent of
all congenital heart survivors have complex problems for which life-
long care from congenital heart specialists is recommended, yet less
than 10 percent of adult congenital heart patients receive recommended
cardiac care. Delays in care can result in premature death and
disability. In adults, this often occurs during prime wage-earning
years.
ACHA
ACHA serves and supports the more than 1 million adults with CHD,
their families and the medical community--working with them to address
the unmet needs of the long-term survivors of congenital heart defects
through education, outreach, advocacy, and promotion of ACHD research.
In order to promote life-saving research and accessible,
appropriate and quality interventions which, in turn, will reduce the
public health burden of this chronic disease, ACHA advocates for
adequate funding of CDC initiatives relating to CHD, and encourages
funding within the National Institutes of Health (NIH) for CHD
research. ACHA continues to work with Federal and State policy makers
to advance policies that will improve and prolong the lives of those
living with CHD.
ACHA is also a founding member of the Congenital Heart Public
Health Consortium (CHPHC). The CHPHC is a group of organizations
uniting resources and efforts to prevent the occurrence of CHD and
enhance and prolong the lives of those with CHD through targeted public
health interventions by enhancing and supporting the work of the member
organizations. Representatives of Federal agencies serve in an advisory
capacity. In addition to ACHA, the Alliance for Adult Research in
Congenital Cardiology, American Academy of Pediatrics, American College
of Cardiology, American Heart Association, March of Dimes Foundation,
National Birth Defects Prevention Network, and the National Congenital
Heart Coalition are all members of the CHPHC.
Federal Support for Congenital Heart Disease Research and Surveillance
Despite the prevalence and seriousness of the disease, CHD data
collection and research are limited and almost non-existent for the
adult CHD population. In 2004, the NHLBI convened a working group on
CHD, which recommended developing a research network to conduct
clinical research and establishing a national database of patients.
In March 2010, the first CHD legislation passed as part of Patient
Protection and Affordable Care Act (ACA).\1\ The ACA calls for the
creation of The National Congenital Heart Disease Surveillance System,
which will collect and analyze nationally representative, population-
based epidemiological and longitudinal data on infants, children, and
adults with CHD to improve understanding of CHD incidence, prevalence,
and disease burden and assess the public health impact of CHD. It also
authorized the NHLBI to conduct or support research on CHD diagnosis,
treatment, prevention and long-term outcomes to address the needs of
affected infants, children, teens, adults, and elderly individuals.
These provisions included in the ACA were originally in the Congenital
Heart Futures Act (H.R. 1570/S.621, 111th Congress), which garnered bi-
partisan support in both the House and Senate and was championed by
Senators Richard Durbin (D-IL) and Thad Cochran (R-MS), Representative
Gus Bilirakis (R-FL) and former Representative Zack Space (D-OH).
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\1\ Patient Protection and Affordable Care Act, Sec. 10411(b).
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Recently, the National Center on Birth Defects and Developmental
Disabilities included preventing congenital heart defects and other
major birth defects, in its recently published 2011-2015 Strategic
Plan, specifically recognizing the need for understanding the
contribution of birth defects to longer term outcomes (i.e., beyond
infancy) and the economic impact of specific birth defects.
The National Congenital Heart Disease Surveillance System at CDC
As survival improves, so does the need for population-based
surveillance across the lifespan. Funding to support the development of
the National Congenital Heart Disease Surveillance System through both
a pilot adult surveillance program, and the enhancement of the existing
birth defects surveillance system will be instrumental in driving
research, improving interventional outcomes, improving loss to care,
and assessing healthcare burden. In turn, the National Congenital Heart
Disease Surveillance System can serve as a model for all chronic
disease states.
The current surveillance system is grossly inadequate. There are
only 14 States currently funded by the CDC to gather data on birth
defects, presenting limitations in generalizing the information across
the entire population. Thus, there are significant inconsistencies in
the methods of collection and reporting across the various State
systems which limits the value of the data. Given the absence of
population-based data across the lifespan, the data we do have excludes
anyone diagnosed after the age of one, as well as those who are lost to
care. It is this population, those lost to care, that is of greatest
concern, and most difficult to identify. Evidence indicates that those
with CHD are at significant risk for heart failure, rhythm disorders,
stroke, and sudden cardiac death as they age, requiring ongoing
specialized medical care. For those who are lost to care, for reasons
such as limited access to affordable or appropriate care or poor
education about the need for ongoing care, they often return to the
system with preventable advanced illness and/or disability. Population
based surveillance across the life span is the only method by which
these patients can be identified, and, as a result, appropriate
intervention can be planned. ACHA is currently working with the CDC to
address these concerns through the National Congenital Heart Disease
Surveillance System.
ACHA requests that Congress provide the CDC $3 million in fiscal
year 2012 to support data collection to better understand CHD
prevalence and assess the public health impact of CHD. This level of
funding will support a pilot adult surveillance system and allow for
the enhancement of the existing birth defects surveillance system.
Funding of Research Related to Congenital Heart Disease at NIH
Our Nation continues to benefit from the single largest funding
source for CHD research, the NIH. Yet, as a leading chronic disease,
congenital heart research is significantly underfunded.
The NHLBI supports basic and clinical research to establish a
scientific basis for the prevention, detection, and treatment of
congenital heart disease. The Bench to Bassinet Program is a major
effort launched by the NHLBI to hasten the pace at which heart research
on genetics and basic science can be developed into new treatments
across the life span for people with congenital heart disease. The
overall goal is to provide the structure to turn knowledge into
clinical practice, and use clinical practice to inform basic research.
ACHA urges Congress to support the NHLBI in efforts to continue its
work with patient advocacy organizations, other NIH Institutes, and the
CDC to expand collaborative research initiatives and other related
activities targeted to the diverse life-long needs of individuals
living with congenital heart disease.
Summary
Thank you for the opportunity to highlight this important disease.
We know that you face many difficult funding decisions for fiscal year
2012 and hope that you consider addressing the life-long needs of those
with CHD. By making an investment in the research and surveillance of
CHD, the return will be seen through reduced healthcare costs,
decreased disability and improved productivity in a population quickly
approaching 2 million.
______
Prepared Statement of the Alliance for Aging Research
Chairman Harkin and members of the Subcommittee, for 25 years the
not-for-profit Alliance for Aging Research has advocated for medical
research to improve the quality of life and health for all Americans as
we grow older. Our efforts have included supporting Federal funding of
aging research by the National Institutes of Health (NIH), through the
National Institute on Aging (NIA) and other NIH institutes and centers.
The Alliance appreciates the opportunity to submit testimony
highlighting the important role that the NIH plays in facilitating
aging-related medical research activities and the ever more urgent need
for increased Federal investment and focus to advance scientific
discoveries to keep individuals healthier longer.
Research toward healthier aging has never been more critical for so
many Americans. In January 2011, the first of the baby boomers began
turning age 65. Older Americans now make up the fastest growing segment
of the population. According to the U.S. Census Bureau, the number of
people age 65 and older will more than double between 2010 and 2050 to
88.5 million or 20 percent of the population; and those 85 and older
will increase three-fold, to 19 million, according to the U.S. Census
Bureau. Late-in-life diseases such as type 2 diabetes, cancer,
neurological diseases, heart disease, and osteoporosis are increasingly
driving the need for healthcare services in this country. Many diseases
of these aging are expected to become more prevalent as the number of
older Americans increases. Preventing, treating or curing chronic
diseases of the aging, is perhaps the single most effective strategy in
reducing national spending on healthcare.
Consider that the number of Americans age 65 and older with
Alzheimer's disease is projected to more than double by 2030. A report
in the Journal of Clinical Oncology projected cancer incidence will
increase by about 45 percent from 2010-2030, accounted for largely by
cancer diagnoses in older Americans and minorities, and by 2030, people
aged 65 and older will represent 70 percent of all cancer diagnoses in
the United States. Currently, the average 75-year old has three chronic
health conditions and takes five prescription medications. Six
diseases--heart disease, stroke, cancer, diabetes, Alzheimer's and
Parkinson's diseases--cost the United States over $1 trillion each
year. In the absence of new discoveries to better treat and prevent
osteoporosis, it is estimated to cost the United States $25.3 billion
per year by 2025. According to an Alzheimer's Association report from
2010, research breakthroughs that slow the onset and progression of
Alzheimer's disease could yield annual Medicare savings of $33 billion
in 2020 and as much as $283 billion by 2050.
The rising tide of chronic diseases of aging threatens to overwhelm
the U.S. healthcare system in the coming years. Research which leads to
a better understanding of the aging process and human vulnerability to
age-related diseases could be the key to helping Americans live longer,
more productive lives, and simultaneously reduce the need for care to
manage costly chronic diseases. Scientists who study aging now
generally agree that aging is malleable and capable of being slowed.
Rapid progress in recent years toward understanding and making use of
this malleability has paved the way for breakthroughs that could
increase human health in later life by opposing the primary risk factor
for virtually every disease we face as we grow older--aging itself.
Better understating of this ``common denominator'' of disease could
usher in a new era of preventive medicine, enabling interventions that
stave off everything from dementia to cancer to osteoporosis. As we now
confront unprecedented aging of our population and staggering increases
in chronic age-related diseases and disabilities, a modest extensions
of healthy lifespan could produce outsized returns of extended
productivity, reduced caregiver burdens, lessened Medicare spending,
and more effective healthcare in future years.
The NIA leads national research efforts within the NIH to better
understand the aging process and ways to better maintain the health and
independence of Americans as they age. NIA is poised to accelerate the
scientific discoveries. The science of aging is showing increasing
power to address the leading public health challenges of our time.
Leaders in the biology of aging believe it is now realistically
possible to develop interventions that slow the aging process and
greatly reduce the risk of many diseases and disabilities, including
cancer, diabetes, Alzheimer's disease, vision loss and bone and joint
disorders. While there has been great progress in aging research, a
large gap remains between promising basic research and healthcare
applications. Closing that gap will require considerable focus and
investment. Key aging processes have been identified by leading
scientists as potentially yielding crucial answers in the next 3-10
years. These include stress response at the cellular level, cell
turnover and repair mechanisms, and inflammation.
A central theme in modern aging research--perhaps its key insight--
is that the mutations, diets, and drugs that extend lifespan in
laboratory animals by slowing aging often increase the resistance of
cells, and animals, to toxic agents and other forms of stress. These
discoveries have two main implications, each of which is likely to lead
to major advances in anti-aging science in the near future.
First is the suggestion that stress resistance may itself be the
facilitator (rather than merely the companion) of the exceptional
lifespan in these animal models, hinting that studies of agents that
modulate resistance to stress could be a potent source of valuable
clinical leverage and preventive medicines. Second is the observation
that the mutations that slow aging augment resistance to multiple
varieties of stress--not just oxidation, or radiation damage, or heavy
metal toxins, but rather resistance to all of these at the same time.
The implication is that cells have ``master switches,'' which, like
rheostats that can brighten or dim all lights in a room, can tweak a
wide range of protective intracellular circuits to tune the rate of
aging differently in long-lived versus short-lived individuals and
species. If this is correct, research aimed at identifying these master
switches, and fine-tuning them in ways that slow aging without unwanted
side-effects, could be the most effective way to postpone all of the
physiological disorders of aging through manipulation of the aging rate
itself. Researchers have formulated, and are beginning to pursue, new
strategies to test these concepts by analysis of invertebrates, cells
lines, laboratory animals and humans, and by comparing animals of
species that age more quickly or slowly.
One hallmark of aging tissues is their reduced ability to
regenerate and repair. Many tissues are replenished by stem cells. In
some aged tissues, stem cell numbers drop. In others, the number of
stem cells changes very little--but they malfunction. Little is
currently known about these stem cell declines, but one suspected cause
is the accumulation of ``senescent'' cells. Cellular senescence stops
damaged or distressed cells from dividing, which protects against
cancer. At advanced ages, however, the accumulation of senescent cells
may limit regeneration and repair, a phenomenon that has raised many
questions. Do senescent cells, for instance, alter tissue
``microenvironments,'' such that the tissue loses its regenerative
powers or paradoxically fuel the lethal proliferation of cancer cells?
A robust research initiative on these issues promises to illuminate
the roots of a broad range of diseases and disabling conditions, such
as osteoporosis, the loss of lean muscle mass with age, and the age-
related degeneration of joints and spinal discs. The research is also
essential for the development of stem cell therapies, the promise of
which has generated much public excitement in recent years. This is
because implanting stem cells to renew damaged tissues in older
patients may not succeed without a better understanding of why such
cells lose vitality with age. Importantly, research in this area would
also help determine whether interventions that enhance cellular
proliferative powers would pose an unacceptable cancer risk.
Acute inflammation is necessary for protection from invading
pathogens or foreign bodies and the healing of wounds, but as we age
many of us experience chronic, low-level inflammation. Such insidious
inflammation is thought to be a major driver of fatal diseases of
aging, including cancer, heart disease, and Alzheimer's disease, as
well as of osteoporosis, loss of lean muscle mass after middle age,
anemia in the elderly, and cognitive decline after 70. Just about
everything that goes wrong with our bodies as we age appears to have an
important inflammatory component, and low-level inflammation may well
be a significant contributor to the overall aging process itself. As
the underlying mechanisms of age-related inflammation are better
understood, researchers should be able to identify interventions that
can safely curtail its deleterious effects beginning in mid-life,
broadly enhancing later-life, and with negligible risk of side effects.
While important advances have been made toward the goal of adding
healthy years to life, it cannot be achieved in a timely way without
significant financial support. In stark contrast to the rapidly rising
costs of healthcare for the aging, we as a Nation are making a
miniscule, and declining, investment in the prevention, treatment or
cure of chronic diseases of aging. Out of each dollar appropriated to
NIH only 3.6 cents goes toward supporting work of the NIA. Between
fiscal year 2003 and fiscal year 2010, NIA-funded scientists saw a
series of nominal increases and cuts that amounted to a 14.7 percent
reduction in constant dollars. The November 11, 2010 issue of Nature
notes that ``[a]lthough the funding situation is tight all around for
NIH-supported investigators, the NIA is in an exceptional predicament .
. . . As both the United States and global populations age, the
prevalence of chronic diseases such as cancer, heart disease and
diabetes will also grow, along with neurodegenerative ailments . . .
The NIA deals with age-related aspects of all of these.''
An increase in funding for aging research is urgently needed to
enable scientists to capitalize on the field's recent exciting
discoveries. Advocates for age-related diseases like Alzheimer's
disease and cancer in the past have called for congressional
appropriations of $2 billion annually in order to achieve major
breakthroughs in treating and curing those diseases. Thus, a goal of $2
billion annually in Federal funding for aging research on the basic
underpinnings of aging over the next 3 to 10 years seems modest
considering its great potential to lower overall disease risk
(including Alzheimer's, cancer, and more) and add healthy years to
life. For the NIA in particular, an increase in funding would enable
flexibility in supporting high-quality grant proposals that fall within
the 20th percentile of submitted grants. In recent years, the percent
of grant applications receiving funding by the NIA has dropped
precipitously and currently only the top 9 percent are being funded.
This means that many valuable projects are being set aside due to
budget constraints, and many talented scientists who might make major
contributions to aging research are being dissuaded from making this
their life's work.
In addition to increased resources, the field would also benefit
greatly from the creation of a trans-NIH initiative that could improve
the quality and pace of research that advances the understanding of
aging, its impact on age-related diseases, and the development of
interventions to extend human healthspan. The initiative would be most
effective if it included the representatives from the National
Institute on Aging (NIA) and the major-disease focused institutes that
have some role in aging research such as the National Institute of
Neurological Disorders and Stroke (NINDS), National Heart, Lung, and
Blood Institute (NHLBI), National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK), and the National Cancer Institute (NCI).
The field of aging research is poised to make transformational
gains in the near future. Few if any areas for investing research
dollars offer greater potential returns for public health. The Alliance
for Aging Research supports funding the NIH at $35 billion in fiscal
year 2012 with a minimum of $1.4 billion in funding for the NIA
specifically. This level of support would allow the NIH and the NIA to
adequately fund new and existing research projects, accelerating
progress toward findings which could prevent, treat, slow the
progression or even possibly cure conditions related to aging. With a
Silver Tsunami of age driven chronic ailments looming as our population
grows older, an increased emphasis on NIH's aging research activities
has never been more urgent, with potential to impact so many Americans.
The payoffs from such focused attention and investment would be
large and lasting. Therapies that delay aging would lessen our
healthcare system's dependence on the relatively inefficient strategy
of trying to redress diseases of aging one at a time, often after it is
too late for meaningful benefit. They would also address the fact that
while advances in lowering mortality from heart attack and stroke have
dramatically increased life expectancy, they have left us vulnerable to
other age-related diseases and disorders that develop in parallel, such
as Alzheimer's disease, diabetes, and frailty. Properly focused and
funded research could benefit millions of people by adding active,
healthy, and productive years to life. Furthermore, the research will
provide insights into the causes of and strategies for reducing the
periods of disability that generally occur at the end of life.
Mr. Chairman, the Alliance for Aging Research thanks you for the
opportunity to outline the challenges posed by the aging population
that lie ahead as you consider the fiscal year 2012 appropriations for
the NIH and we would be happy to furnish additional information upon
request.
______
Prepared Statement of the Alliance of Information and Referral Systems
The Alliance of Information and Referral Systems (AIRS) thanks you
for providing the opportunity to submit testimony as you consider an
fiscal year 2012 Labor-HHS, Education Appropriations bill. AIRS is the
national voice of Information and Referral/Assistance (I&R/A) services
and we provide a professional umbrella for over 1,200 I&R/A providers
in both public and private organizations. Our primary purpose for
submitting this testimony is to urge you not to cut Title IIIB funding
of the Older Americans Act (OAA) as this provides Federal funding to
the States for I&R. President Obama's proposed fiscal year 2012 budget
emphasizes an increase in funding of $48 million for Title IIIB of the
OAA.
Information and Referral brings people and services together. When
people don't know where to turn, I&R/A is there for them. Last year,
AIRS members answered more than 20 million calls for help.
Comprehensive and specialized I&R/A programs help people in every
community and operate as a critical component of the health and human
services delivery system. I&R/A organizations have databases of
programs and services and disseminate information through a variety of
channels to individuals and communities. People in search of critical
services such as, food, shelter, child care, work and job training,
mental health support often do not know where to begin. More often than
not, I&R/A organizations provide the answers.
We encourage you to support a $48 million increase in funding for
Title III of the Older Americans Act and at a very minimum, not cut
funding for I&R/A services. Thank you for your consideration.
______
Prepared Statement of Alluviam LLC
As a small business, we're writing to you today to bring to your
attention what we feel is an urgent issue regarding the National
Library of Medicine (NLM) decision to enter and unfairly compete with
private industry in the market for software for firefighters and other
emergency responders.
It has come to our attention that NLM has been funding development
of a software program (``WISER'') that they then give away at no cost
to first responders. Apparently, NLM has been funding this effort for
the last several years; in spite of the fact that there are at least 6
other companies within this market segment that provide similar
decision support tools for first responders, and have been doing so
prior to NLM entering the marketplace.
Providing government funding to a program that competes with an
established segment of private industry kills jobs, stifles innovation
and seems inherently unfair and contrary to the long term best interest
of the emergency response community and a poor use of taxpayer money.
With NLM's continued practices, there will cease to be any private
industry R&D, innovation or other commercial investment in this market
segment, effectively killing innovative technologies like ours, and the
other companies currently providing products to this market. We have
attempted to raise this issue to the attention of NLM without success,
even though OMB circular A-76 (revised), supra note 182 at A-3
articulates a ``Red Light for On-Line and Informational Government
Activity: Principle 10: The government should exercise substantial
caution in entering markets in which private-sector firms are active.''
We feel that NLM is acting far outside its charter as a library
information service. While we certainly applaud their efforts to
provide concise and useful chemical and health related information to
emergency responders and the public, it seems clear that with the
development of software that they then give away, NLM has crossed the
line of what it has been chartered to do, and is in conflict with OMB
A-76, whose basic tenets are that ``in the process of governing, the
Government should not compete with its citizens'' and that ``a
commercial activity is not a governmental function.'' These principles
provide fundamental policy direction to agencies that the Government
should not be in the business of providing commercial goods and
services in competition with private markets.
We've attempted to contact NLM directly, but their position has
been that they are fulfilling their duty of publishing Government
information. We feel that developing and distributing analytical
software, running focus groups to solicit user feedback, then promoting
the software at the same industry trade shows that we attend is not
consistent with publishing Government data. In fact, it is quite
disingenuous, as if their intent was to publish the information, they
could make the information widely available in any number of portable
document or html formats that would be accessible from a range of
devices, from laptops to smartphones, and would not put them in direct
competition with private industry.
The Government doesn't provide emergency responders free emergency
response vehicles, protective clothing, respirators, radios or chemical
detectors, and neither should the Government be competing with
established private industry companies that are already providing
decision support software to emergency responders. I'm sure that
Microsoft would take umbrage with the Department of Commerce if
Commerce decided to develop and then give away a free spreadsheet
program simply because they thought it would benefit U.S. business.
We respectfully request that you look into defunding this NLM
program and get NLM out of the business of competing with private
industry for this type of software. Since NLM started promoting their
software, we've had existing customers and potential clients wonder why
they should pay for software that NLM makes available for free.
By way of background, as part of the Homeland Security Act of 2002,
Public Law 107-296, known as the SAFETY ACT, Congress passed the Act as
a mechanism to foster and support the development of innovative and
effective anti-terrorism technology. Today, our company is one of a few
companies in the United States that has a CBRNE/IED decision support
system that has earned SAFETY ACT certification and designation as an
approved anti-terrorism technology. We've spent over 5 years, and
nearly 25,000 man hours--all at our own private expense, developing,
fielding and deploying our technology. Today our technology,
HazMasterG3 is deployed with the FBI, the Secret Service Presidential
Protective Detail, every CST/WMD team in the country, the USMC's CBIRF,
DHS, US Special Forces, and many civilian fire departments, HAZMAT
teams and bomb squads throughout the United States.
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Prepared Statement of the American Academy of Family Physicians
The American Academy of Family Physicians representing 97,600
family physicians, residents, and medical students nationwide, is
pleased to submit this statement for the record in support of our
funding priorities for inclusion in the fiscal year 2012 appropriations
bill.
The AAFP urges the Senate Appropriations Subcommittee on Labor,
Health and Human Services, and Education to make a robust fiscal year
2012 investment in our Nation's primary care physician workforce in
order to ensure that it is adequate to provide efficient, effective
healthcare delivery addressing access, quality and value.
We recognize the difficult decisions which our Nation's budgetary
pressures present and remain confident that wise Federal investment
will help to transform healthcare to achieve optimal, cost-efficient
health for everyone. Specifically, we recommend that the Committee
provide the Health Resources and Services Administration and the Agency
for Healthcare Research and Quality with the fiscal year 2012 funding
levels called for in the President's budget request.
Health Resourses and Services Administration
HRSA is the Federal agency chiefly responsible for improving access
to healthcare services for Americans who are uninsured, isolated or
medically vulnerable. HRSA's mission also calls for a skilled health
workforce, and the AAFP supports their efforts to train the necessary
primary care physician workforce. Primary care physicians will serve as
a strong foundation for a more efficient and effective healthcare
system.
The AAFP recommends that the Committee provide at least $449.5
million for all of the Health Professions Training Programs authorized
by Title VII of the Public Health Service Act and administered by the
Health Resources and Services Administration (HRSA) as requested in the
President's fiscal year 2012 budget.
Within that line, we urge you to provide at least:
--$140 million for Health Professions Primary Care Training and
Enhancement authorized under Title VII, Section 747 of the
Public Health Service Act;
--$10 million for Teaching Health Centers development grants
authorized by Title VII, Section 749A; and
--$4 million for Title VII, Section 749B Rural Physician Training
Grants.
Title VII Health Professions Training Programs
As the only medical specialty society devoted entirely to primary
care, the AAFP appreciates this Committee's commitment to a strong
primary care physician workforce. We are concerned that a failure to
provide adequate funding for the Title VII, Section 747, the Primary
Care Training and Enhancement (PCTE) program, would destabilize ongoing
efforts to increase education and training support for family
physicians, exacerbating primary care shortages and further straining
the Nation's healthcare system.
Title VII, Section 747 primary care training grants to medical
schools and residency programs have for decades helped to increase the
number of physicians who select primary care specialties and work in
underserved areas. A study published in the Annals of Family Medicine
on the impact of Title VII training programs on community health center
staffing and national health service corps participation found that
physicians who work with the underserved in CHCs and NHSC sites are
more likely to have trained in Title VII-funded programs.\1\ Title VII
primary care training grants are vital to departments of family
medicine, general internal medicine, and general pediatrics; strengthen
primary care curricula; and offer incentives for training in
underserved areas.
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\1\ Rittenhouse DR, et al. Impact of Title VII training programs on
community health center staffing and National Health Service Corps
participation. Ann Fam Med. 2008;6(5):397-405.
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In the coming years, medical services utilization is likely to rise
given the increasing and aging population as well as the insured status
of more of the populace. These demographic trends will cause primary
care physician shortages to worsen. We urge the Committee to increase
the level of Federal funding for primary care training to reinvigorate
medical education, residency programs, as well as academic and faculty
development in primary care to prepare physicians to support the
patient centered medical home.
Teaching Health Centers
The AAFP has long called for reforms to graduate medical education
programs in order to encourage the training of primary care residents
in non-hospital settings where most primary care is delivered. An
excellent first step is the innovative Teaching Health Centers program
authorized under Title VII, Section 749A to increase primary care
physician training capacity now administered by HRSA.
Federal financing of graduate medical education has led to training
which occurs mainly in hospital inpatient settings in spite of the fact
that most patient care is delivered outside of hospitals in ambulatory
settings across the Nation. The Teaching Health Center program provides
resources to any qualified community based ambulatory care setting that
operates a primary care residency program including federally Qualified
Health Centers or federally Qualified Health Centers Look Alikes, Rural
Health Clinics, Community Mental Health Centers, a Health Center
operated by the Indian Health Service, or a center receiving Title X
grants.
We were pleased that the Patient Protection and Affordable Care Act
authorized a mandatory appropriations trust fund of $230 million over 5
years to fund the operations of Teaching Health Centers. However, if
this program is to be effective, there must be funds for the planning
grants to establish newly accredited or expanded primary care residency
programs.
Rural Health Needs
Another important HRSA Title VII grant program is the Rural
Physician Training Grants program to help medical schools to recruit
students most likely to practice medicine in rural communities. This
modest program authorized by Title VII, Section 749B will help provide
rural-focused training and experience and increase the number of recent
medical school graduates who practice in underserved rural communities.
National Health Service Corps
The National Health Service Corps (NHSC) recruits and places
medical professionals in Health Professional Shortage Areas to meet the
need for healthcare in rural and medically underserved areas. The NHSC
provides scholarships or loan repayment as incentives for practitioners
to enter primary care and provide healthcare to Americans in Health
Professional Shortage Areas. By addressing medical school debt burdens,
the NHSC also helps to ensure wider access to medical education
opportunities.
The Government Accountability Office (GAO-01-1042T) described the
NHSC as ``one safety-net program that directly places primary care
physicians and other health professionals in these medically needy
areas.'' Currently most of the more than 7 million people who rely on
NHSC clinicians for their healthcare needs would not have access to
care without the NHSC.
Since its inception in 1972, the NHSC has helped place 37,000
primary care health professionals in underserved communities across the
country, many of whom remain in these areas following the completion of
their service. According to the fiscal year 2009 Health Resources and
Services Administration budget justification, over 75 percent of the
clinicians placed by the NHSC in underserved areas continued to serve
in their position for at least 1 year after the completion of their
service obligation.
Today, there are over 9,000 vacancies at NHSC approved sites across
the country with more added every day, yet funding is inadequate to
fill all of these needed slots.
The AAFP recommends that Committee provide at least the President's
requested level of $418.5 million for the National Health Service Corps
for fiscal year 2012 to include $295 million in funds made available
for NHSC operations, scholarships and loan repayments by the Affordable
Care Act.
Agency for Heatlhcare Research and Quality
The mission of the Agency for Healthcare Research and Quality
(AHRQ)--to improve the quality, safety, efficiency, and effectiveness
of healthcare for all Americans--closely mirrors the AAFP's own
mission. AHRQ is a small agency with a huge responsibility for research
to support clinical decisionmaking, reduce costs, advance patient
safety, decrease medical errors and improve healthcare quality and
access. Family physicians recognize that AHRQ has a critical role to
play in patient-centered outcomes research also known as comparative
effectiveness research.
Patient-Centered Outcomes Research
AHRQ's investment in patient-centered outcomes research will help
Americans make the informed decisions we must make to focus on paying
for quality rather than quantity. By determining what has limited
efficacy or does not work, this important research can spare patients
from tests and treatments of little value. Today, patients and their
physicians face a broad array of diagnostic and treatment options
without the scientific evidence needed to know what procedure or which
drug is most likely to succeed or how best to time a given therapy.
AHRQ is supporting research to answer those questions so that
physicians and their patients can make the choices about care that are
most likely to succeed. AHRQ also supports the essential research into
the prevention of medical errors and reducing hospital-acquired
infections.
Medical Liability Demonstrations
Solving the professional medical liability has long been one of the
AAFP's highest priorities. Although the medical liability
demonstrations announced by AHRQ in fiscal year 2010 are quite modest,
we support the effort to find alternatives to the current medical tort
system.
Primary Care Extension Program
The AAFP supports the Primary Care Extension Program to be
administered by AHRQ to provide support and assistance to primary care
providers about evidence-based therapies and techniques so that
providers can incorporate them into their practice. As AHRQ develops
more scientific evidence on best practices and effective clinical
innovations, the Primary Care Extension Program will disseminate them
to primary care practices across the Nation in much the same way as the
Federal Cooperative Extension Service provides small farms with the
most current information and guidance.
The AAFP recommends that the Committee provide at least $405
million for AHRQ in fiscal year 2012. In addition, we ask that the
Primary Care Extension program receive the authorized level of $120
million in fiscal year 2012.
______
Prepared Statement of the American Academy of Physician Assistants
On behalf of the nearly 80,000 clinically practicing physician
assistants in the United States, the American Academy of Physician
Assistants is pleased to submit comments on fiscal year 2012
appropriations for Physician Assistant (PA) educational programs that
are authorized through Title VII of the Public Health Service Act.
AAPA believes that the Title VII Health Professions Programs are
essential to placing health professionals in medically underserved
communities. According to the Health Resources and Services
Administration, an additional 301,000 healthcare practitioners are
needed to alleviate existing professional shortages. One of three
healthcare professions providing primary medical care in the United
States, the PA profession is deemed by many economists to be among the
fastest growing professions. Title VII will not only encourage greater
numbers of students to enter PA educational programs; it will also help
increase access to care for millions of Americans who live in medically
underserved areas.
As a member of the Health Professions and Nursing Education
Coalition (HPNEC), AAPA respectfully supports the coalition's request
to fund Title VII health professions education program at the
President's request of $449,454,000.
AAPA recommends that Congress continue its support to grow the PA
primary care work force. The U.S. healthcare system will require a
much-expanded primary healthcare workforce, both in the private and
public healthcare markets. For example, the National Association of
Community Health Centers' March 2009 report, Primary Care Access: An
Essential Building Block of Health Reform, predicts that in order to
reach 30 million patients by 2015, health centers will need at least an
additional 15,585 primary care providers, just over one-third of whom
are non-physician primary care professionals.
A review of PA graduates from 1990-2009 demonstrates that PAs who
have graduated from PA educational programs supported by Title VII are
67 percent more likely to be from underrepresented minority populations
and 47 percent more likely to work in a rural health clinic than
graduates of programs that were not supported by Title VII.
Additionally, a study by the UCSF Center for California Health
Workforce Studies found a strong association between physician
assistants exposed to Title VII during their PA educational preparation
and those who reported working in a federally qualified health center
or other community health center.
Title VII programs are essential to the development and training of
primary healthcare professionals and, in turn, provide increased access
to care by promoting healthcare delivery in medically underserved
communities. Title VII funding is especially important for PA programs
as it is the only Federal funding available on a competitive
application basis to these programs.
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 to maintain
funding to these important programs in fiscal year 2011 at the
President's request.
Overview of Physician Assistant Education
Physician assistant educational programs are located within schools
of medicine or health sciences, universities, teaching hospitals, and
the Armed Services. All PA educational programs are accredited by the
Accreditation Review Commission on Education for the Physician
Assistant.
The typical PA program consists of 26 months of instruction, and
the typical student has a bachelor's degree and about 4 years of prior
healthcare experience. The first phase of the program consists of
intensive classroom and laboratory study. More than 400 hours in
classroom and laboratory instruction are devoted to the basic sciences,
with over 75 hours in pharmacology, approximately 175 hours in
behavioral sciences, and nearly 580 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 to 55 weeks, to
clinical education, divided between primary care medicine--family
medicine, internal medicine, pediatrics, and obstetrics and
gynecology--and various specialties, including 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.
After graduation from an accredited PA program, physician
assistants must pass a national certifying examination developed by the
National Commission on Certification of Physician Assistants. To
maintain certification, PAs must log 100 continuing medical education
hours every 2 years, and they must take a recertification exam every 6
years.
Physician Assistant Practice
By design, PAs always practice in teams with physicians, extending
the reach of medicine and the promise of improved health to the most
remote and in-need communities in our Nation. The PA profession's
patient-centered, team-based approach reflects the changing realities
of healthcare delivery and fits well into the patient-centered medical
home model of care, as well as other integrated models of care
management.
PAs practice in various medical setting across the country and in a
recent survey conducted by the AAPA it is estimated that:
--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);
--41 percent of PAs work in urban and inner city areas;
--40 percent of PAs are in primary care;
--44 percent of PAs worked in group practices or solo physician
offices: and
--80 percent of PAs practice in outpatient settings.
Nearly 300 million patient visits were made to PAs in 2009. PAs
often provide autonomous medical care, have their own patient panels,
and are granted prescribing authority in all 50 States.
Critical Role of Title VII Public Health Service Act Programs
Title VII programs promote access to healthcare in rural and urban
underserved communities by supporting educational programs that train
health professionals in fields experiencing shortages, improve the
geographic distribution of health professionals, increase access to
care in underserved communities, and increase minority representation
in the healthcare workforce.
Title VII programs are the only Federal educational 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, nurse training, and some allied health
professions training have 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--the purpose of Title VII.
Furthermore, Title VII programs seek to recruit students who are
from underserved minority and disadvantaged populations, which is a
critical step toward reducing persistent health disparities among
certain racial and ethnic U.S. populations. Studies have found that
health professionals from disadvantaged regions of the country are
three to five times more likely to return to underserved areas to
provide care.
Title VII Support of PA Educational Programs
Federal support for Title VII is authorized through section 747 of
the Public Health Service Act. It is the only Federal funding available
to PA educational programs. This funding is specifically targeted for
primary care education and training programs and is designed to train
PAs for practice in urban or rural medically underserved areas. The
program is essential to the development and training of the Nation's
health workforce and is critical to providing continued health services
to both underserved and minority communities. It also encourages PAs to
return to these environments with the greatest need after they have
completed their training, being one of the best recruitment tools to
date.
Title VII was last reauthorized in 2010 under the Patient
Protection and Affordable Care Act. Now there is a critical need to
fund the Title VII program through the appropriations process to
increase the supply, diversity, and distribution of PAs and primary
care practitioners in medically underserved communities.
Support for educating PAs to practice in underserved communities is
particularly important given the market demand for physician
assistants. Without 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 attended school.
Title VII funding is a critical link in addressing the natural
geographic maldistribution of healthcare 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 healthcare marketplace reflect a growing reliance on
PAs as part of the healthcare 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 2006 article in the Journal of the
American Medical Association (JAMA) concluded that the Federal
Government should augment the use of physician assistants as physician
substitutes, particularly in urban Community Health Centers (CHCs)
where the proportional use of physicians is higher. The article
suggested that this could be accomplished by adequately funding Title
VII programs. Additionally, the Bureau of Labor Statistics projects
that the number of available PA jobs will increase 39 percent between
2008 and 2018.
Title VII funding has provided a crucial pipeline of trained PAs to
underserved areas. Recognizing that the PA educational programs
received significantly less funding than other programs in the cluster
on primary care medicine and dentistry, the 111th Congress established
a 15 percent set-aside for PA education within the section 747 cluster
on primary care during reauthorization of the Title VII Programs.
Recommendations on Fiscal Year 2012 Funding
The American Academy of Physician Assistants urges members of the
Appropriations Committee to consider the inter-dependency of all public
health agencies and programs when determining funding for fiscal year
2012. For instance, while it is critical, now more than ever, to fund
clinical research at the National Institutes of Health (NIH) and to
have an infrastructure at the Centers for Disease Control and
Prevention (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 results of cutting edge research at NIH to patients through
providers such as PAs who have been educated in Title VII-funded
programs. Likewise, the CDC is heavily dependent upon an adequate
supply of healthcare providers to be sure that disease outbreaks are
reported, tracked, and contained.
Thank you for the opportunity to present the American Academy of
Physician Assistants' views on fiscal year 2012 appropriations.
______
Prepared Statement of the American Academy of Sleep Medicine
Dear Chairman Harkin and Members of the Committee: The American
Academy of Sleep Medicine (AASM), an organization composed of over
9,700 sleep care professionals and the accrediting agent for over 2,200
accredited sleep care centers, is pleased to provide our views on the
HHS research budget for fiscal year 2012. As the leader in setting
standards and promoting excellence in evidence-based sleep medicine
healthcare, education, and research, we can attest to the fact that the
work of the National Institutes of Health (NIH) has proven to be vital
in allowing our members to provide effective sleep care services.
The AASM supports funding levels for the NIH that will allow the
careful continuation of the current research agenda. Savings should be
realized from speeding the research process, vigilant screening of new
research proposals, and an honest examination of spending for ongoing
research. Key criteria in reviewing ongoing research should include
both the potential patient benefit and whether a stoppage today will
result in a restart on some future tomorrow that will duplicate the
initial research and correspondingly duplicate the previously incurred
expenses.
Even in this economic climate, the value of the NIH as an incubator
for advancing scientific and healthcare knowledge has to be recognized.
Efforts need to be made to continue spending that: Enhances our ability
to identify and provide beneficial patient care services; moves
information from the white coats of the research laboratory to the
white coats at the patient's bedside; and ensures a continual pipeline
of research professionals.
Even with this realization, however, we are not blind to the
reality of the need to pare the Federal budget. We accept the fact that
the totality of NIH spending is not immune to budget cuts. The key in
looking at this budget is to take steps that do not fall into the
category of being unexamined cuts that are made without taking into
account the repercussions of these budget-based actions. While across-
the-board cuts provide a clean and arguably simple process for trimming
the budget, taking a budget axe to the NIH has the very real counter-
productive potential of stopping prominent, patient oriented research
in mid-stream and creating a gap in the research field. These
unintended consequences carry significant negative implications that
our patients and our society can ill afford.
Examples of ongoing sleep related and other research recently
funded by the NIH illustrate the difficulty of budget slashing that
fails to take into account the three above noted bullet points. The
sleep related research identified at this site (set out below) provides
clear examples of ongoing research with indisputable patient care
implications. This is the type of research that needs to be completed
and not simply restarted at some future point with duplicated expenses.
It also bears noting that the research funding on the connection
between sleep apnea treatment and cardiovascular disease resulted in 12
new jobs. These are the types of jobs that build the cadre of future
key researchers. The importance of this cannot go unnoticed. For the
future vitality of our society, we can ill afford another ``Sputnik
moment'' by failing to maintain the research pipeline and the personnel
that are essential to its maintenance and growth.
The American Academy of Sleep Medicine urges careful consideration
when addressing budget issues; the Academy is available as a resource
on how those issues are connected with care for patients with sleep
disorders. Please feel free to direct questions for the AASM to Bruce
Blehart, Director of Health Policy and Government Relations, at
[email protected].
Nirinjini Naidoo, Ph.D.
Research Assistant Professor of Medicine, University of Pennsylvania,
Philadelphia, PA
Biomarker for Sleep Loss: A Proteomic Determination
Administered by the NHLBI Division of Lung Diseases, Lung Biology and
Disease Branch
Fiscal Year 2009 Recovery Act Funding: $500,000
Additional Funding
Biomarker for Sleep Loss: A Proteomic Determination
Administered by the NHLBI Division of Lung Diseases, Lung Biology
and Disease Branch
Fiscal Year 2010 Recovery Act Funding: $500,000
Total funding: $1,000,000
Dr. Nirinjini Naidoo grew up in South Africa, where she drew daily
inspiration from her family. Her father, a classical scholar, fed the
young Dr. Naidoo's desire to read voraciously. Over time, she was drawn
to books about energetic, creative women in science like Marie Curie
and Rosalind Franklin. ``Those stories really stuck with me,'' Dr.
Naidoo said, noting that she is intensely curious and always ``wants to
know.'' The attributes suit her well as a frontier scientist in the
world of sleep research. They may be at odds with her getting sleep,
though, she admitted. ``I sometimes wake up at 3 a.m. and send myself
an e-mail about a newly hatched experiment.''
Research Focus.--Humans spend about one-third of their lives
asleep. But according to Dr. Naidoo, many of us do not appreciate that
sleep is a vital part of healthy living and that our bodies accomplish
several important tasks during that time. ``Sleep is definitely not
just an `off' state,'' Dr. Naidoo said. ``Research is telling us that
our bodies are actually very busy when we sleep--re-stocking cellular
components, consolidating memories, and strengthening connections
between nerve cells in the brain.'' Dr. Naidoo's research interest in
sleep came fairly recently. A chemist who specializes in studying the
structures and functions of proteins, she did postdoctoral research in
the area of circadian rhythms--the 24-hour cycles that tune body
systems with the light-and-dark cycle of our environment. Matching her
scientific skills to what she saw as a fascinating question, Dr. Naidoo
decided to look at the molecular features of sleep. What proteins are
talking to each other? Which genes and molecules are active . . . or
asleep themselves?
Grant Close-Up.--Dr. Naidoo's Recovery Act grant is a comprehensive
search for ``biomarkers'' of sleep loss. Biomarkers are substances that
indicate a particular state or process. They can be used to signify
health problems--high cholesterol is one, for example. Or, biomarkers
can denote a normal activity, like growth or sleep. But as useful as
they sound, accurate biomarkers can be very difficult to find. That's
because so many factors can affect how the body functions: our diet,
whether we exercise, what medicines we take, and our genetic make-up.
All these components can influence body systems independently of each
other, which makes finding telltale biomarkers challenging.
You could think of Dr. Naidoo's approach as a variant on the
childhood matching game ``same and different.'' In earlier experiments,
she and other researchers identified people who were different types of
sleepers. Some recovered quickly and fully from sleep deprivation and
could easily pass a question-and-answer knowledge test. Others, Dr.
Naidoo explained, reacted very differently and made several mistakes on
the same relatively simple test. In that earlier experiment, she and
leading sleep researcher Allan I. Pack, Ph.D., also at the University
of Pennyslvania, collected blood samples from all the study
participants. They will now use a high-tech chemical analytical tool
called mass spectrometry to search for molecules that differ between
the two different types of sleepers.
After 2 years, Dr. Naidoo plans to have a profile of sleepiness--a
snapshot of all the proteins and other molecules in blood that define
sleepy or non-sleepy. In general, biomarkers can useful non-invasive
tools for detecting illness and spotting disease risk. She hopes the
sleep biomarkers will help researchers and physicians track sleep
deprivation or the role of sleep loss in various diseases.
Economic Impact.--Dr. Naidoo used Recovery Act funds to buy several
pieces of state-of-the-art scientific equipment, such as a powerful
microscope and machines that screen blood and other fluids for their
component proteins. She is especially excited about the fact that this
funding is enabling her to bring new blood into the field of sleep
research. ``One of my new research specialists working on this
project--a recent chemistry graduate--is now applying to graduate
school to study sleep,'' said Dr. Naidoo. ``It's so important that we
get new thinking and new methods into understanding one of the most
fundamental processes in our daily lives.''
By Alison Davis, Ph.D.--Last Updated: August 10, 2010
Susan Redline, M.D., M.P.H.
Professor, Case Western Reserve University, Cleveland, Ohio
PHASE II Trial of Sleep Apnea Treatment to Reduce Cardiovascular
Morbidity
Administered by the NHLBI Division of Lung Diseases, National Center on
Sleep Disorders Research
Fiscal Year 2009 Recovery Act Funding: $2,190,865
Research Focus.--More than 12 million American adults have sleep
apnea, a disorder where breathing repeatedly pauses or becomes shallow
during sleep. The condition can double or even quadruple a person's
risk of heart disease, high blood pressure, and stroke. Despite sleep
apnea's prevalence and risks, an estimated 1 in 10 patients isn't
diagnosed or treated. One reason for the low treatment rate is that
doctors lack evidence about which sleep apnea therapies actually reduce
cardiovascular disease risk. On top of that, some patients who do get
diagnosed may not follow through with their prescribed treatment
because they think it's uncomfortable or awkward-looking.
Grant Up Close.--Supported by an NHLBI Recovery Act funded Grand
Opportunity grant, Susan Redline, M.D., M.P.H., is leading the first
large-scale study in the United States to determine whether two common
sleep apnea treatments reduce patients' risk of cardiovascular disease.
Her team is recruiting 1,400 cardiovascular clinic patients who have
moderate to severe sleep apnea and monitoring their sleep at home.
One group of patients will receive extra oxygen at night. Dr.
Redline wants to know if this simple therapy reduces the health risks
of sleep apnea by compensating for lost breaths, or raises the risks by
not increasing patients' breath rates. A second group of patients will
receive another common sleep apnea treatment, continuous positive
airway pressure (CPAP), in which a machine blows air into the throat
each night through a mask worn over the nose and mouth. Although both
CPAP and oxygen therapy are widely used, researchers haven't yet
established whether using them to treat sleep apnea reduces
cardiovascular disease risk. Dr. Redline's team will conduct
comparative effectiveness research into the two treatments. A third
group of patients will not undergo sleep apnea treatment.
All three groups will have their early signs of cardiovascular
disease treated. Together, these groups will help Dr. Redline's team
begin to determine whether treating sleep apnea can change patients'
risk of cardiovascular disease. The results of the study will also set
the stage for advanced clinical trials. Her goal is to help doctors
integrate sleep medicine into routine cardiology care and develop
evidence-based treatment guidelines, ultimately lowering deaths from
sleep apnea-related heart disease.
``A true multidisciplinary team''.--The study includes
cardiologists and sleep medicine experts from four sites across the
country. Some of them already collaborate through the NHLBI's Sleep
Heart Health Study, a multi-center population study examining the
cardiovascular effects of sleep apnea. ``My colleagues include
engineers, informaticians, physiologists, geneticists, epidemiologists
and clinicians,'' said Dr. Redline. ``I meet regularly with these
diverse and talented people to review our common or overlapping
goals.''
Economic Impact.--Thanks to Recovery Act funds, the team was able
to create 12 new jobs. They also bought new equipment, including
portable devices to measure patients' blood pressure and other
responses to sleep apnea treatments. Because the trial involves several
sites, the team developed an advanced web-based data management
platform. Researchers beyond the study can adapt it to their own needs
so they can start new studies faster and manage them more efficiently.
Broadening her Dream.--``As a child, I wanted to be a general
physician, with a shingle on my door, and simply help people feel
better,'' said Dr. Redline. She was accepted into an accelerated 6-year
medical honors program when she was just 15 years old. Then her dream
began to evolve. ``As I was exposed to academic medicine and powerful
epidemiological methods, I realized that I wanted to work on broad
issues that impact the health of the community, especially the
underserved,'' she said. Learning about how the environment can impact
people's lung health, and seeing how common but poorly understood sleep
disorders were, Dr. Redline decided that researching sleep medicine was
the way she could help improve public health.
Outside the Lab.--Dr. Redline likes to spend time reading, biking,
and kayaking.
Aiming High.--Dr. Redline wants to find a practical treatment for
sleep apnea that improves people's sleep quality and lowers their risk
of heart disease; and to uncover genes that contribute to sleep apnea,
so researchers can develop better targeted treatments.
By Stephanie Dutchen--Last Updated: August 10, 2010.
______
Prepared Statement of the American Association for Cancer Research
The American Association for Cancer Research (AACR) is the world's
oldest and largest scientific organization focused on every aspect of
high-quality, innovative cancer research. The mission of the AACR and
its more than 33,000 members is to prevent and cure cancer through
research, education, communication and collaboration. We thank the
United States Congress for its longstanding, bipartisan support for the
National Institutes of Health (NIH) and for its commitment to funding
cancer research.
The AACR urges the Senate to continue this commitment to NIH in the
coming fiscal year. To sustain the momentum generated through past
investments in biomedical research and to improve the health of all
Americans, the AACR recommends $35 billion for the NIH, including
$5.795 billion for the National Cancer Institute (NCI) in fiscal year
2012. This level of funding is needed to sustain the momentum generated
through regular appropriations and the additional funds from the
American Recovery and Reinvestment Act of 2009.
Cancer research saves lives
The Nation's historical investment in cancer research is
unquestionably having a remarkable impact. We are in a time of
unprecedented scientific opportunity: we are now able to accelerate
progress against cancer by translating a wealth of scientific
discoveries, such as the mapping of the human genome, into new
treatments and preventive strategies for cancer. We can continue to
make significant advances--but only if we continue to allocate the
required resources to do so. Reversing recent cuts and providing
stable, increased funding will greatly aid a full-scale national effort
to lessen the burden of the more than 200 diseases we collectively call
cancer.
This year marks the 40th anniversary of the enactment of the
National Cancer Act. In the four decades since President Richard M.
Nixon signed this landmark legislation: Annual cancer death rates in
the United States have declined steadily; the 5-year survival rate for
all cancers combined has improved to more than 65 percent; the 5-year
survival rate for all childhood cancers combined has increased from 30
percent in 1976 to 80 percent today; and 12 million Americans have
become cancer survivors, compared with only 3 million in 1971.
These remarkable achievements are a direct result of our national
commitment to funding cancer research, screening, and treatment
programs at the NCI, NIH, and other agencies across the Federal
Government. Yet this substantial progress will be slowed if the Federal
commitment to funding for critical cancer research priorities is not
maintained.
In the last 40 years, innumerable advances in basic science, cancer
prevention and detection, therapeutic development and clinical cancer
management have been achieved. While these advances are too numerous to
list here, the following cancer research advancements occurred in 2010
alone, as a direct result of funding by the NIH:
--12 new cancer drugs or cancer drug uses were approved by the FDA,
including the first-ever therapeutic vaccine, Provenge, which
was approved for men with metastatic prostate cancer; and
--biological knowledge of tumor genes and the tumor microenvironment
has led to the development of drugs that inhibit specific
genetic targets, which may result in new treatments for
multiple types of cancers, including melanoma and lymphoma.
The opportunities and the science currently underway promise many
more successes in improved treatment and prevention of cancer.
Currently, there are: More than 800 cancer therapies from industry in
some step of the trial process; more than 2,000 clinical trials
accepting children and young adults in progress; and more than 200
cancer prevention trials open.
Right now, we are facing a precipice with cancer. The biological
knowledge and the technological advances have positioned scientists at
an inflection point. To pull back from Federal investment is to abandon
science in a time when scientists will be able to make quantum leaps in
prevention and treatment of cancer. It is imperative that sustained
appropriations be provided to the NIH so that these opportunities and
other promising areas such as personalized medicine and cancer
prevention do not slip from our grasp.
Cancer remains a significant public health challenge
We have made significant progress against cancer in recent years,
but as long as cancer remains the leading cause of death for Americans
under age 85 and the second-leading cause of death overall, we cannot
afford to slow down. In 2011, 1.5 million new cancer cases will be
diagnosed and more than half a million American lives will be lost to
this terrible collection of diseases.
Moreover, the United States is facing what some have termed a
``cancer tsunami'' as the baby boom generation reaches age 65 this
year. More than three-quarters of all cancers are diagnosed in
individuals aged 55 and older, and the number of cancer cases is
estimated to approach 2 million new cases per year by 2025. This will
dramatically exacerbate the current problems with the healthcare system
and it will undoubtedly hit those who can least afford it--elderly,
medically underserved, and minority populations--the hardest.
Beyond the enormous toll cancer takes on the lives of affected
individuals and their loved ones, cancer places a heavy burden on the
U.S. economy, costing an estimated $228 billion in direct medical costs
and indirect costs associated with lost productivity due to illness and
premature death.
Targeted therapies as the future of cancer treatment
The future of cancer treatment lies in the ability to treat
patients based on the specific characteristics of a patient and his or
her cancer--often referred to as personalized medicine. Cancer research
is leading the way toward the realization of personalized medicine, in
no small part thanks to Federal investment in deciphering the
fundamental biology of cells, such as the Human Genome Project and,
more recently, The Cancer Genome Atlas, an NCI project that is
identifying important genetic changes involved in cancer.
The NCI is investing in efforts that will facilitate the
translation of this wealth of basic knowledge into new treatments,
including validating cancer biomarkers for prognosis, metastasis,
treatment response, and progression; accelerating the identification
and validation of potential cancer molecular targets; minimizing the
toxicities of cancer therapy; and integrating the clinical trial
infrastructure for speed and efficiency.
Accelerating progress in cancer prevention
The AACR has long been a supporter of cancer prevention research
aimed at identifying effective strategies to prevent cancer through
lifestyle changes, chemoprevention, and early detection and treatment.
Prevention is the keystone to success in the battle against cancer
because preventing the disease is far more desirable--and cost-
effective--than treating it. More than half of all cancers are related
to modifiable behavioral factors, including tobacco use, diet, physical
inactivity and sun exposure. Furthermore, many cancers can be halted in
the early stages if individuals have access to, and take advantage of,
screening tests. Vaccination--one of the most successful approaches for
preventing disease--is one of the most promising areas of ongoing
cancer prevention research.
Research on cancer prevention at the NCI focuses on three main
areas: Risk assessment, including understanding and modifying lifestyle
factors that increase cancer risk; developing medical interventions
(chemoprevention), such as drugs or vaccines, to prevent or disrupt the
carcinogenic process; and developing early detection and screening
strategies that result in the identification and removal of
precancerous lesions and early-stage cancers.
Cancer biology intersects with several areas and disciplines of
cancer prevention, pointing to opportunities for, and the importance
of, integrative, interdisciplinary efforts to advance clinical cancer
prevention through hard-won science. The breadth and excitement of
these current opportunities have never been greater.
Addressing and conquering cancer health disparities
Certain minority and underserved population groups continue to
suffer disproportionately from cancer. Conquering cancer health
disparities will contribute significantly to reducing the Nation's
overall cancer burden, and this issue has been an important focus of
both the NCI and the AACR. The NCI's investments in this area include:
studying the factors that cause cancer health disparities; working with
underserved communities to develop targeted interventions; developing
the knowledge base for integrating cancer services to the underserved;
collaborating to implement culturally appropriate information and
dissemination approaches to underserved populations; and examining the
role of health policy in eliminating cancer health disparities.
One size does not fit all in cancer treatment and prevention--
certain populations may require specialized approaches to achieve
success. We must make every effort to reduce and equalize cancer rates
across all populations. The AACR urges sustained funding for these
programs to ensure that all people benefit from cancer research and
that these disparities are eliminated.
Fighting cancer in challenging fiscal times
We are acutely aware of the difficult decisions Congress must make
as it seeks to improve the Nation's fiscal stability. However, it is
imperative that such efforts be grounded in the goal of securing the
prosperity and well-being of the American people. It is not by chance
that the United States is the world leader in cancer research and the
development of lifesaving treatments. Our preeminence is a direct
result of the steadfast determination of the American public and the
U.S. Congress to reduce the burden of this devastating disease by
supporting and investing in research through the NIH and NCI.
Consider the following:
--Biomedical research is essential to maintaining American global
competitiveness. While our Nation has been the undisputed
leader in research and innovation, other countries are catching
up. According to the Organisation for Economic Co-operation and
Development (OECD), national expenditures for research and
development as a percentage of gross domestic product (GDP)
remained static for the United States between 2001 and 2008
while growing nearly 60 percent in China and 34 percent in
South Korea. If this trend continues, we risk losing our global
preeminence in biomedical research.
--Biomedical research has a strong positive impact on State and local
economies. NIH dollars are creating and preserving high-wage,
high-tech jobs at a critical time for the U.S. economy. A
recent report issued by United for Medical Research estimated
that in fiscal year 2010, NIH awards led to the creation of
488,000 jobs across the country, producing $68 billion in new
economic activity. The NCI alone funds more than 6,500 research
grants at more than 150 cancer centers and specialized research
facilities located in 49 States. In over half the States,
grants and contracts to institutions exceed $15 million
annually.
--Biomedical research is an effective and efficient use of public
dollars. NIH funding does not stay inside the Beltway. More
than 80 percent of the dollars appropriated to the NIH are
distributed throughout the United States to research projects
that have undergone rigorous review for scientific merit. NIH
has consistently received the highest possible ranking of
``effective'' under the Office of Management and Budget's
Program Assessment Rating Tool (PART), demonstrating that its
programs set ambitious goals, achieve results, and are well-
managed and efficient.
Recent cuts to the NIH jeopardize scientific progress
The $320 million in cuts to the NIH enacted in the full-year
continuing appropriations of 2011, which included $45 million in cuts
to the NCI, will yield harmful consequences for cancer research and
cancer patients. This loss of funding will result in the following: a
10 percent reduction in the number of new grants that can be awarded
this year; a 3 percent cut to existing grants; and as much as a 5
percent cut to funding for NCI-designated cancer centers. These cuts
mean that success rates for grants could fall into the single digits,
leaving numerous meritorious grant proposals, which could be the key to
new therapies, unfunded at a time of unprecedented scientific
opportunity. Furthermore, cancer centers and research laboratories may
have to lay off workers as a result of reduced funding, which would
negatively impact local economies across the Nation. Budget cuts and
low success rates for grant proposals also discourage young scientists
from entering the field, putting the future scientific workforce at
risk.
The NIH needs stable, predictable increases in funding
Although cancer remains a costly burden in terms of its human and
economic toll, previous investments have led to an abundance of
promising research opportunities, and it is crucial that such
possibilities are not lost. We thank Congress for its past support for
the NIH and cancer research and urge Congress to continue its
longstanding, bipartisan commitment. The American people are depending
on Congress to ensure the Nation does not lose the health and economic
benefits that result from our extraordinary commitment to medical
research. The AACR looks forward to working with you to assure that our
collective commitment to ending the pain and suffering inflicted by
cancer is upheld and that researchers have the resources needed to
continue to deliver hope and tangible progress.
______
Prepared Statement of the American Association for Dental Research
Introduction
Mr. Chairman and Members of the Subcommittee, I am Jeff Ebersole,
Director of the Center for Oral Health Research at the University of
Kentucky College of Dentistry. My testimony is on behalf of the
American Association for Dental Research, where I currently serve as
President.
I thank the Subcommittee for this opportunity to testify about the
exciting advances in oral health science. With the support of this
Committee, the research funded by the National Institute of Dental and
Craniofacial Research (NIDCR) has not only returned dividends in terms
of improvements in oral health across the U.S. population, but also in
a wide array of other health issues ranging from craniofacial birth
defects to chronic orofacial pain to oral cancer. The investments we
make today will create an exciting tomorrow for the treatment and
prevention of oral health diseases and disorders.
What is the American Association for Dental Research?
The American Association for Dental Research is headquartered in
Alexandria, Virginia. It is a nonprofit organization with more than
4,000 members in the United States. Its mission is to: (1) advance
research and increase knowledge for the improvement of oral health; (2)
support and represent the oral health research community; and (3)
facilitate the dissemination and application of research findings. The
AADR is the largest Division of the International Association for
Dental Research.
Why is Oral Health Important?
Oral health is an essential component of health across the
lifespan. Poor oral health and untreated oral diseases and conditions
can have a significant impact on social development, economic
accomplishment, and the quality of life. They can affect the most basic
human needs including the ability to eat and drink, swallow, maintain
proper nutrition, smile and communicate.
Over the past 50 years, there has been a dramatic improvement in
oral health. Still oral diseases remain a major concern. Tooth decay
and gum disease represent the predominant infections facing the public,
although complete tooth loss, oral cancer, trauma to the mouth, and
congenital facial anomalies also contribute to the ongoing importance
of oral health research and care.
Employed adults in the United States lose more than 164 million
hours of work each year as a result of oral health problems and
children are estimated to lose 54 million school hours.\1\
Approximately 25 percent of adults over the age of 60 have lost all of
their natural teeth.\2\ Americans with the poorest oral health are
usually those who are economically disadvantaged, lack insurance, or
are members of racial and ethnic minorities. Moreover, as the Nation
ages oral health issues, particularly gum disease and the oral health
impact of medical treatments and medicines will continue to increase.
---------------------------------------------------------------------------
\1\ Centers for Disease Control Publication, ``Oral Health for
Adults,'' December 2006.
\2\ Ibid.
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Research Accomplishments
Salivary Diagnostics.--For many decades researchers have known that
saliva is important for more than chewing, tasting, swallowing, and as
the first step in digestion. A multitude of proteins and other
molecules in saliva also play vital roles in protecting us from
bacteria and viruses that are constantly entering through the mouth and
can cause disease.
Now, scientists are well on their way to understanding how saliva
contributes to broader health functions. In 2008, an NIDCR supported
team of biologists, chemists, engineers and computer scientists at five
research institutions across the country mapped the salivary proteome--
a ``catalogue and dictionary'' of proteins present in human saliva.
This saliva database is an important first step toward being able
to use biomarkers in saliva to diagnose or predict oral and systemic
diseases. Saliva tests based on these biomarkers offer many advantages
over blood tests that require a needle stick and can pose contamination
risks from blood-borne diseases. However, much effort is still
required. It is crucial that the research community have the resources
necessary to refine and enrich the ``dictionary'' of proteins present
in human saliva. Saliva tests could prove to be a potentially
lifesaving alternative to detect diseases where early diagnosis is
critical-- as in the case of oral cancer or heart attacks.
Oral Cancer.--Oral cancer affects approximately 38,000 Americans
each year. Oral cancer is any cancerous tissue growth located in the
mouth. The death rate associated with this cancer is especially high
due to delayed diagnosis. Only 60 percent of those with this cancer
will survive more than 5 years.
Researchers are developing a Point of Care diagnostic system (real-
time) for rapid onsite detection of saliva-based tumor markers. Early
detection of oral cancer will increase survival rates, improve the
quality of care for patients, and it will result in a significant
reduction in healthcare costs.
Resources must be available to permit researchers to complete work
on the Point of Care diagnostic systems, and to develop new therapeutic
approaches. It should also be noted that several new drug candidates
are now becoming available to treat oral cancer. It is believed that at
least one of these drugs will be ready for FDA approval in the very
near future.
Health Disparities.--Health Disparities are the persistent gaps
between the health status of minorities and non-minorities in the
United States. Predicted causes of health disparities are related to
educational, socioeconomic, and environmental characteristics of
different ethnic and racial groups, and most recently recognized in
historically underserved rural populations of the United States.
The NIDCR is one of the leading institutes at NIH supporting health
disparities research. The program at NIDCR takes a multidisciplinary
approach to solving the complex problem of health disparities by
addressing it from a holistic health prospective. The institute funded
investigations engage behavioral and social scientists, health policy
experts, economists, and basic and clinical dental and medical
researchers. NIDCR has supported new health centers which focus on
numerous populations at risk, including African Americans, Hispanic/
Latinos, Native Americans and rural communities. The centers partner
with other academic health centers, State and local health agencies,
community and migrant health centers, and institutions that serve these
targeted populations.
The physical and economic burden due to health disparities is real
and efforts must continue in order to eliminate them. I am proud to say
that dental researchers are leading this charge.
Conclusion
As you can see Mr. Chairman, much has been accomplished with the
resources provided by this committee; however, there is much yet to be
done. Science is advancing rapidly and the next generation of
technological innovation may greatly accelerate the next breakthroughs
in oral, dental and craniofacial research. Researchers have already
created prototypes for ``labs-on-a-chip,'' bioengineered tissue
replacements, and developed powerful molecular imaging tools that
provide a new window into complex biological systems about which we
continue to learn. This emerging wave of knowledge and tools will
accelerate the development of molecular-based oral healthcare. As
importantly, the NIDCR provides the resources for training the next
generation of biomedical scientists focusing or oral health issues as
well as the future academics to train the next generation of dentists
for the United States. Thus, it is vital that NIDCR have the resources
to support a diverse portfolio of research and training. The AADR
representing each of these constituencies respectfully requests a
fiscal year 2012 budget of $468 million for NIDCR.
Thank you.
______
Prepared Statement of the American Association for Geriatric Psychiatry
The American Association for Geriatric Psychiatry (AAGP)
appreciates this opportunity to comment on issues related to fiscal
year 2012 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
geriatric psychiatrists as well as other health professionals who focus
on the mental health problems faced by aging adults. 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.
A National Health Crisis: Demographic Projections and the Mental
Disorders of Aging
The aging of the baby boomer generation will result in an increase
in the proportion of persons over 65 from 12.7 percent currently to 20
percent in 2030, with the fastest growing segment of the population
consisting of age 85 and older. During the same period, the number of
older adults with major psychiatric illnesses will more than double,
from an estimated 7 million to 15 million individuals, meeting or
exceeding the number of consumers in discrete, younger age groups.
Center for Mental Health Services
It is critical that there be adequate funding for the mental health
initiatives under the jurisdiction of the Center for Mental Health
Services (CMHS) within the Substance Abuse and Mental Health Services
Administration (SAMHSA). While research is of critical importance to a
better future, today's patients must also receive appropriate treatment
for their mental health problems.
Evidence-based Mental Health Outreach and Treatment for the
Elderly
AAGP was pleased that the final budgets for the last 9 years have
included $5 million for evidence-based mental health outreach and
treatment to the elderly, the only federally funded services program
dedicated specifically to the mental healthcare of older adults. AAGP
is concerned that this program was eliminated in the President's fiscal
year 2012 budget proposal. It is critical that SAMHSA and CMHS ensure
that, as they design programs to promote prevention and recovery from
mental illness, the senior citizen cohort not be ignored. AAGP asks the
Committee to restore the funding for this critical program as well as
ensure that all of CMHS's programs assure a life-span approach by
specifically including the older adult population as a targeted
population.
Centers of Excellence for Depressive and Bipolar Disorders
PPACA also included authorization for a new national network of
centers of excellence for depressive and bipolar disorders, which will
enhance the coordination and integration of physical, mental and social
care that are critical to the identification and treatment of
depression and other mental disorders across the lifespan. The work of
these centers will help to disseminate and implement evidence-based
practices in clinical settings throughout the country. AAGP strongly
supports funding for the centers authorized by this legislation and is
disappointed that the Administration has not recommended funding them.
With respect to older adults, these centers would be able to focus on
new models of care that integrate evidenced-based depression care into
real world primary care and home care to improve the outcomes; specific
combinations of medications and talk therapy that successfully treat
depression and prevent relapse in older adults; specific clinical and
biological factors that link depression and risk of Alzheimer's disease
in some older depressed patients; and prevention of depression in older
people at risk. AAGP recommends that these centers be funded at $10
million for fiscal year 2012.
Preparing a Workforce to meet the Mental Health Needs of the Aging
Population
In 2008, the Institute of Medicine (IOM) released a study of the
readiness of the Nation's healthcare workforce to meet the needs of its
aging population. The Re-tooling for an Aging America: Building the
Health Care Workforce called for immediate investments in preparing our
healthcare system to care for older Americans and their families. AAGP
is deeply grateful to this subcommittee and its House counterpart for
providing, in the appropriations bill for fiscal year 2010, funding for
a follow-up study of the current and projected mental and behavioral
healthcare needs for aging Americans. This study, which is now
underway, will complement the 2008 IOM study in providing in-depth
consideration of the mental health needs of geriatric and ethnic
minority populations that were precluded by the broad scope of the
earlier one.
Virtually all healthcare providers need to be fully prepared to
manage the common medical and mental health problems of old age. In
addition, the number of geriatric health specialists, including mental
health providers, needs to be increased both to provide care for those
older adults with the most complex issues and to train the rest of the
workforce in the common medical and mental health problems of old age.
The small numbers of specialists in geriatric mental health, combined
with increases in life expectancy and the growing population of the
Nation's elderly, foretells a crisis in healthcare that will impact
older adults and their families nationwide.
Already, there are programs administered by the Bureau of Health
Professions in the HHS Health Resources and Services Administration
(HRSA) administers that are aimed to help to assure adequate numbers of
healthcare practitioners for the Nation's geriatric population,
especially in underserved areas. These are the only Federal programs
that seek to increase the number of faculty with geriatrics expertise
in a variety of disciplines, and the breadth of the programs has been
strengthened by provisions included in the Patient Protection and
Affordable Care Act (PPACA).
The geriatric health professions program supports these important
initiatives:
--The Geriatric Education Center (GEC) program provides
interdisciplinary training for healthcare professionals in
assessment, chronic disease syndromes, care planning, emergency
preparedness, and cultural competence unique to older
Americans. PPACA authorizes $10.8 million in supplemental
grants for the GEC Program to support training in geriatrics,
chronic care management, and long-term care for faculty in a
broad array of health professions schools, as well as direct
care workers and family caregivers. GECs receiving these grants
are required to develop and include material on depression and
other mental disorders common among older adults, medication
safety issues for older adults, and management of the
psychological and behavioral aspects of dementia in all
appropriate training courses.
--The Geriatric Training for Physicians, Dentists, and Behavioral and
Mental Health Professionals (GTPD Program) provides fellows
with exposure to older adult patients in various levels of
wellness and functioning and from a range of socioeconomic and
racial/ethnic backgrounds.
--The Geriatric Academic Career Awards (GACA) support the academic
career development of geriatric specialists in junior faculty
positions who are committed to teaching geriatrics in
professional schools. PPACA expands the disciplines eligible
for the awards. GACA recipients are required to provide
training in clinical geriatrics, including the training of
interdisciplinary teams of healthcare professionals.
--PPACA authorized a new Geriatric Career Incentive Awards Program in
Title VIII of the Public Health Service Act for grants to
foster great interest among a variety of health professionals
in entering the field of geriatrics, long-term care, and
chronic care management. This program was authorized for $10
million over 3 years.
--A new program, authorized by PPACA at $10 million for 3 years, will
provide advanced training opportunities for direct care workers
in the field of geriatrics, long term-care or chronic care
management.
AAGP strongly supports increased funding for the existing programs,
particularly as the disciplines included have been expanded, and
funding to fully authorized levels for the new programs.
National Institutes of Health (NIH) and National Institute of Mental
Health (NIMH)
With the graying of the population, mental disorders of aging
represent a growing crisis that will require a greater investment in
research to understand age-related brain disorders and to develop new
approaches to prevention and treatment. Even in the years in which
funding was increased for NIH and the NIMH, these increases did not
always translate into comparable increases in funding that specifically
address problems of older adults. For instance, according to figures
provided by NIMH, NIMH total aging research amounts decreased from
$106,090,000 in 2002 to $85,164,000 in 2006 (dollars in thousands:
$106,090 in 2002, $100,055 in 2003, $97,418 in 2004, $91,686 in 2005,
$85,164 in 2006).
The critical disparity between federally funded research on mental
health and aging and the projected mental health needs of older adults
is continuing. If the mental health research budget for older adults is
not substantially increased immediately, progress to reduce mental
illness among the growing elderly population will be severely
compromised. While many different types of mental and behavioral
disorders occur in late life, they are not an inevitable part of the
aging process, and continued and expanded research holds the promise of
improving the mental health and quality of life for older Americans.
This trend must be immediately reversed to ensure that our next
generation of elders is able to access effective treatment for mental
illness. Federal funding of research must be broad-based and should
include basic, translational, clinical, and health services research on
mental disorders in late life.
AAGP believes that it is critical that NIH begin to invest
increased funding in future evidence-based treatments for our Nation's
elders. Annual increases of funds targeted for geriatric mental health
research at NIH should be used to: (1) identify the causes of age-
related brain and mental disorders to prevent mental disorders before
they devastate lives; (2) speed the search for effective treatments and
efficient methods of treatment delivery; and (3) improve the quality of
life for older adults with mental disorders.
Participation of Older Adults in Clinical Trials
Federal approval for most new drugs is based on research
demonstrating safety and efficacy in young and middle-aged adults.
These studies typically exclude people who are old, who have more than
one health problem, or who take multiple medications. As the population
ages, that is the very profile of many people who seek treatment. Thus,
there is little available scientific information on the safety of drugs
approved by the Food and Drug Administration (FDA) in substantial
numbers of older adults who are likely to take those drugs. Pivotal
regulatory trials never address the special efficacy and safety
concerns that arise specifically in the care of the Nation's mentally
ill elderly. This is a critical public health obligation of the
Nation's health agencies. Just as the FDA has begun to require
inclusion of children in appropriate studies, the agency should work
closely with the geriatric research community, healthcare consumers,
pharmaceutical manufacturers, and other stakeholders to develop
innovative, fair mechanisms to encourage the inclusion of older adults
in clinical trials. Clinical research must also include elders from
diverse ethnic and cultural groups. In addition, AAGP urges that
Federal funds be made available each year for support of clinical
trials involving older adults.
Study on NIH Funding for Mental Disorders among Older
Adults
As little emphasis has been placed on the development of new
treatments for geriatric mental disorders, AAGP encourages NIH to
promote the development of new medications specifically targeted at
brain-based mental disorders of the elderly. AAGP urges this Committee
to request a GAO study on spending by NIH on conditions and illnesses
related to the mental health of older individuals. NIH is already
working to enhance cooperative activities among NIH Institutes and
Centers that support research on the nervous system. A GAO study of the
work being done by these institutes in areas that predominately involve
older adults could provide crucial insights into possible new areas of
cooperative research, which in turn will lead to advances in prevention
and treatment for these devastating illnesses.
Conclusion
AAGP recommends:
--Increased funding for the geriatric health professions education
programs under Title VII of the Public Health Service Act and
full funding for new programs authorized by the PPACA;
--Funding to support clinical trials involving older adults;
--A GAO study on spending by NIH on conditions and illnesses related
to the mental health of older individuals;
--$5 million in funding to continue evidence-based geriatric mental
health outreach and treatment programs at CMHS;
--$10 million in funding for Centers of Excellence for Depressive and
Bipolar Disorders.
______
Prepared Statement of the American Association of Colleges of Nursing
The American Association of Colleges of Nursing (AACN) respectfully
submits this testimony highlighting funding priorities for nursing
education and research programs in fiscal year 2012. AACN represents
667 schools of nursing with baccalaureate and graduate nursing programs
that educate over 337,000 students and employ more than 15,000 full-
time faculty members. These institutions educate approximately half of
our Nation's Registered Nurses (RNs) and all of the Advanced Practice
Registered Nurses (APRNs), nurse faculty, and researchers.
The programs outlined in this testimony play an integral role in
continuing to shape, advance, and promote a professional nursing
workforce to meet the needs of America's patients. An emphasis on two
key components of the profession--education and research--will be
necessary to sustain and enhance the quality of nursing care in the
United States. The release of the landmark Institute of Medicine's
(IOM) report, The Future of Nursing: Leading Change, Advancing Health,
outlines specific priorities for the profession and identifies expanded
Federal support to meet the goals of preparing a more highly educated
nursing workforce, removing barriers so all nurses can practice to the
full scope of their education, and enabling nurses to serve as equal
partners in the redesign of the healthcare system.
The ongoing reform of our healthcare system will continue to
increase access to care, requiring a surge in the number of nurses and
other health professionals. RNs and APRNs will be in high demand given
the needs of an aging population, the increased complexity of care, and
significant growth in the number of patients with chronic diseases.
More specifically, the U.S. Bureau of Labor Statistics projects a
demand on our delivery system that will necessitate the creation of
581,000 new positions by 2018, a 22 percent increase in the nursing
workforce. Without increased attention to the challenges facing nursing
education, schools of nursing will be unable to meet this demand,
further jeopardizing access to quality care.
The current supply and demand of nurses demonstrates two distinct
challenges. First, due to the present and looming need for healthcare
by American consumers, the supply of nurses is not growing at a pace
that will adequately meet long-term projections, including the demand
for primary care provided by APRNs. This issue is further compounded by
the number of nurses who will retire or leave the profession in the
near future, ultimately reducing the nursing workforce. Currently, over
1 million of the total 2.6 million practicing nurses are over the age
of 50. More striking yet, over 275,000 RNs are over the age of 60
according to the 2008 National Sample Survey of Registered Nurses.
Second, the supply of nurses nationwide is stretched thin due, in
large part, to capacity barriers in schools of nursing. According to
AACN, 67,563 qualified applications were turned away from baccalaureate
and graduate nursing programs in 2010, primarily due to budget
constraints which impact the insufficient number of faculty, clinical
sites, classroom space, and clinical preceptors. As the ability of most
States to support the needs of higher education has decreased, Federal
support for nursing education has become even more critical. National
reform goals cannot be met without an adequate number of nurses to
provide the cost-effective and quality care associated with the nursing
discipline.
nursing workforce development programs: a proven solution
For nearly 50 years, the Title VIII Nursing Workforce Development
Programs (42 U.S.C. 296 et seq.) have supported hundreds of thousands
of nurses and nursing students. Between fiscal year 2006 and 2009, the
Title VIII programs supported over 347,000 nurses and nursing students
as well as numerous academic nursing institutions and healthcare
facilities. As the largest source of dedicated funding for nursing, the
Title VIII programs award grants to nursing education programs, as well
as provide direct support through loans, scholarships, traineeships,
and programmatic grants. The programs also favor institutions that
educate nurses for practice in rural and medically underserved
communities and help to develop a more diverse nursing workforce to
meet the cultural healthcare needs of our Nation's population.
Additionally, programs funded through Title VIII contribute to the
promotion of academic progression, a major goal highlighted in the
IOM's Future of Nursing report.
Of specific interest to AACN, the Title VIII programs support
future nurse faculty, a significant barrier to addressing the nursing
care needs in the United States. The nurse faculty shortage has grown
critical as the national vacancy rate is 6.9 percent for schools
offering baccalaureate and graduate nursing programs according to an
AACN Survey on Vacant Faculty Positions for Academic Year 2010-2011. Of
those schools reporting vacancies, the number of positions left
unfilled was 803. Regionally, schools of nursing are struggling to
recruit and hire faculty. Compared to the North Atlantic (9.2 percent),
Southern (9.5 percent), and Mid-Western (9.2 percent) regions of the
country, the West Coast (11.7 percent) has the highest faculty vacancy
rate.
Title VIII Effectiveness
The Nursing Workforce Development Programs are effective and meet
their authorized mission. AACN's 2010-2011 Title VIII Student Recipient
Survey included responses from 1,459 students who noted that these
programs played a critical role in funding their nursing education,
which will ultimately help them to achieve future career goals. The
students responding to the Title VIII survey have career aspirations
that meet the direct needs of the healthcare system and the profession.
Nearly one-third (32.8 percent) of the respondents reported that their
career goal is to become a nurse practitioner. Given the demand for
primary care providers, the Title VIII funds are helping to support the
next generation of these essential practitioners. Moreover, the nurse
faculty shortage continues to inhibit the ability of nursing schools to
increase student capacity. Of the students who responded to the survey,
an additional 33.2 percent stated their ultimate career goal was to
become nurse faculty. Providing support for Title VIII is the key to
help schools expand student capacity, fill vacant nursing positions,
and, in turn, improve healthcare quality.
Demand for Title VIII
While millions of Americans are struggling during this economic
downturn and thousands of students need loans to finance their
education, Federal support is necessary. Nursing students depend on
Federal loans like Title VIII to pay for their education. AACN's Title
VIII Student Recipient Survey also indicated that 73 percent of the
undergraduate and 62.6 percent of the master's students responding to
the question regarding funding for nursing education noted that they
will pay for their education through Federal loans. The average loan
amount that students reported they would take (private/Federal) to
support their education was $19,336 for undergraduate students and
$55,698 for master's students. These students also noted that the total
amount they will pay for their education is $32,307 for undergraduates
and $64,734 for master's. Given this information, it is interesting to
note that 65.6 percent of the students reported that the amount of
support they received from Title VIII was $3,000 or less in one fiscal
year.
Over the last 47 years, Congress has used the Title VIII
authorities as a mechanism to address past nursing shortages. When the
need for nurses was great, such as in the 1970s, appropriations were
higher. Congress provided $160.61 million to the Title VIII programs in
1973. Adjusting for inflation, $160.61 million in 1973 dollars would be
equivalent to $841.371 million in 2011 dollars. The fiscal year 2011
investment of $242.387 million represents a 70 percent reduction in
buying power for the Title VIII programs, at a time when our Nation
faces historic demands on our nursing workforce.
AACN respectfully requests $313.075 million for the Nursing
Workforce Development Programs authorized under Title VIII of the
Public Health Service Act in fiscal year 2012 as recommended in the
President's budget proposal.
nursing research: supporting health promotion and disease prevention
The National Institute of Nursing Research (NINR) is one of the 27
Institutes and Centers at the National Institutes of Health (NIH). As
the Nation's nucleus for nursing science, NINR funds research that
establishes the scientific basis for health promotion, disease
prevention, and high quality nursing care to individuals, families, and
populations. Often working collaboratively with physicians and other
researchers, nurse scientists are vital in setting the national
research agenda. NINR focuses on four strategic areas which include
promoting health and preventing disease, eliminating health
disparities, improving quality of life, and setting directions for end-
of-life research.
NINR's fiscal year 2011 funding level of $144.381 million is
approximately 0.47 percent of the overall $30 billion NIH budget.
Spending for nursing research is a modest amount relative to the
allocations for other health science institutes and for major disease
category funding. For NINR to adequately continue and further its
mission, the institute must receive additional funding. Cuts in funding
have impeded the institute from supporting larger comprehensive studies
needed to advance nursing science and improve the quality of patient
care. With increased appropriations for NINR, more comprehensive,
complex, and longitudinal studies could be funded in the critical areas
of their mission while maintaining their portfolio of current goals,
projects, and priorities of the institute.
Additionally, considering that NINR presently allocates 6 percent
of its budget to training that helps develop the pool of nurse
researchers, increased funding would support NINR's efforts to prepare
faculty researchers desperately needed to educate new nurses. AACN
respectfully requests $163 million for the National Institute of
Nursing Research in fiscal year 2012.
nurse-led practice models: investing in nurse-managed health clinics
The Affordable Care Act amended Sec. 330 of the Public Health
Service Act, allowing Nurse- Managed Health Clinics (NMHCs) to apply
for grant funds to help cover the costs of operating these unique
community-based settings. NMHCs are nurse-practice arrangements and are
managed by APRNs who provide primary care or wellness services to
underserved or vulnerable populations through clinics located in places
like public housing, churches, Native American reservations, rural
communities, senior citizen centers, elementary schools, and
storefronts. Each of these clinics is associated with a school,
college, university or department of nursing, federally qualified
health center, or independent nonprofit health or social services
agency, and serves as safety net of providers for vulnerable
populations. Moreover, NMHCs play a valuable role as teaching and
practice sites for nursing students. AACN respectfully requests $20
million for the Nurse-Managed Health Clinics authorized under Title III
of the Public Health Service Act in fiscal year 2012 as recommended in
the President's budget proposal.
capacity grants: solutions to grow enrollment
According to AACN's latest enrollment and graduation survey, the
major barriers to increasing student capacity in nursing schools are
insufficient numbers of faculty, admission seats, clinical sites,
classroom space, and clinical preceptors, as well as budget
constraints. The Capacity for Nursing Students and Faculty Program, a
section of the Higher Education Opportunity Act of 2008, offers
capitation grants (formula grants based on the number of students
enrolled/or matriculated) to nursing schools allowing them to increase
the number of students. Schools of nursing continue to face budget cuts
at the State level, and capacity grants are a proven method for meeting
the needs of nursing education. AACN respectfully requests $25 million
for this program in fiscal year 2012.
conclusion
AACN acknowledges the fiscal challenges facing this Subcommittee
and Congress, but would be remiss in not highlighting the benefits of
these programs. Title VIII has a long and successful record of
providing dedicated support for the nursing workforce. The National
Institute of Nursing Research invests in developing the scientific
basis for quality nursing care. Nurse-Managed Health Clinics provide
services to the underserved and training and practice settings for
nursing students. The Capacity for Nursing Students and Faculty Program
would allow schools to increase student capacity.
To be effective in meeting the critical goals outlined in the IOM's
report, The Future of Nursing: Leading Change, Advancing Health, and
the larger health reform goals of the Nation, these programs must
receive additional funding. AACN respectfully requests $313.075 million
for Title VIII programs, $163 million for NINR, $20 million for Nurse-
Managed Health Clinics, and $25 million for the Capacity for Nursing
Students and Faculty Program in fiscal year 2012. Additional funding
for these programs will assist schools of nursing to expand their
educational and research programs, educate more nurse faculty, increase
the number of practicing RNs, and ultimately improve the patient care
provided in our healthcare system.
______
Prepared Statement of the American Association of Colleges of
Osteopathic Medicine
On behalf of the American Association of Colleges of Osteopathic
Medicine (AACOM), I am pleased to submit this testimony in support of
increased funding in fiscal year 2012 for programs at the Health
Resources Services Administration (HRSA), the National Institutes of
Health (NIH), and the Agency for Healthcare Research and Quality
(AHRQ). AACOM represents the administrations, faculty, and students of
the Nation's 26 colleges of osteopathic medicine at 34 locations in 26
States. Today, more than 19,000 students are enrolled in osteopathic
medical schools. Nearly one in five U.S. medical students is training
to be an osteopathic physician.
Title VII
The health professions education programs, authorized under Title
VII of the Public Health Service Act and administered through HRSA,
support the training and education of health practitioners to enhance
the supply, diversity, and distribution of the healthcare workforce,
acting as an essential part of the healthcare safety net and filling
the gaps in the supply of health professionals not met by traditional
market forces. Title VII and Title VIII nurse education programs are
the only Federal programs designed to train clinicians in
interdisciplinary settings to meet the needs of special and underserved
populations, as well as increase minority representation in the
healthcare workforce.
According to HRSA, an additional 33,000 health practitioners are
needed to alleviate existing health professional shortages. Combined
with faculty shortages across health professions disciplines, racial
and ethnic disparities in healthcare, a growing, aging population and
the anticipated demand for access to care, these needs strain an
already fragile healthcare system. While AACOM appreciates the
investments that have been made in these programs, we recommend
increasing funding to $449.4 million, the same funding level requested
by the President, in fiscal year 2012 for the Title VII programs.
Investment in these programs, including the Primary Care Training and
Enhancement Program, the Health Careers Opportunity Program, and the
Centers of Excellence, is necessary to address the primary care
workforce shortage. Strengthening the workforce has been recognized as
a national priority, and the investment in these programs recommended
by AACOM will help meet the demand for a well-trained, diverse
workforce that this country will witness as a result of healthcare
reform.
Teaching Health Centers
The Teaching Health Center Graduate Medical Education Program
(THCGME) is the first of its kind to shift graduate medical education
(GME) training to community-based care settings that emphasize primary
care and prevention. It is uniquely positioned to provide much needed
primary care training in underserved populations. However, because the
program is the first of its kind, most community-based settings do not
have existing infrastructure to provide this training. AACOM strongly
supports the President's budget request of $10 million to fund the THC
Development Grants. This funding would allow potential THC training
sites to develop the infrastructure needed to administer residency
training programs.
National Health Service Corps
Approximately 50 million Americans live in communities with a
shortage of health professionals, lacking adequate access to primary
care. Through scholarships and loan repayment, the National Health
Service Corps (NHSC) supports the recruitment and retention of primary
care clinicians to practice in underserved communities. At the close of
fiscal year 2010, the NHSC provided a network of 7,500 primary
healthcare professionals in 10,000 sites in underserved communities.
However, this still fell approximately 20,000 practitioners short of
fulfilling the need for primary care, dental and mental health
practitioners in Health Professional Shortage Areas (HPSAs). Growth in
HRSA's Community Health Center Program must be complemented with
increases in the recruitment and retention of primary care clinicians
to ensure adequate staffing, which the NHSC provides. AACOM supports
the President's budget request of $418 million for this program. This
includes $295 million from the Affordable Care Act (ACA) fund for the
NHSC and $24.695 million in appropriated dollars for field placements
and $98.7 million in appropriated dollars for recruitment.
National Institutes of Health
Research funded by the NIH leads to important medical discoveries
regarding the causes, treatments, and cures for common and rare
diseases, as well as disease prevention. These efforts improve our
Nation's health and save lives. To maintain a robust research agenda,
further investment will be needed. AACOM recommends $32 billion in
fiscal year 2012 for the NIH. While the need is significantly greater,
approximately $35.0 billion, anything less than the President's request
will result in a reduction in real dollars dedicated to research.
With today's increasingly demanding and evolving medical
curriculum, there is a critical need for more research geared toward
evidence-based osteopathic medicine. AACOM believes that it is vitally
important to maintain and increase funding for biomedical and clinical
research in a variety of areas related to osteopathic principles and
practice, including osteopathic manipulative medicine and comparative
effectiveness. In this regard, AACOM supports the President's budget
request of $131.002 million for NIH's National Center for Complementary
and Alternative Medicine to continue fulfilling this essential research
role.
Agency for Healthcare Research and Quality
AHRQ supports research to improve healthcare quality, reduce costs,
advance patient safety, decrease medical errors, and broaden access to
essential services. AHRQ plays an important role in producing the
evidence base needed to improve our Nation's health and healthcare. The
incremental increases for AHRQ's Patient Centered Health Research
Program in recent years, as well as the funding provided to AHRQ in the
ARRA, will help AHRQ generate more of this research and expand the
infrastructure needed to increase capacity to produce this evidence.
More investment is needed, however, to fulfill AHRQ's mission and
broader research agenda, especially research in patient safety and
prevention and care management research. AACOM recommends $405 million
in fiscal year 2012 for AHRQ. This investment will preserve AHRQ's
current programs while helping to restore its critical healthcare
safety, quality, and efficiency initiatives.
AACOM is grateful for the opportunity to submit its views and looks
forward to continuing to work with the Subcommittee on these important
matters.
______
Prepared Statement of the American Association of Colleges of Pharmacy
AACP and its member colleges and schools of pharmacy appreciate the
continued support of the U.S. House of Representatives Appropriations
Subcommittee on Labor, Health and Human Services, and Education. Our
Nation's 124 accredited colleges and schools of pharmacy are engaged in
a wide-range of programs supported by grants and funding administered
through the agencies of the Department of Health and Human Services
(HHS) and the Department of Education. We also understand the difficult
task you face annually in your deliberations to do the most good for
the Nation and remain fiscally responsible to the same. AACP
respectfully offers the following recommendations for your
consideration as you undertake your deliberations.
u.s. department of health and human services supported programs at
colleges and schools of pharmacy
Agency for Healthcare Research and Quality (AHRQ)
AACP supports the Friends of AHRQ recommendation of $405 million
for AHRQ programs in fiscal year 2012.
Pharmacy faculty are strong partners with the Agency for Healthcare
Research and Quality (AHRQ).
--Vincent J. Willey, Associate Professor at the University of the
Sciences in Philadelphia, was appointed to the Comparative
Effectiveness Research Pharmacy Workgroup.
--AHRQ Effective Healthcare programs including the Center for
Education and Research on Therapeutics (CERTs) and the
Developing Evidence to Inform Decisions about Effectiveness (
DEcIDE) support pharmacy faculty researchers focused on
improving the effectiveness of healthcare services.
--Researcher faculty at The University of Arizona College of
Pharmacy's Center for Health Outcomes and PharmacoEconomic
Research, support the Arizona CERT and its mission to improve
therapeutic outcomes and reduce adverse events caused by drug
interactions and drugs that prolong the QT interval, especially
those affecting women. Researchers determined that certain drug
combinations increased the risk of death. Published research
from this CERT includes the 2010 Women's Health Research:
Progress, Pitfalls and Promise, for the Institute of Medicine
and a comparison study on the U.S. Department of Veterans
Affairs drug-drug interactions compared to two standard
compendia. #U18 HS17001
--Almut G. Winterstein, University of Florida, has received a 2-year
$482,000 award from the Agency for Healthcare Research and
Quality for ``Comparative Safety and Effectiveness of
Stimulants in Medicaid Youth with ADHD.'' #5R01HS018506-02
--Sean D. Sullivan, University of Washington, received a $2.45
million grant from AHRQ to implement the multidisciplinary
Mentored Clinical Scientist Comparative Effectiveness Research
Career Development (K12) Program in collaboration with research
partners at Group Health Research Institute, the Fred
Hutchinson Cancer Research Center, and the Veterans'
Administration Health Services Research and Development Center
of Excellence. #1K12HS019482-01
--Daniel C. Malone, University of Arizona, received a 3-year grant
from AHRQ for $1.25 million, to evaluate awareness of CER
guides by pharmacists and physicians and identify critical
skills needed to use these reviews to support and encourage
safe and effective prescribing of medications. #1R18HS019220-01
Centers for Disease Control and Prevention (CDC)
AACP supports the CDC Coalition recommendation of $7.7 billion for
CDC core programs in fiscal year 2012 and the Friends of NCHS
recommendation of $162 million for the National Center for Health
Statistics.
The educational outcomes of a pharmacist's education include those
related to public health. When in community-based positions,
pharmacists are frequently providers of first contact. The opportunity
to identify potential public health threats through regular interaction
with patients provides public health agencies such as the CDC with on-
the-ground epidemiologists. Pharmacy faculty are engaged in CDC-
supported research in areas such as immunization delivery, integration
of pharmacogenetics in the pharmacy curriculum and inclusion of
pharmacists in emergency preparedness. Information from the National
Center for Health Statistics (NCHS) is essential for faculty engaged in
health services research and for the professional education of the
pharmacist.
--Katie J. Suda, faculty member at the University of Tennessee, was
supported by CDC funding to conduct a national analysis of
outpatient anti-infective prescribing patterns. She also
prepared a continuing education program in partnership with the
CDC entitled, ``Weighing in on Antibiotic Resistance: Community
Pharmacists Tip the Scale,'' featured on the CDC Web site:
http://www.cdc.gov/getsmart/specific-groups/hcp/ce-course.html.
The program details the CDC's Get Smart program, focused on
decreasing the amount of unnecessary antibiotics in the
community.
--Grace Kuo, Associate Professor of Clinical Pharmacy at the
University of California San Diego, founded
PharmGenEdTM, an evidence-based pharmacogenomics
education program designed for pharmacists and physicians,
pharmacy and medical students, and other healthcare
professionals and is supported by funding from CDC.
#IU38GD000070
Health Resources and Services Administration (HRSA)
AACP supports the Friends of HRSA recommendation of $7.65 billion
for fiscal year 2012.
HRSA is a Federal agency with a wide-range of policy and service
components. Faculty at colleges and schools of pharmacy are integral to
the success of many of these. Colleges and schools of pharmacy are the
administrative units for interprofessional and community-based linkages
programs including geriatric education centers and area health
education centers. Pharmacy faculty research issues related to rural
health delivery. Student pharmacists benefit from diversity program
funding including Scholarships for Disadvantaged Students.
Office of Pharmacy Affairs
AACP recommends a program funding of $5 million for fiscal year
2012 for the Office of Pharmacy Affairs.
AACP member institutions are actively engaged in Office of Pharmacy
Affairs (OPA) efforts to improve the quality of care for patients in
federally qualified health centers and entities eligible to participate
in the 340B drug discount program. The success of the HRSA Patient
Safety and Clinical Pharmacy Collaborative is a direct result of past
OPA actions linking colleges and schools of pharmacy with federally
qualified health centers. The result of these links has been the
establishment of medical homes that improve health outcomes for
underserved and disadvantaged patients through the integration of
clinical pharmacy services.
Office of Telehealth Advancement
Technology is an important component for improving healthcare
quality and maintaining or increasing access to care. Colleges and
schools of pharmacy utilize technology to increase access to care,
improve care quality and to increase the reach of education to student
and practicing pharmacists.
--Keri H. Naglosky, Marcia M. Worley, Timothy P. Stratton and Randall
D. Seifert University of Minnesota, received a $63,000 grant
for their study, ``Pilot Study to Determine the Effectiveness
of Pharmacist Provided MTM Using Face-to-Face and TeleMTM in
the Treatment of Long-Haul Drivers with Hypertension Department
of Transportation Classifications Stage 1, 2 and 3.''
--Leigh Ann Ross and Sarah Fontenot, faculty at the University of
Mississippi, work with The Delta Health Alliance on many
projects including its HRSA telehealth grant and as members of
the HRSA Patient Safety Collaborative, receiving the Clinical
Pharmacy Services Improvement Award in 2010. Five Delta
hospitals have telemedicine capabilities as a result of its
funding and 86,083 individuals received medical or health
education services during the 2009-2010 fiscal year.
#H2AIT16626
Poison Control Centers
HRSA grant funding supports the management of 10 of the 57 poison
control centers by pharmacy faculty.
--In 2010, the Maryland Poison Center, headed by Bruce Anderson,
faculty at the University of Maryland, answered 36,000 human
exposure calls, 2,000 animal exposures and 25,000 requests
for poison or drug information and over 70 percent of the human
exposure calls were managed on site, avoiding treatment at a
healthcare facility. This year, Paul Starr, also at the
University of Maryland, was recognized for his 20 years as a
certified specialist in poison information. #H4BHS15526
Bureau of Health Professions (BHPr)
AACP supports the Health Professions and Nursing Education
Coalition (HPNEC) recommendation of $762.5 million for Title VII and
VIII programs in fiscal year 2012.
AACP member institutions are active participants in BHPr programs.
Two colleges of pharmacy are current grantees in the Centers of
Excellence program (Xavier University School of Pharmacy). This program
focuses on increasing the number of underserved individuals attending
health professions institutions. Colleges and schools of pharmacy are
also part of Title VII interprofessional and community-based linkages
programs including Geriatric Education Centers and Area Health
Education Centers. These programs are essential for creating the
educational approaches necessary for the Institute of Medicine's
recommendations of improving quality through team-based, patient-
centered care and serve as valuable experiential education sites for
student pharmacists.
--Gayle A. Hudgins, faculty at the University of Montana, was awarded
an ARRA supplement of $132,446 from HRSA, Bureau of Health
Professions, for equipment to enhance training for health
professionals.
Food and Drug Administration (FDA)
AACP recommends a funding level of $3.7 billion for FDA programs in
fiscal year 2012.
The FDA sees the colleges and schools of pharmacy as essential
partners in assuring the public has access to a healthcare professional
well versed in the science of safety. Pharmacy faculty partner with the
FDA to improve the drug manufacturing process through the National
Institute for Pharmaceutical Technology and Education (NIPTE) and
increase the science-base for decisions regarding drug and device
safety and effectiveness.
--Dianne M. Cappelletty, Associate Professor at The University of
Toledo, was recently appointed to serve on the advisory
committee to the Division of Anti-Infective and Ophthalmology
Products.
--James E. Polli, University of Maryland, received $1,099,990 from
the FDA for ``Pharmacokinetic Studies of Epileptic Drugs:
Evaluation of Brand & Generic Antiepileptic Drug Products in
Patients.''
National Institutes of Health (NIH)
AACP supports the Ad Hoc Group for Medical Research recommendation
of $35 billion for fiscal year 2012.
Pharmacy faculty are supported in their research by nearly every
institute at the NIH. The NIH-supported research at AACP member
institutions spans theresearch spectrum from the creation of new
knowledge through the translation of that new knowledge to providers
and patients. In 2010, pharmacy faculty researchers received more than
$358 million in grant support from the NIH. AACP member institutions
are concerned, as are other health professions education organizations,
of the need to increase the number of biomedical researchers.
--At the University of California, San Francisco, Kathleen M.
Giacomini and co-lead Deanna L. Kroetz received $15.1 million
in funding over the next 5 years from the NIH for research into
the genetics behind membrane transporters and a branch project
from that research that will focus on the genetic factors that
determine responses to the anti-diabetic drug, metformin in
African American patients with type 2 diabetes. #2U19GM061390-
11
--Alice M. Clark and Ameeta K. Agarwal, University of Mississippi,
received $388,221 from the National Institute of Allergy and
Infectious Diseases to study New Drugs for Opportunistic
Infections. #5R01AI027094-21
--Eugene D. Morse, the University at Buffalo, received two grants:
$952,000 in funding for, ``Clinical Pharmacology Quality
Assurance and Quality Control'' funded by the National
Institute of Allergies and Infectious Diseases/Division of AIDS
and $2.3 Million for, ``Clinical Pharmacology Lab from NIH to
Promote HIV Research in Africa.'' #272200800019C-4-0-1
--Jordan K. Zjawiony and Charles L. Burandt, the University of North
Carolina, received $71,500 from the NIH to study Chemistry and
Pharmacology of Newly Emerging Psychoactive Plants-Year 2.
#5R03DA023491-02
u.s. department of education supported programs at colleges and schools
of pharmacy
AACP supports the Student Aid Alliance's recommendations for:
--Pell Grant maximum be maintained at $5,550;
--Gaining Early Awareness and Readiness for Undergraduate Programs
(GEAR UP) should be funded at $333 million; and
--Maintaining the in-school interest subsidy for graduate program
loans.
AACP recommends a funding level of $160 million for the Fund for
the Improvement of Post Secondary Education (FIPSE).
The Department of Education supports the education of healthcare
professionals by:
--assuring access to education through student financial aid
programs;
--supporting educational research allows faculty to determine
improvements in educational approaches; and
--maintaining the oversight of higher education through the approval
of accrediting agencies.
AACP actively supports increased funding for undergraduate student
financial assistance programs. Admission to into the pharmacy
professional degree program requires at least 2 years of undergraduate
preparation. Student financial assistance programs are essential to
assuring colleges and schools of pharmacy are accessible to qualified
students. Likewise, financial assistance programs that support graduate
education are an important component meeting our Nation's need for
scientists and educators.
______
Prepared Statement of the American Association of Immunologists
The American Association of Immunologists (AAI), a not-for-profit
professional association representing more than 7,000 of the world's
leading experts on the immune system, appreciates having this
opportunity to submit testimony regarding fiscal year 2012
appropriations for the National Institutes of Health (NIH). The vast
majority of AAI members, whose crucially important discoveries help to
prevent, treat and cure disease, depends on NIH funding to support
their work.\1\
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\1\ AAI members work in academia, government, and industry. Many
members receive grants from the National Institute of Allergy and
Infectious Diseases, the National Cancer Institute, the National
Institute on Aging, and the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, as well as other NIH Institutes and
Centers.
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For more than 50 years, NIH has been envy of the world and has been
instrumental in promoting science, better health, and discovery. Unlike
many Federal agencies, NIH distributes most of its funding to
scientists working in all 50 States. In fact, about 80 percent of the
$31.2 billion NIH budget is awarded to scientists working at research
institutions throughout the United States, making NIH funding the
foundation of our Nation's biomedical research infrastructure and a key
factor in local and national economic growth.\2\ In addition to its
positive economic impact on a community, NIH funding supports highly
skilled jobs that focus on improving human health.\3\ NIH funding also
helps train the next generation of inventors and innovators, crucial to
the nation's future job creation and pipeline of new therapeutics.
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\2\ NIH funding supports ``almost 50,000 competitive grants to more
than 325,000 researchers at over 3,000 universities, medical schools,
and other research institutions in every State and around the world.''
See http://www.nih.gov/about/budget.htm (3/9/11). According to NIH
Director Francis Collins M.D., Ph.D., ``every dollar that NIH gives out
in a grant returns over $2 in investments in terms of economic goods
and services that are produced within just 1 year.'' ``Francis S.
Collins,'' April 26, 2010, http://pubs.acs.org/cen/coverstory/88/
8817cover.html.
\3\ ``[E]very grant that NIH gives creates seven high-quality,
high-paying jobs that sustain American leadership in science.''
``Francis S. Collins,'' April 26,2010, http://pubs.acs.org/cen/
coverstory/88/8817cover.html.
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The role of the immune system
The immune system's job is to protect its human or animal host from
a wide range of infectious and chronic diseases. When the immune system
works, the host remains healthy. But many infectious diseases,
including influenza, HIV/AIDS, malaria, tuberculosis, salmonella, and
the common cold, challenge and sometimes overcome the defenses mounted
by the immune system. And many chronic diseases, including cancer,
diabetes, multiple sclerosis, rheumatoid arthritis, asthma,
inflammatory bowel disease, and lupus, are either caused by--or due in
large part to--an overactive (autoimmune) or underactive immune
response.\4\ Advances in immunological research have already yielded
progress in preventing, diagnosing, and treating some of these
diseases, but further progress depends on increased knowledge in the
field of immunology.
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\4\ The immune system works by recognizing and attacking bacteria
and viruses inside the body and by controlling the growth of tumor
cells. A healthy immune system can protect its human or animal host
from illness or disease either entirely--by destroying the virus,
bacterium, or tumor cell--or partially, resulting in a less serious
illness. It is also responsible for the rejection response following
transplantation of organs or bone marrow. The immune system can also
malfunction, causing the body to attack itself, resulting in an
``autoimmune'' disease, such as Type 1 diabetes, multiple sclerosis,
lupus or rheumatoid arthritis.
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A young and evolving discipline,\5\ immunology has already answered
many key questions and is now needed to explore urgent new challenges
to community and global health, including understanding the human and
animal immune response to: (1) pathogens that threaten to become the
next pandemic, (2) man-made and natural infectious organisms that are
potential agents of bioterrorism (including plague, smallpox, and
anthrax),\6\ (3) environmental threats, and (4) cancer. While
researchers and public health professionals must respond quickly to
these emergent threats, AAI believes that the best preparation is to
support consistent, ongoing research rather than to ``ramp up''
research in times of emergency.\7\
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\5\ 5 Although the first vaccine (against smallpox) was developed
in 1798, most of our basic understanding of the immune system has
developed in the last 50 years, and the pace of discovery is rapidly
increasing.
\6\ To best protect against bioterrorism, scientists should focus
on basic research, including working to understand the immune response,
identifying new and potentially modified pathogens, and developing
tools (including new and more potent vaccines) to protect against these
pathogens.
\7\ For example, to best protect against a pandemic, scientists
should focus on basic research to combat seasonal flu, including
building capacity, pursuing new production methods, and seeking
optimized flu vaccines and delivery methods.
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Recent advances in immunological research
Immunological research has led to unprecedented medical advances in
recent years, including new treatments for lupus and malignant
melanoma, and new vaccines against influenza and cervical cancer.
The value of vaccination against disease and the importance of
continued research and evaluation cannot be overstated. Recent
expansion of the influenza vaccine to all U.S. children ``may induce
herd immunity against influenza for older adults and has the potential
to be more beneficial to older adults than the existing policy of
preventing influenza by vaccinating older adults themselves.'' \8\ A
recent study has shown the efficacy of vaccinating older adults,
whether healthy or with chronic diseases, against shingles, a painful
blistering skin rash caused by the varicella-zoster virus, the virus
that causes chickenpox.\9\ Most recently, a new vaccine against
rotavirus has greatly reduced hospital admissions in the United States
in babies with infectious diarrhea and markedly decreased deaths in
infants in the developing world.\10\ Thousands of children will not die
due to the results of immunological and infectious disease research
originally funded by the NIH on this killer virus.
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\8\ Cohen SA, Chui K, Naumova E, ``Influenza Vaccination in Young
Children Reduces Influenza-associated Hospitalizations in Older Adults,
2002-2006,'' Journal of the American Geriatrics Society, 2011;
59(2):327-332.
\9\ Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ,
``Herpes zoster vaccine in older adults and the risk of subsequent
herpes zoster disease,'' Journal of the American Medical Association,
2011 Jan 12; 305(2):160-166.
\10\ Esposito DH, Tate JE, Kang G, Parashar UD, ``Projected impact
and cost-effectiveness of a rotavirus vaccination program in India,
2008,'' Clinical Infectious Diseases, 2011; 52 (2):171-177. Gagneur A,
Nowak E, Lemaitre T, Segura JF, Delaperriere N, Abalea L, Poulhazan E,
Jossens A, Auzanneau L, Tran A, Payan C, Jay N, de Parscau L, Oger E,
``Impact of rotavirus vaccination on hospitalizations for rotavirus
diarrhea: The IVANHOE study,'' Vaccine, 2011 March 25, doi:10.1016/
j.vaccine.2011.03.035.
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Recently, immunologists have advanced the understanding of the
exquisitely precise regulation of the immune system and are very
hopeful that this understanding will allow for therapeutic manipulation
of the immune system. This important discovery about immune-system
regulation could lead to new approaches for the prevention and
treatment of numerous autoimmune diseases, including lupus (systemic
lupus erythematosus),\11\ a serious chronic autoimmune disease
affecting about 1.5 million Americans. Finally, new monoclonal
antibodies (highly specific immune molecules) that block the immune
response of people with autoimmune diseases (in which one's immune
system attacks one's own body) show enormous promise in improving these
debilitating diseases.
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\11\ Kim HJ, Verbinnen B, Tang X, Linrong L, Cantor H, ``Inhibition
of follicular T-helper cells by CD8+ regulatory T cells is essential
for self tolerance,'' Nature, 2010 July 22; 467: 328-322.
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Sustaining NIH Funding in a Difficult Fiscal Climate
AAI greatly appreciates the strong historical support of this
subcommittee for biomedical research, from doubling the NIH budget
(fiscal year 1999 to fiscal year 2003), to passing the Appropriations
Acts for fiscal year 2009 and 2010, to including in the American
Recovery and Reinvestment Act of 2009 (``ARRA'') a $10.4 billion
supplemental appropriation for NIH. As a result of this generous
support, NIH has been able to fund many excellent, innovative projects
with great promise for advancing human health, and to invest in the
Nation's research infrastructure. AAI--and the entire biomedical
research community--are deeply grateful for this support and for the
subcommittee's strong bipartisan commitment to advancing medical
research. And yet, AAI comes to you this year deeply concerned about
efforts to cut, rather than invest in, the NIH budget. Imminent
advances may not come to fruition if the fiscal year 2012
appropriations level is unable to support NIH's current functional
capacity ($34.4 billion), made possible in large part by this
subcommittee's prior support. AAI remains concerned that investment in
biomedical research continues unfettered by our global competitors,
while our challenged budget makes it difficult for us to attract the
best and brightest to these crucial scientific fields. The AAI funding
recommendation for fiscal year 2012 is premised on these concerns.
NIH Funding for Fiscal Year 2012
AAI greatly appreciates the President's proposed increase for NIH
for fiscal year 2012 ($31.98 billion, or 4 percent increase over the
regular fiscal year 2011 appropriations level). More is required,
however, for NIH to be able to support existing research projects and
fund a reasonable number of excellent new ones. AAI therefore urges the
subcommittee to provide NIH with a fiscal year 2012 budget of $35
billion to enable NIH to maintain its current functional capacity and
to provide a small funding boost for important new research. Sustained
funding, particularly in this challenging fiscal climate, would not
only stabilize ongoing research projects and the overall research
enterprise, but also inspire confidence in the system among many of our
brightest young students who are considering (but due to such limited
grant funding, are fearful to begin) careers in biomedical research.
NIH priorities for Fiscal Year 2012
AAI believes strongly that the engine for biomedical innovation and
discovery is individual investigator-initiated research. Researchers
working in laboratories around the country, with their scientific
collaborators around the world, are the best source of scientific
advancement and progress. ``Top-down'' science, where Government
directives force the research in specified directions, is less likely
to achieve the desired goals than funding the best, most promising,
ripest grant applications.
AAI strongly supports the President's request for a $436 million
increase in funding for individual research project grants (RPGs) that
fund individual scientists. Unfortunately, this increase will only
support approximately 43 additional RPGs. AAI notes that the
President's budget includes $100 million to establish the Cures
Acceleration Network (CAN). AAI recommends a significantly smaller
appropriation for the first year of this program, with the remainder
going to support additional RPGs.
AAI supports the President's request for $300 million for the
Global Fund to Fight AIDS, Tuberculosis, and Malaria--infectious
diseases which devastate people and communities around the world.
AAI supports the President's proposed 4 percent increase for the
National Research Service Awards, a long-needed training stipend
increase for young scientists who are the next generation of research
leaders.
AAI urges this subcommittee to do all it can to reduce the time-
consuming, distracting, and unnecessary administrative burden that too
often accompanies the receipt of Government funds.
AAI recommends strongly against any legislative effort to determine
the size and number of NIH grants. Such a decision should be a
scientific one made by NIH.
AAI supports the President's request for $1.538 billion for NIH
Research, Management, and Services (RM&S) to fund the management,
monitoring, and oversight of all research activities. Only through
adequate funding of this account will NIH be able to supervise and
oversee its large and complex portfolio.
The NIH Public Access Policy
AAI requests that the subcommittee require NIH to publicly report
on the current and historical cost of the NIH Public Access Policy
(``Policy''), and receive the response of private scientific publishers
to this information. AAI continues to believe that the Policy
duplicates publications and services which are already provided cost-
effectively and well by the private sector, including not-for-profit
scientific societies. AAI and other private sector publishers already
publish--and make publicly available--thousands of scientific journals
with millions of articles that report cutting-edge research funded by
NIH and other entities. AAI urges that the subcommittee require NIH to
partner with, rather than compete with, private publishers to enhance
public access while addressing publishers' key concerns, including
respecting copyright law and ensuring journals' continued ability to
provide quality, independent peer review of NIH-funded research.
Conclusion
AAI thanks the subcommittee for its strong support for biomedical
research, the NIH, and the biomedical researchers who devote their
lives to scientific discovery and the prevention, treatment, and cure
of disease.
______
Prepared Statement of the American Association of Nurse Anesthetists
FISCAL YEAR 2012 APPROPRIATIONS REQUEST SUMMARY
----------------------------------------------------------------------------------------------------------------
Fiscal year--
--------------------------------------- AANA fiscal
2012 year 2012
2010 actual 2011 budget budget request
----------------------------------------------------------------------------------------------------------------
HHS/HRSA/BHPr Title VIII Advanced Education Nursing, Nurse \1\ $3,500, ( \2\ ) ( \2\ ) \3\ $4,000,
Anesthetist Education Reserve.............................. 000 000
Total for Advanced Education Nursing, from Title VIII....... 64,440,000 64,440,000 104,438,000 104,438,000
Title VIII HRSA BHPr Nursing Education Programs............. 243,872,000 243,872,000 313,075,000 313,075,000
CDC/Division of Healthcare Quality and Promotion............ ........... ........... ( \4\ ) ( \4\ )
----------------------------------------------------------------------------------------------------------------
\1\ Awards amounted to approximately.
\2\ Grant allocations not specified.
\3\ For nurse anesthesia education.
\4\ Maintain level funding.
The American Association of Nurse Anesthetists (AANA) is the
professional association for the 44,000 Certified Registered Nurse
Anesthetists (CRNAs) and student nurse anesthetists practicing today,
representing over 90 percent of the nurse anesthetists in the United
States. Today, CRNAs deliver approximately 32 million anesthetics 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, and providing acute
and chronic pain management services. CRNAs provide anesthesia for a
wide variety of surgical cases and in some States are the sole
anesthesia providers in 100 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. Nurse anesthetists are experienced and highly trained
anesthesia professionals whose record of patient safety in the field of
anesthesia was bolstered by the Institute of Medicine report in 2000,
which found that anesthesia is 50 times safer than in the 1980s. (Kohn
L, Corrigan J, Donaldson M, ed. To Err is Human. Institute of Medicine,
National Academy Press, Washington DC, 2000.) Nurse anesthetists
continue to set for themselves the most rigorous continuing education
and re-certification requirements in the field of anesthesia. Relative
anesthesia patient safety outcomes are comparable among nurse
anesthetists and anesthesiologists, with a recent Health Affairs
article, ``No Harm Found When Nurse Anesthetists Work without
Supervision by Physicians'' finding that adverse outcomes were no more
prevalent in States that opted out of the Medicare physician
supervision requirement of nurse anesthetists than those States that
didn't opt-out (Dulisse B, Cromwell J. No Harm Found When Nurse
Anesthetists Work Without Supervision By Physicians. Health Aff.
2010;29(8):1469-1475).
In addition, a study published in Nursing Research indicates that
obstetrical anesthesia, whether provided by CRNAs or anesthesiologists,
is extremely safe, and there is no difference in safety between
hospitals that use only CRNAs compared with those that use only
anesthesiologists. (Simonson, Daniel C et al. Anesthesia Staffing and
Anesthetic Complications During Cesarean Delivery: A Retrospective
Analysis. Nursing Research, Vol. 56, No. 1, pp. 9-17. January/February
2007). In addition, a recent AANA workforce study showed that CRNAs and
anesthesiologists are substitutes in the production of surgeries.
Through continual improvements in research, education, and practice,
nurse anesthetists are vigilant in our efforts to ensure patient
safety.
CRNAs provide the lion's share of anesthesia care required by our
U.S. Armed Forces through active duty and the reserves. For decades,
CRNAs have staffed ships, remote U.S. military bases, and forward
surgical teams without physician anesthesiologist support. In addition,
CRNAs predominate in rural and medically underserved areas, and where
more Medicare patients live.
Importance of Title VIII Nurse Anesthesia Education Funding
The nurse anesthesia profession's chief request of the Subcommittee
is for $4 million to be reserved for nurse anesthesia education and
$104.438 million for advanced education nursing from the Title VIII
program. We feel that this funding request is well justified, as we
know that more baby boomers retiring will not only reduce our nurse
workforce from retirements but will increase the demand from an aging
population requiring care. The Title VIII program is an effective means
to help address the nurse anesthesia workforce demand.
Increasing funding for advanced education nursing from $64.44
million in fiscal year 2010 to $104.438 million is necessary to meet
the continuing demand for nursing faculty and other advanced education
nursing services throughout the United Staes. The program provides for
competitive grants that help enhance advanced nursing education and
practice and traineeships for individuals in advanced nursing education
programs. This funding is critical to meet the nursing workforce needs
of Americans who require healthcare, particularly as we see more
patients enter the system with health reform. More APRNs will be needed
to fill the gap to ensure access to care. In addition, this funding
provides a two-fold benefit for the nurse workforce. It not only seeks
to increase the number of providers in rural and underserved America
but also prepares providers at the master's and doctoral levels,
increasing the number of clinicians who are eligible to serve as
faculty.
There continues to be high demand for CRNA workforce in clinical
and educational settings. The supply of clinical providers has
increased in recent years, stimulated by increases in the number of
CRNAs trained. Between 2000-2009, the number of nurse anesthesia
educational program graduates doubled, with the Council on
Certification of Nurse Anesthetists (CCNA) reporting 1,075 graduates in
2000 and 2,375 graduates in 2010. This growth is leveling off somewhat,
but is expected to continue. However, even though the number of
graduates has doubled in 8 years, the demand for nurse anesthetists
continues to rise as the population ages, the number of clinical sites
requiring anesthesia services grows, and CRNA retirements increase.
The problem is not that our 111 accredited programs of nurse
anesthesia are failing to attract qualified applicants. It is that they
have to turn them away by the hundreds. The capacity of nurse
anesthesia educational programs to educate qualified applicants is
limited by the number of faculty, the number and characteristics of
clinical practice educational sites, and other factors. A qualified
applicant to a CRNA program is a bachelor's educated registered nurse
who has spent at least 1 year serving in an acute care healthcare
practice environment.
Recognizing the important role nurse anesthetists play in providing
quality healthcare, the AANA has been working with the 111 accredited
nurse anesthesia educational programs to increase the number of
qualified graduates. In addition, the AANA has worked with nursing and
allied health deans to develop new CRNA programs. To truly meet the
nurse anesthesia workforce challenge, the capacity and number of CRNA
schools must continue to grow. With the help of competitively awarded
grants supported by Title VIII funding, the nurse anesthesia profession
is making significant progress, expanding both the number of clinical
practice sites and the number of graduates.
The AANA is 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. As mentioned earlier, the
Health Affairs study by Dulisse and Cromwell indicates the safety of
CRNA care. Another study published recently in Nursing Economic$
indicates that costs of educating and training a CRNA from
undergraduate education through graduate education is roughly 15
percent of the cost of educating and training an anesthesiologist
(Hogan, PF, Seifert RF, Moore CS, Simonson BE, Cost Effectiveness
Analysis of Anesthesia Providers, Nurs Econ. 2010;28(3): 150-169.) This
study also found that among anesthesia delivery models, CRNAs acting
independently provide anesthesia services at the lowest economic cost;
costs for this model are 25 percent less than the second lowest cost
model in which an anesthesiologist supervises six CRNAs. Nurse
anesthesia education represents a significant educational cost-benefit
for supporting CRNA educational programs with Federal dollars vs.
supporting other, more costly, models of anesthesia education.
To further demonstrate the effectiveness of the Title VIII
investment in nurse anesthesia education, the AANA surveyed its CRNA
program directors to gauge the impact of the Title VIII funding. Of the
eleven schools that had reported receiving competitive Title VIII Nurse
Education and Practice Grants funding from 1998 to 2003, the programs
indicated an average increase of at least 15 CRNAs graduated per year.
They also reported on average more than doubling their number of
graduates. Moreover, they reported producing additional CRNAs that went
to serve in rural or medically underserved areas.
We believe the Subcommittee should allocate $4 million for nurse
anesthesia education for several reasons. First, as this testimony has
documented, the funding is cost-effective and needed. Second, this
particular funding meets a distinct need not met elsewhere; 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. Third, this funding meets an
overall objective to increase access to quality healthcare in medically
underserved America.
Title VIII Funding for Strengthening the Nursing Workforce
The AANA joins The Nursing Community and the Americans for Nursing
Shortage Relief (ANSR) Alliance in support of the Subcommittee
providing a total of $313.075 million in fiscal year 2012 for nursing
shortage relief through Title VIII. AANA asks that of the $313.075
million, $104.438 million go to Advanced Education Nursing and $4
million go to nurse anesthesia education to help increase clinicians in
underserved communities and those eligible to serve as faculty. The
AANA appreciates the support for nurse education funding in fiscal year
2010 and past fiscal years from this Subcommittee and from the
Congress.
In the interest of patients past and present, particularly those in
rural and medically underserved parts of this country, we ask Congress
to invest in CRNA and nursing educational funding programs and to
provide these programs the sustained increases required to help ensure
Americans get the healthcare that they need and deserve. Quality
anesthesia care provided by CRNAs saves lives, promotes quality of
life, and makes fiscal sense. This Federal support for Title VIII and
advanced education nurses will improve patient access to quality
services and strengthen the Nation's healthcare delivery system.
Safe Injection Practices
As a leader in patient safety, the AANA has been playing a vigorous
role in the development and projects of the Safe Injection Practices
Coalition, intended to reduce and eventually eliminate the incidence of
healthcare facility acquired infections. Provider education and
awareness, detection, tracking and response are all extremely important
to preventing healthcare-associated infections. In the interest of
promoting safe injection practice and reducing the incidence of
healthcare facility acquired infections, we recommend the Committee
maintain its level of funding for CDC's Division of Healthcare Quality
and Promotion so they can address outbreaks and promote innovative ways
to adhere to injection safety and infection control guidelines. We also
hope the committee will support the CDC's efforts around provider
education and patient awareness activities, as this issue transcends
provider type and it's important to educate all types of providers and
patients alike. In light of the recent healthcare-associated
transmission of blood-borne pathogens in California, North Carolina,
Florida, Colorado, and Nevada, the CDC needs resources to use the
knowledge they have gained on detection and be able to develop new
strategies to prevent healthcare associated transmission of blood borne
pathogens.
______
Prepared Statement of the American Congress of Obstetricians and
Gynecologists
The American Congress of Obstetricians and Gynecologists,
representing 54,000 physicians and partners in women's healthcare, is
pleased to offer this statement to the Senate Committee on
Appropriations, Subcommittee on Labor, Health and Human Services, and
Education. We thank Chairman Harkin, and the entire Subcommittee for
the opportunity to provide comments on important programs to women's
health. Today, the United States lags behind other nations in healthy
births, yet remains high in birth costs. ACOG's Making Obstetrics and
Maternity Safer (MOMS) Initiative seeks to improve maternal outcomes
through more research and better data, and we urge you to make this a
top priority in fiscal year 2012.
Research is critically needed to understand why our maternal and
infant mortality rate remains comparatively high. Having better data
collection methods and comprehensive maternal mortality reviews has
shown maternal mortality rates in some States, such as California, to
be higher than previously thought. States without these resources are
likely underreporting maternal and infant deaths and complications from
childbirth. Without accurate data, the full range of causes of these
deaths remains unknown. Effective research based on comprehensive data
is a key MOMS element to developing and implementing evidence-based
interventions.
The President's budget for fiscal year 2012 takes a positive first
step toward this goal, including a $1 billion increase for NIH, and
ACOG requests the Subcommittee build on these increases to sustain the
investment for women's health. Please note that given the current
fiscal climate, our requests are more conservative this year and do not
reflect the actual need in the health community. ACOG asks for a 1.7
percent increase over fiscal year 2010 to the NICHD within NIH to
$1.352 billion, a 2.3 percent increase for HRSA to $7.65 billion, a 19
percent increase for CDC to $7.7 billion, and a 2 percent increase for
AHRQ to $405 million.
Funding of research and programs in the following areas are vital
to the MOMS Initiative:
Maternal Mortality Reviews at HHS
National data on maternal mortality is inconsistent and incomplete
due to the lack of standardized reporting definitions and mechanisms.
To capture the accurate number of maternal deaths and plan effective
interventions, maternal mortality should be addressed through multiple,
complementary strategies. ACOG recommends that HHS fund States in
implementing maternal mortality reviews that would allow them to
conduct regular reviews of all deaths within the State to identify
causes, factors in the communities, and strategies to address the
issues. Combined with adoption of the recommended birth and death
certificates in all States and territories, CDC could then collect
uniform data to calculate an accurate national maternal mortality rate.
Results of maternal mortality reviews will inform research needed to
identify evidence based interventions addressing causes and factors of
maternal mortality and morbidity.
ACOG urges Congress to provide $10 million to Health and Human
Services to assist States in setting up maternal mortality reviews.
ACOG also urges Congress to provide $50,000 to NIH to hold a workshop
to identify definitions for severe maternal morbidity and $100,000 to
HHS to develop a research plan to identify and monitor severe maternal
morbidity.
Maternal/Child Health Research at the NIH
The Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) conducts the majority of women's health
research. Despite the NIH's critical advancements, reduced funding
levels have made it difficult for research to continue.
ACOG supports a 1.7 percent increase in funds over fiscal year 2010
to $1.352 billion for the NICHD. A modest increase, these funds will
assist the following research areas critical to the MOMS Initiative:
Reducing the Prevalence of Premature Births.--There is a known link
between pre-term birth and infant mortality, and women of color are at
increased risk for delivering pre-term. NICHD is helping our Nation
understand how adverse conditions and health disparities increase the
risks of premature birth in high-risk racial groups, and how to reduce
these risks. Prematurity rates have increased almost 35 percent since
1981, accounting for 12.5 percent of all births, yet the causes are
unknown in 25 percent of cases. Preterm births cost the Nation $26
billion annually, $51,600 for every infant born prematurely. Direct
healthcare costs to employers for a premature baby average $41,610, 15
times higher than the $2,830 for a healthy, full-term delivery.
Additional research is critically needed to understand how we can
drive down our prematurity rates and NICHD conducts the majority of
this research. For example, a 2003 NICHD study showed that progesterone
supplementation reduces preterm birth in a select group of women,
paving the way for its widespread clinical use. Today, around 139,000
(3.3 percent) women are candidates for this therapy. Among these women,
22 percent, or about 30,500, are likely to have a recurrent preterm
birth without this treatment. With treatment, about one-third, or
10,000, of these preterm births can be prevented. The prevention of all
10,000 preterm births would result in direct medical cost savings of
$334 million and total medical cost savings of $519 million. However,
further studies are needed to determine if progesterone therapy can be
designed to help prevent preterm delivery in other ways, including
optimal preparation, dosage, and route of administration. The high cost
of prematurity and past successful research at NICH highlights the need
to sustain investments to reduce the rate of prematurity.
ACOG supports the Surgeon General's effort to make the prevention
of pre-term birth a national public health priority, and urges Congress
to allocate $1 million to NICHD to create a Trans-disciplinary Research
Center on Prematurity to help streamline efforts to reduce pre-term
births.
Obesity Research, Treatment and Prevention.--Obese pregnant women
are at higher risk for poor maternal and neonatal outcomes. Additional
research and interventions are needed to address the increased risk for
poor outcomes in obese women receiving infertility treatment, the
increased incidence of birth defects and stillbirths in obese pregnant
women, ways to optimize outcomes in obese women who become pregnant
after bariatric surgery, and the increased future risk of childhood
obesity in their offspring.
ACOG is grateful to the NIH for making obesity a priority and
initiating trans-disciplinary approaches to combat obesity. The recent
release of the Strategic Plan for NIH Obesity Research offers some
innovative and promising directions for obesity research, and sustained
funding is critical to implement the plan.
Training Programs.--The average investigator is in his/her forties
before receiving their first NIH grant, a huge dis-incentive for
students considering bio-medical research as a career. Complicating
matters, there is a gap between the number of women's reproductive
health researchers being trained and the need for such research. The
NICHD-coordinated Women's Reproductive Health Research (WRHR) Career
Development program seeks to increase the number of ob-gyns conducting
scientific research in women's health in order to address this gap. To
date 170 WRHR Scholars have received faculty positions, and 7 new and
competing WRHR sites were added in 2010.
Additional funding to add new sites can help sustain this low-
dollar, large impact training program while at the same time shoring up
the women's reproductive research workforce.
Maternal/Child Health Programs at CDC
CDC funds programs that are critical to providing resources to
mothers and children in need. Where NIH conducts research to identify
causes of pre-term birth, CDC funds programs that provide resources to
mothers to help prevent pre-term birth, and help identify factors
contributing to pre-term birth and poor maternal outcomes.
ACOG supports a 19 percent increase in funds over fiscal year 2010
to $7.7 billion to increase CDC's ability to bring prevention,
treatment and interventions to more women and children in need, and to
help enact some of the important provisions within healthcare reform.
This funding will help the following programs important to the MOMS
Initiative:
Electronic Birth Records and Death Records, National Center for
Health Statistics (NCHS), National Vital Statistics System (NVSS).--
NCHS is the Nation's principal health statistics agency; it collects,
analyzes and reports on data critical to all aspects of our healthcare
system. NCHS collects State data needed to monitor maternal and infant
health, such as use of prenatal care, and smoking during pregnancy.
This data allows investigators to monitor maternal and child health
objectives, and develop efficient prevention and treatment strategies.
Uniform consistent data from birth and death records is critical to
conducting research and directing public programs to combat maternal
and infant death. Only 75 percent of States and territories use the
2003 recommended birth certificates and 65 percent have adopted the
2003 recommended death certificate. The President recently issued a
Memorandum to all departments and agencies encouraging expanded data
collection on maternal mortality by using the 2003 U.S. standard birth
certificate and updating to electronic systems, noting that until all
States adopt the same data standards it will be difficult to formulate
national maternal mortality ratios.
ACOG urges Congress to allocate $11 million for States to modernize
their birth and death records systems to the 2003 recommended
guidelines. It is a low cost that will yield enormous gains in CDC's
ability to collect accurate data nationally and better direct medical
research and best practice for physicians.
Safe Motherhood/Infant Health.--Two to three women a day die from
delivery complications. The Safe Motherhood Program supports CDC's work
to identify and gather information on pregnancy-related deaths; collect
and provide information about women's health and health behaviors
around pregnancy; and expand the use of guidelines on preconception
care into everyday practice and healthcare policy.
Safe Motherhood also tracks infant morbidity and mortality
associated with pre-term birth. ACOG is concerned with recent trends
particularly among rates of late pre-term births. Increased funding is
needed for CDC to improve national data systems to track pre-term birth
rates and expand epidemiological research that focuses especially on
the causes and prevention of preterm birth and births at 37-38 weeks
gestation.
ACOG urges Congress to include a 23.7 percent increase in funds to
$55.4 million for Safe Motherhood, consistent with the President's
fiscal year 2011 budget.
Maternal/Child Health Programs at HRSA
HRSA delivers critical resources to communities to improve the
health of mothers and children. ACOG urges a 2.3 percent increase in
funds over fiscal year 2010 to $7.65 billion to increase the scope of
HRSA programs, ultimately bringing more resources to more mothers and
children. This funding will help expand the following programs
important to the MOMS Initiative:
Fetal Infant Mortality Reviews, Healthy Start Program.--The U.S.
infant mortality rate is again on the rise and is particularly severe
among minority and low-income women. The infant mortality rate among
African-American women has been increasing since 2001 and reached 14.2
deaths per 1,000 births in 2004. There also has been a startling rise
in infant mortality in the South in the past few years.
The Healthy Start Program through HRSA promotes community-based
programs that focus on infant mortality and racial disparities in
perinatal outcomes. These programs are encouraged to use the Fetal and
Infant Mortality Review (FIMR) which brings together ob-gyn experts and
local health departments to help solve problems related to infant
mortality. Today more than 220 local programs in 42 States find FIMR a
powerful tool to help solve infant mortality.
ACOG urges Congress to include $.5 million for Healthy Start
Programs to include FIMR.
Maternal Child Health Block Grant (MCH)
The MCH is the only Federal program that exclusively focuses on
improving the health of mothers and children. State and territorial
health agencies and their partners use MCH Block Grant funds to reduce
infant mortality, deliver services to children and youth with special
healthcare needs, support comprehensive prenatal and postnatal care,
screen newborns for genetic and hereditary health conditions, deliver
childhood immunizations, and prevent childhood injuries.
These early healthcare services help keep women and children
healthy, eliminating the need for later costly care. For example, every
$1 spent on preconception care programs for women with diabetes can
reduce health costs by up to $5.19 by preventing costly complications
in both mothers and babies. Studies also suggest that every $1 spent on
smoking cessation counseling for pregnant women saves $3 in neonatal
intensive care costs.
ACOG urges Congress to increase funding for MCH $700 million, a
5.74 percent increase over fiscal year 2010.
Title X Family Planning
The Title X program provides contraceptive services, immunizations
and other preventive healthcare, including screenings for STDs, HIV,
breast cancer, cervical cancer, high blood pressure, and anemia to more
than 5 million low-income men and women at more than 4,500 service
delivery sites. These programs improve maternal and child health
outcomes, prevent unintended pregnancies, and reduce the rate of
abortions. Every $1 spent on family planning results in a $4 savings to
Medicaid. Services provided at Title X clinics accounted for $3.4
billion in healthcare savings in 2008 alone.
ACOG supports a 3.15 percent increase in funds for Title X to $327
million, consistent with the President's budget.
Again, we would like to thank the Committee for its consideration
of funding for programs to improve women's health, and we urge you to
consider our MOMS Initiative in fiscal year 2012.
______
Prepared Statement of the American Dental Education Association
The American Dental Education Association (ADEA) \1\ respectfully
submits this statement for the record and for your consideration as you
begin to prioritize fiscal year 2012 appropriation requests. ADEA urges
you to preserve the funding and fundamental structure of Federal
programs that provide prevention of dental disease, access to oral
healthcare for underserved populations, and access to careers in
dentistry and oral health services.
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\1\ The American Dental Education Association represents all 61
U.S. dental schools, 700 dental residency training programs, nearly 600
allied dental programs, as well as more than 12,000 faculty who educate
and train the nearly 50,000 students and residents attending these
institutions. It is at these academic dental institutions that future
practitioners and researchers gain their knowledge, where the majority
of dental research is conducted, and where significant dental care is
provided.
---------------------------------------------------------------------------
As you know, ADEA's membership is comprised of all 61 dental
schools in the United States. These academic dental institutions make
substantial contributions to the oral health and well-being of the
Nation. Services are provided through campus and offsite dental clinics
where students and faculty provide patient care as dental homes to the
uninsured and underserved populations. However, in order to continue to
provide these services, there must be adequate funding. Therefore, it
is critical that funding for oral healthcare, delivery of services, and
research be preserved in order to ensure the level of care that is
necessary for all segments of the population.
ADEA's requests build upon funding from the American Economic
Recovery and Reinvestment Act (ARRA), the Labor, Health and Human
Services and Education fiscal year 2010 Appropriations, and the
Continuing Resolution for fiscal year 2011. We are asking the committee
to maintain adequate funding for the dental programs in Title VII of
the Public Health Service Act; the National Institutes of Health and
the National Institute of Dental and Craniofacial Research; the Dental
Health Improvement Act; Part F of the Ryan White HIV/AIDS Treatment and
Modernization Act: the Dental Reimbursement Program and the Community-
Based Dental Partnerships Program; and State-Based Oral Health Programs
at the Centers for Disease Control and Prevention. These programs
enhance and sustain State oral health departments, fund public health
programs proven to prevent oral disease, fund research to eradicate
dental disease, and fund programs to develop an adequate workforce of
dentists with advanced training to serve all segments of the population
including children, the elderly, and those suffering from chronic and
life-threatening diseases.
$30 million for Primary Oral Healthcare Workforce Improvements (HHS)
The dental programs in Title VII, Section 748 of the Public Health
Service Act that provide training in general, pediatric, and public
health dentistry and dental hygiene are critical. Support for these
programs will help to ensure there will be an adequate oral healthcare
workforce to care for the American public. The funding supports
predoctoral oral health education and postdoctoral pediatric, general,
and public health dentistry training. The investment that Title VII
makes not only helps to educate dentists and dental hygienists, but
also expands access to care for underserved communities.
Additionally, Section 748 addresses the shortage of professors in
dental schools with the dental faculty loan repayment program and
faculty development courses for those who teach pediatric, general, or
public health dentistry or dental hygiene. There are currently almost
400 open faculty positions in dental schools. These two programs
provide schools with assistance in recruiting and retaining faculty.
$35 billion for the National Institutes of Health, including $468
million for the National Institute of Dental and Craniofacial
Research (NIDCR)
Discoveries stemming from dental research have reduced the burden
of oral diseases, led to better oral health for millions of Americans,
and uncovered important associations between oral and systemic health.
Dental researchers are poised to make breakthroughs that can result in
dramatic progress in medicine and health, such as repairing natural
form and function to faces destroyed by disease, accident, or war
injuries; diagnosing systemic disease from saliva instead of blood
samples; and deciphering the complex interactions and causes of oral
health disparities involving social, economic, cultural, environmental,
racial, ethnic, and biological factors. Dental research is the
underpinning of the profession of dentistry. With grants from NIDCR,
dental researchers in academic dental institutions have built a base of
scientific and clinical knowledge that has been used to enhance the
quality of the nation's oral health and overall health.
Also, dental scientists are putting science to work for the benefit
of the healthcare system through translational research, comparative
effectiveness research, health information technology, health research
economics, and further research on health disparities. NIDCR continues
to make disparities a priority with continued funding for the Centers
for Research to Reduce Disparities in Oral Health at Boston University,
the University of California, San Francisco, and the University of
Colorado at Denver, the University of Florida, and the University of
Washington.
$20 million for the Dental Health Improvement Act (DHIA)
Section 340G of the Public Health Service Act created the Grants to
States to Support Oral Health Workforce Activities as authorized by the
Dental Health Improvement Act. This program supports the development of
innovative dental workforce programs specific to the State's dental
workforce needs and increases access to dental care for underserved
populations.
In 2010, Congress provided at total of $17.5 million to assist
States in developing flexible dental workforce programs tailored to
meet States' individual workforce needs. Grants are being used to
support a variety of initiatives including, but not limited to: loan
repayment programs to recruit culturally and linguistically competent
dentists to work in underserved communities; rotating residents and
students in rural areas; recruiting dental school faculty; training
pediatricians and family medicine physicians to provide oral health
services (screening exams, risk assessments, fluoride varnish
application, parental counseling, and referral of high-risk patients to
dentists); and supporting tele-dentistry. We expect fiscal year 2011
appropriations to continue to fund the fiscal year 2010 awarded grants,
many of which are 3-year projects.
$19 million for Part F of the Ryan White HIV/AIDS Treatment and
Modernization Act: Dental Reimbursement Program (DRP) and the
Community-Based Dental Partnerships Program
Patients with compromised immune systems are more prone to oral
infections like periodontal disease and tooth decay. By providing
reimbursement to dental schools and schools of dental hygiene, the
Dental Reimbursement Program (DRP) provides access to quality dental
care for people living with HIV/AIDS while simultaneously providing
educational and training opportunities to dental residents, dental
students, and dental hygiene students who deliver the care. DRP is a
cost-effective Federal/institutional partnership that provides partial
reimbursement to academic dental institutions for costs incurred in
providing dental care to people living with HIV/AIDS. Congress,
recognizing that dental care is a ``core medical service'' needed by
HIV patients provided $13.6 million to fund Part F in 2010.
$107 million for Diversity and Student Aid
$24 million for Centers of Excellence (COE)
$60 million for Scholarships for Disadvantaged Students (SDS)
$22 million for Health Careers Opportunity Program (HCOP)
$1.2 million for Faculty Loan Repayment Program (FLRP)
Title VII Diversity and Student Aid programs play a critical role
in helping to diversify the health profession's student body and
thereby the healthcare workforce. For the last several years, these
programs have not enjoyed adequate funding to sustain the progress that
is necessary to meet the challenges of an increasingly diverse U.S.
population.
$25 million for Oral Health Programs at the Centers for Disease Control
and Prevention (CDC)
The CDC Oral Health Program expands the coverage of effective
prevention programs. The program increases the basic capacity of State
oral health programs to accurately assess the needs of the State,
organize and evaluate prevention programs, develop coalitions, address
oral health in state health plans, and effectively allocate resources
to the programs. This strong public health response is needed to meet
the challenges of oral disease affecting children, and vulnerable
populations.
As the oral health programs at the CDC are so important, we have
serious concerns about the proposal to downgrade the status of the
Division of Oral Health (DOH) at the CDC to a branch. We request that
you do everything you can to prevent this move.
Thank you for your consideration of this request. ADEA looks
forward to working with you to ensure the continuation of congressional
support for these critical programs. Please feel free to use us a
resource on any issue affecting the oral healthcare of the nation.
If you should have any questions regarding the aforementioned,
please contact Deborah Darcy, ADEA Director of Congressional Affairs at
(202) 289-7201 x 163.
______
Prepared Statement of the American Dental Hygienists' Association
On behalf of the American Dental Hygienists' Association (ADHA),
thank you for the opportunity to submit testimony regarding
appropriations for fiscal year 2012. ADHA appreciates the
Subcommittee's past support of programs that seek to improve the oral
health of Americans and to bolster the oral health workforce. Oral
health is a part of total health and authorized oral healthcare
programs require appropriations support in order to increase the
accessibility of oral health services, particularly for the
underserved.
ADHA is the largest national organization representing the
professional interests of more than 152,000 licensed dental hygienists
across the country. Dental hygienists are primary care providers of
oral health services and are licensed in each of the 50 States.
Hygienists are committed to improving the Nation's oral health, a
fundamental part of overall health and general well-being. In order to
become licensed as a dental hygienist, an individual must graduate from
an accredited dental hygiene education program and successfully
complete a national written and a State or regional clinical
examination.
In the past decade, the link between oral health and total health
has become more apparent and the significant disparities in access to
oral healthcare services have been well documented. At the State and
local level, policymakers and consumer advocates have been pioneering
innovations to extend the reach of the oral healthcare delivery system
and improve oral health infrastructure. At this time, when tens of
millions of Americans struggle to obtain the oral healthcare required
to remain healthy, Congress has a great opportunity to support oral
health prevention, infrastructure and workforce efforts that will make
care more accessible and cost-effective.
ADHA urges full funding of all authorized oral health programs and
describes some of the key oral health programs below:
Title VII Program Grants to Expand and Educate the Dental Workforce--
Fund at a level of $25 million in fiscal year 2012
A number of existing grant programs offered under Title VII support
health professions education programs, students, and faculty. ADHA is
pleased that dental hygienists are now recognized as primary care
providers of oral health services and are included as eligible to apply
for several grants offered under the ``General, Pediatric, and Public
Health Dentistry'' grants.
With millions more Americans eligible for dental coverage in coming
years, it is critical that the oral health workforce is bolstered.
Dental and dental hygiene education programs currently struggle with
significant shortages in faculty and there is a dearth of providers
pursuing careers in public health dentistry and pediatric dentistry.
Securing appropriations to expand the Title VII grant offerings to
additional dental hygienists and dentists will provide much needed
support to programs, faculty, and students in the future.
ADHA recommends funding at a level of $25 million for fiscal year
2012.
Alternative Dental Health Care Provider Demonstration Project Grants--
Fund at a level of $30 million in fiscal year 2012
States have increasingly been pioneering new dental delivery models
to extend access to oral healthcare services to those currently unable
to access needed care. The Alternative Dental Health Care Provider
Demonstration Project grants support State-level efforts to better
utilize the existing oral health workforce as well as develop new
provider models.
A number of dental hygiene-based models are listed as eligible for
the grants, including advanced practice hygienists, public health
hygienists, and independent dental hygienists.
Grants could also be awarded to dental therapist models, programs
where physicians/other medical providers deliver basic dental services
and other models deemed appropriate by the Secretary of Health and
Human Services. Funding would also allow HRSA to fulfill its statutory
requirement to contract with the Institute of Medicine to conduct a
study of the demonstration projects.
Currently, more than 30 States have statutes and rules that allow
dental hygienists to work in community-based settings (like public
health clinics, schools, and nursing homes) to provide oral health
services without the presence or direct supervision of a dentist. These
models extend the reach of dental professionals beyond the private
dental office.
The American Dental Education Association supports funding of this
program. The PEW Charitable Trusts Children's Dental Campaign also
supports funding of this program. Indeed, more than 60 organizations
have called for funding this important program. Without the appropriate
supply, diversity and distribution of the oral health workforce, the
current oral health access crisis will only be exacerbated.
ADHA recommends funding at a level of $30 million for fiscal year
2012 to support these vital demonstration projects.
Oral Health Prevention and Education Campaign--Fund at a level of $5
million in fiscal year 2012
A targeted national campaign led by the Centers for Disease Control
to educate the public, particularly those who are underserved, about
the benefits of oral health prevention could vastly improve oral health
literacy in the country. While significant data has emerged over the
past decade drawing the link between oral health and systemic diseases
like diabetes, heart disease, and stroke, many remain unaware that
neglected oral health can have serious ramifications to their overall
health. Data is also emerging to highlight the role that poor oral
health in pregnant women has on their children, including a link
between periodontal disease and low-birth weight babies.
ADHA advocates an allocation of $5 million in fiscal year 2012 for
a national oral health prevention and education campaign.
School-Based Sealant Programs--Fund at a level sufficient to ensure
school-based sealant programs in all 50 States
Sealants have long-proven to be low-cost and effective in
preventing dental caries (cavities), particularly in children. While
most dental disease is fully preventable, dental caries remains the
most common childhood disease, five times more common than asthma, and
more than half of all children age 5-9 have a cavity or filling.
The CDC has noted that data collected in evaluations of school-
based sealant programs indicates the programs are effective in stopping
and preventing dental decay. Significant progress has been made in
developing best practices for school-based sealant programs, yet most
States lack well developed programs as a result of funding shortfalls.
ADHA encourages the transfer of funding from the Public Health and
Prevention Fund sufficient to allow CDC to meaningfully fund school-
based sealant programs in all 50 States in fiscal year 2012.
Oral Health Programming within the Centers for Disease Control--Fund at
a level of $25 million in fiscal year 2012
ADHA joins with others in the dental community in urging $25
million for oral health programming within the Centers for Disease
Control. This funding level will enable CDC to continue its vital work
to control and prevent oral disease, including vital work in community
water fluoridation. Federal grants to facilitate improved oral health
leadership at the State level, support the collection and synthesis of
data regarding oral health coverage and access, promote the integrated
delivery of oral health and other medical services, enable States to
innovate new types of oral health programs and promote a data-driven
approach to oral health programming.
ADHA joins with others in the oral health community to express
concern with plans to fold the Division of Oral Health at CDC into the
Division of Adult and Community Health, and asks the subcommittee to
urge CDC to maintain the Division of Oral Health as a separate entity
within the chronic disease center so that the Division of Oral Health
can continue to improve the oral health of Americans from inception to
old age.
ADHA advocates for $25 million in funding for grants to improve and
support oral health infrastructure and surveillance.
Dental Health Improvement Grants--Fund at a level of $20 million in
fiscal year 2012
HRSA administered dental health improvement grants are an important
resource for States to have available to develop and carry out State
oral health plans and related programs. Past grantees have used funds
to better utilize the existing oral health workforce to achieve greater
access to care. Previously awarded grants have funded efforts to
increase diversity among oral health providers in Wisconsin, promote
better utilization of the existing workforce including the extended
care permit (ECP) dental hygienist in Kansas, and in Virginia implement
a legislatively directed pilot program to allow patients to directly
access dental hygiene services.
ADHA supports funding of HRSA dental health improvement grants at a
level of $20 million for fiscal year 2012.
National Institute of Dental and Craniofacial Research--Fund at a level
of $468 million in fiscal year 2012
The National Institute of Dental and Craniofacial Research (NIDCR)
cultivates oral health research that has led to a greater understanding
of oral diseases and their treatments and the link between oral health
and overall health. Research breeds innovation and efficiency, both of
which are vital to improving access to oral healthcare services and
improved oral status of Americans in the future.
ADHA joins with others in the oral health community to support
NIDCR funding at a level of $468 million in fiscal year 2012.
Conclusion
ADHA appreciates the difficult task Appropriators face in
prioritizing and funding the many meritorious programs and grants
offered by the Federal Government. In addition to the items listed,
ADHA joins other oral health organizations in support for continued
funding of the Dental Reimbursement Program (DRP) and the Community-
Based Dental Partnerships Program established under the Ryan White HIV/
AIDS Treatment and Modernization Act ($19 million for fiscal year 2012)
as well as block grants offered by HRSA's Maternal Child Health Bureau
($8 million for fiscal year 2012).
ADHA remains a committed partner in advocating for meaningful oral
health programming that makes efficient use of the existing oral health
workforce and delivers high quality, cost-effective care.
______
Prepared Statement of the American Diabetes Association
Thank you for the opportunity to submit this testimony on behalf of
the American Diabetes Association. As someone who has lived with
diabetes for over thirty years, I am proud to be a representative of
the nearly 105 million American adults and children living with
diabetes or prediabetes.
Every minute, three more people are diagnosed with diabetes. While
nearly 26 million Americans have diabetes today, this number is
expected to grow to 44 million in the next 25 years if present trends
continue. Every 24 hours, 230 people with diabetes will undergo an
amputation, 120 people will enter end-stage kidney disease programs and
55 people will go blind from diabetes. Every single day, diabetes costs
our country over a half a billion dollars, yet, that is but a fraction
of the costs we face unless we immediately take action to stop the
march of this epidemic.
Given the toll the diabetes epidemic imposes on the Nation's health
and economy and the promise of public diabetes research and public
health initiatives, the American Diabetes Association (Association)
respectfully requests programs at the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK) at the National Institutes of
Health (NIH) and the Division of Diabetes Translation (DDT) at the
Centers for Disease Control and Prevention (CDC) be top priorities in
fiscal year 2012. As the Nation's leading non-profit health
organization providing diabetes research, information and advocacy, the
Association believes Federal funding for diabetes prevention and
research is critical, not only for the 26 million American adults and
children (8 percent of the population) who currently have diabetes, but
for the 79 million more with prediabetes, a condition placing them at
high risk for developing diabetes.
The Association acknowledges the challenging fiscal climate and
supports fiscal responsibility, but not at the expense of America's
health and well-being. Simply put, our country cannot afford the
consequences of failing to adequately fund diabetes research and
programs, a cost paid in expensive complications and death. We cannot
afford to turn our backs on the promising research which provides tools
to prevent diabetes, better manage it and prevent complications, and
bring us closer to a cure.
Therefore, the Association urges the Senate LHHS Subcommittee to
invest in research and prevention proportionate to the magnitude of the
burden diabetes has on our country and, by doing so, to change the
future of diabetes in America.
Diabetes is a chronic disease that impairs the body's ability to
use food for energy. The hormone insulin, which is made in the
pancreas, is needed for the body to change food into energy. In people
with diabetes, either the pancreas does not create insulin, which is
type 1 diabetes, or the body does not create enough insulin and/or
cells are resistant to insulin, which is type 2 diabetes. If left
untreated, diabetes results in too much glucose in the blood stream.
The majority of diabetes cases, 90 to 95 percent, are type 2, while
type 1 diabetes accounts for 5 percent of diagnosed cases.
Additionally, based on new diagnostic criteria, it is now estimated
that 18 percent of pregnancies are affected by gestational diabetes. In
the short term, blood glucose levels that are too high or too low (as a
result of medication to treat diabetes) can be life threatening. The
long-term complications of diabetes are widespread, serious--and
deadly. In those with prediabetes, blood glucose levels are higher than
normal and taking action to reduce their risk of developing diabetes is
essential.
The Centers for Disease Control and Prevention (CDC) has identified
diabetes as a disabling, deadly epidemic, which is on the rise. Between
1990 and 2001, the prevalence of diabetes increased by 60 percent.
According to the CDC, one in three adults will have diabetes in 2050 if
present trends continue. This number is even greater among minority
populations, where nearly one in two adults will have diabetes in 2050.
Additionally, type 2 diabetes, traditionally seen in older
patients, is beginning to reach a younger population, due in part to
the surge in childhood obesity. Approximately one in every 400 children
and adolescents has diabetes, and an alarming 2 million adolescents (or
1 in 6 overweight adolescents) aged 12-19 have prediabetes. The impact
diabetes has on individuals and the healthcare system is enormous and
continues to grow at a shocking rate. Diabetes is the leading cause of
kidney failure, new cases of adult-onset blindness and non-traumatic
lower limb amputations as well as a significant cause of heart disease
and stroke.
In addition to the physical toll, diabetes also attacks our
pocketbooks. A study by the Lewin Group found when factoring in the
additional costs of undiagnosed diabetes, prediabetes, and gestational
diabetes, the total cost of diabetes and related conditions in the
United States in 2007 was $218 billion ($18 billion for undiagnosed
diabetes; $25 billion for prediabetes; $623 million for gestational
diabetes). In 2007, medical expenditures due to diabetes totaled $116
billion, including $27 billion for diabetes care, $58 billion for
chronic diabetes-related complications, and $31 billion for excess
general medical costs. Indirect costs resulting from increased
absenteeism, reduced productivity, disease-related unemployment
disability and loss of productive capacity due to early mortality
totaled $58 billion. Approximately one out of every five healthcare
dollars is spent caring for someone with diagnosed diabetes, while one
in ten healthcare dollars is directly attributed to diabetes. Further,
one-third of Medicare expenses are associated with treating diabetes
and its complications.
Despite these numbers, there is hope. A greater Federal investment
in diabetes research at the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) at the National Institutes of
Health (NIH), and prevention, surveillance, control, and research work
currently being done at the Division of Diabetes Translation (DDT) at
the CDC is crucial for finding a cure and improving the lives of those
living with, or at risk for, diabetes. Additionally, the National
Diabetes Prevention Program is poised to dramatically cut the number of
new diabetes cases in high-risk individuals. Accordingly, for fiscal
year 2012, the American Diabetes Association is requesting:
--$2.209 billion for the NIDDK, an increase of $267 million over the
fiscal year 2011 level. This additional funding will act to
offset years of decreased or flat funding combined with
inflation that has lead to cutbacks in promising research. It
will also demonstrate Congress's commitment to science and
research in the face of this deadly epidemic.
--$86.1 million for the DDT, which represents a total increase of
$21.3 million over the fiscal year 2011 level for the DDT's
critical prevention, surveillance and control programs. Even as
proposals to consolidate the CDC's chronic disease programs
including DDT circulate, expanded investment in the DDT will
produce much larger savings in reduced acute, chronic, and
emergency care spending.
--$80 million for the implementation of the National Diabetes
Prevention Program through the Prevention and Public Health
Fund.
NIH's National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK)
The NIDDK is poised to make major discoveries to prevent diabetes,
better treat its complications, and--ultimately--find a cure.
Researchers supported by the NIH are working on a variety of projects
representing hope for the millions of individuals with both type 1 and
type 2 diabetes. While the list of advances in treatment and prevention
is long, much more can be achieved for people with diabetes with an
increased investment in scientific research at the NIDDK.
Thanks to research at the NIDDK, people with diabetes now manage
their disease with a variety of insulin formulations and regimens far
superior to those used in decades past. The result is the ability to
live healthier lives with diabetes. Because of these advances, my
hemoglobin A1C, which provides a snapshot of an individual's blood
glucose, went from 12.9 percent, a very dangerous level, to 5.9
percent, an accomplishment that provides me with hope of avoiding
diabetes's devastating complications. This is a dramatic development
for me and proof of the importance of NIDDK's work.
Recent discoveries at the NIDDK include the ability to predict type
1 diabetes risk, new drug therapies for type 2 diabetes, and the
discovery of genetic markers explaining the increased burden of kidney
disease among African Americans. The NIDDK funded the Diabetes
Prevention Program, a multicenter clinical research trial, which found
modest weight loss through dietary changes and increased physical
activity could prevent or delay the onset of type 2 diabetes by 58
percent. While great strides have been made in diabetes research, there
are many unanswered questions about the disease meriting further study.
Diabetes researchers across the country are poised to expand the base
of knowledge of diabetes in order to make new discoveries transforming
diabetes prevention and care.
Increased fiscal year 2012 funding would allow the NIDDK to support
additional research in order to build upon past successes, improve
prevention and treatment, and close in on a cure. For example,
additional funding will support a new comparative effectiveness
clinical trial testing different medications for type 2 diabetes, a
process that is instrumental in finding the most effective treatments
for type 2 diabetes. fiscal year 2012 funding will also support
researchers who are studying how insulin-producing beta cells develop
and function, with an ultimate goal of creating therapies for replacing
damaged or destroyed beta cells in people with diabetes. Finally,
additional funding will support ongoing studies outlining environmental
triggers of disease, which could identify an infectious cause of type 1
diabetes and lead to a vaccine.
CDC's Division of Diabetes Translation (DDT)
The Senate Appropriations Committee's fiscal year 2011 bill
provided increased resources to address chronic diseases through the
creation of the Chronic Disease Initiative (CDI) at CDC. In approving
the fiscal year 2011 LHHS bill, the full Committee acknowledged chronic
disease programs, including the diabetes programs traditionally
operated through the DDT, have been woefully underfunded to adequately
address the trajectory and scope of diabetes and other diseases
including heart disease, stroke and arthritis.
This year, ideas continue to circulate to consolidate programs at
CDC, including DDT. While we think coordination across chronic disease
programs at CDC is an important endeavor, Congress must ensure the
needs of people with, and at risk for, diabetes are adequately
addressed. Given DDT funding has not kept pace with the magnitude of
the growing diabetes epidemic, the Federal investment in DDT programs
should be substantially increased--at a minimum to $86.1 million in
fiscal year 2012--regardless of the organization of chronic disease
programs at CDC or in any consolidation plan. As the dialogue continues
about how best to address chronic disease prevention, DDT should be the
centerpiece in the Federal Government's efforts in this regard and its
State and national expertise should be maintained.
Preserving the DDT's expertise is vital. The Division works to
eliminate the preventable burden of diabetes through proven educational
programs, best practice guidelines and applied research. It performs
vital work in both primary prevention of diabetes and in preventing its
complications. Both key missions must continue. Funds appropriated to
DDT focus on developing and maintaining State-based Diabetes Prevention
and Control Programs (DPCPs), supporting the National Diabetes
Education Program (NDEP), defining the diabetes burden through the use
of public health surveillance, and translating research findings into
clinical and public health practice. Our request of an additional $21.3
million will allow these programs at DDT to reach more at-risk
Americans and help to prevent or delay this destructive disease and its
complications.
DDT's Diabetes Prevention and Control Programs, located in all 50
States, the District of Columbia, and U.S. territories, work to prevent
diabetes, to lower blood glucose and cholesterol levels and to reduce
diabetes-related emergency room visits and hospitalizations. DDT also
plays a leadership role in the dissemination of diabetes prevention and
treatment information through the National Diabetes Education Program,
a joint effort of DDT and NIDDK. Funding for the DDT also supports
vital and groundbreaking translational research like the Search for
Diabetes in Youth study, collaboration between DDT and NIDDK designed
to determine the impact of type 2 diabetes in youth in order to improve
prevention efforts aimed at young people. DDT is also engaged in
efforts to eliminate diabetes related disparities in vulnerable
populations that bear a disproportionate burden of the disease in urban
and rural areas. Finally, DDT maintains vital diabetes data at the
State and national levels through the National Diabetes Surveillance
System, which helps determine how best to deploy resources in the most
appropriate and cost-effective way.
Although DDT has played an instrumental role in fighting the
diabetes epidemic, the reach of the Division could be significantly
broader with additional fiscal year 2012 funding. With an additional
$21.3 million, the DDT will be able to expand the reach of DPCPs in
every State and territory. Given the dramatic decreases in funding for
State and local health departments, supporting the work of the DPCPs is
more critical than ever to ensure access to diabetes care and services.
Increased funding for DDT is needed to allow the Division to build
upon its work in reducing health disparities through vital programs
such as the Native Diabetes Wellness Program, furthering the
development of effective health promotion activities and messages
tailored to American Indian/Native Alaskan communities. Additional
resources will enable the DDT to expand its translational research
studies, leading to improved public health interventions.
The National Diabetes Prevention Program
Further studies of the Diabetes Prevention Program by the CDC have
shown this groundbreaking intervention can be replicated in community
settings for a cost of less than $300 per participant. With this in
mind, the National Diabetes Prevention Program was authorized by the
Patient Protection and Affordable Care Act of 2010. This program will
provide funding to the CDC to expand such evidence-based programs
across the country. We ask the Committee to direct $80 million from the
Fund for the National Diabetes Prevention Program.
The National Diabetes Prevention Program supports the creation of
community-based sites where trained staff will provide those at high
risk for diabetes with cost-effective, group-based lifestyle
intervention programs. Local sites will be required to provide detailed
program plans, ensure adequate training, and be rigorously evaluated
based on the achievement of required standards and goals. The program
also includes applied research grants, which will advance the national
strategy for community-based programs and improve communication
strategies for high-risk communities.
The Fund seeks to make a national investment in prevention and
public health programs, both to improve the health of Americans and to
rein in healthcare costs. The National Diabetes Prevention Program is
exactly the program the Fund should be supporting. The NIH did research
in the clinical setting--it worked. The CDC translated this research to
the community setting--it worked. It is an amazingly inexpensive proven
means of combating a growing epidemic. Indeed, the Urban Institute has
estimated a nationwide expansion of this type of diabetes prevention
program will save a total of $190 billion over 10 years. Based on
estimates that a large portion of burden of chronic disease falls on
the poor and elderly, the Institute's report assumes 75 percent of this
savings would be savings to Medicare or Medicaid.
Conclusion
As you consider the fiscal year 2012 appropriation for NIDDK, and
DDT, and the National Diabetes Prevention Program, we ask you to
consider diabetes is an epidemic growing at an astonishing rate, which
will overwhelm the healthcare system with tragic consequences unless we
take action. To change this future, we must increase our commitment to
research and prevention to reflect the burden diabetes poses both for
us and for our children. Our fight against diabetes must be
significantly expanded. Your leadership in combating this growing
epidemic is essential. Thank you for your commitment to the diabetes
community and for the opportunity to submit this testimony. The
Association is prepared to answer any questions you might have on these
important issues.
______
Prepared Statement of the American Foundation for Suicide Prevention
Chairman Harkin, Ranking Member Shelby and members of the
Committee. The American Foundation for Suicide Prevention (AFSP) thanks
you for the opportunity to provide testimony on the funding needs of
Federal Agencies and programs that play a critical role in suicide
prevention efforts.
AFSP is the leading national not-for-profit organization
exclusively dedicated to understanding and preventing suicide through
research, education and advocacy, and to reaching out to people with
mental disorders and those impacted by suicide. You can find more
information at www.asfp.org and www.spanusa.org.
Preliminary data from the Centers for Disease Control for 2009
shows that suicide is the 10th leading cause of death in the United
States (36,547) and the third leading cause of death in teens and young
adults from ages 15-24. Nearly 1.1 million Americans attempt suicide
each year and another 8 million have suicidal thoughts. Suicide in 1
year costs the United States $13 billion in lost earnings, 1 million
years of lost life and suicide attempts requiring hospitalization
amount to $3.54 billion in lost medical and work-loss costs.
In order to more effectively combat this public health crisis, AFSP
urges the Committee approve funding at the levels requested for the
following programs/agencies for fiscal year 2012:
Garrett Lee Smith Memorial Act Programs
We respectfully request that Garrett Lee Smith Memorial Act (GLSMA)
youth suicide prevention grant programs receive $53.2 million for
fiscal year 2012.
Since 2005, the Substance Abuse and Mental Health Services
Administration (SAMHSA) has awarded GLSMA grants to 45 State programs,
12 tribal programs, and 78 colleges and universities for programs to
help reduce youth suicides rates. State grantees include: Alaska,
Arizona, Colorado, Connecticut, District of Columbia, Delaware,
Florida, Georgia, Guam, Hawaii, Iowa, Idaho, Indiana, Kentucky,
Louisiana, Massachusetts, Maryland, Maine, Michigan, Missouri,
Mississippi, North Carolina, North Dakota, Nebraska, New Hampshire, New
Mexico, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode
Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia,
Vermont, Washington, Wisconsin, West Virginia, and Wyoming.
Funding for the Act is directed to three programs administered by
SAMHSA. We request $5 million for the Suicide Prevention Technical
Assistance Center to support its mission of providing technical
assistance and support to grantees. We request $42 million for the
Youth Suicide Early Intervention and Prevention Strategies grant
program. These grants help States and tribes develop and implement
statewide youth suicide early intervention and prevention strategies
that will raise awareness and educate people about mental illness and
the risk of suicide, help young people at risk of suicide take the
first step toward seeking help, and allow States to expand access to
treatment options. Finally, we request $6.2 million to fund the Mental
and Behavioral Health Services on Campus matching-grant program for
colleges and universities to help raise awareness about youth suicide,
as well as enable those institutions to train students and faculty to
identify and intervene when youth are in crisis, and develop a system
to refer students for care.
Support Federal Investment in Suicide Prevention Research at NIMH for
Fiscal Year 2012
Strategic investments in disease research have produced declines in
deaths, and the same types of investments are necessary to reduce
deaths by suicide. In fiscal year 2010 (latest data) only $41 million
was devoted directly to suicide research. AFSP urges Congress to
increase the investment in suicide prevention research at the National
Institutes of Mental Health by 15 percent, or $6.15 million.
It is illuminating to compare the number of suicide deaths with the
number of deaths in several major disease categories against the direct
dollars spent on research in those areas (see below). In fact, the
Institute of Medicine, in their 2002 report ``Reducing Suicide: A
National Imperative,'' stated the following: ``There is every reason to
expect that a national consensus to declare war on suicide and to fund
research and prevention at a level commensurate with the severity of
the problem will be successful, and will lead to highly significant
discoveries as have the wars on cancer, Alzheimer's disease, and
AIDS.''
Maintain Vital Funding for SAMHSA Suicide Prevention Programs and
Mental Health Services
As the lead Government agency charged with implementation of
suicide prevention initiatives, AFSP urges this Committee to provide
$3.387 billion for SAMHSA in fiscal year 2012. By this action Congress
will recognize the important role SAMHSA plays in healthcare delivery
and mental health services.
As the lead Government agency charged with implementation of
suicide prevention initiatives, SAMHSA has supported the establishment
of a national toll-free hotline (the National Suicide Prevention
Lifeline), a technical assistance center (the Suicide Prevention
Resource Center), and a youth suicide prevention grant program for
States and colleges (authorized and funded under the Garrett Lee Smith
Memorial Act). Since its launch in January 2005, the Suicide Prevention
Lifeline has answered more than 1 million calls and has 140 active
crisis centers in 48 States. Beginning in 2008, SAMHSA's National
Survey on Drug Use and Health asked respondents about suicide attempts
and whether or not they had previously acknowledged major depression.
This was an important first step forward in suicide surveillance,
promoting greater attention to the interrelationship of suicide,
substance abuse and depression. Moreover, the Agency also has been
supporting the identification, development and promotion of best
practices in suicide prevention, focusing on risk and protective
factors related to suicide, with particular attention to mental health
and substance abuse issues affecting suicide risk.
Support Federal Investment in Data Collection in Fiscal Year 2012
To design effective suicide prevention strategies, we must first
have complete, accurate and timely information about deaths by suicide.
The National Violent Death Reporting System (NVDRS) provides this
information, which is essential to improve State and Federal suicide
prevention activities. Current funding of $3.5 million allows only 18
States to participate in this program. This Committee approved an
additional $1.5 million in fiscal year 2011; however, the bill never
got signed into law. AFSP urges this Committee to appropriate the full
$5 million for the NVDRS in fiscal year 2012.
Provide Funding for Depression Centers of Excellence (DCOE)
This Committee included $10 million for the DCOE in the fiscal year
2011 mark up as a down payment toward studying Depression, the most
common psychiatric diagnosis associated with suicide. AFSP urges
Congress to appropriate funds to the DCOE at the highest levels
possible in fiscal year 2012.
Depression Centers of Excellence would increase access to the most
appropriate and evidence-based depression care and develop and
disseminate evidence-based treatment standards to improve accurate and
timely diagnosis of depression and bipolar disorders. Additionally,
they would create a national database for large-sample effectiveness
studies and a repository of evidence-based interventions and programs
for depression and bipolar disorders. They would also utilize the
network of centers as an ongoing national resource for public and
professional education and training, with the goal of advancing
knowledge and eradicating stigma of these mental disorders.
Chairman Harkin, Ranking Member Shelby and Members of the
Committee. AFSP once again thanks you for the opportunity to provide
testimony on the funding needs of Federal Agencies and programs that
play a critical role in suicide prevention efforts.
Suicide robs families, communities and societies of tens of
thousands of its citizens. In a single year, in the United States
alone, suicide is responsible for the deaths of over 36,000 people of
all ages and costs an estimated $13 billion in lost income. With your
help, we can assure those tasked with leading the Federal Government's
response to this public health crisis will have the resources necessary
to effectively prevent suicide.
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Prepared Statement of the American Geriatrics Society
Mr. Chairman and Members of the Subcommittee: We are writing on
behalf of the American Geriatrics Society (AGS), a nonprofit
organization of over 6,000 geriatrics healthcare professionals
dedicated to improving the health, independence and quality of life of
all older Americans. As the Subcommittee begins to work on its Labor-
HHS-Education Appropriations bill, we ask that you prioritize funding
for the geriatrics education and training programs under Title VII and
Title VIII of the Public Health Service Act and for research funding
within the National Institute on Aging in fiscal year 2012.
Continued Federal investments are needed to support the training of
the healthcare workforce and to foster groundbreaking medical research
so that our Nation is prepared to meet the unique healthcare needs of
the rapidly growing population of seniors. While we fully recognize the
fiscal challenges facing our Nation, we also recognize that sustained
and enhanced Federal investments in these initiatives are essential to
fulfilling the promise of health reform to deliver higher quality and
better coordinated care to our Nation's seniors.
We ask that the subcommittee consider the following recommended
funding levels for these programs in fiscal year 2012 $46.5 million for
Title VII Geriatrics Health Professions Programs, $5 million for Title
VIII Comprehensive Geriatric Education Nursing Program, and $1.4
billion for the National Institute on Aging.
Summarized and broken down below are the American Geriatrics
Society's funding priorities in these areas for fiscal year 2012.
Programs to Train Geriatrics Health Care Professionals
This year, the first wave of baby boomers turn 65, signaling the
start of a significant demographic shift in America's population.
According to the Institute of Medicine's (IOM) ground-breaking 2008
report, Retooling for an Aging America: Building the Healthcare
Workforce, America's healthcare workforce is woefully ill-prepared to
care for the growing and unprecedented number of seniors, especially
those with multiple chronic and complex medical conditions.
The increase in the older adult population is expected to be even
greater in rural America, which are more likely to experience poor
health and a shortage of healthcare resources. Not only are
geriatricians few in number, but they are largely concentrated in urban
areas. Of further concern, our Nation is facing a critical shortage of
geriatrics faculty and healthcare professionals across disciplines. At
the same time, the Title VII and VIII geriatrics programs under the
Public Health Service Act have remained essentially level-funded since
fiscal year 2007 and in each subsequent year the geriatrics programs
have received an even smaller percentage of funding provided to Title
VII and VIII programs.
This trend must be reversed if we are to provide our seniors with
the quality care they need and deserve. AGS believes it is critical
that Congress increase the percentage of Title VII and VIII funding
that is devoted to supporting increasing the capacity of America's
healthcare workforce to care for older adults. Care provided by
geriatric healthcare professionals, who understand the most complex
cases and the most frail elderly, has shown to reduce those common and
costly conditions that are often preventable with appropriate care,
such as falls, polypharmacy, and delirium.
Title VII Geriatrics Health Professions Programs ($46.5
million)
Funding for Title VII Geriatrics Health Professions Programs is a
proven investment in ensuring that older adults receive high quality
healthcare now and in the future. These programs support three
initiatives: the Geriatric Academic Career Awards (GACAs), the
Geriatric Education Center (GEC) program, and geriatric faculty
fellowships, the only programs specifically designed to address the
evident shortage of geriatrics healthcare professionals in the United
States. Strong and sustained investments are important to reversing the
chronic under-funding of these essential programs at a time when our
Nation is facing a critical shortage of geriatrics healthcare
professionals across disciplines. We ask the subcommittee to provide a
fiscal year 2012 appropriation of $46.5 million for Title VII
Geriatrics Health Professions Programs.
Our funding request of $46.5 million breaks down as follows:
--Geriatric Academic Career Awards (GACAs) ($5.3 million).--GACAs
support the development of newly trained geriatric physicians
in academic medicine who are committed to teaching geriatrics
in medical schools across the country. GACA recipients are
required to provide training in clinical geriatrics, including
the training of interdisciplinary teams of healthcare
professionals. Under ACA, GACAs have been expanded to a variety
of new disciplines beyond physicians, including those in
nursing, social work, psychology, dentistry, and pharmacy. AGS
has long advocated for this change. We must now ensure that
there is adequate funding to meet the increased demand given
the greater number of disciplines eligible for the award. A
budget of $5.3 million would support 68 awardees at $78,000 per
award.
Program Accomplishments.--In Academic Year 2009-2010, there were
84 non-competing continuation awards. GACA awardees provided
interdisciplinary training in geriatrics training to about
60,000 health professionals. These awardees provided culturally
competent quality healthcare to over 525,000 underserved and
uninsured patients in acute care services, geriatric ambulatory
care, long-term care, and geriatric consultation services
settings.
--Geriatric Education Centers (GECs) ($22.7 million).--GECs provide
grants to support collaborative arrangements involving several
health professions, schools and healthcare facilities to
provide multidisciplinary training in geriatrics, including
assessment, chronic disease syndromes, care planning, emergency
preparedness, and cultural competence unique to older
Americans. Under ACA, Congress authorized $10.8 million over 3
years for a supplemental grant award program that will train
additional faculty through an intensive short-term fellowship
program and also requires faculty to provide training to family
caregivers and direct-care workers. Our funding request of
$22.7 million includes continued support for the core work of
45 GECs and for up to 24 GECs to be funded to undertake the
work through the supplemental grant program.
Program Accomplishments.--In Academic Year 2009-2010, the GEC
grantees provided clinical training to 54,167 health
professional students and to 20,791 interdisciplinary teams in
multiple settings.
--Geriatric Training Program for Physicians, Dentists, and Behavioral
and Mental Health Professions ($8.5 million).--This program is
designed to train physicians, dentists, and behavioral and
mental health professionals who choose to teach geriatric
medicine, dentistry or psychiatry. The program provides fellows
with exposure to older adult patients in various levels of
wellness and functioning, and from a range of socioeconomic and
racial/ethnic backgrounds. Our funding request of $8.5 million
will allow 13 institutions to continue this important faculty
development program.
Program Accomplishments.--In Academic Year 2009-2010, 11 non-
competing continuation grants were supported. Forty-nine
physicians, dentists, and psychiatric fellows provided
geriatric care to 20,078 older adults across the care
continuum. Geriatric physician fellows provided healthcare to
12, 254 older adults. Geriatric dental fellows provided
healthcare to 4,073 older adults. Geriatric psychiatry fellows
provided healthcare to 3,751 older adults.
--Geriatric Career Incentive Awards Program ($10 million).--This is a
new grant award program created under ACA to foster greater
interest among a variety of health professionals in entering
the field of geriatrics, long-term care, and chronic care
management. AGS supports the President's fiscal year 2012
request of $10 million to implement this new program.
Title VIII Comprehensive Geriatric Education Nursing
Program ($5 million)
The American healthcare delivery system for older adults will be
further strengthened by Federal investments in Title VIII Nursing
Workforce Development Programs, specifically the comprehensive
geriatric education grants, as nurses provide cost-effective, quality
care. Increasing funding for the nursing comprehensive geriatric
education program would be highly cost effective. This program supports
additional training for nurses who care for the elderly, development
and dissemination of curricula relating to geriatric care, and training
of faculty in geriatrics. It also provides continuing education for
nurses practicing in geriatrics.
Under the new health reform law, this program is being expanded to
include advanced practice nurses who are pursuing long-term care,
geropsychiatric nursing or other nursing areas that specialize in the
care of older adults. Our funding request of $5 million includes funds
to continue the training of nurses caring for older Americans offer 200
traineeships to nurses under this newly expanded program.
Program Accomplishments.--In Academic Year 2009-2010, 27 CGEP
grantees provided education and training to 3,030 Registered Nurses/
Registered Nursing Students; 260 Advanced Practice Nurses; 221 Faculty;
110 Home Health Aides; 483 Licensed Practical/Vocational Nurses & LPN
students; 730 Nurse Assistants/Patient Care Associates; 810 Allied
Health Professionals and 929 lay persons, guardians, activity
directors. The CGEP grantees provided 459 educational course offerings
in the care of the elderly on a variety of topics to 6,846
participants.
Research Funding Initiatives
National Institute on Aging ($1.4 billion)
The NIA leads a broad scientific effort to understand the nature of
aging and to extend the healthy, active years of life. Robust medical
research in aging is critical to the development of medical advances
which will ultimately lead to higher quality and more efficient
healthcare. Continued Federal investments in scientific research,
including comparative effectiveness initiatives, will ensure that the
NIA has the resources to succeed in its mission to establish research
networks, assess clinical interventions and disseminate credible
research findings to patients, providers and payers of healthcare.
As a member of the Friends of the NIA, a broad-based coalition of
more than 45 aging, disease, research, and patient groups committed to
the advancement of medical research that affects millions of older
Americans, AGS asks that NIA receive $1.4 billion in fiscal year 2012.
Alternatively, in light of our Nation's immediate budget constraints,
we request that that the NIA be funded at no less than the $1.29
billion, as requested in the President's fiscal year 2012 budget.
According to the Congressional Research Service, in fiscal year
2003, NIH reached the peak of its purchasing power from regular
appropriations when Congress completed a 5-year doubling of the NIH
budget. In each year since then, NIH's buying power has declined
because its annual appropriations have grown at a lower rate than the
inflation rate for medical research.
Essentially flat funding of NIH since 2003 has additionally led to
declining numbers of young investigators choosing research careers,
given the scarcity of funding to support their career development. We
must provide the resources and tools to support the next generation of
investigators and expand the pool of clinical researchers focused on
advancing aging research.
The ongoing Federal commitment to investments in science, research,
and technology lead to cutting-edge breakthroughs in medicine and
improved patient care. AGS urges Congress to maintain this commitment
in fiscal year 2012 and beyond, so that we may continue to advance
medicine to improve the quality of care of our Nation's older adults
and the long-term goals of health reform can be fully achieved.
In closing, geriatrics is at a critical juncture, with our Nation
facing an unprecedented increase in the number of older patients with
complex health needs. Strong support such as yours will help ensure
that the promise of health reform is fulfilled and every older American
is able to receive high-quality healthcare.
Thank you for your consideration.
______
Prepared Statement of the American Heart Association
Over the past 50 years, major progress has been made in the battle
against heart disease, stroke and other forms of cardiovascular disease
(CVD). Improved diagnosis and treatment have been remarkable--as has
the survival rate. According to the National Institutes of Health
(NIH), since the 1960s, 1.6 million lives have been saved that would
have been lost to CVD. Americans can now expect to live on average 4
years longer due to the reduction in heart-related deaths.
Yet, one startling fact remains. Heart disease and stroke are still
respectively the No. 1 and No. 3 killers in the United States. Nearly
2,200 people die of CVD each day--one death every 39 seconds. CVD is a
major cause of disability and costs our Nation more than any disease--a
projected $287 billion in medical expenses and lost productivity for
2007. Today, an estimated 83 million adults suffer from CVD. Moreover,
CVD risk factors such as obesity and high blood pressure are on the
rise. At age 40, the lifetime risk for CVD is 2 in 3 for men and over 1
in 2 for women.
Moreover, a new study projects that more than 40 percent of adults
in the United States will live with the consequences of CVD at a cost
to exceed $1 trillion annually by the year 2030. The graying of
Americans combined with the explosive growth in medical spending are
the main drivers of increased costs. Our country is truly facing a
crisis. Without prevention on a nationwide scale, managing CVD will be
an enormous challenge. Clearly, there must be a greater emphasis on
prevention and evidence-based approaches to healthy behaviors. This
will require strategies to reach people where they live, work and play.
Prevention must be an integral part of our toolkit to promote heart
healthy and stroke-free habits and wellness at an early age.
Yet, in the face of these statistics, heart disease and stroke
research, treatment and prevention programs remain woefully underfunded
and money for NIH is unpredictable for the continuity of effort needed
for key advances to redefine disease, ramp up prevention and promote
best care.
Given CVD is the No. 1 killer in each State and preventable and
treatable risk factors continue to rise, many are surprised that the
Centers for Disease Control and Prevention (CDC) invests on average
only 16 cents per person on heart disease and stroke prevention. Also,
only 20 States are funded for WISEWOMAN--a proven heart disease and
stroke prevention program that serves uninsured and under-insured low-
income women with a high prevalence of CVD risk factors.
Where you live could also affect if you survive a very deadly form
of heart disease--sudden cardiac arrest (SCA). Only 21 States received
funding in fiscal year 2010 for the Health Resources and Services
Administration's (HRSA) Rural and Community Access to Emergency Devices
Program designed to save lives from sudden cardiac death.
The American Heart Association applauds the administration and
Congress for providing hope to the 1 in 3 adults in the United States
who live with CVD by wisely investing in the NIH and in the Prevention
and Public Health Fund. These resources have provided a much needed
boost to improve our Nation's physical and fiscal health. However,
stable and sustained funding is critical for fiscal year 2012 to
advance heart disease and stroke research, prevention and treatment.
funding recommendations: investing in the health of our nation
Heart disease and stroke risk factors continue to rise, yet
promising research to stem this tide goes unfunded. Too many Americans
die from CVD, while proven prevention efforts beg for resources for
widespread implementation. Now is the time to boost research,
prevention and treatment of America's No. 1 and most costly killer. If
Congress fails to build on progress of the past half century, Americans
will pay more in lives lost and higher healthcare costs. Our
recommendations address these issues in a comprehensive and fiscally
responsible manner.
Capitalize on Investment for the National Institutes of Health (NIH)
NIH research has revolutionized patient care and holds the key to
finding new ways to prevent, treat and even cure CVD, resulting in
longer, healthier lives and reduced healthcare costs. NIH invests
resources in every State and in 90 percent of congressional districts.
According to a 2008 study, the typical NIH grant paid the salaries of
about 7 mainly high-tech full-time or part-time jobs in fiscal year
2007. Further, every dollar that NIH distributes in a grant returns
$2.21 in goods and services to the local community in 1 year.
American Heart Association Advocates.--We advocate for a fiscal
year 2012 appropriation of $35 billion for NIH to capitalize on the
investment to save lives, advance better health, spur our economy and
spark innovation. NIH research prevents and cures disease, generates
economic growth and preserves the U.S. role as the world leader in
pharmaceuticals and biotechnology.
Enhance Funding for NIH Heart and Stroke Research: A Proven and Wise
Investment
From 1997 to 2007, death rates for coronary heart disease and
stroke fell nearly 28 percent and 45 percent, respectively. However,
there is still much more to be done to improve the lives of heart
disease and stroke patients--and more importantly to prevent CVD and
stroke in the first place. Research will help lead the way. These
declines in mortality are directly related to NIH heart and stroke
research, with scientists on the verge of exciting discoveries that
could lead to new treatments and even cures. For example, the biggest
U.S. stroke rehabilitation study showed that patients who receive home
physical therapy improve walking skills just as effectively as those
treated in a program and that the progress continued up to 1 year post-
stroke. NIH research has also demonstrated that over-zealous blood
pressure lowering and combination lipid drugs did not cut
cardiovascular disease in adult diabetics more than standard evidence-
based care. Moreover, studies have defined the genetic basis of risky
responses to vital blood-thinners.
In addition to saving lives, NIH-funded research can cut healthcare
costs. For example, the original NIH tPA drug trial resulted in a 10-
year net $6.47 billion reduction in stroke healthcare costs. Also, the
Stroke Prevention in Atrial Fibrillation Trial 1 produced a 10-year net
savings of $1.27 billion. Yet, in the face of such solid returns on
investments and other successes, NIH still invests a meager 4 percent
of its budget on heart research, and a mere 1 percent on stroke
research.
Cardiovascular Disease Research: National Heart, Lung, and Blood
Institute (NHLBI)
Even in the face of progress and promising research opportunities,
there is no cure for CVD. As our population ages, demand will only
increase to find better ways for Americans to live healthy and
productive lives despite CVD. Stable and sustained funding is needed to
allow NHLBI to build on investments that provided grants to use
genetics to identify and treat those at greatest risk from heart
disease; hasten drug development to treat high cholesterol and high
blood pressure; and create tailored strategies to treat, slow or
prevent heart failure. Other key studies include an analysis of whether
maintaining a lower blood pressure than currently recommended further
reduces risk of heart disease, stroke, and cognitive decline. This
information is vital to manage the burden of heart disease and stroke.
Sustained critical funding will allow for aggressive implementation of
other initiatives in the NHLBI and cardiovascular strategic plans.
Stroke Research: National Institute of Neurological Disorders and
Stroke (NINDS)
An estimated 795,000 people in this country will suffer a stroke
this year, and more than 135,950 will die. Many of the 7 million
survivors face severe physical and mental disabilities, emotional
distress and huge costs--a projected $41 billion in medical expenses
and lost productivity for 2007. A new study projects stroke prevalence
will increase 25 percent over the next 20 years, striking more than 10
million individuals. Over the same time period, direct medical costs
will rise 238 percent.
Stable and sustained funding is required for NINDS to capitalize on
investments to prevent stroke, protect the brain from damage and
enhance rehabilitation. This includes initiatives to: (1) determine if
MRI brain imaging can assist in selecting stroke victims who could
benefit from the clot busting drug tPA beyond the 3-hour treatment
window; (2) assess chemical compounds that might shield brain cells
during a stroke; and (3) advance stroke rehabilitation by studying if
the brain can be helped to ``rewire'' itself after a stroke. Enhanced
funding will also allow for proactive initiation and implementation of
the NINDS' novel stroke planning process (a result of its Stroke
Progress Review Group) to assess the stroke research field and develop
priorities to advance the most promising prevention, treatment,
recovery and rehabilitation research.
The American Heart Association Advocates.--While AHA supports
increased funding for the 18 Institutes and centers that conduct heart
and stroke research, including the National Institute of Diabetes, and
Digestive and Kidney Diseases; and the National Institute on Aging, we
have specific funding recommendations for the NHLBI and the NINDS. AHA
advocates for an fiscal year 2012 appropriation of $3.514 billion for
NHLBI; and $1.857 billion for NINDS.
Increase Funding for the Centers for Disease Control and Prevention
(CDC)
Prevention is the best way to protect the health of all Americans
and reduce the economic burden of CVD. Yet, effective prevention
strategies and programs are not being implemented due to insufficient
resources. The President's 2012 budget proposes a Coordinated Chronic
Disease Prevention and Health Promotion Grant Program. AHA supports
some consolidation of chronic disease programs, but with some important
modifications and caveats. First, CDC must preserve the Division for
Heart Disease and Stroke Prevention. A consolidation must ensure more
predictable and adequate funding to all 50 States, including an annual
share of the Prevention and Public Health Fund, with resources
allocated by formula on the basis of burden, including cost, mortality,
morbidity, and prevalence. These programs must be evidence-based and
targeted, with a focus on capacity, evaluation and surveillance,
including measurable outcomes and a higher level of accountability. To
preserve the best elements of existing programs, funding should
preserve evidenced-based outcomes work across the full spectrum of
prevention and clinical care, including primary and secondary
prevention, acute treatment, rehabilitation and continuous quality
improvement (CQI). Each State must retain staff expertise to
effectively address heart disease and stroke. State-based advisory
groups of stakeholders from each constituency should be formed to help
with plan implementation. A national advisory committee of
constituencies should be created to foster stakeholder involvement.
Matches, including in-kind, should be required when possible to build
support in State health departments. Plans should use some funding for
at least one program on common risk factors to consolidated diseases
that can show a measurable, population-based impact. The rest of the
funds should be spent on effective, evidence-based projects aimed at
secondary prevention, acute treatment, rehabilitation, and CQI.
This CDC division administers WISEWOMAN that serves uninsured and
under-insured low-income women ages 40 to 64 in 20 States. This program
helps them avoid heart disease and stroke by providing preventive
health services, referrals to local healthcare providers, as needed,
and lifestyle counseling and interventions tailored to their identified
risk factors to promote lasting, healthy behavior modifications. From
July 2008 to June 2010, WISEWOMAN reached more than 70,000 low-income
women. During this time period, 89 percent of them had a least one risk
factor and 28 percent had three or more risk factors for heart disease
and stroke. However, more than 43,000 of these women participated in at
least one lifestyle intervention session.
The American Heart Association Advocates.--AHA joins with the CDC
Coalition in advocating for $7.7 billion for the CDC's ``core
programs,'' including increases for the Division of Heart Disease and
Stroke Prevention and WISEWOMAN. AHA recommends $37 million to expand
WISEWOMAN to more States and serve more eligible women in already
funded States. We join the Friends of the NCHS in asking for $162
million for the National Center for Health Statistics.
Restore Funding for Rural and Community Access to Emergency Devices
(AED) Program
About 92 percent of sudden cardiac arrest (SCA) victims die outside
of a hospital. But, prompt CPR and defibrillation, with an automated
external defibrillator (AED), can more than double their chances of
survival. Communities with comprehensive AED programs have reached
survival rates of about 40 percent. HRSA's Rural and Community AED
Program provides grants to States, competitively, to buy AEDs, train
lay rescuers and first responders in their use and place AEDs where SCA
is likely to occur. From September 2007 to August 2008, 3,051 AEDs were
bought and 10,287 people were trained. And, 795 patients were saved
between August 1, 2009 and July 31, 2010. Due to insufficient budgets,
only 21 states received funds for this program in fiscal year 2010.
The American Heart Association Advocates.--For fiscal year 2012,
AHA advocates restoring HRSA's Rural and Community AED Program to its
fiscal year 2005 level of $8.927 million.
Increase Funding for the Agency for Healthcare Research and Quality
(AHRQ)
AHRQ develops scientific evidence to improve healthcare for
Americans. AHRQ provides patients and caregivers with valuable
scientific evidence to make the right healthcare decisions. AHRQ's
research also enhances quality and efficiency of healthcare, providing
the basis for protocols that prevent medical errors and reduce
hospital-acquired infections, and improve patient confidence,
experiences, and outcomes.
The American Heart Association Advocates.--AHA joins Friends of
AHRQ in advocating for $405 million for AHRQ to preserve its vital
initiatives, boost the research infrastructure, spur innovation,
nurture the next generation of scientists and help reinvent health and
healthcare.
conclusion
Cardiovascular disease continues to inflict a deadly, disabling and
costly toll on Americans. Yet, our funding recommendations for NIH, CDC
and HRSA outlined above will save lives and cut rising healthcare
costs. The American Heart Association urges Congress to seriously
consider our suggestions during the fiscal year 2012 appropriations
process. These proposed resources represent a wise investment for our
nation and for the health and well-being of this and future
generations.
______
Prepared Statement of the American Indian Higher Education Consortium
Summary of Requests.--Summarized below are the fiscal year 2012
recommendations of the Nation's Tribal Colleges and Universities
(TCUs), covering three areas within the Department of Education and one
in the Department of Health and Human Services, Administration for
Children and Families' Head Start Program.
department of education programs
Higher Education Act Programs
Strengthening Developing Institutions.--Section 316 of HEA Title
III-A, specifically supports TCUs' grant programs. The TCUs request
that the Subcommittee appropriate $30 million for this critically
important program, the same level included in the President's fiscal
year 2012 budget request.
TRIO Programs.--Retention and support services are vital to
achieving the national goal of having the highest percentage of college
graduates globally by 2020. The President's fiscal year 2012 budget
request includes funding for TRIO programs at fiscal year 2010 levels,
which is not enough to sustain even the current level of program
services. The TCUs support building on the President's fiscal year 2012
budget request for TRIO programs and technical assistance funding so
that these essential program services can be, at a minimum, maintained
at current levels.
Pell Grants.--TCUs urge the Subcommittee to sustain the current
Pell Grant maximum.
Perkins Career and Technical Education Programs
Section 117 of the Carl D. Perkins Career and Technical Education
Act provides a competitively awarded grant opportunity for tribally
chartered and controlled career and technical institutions. AIHEC
requests $8,200,000 to fund grants under Section 117 of the Perkins
Act. Additionally, TCUs strongly support the Native American Career and
Technical Education Program (NACTEP) authorized under Sec tion 116 of
the Perkins Act.
Elementary and Secondary Education Act and Workforce Investment Act
Programs
American Indian Teacher and Administrator Corps.--Authorized in
Title IX of the Elementary and Secondary Education Act (ESEA) the
American Indian Teacher Corps and the American Indian Administrator
Corps offer professional development grants designed to increase the
number of American Indian teachers and administrators serving their
reservation communities. The TCUs request that the Subcommittee
maintain funding for these programs at the fiscal year 2010 level.
Adult and Basic Education.--Despite the loss of Federal funding for
tribal adult basic education (ABE) in fiscal year 1996, there remains
an extremely high demand for ABE programs in the communities that are
home to the TCUs. While TCUs continue to offer adult education; GED;
remediation and literacy services for American Indians, without
dedicated funding these efforts cannot begin to meet demand. The TCUs
request that the Subcommittee direct that $5 million of the funds
appropriated each year for the Adult Education State Grants be made
available to make competitive awards to TCUs to support the vitally
needed reservation-based adult and basic education programs.
department of health and human services program
Tribal Colleges and Universities Head Start Partnership Program (DHHS-
ACF)
Tribal Colleges and Universities are ideal partners to help achieve
the goals of Head Start in Indian Country. The TCUs request that the
Subcommittee direct the Head Start Bureau to make available $5 million,
of the more than $8.1 billion for Head Start included in the
President's fiscal year 2012 budget request or of the amount ultimately
appropriated in fiscal year 2012, for the TCU-Head Start Partnership
program grants. These funds will help to ensure that each of the TCUs
has the opportunity to compete for these much-needed partnership funds,
thereby giving a jump start to the education successes of more American
Indian children growing up in poor and isolated tribal communities.
background on tribal colleges and universities
The Nation's 36 Tribal Colleges and Universities, operating over 75
sites, provide access to quality higher education to 80 percent of
Indian Country. TCUs are 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, they provide high school completion (GED), basic
remediation, job training, college preparatory courses, and adult
education and literacy programs. TCUs 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 and
elder 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 and Universities, 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
effectively blend traditional teachings with conventional postsecondary
curricula. They have developed innovative ways to address the needs of
tribal populations and are overcoming long-standing barriers to success
in higher education for American Indians. Since the first TCU was
established on the Navajo Nation just over 40 years ago, 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.
justifications for fiscal year 2012 appropriations requests for tcus
Tribal colleges and our students are already disproportionately
impacted by efforts to reduce the Federal budget deficit and control
Federal spending. The final fiscal year 2011 continuing resolution
eliminated all of the Department of Housing and Urban Development's MSI
community-based programs, including a critical TCU-HUD facilities
program. TCUs were able to maximize leveraging potential, often
securing even greater non-Federal funding to construct and equip Head
Start and early childhood centers; student and community computer
laboratories and public libraries; and student and faculty housing in
rural and remote communities where few or none of these facilities
existed. Important STEM program operated by the National Science
Foundation and NASA were cut and for the first time since the program
was established in fiscal year 2001, no new TCU-STEM awards, our sole
STEM education program, are scheduled to be made in fiscal year 2011.
Additionally, TCUs and our students suffer the impact of cuts to
programs such as GEAR-UP, TRIO, SEOG, and year-round Pell more
profoundly than do mainstream institutions of higher education, which
have large endowments, alternative funding sources, including the
ability to charge higher tuition rates, enroll more financially stable
students, and affluent alumnae. The loss of opportunity that cuts to
DoEd, HUD, and NSF programs represent to TCUs, and to other MSIs, is
magnified by cuts to workforce development programs within the
Department of Labor, nursing and allied health professions tuition
forgiveness and scholarship programs operated by the Department of
Health and Human Services, and an important TCU-based nutrition
education program planned by USDA. Combined, these cuts strike at the
most economically disadvantaged and health-challenged Americans.
Higher Education Act
In 1998, section 316 within Title III-A of the Higher Education Act
launched a new program specifically for the Nation's Tribal Colleges
and Universities. Programs under Titles III and V of the Act support
institutions that enroll large proportions of financially disadvantaged
students and that have low per-student expenditures. TCUs, which are
truly developing institutions, are providing access to quality higher
education opportunities to some of the most rural, impoverished, and
historically underserved areas of the country. Seven of the Nation's 10
poorest counties are served by TCUs. A stated goal of the Higher
Education Act Title III programs is ``to improve the academic quality,
institutional management and fiscal stability of eligible institutions,
in order to increase their self-sufficiency and strengthen their
capacity to make a substantial contribution to the higher education
resources of the Nation.'' The TCU Title III-A program is specifically
designed to address the critical, unmet needs of their American Indian
students and communities, in order to effectively prepare them to
succeed in a global, competitive workforce. Yet, in fiscal year 2011
this critical program was cut by 11 percent. The TCUs urge the
Subcommittee to appropriate $30 million in fiscal year 2012 for HEA
Title III-A section 316, which is slightly less than the fiscal year
2010 appropriated funding level and the same as the President's fiscal
year 2012 budget request.
Retention and support services are vital to achieving the national
goal of having the highest percentage of college graduates globally, by
2020. The TRIO-Student Support Services program was created out of
recognition that college access was not enough to ensure advancement
and that multiple factors worked to prevent the successful completion
of higher education for many low-income and first-generation students
and students with disabilities. Therefore, in addition to maintaining
the maximum Pell Grant award level, it is critical that Congress also
sustains student assistance programs such as Student Support Services
and Upward Bound so that low-income and minority students have the
support necessary to allow them to persist in and complete their
postsecondary courses of study.
The importance of Pell Grants to TCU students cannot be overstated.
U.S. Department of Education figures show that the majority of TCU
students receive Pell Grants, primarily because student income levels
are so low and our students have far less access to other sources of
financial aid than students at State-funded and other mainstream
institutions. Within the TCU system, Pell Grants are doing exactly what
they were intended to do--they are serving the needs of the lowest
income students by helping them gain access to quality higher
education, an essential step toward becoming active, productive members
of the workforce. The TCUs urge the Subcommittee to continue to fund
this critical program at the highest possible level.
Carl D. Perkins Career and Technical Education Act
Tribally Controlled Postsecondary Career and Technical
Institutions.--Section 117 of the Carl D. Perkins Career and Technical
Education Act provides a competitively awarded grant opportunity for
tribally chartered and controlled career and technical institutions.
AIHEC requests $8,200,000 to fund grants under Section 117 of the
Perkins Act, the same level included in the President's fiscal year
2012 budget request.
Native American Career and Technical Education Program.--The Native
American Career and Technical Education Program (NACTEP) under Section
116 of the Act reserves 1.25 percent of appropriated funding to support
American Indian career and technical programs. The TCUs strongly urge
the Subcommittee to continue to support NACTEP, which is vital to the
continuation of the career and technical education programs offered at
TCUs that provide job training and certifications to remote reservation
communities.
Greater Support of Indian Education Programs
American Indian Adult and Basic Education (Office of Vocational and
Adult Education).--This program supports adult basic education programs
for American Indians offered by State and local education agencies,
Indian tribes, agencies, and TCUs. Despite a lack of funding, TCUs must
find a way to continue to provide much-in-demand basic adult education
classes for those American 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, even learn to read. There is an extensive need
for basic adult educational programs and TCUs must have adequate and
stable funding to provide these essential activities. TCUs request that
the Subcommittee direct that $5 million of the funds appropriated
annually for the Adult Education State Grants be made available to make
competitive awards to TCUs to help meet the growing demand for adult
basic education and remediation program services on their respective
reservations.
American Indian Teacher/Administrator Corps (Special Programs for
Indian Children).--American Indians are greatly underrepresented in the
teaching and school administrator ranks nationally. TCUs are community
based institutions of higher education making them ideal catalysts for
these two initiatives because of their current work in this area and
the existing articulation agreements they hold with 4-year degree
granting institutions. The TCUs request that the Subcommittee maintain
these two programs at the fiscal year 2010 appropriated levels to
continue to produce well-qualified American Indian teachers and school
administrators in and for Indian Country.
department of health and human services/administration for children and
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. This
program has afforded American Indian children Head Start programs of
the highest quality. A clear barrier to the ongoing success of this
partnership program is the lack of stable funds for the Partnership.
The TCUs request that the Subcommittee direct the Head Start Bureau to
designate $5 million, of the more than $8.1 billion included in the
President's fiscal year 2012 budget request for programs under the Head
Start Act, be made available for the TCU-Head Start Partnership
program.
conclusion
Tribal Colleges and Universities are providing access to high
quality higher education opportunities to many thousands of American
Indians and essential community services and programs to many more. The
modest Federal investment in TCUs has already paid great dividends in
terms of employment, education, and economic development and
continuation of this solid investment makes sound moral and fiscal
sense. TCUs need your help if they are to sustain programs and achieve
their missions to serve their students and communities.
Thank you again for this opportunity to present our funding
requests. We respectfully ask the Members of the Subcommittee for their
continued support of the Nation's Tribal Colleges and Universities and
full consideration of our fiscal year 2012 appropriations needs and
recommendations.
______
Prepared Statement of the American Institute for Medical and Biological
Engineering
Mister Chairman and Members of the Subcommittee: The American
Institute for Medical and Biological Engineering (AIMBE) appreciates
the opportunity to submit testimony to advocate for funding for
research within the National Institutes of Health (NIH) broadly, and
specifically research funding within the National Institute for
Biomedical Imaging and Bioengineering (NIBIB). NIH and NIBIB provide
avenues for research funding that are vital to the Nation's efforts to
support medical and biological engineering (MBE) innovation. AIMBE
represents 50,000 individuals and organizations throughout the United
States, including major healthcare companies, academic research
institutions and the top 2 percent of engineers, scientists and
clinicians whose discoveries and innovations have touched the health of
nearly every American. While today's testimony focuses on the impact
MBE has on improving the health and well-being of Americans, it is
important to note that MBE can also have a positive impact on many of
the other important issues facing us today; ranging from improvements
to the environment by finding green-energy solutions, to solving
problems relating to hunger, disease prevention, diagnosis and
treatment of disease; to economic growth spurred by the innovation of
new health products.
AIMBE was founded in 1991 to establish a clear and comprehensive
identity for the field of medical and biological engineering--which
applies principles of engineering science and practice to imagine,
create, and perfect the medical and biological discoveries that are
used to improve the health and quality of life of Americans and people
across the world. AIMBE's vision is to ensure MBE innovations continue
to develop for the benefit of humanity.
AIMBE applauds the past support of this committee to provide
funding to NIH, and was particularly pleased at the strong investment
in NIH provided by the American Recovery and Reinvestment Act. However,
we were concerned over recent cuts by the continuing resolution budget
for fiscal year 2011. We believe more stable, adequate, and reliable
funding is necessary to ultimately ensure America remains competitive
and continues to develop innovations that improve human health. An
increase in funding will support important work which is highly
translatable or applicable research into products that are life-saving,
and life enhancing. NIBIB is the only institute at the NIH with the
specific purpose of supporting and conducting biomedical engineering
research, which impacts all sectors of health across many disease
states. Research conducted within NIBIB is on the cutting edge of
biomedical engineering and has the potential to save lives and reduce
healthcare costs.
While each Institute within the NIH plays a vital role researching
and identifying disease prevention and treatment; the NIBIB plays a
unique role and has not benefited from large-scale NIH funding
increases, such as the doubling of the budget in 2004. First
appropriated with its own funding in 2004 (fiscal year 2003 and fiscal
year 2004 were funded through transfers from other Institutes within
NIH), the mission of NIBIB is to improve health by leading the
development and accelerating the application of biomedical
technologies. The NIBIB is committed to integrating the physical and
engineering sciences with the life sciences to advance basic research
and medical care. This is achieved through research and development of
new biomedical imaging and bioengineering techniques and devices to
fundamentally improve the detection, treatment, and prevention of
disease; enhancing existing imaging and bioengineering modalities;
supporting related research in the physical and mathematical sciences;
encouraging research and development in multidisciplinary areas;
supporting studies to assess the effectiveness and outcomes of new
biologics, materials, processes, devices, and procedures; developing
non-imaging technologies for early disease detection and assessment of
health status; and developing advanced imaging and engineering
techniques for conducting biomedical research at multiple scales
through modeling and simulation. Finally, the NIBIB plays an important
role in providing engineering research resources to the entirety of the
NIH. As the only engineering research arm within the NIH, NIBIB is
often relied upon to partner with other institutes at the NIH to
provide engineering expertise. The Laboratory of Molecular Imaging and
Nanomedicine, and Laboratory of Bioengineering and Physical Science are
two examples of NIBIB's role as a partner for researchers working at
other Institutes at the NIH.
We strongly recommend that early-stage, proof-of-concept projects
for translational research be funded at an enhanced level, ideally 0.5
percent of all external research budgets, at all Institutes. This is
critical to maintaining the U.S. lead in innovation by moving new
discoveries and novel systems to the stage where third-party private
funding can take them through development to the marketplace where they
help patients and the health of Americans. Publicly-held companies
cannot invest in this stage of work due to stockholder pressures, so
the Federal Government is critical to ensuring the viability of this
innovation pipeline.
NIBIB as a Stimulus for Innovation/Cost Effectiveness
Due in large part to the Great Recession, private industry and
private investors have been less likely to invest in high-risk
research, potentially slowing the pace of innovation. NIBIB fills a
void by providing funding for high-risk, high-reward research that
leads to the development of new technologies. Often times, private
investors in biomedical innovation are unwilling to invest in this type
of research, particularly in our current fiscal climate, because of the
risks involved. However, NIBIB can be a mechanism to bring new
technologies to market and fills the void left by a lack of private
capital.
The NIBIB's Quantum Grants program, for example, challenges the
research community to propose projects that have a highly focused,
collaborative, and interdisciplinary approach to solve a major medical
problem or to resolve a highly prevalent technology-based medical
challenge. The program consists of a 3-year exploratory phase to assess
feasibility and identify best approaches, followed by a second phase of
5 to 7 years. Major advances in medicine leading to quantifiable
improvements in public health require the kind of funding commitment
and intellectual focus found in the Quantum Grants program at NIBIB,
because early stage investors are reluctant to invest in high-risk
research. Additionally, the Quantum Grants offer a place for Government
to invest in translational research, potentially solving huge medical
problems facing Americans today.
The five currently funded Quantum Grants focus on: stem cell
therapies for patients suffering from the effects of diabetes and
stroke; the utilization of nanoparticles to help visualize brain tumors
so that surgeons can easily see and remove a cancerous mass in a
patient's brain; the development of an implantable artificial kidney
offering an improved quality of life for patients currently undergoing
dialysis treatment; and a microchip to capture circulating tumor cells
for clinicians to diagnose cancer earlier than ever before, giving
patients a greater hope for recovery thanks to earlier detection and
treatment. All these projects, in their early stages of funding, have
demonstrated promise for improving patient outcomes in the laboratory
setting.
An increase of funding to NIBIB and the Quantum Grants program may
offer opportunities to expedite research beyond laboratory study and
move to clinical trial. For example, if the artificial kidney research
is successful and brought to market, the cost to a person with kidney
disease would radically decrease because it would eliminate the need
for dialysis, which is a expensive, painful, and resource heavy
procedure typically done in an out-patient hospital setting.
The Fundamental Role of Engineering Research
Advances in the process of engineering research, in a variety of
fields, are a part of technological innovation. Medical and biological
engineering draws from research specialties across disciplines
(including mechanical, electrical, material, medical and biological
engineering, and clinicians), bringing together teams to create unique
solutions to the most pressing health problems. Engineering is the
practical application of science and math to solve problems. For
example, the insulin pump, which is the primary device used by patients
with diabetes who requires continuous insulin infusion therapy, is the
result of multi-disciplinary effort by engineers to develop a more
efficient way to manage diabetes. The science to develop and perfect an
insulin pump existed well before the creation of the medical device;
however it took biomedical engineers to apply the basic science toward
product development.
The first insulin pump to be manufactured was released in the late
70's. It was known as the ``big blue brick'' because of its size and
appearance. It sparked interest among healthcare professionals who saw
it as a device that would render syringes obsolete for people who have
daily insulin injection needs. While the technology was promising, the
first commercial pump lacked the controls and interface to make it a
safe alternative to manual injections. Dosage was inaccurate thus
making the device more of a danger than a solution.
It was only in the beginning of the 1990's that biomedical
engineers began to develop more user-friendly models that could be used
by diabetics. Advances in biomedical engineering research focused on
reducing device size, increasing energy efficiency (and thus improving
battery life), and improving reliability. Such improvements were of
great benefit to insulin pump manufacturers who were able to make their
models smaller, more affordable, and easier for patients to use.
Insulin pumps enable many diabetic patients to live productive lives
due to fewer absences from work and reduced hospitalizations.
A similar advancement in the treatment of atherolosclerosis through
MBE is the use of angioplasty with an arterial stent which releases
drugs directly to the coronary artery (referred to as a drug eluting
stent). This advancement has replaced more then 500,000 bypass
surgeries a year, at an annual cost savings of $4 billion, and an
immeasurable improvement in the quality of life of patients receiving
this treatment.
Engineering research in human physiology, specifically in range of
motion and function, has increased the function for artificial limbs.
The decreasing mortality and increasing number of disabled war veterans
highlights the need for more highly functional prosthetics. Engineering
research and development processes have taken the strapped wooden leg
to a realistic synergic leg and foot transtibial prosthetic that
employs advanced biomechanics and microelectronic controls to allow a
fuller range of motion, including running. Basic engineering research
in polymers and materials science has changed the look and feel of
prosthetic limbs so they are no longer easily discernable, reducing the
stigma, and making them more durable, lessening the cost of maintenance
and replacement. Researchers in Baltimore, Cleveland, and Chicago are
developing the next generation of prosthetic limbs, utilizing cutting
edge biomedical engineering research to develop prostheses that are
more sensitive, more responsive, and more lifelike then anything
developed in the past. These new ``bionic limbs'' are giving patients
pieces of their body back, pieces taken from them through traumatic
injury or disease. Increases in funding to NIBIB, who uniquely partners
with other Federal agencies such as the Department of Veterans Affairs
and Department of Defense, may lead to biomedical engineering
innovations to improve the quality of life of warfighters injured on
the battlefield as well as civilians.
The engineering research process has played a large part in
extending and deploying innovative imaging technologies such as
magnetic resonance imaging (MRI) and ultra-fast computed tomography (CT
scan). These technologies facilitate early detection of disease and
dysfunction, allowing for earlier treatment and slowing the progression
of disease. When prescribed correctly these technologies can reduce the
costs of healthcare by diagnosing diseases earlier, allowing for
earlier clinical intervention and reduced hospitalizations with faster
recovery times.
The Nation deserves a strong return on its investment in the basic
medical research funded by NIH. Additional engineering research,
including translation of basic research into new devices and more
efficient medical procedures, is a critical part of ensuring that
return. This combination of basic scientific studies and engineering
research, will in turn, lead to many technological innovations which
will improve the quality of life and well-being of Americans. The
Government needs to continue to fund the vital research at NIH and
NIBIB to continue to be a leader in healthcare innovation, and for the
creation of jobs in the healthcare segment of our national economy.
AIMBE looks forward to the opportunity to continue this dialogue
with all of you individually. Thank you again for your time and
consideration on this important matter.
______
Prepared Statement of the American Lung Association
summary of programs
Centers for Disease Control and Prevention (CDC)
Increased overall CDC funding--$7.7 billion
--Funding Healthy Communities--$52.8 million
--Office on Smoking and Health--$110 million
--National Asthma Control Program--$31 million
--Environment and Health Outcome Tracking--$32.1 million
--Tuberculosis programs--$231 million
--CDC influenza preparedness--$160 million
--NIOSH--$315.3 million
--Prevention and Public Health Fund--$1 billion, with $330 million
for tobacco control initiatives
National Institutes of Health (NIH)
Increased overall NIH funding--$35 billion
National Heart, Lung and Blood Institute--$3.514 billion
National Cancer Institute--$5.725 billion
National Institute of Allergy and Infectious Diseases--$5.395
billion
National Institute of Environmental Health Sciences--$779.4 million
National Institute of Nursing Research--$163 million
National Institute on Minority Health & Health Disparities--$236.9
million
Fogarty International Center--$78.4 million
For more information about this testimony, please contact Erika
Sward at [email protected].
The American Lung Association is pleased to present our
recommendations for fiscal year 2012 to the Labor, Health and Human
Services, and Education Appropriations Subcommittee. The public health
and research programs funded by this committee will prevent lung
disease and improve and extend the lives of millions of Americans who
suffer from lung disease.
The American Lung Association is the oldest voluntary health
organization in the United States, with national offices and local
associations around the country. Founded in 1904 to fight tuberculosis,
the American Lung Association is the leading organization working to
save lives by improving lung health and preventing lung disease through
education, advocacy and research.
A Sustained and Sustainable Investment
Mr. Chairman, investments in prevention and wellness can and will
pay near term and long term dividends for the health of the American
people and people everywhere. That is why the American Lung Association
strongly supports the Prevention and Public Health Fund established in
the Affordable Care Act. This fund will provide billions of dollars to
critical public health initiatives, like community programs that help
people quit smoking, support groups for lung cancer patients, and
classes that teach people how to avoid asthma attacks.
The United States must also maintain its commitment to medical
research. A growing, sustained, predictable and reliable investment in
the NIH provides hope for millions afflicted with lung disease. While
our focus is on lung disease research, we strongly support increasing
the investment in research across the entire National Institutes of
Health.
Lung Disease
Each year, almost 400,000 Americans die of lung disease. It is
America's number three killer, responsible for one in every six deaths.
More than 37 million Americans suffer from a chronic lung disease. Each
year lung disease costs the economy an estimated $173 billion. Lung
diseases include: lung cancer, asthma, chronic obstructive pulmonary
disease (COPD), tuberculosis, pneumonia, influenza, sleep disordered
breathing, pediatric lung disorders, occupational lung disease and
sarcoidosis.
Improving Public Health
The American Lung Association strongly supports investments in the
public health infrastructure. In order for the Centers for Disease
Control and Prevention (CDC) to carry out its prevention mission and to
assure an adequate translation of new research into effective State and
local programs to improve the health of all Americans, we strongly
support increasing the overall CDC funding to $7.7 billion.
We strongly encourage improved disease surveillance and health
tracking to better understand diseases like asthma. We support an
appropriations level of $32.1 million for the Environment and Health
Outcome Tracking Network to allow Federal, State and local agencies to
track potential relationships between hazards in the environment and
chronic disease rates.
We strongly support investments in communities to bring together
key stakeholders to identify and improve policies and environmental
factors influencing health in order to reduce the burden of chronic
diseases. These programs lead to a wide range of improved health
outcomes including reduced tobacco use. We strongly recommend at least
$52.8 million in funding for the Healthy Communities program and it
remaining a separate, stand alone program.
Tobacco Use
Tobacco use is the leading preventable cause of death in the United
States, killing more than 443,000 people every year. Smoking is
responsible for one in five U.S. deaths. The direct healthcare and lost
productivity costs of tobacco-caused disease and disability are also
staggering, an estimated $193 billion each year.
Given the magnitude of the tobacco-caused disease burden and how
much of it can be prevented; the CDC Office on Smoking and Health (OSH)
should be much larger and better funded. Historically, Congress has
failed to invest in tobacco control--even though public health
interventions have been scientifically proven to reduce tobacco use.
This neglect cannot continue if the nation wants to prevent disease and
promote wellness.
The American Lung Association urges that $110 million be
appropriated to OSH for fiscal year 2012 and that OSH receive an
additional one-third, or $330 million, of funds from the Prevention and
Public Health Fund.
Asthma
The American Lung Association strongly opposes the proposal in the
President's budget request that would merge the National Asthma Control
Program with the Healthy Homes/Lead Poisoning Prevention Program--and
then slash the combined programs by more than 50 percent. The Lung
Association asks this Committee to retain the National Asthma Control
Program as a stand-alone program and that $31 million be appropriated
to it for fiscal year 2012.
It is estimated that almost 25 million Americans currently have
asthma, of whom 7.1 million are children. Asthma prevalence rates are
over 37 percent higher among African Americans than whites. Studies
also suggest that Puerto Ricans have higher asthma prevalence rates and
age-adjusted death rates than all other racial and ethnic subgroups.
Asthma is the third leading cause of hospitalization among children
under the age of 15 and is a leading cause of school absences from
chronic disease--accounting for over 10.5 million lost school days in
2008. Asthma costs our healthcare system over $50.1 billion annually
and indirect costs from lost productivity add another $5.9 billion, for
a total of $56 billion annually.
We recommend that the National Heart, Lung and Blood Institute
receive $3.514 billion and the National Institute of Allergy and
Infectious Diseases be appropriated $5.395 billion, and that both
agencies continue their investments in asthma research in pursuit of
treatments and cures.
Lung Cancer
An estimated 370,000 Americans are living with lung cancer. During
2010, an estimated 222,520 new cases of lung cancer were diagnosed, and
158,664 Americans died from lung cancer in 2009. Survival rates for
lung cancer tend to be much lower than those of most other cancers.
African Americans are the most likely to develop and die from lung
cancer than persons of any other racial group.
Lung cancer receives far too little attention and focus. Given the
magnitude of lung cancer and the enormity of the death toll, the
American Lung Association strongly recommends that the NIH and other
Federal research programs commit additional resources to lung cancer.
We support a funding level of $5.725 billion for the National Cancer
Institute and urge more attention and focus on lung cancer.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease, or COPD, is the third
leading cause of death in the United States. It has been estimated that
13.1 million patients have been diagnosed with some form of COPD and as
many as 24 million adults may suffer from its consequences. In 2009,
133,737 people in the United States died of COPD. The annual cost to
the Nation for COPD in 2010 was projected to be $49.9 billion. This
includes $29.5 billion in direct healthcare expenditures, $8.0 billion
in indirect morbidity costs and $12.4 billion in indirect mortality
costs. Medicare expenses for COPD beneficiaries were nearly 2.5 times
that of the expenditures for all other patients.
The American Lung Association strongly recommends that the NIH and
other Federal research programs commit additional resources to COPD
research programs. We strongly support funding the National Heart, Lung
and Blood Institute and its lifesaving lung disease research program at
$3.514 billion. The American Lung Association also asks the Committee
to direct the National Heart, Lung and Blood Institute to work with the
CDC and other appropriate agencies to prepare a national action plan to
address COPD, which should include public awareness and surveillance
activities.
Influenza
Influenza is a highly contagious viral infection and one of the
most severe illnesses of the winter season. It is unpredictable, with
seasonal death estimates ranging from 3,000 to 49,000 over the last 30
years. Further, the emerging threat of a pandemic influenza is looming
as the recently emerging strain of H1N1 reminded us. Public health
experts warn that 209,000 Americans could die and 865,000 would be
hospitalized if a moderate flu epidemic hits the United States. To
prepare for a potential pandemic, the American Lung Association
supports funding the Federal CDC Influenza efforts at $160 million.
Tuberculosis
Tuberculosis primarily affects the lungs but can also affect other
parts of the body. 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 2009,
there were 11,545 cases of active TB reported in the United States.
While declining overall TB rates are good news, the emergence and
spread of multi-drug resistant TB pose a significant threat to the
public health of our Nation. Continued support is needed if the United
States is going to continue progress toward the elimination of TB. We
request that Congress increase funding for tuberculosis programs at CDC
to $231 million for fiscal year 2012.
Conclusion
The American Lung Association also would like to indicate our
strong support for CDC and NIH, particularly those programs that impact
lung health. We strongly support an across the board increase for NIH
with particular emphasis on the National Heart, Lung and Blood
Institute, the National Cancer Institute, the National Institute of
Allergy and Infectious Diseases, the National Institute of
Environmental Health Sciences, the National Institute of Nursing
Research, the National Institute on Minority Health & Health
Disparities and the Fogarty International Center.
Lung disease is a continuing, growing problem in the United States.
It is America's number three killer, responsible for one in six deaths.
Progress against lung disease is not keeping pace with other major
causes of death and more must be done. The level of support this
committee approves for lung disease programs should reflect the urgency
illustrated by these numbers.
______
Prepared Statement of the American National Red Cross
Chairman Tom Harkin, Ranking Member Richard Shelby, and Members of
the Subcommittee, the American Red Cross and the United Nations
Foundation appreciate the opportunity to submit testimony in support of
measles control activities of the U.S. Centers for Disease Control and
Prevention (CDC). The American Red Cross and the United Nations
Foundation recognize the leadership that Congress has shown in funding
CDC for these essential activities. We sincerely hope that Congress
will continue to support the CDC during this critical period in measles
control.
In 2001, CDC--along with the American Red Cross, the United Nations
Foundation, the World Health Organization, and UNICEF--founded the
Measles Initiative, a partnership committed to reducing measles deaths
globally. The current U.N. goal is to reduce measles deaths by 95
percent by 2015 compared to 2000 estimates. The Measles Initiative is
committed to reaching this goal by proving technical and financial
support to governments and communities worldwide.
The Measles Initiative has achieved ``spectacular'' \1\ results by
supporting the vaccination of more than 700 million children. Largely
due to the Measles Initiative, global measles mortality dropped 78
percent, from an estimated 733,000 deaths in 2000 to 164,000 in 2008
(the latest year for which data is available). During this same period,
measles deaths in Africa fell by 92 percent, from 371,000 to 28,000.
---------------------------------------------------------------------------
\1\ The Lancet, Volume 8, page 13 (January 2008).
Working closely with host governments, the Measles Initiative has
been the main international supporter of mass measles immunization
campaigns since 2001. The Initiative mobilized more than $700 million
and provided technical support in more than 60 developing countries on
vaccination campaigns, surveillance and improving routine immunization
services. From 2000 to 2008, an estimated 4.3 million measles deaths
were averted as a result of these accelerated measles control
activities at a donor cost of $184/death averted, making measles
mortality reduction one of the most cost-effective public health
interventions.
Nearly all the measles vaccination campaigns have been able to
reach more than 90 percent of their target populations. Countries
recognize the opportunity that measles vaccination campaigns provide in
accessing mothers and young children, and ``integrating'' the campaigns
with other life-saving health interventions has become the norm. In
addition to measles vaccine, Vitamin A (crucial for preventing
blindness in under nourished children), de-worming medicine (reduces
malnutrition), and insecticide-treated bed nets (ITNs) for malaria
prevention are distributed during vaccination campaigns. The scale of
these distributions is immense. For example, more than 40 million ITNs
were distributed in vaccination campaigns in the last few years. The
delivery of multiple child health interventions during a single
campaign is far less expensive than delivering the interventions
separately, and this strategy increases the potential positive impact
on children's health from a single campaign.
The extraordinary reduction in global measles deaths contributed
nearly 25 percent of the progress to date toward Millennium Development
Goal #4 (reducing under-five child mortality). However, since 2009,
Africa has experienced outbreaks affecting 28 countries, resulting in a
four-fold increase in reported measles cases. These outbreaks highlight
the fragility of the last decade's progress. If mass immunization
campaigns are not continued, measles deaths will increase rapidly with
more than half a million deaths estimated for 2013 alone.
To achieve the 2015 goal and avoid a resurgence of measles the
following actions are required:
--Fully implementing activities, both campaigns and strengthening
routine measles coverage, in India since it is the greatest
contributor to the global burden of measles.
--Sustaining the gains in reduced measles deaths, especially in
Africa, by strengthening immunization programs to ensure that
more than 90 percent of infants are vaccinated against measles
through routine health services before their first birthday as
well as conducting timely, high quality mass immunization
campaigns.
--Securing sufficient funding for measles-control activities both
globally and nationally. The Measles Initiative faces a funding
shortfall of an estimated $212 million for 2012-2105.
Implementation of timely measles campaigns is increasingly
dependent upon countries funding these activities locally. The
decrease in donor funds available at global level to support
measles elimination activities makes increased political
commitment and country ownership of the activities critical for
achieving and sustaining the goal of reducing measles mortality
by 90 percent.
If these challenges are not addressed, the remarkable gains made
since 2000 will be lost and a major resurgence in measles deaths will
occur.
By controlling measles cases in other countries, U.S. children are
also being protected from the disease. Measles can cause severe
complications and death. A resurgence of measles occurred in the United
States between 1989 and 1991, with more than 55,000 cases reported.
This resurgence was particularly severe, accounting for more than
11,000 hospitalizations and 123 deaths. Since then, measles control
measures in the United States have been strengthened and endemic
transmission of measles cases have been eliminated here since 2000.
However, importations of measles cases into this country continue to
occur each year. The costs of these cases and outbreaks are
substantial, both in terms of the costs to public health departments
and in terms of productivity losses among people with measles and
parents of sick children. For example in 2008, 2 hospitals in Arizona
spent an estimated $800,000 responding and containing 7 measles
cases.\2\ The United States is currently on track to have more measles
cases in 2011 than any year in more than a decade.
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\2\ Chen SY, Anderson S, Kutty PK, et al. J of Infect Dis 2011;
203: 1517-1525.
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The Role of CDC in Global Measles Mortality Reduction
Since fiscal year 2001, Congress has provided approximately $43.6
million annually in funding to CDC for global measles control
activities. These funds were used toward the purchase of measles
vaccine for use in large-scale measles vaccination campaigns in more
than 60 countries in Africa and Asia, and for the provision of
technical support to Ministries of Health. Specifically, this technical
support includes: Planning, monitoring, and evaluating large-scale
measles vaccination campaigns; conducting epidemiological
investigations and laboratory surveillance of measles outbreaks; and
conducting operations research to guide cost-effective and high quality
measles control programs.
In addition, CDC epidemiologists and public health specialists have
worked closely with WHO, UNICEF, the United Nations Foundation, and the
American Red Cross to strengthen measles control programs at global and
regional levels. While it is not possible to precisely quantify the
impact of CDC's financial and technical support to the Measles
Initiative, there is no doubt that CDC's support--made possible by the
funding appropriated by Congress--was essential in helping achieve the
sharp reduction in measles deaths in just 8 years.
The American Red Cross and the United Nations Foundation would like
to acknowledge the leadership and work provided by CDC and recognize
that CDC brings much more to the table than just financial resources.
The Measles Initiative is fortunate in having a partner that provides
critical personnel and technical support for vaccination campaigns and
in response to disease outbreaks. CDC personnel have routinely
demonstrated their ability to work well with other organizations and
provide solutions to complex problems that help critical work get done
faster and more efficiently.
In fiscal year 2011, Congress appropriated approximately $49
million to fund CDC for global measles control activities, this
represented at $2.6 million decrease from the previous year. The
American Red Cross and the United Nations Foundation respectfully
request a return to fiscal year 2010 funding levels ($52 million) for
fiscal year 2012 for CDC's measles control activities to protect the
investment of the last decade, and prevent a global resurgence of
measles and a loss of progress toward Millennium Development Goal #4.
Your commitment has brought us unprecedented victories in reducing
measles mortality around the world. In addition, your continued support
for this initiative helps prevent children from suffering from this
preventable disease both abroad and in the United States.
Thank you for the opportunity to submit testimony.
______
Prepared Statement of the American Nurses Association
The American Nurses Association (ANA) appreciates the opportunity
to comment on fiscal year 2012 appropriations for the Title VIII
Nursing Workforce Development Programs and Nurse-Managed Health
Clinics. Founded in 1896, ANA is the only full-service professional
association representing the interests of the Nation's 3.1 million
registered nurses (RNs) through its State nurses associations, and
organizational affiliates. The ANA advances the nursing profession by
fostering high standards of nursing practice, promoting the rights of
nurses in the workplace, and projecting a positive and realistic view
of nursing.
As the largest single group of clinical healthcare professionals
within the health system, licensed registered nurses are educated and
practice within a holistic framework that views the individual, family
and community as an interconnected system that can keep us well and
help us heal. Registered nurses are fundamental to the critical shift
needed in health services delivery, with the goal of transforming the
current ``sick care'' system into a true ``healthcare'' system. RNs are
the backbone of hospitals, community clinics, school health programs,
home health and long-term care programs, and serve patients in many
other roles and settings. The ANA gratefully acknowledges this
Subcommittee's history of support for nursing education. We also
appreciate your continued recognition of the important role nurses play
in the delivery of quality healthcare services, including Nurse-Managed
Health Clinics (NMHCs).
The Nursing Shortage
A sufficient supply of nurses is critical in providing our Nation's
population with quality healthcare. Registered Nurses (RNs) and
Advanced Practice Registered Nurses (APRNs) play an integral role in
the delivery of primary care and help to bring the focus of our
healthcare system back where it belongs--on the patient and the
community. The current U.S. nursing shortage is already having a
detrimental impact on our healthcare system, and it is expected to grow
to a 260,000 nurse shortfall by 2025. A shortage of this magnitude
would be twice as large as any shortage experienced by this country
since the 1960s. Cuts to Title VIII funding would be detrimental to the
healthcare system and the patients we serve.
As noted above, the nursing shortage is having a detrimental impact
on the entire healthcare system. Numerous studies have shown that
nursing shortages contribute to medical errors, poor patient outcomes,
and increased mortality rates. A study published in the March 17, 2011
issue of the New England Journal of Medicine shows that inadequate
staffing is tied to higher patient mortality rate. The study supports
findings of previous studies and finds that higher than typical rates
of patient admissions, discharges, and transfers during a shift were
associated with increased mortality--an indication of the important
time and attention needed by RNs to ensure effective coordination of
care for patients at critical transition periods.
Nursing Workforce Development Programs
The Nursing Workforce Development programs, authorized under Title
VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) support
the supply and distribution of qualified nurses to meet our Nation's
healthcare needs. Over the last 46 years, Title VIII programs have
addressed each aspect of the nursing shortages--education, practice,
retention, and recruitment.
--Title VIII provides the largest source of Federal funding for
nursing education, offering financial support for nursing
education programs, individual students, and nurses.
--These programs bolster nursing education at all levels, from entry-
level preparation through graduate study.
--Title VIII programs favor institutions that educate nurses for
practice in rural and medically underserved communities.
--In fiscal year 2008, these programs provided loans, scholarships,
traineeships, and programmatic support to 77,395 nursing
students and nurses.
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 Title VIII Nursing
Workforce Development programs to meet the unique characteristics of
today's shortage. These programs were also strengthened and
reauthorized with the adoption of the Affordable Care Act. This
achievement holds the promise of recruiting new nurses into the
profession, promoting career advancement within nursing and improving
patient care delivery. However, this promise cannot be met without a
significant investment. ANA strongly urges Congress to increase funding
for Title VIII programs to a total of $313.075 million in fiscal year
2012. This is also the amount requested in President Obama's fiscal
year 2012 budget.
Current funding levels are clearly failing to meet the need. In
fiscal year 2008 (most recent year statistics are available), the
Health Resources and Services Administration (HRSA) was forced to turn
away 92.8 percent of the eligible applicants for the Nurse Education
Loan Repayment Program (NELRP), and 53 percent of the eligible
applicants for the Nursing Scholarship program due to a lack of
adequate funding. These programs are used to direct RNs into areas with
the greatest need--including departments of public health, community
health centers, and disproportionate share hospitals.
Title VIII includes the following program areas:
Nursing Education Loan Repayment Program and Scholarships.--This
line item is comprised of the Nurse Education Loan Repayment Program
(NELRP) and the Nursing Scholarship Program (NSP). In fiscal year 2010,
the Nurse Education Loan Repayment Program and Scholarships received
$93.8 million.
The NELRP repays up to 85 percent of a RN's student loans in return
for full-time practice in a facility with a critical nursing shortage.
The NELRP nurse is required to work for at least 2 years in a
designated facility, during which time the NELRP repays 60 percent of
the RN's student loan balance. If the nurse applies and is accepted for
an optional third year an additional 25 percent of the loan is repaid.
In fiscal year 2008, HRSA received 3,039 applications for the
nursing scholarship. Due to lack of funding, a mere 177 scholarships
were awarded. Therefore, 2,862 nursing students (94 percent) willing to
work in facilities with a critical shortage 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 use these funds to 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. In fiscal year
2010, this program received $25 million.
This program is vital given the critical shortage of nursing
faculty. America's schools of nursing cannot 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 2008, HRSA funded 95
faculty loans.
Nurse Education, Practice, and Retention Grants.--This section is
comprised of many programs designed to support entry-level nursing
education and to enhance nursing practice. The education grants are
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. All together, the Nurse Education, Practice, and
Retention Grants supported 42,761 nurses and nursing students in fiscal
year 2008. The program received $39.8 million in fiscal year 2010.
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. In fiscal
year 2008, 85 applications were received for workforce diversity
grants, 51 programs were funded. In fiscal year 2010, these programs
received $16 million.
Advanced Nursing Education.--Advanced practice registered nurses
(APRNs) are nurses 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, psychiatry, midwifery,
neonatology, and women's and 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. In
fiscal year 2009, 5,649 advanced education nurses were supported
through these programs. In fiscal year 2010, these programs received
$64.4 million.
Comprehensive Geriatric Education Grants.--This authority awards
grants to train and educate nurses in providing healthcare 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. In fiscal
year 2008, 6,514 nurses and nursing students were supported through
these programs. In fiscal year 2010, these grants received $4.5
million. The growing number of elderly Americans and the impending
healthcare needs of the baby boom generation make this program
critically important.
Nurse-Managed Health Clinics
A healthcare system must value primary care and prevention to
achieve improved health status of individuals, families and the
community. As Congress recognized through the passage of the Affordable
Care Act (ACA) money, resources and attention must be reallocated in
the health system to highlight importance of, and create incentives
for, primary care and prevention.
Nurses are strong supporters of community and home-based models of
care. We believe that the foundation for a wellness-based healthcare
system is built in these settings and reduces the amount of both money
and human suffering. ANA supports the renewed focus on new and existing
community-based programs such as Nurse Managed Health Centers (NMHCs).
Currently, there are more than 200 Nurse Managed Health Centers
(NMHCs) in the United States which have provided care to over 2 million
patients annually. ANA believes that Nurse Managed Health Centers
(NMHCs) are an efficient, sensible, cost-effective way to deliver
primary healthcare services. These clinics are also used as clinical
sites for nursing education. The nurse-managed care model is especially
effective in disease prevention and early detection, management of
chronic conditions, treatment of acute illnesses, health promotion, and
more. Nurse Managed Health Centers (NMHCs) can also provide a medical
home for underserved individuals as well as partnering with the Federal
Government to reduce health disparities.
ANA was pleased to see that the Affordable Care Act (ACA) provided
grant eligibility to Nurse-Managed Health Clinics (NMHCs) to support
operating costs. ACA also authorized up to $50 million a year to
support operating costs. ANA strongly urges Congress to provide $20
million for the Nurse-Managed Health Clinics authorized under Title
VIII of the Public Health Service Act in fiscal year 2012 as
recommended in President Obama's fiscal year 2012 budget.
Conclusion
While ANA appreciates the continued support of this Subcommittee,
we are concerned that Title VIII funding levels have not been
sufficient to address the growing nursing shortage. In preparation for
the implementation of healthcare reform initiatives, which ANA
supports, we believe there will be an even greater need for nurses and
adequate funding for these programs is even more essential. Registered
Nurses (RNs) and Advanced Practice Nurses (APRNs) are key providers
whose care is linked directly to the availability, cost, and quality of
healthcare services. ANA asks you to meet today's shortage with a
relatively modest investment of $313.075 million in fiscal year 2012
for the Health Resources and Services Administration Nursing Workforce
Development programs and $20 million for Nurse-Managed Health Clinics.
Thank you.
______
Prepared Statement of the American Physical Therapy Association
On behalf of more than 77,000 physical therapists, physical
therapist assistants, and students of physical therapy, the American
Physical Therapy Association (APTA) thanks you for the opportunity to
submit official testimony regarding recommendations for the fiscal year
2012 appropriations. APTA's mission is to improve the health and
quality of life of individuals in society by advancing physical
therapist practice, education, and research. Physical therapists across
the country utilize a wide variety of federally funded resources to
work collaboratively toward the advancement of these goals. APTA's
recommendations for Federal funding, as outlined in this document,
reflect a commitment toward these priorities for the good of society
and the rehabilitation community.
Department of Health and Human Services
National Institutes of Health (NIH)
Rehabilitation research was funded at $458 million within NIH's
approximately $31.2 billion budget in fiscal year 2010. This represents
roughly 1 percent of NIH funds for an area of biomedical research that
impacts a growing percentage of our Nation's seniors, persons with
disabilities, young persons with chronic disease or traumatic injuries,
and children with development disabilities. The Institute of Medicine
(IOM) estimates that 1 in 7 individuals have an impairment or
limitation that significantly limits their ability to perform
activities of daily living. Investment in and recognition of
rehabilitation within NIH is a necessary step toward continuing to meet
the needs of these individuals in our population. Through the American
Recovery and Reinvestment Act (ARRA), rehabilitation research was able
to take advantage of an extra infusion of approximately $75 million in
fiscal year 2009 and $93 million in fiscal year 2010. However, APTA
believes that rehabilitation research at NIH has been under-funded for
many years. The funds currently utilized are well-invested for the
impact that rehabilitation interventions will have on the quality of
lives of individuals. Continued investment and greater recognition and
coordination of rehabilitation research among Institutes and across
Federal departments will enhance the returns the Federal Government
receives when investing in this area. Taking this into consideration,
APTA recommends $31.829 billion (a $629 million increase over fiscal
year 2010) for NIH in fiscal year 2012 to ensure that the momentum is
maintained that was gained under the ARRA investment to improve health,
spur economic growth and innovation, and advance science. APTA
recognizes the extraordinary circumstances that exist during these
tough budgetary times, however it still remains crucial that Federal
investments in healthcare research are preserved and at least kept on
pace with the rate of inflation.
Specifically, the physical therapy and rehabilitation science
community recommends that Congress allocate crucial funding
enhancements in the following institutes:
--$1.356 billion (a 2 percent increase over fiscal year 2010) for the
Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) which houses the National Center for
Medical Rehabilitation Research (NCMRR), the only entity within
NIH explicitly focused on the advancement of rehabilitation
science. NCMRR fosters the development of scientific knowledge
needed to enhance the health, productivity, independence, and
quality-of-life of people with disabilities. A primary goal of
the Center-supported research is to bring the health-related
problems of people with disabilities to the attention of the
best scientists in order to capitalize upon the myriad advances
occurring in the biological, behavioral, and engineering
sciences.
--$1.66 billion (a 2 percent increase over fiscal year 2010) for the
National Institute of Neurological Disorders and Stroke
(NINDS). This funding level is required to enhance existing
initiatives and invest in new and promising research to prevent
stroke and advance rehabilitation in stroke treatment. Despite
being a major cause of disability and the number three cause of
death in the United States, NIH invests only 1 percent of its
budget in stroke research. However, APTA recognizes the
advancements that NIH-funded research has achieved in the
specific area of stroke rehabilitation. APTA commends this area
of leadership at NIH and encourages a continued focus on
rehabilitation interventions and physical therapy to maximize
an individual's function and quality of life after a stroke.
--$550 million for the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) for arthritis and
musculoskeletal research.
Centers for Disease Control and Prevention (CDC)
APTA was disappointed to see the cuts that have been implemented
within CDC for fiscal year 2011. The contributions of CDC to the lives
of countless individuals are limited only by the resources available
for carrying out its vital mission. Our Nation and the world will
continue to benefit from further improvement in public health and
investment in scientific advancement and prevention. APTA recommends
Congress provide at least $7.7 billion for CDC's fiscal year 2012
``core programs'' in the fiscal year 2012 Labor-HHS-Education
Appropriations bill. This request reflects the support CDC will need to
fulfill its core missions for fiscal year 2012. APTA strongly believes
that the activities and programs supported by CDC are essential in
protecting the health of the American people. APTA supports the
Prevention and Public Health Fund (PPHF) and its underlying purpose of
providing supplemental funding as an investment to expand
infrastructure for prevention initiatives. We are not supportive of
efforts to use the PPHF to supplant current programmatic funding within
the budgets of agencies, such as CDC.
Physical therapists play an integral role in the prevention,
education, and assessment of the risk for falls. The CDC is currently
only allocating $2 million per year to address the increasing
prevalence of falls, a problem costing more than $19.2 billion a year.
Among older adults, falls are the leading cause of injury deaths. This
is why APTA respectfully requests that $21.7 million be provided in
funding for the ``Unintentional Injury Prevention'' account to allow
CDC's National Center for Injury Prevention and Control (NCIPC) to
comprehensively address the large-scale growth of older adult falls.
CDC has made great strides in developing and laying the groundwork for
evidence-based falls prevention programs that link clinical
intervention with community-based programs to make an impactful benefit
for American society in addressing this expensive and burdensome
healthcare problem. Without an increase in resources, CDC is unable to
effectively scale-up and expand infrastructure beyond the few cities in
which the programs have currently been developed to begin reaching all
communities across the United States.
Traumatic Brain Injury (TBI) is a leading cause of death and
disability among young Americans and continues to be the signature
injury of the conflicts in Iraq and Afghanistan. CDC estimates that at
least 5.3 million Americans, approximately 2 percent of the U.S.
population, currently require lifelong assistance to perform activities
of daily living as a result of TBI. High quality, evidence-based
rehabilitation for TBI is typically a long and intensive process. From
the battlefield to the football field, American adults and youth
continue to sustain TBIs at an alarming rate and funding is desperately
needed for better diagnostics and evaluation, treatment guidelines,
improved quality of care, education and awareness, referral services,
State program services, and protection and advocacy for those less able
to advocate for themselves. APTA recommends at least $10 million in
fiscal year 2012 for CDC's TBI Registries and Surveillance, Brain
Injury Acute Care Guidelines, Prevention, and National Public
Education/Awareness programs, specifically with the great work that has
been produced through the ``Heads Up'' concussions initiative.
CDC's Well-Integrated Screening and Evaluation for Women Across the
Nation (WISEWOMAN) programs screens uninsured and under-insured low-
income women ages 40 to 64 for heart disease and stroke risk and those
with abnormal results receive counseling, education, referral and
follow up. WISEWOMAN reached over 70,000 women in only 20 States from
July 2008 to June 2010. Of these women, nearly 90 percent were found to
have one or more heart disease or stroke risk factors and about 30
percent had at least three. More than 60 percent of the women
participated in a minimum of one behavioral modification session, and
among those WISEWOMAN participants who were re-screened one year later,
average blood pressure and cholesterol levels had decreased
considerably. APTA recommends $37 million ($16.3 million increase over
fiscal year 2010) for CDC's WISEWOMAN Program in fiscal year 2012.
Health Resources and Services Administration (HRSA)
With the passage of healthcare reform legislation, it becomes more
important now than ever that America is able to supply an adequate and
well-trained healthcare workforce to meet the demands of an expanded
market of U.S. citizens that have health insurance coverage. APTA urges
you to provide at least $7.65 billion for HRSA in fiscal year 2012.
While we recognize the reality of the current fiscal climate, this
amount reflects the minimum amount necessary for the agency to
adequately meet the needs of the populations it serves. The relatively
level funding HRSA has received over the past several years has
undermined the ability of its successful programs to grow and be
expanded to represent professions that shape the entire healthcare
team, such as physical therapy. Any shortage areas of physical
therapists and rehabilitation professionals may become more accentuated
as the percentage of the U.S. population that has health coverage
increases and demand rises. It is crucial that efforts are undertaken
to strengthen the healthcare workforce and delivery across the whole
spectrum of an individual's care--from onset through rehabilitation.
More resources are needed for HRSA to achieve its ultimate mission of
ensuring access to culturally competent, quality health services;
eliminating health disparities; and rebuilding the public health and
healthcare infrastructure.
In conjunction with the importance of funding TBI efforts within
CDC, APTA also recommends $8 million for the HRSA Federal TBI State
Grant Program and $4 million for the HRSA Federal TBI Protection &
Advocacy (P&A) Systems Grant Program.
Department of Education
In 2008, as part of the reauthorization of the Higher Education Act
(Public Law 110-315), the Loan Forgiveness for Service in Areas of
National Need (LFSANN) program was created. This program would provide
a modest amount of loan forgiveness for a variety of education and
healthcare professional groups, including physical therapists, upon a
commitment to serve in targeted populations that were identified as
areas of crucial importance and national need. However, the program has
not been implemented because it has not received any funding. APTA
commends the recent efforts of Congress to reform the higher education
loan industry. The lowering of the limit on the income-based repayment
plan for consolidated Federal Direct Loans will assist the burdensome
payments for all higher education loan borrowers. However, this program
still fails to meet the most important impact of LFSANN--channeling
providers and professionals into areas where there are demonstrated
shortages and high need, such as physical therapy care for veterans and
children and adolescents. APTA strongly urges Congress to take action
and provide $10 million in initial funding for this vital LFSANN
program that will impact the healthcare and education services of those
most in need.
National Institute for Disability and Rehabilitation
Research (NIDRR)
NIDRR has been one of the longest standing agencies to focus on
federally funded medical rehabilitation research. Rehabilitation
research makes a difference in the lives of individuals with
impairments, functional limitations, and disability. Advancements in
rehabilitation research have led to greater quality of life for
individuals who have spinal cord injuries, loss of limb, stroke and
other orthopedic, neurological, and cardiopulmonary disorders.
Investment in NIDRR is a necessary step toward continuing to meet the
needs of individuals in our population who have chronic disease,
developmental disabilities or traumatic injuries. Therefore, APTA
recommends at least $20 million per year for NIDRR to support research
and development, capacity building, and knowledge translation in
health, rehabilitation, and function.
APTA also requests $11 million for NIDRR's TBI Model Systems
administered by the Department of Education. The TBI Model Systems of
Care program represents an already existing vital national network of
expertise and research in the field of TBI, and weakening this program
would have resounding effects on both military and civilian
populations. The TBI Model Systems are the only source of non-
proprietary longitudinal data on what happens to people with brain
injury. They are a key source of evidence-based medicine and
rehabilitation care for this crucial and growing population.
Conclusion
As previously stated, APTA recognizes the extraordinarily tough
budgetary pressures that are facing the U.S. Federal Government.
However, there are certain programs and agencies that are essential and
vital to the health of Americans. APTA looks forward to working with
the Subcommittee and the various agencies outlined above to advance the
capability of meeting the rehabilitation needs of society. If the
Subcommittee has questions or needs additional resources, please
contact Nate Thomas, Associate Director of Federal Government Affairs
at APTA, at [email protected] or 703-706-8527. APTA's mailing address
is provided on the letterhead of the first page of this document.
______
Prepared Statement of the American Psychological Association
This statement is the testimony of the American Psychological
Association (APA), the largest scientific and professional organization
representing psychology in the United States and the world's largest
association of psychologists. APA's membership includes more than
154,000 researchers, educators, clinicians, consultants and students.
Through its divisions in 54 subfields of psychology and affiliations
with 60 State, territorial and Canadian provincial associations, APA
works to advance psychology as a science, as a profession and as a
means of promoting health, education and human welfare. APA welcomes
the opportunity to bring to your attention some priority requests and
concerns for the fiscal year 2012 appropriations bill.
Health Resources and Services Administration
Bureau of Health Professions
The APA requests that the Subcommittee include $5 million for the
Graduate Psychology Education Program (GPE) within the Health Resources
and Services Administration. This nationally competitive grant program
provides integrated healthcare services to underserved rural and urban
communities and individuals with the least access to much needed mental
and behavioral health services and support (e.g., children, older
adults, and chronically ill persons, victims of abuse or trauma,
including veterans). To date there have been over 100 grants in 32
States to universities and hospitals throughout the Nation. All
psychology graduate students who benefited from GPE funds are expected
to work with underserved populations and over 80 percent will work in
underserved areas immediately after completing the training.
Currently GPE is authorized under the Public Health Service Act
[Public Law 105-392 Section 755(b)(1)(J)] and funded under the ``Allied
Health and Other Disciplines'' account in the Labor-HHS Appropriations
Bill. An authorization of Appropriations of $10 million was included in
the Patient Protection and Affordable Care Act. It was also included in
the fiscal year 2011 Omnibus bill, which did not pass, for $7 million;
and it has been included in H.R. 1 for fiscal year 2011 and the Senate
2011 continuing resolutions, as well as the President's budget (for a
number of years). Established in 2002, GPE grants have supported the
interdisciplinary training of over 3,000 graduate students of
psychology and other health professions to provide integrated
healthcare services to underserved populations. The fiscal year 2012
GPE funding request will focus especially on providing services to
returning military personnel and their families, unemployed persons and
older adults in underserved communities. Also the GPE funding request
will also be used to create training opportunities at our Nation's
federally Qualified Health Centers, which play a critical role in
meeting the healthcare needs of our Nation's underserved persons.
National Institutes of Health (NIH)
As a member of the Ad hoc Group for Medical Research Funding and
the Coalition for Health Funding, APA encourages the Subcommittee to
provide a minimum of $31.8 billion for the NIH. Sustained growth for
NIH will build on the Nation's longstanding, bipartisan commitment to
better health, which has established the United States as the world
leader in medical research and innovation. NIH research means hope for
patients. Potentially revolutionary new avenues of research hold
promise for new early screenings and new treatments for disease. Recent
funding has created dramatic new research opportunities in areas
ranging from genetics to the behavioral research conducted by APA
members. In addition, NIH research is boosting the economies of
communities nationwide, at over 3,000 universities, medical schools,
teaching hospitals and other research institutions. This committee
should take justifiable pride in the progress and promise that NIH
research is engendering.
There are several issues at NIH to which APA would draw the
Subcommittee's attention:
--Addictions Research Institute.--NIH research on alcohol and
substance abuse has shed important light on critical policy
issues ranging from the rehabilitation of drug-addicted felons
to treatment of children exposed to substances in utero. APA is
closely monitoring NIH's proposal to create a new combined
institute that would fund research on both alcohol and
substance abuse. In our view this research is significantly
underfunded when weighed against the public health and public
safety impacts of alcohol, tobacco and illicit substance use,
and we are concerned that research funding be maintained and
increased as the new institute is created. We urge the
Subcommittee to insist that NIH establish rigorous and
transparent baselines of current funding levels and the
allocation of those funds across the existing NIH Institutes
and Centers to better assess and understand the proposed
organizational change. The continued active involvement of
extramural scientists at every stage of this process, as well
as that of the Office of Behavioral and Social Sciences
Research, will help ensure that the new institute has the right
infrastructure to truly optimize the conduct of addiction
research.
--Funding for OppNet.--For fiscal year 2012, APA supports a budget of
$38.2 million for OBSSR. This sum reflects the Administration's
request of $28 million for OBSSR and includes $10 million
needed to support the NIH-wide commitment to carry out OppNet,
an initiative strongly supported by the Subcommittee. The
OppNet initiative has made significant progress since its
start. Thus far, OppNet has awarded 35 competitive revisions to
add basic science projects to existing research project grants.
Eight competitive revisions to Small Business Innovation
Research/Small Business Technology and Transfer projects have
been awarded. OppNet has also provided much-needed training in
basic social and behavioral sciences research.
--National Center to Advance Translational Sciences.--APA believes
firmly that the proposed new National Center to Advance
Translational Sciences should include sufficient staff
expertise and resources to manage research on the translation
of behavioral interventions into communities. Just as it is
critical for NIH to speed the translation of research into drug
or technology development, it is critical for behavioral
interventions on diet, exercise, and psychotherapy to be
translated and disseminated to communities in need of them.
Centers for Disease Control and Prevention
As a member of the Centers for Disease Control and Prevention (CDC)
Coalition, APA supports an appropriation of $7.7 billion for CDC's
``core programs'' for fiscal year 2012. In addition to playing a key
role in maintaining a strong public health infrastructure and
protecting Americans from public health threats and emergencies, CDC
programs play a crucial role in reducing healthcare costs and
strengthening the Nation's health system. This request reflects the
minimum amount CDC will need to fulfill its core missions for fiscal
year 2012.
National Center for Health Statistics.--APA endorses the
President's fiscal year 2012 request of $162 million in funding for
NCHS. NCHS is the Nation's principal health statistics agency, and the
health data collected by NCHS are an essential part of the Nation's
statistical and public health infrastructure. The Subcommittee's
support is helping NCHS rebuild after years of underinvestment and
restore the collection of essential health data. With your continued
support, NCHS will modernize its data collection efforts to produce
higher quality, more timely data.
Prevention Research Centers.--APA recognizes the importance of a
focus on prevention in improving health in America and the significant
contributions of the Prevention Research Centers network of community,
academic, and public health partners to research on evidenced based
approaches in health promotion. APA urges Congress to allocate the
resources necessary to support the Prevention Research Centers so that
this network of academic institutions and organizations can continue to
contribute as widely and effectively to prevention science. APA opposes
any program consolidation that would lead to disproportionate funding
cuts for the Prevention Research Centers. Insofar as consolidation of
programs as proposed in the fiscal year 2012 President's budget occurs,
APA requests that Congress designate specific funding for Prevention
Research Centers.
Substance Abuse and Mental Health Services Administration (SAMHSA)
APA is highlighting three requests for the Committee's support at
SAMHSA's Center for Mental Health Services:
--First, APA strongly recommends that Congress allocate the fully
authorized amount ($50 million) for SAMHSA's National Child
Traumatic Stress Network (NCTSN) program which works to aid the
recovery of children, families, and communities impacted by a
wide range of trauma, including physical and sexual abuse,
natural disasters, sudden death of a loved one, the impact of
war on military families, and much more. Specifically, APA
recommends that SAMHSA increase the number of NCTSN grantees
and maintain the collaborative model envisioned in the original
authorization.
--Second, APA urges the Committee to increase its support for the
Minority Fellowship Program. Racial and ethnic minorities are
projected to represent 40 percent of our Nation's population in
upcoming years. Therefore, APA urges Congress to increase
funding for the Minority Fellowship Program by $2.6 million.
This unique workforce development initiative trains ethnic
minority healthcare professionals to bring mental and
behavioral healthcare services to rural and underserved
minority communities.
--Third, APA encourages Congress to provide at least level support
for the three programs authorized under the Garrett Lee Smith
Memorial Act, especially the Campus Suicide Prevention Program.
These programs make suicide prevention initiatives and mental
health support available to populations in need and merit
continued appropriations.
Administration on Aging
Mental health.--Older adults are one of the fastest growing
segments of the U.S. population and approximately 25 percent of older
Americans have a mental or behavioral health problem. In particular,
older white males (age 85 and over) currently have the highest rates of
suicide of any group in the United States. Accordingly, APA urges an
expanded effort to address the mental and behavioral health needs of
older adults including implementation of the mental and behavioral
health provisions in the Older Americans Act Amendments of 2006, to
provide grants to States for the delivery of mental health screening,
and treatment services for older individuals and programs to increase
public awareness and reduce the stigma associated with mental disorders
in older individuals. APA also recommends that AoA designate an officer
to administer mental health services for older Americans.
Caregivers.--Family caregivers play an essential role in providing
long-term services and supports for the chronically ill and aging. For
this reason APA supports the Lifespan Respite Care Program and urges
Congress to appropriate $50 million for this initiative in fiscal year
2012. In addition, the Secretary of HHS should ensure that State
agencies and Aging and Disability Resource Centers (ADRCs) use the
funds to serve all age groups, chronic conditions and disability
categories equitably and without preference.
The agencies under this Subcommittee's jurisdiction provide
critical support to APA's members, their home institutions, and their
students and patients. The APA commends the Committee for accepting
written testimony from public witnesses.
______
Prepared Statement of the American Public Health Association
The American Public Health Association (APHA) is the oldest and
most diverse organization of public health professionals and advocates
in the world dedicated to promoting and protecting the health of the
public and our communities. We are pleased to submit our views on
Federal funding for public health activities in fiscal year 2012.
Recommendations for Funding the Public Health Service
APHA's budget recommendations for the Public Health Service
includes funding 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). Together all of these agencies play a
critical role in keeping Americans healthy.
CDC
APHA believes that Congress should support CDC as an agency--not
just the individual programs that it funds. In the best judgment of the
CDC Coalition--given the challenges and burdens of chronic disease, a
potential influenza pandemic, terrorism, disaster preparedness, new and
reemerging infectious diseases and our many unmet public health needs
and missed prevention opportunities--we believe the agency will require
funding of at least $7.7 billion for CDC's ``core programs'' in fiscal
year 2012. This request represents a 36 percent increase over fiscal
year 2011 and a 31 percent increase over the President's fiscal year
2012 request. We are deeply disappointed with the more than $740
million in cuts to CDC's budget authority included in the proposed
fiscal year 2011 continuing resolution (CR). While CDC programs will
receive significant new funding from the Prevention and Public Health
Fund in fiscal year 2011, we are concerned that this funding would
essentially supplant cuts made to CDC's budget authority. As you know
the Prevention and Public Health Fund was intended to supplement and
not supplant the base funding of our public health agencies and
programs.
The President's fiscal year 2012 budget proposes to consolidate a
number of chronic disease programs within CDC. APHA and other advocates
are currently engaged in conversations with CDC and members of Congress
to better understand what this consolidation will mean for the funding
that is passed on to our State and local health agencies and the
various programs our members have supported in the past. We look
forward to working with Congress, the Administration and CDC to ensure
that any effort to consolidate the programs leads to best health
outcomes for the American people. We must ensure that CDC's National
Center for Chronic Disease Prevention and Health Promotion has the
resources it needs to assist our States and communities in their
efforts to reduce the burden of chronic disease.
By translating research findings into effective intervention
efforts, CDC 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. With the potential onset of a worldwide influenza pandemic,
in addition to the many other natural and man-made threats that exist
in the modern world, the CDC has become 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. This has been demonstrated most recently by CDC's
quick response and ongoing investigation into human infections with
H1N1 flu (swine flu) in the United States and internationally.
CDC's National Center for Injury Prevention and Control works to
prevent unintentional and violence-related injuries to minimize the
consequences of injuries when they occur by researching the problem;
identifying the risk and protective factors; developing and testing
interventions; and ensuring widespread adoption of proven strategies.
We urge you to ensure the agency has the resources it needs to address
these leading causes of death and disability.
We must address the growing disparity in the health of racial and
ethnic minorities. CDC is helping States address serious disparities in
infant mortality, breast and cervical cancer, cardiovascular disease,
diabetes, HIV/AIDS and immunizations. APHA is committed to ending
health disparities and we encourage the Subcommittee to provide
adequate funds for these efforts.
We also encourage the Subcommittee to provide adequate funding for
CDC's National Center for Environmental Health. We ask that the
Subcommittee to continue its recent efforts to expand and enhance CDC's
capacity to help the Nation prepare for and adapt to the potential
health effects of climate change by providing CDC with $15 million for
climate change and health activities. Expanded funding would allow CDC
to provide technical assistance, training and tools to help State and
local health officials and improve coordination and integration of
climate change across CDC. We also urge the Committee to closely
evaluate the significant cut made to CDC's Healthy Homes/Lead Poisoning
Prevention and the National Asthma Control programs in the President's
budget to ensure these programs have adequate funding to provide States
and localities with the funding they need to protect public health.
HRSA
We request an overall funding level of $7.65 billion for HRSA in
fiscal year 2012. This recommendation represents a 22 percent increase
over fiscal year 2011 and a 12 percent increase over the President's
fiscal year 2012 request. We believe this level of funding is the
minimum amount necessary for HRSA to continue to meet the healthcare
needs of the American public. Over the past several years, HRSA has
received mostly level funding, undermining the ability of its
successful programs to grow. Additionally we are deeply disappointed
with the more than $1.2 billion in cuts made to the agency in the final
fiscal year 2011 continuing resolution and the potential negative
consequences for public health. Our fiscal year 2012 requested minimum
level of funding will better allow the agency to carry out critical
public health programs and services that reach millions of Americans,
including training for public health and healthcare professionals,
providing primary care services through community health centers,
improving access to care for rural communities, supporting maternal and
child healthcare programs, providing healthcare to people living with
HIV/AIDS, and many more. However, much more is needed for the agency to
achieve its ultimate mission of ensuring access to culturally
competent, quality health services; eliminating health disparities; and
rebuilding the public health and healthcare infrastructure.
HRSA operates programs in every State and thousands of communities
across the country and is a national leader in providing health
services for individuals and families. The agency serves as a health
safety net for the medically underserved, including the 50 million
Americans who were uninsured in 2009 and 50 million Americans who live
in neighborhoods where primary healthcare services are scarce.
The $7.65 billion fiscal year 2012 HRSA funding request is based
upon recommendations provided by public health professionals to support
HRSA programs including:
--Health Professions programs support the education and training of
primary care physicians, nurses, dentists, optometrists,
physician assistants, nurse practitioners, public health
personnel, mental and behavioral health professionals,
pharmacists, and other allied health providers; improve the
distribution and diversity of health professionals in medically
underserved communities; and ensure a sufficient and capable
health workforce able to provide care for all Americans and
respond to the growing demands of our aging and increasingly
diverse population. In addition, the Patient Navigator Program
helps individuals in underserved communities, who suffer
disproportionately from chronic diseases, navigate the health
system.
--Primary Care programs support more than 7,000 community health
centers in every State and territory, improving access to
preventive and primary care in geographically isolated and
economically distressed communities. In addition, the health
centers program targets populations with special needs,
including migrant and seasonal farm workers, homeless
individuals and families, and those living in public housing.
--Maternal and Child Health Flexible Maternal and Child Health Block
Grants, Healthy Start and other programs provide services,
including prenatal and postnatal care, newborn screening tests,
immunizations, school-based health services, mental health
services, and well-child care for more than 34 million
uninsured and underserved women and children not covered by
Medicaid or the Children's Health Insurance Program, including
children with special needs.
--HIV/AIDS programs provide assistance to metropolitan and other
areas most severely affected by the HIV/AIDS epidemic; support
comprehensive care, drug assistance and support services for
people living with HIV/AIDS; provide education and training for
health professionals treating people with HIV/AIDS; and address
the disproportionate impact of HIV/AIDS on women and
minorities.
--Family Planning Title X programs provide reproductive healthcare
and other preventive services for more than 5 million low-
income women at over 4,500 clinics nationwide. These programs
improve maternal and child health outcomes, prevent unintended
pregnancies, and reduce the rate of abortions.
--Rural Health programs improve access to care for the 60 million
Americans who live in rural areas. Rural Health Outreach and
Network Development Grants, Rural Health Research Centers,
Rural and Community Access to Emergency Devices Program, and
other programs are designed to support community-based disease
prevention and health promotion projects, help rural hospitals
and clinics implement new technologies and strategies, and
build health system capacity in rural and frontier areas.
--Special Programs include the Organ Procurement and Transplantation
Network, the National Marrow Donor Program the C.W. Bill Young
Cell Transplantation Program, and National Cord Blood
Inventory. Strong funding would facilitate an increase in
organ, marrow and cord blood transplantation.
Greater investment is necessary to sufficiently fund HRSA services
and programs that continue to face increasing demands. We urge you to
consider HRSA's role in building the foundation for health service
delivery and ensuring that vulnerable populations receive quality
health services, while continuing to strengthen our Nation's health
safety net programs. By supporting, planning for and adapting to change
within our healthcare system, we can build on the successes of the past
and address new gaps that may emerge in the future.
AHRQ
We request a funding level of at least $405 million for AHRQ for
fiscal year 2012. This level of funding is needed for the agency to
fully carry out its Congressional mandate to conduct, support, and
disseminate research and translate research into knowledge and
information that can be used to improve the health of all Americans.
AHRQ focuses on improving healthcare quality, eliminating racial and
ethnic disparities in health, reducing medical errors, and improving
access and quality of care for children and persons with disabilities.
SAMHSA
APHA supports a funding level of $3.671 billion for SAMHSA for
fiscal year 2012. 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.
NIH
APHA supports a funding level of $35 billion for the NIH for fiscal
year 2012. The translation of fundamental research conducted at NIH
provides some of the basis for community based public health programs
that help to prevent and treat disease.
Conclusion
In closing, we emphasize that the public health system requires
stronger 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. Without a
robust and sustained investment in our Nation's public health agencies,
we will fail to meet the mounting health challenges facing our Nation.
______
Prepared Statement of the American Public Power Association
The American Public Power Association (APPA) appreciates the
opportunity to submit this statement supporting funding for the Low-
Income Home Energy Production Assistance Program (LIHEAP) for fiscal
year 2012.
APPA has consistently supported an increase in the authorization
level for LIHEAP. The Administration's fiscal year 2012 budget requests
$2.57 billion for LIHEAP. APPA supports extending the current level of
$5.1 billion for the program.
APPA is the national service organization representing the
interests of over 2,000 municipal and other State and locally owned
utilities throughout the United States (all but Hawaii). Collectively,
public power utilities deliver electricity to 1 of every 7 electricity
consumers (approximately 46 million people), serving some of the
Nation's largest cities. However, the vast majority of APPA's members
serve communities with populations of 10,000 people or less.
APPA is proud of the commitment that its members have made to their
low-income customers. Many public power systems have low-income energy
assistance programs based on community resources and needs. Our members
realize the importance of having in place a well-designed low-income
customer assistance program combined with energy efficiency and
weatherization programs in order to help consumers minimize their
energy bills and lower their requirements for assistance. While highly
successful, these local initiatives must be coupled with a strong
LIHEAP program to meet the growing needs of low-income customers. In
the last several years, volatile home-heating oil and natural gas
prices, severe winters, high utility bills as a result of dysfunctional
wholesale electricity markets and the effects of the economic downturn
have all contributed to an increased reliance on LIHEAP funds. Even at
$5.1 billion, LIHEAP cannot provide assistance to all who qualify for
the program. Cutting this program by $2.5 billion would have very
serious consequences for those who rely on the program.
Also when considering LIHEAP appropriations this year, we encourage
the subcommittee to provide advanced funding for the program so that
shortfalls do not occur in the winter months during the transition from
one fiscal year to another. LIHEAP is one of the outstanding examples
of a State-operated program with minimal requirements imposed by the
Federal Government. Advanced funding for LIHEAP is critical to enabling
States to optimally administer the program.
Thank you again for this opportunity to relay our support for
increased LIHEAP funding for fiscal year 2012.
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM) is pleased to submit
the following testimony on the fiscal year 2012 appropriation for the
Centers for Disease Control and Prevention (CDC). The ASM is the
largest single life science organization in the world with over 38,000
members. The ASM mission is to enhance the science of microbiology, to
gain a better understanding of life processes and to promote the
application of this knowledge for improved health and environmental
well being.
The ASM supports the proposed fiscal year 2012 budget of $11.3
billion for the CDC, a 3.4 percent increase over the fiscal year 2010
funding level. The budget recognizes the importance of maintaining a
strong infrastructure to address infectious disease prevention and
control. The CDC's role, in partnership with State and local health
departments and international partners, is to monitor for known and
emerging infectious disease threats through surveillance and laboratory
diagnosis, and to develop control and prevention strategies for these
diseases. Examples include vaccine preventable diseases, foodborne
diseases, pandemic influenza, vectorborne and zoonotic diseases,
healthcare acquired infections (HAIs) and antimicrobial resistance. The
proposed fiscal year 2012 budget addresses these threats and provides
targeted resources for them.
The fiscal year 2012 proposed budget includes an increase in
funding for HIV/AIDS, sexually transmitted diseases (STD), tuberculosis
(TB), and hepatitis, and gives the States added flexibility to shift
funding among these programs based on local priorities. The ASM
supports this approach. The ASM also supports the $68 million increase
in funding for emerging and zoonotic diseases, including $40 million in
funding from the Prevention and Public Health Fund to enhance
epidemiology and laboratory capacity in State health departments.
However, caution must be taken regarding any reductions in effort
for ``low impact, disease specific programs'' as proposed in the fiscal
year 2012 budget. Experience indicates that an emerging public health
threat can occur with almost any pathogen, and capacity must be
sustained with this possibility in mind. Examples of such complacency
include the reemergence of drug resistant tuberculosis in the 1990s and
West Nile virus in 1999. The proposed elimination of prion activities
at CDC could have such an impact, as these diseases are related to
human variant Creutzfeld Jakob Disease (vCJD) and to chronic wasting
disease, which is an emerging animal health problem in several areas of
the United States.
The ASM supports investments to address healthcare associated
infections. CDC provided resources through the American Recovery and
Reinvestment Act (ARRA) to develop programs for surveillance and
prevention of HAIs, which have resulted in substantial HAI reductions
in these infections with significant cost savings to the healthcare
system. These investments must be sustained after ARRA funding ends,
and the proposed $47 million for HAIs would accomplish this goal.
The ASM supports the $8.7 million increase in funding for food
safety. The CDC recently released new estimates of foodborne diseases,
concluding that 1 in 6 people in the United States get sick each year
(about 48 million people). The delayed recognition of the widespread
outbreaks of salmonellosis associated with eggs during 2010
demonstrates the need to sustain and enhance vigilance for foodborne
outbreaks. In that outbreak, over 1,900 confirmed illnesses were
reported (likely a small percentage of actual cases) and 500 million
eggs were recalled. CDC's surveillance systems will also play a pivotal
role in assessing the success of programs developed as a result of the
recently passed Food Safety Modernization Act.
The ASM is concerned about the following proposed reductions in the
fiscal year 2012 CDC budget:
--There is a substantial decline in preparedness funding, including a
$72 million cut in funds for State and local preparedness
grants. Such declines will have a significant impact on the
ability of frontline public health workers to be able to
respond to all hazard emergencies at a time of restrained
budgets at the State and local level. The ASM recommends such
grants be maintained at fiscal year 2010 funding levels.
--The proposed elimination of funding for the CDC genomics program
should be restored. Public health genomics is an area of
growing importance, including the ability to identify risk
factors for enhanced susceptibility or resistance to infectious
diseases. Such genetic factors have important implications for
disease prevention and treatment, and must be tied to
epidemiologic investigations and disease surveillance efforts.
--The ASM does not endorse the elimination of targeted funding for
CDC's antimicrobial resistance (AR) activities and the transfer
of these funds into the overall budget for emerging infections.
While ASM appreciates the need for funding flexibility,
antimicrobial resistance is a substantial public health problem
that leads to significant morbidity and death and markedly
increases healthcare costs. To address this threat, sustained
dedicated funding is necessary.
CDC Infectious Disease Programs Protect Public Health
Infectious diseases cause about one-fourth of all deaths globally,
more than 11 million people, over half of them children. In the United
States, influenza and pneumonia account for more than 56,000 deaths
each year. Of the 1.1 million people living in the United States living
with HIV/AIDS, about 21 percent do not know that they are HIV positive;
there are more than 56,000 new HIV infections annually. Last year, the
CDC responded to multiple disease outbreaks and incidents that included
surveillance of cholera in post earthquake Haiti and activation of
CDC's Emergency Operations Center as part of the Federal response to
the gulf oil spill.
In the United States, the economic and societal costs of infectious
diseases are significant, exacerbated by previously unknown microbial
pathogens, rising drug resistance among pathogens and increasing travel
and commerce between geographic areas. The CDC Office of Infectious
Diseases leads United States efforts to stop or minimize the onslaught
of infectious diseases, with highly qualified personnel at three
national centers that specialize in (1) Emerging and Zoonotic
Infectious Diseases; (2) HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention; or (3) Immunization and Respiratory Diseases.
The ASM endorses the proposed fiscal year 2012 budget for key
programs at CDC, including the following:
Emerging Infectious Diseases/Antimicrobial Resistance.--CDC is a
world leader in detecting and preventing emerging and reemerging
infectious diseases, a role which depends on strong science
capabilities and readiness to confront the unexpected. CDC's
infrastructure and partnerships have dealt quickly with the more than
three dozen new human pathogens of medical significance identified in
the past 30 years. Recent CDC advances include developing one of the
first candidate vaccines against all four species of dengue virus, now
in human trials, and a plan to screen U.S. blood donations for West
Nile virus. fiscal year 2012 funding will support planned EID
activities like the development and deployment of improved diagnostic
tests for plague, dengue and chikungunya. About 75 percent of recently
emerging human infectious diseases originated in animals, making
zoonotic diseases another high priority at CDC, along with vectorborne
diseases spread by mosquitoes, ticks, fleas and other vectors. Two
reports last year illustrate the critical nature of CDC's EID
activities: In Florida, an estimated 5 percent of Key West's population
showed recent exposure to the dengue fever virus; and the new
antimicrobial resistance gene called New Delhi metallo b lactamase
(NDM-1), first detected in 2008, is spreading to additional countries.
Increased fiscal year 2012 funding will support CDC efforts against
the alarming (and rising) number of pathogens now resistant to
antimicrobial drugs. As part of the U.S. Interagency Task Force on
Antimicrobial Resistance, CDC distributes both intramural and
extramural AR funding for surveillance, prevention, and research
activities. Agency surveillance networks routinely collect data on
cases of resistant pathogens. CDC provides epidemiology and laboratory
support for outbreaks of AR organisms, and distributes educational
materials to promote appropriate use of antimicrobials. Investments in
AR programs are cost effective; one study estimated that the additional
medical cost per U.S. patient infected with an AR pathogen ranges from
about $19,000 to nearly $30,000. Another estimate concluded that
preventing a single case of multidrug resistant (MDR) tuberculosis can
save up to $700,000. In fiscal year 2010, CDC diagnosed and treated
about 1,000 cases of tuberculosis (including 40 MDR) among overseas
immigrant applicants and U.S. bound refugees, saving States an
estimated $45 million.
HIV/AIDS.--Scientific advances announced last year have added new
tools to CDC's numerous HIV prevention activities; using a vaginal
microbicide or daily doses of an oral antiretroviral drug (PrEP) both
lowered risk of infection in clinical trials. In July 2010, the
Administration released its National HIV/AIDS Strategy for the United
States (NHAS). Proposed fiscal year 2012 budget increases would invest
substantially in the NHAS 5 year goals to reduce new infections: (1)
lower the annual number of new infections by 25 percent, from 56,300 to
42,225; (2) reduce the HIV transmission rate by 30 percent, from 5
persons infected per 100 people with HIV to 3.5 persons infected; and
(3) increase from 79 to 90 the percentage of people living with HIV who
know their serostatus.
Viral Hepatitis.--Proposed fiscal year 2012 increases for viral
hepatitis prevention would boost CDC surveillance in 10 high burden
State and local health departments. Prevention of viral hepatitis has
been successful in recent years, in large part due to vaccines against
hepatitis A and B viruses. HAV incidence has decreased approximately 92
percent nationwide since 1995; rates of HBV have been reduced far below
the original Healthy People 2010 goal of 4.5 cases per 100,000. In the
first half of fiscal year 2010, CDC funded health departments
administered over 130,000 doses of HBV vaccine to at risk adults and
ensured that 87 percent of infants born to HBsAg+ women were
vaccinated. Incidence of hepatitis C infections has dropped from more
than 45,000 cases annually to an estimated 20,000, primarily as a
result of screening the U.S. blood supply and falling case numbers
among intravenous drug users. However, 2.7-3.9 million Americans have
HCV, most unaware of their infection. The fiscal year 2012 budget would
address last year's Institute of Medicine report, which concluded that
public health programs have insufficient hepatitis related resources
and that efforts to prevent and control viral hepatitis are not
adequate.
Sexually Transmitted Diseases.--Fiscal year 2012 increases would
strengthen CDC's STD infrastructure, which supports 65 State and local
prevention programs, and sustain the CDC's surveillance of drug
resistant STD pathogens like that causing gonorrhea. Reducing STD
infections is highly cost effective; for example, CDC estimates that
reductions in gonorrhea and syphilis from 1990 to 2003 saved the U.S.
economy $5 billion. Cost savings with chlamydia screening in sexually
active young women are an estimated $2,500-$37,000 per year. Aggressive
public health efforts to prevent STDs have had positive results; for
instance, from 1999 to 2009, rates of primary and secondary syphilis
among females declined by 30 percent, while congenital syphilis dropped
32 percent. Yet, in general, STDs in the United States persist at
unacceptable levels: CDC estimates that there are approximately 19
million new STD infections each year, which cost the U.S. healthcare
system $16.4 billion annually (2009 figures).
CDC Campaigns Prevent Disease in the United States, Worldwide
Healthcare Associated Infections.--In the United States, 1 in 20
hospital patients get an infection during medical treatment. Of the
nearly 2 million infections acquired in some type of healthcare setting
annually, almost 100,000 are fatal. A 2009 CDC report estimates that
each year U.S. hospitals spend between $28 billion and $35.7 billion to
treat often preventable HAIs. Depending on the effectiveness of
infection control interventions used, the CDC expects that prevention
measures could save from $5.7 billion-$31.5 billion of these costs. To
illustrate, intensive care units have reduced bloodstream infections in
patients with central lines by 58 percent since 2001, using CDC
recommended infection control procedures and saving up to 27,000 lives
and $1.8 billion. The proposed fiscal year 2012 budget would
significantly increase support for the CDC's HAI activities and its
National Health Care Safety Network (NHSN) that had provided monitoring
capacity to more than 3,900 health facilities by the end of 2010. With
the increased funding, routine NHSN participation will expand from
2,500 to 6,500 healthcare settings (5,500 hospitals; the rest include
hemodialysis and long-term care facilities). In March this year, the
CDC awarded $10 million for HAI research at five academic medical
centers, as part of its Prevention Epicenter program.
Immunization.--The Administration's fiscal year 2012 CDC budget
invests substantial resources into vaccine preventable diseases,
continuing national immunization campaigns against diseases like
seasonal and pandemic influenza. The number of lives saved and medical
costs reduced can be considerable. According to the CDC, ``for every
birth cohort who receives seven [routine childhood] vaccines . . .
society saves $9.9 billion in direct medical costs; over 33,500 lives
are saved; and 14 million cases of disease are prevented.'' Other
examples of returns on CDC investment include vaccination against
Haemophilus influenzae type b (Hib), responsible for a 99 percent
decline in this leading cause of bacterial meningitis in children under
age 5, for an estimated medical cost savings of $950 million per year
plus another $1.14 billion of retained earnings by unpaid caregivers.
In the past year, CDC reported that 3 years of rotavirus vaccinations
had reduced severe rotavirus disease by 85 percent, and helped develop
the guidelines for deploying the new pneumococcal vaccine expected to
greatly reduce pneumonia and ear infections among children. In
December, CDC launched its Vaccine Tracking System to follow vaccine
orders from manufacturer to distributor to health providers.
Global Health.--Lower respiratory tract infections, diarrheal
diseases, HIV/AIDS, TB and malaria together account for nearly one-
fifth of deaths globally. CDC is a lead partner in the Administration's
Global Health Initiative, underscoring the importance of infectious
diseases no matter where outbreaks occur. The fiscal year 2012 budget
includes increase of funds for global polio eradication, an
international campaign begun in 1988 that is nearing victory with only
four countries still harboring endemic disease. Last year, there were
about 900 cases reported, declining from more than 350,000 in 1988.
fiscal year 2012 funds will purchase 254 million doses of oral polio
vaccine for use in mass immunization campaigns in Southeast Asia,
Africa and Europe, to achieve CDC's target of zero polio endemic
countries by the end of 2012. Funding will support the CDC vaccination
campaign toward a 90 percent reduction in global measles related
mortality; by 2008, CDC and its partners had helped reduce measles
deaths by 78 percent, from an estimated 733,000 in 2000 to about
164,000.
Quarantine and migration related activities also are part of the
agency's multi level strategies in global health; CDC operates 20 U.S.
quarantine stations and responds to outbreaks in refugee camps
overseas. Travel and trade allow pathogens to move quickly. The 2009
``swine flu'' spread to 30 countries within 6 weeks. About 1.8 million
airline passengers cross international borders daily, and about half of
international travelers worldwide have some kind of health problem
while traveling. An estimated 50,000-70,000 refugees and 1.2 million
immigrants resettle in the United States each year, while more than 2
million people travel to or through this country by air, sea, or land
daily.
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM) wishes to submit the
following written testimony on the fiscal year 2012 appropriation for
the National Institutes of Health (NIH). The ASM is the largest single
life science organization with over 38,000 members. Its mission is to
enhance the science of microbiology, to gain a better understanding of
life processes and to promote the application of this knowledge for
improved health and environmental well being.
The ASM urges Congress to support strong Federal funding for
biomedical research and to provide $35 billion in funding for the NIH
in fiscal year 2012. Continued investments in science and public health
programs are critical to the Nation's health, economic growth, national
security and global leadership. Acquiring knowledge at the frontiers of
science is the basis for new technologies, medical discoveries, new
industries and high value jobs. Investments in biomedical research lead
to more effective treatments, preventions and cures for chronic and
infectious diseases, improving the quality of life for people
everywhere. Reducing funding for research project grants will slow
medical progress on a myriad of diseases, adversely affecting human
life. Attracting and retaining scientists and maintaining the vitality
of the research enterprise will become more difficult if the Nation
does not remain committed to sustained and predictable funding for
research and training. We, therefore, urge Congress to make increased
appropriations for biomedical research a national priority as the
Federal budget is considered for the coming fiscal year.
national institutes of health: a crucial investment for the future
The NIH is a primary contributor to growing the Nation's economy
and ensuring U.S. leadership in science. The NIH expends 97 percent of
its annual budget on R&D activities through its 27 centers and
institutes. NIH funding helps foster innovation among more than 300,000
research personnel at over 3,000 universities and research
institutions, with about 6,000 scientists working in NIH's own
laboratories.
Life saving successes in biomedical research depend on NIH support:
for example, the development last year of a new 2 hour diagnostic test
for tuberculosis and drug resistant TB bacteria; a potential drug
against malaria parasites, evidence that an anti-HIV treatment could
also prevent infection, research suggesting a role for intestinal
bacteria in obesity, and the 2010 Nobel Prize winning methods to
synthesize compounds that have already proven effective against HIV and
herpes virus. NIH funded research improves the health of our
communities, represents investment in local and national economic
growth and advances U.S. science and medicine.
Investing in Scientific Innovation, Advancing Medical Knowledge
NIH funded research has repeatedly reshaped medicine and continues
to enhance public health. NIH routinely identifies new research
initiatives and pursues transformative research. NIH recently
delineated five priority areas with particular promise for safeguarding
our future, including:
--High throughput technologies.--DNA sequencing, nanotechnology and
other computer supported technologies can generate massive data
sets that enable comprehensive approaches to disease, like the
NIH microbiome project to understand how interactions with the
microbes that live on and in the human body influence health
and disease.
--Translational medicine.--NIH programs will increasingly focus on
translating basic scientific discoveries into new clinical
diagnostics and treatments (bench to bedside).
--Informing healthcare reform.--With U.S. expenditures on healthcare
approaching 20 percent of our gross domestic product, NIH
research areas like personalized medicine and pharmacogenomics
seek cost effective solutions through disease treatment and
prevention tailored to individual patients.
--Global health.--In addition to NIH's ongoing efforts against AIDS,
tuberculosis and malaria, more resources will go toward
combating neglected tropical diseases that devastate low income
countries.
--Reinvigorating the biomedical research community.--NIH is
reevaluating the Nation's future scientific workforce needs in
terms of its own training programs, as well as optimizing NIH's
extramural research investments to more effectively discover
innovative medical solutions.
the importance of investigator initiated research
The majority of NIH funds are distributed across the country to
extramural researchers through grants, contracts and fellowships.
Investigator initiated, competitively awarded Research Project Grants
(RPGs) are the single most effective mechanism for ensuring research
innovation. Early in the decade, an average of 1 out of 3 grant
applications were funded. In recent years, the success rate has fallen
to roughly 1 in 5, with only a 15 percent success rate estimated for
fiscal year 2011, despite an abundance of research opportunities.
Scientific advances require investigator inspiration and
persistence often over years of research. For example, a large share of
the research awarded the 2010 Nobel Prize in Chemistry occurred in a
laboratory supported since 1979 by the National Institute of General
Medical Sciences (NIGMS). Success developing the DNA based TB rapid
diagnostic test announced last year followed more than 8 years of
National Institute of Allergy and Infectious Diseases (NIAID) support.
NIH funding also enables transformative research that has a higher
degree of risk for failure, but potential for huge scientific rewards,
like recipients of the relatively new EUREKA program (Exceptional,
Unconventional Research Enabling Knowledge Acceleration) managed by
NIGMS. Among this year's new NIGMS grants are projects designed to
decipher the genetic code in yeast and to use bacterial components to
induce patient specific stem cells that facilitate gene therapy.
At NIH, long range strategies for research success include
workforce development and mentoring young researchers. NIAID, for
example, met its own target of supporting ``new investigators'' in
fiscal year 2009 by funding about 20 percent of those who applied for
R01 grants as first time principal investigator. NIGMS, which
distributes 70 percent of its budget to research project grants,
contributes an additional 10 percent to underwrite institutional
training grants and fellowships that specifically fulfill its mission
to train the next generation of medical scientists. In addition, NIGMS
funds approximately 50 percent of Ph.D. research training positions at
NIH, including the Medical Scientist Training (M.D.-Ph.D.) program.
Additional NIH grant programs focus on K-12 education in science,
technology, engineering and mathematics (STEM), to foster a future
technical workforce.
The NIH regularly identifies research intended to ultimately
produce public health benefits. In fiscal year 2009, NIAID released 33
new funding opportunity announcements that are already producing
results in selected areas, including innovative approaches to vaccine
development against HIV, malaria and hepatitis C, and clinical trials
specifically designed to counter the threat of antimicrobial resistance
among pathogens. Research concepts reviewed periodically by NIAID
advisory councils may anticipate potential research initiatives for
upcoming funding cycles. For example, concepts approved in September
2010 included research to prevent the spread of drug resistant
pathogens; support for Functional Genomics Research Centers that will
generate massive genetic data sets readily available to the broad
scientific community; improved diagnostics for Lyme disease; and a
``pluripotent approach'' for sexual and reproductive health that might
combine contraceptive methods with microbicides, vaccine or other
disease preventives.
NIH Research to Address Threats of Infectious Diseases and
Antimicrobial Resistance
Infectious diseases cause approximately 26 percent of all deaths
worldwide, more than 11 million people annually. Each year infectious
diseases kill approximately 6.5 million children, most in developing
countries. These preventable diseases also greatly impact public health
systems in the United States. For example, influenza and pneumonia
account for more than 56,000 deaths annually, while each year there are
more than a million new cases of sexually transmitted diseases. Despite
ground breaking triumphs against infectious diseases over decades of
research, both predictable and unexpected infectious agents continue to
challenge medical science. In recent years of flat funding, NIAID has
had to respond to additional public health threats like bioterrorism
and unforeseen infectious diseases, by steadily expanding its research
portfolio and its capabilities to recognize and quickly counter newly
emerging and reemerging diseases in the United States and elsewhere.
The scope and significance of NIAID sponsored research cannot be
overstated.
The emergence of drug resistant microbial pathogens seriously
complicates efforts to stop or minimize infectious diseases. The
magnitude of the problem elevates the public health significance of
antimicrobial resistance. Examples of clinically important microbes
that are rapidly developing resistance to available drugs include
bacteria that cause pneumonia, ear infections and meningitis, skin,
bone, lung and bloodstream infections, urinary tract infections,
foodborne infections and infections in healthcare settings. In recent
years there have been dramatic examples like chloroquine resistant
malaria, methicillin resistant Staphylococcus aureus (MRSA) infection
and multidrug resistant and extensively drug resistant tuberculosis.
Ten percent of all hospitalized patients in this country have or
develop resistant infections, adding $55 billion in annual healthcare
costs. The public health burden of MRSA is enormous with over 90,000
MRSA infections per year in the United States. As a result, more NIH
funding must be allotted to relevant research. In 2010 NIAID announced
four new contracts for large scale clinical trials (making a total of
eight trials) focused on treatment alternatives for diseases for which
antibiotics are prescribed most often (e.g., middle ear infections).
Also in 2010, NIAID reported a newly identified MRSA toxin, the only
MRSA toxin currently known to destroy specific human immune cells and a
possible target of future drugs.
HIV/AIDS.--Since 1981, when the U.S. epidemic began, HIV/AIDS has
killed more than 565,000 people in the United States. Each year there
are about 2 million AIDS related deaths worldwide and an additional 2.7
million become newly infected, including about 56,000 new infections
annually in the United States. An estimated 33 million are living with
HIV/AIDS, over 1 million of those in this country. In large part due to
NIH support, medical science now offers rising hope amidst these grim
statistics, as those with HIV/AIDS live longer and better. In 2010,
NIAID funded researchers reported several studies that have been called
landmarks in the fight against this difficult disease:
--Preexposure prophylaxis (PrEP) with a daily dose of an approved
anti-HIV drug reduces the risk of infection among men who have
sex with men; studies of other at risk populations continue.
--After nearly 15 years of research, scientists discovered the first
vaginal microbicide gel that gives women some protection
against HIV infection.
--Various research groups have discovered at least eight antibodies
that can stop HIV from infecting human cells in the laboratory,
which could help scientists design effective vaccines.
--A study in Cambodia demonstrated that people coinfected with HIV
and tuberculosis can benefit from starting antiretroviral
therapy earlier than originally believed (antiretroviral
treatment can worsen the symptoms of coinfections, so timing is
critical).
Emerging Infectious Diseases.--Since 2003, NIAID has had principal
responsibility for NIH's research and development of medical
countermeasures against radiological, nuclear, chemical and biological
terrorist threats. NIAID's programs on biodefense and emerging/
reemerging infectious diseases are inevitably intertwined. Researchers
study hemorrhagic fevers caused by Ebola and other viruses, West Nile
virus, prion diseases, influenza viruses, anthrax, and dozens of other
infectious diseases, seeking vaccines, therapeutics, and diagnostics to
prevent or curb disease outbreaks. Last year, for instance, NIAID
scientists announced a new, quick method called real time quaking
induced conversion assay (RT QuIC) to detect prions, which cause fatal
brain diseases like mad cow disease in cattle, Creutzfeldt Jakob
disease in humans, and scrapie in sheep. Other researchers discovered a
new form of murine prion disease that resembles a form of human
Alzheimer's disease.
Last August, after more than a decade of work by NIAID scientists,
a dengue vaccine began human clinical testing; the virus infects about
50 million to 100 million people annually. NIAID also awarded new
contracts to private industry to develop delivery systems for new
vaccines against anthrax and dengue fever; clinical trials of the three
vaccines should begin within 3 years. Two other experimental vaccines
showed promise against Marburg virus (cause of hemorrhagic fever with a
fatality rate up to 80 percent) and Ebola virus (up to 90 percent
fatality).
National Security and Research.--Beginning in the late 1990s and
especially following 2001, funding for research in the Department of
Defense related to global diseases that impact U.S. military on foreign
soil as well as protection against biothreats on U.S. soil decreased.
This research is now primarily entrusted to NIAID and other NIH
institutes, FDA and CDC. Research related to defense is interdependent
on advances in other areas of research, especially those related to
emerging infections. Reports issues recently by the Institute of
Medicine and the National Biodefense Science Board emphasize the need
to properly fund these agencies for medical countermeasure development.
Genomics.--NIAID and NIGMS sponsor genomic research for improving
human health. At NIGMS, investigators are using human genetic
information to explain and identify individuals' reactions to certain
drugs--research called pharmacogenetics, which is focused on the NIH
goal of cost effective ``predictive, personalized, and preemptive
medicine.'' NIAID supported genomic research programs include genome
sequencing centers and bioinformatics resource centers. By the end of
2010, the Institute's two Structural Genomics Centers for Infectious
Diseases had determined 500 3-D protein structures from microorganisms
on the NIAID Category A-C priority lists or otherwise considered major
human pathogens.
Global Health.--Infectious diseases travel easily across
international borders, and the economic stability of nations can be
shaken by high rates of morbidity and mortality from such diseases.
Fiscal year 2009 marked the 30th anniversary of the Institute's
International Collaborations in Infectious Disease Research (ICIDR)
program. That year NIAID supported 643 international projects in 97
countries, with 72 percent of the funds invested in HIV/AIDS research.
In mid 2010, NIAID announced funding to establish 10 new malaria
research centers around the world. NIAID supported researchers recently
developed a chemical that may prove to be a new malaria drug; it has
more than a decade since the last new class of antimalarials became
available against a disease that kills nearly 1 million people every
year. Preliminary data suggest that the new compound might be effective
as a single dose, rather than the current standard treatment of
multiple doses over several days. Also last year, other NIAID grantees
described a previously unknown metabolic pathway used by malaria
parasites to survive inside human blood cells.
conclusion
For over a century, NIH funded discoveries have saved lives,
stimulated private industry and fostered the next generation of
scientists and physicians. More than 130 Nobel Prize winners have
received support from NIH, but more importantly, the health of millions
worldwide has been improved through NIH programs. NIH investments have
also yielded remarkable financial rewards, from basic research that
helped launch the biotech industry to the recent development of a
highly effective meningitis vaccine that each year saves an estimated
$950 million in medical costs and another $1.14 billion in patient/
caregiver earnings. The ASM strongly recommends that Congress support
innovation in the medical sciences and increase funding for the
National Institutes of Health in fiscal year 2012.
______
Prepared Statement of the American Society for Nutrition
The American Society for Nutrition (ASN) appreciates the
opportunity to submit testimony regarding fiscal year 2012
appropriations for the National Institutes of Health (NIH) and the
National Center for Health Statistics (NCHS). ASN is the professional
scientific society dedicated to bringing together the world's top
researchers, clinical nutritionists and industry to advance our
knowledge and application of nutrition to promote human and animal
health. Our focus ranges from the most critical details of nutrition
research to broad societal applications. ASN respectfully requests $35
billion for NIH, and we urge you to adopt the President's request of
$162 million for NCHS in fiscal year 2012.
Basic and applied research on nutrition, nutrient composition, the
relationship between nutrition and chronic disease, and nutrition
monitoring are critical to the health of all Americans and the U.S.
economy. Awareness of the growing epidemic of obesity and the
contribution of chronic illness to burgeoning healthcare costs has
highlighted the need for improved information on dietary components,
dietary intake, strategies for dietary change and nutritional
therapies. The health costs of obesity alone are estimated at $147
billion each year. This enormous health and economic burden is largely
preventable, along with the many other chronic diseases that plague the
United States. It is for this reason that we urge you to consider these
recommended funding levels for two agencies under the Department of
Health and Human Services that have profound effects on nutrition
research, nutrition monitoring, and the health of all Americans--the
National Institutes of Health and the National Center for Health
Statistics.
National Institutes of Health
The National Institutes of Health (NIH) is responsible for
conducting and supporting 90 percent (approximately $1 billion) of
federally funded basic and clinical nutrition research. Nutrition
research, which makes up about 4 percent of the NIH budget, is truly a
trans-NIH endeavor, being conducted and funded across multiple
Institutes and Centers. In order to fulfill the full potential of
biomedical research, including nutrition research, ASN recommends an
fiscal year 2012 funding level of $35 billion for the agency, a modest
increase over the current funding level of $34 billion (including
supplemental appropriations). This increase is necessary to maintain
both the existing and future scientific infrastructure. Although the
discovery process produces tremendous value, it often takes a lengthy
and unpredictable path. Economic stagnation is disruptive to training,
careers, long range projects and ultimately to progress. NIH needs
sustainable and predictable budget growth to achieve the full promise
of medical research to improve the health and longevity of all
Americans and continue our Nation's dominance in this area.
NIH and its grantees have played a major role in the growth of
knowledge that has led to an unprecedented number of scientific
breakthroughs that have transformed our understanding of human health,
helping Americans to live longer, healthier and more productive lives.
Many of these discoveries are nutrition-related and have impacted the
way clinicians prevent and treat heart disease, cancer, diabetes and
other chronic diseases. By 2030 the number of Americans age 65 and
older is expected to grow to 72 million, and the incidence of chronic
disease will also grow. Sustained support for nutrition research is
required if we are to successfully confront the healthcare challenges
associated with an older population.
CDC National Center for Health Statistics
The National Center for Health Statistics (NCHS), housed within the
Centers for Disease Control and Prevention (CDC), is the Nation's
principal health statistics agency. The NCHS provides critical data on
all aspects of our healthcare system, and it is responsible for
monitoring the Nation's health and nutrition status through surveys
such as the National Health and Nutrition Examination Survey (NHANES).
Nutrition and health data are essential for tracking the nutrition,
health and well being of the American public, especially for observing
nutritional and health trends in our Nation's children. Through
learning both what Americans eat and how their diets directly affect
their health, the NCHS is able to monitor the prevalence of obesity and
other chronic diseases in the United States and track the performance
of preventive interventions, as well as assess consumption of
``nutrients of concern'' such as Vitamin D and calcium. Data such as
these are critical to guide policy development in the area of health
and nutrition.
To continue support for the agency and its important mission, ASN
recommends an fiscal year 2012 funding level of $162 million for the
agency. Flat and decreased funding levels threaten the collection of
this important information, most notably vital statistics and the
NHANES. Moreover, nearly 30 percent of the funding for NHANES comes
from other Federal agencies such as the NIH and the USDA Agricultural
Research Service. When these agencies face flat budgets or worse,
budget cuts, they withdraw much-needed support for NHANES, placing this
valuable resource in peril. Sustained funding for NCHS can help to
ensure uninterrupted collection of vital health and nutrition
statistics.
Thank you for your support of the National Institutes of Health
(NIH) and the National Center for Health Statistics (NCHS), and thank
you for the opportunity to submit testimony regarding fiscal year 2012
appropriations. Please contact Sarah Ohlhorst, MS, RD, Director of
Government Relations, if ASN may provide further assistance. She can be
reached at address: 9650 Rockville Pike, Bethesda MD 20814; telephone
number: 301.634.7281 or email address: [email protected].
______
Prepared Statement of the American Society for Pharmacology &
Experimental Therapeutics
The American Society for Pharmacology and Experimental Therapeutics
(ASPET) is pleased to submit written testimony in support of the
National Institutes of Health (NIH) fiscal year 2012 budget. ASPET is a
5,100 member scientific society whose members conduct basic and
clinical pharmacological research within the academic, industrial and
government sectors. Our members discover and develop new medicines and
therapeutic agents that fight existing and emerging diseases, as well
as increase our knowledge regarding how therapeutics affects humans.
For fiscal year 2012, ASPET supports a $35 billion budget for the
NIH. Research funded by the NIH improves public health, helps stimulate
our economy and improves global competitiveness. Sustained growth for
the NIH should be an urgent national priority. Flat funding or cuts to
the NIH budget will delay cures, eliminate jobs, and jeopardize
American leadership and innovation in biomedical research.
A $35 billion budget for the NIH in fiscal year 2012 will help
restore some of the lost opportunities and purchasing power since 2003,
when Congress finished a bipartisan effort of doubling the NIH budget.
Currently, the NIH cannot begin to fund all the high quality research
that needs to be done. At the moment only one-in-five research projects
can be supported. The situation has now reached a critical point:
--Over the past 6 years, the number of research project grants funded
by NIH has declined almost every year.
--NIH funds 2,000 fewer grants in total than in fiscal year 2004.
--NIH made 1,000 fewer competing (new and renewed) awards in 2010
than it did in 2003.
--Success rates for new applications have fallen for three straight
years.
If flat funding continues, or if additional cuts are made to the
NIH budget for fiscal year 2012, important research that improves the
quality of life, offers life-saving new therapeutics, and ultimately
reduces healthcare costs will be delayed or stopped. International
competitors will continue to gain on this highly innovative U.S.
enterprise, and we will lose a generation of young scientists who see
no prospects for careers in biomedical research. Flat or reduced
funding for NIH will mean that the agency would have to dramatically
reduce new awards and many research projects in progress would not
receive sufficient funding to complete the work, thus representing a
waste of valuable research resources.
An fiscal year 2012 NIH budget of $35 billion would help to restore
momentum to NIH funding. Scientific discovery takes time. As recent
experience has shown from the post-doubling experience and more recent
stimulus funding in 2009 and 2010, ``boom and bust'' cycles of rapid
funding followed by significant periods of stagnation or retraction in
the NIH budget diminish scientific progress. A $35 billion fiscal year
20121 NIH budget will help the agency manage its research portfolio
effectively without too much disruption of existing grants to
researchers throughout the country. The NIH, and the entire scientific
enterprise, cannot rationally manage boom or bust funding cycles. Only
through steady, sustainable and predictable funding increases can NIH
continue to fund the highest quality biomedical research to help
improve the health of all Americans and continue to make significant
economic impact in many communities across the country. An fiscal year
2012 NIH budget of $35 billion will help the NIH move to more fully
exploit promising areas of biomedical research and translate the
resulting findings into improved healthcare.
Investing in NIH Improves Human Health
Diminished funding for NIH will mean a loss of scientific
opportunities to discover new therapeutic targets and will create
disincentives to young scientists to commit to careers in biomedical
science. A $35 billion fiscal year 2012 NIH budget would provide the
various institutes that make up the NIH with an opportunity to fund
more high quality and innovative research in many disease areas.
Earlier and significant investments in NIH research have been
instrumental in improving human health:
--Parkinson's disease is estimated to afflict over 1 million
Americans at an annual cost of $26 billion. The discovery of
Levodopa was a breakthrough in treating the disease and allows
patients to lead relatively normal, productive lives. It is
estimated that treatments slowing the progress of disease by 10
percent could save the United States $327 million a year.
Current treatments slow progression of disease, but more
research is needed to identify the causes of the disease and
develop better therapies.
--More than 38 million Americans are blind or visually impaired, and
that number will grow with an aging population. Eye disease and
vision loss cost the United States $68 billion annually. NIH
funded research has developed new treatments that delay or
prevent diabetic retinopathy, saving $1.6 billion a year.
Discovery of gene variations in age related macular
degeneration could result in new screening tests and preventive
therapies.
--Almost 5 million Americans suffer from Alzheimer's disease at
annual costs of more than $100 billion. It is estimated that by
2050 more than 14 million Americans will live with the disease.
There are over 28 new drugs for Alzheimer's disease in
development, but more basic research is needed to keep the
pipeline for new drugs robust. Inadequate funding could delay,
prevent, and improve the treatment of the disease.
--Heart disease and stroke are the number one and three killers of
Americans, respectively. Cardiovascular disease costs the
United States more than $350 billion annually. Since 1970,
death rates from cardiovascular disease have fallen by 50
percent, but still remain the leading cause of death. Statin
drugs that reduce cholesterol help to prevent heart disease and
stroke, decrease recurrence of heart attacks and improve
survival rates for heart transplant patients.
--Cancer is the second leading cause of death in the United States.
The NIH estimates that the annual cost of the disease is over
$228 billion. NIH research has shown that human papillomavirus
(HPV) vaccines protect against persistent infection by the two
types of HPV that cause approximately 70 percent of cervical
cancers. NIH funded researchers are using nanotechnology to
develop probes that could pinpoint the location of tumors and
deliver drugs directly to cancer cells.
NIH-funded studies have also indicated that adopting intensive
lifestyle changes delayed onset of type-2 diabetes by 58 percent, and
that progesterone therapy can reduce premature births by 30 percent in
at-risk women. Historically, our past investment in basic biological
research has led to many innovative medicines. The National Research
Council reported that of the 21 drugs with the highest therapeutic
impact, only five were developed without input from the public sector.
The significant past investment in the NIH has provided major gains in
our knowledge of the human genome, resulting in the promise of
pharmacogenomics and a reduction in adverse drug reactions that
currently represent a major worldwide health concern. Already, there
are several examples where complete human genome sequence analysis has
pinpointed disease-causing variants that have led to improved therapy
and cures. Although the costs for such analyses have been reduced
dramatically by technology improvements, widespread use of this
approach will require further improvements in technology that will be
delayed or obstructed with inadequate NIH funding.
Unless NIH can maintain an adequate funding stream, scientific
opportunities will be delayed, lost, or forfeited to other countries.
This investment in NIH also will directly support jobs for U.S.
citizens and residents and help to stimulate the economy.
Investing in NIH Helps America Compete Economically
A $35 billion budget in fiscal year 2012 will also help the NIH
train the next generation of scientists. This investment will help to
create jobs and promote economic growth.
Worldwide, other nations continue to invest aggressively in
science. China has grown its science portfolio with annual increases to
the research and development budget averaging over 23 percent annually
since 2000. And while Great Britain has imposed strict austerity
measures to address that Nation's debt problems, the British
conservative party had the foresight to keep its strategic investments
in science at current levels. Investment in research and development as
a percentage of gross domestic product has remained static for the
United States in the first decade of the 21st century, while growing by
nearly 60 percent in China and 34 percent in South Korea.
NIH research funding helps to catalyze private sector growth. More
than 83 percent of NIH funding is awarded to over 3,000 universities,
medical schools, teaching hospitals and other research institutions in
every State. NIH also helps form the key scientific foundations for the
pharmaceutical and biotechnology industries.
Inadequate funding for NIH means more than a loss of scientific
potential and discovery. Failing to help meet the NIH's scientific
potential will mean a significant reduction in research grants, the
resulting phasing-out of high quality research programs and jobs lost.
Conclusion
ASPET has full awareness for the many competing and important
priorities facing the subcommittee. However, NIH and the biomedical
research enterprise face a critical moment and the agency's
contribution to the economic and physical well being of American's
health should make it one of the Nation's top priorities. With enhanced
and sustained funding, NIH has the potential to address many of the
more promising scientific opportunities that currently challenge
medicine. A $35 billion fiscal year 2012 NIH budget will allow the
agency to begin moving forward again to prevent, diagnose and treat
disease, restoring the NIH to its role as a national treasure that
attracts and retains the best and brightest to biomedical research, and
providing hope to millions of individuals afflicted with illness and
disease.
______
Prepared Statement of the American Society of Nephrology
Introduction
The American Society of Nephrology (ASN) thank you for the
opportunity to submit a statement for the record to the Senate
Appropriations Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies (LHHS Subcommittee). ASN urges the LHHS
subcommittee to support robust funding for medical research in the
fiscal year 2012 Federal budget.
ASN is a not-for-profit professional society of more than 11,000
scientists and physicians dedicated to cutting-edge medical research
and delivering the highest quality therapies to patients. Foremost
among ASN's concerns is the continued support of basic, translational,
and clinical nephrology research.
The society's statement focuses on those issues and programs that
most immediately fall under the committee's jurisdiction and assist our
members in finding breakthrough treatments and cures for patients with
kidney disease. We want to express our strong support for advancing
programs supported by the National Institutes of Health (NIH) and the
Agency for Healthcare Research and Quality (AHRQ). The ASN thanks the
Subcommittee for its steadfast support of these programs and requests
continued support of medical research in fiscal year 2012.
The Face of Kidney Disease
Chronic kidney disease now is a major public health problem in the
United States, with as many as one in nine Americans or 26 million
people suffering from kidney disease of some degree. This number is
projected to rise, underscoring that support of medical research into
the causes and treatments of kidney disease is essential to protecting
public health. A growing population, a significant and growing cohort
of Americans above age 65, the combined epidemics of cardiovascular
disease, diabetes, and hypertension all lead to an increasing number of
Americans with chronic kidney disease.
Chronic kidney disease affects people regardless of age, race, sex,
socio economic background, or geographic location. It is estimated that
at least 15 million people suffer from CKD, meaning that they have lost
at least 50 percent of their kidney function. Most don't know it.
Another 20 million more Americans are at increased risk of developing
kidney disease. Again, most are unaware. Hypertension and diabetes are
leading causes of kidney disease, with diabetes accounting for 44
percent of new cases of complete kidney failure. With both diabetes and
hypertension on the rise, the need for additional kidney disease
research takes on greater importance.
Kidney disease is also a major risk factor for cardiovascular
disease, with half of patients with kidney failure dying from
cardiovascular disease. Research at NIH continues to disentangle the
relationship between kidney disease, cardiovascular disease, diabetes
and hypertension.
Without treatment chronic kidney disease often progresses to
complete kidney failure also known as end stage renal disease (ESRD),
or permanent kidney failure. Patients with ESRD require dialysis or
transplantation to survive for which Medicare covers the cost for
almost all patients. Nearly 500,000 Americans have ESRD, and that
continues to grow. Additionally, African-Americans, Native Americans,
and Hispanics are at greater risk of developing ESRD than Caucasians.
NIH research is helping to unlock the reasons behind these health
disparities.
Economics Costs
Although no dollar amount can be affixed to human suffering or the
loss of human life, economic data can help to identify and quantify the
current and projected future financial costs associated with ESRD. The
annual average cost per ESRD patient on dialysis is approximately
$71,000. This major cost to Medicare highlights the need to investigate
new, and better apply, recently proven strategies for preventing and
slowing the progress of kidney disease.
In short, we can treat and maintain patients who are at risk for
losing their kidney function but the critical need is to prevent the
loss of kidney function and its complications in the first place.
Meeting this vital goal can only be accomplished through more concerted
research and education.
Kidney Disease Research
National Institutes of Health (NIH)
NIH research is vital to the public and economic health of the
United States. As such, ASN supports the Administration's program level
request of $31.987 billion for NIH in fiscal year 2012. Recognizing the
economic challenges of the country's current fiscal situation, ASN
nonetheless submits that maintaining level funding for NIH is
imperative to the future health and well-being of the Nation. Research
supported by NIH helps discover new cures and treatments for the
millions of Americans with kidney disease and improves the lives of
patients across the country. Medical research funded through NIH means
hope for patients with kidney disease.
NIH research also serves as a vital economic engine. More than 80
percent of NIH funding flows back to States, maintaining jobs and
promoting economic vitality. Support for NIH research helps ensure that
the United States remains the world leader in cutting edge treatments
for chronic disease. NIH grants and research fund the cures of
tomorrow, and also fund researchers who form the backbone of our global
competitiveness in the medical field. A drop in funding, even one that
is short lived could have drastic consequences for the future research
workforce.
In fiscal year 2012 an NIH budget of $31.987 billion will allow
research funding to keep pace with inflation, sustain the invaluable
research projects currently underway, and allow the research workforce
to remain adequately supported and protect a valuable investment in
human talent.
Agency for Health Care Research and Quality (AHRQ)
Complementing the medical research conducted at NIH, AHRQ sponsors
health services research designed to improve the quality of healthcare,
decrease healthcare costs, and provide access to essential healthcare
services by translating research into measurable improvements in the
healthcare system. AHRQ supports emerging critical issues in healthcare
delivery and addresses the particular needs of at risk populations. ASN
firmly believes in the value of AHRQ's research and quality agenda,
which continues to provide healthcare providers, policymakers, and
patients with critical information needed to improve healthcare and
treatment of chronic conditions such as kidney disease. AS such ASN
supports the Administration's budget request of $366 million for AHRQ
in fiscal year 2012.
Conclusion
The progression of chronic kidney disease to kidney failure can be
slowed, with further research, treatments for stopping progression or
even reversing it can be envisioned. Meanwhile, millions of Americans
face a gradual decline in their quality of life because of kidney
disease. Treatments of kidney failure including transplantation
increase the ability of patients to be productive citizens. In many
cases, abnormalities associated with early stage chronic renal disease
remain undetected and are not diagnosed until the late stages. Chronic
kidney disease requires our serious and immediate attention.
Medical research undertaken at NIH and AHRQ is essential to the
health of patients with kidney disease, both present and future. As
such, ASN urges the Subcommittee to adopt level funding for these
programs in fiscal year 2012.
Thank you for your continued support for medical research and
kidney disease. The society appreciates the opportunity to submit
written testimony in support of NIH and AHRQ. To discuss this written
testimony, ASN, medical research or kidney disease, please contact ASN
Director of Policy and Public Affairs Paul Smedberg.
______
Prepared Statement of the American Society of Plant Biologists
On behalf of the American Society of Plant Biologists (ASPB) we
would like to thank the Subcommittee for its support of the National
Institutes of Health (NIH).
ASPB and its members recognize the difficult fiscal environment our
Nation faces, but believe investments in scientific research will be a
critical step toward economic recovery. ASPB asks that the Subcommittee
Members encourage increased support for plant biology research within
NIH, which has contributed in innumerable ways to improving the lives
of people throughout the world.
The American Society of Plant Biologists is an organization of
approximately 5,000 professional plant biology researchers, educators,
graduate students, and postdoctoral scientists with members in all 50
States and throughout the world. A strong voice for the global plant
science community, our mission--achieved through work in the realms of
research, education, and public policy--is to promote the growth and
development of plant biology, to encourage and communicate research in
plant biology, and to promote the interests and growth of plant
scientists in general.
Plant Biology Research and America's Future
Plants are vital to our very existence. They harvest sunlight,
converting it to chemical energy for food and feed; they take up carbon
dioxide and produce oxygen; and they are the primary producers on which
all life depends. Indeed, plant biology research is making many
fundamental contributions in the areas of domestic fuel security and
environmental stewardship; the continued and sustainable development of
better foods, fabrics, pharmaceuticals, and building materials; and in
the understanding of basic biological principles that underpin
improvements in the health and nutrition of all Americans. In fact, the
2009 National Research Council (NRC) report A New Biology for the 21st
Century placed plant biology at the center of urgent priorities in
energy, food, health, and the environment.
For example, because plants are the ultimate source of both human
nutrition and nutrition for domestic animals, plant biology has the
potential to contribute greatly to reducing healthcare costs as well as
playing an integral role in discovery of new drugs and therapies.
Although the National Institutes of Health does offer some funding
support to plant biology research, additional support would enable
plant biologists to offer much more to advance the missions of the
National Institutes of Health.
The importance of disciplinary and agency integration is a central
theme of several recent NRC reports including A New Biology for the
21st Century, Research at the Intersection of the Physical and Life
Sciences, and Inspired by Biology: From Molecules to Materials to
Machines. ASPB encourages NIH to continue and expand its partnerships
with other Federal science agencies--including the National Science
Foundation, Department of Agriculture and Department of Energy--in
advancing understanding about living systems that has application to a
range of areas including human health.
Plant Biology and the National Institutes of Health
The mission of the NIH is to pursue ``fundamental knowledge about
the nature and behavior of living systems and the application of that
knowledge to extend healthy life and reduce the burdens of illness and
disability.'' Plant biology research is highly relevant to this
mission.
Plants are often the ideal model systems to advance our
``fundamental knowledge about the nature and behavior of living
systems,'' as they provide the context of multi-cellularity while
affording ease of genetic manipulation, a lesser regulatory burden, and
inexpensive maintenance requirements than the use of animal systems.
Many basic biological components and mechanisms are shared by both
plants and animals. For example, a molecule named cryptochrome that
senses light was identified first in plants and subsequently found to
also function in humans, where it plays a central role in regulating
our biological clock. Several human genetic disorders are linked to the
malfunctioning of this clock--not to mention the effect of jet lag. As
another example, some fungal pathogens can infect both humans and
plants, and the molecular mechanisms employed by both the pathogen and
its targeted host can be very similar.
More recently, a property known as RNA interface was first noted in
plants; plant biologists trying to increase the color intensity of
petunias by introducing a gene inducing pigment production instead
observed a loss of color. RNA interface, which has potential
application in the treatment of human disease, was further elucidated
in other plants and animals and earned two American scientists--Andrew
Fire and Craig Mello--the 2006 Nobel Prize in Physiology or Medicine.
Health and Nutrition
Plant biology research is also central to the application of basic
knowledge to ``extend healthy life and reduce the burdens of illness
and disability.'' This connection is most obvious in the inter-related
areas of nutrition and clinical medicine. Without good nutrition, there
cannot be good health. Indeed, one World Health Organization study on
childhood nutrition in developing countries concluded that over 50
percent of the deaths of children less than 5 years of age could be
attributed to malnutrition's effects in exacerbating common illnesses
such as respiratory infections and diarrhea. Strikingly, most of these
deaths were not linked to severe malnutrition but only to mild or
moderate nutritional deficiencies. Plant biology researchers are
working today to improve the nutritional content of crop plants by, for
example, increasing the availability of nutrients and vitamins such as
iron, vitamin E, and vitamin A. (Up to 500,000 children in the
developing world go blind every year as a result of vitamin A
deficiency).
By contrast, obesity, cardiac disease, and cancer take a striking
toll in the developed world. Among many plant biology initiatives
relevant to these concerns are research to improve the lipid
composition of plant fats and efforts to optimize concentrations of
plant compounds that are known to have anti-carcinogenic properties,
such as the glucosinolates found in broccoli and cabbage, and the
lycopenes found in tomato. Beta-glucans from certain cereals reduce
serum cholesterol and insulin demand in diabetics. And scientists are
able to use the fundamental knowledge of protein structures to reduce
non-nutritious compounds, increasing the density and quality of
proteins in some grains. Ongoing development of crop varieties with
tailored nutraceutical content is an important contribution that plant
biologists are making toward realizing the goal of personalized
medicine, especially personalized preventative medicine.
Drug Discovery
Plants are also fundamentally important as sources of both extant
drugs and drug discovery leads. In fact, over 10 percent of the drugs
considered by the World Health Organization to be ``basic and
essential'' are still exclusively obtained from flowering plants. Some
historical examples are quinine, which is derived from the bark of the
cinchona tree and was the first highly effective anti-malarial drug;
and the plant alkaloid morphine, which revolutionized the treatment of
pain. These pharmaceuticals are still in use today.
A more recent example of the importance of plant-based
pharmaceuticals is the anti-cancer drug taxol. The discovery of taxol
came about through collaborative work involving scientists at the
National Cancer Institute within NIH and plant biologists at the U.S.
Department of Agriculture. The plant biologists collected a wide
diversity of plant materials, which were then evaluated for anti-
carcinogenic properties. It was found that the bark of the Pacific yew
tree yielded one such compound, which was isolated and named taxol
after the tree's Latin name, Taxus brevifolia. Originally, taxol could
only be obtained from the tree bark itself, but additional research led
to the elucidation of its molecular structure and eventually to its
chemical synthesis in the laboratory.
On the basis of a growing understanding of metabolic networks,
plants will continue to be sources for the development of new medicines
to help treat cancer and other ailments. Taxol is just one example of a
plant secondary compound. Since plants produce an estimated 200,000
such compounds, they will continue to provide a fruitful source of new
drug leads, particularly if collaborations such as the one described
above can be fostered and funded. With additional research support,
plant biologists can lead the way to developing new medicines and
biomedical applications to enhance the treatment of devastating
diseases.
Conclusion
Despite the fact that plant biology research underlies so many
vital practical considerations for our country, the amount invested in
understanding the basic function and mechanisms of plants is small when
compared with broader impacts.
The NIH does recognize that plants are a vital component of its
mission. However, because the boundaries of plant biology research are
permeable and because information about plants integrates with many
different disciplines that are highly relevant to NIH, ASPB hopes that
the Subcommittee will provide direction to NIH to support additional
plant biology research in order to help pioneer new discoveries and new
methods in biomedical research.
Thank you for your consideration of our testimony on behalf of the
American Society of Plant Biologists. Please do not hesitate to contact
ASPB if we can be of any assistance in the future; ASPB Public Affairs
Director Dr. Adam P. Fagen can be reached at 301-296-0898 (phone), 301-
296-0899 (fax), or [email protected].
______
Prepared Statement of the American Society of Tropical Medicine and
Hygiene
The American Society of Tropical Medicine and Hygiene--the
principal professional membership organization representing, educating,
and supporting scientists, physicians, clinicians, researchers,
epidemiologists, and other health professionals dedicated to the
prevention and control of tropical diseases--appreciates the
opportunity to submit testimony to the Senate Labor, Health and Human
Services, and Education Appropriations Subcommittee.
We understand the fiscal constraints we as a country are in and are
sensitive to the job Congress must do. The benefits of U.S. investment
in tropical diseases are not only humanitarian, they are diplomatic as
well. With this in mind, we respectfully request that the Subcommittee
fund the following agencies in the fiscal year 2012 LHHS Appropriations
bill to allow them to maintain their current programs and research
priorities while ensuring a continued U.S. Government investment in
global health and tropical medicine research and development:
National Institutes of Health, specifically:
--Malaria and neglected tropical disease treatment, control, and
research and development efforts within the National Institute
of Allergy and Infectious Diseases;
--An expanded focus on the treatment, control, and research and
development for new tools for diarrheal disease within the NIH;
specifically the inclusion of enteric infections on the
Research, Condition, and Disease Categorization (RCDC) process
on the Research Portfolio Online Reporting Tools (RePORT)
website; and,
--Research capacity development in countries where populations are at
heightened risk for malaria, NTDs, and diarrheal diseases
through the Fogarty International Center.
The Centers for Disease Control and Prevention, including:
--CDC global health programs such as the CDC malaria program and
providing direct funding to the CDC for NTD and diarrheal
disease work; and
--Preserving and funding the activities of the CDC Vector Borne
Disease Program as they merge with the Emerging and Infectious
Disease Program to protect the United States from new and
emerging infections.
return on investment of u.s.-funded research
CDC and NIH play essential roles in research and development for
tropical medicine and global health. Both agencies are at the forefront
of the new science that leads to tools to combat malaria and NTDs. This
research provides jobs for American researchers and an opportunity for
the United States to be a leader in the fight against global disease,
in addition to lifesaving new drugs and diagnostics to some of the
poorest, most at-risk people in the world.
For example, in Illinois, where ASTMH is based, 57,000 people are
employed in bioscience research, which includes global health research.
Illinois receives over $700 million in funding from NIH and over $200
million from CDC.\1\ New Jersey also has a high level of investment in
health-related research and development, with over 211,000 jobs
supported by global health, and an economic impact of more than $60
billion on the State in 2009.\2\ Small investments in global health and
tropical medicine research and development can yield big returns for
State economies and research institutions.
---------------------------------------------------------------------------
\1\ Research America, ``Global Health R&D, A Smart Investment for
Illinois,'' http://www.researchamerica.org/uploads/
ILGHeconomicsheet.pdf.
\2\ Research America, ``Global Health R&D, A Smart Investment for
New Jersey,'' http://www.researchamerica.org/uploads/
NewJerseyFactSheet.pdf.
---------------------------------------------------------------------------
tropical disease
Most tropical diseases are prevalent in either sub-Saharan Africa,
parts of Asia (including the Indian subcontinent), or Central and South
America. Many of the world's developing nations are located in these
areas; thus, tropical medicine tends to focus on diseases that impact
the world's most impoverished individuals.
Malaria.--Malaria remains a global emergency affecting mostly poor
women and children; it is an acute, sometimes fatal disease. Despite
being treatable and preventable, malaria is one of the leading causes
of death and disease worldwide. Approximately every 30 seconds, a child
dies of malaria--a total of about 800,000 under the age of 5 every
year. The World Health Organization estimates that one half of the
world's people are at risk for malaria and that there are 108 malaria-
endemic countries. Additionally, WHO has estimated that malaria reduces
sub-Saharan Africa's economic growth by up to 1.3 percent per year.
Neglected Tropical Diseases, also known as Diseases of Poverty.--
NTDs are a group of chronic parasitic diseases, such as hookworm,
elephantiasis, schistosomiasis, and river blindness, which represent
the most common infections of the world's poorest people. These
infections have been revealed as the stealth reason why the ``bottom
billion''--the 1.4 billion poorest people living below the poverty
line--cannot escape poverty, because of the effects of these diseases
on reducing child growth, cognition and intellect, and worker
productivity.
Diarrheal disease.--The child death toll due to diarrheal illnesses
exceeds that of AIDS, tuberculosis, and malaria combined. In poor
countries, diarrheal disease is second only to pneumonia as the cause
of death among children under 5 years old. Every week, 31,000 children
in low-income countries die from diarrheal diseases.
The United States has a long history of leading the fight against
tropical diseases that cause human suffering and pose financial burden
that can negatively impact a country's economic and political
stability. Tropical diseases, many of them neglected for decades,
impact U.S. citizens working or traveling overseas, as well as our
military personnel. Furthermore, some of the agents responsible for
these diseases can be introduced and become established in the United
States (like West Nile virus), or might even be weaponized.
national institutes of health
National Institute of Allergy and Infectious Diseases.--A long-term
investment is critical to achieve the drugs, diagnostics, and research
capacity needed to control malaria and NTDs. NIAID, the lead institute
for malaria research, plays an important role in developing the drugs
and vaccines needed to fight malaria. The NIH, through NIAID, also
conducts research to better understand NTDs, through its own basic and
clinical studies as well as extramural research.
ASTMH encourages the subcommittee to:
--Increase funding for NIH to expand the agency's investment in
malaria, NTD, diarrheal disease research and to coordinate that
work with other government agencies to maximize resources and
ensure development of basic discoveries into usable solutions;
--Specifically invest in NIAID to support its role at the forefront
of these efforts to developing the next generation of drugs,
vaccines, and other interventions; and,
--Urge NIH to include enteric infections and neglected diseases in
its RCDC process on the RePORT website to outline the work that
is being done in these important research areas.
Fogarty International Center (FIC).--Biomedical research has
provided major advances in the treatment and prevention of malaria,
NTDs, and other infectious diseases. These benefits, however, are often
slow to reach the people who need them most. FIC plays a critical role
in strengthening science and public health research institutions in
low-income countries. FIC works to strengthen research capacity in
countries where populations are particularly vulnerable to threats
posed by malaria, NTDs, and other infectious disease. This maximizes
the impact of U.S. investments and is critical to fighting malaria and
other tropical diseases.
ASTMH encourages the subcommittee to:
--Allocate sufficient resources to FIC in fiscal year 2012 to
increase these efforts, particularly as they address the
control and treatment of malaria, NTDs and diarrheal disease.
the centers for disease control and prevention
Malaria Efforts.--Malaria has been eliminated as an endemic threat
in the United States for over fifty years and CDC remains on the
cutting edge of global efforts to reduce the toll of this deadly
disease. CDC efforts on malaria fall into three broad categories:
prevention, treatment, and monitoring/evaluation of efforts. The agency
performs a wide range of basic research within these categories, such
as:
--Conducting research on antimalarial drug resistance to inform new
strategies and prevention approaches;
--Assessing new monitoring, evaluation, and surveillance strategies;
--Conducting additional research on malaria vaccines, including field
evaluations; and
--Developing innovative public health strategies for improving access
to antimalarial treatment and delaying the appearance of
antimalarial drug resistance.
ASTMH encourages the subcommittee to:
--Fund a comprehensive approach to effective and efficient malaria
control, including adequately funding the important
contributions of CDC.
NTD Programs.--CDC currently receives zero dollars directly for NTD
work; however this should be changed to allow for more comprehensive
work to be done on NTDs at the CDC. CDC has a long history of working
on NTDs and has provided much of the science that underlies the global
policies and programs in existence today. This work is important to any
global health initiative, as individuals are often infected with
multiple NTDs simultaneously.
ASTMH encourages the subcommittee to:
--Provide direct funding to CDC to continue its work on NTDs; and
--Urge CDC to continue its monitoring, evaluation, and technical
assistance in these areas as an underpinning of efforts to
control and eliminate these diseases.
Vector-borne Disease Program (VBDP).--The President's fiscal year
2012 budget folds the CDC Vector Borne Disease Program into the newly
configured Emerging and Zoonotic Infectious Diseases program at CDC.
Through the VBDP, researchers are able to practice essential
surveillance and monitoring activities that protect the United States
from deadly infections before they reach our borders. The world is
becoming increasingly smaller as international travel increases and new
pathogens are introduced quickly into new environments. We have seen
this with SARS, avian influenza, and now, dengue fever, in the United
States. Arboviruses like dengue, and others, such as chikungunya, are a
constant threat to travelers, and to Americans generally.
Dengue fever, a disease with increased risk for Americans as the
weather warms and dengue cases increase, is an example of why it is
imperative that CDC be able to continue its disease monitoring and
surveillance activities to protect the country from new and emerging
threats like dengue and other arboviruses. Dengue fever, a viral
disease transmitted by the Aedes mosquito, recently reemerged as a
threat to Americans, with documented cases in the Florida Keys. Dengue
usually results in fever, headache, and chills, but hemorrhagic dengue
fever can cause severe internal bleeding, loss of blood, and even
death. Because the Aedes mosquito is urban dwelling and often breeds in
areas of poor sanitation, dengue is a serious concern for poor
residents of costal, urban areas in Texas, Louisiana, Mississippi,
Alabama, and Florida.
ASTMH encourages the subcommittee to:
--Ensure that CDC maintain these important activities by continuing
CDC funding for VBDP activities and require the program receive
at least their fiscal year 2010 level of funding.
conclusion
Thank you for your attention to these important U.S. and global
health matters. We know Congress and the American people face many
challenges in choosing funding priorities, and we hope you will provide
the requested fiscal year 2012 resources to those programs identified
above that meet critical needs for Americans and people around the
world. ASTMH appreciates the opportunity to share its expertise, and we
thank you for your consideration of these requests that will help
improve the lives of Americans and the global poor.
______
Prepared Statement of the American Thoracic Society
SUMMARY: FUNDING RECOMMENDATIONS
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
National Institutes of Health............................. 35,000
National Heart, Lung and Blood Institute.............. 3,514
National Institute of Allergy and Infectious Disease.. 5,395
National Institute of Environmental Health Sciences... 779.4
Fogarty International Center.......................... 78.4
National Institute of Nursing Research................ 163
Centers for Disease Control and Prevention................ 7,700
National Institute for Occupational Safety & Health... 332.4
Asthma Programs....................................... 31
Div. of Tuberculosis Elimination...................... 231
Office on Smoking and Health.......................... 330
National Sleep Awareness Roundtable (NSART)........... 1
------------------------------------------------------------------------
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. Founded in 1905, the ATS
is an international education and scientific society of 15,000
specialists focused on respiratory, critical care and sleep medicine.
Lung Disease in America
Diseases of breathing constitute the third leading cause of death
in the United States, responsible for one of every seven deaths.
Diseases affecting the respiratory (breathing) system include chronic
obstructive pulmonary disease (COPD), lung cancer, tuberculosis,
influenza, sleep disordered breathing, pediatric lung disorders,
occupational lung disease, sarcoidosis, asthma, and critical illness.
COPD is now the third leading cause of disease death. The number of
people with asthma in the United States has surged over 150 percent
since 1980 and the root causes of the disease are still not fully
known.
Despite the rising lung disease burden, lung disease research is
underfunded. In fiscal year 2010, lung disease research represented
just 22.6 percent of the National Heart Lung and Blood Institute's
(NHLBI) budget. Although COPD is the third leading cause of death in
the United States, research funding for the disease is a small fraction
of the money invested for the other three leading causes of death. In
order to stem the devastating effects of lung disease, research funding
must continue to grow.
National Institutes of Health
The NIH is the world's leader in groundbreaking biomedical health
research into the prevention, treatment and cure of diseases such as
lung cancer, COPD and tuberculosis. Eighty-five percent of the NIH
budget is invested in U.S. communities through universities, medical
schools, hospitals and innovative small businesses, creating jobs and
economic productivity. The American Reinvestment Recovery Act (ARRA)
has generated remarkable scientific innovation that is paving the way
for medical advances to improve patient outcomes. Without a funding
increase in fiscal year 2012 to sustain the research pipeline, the NIH
will be forced to reduce the number of research grants funded, which
will result in the halting of vital research into diseases affecting
millions around the world. We ask the subcommittee to provide $35
billion in funding for the NIH in fiscal year 2012.
Centers for Disease Control and Prevention
In order to ensure that health promotion and chronic disease
prevention are given top priority in Federal funding, the ATS supports
a funding level for the Centers for Disease Control and Prevention
(CDC) that enables it to carry out its prevention mission, and ensure a
translation of new research into effective State and local public
health programs. We ask that the CDC budget be adjusted to reflect
increased needs in chronic disease prevention, infectious disease
control, including TB control to prevent the spread of drug-resistant
TB, and occupational safety and health research and training. The ATS
recommends a funding level of $7.7 billion for the CDC in fiscal year
2012.
COPD
COPD is the third leading cause of death in the United States and
the third leading cause of death worldwide, yet the disease remains
relatively unknown to most Americans. COPD is the term used to describe
the limitation in breathing due mainly to emphysema and chronic
bronchitis. CDC estimates that 12 million patients have COPD; an
additional 12 million Americans are unaware that they have this life
threatening disease. In 2010, the estimated economic cost of lung
disease in the United States was $186 billion, including $117 billion
in direct health expenditures and $69 billion in indirect morbidity and
mortality costs.
Despite the growing burden of COPD, the United States does not
currently have a comprehensive public health action plan on the
disease. The ATS urges Congress to direct the NHLBI to develop a
national action plan on COPD, in coordination with the Centers for
Disease Control and Prevention (CDC) to expand COPD surveillance,
development of public health interventions and research on the disease
and increase public awareness of the disease. The NHLBI has shown
successful leadership in educating the public about COPD through the
COPD Education and Prevention Program.
CDC has an additional role to play in this work. We urge CDC to
include 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).
Tobacco Control
Cigarette smoking is the leading preventable cause of death in the
United States, responsible for one in five deaths annually. The ATS is
pleased that the Department of Health and Human Services has made
tobacco use prevention a key priority. The CDC's Office of Smoking and
Health coordinates public health efforts to reduce tobacco use. In
order to significantly reduce tobacco use within 5 years, as
recommended by the subcommittee in fiscal year 2010, the ATS recommends
a total funding level of $330 million for the Office of Smoking and
Health in fiscal year 2012, which includes an allocation of $220
million from the Prevention and Public Health Fund.
Pediatric Lung Disease
The ATS is pleased to report that infant death rates for various
lung diseases have declined for the past 10 years. In 2007, of the 10
leading causes of infant mortality, 4 were lung diseases or had a lung
disease component. Many of the precursors of adult respiratory disease
start in childhood. It is estimated that close to 22 million people
suffer from asthma, including an estimated 7.1 million children. The
ATS encourages the NHLBI to continue with its research efforts to study
lung development and pediatric lung diseases.
Asthma
Asthma is a significant public health problem in the United States.
Approximately 23 million Americans currently have asthma, including 7.1
million children. In 2009, 3,445 Americans in 2009 died as a result of
asthma exacerbations. Asthma is the third leading cause of
hospitalization among children under the age of 15 and is a leading
cause of school absences from chronic disease. The disease costs our
healthcare system over $50.1 billion per year. African Americans have
the highest asthma prevalence of any racial/ethnic group.
The President's fiscal year 2012 budget request proposes to merge
the CDC's National Asthma Control Program with the Healthy Homes/Lead
Poisoning Prevention Program and recommends funding cuts to the
combined programs of over 50 percent. The ATS is deeply concerned that
this proposal would drastically reduce States' capacity to implement a
proven public health response to this disease. Asthma public health
interventions are cost-effective. A study published in the American
Journal of Respiratory Critical Care recently found that for every
dollar invested in asthma interventions, there was a $36 benefit. We
urge the subcommittee to ensure that CDC's National Asthma Control
Program remains a stand-alone program and receives an appropriation of
$31 million for fiscal year 2012.
Sleep
Several research studies demonstrate that sleep-disordered
breathing and sleep-related illnesses affect an estimated 50-70 million
Americans. The public health impact of sleep illnesses and sleep
disordered breathing is still being determined, but is known to include
increased mortality, traffic accidents, lost work and school
productivity, cardiovascular disease, obesity, mental health disorders,
and other sleep-related comorbidities. Despite the increased need for
study in this area, research on sleep and sleep-related disorders has
been underfunded. The ATS recommends a funding level of $1 million in
fiscal year 2012 to support activities related to sleep and sleep
disorders at the CDC, including for the National Sleep Awareness
Roundtable (NSART), surveillance activities, and public educational
activities. The ATS also recommends an increase of funding for research
on sleep disorders at the Nation Center for Sleep Disordered Research
(NCSDR) at the NHLBI.
Tuberculosis
Tuberculosis (TB) is the second leading global infectious disease
killer, claiming 1.7 million lives each year. It is estimated that 9-12
million Americans have latent tuberculosis. Drug-resistant TB poses a
particular challenge to domestic TB control due to the high costs of
treatment and intensive healthcare resources required. The global TB
pandemic and spread of drug resistant TB presents a persistent public
health threat to the United States.
Despite declining rates, persistent challenges to TB control in the
United States remain. Specifically: (1) racial and ethnic minorities
continue to suffer from TB more than majority populations; (2) foreign-
born persons are adversely impacted; (3) sporadic outbreaks occur,
outstripping local capacity; (4) continued emergence of drug
resistance; and (5) there are critical needs for new diagnostics,
treatment and prevention tools.
The Comprehensive Tuberculosis Elimination Act (CTEA, Public Law
110-392), enacted in 2008, reauthorized programs at CDC with the goal
of putting the United States back on the path to eliminating TB. The
ATS, recommends a funding level of $231 million in fiscal year 2012 for
CDC's Division of TB Elimination, as authorized under the CTEA, and
encourages the NIH to expand efforts, as requested under the CTEA, to
develop new tools to reduce the rising global TB burden.
Critical Illness
The burden associated with the provision of care to critically ill
patients is anticipated to increase significantly as the population
ages. Approximately 200,000 people in the United States require
hospitalization in an intensive care unit because they develop a form
of pulmonary disease called Acute Lung Injury. Despite the best
available treatments, 75,000 of these individuals die each year from
this disease. Investigation into diagnosis, treatment and outcomes in
critically ill patients should be a high priority, and the NIH should
be encouraged and funded to coordinate investigation related to
critical illness in order to meet this growing national imperative.
Fogarty International Center
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. Because of the
link between AIDS and TB infection, FIC has created supplemental TB
training grants for these institutions to train international health
professionals in TB treatment and research. The ATS recommends Congress
provide $78.4 million for FIC in fiscal year 2012, to allow expansion
of the TB training grant program from a supplemental grant to an open
competition grant.
Researching and Preventing Occupational Lung Disease
The National Institute of Occupational Safety and Health (NIOSH) is
the sole Federal agency responsible for conducting research and making
recommendations for the prevention of work-related diseases and injury.
The ATS recommends that Congress provide $364.3 million in fiscal year
2012 for NIOSH to expand or establish the following activities: the
National Occupational Research Agenda (NORA); tracking systems for
identifying and responding to hazardous exposures and risks in the
workplace; emergency preparedness and response activities; and training
medical professionals in the diagnosis and treatment of occupational
illness and injury.
Conclusion
Lung disease is a growing problem in the United States. The level
of support this subcommittee approves for lung disease programs should
reflect the urgency illustrated by these numbers. The ATS appreciates
the opportunity to submit this statement to the subcommittee.
______
Prepared Statement of the Americans for Nursing Shortage Relief
The undersigned organizations of the ANSR Alliance greatly
appreciate the opportunity to submit written testimony regarding fiscal
year 2012 appropriations for the Title VIII Nursing Workforce
Development Programs at the Health Resources and Services
Administration (HRSA) and the Nurse Managed Health Clinics as
authorized under Title III of the Public Health Service Act. We
represent a diverse cross-section of healthcare and other related
organizations, healthcare providers, and supporters of nursing issues
that have united to address the national nursing shortage. ANSR stands
ready to work with Congress to advance programs and policy that will
ensure our Nation has a sufficient and adequately prepared nursing
workforce to provide quality care to all well into the 21st century.
The Alliance, therefore, urges Congress to:
--Appropriate $313 million in funding for Nursing Workforce
Development Programs under Title VIII of the Public Health
Service Act at the Health Resources and Services Administration
(HRSA) in fiscal year 2012.
--Appropriate $20 million in fiscal year 2012 for the Nurse Managed
Health Clinics as authorized under Title III of the Public
Health Service Act.
The Nursing Shortage
Nursing is the largest healthcare profession in the United States.
According to the National Council of State Boards of Nursing, there
were nearly 3.780 million licensed RNs in 2009. Nurses and advanced
practice nurses (nurse practitioners, nurse midwives, clinical nurse
specialists, and certified registered nurse anesthetists) work in a
variety of settings, including primary care, public health, long-term
care, surgical care facilities, and hospitals. The March 2008 study,
The Future of the Nursing Workforce in the United States: Data, Trends,
and Implications, calculates a projected demand of 500,000 full-time
equivalent registered nurses by 2025. According to the U.S. Bureau of
Labor Statistics, employment of registered nurses is expected to grow
by 22 percent from 2008 to 2018, much faster than the average for all
occupations and, because the occupation is very large, 581,500 new jobs
will result. Based on these scenarios, the shortage presents an
extremely serious challenge in the delivery of high quality, cost-
effective services, as the Nation looks to reform the current
healthcare system. Even considering only the smaller projection of
vacancies, this shortage still results in a critical gap in nursing
service, essentially three times the 2001 nursing shortage.
The Desperate Need for Nurse Faculty
Nursing vacancies exist throughout the entire healthcare system,
including long-term care, home care and public health. Even the
Department of Veterans Affairs, the largest sole employer of RNs in the
United States, has a nursing vacancy rate of 10 percent. In 2006, the
American Hospital Association reported that hospitals needed 116,000
more RNs to fill immediate vacancies, and that this 8.1 percent vacancy
rate affects hospitals' ability to provide patient care. Government
estimates indicate that this situation only promises to worsen due to
an insufficient supply of individuals matriculating in nursing schools,
an aging existing workforce, and the inadequate availability of nursing
faculty to educate and train the next generation of nurses. At the
exact same time that the nursing shortage is expected to worsen, the
baby boom generation is aging and the number of individuals with
serious, life-threatening, and chronic conditions requiring nursing
care will increase. Consequently, more must be done today by the
government to help ensure an adequate nursing workforce for the
patients/clients of today and tomorrow.
A particular focus on securing and retaining adequate numbers of
faculty is essential to ensure that all individuals interested in--and
qualified for--nursing school can matriculate in the year that they are
accepted. The National League for Nursing found that in the 2009-2010
academic year,
--42 percent of qualified applications to prelicensure RN programs
were turned away.
--One in four (25.1 percent) of prelicensure RN programs turned away
qualified applicants.
--Four out of five (60 percent) of prelicensure RN programs were
considered ``highly selective'' by national college admissions
standards, accepting less than 50 percent of applications for
admission.
Aside from having a limited number of faculty, nursing programs
struggle to provide space for clinical laboratories and to secure a
sufficient number of clinical training sites at healthcare facilities.
ANSR supports the need for sustained attention on the efficacy and
performance of existing and proposed programs to improve nursing
practices and strengthen the nursing workforce. The support of research
and evaluation studies that test models of nursing practice and
workforce development is integral to advancing healthcare for all in
America. Investments in research and evaluation studies have a direct
effect on the caliber of nursing care. Our collective goal of improving
the quality of patient care, reducing costs, and efficiently delivering
appropriate healthcare to those in need is served best by aggressive
nursing research and performance and impact evaluation at the program
level.
The Nursing Supply Impacts the Nation's Health and Economic Safety
Nurses make a difference in the lives of patients from disease
prevention and management to education to responding to emergencies.
Chronic diseases, such as heart disease, stroke, cancer, and diabetes,
are the most preventable of all health problems as well as the most
costly. Nearly half of Americans suffer from one or more chronic
conditions and chronic disease accounts for 70 percent of all deaths.
In addition, increased rates of obesity and chronic disease are the
primary cause of disability and diminished quality of life.
Even though America spends more than $2 trillion annually on
healthcare--more than any other nation in the world--tens of millions
of Americans suffer every day from preventable diseases like type 2
diabetes, heart disease, and some forms of cancer that rob them of
their health and quality of life. In addition, major vulnerabilities
remain in our emergency preparedness to respond to natural,
technological and manmade hazards. An October 2008 report issued by
Trust for America's Health, entitled ``Blueprint for a Healthier
America,'' found that the health and safety of Americans depend on the
next generation of professionals in public health. Further, existing
efforts to recruit and retain the public health workforce are
insufficient. New policies and incentives must be created to make
public service careers in public health an attractive professional
path, especially for the emerging workforce and those changing careers.
The Institute of Medicine report, Hospital-Based Emergency Care: At
the Breaking Point, notes that nursing shortages in U.S. hospitals
continue to disrupt hospitals operations and are detrimental to patient
care and safety. Hospitals and other healthcare facilities across the
country are vulnerable to mass casualty incidents themselves and/or in
emergency and disaster preparedness situations. As in the public health
sector, a mass casualty incident occurs as a result of an event where
sudden and high patient volume exceeds the facilities resources. Such
events may include the more commonly realized multi-car pile-ups, train
crashes, hazardous material exposure in a building or within a
community, high occupancy catastrophic fires, or the extraordinary
events such as pandemics, weather-related disasters, and intentional
catastrophic acts of violence.
Since 80 percent of disaster victims present at the emergency
department, nurses as first receivers are an important aspect of the
public health system as well as the healthcare system in general. The
nursing shortage has a significant adverse impact on the ability of
communities to respond to health emergencies, including natural,
technological and manmade hazards.
Summary
The link between healthcare and our Nation's economic security and
global competitiveness is undeniable. Having a sufficient nursing
workforce to meet the demands of a highly diverse and aging population
is an essential component to reforming the healthcare system as well as
improving the health status of the Nation and reducing healthcare
costs. To mitigate the immediate effect of the nursing shortage and to
address all of these policy areas, ANSR requests $313 million in
funding for Nursing Workforce Development Programs under Title VIII of
the Public Health Service Act at HRSA and $20 million for the Nurse
Managed Health Clinics under Title III of the Public Health Service Act
in fiscal year 2012.
list of ansr member organizations
Academy of Medical-Surgical Nurses
American Academy of Ambulatory Care Nursing
American Association of Critical-Care Nurses
American Association of Nurse Assessment Coordinators
American Organization of Nurse Executives
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
Association for Radiologic & Imaging Nursing
Association of Community Health Nursing Educators
Association of Pediatric Hematology/Oncology Nurses
Emergency Nurses Association
Infusion Nurses Society
International Nurses Society on Addictions
National Association of Clinical Nurse Specialists
National Association of Hispanic Nurses
National Association of Nurse Practitioners in Women's Health
National Council of State Boards of Nursing
National Council of Women's Organizations
National League for Nursing
National Nursing Centers Consortium
National Student Nurses' Association, Inc.
Nurses Organization of Veterans Affairs
Society of Trauma Nurses
______
Prepared Statement of the Arthritis Foundation
The Arthritis Foundation greatly appreciates the opportunity to
submit testimony in support of increased investment for arthritis
research, prevention and programs at the Centers for Disease Control
and Prevention (CDC); National Institutes of Health (NIH); Agency for
Healthcare Research and Quality (AHRQ); and for the Health Resources
and Services Administration (HRSA).
Arthritis is a complex family of musculoskeletal disorders with
many causes, not yet fully understood, and so far there are no cures.
It consists of more than 100 different diseases or conditions that
destroy joints, bones, muscles, cartilage and other connective tissue
which hampers or halts physical movement. Arthritis is one of the most
prevalent chronic health problems and the most common cause of
disability in the United States. 50 million people (1 in 5 adults) and
almost 300,000 children live with the pain of arthritis every day.
Arthritis limits the daily activities of 21 million Americans and
accounts for $128 billion annually in economic costs, including $81
billion in direct costs for physician visits and surgical interventions
and $47 billion in indirect costs for missed work days. Counter to
public perception, two-thirds of the people with doctor-diagnosed
arthritis are under the age of 65. The pain, cost and disability
associated with arthritis is simply unacceptable.
By the year 2030, an estimated 67 million or 25 percent of the
projected adult population will have arthritis. Furthermore, arthritis
limits the ability of people to effectively manage other chronic
diseases. More than 57 percent of adults with heart disease and more
than 52 percent of adults with diabetes also have arthritis. The
Arthritis Foundation strongly believes that in order to prevent or
delay arthritis from disabling people and diminishing their quality of
life that a significant investment in proven prevention and
intervention strategies is essential.
The following items summarize the Arthritis Foundation fiscal year
2012 funding recommendations for health agencies under the
Subcommittee's jurisdiction.
Centers for Disease Control and Prevention
The Arthritis Foundation recommends a level of $7.7 billion for
CDC's core programs in fiscal year 2012. This amount is representative
of what CDC needs to fulfill its core public health mission in fiscal
year 2012; activities and programs that are essential to protect the
health of the American people. CDC continues to be faced with
unprecedented challenges and responsibilities, ranging from chronic
disease prevention, eliminating health disparities, bioterrorism
preparedness, to combating the obesity epidemic. More than 70 percent
of CDC's budget actually flows out to States and local health
organizations and academic institutions, many of which are currently
struggling to meet growing needs with fewer resources.
The President's fiscal year 2012 budget request proposed to
collapse existing programs for the top five leading chronic disease
causes of death and disability--arthritis, cancer, diabetes, and heart
disease and stroke--into a single State Block Grant program along with
State funding for public health activities related to nutrition,
physical activity, obesity and school health. These Administration
proposals also rely on funding from the Prevention and Public Health
Fund to support these activities.
In light of the fiscal challenges facing the Nation and the need to
reduce inefficiencies from Federal program overlap and lack of
coordination, the Arthritis Foundation recognizes that the CDC must
combat chronic disease through careful coordination and collaboration
across strategic programs. However, at the same time, agency leadership
must ensure that the vital public health infrastructure that has been
developed over the past two decades for combating arthritis should not
be dismantled.
The clear need to ensure that the burgeoning number of Americans
with arthritis are served by effective efforts, lead the Arthritis
Foundation to conclude that, as proposed, the Administration's
consolidated chronic disease prevention program is not in the best
interest of those with arthritis. To sustain and build on the
achievements and progress made to date in combating arthritis, it is
critical that arthritis-specific activities are preserved and
strengthened in any approach to combating chronic disease.
As the fiscal year 2012 funding process continues, the Arthritis
Foundation appreciates the opportunity to evaluate any consolidated
chronic disease program proposal to ensure that the following
priorities are addressed:
--Programs should be designed around similar target populations,
including people with or at risk of arthritis, the Nation's
most common cause of disability and a major barrier to physical
activity.
--Any consolidation must be limited to programs with clear
programmatic and operational overlap.
--CDC and states must retain staff expertise in disease areas and the
infrastructure to support them;
--Programs must be supported by State-based advisory groups made up
of stakeholders from the impacted disease areas;
--A national advisory committee at CDC should be created to foster
stakeholder involvement from arthritis and other chronic
disease communities.
The CDC's arthritis program received $13.1 million in fiscal year
2011 funding and about half of that amount will be distributed via
competitive grant to 12 States. Research shows that the pain and
disability of arthritis can be decreased through early diagnosis and
appropriate management, including evidence-based self-management
activities that enable weight control and physical activity. The
Arthritis Foundation's Self-Help Program, a group education program,
has been proven to reduce arthritis pain by 20 percent and physician
visits by 40 percent. These evidence-based interventions are recognized
by the CDC to reduce the pain of arthritis and importantly reduce
healthcare expenditures through a reduction in physician visits. For
arthritis prevention to grow to include another 12-15 States an
investment of an additional $10 million is required.
National Institutes of Health/National Institute of Arthritis and
Musculoskeletal and Skin Diseases
The Arthritis Foundation supports $35 billion in fiscal year 2012
for NIH to invest in improving the health and quality of life for all
Americans. NIH-funded research drives scientific innovation and
develops new and better diagnostics, improved prevention strategies,
and more effective treatments. Approximately 83 percent of appropriated
funds for NIH research are sent to every State in the Nation in the
form of merit based peer review grants. These investigator initiated
grants enable the highest quality of research to be conducted at
research facilities and hospitals all across the Nation employing
hundreds of thousand of individuals and representing an integral part
of hundreds of local communities. Congress should recognize the unique
role NIH plays as the economic engine in the biomedical industry.
NIH-funded research has led to new treatments, which have greatly
improved the quality of life for people living with arthritis; however,
the ultimate goal is to find a cure. The Arthritis Foundation firmly
believes research holds the key to tomorrow's advances and provides
hope for a future free from arthritis pain. As one of the largest non-
profit contributors to arthritis research, the Arthritis Foundation
fills a vital role in the big picture of arthritis research. Our
research program complements government and industry-based arthritis
research by focusing on training new investigators and pursuing
innovative strategies for preventing, controlling and curing arthritis.
The mission of the NIH/National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) is to support research into
the causes, treatment, and prevention of arthritis and musculoskeletal
and skin diseases and the training of basic and clinical scientists to
carry out this research. Research opportunities at NIAMS are being
curtailed due to the stagnating and in some cases declining numbers of
new grants being awarded. The training of new investigators has
unnecessarily slowed down and contributed to a crisis in the research
community where new investigators have begun to leave biomedical
research careers. The Arthritis Foundation urges Congress to prioritize
NIAMS funding to address the Nations most chronic, disabling and costly
diseases.
Last year, scientists supported by the National Institutes of
Health developed a technique that lead to the successful re-growth of
damaged leg joints in animals. The accomplishment shows that it's
possible to lure the body's own cells to injured regions and generate
new tissues, such as cartilage and bone. The finding could point the
way toward joint renewal in humans, which could be a dramatic and less
costly alternative to the 1 million joint replacement surgeries each
year.
Juvenile arthritis afflicts 300,000 children in the United States
and when left untreated, it can cause permanent damage to joints and
tissues throughout the body. Juvenile arthritis has serious
consequences that can limit a young person's ability to grow properly,
learn, and become a productive citizen in the workforce. With a dire
critical shortage of pediatric rheumatologists to treat these children,
it is vital that the NIH and NIAMS continue supporting a national
network of cooperating clinical centers for the care and study of
children with arthritis through the Childhood Arthritis and
Rheumatology Research Alliance (CARRA). This NIH funded project is in
the beginning stages of collecting data from the largest group of
children with juvenile rheumatic diseases nationwide. The data will be
available to pediatric rheumatologists throughout the United States.
The collection and distribution of such disease data are crucial to the
understanding of the progression of juvenile arthritis and specific
outcomes related to treatment. NIH must continue to fund this
invaluable resource to improve the outcomes and lives of children with
juvenile arthritis as is currently done for children with cancer. The
Arthritis Foundation has also invested our research dollars in this
CARRA initiative.
Public investment in biomedical research holds the real promise of
improving the lives of millions of Americans with arthritis. An
investment in NIH funded research is an investment in our Nation's
future.
Health Resources and Services Administration
The Arthritis Foundation strongly recommends funding a loan
repayment program for pediatric specialist at the $30 million level
within HRSA for fiscal year 2012. A pediatric loan repayment program
was authorized by Congress in 2010 (in the Affordable Care Act) and
requires funding to commence. HRSA is essential to developing the
healthcare workforce that is so critical in primary care as well as
shortages in specialty care, like pediatric rheumatology.
Juvenile arthritis is the leading cause of acquired disability in
children and is the sixth most common childhood disease. Sustaining the
field of pediatric rheumatology is essential to the care of the almost
300,000 children under the age of 18 living with a form of juvenile
arthritis. Children who are diagnosed with juvenile arthritis will live
with this chronic and potentially disabling disease for their entire
life. Therefore, it is imperative that children are diagnosed quickly
and start treatment before significant irreversible joint damage is
done. However, it is a challenge to first find a pediatric
rheumatologist, as nine States do not have a single one, and then to
have a timely appointment as many States have only one or two to see
thousands of patients. Pediatric rheumatology is one of the smallest
pediatric subspecialties with less than 200 pediatric rheumatologists
actively practicing in the United States. A report to Congress in 2007
stated there was a 75 percent shortage of pediatric rheumatologists and
recommended loan repayment program to help address this critical
workforce shortage issue. The Affordable Care Act included authorizing
HRSA $30 million to establish a loan repayment program for pediatric
specialists including pediatric rheumatologists. The Arthritis
Foundation strongly recommends the Subcommittee provide an initial
appropriation to begin this critical program.
Agency for Healthcare Research and Quality (AHRQ)
The Arthritis Foundation recommends an overall funding level of
$405 million for AHRQ in fiscal year 2012. AHRQ funds research and
programs at local universities, hospitals, and health departments that
improve healthcare quality, enhance consumer choice, advance patient
safety, improve efficiency, reduce medical errors, and broaden access
to essential services. Specifically, the science funded by AHRQ
provides consumers and their healthcare professionals with valuable
evidence to make the right healthcare decisions for themselves and
their families.
The Arthritis Foundation appreciates the opportunity to submit our
recommendations for fiscal year 2012 to Congress on behalf of the 50
million adults and 300,000 children with arthritis and looks forward to
working with the Subcommittee in the coming months.
______
Prepared Statement of ASME International
The NIH Task Force (``Task Force'') of the ASME Bioengineering
Division is pleased to provide comments on the bioengineering-related
programs contained within the National Institutes of Health (NIH)
fiscal year 2012 budget request. The Task Force is focused on the
application of mechanical engineering knowledge, skills, and principles
for the conception, design, development, analysis and operation of
biomechanical systems.
The Importance of Bioengineering
Bioengineering is an interdisciplinary field that applies physical,
chemical, and mathematical sciences, and engineering principles to the
study of biology, medicine, behavior, and health. It advances knowledge
from the molecular to the organ levels, and develops new and novel
biologics, materials processes, implants, devices, and informatics
approaches for the prevention, diagnosis, and treatment of disease, for
patient rehabilitation, and for improving health. Bioengineers have
employed mechanical engineering principles in the development of many
life-saving and life-improving technologies, such as the artificial
heart, prosthetic joints, diagnostics, and numerous rehabilitation
technologies.
Background
The NIH is the world's largest organization dedicated to improving
health through medical science. During the last 50 years, NIH has
played a leading role in the major breakthroughs that have increased
average life expectancy by 15 to 20 years.
The NIH is comprised of different Institutes and Centers that
support a wide spectrum of research activities including basic
research, disease and treatment-related studies, and epidemiological
analyses. The mission of individual Institutes and Centers varies from
either study of a particular organ (e.g. heart, kidney, eye), a given
disease (e.g. cancer, infectious diseases, mental illness), a stage of
life (e.g. childhood, old age), or finally it may encompass
crosscutting needs (e.g., sequencing of the human genome). The National
Institute of Biomedical Imaging and Bioengineering (NIBIB) focuses on
the development, application, and acceleration of biomedical
technologies to improve outcomes for a broad range of healthcare
challenges.
Fiscal Year 2012 NIH Budget Request
The total fiscal year 2012 NIH budget request is $31.98 billion, or
2.4 percent above the $31.08 billion fiscal year 2010 appropriated
amount and 4.1 percent above the $30.7 billion provided for fiscal year
2011. The Task Force recognizes that this proposed increase is
significant given the Administration's commitment to reducing the
Federal deficit. However, the Task Force notes that the
Administration's 2.4 percent increase to the overall NIH budget from
fiscal year 2010 to fiscal year 2012 is less than the up to 3 percent
projected increase in medical research costs due to inflation for
fiscal year 2012 alone--as predicted by the Biomedical Research and
Development Price Index (BRDPI). This inflationary pressure is
compounded with the $30.7 billion appropriation for fiscal year 2011, a
$260 million or 0.8 percent reduction in funding from the previous
fiscal year, and a BRDPI of 2.9 percent for fiscal year 2011, resulting
in a significant decrease in funding for the NIH over fiscal year 2010
to fiscal year 2012.
NIH is enacting policies to guide investments while limiting the
impact of these inflationary cost increases, including a 1 percent
increase in the average cost of competing and non-competing Research
Project Grants (RPGs); a 1 percent increase in Research Centers and
Other Research; and a 1 percent increase for Intramural Research and
Research Management and Support; and constraints on staffing levels.
However, these policies alone are not sufficient to offset the need for
additional support for critical areas of health research, especially
given reduction in funding and high inflation rate for fiscal year
2011. We therefore fully support the President's proposed fiscal year
2012 budget level for the NIH given current budget constraints, but
further recommend out-year budget increases well beyond BRDPI inflation
rates.
The Task Force further notes that NIH received $10.4 billion as
part of the American Recovery and Reinvestment Act (ARRA) of 2009
(Public Law 111-5), an important influx for several key divisions of
NIH over the fiscal year 2009 and fiscal year 2010 funding cycles,
particularly the NIBIB, which received $78 million--less than 1 percent
of the $10.4 billion ARRA budget assigned to the NIH for the fiscal
year 2009 and fiscal year 2010 funding cycles. NIBIB has already
exhausted this budget, leaving no additional ARRA funding to leverage
through the fiscal year 2011 budget cycle and underscoring the need for
more robust investment in bioengineering at NIBIB. While this one-time
influx of funding for health research and infrastructure was justified,
the Task Force notes that the unstable nature of such funding inhibits
the potential impact on the economy and should not be viewed as a
viable substitute for steady and consistent support from Congress for
these critical national research priorities.
The Administration estimates 9,158 Research Project Grants (RPG)
will be supported under the fiscal year 2012 budget for NIH-wide RPGs.
From fiscal year 2010 to fiscal year 2011, inflationary pressures and
budget factors combined to result in a decrease of 652 in the number of
competing RPGs. The Task Force commends the Administration for again
focusing on funding RPGs in fiscal year 2012, resulting in an increase
of 424 supported grants over the fiscal year 2011 level of competing
RPGs. We reiterate again however, that the number of RPGs supported
from fiscal year 2010 to fiscal year 2012 will still decline by 228
under this austere fiscal year 2012 budget scenario.
NIBIB Research Funding
The Administration's fiscal year 2012 budget request supports $322
million for the NIBIB, an increase of $5.6 million or 1.8 percent from
the fiscal year 2010 appropriated amount. The mission of the NIBIB is
to seek to improve human health by leading the development and
application of emerging and breakthrough technologies based on a
merging of the biological, physical, and engineering sciences. As noted
above, this increase is well under the 3 percent projected increase in
research costs due to inflation (predicted by the BRDPI index) and, as
a consequence, actually results in an effective decrease in funding for
NIBIB compared to fiscal year 2010.
The budget for NIBIB Research Grants would remain flat at $262.7
million. Funding for intramural research would increase 7.3 percent to
$11.8 million from $11 million in fiscal year 2010. NIBIB's Research
Management and Support request is $17.3 million, a 3 percent increase
over fiscal year 2010.
NIBIB funds the Applied Science and Technology (AST) program, which
supports the development and application of innovative technologies,
methods, products, and devices for research and clinical application
that transform the practice of medicine. The fiscal year 2012 request
for AST is $170.6 million, a $2.2 million increase or 1.3 percent
increase from fiscal year 2010.
Additionally, NIBIB funds the Discover Science and Technology (DST)
program, which is focused on the discovery of innovative biomedical
engineering and imaging principles for the benefit of public health.
The fiscal year 2011 request for DST is $95.3 million, a $1.2 million
or 1.3 percent increase from fiscal year 2010.
The Technological Competitiveness-Bridging the Sciences program,
which funds interdisciplinary approaches to research, would receive
$25.9 million in fiscal year 2012, a $0.9 million increase or 3.6
percent over the fiscal year 2010 enacted level.
Task Force Recommendations
The Task Force is concerned that the United States faces rapidly
growing challenges from our counterparts in the European Union and Asia
with regards to bioengineering advancements. While total health-related
U.S. research and development investments have expanded significantly
over the last decade, investment in bioengineering at NIBIB have
remained relatively flat over the last several years. In fact, the
fiscal year 2012 budget actually represents a small reduction in
funding when the fiscal year 2003 NIBIB appropriation of $280 million
is adjusted for inflation--$329 million in 2010 dollars--leaving NIBIB
with an effective reduction in funding of $7 million since 2003.
The Task Force wishes to emphasize that, in many instances,
bioengineering-based solutions to healthcare problems can result in
improved health outcomes and reductions in healthcare costs. For
example, coronary stent implantation procedures cost approximately
$20,000, compared to bypass graft surgery at double the cost. Stenting
involves materials science (metals and polymers), mechanical design,
computational mechanical modeling, imaging technologies, etc. that
bioengineers work to develop. Not only is the procedure less costly,
but the patient can return to normal function within a few days rather
than months to recover from bypass surgery, greatly reducing other
costs to the economy. Therefore, we strongly urge Congress to consider
increased funding for bioengineering within the NIBIB and across NIH,
and work to strengthen these investments in the long run to reduce U.S.
healthcare costs and support continued U.S. leadership in
bioengineering.
Even during these challenging fiscal times, the NIBIB must obtain
sustained funding increases, both to accelerate medical advancements as
our Nation's population ages, and to mirror the growth taking place in
the bioengineering field. The Task Force believes that the
Administration's budget request for fiscal year 2012 is not aligned
with the long-term challenges posed by this objective; a 1.8 percent
budget increase will not keep up with current inflationary increases
for biomedical research, eroding the United States' ability to lay the
groundwork for the medical advancements of tomorrow.
While the Task Force supports Federal proposals that seek to double
Federal research and development in the physical sciences over the next
decade, we believe that strong Federal support for bioengineering and
the life sciences is essential to the health and competitiveness of the
United States. The supplemental funding that NIH received as part of
ARRA and the budget request by the Administration does not erase the
past several years of disappointing budgets. Congress and the
Administration should work to develop a specific plan, beyond President
Obama's call for ``innovations in healthcare technology'' to focus on
specific and attainable medical and biomedical research priorities
which will reduce the costs of healthcare and improve healthcare
outcomes. Further, Congress and the Administration should include in
this strategy new mechanisms for partnerships between NSF and the NIH
to promote bioengineering research and education. The Task Force feels
these initiatives are necessary to build capacity in the U.S.
bioengineering workforce and improve the competitiveness of the U.S.
bioengineering research community.
______
Prepared Statement of the Association for Professionals in Infection
Control and Epidemiology (APIC) and the Society for Healthcare
Epidemiology of America (SHEA)
The Association for Professionals in Infection Control and
Epidemiology (APIC) and The Society for Healthcare Epidemiology of
America (SHEA) thank you for this opportunity to submit testimony on
Federal efforts to eliminate healthcare-associated infections (HAIs).
APIC's mission is to improve health and patient safety by reducing
the risk of HAIs and related adverse outcomes. The organization's more
than 14,000 members, known as infection preventionists, direct
infection prevention and control programs that save lives and improve
the bottom line for hospitals and other healthcare facilities
throughout the United States and around the globe. Our association
strives to promote a culture within healthcare institutions where all
members of the healthcare team fully embrace the elimination of HAIs.
We advance these efforts through education, research, collaboration,
practice guidance, public policy, and support for credentialing.
SHEA was founded in 1980 to advance the application of the science
of healthcare epidemiology. The Society works to achieve the highest
quality of patient care and healthcare personnel safety in all
healthcare settings by applying epidemiologic principles and prevention
strategies to a wide range of quality-of-care issues. SHEA is a growing
organization, strengthened by its membership in all branches of
medicine, public health, and healthcare epidemiology. SHEA and its
members are committed to implementing evidence-based strategies to
prevent HAIs. SHEA members have scientific expertise in evaluating
potential strategies for eliminating preventable HAIs.
APIC and SHEA collaborate with a wide range of infection prevention
and infectious diseases societies, specialty medical societies in other
fields, quality improvement organizations, and patient safety
organizations in order to identify and disseminate evidence-based
practices. The Centers for Disease Control and Prevention (CDC), its
Division of Healthcare Quality Promotion (DHQP) and the Federal
Healthcare Infection Control Practices Advisory Committee (HICPAC), and
the Council of State and Territorial Epidemiologists (CSTE) have been
invaluable Federal partners in the development of guidelines for the
prevention and control of HAIs and in their support of translational
research designed to bring evidence-based practices to patient care.
Further, collaboration between experts in the field (epidemiologists
and infection preventionists), the CDC and the Agency for Healthcare
Research and Quality (AHRQ) plays a critical role in defining and
prioritizing the research agenda. In 2008, APIC and SHEA aligned with
The Joint Commission and the American Hospital Association to produce
and promote the implementation of evidence-based recommendations in the
Compendium of Strategies to Prevent Healthcare-Associated Infections in
Acute Care Hospitals (http://www.shea-online.org/about/compendium.cfm).
APIC and SHEA also contribute expert scientific advice to quality
improvement organizations such as the Institute for Healthcare
Improvement (IHI), the National Quality Forum (NQF), and State-based
task forces focused on infection prevention and public reporting
issues.
HAIs are among the leading causes of preventable death in the
United States, accounting for an estimated 1.7 million infections and
99,000 associated deaths in 2002. In addition to the substantial human
suffering caused by HAIs, these infections contribute $28 billion to
$33 billion in excess healthcare costs each year.
The good news is that some of these infections are on the decline.
In particular, bloodstream infections associated with indwelling
central venous catheters, or ``central lines,'' are largely preventable
when healthcare providers use the CDC infection prevention
recommendations in the context of a performance improvement
collaborative. Healthcare professionals have reduced these infections
in hospital intensive care unit (ICU) patients by 58 percent since
2001, which represents up to 27,000 lives saved. In spite of this
notable progress, there is a great deal of work to be done to achieve
the goal of HAI elimination. These additional opportunities to save
lives and improve patient safety involve settings outside ICUs and
those patients who need hemodialysis.
To build and then sustain these winnable battles against HAIs, we
urge you, in fiscal year 2012, to support the CDC Coalition's request
for $7.7 billion for the CDC's ``core programs.'' Within that broader
area, the CDC is currently involved in a number of projects that have
allowed for significant progress to be made in reducing HAIs. In light
of this important work, we ask that you provide the CDC with its
requested amount of $47.4 million for HAI prevention activities.
Included among these activities is support for State-based programs
to expand facility enrollment in the CDC's National Healthcare Safety
Network (NHSN), an important reporting and monitoring tool that enables
officials to track where HAIs are occurring and identify where
improvements need to be made. NHSN's data analysis function helps our
members analyze facility-specific data and compare rates to national
metrics. Importantly, the patients we serve throughout the United
States have established expectations that reported reductions in the
frequency of HAIs are accurate. APIC and SHEA have, through their
respective networks of members, identified limitations in other
measures of performance. These studies have consistently identified
that data from the CDC's NHSN provides a more precise picture of
performance relative to reduction of HAIs. Many States consider NHSN to
be the best option for implementing standardized reporting of HAI data.
The CDC has also been supporting research networks to address important
scientific gaps in HAI prevention, improvement in HAI tracking and
monitoring methodologies, as well as responding to requests for
assistance from health departments and healthcare facilities. It is
vital to ensure that the NHSN meets these expectations from patients
and that our successes are real and tangible improvements in the care
provided.
In addition, we request that the Subcommittee provide $50 million
for antimicrobial resistance activities. As the CDC states in its
request, ``repeated and improper uses of antibiotics are important
factors in the increase in drug-resistant bacteria, viruses, and
parasites,'' and ``preventing infections and decreasing inappropriate
antibiotic use are the best strategies to control resistance.''
Ensuring the effectiveness of antibiotics well into the future is vital
for the nation's public health. It is essential, therefore, that the
CDC maintains the ability to monitor organism resistance in healthcare
and promote appropriate antibiotic use. This has become even more
critical due to two recent developments. First, pharmaceutical
manufacturers have largely abandoned development of newer antibiotics
because there are several market-based disincentives to investing in
this research and development. Second, there is an epidemic of
infections caused by Clostridium difficile, a bacterium that is
triggered by use of antibiotics. These infections are widespread,
disproportionately affect older adults, and can be fatal. There are
several examples in the scientific literature that demonstrate the rate
of C. difficile infections drops in facilities with active, effective
antimicrobial stewardship programs.
We also support the Administration's $5 million request for HAI
activities. This funding will allow HHS, under the HHS Action Plan to
Prevent Healthcare-Associated Infections (HAI Action Plan), to
prioritize recommended clinical practices, strengthen data systems, and
develop and launch a nationwide HAI prevention campaign. APIC and SHEA
members have been engaged in this partnership for HAI prevention under
the leadership of HHS Assistant Secretary for Health, Dr. Howard Koh
and Deputy Assistant Secretary for Healthcare Quality, Dr. Don Wright.
We believe the development of the HAI Action Plan and the funding
to support these activities has been critical to the effort to build
support for a coordinated Federal plan and message on preventing
infections. Additionally, we strongly believe that the CDC has the
necessary expertise to define appropriate metrics through which the HAI
Action Plan can best measure its efforts.
APIC and SHEA also request that the Subcommittee approve $10.7
million for the Centers for Medicare and Medicaid Services (CMS)
surveys of ambulatory surgical centers (ASCs) as part of the budget
request addressing direct survey costs. CMS's survey process, jointly
developed with the CDC in this case, consists of targeting infection
control deficiencies in ASCs with a frequency of every 4 years. Due to
the increasing number of surgeries performed in outpatient settings,
and the need to ensure that basic infection prevention practices are
followed, APIC believes continuation of this survey tool is essential.
This support will also protect patients' lives as there have been
several outbreaks in ASCs involving transmission of bloodborne
pathogens, such as hepatitis C, due to unsafe practices.
Also within the direct survey costs portion of CMS's request, the
agency indicates plans to launch an HAI pilot program as part of the
HHS HAI strategic plan. This promises to produce a significant amount
of feedback on HAI prevention as CMS intends to survey critical access
hospitals and smaller hospitals across 10 to 25 States. This will allow
officials to gather information from facilities whose practices and
data have not traditionally been monitored or widely shared.
APIC and SHEA are pleased with the Administration's continued
support of biomedical research by providing an increase of almost $32
billion for the National Institutes of Health (NIH) in fiscal year
2012, a 2.4 percent increase over fiscal year 2010 levels. The NIH is
the single largest funding source for infectious diseases research in
the United States and the life-source for many academic research
centers. The NIH-funded work conducted at these centers lays the ground
work for advancements in treatments, cures, and medical technologies.
It is critical that we maintain this momentum for medical research
capacity.
Unfortunately, support for basic, translational, and
epidemiological HAI research has not been a priority of the NIH.
Despite the fact that HAIs are among the top ten annual causes of death
in the United States, scientists studying these infections have
received relatively less funding than colleagues in many other
disciplines. In 2008, NIH estimated that it spent more than $2.9
billion on funding for HIV/AIDS research, approximately $2 billion on
cardiovascular disease research, and about $664 million on obesity
research. By comparison, the National Institute of Allergy and
Infectious Diseases (NIAID) provided $18 million for MRSA research.
APIC and SHEA believe that as the magnitude of the HAI problem becomes
an increasing part of our public health dialogue, it is imperative that
the Congress and funding organizations put significant resources behind
this momentum.
The limited availability of Federal funding to study HAIs has the
effect of steering young investigators interested in pursuing research
on HAIs toward other, better-funded fields. While industry funding is
available, the potential conflicts of interest, particularly in the
area of infection prevention technologies, make this option seriously
problematic. These challenges are limiting professional interest in the
field and hampering the clinical research enterprise at a time when it
should be expanding.
Our field is faced with the need to bundle, implement and adhere to
interventions we believe to be successful while simultaneously
conducting basic, epidemiological, pathogenetic and translational
studies that are needed to move our discipline to the next level of
evidence-based patient safety. The current convergence of scientific,
public and legislative interest in reducing rates of HAIs can provide
the necessary momentum to address and answer important questions in HAI
research. APIC and SHEA strongly urge you to enhance NIH funding for
fiscal year 2012 to ensure adequate support for the research foundation
that holds the key to addressing the multifaceted challenges presented
by HAIs.
Finally, we support the $34 million in the Administration's fiscal
year 2012 budget that would continue, and allow expansion of, funding
for AHRQ grants related to HAI prevention in multiple healthcare
settings, including surgical and dialysis centers. Infections are one
of the leading causes of hospitalization and death for patients on
hemodialysis. According to the CDC, approximately 37,000 bloodstream
infections occurred in hemodialysis outpatients with central lines
(2008). AHRQ's plans to broaden research support in ambulatory and
long-term care settings to align with the HHS HAI Action Plan represent
another positive step in addressing HAIs in a comprehensive fashion.
We thank you for the opportunity to submit testimony and greatly
appreciate this Subcommittee's assistance in providing the necessary
funding for the Federal Government to have a leadership role in the
effort to eliminate HAIs.
______
Prepared Statement of the Association for Research in Vision and
Ophthalmology
Congressional and Presidential support for biomedical research
In 2009, Congress spoke volumes in passing S. Res. 209 and H. Res.
366, which designated the years 2010 to 2020 as The Decade of Vision,
in which the majority of 78 million Baby Boomers will face the greatest
risk for aging eye disease. This decade is not the time for a less-
than-inflationary increase for a community that lost 20.1 percent
purchasing power over the course of the last 10 years.\1\
---------------------------------------------------------------------------
\1\ Calculations were based solely upon annual biomedical research
and development price index (BRDPI) and annual appropriated amounts.
Fiscal year 2011 funding levels and fiscal year 2011 BRDPI were not
part of the calculation.
---------------------------------------------------------------------------
As President Obama has stated repeatedly, most recently during the
2011 State of the Union Address, biomedical research reduces healthcare
costs, increases productivity, and it ensures global competitiveness of
the United States.
ARVO has two major requests for Senate:
--For Senate to budget NIH in fiscal year 2012 at $35 billion.
This amount: Is a $3 billion increase over the President's
proposed budget; maintains NIH net funding levels from fiscal
year 2009 and fiscal year 2010; and ensures that NIH can
maintain funding for existing grants and award the same number
of new grants.
--For Senate to make vision health a priority and fund NEI in fiscal
year 2012 above the 1.8 percent increase over last year that
was proposed by the President.
--We request this even if Congress does not fund NIH at $35
billion.
--Why? Investing in research is a short term investment, with a
2.2-fold economic return from innovation. It has a long
term pay-off that can reduce healthcare spending on eye
diseases that are increasing in aging populations and
growing minority populations that have vision health
disparities (e.g. glaucoma and diabetic retinopathy). The
majority of research grant budgets pay for good paying
positions. Very little of the budget goes towards supplies
and equipment. It addresses one of American's greatest
fears: fear of losing eye sight.
Grant review eliminates budget excess
ARVO stands behind member John Ash, Ph.D., who stated the following
during January 2011 ARVO Advocacy Day visits to Capitol Hill: ``We
understand the need for budget cuts, but we should be cutting budgets
similar to how U.S. citizens trim their household budgets, not across
the board, but rather where there is waste and inefficiency. We
challenge you to find another government agency that uses money more
efficiently than the National Institutes of Health.''
The strategic plan for NIH grant programs (for example, the NEI
strategic plan) represents the collective vision of hundreds of
scientists throughout the United States. Funding decisions for
individual grant applications are awarded based on scientific merit and
past progress. Specifically, experts review grant applications and
assign scores based on the quality and impact of the proposed research.
Scientific merit and funding decisions are based on applicant
competitiveness among peers. An additional level of scrutiny and
guidance is provided by an NEI program panel of experts, the National
Advisory Eye Council. Progress on funded projects is monitored annually
by NIH, and excess budgets are trimmed taking into consideration
ongoing development of other projects. Thus, the process is highly
competitive from conception of a project through completion.
Cost of vision impairment
Vision disorders are the fourth most prevalent disability in the
United States and the most frequent cause of disability in children.
NEI estimates that vision impairment and eye disease cost the United
States $68 billion annually. However, this number does not factor in
the impact of indirect healthcare costs, lost productivity, reduced
independence, diminished quality of life, increased depression, and
accelerated mortality.
NEI's fiscal year 2010 baseline funding of $707 million reflects
just a little more than 1 percent of the annual costs of eye disease.
The continuum of vision loss presents a major public health problem, as
well as a significant financial challenge to the public and private
sectors.
Prevention saves money long term
Seventy-seven percent of Americans agree that research is part of
the solution to rising healthcare costs, and 84 percent understand that
prevention and wellness reduce healthcare costs (Your Candidates-Your
Health Poll, August 2010). Less-than-inflationary budget increases
represent short term cost-cutting that will cost taxpayers more money
in the long term. Prevention can save Medicare/Medicaid payments for
vision care in the aging population and in minority populations with
disproportionate incidence of eye disease (e.g. glaucoma and diabetic
retinopathy). NEI funding is a vital investment in overall health and
vision health of our Nation that prevents health expenditures.
Maintaining vision allows people to remain independent and employed,
reduces family burdens, and ultimately, improves the safety of
individuals and the entire community (driving safety being a prime
example).
Research is an economic investment
Merely 2 percent of Americans think research is not important to
the U.S. economy (National Poll, May 2010). The largest portion of NIH
grant budgets is for salaries distributed across the country, and many
of the positions funded are for good paying jobs. The lower paying jobs
are an investment in training the future biomedical research work
force. To learn about the economic impact of research by state, visit
http://www.researchamerica.org/economic_impact.
Vision research improves eye care
Below are three of the top vision success stories since 2003, as
reported by nearly 400 U.S.-based ARVO members, who work at NEI-funded
institutions. Examples come from responses to an ARVO survey about the
NEI strategic plan. There were too many vision achievements to list
them all.
Drug therapies for macular degeneration (AMD).--Vision researchers
developed a therapy to treat the most aggressive form of AMD (``wet''
AMD) that works much better than even hoped for. Not only is vision
loss stopped, in many cases sight is partially regained. The therapy is
so successful that it is now being used for other eye complications
(e.g., eye infections, injuries and diabetes). Furthermore, a National
Eye Institute-funded clinical trial (Comparison of AMD Treatments
Trial), comparing safety and effectiveness of two drugs to treat
advanced AMD, shows that a $50 drug (Avastin) is as effective as a
$2,000 drug (Lucentis). Since 250,000 patients are treated each year
for AMD, this will reduce Medicare and other government health
spending. http://1.usa.gov/jZpZyv
Gene therapies for eye disease.--Vision researchers developed gene
therapies for three retinal diseases: Leber congenital amaurosis, color
blindness and retinitis pigmentosa. They also identified important
genetic risk factors for age-related eye diseases, including age-
related macular degeneration and glaucoma. Critically, these
discoveries are the first ``pay-off'' of any kind from the Human Genome
Project for patients and taxpayers.
Cellular and molecular therapies.--Using regenerative medical
approaches, vision researchers made important progress in repairing
damaged eye tissues (e.g., cornea and retina). By repairing damaged
tissues vision function is rescued.
Continued vision research needs
ARVO members expressed continued need for research support for the
following areas (and many additional areas not covered here).
--Aging eye disease.--Accelerate our efforts in basic and
translational research to discover the causes of and new
treatments for macular degeneration, diabetic retinopathy and
other vision-robbing diseases whose risks of occurrence and
severity increase with age.
--Children's vision.--Find noninvasive ways to detect vision problems
in children early enough to start treatment before vision is
lost or their education is affected.
--Brain and eye injury.--Develop ways to rapidly seal wounds and
trauma encountered by civilians and the military, so ocular and
brain function can be maintained.
--Eye pain.--Understand the basis of eye pain and develop therapies
to treat it.
--Eye infections.--Identify better ways to identify and treat drug-
resistant eye-infections with antibiotics and anti-viral
medications. Certain infections can destroy eye tissues in just
24 hours.
--Invest in shared therapeutic targets.--Identify common, shared
causes for common eye diseases and common systemic diseases.
Establish meaningful collaborations between researchers, so
shared therapeutic strategies may be developed that can treat
multiple diseases.
--Identify at-risk groups and raise awareness.--Support development
of educational tools to raise awareness and treatment
compliance in people in age groups or ethnic groups, who are
more susceptible to certain eye diseases.
Understand environmental factors that make it more likely to
develop eye disease and educate people on how to prevent eye
disease.
--Eye surgery.--Identify circumstances when the risk of performing
eye surgery is greater than the benefit. Develop ways to treat
sight problems without surgery, including facilitating natural
wound healing.
Resources
Facts about State vision health: http://apps.nccd.cdc.gov/DDT_VHI/
VHIHome.aspx.
Fact sheet about vision and blindness: http://
www.researchamerica.org/uploads/factsheet16vision.pdf.
The Silver Book: Vision Loss. http://www.eyeresearch.org/pdf/
VisionLossSilverbook.pdf.
About ARVO
ARVO is the world's largest international association of vision
scientists (scientists who study diseases and disorders of the eye).
About 80 percent of members from the United States (>7,000 total) are
supported by NIH grant funding. Vision science is a multi-disciplinary
field, but the National Eye Institute is the only freestanding NIH
institute with a mission statement that specifically addresses vision
research. ARVO supports increased fiscal year 2011 and fiscal year 2012
NIH funding.
ARVO is also a member of the National Alliance for Eye and Vision
Research, and supports their testimony. www.eyeresearch.org
______
Prepared Statement of the Association of American Cancer Institutes
The Association of American Cancer Institutes (AACI), representing
94 of the Nation's premier academic and free-standing cancer centers,
appreciates the opportunity to submit this statement for consideration
by the United States Senate Subcommittee on Labor, Health and Human
Services, Education and Related Agencies, Committee on Appropriations.
AACI thanks the administration, Congress and the Subcommittee for
their long-standing commitment to ensuring quality care for cancer
patients, as well as for providing researchers with the tools that they
need to develop better cancer treatments and, ultimately, to cure this
disease.
President Obama's fiscal year 2012 budget calls for $31.829 billion
for NIH. This is an increase of $1.045 billion (3.4 percent) over the
fiscal year 2010 comparable level of $30.784 billion. The President's
proposed budget for the National Cancer Institute would be increased by
$95 million, to $5.2 billion.
Sustaining progress against cancer requires a Federal commitment to
funding research through the NIH and NCI at a level that at least keeps
pace with medical inflation. With that in mind, AACI is joining with
its colleagues in the biomedical research community in supporting the
proposed increases for NIH and NCI and in calling on Congress to
further strengthen the impact of the President's request by increasing
funding to $35 billion for NIH and to $5.9 billion for NCI. The
requested increases account for lost funding due to discontinuation of
the American Recovery and Reinvestment Act of 2009, and the ongoing
shortfall in NIH and NCI funding in relation to annual changes in the
Biomedical Research and Development Price Index (BRDPI), which
indicates how much the NIH budget must change to maintain purchasing
power.
Taking a closer look at the President's proposed fiscal year 2012
budget, as with so many complicated and vitally important matters, the
devil is in the details. While the President's budget includes a
proposed increase of $95.31 million over fiscal year 2010 for NCI, the
line item funding for Cooperative Clinical Research remains the same as
fiscal year 2010--$254.487 million. Other NCI line items show funding
decreases, including Comprehensive/Specialized Cancer Centers ($46.001
million decrease) and Research and Development Contracts ($39.409
million decrease).
AACI and its members are acutely aware of the difficult fiscal
environment that the country is facing. The vast majority of our cancer
centers exist within universities that are undergoing drastic budget
reductions and as a consequence, directors at our member cancer centers
are already facing extreme budgetary challenges. Furthermore, many of
our senior and most promising young investigators are now without NCI
funding and are requiring significant bridge funding from private
sources. In recent years, however, it has become more challenging to
raise philanthropic and other external funds. As a result, we continue
to be highly dependent on Federal cancer center grants.
Recent developments at one member center, the Nevada Cancer
Institute (NVCI), illustrate that need. Serving 15,000 patients since
it opened in 2005, NVCI has recently lain off half of its 300
employees. In a local news report, NVCI officials cited a number of
reasons for the layoffs, including a miserable economy that has hurt
fundraising, a worsening reimbursement environment that provides less
money from government and private insurance entities for services
rendered, and fewer Federal grant dollars in the recession. (``Debt
puts Nevada Cancer Institute on heels'', Las Vegas Review-Journal,
April 8, 2011.)
Cancer centers are already challenged to provide the infrastructure
necessary to support funded researchers, and cuts in Federal grants
will limit our ability to provide well functioning shared resources to
investigators who depend on them to complete their research. For most
matrix cancer centers, the majority of NCI grant funds are used to
sustain the shared resources so essential to basic, translational,
clinical and population cancer research, or to provide matching dollars
which allow departments to recruit new cancer researchers to a
university and support them until they receive their first grants.
As highlighted by NCI Director Harold Varmus in a January ``town
hall'' meeting with NCI staff, independent investigator research is a
particularly valuable resource, particularly in the area of genomics
and molecular epidemiology. Such research is highly dependent on state-
of-the-art shared resources like tissue processing and banking, DNA
sequencing, microRNA platforms, proteomics, biostatistics and
biomedical informatics. This infrastructure is expensive, and it is not
clear where cancer centers would turn for alternative funding if NCI
grant contributions to these efforts were reduced.
An investigator and medicinal chemist at a large AACI member center
spent 7 years developing two new targeted drugs that are now in
clinical trial testing. One agent shows promise in cancers of the
blood; the other against breast, colon, lung and prostate tumors.
Research on these agents required advanced technologies provided by the
center's shared resources, including analytical cell-sorting,
microarray assays, and toxicopathological evaluations of mouse models,
which are an essential part of drug discovery. If budget cuts had
forced the closure of one or more of these shared resources, these new
targeted therapies might never have made it to the patients who are now
benefiting from them. The researcher has 8 to 10 more compounds in the
pipeline, the fate of which hinges largely on the 2012 budget.
Unfortunately, hundreds of other promising cancer researchers across
the U.S. share this troubling uncertainty.
Cancer Research: Benefiting Americans' Health and Economic Well-being
Cancer's financial and personal impact on America is substantial
and growing--one in two men and one in three women will face cancer in
their lifetimes, and cancer cost our Nation more than $228 billion in
2008 (Centers for Disease Control and Preventions, Addressing The
Cancer Burden: At A Glance 2010).
The U.S. Centers for Disease Control & Prevention's latest report
on cancer survivorship, ``Cancer Survivors-United States, 2007'', shows
that the number of cancer survivors in the United States increased from
3 million in 1971 to 9.8 million in 2001 and 11.7 million in 2007--an
increase from 1.5 percent to 4 percent of the U.S. population. Cancer
survivors largely consist of people who are 65 years of age or older
and women. More than a million people were alive in 2007 after being
diagnosed with cancer 25 years or more earlier. Of the 11.7 million
people living with cancer in 2007, 7 million were 65 years of age or
older, 6.3 million were women, and 4.7 million were diagnosed 10 years
earlier or more
Investing in cancer research is a prudent step--both for the health
of our Nation and for its economic well-being. Cancer research,
conducted in academic laboratories across the country, saves money by
reducing healthcare costs associated with the disease, enhances the
United States' global competitiveness, and has a positive economic
impact on localities that house a major research center.
In May 2011, AACI engaged Tripp Umbach, a research firm
specializing in economic impact studies, to conduct an analysis of
potential effects on statewide and national economic activity and
employment resulting from NCI funding cuts to AACI cancer centers. Two
reduced funding levels were considered: (1) a ``conservative'' 0.8
percent reduction, as implemented in the 2011 continuing resolution for
the Federal budget, passed by Congress in March, and, (2) an
``aggressive'' 5.3 percent cut, reflecting an overall fiscal year 2012
budget reduction proposed by some members of Congress. This reduction
would rollback NCI funding to 2008 levels. The impact of the 0.8
percent cut is already being felt: NCI announced on May 5 that it would
need to cut funding for the NCI cancer centers program by 5 percent.
The report estimates that the total economic decline resulting from
a 0.8 percent cut in NCI funding would result in a loss of at least
$84.5 million to the U.S. economy, with a 5.3 percent funding drop
causing a $564.7 million economic loss nationwide. The economic impact
is even greater when overall NIH funding is considered. A 0.8 percent
reduction in NIH funding would mean a $530.8 million loss to the U.S.
economy, with a 5.3 percent reduction leading to a $3.5 billion loss.
Employment declines from the 0.8 percent NCI funding reduction
would total at least 629 jobs while 4,200 jobs would be lost with a 5.3
percent funding cut. Applying the same calculations to total NIH
appropriations would eliminate nearly 4,000 jobs based on the
conservative reduction, increasing to 26,300 jobs lost with a 5.3
percent cut. It is important to note that research and health sciences
jobs are generally high-paying and the loss of even a handful of such
jobs can have a measurable effect on local economic activity.
While the economic aspects of cancer research are important, what
cannot be overstated is the impact cancer research has had on
individuals' lives--lives that have been lengthened and even saved by
virtue of discoveries made in cancer research laboratories at cancer
centers across the United States.
Biomedical research has provided Americans with better cancer
treatments, as well as enhanced cancer screening and prevention
efforts. Some of the most exciting breakthroughs in current cancer
research are those in the field of personalized medicine. In
personalized medicine for cancer, not only is the disease itself
considered when determining treatments, but so is the individual's
unique genetic code. This combination allows physicians to better
identify those at risk for cancer, detect the disease, and treat the
cancer in a targeted fashion that minimizes side effects and refines
treatment in a way to provide the maximum benefit to the patient.
In the laboratory setting, multi-disciplinary teams of scientists
are working together to understand the significance of the human genome
in cancer. For instance, the Cancer Genetic Markers of Susceptibility
initiative is comparing the DNA of men and women with breast or
prostate cancer with that of men and women without the diseases to
better understand the diseases. The Cancer Genome Atlas is in
development as a comprehensive catalog of genetic changes that occur in
cancer.
Illustrating the successes realized by cancer research, NCI's most
recent Annual Report to the Nation on the Status of Cancer reported
that rates of death in the United States from all cancers for men and
women continued to decline between 2003 and 2007, the most recent
reporting period available. The report also finds that the overall rate
of new cancer diagnoses for men and women combined decreased an average
of slightly less than 1 percent per year for the same period.
Despite those improvements, ``cancer disparities'' abound, with
different groups of cancer sufferers and cancer types showing little
improvement or higher rates of incidence. For example, childhood cancer
incidence rates (rates of new diagnoses) continued to increase while
death rates in this age group decreased. Childhood cancer is classified
as cancers occurring in those 19 years of age or younger. And there are
several other forms of cancer (e.g. pancreatic, lung) and patient
populations (racial and ethnic minorities, the poor, those with
psychosocial issues) with high rates of cancer mortality and morbidity.
Furthermore, with the increased incidence and survival comes higher
morbidity because two-thirds of this surviving patient population
experience late effects that are classified as serious to life-
threatening.
The Nation's Cancer Centers
The nexus of cancer research in the United States is the Nation's
network of cancer centers represented by AACI. These cancer centers
conduct the highest-quality cancer research anywhere in the world and
provide exceptional patient care. The Nation's research institutions,
which house AACI's member cancer centers, receive an estimated $3.71
billion from the National Cancer Institute (NCI) to conduct cancer
research in fiscal year 2010; more than two-thirds of NCI's total
budget (U.S. Department of Health and Human Services, National
Institutes of Health, National Cancer Institute 2010 Fact Book). In
fact, approximately 84 percent of NCI's budget supports research at
nearly 650 universities, hospitals, cancer centers, and other
institutions in all 50 States. Because these centers are networked
nationally, opportunities for collaborations are many--assuring wise
and non-duplicative investment of scarce Federal dollars.
In addition to conducting basic, clinical, and population research,
the cancer centers are largely responsible for training the cancer
workforce that will practice in the United States in the years to come.
Much of this training depends on Federal dollars, via training grants
and other funding from NCI. Sustained Federal support will
significantly enhance the centers' ability to continue to train the
next generation of cancer specialists--both researchers and providers
of cancer care.
By providing access to a wide array of expertise and programs
specializing in prevention, diagnosis, and treatment of cancer, cancer
centers play an important role in reducing the burden of cancer in
their communities. The majority of the clinical trials of new
interventions for cancer are carried out at the nation's network of
cancer centers.
Conclusion
These are exciting times in science and, particularly, in cancer
research. The AACI cancer center network is unrivaled in its pursuit of
excellence, and places the highest priority on affording all Americans
access to superior cancer care, including novel treatments and clinical
trials. It is through the power of collaborative innovation that we
will accelerate progress toward a future without cancer, and research
funding through the NIH and NCI is essential to achieving our goals.
______
Prepared Statement of the Association of American Medical Colleges
The Association of American Medical Colleges (AAMC) is a not-for-
profit association representing all 134 accredited U.S. and 17
accredited Canadian medical schools; nearly 400 major teaching
hospitals and health systems; and nearly 90 academic and scientific
societies. Through these institutions and organizations, the AAMC
represents 128,000 faculty members, 75,000 medical students, and
110,000 resident physicians. The association appreciates the
opportunity to address four 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 (NIH); the Agency for Healthcare Research and
Quality (AHRQ); health professions education funding through the Health
Resources and Services Administration (HRSA)'s Bureau of Health
Professions; and the National Health Service Corps. The AAMC
appreciates the Subcommittee's longstanding, bipartisan efforts to
strengthen these programs.
National Institutes of Health.--The NIH is one of the Nation's
greatest achievements. The Federal Government's unwavering support for
medical research through the NIH has created a scientific enterprise
that is the envy of the world and has contributed greatly to improving
the health and well-being of all Americans--indeed of all humankind.
The AAMC is grateful to the Subcommittee for its efforts to
prioritize NIH funding in fiscal year 2011 and supports the budget
request of $31.748 billion for NIH in fiscal year 2012. More than 83
percent of NIH research funding is awarded to more than 3,000 research
institutions in every State; at least half of this funding supports
life-saving research at America's medical schools and teaching
hospitals. This successful partnership not only lays the foundation for
improved health and quality of life, but also strengthens the Nation's
long-term economy.
The foundation of scientific knowledge built through NIH-funded
research drives medical innovation that improves health and quality of
life through new and better diagnostics, improved prevention
strategies, and more effective treatments. NIH research has contributed
to dramatically increased and improved life expectancy over the past
century. A baby born today can look forward to an average life span of
nearly 78 years--almost three decades longer than a baby born in 1900,
and life expectancy continues to increase. People are staying active
longer, too: the proportion of older people with chronic disabilities
dropped by nearly a third between 1982 and 2005. Thanks to insights
from NIH-funded studies, the death rate for coronary heart disease is
more than 60 percent lower--and the death rate for stroke, 70 percent
lower--than in the World War II era.
For example, a new ability to comprehend the genetic mechanisms
responsible for disease is already providing insights into diagnostics
and identifying a new array of drug targets. We are entering an era of
personalized medicine, where prevention, diagnosis, and treatment of
disease can be individualized, instead of using the standardized
approach that all too often wastes healthcare resources and potentially
subjects patients to unnecessary and ineffective medical treatments and
diagnostic procedures.
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 historically have been underfunded.
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 further basic research opportunities. 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; and career support for established
clinical investigators, especially to enable them to mentor new
investigators.
Anecdotal evidence suggests that changes in healthcare 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. The AAMC supports
efforts to enhance the research infrastructure, including resources for
clinical and translational research; instrumentation and emerging
technologies; and animal and other research models.
Among the areas NIH has identified as ripe for investment and
integral to the health of the American people is enhancing the evidence
base for healthcare decisions. NIH's long-standing investment in
Comparative Effectiveness Research (CER) has informed the clinical
guidelines that assist physicians and their patients in making better
decisions about the most effective care. Knowledge from NIH-supported
CER has changed the way diabetes, atrial fibrillation, hypertension,
HIV/AIDS, schizophrenia, and many other conditions are treated. In
addition to diagnostic and treatment trials, knowing more about the
performance of disease prevention initiatives and medical care delivery
will improve health.
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 genomics research, 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.
The AAMC is heartened by the Administration's proposals to provide
a four percent stipend increase for predoctoral and postdoctoral
research trainees supported by NIH's Ruth L. Kirschstein National
Research Service Awards program. These stipend increases are necessary
if medical 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.
As Raymond Orbach, former Under Secretary for Science at the
Department of Energy for President George W. Bush, noted in a recent
editorial in Science, ``Other countries, such as China and India, are
increasing their funding of scientific research because they understand
its critical role in spurring technological advances and other
innovations. If the United States is to compete in the global economy,
it too must continue to invest in research programs.''
Agency for Healthcare Research and Quality.--Complementing the
medical research supported by NIH, AHRQ sponsors health services
research designed to improve the quality of healthcare, decrease
healthcare costs, and provide access to essential healthcare services
by translating research into measurable improvements in the healthcare
system. The AAMC firmly believes in the value of health services
research as the Nation continues to strive to provide high-quality,
efficient, and cost-effective healthcare to all of its citizens. The
AAMC joins the Friends of AHRQ in recommending $405 million for the
agency in fiscal year 2012.
As the lead Federal agency to improve healthcare quality, AHRQ's
overall mission is to support research and disseminate information that
improves the delivery of healthcare by identifying evidence-based
medical practices and procedures. The Friends of AHRQ funding
recommendation will allow AHRQ to continue to support patient-centered
health research and other valuable research initiatives including
strategies for translating the knowledge gained from patient-centered
research into clinical practice, healthcare delivery, and provider and
patient behaviors. These research findings will better guide and
enhance consumer and clinical decisionmaking, provide improved
healthcare services, and promote efficiency in the organization of
public and private systems of healthcare delivery.
Health Professions Funding.--The Title VII and VIII health
professions and nursing education programs are the only Federal
programs designed to improve the supply, distribution, and diversity of
the Nation's healthcare workforce. For almost 50 years, Title VII and
Title VIII have provided education and training opportunities to a wide
variety of aspiring healthcare professionals, both preparing them for
careers in the health professions and helping bring healthcare services
to our rural and underserved communities. Through loans, loan
guarantees, and scholarships to students, and grants and contracts to
academic institutions and non-profit organizations, the Title VII and
Title VIII programs fill the gaps in the supply of health professionals
not met by traditional market forces. The AAMC supports the fiscal year
2012 request of $762.5 million for these important workforce programs
in the upcoming fiscal year.
Since 1963, the Title VII and Title VIII education and training
programs have helped the workforce adapt to the evolving healthcare
needs of the ever-changing American population. In an effort to renew
and update Titles VII and VIII to meet current workforce challenges,
the programs were reauthorized in 2010--the first reauthorization in
the past decade. Reauthorization not only improved the efficiency of
the Title VII and Title VIII programs, but also laid the groundwork for
innovative programs with an increased focus on recruiting and retaining
professionals in underserved communities.
The AAMC appreciates the Subcommittee's longstanding support of the
Title VII and Title VIII programs, as well as bipartisan recognition
that a strong healthcare workforce is essential to the continued health
and prosperity of the American people, particularly in the face of
unprecedented existing and looming provider shortages. However,
recognition alone will not solve the significant disparities between
the needs of the American people and the number of providers willing
and able to care for them. To ensure that the Nation's already fragile
healthcare system is able to care for the expanding elderly population;
meet the unique needs of the country's sick and ailing children and
minority populations; and provide essential primary care services to
the neediest amongst us, it is essential that Congress prioritize the
healthcare workforce with a strong commitment to the Title VII and
Title VIII health professions programs in fiscal year 2012.
In addition to funding for Title VII and Title VIII, HRSA's Bureau
of Health Professions also supports the Children's Hospitals Graduate
Medical Education program. This program provides critical Federal
graduate medical education support for children's hospitals to prepare
the future primary care workforce for our Nation's children and for
pediatric specialty care--the greatest workforce shortage in children's
healthcare. The AAMC has serious concerns about the President's plan to
eliminate support for this essential program in fiscal year 2012, as
well as the $48.5 million (15 percent) cut imposed on the program in
fiscal year 2011. At a time when the Nation faces a critical doctor
shortage and more Americans are about to enter the health insurance
system, any cuts to funding that supports physician training will have
serious repercussions for Americans' health. We strongly urge
restoration to $317.5 million in fiscal year 2012.
National Health Service Corps.--The AAMC lauds the commitment of
the Affordable Care Act to address health professional workforce
shortages by authorizing up to $535.1 million for the NHSC in fiscal
year 2012. The NHSC is widely recognized--both in Washington and in the
underserved areas it helps--as a success on many fronts. It improves
access to healthcare for the growing numbers of underserved Americans,
provides incentives for practitioners to enter primary care, reduces
the financial burden that the cost of health professions education
places on new practitioners, and helps ensure access to health
professions education for students from all backgrounds. Over its 39-
year history, the NHSC has offered recruitment incentives, in the form
of scholarship and loan repayment support, to more than 37,000 health
professionals committed to serving the underserved.
In spite of the NHSC's success, demand for health professionals
across the country remains high. At a field strength of 7,530 in fiscal
year 2010, the NHSC fell over 24,000 practitioners short of fulfilling
the need for primary care, dental, and mental health practitioners in
Health Professions Shortage Areas (HPSAs), as estimate by HRSA. While
the ``American Recovery and Reinvestment Act of 2009'' (Public Law 111-
5) provided a temporary boost in annual awards, this increase must be
sustained to help address the health professionals workforce shortage
and growing maldistribution.
The AAMC supports the president's fiscal year 2012 budget request
of $124 million, which returns the NHSC to fiscal year 2008
discretionary levels. The president's budget also assumes that the NHSC
has access to $295 million in additional dedicated funding through the
HHS Secretary's CHC Fund. This additional funding is necessary to
sustain the increased NHSC field strength and help address current
health professional workforce shortages. The AAMC further recommends
that the Subcommittee include report language directing the Secretary
to provide this enhanced funding for the NHSC over the fiscal year 2008
level, as directed under healthcare reform.
______
Prepared Statement of the Association of American Veterinary Medical
Colleges
The Association of American Veterinary Medical Colleges (AAVMC) is
pleased to submit this statement for the record in support of the
fiscal year 2012 budget request of $449.5 million for the health
professions education programs authorized under Title VII of the Public
Health Service Act and administered through the Health Resources and
Services Administration (HRSA). AAVMC is also pleased to provide
comments on the pending transfer of authorities of the National Center
for Research Resources (NCRR) within the National Institutes of Health
(NIH).
AAVMC provides leadership for and promotes excellence in academic
veterinary medicine to prepare the veterinary workforce with the
scientific knowledge and skills required to meet societal needs through
the protection of animal health, the relief of animal suffering, the
conservation of animal resources, the promotion of public health, and
the advancement of medical knowledge. AAVMC provides leadership for the
academic veterinary medical community, including in the United States
all 28 colleges of veterinary medicine, nine departments of veterinary
science, eight departments of comparative medicine, two other
veterinary medical educational institutions; and internationally, all
five veterinary medical colleges in Canada, eleven international
colleges of veterinary medicine, and three international affiliate
colleges of veterinary medicine.
The Title VII and VIII health professions and nursing programs
provide education and training opportunities to a wide variety of
aspiring healthcare professionals, including veterinarians. An
essential component of the healthcare safety net, the Title VII and
Title VIII programs are the only Federal programs designed to train
healthcare providers in interdisciplinary settings to meet the needs of
the country's special and underserved populations, as well as to
increase minority representation in the healthcare workforce.
While we are keenly aware that the Subcommittee continues to face
difficult decisions as it seeks to improve the Nation's fiscal health,
a continued Congressional commitment to programs supporting healthcare
workforce development is essential to the physical health and
prosperity of the American people.
The two areas within HRSA of greatest importance to AAVMC members
are the Public Health Workforce Development programs and Student
Financial Assistance.
The Public Health Workforce Development programs are designed to
increase the number of individuals trained in public health, to
identify the causes of health problems, and to respond to such issues
as managed care, new disease strains, food supply, and bioterrorism.
The Public Health Traineeships and Public Health Training Centers seek
to alleviate the critical shortage of public health professionals by
providing up-to-date training for current and future public health
workers, particularly in underserved areas. The Title VII
reauthorization reorganized this cluster to include a focus on loan
repayment as an incentive for public health professionals to practice
in disciplines and settings experiencing shortages. The Public Health
Workforce Loan Repayment Program provides loan repayment for public
health professionals accepting employment with Federal, State, local,
and tribal public health agencies.
AAVMC is also working to amend these authorizations so that
veterinarians engaged in public health are explicitly included and
prioritized for funding as their counterparts in human medicine and
dentistry are. On March 8, 2011 the United States House of
Representatives passed H.R. 525, the Veterinary Public Health
Amendments Act. AAVMC is eager to see this legislation pass the Senate
and become law so that the urgent workforce needs of veterinarians
engaged in public health are fully recognized and supported, as the
needs of their counterparts in human medicine are.
The loan programs under Student Financial Assistance support
financially needy and disadvantaged medical and nursing school students
in covering the costs of their education The Health Professional
Student Loan (HPSL) program provides loans covering the cost of
attendance for financially needy health professions students based on
institutional determination. The HPSL program is funded out of each
institution's revolving fund and does not receive Federal
appropriations. The Loans for Disadvantaged Students program provides
grants to health professions institutions to make loans to health
professions students from disadvantaged backgrounds.
AAVMC would also like to express concern over the pending
reorganization and possible elimination of NCRR programs over the
coming fiscal year. We recognize the importance of the NIH's initiative
to create the National Center for Advancing Translational Sciences
(NCATS) and welcome the potential benefits to our Nation's health of an
invigorated focus on translational medicine and therapeutics. AAVMC's
faculty members are proud of their significant contributions toward
improving human health through transdisciplinary involvement and
collaboration in translational research and comparative medicine. The
support offered by NCRR programs and resources to our institutions and
faculty have made possible their important contributions to our
Nation's health.
To successfully fulfill its mission of accelerating the development
and delivery of new, more effective therapeutics, NCATS will rely on a
diverse team of appropriately trained laboratory scientists and
clinical researchers capitalizing on the development of tools and
technologies and making discoveries at molecular and cellular levels
that can be tested and proven in animal-based studies. Although a
logical and rational argument can be made for including NCRR's Clinical
and Translational Science Award (CTSA) program, which is designed to
develop teams of investigators from various fields of research who can
transform scientific discoveries made in the laboratory into treatments
and strategies for patients in the clinic, into the new NCATS, the same
cannot be said for excluding and dismembering other components of NCRR,
such as animal resources, training programs, and high-end
instrumentation and technologies which are so critical to NCATS
mission.
Further, as indicated in the NCRR Task Force Straw Model, proposing
to subdivide these other NCRR components disrupts the extant scientific
synergies that have been demonstrated meritorious to date, and forfeits
the strategic relationships that have been built between programs over
the last 20 years. For example, splitting the animal resources into
different administrative structures erects a bureaucratic obstacle that
needlessly hinders the flow of basic scientific discoveries made in
induced genetic mutations in mice to clinically applicable mechanisms-
of-action studied and tested in non-human primates.
Although it is expected that following this restructuring NCRR will
no longer exist as a center, a rational consideration would be to
maintain a large component of NCRR programs together after reassignment
of the CTSA program within the new NCATS. Those charged with making
these decisions should be mindful that NCRR's unique, cross-cutting
programs are and have been successful through careful planning,
thoughtful leadership, and effective management by its administrative
and scientific staff, program officers, and officials who understand
these programs and are most qualified to ensure continued success of
their respective programs and initiatives.
We urge members of this committee to examine the issues raised
above and seek answers from the Administration as you conduct the
constitutionally mandated responsibility of overseeing Federal agencies
and their actions, such as the proposed reorganization within NIH.
Thank you for the opportunity to provide comments on the fiscal
year 2012 budget for the Department of Health and Human Services. AAVMC
is please to serve as a resource to Congress as you debate these
important issues. Please feel free to contact me directly at 202-371-
9195 x. 117 or by writing to [email protected].
______
Prepared Statement of the Association of Independent Research
Institutes
The Association of Independent Research Institutes (AIRI)
respectfully submits this written testimony for the record to the
Senate Appropriations Subcommittee on Labor, Health and Human Services,
Education and Related Agencies. AIRI appreciates the commitment that
the members of this Subcommittee have made to biomedical research
through your strong support for the National Institutes of Health
(NIH), and recommends that you maintain this support for NIH in fiscal
year 2012 by providing $31.987 billion for NIH in fiscal year 2012,
which represents a 3.4 percent increase above the fiscal year 2011
level.
AIRI is a national organization of more than 80 independent, non-
profit research institutes that perform basic and clinical research in
the biological and behavioral sciences. AIRI institutes vary in size,
with budgets ranging from a few million to hundreds of millions of
dollars. In addition, each AIRI member institution is governed by its
own independent board of directors, which allows our members to focus
on discovery-based research while remaining structurally nimble and
capable of adjusting their research programs to emerging areas of
inquiry. Researchers at independent research institutes consistently
exceed the success rates of the overall NIH grantee pool, and receive
about 10 percent of NIH's peer-reviewed, competitively awarded
extramural grants.
In recent years, Congress has taken important steps to jump start
the Nation's economy through investments in science. Simultaneously,
the NIH community is advancing and accelerating the biomedical research
agenda in this country by focusing on scientific opportunities to
address public health challenges. However, flat NIH budgets since 2003
have affected the agency's ability to pursue new, cutting-edge
opportunities. This funding uncertainty is disruptive to training,
careers, long-range projects, and ultimately, to research progress. The
research engine needs a predictable, sustained investment in science to
maximize the Nation's return.
Not only is NIH research essential to advancing health, it also
plays a key economic role in communities nationwide. More than 83
percent of NIH funding is spent in communities across the Nation,
creating jobs at more than 3,000 independent research institutions,
universities, teaching hospitals, and other institutions in every
State. NIH research also supports long-term competitiveness for
American workers. NIH funding forms one of the key foundations for
sustained U.S. global competitiveness in industries like biotechnology,
medical device and pharmaceutical development, and more.
Highlighted below are examples of how independent research
institutes uniquely contribute to the NIH mission and activities.
Translating Research into Treatments and Therapeutics.--To further
its primary goal of improving health, NIH is engaged in a significant
reorganization process focused on advancing translational science. AIRI
looks forward to collaborating with NIH in this area as independent
research institutes are particularly adept at translating basic
discoveries into therapeutics, often partnering with industry. As a
network of efficient, nimble independent research institutes that have
been conducting translational research for years, AIRI is well-
positioned to be a strong partner in bringing research from the bench
to the bedside.
Currently, over 15 AIRI member institutions are affiliated and
collaborate with the Clinical and Translational Science Awards (CTSA)
program. Many AIRI institutes also support research on human embryonic
stem cells (hESC) with the hope of discovering new and innovative
disease interventions. However, uncertainty surrounding NIH funding and
hESC research will hinder the agency's efforts to advance the
introduction of new, life-saving cures and treatments into the
marketplace.
Fostering the Next Generation Scientific Workforce.--The biomedical
research community is dependent upon a knowledgeable, skilled, and
diverse workforce to address current and future critical health
research questions. While the primary function of AIRI member
institutions is research, most are highly involved in training the next
generation of biomedical researchers and ensuring that a pipeline of
promising scientists are prepared to make significant and potentially
transformative discoveries in a variety of areas.
AIRI supports policies that promote the United States' ability to
maintain a competitive edge in biomedical science. Initiatives focusing
on career development and recruitment of a diverse scientific workforce
are important to innovation in biomedical research and the public
health of the Nation. The cultivation and preservation of this
workforce is dependent upon several factors:
--The ability to recruit scientists and students globally is
essential to maintaining a strong workforce.
--Training programs both in basic and clinical biomedical research,
initiatives focusing on career development, and recruiting a
diverse scientific workforce are important to innovation in
biomedical research for the benefit of public health.
--The continued national emphasis on promoting education in the
fields of science, technology, engineering, and mathematics
(STEM) is key to bolstering the pipeline.
Pursuing New Knowledge.--The NIH model for conducting biomedical
research, which involves supporting scientists at universities, medical
centers, and independent research institutes, provides an effective
approach to making fundamental discoveries in the laboratory that can
be translated into medical advances that save lives. Moreover, efforts
to expand the knowledge base in medical and associated sciences bolster
the Nation's economic well-being and ensure a continued high return on
the public investment in research.
AIRI member institutions are private, stand-alone research centers
that set their sights on the vast frontiers of medical science,
specifically focused on pursuing knowledge about the biology and
behavior of living systems and the application of that knowledge to
improve human life and reduce the burdens of illness and disability.
Additionally, AIRI member institutes have embraced technologies and
research centers to collaborate on biological research for all
diseases. Using advanced technology platforms or ``cores,'' AIRI
researchers use genomics, imaging, and other broad-based technologies
to advance therapeutics development and drug discovery.
Providing Efficiency and Flexibility.--AIRI member institutes'
small size and flexibility provide an environment that is particularly
conducive to creativity and innovation. Independent research institutes
possess a unique versatility and culture that encourages them to share
expertise, information, and equipment across all research institutions
and elsewhere. These collaborative activities help minimize bureaucracy
and increase efficiency, allowing for fruitful partnerships with
entities in a variety of disciplines and industries. Also, unlike
institutes of higher education, independent research institutes are
able to focus solely on scientific inquiry and discoveries, allowing
them to respond quickly to the research needs of the country.
Supporting Local Economies.--AIRI is unique from other biomedical
research organizations in that our membership consists of institutions
located in regions not traditionally associated with cutting-edge
research. AIRI members are located in 25 States, including many smaller
or less-populated States that do not have major academic research
institutions. In many of these regions, independent research institutes
are major employers and economic engines, and exemplify the positive
impact of investing in research and science.
AIRI thanks the Subcommittee for its important work dedicated to
ensuring the health of the Nation, and we appreciate this opportunity
to urge the Subcommittee to provide $31.987 billion for NIH in the
fiscal year 2012 appropriations bill. AIRI looks forward to working
with Congress to support research that improves the health and quality
of life for all Americans.
______
Prepared Statement of the Association of Maternal & Child Health
Programs
Chairman Harkin and distinguished subcommittee members: On behalf
of the Association of Maternal & Child Health Programs (AMCHP), I am
pleased to submit testimony describing AMCHP's request for $700 million
in funding for fiscal year 2012 for the Title V Maternal and Child
Health Services block grant, a 5 percent increase over fiscal year
2010. The Maternal and Child Health (MCH) Services Block Grant supports
a wide range of programs that meet State and locally determined needs.
In 2008, over 40 million individuals were served by maternal and child
health programs supported through the MCH Services Block Grant.
AMCHP did not develop this request lightly and our members are very
cognizant of the many important and urgent discussions about reducing
the Federal deficit and Government spending. However, we strongly
contend that with the recent economic downturn and increased need to
provide services to vulnerable populations a $700 million request is
worthy of serious consideration by the Committee.
The MCH Services Block Grant provides support and services to
millions of American women, infants and children, including children
with special healthcare needs. It has been proven a cost effective,
value-based, and flexible funding source used to address the most
pressing and unique needs of each State. States and jurisdictions use
the MCH Services Block Grant to design and implement a wide range of
maternal and child health programs that meet national and State needs.
Although specific initiatives may vary among the 59 States and
jurisdictions, all of them work to accomplish the following:
--Reduce infant mortality and incidence of disabling conditions among
children;
--Increase the number of children appropriately immunized against
disease;
--Increase the number of children in low-income households who
receive assessments and follow-up diagnostic and treatment
services;
--Provide and ensure access to comprehensive perinatal care for
women; preventative and child care services; comprehensive
care, including long-term care services, for children with
special healthcare needs; and rehabilitation services for blind
and disabled children; and
--Facilitate the development of comprehensive, family centered,
community-based, culturally competent, coordinated systems of
care for children with special healthcare needs.
The MCH Services Block Grant improves the health of America's women
and children by:
--Supporting programs that work. The MCH Services Block Grant earned
the highest program rating by the Office of Management and
Budget's (OMB) Program Assessment Rating Tool (PART). OMB found
that MCH Services Block Grant funded programs helped to
decrease the infant mortality rate, prevent disabling
conditions, increase the number of children immunized, increase
access to care for uninsured children, and improve the overall
health of mothers and children. Reduced MCH Services Block
Grant funding threatens the ability of these programs to carry
on this work. Our results are available to the public through a
national website known as the Title V Information System. Such
a transparent system is remarkably rare for a Federal program
and we are proud of the progress we have made in demonstrating
results.
--Addressing the growing health needs of women, children and
families. As States face economic hardships and face limits on
their Medicaid and CHIP programs, more women and children seek
care and preventive services through MCH Services Block Grant
funded programs. Resources are needed to reduce infant
mortality, provide a range of preventive health and early
intervention services to those in need, improve oral
healthcare, reach more children and youth with special
healthcare needs, and reduce racial disparities in healthcare.
--Supporting and integrating other federally funded programs such as
Community Health Centers, Healthy Start, WIC, CHIP and
Medicaid. The MCH Services Block Grant helps identify areas of
need in a State and works with all State and Federal programs
to complement healthcare services and promote disease
prevention for women, children, and families.
To help illustrate the importance of MCH Services Block Grant
funding I would like to share Michelle's story. Michelle is a young
girl from Iowa who was helped by Iowa's MCH Services Block Grant
supported programs.
Katrina is the mother of Michelle, an energetic, 10 year old girl
from Spencer, Iowa who loves listening to music, riding and playing
with horses. While enrolling her daughter into school, Katrina got a
``mother's feeling'' that something just wasn't quite right with her
daughter and despite the family pediatrician telling her that there was
nothing wrong, she reached out to the Child Health Specialty Clinic
(CHSC) in Sioux City for help. It was at that Title V funded clinic
that it was discovered by a professional geneticist that her child was
suffering from Phelan-McDermid Syndrome (PMS). PMS is caused by damage
to, or deletion of, specific genes and impacts normal childhood
development. Frequently, individuals with PMS have intellectual
disabilities along with little or no expressive language and often
there can be a large variety of moderate and even some severe physical
disabilities.
Because of the proper diagnosis from the geneticist at the
specialty clinic, Katrina is able to get her daughter proper physical
rehabilitation treatments twice a week from her local hospital back
home in Spencer. A diagnosis of this kind could not have been found
without the aid of CHSC staff and the clinic in Sioux City, which along
with all Iowan CHSC clinics, are funded by the Title V Maternal & Child
Health Block Grant. Title V is so valuable because CHSC clinics provide
direct clinical services to children when services are not readily
available in the community. CHSC clinics also provide care
coordination, family support and infrastructure building, all in an
effort to continue to improve healthcare for children and families
across the entire state.
Thanks to Child Health Specialty Clinics, Iowan families are able
to receive testing and diagnosis that they can find nowhere else. Not
only are the people at these clinics determined to help children
medically, they also make a point to get to know the children on a
personal level. Katrina describes the people at the clinic by stating:
``They know each and every child when they arrive, and they truly love
the kids they see.'' If you were to ask Katrina how she felt about
Iowa's Title V funded specialty clinics she wouldn't shy away from
telling you that, ``They help so much. The people there really do
care.''
The MCH Services Block Grant supports a similar network in every
State and none of this could happen without the MCH Services Block
Grant. We hope that all our Nation's citizens are as proud as Katrina
because of the work of MCH Services Block Grant supported programs and
professionals.
America has made huge strides in advancing the health of women and
children but our country faces huge challenges in improving maternal
and child health outcomes and addressing the needs of vulnerable
children. On the sentinel measures of how well our society is doing to
protect women and children we compare badly to other industrialized
countries. Today, the United States ranks 30th in infant mortality
rates and 41st in maternal mortality. Sadly, every 18 minutes a baby in
America dies before his or her first birthday and each day in America
we lose 12 babies due to a Sudden Unexpected Infant Death. There are
places in this country where the African-American infant mortality rate
is double, and in some places even triple, the rate for whites.
Preventable injuries remain the leading cause of death for all
children. Nationwide we still fail to adequately screen all young
children for developmental concerns, and childhood obesity has reached
epidemic proportions threatening to reverse a century of progress in
extending life expectancy to our Nation's very future.
Without adequate funding MCH Services Block Grant programs will be
overwhelmed by the mismatch between State needs and available
resources. AMCHP members ask for your leadership in making the
important decision to fund the MCH Services Block Grant at $700 million
for fiscal year 2012. State maternal and child health programs have a
long track record of demonstrating our positive impact on MCH outcomes
and are fully accountable for the funds that we receive. Maintaining
vital funding for the MCH Services Block Grant is an effective and
efficient way to support our Nation's women, children, and families.
In closing Mr. Chairman and distinguished members, I ask you to
imagine with me an America in which every child has the opportunity to
live until his or her first birthday; a Nation where our Federal and
State partnership has effectively moved the needle on our most pressing
maternal and child health issues such as infant mortality. Imagine all
American parents being as proud as Katrina. Imagine a day when we are
celebrating significant reductions or even the total elimination of
health disparities by creatively solving our most urgent maternal and
child health challenges.
The MCH Services Block Grant aims to do just that using resources
effectively to improve the health of all of America's women and
children. Supporting the MCH Services Block Grant is a cost-effective
investment in our Nation's future. We appreciate you support and
leadership in funding it at $700 million for Federal fiscal year 2012.
Thank you.
______
Prepared Statement of the Association of Minority Health Professions
Schools
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Wayne J.
Riley, Chairman of the Board of Directors of the Association of
Minority Health Professions Schools (AMHPS) and the President and Chief
Executive Officer of Meharry Medical College. AMHPS, established in
1976, is a consortium of our Nation's 12 historically black medical,
dental, pharmacy, and veterinary schools. The members are two dental
schools at Howard University and Meharry Medical College; four schools
of medicine at The Charles Drew University, Howard University, Meharry
Medical College, and Morehouse School of Medicine; five schools of
pharmacy at Florida A&M University, Hampton University, Howard
University, Texas Southern University, and Xavier University; and one
school of veterinary medicine at Tuskegee University. In all of these
roles, I have seen firsthand the importance of minority health
professions institutions and the Title VII Health Professions Training
programs.
Mr. Chairman, I want to welcome you to this new role of leading the
L-HHS Subcommittee. I speak for our institutions, when I say that the
minority health professions institutions and the Title VII Health
Professionals Training programs address a critical national need.
Persistent and severe staffing shortages exist in a number of the
health professions, and chronic shortages exist for all of the health
professions in our Nation's most medically underserved communities.
Furthermore, even after the landmark passage of health reform, it is
important to note that our Nation's health professions workforce does
not accurately reflect the racial composition of our population. For
example while blacks represent approximately 15 percent of the U.S.
population, only 2-3 percent of the Nation's health professions
workforce is black. Mr. Chairman, I would like to share with you how
your committee can help AMHPS continue our efforts to help provide
quality health professionals and close our Nation's health disparity
gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need--even in austere
financial times.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
In fiscal year 2012, funding for the Title VII Health Professions
Training programs must at the very least be maintained, especially the
funding for the Minority Centers of Excellence (COEs) and Health
Careers Opportunity Program (HCOPs). In addition, the funding for the
National Institutes of Health (NIH)'s National Institute on Minority
Health and Health Disparities (NIMHD), as well as the Department of
Health and Human Services (HHS)'s Office of Minority Health (OMH),
should be preserved.
Minority Centers of Excellence.--COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions to the training
of minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs. For fiscal year 2012, I recommend a
funding level of $24.602 million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. For fiscal year 2012, I recommend a funding level
of $22.133 million for HCOPs.
National Insitutes of Health
Research Centers at Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI), currently administered by 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, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professions institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Centers of Excellence
program. For fiscal year 2012, I recommend funded increases
proportional with the funding of the over NIH.
Department of Health and Human Services
Office of Minority Health.--Specific programs at OMH include:
assisting medically underserved communities with the greatest need in
solving health disparities and attracting and retaining health
professionals; assisting minority institutions in acquiring real
property to expand their campuses and increase their capacity to train
minorities for medical careers; supporting conferences for high school
and undergraduate students to interest them in healthcareers, and
supporting cooperative agreements with minority institutions for the
purpose of strengthening their capacity to train more minorities in the
health professions.
The OMH has the potential to play a critical role in addressing
health disparities. For fiscal year 2012, I recommend a funding level
of $65 million for the OMH.
Department of Education
Strengthening Historically Black Graduate Institutions.--The
Department of Education's Strengthening Historically Black Graduate
Institutions (HBGI) program (Title III, Part B, Section 326) is
extremely important to AMHPS. 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. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
AMHPS' member institutions and the Title VII Health Professions
Training programs and the historically black health professions schools
can help this country to overcome health disparities. Congress must be
careful not to eliminate, paralyze or stifle the institutions and
programs that have been proven to work. The Association seeks to close
the ever widening health disparity gap. If this subcommittee will give
us the tools, we will continue to work towards the goal of eliminating
that disparity everyday.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the Association of Public Television Stations
On behalf of America's 361 public television stations, we
appreciate the opportunity to submit testimony for the record on the
importance of Federal funding for local public television stations.
Corporation for Public Broadcasting--Fiscal Year 2014 Request: $495
million, 2-year advance funded
More than 40 years after the inception of public television, local
stations continue to serve as the treasured cultural institutions
envisioned by their founders, reaching America's local communities with
unsurpassed programming and services.
Public broadcasting serves the public good--in education, public
affairs, public safety, cultural affairs and many other areas--and
richly deserves public support. The overwhelming majority of Americans
agree. In a recent bi-partisan poll conducted by Hart Research
Associates/American Viewpoint, nearly 70 percent of American voters,
including majorities of self-identifying Democrats, Independents, and
Republicans, support continued Federal funding for public broadcasting.
In addition, the same poll shows that Americans consider PBS to be the
second most appropriate expenditure of public funds, behind only
national defense. Federal support for CPB and local public television
stations has resulted in a nationwide system of locally owned and
controlled, trusted, community-driven and community responsive media
entities.
Furthermore, the power of digital technology has enabled stations
to greatly expand their delivery platforms to reach Americans where
they are increasingly consuming media--online and on-demand--in
addition to on-air. At the same time that stations are expanding their
services and the impact they have in their communities, stations are
also facing unprecedented funding challenges--presenting them with the
greatest financial hurdles in their 40 year history. Every revenue
source upon which our operations depend is under tremendous pressure.
State funding support is in a wholesale free-fall. Despite serving as a
long-time example of the incredible work that can be accomplished by a
public-private partnership, this model is in peril as the current
economic climate has put immense pressure on private funding sources.
Continued Federal support for public broadcasting is more important now
than ever before.
More than 70 percent of funding appropriated to CPB reaches local
stations in the form of Community Service Grants (CSGs). On average,
Federal spending makes up approximately 15 percent of local television
station's budgets. However, for many smaller and rural stations,
Federal funding represents more than 30-50 percent (and in a handful of
instances, an even larger percentage) of their total budget. For all
stations, this Federal funding is the ``lifeblood'' of public
broadcasting, providing critical seed money to local stations which
leverage each $1 of the Federal investment to raise over $6 from state
legislatures, private foundations and their viewers.
Funding through CPB is absolutely essential to public television
stations. Stations rely on the Federal investment to develop local
programming, operate their facilities, pay their employees and provide
community resources on-air, on-line and on-the-ground. This funding is
particularly important to rural stations who struggle to raise local
funds from individual donors due to the smaller and often economically
strained population base. At the same time it is often more costly to
serve rural areas due to the topography and distances between
communities.
A 2007 GAO report concluded that Federal funding, such as CSGs, is
an irreplaceable source of revenue, and that ``substantial growth of
nonFederal funding appears unlikely.'' It also found that ``cuts in
Federal funding could lead to a reduction in staff, local programming
or services.''
At an annual cost of about $1.39 per year for each American, public
broadcasting is a smart investment. This successful public-private
partnership creates important economic activity while providing an
essential educational and cultural service. Public broadcasting
directly supports over 21,000 jobs, and of the vast majority of them
are in local public television and radio stations in hundreds of
communities across America.
In addition, the advent of digital technology has created enormous
potential for stations, allowing them to bring content to Americans in
new, innovative ways while retaining our public service mission. Public
television stations are now utilizing a wide array of digital tools to
expand their current roles as educators, local conveners and vital
sources of trusted information at a time when their communities need
them most.
For example, in an effort to confront the dropout crisis in
America's high schools, CPB has just announced a significant investment
and partnership with local stations and their communities to address
this daunting problem that could have disastrous effects on America's
future if it is not soon addressed. Together with schools and
organizations that are already addressing the dropout crisis, the
stations will provide their resources and services to raise awareness,
coordinate action with community partners, and work directly with
students, parents, teachers, mentors, volunteers and leaders to lower
the drop-out rate in their respective communities.
In order for our stations to continue playing this vital role in
their communities, APTS and PBS respectfully request $495 million for
CPB, two-year advance funded for fiscal year 2014.
Advance funding is essential to the mission of public broadcasting.
This longstanding practice, which was enacted by President Ford in
1976, allows stations the ability to maximize fundraising efforts to
leverage the promise of Federal dollars for local impact--ensuring the
continuation of this strong public-private partnership. The 2-year
advance funding mechanism also gives stations critical lead time needed
to plan and produce high-quality programs. Additionally, the 2-year
advance funding mechanism insulates programming decisions from
political influence, as President Ford and the Congress intended in
their initial proposal for advance funding.
Ready To Learn--Fiscal Year 2012 Request: $27.3 million (Department of
Education)
The Ready to Learn Television program's success in improving
children's literacy and preparing them for school is proven and
unquestioned.
Ready To Learn combines the power of public media's on-air and
online educational content with on-the-ground local station community
engagement to build the reading skills of children between the ages of
two and eight, especially those from low-income families or those most
lacking reading skills.
Over the last 5 years, 60 independent studies have proven the
effectiveness of the Ready To Learn approach. For example, in one study
pre-schoolers who were exposed to a curriculum composed of programming
and interactive games from top Ready To Learn programs, including SUPER
WHY!, Between the Lions and Sesame Street, outscored children who
received a comparison (science) curriculum in all five measures of
early literacy.
In addition to being research-based and teacher tested, the Ready
To Learn Television program also provides excellent value for our
Federal dollars. In the last five-year grant round, public broadcasting
leveraged an additional $50 million in funding to augment the $73
million investment by the Department of Education for content
production. Without the investment of the Federal Government, this
supplemental investment would likely end.
The President's budget proposes consolidating public broadcasting's
signature early education initiative, the Ready To Learn Television
program, into a larger grant program. APTS and PBS are concerned that
the consolidation of this program could lead to, at worst, the
elimination of this critical program that has been the driving force
behind the creation of public television's unparalleled children's
educational programming. At best, the proposed budget would remove the
mechanisms that have provided for the tremendously efficient and
effective nature in which the Ready To Learn Television program has
successfully operated.
Consolidation or elimination of the Ready To Learn Television
program would severely affect the ability of local stations to respond
to their communities' educational needs, removing the needed resources
provided by this program for children, parents and teachers.
Ready To Learn is public television. This program is a shining
example of a public-private partnership as Federal funds are leveraged
to create the most popular and impactful children's educational content
that is supplemented by on-line and on-the-ground resources. Without
the Ready To Learn Television program, millions of families would lose
access to this incredible high-quality education content, especially
low-income and underserved households for whom this program is
targeted.
We urge the Committee to maintain the Ready To Learn Television
program as a stable line-item in the fiscal year 2012 budget and resist
the calls for consolidation. APTS and PBS respectfully request level
funding of $27.3 million for the Ready To Learn Television program in
fiscal year 2012.
CPB Digital Funding--Fiscal Year 2012 Request: $36 million
Public television stations have been at the forefront of the
digital transition, embracing the technology early and recognizing its
benefits to their viewers. Fortunately, Congress wisely recognized that
the federally mandated transition to digital broadcast would place a
hardship on public television's limited resources. Since 2001, Congress
has provided public television stations with funds to ensure that they
have the ability to continue to meet their public service mission and
deliver the highest quality educational, cultural and public affairs
programming post-transition.
Although the federally mandated portion of the transition is
complete, what remains to be finished is the ability of stations to
fully replicate their analog services in digital. As stations have
completed the transition of their main transmitters, they will continue
to convert their master controls, digital storage equipment and other
studio equipment--necessary to produce and distribute local educational
programming. The CPB Digital program is also critical to providing
funds that can be invested in interactive public media that maximizes
investments in digital infrastructure--including such content
investments as the American Archive.
Public television has used this new public digital spectrum to
maximize programming choices by offering an array of new channel
options, including the national offerings of Vme (the first 24-hour,
Spanish-language, educational channel), World, and Create.
More importantly, stations have also used these multicast
capabilities to expand their local offerings with digital channels
dedicated to community or State-focused programming. Some stations have
even utilized this technology to provide gavel-to-gavel coverage of
their State legislatures. In addition, digital broadcasting has enabled
stations to double the amount of noncommercial, children's educational
programming offered to the American public.
APTS and PBS respectfully request $36 million in CPB Digital
funding for fiscal year 2012 to enable stations to fully leverage this
groundbreaking technology.
______
Prepared Statement of the Association of Rehabilitation Nurses
Introduction
On behalf of the Association of Rehabilitation Nurses (ARN), I
appreciate having the opportunity to submit written testimony to the
Senate L-HHS Appropriations Subcommittee regarding funding for nursing
and rehabilitation related programs in fiscal year 2012. ARN represents
more than 5,700 Registered Nurses (RNs) who work to enhance the quality
of life for those affected by physical disability and/or chronic
illness. ARN understands that Congress has many concerns and limited
resources, but believes that chronic illnesses and physical
disabilities are heavy burdens on our society that must be addressed.
Rehabilitation Nurses and Rehabilitation Nursing
Rehabilitation nurses help individuals affected by chronic illness
and/or physical disability adapt to their condition, achieve their
greatest potential, and work toward productive, independent lives. They
take a holistic approach to meeting patients' nursing and medical,
vocational, educational, environmental, and spiritual needs.
Rehabilitation nurses begin to work with individuals and their families
soon after the onset of a disabling injury or chronic illness. They
continue to provide support and care, including patient and family
education, which empowers these individuals when they return home, or
to work, or school. The rehabilitation nurse often teaches patients and
their caregivers how to access systems and resources.
Rehabilitation nursing is a philosophy of care, not a work setting
or a phase of treatment. These nurses base their practice on
rehabilitative and restorative principles by: (1) managing complex
medical issues; (2) collaborating with other specialists; (3) providing
ongoing patient/caregiver education; (4) setting goals for maximum
independence; and (5) establishing plans of care to maintain optimal
wellness. Rehabilitation nurses practice in all settings, including
freestanding rehabilitation facilities, hospitals, long-term subacute
care facilities/skilled nursing facilities, long-term acute care
facilities, comprehensive outpatient rehabilitation facilities, home
health, and private practices, just to name a few.
With the Affordable Care Act's focus on creating a system that will
increase access to quality care, emphasize prevention, and decrease
cost, it is critical that a substantial investment be made in the
nursing workforce programs and in the scientific research that provides
the basis for nursing practice. To ensure that patients receive the
best quality care possible, ARN supports Federal programs and research
institutions that address the national nursing shortage and conduct
research focused on nursing and medical rehabilitation, e.g., traumatic
brain injury. Therefore, ARN respectfully requests that the
Subcommittee provide increased funding for the following programs:
Nursing Workforce and Development Programs at the Health
Resources and Services Administration (HRSA)
ARN supports efforts to resolve the national nursing shortage,
including appropriate funding to address the shortage of qualified
nursing faculty. Rehabilitation nursing requires a high-level of
education and technical expertise, and ARN is committed to assuring and
protecting access to professional nursing care delivered by highly-
educated, well-trained, and experienced Registered Nurses (RNs) for
individuals affected by chronic illness and/or physical disability.
According to the Health Resources and Services Administration
(HRSA), in 2010, our healthcare workforce experienced a shortage of
more than 400,000 nurses.\1\ The demand for nurses will continue to
grow as the baby-boomer population ages, nurses retire, and the need
for healthcare intensifies. Implementation of the new health reform law
will also increase the need for a well-trained and highly skilled
nursing workforce. The Institute of Medicine has released
recommendations on how to help the nursing workforce to meet these new
demands, but we are destined to fall short of these lofty goals if
there are not enough nurses to facilitate change.
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\1\ http://bhpr.hrsa.gov/healthworkforce/reports/nursing/
rnbehindprojections/4.htm.
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According to the U.S. Bureau of Labor Statistics, nursing is the
Nation's top profession in terms of projected job growth, with more
than 581,500 new nursing positions being created through 2018.\2\ These
positions are in addition to the existing jobs that healthcare
employers have not been able to fill. Educating new nurses to fill
these gaping vacancies is a great way to put Americans back to work and
simultaneously enhance an ailing healthcare system.
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\2\ http://www.bls.gov/oco/ocos083.htm#outlook.
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ARN strongly supports the national nursing community's request of
$313.075 million in fiscal year 2012 funding for Federal Nursing
Workforce Development programs at HRSA.
National Institute on Disability and Rehabilitation
Research (NIDRR)
The National Institute on Disability and Rehabilitation Research
(NIDRR) provides leadership and support for a comprehensive program of
research related to the rehabilitation of individuals with
disabilities. As one of the components of the Office of Special
Education and Rehabilitative Services at the U.S. Department of
Education, NIDRR operates along with the Rehabilitation Services
Administration and the Office of Special Education Programs.
The mission of NIDRR is to generate new knowledge and promote its
effective use to improve the abilities of people with disabilities to
perform activities of their choice in the community, and also to expand
society's capacity to provide full opportunities and accommodations for
its citizens with disabilities. NIDRR conducts comprehensive and
coordinated programs of research and related activities to maximize the
full inclusion, social integration, employment and independent living
of individuals of all ages with disabilities. NIDRR's focus includes
research in areas such as: employment, health and function, technology
for access and function, independent living and community integration,
and other associated disability research areas.
ARN strongly supports the work of NIDRR and encourages Congress to
provide the maximum possible fiscal year 2012 funding level.
National Institute of Nursing Research (NINR)
ARN understands that research is essential for the advancement of
nursing science, and believes new concepts must be developed and tested
to sustain the continued growth and maturation of the rehabilitation
nursing specialty. The National Institute of Nursing Research (NINR)
works to create cost-effective and high-quality healthcare by testing
new nursing science concepts and investigating how to best integrate
them into daily practice. 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 for those with chronic illness, and care for individuals at the
end of life. NINR's broad mandate includes seeking to prevent and delay
disease and to ease the symptoms associated with both chronic and acute
illnesses. NINR's recent areas of research focus include the following:
End of life and palliative care in rural areas; research in multi-
cultural societies; bio-behavioral methods to improve outcomes
research; and increasing health promotion through comprehensive
studies.
ARN respectfully requests $163 million in fiscal year 2012 funding
for NINR to continue its efforts to address issues related to chronic
and acute illnesses.
Traumatic Brian Injury (TBI)
According to the Brain Injury Association of America, 1.7 million
people sustain a traumatic brain injury (TBI) each year.\3\ This figure
does not include the 150,000 cases of TBI suffered by soldiers
returning from wars in Afghanistan and conflicts around the world.
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\3\ http://www.biausa.org/living-with-brain-injury.htm.
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The annual national cost of providing treatment and services for
these patients is estimated to be nearly $60 million in direct care and
lost workplace productivity. Continued fiscal support of the Traumatic
Brain Injury Act will provide critical funding needed to further
develop research and improve the lives of individuals who suffer from
traumatic brain injury.
Continued funding of the TBI Act will promote sound public health
policy in brain injury prevention, research, education, treatment, and
community-based services, while informing the public of needed support
for individuals living with TBI and their families.
ARN strongly supports the current work being done by the Centers
for Disease Control and Prevention (CDC) and HRSA on TBI programs.
These programs contribute to the overall body of knowledge in
rehabilitation medicine.
ARN urges Congress to support the following fiscal year 2012
funding requests for programs within the TBI Act: $10 million for CDC's
TBI registries and surveillance, prevention and national public
education and awareness efforts; $8 million for the HRSA Federal TBI
State Grant Program; and $4 million for the HRSA Federal TBI Protection
and Advocacy Systems Grant Program.
Conclusion
ARN appreciates the opportunity to share our priorities for fiscal
year 2012 funding levels for nursing and rehabilitation programs. ARN
maintains a strong commitment to working with Members of Congress,
other nursing and rehabilitation organizations, and other stakeholders
to ensure that the rehabilitation nurses of today continue to practice
tomorrow. By providing the fiscal year 2012 funding levels detailed
above, we believe the Subcommittee will be taking the steps necessary
to ensure that our Nation has a sufficient nursing workforce to care
for patients requiring rehabilitation from chronic illness and/or
physical disability.
______
Prepared Statement of the Brain Injury Association of America
Thank you for the opportunity to submit this written testimony with
regard to the fiscal year 2012 Labor-HHS-Education appropriations bill.
My testimony is on behalf of the Brain Injury Association of America
(BIAA), our national network of State affiliates, and hundreds of local
chapters and support groups from across the country.
In the civilian population alone every year, more than 1.7 million
people sustain brain injuries from falls, car crashes, assaults and
contact sports. Males are more likely than females to sustain brain
injuries. Children, teens and seniors are at greatest risk.
Recently, we are seeing an increasing number of service members
returning from the conflicts in Iraq and Afghanistan with TBI, which
has been termed one of the signature injuries of the war. Many of these
returning service members are undiagnosed or misdiagnosed and
subsequently they and their families will look to community and local
resources for information to better understand TBI and to obtain vital
support services to facilitate successful reintegration into the
community.
For the past 13 years Congress has provided minimal funding through
the HRSA Federal TBI Program to assist States in developing services
and systems to help individuals with a range of service and family
support needs following their loved one's brain injury. Similarly, the
grants to State Protection and Advocacy Systems to assist individuals
with traumatic brain injuries in accessing services through education,
legal and advocacy remedies are woefully underfunded. Rehabilitation,
community support and long-term care systems are still developing in
many States, while stretched to capacity in others. Additional numbers
of individuals with TBI as the result of war-related injuries only adds
more stress to these inadequately funded systems.
BIAA respectfully urges you to provide States with the resources
they need to address both the civilian and military populations who
look to them for much needed support in order to live and work in their
communities.
With broader regard to all of the programs authorized through the
TBI Act, BIAA specifically requests:
--$10 million (+$4 million) for the Centers for Disease Control and
Prevention TBI Registries and Surveillance, Brain Injury Acute
Care Guidelines, Prevention and National Public Education/
Awareness
--$8 million (+$1 million) for the Health Resources and Services
Administration (HRSA) Federal TBI State Grant Program
--$4 million (+$1 million) for the HRSA Federal TBI Protection &
Advocacy (P&A) Systems Grant Program
CDC--National Injury Center.--The Centers for Disease Control and
Prevention's National Injury Center is responsible for assessing the
incidence and prevalence of TBI in the United States. The CDC estimates
that 1.7 million TBIs occur each year and 3.4 million Americans live
with a life-long disability as a result of TBI. In addition, the TBI
Act as amended in 2008 requires the CDC to coordinate with the
Departments of Defense and Veterans Affairs to include the number of
TBIs occurring in the military. This coordination will likely increase
CDC's estimate of the number of Americans sustaining TBI and living
with the consequences.
CDC also funds States for TBI registries, creates and disseminates
public and professional educational materials, for families, caregivers
and medical personnel, and has recently collaborated with the National
Football League and National Hockey League to improve awareness of the
incidence of concussion in sports. CDC plays a leading role in helping
standardize evidence based guidelines for the management of TBI and $1
million of this request would go to fund CDC's work in this area.
HRSA TBI State Grant Program.--The TBI Act authorizes the HHS,
Health Resources and Service Administration (HRSA) to award grants to
(1) States, American Indian Consortia and territories to improve access
to service delivery and to (2) State Protection and Advocacy (P&A)
Systems to expand advocacy services to include individuals with
traumatic brain injury. For the past 13 years the HRSA Federal TBI
State Grant Program has supported State efforts to address the needs of
persons with brain injury and their families and to expand and improve
services to underserved and unserved populations including children and
youth; veterans and returning troops; and individuals with co-occurring
conditions
In fiscal year 2009, HRSA reduced the number of State grant awards
to 15, in order to increase each monetary award from $118,000 to
$250,000. This means that many States that had participated in the
program in past years have now been forced to close down their
operations, leaving many unable to access brain injury care.
Increasing the program to $8 million will provide funding necessary
to sustain the grants for the 15 States currently receiving funding
along with the 3 additional States added this year and to ensure
funding for 4 additional States. Steady increases over 5 years for this
program will provide for each State including the District of Columbia
and the American Indian Consortium and territories to sustain and
expand State service delivery; and to expand the use of the grant funds
to pay for such services as Information & Referral (I&R), systems
coordination and other necessary services and supports identified by
the State.
HRSA TBI P&A Program.--Similarly, the HRSA TBI P&A Program
currently provides funding to all State P&A systems for purposes of
protecting the legal and human rights of individuals with TBI. State
P&As provide a wide range of activities including training in self-
advocacy, outreach, information and referral and legal assistance to
people residing in nursing homes, to returning military seeking
veterans benefits, and students who need educational services.
Effective Protection and Advocacy services for people with
traumatic brain injury is needed to help reduce Government expenditures
and increase productivity, independence and community integration.
However, advocates must possess specialized skills, and their work is
often time-intensive. A $4 million appropriation would ensure that each
P&A can move toward providing a significant PATBI program with
appropriate staff time and expertise.
NIDRR TBI Model Systems of Care.--Funding for the TBI Model Systems
in the Department of Education is urgently needed to ensure that the
Nation's valuable TBI research capacity is not diminished, and to
maintain and build upon the 16 TBI Model Systems research centers
around the country.
The TBI Model Systems of Care program represents an already
existing vital national network of expertise and research in the field
of TBI, and weakening this program would have resounding effects on
both military and civilian populations. The TBI Model Systems are the
only source of non-proprietary longitudinal data on what happens to
people with brain injury. They are a key source of evidence-based
medicine, and serve as a ``proving ground'' for future researchers.
In order to make this program more comprehensive, Congress should
provide $11 million (+$1.5 million) in fiscal year 2011 for NIDRR's TBI
Model Systems of Care program, in order to add one new Collaborative
Research Project. In addition, given the national importance of this
research program, the TBI Model Systems of Care should receive ``line-
item'' status within the broader NIDRR budget.
We ask that you consider favorably these requests for the CDC, the
HRSA Federal TBI Program, and the NIDRR TBI Model Systems Program to
further data collection, increase public awareness, improve medical
care, assist States in coordinating services, protect the rights of
persons with TBI, and bolster vital research.
______
Prepared Statement of the CAEAR Coalition
On behalf of the tens of thousands of individuals living with HIV/
AIDS to whom members of the Communities Advocating Emergency AIDS
Relief (CAEAR) Coalition provide care, I thank Chairman Harkin and
Ranking Member Shelby for affording us the opportunity to submit
testimony regarding increased funding for the Ryan White HIV/AIDS
Program.
The Communities Advocating Emergency AIDS Relief (CAEAR) Coalition
is a national membership organization which advocates for sound Federal
policy, program regulations, and sufficient appropriations to meet the
care, treatment, support service and prevention/wellness needs of
people living with HIV/AIDS and the organizations that serve them,
focusing on ensuring access to high quality healthcare and the evolving
role of the Ryan White Program.
A Wise Investment in a Program That Works
The Ryan White Program works. In its Program Assessment Rating Tool
(PART), the White House Office of Management and Budget (OMB) gave the
Ryan White Program its highest possible rating of ``effective''--a
distinction shared by only 18 percent of all programs rated. According
to OMB, effective programs ``set ambitious goals, achieve results, are
well-managed and improve efficiency.'' Even more impressively, OMB's
assessment of the Ryan White Program found it to be in the top 1
percent of all Federal programs in the area of ``Program Results and
Accountability.'' Out of the 1,016 Federal programs rated--98 percent
of all Federal programs--the Ryan White Program was one of seven that
received a score of 100 percent in ``Program Results and
Accountability.''
The Ryan White Program serves as the indispensable safety net for
thousands of low-income, uninsured or underinsured people living with
HIV/AIDS.
--Part A provides much-needed funding to the 52 major metropolitan
areas hardest hit by the HIV/AIDS epidemic with severe needs
for additional resources to serve those living with HIV disease
in their communities.
--Part B assists States and territories in improving the quality,
availability, and organization of healthcare and support
services for individuals and families with HIV.
--The AIDS Drug Assistance Program (ADAP) in Part B provides life-
saving, urgently needed medications to people living with HIV/
AIDS in all 50 States and the territories.
--Part C provides grants to 349 faith- and community-based primary
care health clinics and public health providers in 49 States,
Puerto Rico and the District of Columbia. These clinics play a
central role in the delivery of HIV-related medical services to
underserved communities, people of color, and rural areas where
Part C funded clinics provide the only HIV specific medical
services available in the region.
--Part F AETC supports training for healthcare providers to identify,
counsel, diagnose, treat, and manage individuals with HIV
infection and to help prevent high-risk behaviors that lead to
infection. It has 130 program sites with coverage in all 50
States.
CAEAR Coalition's fiscal year 2012 funding requests for Part A,
Part B base and ADAP, and Part C reflect the amounts authorized by
Congress in the most recent authorization of the program.
There continues to be an increasing gap between the number of
people living with HIV/AIDS in the United States in need of care and
the Federal resources available to serve them. Between 2001 and 2008
the number of people living with AIDS grew 35 percent and yet funding
for medical care and support services in communities with the greatest
burden of HIV disease grew less than 12 percent between 2001 and 2011.
Similarly, funding for Part C-funded, faith and community-based primary
care clinics, which provide medical care for people living with HIV/
AIDS in remote, rural and geographically isolated, urban communities
nationwide, grew by only 11 percent between 2001 and 2011 as the number
of people they care for grew by 52 percent. The authorized amounts we
request would not fully address these funding deficiencies, but would
begin to reduce the still growing gaps in funding.
We thank you in advance for your consideration of our comments and
our request for:
--$751.9 million for Part A to support grants to the cities where
most people with HIV/AIDS live and receive their care and
treatment.
--$495 million for Part B base to provide additional needed resources
to the States to bolster the public health response statewide
regardless of location.
--$991 million in funding for the ADAP line item in Part B so
uninsured and underinsured people with HIV/AIDS can access the
anti-HIV and other prescribed medications they need to survive.
--$272.2 million for Part C to support grants to faith- and
community-based organizations, healthcare agencies, and
clinics.
--$50 million to fund the 11 regional centers funded under by Part F
AETC to offer specialized clinical education and consultation
to frontline providers.
Sufficient Funding for Ryan White Programs Saves Money and Saves Lives
Increased funding for Ryan White Programs will reap a significant
health return for minimal investment. Data show that Part A and Part C
programs have reduced HIV-related hospital admissions by 30 percent
nationally and by up to 75 percent in some locations. The programs
supported by the Ryan White HIV/AIDS Program also have been critical in
reducing AIDS mortality by 70 percent. The Ryan White Program works,
resulting in both economic stimulus and social savings by helping keep
people, stable, healthy and productive.
Growing Needs as More Tested and Entering Care
The Centers for Disease Control and Prevention (CDC) estimates that
as of 2006 there were 1,106,400 persons living with HIV/AIDS in the
United States. Approximately one-half were not in care and receiving
treatment. New CDC recommendations for routine HIV testing have
increased the influx of newly diagnosed individuals into care, but with
56,000 newly diagnosed individuals per year, the Federal resources have
not kept pace with the burgeoning need.
The fiscal year 2012 appropriation presents a crucial opportunity
to provide the Ryan White Program with the levels of funding needed to
address a growing epidemic in young men, as the CDC continues to
increase efforts to expand HIV testing so people living with HIV know
their status, control their health, and protect others.
CAEAR Coalition supports efforts to help individuals infected with
HIV learn their status at the earliest possible time. However, CAEAR
Coalition is concerned about the unmet demand for services created by
insufficient resources at the Federal level. Researchers estimate that
CDC's expanded HIV testing guidelines will bring an additional 46,000
people into care over 5 years and significantly reduce the 21 percent
of people living with HIV who do not know they are infected and
therefore are not in care. Bringing these individuals into care will
save large sums of money in the long run, but requires an initial
investment now. Research clearly shows that averting a single HIV
infection saves $221,365 in lifetime healthcare costs \1\, and getting
people on anti-HIV treatment early lowers levels of HIV circulating in
the body and reduces potential transmissions \2\--saving lives and
money in the long term--but we must invest now in care and treatment to
reap those rewards. Caring for individuals early in their disease will
increase the cost of care by $2.7 billion over 5 years and the majority
of those costs will fall to Federal discretionary programs like the
Ryan White Program and will not be offset by entitlement programs.\3\
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\1\ Holtgrave DR, Briddell K, Little E, Bendixen AV, Hooper M,
Kidder DP, et al. Cost and threshold analysis of housing as an HIV
prevention intervention. AIDS & Behavior.(2007)11(Suppl 2), S162-S166.
\2\ Montaner J, Lima VD, Barrios R, et al. Association of highly
active antiretroviral therapy coverage, population viral load, and
yearly new HIV diagnoses in British Columbia, Canada: a population-
based study. The Lancet (2010) 376(9740): 532-539.
\3\ Martin EG, Paltiel AD, Walensky, RP, Schackman BR, Expanded HIV
Screening in the United States: What Will It Cost Government
Discretionary and Entitlement Programs? A Budget Impact Analysis. Value
in Health (2010) 13: 893--902.
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Community-based providers are stretched to provide high-quality
care with the scarce resources available. CAEAR Coalition is concerned
that many HIV expert medical staff are scheduled to retire and the
persistent financial pressures may accelerate the loss of trained
professionals in the field. This additional pressure on an already
overburdened system will leave many of the more than 200,000 HIV-
infected individuals who do not know their HIV status without access to
the care they need.
State budget cuts have created a continuing and growing ADAP
funding crisis as a record number of people are in need of ADAP
services due to the economic downturn. As of May 2011, there are 8,100
people on ADAP waiting lists in 13 States. Additionally, ADAP waiting
lists and other cost-containment measures, including limited
formularies, reducing eligibility, or removing already enrolled people
from the program, are clear evidence that the need for HIV-related
medications continues to outstrip availability. ADAPs are forced to
make difficult trade-offs between serving a greater number of people
living with HIV/AIDS with fewer services or serving fewer people with
more services. Additional resources are needed to reduce and prevent
further use of cost-containment measures to limit access to ADAPs and
to allow all State ADAPs to provide a full range of HIV antiretrovirals
and treatment for opportunistic infections.
The number of clients entering the 349 Part C community health
centers and outpatient clinics has consistently increased over the last
5 years. Over 247,000 unduplicated persons living with HIV/AIDS receive
medical care in Part C-funded community health centers and clinics each
year. These faith- and community-based HIV/AIDS providers are
staggering under the burden of treatment and care after years of
funding cuts prior to the modest increase in recent years. The success
of the CDC's routine HIV testing recommendations has generated new
clients for Part C-funded health centers and clinics too, but
unfortunately with no increase in funding to provide the high quality
healthcare services and treatment access people with HIV/AIDS require.
Ryan White-Funded Programs are Economic Engines in their Communities
Ryan White--funded programs, including many community health
centers, are small businesses providing jobs, vendor contracts and
other types of economic development to low-income, urban and rural
communities, frequently serving as anchors for existing and new
businesses and investments. These organizations employ people in their
communities, providing critical entry-level jobs, community-based
training and career building.
For example, a large, urban community health center brings an
estimated economic impact of $21.6 million, employing 281 people, and a
small, rural health center has an estimated economic impact of $3.9
million, employing 52 people. Investing in AIDS care and treatment is
an investment in jobs and community development in communities that
need it most.
Ryan White Program Key to Meeting the Goals of the National HIV/AIDS
Strategy
CAEAR Coalition is eager to work with Congress to meet the
challenges posed by the HIV/AIDS epidemic. In 2012, we have the
collective chance to implement the community-embraced healthcare goals
and policies in the National HIV/AIDS Strategy (NHAS). The National
Strategy is an opportunity to reinvigorate the Nation's response to the
HIV/AIDS epidemic and stop its relentless movement into our
communities. The Ryan White HIV/AIDS Program is key to reaching the
NHAS goals of reducing new HIV infections, increasing access to care
and improving health outcomes for people living with HIV/AIDS, and
reducing HIV-related health disparities. Ryan White provides HIV/AIDS
care and treatment services to a significantly higher proportion of
racial/ethnic minorities and women than their representation among
reported AIDS cases--suggesting the programs and resources are targeted
to underserved and marginalized populations. Early care and treatment
are more critical than ever because we can help those infected learn
their status and get into care and treatment in order to improve their
own health and the health of their communities.
The Ryan White Program's history of accomplishments for public
health and people living with HIV/AIDS is a wonderful legacy for the
U.S. Congress. There continues to be a vast need for additional
resources to address the healthcare and treatment needs of people
living with HIV across the country. In recognition of its high level of
effectiveness and validation over time from credible Federal Government
institutions, CAEAR urges the committee to provide the Ryan White HIV/
AIDS Program with the funding levels authorized by Congress for fiscal
year 2012.
______
Prepared Statement of the Centers for Disease Control and Prevention
(CDC) Coalition
The CDC Coalition is a nonpartisan coalition of more than 140
organizations committed to strengthening our Nation's prevention
programs. Our mission is to ensure 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, clinicians, researchers, educators, and citizens served by CDC
programs.
The CDC Coalition believes that Congress should support CDC as an
agency--not just the individual programs that it funds. In the best
judgment of the CDC Coalition--given the challenges and burdens of
chronic disease, a potential influenza pandemic, terrorism, disaster
preparedness, new and reemerging infectious diseases and our many unmet
public health needs and missed prevention opportunities--we believe the
agency will require funding of at least $7.7 billion for CDC's ``core
programs'' in fiscal year 2012. This request represents a 36 percent
increase over fiscal year 2011 and a 31 percent increase over the
President's fiscal year 2012 request. We are deeply disappointed with
the more than $740 million in cuts to CDC's budget authority included
in the proposed fiscal year 2011 continuing resolution (CR). While CDC
programs will receive significant new funding from the Prevention and
Public Health Fund in fiscal year 2011, we are concerned that this
funding would essentially supplant cuts made to CDC's budget authority.
As you know the Prevention and Public Health Fund was intended to
supplement and not supplant the base funding of our public health
agencies and programs.
By translating research findings into effective intervention
efforts, CDC 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. With the potential onset of a worldwide influenza pandemic,
in addition to the many other natural and man-made threats that exist
in the modern world, the CDC has become 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.
The Multiple Roles of CDC
CDC serves as the lead agency for bioterrorism and other public
health emergency preparedness and must receive sustained support for
its preparedness programs in order for our Nation to meet future
challenges. Given the challenges of terrorism and disaster
preparedness, and our many unmet public health needs and missed
prevention opportunities we urge you to provide adequate funding for
State and local capacity grants. We ask the Subcommittee to ensure that
our States and local communities are prepared in the event of an act of
terrorism or other public health threat this year and in future years.
Unfortunately, this is not a threat that is going away.
Addressing the Leading Causes of Death and Disability
The President's fiscal year 2012 budget proposes to consolidate a
number of chronic disease programs within CDC. Members of the CDC
Coalition are currently engaged in conversations with CDC and members
of Congress to better understand what this consolidation will mean for
the funding that is passed on to our State and local health and
education agencies and the various programs our members have supported
in the past. We look forward to working with Congress, the
administration and CDC to ensure that any effort to consolidate
programs leads to the best health outcomes for the American people. We
must ensure that CDC's National Center for Chronic Disease Prevention
and Health Promotion has the resources it needs to assist our States
and communities in their efforts to reduce the burden of chronic
disease.
Heart disease remains the Nation's No. 1 killer. In 2007, over
616,000 people in the United States died from heart disease, accounting
for nearly 25 percent of all U.S. deaths. More women than men die of
heart disease each year, and in 2007, females had higher rates of
inpatient heart attack mortality than males. Stroke is the third
leading cause of death and is a leading cause of disability. In 2007,
stroke killed more than 135,000 people (61 percent of them women),
accounting for about 1 of every 18 deaths.
Cancer is the second most common cause of death in the United
States. There were an estimated 1,529,560 new cancer cases and 569,490
deaths from cancer in 2010. The financial cost of cancer is also
significant. According to the National Institutes of Health (NIH), in
2008 the overall cost for cancer in the United States was more than
$228.1 billion: $93.2 billion for direct medical costs, $18.8 billion
for lost worker productivity due to illness, and $116.1 billion for
lost worker productivity due to premature death.
Among the ways CDC is fighting cancer, is through funding the
National Breast and Cervical Cancer Early Detection Program that helps
low-income, uninsured and medically underserved women gain access to
lifesaving breast and cervical cancer screenings and provides a gateway
to treatment upon diagnosis. CDC also funds grants to States to develop
Comprehensive Cancer Control (CCC) plans, bringing together a broad
partnership of public and private stakeholders to set joint priorities
and implement specific cancer prevention and control activities
customized to address each State's particular needs.
Although more than 25.8 million Americans have diabetes, nearly 7
million cases are undiagnosed. In 2010, about 1.9 million people aged
20 years or older were newly diagnosed with diabetes. Diabetes is the
leading cause of kidney failure, nontraumatic lower-limb amputations,
and new cases of blindness among adults in the United States. The total
direct and indirect costs associated with diabetes were $178 billion in
2007. Preventive care such as routine eye and foot examinations, self-
monitoring of blood glucose, and glycemic control could reduce these
numbers.
Over the last 25 years, obesity rates have doubled among 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. CDC funds programs to encourage the
consumption of fruits and vegetables, encourage sufficient exercise,
and to develop other habits of healthy nutrition and activity.
An estimated 443,000 people die prematurely every year due to
tobacco use. CDC's tobacco control efforts seek to prevent tobacco
addition in the first place, as well as help those who want to quit. We
must continue to support these vital programs and reduce tobacco use in
the United States.
Each day more than 3,900 young people initiate cigarette smoking.
At the same time, according to CDC, only 3.8 percent of elementary
schools, 7.9 percent of middle schools and 2.1 percent of high schools
provide daily physical education or its equivalent for the entire
school year. Almost 90 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 nearly 4 million teens are infected with a sexually transmitted
disease. CDC plays a critical role in ensuring good public health and
health promotion in our schools.
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. CDC estimates that about 1.1 million Americans are living
with HIV, 21 percent of who are undiagnosed. Also, the number of people
living with HIV is increasing, as new drug therapies are keeping HIV-
infected persons healthy longer and dramatically reducing the death
rate. Prevention of HIV transmission is the best defense against the
AIDS epidemic that has already killed more than 617,000 in the United
States and dependant areas and is devastating populations around the
globe.
The United States has the highest rates of sexually transmitted
diseases (STDs) in the industrialized world. More than 19 million new
infections occur each year, almost half of them among young people. CDC
estimates that STDs, including HIV, cost the U.S. healthcare system as
much as $15.3 billion annually. Over the past several years,
significant ground has been lost in the fight against STDs. While
syphilis was on the verge of elimination in the United States at the
start of the decade, rates have increased by 114 percent since 2000. An
adequate investment in STD prevention could save millions in annual
healthcare costs in the future.
CDC and its National Center for Health Statistics collect data on
chronic disease prevalence, health disparities, emergency room use,
teen pregnancy, infant mortality and causes of death. The health data
collected through the Behavioral Risk Factor Surveillance System, Youth
Risk Behavior Survey, Youth Tobacco Survey, National Vital Statistics
System, and National Health and Nutrition Examination Survey are an
essential part of the Nation's statistical and public health
infrastructure. Adequate funding for these activities is essential for
tracking America's health as a nation and developing targeted and
appropriate public health policies and prevention interventions.
We must address the growing disparity in the health of racial and
ethnic minorities. CDC is helping States address serious disparities in
infant mortality, breast and cervical cancer, cardiovascular disease,
diabetes, HIV/AIDS and immunizations. Our members are committed to
ending the disparities and we encourage the Subcommittee to provide
adequate funds for these 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 healthcare 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 and significant racial and ethnic disparities
in vaccination levels persist among the elderly. 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.
Childhood immunizations provide one of the best returns on
investment of any public health program. For every dollar spent on
seven vaccines recommended in the childhood series, $16.50 is saved in
direct and indirect costs. An estimated 14 million cases of childhood
disease and 33,000 deaths are prevented each year through timely
immunization. Despite the incredible success of the program, it faces
serious financial challenges.
Injuries are the leading causes of death for persons aged 1-44
years. Unintentional injuries and violence such as older adult falls,
unintentional drug poisonings, child maltreatment and sexual violence
accounts for over 35 percent of emergency department visits annually.
Annually, injury and violence cost the United States approximately $406
billion in direct and indirect medical costs including lost
productivity. Unintentional injury consistently remains the leading
cause of death among young Americans ages 1-34 with 37.1 percent of
unintentional fatal injuries caused by motor vehicle traffic
fatalities. Conversely, violence related injuries are also substantial
with homicide being the second leading cause of death for persons 15-24
years, while suicide is the 11th leading cause of death across all age
groups. The consequences of these injuries can be far reaching from
physical, emotional, financial turmoil to long term disability. CDC's
Injury Center works to prevent unintentional and violence-related
injuries to minimize the consequences of injuries when they occur by
researching the problem; identifying the risk and protective factors;
developing and testing interventions; ensuring widespread adoption of
proven strategies and gathering data to assist States and communities
to develop prevention programs and practices through the use of
surveillance systems like the National Violent Death Reporting System.
One in every 33 babies born each year in the United States is born
with one or more birth defects. Birth defects are the leading cause of
infant mortality. Children with birth defects who survive often
experience lifelong physical and mental disabilities. More than 50
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. The National Center on Birth Defects and Developmental
Disabilities 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 also encourage the Subcommittee to provide adequate funding for
CDC's Center for Environmental Health to revitalize environmental
public health services at the national, State and local level and
sustain current programs. These services are essential to protecting
and ensuring the health and well being of the American public from
threats associated with West Nile virus, climate change, terrorism, E.
coli, lead-based paint and other hazards.
We appreciate the Subcommittee's past support for CDC programs in a
climate of competing priorities. We thank you for considering our
fiscal year 2012 request for $7.7 billion for CDC's ``core programs.''
______
Prepared Statement of the Charles R. Drew University of Medicine and
Science
Mr. Chairman and members of the Subcommittee, thank you for the
opportunity to present you with testimony. The Charles Drew University
is distinctive in being the only dually designated Historically Black
Graduate Institution and Hispanic Serving Institution in the Nation. We
would like to thank you, Mr. Chairman, for the support that this
subcommittee has given to our University to produce minority health
professionals to eliminate health disparities as well as do
groundbreaking research to save lives.
The Charles Drew University is located in the Watts-Willowbrook
area of South Los Angeles. Its mission is to prepare predominantly
minority doctors and other health professionals to care for underserved
communities with compassion and excellence through education, clinical
care, outreach, pipeline programs and advanced research that makes a
rapid difference in clinical practice. The Charles Drew University has
established a national reputation for translational research that
addresses the health disparities and social issues that strike hardest
and deepest among urban and minority populations.
Health Resources and Services Administration
Title VII Health Professions Training Programs.--The health
professions training programs administered by the Health Resources and
Services Administration (HRSA) are the only Federal initiatives
designed to address the longstanding under representation of minorities
in healthcareers. HRSA's own report, ``The Rationale for Diversity in
the Health Professions: A Review of the Evidence,'' found that minority
health professionals disproportionately serve minority and other
medically underserved populations, minority populations tend to receive
better care from practitioners of their own race or ethnicity, and non-
English speaking patients experience better care, greater comprehension
and greater likelihood of keeping follow-up appointments when they see
a practitioner who speaks their language. Studies have also
demonstrated that when minorities are trained in minority health
professions institutions, they are significantly more likely to: (1)
serve in medically underserved areas, (2) provide care for minorities
and (3) treat low-income patients.
Minority Centers of Excellence.--The purpose of the COE program is
to assist schools, like Charles Drew University, that train minority
health professionals, by supporting programs of excellence. The COE
program focuses on improving student recruitment and performance;
improving curricula and cultural competence of graduates; facilitating
faculty and 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 2012, the funding level for COE should be $24.602 million.
Health Careers Opportunity Program.--Grants made to health
professions schools and educational entities under 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 health professions schools. For fiscal
year 2012, the HCOP funding level of $22.133 million is recommended.
National Institutes of Health
National Institute on Minority Health and Health Disparities.--The
NIMHD is charged with addressing the longstanding health status gap
between under-represented minority and non minority populations. The
NIMHD helps health professional institutions to narrow the health
status gap by improving research capabilities through the continued
development of faculty, labs, telemedicine technology and other
learning resources. The NIMHD also supports biomedical research focused
on eliminating health disparities and developed a comprehensive plan
for research on minority health at NIH. Furthermore, the NIMHD provides
financial support to health professions institutions that have a
history and mission of serving minority and medically underserved
communities through the COE program and HCOP. For fiscal year 2012, an
increase proportional to NIH's increase is recommended for NIMHD to
support these critical activities.
Research Centers At Minority Institutions.--RCMI at the National
Center for Research Resources (NCRR) has a long and distinguished
record of helping institutions like The Charles Drew University develop
the research infrastructure necessary to be leaders in the area of
translational research focused on reducing health disparities research.
Although NIH has received some budget increases over the last 5 years,
funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
Department of Health and Human Services
Office of Minority Health.--Specific programs at OMH include:
assisting medically underserved communities, supporting conferences for
high school and undergraduate students to interest them in
healthcareers, and supporting cooperative agreements with minority
institutions for the purpose of strengthening their capacity to train
more minorities in the health professions. For fiscal year 2012, I
recommend a funding level of $65 million for OMH to support these
critical activities.
Department of Education
Strengthening Historically Black Graduate Institutions.--The
Department of Education's Strengthening Historically Black Graduate
Institutions program (Title III, Part B, Section 326) is extremely
important to MMC and other minority serving health professions
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. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Conclusion
Despite all the knowledge that exists about racial/ethnic, socio-
cultural and gender-based disparities in health outcomes, the gap
continues to widen. 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 preventative care and research are inaccessible
either due to distance or lack of facilities and expertise. As noted
earlier, in just one underserved area, South Los Angeles, the number
and distribution of beds, doctors, nurses and other health
professionals are as parlous as they were at the time of the Watts
Rebellion, after which the McCone Commission attributed the so-named
``Los Angeles Riots'' to poor services--particularly access to
affordable, quality healthcare. The Charles Drew University has proven
that it can produce excellent health professionals who 'get' the
mission--years after graduation they remain committed to serving people
in the most need. But, the university needs investment and committed
increased support from Federal, State and local governments and is
actively seeking foundation, philanthropic and corporate support.
Even though institutions like The Charles Drew University are
ideally situated (by location, population, community linkages and
mission) to study conditions in which health disparities have been well
documented, research is limited by the paucity of appropriate research
facilities. With your help, the Life Sciences Research Facility will
translate insight gained through research into greater understanding of
disparities and improved clinical outcomes. Additionally, programs like
Title VII Health Professions Training programs will help strengthen and
staff facilities like our Life Sciences Research Facility.
We look forward to working with you to lessen the huge negative
impact of health disparities on our Nation's increasingly diverse
populations, the economy and the whole American community.
Mr. Chairman, thank you again for the opportunity to present
testimony on behalf of The Charles Drew University. It is indeed an
honor.
______
Prepared Statement of the Children's Environmental Health Network
On behalf of the Children's Environmental Health Network (CEHN), a
national multi-disciplinary organization whose mission is to protect
the fetus and the child from environmental health hazards and promote a
healthy environment, I thank you for the opportunity to submit
testimony in support of fiscal year 2012 appropriations for U.S.
Department of Health and Human Services (HHS) for activities that
protect children from environmental hazards.
CEHN appreciates the wide range of needs that you must consider for
funding. We urge you to give priority to those programs that directly
protect and promote children's environmental health. In so doing, you
will improve not only our children's health and development, but also
their educational outcomes and their future.
The world in which today's children live has changed tremendously
from that of previous generations, including a phenomenal increase in
the substances to which children are exposed. Every day, children are
exposed to a mix of chemicals, most of them untested for their effects
on developing systems. In general, children have unique vulnerabilities
and susceptibilities to toxic chemicals. In some cases, an exposure
which may cause little or no harm to an adult may lead to irreparable
damage to a child. Exposure to neurotoxicants in utero or early
childhood can result in life-long learning and developmental delays.
Investments in programs that protect and promote children's health
will be repaid by healthier children with brighter futures. Protecting
our children--those born as well as those yet to be born--from
environmental hazards is truly a national security issue. Cutting or
weakening programs that protect children from harmful chemicals in
their environment is not only very costly to our Nation (for example,
the Clean Air Act Amendments of 1990 have saved $1 trillion in
healthcare costs\1\), such cuts will reduce the number of exceptionally
bright children in future generations. Our Nation's future will depend
upon its future leaders. As our experience with removing lead from
gasoline illustrates (removing lead in gasoline has saved the United
States an estimated $200 billion each year since 1980 in the form of
higher IQs for that year's newborns) \2\, when we protect children from
harmful chemicals in their environment, we help to assure that they
will reach their full potential. We have a responsibility to our
Nation's children, and to the Nation that they will someday lead, to
provide them with a healthy environment.
---------------------------------------------------------------------------
\1\ Health and Welfare Benefits Analyses to Support the Second
Section 812 Benefit-Cost Analysis of the Clean Air Act, Final Report,
prepared by Industrial Economics for the U.S. EPA, February 2011.
\2\ ``Economic Gains Resulting from the Reduction in Children's
Exposure to Lead in the United States,'' Grosse SD, Matte TD, Schwartz
J, Jackson RJ, Environ Health Perspectives 2002, 110(6): doi:10.1289/
ehp.02110563
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Additionally, American competiveness depends on having healthy
educated children who grow up to be healthy productive adults. Yet,
growing numbers of our children are diagnosed with chronic and
developmental illnesses and disabilities. The National Academy of
Sciences estimates that toxic environmental exposures play a role in 28
percent of neurobehavioral disorders in children and this does not
include other conditions such as asthma or cancers. Thus it is vital
that the Federal programs and activities that protect children from
environmental hazards receive adequate resources. Key programs in your
jurisdiction which CEHN urges you to support include:
Centers for Disease Control and Prevention (CDC)
The CDC is the Nation's leader in public health promotion and
disease prevention, and should receive top priority in Federal funding.
CDC continues to be faced with unprecedented challenges and
responsibilities. CEHN applauds your support for CDC in past years and
urges you to support a funding level of $7.7 billion for CDC's core
programs in fiscal year 2012.
Within CDC, the National Center for Environmental Health (NCEH) is
particularly important to protecting the environmental health of young
children. NCEH programs, such as its efforts to continue and expand
biomonitoring and its national report card on exposure information, are
key national assets. CEHN is thus deeply concerned about the proposed
severe cuts to CDC's environmental public health programs in the
President's fiscal year 2012 budget. We join with many others in
strongly opposing the proposal to consolidate CDC's Healthy Homes/Lead
Poisoning Prevention and the National Asthma Control Programs and
reducing funding for these programs by more than half.
The CDC's National Environmental Public Health Tracking Program
helps to track environmental hazards and the diseases they may cause
and to coordinate and integrate local, State and Federal health
agencies' collection of critical health and environmental data. Public
health officials need integrated health and environmental data so that
they can protect the public's health. We urge you to reverse the CDC
operating plan for fiscal year 2011, which eliminates all budget
authority for this vital program. We urge you to support additional
funding for the program in fiscal year 2012.
The Built Environment and Health Program (also known as the Healthy
Community Design Initiative) would be abolished. Other cuts to the
center's core environmental work include its radiation activities and
building capacity in local health departments. We urge you to oppose
these cuts.
CEHN also strongly supports CDC's Environmental Health Laboratory
and its biomonitoring activities, which allow us to measure with great
precision the actual levels of more than 450 chemicals and nutritional
indicators in people's bodies. This information helps public health
officials to determine which population groups are at high risk for
exposure and adverse health effects, assess public health
interventions, and monitor exposure trends over time.
National Institutes of Health (NIH)
CEHN joins others in the health field in requesting that the
Committee provide $35 billion for the National Institutes of Health
(NIH) in fiscal year 2012, including $779.4 million for the National
Institute of Environmental Health Sciences (NIEHS).
NIEHS is the leading institute conducting research to understand
how the environment influences the development and progression of human
disease. Children are uniquely vulnerable to harmful substances in
their environment, and the NIEHS plays a critical role in uncovering
the connections between environmental exposures and children's health.
Thus it plays a vital role in our efforts to understand how to protect
children, whether it is identifying and understanding the impact of
substances that are endocrine disruptors or understanding childhood
exposures that may not affect health until decades later.
CEHN therefore urges you to provide $779.4 million for NIEHS in
fiscal year 2012.
Children's Environmental Health Research Centers of Excellence
The Children's Environmental Health Research Centers, jointly
funded by the NIEHS and the EPA, play a key role in providing the
scientific basis for protecting children from environmental hazards.
With their modest budgets, which have been unchanged for more than 10
years, these centers generate valuable research. A unique aspect of
these Centers is the requirement that each Center actively involves its
local community in a collaborative partnership, leading both to
community-based participatory research projects and to the translation
of research findings into child-protective programs and policies. The
scientific output of these centers has been outstanding. For example,
findings from four Centers clearly showed that prenatal exposure to a
widely used pesticide affected developmental outcomes at birth and
early childhood. This was important information to EPA's decision
makers in their regulation of this pesticide.
Several Centers have established longitudinal cohorts which have
resulted in valuable research results. The Network is concerned that as
a Center's multi-year grant ends and the Center is shuttered, these
cohorts and the invaluable information they can provide are being lost.
The Network urges the Committee to assure that NIEHS has the funding
and the direction to support Centers in continuing these cohorts.
The work of these Centers has also shown us that, in addition to
research regarding a specific pollutant or health outcome, research is
desperately needed in understanding the totality of the child's
environment--for example, all of the exposures the child experiences in
the home, school, and child care environment--and how to evaluate those
multiple factors. CEHN urges you to support these Centers, to assure
they receive full funding and are extended and expanded as described
above.
National Children's Study
CEHN urges the Committee to assure stable support for the National
Children's Study (NCS) for all Institutes involved in this landmark,
evidence-based longitudinal study examining the effects of
environmental influences on the health and development of more than
100,000 children across the United States. This study may be the only
means that we will have to understand the links between exposures and
the health and development of children and to identify the antecedents
for a healthy adulthood. 2012 will be a critical year for the NCS. It
is vital that the funding is in place to launch the main study
involving all of the centers. Already approximately 700 babies have
been born into the study.
We urge the Committee to assure that the NCS retains on its
original focus on environmental chemicals. While the NCS is housed at
NIH, it must be a multi-agency study and it must be responsive to its
mission and to the lead agencies, in and out of NIH
CEHN also asks the Committee to direct NIH to ensure that protocols
are in place within NCS for measuring exposures in child care and
school settings; it is critically important to understand how school
and child care exposures differ from home exposures very early in the
study process.
Pediatric Environmental Health Specialty Units
Funded jointly by the Agency for Toxic Substances and Disease
Registry (ATSDR) and the U.S. Environmental Protection Agency (EPA),
the Pediatric Environmental Health Specialty Units (PEHSUs) form a
valuable resource network, with a center in each of the U.S. Federal
regions. PEHSU professionals provide medical consultation to healthcare
professionals on a wide range of environmental health issues, from
individual cases of exposure to advice regarding large-scale community
issues. PEHSUs also provide information and resources to school, child
care, health and medical, and community groups to help increase the
public's understanding of children's environmental health, and help
inform policymakers by providing data and background on local or
regional environmental health issues and implications for specific
populations or areas. For example, following the gulf oil spill in
2010, the PEHSUs quickly produced and released a series of factsheets
and advisories in multiple languages for local patients and health
professionals. We urge the Committee to fully fund ATSDR's portion of
this program in fiscal year 2012.
In conclusion, investments in programs that protect and promote
children's health will be repaid by healthier children with brighter
futures, an outcome we can all support. That is why CEHN asks you to
give priority to these programs. Thank you for the opportunity to
comment. CEHN's staff and I would be happy to answer any questions you
may have.
______
Prepared Statement of the Coalition for Health Funding
The Coalition for Health Funding is pleased to provide the Senate
Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee with a statement for the record on fiscal
year 2012 funding levels for health agencies and programs. Since 1970,
the Coalition for Health Funding has advocated for sufficient and
sustained discretionary funding for the public health continuum to meet
the mounting and evolving health challenges confronting the American
people.
Our Nation's strength is inextricably linked to our health.
Evidence abounds--from the Department of Defense to the U.S. Chamber of
Commerce--that healthy Americans are stronger on the battlefield, have
higher academic achievement, and are more productive in school and on
the job. Federal funding helps discover cures and fuel innovation,
ensure the safety of our drugs, food, water, and air, prevent disease,
protect and respond in times of crisis, train healthcare professionals,
and provide care to our Nation's most vulnerable. Much of what public
health does--and the impact of Federal investment in it--is such a part
of Americans' daily living that it is often invisible and almost always
taken for granted. For example, Federal health funding has:
--Improved and saved the lives of many of those suffering from
illnesses through scientific innovation and discovery.
--Prevented unnecessary and costly injuries through seat belt and
helmet laws, mandatory airbags, and car seats for infants and
toddlers.
--Promoted safe and healthy foods through dietary guidelines and food
labeling that help Americans better understand what we eat and
how to eat better.
--Improved the health of mothers and reduced birth defects and infant
deaths through recommendations to take folic acid during early
stages of pregnancy, place babies on their backs to prevent
Sudden Infant Death Syndrome, and avoid tobacco and alcohol use
during pregnancy.
--Combated tobacco addiction by regulating advertisements, imposing
age limits on tobacco purchases, and instituting smoking bans
in public places, cutting smoking rates by nearly half and
reducing the number of smoking-related deaths and illnesses and
the opportunity and real costs associated with them.
--Treated and eradicated infectious diseases through vaccines,
preventing epidemics and saving lives.
--Improved the environment through bans on asbestos in household
products and lead in paint and gasoline.
--Protected the American people in all communities from infectious,
occupational, environmental, and terrorist threats.
These are just some of the ways in which Federal funding for public
health has changed our lives and those of our children for the better.
Still, Federal funding is necessary to further improve, save, and
protect those in America and around the world. The treatments and cures
for many devastating diseases are just out of reach. Racial,
socioeconomic, and geographic health disparities persist. Costly and
often preventable chronic conditions such as asthma, diabetes, heart
disease and obesity--particularly among young people--are on the rise
and threaten military readiness, academic achievement, and societal
productivity. The failure to prioritize behavioral health issues
continues to have stunning, debilitating social and economic
consequences. Oral health is still not widely recognized as a
healthcare priority in spite of the fact that tooth decay remains a
common chronic disease among all ages and is preventable.
The Coalition for Health Funding's 70 national, member
organizations--representing the interests of more than 100 million
patients, healthcare providers, public health professionals, and
scientists--support the belief that the Federal Government is an
essential partner with State and local governments and the nonprofit
and private sectors in improving health. A pressing and immediate goal
is to build the capacity of our public health system to address
America's mounting health needs under the weight of a fragile economy,
an aging population, a health workforce shortage, and persisting
declines in health status.
Given current fiscal challenges, the Coalition for Health Funding
appreciates the efforts of the President and Congress to maintain
funding for many critical health programs in the final fiscal year 2011
spending legislation. Nevertheless, the Coalition remains concerned
about prospects for future cuts to health programs. The Coalition
supports fiscal responsibility, but not at the expense of America's
health and well-being. Cuts to federally funded health services and
scientific research will not significantly reduce the deficit, nor make
a dent in the national debt; discretionary health spending represents
less than 2 percent of all Federal spending. These cuts adversely
affect American families, cost jobs, and ultimately compromise
America's global competitiveness and economic growth.
The Coalition for Health Funding organized more than 470 national,
State, and local organizations and six former Surgeons General in a
letter that urged Congress to increase discretionary health funding.
The following list summarizes the Coalition for Health Funding's fiscal
year 2012 funding recommendations for health agencies under the
subcommittee's jurisdiction.
National Institutes of Health (NIH)
The Coalition supports $35 billion in fiscal year 2012 for NIH, a
14.4 percent increase over the fiscal year 2011 funding level and a 10
percent increase over the President's fiscal year 2012 request. The
partnership between NIH and America's scientific research community is
a national investment in improving the health and quality of life of
all Americans. As the primary Federal agency responsible for conducting
and supporting medical research, NIH-funded research drives scientific
innovation and develops new and better diagnostics, improved prevention
strategies, and more effective treatments.
NIH-funded research also contributes to the Nation's economic
strength by creating skilled, high-paying jobs; new products and
industries; and improved technologies. More than 83 percent of NIH
research funding is awarded to more than 3,000 universities, medical
schools, teaching hospitals, and other research institutions, located
in every State. The Nation's longstanding, bipartisan commitment to NIH
has established the United States as the world leader in medical
research and innovation. Other countries, such as China and India, are
increasing their funding of scientific research because they understand
its critical role in spurring technological advances and other
innovations. If the United States is to continue to compete in a
global, information-based economy, it too must continue to invest in
research programs such as NIH.
Centers for Disease Control and Prevention (CDC)
The Coalition for Health Funding recommends a level of $7.7 billion
for CDC's core programs in fiscal year 2012, a 36 percent increase over
fiscal year 2011 and a 31 percent increase over the President's fiscal
year 2012 request. This amount is representative of what CDC needs to
fulfill its core mission in fiscal year 2012; activities and programs
that are essential to protect the health of the American people. CDC
continues to be faced with unprecedented challenges and
responsibilities, ranging from chronic disease prevention, eliminating
health disparities, bioterrorism preparedness, to combating the obesity
epidemic. In addition, CDC funds community programs in injury control;
health promotion efforts in schools and workplaces; initiatives to
prevent diabetes, heart disease, cancer, stroke, and other chronic
diseases; improvements in nutrition and immunization; programs to
monitor and combat environmental effects on health; prevention programs
to improve oral health; prevention of birth defects; public health
research; strategies to prevent antimicrobial resistance and infectious
diseases; and data collection and analysis on a host of vital
statistics and other health indicators. It is notable that more than 70
percent of CDC's budget flows out to States and local health
organizations and academic institutions, many of which are currently
struggling to meet growing needs with fewer resources.
Health Resources and Services Administration (HRSA)
The Coalition for Health Funding recommends an overall funding
level of $7.65 billion for HRSA in fiscal year 2012, a 22 percent
increase over fiscal year 2011 and a 12 percent increase over the
President's fiscal year 2012 request. HRSA operates programs in every
State and thousands of communities across the country. It is a national
leader in providing health services for individuals and families,
serving as a health safety net for the medically underserved.
Over the past several years, HRSA has received mostly level
funding, undermining the ability of its successful programs to grow.
Additionally, the deep cuts made to the agency in the final fiscal year
2011 continuing resolution will likely have negative consequences for
public health. Therefore, the requested minimum level of funding for
fiscal year 2012 is critical to allow the agency to carry out critical
public health programs and services that reach millions of Americans,
including developing the public health and healthcare workforce;
delivering primary care services through community health centers;
improving access to care for rural communities; supporting maternal and
child healthcare programs; providing healthcare to people living with
HIV/AIDS; and many more. However, much more is needed for the agency to
achieve its ultimate mission of ensuring access to culturally
competent, quality health services; eliminating health disparities; and
rebuilding the public health and healthcare infrastructure.
Substance Abuse and Mental Health Services Administration (SAMHSA)
The Coalition for Health Funding recommends an overall funding
level of $3.671 billion for SAMHSA in fiscal year 2012, an 8.6 percent
increase over fiscal year 2011 and an 8.4 percent increase over the
President's fiscal year 2012 request. According to recent results from
a national survey conducted by SAMHSA, 45.1 million American adults in
the United States have experienced mental illness over the past year.
However, only two-thirds of adults in the United States with mental
illness in the past year received mental health services.
In fact, suicide claims over 34,000 lives annually, the equivalent
of 94 suicides per day; one suicide every 15 minutes. In the past year,
8.4 million adults aged 18 or older thought seriously about committing
suicide, 2.3 million made a suicide plan, and 1.1 million attempted
suicide. The funding for community mental health services from SAMHSA
has never been more critical especially in light of the $2.2 billion
reduction in State mental health funding for programs serving this
vulnerable population.
Agency for Healthcare Research and Quality (AHRQ)
The Coalition for Health Funding recommends an overall funding
level of $405 million for AHRQ in fiscal year 2012, a 9 percent
increase over fiscal year 2011 and a 10 percent increase over the
President's fiscal year 2012 request. AHRQ funds research and programs
at local universities, hospitals, and health departments that improve
healthcare quality, enhance consumer choice, advance patient safety,
improve efficiency, reduce medical errors, and broaden access to
essential services--transforming people's health in communities in
every State around the Nation. Specifically, the science funded by AHRQ
provides consumers and their healthcare professionals with valuable
evidence to make the right healthcare decisions for themselves and
their families. AHRQ's research also provides the basis for protocols
that reduce hospital-acquired infections, and improve patient
confidence, experiences, and outcomes.
The Coalition for Health Funding appreciates this opportunity to
provide its fiscal year 2012 discretionary health funding
recommendations and looks forward to working with the Subcommittee in
the coming weeks and months.
______
Prepared Statement of the Coalition for Health Services Research
The Coalition for Health Services Research (Coalition) is pleased
to offer this testimony regarding the role of health services research
in improving our Nation's health. The Coalition's mission is to support
research that leads to accessible, affordable, high-quality healthcare.
As the advocacy arm of AcademyHealth, the Coalition represents the
interests of more than 4,000 scientists and policy experts throughout
the country and 160 organizations that produce and use research that
improves health and healthcare. We advocate for the funding to support
health services research and health data; better access to data and
information to use in producing this research; and more transparent
dissemination of the results of this research.
Health services research studies how to make the healthcare system
work better and deliver improved outcomes for more people, at great
value. These scientific findings improve healthcare by informing
patient and healthcare provider choices; enhancing the quality,
efficiency, and value of the care patients receive; and improving
patients' access to care. Health services research both uncovers
critical challenges confronting our Nation's healthcare system, and
seeks ways to address them. For example, health services research tells
us:
--Only 55 percent of adults receive recommended care and 47 percent
of children receive indicated care (McGlynn et al, 2003;
Mangione-Smith et al, 2007).
--The increased prevalence of obesity is responsible for almost $40
billion of increased medical spending through 2006, including
$7 billion in Medicare prescription drug costs (Finkelstein,
2009).
--How hospitals were able to achieve more than 60 percent reduction
in rates of bloodstream infections in very sick patients
(Pronovost et al, 2006).
--More than 83,000 excess deaths each year could be prevented in the
United States if the health disparities could be eliminated
(Satcher et al, 2005).
--The percentage of heart attack patients receiving needed
angioplasties within the recommended 90 minutes of arriving at
the hospital improved from just 42 percent in 2005 to 81
percent by 2008 (Agency for Healthcare Research and Quality,
2011).
The primary economic rationale for a Government role in funding
health services research is that the private market would not
adequately supply for it, since the full economic value of the evidence
is unlikely to accrue solely to its discoverer. Like any corporation
making sure it is developing and providing high quality products
through R&D, the Federal Government has a responsibility to get the
most out of every taxpayer dollar it spends on Federal health
programs--Medicare, Medicaid, veterans' and service members'
healthcare--by funding research that helps enhance their performance.
Finding new ways to get the most out of every healthcare dollar is
critical to our Nation's long-term fiscal health. Funding for research
on the quality, value, and organization of the health system will
deliver real savings for the Federal Government, employers, insurers,
and consumers. Research into the merits of different policy options for
delivery system transformation, patient-centered quality improvement,
community health, and disease prevention offers policymakers in both
the public and private sectors the information they need to improve
quality and outcomes, identify waste, eliminate fraud, increase
efficiency and value, and promote personal responsibility.
Despite the positive impact health services research has had on the
U.S. healthcare system, and the potential for future improvements in
quality and value, the United States spends less than 1 cent of every
healthcare dollar on this research; research that can help Americans
spend their healthcare dollars more wisely and make more informed
healthcare choices.
The Coalition for Health Services Research greatly appreciates the
subcommittee's efforts to increase the Federal investment in health
services research and health data. We respectfully ask that the
subcommittee further strengthen capacity of health services research to
address the pressing challenges America faces in providing access to
high-quality, efficient care for all its citizens. The following list
summarizes the Coalition's fiscal year 2012 funding recommendations for
agencies that support health services research and health data under
the subcommittee's jurisdiction.
Agency for Healthcare Research and Quality (AHRQ)
AHRQ funds research and programs at local universities, hospitals,
and health departments that improve healthcare quality, enhance
consumer choice, advance patient safety, improve efficiency, reduce
medical errors, and broaden access to essential services--transforming
people's health in communities in every State around the Nation. The
science funded by AHRQ provides consumers and their healthcare
professionals with valuable evidence to make the right healthcare
decisions for themselves and their families. AHRQ's research also
provides the basis for protocols that prevent medical errors and reduce
hospital-acquired infections, and improve patient confidence,
experiences, and outcomes in hospitals, clinics, and physician offices.
The Coalition joins the Friends of AHRQ--an alliance of more than
250 health professional, research, consumer, and employer organizations
that support the agency--in recommending an overall funding level of
$405 million for AHRQ in fiscal year 2012, a 9 percent increase over
fiscal year 2011 and a 10 percent increase over the President's fiscal
year 2012 request. Within the funding provided to AHRQ, the Coalition
recommends that the subcommittee support:
--A Breadth of Research Topics.--During the last decade, AHRQ's
research portfolio has focused predominantly on patient safety
and healthcare quality. There has been less investment in
research that provides evidence to improve the efficiency and
value of the healthcare system itself. The Coalition is
grateful to the subcommittee for its leadership in building a
more balanced research agenda at AHRQ, and requests continued
support for all aspects of research outlined in AHRQ's
statutory mission, including the ways in which healthcare
services are organized, delivered, and financed.
--Innovation through Competition.--Many of the sentinel studies that
have changed the face of health and healthcare in the United
States--diagnosis-related groups for hospital payments, check-
lists for improved patient safety, geographic variation in
healthcare, re-hospitalizations among Medicare beneficiaries--
are the result of ingenuity on the part of investigators and
rigorous, scientific competition. Federal support for
innovative approaches to problem solving increases
opportunities for constructive competition and creative
solutions. The Coalition is grateful to the subcommittee for
its leadership in recognizing the value of investigator-
initiated research at AHRQ and requests sustained momentum for
these competitive, innovative grants that advance discovery and
the free marketplace of ideas.
--The Next Generation of Researchers.--At the direction of the
subcommittee, AHRQ has doubled its investment in training
grants for the next generation of researchers. Still, training
grants for new researchers--both physicians and non-
physicians--fall far short of what is needed to meet growing
public and private sector demands for health services research.
The Coalition appreciates the subcommittee's continuing support
of the next generation of researchers and requests that funding
for training grants be increased to ensure America stays
competitive in the global research market.
--Research Translation and Dissemination.--Health services research
has great potential to improve health and healthcare when
widely used by patients, providers, and policymakers. The
Coalition recommends that the subcommittee support AHRQ's
research translation and dissemination activities, including
patient forums, practice-based research centers, and learning
networks. These programs are designed to move the best
available research and decisionmaking tools into healthcare
practice and thus enhance patient choice and improve healthcare
delivery.
Centers for Disease Control and Prevention (CDC)
The National Center for Health Statistics (NCHS) is the Nation's
principal health statistics agency. Housed within CDC, NCHS provides
critical data on all aspects of our healthcare system through data
cooperatives and surveys that serve as a gold standard for data
collection around the world. The Coalition appreciates the
subcommittee's leadership in securing steady and sustained funding
increases for NCHS in recent years. Such efforts have allowed NCHS to
reinstate some data collection and quality control efforts, continue
the collection of vital statistics, and enhance the agency's ability to
modernize surveys to reflect changes in demography, geography, and
health delivery.
We join the Friends of NCHS--a coalition of more than 250 health
professional, research, consumer, industry, and employer organizations
that support the agency--in endorsing the President's fiscal year 2012
request of $162 million, a funding level that will build on previous
investments and put the agency on track to become a fully functioning,
21st century, national statistical agency.
The Patient Protection and Affordable Care Act recognizes the need
for linking the medical care and public health delivery systems by
authorizing a new CDC research program to study public health systems
and service delivery. If funded in fiscal year 2012, this program will
identify effective strategies for organizing, financing, and delivering
public health services in real-world community settings by, for
example, comparing State and local health department structures and
systems in terms of effectiveness and costs. The Coalition urges you to
appropriate $35 million in fiscal year 2012 for Public Health Services
and Systems Research at CDC, enabling us to study ways to improve the
efficiency and effectiveness of public health service delivery.
National Institutes of Health (NIH)
NIH reports that it spent $1.1 billion on health services research
in fiscal year 2010--roughly 3.6 percent of its entire budget--making
it the largest Federal sponsor of health services research. For fiscal
year 2012, the Coalition joins the Ad Hoc Group for Medical Research in
requesting $35 billion for NIH in fiscal year 2012, which would, based
on historical funding levels, provide roughly $1.3 billion for the
agency's health services research portfolio. The Coalition believes
that NIH should increase the proportion of its overall funding that
goes to health services research to ensure that discoveries from
clinical trials are effectively translated into health services. We
also encourage NIH to foster greater coordination of its health
services research investment across its institutes.
Centers for Medicare and Medicaid Services (CMS)
Steady funding reductions for the Office of Research, Development
and Information have hindered CMS's ability to meet its statutory
requirements and conduct new research to strengthen public insurance
programs--including Medicare, Medicaid, and the Children's Health
Insurance Program--which together cover nearly 100 million Americans
and comprise almost half of America's total health expenditures. As
these Federal entitlement programs continue to pose significant budget
challenges for both Federal and State governments, it is critical that
we adequately fund research to evaluate the programs' efficiency and
effectiveness and seek ways to manage their projected spending growth.
The Coalition supports an fiscal year 2012 base funding level of
$40 million for CMS's discretionary research and development budget.
This funding is a critical down payment to help CMS restore research to
evaluate its programs, analyze pay for performance and other tools for
updating payment methodologies, and further refine service delivery
methods.
In conclusion, the accomplishments of health services research
would not be possible without the leadership and support of this
subcommittee. Health services research will continue to yield valuable
scientific evidence in support of improved quality, accessibility, and
affordability of healthcare. We urge the subcommittee to accept our
fiscal year 2012 funding recommendations for the Federal agencies
funding health services research and health data.
If you have questions or comments about this testimony, please
contact our Washington, DC, representative, Emily Holubowich at
[email protected].
______
Prepared Statement of the Coalition for International Education
Mr. Chairman and Members of the Subcommittee: We are pleased to
submit the views of the Coalition for International Education on fiscal
year 2012 funding for the Higher Education Act, Title VI and the Mutual
Educational and Cultural Exchange Act, Section 102(b)(6), commonly
known as Fulbright-Hays. The Coalition for International Education
consists of over 30 national higher education organizations with
interest in the U.S. Department of Education's international and
foreign language education programs. The Coalition represents the
Nation's 3,300 colleges and universities, and organizations
encompassing various academic disciplines, as well as the international
exchange and foreign language communities.
We express our deep appreciation for the Subcommittee's long-time
support for the U.S. Department of Education's premier international
and foreign language education programs noted above. We recognize the
difficult decisions Congress and the Administration faced on education
spending cuts for the remainder of fiscal year 2011, and now face for
fiscal year 2012. However, we are deeply concerned over the severe and
disproportionate $50 million or 40 percent cut to the Title VI/
Fulbright-Hays programs under H.R. 1473, the final fiscal year 2011
Continuing Resolution agreement. Title VI/Fulbright-Hays contain 14
small ``pipeline'' programs, 12 of which are under $20 million. A cut
of this magnitude will seriously weaken our Nation's world-class
international education capacity, which has taken decades to build and
would be impossible to easily recapture. Among the first casualties
likely will be the high-cost, low-enrollment critical language programs
needed for national security, such as Pashto or Urdu.
Today we strongly urge the Appropriations Committee to safeguard
these programs by providing funding for them that is equal to their
fiscal year 2010 funding levels in the fiscal year 2012 appropriations
bill. For the International and Foreign Language Studies account, we
urge a total of $125.881 million, which includes $108.360 million for
Title VI-A&B; $15.576 million for Fulbright-Hays 102(b)(6); and $1.945
million for the Institute for International Public Policy, Title VI-C.
After 9/11, Congress began a decade of enhancements to Title VI/
Fulbright because of the sudden awareness of an urgent need to improve
the Nation's in-depth knowledge of world areas and transnational
issues, and fluency of U.S. citizens in foreign languages.
Unfortunately these gains and many program enhancements on strategic
world areas will be eliminated unless funding is restored to fiscal
year 2010 levels.
We believe maintaining a strong Federal role in these programs is
critical to supporting our Nation's long-term national security, global
leadership, economic competitiveness capabilities, as well as mutual
understanding and collaboration around the world. Successful U.S.
engagement in these areas, at home or abroad, relies on Americans with
global competence, including foreign language skills and the ability to
understand and function in different cultural and business
environments.
Background and Federal Role
In 1958 at the height of the cold war, Congress created NDEA-Title
VI out of a sense of crisis about U.S. ignorance of other countries and
cultures. Fulbright 102(b)(6) was created in 1961 and placed with Title
VI to provide complementary overseas training. These programs have
served as the lynchpin for producing international specialists for more
than five decades, and continue to do so. Improving over time to
address new global challenges and expanded needs across the Nation's
workforce, 14 Title VI/Fulbright-Hays programs support activities to
improve capabilities and knowledge throughout the educational pipeline,
from K-12 through the graduate levels and advanced research, with
emphasis on the less commonly-taught languages and areas, such as
China, Russia, India and the Muslim world. Today they are the Federal
Government's most comprehensive programs supporting the development of
high quality national capacity in international, foreign language and
business education and research. A March 2007 report by the National
Academies of Sciences (NAS) concluded, ``Title VI/Fulbright-Hays serve
as our Nation's foundational programs for building U.S. global
competence.''
This Federal-university partnership ensures resources and knowledge
are available to meet national needs that are not priorities of
individual States or universities. Federal resources are essential
incentives to develop and sustain high-cost programs in the less
commonly-taught languages and world areas, and provide extensive
outreach and collaboration among educational institutions, government
agencies, and corporations. Most of these programs would not exist
without Federal support, especially at a time when State/local
governments and institutions of higher education are financially
strapped.
Why Investing in Title VI/Fulbright-Hays Is Important
The NAS reported in 2007: ``A pervasive lack of knowledge about
foreign cultures and foreign languages in this country threatens the
security of the United States as well as its ability to compete in the
global marketplace and produce an informed citizenry.''
Government Needs.--The quantity, level of expertise, and
availability of U.S. personnel with high-level expertise in foreign
languages, cultures, and political, economic and social systems
throughout the world do not match our national strategic needs at home
or abroad. Some 80 Federal agencies depend in part on proficiency in
more than 100 foreign languages; in 1985, only 19 agencies identified
such requirements.
``Foreign language skills are vital to effectively communicate and
overcome language barriers encountered during critical operations and
are an increasingly key element to the success of diplomatic efforts,
military operations, counterterrorism, law enforcement and intelligence
missions, as well as to ensure access to Federal programs and services
to Limited English Proficient (LEP) populations within the United
States.'' David Maurer Testimony on Foreign Language Capabilities.
Departments of Homeland Security, Defense, and State Could Better
Assess their Foreign Language Needs and Capabilities and Address
Shortfalls, GAO, July 2010
``As of October 31, 2008, 31 percent of Foreign Service officers in
overseas language-designated positions (LDP) did not meet both the
foreign languages speaking and reading proficiency requirements for
their positions. State continues to face foreign language shortfalls in
regions of strategic interest--such as the Near East and South and
Central Asia, where about 40 percent of officers in LDPs did not meet
requirements. Past reports by GAO, State's Office of the Inspector
General, and others have concluded that foreign language shortfalls
could be negatively affecting U.S. activities overseas.'' Comprehensive
Plan Needed to Address Persistent Foreign language Shortfalls, GAO,
September 2009.
Workforce Needs.--National security is increasingly linked to
commerce, and U.S. business is widely engaged around the world with
joint ventures, partnerships, and economic linkages that require its
employees to have international expertise both at home and abroad.
``Most of the growth potential for U.S. businesses lies in overseas
markets. Already, one in five U.S. manufacturing jobs is tied to
exports. Foreign consumers, the majority of whom primarily speak
languages other than English, represent significant business
opportunities for American producers, as the United States is home to
less than 5 percent of the world's population. American companies lose
an estimated $2 billion a year due to inadequate cross-cultural
guidance for their employees in multicultural situations.'' Education
for Global Leadership, Committee for Economic Development, 2006.
Education Needs.--Education institutions at all levels are
challenged to keep up with rapidly expanding 21st century needs for
global competence.
-- Although higher education foreign language enrollments have
increased and diversified over the past decade, according to
the Modern Language Association's 2010 survey, enrollments are
only 8.7 percent of total student enrollments, well behind the
1960 high point of 16 percent.
-- Only 5 percent of all higher education students taking foreign
languages study non-European languages spoken by roughly 85
percent of the world's population.
-- Less than 2 percent of students in U.S. postsecondary education
study abroad, and only about half studied outside Western
Europe. Yet, an educational experience abroad is an essential
element for achieving foreign language fluency, learning how to
function in other cultures, and developing mutual understanding
with others beyond our borders.
-- U.S. educational institutions from K-16 face a shortage of
teachers and faculty with international knowledge and expertise
across the professions and across types of higher education
institutions. This problem is especially acute for foreign
language teachers of the less commonly taught languages.
What Title VI/Fulbright-Hays Programs Do
Title VI/Fulbright programs produce U.S. experts, prepare Americans
for the global workplace, and generate knowledge on the foreign
languages and business, economic, political, social, cultural and
regional affairs of other countries and world areas. Grantees also
engage in extensive outreach and collaboration across the educational
spectrum, and with business, government, the media and the general
public. Title VI-funded centers are relied upon for their expertise by
Federal agencies, corporations, and local school districts. Their many
accomplishments include the following:
Language and Culture
Through several pipeline programs, Title VI institutions provide
the major, and often the only, source of national expertise and
research on non-European countries and their languages.
Title VI institutions account for 21 percent of undergraduate
enrollment and 56 percent of graduate enrollment in the less commonly
taught languages (LCTLs) such as Arabic and Chinese. For the least
commonly taught languages such as Pashto and Urdu, Title VI
institutions account for 49 percent of undergraduate and 78 percent of
graduate enrollments.
Title VI institutions provide instruction and R&D in over 130
languages and in all world areas, and have the capacity to teach over
200 languages. Because of the high cost per student, many of these
languages would not be taught on a regular basis but for Title VI/
Fulbright support. In contrast, the Defense Language Institute (DLI)
and the Foreign Service Institute (FSI) together offer instruction in
only 75 LCTLs.
Title VI/Fulbright programs support advanced research abroad in
international, area and language studies--such as through the Fulbright
programs and overseas research centers--that otherwise would have few
or no other funding sources.
Title VI programs support the development and maintenance of world
class digital information resources in international, area and foreign
language studies--using modern technologies for accessibility--that
exist no where else in the world.
Title VI/Fulbright programs provide opportunity and access to all
types of institutions of higher education, including minority-serving
institutions, community colleges, and small and medium-sized 4-year
institutions. With seed funding from the Undergraduate International
Studies and Foreign Language, Institute for International Public Policy
and Fulbright programs, training, fellowship, scholarship and study
abroad opportunities are provided to students, faculty and
administrators.
With enhancements provided by Congress between 2000-08, Title VI
National Resource Centers increased annual job placements in key
sectors. 2008 placements and percent increase over 2000: Federal
Government 1,515 (+32 percent), U.S. military 552 (+20 percent),
international organizations 1,567 (+22 percent), and higher education
3,414 (+51 percent).
During this same period, the NRCs have seen triple digit increases
in courses and enrollments in critical languages. Between 2000 and
2008, enrollments in Arabic increased from 5,218 to 16,721, in Chinese
from 9,637 to 23,724, in Persian from 1,231 to 3,878, in Turkish from
594 to 1,602, and in Urdu from 221 to 904.
Examples of renowned graduates include Secretary of Defense Robert
Gates, General John Abizaid, former Ambassador to Russia James Collins,
advisor to six Secretaries of State Aaron David Miller, and NY Times
Pulitzer prize-winning journalist Anthony Shadid.
International Business
Title VI supports two important programs that internationalize
business education, train Americans for the global workplace, and help
U.S. small and mid-size businesses engage emerging markets: Centers for
International Business Education and Research (CIBERs) and Business and
International Education (BIE).
CIBERs offer training at all levels of education in all 50 States,
including training for managers already active in the workforce, and
research on cutting edge issues affecting the U.S. business
environment, the Nation's global economic competitiveness and homeland
security.
Before these programs were established, few business education
programs in the United States incorporated a global dimension. Over 2
million students have taken international business courses through
CIBER programs and over 160,000 faculty have gained international
business and cultural expertise through faculty programs, domestically
and abroad.
Over 42,000 language faculty have participated in over 900
international business language workshops, and 4.5 million students
across the United States have benefited from enhanced commercial
foreign language instruction.
Outreach
Title VI/Fulbright grantees provide access to international
knowledge to other institutions of higher education, government,
business, K-12 and the public through web resources, seminars, training
and other means. Many educators, government agencies, nonprofit groups
and corporations depend on these resources. Without Title VI/Fulbright
funding, this outreach would disappear.
Title VI National Resource Centers provide training and
consultation for foreign language and area staff in many government
agencies. For example, the U.S. Army Foreign Area Officer (FAO) Program
sends its officers to Title VI centers for their M.A. in language and
area studies training and has done so since the inception of the FAO
program three decades ago.
Title VI Language Resource Centers (LRC) train an estimated 2,000
teachers annually, and develop resources in critical languages used by
educators and government agencies. For example, an LRC recently
developed a free iPad app that provides tutorials in Pashto for U.S.
soldiers in Afghanistan.
CIBER and BIE grantees work closely with the U.S. Department of
Commerce and with the local District Export Councils on export
development. In response to President Obama's 2010 National Export
Initiative (NEI), the CIBERs continue to expand the global knowledge
base of U.S. companies, enabling and assisting them to export their
goods and services especially to the BRIC and other emerging markets.
By enabling small and mid-sized U.S. business to increase exports,
CIBER/BIE activities support job creation in America and reduction of
the trade deficit.
Title VI grantees also work extensively with minority-serving
institutions of higher education, community colleges and K-12 on
language and culture programs, as well as with the media to promote
citizen understanding of complex global issues.
Clearly, this Federal-higher education partnership pays dividends
that vastly outweigh the small 0.2 percent investment within the
Department of Education's budget.
______
Prepared Statement of the Coalition for Workforce Solutions
I represent The Coalition for Workforce Solutions (CWS), a national
organization exclusively representing employers, workforce development
providers, vendors and service organizations that operate and utilize
One-Stop Career Centers, Temporary Assistance for Needy Families
initiatives, career and technical education programs and workforce
investment services. Members of CWS are proud to play a role in our
workforce system as it promotes economic growth while giving
unemployed, underemployed and disadvantaged workers an opportunity to
gain new skills.
Today, while the Nation faces many complex challenges in light of
mass layoffs and business realignments, the private sector is showing
signs of recovery and businesses new and old need increased assistance
in addressing their workforce needs. And our national network of WIA
supported workforce services is in a unique position not only to train
workers for economic recovery, but to match large and small employers
with qualified workers in advanced manufacturing, healthcare, energy
and other high-growth sectors. As the economy grows, our workforce
system should be maintained and strengthened, not reduced or targeted
for elimination.
We understand the budget issues and the need for debt reduction. We
are confident that through integration of workforce services there is
the capacity to maintain the existing level of service to the job
seekers and employers. We look to the State of Florida and Texas as the
model of integrated services for replication nationwide. This will
ensure our workforce development and job-training system continues its
vital support for businesses of all sizes to create and retain jobs,
provide needed skills and transition assistance to workers, and enhance
economic growth through the private sector in thousands of communities
around the country.
Our Nation's workforce systems funded through WIA have become
critical partners in regional economic development efforts--from
directly supporting efforts to recruit new businesses (by offering
access to skilled workers and employment and training incentives), to
saving money for local businesses as they begin to rehire workers. The
programs also assist businesses to avert layoffs through skills
upgrading, and support businesses that are closing or downsizing. These
partnerships with employers and economic development services are
critical to helping businesses survive and contribute to regional
economic growth and prosperity. Now is not the time to take away these
vital services when economic growth is paramount to our recovery and
competitiveness.
WIA has experienced a 234 percent increase in demand for services
since the onset of the recession and demand remains steady as the
economy grows. It is easy to see why this is so: the one-stop system
supported with WIA funds fosters community partnerships that drive job
creation and economic recovery efforts while also providing vital labor
market information, skills assessments, career guidance, counseling,
employment assistance, support and training services to jobseekers and
workers who need help in getting good jobs.
In every State and region, the workforce system addresses the needs
of business so that local companies can remain competitive. By building
relationships with community development organizations and local
officials, businesses are provided with a collaborative network of
support that is best-suited to the needs of employers. Only this system
can provide businesses with the resources they can use to survive and
thrive in this difficult economic time.
In fact, the workforce system is the only system of its kind to
engage employers and address the kind of compelling challenges that
business face in the following areas:
--Reducing turnover in entry level occupations in high growth
industries such as healthcare through early immersion and
career ladder programs.
--Finding the talent that advanced manufacturing companies need to
compete by training workers in new skills and providing the
next generation of workers a path to the modern workforce.
--Supporting economic development and business attraction activities
so that new employers and manufacturers get assistance in
determining local infrastructure, specific fits for training
needs, and whatever it takes to be successful.
--Preparing youth in high demand IT careers as well as providing soft
skills training, job search preparation, coaching and the life
transforming skills that businesses need to develop a stable,
high-quality workforce.
--Improving hiring efficiency such that employers improve their
application conversion rate by 50 percent through collaborative
partnerships with the workforce system that produce qualified
candidates with the right skill-sets, dedication and motivation
that employers need.
Businesses as well as jobseekers and workers benefit from WIA
services. Research indicates that the workforce system produces a high
return on investment. Last year, over 8 million job-seekers utilized
the workforce system and over 4.3 million of them got jobs. While this
is less than the normal 80 to 85 percent placement rate common in
stronger economic times, the recent job environment had four jobseekers
for every one vacancy. However, when jobs were simply not available,
the system placed many of the unemployed in education and training
programs that will lead to good new jobs.
The system is also effective. According to an Upjohn Institute
Study, positive and statistically significant results were found for
WIA Adult Program participants and for the Dislocated Worker Program.
Furthermore, these employment and training services were shown to
reduce reliance on public assistance. The average duration on TANF
public assistance also was reduced by several percentage points for
those participating in WIA or TANF welfare-to-work programs. One can
conclude from a variety of studies that WIA training services raise
employment rates and earnings while reducing reliance on TANF.
Many CWS members are private businesses that struggle everyday with
budgets, so we can appreciate the need to make tough decisions. Since
job creation is a priority for the Congress and since workers pay taxes
and reduce pressure on public programs, maintaining support for the
workforce system should remain a top priority. The workforce system is
a critical partner in the Nation's economic recovery as it trains and
retrains workers to meet the demands of our changing economy. In our
judgment, this system is essential to addressing the employment needs
of the more than 14 million unemployed in this country--we cannot
afford to lose this valuable resource.
Nevertheless, Congress recently reduced WIA's three State/local
program sections by about $307 million below the fiscal year 2010
levels enacted in Public Law 111-117. Overall, the last CR provides
about $2.8 billion for job-training State grants for adult employment,
youth activities, and dislocated workers. The more than $1 billion in
reductions to key job training and education programs equate to more
than 10 percent less than fiscal year 2010 enacted levels.
While funding for Program Year 2011 is now set, the spending
agreement covers only the first quarter of the next WIA program year
ending September 30, 2011. Funding for the final three quarters will be
contained in the fiscal year 2012 appropriations.
Many WIA programs have received funding reductions in real dollar
terms in recent years--these programs are significantly underfunded
already relative to their mission. Congress should use the findings of
duplication and overlap in workforce programs not to make further
reductions but rather to work with the House Education and Workforce
Committee to achieve better coordination and integration of services.
Despite the significant cuts in the latest CR, the bill represents
substantial progress for thousands of jobseekers and employers across
the country who informed their policymakers on the critical benefits of
our workforce system. We are encouraged to see that Congress has
rejected the severest cuts proposed early this year and we hope there
is a more accurate picture for fiscal year 2012 emerging of how WIA
programs help employers find qualified workers and train workers for
new careers.
In short, CWS will work with Members of this Committee, the
authorizing committees and other Members of Congress as they consider
policies to better align planning and service delivery, and strengthen
the overall system. As issues develop, there will be discussions about
expectations for the future of the workforce system. Here are some
issues of primary importance to CWS:
--Enhancing WIA accountability and driving high performance;
--Empowering Workforce Investment Boards to play a strategic role
that promotes coordination and integration of services across
federally funded systems;
--Serving disadvantaged and underserved populations; and
--Sharing and promoting best practices throughout the system.
CWS believes that WIA's core services and training have paid off in
terms of higher employment rates and improved earnings for dislocated
workers, the unemployed and disadvantaged youth and adults. As Members
of the Committee examine the facts concerning WIA services, we trust
that they will agree that the workforce system provides vital services
to businesses and jobseekers. Thank you for your consideration of my
testimony.
______
Prepared Statement of the Coalition for the Advancement of Health
Through Behavioral and Social Science Research
Mr. Chairman and Members of the Subcommittee, the Coalition for the
Advancement of Health Through Behavioral and Social Science Research
(CAHT-BSSR) appreciates and welcomes the opportunity to comment on the
fiscal year 2012 appropriations for the National Institutes of Health
(NIH). CAHT-BSSR includes 14 professional organizations, scientific
societies, coalitions, and research institutions concerned with the
promotion of and funding for research in the social and behavioral
sciences. Collectively, we represent more than 120 professional
associations, scientific societies, universities, and research
institutions.
CAHT-BSSR would like to thank the Subcommittee and the Congress for
their continued support of the NIH. Strong sustained funding is
essential to national priorities of better health and economic
revitalization. Providing adequate resources in fiscal year 2012 that
allow the NIH to keep up with the rising costs of biomedical,
behavioral, and social sciences research will help NIH begin to prepare
for the era beyond recovery. We recognize that these are difficult
times for our Nation, but at the same time, it is essential that
funding in fiscal year 2012 and beyond allow the agency to resume
steady, sustainable growth of the foundation of knowledge built through
NIH-funded research at more than 3,000 universities, medical schools,
teaching hospitals, and research institutions. CAHT-BSSR supports the
NIH fiscal year 2012 request of $31.7 billion, at a minimum, and joins
the Ad Hoc Group for Medical Research in its request for $35 billion in
funding for NIH in fiscal year 2012.
NIH Behavioral and Social Sciences Research.--NIH supports
behavioral and social science research throughout most of its 27
institutes and centers. The behavioral and social sciences regularly
make important contributions to the well-being of this Nation. Due in
large part to the behavioral and social science research sponsored by
the NIH, we are now aware of the enormous contribution behavior makes
to our health. At a time when genetic control over diseases is
tantalizingly close but not yet possible, knowledge of the behavioral
influences on health is a crucial component in the Nation's battles
against the leading causes of morbidity and mortality: obesity, heart
disease, cancer, AIDS, diabetes, age-related illnesses, accidents,
substance use and abuse, and mental illness.
As a result of the strong congressional commitment to the NIH in
years past, our knowledge of the social and behavioral factors
surrounding chronic disease health outcomes is steadily increasing. The
NIH's behavioral and social science portfolio has emphasized the
development of effective and sustainable interventions and prevention
programs targeting those very illnesses that are the greatest threats
to our health, but the work is just beginning.
From global warming to unlocking the secrets of memory; from self
destructive behavior, such as addiction, to lifestyle factors that
determine the quality of life, infant mortality rate and longevity; the
grandest challenge we face is understanding the brain, behavior, and
society. Nearly 125 million Americans are living with one or more
chronic conditions, like heart disease, cancer, diabetes, kidney
disease, arthritis, asthma, mental illness and Alzheimer's disease.
Significant factors driving the increase in healthcare spending in the
United States are the aging of the U.S. population, and the rapid rise
in chronic diseases, many of which can be caused or exacerbated by
behavioral factors. Obesity may be the result of sedentary behavior and
poor diet; and addictions, resulting in health problems caused by
tobacco and other drug use. Behavioral and social sciences research
supported by NIH is increasing our knowledge about the factors that
underlie positive and harmful behaviors, and the context in which those
behaviors occur.
CAHT-BSSR continues to applaud the Congress' and NIH's recognition
that the ``scientific challenges in developing an integrated science of
behavior change are daunting.'' The agency's efforts to launch the
basic behavioral and social science research trans-NIH initiative,
Opportunity Network for Basic Behavioral and Social Sciences Research
(OppNet), likewise, is applauded. OppNet is designed to examine the
important scientific opportunities that cut across the structure of NIH
and designed to look for strategic opportunities to build areas of
research where there are gaps that have the potential to affect the
missions of multiple institutes and centers. Research results could
lead to new approaches for reducing risky behaviors and improving
health.
Equally, we commend the agency's support of the ``Science of
Behavior Change'' Common Fund Initiative included in the third cohort
of research areas for the Common Fund. We agree with the goals of this
Common Fund Pilot to ``establish the groundwork for a unified science
of behavior change that capitalizes on both the emerging basic science
and the progress already made in the design of behavioral interventions
in specific disease areas. By focusing basic research on the
initiation, personalization, and maintenance of behavior change, and by
integrating work across disciplines, this Common Fund effort and
subsequent trans-NIH activity could lead to an improved understanding
of the underlying principles of behavior change. This should drive a
transformative increase in the efficacy, effectiveness, and (cost)
efficiency of many behavioral interventions.''
With the recent passage of healthcare reform legislation, there has
been the accompanying and appropriate attention to the issue of
personalized healthcare. CAHT-BSSR believes that personalization needs
to reflect genes, behaviors, and environments. And as the agency has
acknowledged with its recent support of the Science of Behavior Change
initiative, assessing behavior is critical to helping individuals see
how they can improve their health. It is also critical to helping
healthcare systems see where to put resources for behavior change.
Fortunately, the NIH acknowledges the need to focus less on finding the
``magic answer'' and, at the same time, recognizes that healthcare is
different from region to region across the country. Full
personalization needs to consider the environmental, community, and
neighborhood circumstances that govern how individuals' genes and
behavior will influence their health. For personalized healthcare to be
realized, we need a sophisticated understanding of the interplay
between genetics and the environment, broadly defined.
In fiscal year 2012, NIH priorities include establishment of the
National Center for Advancing Translational Sciences (NCATS) intended
to align and bring together a number of trans-NIH programs that do not
have a specific disease focus in one organization. As with development
of more effective drugs, surgical techniques and medical devices, the
development of more powerful health-related behavioral interventions is
dependent on improving the understanding of human behavior, and then
translating that knowledge into new and more effective interventions
with enduring effects. It is critical that the NIH support for
translational research extends to translation research designed to
adapt findings from basic behavioral and/or social science research to
develop behavioral interventions directed at improving health-related
behaviors such as adequate physical activity and nutrition, learning
and learning disabilities, and preventing or reducing health-risking
behaviors including tobacco, alcohol, and/or drug abuse, and
unprotected sexual activity. CAHT-BSSR strongly believes that the
translation of behavioral interventions is a critical part of the NCATS
initiative and must be accompanied by sufficient staff expertise and
resources to manage research on the translation of behavioral
interventions into communities.
CAHT-BSSR applauds the NIH's recognition of a unique and compelling
need to promote diversity in health-related research. The agency
expects these efforts to lead to: the recruitment of the most talented
researchers from all groups; an improvement in the quality of the
educational and training environment; a balanced perspective in the
determination of research priorities; an improved ability to recruit
subjects from diverse backgrounds into clinical research; and an
improved capacity to address and eliminate health disparities. Numerous
studies provide evidence that the biomedical and educational enterprise
will directly benefit from broader inclusion.
NIH recognizes that developing a more diverse and academically
prepared workforce of individuals in STEM (science, technology,
engineering, and math) disciplines will benefit all aspects of
scientific and medical research and care. CAHT-BSSR applauds the
agency's recognition that, to remain competitive in the 21st century
global economy, the Nation must foster new opportunities, approaches,
and technologies in math and science education.
This recognition extends to the need for a coordinated effort to
bolster STEM education nationwide, starting at the earliest stages in
education. Unfortunately, the narrow perception of ``science''
persists, and the social and behavioral sciences are often excluded in
discussion of STEM issues and remain outside of the science education
curriculum. The considerable activity on STEM education provides the
opportunity to improve the recognition of social and behavioral
sciences as ``science.''
In 2010, the NIH commissioned the Institute of Medicine (IOM) to do
a study surrounding LGBT (lesbian, gay, bisexual, and transgender)
health issues, research gaps and opportunities. The recently released
study, The Health of Lesbian, Gay, Bisexual, and Transgender People,
examined the current state of knowledge on LGBT health, including
general health concerns and health disparities, identified research
gaps and opportunities; and outlined a research agenda which reflects
the most pressing areas, specifically demographic research, social
influences, healthcare inequities, intervention research, and
transgender-specific health needs.
nih office of behavioral and social sciences research
The NIH Office of Behavioral and Social Sciences Research (OBSSR),
authorized by Congress in the NIH Revitalization Act of 1993 and
established in 1995, serves as a convening and coordinating role among
the institutes and centers at NIH. In this capacity, OBSSR develops,
coordinates, and facilitates the social and behavioral science research
agenda at NIH; advises the NIH director and directors of the 27
institutes and centers; informs NIH and the scientific and lay publics
of social and behavioral science research findings and methods; and
trains scientists in the social and behavioral sciences. For fiscal
year 2012, CAHT-BSSR supports a budget of $38.2 million for OBSSR. This
sum reflects the Administration's request of $28 million for OBSSR and
includes the $10 million needed to support the NIH-wide commitment to
carry out OppNet, an initiative strongly supported by the Subcommittee.
The OppNet initiative has made significant progress since its start.
Thus far, OppNet has awarded 35 competitive revisions to add basic
science projects to existing research project grants. Eight competitive
revisions to Small Business Innovation Research/Small Business
Technology and Transfer projects have been awarded. OppNet has also
provided the much-needed training in basic social and behavioral
sciences research.
In fiscal year 2012, OBSSR intends partner with the NIH institutes
and centers and other Federal agencies to fund Mobile Technology
Research (mHealth) to Enhance Health. Recent advances in mobile
technologies and the use of these technologies in daily life have
created opportunities for research applications that were not
previously possible, such as assessing behavioral and psychological
states in real time. To make use of this technology as effective as
possible there is a need to integrate the behavioral, social sciences,
and clinical research fields. The NIH mHealth Summer Institute is
designed to address the lack of integration of these fields.
Over the years, OBSSR has sponsored summer training institutes for
scientists interested in social and behavioral science research areas.
The interest in these training sessions have been overwhelming and have
exceeded the Office's capacity to provide the opportunity for
scientists and researchers to gain critical training in these areas.
These institutes include training in: systems science methodology and
health; randomized clinical trials involving behavioral interventions;
dissemination and implementation research in health; and mobile health.
The Dissemination and Implementation Research in Health training
institute, for example, features a faculty of leading experts from a
variety of behavioral and social science disciplines and is designed to
empower scientists to conduct this research. Drawing from these
disciplines, dissemination and implementation research uses approaches
and methods that in the past have not been taught comprehensively in
most graduate degree programs. Given the demand for the training these
institutes provide and the potential this research has for propelling
the science forward, CAHT-BSSR believes that greater collaboration with
the NIH institutes and centers is needed to meet the demand.
CAHT-BSSR would be pleased to provide any additional information on
these issues. Below is a list of coalition member societies. Again, we
thank the Subcommittee for its generous support of the National
Institutes of Health and for the opportunity to present our views.
caht-bssr
American Association of Geographers
American Educational Research Association
American Psychological Association
American Sociological Association
Association of Population Centers
Consortium of Social Science Associations
Council on Social Work Education
Federation of Associations in Behavioral & Brain Sciences
National Association of Social Workers
National Communication Associations
Population Association of America
Society for Behavioral Medicine
Society for Research in Child Development
The Alan Guttmacher Institute (AGI)
______
Prepared Statement of the Coalition of Heritable Disorders of
Connective Tissue
Chairman Tom Harkin, Chairman, and Richard Ranking Member Shelby,
and members of the Subcommittee: the Coalition of Heritable Disorders
of Connective Tissue thanks you for the opportunity to submit testimony
regarding the fiscal year 2012 budget for the National Heart, Lung and
Blood Institute (NHLBI), the National Institute of Arthritis,
Musculoskeletal and Skin Diseases, (NIAMS), and the NIH Office of
Research Information Services/Office of Extramural Research. We are
extremely grateful for the Subcommittee's strong support of the NIH,
particularly as it relates to life threatening genetic disorders such
as Heritable Disorders of Connective Tissue. Thanks to your leadership,
we are at a time of unprecedented hope for patients with these
diseases.
It is estimated that over 1 million people in the United States are
affected by Heritable Disorders of Connective Tissue (HDCT). These
disorders manifest themselves in many areas of the body, including the
heart, eyes, skeleton, lungs and blood vessels. Connective tissue is
the ``glue'' that holds the body together. These disorders are
progressive conditions caused by genetic mutations and cause
deterioration in each of these body systems. The most life-threatening
are those which affect the aorta and the heart--the most disabling are
orthopedic and ophthalmological.
Some 60 years ago, Victor McKusick, the ``father'' of modern
medical genetics, described and coined the term ``heritable disorders
of connective tissues.'' These disorders included over 200 such rare
disorders, among which were the Marfan syndrome, Weill-Marchesani
syndrome, Ehlers-Danlos syndrome, Cutis Laxa, Osterogenesis imperfecta,
the chondrodysplasias, and Pseudoxanthoma elasticum (Heritable
Disorders of Connective Tissue, McKusick, Va 1972).
Awareness of these disorders has grown through the years due to
collaborative research. Clues to the underlying causes of these
diseases were obtained from the major manifestations found in the
connective tissue and elaboration of connective tissue pathways
involving identified disease genes and their protein products uncovered
additional disease genes with related connective tissue manifestations.
Identification of disease genes have led to surprising new information
regarding important connective tissue pathways depending on the history
of the particular disorder. Thus, the concept of the heritable
disorders of connective tissue have reiterated and epitomized important
lessons regarding how the connective tissue integrates cellular and
organ function.
National Heart Lung and Blood Institute
Thanks to research funded by the NHLBI, we have seen amazing
responses to HDCT disorders with cardiovascular disease. In the 1960s
there was no intervention available, not even surgery for heart defects
and dissection, this before the development of the ``heart-lung''
machine. It was not so long ago, when in the early 1960s, a 13 year old
girl with Marfan syndrome was sent home from the hospital to die since
there was no surgical intervention possible for her dissecting
aneurysm. Early on, surgery required replacing the aortic valve with an
animal's heart, further research used a mechanical valve, and then came
the sturdy composite graft, which became the ``Cadillac'' of surgical
repair. Although the valve sparing method was used throughout this
time, it has been continually improved to address the compromised
tissue regarding longevity. Now we are seeing additional
``translational'' clinical trials, which look at therapies for
prevention as well as surgical response. It is important to remember
these amazing leaps and bounds in medical, surgical and technological
advancement.
NHLBI support has been essential in promoting research
collaboration. The Pediatric Heart Network, a cooperative network of
pediatric cardiovascular clinical research centers, serves as a data
coordinating center to promote the exchange of information to evaluate
therapeutic and management strategies for children and adults with
congenital and genetic heart defects.
NHLBI funded Clinical Trials in the use of Losarton have led to
exciting new findings and pointed the way in future research
directions. It has inspired current concepts of architectural and
signaling pathways underlying the various heritable disorders of
connective tissue in order to integrate these concepts in new
productive ways. For example, can the recent advances in treating
Marfan syndrome with TGF beta inhibitors and Losarton be applied to
other heritable disorders of connective tissue? Does TGF beta signaling
play pathological roles in other disorders? For another example, is
there an important adhesion junction of architectural pathway that
connects the vascular smooth muscle cell to the extracellular matrix?
And, again: How do cell surface receptors (integrin and growth factor
receptors) coordinate architectural and signaling pathways in
connective tissue disorders? All pointing to future research avenues.
National Institute of Arthritis, Musculoskeletal and Skin Diseases
The collaboration of NHLBI and NIAMS has provided an even greater
overview of the information gleaned from the Losarton clinical trial
and a global view of these mult-system disorders. The muscular and
orthopedic involvement is being addressed by the NIAMS. Through NIAMS
support, there is a meeting in July, which is devoted to
``Translational'' avenues grown of current research progress in the
understanding of heritable disorders of connective tissue. Great
progress in the understanding of HDCT has been made over the past 15
years through NIAMS supported workshops on Heritable Disorders of
Connective Tissue. Symposia have been convened in 1990, 1995, and 2000.
In 1990 and 1995, the emphasis was on finding the genes for the various
heritable disorders and understanding whether mutations could be
correlated with specific phenotypes. Many of these goals have been met,
due to research supported in large part by the NIAMS. In 2000, meeting
themes were intentionally broader, focusing on multidisciplinary
approaches and common themes in matrix biology in order to (1) promote
a better understanding of pathogenesis of connective tissue disorders,
(2) stimulate new collaborations between investigators, and (3)
identify areas in which rapid progress could be made. In the decade
since the 2000 Workshop, tremendous progress has been made, leading
notably to new therapies. An example of this is Marfan syndrome, for
which a clinical trial is underway to test for a therapy, which may
prove to play a pivotal role in preventing heart disease. Epidermolysis
bullosa is another disease--for which a research has improved prospects
for new therapies, as well as for a number of other heritable disorders
of connective tissue.
Research has emphasized an understanding of the role of cells in
developing treatments for connective tissue disorders. The success of
bone marrow transplantation in treating Epidermolysis Bullosa has
called attention to this area. While connective tissue researchers have
been interested in stem cell treatments--Osteogenesis imperfecta, for
example--more discussion and emphasis in this area are needed.
The impact of this collaboration between these similar disease
entities in heritable disorders of connective tissue continues to be of
major importance. We are moving rapidly from the ``bench to the
patient,'' from basic research to the important translational benefit
of research findings to treatments which directly benefit the patient.
The collaboration between the basic research and clinical studies is
what we are able to focus on in these disorders for the benefit of all
disease groups.
NIH/Office of Research Information Services/Office of Extramural
Research--RePorter
The National Institute of Health (NIH) has established the NIH
RePorter, or research/condition/disease category (RCDC) which provides
easy retrieval of information on scientific projects and studies. This
excellent new tool provides information on research results, expediting
access and the avoidance of duplication and is located in the Office of
Research Information Services/Office of Extramural Research. It
provides access to research information on all disease groups. We urge
the inclusion of the category ``Heritable Disorders of Connective
Tissue'' (HDCT) in order to facilitate the exchange of information in
the research community of these similar disorders.
What is so important about the study of these disorders is their
very complexity--with genetic origins, requiring basic science for
understanding, and clinical trials in order to maximize the
translational advantages of this research. The mutations of HDCT affect
all body systems and require particular depth of investigation. This
very complexity informs the researcher, as well as contributes to the
understanding of other more common disorders. Research on these
disorders in all of the body systems, will ``spill'' over into research
into many of the categories identified in both the short range and the
long range strategic plans for NHLBI and NIAMS, and provide benefits
for many diseases beyond the scope of HDCT.
About the Coalition of Heritable Disorders of Connective Tissue (CHDCT)
The CHDCT is a nonprofit voluntary health organization founded in
1989, dedicated to saving lives and improving the quality of life for
individuals and families affected by any 1 of the over 200 Heritable
Disorders of Connective Tissue. The mission is to raise awareness of
these disabling and often deadly disorders and to support and promote
research and collaboration between researchers in the field.
We thank you for this opportunity to thank the Committee for its
past support and to voice the interests and concerns of the CHCDT
member organizations relating to future priorities of NHLBI and the
NIAMS.
______
Prepared Statement of the Commissioned Officers Association of the U.S.
Public Health Service
On behalf of the Commissioned Officers Association of the U.S.
Public Health Service, Inc. (COA), and in the context of the
President's fiscal year 2012 budget request, I respectfully ask to
submit this statement for the record. I speak for our Association's
members, all of whom are active-duty or retired officers of the
Commissioned Corps of the U.S. Public Health Service (USPHS).
We respectfully make two funding requests: Support for a pilot
program to recruit and train public health doctors, dentists, and
nurses for careers in the Commissioned Corps of the U.S. Public Health
Service (USPHS), and support for the establishment of a USPHS Ready
Reserve component. Congress authorized both programs last year, and
directed the Department of Health and Human Services to implement them.
u.s. public health sciences track
First, we ask this subcommittee to approve $30 million to establish
a scaled-back version of the public health workforce training program
for would-be USPHS officers that was authorized by the Patient
Protection and Affordable Care Act (Public Law 111-148). This pilot
program would be based first at the Uniformed Services University of
the Health Sciences (USUHS), which is the dedicated medical school and
research institute for uniformed services personnel (Army, Navy, Air
Force, Public Health Service.) Additional schools would be selected by
the Surgeon General as provided for in law.
Background and Rationale
USPHS health professionals serve the health needs of the Nation's
most underserved populations. They also serve side-by-side with Armed
Forces personnel at home and abroad, on joint training missions, and
even in forward operating bases in combat zones. USPHS psychiatric
nurses have treated injured soldiers under fire in Afghanistan. At
home, USPHS psychologists and other mental health specialists have been
detailed to the military to treat returning soldiers and Marines
suffering from traumatic brain injury and post-traumatic stress
disorder. The PHS Commissioned Corps is a public health and national
security force multiplier.
The original proposal, set forth in Section 5315 of PPACA, would
have established a ``U.S. Public Health Sciences Track'' providing for
a total of 850 annual scholarships for medical, dental, nursing, and
public health students who commit to public service careers in the
USPHS. Such a program would be the first of its kind, the first
dedicated pipeline into the USPHS Commissioned Corps.
Funding
The PPACA provisions authorizing the U.S. Public Health Sciences
Track also identified an existing source of funds within the Department
of Health and Human Services (DHHS). Support was to come from the
Public Health and Social Services Emergency Fund. The law directed the
DHHS Secretary to ``transfer from the Public Health and Social Services
Emergency Fund such sums as may be necessary'' (Sec. 274). The language
in the PPACA is clear and straightforward, but, for reasons unknowable
to this Association, the directed funding transfer has not occurred.
usphs ready reserve
This Association's second request is for sufficient funding to
establish a Ready Reserve component within the USPHS Commissioned
Corps. We ask the subcommittee to appropriate $12,500,000 annually
through fiscal year 2014 for this purpose. Creation of a USPHS Ready
Reserve was approved by Congress last year as part of the PPACA
(Section 5210). Lawmakers wanted to bring the structure of the USPHS
into line with that of its sister services in the Department of
Defense; that objective is articulated several times in the text of the
legislation.
The text of the law speaks to congressional intent with unusual
specificity. Lawmakers wanted to establish a USPHS Ready Reserve Corps
``for service in time of national emergency;'' that is, to enhance the
capability of the USPHS to respond to natural disasters, terrorist
incidents, and other public health emergencies ``both foreign and
domestic.'' This reflects the growing realization that protection of
the public's health is a fundamental component of national security.
Congress intended that USPHS Ready Reserve personnel would be
``available on short notice.'' They would be ``available and ready for
involuntary calls to active duty during national emergencies and public
health crises.'' They would be available for ``backfilling critical
positions left vacant'' when active-duty USPHS personnel are deployed
in response to public health emergencies, both foreign and domestic''
and, finally, they would also ``be available for service assignments in
isolated, hardship, and medically underserved communities.'' Absent the
appropriated funding necessary to meet these legal obligations, the
Nation has no public health emergency response capacity.
conclusion
This Association recognizes, of course, that start-up and even
continued funding of various provisions of PPACA are a matter of
ongoing debate and very much in doubt. But these two provisions--
creation of a USPHS Ready Reserve and establishment of a pilot program
at USUHS--warrant broad bipartisan support. They are modest, practical,
and well thought-through, and they speak to the short-term and long-
term national security needs of this country.
I would be pleased to expand on these points or to answer any
questions. I can be reached at the COA offices at 301-731-9080, ext.
211.
______
Prepared Statement of the Council of Academic Family Medicine
On behalf of the Council of Academic Family Medicine (CAFM)
(Association of Departments of Family Medicine, Association of Family
Medicine Residency Directors, North American Primary Care Research
Group, and Society of Teachers of Family Medicine), we are pleased to
submit testimony on behalf of several programs under the jurisdiction
of the Health Resources and Services Administration (HRSA) and the
Agency for Healthcare Research and Quality (AHRQ). We thank you for
your continued support for programs that encourage the development of
primary care physicians to serve our countries healthcare needs. Your
fiscal year 2011 committee passed budget was encouraging as a signal of
your recognition for the need to invest in these important health
professions and workforce programs.
Members of both parties agree there is much that must be done to
support primary care production and nourish the development of a high
quality, highly effective primary care workforce to serve as a
foundation for our healthcare system. Providing strong funding for
these programs is essential to the development of a robust workforce
needed to provide this foundation.
Primary Care Training and Enhancement
The Primary Care Training and Enhancement Program (Title VII
Section 747 of the Public Health Service Act) has a long history of
providing indispensible funding for the training of primary care
physicians. With each successive reauthorization, Congress has modified
the Title VII health professions programs to address relevant workforce
needs. The most recent authorization directs the Health Resources and
Services Administration (HRSA) to prioritize training in the new
competencies relevant to providing care in the patient-centered medical
home model. It also calls for the development of infrastructure within
primary care departments for the improvement of clinical care and
research critical to primary care delivery, as well as innovations in
team management of chronic disease, integrated models of care, and
transitioning between healthcare settings.
Key advisory bodies such as the Institute of Medicine (IOM) and the
Congressional Research Service (CRS) have also called for increased
funding. The IOM (December 2008) pointed to the drastic decline in
Title VII funding and described these health professions workforce
training programs as ``an undervalued asset.'' The CRS found that
reduced funding to the primary care cluster has negatively affected the
programs during a time when more primary care is needed (February
2008).
According to the Robert Graham Center, (Title VII's decline:
Shrinking investment in the primary care training pipeline, Oct. 2009),
``the number of graduating U.S. allopathic medical students choosing
primary care declined steadily over the past decade, and the proportion
of minorities within this workforce remains low.'' Unfortunately, this
decline coincides with a decline in funding of primary care training
funding--funding that we know is associated with increased primary care
physician production and practice in underserved areas. The report goes
on to say that ``the Nation needs renewed or enhanced investment in
programs like Title VII that support the production of primary care
physicians and their placement in underserved areas.''
Title VII has a profound impact on States across the country and is
vital to the continued development of a workforce designed to care for
the most vulnerable populations and meet the needs of the 21st century.
Attached are just a few examples of the impact Title VII has across the
country in States like Alabama, Kansas, Ohio, Rhode Island, Tennessee,
Texas, and Washington. Included are examples of opportunities lost
through the lack of robust funding for the program.
We urge the Congress to appropriate at least $140 million for the
health professions program, Primary Care Training and Enhancement
authorized under Title VII, Section 747 of the Public Health Service
Act in fiscal year 2012 as requested in the President's budget.
Rural Physician Training Grants
``Rural Physician Training Grants,'' Title VII Section 749B of the
Public Health Service Act, were developed to increase the supply of
rural physicians by authorizing grants to medical schools which
establish or expand rural training. The program would provide grants to
produce rural physicians of all specialties. It would help medical
schools recruit students most likely to practice medicine in
underserved rural communities, provide rural-focused training and
experience, and increase the number of medical graduates who practice
in underserved rural communities.
According to a July 2007 report of the Robert Graham Center
(Medical school expansion: An immediate opportunity to meet rural
healthcare needs), data show that although 21 percent of the U.S.
population lives in rural areas, only 10 percent of physicians practice
there. The Graham Center study describes the educational pipeline to
rural medical practice as ``long and complex.'' There are multiple
tactics needed to reverse this situation, and this grant program
includes several of them. Strategies to increase the number of
physicians practicing in rural areas include ``increasing the number of
rural-background students in medical school, selecting the ``right''
students and giving them the ``right'' content and experiences to train
them for rural practice.'' This is exactly what this grant program is
designed to do.
We request the Committee provide the fully authorized amount of $4
million in fiscal year 2012 for Title VII Section 749B Rural Physician
Training Grants.
Teaching Health Centers
Teaching Health Centers (THC) are community health centers or other
similar venues that sponsor residency programs and provide residents
with their ambulatory training experiences in the health center. This
training in the community, rather than solely at the hospital bedside
is one of the hallmarks of family medicine training. However, payment
issues have always caused a tension and struggle between the hospital,
which currently receives reimbursement for residents it sponsors when
they train in the hospital, and programs that require training in non-
hospital settings. This program is designed to provide residency
programs and community health centers grant funding to plan for a
transition in sponsorship, or the establishment of new programs. There
are already 11 community-based entities from states across the country
that have committed to train 44 primary care residents, demonstrating
early success in this program.
We are pleased that THC's operations are currently funded through a
mandatory appropriations trust fund of $230 million over 5 years, and
it is essential that these important centers continue to be funded
through this mandatory appropriation. Despite the positive impact that
family medicine and other primary care residency training programs have
on those community-based entities that initiate them, a multitude of
challenges make it clear that many of these entities would have
difficulty doing the same without adequate and predictable financing.
Converting this program to discretionary funding also would deter other
entities from making the business decisions necessary to expand
residency training (e.g., securing commitments from key stakeholders to
agree to train new or additional residents, applying for accreditation
if not already part of an eligible consortia, and hiring new faculty)
since funding over the next few years would be subject to the annual
appropriations process.
Teaching Health Center Development Grants
If this program is to be effective, there must be funds for the
planning grants to establish newly accredited or expanded primary care
residency programs. Teaching Health Center Development Grants are
important to help establish these innovative programs.
We recommend the Committee appropriate the full authorized amount
for the new Title VII Teaching Health Centers development grants of at
least $10 million for fiscal year 2012.
AHRQ
Research related to the most common acute, chronic, and comorbid
conditions that primary care clinicians care for on a daily basis is
lacking. Research in these areas is vital because the overall health of
a population is directly linked to the strength of its primary
healthcare system. AHRQ supports research to improve healthcare
quality, reduce costs, advance patient safety, decrease medical errors,
and broaden access to essential services. This research is key to
helping create a robust primary care system for our Nation--one that
delivers higher quality of care and better health while reducing the
rising cost of care. Despite this need, little is known about how
patients can best decide how and when to seek care, introduce and
disseminate new discoveries into real life practice, and how to
maximize appropriate care. Ample funding for AHRQ can help researchers
address these problems confronting our health system today.
We recommend the Committee fund AHRQ at a level of at least $405
million for fiscal year 2012
Primary Care Extension Program
The Primary Care Extension Program was modeled after the successful
United States Agriculture Extension Service. This program, under Title
III of the Public Health Service Act, is designed to support and assist
primary care providers with the adoption and incorporation of
techniques to improve community health. As the authors of an article
describing this concept (JAMA, June 24, 2009) have stated, ``To
successfully redesign practices requires knowledge transfer,
performance feedback, facilitation, and HIT support provided by
individuals with whom practices have established relationships over
time. The farming community learned these principles a century ago.
Primary care practices are like small farms of that era, which were
geographically dispersed, poorly resourced for change, and inefficient
in adopting new techniques or technology but vital to the Nation's
well-being.''
Congress agreed with the authors that ``practicing physicians need
something similar to the agricultural extension agent who was so
transformative for farming,'' and authorized this program at $120
million for fiscal year 2011 and 2012.
We recommend the Committee fund the Primary Care Extension program
at the authorized level of $120 million for fiscal year 2012.
Title VII Testimonials from the field
Brown University.--``Our Title VII grant is devoted to training
students in the care of the underserved. In our first year, we have
already recruited two new Community Health Center clinical training
sites for our medical students. Our first student at one of the two
sites decided, after his family medicine rotation, to change his career
path from Urology to Family Medicine.'' An additional grant has allowed
for the development of a curriculum centered around the Patient
Centered Medical Home and Practice transformation and has started
transforming family medicine practices in Rhode Island. David Anthony,
Director of Medical School Education, and Jeffrey Borkan, MD, PhD,
Chair, Department of Family Medicine
East Tennessee State University.--We were able to use a Title VII
grant to establish health fairs, including health screening exams, for
rural and underserved communities in northeast Tennessee and southwest
Virginia. We started small, but now there are 6 health fairs per year,
including 2-3 days per event. During the fairs, the average number of
visits per site is 180 and we estimate 27,000 visits in 11 years (1999-
2010). John Franko MD, Chair and Professor, Department of Family
Medicine
The Ohio State University.--With Title VII grants, ``We were able
to establish a four-track university program--university, academic,
urban, and rural, which allowed us to provide a unique training
experience involving a diverse population. We have been able to
successfully match students in all tracks. We have also been able to
provide primary care to the community in settings that were previously
physician shortage areas. Finally, we were able to develop training
modules for community medicine that address real issues, such as
domestic violence, alcohol and substance abuse, teenage pregnancy,
obesity, etc.'' W. Fred Miser, MD, Associate Professor of Family
Medicine
University of Kansas School of Medicine.--The school applied for
but did not receive funding for a program designed to help educate
volunteer community physician educators. 29 percent of Kansas Medical
students go into family medicine but the school has struggled with
faculty development education, this is necessary to teach our community
physicians the skills necessary to efficiently and effectively teach.
Rick Kellerman MD, Professor and Chair, Department of Family and
Community Medicine
University of South Alabama.--The Department of Family Medicine
applied for but did not receive funding for a program designed to allow
us to train residents in a simulated environment to ensure experiences
with patients with disability, access and mental health problems. Allen
Perkins, MD, MPH, Professor and Char, Department of Family Medicine
University of Texas Health Science Center at San Antonio.--Title
VII grants are helping the program transition to be core transitional
laboratories for the NIH's Clinical and Translational Science Awards
(CTSA) efforts and have helped in getting support for a new a Practice
Based Research Network Resource Center for community engagement. Carlos
Roberto Jaen, MD PhD FAAFP, Professor of Epidemiology and Health
Statistics
WWAMI (a partnership between the University of Washington School of
Medicine and the States of Wyoming, Alaska, Montana, and Idaho).--Title
VII grants have helped fund over 30 faculty positions across the States
of Washington, Wyoming, Alaska, Montana, and Idaho. These grants have
helped fund the development of areas of scholarship for residency
programs in Montana, assisted in the training of fellows that became
Residency Directors at other programs, and funded faculty development
programs delivered with televideo to rural areas in Wyoming. Ardis
Davis MSW,University of Washington Department of Family Medicine,
Teaching Associate
Thomas Jefferson Medical School.--Title VII grants have allowed us
to expand our successful rural Physician Shortage Area and Urban
Underserved Programs, teach all of our students about the Patient
Centered Medical Home in all 4 years of medical school, and train over
1,400 students, residents, and faculty in community medicine and
population health. We have also expanded the infrastructure and rigor
of our research fellowship, doubling the publication outcomes of our
research fellows over the past 2 years. Howard Rabinowitz, Department
of Family and Community Medicine
______
Prepared Statement of the Council on Social Work Education
On behalf of the Council on Social Work Education (CSWE), I am
pleased to offer this written testimony to the Senate Appropriations
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies for inclusion in the official Committee record. I will
focus my testimony on the importance of fostering a skilled,
sustainable, and diverse social work workforce to meet the healthcare
needs of the Nation through professional education, training and
financial support programs at the Department of Health and Human
Services (HHS) and the Department of Education (ED).
CSWE is a nonprofit national association representing more than
3,000 individual members as well as 650 master's and baccalaureate
programs of professional social work education. Founded in 1952, this
partnership of educational and professional institutions, social
welfare agencies, and private citizens is recognized by the Council for
Higher Education Accreditation (CHEA) as the single accrediting agency
for social work education in the United States. Social work education
focuses students on leadership and direct practice roles helping
individuals, families, groups, and communities by creating new
opportunities that empower people to be productive, contributing
members of their communities.
Social work is rooted in a tradition of social justice, with a
central mission of eliminating inequities by helping vulnerable
populations navigate societal and personal challenges. Social workers
are embedded in a variety of settings, such as schools, hospitals,
Veteran health facilities, rehabilitation centers, social service
agencies, child welfare organizations, assisted living centers, nursing
homes, and faith-based organizations, which allows us to reach diverse
segments of the population and play a significant role in the lives of
Americans from all walks of life. For example, we provide psychosocial
support for individuals and families to help them cope with disease,
such as Alzheimer's disease and cancer; we assist families who struggle
with homelessness and un- or underemployment; we work with families
dealing with domestic violence, including child and spousal abuse; and
we work with children in school or afterschool settings to ensure that
they meet their full academic potential and to help them cope with
issues they may be experiencing in their home lives. As you can see,
social workers have an important role to play in all aspects of daily
life.
Unfortunately, recruitment and retention in social work continues
to be a serious challenge that threatens the workforce's ability to
meet societal needs. The U.S. Bureau of Labor Statistics estimates that
employment for social workers is expected to grow faster than the
average for all occupations through 2018, particularly for social
workers specializing in the aging population and working in rural
areas. In addition, the need for mental health and substance abuse
social workers is expected to grow by almost 20 percent over the 2008-
2018 decade.\1\
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\1\ U.S. Bureau of Labor Statistics. 2009. Occupational Outlook
Handbook, 2010-11 Edition: Social Workers, http://data.bls.gov/cgi-bin/
print.pl/oco/ocos060.htm. Retrieved April 13, 2011.
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Recruitment into the social work profession faces many obstacles,
the most prevalent being low wages coupled with high educational debt.
For example, the median annual wage for child, family, and school
social workers in May 2008 was $39,530, while the wage for mental
health and substance abuse social workers was $37,210. While a
bachelor's degree (BSW) is necessary for most entry-level positions, a
master's degree (MSW) is the terminal degree for social work practice,
which significantly contributes to the debt load of social work
graduates entering careers with low starting wages. According to the
2007-2008 National Postsecondary Student Aid Study conducted by the
National Center for Education Statistics at ED, 72 percent of students
graduating from MSW programs incurred debt to earn their graduate
degree. The average debt was approximately $35,500. The percentage of
MSW students borrowing money is 17 percent higher than the average for
all master's degrees and the amount borrowed is approximately $5,000
higher than the average for all master's degrees. These difficult
realities have made recruitment and retention of social workers an
ongoing challenge.
CSWE understands and appreciates the tough funding decisions
Congress is faced with this year. However, we urge you to consider the
needs of our frontline workforce if we are to see real progress in
meeting the healthcare and societal demands of the Nation. The below
recommendations for fiscal year 2012 would help to ensure that we are
fostering a sustainable, skilled, and diverse workforce that will be
able to keep up with the increasing demand for social work services.
health resources and services administration (hrsa) title vii and title
viii health professions programs
CSWE urges the Subcommittee to provide $762.5 million for the Title
VII and Title VIII health professions programs at HRSA in fiscal year
2012. HRSA's Title VII and Title VIII health professions programs
represent the only Federal programs designed to train healthcare
providers in an interdisciplinary way to meet the healthcare needs of
all Americans, including the underserved and those with special needs.
These programs also serve to increase minority representation in the
healthcare workforce through targeted programs that improve the
quality, diversity, and geographic distribution of the health
professions workforce. The Title VII and Title VIII programs provide
loans, loan guarantees and scholarships to students, and grants to
institutions of higher education and nonprofit organizations to help
build and maintain a robust healthcare workforce. Social workers and
social work students are eligible for Title VII funding.
The Title VII and Title VIII programs were reauthorized in 2010,
which helped to improve the efficiency of the programs as well as
enhance efforts to recruit and retain health professionals in
underserved communities. Allow me to highlight a few of the programs
that are of critical importance to the training of social workers.
--Mental and Behavioral Health Education and Training.--Recognizing
the severe shortages of mental and behavioral health providers
within the healthcare workforce, a new Title VII program was
authorized in the Patient Protection and Affordable Care Act
(Public Law 111-148). This program--Mental and Behavioral
Health Education and Training Grants--would provide grants to
institutions of higher education (schools of social work and
other mental health professions) for faculty and student
recruitment and professional education and training. The
President's budget request includes $17.9 million for these
grants in fiscal year 2012. This funding would allow for
approximately 10 grants in graduate social work education, 17
grants in graduate psychology education, 12 grants for
professional child and adolescent mental health education, and
6 grants for paraprofessional child and adolescent mental
health. This is the only program in the Federal Government that
is explicitly focused on recruitment and retention of social
workers and other mental and behavioral health professionals.
CSWE strongly urges the Subcommittee to provide $17.9 million
for the Title VII Mental and Behavioral Health Education and
Training Grants in fiscal year 2012.
--Geriatrics Health Professions Training.--Within the overall request
for HRSA's Title VII and Title VIII programs, CSWE urges the
Subcommittee to appropriate $46.5 million for Geriatrics Health
Professions Programs. This includes the Geriatric Academic
Career Incentive Awards (GACA), Geriatric Education Centers
(GEC), and Geriatric Career Incentive Awards. As mentioned
earlier, the reauthorization that occurred last year made
enhancement to the Title VII and Title VIII programs.
Specifically, the reauthorization enhanced the geriatrics
programs to allow additional health professions--such as social
workers and other mental healthcare providers--to participate.
Rapid job growth is anticipated for gerontological social
workers. In fact, the demand for geriatric social workers is
expected to increase by 45 percent by 2015, faster than the
average of all other occupations \2\. Additional funding for
these programs is needed to ensure that the geriatric workforce
is adequately equipped to deal with the aging population, which
is only expected to grow to breaking-point levels within the
next several years.
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\2\ Hooyman, N., and Unutzer, J. 2011. ``A Perilous Arc of Supply
and Semand: How Can America Meet the Multiplying Mental Health Care
Needs of an Again Populations.'' Generations 34 (4): 36-42.
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substance abuse and mental health services administration (samhsa)
minority fellowship program
The goal of the SAMHSA Minority Fellowship Program (MFP) is to
achieve greater numbers of minority doctoral students preparing for
leadership roles in the mental health and substance abuse fields.
According to SAMHSA, minorities make up approximately one-fourth of the
population, but only about 10 percent of mental health providers are
ethnic minorities. CSWE is a grantee of this critical program and
administers funds to exceptional minority social work students. For
fiscal year 2012, CSWE urges the Subcommittee to appropriate $7.5
million to the SAMHSA Minority Fellowship Program. This would include
$6.882 million for the Center for Mental Health Services, where the
majority of MFP funds are administered; $71,000 for the Center for
Substance Abuse Prevention; and $547,000 for the Center for Substance
Abuse Treatment.
The program has helped support doctoral-level professional
education for over 1,000 ethnic minority social workers, psychiatrists,
psychologists, psychiatric nurses, and family and marriage therapists
since its inception. Still, the program continues to struggle to keep
up with the demands that are plaguing our health professions. Severe
shortages of mental health professionals often arise in underserved
areas due to the difficulty of recruitment and retention in the public
sector. Nowhere are these shortages more prevalent than in Indian
Country, where mental illness and substance abuse go largely untreated
and incidences of suicide continue to increase. Studies have shown that
ethnic minority mental health professionals practice in underserved
areas at a higher rate than non-minorities. Furthermore, a direct
positive relationship exists between the numbers of ethnic minority
mental health professionals and the utilization of needed services by
ethnic minorities.
The $7.5 million request would be used to substantially increase
access to professional education and training for additional minority
mental health and substance abuse professionals, in turn helping to
ensure that underserved minority populations receive the mental health
and substance abuse services they so desperately need. President
Obama's fiscal year 2012 budget request includes flat funding for the
MFP at about $4.9 million. Funding the MFP at $7.5 million would
directly encourage more social workers of minority backgrounds to
pursue doctoral degrees in mental health and substance abuse and will
turnout more minority mental health professionals equipped to provide
culturally competent, accessible mental health and substance abuse
services to diverse populations.
department of education student aid programs
CSWE supports full funding to keep the maximum Pell Grant at $5,550
in fiscal year 2012. While Congress is understandably focused on
identifying a solution that will place the Pell Grant program on solid
ground in regards to its fiscal future, we urge you to remember that
these grants help to ensure that all students, regardless of their
economic situation, can achieve higher education. Moreover, as
described above with regard to the SAMHSA Minority Fellowship Program,
one goal of social work education is recruiting students from diverse
backgrounds (which includes racial, economic, religious, and other
forms of diversity) with the hope that they will return to serve
diverse communities once they have completed their education. In many
cases, this includes encouraging social workers to return to their own
communities and apply the skills they have acquired through their
social work education to individuals, groups, or families in need.
Without support such as Pell Grants, many low-income individuals would
not be able to access higher education, and in turn, would not acquire
skills needed to best serve in the communities that would most benefit
from their service.
The Graduate Assistance in Areas of National Need (GAANN) program
provides graduate traineeships in critical fields of study. Currently,
social work is not defined as an area of national need for this
program; however it was recognized by Congress as an area of national
need in the Higher Education Opportunity Act of 2008. We are hopeful
that ED will recognize the importance of including social work in the
GAANN program in future years. Inclusion of social work would help to
significantly enhance graduate education in social work, which is
critically needed in the country's efforts to foster a sustainable
health professions workforce. CSWE urges the Subcommittee to provide
$31 million for the GAANN Program. However, if social work was to be
added by the Department as a new area of national need, additional
resources would need to be provided so as not to take funding away from
the already determined areas of national need.
Thank you for the opportunity to express these views. Please do not
hesitate to call on the Council on Social Work Education should you
have any questions or require additional information.
______
Prepared Statement of the Crohn's and Colitis Foundation of America
Mr. Chairman and members of the Subcommittee, thank you for the
opportunity to submit testimony on behalf of the 1.4 million Americans
living with Crohn's disease and ulcerative colitis. My name is Gary
Sinderbrand and I have the privilege of serving as the Chairman of the
National Board of Trustees for the Crohn's and Colitis Foundation of
America. CCFA is the Nation's oldest and largest voluntary organization
dedicated to finding a cure for Crohn's disease and ulcerative
colitis--collectively known as inflammatory bowel diseases.
Let me express at the outset how appreciative we are for the
leadership this Subcommittee has provided in advancing funding for the
National Institutes of Health.
Mr. Chairman, Crohn's disease and ulcerative colitis are
devastating inflammatory disorders of the digestive tract that cause
severe abdominal pain, fever and intestinal bleeding. Complications
include arthritis, osteoporosis, anemia, liver disease and colorectal
cancer. We do not know their cause, and there is no medical cure. They
represent the major cause of morbidity from digestive diseases and
forever alter the lives of the people they afflict--particularly
children. I know, because I am the father of a child living with
Crohn's disease.
Seven years ago, during my daughter, Alexandra's sophomore year in
college, she was taken to the ER for what was initially thought to be
acute appendicitis. After a series of tests, my wife and I received a
call from the attending GI who stated coldly: Your daughter has Crohn's
disease, there is no cure and she will be on medication the rest of her
life. The news froze us in our tracks. How could our vibrant, beautiful
little girl be stricken with a disease that was incurable and has
ruined the lives of countless thousands of people?
Over the next several months, Alexandra fluctuated between good
days and bad. Bad days would bring on debilitating flares which would
rack her body with pain and fever as her system sought equilibrium. Our
hearts were filled with sorrow as we realized how we were so incapable
of protecting our child.
Her doctor was trying increasingly aggressive therapies to bring
the flares under control.
Asacol, Steroids, Mercaptipurine, Methotrexate and finally
Remicade. Each treatment came with its own set of side effects and
risks. Every time A would call from school, my heart would jump before
I picked up the call in fear of hearing that my child was in pain as
the flares had returned. Ironically, the worst call came from one of
her friends to report that A was back in the ER and being evaluated by
a GI surgeon to determine if an emergency procedure was needed to clear
an intestinal blockage that was caused by the disease. Several hours
later, a brilliant surgeon at the University of Chicago, removed over a
foot of diseased tissue from her intestine. The surgery saved her life,
but did not cure her. We continue to live every day knowing that the
disease could flare at any time with devastating consequences.
Mr. Chairman, I will focus the remainder of my testimony on our
appropriations recommendations for fiscal year 2012.
recommendations for fiscal year 2012
Centers For Disease Control And Prevention
Inflammatory Bowel Disease Epidemiology Program
As I mentioned earlier, CCFA estimates that 1.4 million people in
the United States suffer from IBD, but there could be many more. We do
not know the exact number due to the complexity of these diseases and
the difficulty in identifying them. The Centers for Disease Control and
Prevention's Inflammatory Bowel Disease Program is helping answer this
and many other important questions related to these challenging
conditions. This program is the only one of its kind and its
accomplishments have been applauded by the CDC.
CCFA has been a proud partner with CDC in conducting the research
funded under the epidemiology program. For the first 2 years of the
project the Foundation worked collaboratively with Kaiser Permanente in
California to better understand the incidence and prevalence of IBD,
the natural history of the disease, and why patients respond
differently to the same therapy. This research has resulted in 11
publications to date and another 11 papers to be submitted to high-
quality peer-reviewed journals. Topics include but are not limited to
the following:
--Incidence and Prevalence of IBD
--Patterns of Care and Outcomes in IBD
--Qualitative study of provider opinions
--Utilization of biologics (Infliximab)
--Disparities in Mortality
--Myelosuppression during Thiopurine Therapy for Inflammatory Bowel
Disease: Implications for Monitoring Recommendations
--Severity and Flare Algorithms
--Disparities in Surveillance for Colorectal Cancer
--Pediatric Epidemiology
In 2007, our focus shifted to the establishment of the ``Ocean
State Crohn's & Colitis Area Registry'' or OSCCAR. Under the leadership
of Dr. Bruce Sands, this study is being conducted jointly by
investigators at the Massachusetts General Hospital and Rhode Island
Hospital/Brown University. The State of Rhode Island is an excellent
location to conduct a population-based IBD study because; (1) it is a
small State geographically; (2) it has a diverse ethnic and
socioeconomic population that does not tend to migrate out of State:
and (3) a small number of gastroenterologists treat essentially all IBD
patients within the State. Since 2007, Dr. Sands has been able to
recruit virtually all GI physicians in Rhode Island to refer patients
into the study. To date, almost 310 patients have been recruited, 89 of
whom are pediatric patients. All of this progress will be lost if the
program is eliminated in 2012.
The goals of the OSCCAR study moving forward are to: (1) describe
the age and sex adjusted incidence rate of Crohn's disease and
ulcerative colitis; (2) describe variations in presenting symptoms
among children, men and women with newly diagnosed disease; (3)
identify factors that predict resistance to steroids, including
clinical characteristics and blood test markers that could be useful to
treating physicians; (4) identify predictors of the need for surgery;
and (5) describe factors that predict either impaired quality of life
or a benign course of disease. Mr. Chairman, to ensure that this
important epidemiological work moves forward in fiscal year 2012, CCFA
recommends an appropriation of $680,000 (fiscal year 2010 level).
Pediatric Inflammatory Bowel Disease Patient Registry
Mr. Chairman, the unique challenges faced by children and
adolescents battling IBD are of particular concern to CCFA. In recent
years we have seen an increased prevalence of IBD among children,
particularly those diagnosed at a very early age. To combat this
alarming trend CCFA, in partnership with the North American Society for
Pediatric Gastroenterology, Hepatology and Nutrition, has instituted an
aggressive pediatric research campaign focused on the following areas:
--Growth/Bone Development.--How does inflammation cause growth
failure and bone disease in children with IBD?
--Genetics.--How can we identify early onset Crohn's disease and
ulcerative colitis?
--Quality Improvement.--Given the wide variation in care provided to
children with IBD, how can we standardize treatment and improve
patients' growth and well-being?
--Immune Response.--What alterations in the childhood immune system
put young people at risk for IBD, how does the immune system
change with treatment for IBD?
--Psychosocial Functioning.--How does diagnosis and treatment for IBD
impact depression and anxiety among young people? What
approaches work best to improve mood, coping, family function,
and quality of life.
The establishment of a national registry of pediatric IBD patients
is central to our ability to answer these important research questions.
Empowering investigators with HIPPA compliant information on young
patients from across the Nation will jump-start our effort to expand
epidemiologic, basic and clinical research on our pediatric population.
We encourage the Subcommittee to support our efforts to establish a
Pediatric IBD Patient Registry with the CDC in fiscal year 2012.
National Institutes of Health
Throughout its 40 year history, CCFA has forged remarkably
successful research partnerships with the NIH, particularly the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), which sponsors the majority of IBD research, and the National
Institute of Allergy and Infectious Diseases (NIAID). CCFA provides
crucial ``seed-funding'' to researchers, helping investigators gather
preliminary findings, which in turn enables them to pursue advanced IBD
research projects through the NIH. This approach led to the
identification of the first gene associated with Crohn's--a landmark
breakthrough in understanding this disease.
Mr. Chairman, NIDDK-sponsored research on IBD has been a remarkable
success story. In 2008, a consortium of researchers from the United
States, Canada, and Europe identified 21 new genes for Crohn's disease.
This discovery, funded in part by the NIDDK, brings the total number of
known genes associated with Crohn's disease to more than 30 and
provides new avenues for the development of promising treatments. We
are grateful for the leadership of Dr. Stephen James, Director of
NIDDK's Division of Digestive Diseases and Nutrition, for aggressively
pursuing this and other promising areas of research.
CCFA's scientific leaders, with significant involvement from NIDDK,
have developed an ambitious research agenda entitled ``Challenges in
Inflammatory Bowel Diseases.'' In addition, CCFA-affiliated
investigators played a leading role in developing the recommendations
on IBD in the new NIH National Commission on Digestive Diseases
strategic plan. We look forward to working with the NIDDK to advance
the cutting-edge science called for in these two roadmaps.
For fiscal year 2012, CCFA joins with other voluntary patient and
medical organizations in recommending an appropriation of $35 billion
for the NIH. Once again Mr. Chairman, thank you very much for the
opportunity to submit our views for your consideration.
______
Prepared Statement of the Cystic Fibrosis Foundation
On behalf of the Cystic Fibrosis Foundation and the 30,000
Americans with cystic fibrosis (CF), we are pleased to submit the
following testimony with our requests for fiscal year 2012 Labor,
Health and Human Services, and Education Appropriations.
about cystic fibrosis
Cystic fibrosis is a life-threatening genetic disease for which
there is no cure. People with CF have two copies of a defective gene,
known as CFTR, which causes the body to produce abnormally thick,
sticky mucus that clogs the lungs and results in fatal lung infections.
The thick mucus in those with CF also obstructs the pancreas, making it
difficult for patients to absorb nutrients from food.
Since its founding, the CF Foundation has maintained its focus on
promoting research and improving treatments for CF. More than 30 drugs
are now in development to treat CF; some treat the basic defect of the
disease, while others target its symptoms. Through the research
leadership of the Cystic Fibrosis Foundation, people with CF are living
into their 30s, 40s and beyond. This improvement in the life expectancy
for those with CF can be attributed to research advances and to the
teams of CF caregivers who offer specialized care. Although life
expectancy has improved dramatically, we continue to lose young lives
to this disease.
The promise for people with CF lies in research. In the past 6
years, the Cystic Fibrosis Foundation has invested over $1 billion in
its medical programs of drug discovery, drug development, research, and
care focused on life-sustaining treatments and a cure for CF. A greater
investment is necessary, however, to accelerate the pace of discovery
and development of CF therapies.
sustaining the federal investment in biomedical research
This Committee and Congress are to be commended for their support
for biomedical research through the years. It is vital that we continue
to sufficiently fund the NIH, so that it can capitalize on scientific
advances and maintain the momentum generated by the doubling of funds
and the infusion from the American Recovery and Reinvestment Act
(ARRA). These increases in funding brought a new era in drug discovery
that has benefited all Americans.
Cutting discretionary health spending by 13.5 percent, as has been
proposed, would halt this progress. Deep cuts would have a detrimental
effect on the fight against many of our most serious diseases, stifle
scientific opportunities, and result in high-wage job loss in all 50
States. In 2007, NIH grants and contracts created and supported more
than 350,000 jobs across the United States, an important contribution
to the American economy.
We urge this Committee and Congress to maintain robust investment
in biomedical research at the NIH so it can fund critical research
today that will provide the care and cures of tomorrow.
strengthening clinical research and drug development
The Cystic Fibrosis Foundation has been recognized for its unique
research approach, which encompasses everything from basic research
through Phase 4 post-marketing monitoring of drug safety, and has
created the infrastructure required to accelerate the development of
new CF therapies. As a result, we now have a pipeline of more than 30
potential therapies that are being examined to treat people with CF.
One such treatment is VX-770, a drug being developed by Vertex
Pharmaceuticals that was discovered in collaboration with CFF. This
promising therapy targets the physiological defect that causes CF in
patients with a particular type of genetic mutation, as opposed to only
addressing symptoms of the disease. In late February 2011 we learned
that Phase 3 clinical trial data of VX-770 showed profound improvements
in lung function and other health measures in CF patients, and a New
Drug Application is expected to be submitted to the FDA for review
later this year. This new treatment is a direct result of the
Foundation's innovative research agenda, advancing from bench to
bedside through the Foundation's research program which speeds the
creation of new CF therapies.
The Foundation is a leader in creating a clinical trials network to
achieve greater efficiency in clinical investigation. Because the CF
population is small, a higher proportion of people with the disease
must partake in clinical trials than in most other diseases. This
unique challenge prompted the Foundation to streamline our clinical
trials processes. As a result, research conducted by the Foundation is
more efficient than ever before and we are a model for other disease
groups.
While the CF Foundation has made great progress in creating a more
efficient drug development process for cystic fibrosis, still more
needs to be done for other rare diseases, many of which have no
treatments available. The Federal Government has the opportunity to
make a real difference in this regard, and we are hopeful that the
Committee will direct the national health agencies to encourage all
investigators and institutions receiving Federal funding to advance
novel methodologies and mechanisms for translating basic research into
therapies that can benefit patients.
Advancing Translational Science
The CF Foundation strongly urges this Committee and Congress to
support funding for NIH's proposed National Center for Advancing
Translational Sciences (NCATS), which will house the Institutes'
existing translational science programs while establishing and
providing a more focused, integrated, and systematic approach for
linking basic discovery to therapeutic development.
The existing programs to be housed under NCATS are integral to
translating basic science into treatments and will benefit from funding
for the new center. These programs include Clinical and Translational
Science Awards (CTSA), discussed in further detail below, and the newly
authorized Cures Acceleration Network (CAN), both designed to transform
the way in which clinical and translational research is conducted and
funded. The Therapeutics for Rare and Neglected Diseases (TRND) program
will also be housed in the new center. NIH Director Collins has
specifically cited the Cystic Fibrosis Foundation's Therapeutics
Development Network (TDN), which plays a pivotal role in accelerating
the development of new treatments for cystic fibrosis patients, as an
exemplar for TRND's innovative therapeutics development model.
The Foundation's investment in pharmaceutical and biotech companies
can also serve as a model for the new center's overall mission. NCATS,
like CFF, will promote public-private partnerships and convene cross-
sector collaborations between industry, government, academia, and
others to advance drug development, as well as provide services and
resources for high throughput screening, assay development, and
preclinical modeling. Prioritizing these initiatives through a
standalone center at NIH has the potential to greatly accelerate the
development of drugs for diseases that have historically received
little pharmaceutical industry attention. In addition, integrating
translational science programs from throughout NIH into one center will
help bring greater efficiency to the Institutes' pursuit of this
important research. Once again, we applaud NIH Director Collins for
spearheading NCATS and look forward to working with him as this new
initiative is implemented.
Clinical and Translational Science Awards (CTSA)
The CTSA program, soon to be housed in NCATS, encourages novel
approaches to clinical and translational research, enhances the
utilization of informatics, and strengthens the training of young
investigators. Key to the success of CTSAs is the parallel maintenance
of infrastructure support for Clinical Research Centers (CRC). Without
a mechanism to offset clinical research costs, young investigators or
Principle Investigators (PIs) studying rare diseases for which there is
limited funding will not be able to continue to conduct clinical
research. It is important that all NIH institutes recognize that there
is a significant cost associated with the conduct of well designed and
safe clinical trials, and not all of these costs can be borne by the
CTSAs. Congress should direct the NIH to cover costs that used to be
borne by the General Clinical Research Centers (GCRCs) through
individual research grants.
Support should also be directed toward the continuation and
expansion of research networks, such as NIH's pediatric liver disease
consortium at the National Institute of Diabetes, Digestive, and Kidney
Diseases (NIDDK). This successful collaboration is helping researchers
discover treatments not only for CF liver disease but for other
diseases that affect thousands of children each year.
supporting drug discovery
The Cystic Fibrosis Foundation's clinical research is fueled by a
vigorous drug discovery effort comprised of early stage translational
research into successful treatments for this disease. Several research
projects at the NIH will expand our knowledge about the disease, and
could eventually be the key to controlling or curing cystic fibrosis.
Opportunities in Animal Models
The Cystic Fibrosis Foundation is encouraged by the NIH's
investment in a research program at the University of Iowa to study the
effects of CF in a pig model. The program, funded through research
awards from both the National Heart, Lung, and Blood Institute (NHLBI)
and the Cystic Fibrosis Foundation, bears great promise to help make
significant developments in the search for a cure. While a company has
been established to produce the animals, the infrastructure and
extensive animal husbandry required to keep the animals alive and
conduct research on them is available at few academic institutions.
Such barriers have greatly limited widespread adoption of these
valuable research tools. We urge additional funding to create a common
facility that would enable researchers from multiple institutions to
conduct research with these models.
Understanding CFTR Folding and Trafficking
The data that emerged from the VX-770 Phase 2 and 3 clinical
trials, discussed above, is proof that the way in which this drug
targets the physiological defect that causes CF, called CFTR protein
function modulation, is a viable therapeutic approach. However, this
exciting data was obtained from patients with a specific CF mutation
which affects only approximately 4 percent of CF patients. More
research is needed to understand other genetic mutations, the most
common of which is called F508del. F508del causes multiple negative
effects, including misfolding and poor activation properties of the
CFTR protein. We encourage the Committee to increase investment in
genetic research that can help scientists to better understand the
F508del mutation. This will facilitate CF drug discovery and has the
potential to benefit not just those with cystic fibrosis, but also
those with other protein misfolding diseases.
Personalized Medicine
Strong Federal and private investment in research is bringing
personalized medicine into the forefront. As we gain a deeper
understanding of many diseases and their accompanying genetic profiles,
we understand the great challenge of personalizing therapies. While
exciting and promising for patients, it is also expensive, complex, and
scientifically challenging. For instance, CF doctors are facing
difficulties in delivering appropriate care to CF patients, as
insurance providers will not cover certain combinations of medicines
that clinicians have found are effective for cystic fibrosis in
particular when there is no formal clinical data to support it. This
puts patients in a difficult position, as these clinical trials are
expensive and unlikely to be performed by pharmaceutical companies,
especially for treatment of a small, targeted population. As such we
urge the Committee to provide sustained Federal investment in
personalized medicine, to help move this burgeoning field forward and
advance exciting scientific discoveries.
supporting greater access to quality health care
We are making remarkable strides in our fight against cystic
fibrosis, but people who live with it face greater obstacles each year,
as high medical costs can prevent them from accessing appropriate
medical care. Healthcare for a CF patient costs $64,000 per year on
average, 15 times more than that of the average person. Because of high
costs, nearly a quarter of CF patients delay getting medical care or
skip treatments their providers recommend to enhance and lengthen their
life.
The Foundation sees some promise in a number of provisions in the
new healthcare reform law that increase access to health insurance
coverage for those with rare and chronic diseases, a critical tool in
decreasing out of pocket costs for patients. These provisions include
those allowing children to remain on their parents' insurance until
they are 26; prohibiting insurance companies from denying or rescinding
coverage based on a pre-existing condition; banning annual and lifetime
caps on coverage; and the expansion of Medicaid eligibility.
The new law is not perfect, however, and we are concerned that
while the provisions listed above will ensure continuity of coverage
and greater access to care for those with CF and other chronic
diseases, more must be done to reduce the financial burden so many
families face in affording their care, especially in these challenging
economic times.
While we urge Congress to explore new options to help make care
more affordable and reduce shifting costs to patients, we ask that
provisions that have the potential to provide desperately needed relief
to people with cystic fibrosis be retained, and that they are
sufficiently funded so that those with rare and chronic diseases can
access the care they need.
In addition, the Foundation wishes to applaud the formation of the
Patient Centered Outcomes Research Institute (PCORI) and urges the
Committee to support this important entity. PCORI, a private non-profit
institute created by the Patient Protection and Affordable Care Act,
will support and direct research that gives patients, doctors, and
others the information they need make informed decisions about the most
effective and appropriate methods for preventing and treating health
conditions. The CF Foundation has had great success in improving
quality of care for cystic fibrosis patients through the development
and administration of a comprehensive patient registry and the
collection of comprehensive data on outcomes and practice patterns for
use in comparative effectiveness research, and we are confident that
dedicating a national institute to such pursuits will improve care for
all Americans.
The Cystic Fibrosis Foundation has devoted our own resources to
developing treatments through drug discovery, clinical development, and
clinical care. Several of the drugs in our pipeline show remarkable
promise in clinical trials and we are increasingly hopeful that these
discoveries will bring us even closer to a cure. However, sufficient
investment in basic science, translational science, clinical research,
and drug development programs at NIH is needed to continue these
successes not only for CF but for all rare diseases. Additionally,
funding for programs that promote access and quality of care will help
achieve a greater quality of life for those living with chronic
diseases like cystic fibrosis.
We urge the Committee to consider these factors as you craft the
fiscal year 2012 Labor, Health and Human Services, and Education
Appropriations legislation, and stand ready to work with NIH and
Congressional leaders on the challenging issues ahead. Thank you for
your consideration.
______
Prepared Statement of the Digestive Disease National Coalition
Summary of Fiscal Year 2012 Recommendations
$35 billion for the National Institutes of Health (NIH) at an
increase of 12 percent over fiscal year 2011. 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 (NIAID) by 12 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, and celiac disease.
$50 million for the Centers for Disease Control and Prevention's
(CDC) hepatitis prevention and control activities.
$50 million for the Center for Disease Control and Prevention's
(CDC) colorectal cancerscreening and prevention program.
Chairman Rehberg, 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 29 professional societies and patient organizations concerned with
the many diseases of the digestive tract. 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, and Celiac Disease.
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).
Specifically the DDNC recommends: $2.16 billion for the National
Institute of Diabetes and Digestive and Kidney Disease (NIDDK); and $35
billion for the NIH.
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 competing 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. 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. 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 to continue its work in IBD research. Therefore the DDNC
and its member organization the Crohn's and Colitis Foundation of
America encourage the CDC to continue to support a nationwide IBD
surveillance and epidemiological program in fiscal year 2012.
Viral Hepatitis: A Looming Threat to Health
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 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 viral hepatitis.
The DDNC supports $50 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.
The DDNC recommends a funding level of $50 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 2006, an estimated 33,730 people in the United States will be
found to have pancreatic cancer and approximately 32,300 will die from
the disease. Pancreatic cancer is the fifth leading cause of cancer
death in men and women. Only lout of 4 patients will live 1 year after
the cancer is found and only 1 out of 25 will survive 5 or more years.
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 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.
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. The DDNC recommends
that NIDDK increase its research portfolio on Functional
Gastrointestinal Disorders and Motility Disorders.
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 DDNC recognizes the creation of the National Commission on
Digestive Diseases, and looks forward to working with the National
Commission to address the numerous digestive disorders that remain in
today's diverse population.
Conclusion
The DDNC understands the challenging budgetary constraints and
times we live in that this 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 30 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 healthcare 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 Dystonia Medical Research Foundation
Summary of recommendations for fiscal year 2012:
--$35 Billion for the National Institutes of Health (NIH) and
concurrent percentage increases across its institutes and
centers.
--Expand dystonia research at NIH through the National Institute on
Neurological Disorders and Stroke (NINDS), the National
Institute on Deafness and other Communication Disorders
(NIDCD), the National Eye Institute (NEI), and the National
Institute on Child Health and Human Development (NICHD).
--Continue to advance dystonia research through partnerships with the
Office of Rare Diseases Research (ORDR) and the Rare Diseases
Clinical Research Network (RDCRN).
--$100 million for the Cures Acceleration Network (CAN)
Dystonia is a neurological movement disorder characterized by
involuntary muscle spasms that cause the body to twist, repetitively
jerk, and sustain postural deformities. Focal dystonia affects specific
parts of the body, while generalized dystonia affects multiple parts of
the body at the same time. Some forms of dystonia are genetic but
dystonia can also be caused by injury or illness. Although dystonia is
a chronic and progressive disease, it does not impact cognition,
intelligence, or shorten a person's life span. Conservative estimates
indicate that between 300,000 and 500,000 individuals suffer from some
form of dystonia in North America alone. Dystonia does not
discriminate, affecting all demographic groups. There is no known cure
for dystonia and treatment options remain limited.
Although little is known regarding the causes and onset of
dystonia, two therapies have been developed and proved particularly
useful to control patients' symptoms. Botulinum toxin (Botox/Myobloc)
injections and deep brain stimulation (DBS) have shown varying degrees
of success alleviating dystonia symptoms. Until a cure is discovered,
the development of management therapies such as these remains vital,
and more research is needed to fully understand the onset and
progression of the disease in order to better treat patients.
Dystonia Research at the National Institutes of Health (NIH)
Currently, dystonia research at NIH is conducted through the
National Institutes on Neurological Disorders and Stroke (NINDS), the
National Institute on Deafness and Other Communication Disorders
(NIDCD), the National Eye Institute (NEI), and the Office of the
Director.
The majority of dystonia research at NIH is conducted through
NINDS. NINDS has utilized a number of funding mechanisms in recent
years to study the causes and mechanisms of dystonia. These grants
cover a wide range of research including the genetics and genomics of
dystonia, the development of animal models of primary and secondary
dystonia, molecular and cellular studies in inherited forms of
dystonia, epidemiology studies, and brain imaging. DMRF works to
support NINDS in conducting critical research and advancing the
understanding of dystonia.
NIDCD has funded many studies on brainstem systems and their role
in spasmodic dysphonia. Spasmodic dysphonia is a form of focal dystonia
which involves involuntary spasms of the vocal cords causing
interruptions of speech and affecting voice quality. In addition, NEI
focuses some of its resources on the study of blepharospasm.
Blepharospasm is an abnormal, involuntary blinking of the eyelids which
can cause blindness due to a patient's inability to open their eyelids.
DMRF encourages partnerships between NINDS, NIDCD and NEI to further
dystonia research.
When ORDR initiated the second phase of the Rare Disease Clinical
Research Network at NIH, they provided funding for an additional 19
grants aimed at studying the natural history, epidemiology, diagnosis,
and treatment of rare diseases. This includes the Dystonia Coalition,
which facilitates collaboration between researchers, patients, and
patient advocacy groups to advance the pace of clinical research on
cervical dystonia, blepharospasm, spasmodic dysphonia, craniofacial
dystonia, and limb dystonia. Working primarily through NINDS and ORDR,
the RDCRN holds great hope for advancing understanding and treatment of
primary focal dystonias.
Treatment for dystonia is highly individualized, and many dystonia
patients do not respond to the current available therapies. The study
of potential dystonia therapies is critical for the community. The
Cures Acceleration Network (CAN) promises to advance the development of
``high need cures,'' particularly by reducing the barriers between
research discovery and clinical trials in areas that the private sector
is unlikely to pursue in an adequate or timely way. DMRF supports this
initiative and asks that it be funded at $100 million, as requested in
the President's budget.
In summary, the DMRF recommends the following for fiscal year 2012:
--$35 billion for NIH and a proportional increase for its Institutes
and Centers.
--Increased portfolio of dystonia research at NIH through the
National Institute on Neurological Disorders and Stroke, the
National Institute on Deafness and Other Communication
Disorders, the National Eye Institute, and the National
Institute on Child Health and Human Development.
--Continued partnerships on dystonia research between the Office of
Rare Diseases Research, other NIH Institutes and Centers, the
Rare Diseases Clinical Research Network, and the dystonia
patient community.
--$100 million for the Cures Acceleration Network
The Dystonia Medical Research Foundation (DMRF)
The Dystonia Medical Research Foundation was founded over 30 years
ago and has been a membership-driven organization since 1993. Since our
inception, the goals of DMRF have remained to advance research for more
effective treatments of dystonia and ultimately find a cure; to promote
awareness and education; and support the needs and well being of
affected individuals and their families.
Thank you for the opportunity to present the views of the dystonia
community, we look forward to providing any additional information.
______
Prepared Statement of the Elder Justice Coalition
The Elder Justice Coalition (EJC) thanks you for providing an
opportunity to submit testimony as you consider an fiscal year 2012
Labor-HHS and Education Appropriations bill. The EJC is a 705 member
strong, non-partisan organization dedicated to advocating for funding
for the Elder Justice Act (EJA), a bipartisan bill authored by Rep.
Pete King (NY) and sponsored by Rep. Tammy Baldwin (WI) and Rep. Janice
Schakowsky (IL). Senator Orrin Hatch (UT) was the sponsor of the Senate
version of the bill. The EJA was passed over a year ago. Authorized
funding for the EJA is $195 million per year for 4 years, but first
time funding has yet to be appropriated.
Since passage of the EJA, a year later, vulnerable older adults who
should be protected by the law are confronted with the same threats
they faced a year ago. This is a sad reality given the increasing
severity of elder abuse in this country. The most recent study
estimates that 14.1 percent of non-institutionalized older adults
nationwide had experienced some form of elder abuse in the past year.
According to a recent National Institute of Justice study, almost 11
percent of people ages 60 and older (5.7 million) faced some form of
elder abuse in 2009. Financial exploitation of older adults is
increasingly alarming. A 2009 report by the MetLife Mature Market
Institute and the National Committee for the Prevention of Elder Abuse
(NCPEA) estimates that seniors lose a minimum of $2.5 billion each
year. A study of financially exploited older persons in one State found
that 9 percent of the victims had to turn to Medicaid for their care
after their own funds were stolen. Elder financial exploitation
undoubtedly represents a large drain on Medicaid throughout the
country.
In his proposed budget for fiscal year 2012, President Obama
included $21.5 million for Elder Justice Act funding. The proposed
funding would benefit States and local communities and create jobs. Of
the $21.5 million, $16.5 million was included for State adult
protective services, the first and front line responders to cases of
elder abuse in the home. Of these funds, $1.5 million would be used to
prevent and address elder abuse within Tribal nations.
APS workers are faced with increasing and complex caseloads while
both Federal and State funding for these programs lag behind.
Currently, there is no dedicated Federal funding stream for State APS
agencies. A recently released report outlines the challenges APS faces
and notes that Federal leadership on elder abuse prevention is lacking.
Another report points to an overall increase in calls to adult
protective services. Over $100 million is authorized for State APS
programs in fiscal year 2012 and we urge the Subcommittee to use the
President's budget proposal, $21.5 million, as the minimum amount for
APS funding. Strengthening APS will enhance its ability to protect both
older victims and their assets before it is too late.
The President also included an increase of $5 million for the Long-
Term Care Ombudsman Program to improve resident advocacy to elders and
adults with disabilities who reside in a long-term care setting. The
Long-Term Care Ombudsman Program is a critical tool in the fight
against elder abuse yet, consistently underfunded.
We urge you to include a minimum appropriation of $21.5 million for
the Elder Justice Act in your fiscal year 2012 Labor-HHS Appropriations
bill. We thank you for your consideration and please feel free to
contact me with questions or concerns.
______
Prepared Statement of the Eldercare Workforce Alliance
Mr. Chairman and Members of the Subcommittee: We are writing on
behalf of the Eldercare Workforce Alliance (EWA), which is comprised of
28 national organizations united to address the immediate and future
workforce crisis in caring for an aging America. As the Subcommittee
begins consideration of funding for programs in fiscal year 2012, the
Alliance \1\ asks that you consider $54.9 million in funding for the
geriatrics health professions and direct-care worker training programs
that are authorized under Titles VII and VIII of the Public Health
Service Act as follows: $46.5 million for Title VII Geriatrics Health
Professions Programs; $3.4 million for direct care workforce training;
and $5 million for Title VIII Comprehensive Geriatric Education
Programs.
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\1\ The positions of the Eldercare Workforce Alliance reflect a
consensus of 75 percent or more of its members. This testimony reflects
the consensus of the Alliance and does not necessarily represent the
position of individual Alliance member organizations.
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Geriatrics health profession and direct-care worker training
programs are integral to ensuring that America's healthcare workforce
is prepared to care for the Nation's rapidly expanding population of
older adults.
The first of the baby boomers began to turn 65 this year. Within 20
years, one in five Americans will be over 65; 90 percent of those
Americans will have one or more chronic conditions. Despite the growing
need for services, there is a growing shortage of health professionals
and direct-care workers with specialized training in geriatrics and an
even greater shortage of the geriatrics faculty needed to train the
entire workforce.
In 2008, the Institute of Medicine (IOM) issued a ground-breaking
report, Retooling for an Aging America: Building the Health Care
Workforce, which spotlighted these shortages and their impact on
eldercare. The report called for an expansion of geriatrics faculty
development awards to include additional professional disciplines,
increased training for the direct-care workforce, and other efforts to
create a healthcare workforce with adequate capacity to care for older
adults. The Eldercare Workforce Alliance was established to encourage
policymakers to act on the IOM's recommendations for addressing the
eldercare workforce crisis.
The enactment of the Patient Protection and Affordable Care Act
(ACA) was a historic moment for healthcare in this country. ACA makes
important strides toward addressing the severe and growing shortages of
healthcare providers with the skills and training to meet the unique
healthcare needs of our Nation's growing aging population.
ACA includes provisions from the Retooling for an Aging America Act
(S. 245 and H.R. 468 in the 111th Congress), sponsored by Senator Kohl
(D-WI) and Representative Schakowsky (D-IL). These provisions enhance
existing and establish new geriatrics programs in an effort to build
the capacity of the healthcare workforce needed to care for older
adults, as recommended in the IOM report.
We very much appreciate the funding for the Title VII Geriatrics
Health Professions programs that President Obama included in his fiscal
year 2012 budget. We urge you to appropriate adequate funds for
geriatrics training programs in fiscal year 2012 so that we can
immediately begin to realize the healthcare workforce goals set forth
in health reform. Specifically, the Eldercare Workforce Alliance
requests $54.9 million in total funding for the following programs
under Title VII and VIII of the Public Health Service Act:
Title VII Geriatrics Health Professions Appropriations Request: $46.5
Million
Title VII Geriatrics Health Professions programs are the only
Federal programs that: (1) increase the number of faculty with
geriatrics expertise in a variety of disciplines; and (2) offer
critically important geriatrics training to the entire healthcare
workforce.
--Geriatric Academic Career Awards (GACA).--The goal of this program
is to promote the development of academic clinician educators
in geriatrics.
Program Accomplishments.--In Academic Year 2009-2010, GACA funded
84 non-competing continuation awards. GACA awardees provided
approximately 60,000 health professionals with
interdisciplinary geriatrics training. In turn, these trainees
provided culturally competent quality healthcare to over
525,000 underserved and uninsured patients in acute care
services, geriatric ambulatory care, long-term care, and
geriatric consultation services settings.
In 2010, HRSA expanded the awards to be available to more
disciplines. EWA advocated for this expansion and we now want
to ensure that there is adequate funding for this vital
program. Our request of $5.3 million, as reflected in the
President's budget, includes necessary support for 68 Geriatric
Academic Career Awardees, promoting the development of
clinician educators.
--Geriatric Education Centers (GEC).--The goal of the Geriatric
Education Centers is to provide quality interdisciplinary
geriatric education and training to geriatrics specialists and
non-specialists, including family caregivers and direct care
workers.
Program Accomplishments.--In Academic Year 2009-2010, the GEC
grantees provided clinical training to 54,167 health
professional students and to 20,791 interdisciplinary teams in
multiple settings.
As part of the ACA, Congress authorized a supplemental grant
award program that will train additional faculty through a
mini-fellowship program. The program requires awarded faculty
to provide training to family caregivers and direct care
workers. Our funding request of $22.7 million, as reflected in
the President's budget plus $2.7 million for the supplemental
grants, includes support for the core work of 45 GECs and for
the 24 GECs that would be funded to undertake development of
mini-fellowships under the supplemental grants program included
in ACA.
--Geriatric Training Program for Physicians, Dentists, and Behavioral
and Mental Health Professions.--The goal of the GTPD is to
increase the supply of quality and culturally competent
geriatric clinical faculty and to retrain mid-career faculty in
geriatrics. This program supports training additional faculty
in medicine, dentistry, and behavioral and mental health so
that they have the expertise, skills and knowledge to teach
geriatrics and gerontology to the next generation of health
professionals in their disciplines.
Program Accomplishments.--In Academic Year 2009-2010, 11 non-
competing continuation grants were supported. Forty-nine
physicians, dentists, and psychiatric fellows received support
to provide geriatric care to 20,078 older adults across the
care continuum. Geriatric physician fellows provided healthcare
to 12,254 older adults. Geriatric dental fellows provided
healthcare to 4,073 older adults. Geriatric psychiatry fellows
provided healthcare to 3,751 older adults.
Our funding request of $8.5 million, as reflected in the
President's budget, includes support for 13 institutions to
continue this important faculty development program.
--Geriatric Career Incentive Awards Program.--Congress has authorized
this new program created through the ACA, which offers grants
to foster greater interest among a variety of health
professionals in entering the field of geriatrics, long-term
care, and chronic care management. President Obama included $10
million in his fiscal year 2012 budget to establish this awards
program. Our funding request of $10 million, as reflected in
the President's budget, includes support for implementation of
this new program.
Title VII Direct-Care Worker Training Program Appropriations Request:
$3.4 million
Direct-care workers help older adults who need long-term services
and supports including assistance with activities of daily living (e.g.
eating, bathing, dressing, toileting). Expanded training opportunities
for these essential workers are critical to ensuring an adequate
geriatrics workforce. According to current employment projections, more
than 1 million new direct care workers will be needed by 2018 in order
to meet the growing need for care.
--Training Opportunities for Direct Care Workers.--As part of the
ACA, Congress approved an advanced training program for direct
care workers, administered by HHS. Although President Obama's
budget did not include this vital training program, EWA urges
Congress to fund it in order to enhance direct care worker
skills and knowledge, and thereby, improve the quality of care
for older adults. EWA's funding request of $3.4 million
includes support to establish this unique grant program at
community colleges as they look to increase the geriatrics
knowledge and expertise of the direct care workforce.
Title VIII Geriatrics Nursing Workforce Development Programs
Appropriations Request: $5 million
These programs, administered by the HRSA, are the primary source of
Federal funding for advanced education nursing, workforce diversity,
nursing faculty loan programs, nurse education, practice and retention,
comprehensive geriatric education, loan repayment, and scholarship.
--Comprehensive Geriatric Education Program.--The goal of this
program is to provide quality geriatric education to
individuals caring for the elderly. This program supports
additional training for nurses who care for the elderly;
development and dissemination of curricula relating to
geriatric care; and training of faculty in geriatrics. It also
provides continuing education for nurses practicing in
geriatrics.
Program Accomplishments.--In Academic Year 2009-2010, 27 CGEP
grantees provided education and training to [suggest adding all
of these together--total of x professionals in nursing, home
health, as well as lay people] 3,030 Registered Nurses/
Registered Nursing Students; 260 Advanced Practice Nurses; 221
Faculty; 110 Home Health Aides; 483 Licensed Practical/
Vocational Nurses & LPN students; 730 Nurse Assistants/Patient
Care Associates; 810 Allied Health Professionals and 929 lay
persons, guardians, activity directors. The CGEP grantees
provided 459 educational course offerings in the care of the
elderly on a variety of topics to 6,846 participants.
--Traineeships for Advanced Practice Nurses.--Through the ACA, the
Comprehensive Geriatric Education Program is being expanded to
include advanced practice nurses who are pursuing long-term
care, geropsychiatric nursing or other nursing areas that
specialize in care of elderly.
Our funding request of $5 million, as reflected in the
President's budget, includes funds that will continue the
training of nurses caring for the elderly and offer 200
traineeships to nurses under the newly implemented traineeship
program.
Without additional funds in these programs, we will fail to ensure
that America's healthcare workforce will be prepared to care for older
Americans. We understand that the Committee faces difficult budget
decisions. However, we strongly believe that by investing in these
programs, which create geriatrics faculty and offer the training that
is needed to ensure a competent workforce, we will be delivering better
care to America's older adults. Healthcare dollars will be saved from
better care coordination and health outcomes, and the workforce will
grow as more people are trained, recruited and retained in the field of
geriatrics.
On behalf of the members of the Eldercare Workforce Alliance, we
commend you on your past support for geriatric workforce programs and
ask that you join us in expanding the geriatrics workforce at this
critical time--for all older Americans deserve quality of care, now and
in the future.
Thank you for your consideration.
______
Prepared Statement of the FSH Society, Inc.
Honorable Senator Harkin, Mr. Chairman, Honorable Senator Shelby,
Ranking Member, Subcommittee members and members of the U.S. Senate
Appropriations Committee, Subcommittee on Labor, Health and Human
Services, Education and Related Agencies thank you for the opportunity
to submit this testimony.
I am Daniel Paul Perez, of Bedford, Massachusetts, President and
CEO of the FSH Society, Inc. and an individual who has lived with
facioscapulohumeral muscular dystrophy (FSHD) for 48 years. FSHD is
also known as facioscapulohumeral muscular disease, FSH muscular
dystrophy and Landouzy-Dejerine muscular dystrophy. For hundreds of
thousands of men, women, and children the major consequence of
inheriting the most prevalent form of muscular dystrophy is a lifelong
progressive and severe loss of all skeletal muscles. FSHD is a
crippling and life shortening disease. No one is immune, it is
genetically and spontaneously (by mutation) transmitted to children and
it affects entire family constellations.
My testimony seeks to address the urgent need for NIH to redress
and increase funding for research on FSHD.
A consortium of European partners known as Orphanet, led by the
French government research agency, INSERM (Insitut National de la Sante
et de la Recherche Medicale), that is comparable to the United States.
NIH, which includes both government and private members, has issued new
epidemiology and prevalence data for hundreds of diseases that ranks
FSHD as the first and most prevalent muscular dystrophy. The ``Orphanet
Series'' report November 2010, ``Prevalence of Rare Diseases'' report
can be found at Internet web site: (http://www.orpha.net/orphacom/
cahiers/docs/GB/Prevalence_of_rare_diseases_by_alphabetical_list.pdf).
FSHD is presented as the third most prevalent muscular dystrophy in the
Muscular Dystrophy Community Assistance, Research and Education
Amendments of 2001 and 2008 (the MD-CARE Act). This new data changes
the findings as listed in the MD-CARE Act. FSHD is 40 percent more
prevalent than Duchenne muscular dystrophy (DMD), now recognized as the
second most prevalent dystrophy.
------------------------------------------------------------------------
Cases/
Estimated Prevalence 100,000
------------------------------------------------------------------------
Facioscapulohumeral muscular dystrophy (FSHD)............. 7
Duchenne (DMD) and Becker dystrophy (BMD)................. 5
Steinert myotonic dystrophy (DM).......................... 4.5
------------------------------------------------------------------------
Figures from the online NIH database RCDC RePORT and the NIH
Appropriations History for Muscular Dystrophy report provided by NIH/OD
Budget Office & NIH OCPL show that from the inception of the MD CARE
Act 2001, funding has more than quadrupled from $21 million to $86
million in fiscal year 2010 for muscular dystrophy. In fiscal year
2010, total muscular dystrophy funding grew by 3.6 percent ($3 million/
$83 million) over the previous fiscal year.
In fiscal year 2010, FSHD funding represented 7 percent of the NIH-
wide muscular dystrophy budget ($6 million/$86 million). In the
previous year, FSHD represented 6 percent of the total muscular
dystrophy funding ($5 million/$83 million). FSHD funding as a
percentage of overall NIH muscular dystrophy funding has been level
over the last 9 years.
NATIONAL INSTITUTES OF HEALTH (NIH) FSHD FUNDING AND APPROPRIATIONS
[Dollas in millions]
------------------------------------------------------------------------
FSHD as a
Percentage
of Total
Fiscal Year FSHD NIH
Research Muscular
Dystrophy
Funding
------------------------------------------------------------------------
2006......................................... $1.7 4
2007......................................... 3 5
2008......................................... 3 5
2009......................................... 5 6
2010......................................... 6 7
------------------------------------------------------------------------
Sources: NIH/OD Budget Office & NIH OCPL & NIH RCDC RePORT.
We highly commend the NIH on the ease of use and the continued
accuracy of the Research Portfolio Online Reporting Tool (RePORT)
report ``Estimates of Funding for Various Research, Condition, and
Disease Categories (RCDC)'' with respect to reporting projects on
muscular dystrophy.
Now that FSHD has been established as the most prevalent muscular
dystrophy, and in light of recent advances in research it makes no
sense that FSHD remains the most underfunded dystrophy by the NIH and
in the Federal research agency system (CDC, DOD and FDA). Given FSHD's
prevalence, disease burden, the overall percentage of funding of the
muscular dystrophy research portfolio and major mechanistic
breakthroughs on FSHD etiology in 2010 and 2011, we ask Congress to
urge NIH to provide a catalyst for scientific opportunity in FSHD.
Inter-dystrophy funding changes and comparisons year after year
clearly depicts that NIH FSHD funding needs to be increased and set
right. Intra-dystrophy funding changes are misleading as a large change
in a small number is still an anemic amount. In fiscal year 2010, the
most prevalent muscular dystrophy, FSHD, received a $1 million increase
from NIH to $6 million, up 20 percent from $5 million. In fiscal year
2010, the second most prevalent, Duchenne (DMD/BMD) type, received a $5
million increase from NIH to $38 million, up 15 percent from $33
million. In fiscal year 2010, the third most prevalent myotonic
dystrophy (DM) type, received $1 million less from NIH to $12 million
down 8 percent from $13 million. There is an obvious funding disparity
as the first and third most prevalent dystrophies combined, each with
major breakthroughs in the past 2 years, are receiving less than half
of NIH funding that the second prevalent dystrophy with its disease
causing gene being discovered 25 years ago.
The MD CARE Act mandates the NIH Director to intensify efforts and
research in the muscular dystrophies, including FSHD, across the entire
NIH. It should be very concerning that: (1) in the last 9 years
muscular dystrophy has quadrupled to $86 million and that FSHD has
remained on average at 5 percent of the NIH muscular dystrophy
portfolio; (2) FSHD, the most prevalent muscular dystrophy is far
underrepresented based on percentage of overall NIH dystrophy funding
given its prevalence and disease burden; and (3) that both FSHD and DM
have had extraordinary major breakthroughs in understanding the disease
mechanism in the current and past fiscal years and NIH funding remains
level in one and has declined in the other.
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
NIH Funding Percentage of Total MD
-------------------------- funding at NIH
Muscular Dystrophy Type -------------------------
Fiscal Year Fiscal Year Fiscal Year Fiscal Year
2009 2010 2009 2010
----------------------------------------------------------------------------------------------------------------
FSHD........................................................ $5 $6 6 7
DMD/BMD..................................................... 33 38 40 44
DM.......................................................... 13 12 16 14
----------------------------------------------------------------------------------------------------------------
Two major breakthroughs on FSHD occurred in fiscal year 2010 and
fiscal year 2011 that make it urgent for the NIH to redress funding for
FSHD. On August 19, 2010, a paper titled, ``A Unifying Genetic Model
for Facioscapulohumeral Muscular Dystrophy'' [Science 24 September
2010: Vol. 329 no. 5999 pp. 1650-1653] was published online in the top-
rated journal by a group of researchers who started their careers in
FSHD research with post-doctoral fellowships from the FSH Society. This
paper was a major breakthrough in understanding how FSHD works. It made
the front page of the New York Times on the following day. The Times
article ``Reanimated `Junk' DNA Is Found to Cause Disease,'' quoted Dr.
Francis Collins, a human geneticist and Director of the National
Institutes of Health saying, ``If we were thinking of a collection of
the genome's greatest hits, this would go on the list.'' Dr. Collins
went on to say, ``Well, my gosh, . . . here's a simple disease with an
incredibly elaborate mechanism. To come up with this sort of mechanism
for a disease to arise--I don't think we expected that.'' Professor
David E. Housman, FSH Society Scientific Advisory Committee Chairman
and a geneticist at Massachusetts Institute of Technology (M.I.T.), was
quoted saying, ``Scientists will now be looking for other diseases with
similar causes, and they expect to find them. As soon as you understand
something that was staring you in the face and leaving you clueless,
the first thing you ask is, `Where else is this happening?' ''
Two months later, another paper was published that originated with
seminal funding from the FSH Society that made a second critical
advance in determining the cause of FSHD. ``Facioscapulohumeral
Dystrophy: Incomplete Suppression of a Retrotransposed Gene'' was
published in PLoS Genetics, October 28, 2010, that made a second
critical advance in FSHD. The research shows that FSHD is caused by the
inefficient suppression of a gene that may be normally expressed only
in early development. The international team of researchers led by
Stephen Tapscott, M.D., Ph.D., a member of the Hutchinson Center's
Biology Division thinks that the work will lead to new approaches for
therapy and new insights into human evolution of disease.
The international FSHD clinical and research community recently
came together at the DHHS NIH Eunice Kennedy Shriver National Institute
of Child Health and Human Development (NICHD) Boston Biomedical
Research Institute Senator Paul D. Wellstone MD CRC for FSHD. Almost 90
scientists working on FSHD globally met at the 2010 FSH Society FSHD
International Research Consortium, held October 21-22, 2010 to identify
areas of scientific opportunity in FSHD that need funding. The summary
and recommendations of the group state that given the recent
developments in our definition of FSHD, that within 1 to 2 years
evidence-based intervention strategies, therapeutics, and trials need
to be planned and conducted. Our immediate priorities should be to
confirm that the DUX4 gene hypothesis is valid. Then we must understand
the normal DUX4 function. Finally, we must understand the naturally
occurring variability to enable us to manipulate the disease in our
favor. We need to be prepared for this new era in the science of FSHD
by accelerating efforts in the following 10 areas: Shareable protocols;
common and shareable materials and data by the whole community;
corroborate and verify DUX4 finding; FSHD alleles in context of
population genetics need to be defined; biomarkers; FSHD clinical
evaluation scales/systems need be defined under one agreed standard;
Working Groups/animal and mouse model working group consortium; model
systems for mechanistic, intervention work and advancement to clinical
trials; Epigenetics/Genetics; clinical trials readiness.
To read the expanded summary and recommendations of the group
please go to online file at: http://www.fshsociety.org/assets/pdf/
IRCWorkshop2010WorkingConsensusOfPrioritiesGalley.pdf.
It is impossible to justify the current low level of FSHD funding
in the current context of muscular dystrophy budget at the NIH. We have
worked hard with our scientific colleagues and member patients and
families to build the corpus of knowledge to understand FSHD. We have
made great progress in understanding our own disease. We have worked
side by side with the NIH directors, program and legislative staff the
whole distance to these remarkable discoveries. Still, there has been a
confounding and recalcitrant lack of traction at NIH for funding in
FSHD. Our request to the NIH--increase FSHD funding now!
NIH constantly reminds us that the NIH system of peer-review
delivers the best science from investigator initiated grant
applications, thus delivering quality science to the American taxpayer.
NIH is receiving more and more grant applications on FSHD. As a
nonprofit volunteer health agency that funds breakthrough research
based on peer-review mechanics and on a shoe-string compared to NIH, we
appreciate the need for peer review, the need to fund the best science
and also the need to recalibrate the process to ensure that pragmatic
and necessary choices are being pursued in the advent of paradigmatic
changes in a disease. We FSHD patients and fellow citizens appreciate
this as taxpayers as well.
What it comes down to is--the choice of ``the best science'' in a
disease area and how this has been achieved. This is difficult to
measure except in hindsight e.g. what hypotheses represent the best
science. The Director of NIH said, set this down, take note, this is 1
of the 10 greatest discoveries in human genomics and that we never
expected diseases to be caused by unwanted RNA from reanimated junk
DNA. The implications are enormous. FSHD has an incredibly elaborate
mechanism that we did not expect. We now know that inadvertent
expression of DUX4 from a stretch of reactivated ``junk-DNA'' causes
muscle disease known as FSHD. It is clear that this type of research
does not and has not done well in peer-review and it is obvious by the
fact that funding is dwarfed. Looking back at the recent NIH Request
For Proposals (RFAs) that covered FSHD we can see that all of the
breakthrough D4Z4 DUX4 gene grant applications went unfunded by NIH.
Perhaps the study sections need to be pulled apart and examined in the
broader context of muscular dystrophy. Perhaps comparing Duchenne,
Myotonic and FSHD is now much akin to determining the best science in
computer science and biology combined. Computer science and biology
seems an obvious apples to oranges comparison. We are saddened that the
most brilliant work on FSHD was turned away by the NIH. It is crystal
clear, if not completely black and white, that FSHD is not achieving
the goals of parity in funding as set down in mandates set forth in the
MD CARE Acts 2001/2008 and by the NIH Action Plan for the Dystrophies
submitted to the Congress by the NIH.
As you know, we are impressed with the efforts of NIH staff and
Muscular Dystrophy Coordinating Committee (MDCC) on behalf of the
community of patients and their families with muscle disease and the
research community pursuing solutions for all of us. We recognize in
particular the efforts and hard work of the following NIH staff: Story
Landis, Ph.D. and John D. Porter, Ph.D. of National Institute of
Neurological Disorders and Stroke (NINDS); Stephen I. Katz, M.D., Ph.D.
and Glen H. Nuckolls, Ph.D. and Vittorio Satorelli, Ph.D., National
Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS);
James W. Hanson, M.D. and Ljubisa Vitkovic, M.D., Ph.D., (NICHD).
The pace of discovery and numbers of experts in the field of
biological science and clinical medicine working on FSHD are rapidly
expanding. Many leading experts are now turning to work on FSHD not
only because it is one of the most complicated and challenging problems
seen in science, but because it represents the potential for great
discoveries, insights into stem cells and transcriptional processes and
new ways of treating human disease.
We request this year in fiscal year 2012, immediate help for those
of us coping with and dying from FSHD. We ask NIH to fund research on
facioscapulohumeral muscular dystrophy (FSHD) at a level of $35 million
in fiscal year 2012. In view of the tremendous breakthroughs in FSHD
research that may rewrite genetics, we implore the NIH to immediately
address the inadequacy in FSHD muscular dystrophy funding.
We implore the Appropriations Committee to request that the
Director of NIH, the Chair, and Executive Secretary of the Federal
advisory committee MDCC to increase the amount of FSHD research and
projects in its portfolios using all available passive and pro-active
mechanisms and interagency committees.
We request that NIH be more proactive in facilitating grant
applications (unsolicited and solicited) from new and existing
investigators and through new and existing mechanisms, special
initiatives, training grants and workshops--to bring knowledge of FSHD
to the next level.
We ask NIH to consider increasing the scope and scale of the
existing DHHS U.S. NIH Senator Paul D. Wellstone Muscular Dystrophy
Cooperative Research Centers (U54) to double or triple their size--they
are financially under-powered as compared to their potential. These
centers have provided an excellent source of human biomaterials and are
a catalyst for research, clinical research and training on muscular
dystrophy. We ask NIH to develop funding mechanisms to help expand work
from NIH Wellstone Centers outward to address needs and priorities of
the scientific communities.
We ask NIH for more than one Wellstone center solely dedicated to
FSHD. There needs to be one-half dozen groups with 6 to 10 people
solely working on FSHD across the United States to assure continuity in
FSHD efforts.
We strongly support research discovery through the use of post-
doctoral and clinical training fellowships--a model that has worked
very effectively for us. It produces results and progeny. Yet, NIH has
only a few fellows in dystrophy. We request that NIH issue an RFA to
exclusively fund 12 new post-doctoral fellows and four clinical fellows
a year on an ongoing basis for the next 5 years on FSHD. We ask that
FSHD be the pilot dystrophy for such initiative.
We request that the Director of the NIH initiate solely for FSHD an
RFA for Specialized Centers (P50s) to encourage multidisciplinary
research approaches on the complexity of FSHD.
We request that the Director of the NIH redress the low level of
funding in FSHD by issuing an RFA exclusively for FSHD to allow it to
be a prototype disease in the newly forming National Center for
Advancing Translational Sciences. This will help advance the
translational science in FSHD and catalyze the development of novel
diagnostics and therapeutics for FSHD.
We request that the Directors of the NIH develop, through an RFA
for FSHD, a central place where clinical trials can be designed and run
on animal models of FSHD (mouse, dog, sheep, etc.). It is cost
prohibitive to have each U54, P01, P50 funding infrastructure to
support these resources. We ask that FSHD be the proof-of-concept
disease for such a facility.
Thanks to your efforts and the efforts of your Committee, Mr.
Chairman, the Congress, the NIH and the FSH Society are all working to
promote progress in FSHD. Our successes are continuing and your support
must continue and increase.
Mr. Chairman, thank you for this opportunity to testify before your
committee.
______
Prepared Statement of the Federation of American Societies for
Experimental Biology
The Federation of American Societies for Experimental Biology
(FASEB) urges Congress to make investment in the National Institutes of
Health (NIH) an urgent national priority and respectfully requests an
appropriation of $35 billion for the agency in fiscal year 2012. This
figure represents an increase that responds to the effects of inflation
on the current program level and is needed to continue ongoing
initiatives and prevent severe damage to the Nation's capacity for
innovation in its fight against disease.
As a federation of 23 scientific societies, FASEB represents more
than 100,000 life scientists and engineers, making it the largest
coalition of biomedical research associations in the United States.
FASEB's mission is to advance health and welfare by promoting progress
and education in biological and biomedical sciences, including the
research funded by NIH, through service to its member societies and
collaborative advocacy. FASEB enhances the ability of scientists and
engineers to improve--through their research--the health, well-being,
and productivity of all people.
NIH is the driving force behind our Nation's leadership in
biomedical science and the dramatic improvements in our health and
quality of life. Because of NIH and the research it supports, we stand
on the brink of an era of enormous potential progress against the
ravages of disease. NIH funds the research of more than 325,000
scientists at over 3,000 universities, medical schools, and other
research institutions across the United States. Eighty percent of NIH
funding is distributed through competitive grants to researchers in
nearly every congressional district and the U.S. territories. More than
130 Nobel Prize winners have received support from the agency. NIH
considers many different perspectives in establishing scientific
priorities and identifies and, within the limits of its budget, funds
the most promising and highest quality research to address them. NIH is
also training the next generation of researchers to ensure that the
United States continues to be a global leader in advancing medical
science.
Improving Health, Saving Lives
Research funded by NIH has produced an outstanding legacy. NIH-
funded discovery has meant that more than 1 million lives per year are
saved due to therapies to prevent heart attacks and stroke. That alone
has increased American life expectancy by 4 years. Biomedical research
discovery has also meant that since 2002 deaths from cancer have
steadily declined; and in the past 30 years, survival rates for
childhood cancers have increased from less than 50 percent to over 80
percent. More recent advances include:
--Improving Treatments for Acute Myeloid Leukemia (AML).--
Investigators have discovered mutations in a gene that affects
the treatment prognosis for some patients with AML, an
aggressive blood cancer that kills 9,000 Americans annually.
The findings may help guide future treatment strategies for
individuals with AML, as well as lead to more effective
therapies for patients who carry the mutations.
--Increasing Pediatric Cancer Survival Rates.--A new form of
immunotherapy has significantly improved survival rates of
children with neuroblastoma, a deadly nervous system cancer
responsible for 12 percent of all cancer deaths in children
under age 15. The new therapy has dramatically increased the
percentage of children who were alive and free of disease
progression after 2 years.
--Reversing Aspects of Aging.--Researchers have reversed age-related
degeneration in a mouse model of aging. While the findings
don't prove that natural aging could be halted or reversed,
they may lead to new strategies to combat certain age-related
conditions.
--Rapidly Detecting Tuberculosis (TB).--Scientists have developed an
automated test that can rapidly and accurately detect TB and
drug-resistant TB in patients. The finding could pave the way
for earlier diagnosis and more targeted treatment of this
disease. TB kills about 1.8 million people each year, and drug-
resistant TB is a growing threat. The new test makes it
possible to detect TB and drug resistance in a single clinic
visit and perhaps begin treatment immediately.
Predictable and Sustainable Funding Will Drive Innovation and Progress
Our leadership in biomedical research has made us the envy of the
rest of the world. Our dominant position in the discovery of new drugs
and therapies is the result of research conducted by scientists and
engineers in academia and in the biotech firms that they have
started.\1\ A study published in the February 9 issue of the New
England Journal of Medicine found that 153 new drugs approved by the
U.S. Food and Drug Administration during the past 40 years were
discovered at least in part by public sector research institutions
(universities, research hospitals, nonprofit research institutes, and
Federal laboratories), highlighting the increasingly important role of
the public sector in the development of pharmaceuticals and other
medical interventions.\2\ At present, the NIH budget is insufficient to
fund all of the promising research that needs to be done. Less than one
in five research proposals can be funded. Over the past 6 years, the
number of research project grants funded by NIH has declined in almost
every year, and the agency is now funding 2,000 fewer grants that it
did in 2004. Due to the extreme competition for support, NIH grant
applicants have pared their funding requests to the bare minimum needed
to fulfill the goal of their research.
---------------------------------------------------------------------------
\1\ R. Kneller, Nature Reviews: Drug Discovery 9 (November) 2010.
\2\ Ashley J. Stevens, D.Phil., Jonathan J. Jensen, M.B.A., Katrine
Wyller, M.B.E., Patrick C. Kilgore, B.S., Sabarni Chatterjee, M.B.A.,
Ph.D., and Mark L. Rohrbaugh, Ph.D., J.D. The Role of Public-Sector
Research in the Discovery of Drugs and Vaccines, New England Journal of
Medicine, February 9, 2011.
---------------------------------------------------------------------------
If we fail to continue to capitalize on our investment, others
will. We have built laboratories, trained young researchers, and
initiated exciting new projects. Potentially revolutionary new avenues
of research hold promise for earlier screening and better therapies,
but these advances will not become a reality unless the NIH budget is
sustained and enhanced to meet inflation's demands. Failure to continue
our commitment to biomedical research will terminate important
scientific investigations, stunt graduate training, and discourage
young scientists who are the key to our future.
The NIH budget is currently $34 billion (including supplemental
appropriations). Exciting new initiatives at NIH are poised to
accelerate our progress in the search for cures, and it would be tragic
if we could not capitalize on the many opportunities before us. A
modest increase over the current program level is needed to continue
ongoing initiatives and prevent severe damage to our capacity for
innovation. Maintaining our current level of effort requires an
increase equal to the biomedical research and development price index
(BRDPI), which the Bureau of Economic Analysis in the U.S. Department
of Commerce estimates will be 3 percent in fiscal year 2012.
A small fraction of our Federal budget, research funding generates
an enormous return in new technologies and improved quality of life.
Boom and bust cycles are wasteful and inefficient strategies for
funding science. The Nations medical research agency needs sustainable
and predictable budget growth to maximize the return on this investment
in the health and longevity of all Americans. To that end, FASEB
recommends an appropriation of $35 billion for NIH in fiscal year 2012.
Thank you for the opportunity to offer FASEB's support for NIH.
______
Prepared Statement of Friends of the Health Resources and Services
Administration
The Friends of HRSA is a nonprofit and non-partisan alliance of
more than 180 national organizations, collectively representing
millions of public health and healthcare professionals, academicians
and consumers. The coalition's principal goal is to ensure that HRSA's
broad health programs have continued support in order to reach the
populations presently underserved by the Nation's patchwork of health
services.
HRSA operates programs in every State and territory and thousands
of communities across the country and is a national leader in providing
health services for individuals and families. The agency serves as a
health safety net for the medically underserved, including the 50
million Americans who were uninsured in 2009 and 60 million Americans
who live in neighborhoods where primary healthcare services are scarce.
To respond to these challenges, it is the best professional judgment of
the members of the Friends of HRSA that the agency will require an
overall funding level of at least $7.65 billion for fiscal year 2012.
While we recognize the reality of the current fiscal climate, our
request of $7.65 billion represents the minimum amount necessary for
HRSA to continue to meet the healthcare needs of the American public.
Anything less will undermine the efforts of HRSA programs to improve
access to quality healthcare for millions of our neediest citizens.
Additionally, the Friends of HRSA coalition members remain concerned
about the deep cuts made to the agency in the final fiscal year 2011
Continuing Resolution and the negative consequences for public health.
Therefore, the requested minimum level of funding for fiscal year 2012
is essential to allow the agency to carry out critical public health
programs and services that reach millions of Americans, including
training for public health and healthcare professionals, providing
primary care services through community health centers, improving
access to care for rural communities, supporting maternal and child
healthcare programs, and providing healthcare to people living with
HIV/AIDS. However, much more is needed for the agency to achieve its
ultimate mission of ensuring access to culturally competent, quality
health services; eliminating health disparities; and rebuilding the
public health and healthcare infrastructure.
Our $7.65 billion fiscal year 2012 HRSA funding request is based
upon recommendations provided by coalition members to support HRSA
programs including:
--Health Professions programs support the education and training of
primary care physicians, nurses, dentists, dental hygienists
physician assistants, nurse practitioners, public health
personnel, mental and behavioral health professionals,
optometrists, pharmacists, and other allied health providers;
improve the distribution and diversity of health professionals
in medically underserved communities; and ensure a sufficient
and capable health workforce able to provide care for all
Americans and respond to the growing demands of our aging and
increasingly diverse population. In addition, the Patient
Navigator Program helps individuals in underserved communities,
who suffer disproportionately from chronic diseases, navigate
the health system.
--Primary Care programs support community health centers operating in
more than 8,000 communities in every State and territory,
improving access to cost-effective and high-quality primary and
preventive care in rural and urban underserved areas. In
addition, the Health Centers program targets the country's most
vulnerable populations, including migrant and seasonal farm
workers, homeless individuals and families, and those living in
public housing.
--Maternal and Child Health Flexible Maternal and Child Health Block
Grants, Healthy Start and other programs provide services,
including prenatal and postnatal care, newborn screening tests,
immunizations, school-based health services, mental health
services, and well-child care for more than 34 million
uninsured and underserved women and children not covered by
Medicaid or the Children's Health Insurance Program, including
children with special needs.
--HIV/AIDS programs provide assistance to metropolitan and other
areas most severely affected by the HIV/AIDS epidemic; support
comprehensive care, drug assistance and support services for
people living with HIV/AIDS; provide education and training for
health professionals treating people with HIV/AIDS; and address
the disproportionate impact of HIV/AIDS on women and
minorities.
--Family Planning Title X programs provide reproductive healthcare
and other preventive services for more than 5 million low-
income women at over 4,500 clinics nationwide. These programs
improve maternal and child health outcomes, prevent unintended
pregnancies, and reduce the rate of abortions.
--Rural Health programs improve access to care for the 60 million
Americans who live in rural areas. Rural Health Outreach and
Network Development Grants, Rural Health Research Centers,
Rural and Community Access to Emergency Devices Program, and
other programs are designed to support community-based disease
prevention and health promotion projects, help rural hospitals
and clinics implement new technologies and strategies, and
build health system capacity in rural and frontier areas.
--Special Programs include the Organ Procurement and Transplantation
Network, the National Marrow Donor Program the C.W. Bill Young
Cell Transplantation Program, and National Cord Blood
Inventory. Strong funding would facilitate an increase in
organ, marrow, and cord blood transplantation.
Greater investment is necessary to sufficiently fund HRSA services
and programs that continue to face increasing demands. We urge you to
consider HRSA's role in building the foundation for health service
delivery and ensuring that vulnerable populations receive quality
health services, while continuing to strengthen our Nation's health
safety net programs. By supporting, planning for and adapting to change
within our healthcare system, we can build on the successes of the past
and address new gaps that may emerge in the future.
We appreciate the Subcommittee's hard work in advocating for HRSA's
programs in a climate of competing priorities. The members of the
Friends of HRSA thank you for considering our fiscal year 2012 request
for $7.65 billion for HRSA in the fiscal year 2012 Labor, Health and
Human Services, Education, and Related Agencies Appropriations bill and
are grateful for this opportunity to present our views to the
Subcommittee.
______
Prepared Statement of Friends of the National Center on Birth Defects
and Developmental Disabilities Advocacy Coalition
The Friends of NCBDDD Advocacy Coalition recommends that Congress
provide at least $144 million in fiscal year 2012 to sustain the vital
programs and activities funded by NCBDDD. Furthermore, we call on
Congress to ensure any program modifications do no harm for children
and adults currently served by the Center and that funds intended to
directly benefit the targeted populations not be diverted.
CDC's National Center on Birth Defects and Developmental
Disabilities (NCBDDD) works to prevent birth defects and developmental
disabilities and help people with disabilities and blood disorders live
the healthiest life possible. It is the only CDC Center whose primary
mission is focused on birth defects, disability and blood disorders.
2011 marks the 10th year of the Center's accomplishments.
NCBDDD impacts millions of our Nation's most vulnerable: infants
and children, people with disabilities, and people with blood
disorders. During times of increasing fiscal constraint, NCBDDD is
committed to finding strategic approaches to support and strengthen
core public health activities for these vulnerable and underserved
populations. Public health is the science and art of preventing disease
and disability, promoting physical and behavioral wellness, supporting
personal responsibility, and prolonging life in communities where
people live, work, and learn. Building upon the latest science and
evidence-based research, the Center has identified key priorities to
these populations to ensure continued public health advancements are
made, as well as demonstrating sound returns on investments.
Child Health and Development--Assuring Child Health
Division of Birth Defects and Developmental Disabilities
Success in this NCBDDD program area includes rapidly translating
research findings into prevention strategies that prevent birth defects
and developmental disabilities, focusing attention on the importance of
early care and special intervention services for children born with a
birth defect or developmental disability, and supporting parents in
helping their children grow into healthy, safe, productive members of
society.
Health and Development for People with Disabilities--Improving the
Health of People with Disabilities
Division of Human Development and Disability
This spectrum of NCBDDD activities promotes healthy development and
reduces health disparities across the life course for persons with or
at risk of disability. Program goals include: Improving the health and
developmental outcomes for children, improving the quality of life and
life expectancy for people with disabilities, and eliminating health
disparities faced by persons of all ages living with disabilities.
Public Health Approach to Blood Disorders
Division of Blood Disorders
The history of NCBDDD activities in this area includes bleeding and
clotting disorders, hemoglobinopathies and blood product safety. The
future of blood disorders is predicated on building upon our past
successes and expanding our public health activities to begin
addressing the most prevalent, costly, and debilitating bleeding and
clotting disorders.
CDC's National Center on Birth Defects and Developmental Disabilities
(NCBDDD) Focus on Public Health-Social Impact-Safety Net Need
of the Populations Served
The Friends advocacy coalition calls on congressional appropriators
and the administration to continue to focus the Center's programs on
outcomes that affect positive public health, positive social impact,
and the safety net purpose. These include:
Assuring Child Health
Decrease or eliminate birth defects and developmental disabilities
occurring due to known causes.
Improve longer term outcomes of children with birth defects,
autism, and other developmental disabilities, and eliminate racial/
ethnic disparities in these outcomes.
Identify preventable risk factors of birth defects and
developmental disabilities, and develop appropriate interventions to
reduce these risks.
Increase early identification and intervention for infants and
young children with disabling conditions.
Mediate the impact of poverty on developmental outcomes for young
children.
Improving the Health of People with Disabilities
Change individual health behaviors to improve health in children,
youth, and adults with disabilities.
Improve healthcare access and screening for children, youth, and
adults with disabilities.
Reduce the incidence of secondary conditions by increasing health
promotion and wellness interventions for children and adults with
disabilities.
Improve public health surveillance systems to track the health,
development, and participation of persons with disabilities across the
life course.
Implement fully the Section 4302 ``Patient Protection and
Affordable Care Act'' intent, expectations, and requirements in
``Understanding Health Disparities: Data Collection and Analysis''
including ``disability status'' as well as Section 5307 ``Cultural
Competency, Prevention, and Public Health'' including ``individuals
with disabilities training.''
Public Health Approach to Blood Disorders
Improve the life expectancy of people with Sickle Cell Disease.
Reduce the morbidity and mortality related to bleeding disorders in
women.
Reduce the incidence of DVT/PE, and prevent related mortality and
serious morbidity.
Prevent emerging morbidities of people with bleeding disorders.
Positive Outcomes
These outcomes should positively affect several social impact goals
to improve the life situation of persons with disabilities and other
challenges. These include:
--Seamless, positive, and helpful transitions from one of life's
stages to the next stage in life, such as the transition from
high school to adulthood and work.
--Promotion and support of independent living in the community--a
community participation that encourages and promotes self-
direction.
--Continued coordinated efforts to assist parents and consumers make
informed medical and life decisions.
--Focused activities with the goal of reducing the severity of
disability.
______
Prepared Statement of the Friends of the National Institute on Aging
(NIA)
The Friends of the NIA is a coalition of 50 academic, patient-
centered and not-for-profit organizations that conduct, fund or
advocate for scientific endeavors to improve the health and quality of
life for Americans as we age. As a coalition, we support the
continuation and expansion of NIA research activities and seek to raise
awareness about important scientific progress in the area of aging
research currently sponsored by the Institute.
To ensure that progress in Nation's biomedical, social, and
behavioral research is sustained, the Coalition endorses the NIH fiscal
year 2012 request, $31.7 billion, as a floor and joins the Ad Hoc Group
for Medical Research in supporting $35 billion for NIH as a ceiling.
Given the unique funding challenges facing the NIA, and the range of
promising scientific opportunities in the vast, diverse field of aging
research, the Friends of NIA ask the subcommittee to recommend NIA
receive $1.4 billion in fiscal year 2012--an amount endorsed by the
Leadership Conference on Aging.
The NIA Mission
Established in 1974, NIA leads the national scientific effort to
understand the nature of aging in order to promote the health and well
being of older adults. NIA's mission is three-fold: (1) Support and
conduct genetic, biological, clinical, behavioral, social, and economic
research related to the aging process, diseases and conditions
associated with aging, and other special problems and needs of older
Americans; (2) Foster the development of research- and clinician-
scientists for research on aging; and (3) Communicate information about
aging and advances in research on aging with the scientific community,
healthcare providers, and the public. The NIA fulfills this mission by
supporting both extramural research at universities and medical centers
across the United States and intramural research at laboratories in
Baltimore and Bethesda, Maryland.
Research Activities and Advances
Adding to its strong record of progress throughout its 37-year
history, recent NIA-supported activities and advances have contributed
to improving the health and well-being of older people worldwide. Below
is a summary of some of these most recent activities and advances.
Alzheimer's Disease
Alzheimer's disease (AD) is the most common cause of dementia in
the elderly. Between 2.6 million and 5.1 million Americans aged 65
years and older may have AD, with a predicted increase to 13.2 million
by 2050. While researchers have achieved greater understanding of the
disease, there is no cure. In light of the exploding aging population,
which by 2030 is expected to reach 72 million Americans ages 65 or
older, scientists are in a race against time to prevent an
unprecedented AD epidemic threatening our older population.
NIA is the lead Federal research agency for Alzheimer's disease
(AD). In this regard, the Institute coordinates trans-NIH AD
initiatives and encourages collaboration with other Federal agencies
and private research entities. As illustration of its leadership role,
NIA partnered with the McKnight Brain Research Foundation to support
the 2010 Cognitive Aging Summit. This meeting, a follow-up to a 2007
summit, brought together experts in a variety of research fields to
discuss advances in understanding brain and behavioral changes
associated with normal aging, including clinical translational research
for prevention of age-related cognitive decline.
As part of its ongoing AD Neuroimaging Initiative (ADNI), the
largest public-private partnership currently in AD research, NIA-funded
researchers continued to make important progress in 2010. Phase two is
underway to define changes in brain structure and function as people
transition from normal cognitive aging to mild cognitive impairment
(MCI is often a precursor to Alzheimer's) to AD. Using imaging
techniques and biomarker measures in blood and cerebrospinal fluid
(CSF), ADNI investigators have already established a method and
standard of testing levels of AD characteristic tau and beta-amyloid
proteins in the CSF, correlated levels of these proteins with changes
in cognition over time, and determined that changes in these two
protein levels in the CSF may signal the onset of mild AD.
Genetic research on AD is also yielding important insights into the
disease. In 2009 and 2010, several new candidate risk factors gene,
including CR1, CLU, PICALM and SORL1, were identified. Identification
of new pathways that contribute to the development of AD will provide
novel avenues for drug targeting. As part of another initiative, the AD
Translational Initiative, 40 compounds are being studied. In addition,
industry partners are considering several compounds that NIH funded in
the pre-clinical phase for full-scale clinical testing. In total, NIH
currently supports 38 clinical trials, including both pilot and large
scale trials, of a wide range of interventions to prevent, slow, or
treat AD and/or cognitive decline. Any one or more of these trials may
hold the key to curing or preventing this terrible disease.
In a major announcement, revised clinical diagnostic criteria for
AD dementia were published in the April 19, 2011 issue of Alzheimer's &
Dementia: The Journal of the Alzheimer's Association, marking the first
time in 27 years clinical diagnostic criteria and research guidelines
for earlier stages of AD have been revised. The revised guidelines
cover the full spectrum of the disease as it gradually changes over
many years. They describe the earliest pre-clinical stages of the
disease, mild cognitive impairment, and dementia due to AD's pathology.
The guidelines also address the use of imaging and biomarkers in blood
and spinal fluid that may help determine whether changes in the brain
and those in body fluids are due to AD. The guidelines outline some new
approaches for clinicians and provide scientists with more advanced
guidelines for moving forward with research on diagnosis and
treatments.
Increasing Healthy Life Span
Through its Division of Aging Biology, NIA supports research to
improve understanding of the basic biological mechanisms underlying the
process of aging and age-related diseases. The program's primary goal
is to provide the biological basis for interventions in the process of
aging, which is the major risk factor for many chronic diseases
affecting older people. Recent significant findings that could help
advance understanding of a range of chronic diseases, include the
discovery of the drug rapamycin, which has been shown to extend median
lifespan in a mouse model. Grantees supported by this program have also
identified genetic pathways that regulate the maintenance of the stem
cell microenvironment in aging tissues.
In fiscal year 2012, the Institute intends to continue supporting
the Interventions Testing Program to extend median and/or maximal life
span in a mouse model; an initiative to determine cell fates in various
tissues of aged mammals, under both normal and injury conditions; and
studies to identify neural, neuroendocrine, and other mechanisms that
influence age-related changes in bone metabolism and health.
Behavioral and Social Science Research
The Division of Behavioral and Social Research Program supports
social and behavioral research to increase understanding of the aging
process at the individual, institutional, and societal levels. Research
areas include the behavioral, psychological, and social changes
individuals undergo throughout the adult lifespan; participation of
older people in the economy, families, and communities; the development
of interventions to improve the health and cognition of older adults;
and the societal impact of population aging and of trends in labor
force participation, including fiscal effects on the Medicare and
Social Security programs. The Division also leads numerous trans-NIH
behavioral and social science research initiatives, such as the ongoing
Behavioral Economics initiatives.
One of the Division's signature projects, the Health and Retirement
Study (HRS), is recognized as the Nation's leading source of combined
data on health and financial circumstances of Americans over age 50.
HRS data have been cited in over 1,700 scientific papers and have
informed findings regarding the effects of early-life exposures on
later-life health, variables associated with cognitive and functional
decline in later life, and trends in retirement, savings, and other
economic behaviors. In 2010, NIA expanded the HRS to increase minority
representation and conduct genome-wide scans of a subset of
participants. Also, in 2010, HRS data were used by scientists who found
that older adults who survive hospitalization involving severe sepsis,
a serious medical condition caused by an overwhelming immune response
to severe infection, are at higher risk for cognitive impairment and
physical limitations than older adults hospitalized for other reasons.
Funding Challenges
In November 2010, Nature magazine featured an article, ``Funding
crisis hits U.S. ageing research,'' describing funding challenges
facing the NIA and the field of aging research. The article reported
that ``in 2010, a researcher submitting a grant application for any
single deadline had only an 8 percent chance of winning funding''--
falling from 12 percent in 2009. Dr. Richard Hodes, NIA Director, is
quoted as saying the currently funding dilemma ``threaten[s] the
viability of ageing research'' and expresses concern, in particular,
about the effect the declining success rates could have on the morale
of the next generation of scientists and on their ability to compete
successfully for an NIA grant. The dire implications of the Institute's
declining success rates is one reason, among others, that the Friends
of NIA ask the Subcommittee to support $1.4 billion, an increase of
$300 million, for the Institute in fiscal year 2012.
Conclusion
We thank you, Mr. Chairman, and the Subcommittee for supporting the
NIA and, again, for the opportunity to express our support for the
Institute and its important research.
______
Prepared Statement of Futures Without Violence
Futures Without Violence, formerly Family Violence Prevention Fund,
has worked for 30 years to end violence against women and children
around the world, and is proud to be a co-chair the nonpartisan Funding
to End Domestic and Sexual Violence Coalition, a coalition of over 30
national organizations committed to domestic violence, dating violence,
sexual assault, and stalking. As the National Health Resource Center on
Domestic Violence, we provide critical information to thousands of
healthcare providers, institutions, domestic violence service
providers, government agencies, researchers and policy makers each
year. Our public education campaigns, conducted in partnership with The
Advertising Council, have shaped public awareness and changed social
norms for 15 years.
Violence Against Women Health Initiative (HHS Office of Women'
Health).--I wish to request $3.375 million for the Violence Against
Women Health Initiative as authorized by the Violence Against Women and
Department of Justice Reauthorization Act of 2005 (Public Law 109-162);
the President's fiscal year 2012 budget requested $3 million for this
Initiative. The Violence Against Women Health Initiative is a
consolidation of two Violence Against Women Act 2005 programs (Grants
to Foster Public Health Partnerships and Education and Training of
Health Care Providers), and a top LHHS priority by the Funding to End
Domestic and Sexual Violence Coalition. The Violence Against Women
Health Initiative through the Office of Women's Health, with additional
support by the Administration on Children and Families, provides
funding to public health programs that integrate domestic and sexual
violence assessment and intervention into basic care, as well as
encourages collaborations between healthcare providers, public health
programs, and domestic and sexual violence programs. The field is
already seeing impressive results. We strongly support the continued
need to engage health providers to prevent and respond to violence and
abuse. Our other priorities are listed at the end of my testimony.
Domestic and sexual violence is a critical healthcare problem and
one of the most significant social determinants of health for women and
girls. Nearly one in four women in the United States reports
experiencing violence by a current or former spouse or boyfriend at
some point in her life, and one in six women reported experiencing a
completed sexual assault. The Centers for Disease Control and
Prevention (CDC) conservatively estimates that intimate partner rape,
physical assault and stalking costs the healthcare system $8.3 billion
annually from direct injuries and services. In addition to the
immediate trauma caused by abuse, it contributes to a number of chronic
health problems. The CDC classifies violence and abuse as a
``substantial public health problem in the United States.''
Children who experience childhood trauma, including witnessing
incidents of domestic violence, are at a greater risk of having serious
adult health problems including tobacco use, substance abuse, cancer,
heart disease, depression and a higher risk for unintended pregnancy.
Twenty years of research links childhood exposure to violence with
chronic health conditions including obesity, asthma, arthritis, and
stroke. It is worth noting that victims, particularly of sexual
violence, are linked with obesity. A meta-analysis of research on the
impact of adult intimate partner violence finds that victims of
domestic violence are at increased risk for conditions such as heart
disease, stroke, hypertension, cervical cancer, chronic pain including
arthritis, neck and pain, and asthma. In addition to injuries, adult
intimate partner violence also contributes to a number of mental health
problems including depression and PTSD, risky health behaviors such as
smoking, alcohol and substance abuse, and poor reproductive health
outcomes such as unintended pregnancy, pregnancy complications, post
partum depression, poor infant health outcomes and sexually transmitted
infections including HIV.
But early identification and treatment of victims can financially
benefit the healthcare system. Initial findings from one study found
that hospital-based domestic violence interventions may reduce
healthcare costs by at least 20 percent. Preventing abuse or associated
health risks and behaviors clearly could have long term implications
for decreasing chronic disease and costs. Because of the long-term
impact of abuse on a patient's health, the Violence Against Women
Health Initiative is integrating assessment for current and lifetime
physical or sexual violence exposure and interventions into routine
care. Regular, face-to-face screening of patients by skilled healthcare
providers markedly increases the identification of victims of intimate
partner violence, as well as those who are at risk for verbal,
physical, and sexual abuse. Routine inquiry of all patients, as opposed
to indicator-based assessment, increases opportunities for both
identification and effective interventions, validates violence and
abuse as a central and legitimate healthcare issue, and enables
providers to assist both victims and their children.
When victims or children exposed to violence and abuse are
identified early, providers may be able to break the isolation and
coordinate with domestic or sexual violence advocates to help patients
understand their options, live more safely within the relationship, or
safely leave the relationship. Expert opinion suggests that such
interventions in adult health settings may lead to reduced morbidity
and mortality. Assessment for exposure to lifetime abuse has major
implications for primary prevention and early intervention to end the
cycle of violence.
Just as the healthcare system has always played an important role
in identifying and preventing other serious public health problems, I
believe it can and must play a pivotal role in domestic and sexual
violence prevention and intervention. It is clear that by funding these
innovative and life-saving health provisions, we can help save the
lives of victims of violence and greatly reduce healthcare expenses.
In order to advance necessary and needed health goals, I urge you
to fund the following LHHS programs accordingly:
Violence Against Women Health Initiative at $3.375 million
The existing program, entitled ``Project Connect: A Coordinated
Public Health Initiative to Prevent Violence Against Women,'' is
working with two southern California tribes and eight States (Arizona,
Georgia, Ohio, Iowa, Maine, Michigan, Texas, Virginia) to change how
adolescent health, reproductive health, and home visiting programs
respond to sexual and domestic violence. The Initiative is developing
and distributing education and training materials to respond to abuse
across the lifespan. Research demonstrates that women in these programs
are at high risk for abuse, and that there are evidence-based
interventions that can improve maternal and child health, and decreases
the risks for unplanned pregnancy, poor pregnancy outcomes and further
abuse. These sites provide much-needed services for women in abusive
relationships including historically medically underserved communities
that have high rates of domestic and sexual violence, such as rural/
frontier areas, immigrant women, and Native Americans. UC Davis School
of Medicine is implementing an evaluation plan to measure the
effectiveness of both the clinical intervention and policy change
efforts.
The approach includes creating and disseminating:
--Enhanced clinical interventions to respond to domestic and sexual
violence, including training and supporting materials for
providers and health systems,
--Patient education materials on the connection between abuse and
their health,
--Policy and systems change at the local, State and national level,
--National training of providers through an eLearning platform,
--Pilot programs to offer basic health services within domestic and
sexual violence programs, and
--Evaluation and research on the health impact of abuse and the
impact of health-based interventions.
In the first year using fiscal year 2009 funding, the Initiative
had a significant impact:
--With over 1,500 providers from 50 clinical sites receiving
training, programs serving over 200,000 women will integrate
assessment for abuse into routine care and offer help when
needed, using an evidence-based and setting-specific clinical
intervention.
--New education materials for providers and patients/clients have
been developed, including:
--New training curriculum for home visitation programs
--New safety cards for adolescents talking about healthy
relationships
--Twelve new video vignettes an electronic distance learning platform
that will be used to train providers in adolescent,
reproductive and maternal and child health programs nationwide.
--Coordinated State level teams of public health and domestic and
sexual violence partners have been formed to create lasting
health policy and coordinated response to victims. Examples of
policy change include adding assessment of domestic and sexual
violence into statewide nursing guidelines, and improving data
collection by adding new questions about domestic and sexual
violence to statewide surveillance systems.
This year, the sites are continuing this work but building on the
momentum by:
--Implementing an e-learning platform to train tens of thousands of
additional physicians, nurses, and students. Beginning in
Spring 2011, the free online CME trainings will be offered to
Project Connect sites, as well as national health associations,
such as the American College of Obstetricians and
Gynecologists.
--Offering basic health services on site in select domestic and
sexual violence programs in each Project Connect site. Program
strategies include: utilizing mobile health vans, stationing
public health nurses in family violence programs, integrating
basic health assessment questions into domestic violence
shelter intake, and partnering with local providers for ongoing
care.
--Evaluating the impact of Project Connect's clinical intervention on
the health and safety of victims of abuse. In addition to the
initiative-wide evaluation of provider behavior change, four
sites have partnered with local universities to conduct an in-
depth evaluation of the effect that integrating the assessment
of domestic and sexual violence into clinical settings has on
clients.
--Disseminating information on best practice models for integration
in other States/tribes and service settings. Plans include an
educational briefing and development of a report outlining
model programs.
Report Language under Centers for Disease Control and Prevention
Injury Prevention and Control regarding Domestic and Sexual
Violence
In VAWA 2005, Congress approved a program entitled ``Research on
Effective Interventions to Address Violence Against Women'' at $5
million through CDC and ARHQ to support research and evaluation on
effective interventions in the healthcare setting to improve victim's
health and safety and prevent initial victimization. This authorized
program from Public Law 109-162 has not been funded. The President's
fiscal year 2012 budget recommends $20 million of the Prevention and
Public Health Fund go to unintentional injuries through CDCs Injury
Prevention and Control. To fulfill the need recognized by the earlier
VAWA program, I respectfully recommend the following report language:
``The Committee finds that domestic and sexual violence is a
healthcare problem and one of the most significant social determinants
of health for women and girls. In addition to the immediate trauma
caused by abuse, it contributes to a number of chronic health problems.
The CDC classifies violence and abuse as a ``substantial public health
problem in the United States.'' As part of the budget request to fund
unintentional injury prevention activities from the Prevention and
Public Health Fund, the Committee supports a portion of the funding
support the prevention of intentional injuries from lifetime exposure
to intimate partner violence, child maltreatment, youth violence, and
sexual violence.''
Proposed Report Language under HHS Office of Adolescent Health
regarding Teen Dating Violence and Communities of Color
The work by the Office of Adolescent Health to create and
administer the Teen Pregnancy Prevention Program in such a short time
period has been remarkable. That said, adolescents from communities of
color are disproportionately affected by teenage pregnancy, and
research also shows that teenage dating violence and abuse are
associated with higher levels of teenage pregnancy and unplanned
pregnancy. Adolescent girls in physically abusive relationships are
three times more likely to become pregnant than non-abused girls. To
fulfill the promise of the Office of Adolescent Health to holistically
address teen pregnancy prevention, I respectfully recommend the
following report language:
``The Committee strongly urges the Secretary, through the Office of
Adolescent Health, to include teen dating violence prevention and
healthy relationship strategies within existing adolescent health
working groups and better integrate preventing violence and abuse as a
strategy to prevent teen and unplanned pregnancy within communities of
color. Further, the Committee strongly urges the Secretary, though the
Office of Adolescent Health, to conduct a review of the evidence-based
programs chosen by the Teen Pregnancy Prevention Program and issue a
report to determine which programs address teen dating violence and
healthy relationship strategies as a means to prevent teen pregnancy.''
In addition, I ask that you at least meet the President's fiscal
year 2012 request of $135 million for the Family Violence Prevention
and Services Act (FVPSA) under ACF, the Nation's only designated
Federal funding source for domestic violence shelters and services. As
we are all committed to both the prevention of violence and abuse and
to the health and safety of victims, I urge you to fund these critical
programs.
______
Prepared Statement of the Global Health Technologies Coalition
Chairman Harkin, Ranking Member Shelby and members of the
Committee, thank you for the opportunity to provide testimony on the
fiscal year 2012 appropriations funding for the National Institutes of
Health (NIH) and the Centers for Disease Control and Prevention (CDC).
We appreciate your leadership in promoting the importance of
international development, in particular global health. We hope that
your support will continue. I am submitting this testimony on behalf of
the Global Health Technologies Coalition (GHTC), a group of nearly 40
nonprofit organizations working together to advance U.S. policies which
can accelerate the development of new global health innovations--
including new vaccines, drugs, diagnostics, microbicides, and other
tools--to combat global health diseases. The GHTC's members strongly
believe that to meet the global health needs of tomorrow, it is
critical to invest in research today so that the most effective health
solutions are available when we need them, and that the U.S. Government
has a historic and unique role in doing so. My testimony reflects the
needs expressed by our member organizations \1\ which include nonprofit
advocacy organizations, policy think-tanks, implementing organizations,
and many others. One-third of our members are also nonprofit product
development partnerships, which work with partners in the private
biotechnology and pharmaceutical and medical device sectors, as well as
public research institutions, academia, and nongovernmental
organizations to develop new and more effective life-saving
technologies for the world's most pressing health issues. We strongly
urge the Committee to continue its established support for global
health research and development (R&D) by (1) sustaining and protecting
the U.S. investment in global health research and product development,
(2) instructing NIH and CDC, in collaboration with other agencies
involved in global health, to continue their commitment to global
health in their R&D programs, and (3) requiring leaders at U.S.
agencies to put plans in place to ensure that global health R&D is
efficient, coordinated and streamlined.
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\1\ GHTC member list: http://www.ghtcoalition.org/coalition-
members.php.
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Critical need for new global health tools
Our Nation's investments have made historic strides in promoting
better health around the world: nearly 6 million people living with
HIV/AIDS now have access to life-saving medicines, new, cost-effective
tools help us diagnose diseases quicker and more efficiently than ever
before, and innovative new vaccines are making significant dents in
childhood mortality. While we must increase access to these and other
proven, existing health tools to tackle global health problems, it is
just as critical that we continue to invest in developing the next
generation of tools to stamp out disease and address current and
emerging threats. For instance, newer, more robust, and easier to use
antiretroviral drugs, particularly for infants and young children, are
needed to treat (and prevent) HIV and even a 50 percent effective AIDS
vaccine could prevent 1 million HIV infections every year. Drug-
resistant tuberculosis is on the rise globally, including in the United
States, however the only vaccine on the market is insufficient at 90
years old, and most therapies are more than 50 years old, extremely
toxic, and exorbitantly expensive. New tools are also urgently needed
for fatal neglected tropical diseases such as sleeping sickness for
which diagnostic tools are inadequate, and the few drugs that are
available are toxic and difficult to use. There are many very promising
technology candidates in the R&D pipeline to address these and other
health issues; however, these tools will never be available if the
support needed to continue R&D is not protected and sustained.
Research and US global health efforts
The United States is at the forefront of innovation in global
health technologies. For example, as recently as December, a new
meningitis vaccine costing less than 50 cents per dose developed by the
Meningitis Vaccine Project--a partnership between the World Health
Organization and the international nonprofit PATH--was distributed for
the first time in Africa--the development and implementation of which
was supported through strategic funding and scientific expertise from
the CDC, NIH, U.S. Food and Drug Administration (FDA), and the U.S.
Agency for International Development (USAID).
The NIH is the largest funder of global health research in the U.S.
Government, and the agency has recently demonstrated a growing interest
in global health issues. NIH Director Francis Collins made global
health one of his top five priorities for the future of NIH, stating,
``. . . the world has seen us as the soldier to the world. Might we not
do better both in terms of our benevolence and our diplomacy by being
more of a doctor to the world? \2\ The NIH's Fogarty International
Center recently began collaborating with the Department of Health and
Human Services' Health Research Services Administration and the U.S.
Department of State's Office of the U.S. Global AIDS Coordinator on the
Medical Education Partnership Initiative to develop, expand, and
enhance models of medical education. This includes enhancing the
capacity of local individuals to conduct research on global health
diseases. Also recently, the Therapeutics for Rare and Neglected
Diseases (TRND) program at the NIH launched five pilot projects to spur
drug development for diseases including schistosomiasis and hookwoom.
Each of these efforts build on the historic work carried out by the
agency which contributes to improved health around the world.
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\2\ NIH all-hands town meeting, 17 August 2009. http://
videocast.nih.gov/Summary.asp?File=15247.
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With operations in more than 54 countries, the CDC is engaged in
many global health research efforts. The work of CDC scientists has led
to major advances against devastating diseases, including the
eradication of smallpox and early identification of the disease that
became known as AIDS. Although CDC is known for its expertise and
participation in HIV, TB, and malaria programs, it also operates
several activities for neglected diseases in its National Center for
Zoonotic, Vector-Borne, and Enteric Diseases.
Leveraging the private sector for innovation
NIH, CDC, USAID and other agencies involved in global health R&D
regularly collaborate with the private sector in developing,
manufacturing, and introducing important technologies such as those
described above through public-private partnerships, including product-
development partnerships. These partnerships leverage public-sector
expertise in developing new tools, partnering with academia, large
pharmaceutical companies, the biotechnology industry, and governments
in developing countries to drive greater development of products for
neglected diseases for which private industries have not historically
invested. This unique model has generated twelve new global health
products and has enormous potential for continued success if robustly
supported.
In order to more fully engage the private sector in developing
products for global health R&D, additional market-based incentives are
needed. With little-to-no commercial drive to develop new drugs and
vaccines for diseases that primarily affect the developing world,
financial incentives and innovative financing must be pursued. No
single incentive scheme or financing mechanism is capable of filling
all the gaps and encouraging the full range of R&D activities across
all of the diseases and products that the developing world urgently
needs. A portfolio of incentives and financing mechanisms that can fill
the multiple gaps in the product development pipeline for multiple
diseases is needed. NIH should be applauded for its participation in
the small business innovation research awards and a patent pool for HIV
medicines, and additional efforts in this area are encouraged. The
development of new incentive strategies is critical for long-term,
meaningful private-sector engagement in global health.
Innovation as a smart economic choice
Global health R&D brings life-saving tools to those who need them
most, however the benefits these efforts bring are much broader than
preventing and treating disease. Global health R&D is also a smart
economic investment in the United States, where it drives job creation,
spurs business activity, and benefits academic institutions. Biomedical
research, including global health, is a $100 billion enterprise in the
United States. In a time of global financial uncertainty, it is
important that the United States support industries, such as global
health R&D, which build the economy at home and abroad.
History has shown that investing in global health research not only
saves lives but is also a cost-effective approach to addressing health
challenges. And an investment made today can help save significant
money in the future. In the United States alone, for example, polio
vaccinations during the last 50 years have resulted in a net savings of
$180 billion, funds that would have otherwise been spent to treat those
suffering from polio. In addition, new therapies to treat drug-
resistant tuberculosis have the potential to reduce the price of
tuberculosis treatment by 90 percent and cut health system costs
significantly. The United States has made smart investments in research
in the past that have resulted in lifesaving breakthroughs for global
health diseases, as well as important advances in diseases endemic to
the United States. We must now build on those investments to turn those
discoveries into new vaccines, drugs, tests, and other tools.
Recommendations
In this time of fiscal constraint, support for global health
research that improves the lives of people around the world--while at
the same time creating jobs and spurring economic growth at home--
should unquestionably be one of the Nation's highest priorities. In
keeping with this value, the GHTC respectfully requests that the
Committee do the following:
--Sustain and protect U.S. investments in global health research and
product development within both the CDC and NIH budgets. We ask
that this not come at the expense of robust funding for the
entire set of global public health accounts, all of which
complement each other and ultimately serve the common goal of
building a healthier and more prosperous world.
--Instruct all U.S. agencies in its jurisdiction to continue their
commitment to global health in their R&D programs by developing
actions plans, including metrics to measure progress. The
Committee shall request that leaders at NIH and CDC work with
leaders at other U.S. agencies to ensure that efforts in global
health R&D are coordinated, efficient, and streamlined by
establishing transparency mechanisms designed to show what
global health R&D efforts are taking place and how U.S.
agencies are collaborating with each other to make efficient
use of the U.S. investment.
--Request relevant agencies report on their progress to Congress and
be made publicly available. Past accounting of the health R&D
activities at individual agencies, such as Research, Condition,
and Disease Categorization at NIH, have been very helpful in
coordinating efforts between agencies and informing the public
and such efforts should be expanded to include neglected
disease categorization and extended to provide a comprehensive
picture of this investment from all agencies involved in global
health R&D.
We respectfully request that the Committee consider inclusion of
the following language in the report on the fiscal year 2012 State and
Foreign Operations appropriation legislation:
``The Committee recognizes the urgent need for new global health
technologies in the fight against global health diseases, and the
critical contribution that the NIH, CDC, and FDA make to this cause
through their health research and training portfolios, operations
research and regulatory capabilities. The Committee also acknowledges
the urgent need to sustain and protect U.S. investment in this
important research by fully funding these three agencies to carry out
their work.
``New global health products such as drugs, vaccines, diagnostics,
and devices are cost-effective public health interventions that play an
important role in improving global health and are vital in stopping
pandemics. The Committee understands the positive impact that global
health research and development has on the U.S. economy through the
creation of U.S. jobs and the development of foreign markets for U.S.
products. NIH is widely recognized as the world leader in basic
research, and has supplied invaluable breakthroughs that have led to
new health tools, saving millions of lives globally. Through its
Fogarty International Center, NIH harnesses its wealth of expertise to
train the next generation of health scientists.
``The Committee directs the CDC, FDA, and NIH to each create
metrics to measure progress and to develop concrete plans to prioritize
and incorporate global health research, product development, and
regulation into their U.S. global health and development strategies.
The Committee directs CDC, FDA, and NIH to work with each other as well
as the Department of State, the U.S. Agency for International
Development, and the Office of the U.S. Global AIDS Coordinator to
ensure that these efforts are coordinated, efficient, and streamlined
across the agencies involved in implementing the President's Global
Health Initiative. CDC, FDA, and NIH shall each make the documentation
and results of these efforts available to Congress and the public.''
As a leader in science and technology, the United States has the
ability to capitalize upon our strengths to help reduce illness and
death and ultimately eliminate disabling and fatal diseases for people
worldwide, contributing to a healthier world and a more stable global
economy. Sustained investments in global health research to develop new
drugs, vaccines, tests, and other health tools--combined with better
access to existing methods to prevent and treat disease--present the
United States with an opportunity to dramatically alter the course of
global health while building political and economic security across the
globe.
On behalf of the members of the GHTC, I would like to extend my
gratitude to the Committee for the opportunity to submit written
testimony for the record.
______
Prepared Statement of Goodwill Industries International
Mr. Chairman, Ranking Member, and Members of the Subcommittee, on
behalf of Goodwill Industries International (GII), I appreciate this
opportunity to submit written testimony on Goodwill's priorities for
fiscal year 2012 funding programs administered by the U.S. Departments
of Labor, Health and Human Services, and Education.
Goodwill Industries International (GII) represents 158 local and
autonomous Goodwill Industries agencies in the United States that help
people with barriers to employment to participate in the workforce. One
of Goodwill Industries' greatest strengths continues to be its
entrepreneurial approach to sustaining its mission. In 2010, Goodwill
raised more than $4 billion in its retail stores and other social
enterprises and invested 84 percent of its privately raised revenues to
supplement Federal investments in programs that give people the skills
they need to reenter the workforce. Goodwill provided job training,
employment services, and supportive services to nearly 2.5 million
people, placing more than 170,000 people in jobs and employing 97,000.
Nearly 160,000 people were referred to Goodwill from the workforce
system or a State Vocational Rehabilitation Agency. In addition to our
efforts to help people find jobs and advance in careers, Goodwill
understands that many people need additional supportive services--child
care, reliable transportation, stable housing, counseling and
assistance in adjusting to the workplace, assistive technology--to
ensure their success.
Now more than ever, with unemployment slowly declining from the
highest levels experienced in a generation, local Goodwill agencies are
on the front lines of the fragile recovery assisting people with
employment barriers, including individuals with disabilities, older
workers, and Temporary Assistance to Needy Families (TANF) recipients
who are struggling to find and keep jobs during a stubbornly tight job
market. In addition in 2010, Goodwill's collective investment in these
services eclipsed the Department of Labor's combined investment in
WIA's adult, youth, and dislocated workers.
While Goodwill is proud of these and other achievements, they are
truly the result of a public-private partnership. As the fragile
recovery from the worst recession since the Great Depression continues
and unemployment rates slowly decline from near 10 percent, Goodwill
understands the difficult challenge that appropriators face as they
struggle to reduce the deficit while stretching limited resources to
support an ever-increasing list of national priorities. Reducing the
deficit is a serious issue that will require all to make sacrifices to
address the Nation's spending problem while investing in integrated
strategies that build upon and leverage existing resources that will
address our Nation's revenue problem. Therefore, Goodwill was very
concerned about the drastic cuts to the workforce system that were
proposed in the fiscal year 2011 continuing resolution (H.R. 1) that
was passed by the House of Representatives earlier this year, and
thanks the Senate for its efforts to mitigate the cuts in the final
fiscal year 2011 spending deal. As Congress works to develop its
spending bills for fiscal year 2012, Goodwill is again concerned
because the House budget allocation for Labor, Health and Human
Services, and Education is $18 billion less than the amount agreed to
in the final fiscal year 2011 budget deal.
Goodwill is aggressively moving to increase its capacity to do more
to help people find jobs and advance in careers during and after these
difficult times. Goodwill is working to open more stores and attended
donation centers in order to create jobs and generate more privately
raised revenues to invest in people who are facing employment
challenges in the communities that local Goodwill agencies serve. In
addition, Goodwill is more committed than ever to partnering with
stakeholders at the Federal, State, and local levels by contributing
the resources and expertise of local Goodwill agencies in support of
public efforts and investments.
While our agencies care about a range of Federal funding sources,
Goodwill urges Congress to provide funding for the Department of
Labor's Senior Community Service Employment Program (SCSEP); the
Workforce Investment Act's adult, dislocated worker, and youth funding
streams; summer jobs for youth; and the Department of Education's
Vocational Rehabilitation programs.
Senior Community Service Employment Program (SCSEP)
Workers who are 55 and older have multiple barriers to employment
and will be among the last rehired as the economy improves.
Furthermore, according to the Bureau of Labor Statistics, the
unemployment rate for older workers (over 55 years old) was 6.2 percent
in April, 2011. While older workers are less likely to be unemployed
than their younger counterparts, older workers who do lose their jobs
face significant odds of finding another one. The average time spent
looking for a job by someone between the ages of 55 and 64 is 44.6
weeks. Those over the age of 64 also spend nearly 1 year seeking work
for an average of 43.9 weeks. Older workers are more likely to be laid
off from industries that are in structural decline. This population may
be less likely to go back to school as they have other financial
burdens and are less mobile due to home ownership. Finally, these
workers may face age discrimination when applying for a new job.
Therefore, Goodwill is alarmed by the Administration's proposal to cut
funding for the Community Services Employment for Older Americans
program (also called the Senior Community Service Employment Program)
by 45 percent which will result in the elimination of services to
nearly 50,000 low income older workers who badly in need of assistance.
SCSEP helps provide low-income older workers with community
services employment and private sector job placements. Preserving SCSEP
funding is critical as it is the only program targeted to helping low
income seniors regain employment, as this population is experiencing
the toughest employment prospects in a generation. Goodwill is a
national SCSEP grantee with providers around the country. While many
individuals assume that SCSEP is for much older workers and question
the type of training received, 42 percent of Goodwill's SCSEP
participants are between the ages of 55 and 59. In 2010, SCSEP
participants contributed nearly 1.4 million community service hours and
our private sector placements averaged a starting wage of $9.75 per
hour.
In recent years, Congress has demonstrated its commitment to older
workers by providing an additional $120 million for SCSEP in the
Recovery Act, and a $250 million increase in fiscal year 2010. These
funds have allowed local Goodwill agencies to better address our
waiting list of participants and help many older workers with part-time
employment. Private sector placement wages also increased. Goodwill
very much appreciates the monumental investment that the Congress has
placed on helping older workers to survive the economic crisis.
However, as SCSEP program providers prepare for a cut in funding,
community service hours have been cut, new enrollees have not been
accepted, and additional classroom training that has an added cost have
been reduced or eliminated. Should SCSEP be cut further, it will result
in a loss of professional staff and it will be more difficult to get
out to non-urban areas since rural communities will have fewer slots.
Goodwill urges the Subcommittee to reject the Administration's
proposed cuts to SCSEP. At a minimum Congress should fund SCSEP at no
less than $600 million, which will allow a restoration of assistance to
an additional 24,000 participants, nearly half of the participants cut
from the program by funding reductions in the fiscal year 2011
Continuing Resolution.
Workforce Investment Act
Funding for the Workforce Investment Act's youth, adult, and
dislocated worker formulas is one of Goodwill's top funding priorities
for fiscal year 2012. Most Goodwill agencies have people referred to
them through the workforce system. In addition, several agencies are
one-stop lead operators or operators in association with other service
providers, and are active on state and local workforce boards.
It should be noted that, in 2002, when the unemployment rate was
5.8 percent, combined funding for WIA's youth, adult, and dislocated
worker funding streams was more that $3.67 billion. Since then, funding
has steadily eroded; and nearly 10 years later, at a time when the
unemployment rate remains much higher--around 9 percent--the
Administration proposes just $2.96 billion for WIA's three main funding
streams, nearly 20 percent less than the fiscal year 2002 level.
Furthermore, the Administration proposes to divert 8 percent to
contribute to the creation of a Workforce Innovation Fund to ``support
and test promising approaches to training, and breaking down program
silos, building evidence about effective practices, and investing in
what works.''
Goodwill believes that a Workforce Innovation Fund is a promising
idea, is very interested in the details, and is encouraged by the
Administration's efforts to increase interagency collaborations and
leverage resources provided by community-based organizations, however
the proposed Workforce Innovation Funds should be paid for with funds
in addition to, rather than at the expense of, existing WIA formula
funds--in fiscal year 2012 and beyond.
In 2010, the workforce system served more than 8 million people,
placing more than half in jobs while helping others to access education
and training aimed at improving their future employment prospects. As
noted earlier, Goodwill is doing all it can to help people who have
been affected by the recession. In fact in 2010, Goodwill's collective
investment in job training and employment services eclipsed the
Department of Labor's combined investment in WIA's adult, youth, and
dislocated workers. Some agencies have, in fact, been doing more than
they can by deliberately using their reserves in order to provide help
to more people than their current revenues support. If not now, when?
Therefore, Goodwill is very concerned the continued delay in
reauthorizing WIA may put the whole system at risk, causing many
Goodwill agencies to wonder how they would respond to the dramatic
increase in requests for services if the workforce system were to be
dismantled completely. Most agencies would be forced to turn away
people in need or risk being overleveraged to the brink.
Goodwill understands that this Subcommittee faces a difficult
challenge in stretching limited resources to cover a range of
priorities; however the workforce system is vastly under-funded and
preservation of WIA's formula funding streams should be a high
priority. Therefore, Goodwill urges Congress to sustain WIA's adult,
dislocated worker, and youth funding streams at current funding levels
at a minimum. Before diverting funds from WIA's already underfunded
programs, Congress should reauthorize WIA and include provisions that
would establish the Workforce Innovation Fund without jeopardizing
existing funds for WIA's three core funding streams.
Vocational Rehabilitation (VR) Funding
Goodwill Industries has a long history of helping people with
disabilities to participate in the workforce despite the challenges
their disabilities present. Years of inadequate funding for VR have
left the system stretched much too thin to serve all who are eligible
for assistance. As a result, most State VR agencies have Orders of
Selection, a provision within the Rehabilitation Act that requires
State VR agencies, when faced with a shortage of funds to meet the
demand for services, to prioritize the provision of services to
eligible people based on the severity of people's disabilities. In
addition, reduced funding for WIA has placed an additional strain on
mandatory partner programs, including VR, which are being asked to
contribute more funding to pay for infrastructure and other costs
associated with the operation of one-stop centers.
Goodwill supports the Administration's intent to increase multi-
system collaboration and support for youth with disabilities who are
transitioning from education to the workforce. The Administration's
fiscal year 2012 budget proposes to increase funding for VR State
agencies by $57 million, while diverting $30 million of VR's State
grant funds to contribute to a new Workforce Innovation Fund. Funding
for the Rehabilitation Services Administration's Migrant and Seasonal
Farmworker program, Projects with Industry, and Supported Employment
would be eliminated, thus offsetting the increase by $50 million.
For more than two decades, Goodwill has offered supported
employment as a part of its service array. According to Goodwill
Industries International's Annual Statistical Report, participation in
local Goodwill agencies' supported employment programs has grown
dramatically in recent years from providing 270,000 coaching sessions
in 2007 to 630,000 sessions in 2009.
Goodwill is intrigued by the Administration's proposal to stimulate
system collaboration by creating a Workforce Innovation Fund; however,
Goodwill believes that funding for the Workforce Innovation Fund should
not come at the expense of existing and already inadequate funds for
the VR system.
Goodwill thanks the Subcommittee for considering these requests,
and looks forward to working with the Subcommittee to help government
meet the serious challenges our nation faces.
______
Prepared Statement of the Harlem Children's Zone
Thank you for this opportunity to support comprehensive services
for poor children and the U.S. Department of Education's (ED) Promise
Neighborhoods program which we believe will break the cycle of
generational poverty for hundreds of thousands of poor children.
Like the work at the Harlem Children's Zone (HCZ), the Promise
Neighborhoods program has already begun to transform the odds for
entire communities. High-achieving schools are at the core of Promise
Neighborhoods, but it is not only about creating a successful school.
It is about programs for children from birth through college and
career, supporting families and rebuilding community. Doing this
changes the trajectory of an entire community.
In the mid-1990s it became clear to the HCZ team that despite
heroic efforts at saving poor children, success stories remained the
exception. Our piecemeal approach was of limited value against a
perfect storm of problems and challenges. So the HCZ Project was
created in Central Harlem to work with kids, their families and their
community. Starting with one building, HCZ has grown to 97 blocks. Last
year, the HCZ Project served 15,508 clients including 8,838 youth and
6,670 adults. HCZ, Inc., which includes the HCZ Project plus our Beacon
Centers and Preventive Foster Care programs, served 23,556 clients
including 10,541 youth and 13,015 adults.
Now, over a decade later, the Children's Zone model is working.
Parents are reading more to their children. Four year olds are ready
for kindergarten. Students are closing the black-white achievement gap
in several subjects. Teenagers are graduating from high school and this
school year, over 600 of them who attended traditional public schools
are in college. HCZ helps parents file for taxes including the Earned
Income Tax Credit (EITC) and last tax season, families collectively
received over $8 million.
HCZ's theory of change is embodied in the application of all of the
following five principles:
--Serve an entire neighborhood comprehensively and at scale.
--Create a pipeline of high-quality programs that starts from birth
and continues to serve children until they graduate from
college. Provide parents with supports as well.
--Build community among residents, institutions, and stakeholders,
who help to create the environment necessary for children's
healthy development.
--Evaluate program outcomes; create a feedback loop that cycles data
back to management for use in improving and refining program
offerings; and hold people accountable.
--Cultivate a culture of success rooted in passion, accountability,
leadership, and teamwork.
The HCZ model is not cheap. On average, HCZ spends $5,000 per
child each year to ensure children's success. For far less money than
is already spent, just on incarceration, we can educate, graduate our
children, and bring them back to our communities ready to be
successful, productive citizens. We think the choice is obvious.
HCZ's achievements are not magic. They are a result of hard work
and a comprehensive effort.
This same type of hard work and comprehensive effort is happening
in countless communities across the country. To provide a sense of the
level of interest in the Promise Neighborhoods program, when the
Department of Education offered the first round of planning grants in
fiscal year 2010's budget, over 339 communities competed for just 21
grants. Additionally, over 100 of these communities scored over 80,
leading Secretary of Education Arne Duncan to note that there would
have been more grants if resources were available. Just 7 months later,
these communities are going strong. For example:
Buffalo, New York
The Buffalo Promise Initiative, which is led by M&T's Westminster
Foundation, is collaborating with the John R. Oishei Foundation, Read
to Succeed Buffalo, the City of Buffalo, Buffalo Public Schools, United
Way of Buffalo and Erie County, Catholic Charities, Buffalo Urban
League, and the University at Buffalo to serve 11,000 residents in a 1-
square mile, low-income neighborhood. The Buffalo Promise Initiative is
a vital counterpoint to the challenges brought about in Buffalo due to
a shift away from industrially focused jobs, a shrinking population,
and increasing poverty. A comprehensive approach is blooming,
addressing the needs and hopes of children and their families in a
changing Buffalo.
Indianola, Mississippi
The Indianola Promise Community (IPC) is located in Indianola,
Mississippi, in the heart of the Mississippi Delta and the birthplace
of musician B.B. King. The Delta Health Alliance is the lead agency for
this unique public policy initiative. The Indianola Promise Community
unites healthcare, education, community, and faith-based services to
provide Indianola residents the chance to realize their promise as
active members and leaders in their town and neighborhoods. The Delta
Health Alliance has teamed up with a number of nonprofit organizations
and government agencies, including the local school district, the
municipal government, Mississippi State University, the county
hospital, and the Children's Defense Fund, to develop a comprehensive
collaborative with the ability to take on a number of pressing
challenges.
Although Indianola has a number of obstacles to overcome, leaders
from all aspects of the community have joined together to make the IPC
a success. The Delta Health Alliance is integrating more than a dozen
of their preexisting services and adding new programs and new partners
into a robust set of resources. The goal is to create a set of
integrated services for children and their families. The IPC engages
with all community service providers to prevent the duplication of
resources and highlight service gaps. Community members also serve on
the Steering Committee that oversees the work of the project.
Northern Cheyenne Reservation
The rich and deep history of the Northern Cheyenne community and
their commitment to engage their members is apparent in their plans to
develop a thriving Promise Neighborhood for their community. The
Promise Neighborhood is located on the Northern Cheyenne Reservation
and the surrounding communities of Colstrip and Ashland in southeast
Montana. The land is sprawling, approximately 700 square miles, and
approximately 7,300 people live within the Neighborhood.
The Boys and Girls Club of Northern Cheyenne Nation (BGCNCN), the
Promise Neighborhood lead partner, believes in ``systemic,
collaborative, strengths-based and culturally appropriate approaches''
to youth and community development that will comprehensively address
the disadvantages that the community faces.
The Boys and Girls Club has established relationships with local
communities, and thus is an excellent lead partner for this initiative.
All of the primary institutions that serve young people in the area are
involved in collaborating during this planning year. The Promise
Neighborhood has the full support of the Northern Cheyenne government,
local schools and agencies, Chief Dull Knife College, and a number of
nonprofits. All are working together to specifically create and
implement in- and out-of-school strategies and services that will
support the academic achievement, healthy development, cultural
awareness and connectedness, and college and career success of the
Neighborhood's children. Some of the BGCNCN's programs for youth
include a Native American Mentoring Program, a diabetes prevention
program, leadership groups, and a computer lab. The planning phase has
brought these groups together to begin a more concerted effort to
assess and develop a pipeline of programs that will benefit the youth
and community.
San Antonio, Texas
The Eastside Promise Neighborhood in San Antonio, Texas is led by
the United Way and has a strong partnership with the City of San
Antonio. San Antonio Mayor Julian Castro and other community leaders
are major supporters of the initiative. The Promise Neighborhood
initiative is part of the City's larger plan to support the struggling
Eastside, including the development of affordable housing, education,
environment, and other supports, and developing a strategic framework
that speaks to the community's core problems.
The Promise Neighborhood initiative, with its set of partners like
the San Antonio Independent School District, Family Service
Association, Housing Authority, City Year, Trinity University, San
Antonio for Growth on the Eastside (SAGE), and the Urban Land
Institute, is working hard to coordinate the supports and resources in
the neighborhood to activate their collective vision for community
transformation. The planning and coordination of resources going into
the community as a part of the Promise Neighborhood initiative fits
into the City's broader Eastside Reinvestment Plan aiming to shift away
from siloed and uncoordinated services on the Eastside.
Because parents are a key element to their children's success,
Eastside Promise Neighborhood has a commitment to parental engagement
and capacity-building through focus groups, community meetings during
which the community shapes the agenda, and parentally focused career
and empowerment groups through initiatives like the United Way's
Family-School-Community Partnership.
This asset-based approach and vision ensures more efficient and
effective use of neighborhood talent, resources, rich opportunities for
young people through high quality neighborhood schools and engaged
parents, and a solid physical infrastructure including high-quality
housing in the neighborhood to support the community. The community
looks to be on the right path toward stabilizing and empowering the
Eastside to stay, grow, graduate and . . . stay.
To support all of the Promise Neighborhoods' efforts, HCZ,
PolicyLink and the Center for the Study of Social Policy joined
together to create the Promise Neighborhoods Institute at PolicyLink
(PNI). Supported solely by private philanthropic dollars, PNI provides
communities with a system of support, resources, and information to
help them in local Promise Neighborhoods efforts. PNI is already
supporting 38 Promise Neighborhoods--including 21 funded by the U.S.
Department of Education. PNI has three goals:
--Ensure the 21 Federal planning grantees are successful and
transition to implementation.
--Support an additional 17 communities in their planning efforts and
transition to implementation.
--Foster a national learning network that enable communities to learn
from their peers and leverage resources in order to
significantly improve the educational and developmental
outcomes of children and youth in the Nation's most distressed
communities.
To accomplish these goals, PNI offers:
--Site visits designed to assess community need and implement a
comprehensive and personalized package of technical assistance
services that help communities learn, make systemic,
organizational and programmatic improvements and achieve
measurable and sustainable results.
--Promise Neighborhood Network conferences to share best practices.
--Trainings on topics such as how to attract funding and talk to the
media.
--Webinars and discussions moderated by experts in the field.
--A website--PromiseNeighborhoodsInstitute.org--featuring in-depth
resources and tools.
Since its launch, PNI has:
--Developed a rich menu of technical assistance that is based on what
works.
--Grown a robust community of practice that is being accessed by more
than 2,000 people.
--Implemented a feedback loop to continually refine city, county,
State, and Federal public policy and philanthropic approaches.
--Mobilized neighborhood leaders to advocate for integrated
neighborhood revitalization investments to become the norm in
solving some of the Nation's most intractable problems
affecting poor children and families.
In the current planning phase, Promise Neighborhoods are getting
ready to apply for full implementation. They are developing strategic
business plans to estimate revenues and cover costs. Part of this
includes the development of data systems for how they will track and
evaluate data to make sure that they can document success, and catch
and deal with challenges. In addition, they are developing powerful
partnerships with schools and with organizations and agencies so they
can provide children and families with the supports and services that
are needed for success from cradle to college and career. We look
forward to continuing to work with the Promise Neighborhoods grantees
and others as they transition from planning to implementation. And, we
look forward to seeing the results of their efforts.
We urge the Committee to support Promise Neighborhoods with
resources for new sites to engage in planning, and for robust support
for implementation in communities across the country. Thank you for
your consideration. If you should need additional information about The
Promise Neighborhoods program please contact Judith Bell from
PolicyLink ([email protected]) or Katie Shoemaker at HCZ
([email protected]).
______
Prepared Statement of the Health Professions and Nursing Education
Coalition
The members of the Health Professions and Nursing Education
Coalition (HPNEC) are pleased to submit this statement for the record
in support of the fiscal year 2012 budget request of $762.5 million for
the health professions education programs authorized under Titles VII
and VIII of the Public Health Service Act and administered through the
Health Resources and Services Administration (HRSA). HPNEC is an
informal alliance of more than 60 national organizations representing
schools, programs, health professionals, and students dedicated to
ensuring the healthcare workforce is trained to meet the needs of the
country's growing, aging, and diverse population. For a complete list
of HPNEC members, visit http://www.aamc.org/advocacy/hpnec/members.htm.
As you know, the Title VII and VIII health professions and nursing
programs provide education and training opportunities to a wide variety
of aspiring healthcare professionals, both preparing them for careers
in the health professions and helping bring healthcare services to our
rural and underserved communities. An essential component of the
healthcare safety net, the Title VII and Title VIII programs are the
only Federal programs designed to train healthcare providers in
interdisciplinary settings to meet the needs of the country's special
and underserved populations, as well as increase minority
representation in the healthcare workforce. Through loans, loan
guarantees, and scholarships to students, and grants and contracts to
academic institutions and nonprofit organizations, the Title VII and
Title VIII programs fill the gaps in the supply of health professionals
not met by traditional market forces.
Authorized since 1963, the Title VII and Title VIII education and
training programs are designed to help the workforce adapt to the
evolving healthcare needs of the ever-changing American population. In
an effort to renew and update Titles VII and VIII to meet current
workforce challenges, the programs were reauthorized in 2010--the first
reauthorization in the past decade. Reauthorization not only improved
the efficiency of the Title VII and Title VIII programs, but also laid
the groundwork for innovative programs with an increased focus on
recruiting and retaining professionals in underserved communities.
HPNEC is grateful for the Subcommittee's longstanding support of
these important workforce programs. While we are keenly aware that the
Subcommittee continues to face difficult decisions as it seeks to
improve the Nation's fiscal health, a continued congressional
commitment to programs supporting healthcare workforce development is
essential to the physical health and prosperity of the American people.
The country faces a critical disparity between the supply of practicing
healthcare providers and the increasing demand for care, with HRSA
estimating that over 33,000 additional health practitioners are needed
to alleviate existing shortages. Destabilizing funding for the Title
VII and Title VIII programs would reduce education and training support
for primary care physicians, nurses, and other health professionals,
exacerbating shortages and further straining the Nation's already
fragile healthcare system. We recognize that relative to other Federal
programs, HRSA's fiscal year 2011 operating plan imposes modest cuts to
most Title VII and Title VIII programs, and we look forward to working
with the subcommittee to prevent any further erosion to Federal support
for health professions training.
Failure to fully fund the programs would jeopardize activities to
train professionals across all disciplines to coordinate care for the
Nation's expanding elderly population; limit training opportunities for
providers to meet the unique needs of the Nation's sick and ailing
children; severely impact the distribution of professionals practicing
in rural and underserved communities; and hinder efforts to recruit and
retain a diverse and culturally competent workforce. To ensure the
healthcare workforce is equipped to address these issues, a strong
commitment to the Title VII and Title VIII programs is essential.
The existing Title VII and Title VIII programs can be considered in
seven general categories:
--The Primary Care Medicine and Oral Health Training programs, now
authorized separately, provide for the education and training
of primary care physicians, physician assistants, and dentists,
to improve access and quality of healthcare in underserved
areas. Two-thirds of all Americans interact with a primary care
provider every year. Approximately one-half of primary care
providers trained through these programs go on to work in
underserved areas, compared to 10 percent of those not trained
through these programs. The General Pediatrics, General
Internal Medicine, and Family Medicine programs provide
critical funding for primary care training in community-based
settings and have been successful in directing more primary
care physicians to work in underserved areas. They support a
range of initiatives, including medical student training,
residency training, faculty development and the development of
academic administrative units. These programs also enhance the
efforts of osteopathic medical schools to continue to emphasize
primary care medicine, health promotion, and disease
prevention, and the practice of ambulatory medicine in
community-based settings. Recognizing that all primary care is
not only provided by physicians, the primary care cluster also
provides grants for Physician Assistant programs to encourage
and prepare students for primary care practice in rural and
urban Health Professional Shortage Areas. The General
Dentistry, Pediatric Dentistry, and Public Health Dentistry
programs provide grants to dental schools and hospitals to
create or expand primary care and public health dental
residency training programs.
--Because much of the Nation's healthcare is delivered in areas far
removed from health professions schools, the Interdisciplinary,
Community-Based Linkages cluster provides support for
community-based training of various health professionals. These
programs are designed to provide greater flexibility in
training and to encourage collaboration between two or more
disciplines. These training programs also serve to encourage
health professionals to return to such settings after
completing their training. The Area Health Education Centers
(AHECs) provide clinical training opportunities to health
professions and nursing students in rural and other underserved
communities by extending the resources of academic health
centers to these areas. AHECs, which have substantial State and
local matching funds, form networks of health-related
institutions to provide education services to students, faculty
and practitioners. Geriatric Health Professions programs
support geriatric faculty fellowships, the Geriatric Academic
Career Award, and Geriatric Education Centers, which are all
designed to bolster the number and quality of healthcare
providers caring for our older generations. Given America's
burgeoning aging population, there is a need for specialized
training in the diagnosis, treatment, and prevention of disease
and other health concerns of older adults. The Mental and
Behavioral Health Education and Training Programs help mitigate
the growing shortages of mental and behavioral health providers
by providing grants for training social workers, child and
adolescent mental health professionals, and paraprofessionals
working with children and adolescents. They also provide grants
to doctoral, internship, and postdoctoral programs through the
Graduate Psychology Education program, which supports
interdisciplinary training of psychology students with other
health professionals for the provision of mental and behavioral
health services to underserved populations (i.e., older adults,
children, chronically ill, and victims of abuse and trauma,
including returning military personnel and their families),
especially in rural and urban communities.
--The purpose of the Minority and Disadvantaged Health Professionals
Training programs is to improve healthcare access in
underserved areas and the representation of minority and
disadvantaged healthcare providers in the health professions.
Minority Centers of Excellence support programs that seek to
increase the number of minority health professionals through
increased research on minority health issues, establishment of
an educational pipeline, and the provision of clinical
opportunities in community-based health facilities. The Health
Careers Opportunity Program seeks to improve the development of
a competitive applicant pool through partnerships with local
educational and community organizations. The Faculty Loan
Repayment and Faculty Fellowship programs provide incentives
for schools to recruit underrepresented minority faculty. The
Scholarships for Disadvantaged Students make funds available to
eligible students from disadvantaged backgrounds who are
enrolled as full-time health professions students.
--The Health Professions Workforce Information and Analysis program
provides grants to institutions to collect and analyze data on
the health professions workforce to advise future
decisionmaking on the direction of health professions and
nursing programs. The Health Professions Research and Health
Professions Data programs have developed a number of valuable,
policy-relevant studies on the distribution and training of
health professionals, including the Eighth National Sample
Survey of Registered Nurses, the Nation's most extensive and
comprehensive source of statistics on registered nurses. In
conjunction with the reauthorization of the Title VII programs
and in recognition of the need for better health workforce data
to inform both public and private decisionmaking, the National
Center for Workforce Analysis serves as a source of data and
information on the health workforce for the Nation.
--The Public Health Workforce Development programs are designed to
increase the number of individuals trained in public health, to
identify the causes of health problems, and respond to such
issues as managed care, new disease strains, food supply, and
bioterrorism. The Public Health Traineeships and Public Health
Training Centers seek to alleviate the critical shortage of
public health professionals by providing up-to-date training
for current and future public health workers, particularly in
underserved areas. Preventive Medicine Residencies, which
receive minimal funding through Medicare GME, provide training
in the only medical specialty that teaches both clinical and
population medicine to improve community health. The Title VII
reauthorization reorganized this cluster to include a focus on
loan repayment as an incentive for health professionals to
practice in disciplines and settings experiencing shortages.
The Pediatric Subspecialty Loan Repayment Program offers loan
repayment for pediatric medical subspecialists, pediatric
surgical specialists, and child and adolescent mental and
behavioral health specialists, in exchange for services in
areas where these types of professionals are in short supply.
The Public Health Workforce Loan Repayment Program provides
loan repayment for public health professionals accepting
employment with Federal, State, local, and tribal public health
agencies.
--The Nursing Workforce Development programs under Title VIII provide
training for entry-level and advanced degree nurses to improve
the access to, and quality of, healthcare in underserved areas.
These programs provide the largest source of Federal funding
for nursing education, providing loans, scholarships,
traineeships, and programmatic support that, between fiscal
year 2006 and 2009, supported over 347,000 nurses and nursing
students as well as numerous academic nursing institutions, and
healthcare facilities. Healthcare entities across the Nation
are experiencing a crisis in nurse staffing, caused in part by
an aging workforce and capacity limitations within the
educational system. Each year, nursing schools turn away tens
of thousands of qualified applications at all degree levels due
to an insufficient number of faculty, clinical sites, classroom
space, clinical preceptors, and budget constraints. At the same
time, the need for nursing services and licensed, registered
nurses is expected to increase significantly over the next 20
years. The Advanced Education Nursing program awards grants to
train a variety of advanced practice nurses, including nurse
practitioners, certified nurse-midwives, nurse anesthetists,
public health nurses, nurse educators, and nurse
administrators. Workforce Diversity grants support
opportunities for nursing education for students from
disadvantaged backgrounds through scholarships, stipends, and
retention activities. Nurse Education, Practice, and Retention
grants are awarded to help schools of nursing, academic health
centers, nurse-managed health centers, State and local
governments, and other healthcare facilities to develop
programs that provide nursing education, promote best
practices, and enhance nurse retention. The Loan Repayment and
Scholarship Program repays up to 85 percent of nursing student
loans and offers full-time and part-time nursing students the
opportunity to apply for scholarship funds. In return these
students are required to work for at least 2 years of practice
in a designated nursing shortage area. The Comprehensive
Geriatric Education grants are used to train RNs who will
provide direct care to older Americans, develop and disseminate
geriatric curriculum, train faculty members, and provide
continuing education. The Nurse Faculty Loan program provides a
student loan fund administered by schools of nursing to
increase the number of qualified nurse faculty.
--The loan programs under Student Financial Assistance support
financially needy and disadvantaged medical and nursing school
students in covering the costs of their education. The Nursing
Student Loan (NSL) program provides loans to undergraduate and
graduate nursing students with a preference for those with the
greatest financial need. The Primary Care Loan (PCL) program
provides loans covering the cost of attendance in return for
dedicated service in primary care. The Health Professional
Student Loan (HPSL) program provides loans covering the cost of
attendance for financially needy health professions students
based on institutional determination. The NSL, PCL, and HPSL
programs are funded out of each institution's revolving fund
and do not receive Federal appropriations. The Loans for
Disadvantaged Students program provides grants to health
professions institutions to make loans to health professions
students from disadvantaged backgrounds.
By improving the supply, distribution, and diversity of the
Nation's healthcare professionals, the Title VII and Title VIII
programs not only prepare aspiring professionals to meet the country's
workforce needs, but also help to improve access to care across all
populations. The multi-year nature of health professions education and
training, coupled with unprecedented existing and looming provider
shortages across many disciplines and in many communities, necessitate
a strong, continued, and reliable commitment to the Title VII and Title
VIII programs.
While HPNEC members understand of the immense fiscal pressures
facing the Subcommittee, we respectfully urge support for $762.5
million for the Title VII and VIII programs, a commitment essential not
only to the development and training of tomorrow's healthcare
professionals but also to our Nation's efforts to provide needed
healthcare services to underserved communities. We forward to working
with Senators to prioritize the health professions programs in fiscal
year 2012 and into the future.
______
Prepared Statement of the Hepatitis B Foundation
Highlighting the urgent need to address the public health
challenges of chronic hepatitis B by strengthening programs at the
Centers for Disease Control and Prevention, and the National Institutes
of Health.
Mr. Chairman, my name is Dr. Timothy Block, and I am the President
and Co-Founder of the Hepatitis B Foundation and its research
institute, the Institute for Hepatitis and Virus Research. I also serve
as the President of the Pennsylvania Biotechnology Center and am a
professor at Drexel University College of Medicine. My wife Joan, and
I, and another couple, Paul and Janine Witte, from Pennsylvania started
the Hepatitis B Foundation 20 years ago to find a cure for this serious
chronic liver disease and provide information and support to those
affected.
Thank you for giving the Hepatitis B Foundation (HBF) the
opportunity to provide testimony to the Subcommittee as you begin to
consider funding priorities for fiscal year 2012. We are grateful to
the Members of this Subcommittee for their interest and strong
leadership for efforts to control and find cures for hepatitis B.
Today, the HBF is the only national nonprofit organization solely
dedicated to finding a cure and improving the lives of those affected
by hepatitis B worldwide through research, education and patient
advocacy. Our scientists focus on drug discovery for hepatitis B and
liver cancer, and early detection markers for liver cancer. HBF staff
manages a comprehensive website which receives almost 1 million
visitors each year, a national patient conference and outreach
services. HBF public health professionals conduct research initiatives
to advance our mission.
The hepatitis B virus (HBV) is the world's major cause of liver
cancer--and while other cancers are declining, liver cancer is the
fastest growing in incidence in the United States. Without
intervention, as many as 100 million worldwide will die from a HBV-
related liver disease, most notably liver cancer. In the United States,
up to 2 million Americans have been chronically infected and more than
5,000 people die each year from complications due to HBV.
HBV is 100 times more infectious than the HIV/AIDS virus. Yet,
hepatitis B can be prevented with a safe and effective vaccine.
Unfortunately, for those who are chronically infected with HBV, the
vaccine is too late. There are, however, promising new treatments for
HBV. We are getting close to solutions but lack of sustained support
for public health measures and scientific research is threatening
progress. New research has confirmed that early detection and treatment
significantly reduces healthcare costs, morbidity and mortality. The
growing incidence of liver cancer, while most other cancer rates are on
the decline, represents examples of serious shortcomings in our system.
In the United States, 20,000 babies are born to mothers infected with
HBV each year, and as many as 1,200 newborns will be chronically
infected with the hepatitis B virus. More needs to be done to prevent
new infections.
HHS Interagency Working Group on Viral Hepatitis
Last year, the Department of Health and Human Services put together
an Interagency Working Group on Hepatitis to put together an Action
Plan on Viral Hepatitis. This action plan will describe opportunities
for HHS to respond to the 2010 Institute of Medicine (IOM) review of
the viral hepatitis challenge in the United States and the IOM
recommendations to prevent and build the capacity and collaborations
essential for reducing the number of viral hepatitis infections and
ameliorating the health and economic consequences of viral hepatitis
among persons chronically infected. The Hepatitis B Foundation is very
supportive of the efforts of the Working Group and is hopeful that its
recommendations will result in actions to address the chronic
underfunding of viral hepatitis prevention, research and outreach
programs within the Department. We look forward to the release of the
Hepatitis Action Plan in May of this year.
Mr. Chairman, as you know the two Federal agencies that are
critical to the effort to help people concerned with hepatitis B are:
the Centers for Disease Control and Prevention (CDC), and the National
Institutes of Health (NIH).
The Centers for Disease Control
CDC's Division of Viral Hepatitis (DVH), the centerpiece of the
Federal response to controlling, reducing and preventing the suffering
and deaths resulting from viral hepatitis, is chronically underfunded.
DVH is included in the National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention at the CDC, and is responsible for the
prevention and control of viral hepatitis. DVH is currently (prior to
finalization of the fiscal year 2011 continuing resolution) funded at
$19.8 million, approximately $6 million less than its funding level in
fiscal year 2003. In the President's fiscal year 2012 budget proposal,
DVH is funded at $25 million, an increase of $5.2 million. The HBF is
very supportive of this increase and joins the hepatitis community in
urging the Committee to fund the President's request for the Division
of Viral Hepatitis.
The responsibility for addressing the problem of hepatitis should
not lie solely with the Division. In view of the preventable nature of
these diseases, the Hepatitis B Foundation feels that the National
Center for Chronic Disease Prevention should also include a targeted
effort focused on the prevention of chronic viral hepatitis which
adversely impacts 5 million Americans. Specifically, we ask that the
Committee include language urging the Center to help insure that the
Prevention and Public Health Funds, particularly the Community
Transformations Grants, are available to support viral hepatitis
prevention projects.
Furthermore, there are 400 million people chronically infected with
hepatitis B worldwide, with more than 120 million of these individuals
in China. While hepatitis B transmission requires direct exposure to
infected blood, worldwide misinformation about the disease has fueled
inappropriate discrimination against individuals with this vaccine-
preventable and treatable bloodborne disease. HBF urges the Committee
to instruct the CDC to initiate global programs to increase the rate of
vaccination, reduce mother-child transmission and promote educational
programs to prevent the disease and to reduce discrimination targeted
against individuals with the disease.
The National Institutes of Health
We depend upon the NIH to fund research that will lead to new and
more effective interventions to treat people with hepatitis B and liver
cancer. The Hepatitis B Foundation joins with the Ad Hoc Group for
Biomedical Research and requests a funding level of $35 billion for the
National Institutes of Health in fiscal year 2012.
We thank the Committee for their continued investment in the NIH.
Sustaining progress in medical research is essential to the twin
national priorities of smarter healthcare and economic revitalization.
With additional investment, the Nation can seize the unique opportunity
to build on the tremendous momentum emerging from the strategic
investment in NIH made through the 2009 American Recovery and
Reinvestment Act (ARRA). NIH invested those funds in a range of
potentially revolutionary new avenues of research that will lead to new
early screenings and new treatments for disease.
In fiscal year 2010, NIH spent approximately $70 million on
hepatitis B funding overall including $4 million of onetime funding
from the American Recovery and Reinvestment Act. It is estimated that
in fiscal year 2011 hepatitis B funding will return to the base level
of $66 million. Additional funding could make transformational advances
in research leading to better treatments for HBV. The Hepatitis B
Foundation recommends that at a minimum, funding allocated for HBV
research in fiscal year 2012 be increased at the same rate recommended
for NIH overall and, therefore, funded at $75.7 million.
The current leadership of the NIH has performed admirably with the
limited resources they are provided; however, more is needed. While a
number of cancers have achieved 5-year survival rates of over 80
percent and the average 5-year survival rate for all cancers has
increased from 50 percent in 1971 to 66 percent, significant challenges
still remain for other types of cancers, particularly the most deadly
forms of cancer. In fact, nearly half of the 562,340 cancer deaths in
2009 were caused by eight forms of cancer with 5-year relative survival
rates of less than 50 percent: ovary (45.5 percent), brain (35.0
percent), myeloma (34.9 percent), stomach (24.7 percent), esophagus
(15.8 percent), lung (15.2 percent), liver (11.7 percent), and pancreas
(5.1 percent). It is no coincidence that cancers with significantly
better 5 year survival rates, such as breast, prostate, colon,
testicular, and chronic myelogenous leukemia, also have early detection
tools, and in many cases, several effective treatment options thanks to
research programs championed and supported by Congress. By contrast,
research into the cancers with the lowest 5-year survival rates has
been relatively under-funded, and as a result, these cancers have no
early detection or treatment tools.
The Hepatitis B Foundation requests the establishment of a targeted
cancers program at the National Cancer Institute (NCI) for the high
mortality cancers. It should include a strategic plan for progress, an
annual report from NCI to Congress, and a new grant program
specifically focused on the deadly cancers. Additionally, the Hepatitis
B Foundation urges a stronger focus on liver cancer and urges the
funding of a series of Specialized Programs of Research Excellence
(SPOREs) focused on liver cancer. While SPOREs currently exist for
every other major cancer, none currently exist that are focused on
liver cancer.
Prevention Fund
The Patient Protection and Affordable Care Act included the
creation of a Prevention and Public Health Fund, to be used to reduce
chronic disease rates and to address health disparities. To further
clarify the intended use of these funds, earlier this year, the
National Prevention, Health Promotion and Public Health Council that
was established to advice on the use of these funds, released a report
with recommendations. Included in the report were recommendations that
``opportunities be expanded within communities and populations at
greatest risk for diseases such as Viral Hepatitis B and C'' and that
there be an increased use of the ``the most effective and highest
impact evidence-based clinical preventive services and medications,
such as screening and treatment for chronic viral hepatitis.''
Therefore, it is our view that insuring the Prevention Funds resources
can be used for viral hepatitis prevention projects would help address
this urgent need to help close the gap between diagnosis and access to
care for hepatitis patients. We urge the Committee to include language
in both the Office of the Secretary and the CDC's National Center for
Chronic Disease Prevention to insure that Prevention Funds,
specifically Community Transformation Grants, be eligible to viral
hepatitis initiatives.
summary and conclusion
While the HBF recognizes the demands on our Nation's resources, we
believe the ever-increasing health threats and expanding scientific
opportunities continue to justify higher funding levels for the CDC's
Division of Viral Hepatitis and the National Institutes of Health.
Significant progress has been made in developing better treatments
and cures for the diseases that affect humankind due to your leadership
and the leadership of your colleagues on this Subcommittee. Significant
progress has also similarly been made in the fight against hepatitis B.
In conclusion, we specifically request the following for fiscal
year 2012:
--Fund the CDC's Division of Viral Hepatitis at $25 million;
--Language urging the HHS and the National Center for Chronic Disease
Prevention to help insure that the Prevention and Public Health
Funds, particularly the Community Transformations Grants, are
available to support viral hepatitis prevention projects.
--Initiate global programs at the CDC to increase the rate of
vaccination, reduce mother-child transmission and promote
educational programs to prevent the disease and to reduce
discrimination targeted against individuals with the disease;
--Provide $35 billion for the National Institutes of Health,
including a $9.7 million increase per year for hepatitis B
research;
--Establish a targeted cancers program at the NCI; and
--Fund a series of Specialized Programs of Research Excellence
(SPOREs) focused on liver cancer at the NCI.
The Hepatitis B Foundation appreciates the opportunity to provide
testimony to you on behalf of our constituents and yours.
______
Prepared Statement of the HIV Medicine Association
The HIV Medicine Association (HIVMA) of the Infectious Diseases
Society of America (IDSA) represents more than 4,500 physicians,
scientists and other healthcare professionals who practice on the
frontline of the HIV/AIDS pandemic. Our members provide medical care
and treatment to people with HIV/AIDS throughout the United States,
lead HIV prevention programs and conduct research to develop effective
HIV prevention and treatment options. We work in communities across the
country and around the globe as medical providers and researchers
dedicated to the field of HIV medicine.
We appreciate the importance of addressing the fiscal challenges
facing our Nation, but the continued fragile state of the economy makes
it imperative to set priorities to ensure that our Nation has a strong
healthcare safety-net, effective programs for preventing infectious
diseases like HIV and a robust scientific research agenda.
The U.S. investment in HIV/AIDS programs has revolutionized HIV
care globally, making HIV treatment one of the most effective medical
interventions available. A vibrant research agenda and rapid public
health implementation of scientific findings have transformed the HIV
epidemic, reducing morbidity and mortality due to HIV disease by nearly
80 percent in the United States.
Implementation of healthcare reform and the administration's plans
for a National HIV/AIDS Strategy offer promise for making significant
progress in reducing the impact of the domestic HIV epidemic. However,
their success will depend on maintaining adequate investments in the
healthcare safety net, and in prevention, public health and research
programs. The funding requests in our testimony largely reflect the
consensus of the Federal AIDS Policy Partnership (FAPP), a coalition of
HIV organizations from across the country, and are estimated to be the
amounts necessary to sustain and strengthen our investment in
combatting HIV disease.
Health Care Reform
We urge full funding of the President's fiscal year 2012 request
level for healthcare reform programs supported with discretionary
funding under the Patient Protection and Affordable Care Act (ACA), in
particular: health workforce education and training programs under
Titles VII and VIII of the Public Health Service Act (PHSA); healthcare
quality improvement programs, and the Community Health Centers program.
HIV/AIDS Bureau of the Health Resources and Services Administration
We urge you to increase funding for the Ryan White program by $371
million in fiscal year 2011 with at least an increase of $65.8 million
over the fiscal year 2010 level for Part C. At minimum, we strongly
urge you to support the President's proposed fiscal year 2012 increase
of $88.3 million for the Ryan White program, including a $5.1 million
increase for Part C. Part C of the Ryan White Program funds
comprehensive HIV care and treatment--services that are directly
responsible for the dramatic decreases in AIDS-related mortality and
morbidity over the last decade. On average it costs $3,501 per person
per year to provide the comprehensive outpatient care and treatment
available at Part C funded programs, including lab work, STD/TB/
Hepatitis screening, ob/gyn care, dental care, mental health and
substance abuse treatment, and case management. Part C funding covers a
small percentage of the total cost of providing comprehensive care with
some programs receiving $450 or lower per patient per year to cover
care.
The Ryan White Program generally is underfunded and Part C of the
program is disproportionately and severely underfunded. The Centers for
Disease Control and Prevention estimate that there are more than 1.1
million persons living with HIV/AIDS and approximately 240,000, or
almost 1 in 4, of these individuals receive services from Part C
medical providers. Of the 240,000 patients, approximately 1 out of 3 is
uninsured, and 2 out of 3 are underinsured.
While the patient caseload in Part C programs has been rising,
funding for Part C has effectively decreased due to flat funding and
funding cuts at the clinic level. Part C programs expect a continued
increase in patients due to higher diagnosis rates and economic-related
declines in insurance coverage. During this economic downturn people
with HIV across the country are relying on Part C comprehensive
services more than ever. As a result of consistently increasing
caseloads and limited funding, Part C clinics are taking dramatic steps
that adversely impact their ability to serve patients, including:
Limiting primary care services; discontinuing critical services such as
laboratory monitoring; suffering eviction from institutional-based
clinic sites; laying off staff; and operating only 4 days/week.
The HIV medical clinics funded through Part C have been in dire
need of increased funding for years, but new pressures are creating a
crisis in communities across the country. An increase in funding is
critical to prevent additional staffing and service cuts and ensure the
public health of our communities.
National Institutes of Health (NIH)--Office of AIDS Research
HIVMA supports the medical research community's requested increase
of $4 billion over the fiscal year 2010 level for all research programs
at the NIH, including at least a $400 million increase for the NIH
Office of AIDS. This level of funding is vital to sustain the pace of
research that will improve the health and quality of life for millions
of Americans. At minimum, we urge you to support the President's
proposed fiscal year 2012 increase of $1 billion for the NIH.
A continued robust AIDS research portfolio is essential to sustain
and to accelerate our progress in offering more effective prevention
technologies; developing new and less toxic therapy; and supporting the
basic research necessary to continue our work developing a vaccine that
may end the deadliest pandemic in human history.
We appreciate the many difficult decisions that Congress faces this
year, but urge you to recognize the importance of investing in HIV
prevention, treatment and research now to avoid the much higher cost
that individuals, communities and broader society will incur if we fail
to support these programs. We must seize the opportunity to limit the
toll of this deadly infectious disease on our planet and to save the
lives of millions who are infected or at risk of infection here in the
United States and around the globe.
Center for Disease Control and Prevention's (CDC) National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
HIVMA strongly urges total fiscal year 2012 funding of $1.953
billion for the CDC's NCHHSTP, an increase of $834.1 million over the
fiscal year 2010 level, including increases of: $515.3 million for HIV
prevention and surveillance, $20.2 million for viral hepatitis and
$85.9 million for tuberculosis prevention.
Every 9\1/2\ minutes a new HIV infection happens in the United
States with more than 60 percent of new cases occurring among African
Americans and Hispanic/Latinos. Despite the known benefit of effective
treatment, 21 percent of people living with HIV in the United States
are still not aware of their status and as many as 36 percent of people
newly diagnosed with HIV progress to AIDS within 1 year of diagnosis. A
sustained commitment to HIV prevention funding is critical to enhance
HIV/AIDS surveillance and expand HIV testing and linkage to care, in
order to lower HIV incidence and prevalence in the United States. We
appreciate that the President proposed a $68.8 million increase for HIV
prevention at the CDC, and at a bare minimum we strongly urge the
Committee to at least meet this request.
Finally, we strongly support adequate funding for science-based,
comprehensive sex education programs. We are pleased that the fiscal
year 2011 continuing resolution provides $109 million for the Teen
Pregnancy Prevention Program, which focuses on reducing the risks of
pregnancy and sexually transmitted diseases through proven and
successful models. We urge the Committee to adopt report language
supporting true, comprehensive sex education that promotes healthy
behaviors and relationships for all young people, including lesbian,
gay, bisexual, and transgender youth, including an explicit focus on
prevention of HIV and other STDs.
CDC--Tuberculosis
Tuberculosis is the major cause of AIDS-related mortality worldwide
and the second leading infectious disease killer. Congress passed
landmark legislation in the Comprehensive Tuberculosis Elimination Act
of 2008 to shore up State TB control programs, to enhance U.S. capacity
to address drug-resistant tuberculosis; and to develop new drugs,
diagnostics and vaccines.
State budget cuts have hit local TB control programs hard, and the
CDC Division of TB Elimination has seen some budget reductions in the
last 2 fiscal years. Our ability to respond to TB within our own
borders is being compromised as a result. We must do better. Finally,
we are beginning to see exciting new tools to combat tuberculosis after
decades of little or no productive research and development in this
area. We have an exciting new diagnostic test that can identify drug-
susceptible and drug-resistant TB very quickly. There are a number of
new drugs in clinical trials for both drug resistant and drug-
susceptible TB. There are promising new TB vaccine candidates being
tested. Now, resources are needed more urgently than ever to follow
through on the research and development in progress and to ensure that
these new tools reach the public health officials on the ground who
need them. We respectfully request fiscal year 2012 funding for the CDC
Division of TB Elimination at a level of $231 million. At minimum, we
urge full funding of the President's fiscal year 2012 budget request of
$143.6 million for this program.
CDC--Viral Hepatitis
A much more substantial commitment to Hepatitis co-infection is
urgently needed, in addition to funding for core public health services
and tracking of chronic cases of hepatitis. Co-infection is a serious
health threat for nearly one-third of our HIV patients, and has an
enormous impact on morbidity and mortality. Furthermore, with the
advent of the recently approved protease inhibitors, providing funding
to enable this population to receive treatment and/or access clinical
trials becomes absolutely critical. We strongly urge you to boost
funding for viral hepatitis at the CDC by $20.2 million over the fiscal
year 2010 level million for a total funding of $40 million. At the very
least, we urge you to support the President's proposed fiscal year 2012
increase of $5.2 million to respond to the viral Hepatitis epidemic.
Agency for Health Care Quality and Research (AHRQ)
HIVMA urges the Committee to provide $2.2 million, a $200,000
increase over the fiscal year 2010 level for the HIV Research Network
(HIVRN), the only significant HIV work being done at AHRQ. The HIVRN is
a consortium of 18 HIV primary care sites co-funded by AHRQ and HRSA to
evaluate healthcare utilization and clinical outcomes in HIV infected
children, adolescents and adults in the United States. The Network
analyzes and disseminates information on the delivery and outcomes of
healthcare services to people with HIV infection. These data help to
improve delivery and outcomes of HIV care in the United States and to
identify and address disparities in HIV care that exist by race,
gender, and HIV risk factor. The HIVRN is a unique source of
information on the cost and cost-effectiveness of HIV care in the
United States at a time when data on comparative cost and effectiveness
of healthcare is particularly needed to inform health systems reform
and the development and implementation of a National HIV/AIDS Strategy.
______
Prepared Statement of Howard University
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Eve
Higginbotham, Senior Vice-President and Executive Dean for Howard
University Health Sciences. I am the senior health official at Howard,
with responsibilities for our College of Medicine, College of
Dentistry, College of Pharmacy, Nursing, and Allied Health, Louis
Stokes Health Sciences Library, and the Howard University Hospital.
Howard University is the only Historically Black College or University
(HBCU) with so many aspects of the health sciences housed at one
institution. For that reason, we are poised to continue to impact the
education of minorities and others dedicated to improving the health of
all Americans.
Mr. Chairman, Howard University Health Sciences has made historic
contributions to the reduction of health disparities, and it is because
of programmatic activity like the Title VII Health Professionals
Training programs that we are able to address a critical national need.
Persistent and severe staffing shortages exist in a number of the
health professions, and chronic shortages exist for all of the health
professions in our Nation's most medically underserved communities.
Furthermore, even after the landmark passage of health reform, it is
important to note that our Nation's health professions workforce does
not accurately reflect the racial composition of our population. For
example while blacks represent approximately 15 percent of the U.S.
population, only 2-3 percent of the Nation's health professions
workforce is black. Mr. Chairman, I would like to share with you how
your committee can help HUHS continue our efforts to help provide
quality health professionals and close our Nation's health disparity
gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health professions institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need--even in austere
financial times.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
In fiscal year 2012, funding for the Title VII Health Professions
Training programs must at the very least be maintained, especially the
funding for the Minority Centers of Excellence (COEs) and Health
Careers Opportunity Program (HCOPs). In addition, the funding for the
National Institutes of Health (NIH)'s National Institute on Minority
Health and Health Disparities (NIMHD), as well as the Department of
Health and Human Services (HHS)'s Office of Minority Health (OMH),
should be preserved.
Minority Centers of Excellence.--COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions to the training
of minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs. For fiscal year 2012, I recommend a
funding level of $24.602 million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. For fiscal year 2012, I recommend a funding level
of $22.133 million for HCOPs.
National Institutes of Health
Research Centers at Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI), currently administered by 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, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professions institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Centers of Excellence
program. For fiscal year 2012, I recommend funded increases
proportional with the funding of the over NIH.
Department of Health and Human Services
Department of Health and Human Services' Office of Minority
Health.--Specific programs at OMH include: assisting medically
underserved communities with the greatest need in solving health
disparities and attracting and retaining health professionals;
assisting minority institutions in acquiring real property to expand
their campuses and increase their capacity to train minorities for
medical careers; supporting conferences for high school and
undergraduate students to interest them in healthcareers, and
supporting cooperative agreements with minority institutions for the
purpose of strengthening their capacity to train more minorities in the
health professions. The OMH has the potential to play a critical role
in addressing health disparities. For fiscal year 2012, I recommend a
funding level of $65 million for the OMH.
Department of Education
Howard University Academic, Research, and Hospital Support.--The
Department of Education maintains support for Howard University's
academic programs, research programs, construction activities, and the
Howard University Hospital. Howard University has played a historic
role in providing access to postsecondary educational opportunities for
students from traditionally underrepresented backgrounds, especially
African Americans. For this reason, and others, Howard is supported
annually with a Federal appropriation. The direct Federal appropriation
accounts for approximately 50 percent of the Howard University's
operating costs, including nearly $29 million for the operation of the
Howard Hospital--a staple of care for residents in Northwest
Washington, DC. In fiscal year 2012, an appropriation of $235 million
is suggested to continue the vital programs and services which we
provide.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Howard University's Health Sciences can help this country to overcome
health disparities. Congress must be careful not to eliminate, paralyze
or stifle programs that have been proven to work. HUHS seeks to close
the ever widening health disparity gap. If this subcommittee will give
us the tools, we will continue to work towards the goal of eliminating
that disparity everyday.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the International Foundation for Functional
Gastrointestinal Disorders
Thank you for the opportunity to present the views of the
International Foundation for Functional Gastrointestinal Disorders
(IFFGD) regarding the importance of functional gastrointestinal (GI)
and motility disorders research.
Established in 1991, IFFGD is a patient-driven nonprofit
organization dedicated to assisting individuals affected by functional
GI disorders, and providing education and support for patients,
healthcare providers, and the public at large. The IFFGD also works to
advance critical research on functional GI and motility disorders, in
order to provide patients with better treatment options, and to
eventually find a cure. IFFGD has worked closely with NIH on a number
of priorities, including the NIH State-of-the-Science Conference on the
Prevention of Fecal and Urinary Incontinence in Adults through NIDDK,
the National Institute of Child Health and Human Development (NICHD),
and the Office of Medical Applications of Research (OMAR). I have
served on the National Commission on Digestive Diseases (NCDD), which
released a long-range road map for digestive disease research in 2009,
entitled Opportunities and Challenges in Digestive Diseases Research:
Recommendations of the National Commission on Digestive Diseases.
The need for increased research, more effective and efficient
treatments, and the hope for discovering a cure for functional GI and
motility disorders are close to my heart. My own personal experiences
of suffering from functional GI and motility disorders motivated me to
establish IFFGD 20 years ago. I was shocked to discover that despite
the high prevalence of these conditions among all demographic groups
worldwide, such an appalling lack of dedicated research existed. This
lack of research translates into a dearth of diagnostic tools,
treatments, and patient supports. Even more shocking is the lack of
awareness among both the medical community and the general public,
leading to significant delays in diagnosis, frequent misdiagnosis, and
inappropriate treatments including unnecessary medication and surgery.
It is unacceptable for patients to suffer unnecessarily from the
severe, painful, life-altering symptoms of functional GI and motility
disorders due to a lack of awareness and education.
The majority of functional GI disorders have no cure and treatment
options are limited. Although progress has been made, the medical
community still does not completely understand the mechanisms of the
underlying conditions. Without a known cause or cure, patients
suffering from functional GI disorders face a lifetime of chronic
disease management, learning to adapt to intolerable, disruptive
symptoms. The medical and indirect costs associated with these diseases
are enormous; estimates range from $25-$30 billion annually. Economic
costs spill over into the workplace, and are reflected in work
absenteeism and lost productivity. Furthermore, the emotional toll of
these conditions affects not only the individual but also the family.
Functional GI disorders do not discriminate, effecting all ages, races
and ethnicities, and genders.
Irritable Bowel Syndrome (IBS)
IBS, one of the most common functional GI disorders, strikes all
demographic groups. It affects 30 to 45 million Americans,
conservatively at least 1 out of every 10 people. Between 9 to 23
percent of the worldwide population suffers from IBS, resulting in
significant human suffering and disability. IBS as a chronic disease is
characterized by a group of symptoms that may vary from person to
person, but typically include abdominal pain and discomfort associated
with a change in bowel pattern, such as diarrhea and/or constipation.
As a ``functional disorder'', IBS affects the way the muscles and
nerves work, but the bowel does not appear to be damaged on medical
tests. Without a definitive diagnostic test, many cases of IBS go
undiagnosed or misdiagnosed for years. It is not uncommon for IBS
suffers to have unnecessary surgery, medication, and medical devices
before receiving a proper diagnosis. Even after IBS is identified,
treatment options are sorely lacking and vary widely from patient to
patient. What is known is that IBS requires a multidisciplinary
approach to research and treatment.
IBS can be emotionally and physically debilitating. Due to
persistent pain and bowel unpredictability, individuals who suffer from
this disorder may distance themselves from social events, work, and
even may fear leaving their home. Stigma surrounding bowel habits may
act as barrier to treatment, as patients are not comfortable discussing
their symptoms with doctors. Because IBS symptoms are relatively common
and not life-threatening, many people dismiss their symptoms or attempt
to self-medicate using over-the-counter medications. In order to
overcome these barriers to treatment, ensure more timely and accurate
diagnosis, and reduce costly unnecessary procedures, educational
outreach to physicians and the general public remain critical.
Fecal Incontinence
At least 12 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 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 spinal
cord injuries, multiple sclerosis, diabetes, prostate cancer, colon
cancer, uterine cancer, and a host of other diseases.
Courses of fecal incontinence include: 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. 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 attempt to hide the
problem for as long as possible. They withdraw from friends and family,
and often limit work or education efforts. Incontinence in the elderly
burdens families and is the primary reason for nursing home admissions,
an already huge social and economic burden in our aging population.
In November 2002, IFFGD sponsored a consensus conference entitled,
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 including more comprehensive identification of quality
of life issues; improved diagnostic tests for affecting management
strategies and treatment outcomes; development of new drug treatment
compounds; development of strategies for primary prevention of fecal
incontinence associated with childbirth; and attention to the stigmas
that apply to individuals with fecal incontinence.
In December 2007, IFFGD collaborated with NIDDK, NICHD, and OMAR on
the NIH State-of-the-Science Conference on the Prevention of Fecal and
Urinary Incontinence in Adults. The goal of this conference was to
assess the state of the science and outline future priorities for
research on both fecal and urinary incontinence; including, the
prevalence and incidence of fecal and urinary incontinence, risk
factors and potential prevention, pathophysiology, economic and quality
of life impact, current tools available to measure symptom severity and
burden, and the effectiveness of both short and long term treatment.
For fiscal year 2012, IFFGD urges Congress to review the Conference's
Report and provide NIH with the resources necessary to effectively
implement the report's recommendations.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, or GERD, is a 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. Sometimes there are no apparent symptoms, and the presence of
GERD is revealed when complications become evident. One uncommon but
serious complication is Barrett's esophagus, a potentially pre-
cancerous condition associated with esophageal cancer. 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. There are several treatment options available
for individuals suffering from GERD. Nonetheless, treatment response
varies from person to person, is not always effective, and long-term
medication use and surgery expose individuals to risks of side-effects
or complications.
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.
Gastroparesis
Gastroparesis, or delayed gastric emptying, refers to a stomach
that empties slowly. Gastroparesis is characterized by symptoms from
the delayed emptying of food, namely: bloating, nausea, vomiting, or
feeling full after eating only a small amount of food. Gastroparesis
can occur as a result of several conditions, including being present in
30 percent to 50 percent of patients with diabetes mellitus. A person
with diabetic gastroparesis may have episodes of high and low blood
sugar levels due to the unpredictable emptying of food from the
stomach, leading to diabetic complications. Other causes of
gastroparesis include Parkinson's disease and some medications,
especially narcotic pain medications. In many patients the cause of the
gastroparesis cannot be found and the disorder is termed idiopathic
gastroparesis. Over the last several years, as more is being found out
about gastroparesis, it has become clear this condition affects many
people and the condition can cause a wide range of symptom severity.
Cyclic Vomiting Syndrome
Cyclic vomiting syndrome (CVS) is a disorder with recurrent
episodes of severe nausea and vomiting interspersed with symptom free
periods. The periods of intense, persistent nausea, vomiting, and other
symptoms (abdominal pain, prostration, and lethargy) lasts hours to
days. Previously thought to occur primarily in pediatric populations,
it is increasingly understood that this crippling syndrome can occur in
a variety of age groups including adults. Patients with these symptoms
often go for years without correct diagnosis. The condition leads to
significant time lost from school and from work, as well as substantial
medical morbidity. The cause of CVS is not known. Better understanding,
through research, of mechanisms that underlie upper gastrointestinal
function and motility involved in sensations of nausea, vomiting and
abdominal pain is needed to help identify at risk individuals and
develop more effective treatment strategies.
Support for Critical Research
IFFGD urges Congress to fund the NIH at level of $35 billion for
fiscal year 2012, an increase of 13 percent over fiscal year 2011. This
funding level will help preserve the initial investment in healthcare
innovation established by the American Recovery and Reinvestment Act of
2009. Strengthening and preserving our Nation's biomedical research
enterprise fosters economic growth, and supports innovations that
enhance the health and well-being of the Nation.
Concurrent with overall NIH funding, the IFFGD supports growth of
research activities on functional GI and motility disorders,
particularly through NIDDK and the Office of Research on Women's Health
(ORWH). Increased support for NIDDK and ORWH will facilitate necessary
expansion of the research portfolio on functional GI and motility
disorders necessary to grow the medical knowledge base and improve
treatment. Such support would also expedite the implementation of
recommendations from the National Commission on Digestive Diseases. It
is also vitally important for NIDDK to work to expand its research on
the impact these disorders have on pediatric populations, in addition
the adult population.
Following years of near level-funding at NIH, research
opportunities have been negatively impacted across all NIH Institutes
and Centers, including NIDDK. With the expiration of funding from the
American Recovery and Reinvestment Act of 2009, medical researchers run
the risk of ``falling off a cliff'', stalling, if not losing promising
research from that 2 year period. For this reason, IFFGD encouraged
support for initiatives such as the Cures Acceleration Network (CAN),
authorized in the Patient Protection and Affordable Coverage Act. IFFGD
urges the Subcommittee to show strong leadership in pursuing a
substantial funding increase for CAN through the fiscal year 2012
appropriations process.
Thank you for the opportunity to present the views of the
functional GI disorders community.
______
Prepared Statement of the International Myeloma Foundation
The International Myeloma Foundation (IMF) appreciates the
opportunity to submit written comments for the record regarding fiscal
year 2012 funding for myeloma cancer programs. The IMF is the oldest
and largest myeloma foundation dedicated to improving the quality of
life of myeloma patients while working toward prevention and a cure.
To ensure that myeloma patients have access to the comprehensive,
quality care that they need and deserve, the IMF advocates ongoing and
significant Federal funding for myeloma research and its application.
The IMF stands ready to work with policymakers to advance policies and
programs that work toward prevention and a cure for myeloma and for all
other forms of cancer.
Myeloma Background
The second most common blood cancer worldwide, multiple myeloma (or
myeloma) is a cancer of plasma cells in the bone marrow. It is called
``multiple'' myeloma because the cancer can occur at multiple sites in
multiple bones. Each year approximately 20,000 Americans are diagnosed
with myeloma and 10,000 lose their battle with this disease.
Although the incidence of many cancers is decreasing, the number of
myeloma cases is on the rise. Once a disease of the elderly, it is now
being found in increasing numbers in people under the age of 65. The
2009 President's Cancer Panel Report suggests that much of the increase
in cancer incidence is being caused by environmental toxins. To give
just one example supporting this hypothesis, a recently published study
in The Journal of Occupational and Environmental Medicine, suggests a
link between blood cancers like myeloma and exposure to the toxic dust
at Ground Zero.
In recent years significant gains have been made, extending myeloma
patients' lives and improving their quality of life. Furthermore,
progress begun in myeloma is already helping patients with other blood
cancers and even solid tumors. It is important to maintain that
momentum.
--There is no cure for myeloma.
--Remissions are not always permanent.
--Additional treatment options are essential.
Living with the disease, myeloma patients can suffer debilitating
fractures and other bone disorders, severe side effects of certain
treatments, and other problems that profoundly affect their quality of
life, and significantly impact the cost of their healthcare.
Sustain and Seize Cancer Research Opportunities
Myeloma research is producing extraordinary breakthroughs--leading
to new therapies that translate into longer survival and improved
quality of life for myeloma patients and potentially those with other
forms of cancer as well. Myeloma was once considered a death sentence
with limited options for treatment, but today myeloma is an example of
the progress that can be made and the work that still lies ahead in the
war on cancer. Many myeloma patients are living proof of what
innovative drug development and clinical research can achieve--
sequential remissions, long-term survival, and good quality of life.
Our Nation has benefited immensely from past Federal investment in
biomedical research at the National Institutes of Health (NIH) and the
IMF advocates $35 billion for NIH in fiscal year 2012.
A study in the Journal of Clinical Oncology projects that the
number of new cancer cases diagnosed each year will jump 45 percent
over the next 20 years. In multiple myeloma an even greater increase
(57 percent) is projected, and we are already seeing increasing
diagnoses in patients under age 65, including patients in their 30s, in
what was once a rare disease of the elderly.
While a number of cancers have achieved 5-year survival rates of
over 80 percent since passage of the National Cancer Act of 1971,
significant challenges still remain for other cancers. In fact, nearly
half of the 562,490 cancer deaths in 2010 were caused by just eight
forms of cancer with 5-year survival rates of 45 percent or less--one
of which is myeloma. Yet, myeloma and these other cancers have
historically also received the least amount of Federal funding. As we
have seen mortality rates of diseases such as breast cancer, prostate
cancer, AIDS, and childhood leukemia greatly reduced through targeted,
comprehensive, and well-funded programs that have led to earlier
detection and superior forms of treatment, so too must we shine a
brighter light on myeloma and the other seven deadly cancers to achieve
this same goal for them. The IMF urges Congress to allocate $5.740
billion to the National Cancer Institute (NCI) in fiscal year 2012 to
continue our battle against myeloma.
Boost Our Nation's Investment in Myeloma Prevention, Early Detection,
and Awareness
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.
Therefore, the IMF advocates $6 million for the Geraldine Ferraro Blood
Cancer Program. Authorized under the Hematological Cancer Research
Investment and Education Act of 2002, this program was created to
provide public and patient education about blood cancers, including
myeloma.
With grants from the Geraldine Ferraro Blood Cancer Program, the
IMF has successfully promoted awareness of myeloma, particularly in the
African-American community and other underserved communities. IMF
accomplishments include the production and distribution of more than
4,500 copies of an informative video which addresses the importance of
myeloma awareness and education in the African-American community to
churches, community centers, inner-city hospitals, and Urban League
offices around the country, increased African-American attendance at
IMF Patient and Family Seminars (these seminars provide invaluable
treatment information to newly diagnosed myeloma patients), increased
calls by African-American myeloma patients, family members, and
caregivers to the IMF's myeloma Hotline, and the establishment of
additional support groups in inner city locations in the United States
to assist underserved areas with myeloma education and awareness
campaigns. Furthermore, the more than 90 IMF-affiliated patient support
groups in the United States also made this effort their main goal
during Myeloma Awareness Week in October 2005.
An allocation of $6 million in fiscal year 2012 will allow this
important program to continue to provide patients--including those
populations at highest risk of developing myeloma--with educational,
disease management and survivorship resources to enhance treatment and
prognosis.
Additionally, the IMF is concerned about the consolidation plan for
chronic disease programs at the CDC outlined in the President's fiscal
year 2012 budget. This would be a substantial change in the chronic
disease program where the Geraldine Ferraro Blood Cancer Program is
currently housed. While we agree that there are health issue areas that
share risk factors such as healthy eating and maintaining an active
lifestyle that make sense to consolidate, unfortunately those are not
risk factors for myeloma. We urge the CDC to maintain the programs like
the Geraldine Ferraro Blood Cancer Program as a stand-alone program
which would cease to exist under the proposed consolidation plan.
Conclusion
The IMF stands ready to work with policymakers to advance policies
and support programs that work toward prevention and a cure for
myeloma. Thank you for this opportunity to discuss the fiscal year 2012
funding levels necessary to ensure that our Nation continues to make
gains in the fight against myeloma.
______
Prepared Statement of the Interstate Mining Compact Commission
We are writing in support of the fiscal year 2012 budget request
for the Mine Safety and Health Administration (MSHA), which is part of
the U.S. Department of Labor. In particular, we urge the Subcommittee
to support a full appropriation for grants to States for safety and
health training of our Nation's miners pursuant to section 503(a) of
the Mine Safety and Health Act of 1977. MSHA's budget request for State
grants is $8.941 million. This is the same amount that has been
appropriated for State training grants by Congress over the past 2
fiscal years and, as such, does not fully consider inflationary and
programmatic increases being experienced by the States. We therefore
urge the subcommittee to restore funding to the statutorily authorized
level of $10 million for State grants so that States are able to meet
the training needs of miners and to fully and effectively carry out
State responsibilities under section 503(a) of the Act.
The Interstate Mining Compact Commission is a multi-state
governmental organization that represents the natural resource,
environmental protection and mine safety and health interests of its 24
member States. The States are represented by their Governors who serve
as Commissioners.
IMCC's member States are concerned that without full funding of the
State grants program, the federally required training for miners
employed throughout the United States will suffer. States are
struggling to maintain efficient and effective miner training and
certification programs in spite of increased numbers of trainees and
the incremental costs associated therewith. State grants have flattened
out over the past several years and are not keeping place with
inflationary impacts or increased demands for training. The situation
is of particular concern given the enhanced, additional training
requirements growing out of the recently enacted MINER Act and MSHA's
implementing regulations.
As you consider our request to increase MSHA's budget for State
training grants, please keep in mind that the States play a
particularly critical role in providing special assistance to small
mine operators (those coal mine operators who employ 50 or fewer miners
or 20 or fewer miners in the metal/nonmetal area) in meeting their
required training needs.
We appreciate the opportunity to submit our views on the MSHA
budget request as part of the overall Department of Labor budget.
Please feel free to contact us for additional information or to answer
any questions you may have.
______
Prepared Statement of the Interstitial Cystitis Association
Thank you for the opportunity to present the views of the
Interstitial Cystitis Association (ICA) regarding the importance of
public awareness activities and the importance of interstitial cystitis
(IC) research.
ICA was founded in 1984 and remains the only nonprofit organization
dedicated to improving the lives of those living with IC. The
Association provides an important avenue for advocacy, research, and
education in matters relating to IC. Since its founding, ICA has acted
as a voice for those living with IC, including support groups and
empowering patients. ICA advocates for the expansion of the IC
knowledge-base and the development of new treatments, including
investigator initiated research. Finally, ICA works doggedly to educate
patients, healthcare providers, and the public at large about IC,
including educational forums and information on how to live with this
terrible condition.
IC is a condition that consists of recurring pain, pressure, or
discomfort in the bladder and pelvic region and is often associated
with urinary frequency and urgency. An estimated 4-12 million Americans
have IC, approximately two-thirds of whom are women. The cause of IC is
unknown and treatment options are limited. Diagnosis is made only after
excluding other urinary/bladder conditions, possibly causing 1 or more
years delay between onset of the symptoms and treatment. When
healthcare providers are not properly educated about IC, patients may
suffer for years before receiving an accurate diagnosis and appropriate
treatment.
The effects of IC are pervasive and insidious, damaging work life,
psychological well-being, personal relationships, and general health.
The impact of IC on quality of life is equally as severe as rheumatoid
arthritis and end-stage renal disease. Health-related quality of life
in women with IC is worse than in women with endometriosis, vulvodynia,
and overactive bladder. IC patients have significantly more sleep
dysfunction, higher rates of depression, increased catastrophizing,
anxiety, and sexual dysfunction.
Public Awareness and Education
As IC is a condition that often takes long periods to diagnosis,
and this late diagnosis has such a major impact on the lives of
patients, it is vitally important to continue to educate both the
public and healthcare providers. The IC Education and Awareness Program
at the Centers for Disease Control and Prevention (CDC) has played a
major role in increasing the public's awareness of the devastating
disease and is the only program in the Nation which promotes public
awareness of IC. The public outreach of the CDC program includes public
service announcements on major television networks and the Internet.
Further, the CDC program has provided resources to make information on
IC available to patients and the public though videos, booklets,
publications, presentations, educational kits, websites, blogs,
Facebook pages, and a YouTube channel. For providers, this program has
included the development of an IC newsletter with information on IC
treatments, research, news, and events; targeted mailings to providers;
and exhibits at national medical conferences.
In order to continue these vitally important initiatives, which
have reached thousands of Americans, it is critical that the CDC IC
Education and Awareness Program be continued and receive a specific
appropriation of $660,000 for fiscal year 2012.
Research Through the National Institutes of Health
The National Institutes of Health (NIH), mainly through the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), maintains a robust research portfolio on IC, including five
recent major studies yielding significant new information. The RAND IC
Epidemiology (RICE) study found that nearly 2.7-6.7 percent of adult
women have symptoms consistent with IC and will prove important to the
future development of clinical trials and epidemiological studies. The
IC Genetic Twin study found environmental factors, rather than genetic
factors, to be substantial risk factors of developing IC. The Events
Preceding Interstitial Cystitis (EPIC) study has yielded significant
information linking non-bladder conditions and infectious agents to the
development of IC in many newly diagnosed IC patients. The findings of
the EPIC study have been reinforced in a Northwestern University study
which found that an unusual form of toxic bacterial molecule (LPS) has
an impact the development of IC as a result of an infectious agent.
Finally, the Urologic Pelvic Pain Collaborative Research Network
(UPPCRN) has indicated promising results for a new therapy for IC
patients.
Research currently underway and expected to begin in the near
future also holds great promise to increase our understanding of IC,
and thus find new treatments and cure. The Multidisciplinary Approach
to the Study of Chronic Pelvic Pain (MAPP) Syndrome Research Network
holds great potential to understanding the underlying issues related to
IC, other conditions possibly associated with IC, and new information
related to flares of the condition. Additionally, the investigator-
initiated research portfolio will continue to support research relating
to fundamental issues relating to IC and pelvic pain, including new
avenues for interdisciplinary research and new treatment options.
Finally, NIH will continue to focus on developing new treatment and
therapies to relieve this condition.
In order for this positive research to reach its full potential, it
is essential NIH continue to receive funding which will allow it to
continue and expand on past and current research. For this reason we
recommend a funding level of $35 billion for fiscal year 2012. We also
recommend the continuation of the MAPP study and collaboration between
NIDDK and the Office of Women's Health on issues related to IC.
Thank you for the opportunity to present the views of the
interstitial cystitis community.
______
Prepared Statement of the Iowa Statewide Independent Living Council
I am contacting you regarding the proposed restructuring of the
Independent Living funding that is outlined in President Obama's 2012
budget.
The seven Iowa Centers for Independent Living, along with all the
other Centers for Independent Living across the country, need your
help.
As you may know, Centers for Independent Living (CILs) are
nonprofit organizations run by people with disabilities for people with
disabilities. They are authorized by the Federal Rehabilitation Act.
CILs help people with disabilities to remain independent in their own
homes and communities, being productive and contributing members of
society. CILs work to help people remain independent so they are not
forced to live in institutions such as nursing homes. As I am sure you
are aware, in the vast majority of cases it is much less costly for a
person with a disability to remain in their own home and community
rather than pay for them to be institutionalized, and even more
importantly people with disabilities have the same right to live
independently as do people who do not have a disability.
The Independent Living movement, CILs, and SILCs promote the
philosophy of consumer control. Consumers, who are people with
disabilities, control the operations of CILs and SILCs.
I would like to provide you with some education about the reality
of what the President's proposed restructuring of Independent Living
funding will do to many Centers for Independent Living (CILs). I am
opposed to this restructuring because of the damage it will do to many
CILs, including the very real possibility that many CILs will have to
close their doors as they will not be able to fiscally operate under
this new structure.
Currently, under the Federal Rehabilitation Act, CILs receive their
Part C Federal Independent Living funding directly from the Federal
Rehabilitation Services Administration (RSA). The Federal Part B funds
are given to the States, in most cases to the State Vocational
Rehabilitation Services (VR) agency, and the VR does contracts with the
CILs and the Statewide Independent Living Council (SILC) for these Part
B Federal funds. The Federal Part C funds do not require a State match
as they come directly from RSA at the Federal level to the individual
CILs. The Part B funding does require a State match as it comes
directly to the state VR agency.
Combining the Federal Part B and the Federal Part C Independent
Living funding, and making these funds into a new block grant to States
for Independent Living funding, is not acceptable for a number of
reasons, and I would like to outline those reasons.
Combining these funds into a block grant and giving them to States
will significantly reduce, if not eliminate, consumer control of
independent living programs. Prior to the Part C funds being given to
RSA to distribute directly to CILs, the funds were given out in grants
to States. There were numerous problems with the State administering
these grant funds, which is why the funding structure was changed to
Part C going directly from RSA to CILs. Here are some examples of what
happened in the past, and these problems will also occur under the
President's proposed block grant funding:
--Under the past IL grant process, if the State had a freeze on
hiring or travel, they would also make the CILs have a freeze
on travel and hiring. This meant the CILs could not hire staff
when needed, nor could they travel when needed. So even though
the consumer controlled CIL Board directed the CIL Executive
Director to hire a new staff, or directed that staff was to
travel to attend a national conference, the State would not
allow the CIL to do these things and would not provide the
money to do these things, even though these things were an
allowable use of the Federal grant funds. The State agency
controlled the CIL, the Consumer Board did not have any
control.
--In many States, the Vocational Rehabilitation Services agency has
procedures for reimbursing funds to the CILs, and in many
States CILs would submit documentation for reimbursement and it
would take 3, 4 or 5 months for the VR agency to get the money
back to the CIL, which caused a great hardship for CILs to be
able to keep their doors open. Here is one true example. One
CIL Director re-financed his own house to take out a loan to
meet staff payroll until the CIL received the reimbursement
funds for their expenses from the State VR agency. Currently, I
know this is an issue with the Federal Part B funds that the VR
agencies give to CILs. It can take up to 4 or 5 months for a
CIL to get reimbursed for their Part B funds. Fortunately, many
of those CILs also get Federal Part C funds directly from RSA
so they have money to cover their expenses until they get the
Part B reimbursement check from VR. If the President's proposal
becomes reality, there are many CILs that will most likely have
to close as they will not have the working capital to pay their
bills and then wait 4-5 months to get reimbursed by the VR
agency.
There are additional concerns to consider.
--VR agencies are already under stress from State budget cuts, and it
takes VR staff time to be able to do contracts and
reimbursements for CILs. If these contracts become bigger, VRs
will have to hire additional staff to manage these funds and do
the contracts with the CILs. Where will the money come from for
the VR agency to do this? Will it be taken out of the combined
Part B and Part C funds, which means less funds going to CILs
for direct consumer partner services, and less money to SILCs
to be able to operate?
--Currently only the Part B funds require a State match. If you
combine B and C into one block grant, will State match be
required for this total amount? If so, where are States going
to get the State funds to match the additional Part C funds?
Many States can barely find the match for the Part B funds, so
it is possible that States will not have funds to match the
Part C funds too. That means the State will not get the Part C
funds, and Centers will not have enough funding to keep their
doors open.
--Providing direct funding to CILs is required by the Federal
Rehabilitation Act, and for the President's budget proposal to
be enacted, the Rehabilitation Act would have be significantly
altered and then reauthorized.
These are very real and disturbing concerns. I would like to know
that President Obama, as well as the Federal legislators, are looking
at these concerns and how to address them before going ahead with the
President's proposed restructuring. There must be a better way to do
this that will maintain consumer partner control of CIL operations, and
that will allow CILs to fiscally operate without risk of having to
close their doors, and/or reduce staff and services to consumer
partners.
______
Prepared Statement of the Joint Advocacy Coalition of the: Association
for Clinical Research Training, Association for Patient-Oriented
Research, and Clinical Research Forum
The Association for Clinical Research Training (ACRT), the
Association for Patient-Oriented Research (APOR), the Clinical Research
Forum (CR Forum), and the Society for Clinical and Translational
Science (SCTS) represent a coalition of professional organizations
dedicated to improving the health of the public through increased
clinical and translational research, and clinical research training.
United by the shared priorities of the clinical and translational
research community, ACRT, APOR, CR Forum, and SCTS advocate for
increased clinical and translational research at the National
Institutes of Health (NIH), the Agency for Healthcare Research and
Quality (AHRQ), and other Federal science agencies.
On behalf of ACRT, APOR, CR Forum, and SCTS, I would like to thank
the Subcommittee for their continued support of clinical and
translational research, and clinical research training. The creation of
the Patient-Centered Outcomes Research Institute and National Center
for the Advancement of Translational Science in healthcare reform will
provide a much-needed and greatly appreciated boost to comparative
effectiveness research (CER) at the Federal level, as well as the
organization of the new National Center for Translational Science
(NCATS). As outlined by NIH Director Dr. Francis Collins in his five
priorities for NIH, the translation of basic science to clinical
treatment is an integral component of modern biomedical research, and a
necessity to developing the treatments and cures of tomorrow.
Today, I would like to address a number of issues that cut to the
heart of the clinical and translational research community's
priorities, including the Clinical and Translational Science Awards
program (CTSA) at NIH, career development for clinical researchers, and
support for CER at the Federal level.
As our Nation's investment in biomedical research expands to
provide more accurate and efficient treatments for patients, we must
continue to focus on the translation of basic science to clinical
research. The CTSA program at NIH is quickly becoming an invaluable
resource in this area, but full funding is needed if we are to truly
take advantage of the CTSA infrastructure.
Fully Funding and Support for the CTSA Program at NIH
With its establishment in 2006, the CTSA program at NIH began to
address the need for increased focus on translational research, or
research that bridges the gap between basic scientific discoveries and
the bedside. Originally envisioned as a consortium of 60 academic
institutions, the CTSA program currently funds 55 academic medical
research institutions nationwide, and is set to expand to the full 60
by the end of 2011. The CTSAs have an explicit goal of improving
healthcare in the United States by transforming the biomedical research
enterprise to become more effectively translational. Specifically, the
CTSA program hopes to (1) improve the way biomedical research is
conducted across the country; (2) reduce the time it takes for
laboratory discoveries to become treatments for patients; (3) engage
communities in clinical research efforts; (4) increase training and
development in the next generation of clinical and translational
researchers; and (5) accelerate T1 translational science.
Although the promise of the CTSA program is recognized both
nationally and internationally, it has suffered from a lack of proper
funding along with NIH, and the National Center for Research Resources
(NCRR). In 2006, 16 initial CTSAs were funded, followed by an
additional 12 in 2007 and 14 in 2008, 4 in 2009, and 9 in 2010. Level-
funding at NIH curtailed the growth of the CTSAs, preventing recipient
institutions from fully implementing their programs and causing them to
drastically alter their budgets after research had already begun. If
budgets continue to decline, the CTSAs risk jeopardizing not only new
research but also the research begun by first, second, and third
generation CTSAs. Professional judgments have determined full funding
to be at a level of $700 million.
We recognize the difficult economic situation our country is
currently experiencing, and greatly appreciate the commitment to
healthcare Congress has demonstrated through stimulus funding, the
fiscal year 2011 appropriations process, and through healthcare reform.
The CTSAs are currently funding 55 academic research institutions
nationwide at a level of $464 million, with the goal of full
implementation by late 2011. In order to reach full implementation of
60 CTSAs by late 2011, and to realize the promise of the CTSAs in
transforming biomedical research to improve its impact on health, it is
imperative that the CTSA program receive funding at the level of $700
million in fiscal year 2012. Without full funding, more CTSAs will be
expected to operate with fewer resources, curtailing their
transformative promise.
A major part of the CTSA program's promise lies in its synergy with
all of NIH's Institutes and Centers (ICs), and the acceleration and
facilitation of the ICs' impact. The translation of laboratory research
to clinical treatment directly benefits patients suffering from complex
diseases and all fields of medicine. The CTSA program has created
improved translational research capacity and processes from which all
NIH's ICs stand to benefit. The development of a formal NIH-wide plan
to link all ICs to the CTSA program would efficiently capitalize on NIH
investment and the new opportunities presented by the advent of NCATS
for clinical and translational science.
It is our recommendation that the Subcommittee support full
implementation of the CTSA program by providing $700 million in fiscal
year 2011, and we ask that the Subcommittee support the development of
a formal NIH-wide plan to integrate the CTSAs to all of NIH's Institues
and Centers.
Continuing Support for Research Training and Career Development
Programs Through the K Awards
The future of our Nation's biomedical research enterprise relies
heavily on the maintenance and continued recruitment of promising young
investigators. Clinical investigators have long been referred to as an
``endangered species'', as financial barriers push medical students
away from research. This trend must be arrested if we are to continue
our pursuits of better treatments and cures for patients.
The K Awards at NIH and AHRQ provide much-needed support for the
career development of young investigators. As clinical and
translational medicine takes on increasing importance, there is a great
need to grow these programs, not reduce them. Career development grants
are crucial to the recruitment of promising young investigators, as
well as to the continuing education of established investigators.
Reduced commitment to the K-12, K-23, K-24, and K-30 awards would have
a devastating impact on our pool of highly trained clinical
researchers. Even with the full implementation of the CTSA program, it
will be critical for institutions without CTSAs to retain their K-30
Clinical Research Curriculum Awards, as the K-30s remain a highly cost-
effective method of ensuring quality clinical research training. ACRT,
APOR, CRF, and SCTS strongly support the ongoing commitment to clinical
research training through K Awards at NIH and AHRQ.
We ask the Subcommittee to continue their support for clinical
research training and career development through the K Awards at NIH
and AHRQ, in order to promote and encourage investigators working to
transform biomedical science.
Continuing Support for CER
Comparative effectiveness research or ``CER'' emerged at the
forefront of the healthcare reform debate, capturing the interest of
lawmakers and the American people. CER is the evaluation of the impact
of different options that are available for treating a given medical
condition for a particular set of patients. This broad definition can
include medications, behavioral therapies, and medical devices among
other interventions, and is an important facet of evidence-based
medicine. On behalf of ACRT, APOR, CR Forum, and SCTS, I would like to
thank the Senate for the creation of the Patient-Centered Outcomes
Research Institute in the Patient Protection and Affordable Care Act,
as well as the $1.1 billion included for CER at NIH and AHRQ in the
American Recovery and Reinvestment Act (ARRA). Both AHRQ and NIH have
long histories of supporting CER, and the standards for research
instituted by agencies like NIH and AHRQ serve as models for best
practices worldwide. Not only are these agencies experienced in CER,
they are universally recognized as impartial and honest brokers of
information.
We are pleased that Congress recognizes the importance of these
activities and believe that the peer review processes and
infrastructure in place at NIH and AHRQ ensure the highest quality CER.
We believe that collaboration between the Patient-Centered Outcomes
Research Institute, NIH, and AHRQ will motivate all Federal CER
efforts. In addition to support for the CTSA program at NIH, we
encourage the Subcommittee to provide continued support for Patient-
Centered Health Research at AHRQ.
Thank you for the opportunity to present the views and
recommendations of the clinical research training community. On behalf
of ACRT, APOR, CR Forum, and SCTS, I would be happy to be of assistance
as the appropriations process moves forward.
______
Prepared Statement of Lions Clubs International
Lions Clubs International (LCI) its official charity arm, Lions
Clubs International Foundation (LCIF), have been world leaders in
serving the vision, hearing, youth development, disability and
humanitarian needs of millions of people in America and around the
world, and we work closely with other NGOs. Since LCIF was founded in
1968, it has awarded more than 9,000 grants, totaling more than $700
million for service projects ranging from affordable hearing aids to
diabetes-prevention. All Administrative costs are paid for through
interest earned on investments, allowing LCIF to maximize out impact on
the community and demonstrating the motto ``We Serve.''
Our current 1.35 million-member global membership, representing
over 206 countries, serves communities through the following ways:
protect and preserve sight; provide disaster relief; combat disability;
promote health; and serve youth. The 12,000 individual clubs
representing over 375,000 individual citizens in North America are
constantly expanding to add new programs and its volunteers are working
to bring health services to as many communities as possible.
LCI represents the largest and most effective NGO service
organization presence in the world. Awarded and recognized as the #1
NGO organization for partnership globally by The Financial Times 2007,
LCI also holds a four star (highest) rating from the
CharityNavigator.com (an independent review organization).
Today, we face many complex challenges in the health and education
sector, from preventable diseases that cause blindness in children to
bullying, violence, and drug use among school-aged children. I will
offer a brief summary of recommendations in programs under the general
jurisdiction of the Labor-HHS-Education Subcommittee.
health and human services
Domestic Sight Services
Through our network of foundations and programs across America, LCI
remains the single largest provider of charitable vision care,
eyeglasses and hearing care services to needy and indigent people. Some
of our major sight initiatives include:
--The Sight for Kids Program in collaboration with Johnson and
Johnson. The program has provided 6 million vision screenings
and eye-health education programs for children.
--Core 4 Preschool Vision Screening program enables LCI to conduct
screenings for children in preschools. The program strives to
deliver early detection and treatment for the most common
vision disorders that can lead to amblyopia or ``lazy eye.''
LCIF has also provided grants and services to those affected by
eye conditions that cannot be improved medically.
--LCI Clubs sponsored ``United We Serve Health Week'' events around
the country. These Health Week efforts, in conjunction with the
White House, were effective in bringing awareness to vision
health issues.
National Eye Institute--Vision Health Recommendations
LCI believes that vision loss is a major public health problem that
increases healthcare costs and reduces productivity and quality of life
for millions of Americans. LCI played an important role in the creation
of a free-standing eye institute separate from the then-National
Institute for Neurological Diseases and Blindness. The National Eye
Institute Act was signed into law by President Johnson in 1968 as the
Nation's lead Institute within the NIH to prevent blindness and save
and restore vision of all Americans. NEI-funded research is resulting
in treatments and therapies that save vision and restore sight,
resulting in reduced healthcare costs and higher productivity.
LCI is concerned that proposals to reduce NIH funding to fiscal
year 2008 levels would result in NEI funding for fiscal year 2011 at
$667 million, or a $30 million loss. This would result in 43 fewer
investigator-initiated research grants to save or restore vision.
According to the National Association Eye and Vision Research, this
funding reflects little more than 1 percent of the $68 billion annual
cost of eye disease and vision impairment in the United States.
LCI supports fiscal year 2012 NIH funding at $35 billion. This
funding level would ensure that NIH can maintain the number of multi-
year investigator-initiated research grants, and enables NEI to build
upon its record of basic clinical/translational research. We also
support an increase in NEI funding above the 1.8 percent proposed by
the President.
Vision 2020 USA Partnership
VISION 2020 USA members, including Lions Clubs International, share
a commitment to blindness prevention, preserving sight, and ensuring
that all individuals receive the vision and eye healthcare they need
and deserve. We are particularly interested in ensuring that Congress
provides for fiscal year 2012 to support the following programs and
initiatives:
--Sustainment of at least $3.23 million for vision and eye health
initiatives at the Centers for Disease Control and Prevention
(CDC)
--Support of the Maternal and Child Health Bureau's (MCHB) National
Center for Children's Vision and Eye Health
Vision-related conditions affect people across the lifespan from
childhood through elder years. Fortunately, in children, many serious
ocular conditions--such as amblyopia, nearsightedness, farsightedness,
and astigmatism--are treatable, if diagnosed at an early stage. Yet,
too many children do not receive vision screenings or follow-up
comprehensive eye examinations and treatment. More than 80 million
Americans are at risk for a potentially blinding eye disease such as
diabetic retinopathy, glaucoma, cataract, and age-related macular
degeneration. If nothing is done, the number of blind Americans is
expected to double by 2030.
With fiscal year 2012 appropriations that maintain current funding
for vision and eye health efforts of the CDC and increased resources
for the NIH and NEI, these Federal vision and eye health partners will
have the resources they need to sustain and expand their respective
efforts and programs to advance the prevention, diagnosis, and
treatment of vision problems and eye disease.
Lions Affordable Hearing Aid Project (AHAP)
LCI is committed to fighting hearing loss as well as blindness. By
listening to community health organizations across the country, Lions
Clubs International and their volunteer members became aware of the
lack of quality and affordable hearing care, especially for people with
incomes below or at 200 percent of the poverty level. Many people have
been unable to access other personal and family resources to purchase
hearing aids, and have been denied State and Federal assistance.
Fourteen centers have been working to expand output in this area as
demand continues to rise with a network of mobile health units and
community based programs that screen more than 2 million people each
year and provide hearing aids to 14,000 low income patients.
The statistics are unacceptable: 31 million persons in the United
States experience some form of hearing loss, yet only 7.3 million opt
to use hearing aids. According to audiology researchers, the market
penetration for hearing aids is about 23.6 percent. For every four
patients that enter a practice needing hearing aids, only one will
purchase them. The median price tag is $1,900 (2005) for a digital
hearing aid and prices go as high as $4,000. State Foundations, public
health departments, and aging departments are in need of assistance in
this area.
With the recent 25-30 percent increase in people seeking assistance
for hearing aids, there is an immediate public imperative to address
the problem. Federal dollars are stretched, but Federal support in this
area would have significant public health dividends in difficult
economic times.
``lions quest''/education/health programs
LCIF's youth development initiatives, known collectively as ``Lions
Quest,'' have been a prominent part of school-based K-12 programs since
1984. Fulfilling its mission to teach responsible decisionmaking,
effective communications and drug prevention, Lions Quest has been
involved in training more than 350,000 educators and other adults to
provide services for over 11 million youth in programs covering 43
States. LCIF currently invests more than $2 million annually in
supporting life skills training and service learning, and that funding
is matched by local Lions, schools and other partners.
Lions Quest curricula incorporate parent and community involvement
in the development of health and responsible young people in the areas
of: life skills development (social and emotional learning), character
education, drug prevention, service learning, and bullying prevention.
There is even a physical fitness component to this program that can
assist Federal goals of reducing obesity in school-aged children.
These Lions Quest programs provide strong evidence of decreased
drug use, improved responsibility for students own behavior, as well as
stronger decisionmaking skills and test scores in math and reading. In
August 2002, Lions Quest received the highest ``Select'' ranking from
the University of Illinois at Chicago-based Collaborative for Academic,
Social and Emotional Learning (CASEL) for meeting standards in life
skills education, evidence of effectiveness and exemplary professional
development.
Lions Quest has extensive experience with Federal programs. Lions
Quest Skills for Adolescence received a ``Promising Program'' rating
from the U.S. Department of Education Safe and Drug Free Schools and a
``Model'' rating from the U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration (SAMHSA).
Lions Quest also has extensive experience of partnering with State
service commissions to reach more schools and engage more young people
in service learning. Successful partnerships have been active in
Michigan, New York, Oklahoma, Tennessee and West Virginia with progress
being made in Texas and Ohio.
Social and Emotional Learning Programs
In addition, Lions Clubs recommends Congressional support for
social and emotional learning (SEL) programs that stimulate growth
among schools nationwide through distribution of materials and teacher
training, and to create opportunities for youth to participate in
activities that increase their social and emotional skills. Not only do
SEL curricula contribute to the social and emotional development of
youth, but they also provide invaluable support to students' school
success, health, well-being, peer and family relationships, and
citizenship. While still conducting scientific research and reviewing
the best available science evidence, over time Lions Clubs and its SEL
partners have increasingly worked to provide SEL practitioners,
trainers and school administrators with the guidelines, tools,
informational resources, policies, training, and support they need to
improve and expand SEL programming.
Overall, SEL training programs and curricula have outstanding
benefits for school-aged children:
--SEL prevents a variety of problems such as alcohol and drug use,
violence, truancy, and bullying. SEL programs for urban youth
emphasize the importance of cooperation and teamwork.
--Positive outcomes increase in students who are involved in social
and emotional learning programming by an average of 11
percentile points over other students.
--With greater social and emotional desire to learn and commit to
schoolwork, participants benefit from improved attendance,
graduation rates, grades, and test scores.
conclusion
Lions Clubs remains committed to domestic activities such as major
sight initiatives and positive youth development and youth service
programs. Today we face great health and educational challenges, and
Lions Clubs International understands the importance not only of
community service but of instilling those among members of our next
generation. The success of nonprofit entities such as Lions Clubs show
what the service sector can do for economic and social development of
communities that are especially hard hit by the recession, and we are
committed to forming more effective alliances and partnerships to
increase our domestic impact.
______
Prepared Statement of the March of Dimes Foundation
The 3 million volunteers and nearly 1,300 staff members of the
March of Dimes Foundation appreciate the opportunity to submit Federal
funding recommendations for fiscal year 2012.
The March of Dimes was founded in 1938 by President Franklin D.
Roosevelt to support research to prevent polio. Today, the Foundation
aims to improve the health of women, infants and children by preventing
birth defects, premature birth, and infant mortality through scientific
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 51 chapters and 213 divisions in every
State, the District of Columbia and Puerto Rico. Additionally, in 1992,
the March of Dimes extended its mission globally and now operates
through partnerships in 33 countries on four continents.
The March of Dimes is aware that the current fiscal environment
necessitates restrictions on Federal funding increases and program
expansions. However, it is our hope that these budgetary limitations
will not put at risk our vital mission on which affected families rely.
Therefore, the March of Dimes recommends the following funding levels
for programs and initiatives that are essential investments in maternal
and child health.
preterm birth
In 2008, one in eight infants was born preterm (before 37 weeks).
Preterm birth is the leading cause of newborn mortality (death within
the first month) and the second leading cause of infant mortality
(death within the first year). In 2009, the National Center for Health
Statistics (NCHS) reported that the primary reason for the higher
infant mortality rate in the United States compared to other high
resource countries is the greater percentage of preterm births--12.4
percent in the United States compared to 5.5 percent in Ireland. But
survival alone does not necessarily result in good health for these
infants. Among those who survive, one in five faces health problems
that persist for life. Prematurity-related conditions include cerebral
palsy, intellectual disabilities, chronic lung disease, blindness and
deafness. A comprehensive report published by the Institute of Medicine
in 2007 estimated that preterm births cost the United States more than
$26 billion in 2005 alone, with costs climbing each year.
As a result of legislation enacted in 2006 (Public Law 109-450),
the U.S. Surgeon General sponsored a conference in 2008 of more than
200 of the country's foremost experts that convened for 2 days to
develop a strategy to address the costly and serious problems of
preterm birth. The meeting resulted in an action plan that included
several overarching themes and recommendations. Among the most
important were the enhancement of biomedical and epidemiological
research and strengthening our Nation's data resources that document
the health status of pregnant women and infants. The Foundation's
funding requests regarding preterm birth are based on these
recommendations.
National Institutes of Health
The March of Dimes commends members of the Subcommittee for their
continuing support of the National Children's Study (NCS). For fiscal
year 2012, the Foundation supports the President's funding
recommendation of $193.9 million for the NCS and we urge the
Subcommittee to support this recommendation as well. The NCS is the
largest and most comprehensive study of children's health and
development ever planned in the United States. The 37 ``vanguard
centers'' have recruited nearly 3,000 participants thus far and more
than 650 children have been born into the study. When fully
implemented, this study will follow a representative sample of 100,000
children in the United States from before birth until age 21. The data
from this important study will help scientists at universities and
research organizations across the country and around the world identify
precursors of diseases and develop new strategies for treatment and
prevention. Specifically, the first data generated by the NCS will
provide information concerning disorders of birth and infancy,
including preterm birth and its health consequences. The Foundation
remains committed to supporting a well-designed NCS that promotes
research of the highest quality and asks the Subcommittee to do the
same.
Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD)
For fiscal year 2012, the March of Dimes recommends at least $1.35
billion for the NICHD. This $30 million increase compared to the fiscal
year 2011 enacted level will enable NICHD to expand its support for
preterm birth-related research through the Maternal-Fetal Medicine
Units, Neonatal Research Network, and Genomic and Proteomic Network for
Preterm Birth Research. In addition, it will allow for planning grants
to begin establishing a network of integrated trans-disciplinary
research centers, as recommended by the Institute of Medicine report
and the aforementioned 2008 Surgeon General's Conference. The causes of
preterm birth are multi-faceted and necessitate a coordinated and
collaborative approach integrating many disciplines. These trans-
disciplinary centers would serve as a national resource for
investigators to design and share new research approaches and
strategies to comprehensively address preterm birth.
Centers for Disease Control and Prevention--Preterm Birth
The National Center for Chronic Disease Prevention and Health
Promotion's Safe Motherhood Program works to promote optimal
reproductive and infant health. In 2009, CDC created a robust research
agenda to prevent preterm birth by improving derivation of accurate
data to understand preterm birth; developing, implementing and
evaluating prevention methods; and conducting targeted etiologic and
epidemiologic studies. For fiscal year 2012, the March of Dimes
recommends a $6 million increase in the CDC's preterm birth budget
compared to the fiscal year 2011 enacted level (for a total of $8
million) to strengthen our national data systems and to expand preterm
birth research as authorized by the PREEMIE Act (Public Law 109-450).
Centers for Disease Control and Prevention--National Center for Health
Statistics
The National Center for Health Statistics' (NCHS) vital statistics
program collects birth and death data that are used to monitor the
Nation's health status, set research and intervention priorities, and
evaluate the effectiveness of existing health programs. It is
imperative that data collected by NCHS be comprehensive and timely.
Unfortunately, one-quarter of the States and territories lack the
capacity to use the most recent (2003) birth certificate format and
only two-thirds have adopted the most recent (2003) death certificate
format. The March of Dimes supports the President's recommendation to
provide $162 million for the NCHS in fiscal year 2012 and urges the
Subcommittee to support this recommendation in both the bill language
and in the accompanying committee report as well.
Health Resources and Services Administration--Healthy Start
The Maternal and Child Health Bureau's Healthy Start Program is a
collection of community-based projects focused on reducing infant
mortality, low birth weight, and racial disparities in perinatal
outcomes among high-risk populations by strengthening local health
systems and resources. Communities with Healthy Start programs have
seen significant improvements in perinatal health outcomes. The March
of Dimes supports the President's recommendation to provide $105
million for Healthy Start in fiscal year 2012 and urges the
Subcommittee to support this recommendation as well.
birth defects
According to the Centers for Disease Control and Prevention, an
estimated 120,000 infants in the United States are born with major
structural birth defects each year. Genetic or environmental factors,
or a combination of both, can cause various birth defects; yet the
causes of more than 70 percent are unknown. Many birth defects result
in childhood and adult disability that require costly, lifelong
treatments and special care. Additional Federal resources are sorely
needed to support research to discover causes of all birth defects and
for the development of effective interventions to prevent or at least
reduce their prevalence.
CDC's National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
The NCBDDD conducts programs to protect and improve the health of
children by preventing birth defects and developmental disabilities and
by promoting optimal development and wellness among children with
disabilities. For fiscal year 2012, the March of Dimes requests at
least $144 million for NCBDDD. In addition, we encourage the
Subcommittee to allocate an additional $5 million specifically to
support birth defects research and surveillance and an additional $2
million specifically to support folic acid education. A source for this
$7 million in additional funding could be the Prevention and Public
Health Fund. Investing in the work of the NCBDDD will promote wellness
and preventive strategies aimed at children, reduce health disparities,
and enable CDC to more effectively support transition to adulthood for
children with lifelong disabilities.
Allocating an additional $5 million to support genetic analysis of
the research samples already obtained through the NCBDDD's National
Birth Defects Prevention Study--the largest case-controlled study of
birth defects ever conducted--would be a sound investment. This
analysis would enable researchers to begin the work needed to translate
their findings into effective birth defects intervention and treatment
programs. The study has already yielded rich results. In 2009 alone, 29
articles regarding risk factors for birth defects--for example maternal
diabetes, obesity, use of certain medications, and smoking--were
published in medical and health journals. In addition, this investment
would make possible the continuation of NCBDDD's State-based birth
defects surveillance grant program. Surveillance is the backbone of the
public health network and its support should be a Subcommittee
priority. Because of the current fiscal situation facing many States,
funding for State-based surveillance systems is in jeopardy and
requires increased Federal support to ensure the survival of essential
birth defects surveillance programs.
Allocating an additional $2 million to NCBDDD will allow the CDC to
expand its effective national education campaign aimed at reducing the
incidence of spina bifida and anencephaly by promoting consumption of
folic acid. Since the institution of fortification of U.S. enriched
grain products with folic acid, the rate of neural tube defects has
decreased by 26 percent. However, CDC estimates that up to 70 percent
of neural tube defects could be prevented if all women of childbearing
age consumed 400 micrograms of folic acid daily. To raise awareness
among women of childbearing age and thereby increase the use of folic
acid, NCBDDD's national education campaign must be expanded.
The March of Dimes is very concerned about the Administration's
recommendation that the NCBDDD's budget lines be consolidated into
three categories: Child Health and Development, Health and Development
for People with Disabilities, and Public Health Approach to Blood
Disorders. As proposed, the Birth Defects and Developmental
Disabilities budget line would be renamed Child Health and Development
and existing sub-categories would be eliminated (e.g. Birth Defects,
Fetal Alcohol Syndrome, Folic Acid). While the March of Dimes
recognizes and supports program flexibility for CDC management, we are
concerned that the title ``Child Health and Development'' fails to make
clear the overall purpose of the programs covered, masking the urgency
and importance of the need for ongoing support from Congress. We urge
the Subcommittee to modify the Administration's proposal by retaining
the term ``Birth Defects'' as a sub-line with the category ``Child
Health and Development.'' We believe this adjustment is needed to
ensure that the content of these essential programs to reduce birth
defects is clearly articulated.
newborn screening
Newborn screening is a vital public health activity used to
identify genetic, metabolic, hormonal and functional disorders in
newborns so that treatment can be provided. Screening detects
conditions in newborns that, if left untreated, can cause disability,
developmental delays, intellectual disabilities, serious illnesses or
even death. If diagnosed early, many of these disorders can be
successfully managed. Across the Nation, State and local governments
are experiencing significant budget shortfalls. Because of this fiscal
pressure, discontinuing screening for certain conditions or postponing
the purchase of necessary technology is a serious threat that, if left
unresolved, will put infants at risk of permanent disability or even
death. For fiscal year 2012, an additional $5 million for HRSA's
heritable disorders program, as authorized by the Newborn Screening
Saves Lives Act (Public Law 110-204), is necessary to increase support
for State efforts to improve screening, enhance counseling, and
increase capacity to reach and educate health professionals and parents
about newborn screening programs and follow-up services.
other
Agency for Health Research and Quality (AHRQ)
AHRQ supports research to improve healthcare quality, reduce costs
and broaden access to essential health services. For fiscal year 2012,
the March of Dimes recommends $405 million total for AHRQ to continue
its important work, including the development and dissemination of
maternal and pediatric quality measures and comparative effectiveness
research. Moreover, with the historic enactment of health reform last
year, AHRQ's research is needed more than ever to build the evidence-
base that will be used to improve health and healthcare coverage.
Health Resources and Services Administration--Maternal and Child Health
Block Grant
Title V of the Social Security Act, the Maternal and Child Health
Block Grant, supports a growing number of community-based programs
(e.g. home visiting, respite care for children with special healthcare
needs, and supplementary services for pregnant women and children
enrolled in Medicaid and the State Children's Health Insurance
Program), but Federal support has not kept pace with increased
enrollment and demand for these services. For fiscal year 2012, the
March of Dimes recommends $700 million for the Maternal and Child
Health Block Grant--$44 million more than the fiscal year 2011 enacted
level.
CDC National Immunization Program
Infants are particularly vulnerable to infectious diseases, which
is why it is critical to protect them through immunization. In 2008,
the national estimated immunization coverage among children 19-35
months of age was 76 percent. The CDC's National Immunization Program
supports States, communities and territorial public health agencies
through grants to reduce the incidence of disability and death
resulting from vaccine-preventable diseases. The March of Dimes is
requesting $685 million in fiscal year 2012 for the National
Immunization Program.
CDC Polio Eradication
Since its creation as an organization dedicated to research and
services related to polio, the March of Dimes has been committed to the
eradication of this disabling disease. We support the Administration's
Global Polio Eradication Strategic Plan for the remaining endemic
countries, and urge the Subcommittee to approve the President's request
for $112 million in fiscal year 2012 to support CDC's Polio Eradication
Program.
closing
Thank you for the opportunity to testify on the federally supported
programs of highest priority to the March of Dimes. The Foundation's
volunteers and staff in every State, the District of Columbia and
Puerto Rico look forward to working with Members of this Subcommittee
to secure the resources needed to improve the health of the Nation's
mothers, infants and children.
MARCH OF DIMES FISCAL YEAR 2012 FEDERAL FUNDING PRIORITIES
------------------------------------------------------------------------
Fiscal year
2011 funding
(w/prevention March of Dimes
Program fund add-on fiscal year
where 2012 request
applicable)
------------------------------------------------------------------------
National Institutes of Health (Total)... $30.77 B $35 B
National Children's Study........... 191.05 M 193.9 M
Common Fund......................... 543.02 M 556.9 M
National Institute of Child Health 1.32 B 1.35 B
and Human Development..............
National Human Genome Research 511.5 M 524.8 M
Institute..........................
National Center on Minority Health 209.71 M 214.6 M
and Disparities....................
Centers for Disease Control and 6.26 B 7.7 B
Prevention (Total).....................
Birth Defects Research & 20.3 M 25.3 M
Surveillance.......................
Folic Acid Campaign................. 2.8 M 4.8 M
Immunization........................ 525.57 M 685 M
Polio Eradication................... 101.6 M 112 M
Preterm Birth (Safe Motherhood)..... 1.97 M 8 M
National Center for Health 168.68 M 162 M
Statistics.........................
Health Resources and Services 6.29 B 7.65 B
Administration (Total).................
Maternal and Child Health Block 656.32 M 700 M
Grant..............................
Newborn Screening................... 9.95 M 15 M
Newborn Hearing Screening........... 18.88 M 19 M
Community Health Centers............ 2.48 B 2.56 B
Healthy Start....................... 104.36 M 105 M
Agency for Healthcare Research and 392.05 M 405 M
Quality (Total)........................
------------------------------------------------------------------------
______
Prepared Statement of the Meals On Wheels Association of America
Thank you for the opportunity to present testimony to your
subcommittee concerning fiscal year 2012 funding for Senior Nutrition
Programs administered by the Administration on Aging (AoA) within the
U.S. Department of Health and Human Services (HHS). I am Enid A.
Borden, President and CEO of the Meals On Wheels Association of America
(MOWAA), the oldest and largest national organization representing
local, community-based Senior Nutrition Programs--both congregate and
home-delivered (commonly referred to as Meals On Wheels)--and the only
national organization and network dedicated solely to ending senior
hunger in America. I speak on behalf not only of that national network
of Senior Nutrition Programs but also for the hundreds of thousands of
seniors in communities across this Nation who depend upon those
programs for access to nutritious meals. I speak for them because many
are behind closed doors, invisible and without a voice of their own.
But it is not only for those particular seniors that I bring our
concerns before you. I also speak for those other seniors who like
their peers need meals, but who do not receive them, not because we
lack the infrastructure and expertise to serve them but because our
Senior Nutrition Programs lack the adequate financial resources to
provide them. At MOWAA we call those individuals the hidden hungry, and
we call the situation that lets them remain so a national tragedy and
morally unacceptable circumstance in the richest Nation on earth.
Those, I realize, are strong words. But they are also carefully chosen
and in no way hyperbolic. Later I will attempt to put impartial numbers
to those words, and then some humanity.
But before I do that, let me stop and offer MOWAA's sincere thanks
to this Subcommittee, and in particular to you, Mr. Chairman, for your
longstanding support of Senior Nutrition Programs as well as for your
leadership in ensuring that these programs received increases in
appropriations the past several fiscal years. We are quite mindful that
the chairman's mark of the Senate version of the fiscal year 2011 bill,
crafted by this Subcommittee and approved by the full Committee,
contained increases of $38 million above the fiscal year 2010 level for
these programs. We are grateful for those actions at the same time that
we are extremely disheartened that the final fiscal year 2011
continuing resolution did not provide for any increases.
Today Senior Nutrition Programs are struggling to maintain
services; many are unable to do so and therefore are forced to reduce
services. That is today, and as prices of gasoline and food continue to
climb, more and more programs will find themselves in that predicament.
More starkly, homebound seniors who cannot shop and prepare meals for
themselves, who have no other access to nutritious food, will be forced
to go without meals. The consequences of that are something for which
we will all pay. I use the word ``pay'' both literally and
figuratively. If we leave frail seniors languishing in their homes
without proper nutrition, their health will inevitably fail. If they
survive, they will end up hospitalized or institutionalized at a cost
to the Government that far exceeds the cost of providing adequate funds
to Senior Nutrition Programs to enable them to furnish seniors meals in
the homes and other settings. Senior Nutrition Programs can provide
meals for nearly 1 year for roughly the cost of one Medicare day in the
hospital. We can quantify the savings that can accrue when seniors
receive nutritious meals immediately following a hospital stay for an
acute condition.
Our evidence in this regard is based on 2006 data (in 2006 dollars)
from a special project that MOWAA carried out in partnership with a
major national insurance company. The findings were presented in
December 2006 in Washington at a Leadership Summit sponsored by AoA.
Through the special partnership, Medicare Advantage patients in select
markets across the United States were offered without cost to
themselves 10 meals, delivered by local Meals On Wheels programs,
immediately following hospital discharge. Participation was purely
voluntary. Individuals who chose to receive the service were typically
sicker than those who declined it. Despite this, the insurance data
show that those seniors who received meals had first month post-
discharge healthcare costs on average $1,061 lower than those who did
not. The beneficial affects were also lasting. The third month after
receiving those meals, the average per person savings were $316.
Individuals who did not receive meals had both more inpatient hospital
days and more inpatient admissions per 1,000 than those who did receive
meals. I cannot calculate the savings had meals been provided to every
senior who was discharged from the hospital, or even to half of them,
but I know that it is significant. According to PricewaterhouseCoopers,
preventable hospital readmissions cost the Nation approximately $25
billion each year. One out of every five Medicare patients discharged
from a hospital is readmitted within 30 days at an annual cost to
Medicare of $17 billion. Given these facts, providing adequate funds
for Senior Nutrition Programs can only be regarded as a strong and
demonstrable value proposition. Beyond that, from a human and humane
perspective, and from the perspective of the value of individuals and
their liberty--principals on which this Nation was founded and for
which it still stands--it is the only acceptable and right thing to do.
As you are well aware, however, the President's fiscal year 2012
budget proposes continued funding for these programs for another fiscal
year at the fiscal year 2010 level. If that occurs it will not only be
costly on the other side of the Federal ledger but it will also be
nothing less than disastrous for seniors who are already vulnerable. So
we appeal to this Subcommittee to provide substantial increases above
the President's request for Title III C1 (Congregate Meals), Title III
C2 (Home-Delivered Meals) and Nutrition Services Incentive Program
(NSIP). We ask knowing that the fiscal context in which you are working
for this fiscal year 2012 appropriation bill is extraordinarily
challenging, and we ask knowing that providing increases to our
programs means reducing or eliminating others. But we also ask knowing
that without such increases vulnerable seniors will go hungry.
One of the great strengths of community-based Senior Nutrition
Programs is that they are strong public-private partnerships that rely
on the community to contribute significant financial support to augment
those Federal funds furnished through this Labor, Health and Human
Services, Education and Related Agencies appropriation bill. A host of
partners give generously, and without them Senior Nutrition Programs
could not operate. But without a strong Federal commitment in the form
of adequate appropriations most Senior Nutrition Programs could not
leverage these other funds effectively. In fiscal year 2009, the last
year for which AoA has data, only 28.4 percent of the expenditures for
Title III C2 home-delivered meals were Title III dollars. The remainder
was from other sources. For Title III C1 congregate meals the Title III
share was 41 percent. Funds are not the only invaluable resources that
communities contribute to Senior Nutrition Programs. The programs
typically rely on volunteers to perform many of the critical functions
of the operation, such as meal delivery. We are proud to claim what we
believe to be the largest volunteer army in the world, numbering in the
neighborhood of 1.7 million individuals each year. Despite all of these
assets Senior Nutrition Programs will fail to reach the most vulnerable
elderly in their communities without adequate Federal financial
support.
Simply put, Senior Nutrition Programs are lifelines to those men
and women they serve. Regrettably they are reaching only a small
proportion of the population needing services. A February 2011
Government Accountability Office (GAO) report prepared for Senator Herb
Kohl paints a grim picture. The GAO (GAO-11-237) found that ``. . .
approximately 9 percent of an estimated 17.6 million low-income older
adults received meal services like those provided by Title III
programs. However, many more older adults likely needed services, but
did not receive them . . . For instance, an estimated 19 percent of
low-income older adults were food insecure and about 90 percent of
these individuals did not receive any meal services [emphasis added].
Similarly approximately 17 percent of those with low incomes had two or
more types of difficulties with daily activities that could make it
difficult to obtain or prepare food. An estimated 83 percent of those
individuals with such difficulties did not receive meal services
[emphasis added].
As dire as this report is, we wish to point out that it undercounts
the percentage of the population needing services that fail to receive
them. This is due to the fact that the GAO confined their investigation
to low-income seniors. Title III and NSIP funded meal programs are
explicitly prohibited by the Older Americans Act (OAA) from means-
testing and many individuals with incomes above the Federal poverty
line receive services based on their physical condition, homebound
status, social or geographic isolation and other factors that create an
inability to access nutritious food from any other source. If you
factor individuals meeting these criteria into the equation, the
percentage of seniors needing meal services but who do not get them
will certainly increase. Surely our Federal and national commitment to
our most vulnerable elders should reach more than 10 percent of those
needing meals.
Given the current economic situation and the exponential growth of
the aging population, if funding remains static it is unavoidable that
the percentage of people needing services to whom Senior Nutrition
Programs will be able to provide services will erode substantially.
Sky-rocketing food and fuel prices are having a deleterious impact on
programs that are dependent upon these two items. MOWAA has determined
that every 1 cent increase in the price of gasoline results in a
$250,000 increase in the cost of providing services. Gasoline prices
for the week of May 9, 2011 were $1.06 higher than for the same week of
2010. This means that costs nationally of delivering services based on
this factor alone increased by $26,500,000. It is true that some, but
not all, of these costs are borne by volunteers who donate the use of
their vehicles, but as gas prices increase many of these individuals, a
number of whom are older and on fixed incomes themselves, are either
requesting reimbursement from programs or suspending their volunteer
activities. When this happens, Senior Nutrition Programs often must
bear the costs. The point is that factors far outside the control of
Senior Nutrition Programs are increasing their costs; so flat funding
will translate into a significant reduction or curtailment of nutrition
services to our most vulnerable seniors.
Last year, MOWAA engaged an expert actuary to examine Federal
funding for Senior Nutrition Programs for the past two decades. Looking
at population data and appropriations, he determined a per capita
commitment to seniors and Senior Nutrition Programs in fiscal year
1992. Then, taking into account the growth in the ages 60+ and the 85+
population and the changes in the CPI-U, he projected what the fiscal
year 2012 total appropriation for Title III C1, Title III C2 and NSIP
would be in fiscal year 2011 if that per capita commitment were
maintained. The current year (fiscal year 2011) figure would be
$1,275,571,000 based on the 60+ population and $1,743,182,000 based on
the 85+ population. We are not asking for either of those funding
levels, the latter of which be more than double the current year
appropriation of $819,474,000 for the three line items combined. But we
do believe that this provides a reasonable context in which to make
decisions. Surely the senior citizens of today are as valuable and
deserving of life sustaining meals as those seniors of two decades ago
were. Meals are not dispensable. To live and live healthily people must
eat. To ensure that frail seniors do, Congress must increase funding
for Senior Nutrition Programs. We respectfully request that increases
of no less than your Subcommittee originally approved for fiscal year
2011, that is of at least $38 million for Title III C combined with a
commensurate increase for NSIP, should be the baseline.
In closing I would like to thank this Subcommittee again for its
longstanding support, acknowledge that MOWAA understands the difficulty
of your task and the boldness of our ``ask'' in this difficult budget
year. We mean no disrespect. But part of our role, in addition to
supporting our member Senior Nutrition Programs in providing meals, is
to call attention to the need to afford those older adults, who
contributed so much to this Nation, the respect that they are due. It
is in that spirit that we make our request. As you consider it and as
you make the difficult funding decisions that the Subcommittee must, we
respectfully request that you think of Senior Nutrition Programs not
simply as one of the hundreds of programs supported through the Labor,
Health and Human Services, Education and Related Agencies appropriation
bill, but instead as an essential service. For what is more essential
to the sustaining of life than nutritious food and hydration? Those are
the fundamental services Senior Nutrition Programs deliver.
Again, we thank you for the opportunity to present this testimony
to you.
______
Prepared Statement of the Medical Library Association and Association
of Academic Health Sciences Libraries
summary of recommendations for fiscal year 2011
Continue the commitment to the National Library of Medicine (NLM)
by increasing funding levels to $402 million for fiscal year 2012.
Continue to support the medical library community's role in NLM's
outreach, telemedicine, disaster preparedness and health information
technology initiatives and the implementation of healthcare reform.
introduction
The Medical Library Association (MLA) and the Association of
Academic Health Sciences Libraries (AAHSL) thank the Subcommittee for
the opportunity to submit testimony regarding fiscal year 2012
appropriations for the National Library of Medicine (NLM), a division
of the National Institutes of Health. Working in partnership with other
parts of the NIH and other Federal agencies, NLM is the key link in the
chain that translates biomedical research into practice, making the
results of research readily available worldwide.
MLA is a nonprofit, educational organization with approximately
4,000 health sciences information professional members worldwide.
Founded in 1898, MLA provides lifelong educational opportunities,
supports a knowledge base of health information research, and works
with a global network of partners to promote the importance of quality
information for improved health to the healthcare community and the
public. AAHSL is composed of the directors of 123 libraries of
accredited U.S. and Canadian medical schools, and 26 associate members.
AAHSL's goals are to promote excellence in academic health sciences
libraries and to ensure that the next generation of health
practitioners is trained in information seeking skills that enhance the
quality of information delivery. Together, MLA and AAHSL address health
information issues and legislative matters of importance to both our
organizations.
the importance of annual funding increases for nlm
We are pleased that the fiscal year 2010 appropriations package
contained funding increases for NIH and NLM which
bolstered their baseline budgets, and that the proposed fiscal year
2011 budget included increases. In today's challenging budget
environment, we recognize the difficult decisions Congress faces as it
seeks to improve our Nation's fiscal stability. We appreciate and thank
the Subcommittee for its commitment to strengthening the NIH and NLM
budget.
MLA and AAHSL believe that increased funding for NLM is essential
to maximize the return on the investment in research conducted by the
NIH and other organizations. By collecting, organizing, and making the
results of biomedical information more accessible to other researchers,
clinicians, business innovators, and the public, NLM enables such
information be used more efficiently and effectively to drive
innovation and improve the national's health. This role has become more
important as the volume of biomedical data produced each year expands
exponentially driven by the influx of data from high-throughput genome
sequencing systems and genome-wide association studies. NLM plays a
critical role in accelerating nationwide deployment of health
information technology, including electronic health records (EHRs) by
leading the development, maintenance and dissemination of key standards
for health data interchange that are now required of certified EHRs.
NLM also contributes to Congressional priorities related to drug safety
through its efforts to expand its clinical trial registry and results
database in response to recent legislation requirements, and to the
nation's ability to prepare for and respond to disasters.
We encourage the Subcommittee to continue to provide meaningful
annual increases for NLM in the coming years and recommend an increase
to $402 million for fiscal year 2012. Recovery funding and the fiscal
year 2010 budget increases stimulated the economy and biomedical
research. For NLM, Recovery Act funding allowed timely and much needed
increases in support of leading edge research and training in
biomedical informatics--the kinds of programs that will influence
future health information technology developments. In fiscal year 2012
and beyond, it is critical to augment NLM's baseline budget to
accommodate expansion of its information resources, services, and
programs which must collect, organize, and make accessible rapidly
expanding volumes of biomedical knowledge.
Growing Demand for NLM's Basic Services
The National Library of Medicine is the world's largest biomedical
library and the source of trusted health information. Every day,
medical librarians across the Nation assist clinicians, students,
researchers, and the public in accessing the information they need to
save lives and improve health. NLM delivers more than a trillion bytes
of data to millions of users every day to help researchers advance
scientific discovery and accelerate its translation into new therapies;
provides health practitioners with information that improves medical
care and lowers its costs; and gives the public access to resources and
tools that promote wellness and disease prevention. Without NLM, our
Nation's medical libraries would be unable to provide the quality
information services that our Nation's health professionals, educators,
researchers and patients have come to expect.
NLM's data repositories and online integrated services such as such
as GenBank, PubMed, and PubMed Central are helping to revolutionize
medicine and advance science to the next important era which includes
individualized medicine based on an individual's unique genetic
differences. GenBank, with its international partners, has become the
definitive source of gene sequence information and organizing, along
with NLM's other genetic databases, the volumes of data that are needed
to detect associations between genes and disease and translate that
knowledge into better diagnosis and treatments. PubMed, with more than
20 million citations to the biomedical literature, is the world's most
heavily used source of information about published results of
biomedical research. Approximately 700,000 new citations are added each
year, and it is searched more than 2.2 million times each day. PubMed
Central, NLM's freely accessible digital repository of biomedical
journal articles, has become a valuable resource for researchers,
clinicians, consumers and librarians. On a typical weekday more than
420,000 users download 740,000 full-text articles. We commend the
Appropriations Committee for its support of the NIH public access
policy which requires all NIH-funded researchers to deposit their
final, peer-reviewed manuscripts in NLM's PubMed Central database
within 12 months of publication. This highly beneficial policy is
improving access to timely and relevant scientific information,
stimulating discovery, informing clinical care, and improving public
health literacy. We ask the Committee to remain a strong voice in
support of the NIH policy and to support the extension of public access
policies to other Federal science and education agencies because this
would bring the benefits of public access to other research disciplines
and because research in other fields is increasingly relevant to
biomedicine.
As the world's largest and most comprehensive medical library,
NLM's traditional print and electronic collections continue to steadily
increase each year. These collections stand at more than 11.4 million
items--books, journals, technical reports, manuscripts, microfilms,
photographs and images. By selecting, organizing and ensuring permanent
access to health science information in all formats, NLM is ensuring
the availability of this information for future generations, making it
accessible to all Americans, irrespective of geography or ability to
pay, and ensuring that each citizen can make the best, most informed
decisions about their healthcare.
Clearly, NLM is a national treasure which is making a difference in
patients' lives and healthcare outcomes. For example, an MLA member
shared that recently a surgeon came to the library 12 minutes before
surgery to find an article on the complex procedure he was about to
perform. By searching NLM's PubMed/Medline database, the librarian
found illustrations that guided the surgeon during surgery enabling him
to save the man's foot.
encourage nlm partnerships with the medical library community
Outreach and Education
NLM's outreach programs are of interest to both MLA and AAHSL.
These activities are designed to educate medical librarians, health
professionals and the general public about NLM's services and to train
them in the most effective use of these services. NLM has taken a
leadership role in promoting educational outreach aimed at public
libraries, secondary schools, senior centers and other consumer-based
settings. Furthermore, NLM's emphasis on outreach to underserved
populations assists the effort to reduce health disparities among large
sections of the American public. One example of NLM's leadership is the
``Partners in Information Access'' program which is designed to improve
the access of local public health officials to information needed to
prevent, identify and respond to public health threats. With nearly
6,000 members in communities across the country, the National Network
of Libraries of Medicine (NNLM) is well positioned to ensure that every
public health worker has electronic health information services that
can protect the public's health.
NLM is also at the forefront of efforts to provide consumers with
trusted, reliable health information. Its MedlinePlus system provides
consumer-friendly information on more than 80 topics in English and
Spanish and has become a top destination for those seeking information
on the Internet, attracting more than half-million visitors per day.
Librarians at Louisiana State University's Health Sciences Center
Medical Library in Shreveport provide in-person support for patients
and the public seeking health information and have also established
``healthelinks.org'', a website with information on diseases and
conditions, medicines, procedures and surgical operations, lab tests,
and more from NLM's MedlinePlus system. With help from Congress, NLM,
NIH and the Friends of NLM launched NIH MedlinePlus Magazine in
September 2006. This quarterly publication is distributed in doctors'
waiting rooms and provides the public will access to high-quality,
easily understood health information. Its readership is now estimated
at 5 million people nationwide and is poised to grow thanks to the
launch of a Spanish/English version, NIH MedlinePlus Salud, in January
2009. NLM also continues to work with medical librarians and health
professionals to encourage doctors to provide MedlinePlus ``information
prescriptions'' to their patients, directing them to relevant
information on NLM's consumer-oriented MedlinePlus information system.
This initiative also encourages genetics counselors to prescribe the
use of NLM's Genetic Home Reference website. Using NLM's new
MedlinePlus Connect utility, a growing number of clinical care
organizations are implementing specific links from their electronic
health record systems to relevant patient education materials in
MedlinePlus, enabling them to achieve an emerging criterion for
achieving meaningful use of health information technology. MedinePlus
Connect was recently named a winner in the HHS Innovates competition.
NLM also provides access to information about clinical research for
a wide range of diseases. Launched in February 2000, ClinicalTrials.gov
contains registration information for some 105,000 trials. The database
is a free and invaluable resource for patients and families who are
interested in participating in cutting-edge treatments for serious
illnesses. In recent years, it has become more valuable for patients,
clinicians, researchers, and others, including librarians, who help
patients identify relevant trials and provide clinicians and
researchers with access to information about specific products such as
new drugs under study. In response to the Food and Drug Administration
Amendments Act of 2007, NLM has expanded ClinicalTrials.gov to accept
summary results of clinical trials, including adverse events. Such
information is not available systematically from other publicly
accessible resources, and all too often is not published in the
scientific literature. The system currently contains results for more
than 3,200 trials, and the Library receives approximately 50 new
results submission each week. More than 50,000 users visit the site ach
day.
MLA and AAHSL applaud the success of NLM's outreach initiatives,
particularly those initiatives that reach out to the medical libraries
and health consumers. We ask the Committee to encourage NLM to continue
to coordinate its outreach activities with the medical library
community in fiscal year 2012.
Emergency Preparedness and Response
NLM has a long history of programs and resources that support
disaster preparedness and response activities. Building on its
experiences in responding to Hurricane Katrina, NLM established a
Disaster Information Management Research Center to collect and organize
disaster-related health information, ensure effective use of libraries
and librarians in disaster planning and response, and develop
information services to assist responders. MLA and NLM are developing a
Disaster Information Specialization (DIS) program aimed at building the
capacity of librarians and other interested professionals to provide
disaster-related health information outreach. Earlier this year, NLM
convened a Disaster Information Outreach Symposium for information
professionals across the country. This highly successful program
addressed strategies for assessing and meeting the information needs of
disaster managers and responders; communications, social media and
disasters; using library facilities to support disaster needs during
response and recovery, workforce development; disaster resources for
librarians; and tools for providing disaster health information.
Working with libraries and American publishers, NLM has established an
Emergency Access Initiative that makes available free full-text
articles from hundreds of biomedical journals and reference books for
use by medical teams responding to disasters. This initiative has been
activated multiple times in the last 15 months to assist relief efforts
in Japan, Pakistan, and Haiti. It organized and made available health
information resources relevant to the Gulf Oil spill. MLA and AAHSL see
a clear role for NLM and the Nation's health sciences libraries in
disaster preparedness and response activities, and we ask the
Subcommittee to support NLM's role in this initiative which has a major
objective of ensuring continuous access to health information and
effective use of libraries and librarians when disasters occur.
MLA and AAHSL see a clear role for NLM and the Nation's health
sciences libraries in disaster preparedness and response activities,
and we ask the Subcommittee to support NLM's role in this initiative
which has a major objective of ensuring continuous access to health
information and effective use of libraries and librarians when
disasters occur.
Health Information Technology and Bioinformatics
NLM has played a pivotal role in creating and nurturing the field
of medical informatics which is the intersection of information
science, computer science and healthcare. Health informatics tools
include computers, clinical guidelines, formal medical terminologies,
and information and communication systems. For nearly 35 years, NLM has
supported informatics research, training and the application of
advanced computing and informatics to biomedical research and
healthcare delivery including a variety of telemedicine projects. Many
of today's informatics leaders are graduates of NLM-funded informatics
research programs at universities across the country. Many of the
country's exemplary electronic and personal health record systems
benefits from NLM grant support.
The importance of NLM's work in health information technology
continues to grow as the Nation moves toward more interoperable health
information technology systems. A leader in supporting, licensing,
developing and disseminating standard clinical terminologies for free
United States-wide use (e.g., SNOWMED), NLM works closely with the
Office of the National Coordinator for Health Information Technology
(ONCHIT) to promote the adoption of interoperable electronic records,
It has developed tools to make it easier for EHR developers and users
to implement accepted health data standards in their systems.
MLA and AAHSL encourage the Subcommittee to continue their strong
support for NLM's medical informatics and genomic science initiatives,
at a point when the linking of clinical and genetic data holds
increasing promise for enhancing the diagnosis and treatment of
disease. MLA and AAHSL also support health information technology
initiatives in ONCHIT that build upon initiatives housed at NLM.
Building and Facility Needs
The tremendous growth in NLM's basic functions related to the
acquisition, organization and preservation of its ever-expanding
collection of biomedical literature, combined with its growing
contributions to healthcare reform, health information technology, drug
safety, and exploitation of genomic information is straining the
Library's physical resources. During times of economic hardship, NLM's
role becomes increasingly important and it often serves as an archive
of last resort for medical libraries looking for ways to cut back and
trim their own collections.
NLM now houses 1,100 staff in a facility built to accommodate 650.
This increase in the volume of biomedical information and in the number
of personnel has led to a serious space shortage. Digital archiving--
once thought to be a solution to the problem of housing physical
collections--has only added to the challenge, as materials must often
be stored in multiple formats and as new digital resources consume
increasing amounts of data center storage space. As a result, the space
needed for computing facilities has also grown, and a new facility is
urgently needed. This need has been recognized by the NLM Board of
Regents as well as the Subcommittee in Senate Report 108-345 that
accompanied the fiscal year 2005 appropriations bill. However, the
economic challenges of the last several years have hampered movement on
this project.
While Congress continues to face tremendous funding challenges in
fiscal year 2012, MLA and AAHSL encourage the Subcommittee to
acknowledge the need for construction of the new building to take place
when the Federal budget stabilizes so that information-handling
capabilities and biomedical research are not jeopardized. At a time
when medical and health science libraries across the Nation face
growing financial and space constraints, ensuring that NLM continues to
serve as the archive of last resort for biomedical collections is
critical to the medical library community and the public we serve.
Thank you again for the opportunity to present the views of the
medical library community.
______
Prepared Statement of the Meharry Medical College
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Wayne J.
Riley, President and CEO of Meharry Medical College in Nashville,
Tennessee. I have previously served as vice-president and vice dean for
health affairs and governmental relations and associate professor of
medicine at Baylor College of Medicine in Houston, Texas and as
assistant chief of medicine and a practicing general internist at
Houston's Ben Taub General Hospital. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the Title VII Health Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I took you seriously and came here
prepared to offer my best judgments. First, I want to say that it is
clear that health disparities among various populations and across
economic status are rampant and overwhelming. Over the next 10 years,
we will need to be able to deliver more culturally relevant and
culturally competent healthcare services. Bringing healthcare delivery
up to this higher standard can serve as our Nation's own preventive
healthcare agenda keeping us well positioned for the future.
Minority health professional institutions and the Title VII Health
Professions Training programs address this critical national need.
Persistent and severe staffing shortages exist in a number of the
health professions, and chronic shortages exist for all of the health
professions in our Nation's most medically underserved communities. Our
Nation's health professions workforce does not accurately reflect the
racial composition of our population. For example, African Americans
represent approximately 15 percent of the U.S. population while only 2-
3 percent of the Nation's healthcare workforce is African American.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Institutions that cultivate minority health professionals have been
particularly hard-hit as a result of the cuts to the Title VII Health
Profession Training programs in fiscal year 2006 and fiscal year 2007
funding resolution passed earlier this Congress. Given their historic
mission to provide academic opportunities for minority and financially
disadvantaged students, and healthcare to minority and financially
disadvantaged patients, minority health professions institutions
operate on narrow margins. The cuts to the Title VII Health Professions
Training programs amount to a loss of core funding at these
institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my medical degree from Morehouse School of Medicine,
a historically black medical school in Atlanta. I give credit to my
career in academia, and my being here today, to Title VII Health
Profession Training programs' Faculty Loan Repayment Program. Without
that program, I would not be the president of my father's alma mater,
Meharry Medical College, another historically black medical school
dedicated to eliminating healthcare disparities through education,
research and culturally relevant patient care.
Minority Centers of Excellence.--COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions (the Medical
and Dental Institutions at Meharry Medical College; The College of
Pharmacy at Xavier University; and the School of Veterinary Medicine at
Tuskegee University) to the training of minorities in the health
professions. Congress later went on to authorize the establishment of
``Hispanic'', ``Native American'' and ``Other'' Historically black
COEs. For fiscal year 2012, I recommend a funding level of $24.602
million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. Over the last three decades, HCOPs have trained
approximately 30,000 health professionals including 20,000 doctors,
5,000 dentists and 3,000 public health workers. For fiscal year 12, I
recommend a funding level of $22.133 million for HCOPs.
National Institutes of Health (NIH)
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, the
funding for this important program grow at the same rate as NIH overall
in fiscal year 2012.
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professional institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities. For fiscal year 2012, I recommend
that this Institute's funding grow proportionally with the funding of
the NIH.
Department of Health and Human Services
Office of Minority Health: Specific programs at OMH include:
-- Assisting medically underserved communities with the greatest need
in solving health disparities and attracting and retaining
health professionals,
--Assisting minority institutions in acquiring real property to
expand their campuses and increase their capacity to train
minorities for medical careers,
--Supporting conferences for high school and undergraduate students
to interest them in healthcareers, and
--Supporting cooperative agreements with minority institutions for
the purpose of strengthening their capacity to train more
minorities in the health professions.
The OMH has the potential to play a critical role in addressing
health disparities. For fiscal year 2012, I recommend a funding level
of $65 million for the OMH.
Department of Education
Strengthening Historically Black Graduate Institutions Program.--
The Department of Education's Strengthening Historically Black Graduate
Institutions program (Title III, Part B, Section 326) is extremely
important to MMC and other minority serving health professions
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. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Meharry Medical College along with other minority health professions
institutions and the Title VII Health Professions Training programs can
help this country to overcome health and healthcare disparities.
Congress must be careful not to eliminate, paralyze or stifle the
institutions and programs that have been proven to work. Meharry and
other minority health professions schools seek to close the ever
widening health disparity gap. If this subcommittee will give us the
tools, we will continue to work towards the goal of eliminating that
disparity as we have done for 1876.
Thank you, Mr. Chairman, for this opportunity.
______
Prepared Statement of the Morehouse School of Medicine
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. John E.
Maupin, President of Morehouse School of Medicine (MSM) in Atlanta,
Georgia. I have previously served as President of Meharry Medical
College, executive vice-president at Morehouse School of Medicine,
director of a community health center in Atlanta, and deputy director
of health in Baltimore, Maryland. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the Title VII Health Professions Training programs.
I want to say that minority health professional institutions and
the Title VII Health Professionals Training programs address a critical
national need. Persistent and sever staffing shortages exist in a
number of the health professions, and chronic shortages exist for all
of the health professions in our Nation's most medically underserved
communities. Furthermore, our Nation's health professions workforce
does not accurately reflect the racial composition of our population.
For example while blacks represent approximately 15 percent of the U.S.
population, only 2-3 percent of the Nation's health professions
workforce is black. Morehouse is a private school with a very public
mission of educating students from traditionally underserved
communities so that they will care for the underserved. Mr. Chairman, I
would like to share with you how your committee can help us continue
our efforts to help provide quality health professionals and close our
Nation's health disparity gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Given the historic mission, of institutions like MSM, to provide
academic opportunities for minority and financially disadvantaged
students, and healthcare to minority and financially disadvantaged
patients, minority health professions institutions operate on narrow
margins. The slow reinvestment in the Title VII Health Professions
Training programs amounts to a loss of core funding at these
institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my dental degree from Meharry Medical College, a
historically black medical and dental school in Nashville, Tennessee. I
have seen first hand what Title VII funds have done to minority serving
institutions like Morehouse and Meharry. I compare my days as a student
to my days as president, without that Title VII, our institutions would
not be here today. However, Mr. Chairman, since those funds have been
slowly replenished, we are standing at a cross roads. This committee
has the power to decide if our institutions will go forward and thrive,
or if we will continue to try to just survive. We want to work with you
to eliminate health disparities and produce world class professionals,
but we need your assistance.
Minority Centers of Excellence: COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions (the Medical
and Dental Institutions at Meharry Medical College; The College of
Pharmacy at Xavier University; and the School of Veterinary Medicine at
Tuskegee University) to the training of minorities in the health
professions. Congress later went on to authorize the establishment of
``Hispanic'', ``Native American'' and ``Other'' Historically black
COEs. For fiscal year 2012, I recommend a funding level of $24.602
million for COEs.
Health Careers Opportunity Program (HCOP): HCOPs provide grants for
minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. Over the last three decades, HCOPs have trained
approximately 30,000 health professionals including 20,000 doctors,
5,000 dentists and 3,000 public health workers. For fiscal year 2012, I
recommend a funding level of $22.133 million for HCOPs.
National Institutes of Health (NIH)
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professional institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Minority Centers of
Excellence program. For fiscal year 2012, I recommend a funding
increase proportional to any increase given to the NIH for the NIMHD.
Research Centers at Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI), currently administered 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, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
Department of Health and Human Services
Office of Minority Health.--Specific programs at OMH include: (1)
Assisting medically underserved communities with the greatest need in
solving health disparities and attracting and retaining health
professionals; (2) Assisting minority institutions in acquiring real
property to expand their campuses and increase their capacity to train
minorities for medical careers; (3) Supporting conferences for high
school and undergraduate students to interest them in healthcareers,
and (4) Supporting cooperative agreements with minority institutions
for the purpose of strengthening their capacity to train more
minorities in the health professions. The OMH has the potential to play
a critical role in addressing health disparities, and with the proper
funding this role can be enhanced. For fiscal year 2012, I recommend a
funding level of $65 million for the OMH.
Department of Education
Strengthening Historically Black Graduate Institutions.--The
Department of Education's Strengthening Historically Black Graduate
Institutions program (Title III, Part B, Section 326) is extremely
important to MSM and other minority serving health professions
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. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Morehouse School of Medicine along with other minority health
professions institutions and the Title VII Health Professions Training
programs can help this country to overcome health and healthcare
disparities. Congress must be careful not to eliminate, paralyze or
stifle the institutions and programs that have been proven to work. MSM
and other minority health professions schools seek to close the ever
widening health disparity gap. If this subcommittee will give us the
tools, we will continue to work towards the goal of eliminating that
disparity as we have since our founding day.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the National AHEC Organization
The National AHEC Organization (NAO) is the professional
organization representing Area Health Education Centers (AHECs). Our
message is simple:
--The Area Health Education Center program is effective and provides
vital services and national infrastructure.
--Area Health Education Centers are the workforce development,
training and education machine for the Nation's healthcare
safety-net programs.
AHEC is one of the Title VII Health Professions Training programs,
originally authorized at the same time as the National Health Service
Corps (NHSC) to create a complete mechanism to provide primary care
providers for Community Health Centers (CHCs) and other direct
providers of healthcare services for underserved areas and populations.
The plan envisioned by creators of the legislation was that the CHCs
would provide direct service. The NHSC would be the mechanism to fund
the education of providers and supply providers for underserved areas
through scholarship and loan repayment commitments. The AHEC program
would be the mechanism to recruit providers into primary health
careers, diversify the workforce, and develop a passion for service to
the underserved in these future providers, i.e. Area Health Education
Centers are the workforce development, training and education machine
for the Nation's healthcare safety-net programs. The AHEC program is
focused on improving the quality, geographic distribution and diversity
of the primary care healthcare workforce and eliminating the
disparities in our Nation's healthcare system.
AHECs develop and support the community based training of health
professions students, particularly in rural and underserved areas. They
recruit a diverse and broad range of students into health careers, and
provide continuing education, library and other learning resources that
improve the quality of community-based healthcare for underserved
populations and areas.
The Area Health Education Center program is effective and provides
vital services and national infrastructure. Nationwide, over 379,000
students have been introduced to health career opportunities, and over
33,000 mostly minority and disadvantaged high school students received
more than 20 hours each of health career exposure. Over 44,000 health
professions students received training at 17,530 community-based sites,
and furthermore; over 482,000 health professionals received continuing
education through AHECs. AHECs perform these education and training
services through collaborative partnerships with Community Health
Centers (CHCs) and the National Health Service Corps (NHSC), in
addition to Rural Health Clinics (RHCs), Critical Access Hospitals,
(CAHs), Tribal clinics and Public Health Departments.
Justification for Recommendations
Imbalances in our healthcare system result in marked inequities in
access to and quality of healthcare services. This perpetuates
disparities in health status and the under-representation of minority
and disadvantaged individuals in the healthcare workforce. AHEC
programs play a key role in correcting these inequities and
strengthening the Nation's healthcare safety net.
In order to continue the progress that the Title VII Health
Professions Training programs, especially AHECs, have already made
toward their goal, an additional Federal investment is required. NAO
recommends that the AHEC program is funded at $75 million. Investment
at this level and at this time will be the first step toward full
investment at the authorized level of $125 million.
______
Prepared Statement of the National Alliance for Eye and Vision Research
executive summary
NAEVR requests fiscal year 2012 NIH funding at $35 billion, which
reflects a $3 billion increase over President Obama's proposed funding
level of $32 billion. Funding at $35 billion, which reflects NIH net
funding levels in both fiscal year 2009 and fiscal year 2010, ensures
it can maintain the number of multi-year investigator-initiated
research grants, the cornerstone of our Nation's biomedical research
enterprise.
The vision community commends Congress for $10.4 billion in NIH
funding in the American Recovery and Reinvestment Act (ARRA), as well
as fiscal year 2009 and fiscal year 2010 funding increases that enabled
NIH to keep pace with biomedical inflation after 6 previous years of
flat funding that resulted in a 14 percent loss of purchasing power.
Fiscal year 2012 NIH funding at $35 billion enables it to meet the
expanded capacity for research--as demonstrated by the significant
number of high-quality grant applications submitted in response to ARRA
opportunities--and to adequately address unmet need, especially for
programs of special promise that could reap substantial downstream
benefits, as identified by NIH Director Francis Collins, M.D., Ph.D. in
his top five priorities. As President Obama has stated repeatedly, most
recently during the 2011 State of the Union Address, biomedical
research has the potential to reduce healthcare costs, increase
productivity, and ensure the global competitiveness of the United
States.
NAEVR requests that Congress increase NEI funding above the 1.8
percent proposed by the President--even if it does not fund NIH at $35
billion--since the proposed increase does not match biomedical
inflation.
In 2009, Congress spoke volumes in passing S. Res. 209 and H. Res.
366, which designated 2010-2020 as The Decade of Vision, in which the
majority of 78 million Baby Boomers will turn 65 years of age and face
greatest risk of aging eye disease. This is not the time for a less-
than-inflationary increase that nets a loss in the NEI's purchasing
power, which eroded by 18 percent in the fiscal year 2003-fiscal year
2008 timeframe. NEI-funded research is resulting in treatments and
therapies that save vision and restore sight, which can reduce
healthcare costs, maintain productivity, ensure independence, and
enhance quality of life.
the bipartisan nih support displayed at the subcommittee's march 30
hearing with secretary sebelius demonstrates the value of increased and
timely appropriations
NAEVR was pleased to hear the level of bipartisan support expressed
for NIH at the March 30 Senate L-HHS Appropriations Subcommittee
hearings with Department of Health and Human Services (DHHS) Secretary
Kathleen Sebelius and was especially impressed by two sets of comments:
--Senate Ranking Member Richard Shelby (R-AL) cautioned against
across-the-board cuts and urged Congress to sustain programs
that are effective--where he cited NIH as ``one of the most
results-driven aspects of our entire Federal budget.'' He added
that ``research conducted at NIH reduces disabilities, prolongs
life, and is an essential component to the health of all
Americans. NIH programs consistently meet their performance and
outcomes measures, as well as achieve their overall mission.''
These comments are stated so well that NAEVR will not expand
upon them, other than to cite vision examples in the next
sections.
--Senator Barbara Mikulski (D-MD) noted that a government shutdown,
NIH cuts, or delayed appropriations, individually or in
combination, will have far-reaching consequences, especially
for academic Institutions across the country which receive
funding.
To demonstrate that point, in late January 2011, NAEVR hosted 11
domestic and 6 international members of the Association for
Research in Vision and Ophthalmology (ARVO) in Capitol Hill
visits. They educated staff that a cutback to the fiscal year
2008 level would reduce NEI funding by $30 plus million and
reduce the number of grants by 43--any one of which could hold
the key to saving or restoring vision. The advocates also
described the impact of delayed appropriations, in terms of
continuity of research and retention of trained staff. If a
department does not have bridge or philanthropic funding to
retain staff while awaiting full funding of awards, it will
need to let staff go, and that usually means a highly trained
person is lost to another area of research or an institution in
another State, or even another country.
fiscal year 2012 nih funding at $35 billion enables the nei to build
upon the impressive record of basic and clinical/translational research
that meets nih's top five priorities and was funded through fiscal year
2009/2010 arra and increased ``regular'' appropriations
NEI's research addresses the preemption, prediction, and prevention
of eye disease through basic, translational, epidemiological, and
comparative effectiveness research which also address the top five NIH
priorities, as identified by Dr. Collins: genomics, translational
research; comparative effectiveness; global health, and empowering the
biomedical enterprise.
With respect to translational research, in June 2010, NEI hosted a
Translational Research and Vision conference as the last of a series of
NIH-campus based educational events recognizing its 40th anniversary
(previous events addressed genetics/genomics, optical imaging, stem
cell therapies, and the latest glaucoma research). In keynote comments,
Dr. Collins recognized NEI as a leader in translational research. He
specifically cited NEI's leadership in ocular genetics, noting that NEI
has worked collaboratively with other NIH Institutes, especially the
National Human Genome Research Institute (NHGRI) to elucidate the basis
of eye disease and to develop treatments. As NEI Director Paul Sieving,
M.D., Ph.D. has stated, one-quarter of all genes identified to date are
associated with eye disease/visual impairment.
Dr. Collins also lauded the NEI's use of Genome-Wide Association
Studies (GWAS) to determine the increased risk of developing age-
related macular degeneration (AMD) from gene variants in the Complement
Factor H (CFH) immune pathway, noting that ``this was the first
demonstration that GWAS is a useful tool to make the connection between
gene variants and disease conditions.'' He added that, ``Twenty years
ago we could do little to prevent or treat AMD. Today, because of new
treatments and procedures based on NIH/NEI research, 1.3 million
Americans at risk for severe vision loss from AMD over the next 5 years
can receive potentially sight-saving therapies.''
With increased ``regular'' fiscal year 2009/2010 appropriations and
ARRA funding, NEI has been able to build upon past research in two
important areas:
Genetic Basis of AMD.--In 2010, NEI initiated the International AMD
Genetics Consortium, reflecting researchers on five continents who will
be sharing and analyzing GWAS results to further elucidate the genetic
basis of AMD. This may lead to new diagnostics and treatments for this
leading blinding eye disease, growing in incidence with the aging of
the population and with potential significant costs to the Medicare
program.
Treatment of Diabetic Macular Edema.--In May 2010, the NEI's
Diabetic Retinopathy Clinical Research (DRCR) Network--a multi-center
network dedicated to facilitating clinical research into diabetic
retinopathy, diabetic macular edema, and associated conditions--
reported results of a comparative effectiveness trial. The study
confirmed that laser treatment for diabetic macular edema, when
combined with injections of the Food and Drug Administration (FDA)-
approved anti-angiogenic drug Lucentis, is more effective than laser
treatment alone, the latter of which has been the standard of care for
the past 25 years. With NIH's recent announcement of a new strategic
plan to combat diabetes, led by the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK), this research is more important
than ever within the larger context of NIH priorities. The current DRCR
Network is a successor to several previous networks, all of which
involved NEI-NIDDK collaboration. NEI's emphasis on diabetic
retinopathy reflects the fact that it is the leading cause of vision
loss in the working-age population and occurs with disproportionately
greater incidence in the Hispanic population.
if congress does not increase fiscal year 2012 nih funding above the
president's request, it is even more vital to improve upon the proposed
1.8 percent increase for nei
The NIH budget proposed by the administration and finalized by
Congress during the second year of the congressionally designated
Decade of Vision should not contain a less-than-inflationary increase
for the NEI due to the enormous challenges it faces in terms of the
aging population, the disproportionate incidence of eye disease in
fast-growing minority populations, and the visual impact of chronic
disease (e.g., diabetes). If Congress is unable to fund NIH at $35
billion in fiscal year 2012 (NEI level of $794.5 million) and adopts
the President's proposal, the 1.8 percent increase in funding must be
increased to at least an inflationary level of 2.4 percent to prevent
any further erosion in NEI's purchasing power. NEI funding is an
especially vital investment in the overall health, as well as the
vision health, of our Nation. It can ultimately delay, save, and
prevent health expenditures, especially those associated with the
Medicare and Medicaid programs, and is, therefore, a cost-effective
investment.
vision loss is a major public health problem: increasing healthcare
costs, reducing productivity, diminishing life quality
The NEI estimates that more than 38 million Americans age 40 and
older experience blindness, low vision, or an age-related eye disease
such as AMD, glaucoma, diabetic retinopathy, or cataracts. This is
expected to grow to more than 50 million Americans by year 2020. The
economic and societal impact of eye disease is increasing not only due
to the aging population, but to its disproportionate incidence in
minority populations and as a co-morbid condition of chronic disease,
such as diabetes.
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 indirect healthcare costs,
lost productivity, reduced independence, diminished quality of life,
increased depression, and accelerated mortality. NEI's fiscal year 2010
baseline funding of $707 million reflects just a little more than 1
percent of this annual costs of eye disease. The continuum of vision
loss presents a major public health problem, as well as a significant
financial challenge to the public and private sectors.
naevr urges congress to fund the nih at $35 billion in fiscal year 2012
which will ensure the momentum of breakthrough nei-funded vision
research and the retention of trained personnel
about naevr
The National Alliance for Eye and Vision Research (NAEVR) is a
501(c)4 nonprofit advocacy coalition comprised of 55 professional
(ophthalmology and optometry), patient and consumer, and industry
organizations involved in eye and vision research. Visit NAEVR's Web
site at www.eyeresearch.org.
______
Prepared Statement of the National Alliance of State & Territorial AIDS
Directors
The National Alliance of State & Territorial AIDS Directors
(NASTAD) represents the Nation's chief State health agency staff who
have programmatic responsibility for administering HIV/AIDS and viral
hepatitis healthcare, prevention, education, and supportive service
programs funded by State and Federal governments. On behalf of NASTAD,
we urge your support for increased funding for Federal HIV/AIDS and
viral hepatitis programs in the fiscal year 2012 Labor-HHS-Education
Appropriations bill, and thank you for your consideration of the
following critical funding needs for HIV/AIDS, viral hepatitis and STD
programs in fiscal year 2012. These funding needs support activities
aligned with the goals set forth in the National HIV/AIDS Strategy
(NHAS)--a game-changing blueprint for tackling the Nation's HIV/AIDS
epidemic.
As we approach 30 years into the HIV/AIDS epidemic, we must be
mindful that HIV/AIDS is still a crisis in the United States, not just
a global issue. HIV/AIDS is an emergency and while there are life-
saving medications that did not exist 20 years ago, there is still no
cure, and we still see new infections--about 56,000 annually. The
Nation's prevention efforts must match our commitment to the care and
treatment of infected individuals. First and foremost we must address
the devastating impact on racial and ethnic minority communities,
particularly African Americans and Latinos, as well as gay men and
other men who have sex with men (MSM) of all races and ethnicities,
substance users, women and youth. To be successful, we must expand
outreach, scale-up and consider new and innovative approaches to arrest
the epidemic here at home.
The President's fiscal year 2012 budget proposal provides increases
to HIV/AIDS prevention, care and the Ryan White Program in support of
the National HIV/AIDS Strategy for a total investment of $3.5 billion.
The Budget prioritizes HIV/AIDS resources within high burden
communities and among high-risk groups, including MSM, African
Americans and Hispanics, and realigns resources within CDC, HRSA,
SAMHSA, and the Office of the Secretary to support the National HIV/
AIDS Federal Implementation Plan. Additionally, the budget allows CDC
and States to transfer up to 5 percent across HIV/AIDS, tuberculosis,
STD and viral hepatitis programs to improve coordination and
integration.
HIV/AIDS Care and Treatment Programs
The Health Resources and Services Administration (HRSA) administers
the $2.2 billion Ryan White Program that provides health and support
services to more than 500,000 persons living with HIV/AIDS (PLWHA). The
President's budget includes an increase of $63 million for a total of
$2.4 billion for the entire Ryan White Program. The Budget also
includes $940 million for AIDS Drug Assistance Programs (ADAPs), an
increase of $55 million.
NASTAD requests a minimum increase of $183 million in fiscal year
2012 for State Ryan White Part B grants compared to the President's
budget of flat funding Part B at its fiscal year 2010 level of $418.8
million and requesting a $55 million increase or a total of $940
million for ADAPs. We are requesting an increase of $77 million for the
Part B Base and $106 million or a total of $991 million for ADAPs.
ADAPs truly need an increase of $360 million in fiscal year 2012 to
maintain their programs and fill the structural deficits that have
built up during the last several years. With these funds States and
territories provide care, treatment and support services to PLWHA, who
need access to HIV clinicians, life-saving and life-extending
therapies, and a full range of support services to ensure adherence to
complex treatment regimens. All States have reported to NASTAD a
significant increase in the number of individuals seeking Part B Base
and ADAP services.
State ADAPs provide medications to low-income uninsured or
underinsured PLWHA. In fiscal year 2009, over 213,000 clients were
enrolled in ADAPs nationwide. Due to many factors such as unemployment,
economic challenges, increased HIV testing and linkages to care, and
new HIV treatment guidelines calling for earlier therapeutic
treatments, program demand has increased dramatically, and thus ADAPs
are ever more in crisis. As of May 19, 2011, there 8,310 individuals
are on waiting lists in 13 States to receive their life-sustaining
medications through ADAP:
--Alabama: 15 individuals
--Arkansas: 59 individuals
--Florida: 3,938 individuals
--Georgia: 1,520 individuals
--Idaho: 14 individuals
--Louisiana: 696 individuals
--Montana: 26 individuals
--North Carolina: 242 individuals
--Ohio: 413 individuals
--South Carolina: 693individuals
--Utah: 6 individuals
--Virginia: 684 individuals
--Wyoming: 4 individuals
Last year, as of April 2010, there were 10 States with less than
900 individuals on waiting lists. Thus, we have seen an over 900
percent increase in individuals on waiting lists in the last year.
HIV/AIDS Prevention and Surveillance Programs
One of the major goals of the NHAS is to lower the annual number of
new infections from 56,300 to 42,225 by 2015. In order to meet this
ambitious goal, NASTAD requests an increase of $90 million above fiscal
year 2011 funding levels for a total of $555 million compared to the
President's request of a $4 million increase for State and local health
department HIV prevention and surveillance cooperative agreements in
order to provide comprehensive prevention programs. By providing
adequate resources to State and local health departments to scale up
HIV prevention and surveillance programs, we will be closer to meeting
the NHAS goal of reducing new HIV infections by 25 percent by 2015. In
addition, NASTAD fully supports the President's request to allocate
$30.4 million from the Prevention and Public Health Fund for HIV
prevention activities consistent with the allocation of these resources
in fiscal year 2010.
Of the total increase requested, NASTAD supports an increase of $60
million above fiscal year 2011 levels compared to the President's
request of a $6.4 million increase for the HIV prevention cooperative
agreements with health departments in order to scale up effective
prevention programs and enable CDC to implement a new funding formula
that would provide equitable funding to all jurisdictions based on
disease burden without dismantling existing prevention efforts in some
jurisdictions. Moreover, these additional resources will allow health
departments to increase their efforts in a variety of areas such as:
expanding the reach of activities targeting men who have sex with men
(MSM). According to the September 2010 CDC Fact Sheet HIV/AIDS Among
Gay and Bisexual Men, MSM account for nearly half (48 percent) of the
more than 1 million people living with HIV/AIDS and account for 53
percent of new infections. Young men from racial and ethnic minority
communities bear a disproportionate burden of the disease and there are
more new HIV infections among young Black MSM (aged 13-29) than among
any other age and racial group of MSM. Additional funding will allow
heath departments to continue developing and implementing innovative,
cost effective and evidence-based prevention programming. Increased
funding will also allow health departments to expand services to other
disproportionately impacted populations including Black women, persons
who inject drugs and youth. With additional funding, health departments
will expand outreach, targeted and routine HIV testing, partner
services and linkage to care and other evidence-based prevention
interventions. Increased funding will also allow for the expansion of
additional core prevention services such as partner services (the
identification, notification and counseling of partners of persons whom
have tested HIV positive), capacity building and technical assistance
to implement routine HIV testing and highly targeted behavior change
interventions to community-based organizations and healthcare providers
as well as public education campaigns to reinforce accurate, evidence-
based information and begin to reduce the stigma associated with the
disease.
In addition, NASTAD believes increased funding should be directed
toward critical HIV surveillance efforts and requests an increase of
$30 million above fiscal year 2011 levels compared to the President's
request of a decrease of nearly $2 million. Additional resources will
allow improvements in core surveillance and expand surveillance for HIV
incidence, behavioral risk, and receipt of care information including
CD4 and viral load reporting. HIV surveillance data are the mechanism
through which the success at achieving the goals of the NHAS will be
measured. The completeness of national HIV surveillance activities is
critical to monitor the HIV/AIDS epidemic and to provide data for
targeting with greater precision the delivery of HIV prevention, care,
and treatment services.
The funding increase will also allow for the continuation of the
Expanded Testing Program, Enhanced Comprehensive HIV Prevention
Planning (ECHPP) and Program Collaboration and Service Integration
(PCSI) activities. NASTAD supports maintaining funding at $70 million
to health departments to continue the highly successful Expanded
Testing Program (ETP), which targets African Americans, Latinos, gay
and bisexual men of all races and ethnicities, and persons who inject
drugs. For the 30 jurisdictions currently funded for ETP, the program
has been an effective way to implement routine HIV testing in clinical
settings--increasing the number of people who know their HIV status and
linking those with HIV to care and treatment. During the first 3 years
of the program approximately 2.6 million tests were conducted with an
estimated 28,000 being confirmed HIV positive. Reducing new HIV
infections relies heavily on ``knowing your status.'' This program
should be preserved with adequate funding to ensure that more
individuals learn their HIV status and are linked to care.
The first step in the NHAS is to ``intensify HIV prevention efforts
in communities where HIV is most heavily concentrated.'' In response,
in August 2010, the CDC funded ECHPP. Eligible jurisdictions were
awarded on September 30, 2010 with an average award of $960,000.
Through ECHPP, these highly impacted urban areas were awarded resources
to test and evaluate new approaches to integrate planning, monitoring
and delivering HIV prevention and care services in their specific
localities. NASTAD supports continuing ECHPP funding at $12 million in
order to fund the next round of State health departments for this
important activity.
NASTAD also requests continued support for Program Collaboration
and Service Integration (PCSI) to enable health departments to
integrate prevention services for HIV, STD, viral hepatitis, and TB at
the client level. Currently six jurisdictions are funded by CDC for
PCSI activities.
HIV School-based Prevention for Youth
NASTAD also supports an increase for evidence-based programs for
youth funded through the CDC. An increase of $10 million above the
President's fiscal year 2012 level of $40 million should be supported
for HIV school health for a total of $50 million. CDC currently funds
HIV school health programs through the Division of Adolescent and
School Health (DASH). The President's budget proposal moves HIV-
specific DASH funding to the National Center for HIV/AIDS, Viral
Hepatitis, STD and TB Prevention to ensure closer coordination with
other HIV prevention programs, which NASTAD supports. One-third of all
new infections are among young people under the age of 29, the largest
share of any age group of new infections.
Viral Hepatitis Prevention Programs
NASTAD requests an increase of $40 million for a total of $59.8
million in fiscal year 2012 compared to the President's request of $5.2
million for a total of $25 million. Funding increases would go to the
CDC's Division of Viral Hepatitis (DVH) to support the HHS Action Plan
on Viral Hepatitis for a national testing, education and surveillance
initiative as outlined in the Division's professional judgment budget
submitted to Congress last year. While we are hopeful about the first-
ever HHS Viral Hepatitis Action Plan, funding is needed to support
increased capacity at the HHS Office of the Assistant Secretary for
Health (ASH) for supporting the implementation of this plan.
We believe that testing to identify over 3 million people or 65-75
percent of chronic hepatitis B and C patients who do not know they are
infected is the highest priority for reducing illness and death related
to viral hepatitis. Testing must accompany education efforts to reach
those already infected and at high risk of death and of spreading the
disease. Surveillance is needed to monitor disease trends and evaluate
evidence-based interventions. Unlike other infectious diseases, viral
hepatitis lacks a national surveillance system. Further this funding
would enhance the role of Adult Viral Hepatitis Prevention Coordinators
(AVHPCs) based in State health departments to implement and integrate
testing, education and surveillance into the existing public health
infrastructure. States and cities receive an average funding award from
DVH of $90,000, which supports a single staff position and is not
sufficient for the provision of core prevention services. Therefore,
NASTAD requests funding to State adult viral hepatitis prevention
coordinators be increased from $5 to $10 million.
In addition, we encourage Congress to work with CDC to provide
adequate hepatitis B vaccination through the Section 317 program as
proposed in CDC's fiscal year 2012 budget. In years past, cost-savings
from the Section 317 program supported an at-risk adult hepatitis B
vaccine initiative with a funding high of $20 million. While this
funding went to vaccine-purchase only and not staff capacity or
infrastructure, it was a highly successful initiative at administering
nearly 1 million doses of vaccine. Unfortunately cost-savings for the
program were expended in fiscal year 2011.
Further we encourage the utilization of health reform's Prevention
and Public Health Fund to support a broad testing and screening
initiative that would include neglected diseases such as viral
hepatitis in order to capture patients before they progress in their
liver disease and increase costs to public healthcare systems.
STD Prevention Programs
NASTAD supports an increase of $212.7 million for a total of $367.4
million in fiscal year 2012 compared to the President's request of a $7
million increase for STD prevention, treatment and surveillance
activities undertaken by State and local health departments. CDC's
Division of STD Prevention has prioritized four disease prevention
goals--Prevention of STD-related infertility, STD-related adverse
pregnancy outcomes, STD-related cancers and STD-related HIV
transmission. CDC estimates that 19 million new infections occur each
year, almost half of them among young people ages 15 to 24. In one
year, the United States may spend over $8 billion to treat the symptoms
and consequences of STDs. Untreated STDs contribute to infant
mortality, infertility, and cervical cancer. Additional Federal
resources are needed to reverse these alarming trends and reduce the
Nation's health spending. The teen pregnancy prevention initiative
should be expanded to include prevention of HIV and STDs and funded at
$20 million above the President's 2012 request of $114.5 million. Such
an increase would allow providers to serve an additional 100,000 youth.
As you contemplate the fiscal year 2012 Labor, HHS and Education
Appropriations bill, we ask that you consider all of these critical
funding needs. We thank the Chairman, Ranking Member and members of the
Subcommittee, for their thoughtful consideration of our
recommendations. Our response to the HIV, viral hepatitis and STD
epidemics in the United States defines us as a society, as public
health agencies, and as individuals living in this country. There is no
time to waste in our Nation's fight against these infectious and often
chronic diseases. The Nation's prevention efforts must match our
commitment to the care and treatment of infected individuals.
______
Prepared Statement of the National Association for Public Health
Statistics and Information Systems
The National Association for Public Health Statistics and
Information Systems (NAPHSIS) welcomes the opportunity to provide this
written statement for the public record as the Labor, Health and Human
Services (HHS), Education and Related Agencies Appropriations
Subcommittee prepares its fiscal year 2012 appropriations legislation.
NAPHSIS represents the 57 vital records jurisdictions that collect,
process, and issue birth and death records in the United States and its
territories, including the 50 States, New York City, the District of
Columbia and the five territories. NAPHSIS coordinates and enhances the
activities of the vital records jurisdictions by developing standards,
promoting consistent policies, working with Federal partners, and
providing technical assistance.
NAPHSIS respectfully requests that the Subcommittee provide the
National Center for Health Statistics (NCHS) $162 million, consistent
with the President's budget request. This funding will enable the
National Vital Statistics System to support States and territories as
they implement the 2003 Standard Certificates of Birth, Death, and
Fetal Deaths and move toward electronic collection of vital events
data. This infrastructure investment will address the Healthy People
2020 goal of increasing the number of States that record vital events
using the latest U.S. standard certificates (PHI-10.1-10.3).
Ultimately, this investment will lead to timelier, richer data that
will facilitate public health planning, surveillance, service delivery,
and evaluation. Specifically, such data will facilitate tracking of
other Healthy People 2020 objectives in maternal, infant, and child
health, cancer, diabetes, heart disease, respiratory disease, injury
and prevention, and substance abuse, among others.
Collection of birth and death data through vital records is a State
function and thus governed under State laws. NCHS purchases birth and
death data from the States to compile national data on vital events--
births, deaths, marriages, divorces, and fetal deaths. These data are
used to monitor disease prevalence and our Nation's overall health
status, develop programs to improve public health, and evaluate the
effectiveness of those interventions. For example, birth data have been
used to:
--Establish the relationship of smoking and adverse pregnancy
outcomes;
--Link the incidence of major birth defects to environmental factors;
--Establish trends in teenage births;
--Determine the risks of low birth weight; and
--Measure racial disparities in pregnancy outcomes.
Just as fundamentally, death data are used to:
--Monitor the infant mortality rate as a leading international
indicator of the Nation's health status;
--Track progress and regress in reducing mortality from the leading
causes of death, such as heart disease, cancer, stroke, and
diabetes;
--Document racial disparities; and
--Otherwise provide sound information for programmatic interventions.
Years of chronic underfunding at NCHS have threatened the
collection of these important data on the national level, to the extent
that in fiscal year 2007 NCHS would have been unable to collect a full
12 months of vital statistics data from States. Had the Subcommittee
not intervened with a small but critical budget increase to continue
vital statistics collection, the United States would have been the
first nation in the industrialized world to be without a complete
year's worth of vital data. Countless national programs and businesses
that depend on vital events information would have been immeasurably
affected.
Since that time, the Subcommittee has continually supported NCHS's
vital statistics cooperative with the States. NAPHSIS and the broader
public health community deeply appreciate these efforts. We are pleased
that the President has once again followed the Subcommittee's lead in
seeking to build a 21st century national statistical agency, requesting
a $23 million increase for NCHS in fiscal year 2012, and directing NCHS
to support the modernization of the National Vital Statistics System.
This funding increase will support States as they upgrade their
outdated and vulnerable paper-based vital statistics systems,
addressing critical needs for activities that have been on hold or
curtailed because of budget constraints.
As we make significant strides in implementing and meaningfully
using health information technology, it is imperative that we similarly
invest in building a modern vital statistics system that monitors our
citizens' health, from birth until death. The requested funding will
move us toward a timelier and more comprehensive vital statistics
infrastructure where all States collect the same data and all States
collect these data electronically. Two forms of birth and death
certificates are in use by States--the older 1989 standard certificate
and the newer 2003 standard certificate This more recent birth
certificate revision includes data on insurance and access to prenatal
care, labor and delivery complications, delivery methods, congenital
anomalies of the newborn, maternal morbidity, mother's weight and
height, breast feeding status, maternal infections, and smoking during
pregnancy, among other factors. The 2003 death certificate includes
data on smoking-related, pregnancy-related, and job-related deaths.
Currently, only 75 percent of the States and territories use the
2003 standard birth certificate and 65 percent have adopted the 2003
standard death certificate (see Table 1). Many States continue to rely
on paper-based records, a practice which compromises the timeliness and
interoperability of these data. Jurisdictions that had planned and
budgeted to upgrade their certificates and systems have seen funding
for these projects erode as States face severe budget shortfalls. These
jurisdictions need the Federal Government's help to complete building a
21st century vital statistics system. The President's requested down
payment will help in this regard, allowing all jurisdictions to
implement the 2003 birth certificate and electronic birth record
systems. Approximately $30 million is needed to modernize the death
statistics system; but the President's budget request is nonetheless an
important first step.
TABLE 1.--JURISDICTIONS REQUIRING SUPPORT TO MODERNIZE VITAL STATISTICS SYSTEM
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Incomplete Electronic Birth Incomplete Electronic Death
No 2003 Birth Certificate No Electronic Birth Records Records \1\ No 2003 Death Certificate No Electronic Death Records Records \2\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Total = 20 Total = 17 Total = 4 Total = 19 Total = 24 Total = 27
Alabama Alaska Alabama Alabama Alaska Alabama
Alaska American Samoa Hawaii Alaska American Samoa Arizona
American Samoa Arizona Mississippi American Samoa Arkansas Delaware
Arizona Arkansas Rhode Island Colorado Colorado Washington, DC
Arkansas Connecticut Guam Connecticut Georgia
Connecticut Guam Iowa Florida Hawaii
Guam Louisiana Louisiana Iowa Idaho
Louisiana Maine Maryland Kentucky Illinois
Maine Massachusetts Massachusetts Louisiana Indiana
Massachusetts Minnesota Mississippi Maine Michigan
Minnesota New Jersey North Carolina Maryland Minnesota
Mississippi Northern Mariana Northern Mariana Massachusetts Montana
New Jersey North Carolina Pennsylvania Mississippi Nebraska
Northern Mariana Puerto Rico Puerto Rico Missouri Nevada
North Carolina Virgin Islands Tennessee New York New Hampshire
Rhode Island West Virginia Virgin Islands North Carolina New Jersey
Virgin Islands Wisconsin Virginia Oklahoma New Mexico
Virginia West Virginia Pennsylvania New York City
West Virginia Wisconsin Rhode Island North Dakota
Wisconsin Tennessee Ohio
Virginia Oregon
Washington South Carolina
West Virginia South Dakota
Wisconsin Texas
Utah
Vermont
Wyoming
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Has an electronic birth record but does not collect all 2003 data items; requires funding to modify the electronic birth record to collect the 2003 data items.
\2\ Has an electronic death record but requires funding to finish enrolling physicians and funeral directors in the system.
Source: NAPHSIS Survey of Vital Statistics Jurisdictions.
The data NCHS collects are needed to track Americans' health and
evaluate our progress improving it. The President's requested increase
of $23 million for NCHS and the National Vital Statistics System will
move us toward a timelier and more comprehensive system where all
States collect the same data and all States collect these data
electronically, enabling us to better compare critical information on a
local, State, regional, and national basis. Without additional funding,
a potential erosion of State data infrastructure and lack of
standardized data will undeniably create enormous gaps in critical
public health information and may have severe and lasting consequences
on our ability to appropriately assess and address critical health
needs.
NAPHSIS appreciates the opportunity to submit this statement for
the record and looks forward to working with the Subcommittee. If you
have questions about this statement, please do not hesitate to contact
NAPHSIS Executive Director, Patricia W. Potrzebowski, Ph.D., at
[email protected] or (301) 563-6001. You may also contact our
Washington representative, Emily Holubowich, at [email protected]
or (202) 484-1100.
______
Prepared Statement of the National Association of Community Health
Centers
Introduction
Chairman Harkin, Ranking Member Shelby, and Distinguished Members
of the Subcommittee: My name is Dan Hawkins, and I am the Senior Vice
President for Public Policy and Research at the National Association of
Community Health Centers. On behalf of the 23 million patients served
nationwide by health centers; 150,000 full-time health center staff;
and countless volunteer board members; I would like to express my
heartfelt appreciation to the Subcommittee for your support of
America's healthcare safety net, and specifically of our mission to
deliver affordable and accessible care to all Americans. I am pleased
to have an opportunity to submit testimony for your consideration as
you prepare the fiscal year 2012 Labor-Health and Human Services-
Education and Related Agencies Appropriations bill.
About Community Health Centers
Health centers offer cost-effective, high-quality, and patient-
directed primary and preventive care in 8,000 rural and urban
underserved communities across the United States. In Iowa and Alabama,
respectively, health centers deliver care to 154,020 patients in 108
communities and 315,670 patients in 140 communities.\1\ By statute,
health centers must be located in a medically underserved area (MUA) or
serve a medically underserved population (MUP) and provide
comprehensive primary care services to all community residents
regardless of insurance status--offering care on a sliding fee scale.
Because of this, health centers serve as the ``healthcare home'' for
America's most vulnerable populations, including one-third of
individuals living below poverty, one in seven Medicaid beneficiaries,
and one in seven of America's uninsured. And nearly half of health
center organizations are located in our Nation's rural areas.
---------------------------------------------------------------------------
\1\ See http://www.nachc.com/state-healthcare-data-list.cfm for
State Fact Sheets on Health Centers.
---------------------------------------------------------------------------
Presidents of both parties and Senators on both sides of the
aisle--including many members of this Subcommittee--have long-
recognized the value of health centers. As a result and with bipartisan
support, health centers have been on an expansion path for over a
decade. Within the past 2 years, and as a result of investments this
Subcommittee made through the American Recovery and Reinvestment Act,
127 new health centers opened and over 4.3 million new patients
received access to care at virtually every health center in the
country. I'd like to elaborate on why the Health Centers program is
such a worthwhile investment that produces documented savings to the
entire health system--a primary reason this program has been able to
count on the Subcommittee's support for several decades.
Health centers save the country money by keeping patients out of
costlier healthcare settings (like emergency departments and
hospitals), coordinating care amongst providers of many health
disciplines, and effectively managing chronic conditions. Medicaid
beneficiaries who rely on health centers for routine care are 19
percent less likely to use the emergency department (ED) and 11 percent
less likely to be hospitalized for ambulatory care-sensitive (ACS)
conditions when compared to beneficiaries who see other providers.\2\
Additionally, counties with at least one health center have 25 percent
fewer ED visits for ACS conditions than counties without a health
center presence.\3\ By providing timely and appropriate care, health
centers save over $1,200 per person per year, lowering costs across the
healthcare system--from ambulatory care settings to hospital stays.\4\
All told, health centers currently generate $24 billion in savings each
year. This is all possible through an investment of just $1.67 per
patient per day.\5\
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\2\ Falik M, et al. ``Comparative Effectiveness of Health Centers
as Regular Source of Care.'' January-March 2006 Journal of Ambulatory
Care Management 29(1):24-35.
\3\ Rust G, et al. ``Presence of a Community Health Center and
Uninsured Emergency Department Visit Rates in Rural Counties.'' Winter
2009 Journal of Rural Health 25(1):8-16.
\4\ Ku L, et al. Strengthening Primary Care to Bend the Cost Curve:
The Expansion of Community Health Centers Through Health Reform. Geiger
Gibson/RCHN Community Health Foundation Collaborative at the George
Washington University. June 30 2010. Policy Research Brief No. 19.
\5\ Bureau of Primary Health Care, Health Resources and Services
Administration, DHHS. 2009 Uniform Data System.
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Health centers meet or exceed national practice standards for
chronic condition treatment and ensure that their patients receive more
recommended screening and health promotion services than patients of
other providers--despite serving underserved and traditionally at-risk
populations.\6\ The Institute of Medicine (IOM) and the U.S. Government
Accountability Office (GAO) have recognized health centers as models
for screening, diagnosing, and managing a wide array of relatively
common and costly chronic conditions such as diabetes, cardiovascular
disease, asthma, depression, cancer, and HIV.\7\ Specifically related
to diabetes, a leading cause of death and disability, health centers
significantly reduce the expected lifetime incidence of diabetes
complications, including blindness, kidney failure, and certain forms
of heart disease.\8\ America's health centers also play an important
role in improving access to prenatal care and improving birth outcomes.
Health centers have demonstrated their ability to reduce the disparity
of low birth weight by at least 50 percent compared to the national
average.\9\
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\6\ Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and
socioeconomic disparities in access to care and quality of care for
U.S. health center patients compared with non-health center patients.
Journal of Ambulatory Care Management 32(4): 342-50. Hing E, Hooker RS,
Ashman JJ. (2010). Primary Health Care in Community Health Centers and
Comparison with Office-Based Practice. Journal of Community Health.
2010 Nov 3 epublished.
\7\ U.S. General Accounting Office. (2003). Healthcare: Approaches
to address racial and ethnic disparities. Publication No. GAO-03-862R.
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic
Disparities in Healthcare. Washington, DC: National Academy of Sciences
Press; 2003.
\8\ Huang E, et al. ``The Cost-effectiveness of Improving Diabetes
Care in U.S. Federally Qualified Community Health Centers.'' 2007
Health Services Research, 42(6): 2174-93.
\9\ Politzer R, Yoon J, Shi L, Hughes R, Regan J, and Gaston M.
``Inequality in America: The Contribution of Health Centers in Reducing
and Eliminating Disparities in Access to Care.'' 2001 Medical Care
Research and Review 58(2):234-248.
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A key driver of the success of the health center model is that each
non-profit entity is locally-owned and directed by a patient majority
board that ensures the health center is accountable and responsive to
the needs of the community it serves. Research has demonstrated that
this type of consumer participation on governing boards ensures higher
quality care, lower costs of services, and better results.\10\ In
addition to tailoring their services to make healthcare delivery
individualized to unique local circumstances, health centers also have
a substantial and positive economic impact on their communities. In
2009 alone, health centers generated $20 billion in total economic
benefit and created 189,158 jobs.\11\
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\10\ Crampton P, et al. ``Does Community-Governed Nonprofit Primary
Care Improve Access to Services?'' 2005 International Journal of Health
Services 35(3): 465-78.
\11\ NACHC, Capital Link. Community Health Centers as Leaders in
the Primary Care Revolution. August 2010. www.nachc.com/research-
data.cfm.
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Funding Background
The Health Resources and Services Administration (HRSA) fiscal year
2011 spending or operating plan, pursuant to Section 1863 of Public Law
112-10, provides $1.581 billion in discretionary funding for the Health
Centers program--a reduction of $604.4 million relative to the fiscal
year 2010-enacted level of $2.185 billion. Together with the $1.0
billion in fiscal year 2011 funding available for health centers
through the Affordable Care Act (ACA), health centers have a net
increase of $395.6 million in total programmatic funding for fiscal
year 2011.
While we await word from HRSA about how available fiscal year 2011
programmatic funding will be allocated between existing and new health
center efforts, we are heartened that there should be no interruption
of existing health center activities, including the new centers and
patients added in the past 2 years. We strongly support prioritizing
fiscal year 2011 funding to maintain existing health center activities.
It is worth noting, however, that most of the nearly $400 million
programmatic increase in the fiscal year 2011 CR is needed to continue
ongoing operations--leaving very limited funding to support expansion
efforts that would otherwise have been possible if the $1.0 billion in
new ACA resources were not being redirected to continue existing
operations.
Currently, 60 million Americans lack access to a routine source of
care.\12\ And even with implementation of ACA, it is imperative that as
more Americans become insured, they have access to care through a
healthcare home in their community. Prior to the completion of fiscal
year 2011 appropriations, health centers were on track to double their
capacity and serve 40 million patients over the next 5 years, reaching
a sizeable portion of the medically underserved individuals who would
otherwise be forced to seek care in EDs, or delay care until
hospitalization is the only option.
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\12\ NACHC, the Robert Graham Center, and Capital Link. Access
Granted: The Primary Care Payoff. August 2007. www.nachc.com/
accessreports.cfm.
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HRSA previously announced several fiscal year 2011 funding
opportunities, including grants for new health centers and support for
expanded capacity at virtually every existing health center nationwide.
These opportunities produced: (1) over 800 applications submitted for
350 New Access Point (new health center) awards in communities not
currently served by existing health centers, demonstrating the great
need across the country for new centers to serve patients who most need
access to primary care; and (2) nearly 1,100 health center grantee
applications submitted to expand health center services to reach
additional individuals in need in their current communities, adding new
medical, oral, behavioral, pharmacy, and vision capacity. The reduction
to the Health Center program's fiscal year 2011 discretionary funding
leaves HRSA far short of the funding needed to make their previously-
announced awards at this time.
Fiscal Year 2012 Funding Request
Health centers stand ready to continue working to ensure that
everyone has access to primary and preventive healthcare services. In
fiscal year 2012, we respectfully ask that the Subcommittee provide a
discretionary funding level of no less than $1.79 billion for the
Health Centers program. This funding level, together with ACA funding
available in fiscal year 2012, will allow health centers to extend
cost-effective primary care over 3 million Americans this year alone.
It will also allow HRSA to fund remaining and worthwhile applications
that will go unfunded in fiscal year 2011, including over 200 new
health center applications and funding for expanded medical, oral,
behavioral, pharmacy, and vision health services at existing health
centers.
Conclusion
As the Congress works to tackle our Nation's deficit, I understand
Members of this Subcommittee are faced with incredibly difficult
decisions about funding levels for the programs within the fiscal year
2012 Labor-Health and Human Services-Education and Related Agencies
Appropriations bill. However, health centers have proven time and time
again that the Federal investment in the Health Centers program is
prudent--translating to improved health outcomes for our most
vulnerable Americans and reduced healthcare expenditures for this
Nation. I'd ask for this Subcommittee's support in continuing the
bipartisan expansion of health centers in fiscal year 2012 to ensure
that our shared goal of improved access to high-quality and cost-
effective care is realized.
______
Prepared Statement of the National Association of County and City
Health Officials
Summary
The National Association of County and City Health Officials
(NACCHO) represents the Nation's 2,800 local health departments (LHDs).
These governmental agencies work every day in their communities to
protect people, prevent disease, and promote wellness. Local health
departments have a unique and distinctive role and set of
responsibilities in the larger health system and within every
community. The Nation depends upon the capacity of local health
departments to play this role well.
The Nation's current financial challenges are compounded by those
in State and local government further diminishing the ability of local
health departments to measure population-wide illness, take steps to
prevent disease and prolong quality of life, and to serve the public in
ways others don't. Repeated rounds of budget cuts and lay-offs continue
to erode local health department capacity. NACCHO surveys have found
that from 2008 to 2010, local health departments have lost 29,000 jobs
due to budget reductions. This represents a nearly 20 percent reduction
in local public workforce. These are jobs in local communities
nationwide.
On a fraying shoestring, local health departments continue to
respond to an ever changing set of challenges, including ongoing public
health emergency threats like floods, hurricanes, oil spills,
infectious and chronic disease epidemics. The protection offered by
local health departments can't be taken for granted. To help maintain
the stability of LHDs, the Federal Government should invest in the
following programs in fiscal year 2012 appropriations: National Public
Health Improvement Initiative, Public Health Emergency Preparedness
cooperative agreements, Advanced Practice Centers, Public Health
Workforce Development, Chronic Disease Prevention and Health Promotion
Grants, and Community Transformation Grants.
Public Health Recommendations
National Public Health Improvement Initiative
NACCHO request: $50 million
Fiscal Year 2012 President's Budget: $40.2 million
Fiscal Year 2010: $50 million
The National Public Health Improvement Initiative (NPHII) increases
local health departments' capability to meet national public health
standards and conduct effective performance management. This initiative
promotes the effective and efficient use of resources in local health
departments across the country while strengthening our public health
infrastructure. In addition, these funds improve public health policies
and decisionmaking crucial to protecting our communities from public
health threats. NPHII boosts the ability of local health departments to
reengineer their systems to meet 21st century challenges including
implementation of the full range of science-based approaches to
improving community health. As local health departments prepare to meet
newly established national accreditation standards, NACCHO recommends
$50 million in funding for fiscal year 2012 to continue to improve
efficiency and effectiveness at local health departments.
Public Health Workforce Development
NACCHO request: $73 million
Fiscal Year 2012 President's Budget: $73 million
Fiscal Year 2010: $38 million
The Nation suffers an acute shortage of trained public health
professionals, including epidemiologists, laboratorians, public health
nurses, and public health informaticians. This investment in public
health education and training is essential to maintain a prepared and
sustainable public health workforce. With the increasing variety and
magnitude of public health threats, it is vital to train new public
health staff and provide continuous education for existing staff in
order to maintain and upgrade the skills needed to protect our
communities. This funding also supports the Centers for Disease Control
and Prevention (CDC) Prevention Corps, a workforce program to recruit
and train new talent for assignments in State and local health
departments. This new program will also address retention by requiring
professionals to commit to a designated timeframe in State and local
health departments as a condition of the fellowship. NACCHO recommends
$73 million in funding for fiscal year 2012 to bolster the public
health workforce.
Emergency Preparedness Recommendations
Public Health Emergency Preparedness Cooperative Agreements
NACCHO request: $730 million
Fiscal Year 2012 President's Budget: $643 million
Fiscal Year 2010: $715 million
Constant readiness for both new and emerging public health threats
requires an established local public health team that can plan, train,
and practice on a regular basis. Emergency response capabilities and
tasks, such as distributing medical countermeasures, addressing the
needs of at-risk individuals, conducting drills, and organizing
collaboration among staff in public health departments, schools,
businesses and with volunteers, requires continuous attention and
ongoing preparation. These are not supplies purchased once and stored
until needed. If a community is not prepared to respond to multiple
hazards, capacity to respond will not be immediately available when
disasters happen. Valuable time will be lost and people will suffer,
particularly the elderly, disabled and disenfranchised, low-income
residents, vulnerable populations. The only way to ensure that local
health departments and their community partners are ready to respond to
emergencies is to maintain consistent funding. With this funding, local
health departments can sustain their level of readiness to meet
benchmarks that align with the Pandemic and All Hazards Preparedness
Act.
With recent progress in nationwide preparedness, now is not the
time to reduce Federal funding that helps health departments continue
their progress and address new, emerging threats. Especially when local
health departments are under great stress from the loss of over 29,000
jobs in the last few years, the Nation cannot afford to lose the gains
made by recent Federal investment in public health. Continuous training
and exercising of all health department staff so that they are all
ready for the next emergency must continue. A loss of readiness is
inevitable if the level of Federal investment is reduced.
The safety and well-being of America's communities is dependent on
the capacity of their health departments to respond in any emergency
that threatens human health, including bioterrorism, infectious disease
outbreaks, nuclear emergencies and natural disasters. The CDC has
explicitly adopted an ``all-hazards'' approach to preparedness,
recognizing that the capabilities necessary to respond to differing
public health threats have many common elements. Through the Public
Health Emergency Preparedness cooperative agreements CDC supports State
and local health departments so that they can adequately prepare for
and respond to such emergencies. NACCHO recommends $730 million in
funding for fiscal year 2012 to continue to support emergency
preparedness in our communities.
Advanced Practice Centers
NACCHO request: $5.4 million
Fiscal Year 2012 President's Budget: 0
Fiscal Year 2010: $5.4 million
The Advanced Practice Center program started as a CDC pilot project
in 1999, and has since expanded to a national program. The APC program
funds exemplary local health departments to be innovative leaders in
public health preparedness to develop, evaluate, and promote products
and resources that other local health department practitioners can use
to meet the preparedness requirements expected for their organization
or community. Since its inception, the APC program has created over 150
products and hosted numerous workshops, webinars, and other
presentations to local health departments. NACCHO recommends level
funding in fiscal year 2012 of $5.4 million for the Advanced Practice
Center program administered by CDC's Office of Public Health
Preparedness and Response.
Disease Prevention Recommendations
Chronic Disease Prevention and Health Promotion Grants
NACCHO request: $705 million
Fiscal Year 2012 President's Budget: $705 million
Chronic diseases such as heart disease, cancer, stroke and diabetes
are responsible for 7 of 10 deaths among Americans each year and
account for 75 percent of healthcare spending. The President's budget
consolidates several previously existing grants for disease prevention
and health promotion to provide State and local health departments with
greater flexibility to target funds to those diseases that most burden
their jurisdictions, using the most effective strategies for the
populations they serve. The program recognizes that many chronic
diseases have common risk factors such as obesity and physical
inactivity.
Supporting effective approaches to reducing contributing factors
and therefore rates of chronic disease will not only make our
communities healthier, but save money for taxpayers and the Government
in the long run. NACCHO recommends $705 million in funding for fiscal
year 2012 to reduce chronic disease in our communities and looks
forward to working with Congress on the array of details that will
ensure successful, efficient, accountable implementation of a
consolidated grant program that enables communities to address their
chronic disease burden.
Community Transformation Grants
NACCHO request: $221 million
Fiscal Year 2012 President's Budget: $221 million
This program builds on the success of its predecessors: Healthy
Communities, Racial and Ethnic Approaches to Community Health, and
Communities Putting Prevention to Work. These funds are awarded on a
competitive basis to State or local government agencies, territories,
national networks of community based organizations, State or local
nonprofit organizations and Indian tribes or tribal organizations to
reduce health disparities and leading causes of death. Communities will
use these resources to invest in evidence-based approaches to creating
a healthy population by promoting smoking cessation, active living,
healthy eating, and prevention of injuries. NACCHO recommends an
allocation process which makes these funds available to communities of
all sizes. NACCHO recommends $221 million in funding for fiscal year
2012 to continue proven approaches to protecting public health in our
communities.
As the Subcommittee drafts the fiscal year 2012 Labor-Health and
Human Services-Education Appropriations bill, we ask for consideration
of NACCHO's recommendations for these programs that are critical to
protecting people and improving the public's health. We are fully aware
of the budgetary challenges facing Congress and the need to reduce
deficit spending. Budgetary cuts must be made carefully to cause the
least disruption to critical public health functions and protect the
health of the U.S. population.
NACCHO thanks the Subcommittee members for their previous support
of public health initiatives that support work in local communities and
welcomes the opportunity to discuss these requests further.
______
Prepared Statement of the National Association of Nutrition and Aging
Services Programs
On behalf of NANASP, the National Association of Nutrition and
Aging Services Programs, I thank you for providing an opportunity to
submit testimony as you consider an fiscal year 2012 Labor-HHS and
Education Appropriations bill. NANASP is a national membership
organization for persons across the country working to provide older
adults healthful food and nutrition through community-based services.
NANASP has 14 members in Iowa and 17 members in Alabama.
I am writing today to urge you to provide a much needed increase to
President Obama's fiscal year 2012 funding proposal for two major
programs in the Older Americans Act: the senior nutrition programs and
Community Service Employment for Older Adults.
The congregate and home-delivered (Meals on Wheels) nutrition
programs and the Nutrition Services Incentive Program (NSIP) are the
largest and most visible component of the Older Americans Act. Next
year, the senior nutrition program celebrates its 40th anniversary of
helping to keep millions of the vulnerable elderly healthy and
independent in their homes and communities. This is a much more
fiscally sound solution than having our seniors institutionalized
because of the detrimental effects of hunger and malnutrition.
The President's budget proposes no increase for the senior
nutrition programs in fiscal year 2012. This is extremely alarming as
these same programs were deemed worthy of increases for the past 5
fiscal years. The need for an increase in funding for meals for our
seniors remains today. According to the Administration on Aging (AoA),
flat funding for the nutrition programs means that 36 million fewer
home-delivered and congregate meals will be served in fiscal year 2012
compared to fiscal year 2010. These meals are especially critical for
the health of the 58 percent of congregate and 60 percent of home-
delivered meal participants who report that they receive the majority
of their daily food intake from the nutrition program.
The second major program we ask you to consider for increased
funding is the Community Service Employment for Older Adults, also
known as the Senior Community Service Employment Program or SCSEP.
Administered by the Labor Department, SCSEP provides part-time jobs to
thousands of low-income seniors, about one-fourth of them working in
senior nutrition and other programs serving the elderly. These
disadvantaged and previously unemployed seniors earn the minimum wage
as they re-enter the job market.
In fiscal year 2012, the President's budget proposes to reduce the
number of SCSEP participants by 25 percent below the fiscal year 2008
level. SCSEP is the only Federal job training program targeted for
older workers, who continue to suffer in today's economy. While the
current unemployment rate among older adults is lower than among
younger workers, older workers are less likely to find new employment,
and when they do find new jobs, their job search has taken longer. For
example, nearly 30 percent of unemployed people aged 55+ were jobless
for an entire year or more, a rate that exceeds that of all other age
groups. Such a drastic cut in funding would not only eliminate over
22,000 job opportunities for older workers, but also take away 12
million hours of staffing for senior nutrition and other programs
serving the community.
At NANASP we always say, ``It is more than just a meal.'' Our
programs provide much needed socialization for older adults and the
link between nutrition and health is irrefutable. The senior nutrition
and community service employment programs play a key role in health
promotion and disease prevention. Our programs keep the very vulnerable
elderly healthy, engaged, and independent and out of expensive long-
term care institutions that are very costly to the Medicaid program. We
hope you will strongly consider an increase in funding for the
nutrition and community service employment programs in your Labor-HHS,
Education Appropriations bill for fiscal year 2012.
______
Prepared Statement of the National Association of State Comprehensive
Health Insurance Plans
The National Association of State Comprehensive Health Insurance
Plans (NASCHIP) appreciates the opportunity to submit testimony as you
consider an fiscal year 2012 Labor-HHS and Education Appropriations
bill. NASCHIP represents the State high risk pools which were
established by statute initially passed 10 years before the Federal
high risk pool program (PCIP) was created by the ACA, the Affordable
Care Act. Our programs operate in 35 States including your States, Mr.
Chairman and Mr. Shelby. We serve more than 200,000 people providing
them with insurance notwithstanding their preexisting conditions. This
number reflects a 7 percent increase from 2009 levels which we consider
a significant indicator of the value and necessity of our programs.
We are here to urge that you support a level of $75 million for the
Federal grant program for State high risk pool programs for fiscal year
2012. This was the authorization level contained in our statute the
State High-Risk Pool Funding Extension Act of 2006. This funding allows
many States to provide means based premium subsidies to their citizens
who might otherwise not be able to afford coverage.
We consider this level of funding the essential minimum for us to
continue to do our work of providing a vital safety net to individuals
who might otherwise be uninsured. For the current fiscal year, the
Federal grant program for State high risk pool programs has $55 million
in available funding which represents only a fraction of the total
costs of care for State high risk pools. In fact, total State pool
expenses in 2009 were approximately $2.2 billion.
We were disappointed that the President only requested $44 million
in funding for the Federal grant program for State high risk pools in
his fiscal year 2012 budget proposal. It was based in part on an
incorrect premise that as enrollments grow in the PCIP program it would
lessen enrollment in our programs. The request also ignores the reality
of increased enrollment into our programs in 2010. Only by receiving
$75 million in funding for fiscal year 2012 would we stand a chance of
serving the individuals we need to serve.
The issues related to the PCIP program and either lower or higher
than expected enrollments should have no bearing on the funding level
we request. We have and will continue to work with administration
officials to improve enrollments in PCIP as we want to see this program
succeed. However, the State high risk pools serve a growing population
and are in need of continued funding. We urge you to include $75
million in your Labor-HHS and Education appropriations bill for fiscal
year 2012.
______
Prepared Statement of the National Association of State Head Injury
Administrators
Thank you for this opportunity to submit testimony regarding the
fiscal year 2012 budget as it pertains to funding for programs
authorized by the Traumatic Brain Injury (TBI) Act of 1996, as amended
in 2008. The TBI Act authorizes funding to the U.S. Department of
Health and Human Services (HHS) to carry out the intent of the Act
through the (1) Centers for Disease Control and Prevention (CDC) for
purposes of brain injury surveillance, prevention and education; and
the (2) Health Resources and Services Administration (HRSA) for grants
to State governmental agencies and to Protection and Advocacy Systems
to improve and increase access to rehabilitation services and community
services and supports for individuals with TBI and their families.
NASHIA is a nonprofit organization representing State governmental
officials who administer an array of short-term and long-term
rehabilitation and community services and supports for individuals with
TBI and their families. These services are generally financed through
an array of Federal, State and dedicated funds (State trust funds) with
the HRSA Federal TBI grants used to support and improve the necessary
infrastructure to support these service systems. While NASHIA is well
aware that Federal funds are becoming increasingly difficult to obtain,
NASHIA is recommending increased funding for the Federal TBI Act
programs because:
--The number of Americans who sustain a TBI is increasing, especially
among the elderly and young children, and among our men and
women in uniform as a result of the wars in Iraq and
Afghanistan, while at the same time,
--States are experiencing significant budget cuts impacting
rehabilitation and community services and supports for
individuals with TBI, yet
--The number of States receiving grants has been reduced from 49 to
21 due to recent changes in HRSA policy and the level of
appropriations to support State grant activities.
These factors, as well as the overall economy, are creating a
strain on State TBI systems. As the TBI Act program is the only Federal
funding to help States to better serve individuals with TBI, NASHIA
recommends:
--$10 million for the CDC programs to support TBI registries and
surveillance; to develop Brain Injury Acute Care Guidelines,
and to expand prevention and public education regarding injury
prevention, including sports-related concussions (mild TBI);
--$ 8 million for the HRSA Federal TBI State Grant Program to
increase the number of grants to States; and
--$ 4 million for the HRSA Federal TBI Protection & Advocacy (P&A)
Systems Grant Program to increase the amount of grant awards.
hrsa federal tbi state grant program
Since 1997, HRSA has awarded grants to 48 States, District of
Columbia and one Territory to develop and improve services and systems
to address the short-term and long-term needs. These grants have been
time limited and are relatively small. Two years ago, HRSA increased
the amount of the award from approximately $100,000 to $250,000 to make
it more feasible for States to carry out their grant goals and the
legislative intent. While this increased amount is more attractive to
States, this change reduced the number of grantees from 49 to 21--less
than half of the States and Territories. As a result, States that do
not have Federal funding are finding it increasingly more difficult to
sustain their previous efforts, let alone expand and improve, due to
other budget constraints in their States.
Over the course of the grant program, States, depending on
individual State needs, have developed State plans for improving
service delivery; information and referral systems; service
coordination systems; outreach and screening among unidentified
populations such as children, victims of domestic violence, and
veterans; and training programs for direct care workers and other
staff. States have also conducted public awareness and educational
activities that have helped States to leverage and coordinate funding
in order to maximize resources to the benefit of individuals with TBI.
In keeping with the HRSA Federal TBI State Grant Program most
States have identified a lead State agency responsible for providing
and coordinating services and an advisory board to plan and coordinate
public policies to better serve individuals who frequently needs
assistance from multiple agencies and funding streams in order to
address the complexity of their needs.
state collaborative efforts to address the needs of veterans
The HRSA grant funding has been used to address the needs of
returning service members and veterans with TBI and their families.
Since service members and veterans first began to return from Iraq and
Afghanistan, States have been contacted by families and returning
servicemembers, especially those who served in the National Guard and
Reserves, to obtain community resources in order to return to work,
home and community.
NASHIA and some individual States have reached out to U.S.
Department of Veterans Affairs (VA), particularly staff from individual
Polytrauma Centers, to promote collaboration in order to better
understand VA benefits for veterans that may be seeking State services,
and for VA to understand what is available in the communities. In
addition, some States have added representatives from VA, National
Guard and Reserves, State Veterans Affairs, and/or veterans
organizations to serve on their State advisory board in order to
improve communications and policies across these programs.
the incidence and prevalence of tbi is on the rise
CDC released new data last year showing that the incidence and
prevalence of TBI in the United States is on the rise. CDC reported
that each year, an estimated 1.7 million people sustain a TBI. Of that
amount: 52,000 die; 275,000 are hospitalized; and 1.365 million (nearly
80 percent) are treated and released from an emergency department. TBI
is a contributing factor to a third (30.5 percent) of all injury-
related deaths in the United States. About 75 percent of TBIs that
occur each year are concussions or other forms of mild TBI. The number
of people with TBI who are not seen in an emergency department or who
receive no care is unknown.'' (www.cdc.gov/TraumaticBrainInjury/
statistics.hml)
The data collected by CDC relies heavily on State data, gathered
through State registries and hospital discharge data. These numbers do
not include the veterans who sustained TBIs in Iraq or Afghanistan and
now use private or State funded resources for care, or undiagnosed
TBIs.
about state resources and services
Since the 1980s, States have developed services and supports
largely in response to families who often seek help in crisis
situations, such as loss of job due to TBI; or out of control behaviors
or substance abuse that may result in family violence or dangerous
situations to self and others; and the need for overall help in
providing care to their family members who have extensive medical,
behavioral and cognitive problems. A critical service that States
provide is service coordination to help coordinate and maximize
resources and supports for individuals with TBI and their families.
Over the past 25 years, States have developed service delivery
systems that generally offer information and referral, service
coordination, rehabilitation, in-home support, personal care,
counseling, transportation, housing, vocational and other support
services for persons with TBI and their families. These services are
funded by State appropriations, designated funding (trust funds),
Medicaid and Rehabilitation Act programs and are administered by
programs located in the State public health, Vocational Rehabilitation,
mental health, Medicaid, developmental disabilities, education or
social services agencies.
Approximately half of all States have a dedicated funding
mechanism, mainly through traffic related fines, and about half of all
States also administer a Medicaid Home and Community-Based Services
(HCBS) Waiver for individuals with brain injury who are Medicaid
eligible. Individuals with TBI are also served in other State waiver
programs designed for physical disabilities, developmental
disabilities, elderly and other populations. Some States have the
advantage of both waiver and trust fund programs, in addition to other
State and Federal resources.
As private insurance generally does not provide for extended
rehabilitation and long-term care, supports and services, most long-
term services and supports for persons with TBI are administered by the
States. These programs are funded mainly through the shared Federal/
State Medicaid Home and Community-based Services Waivers (HCBS) program
and Medicaid State Plan services, such as personal assistance, nursing
homes and in-home care.
Medicaid HCBS Waivers for Individuals with TBI have grown
significantly in recent years, doubling from 5,400 individuals served
in 2002 to 11,214 in 2006, at a cost of $155 million in 2002 to $327
million in 2006 (Kaiser Commission on Medicaid and the Uninsured (2007,
December); Medicaid Home and Community-Based Service Programs: Data
Update, The Henry J. Kaiser Family Foundation, Washington, DC).
Without appropriate services and supports, individuals with TBI may
become homeless, or inappropriately placed in institutional settings or
end up in State or local Correctional facilities due to their cognitive
and behavioral disabilities. A recent report issued by the Centers for
Disease Control and Prevention (CDC) cited other jail and prison
studies indicating that 25-87 percent of inmates report having
experienced a TBI as compared to 8.5 percent in a general population
reporting a history of TBI.
about nashia
The mission of NASHIA is to assist State government in promoting
partnerships and building systems to meet the needs of individuals with
brain injury and their families. Since 1990, NASHIA has held an annual
State-of-the-States conference, and has served as a resource to State
TBI program managers. NASHIA also maintains a website (www.nashia.org)
containing State program contacts and other resources. NASHIA members
include State officials administering public TBI programs and services,
and associate members who are professionals, provider agencies, State
affiliates of the Brain Injury Association of America (BIAA), family
members and individuals with brain injury.
Should you wish additional information on State services and
resources, or other information, please do not hesitate to contact
Rebeccah Wolfkiel, Governmental Consultant at 202-480-8901 (office) or
[email protected]. You may also contact Susan L. Vaughn,
Director of Public Policy, at 573-636-6946 or [email protected]
or William A.B. Ditto, Chair of the Public Policy Committee, at
[email protected].
Thank you.
______
Prepared Statement of the National Association of Workforce Boards
Thank you for the opportunity to comment on the Administration's
proposed 2012 budget for the Department of Labor. The National
Association of Workforce Boards (NAWB) is a member association, which
represents a majority of the 575 local employer-led Workforce
Investment Boards and their nearly 13,000 employer member volunteers.
We write in support of the Administration's fiscal year 2012
overall appropriations request for the Training and Employment Services
account under the Department of Labor. Adequate funding for the public
workforce system has never been more critical. While the worst of the
economic downturn seems behind us, one-stop centers across the Nation
continue to deal with large numbers of unemployed individuals who seek
advice about career options and whose skills need upgraded. In short,
our employment crisis is not expected to ease in the foreseeable
future.
The annual Economic Report of the President indicated that
unemployment would remain above 8 percent through 2012. In April of
this year the rate stood at 9 percent. Federal Reserve Chairman Ben S.
Bernanke said the unemployment rate is likely to remain high ``for some
time'' even after the biggest 2-month drop in the jobless rate since
1958.
Mr. Bernanke appearing before the House Budget Committee in
February 2011, said that while the declines in the jobless rate in
December and January ``do provide some grounds for optimism,'' he
cautioned that ``with output growth likely to be moderate for a while
and with employers reportedly still reluctant to add to their payrolls,
it will be several years before the unemployment rate has returned to a
more normal level.''
Workforce Investment Act programs have been on the front lines of
assisting job seekers impacted by the recession. Over the past year,
Title I of the Workforce Investment Act (WIA) system has seen over 8
million American workers turn to it for help in navigating the labor
market in search of jobs and/or the training individuals need to be
competitive in their labor market. This continues the trend of an over
234 percent increase in the numbers of people who have sought
assistance over the last two reporting years.
Despite a ratio of four/five job seekers nationally for every
available job, over 4 million were helped back into the labor force. In
short, those who received WIA services were likely to find jobs with
the likelihood increasing the higher the service level. Information for
the quarter ending September 30, 2010 shows the following results:
Performance Results
Workforce Investment Act Adult Program
--Entered Employment Rate 53.1 percent
--Employment Retention Rate 75.3 percent
--Average 6 months Earnings $13,482
Workforce Investment Act Dislocated Worker Program
--Entered Employment Rate 50.3 percent
--Employment Retention Rate 79 percent
--Average 6 months Earnings $17,227
Workforce Investment Act Youth Program
--Placement in Employment or Education rate 59.5 percent
--Attainment of Literacy and Numeracy gains 49.5 percent
The ability of the pubic workforce system to maintain this level of
success on behalf of job seekers and employers seeking skilled workers
is incumbent upon the continuation of adequate funding. We encourage
the Subcommittee to fund WIA formula programs at a minimum at the
administration's request levels, as we expect to continue to face the
challenges brought about by high unemployment for the foreseeable
future.
Program Funding
We applaud the Administration's proposal for a Workforce Innovation
Fund. We believe that the State and local workforce boards have
developed a host of promising practices since WIA was enacted in 1998,
particularly in helping address the large numbers of persons dislocated
during this recession or shut-out of the labor market due to a lack of
appropriate skills. The Workforce Innovation Fund will allow local
areas to engage with community partners and quickly scale effective
practices on behalf of jobseekers in need.
However, we strongly urge the Subcommittee to fully fund the
administration's request for WIA formula programs before allocating
funding for the Workforce Innovation Fund, as these formula funds are
essential to our ability to provide services to job seekers at the
local level around the Nation.
The protection of the WIA formula programs to support the locally
delivered services is critical as the system continues to deal with
large numbers of individuals seeking work. The Continuing Resolution
passed in April contained budget reductions that are already having the
impact of local areas having to close and consolidate local career one-
stop centers.
Policy Riders
NAWB would strongly encourage the committee to continue the policy
riders that prohibit the re-designation of local areas or changes to
the definition of administrative costs until WIA is reauthorized. There
have been instances where there has been arbitrary action to
reconfigure local areas and NAWB believes these riders will prevent any
State v. local conflict until reauthorization.
We urge the Subcommittee to continue to provide the support
necessary for the workforce system to help our jobseekers retool for
employment in high demand sectors and maintain our global
competitiveness.
Summer Youth employment
While our testimony is focused on fiscal year 2012 funding, we
would be remiss if we did not express our support for summer youth
funding. Youth unemployment remains at all-time highs. The unemployment
rate in April 2011 was listed as 9 percent for the total civilian labor
force, but for youth the rate is over 24 percent for 16-19 year olds.
In summer 2009 utilizing ARRA funding for WIA Youth programs, 313,000
young people had a summer job. Youth reported to us that their wages
provided much needed income to the household for basic needs of their
family and for the expenses in returning to school. Lack of youth funds
imperils business finding job-ready youth to fill their employment
needs as the ``boomer'' generation begins to retire. Serving youth that
are at-risk and/or school drop-outs with the level of service needed
requires intense intervention that combines academic, as well as,
experiential learning techniques. The summer youth employment project
allowed the system to provide youth practical work experience that
reinforced classroom academics. Without it, employers in the private
sector become the work-ready trainers; training that we have reason to
believe employers are ill-prepared and/or unwilling to provide.
We understand these budget times, but would hope that at some point
the Congress would take-up the issue of youth unemployment and we are
prepared to assure Congress that any additional funding for WIA Youth
programs would allow us to better address the crisis we are facing in
youth employment.
Thank you for the opportunity to testify.
______
Prepared Statement of the National Coalition for Cancer Survivorship
It is my pleasure to submit this statement regarding fiscal year
2012 funding for the National Institutes of Health (NIH) and the
Centers for Disease Control and Prevention (CDC) on behalf of the
National Coalition for Cancer Survivorship (NCCS) and the 12 million
cancer survivors living in the United States. NCCS advocates for
quality healthcare for survivors of all forms of cancer, and we believe
the Federal Government should play a strong leadership role, through
basic and clinical cancer research and delivery of survivorship
services, to boost the quality of cancer care from diagnosis and for
the balance of life. These research and survivorship programs should be
conducted in partnership with private sector organizations.
In this statement, NCCS will focus on the need for a balanced
program of basic, translational, and clinical research at the National
Institutes of Health (NIH) and the National Cancer Institute (NCI) as
well as the urgent need for Centers for Disease Control and Prevention
(CDC) leadership to strengthen educational and informational services
for survivors and improve access to cancer screening for the medically
underserved.
Two recent reports--the Annual Report to the Nation on the Status
of Cancer, 1975-2007, Featuring Tumors of the Brain and Other Nervous
System and the Morbidity and Mortality Weekly Report of March 11, 2011,
reporting on the number of cancer survivors in 2007--provide a
compelling portrait of the progress the Nation has made in the fight
against cancer, the work still to be done, and the pressing needs of
millions of cancer survivors who are still in active treatment or
living as long-term survivors.
The Annual Report notes that the incidence of cancer is decreasing;
the decrease is statistically significant for women although not for
men, because of a recent increase in prostate cancer incidence. The
cancer death rates are decreasing for both sexes. The decreases in
incidence and mortality are attributed to progress in cancer
prevention, early detection, and treatment. Despite the overall
progress, there are increasing incidence rates for some cancers and low
survival for certain forms of cancer. For example, pediatric cancer
incidence is increasing, although death rates are down. The survival
from melanoma, pancreatic cancer, liver cancer, and many forms of
malignant brain tumors remains much too short.
Those who do survive cancer experience a myriad of late and long-
term effects. In the editorial note accompanying the Morbidity and
Mortality Weekly Report that found almost 12 million American cancer
survivors, CDC stressed the need for more research to identify those
cancer survivors at risk of recurrence, second cancers, and the late
effects of cancer and its treatment. CDC also recommended that special
attention be paid to the burden of survivorship for the medically
underserved and the older cancer survivor.
Recommendations for Fiscal Year 2012 Funding
NCCS recommends smart, effective, and aggressive Federal
investments in initiatives to improve the quality of care and quality
of life for cancer survivors. We recommend:
--A strong and sustained investment in NIH and NCI in fiscal year
2012 to support basic, translational, and clinical research
aimed at answering fundamental questions about cancer,
advancing new and improved cancer treatments, identifying the
side effects of cancer treatments, and strengthening
interventions for the late and long term effects of cancer and
treatment. No reductions should be made in NIH funding in
fiscal year 2012, in order to prevent interruption of both
basic and clinical studies and to sustain the progress in
cancer treatment that we are making through research.
--Steady progress in the overhaul of the NCI clinical trials system.
The Institute of Medicine (IOM) has outlined a plan for
modernizing the clinical trials system and eliminating
inefficiencies, and NCI leaders have taken steps to implement
the IOM recommendations. We urge completion of this reform
effort, to guarantee that patients are willing to enroll in
clinical research studies because they know they will be
studies of high quality investigating important issues and
treatments. An improved system will also ensure that research
studies are efficiently completed and questions related to new
treatments are answered without delay.
--A strong investment in survivorship research that will discover
those at risk of late and long-term effects from cancer and
treatment and appropriate interventions for those individuals.
--A sustained commitment to basic research aimed at detecting
subtypes of cancer and contributing to the development of
targeted, or personalized, cancer therapies.
--Maintenance of the Federal cancer screening programs--including the
breast and cervical cancer screening program and the colorectal
cancer screening program--in a manner that will support
services to medically underserved individuals and ensure early
detection and diagnosis. The proposal to create a block grant
of chronic disease programs should not include the screening
programs, which do not lend themselves to effective
administration through a block grant.
--A strong program of education and information regarding
survivorship services for the 12 million cancer survivors
living in the United States. CDC has provided grant funding to
support a survivorship resource center, and we urge that steps
be taken to ensure that the services offered through the center
reflect the latest knowledge about the problems of survivors
and the most appropriate interventions. Morever, special
populations, including the medically underserved and the
elderly, should be provided adequate and appropriate
information and services.
Federal research and survivorship programs have yielded better
treatments and enhanced quality of life for millions of American cancer
patients. These programs should be sustained through continued Federal
support so that the needs of a growing population of cancer survivors
can be met.
______
Prepared Statement of the National Coalition for Osteoporosis and
Related Bone Diseases
The National Coalition for Osteoporosis and Related Bone Diseases
(Bone Coalition) would like to take this opportunity to thank you all
for your continued visionary support of the National Institutes of
Health--the Nation's biomedical research agency. Because of your past
efforts and your appreciation of the potential and value of medical
research, new scientific opportunities are being pursued that hold
potential for better diagnosis, treatment, prevention and eventually
cures for diseases such as osteoporosis, osteogenesis imperfecta,
Paget's disease of bone, and a wide range of rare bone diseases.
Recommendation.--The National Coalition for Osteoporosis and
Related Bone Diseases joins with hundreds of health and medical
organizations of the Ad Hoc Group for Medical Research Funding in
urging the Committee to provide an appropriation of $35 billion in
fiscal year 2012 for the National Institutes of Health. This increase
will create substantial opportunities for scientific and health
advances, while also providing key economic scientific support in
communities across the Nation.
Organized in the early 1990s, the Bone Coalition is dedicated to
increasing Federal research funding for bone diseases through advocacy
and education. Five leading national bone disease groups comprise the
Bone Coalition: two professional societies, the American Academy of
Orthopaedic Surgeons and the American Society for Bone and Mineral
Research; and three voluntary health organizations, the National
Osteoporosis Foundation, the Osteogenesis Imperfecta Foundation, and
the Paget Foundation for Paget's Disease of Bone and Related Disorders.
Osteoporosis and related bone diseases are omnipresent--affecting
people of all ages, ethnicities, and gender. These diseases profoundly
alter the quality of life and constitute a tremendous burden to
patients, society and the economy--causing loss of independence,
disability, pain and death. The annual direct and indirect costs for
bone and joint healthcare are $849 billion--7.7 percent of the U.S.
gross domestic product.
--Osteoporosis is a bone-thinning disease in which the skeleton can
become so fragile that the slightest movement, even a cough or
a sneeze can cause a bone to fracture. About 10 million
Americans already have the disease, and another 34 million
people have low bone density, which puts them at risk for
osteoporosis and bone fractures. According to estimated
figures, osteoporosis was responsible for more than 2 million
fractures in 2005, including hip, spine, wrist, and other
fractures. The number of fractures due to osteoporosis is
expected to rise to more than 3 million by 2025. Approximately
1 in 2 women and up to 1 in 4 men over age 50 will break a bone
because of osteoporosis, and an average of 24 percent of hip
fracture patients age 50 and older will die in the year
following their fracture. Individuals with certain diseases are
at higher risk of developing osteoporosis. For example:
diabetes patients are at increased risk for developing an
osteoporosis-related fracture; cancer patients are at increased
risk because many cancer therapies, such as chemotherapy and
corticosteroids, have direct negative effects on bone; and
certain cancers, including prostate and breast cancer, may be
treated with hormonal therapy, which can cause bone loss.
--Osteogenesis imperfecta, or ``brittle bone disease,'' is an
inherited genetic disorder characterized by fragile bones which
fracture easily, often from no apparent cause. A severely
affected child begins fracturing before birth. Hundreds of
fractures can be experienced in a lifetime, as well as hearing
loss, short stature, skeletal deformities, weak muscles and
respiratory difficulties. As many as 50,000 Americans may be
affected by this disease.
--Paget's disease of bone is a geriatric disorder that results in
enlarged and deformed bones in one or more parts of the body.
Excessive bone breakdown and formation can result in bone which
is structurally disorganized, resulting in an overall decrease
in bone strength and an increase in susceptibility to bowing of
limbs and fractures. Pain is the most common symptom. Other
complications include arthritis and hearing loss if Paget's
disease affects the skull. Paget's disease of bone affects 1\1/
2\ to 8 percent of older adults depending on a person's age and
where he or she lives. Approximately 700,000 Americans over the
age of 60 are affected.
Past investments in NIH by your Committee have paid dividends for
patients in the many advances in the bone research field, and these
investments have had significant impact on public health. In just one
example, researchers have recently discovered that bisphosphonate drugs
commonly prescribed for osteoporosis and Paget's disease significantly
reduce death rates by preventing fractures among older adults,
producing mortality rates five times lower than those over 60 taking no
bone medications. Years of basic research by NIH established the
scientific foundation for development of this type of medication now
producing significant results.
And while progress to date has clearly been impressive, there is
still no cure for osteoporosis, osteogenesis imperfecta, Paget's
disease or numerous other diseases and conditions that affect the
skeleton. Depending on the disease, the opportunity to build on recent
discoveries for new treatments, cures and preventive measures has never
been greater. With that in mind, the Coalition has identified the
following areas where further intensive investigation is warranted:
Office of the NIH Director.--The Coalition urges the Director to
work with all relevant Institutes to enhance interdisciplinary research
leading to targeted therapies for improving the density, quality and
strength of bone for all Americans. More scientific knowledge is needed
in a number of key areas involving bone and muscle, fat, and the
central nervous system. Research is also urgently needed to improve the
identification of populations who might require earlier treatment
because they are at risk of rapid bone loss due to a wide range of
conditions or diseases: obesity, diabetes, chronic renal failure,
cancer, HIV, conditions that affect absorption of nutrients or
medications, or addiction to tobacco, alcohol or other opiates. The
Coalition encourages NIH to develop a plan to expand genetics and other
research on rare bone diseases, including: osteogenesis imperfecta,
Paget's disease of bone, fibrous dysplasia, osteopetrosis, fibrous
ossificans progressiva, melorheostosis, X-linked hypophosphatemic
rickets, multiple hereditary exostoses, multiple osteochondroma,
Gorham's disease, and lymphangiomatosis.
National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS).--The Coalition urges support for research into the
pathophysiology of bone loss in diverse populations. The information
gained will be critical in developing targeted therapies to reduce
fractures and improve bone density, quality and strength. Efforts are
needed to determine appropriate levels of calcium and vitamin D for
bone health at different life stages. Research is also needed in
assessing bone microarchitecture and remodeling rates for determining
fracture risk, anabolic approaches to increase bone mass, novel
molecular and cell-based therapies for bone and cartilage regeneration,
and discerning the clinical utility of new, non-invasive bone imaging
techniques to measure bone architecture and fragility. Support for
studies on the molecular basis of bone diseases such as Paget's
disease, osteogenesis imperfecta and other rare bone diseases should
also be a priority.
National Cancer Institute (NCI).--The Coalition urges
investigations on how to repair bone defects caused by cancer cells.
Translational research is also needed to understand the impact of
metastasis on the biomechanical properties of bone and the mechanisms
by which bone marrow and tumor derived cells can influence metastatic
growth, survival and therapeutic resistance.
National Institute on Aging (NIA).--The Coalition encourages
research to better define the causes of age-related bone loss and
fractures, reduced physical performance and frailty, including
identifying epigenetic changes, with the aim of translating basic and
animal studies into new therapeutic approaches. Critical research is
also needed on changes in bone structure and strength with aging, and
the relationship of age-related changes in other organ systems. The
prevention and treatment of other metabolic bone diseases, including
osteogenesis imperfecta, glucocorticoid-induced osteoporosis, and bone
loss due to kidney disease should also be priority research areas.
National Institute of Child Health and Human Development (NICHD).--
The Coalition urges research in the new, emerging field of metabolic
disease and bone in children and adolescents, especially childhood
obesity, anorexia nervosa and other eating disorders. Research is also
needed on what the optimal Vitamin D levels should be in children to
achieve bone health, and the implications of chronic or seasonal
Vitamin D deficiency to the growing skeleton. Development and testing
of therapies and bone building drugs for pediatric patients are also a
pressing clinical need. The committee is encouraged by results thus far
from the Bone Mineral Density in Childhood Study (BMDCS) that will
serve as a valuable resource for clinicians and investigators to assess
bone deficits in children and risk factors for impaired bone health.
However the committee is concerned that without further funding to
continue the study, there will be inadequate data on bone development
in adolescents and different ethnic groups. Therefore the committee
encourages NIH to extend the study and to explore research that will
lead to better understanding and prevention of osteopenia and
osteoporosis.
National Institute of Dental and Craniofacial Research (NIDCR).--
The Coalition urges continued research support on the effects of
systemic bone active therapeutics on the craniofacial skeleton,
including factors predisposing individuals to osteonecrosis of the jaw,
as well as new approaches to facilitate bone regeneration. The
Coalition commends NIDCR for its longstanding intramural program on
fibrous dysplasia.
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK).--The Coalition encourages support for research on the
relationship between Vitamin D and morbidity and mortality in chronic
kidney disease. Research is also needed on the value of anti-resorptive
therapies, the link between renal insufficiency and diabetic bone
disease, the differences in calcification of blood vessels, the
mechanisms of metastasis of renal cell carcinoma, and diseases that
occurs in patients with end stage chronic renal disease on
hemodialysis.
National Institute of Neurological Disorders and Stroke (NINDS).--
The Coalition encourages research support into the pathophysiology of
spinal cord, brachial plexus, and peripheral nerve injuries in order to
develop targeted therapies to improve neural regeneration and
functional recovery.
National Institute of Biomedical Imaging and Bioengineering
(NIBIB).--The Coalition encourages critical research to advance our
ability to treat bone diseases and disorders through bone imaging, as
well as managing the loss of bone and soft tissue associated with
trauma by advancing tissue engineering strategies to replace and
regenerate bone and soft tissue.
Centers for Disease Control and Prevention
On another front, prevention is of major concern to the Coalition.
As the population ages and the ranks of senior citizen Baby Boomers
expand, the annual cost of acute and long-term care for osteoporosis,
alone, is projected to increase dramatically from $19 billion annually
to more than $25 billion by 2025. Without significant intervention now,
chronic diseases such as osteoporosis will overwhelm efforts to contain
healthcare costs. Thanks to medical research better diagnosis,
prevention and screening strategies and treatment therapeutics are now
available to address the growing problem of osteoporosis.
The recent HHS report, ``Enhancing Use of Clinical Preventive
Services Among Older Adults: Closing the Gap,'' calls attention to the
potential of preventive measures for osteoporosis. The report shows new
data outlining critical gaps with a high percentage of women on
Medicare reporting never having received osteoporosis screenings. Yet,
as the report states, studies have proven that osteoporosis screening
using hip scans and follow-up management can reduce hip fractures by 36
percent. In 1999 alone, Medicare spent more than $8 billion to treat
injuries to seniors, with fractures accounting for two-thirds of the
spending.
The Coalition, therefore, urges the Director of the Centers for
Disease Control to develop an education and outreach plan in
consultation with the patient and medical community to begin laying the
ground work to address osteoporosis on a public health basis.
______
Prepared Statement of the National Consumer Law Center
The Federal Low Income Home Energy Assistance Program (LIHEAP) \1\
is the cornerstone of Government efforts to help needy seniors and
families stay warm and avoid hypothermia in the winter, as well as stay
cool and avoid heat stress (even death) in the summer. LIHEAP is an
important safety net program for low-income, unemployed and
underemployed families struggling in this economy. The demand for
LIHEAP assistance remains at record high levels for a third year in a
row. In fiscal year 2011, the program is expected to help an estimated
9 million low-income households afford their energy bills. The
unemployment and poverty forecasts for fiscal year 2012 indicate that
the number of struggling households will also remain at these high
levels. In light of the crucial safety net function of this program in
protecting the health and well-being of low-income seniors, the
disabled, and families with very young children, we respectfully
request that LIHEAP be fully funded at its authorized level of $5.1
billion for fiscal year 2012 and that advance funding of $5.1 billion
be provided for the program in fiscal year 2013.
---------------------------------------------------------------------------
\1\ 42 U.S.C. Sec. Sec. 8621 et seq.
---------------------------------------------------------------------------
LIHEAP Provides Critical Help With Home Energy Bills for The Large
Number of Low-Income Households Struggling to Move Forward in
These Difficult Economic Times
Funding LIHEAP at $5.1 billion for the regular program in fiscal
year 2011 is essential in light of the sharp increase in poverty and
unemployment and the steady climb in home energy prices in recent
years.\2\ One indicator of the growing need for energy assistance is
the growing number of disconnections. In States like Ohio that track
utility disconnections, the disconnection numbers for gas and electric
residential customers have increased by 23.9 percent over 5 years. For
the year ending December 2010, there were 452,221 disconnections. For
the year ending December 2006, there were 364,912 gas and electric
disconnections. For the years ending December 2009, 2008, and 2007,
there were 476,490, 424,952, and 424,411 gas and electric
disconnections respectively. LIHEAP helps bring the cost of essential
heating and cooling within reach for an estimated 9 million low-income
households and helps keep these struggling households connected to
essential utility service.
---------------------------------------------------------------------------
\2\ See, Chad Stone, Arloc Sherman and Hannah Shaw,
Administration's Rational For Severe Cut in Low-Income Home Energy
Assistance is Weak, Figure 2 (CBPP calculation of winter fuel price
index from EIA) Center on Budget and Policy Priorities, February 18,
2011.
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The demand for LIHEAP increases when residential home energy prices
increase, such as the fly up in home heating oil and propane in the
winter of fiscal year 2011.\3\ Since the winter of 2005-2006, energy
costs have increased from $1,337 to $2,291 for households heating with
home heating oil; $1,275 to $2,040 for households heating with propane,
and $723 to $947 for households heating with electricity. Households
heating with natural gas have experience more moderate increases from
$813 to $990. Home energy is also more expensive during prolonged
periods of extreme temperatures because households use more fuel to
keep the home at safe temperatures. For example, a colder than normal
winter can result in higher heating bills than in years past. The third
variable that drives up the demand for LIHEAP is the number of
households that are struggling with unemployment, underemployment and
the number of households in poverty.
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\3\ Id.
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Unfortunately, the number of households that are struggling to make
ends meet remains very high. According a Pew Fiscal Analysis Initiative
report, as of December 2010, 30 percent of the 14 million unemployed
have been unemployed for a year or longer.\4\ While long-term
unemployment has affected all age groups, older workers have been hit
particularly hard by this downturn.\5\ CBO's budget and economic
outlook report projects that unemployment will be 8.2 percent by the
fourth quarter in fiscal year 2012, far from the 5.3 percent that CBO
estimates is the natural rate of unemployment.\6\ A recent Brookings
Center on Children & Families analysis looks at the correlation between
unemployment rates and poverty rates and estimates that the poverty
rate will increase to over 15 percent in 2012.\7\ Thus indications are
that the demand for LIHEAP in fiscal year 2012 will remain very strong
as this program helps struggling households in a number of ways. LIHEAP
protects the health and safety of the frail elderly, the very young and
those with chronic health conditions, such as diabetes, that increase
susceptibility to temperature extremes. LIHEAP assistance also helps
keep families together by keeping homes habitable during the bitter
cold winter and sweltering summers.
---------------------------------------------------------------------------
\4\ Pew Economic Policy Group Fiscal Analysis Initiative, Addendum:
A Year or More: The High Cost of Long-Term Unemployment, January 27,
2011.
\5\ Id. (``More than 40 percent of unemployed workers older than 55
have been out of work for at least a year'').
\6\ CBO, The Budget and Economic Outlook: Fiscal Years 2011 to
2021, Summary (January 2011 at Summary Table 2).
\7\ Emily Monea and Isabel Sawhill, An Update to ``Simulating the
Effect of the `Great Recession' on Poverty'', Brookings Center on
Children and Families (September 16, 2010).
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LIHEAP Is a Critical Safety Net Program for the Elderly, the Disabled
and Households With Young Children
Dire Choices and Dire Consequences.--Recent national studies have
documented the dire choices low-income households face when energy
bills are unaffordable. Because adequate heating and cooling are tied
to the habitability of the home, low-income families will go to great
lengths to pay their energy bills. Low-income households faced with
unaffordable energy bills cut back on necessities such as food,
medicine and medical care.\8\ The U.S. Department of Agriculture has
released a study that shows the connection between low-income
households, especially those with elderly persons, experiencing very
low food security and heating and cooling seasons when energy bills are
high.\9\ A pediatric study in Boston documented an increase in the
number of extremely low weight children, age 6 to 24 months, in the 3
months following the coldest months, when compared to the rest of the
year.\10\ Clearly, families are going without food during the winter to
pay their heating bills, and their children fail to thrive and grow. A
2007 Colorado study found that the second leading cause of homelessness
for families with children is the inability to pay for home energy.\11\
---------------------------------------------------------------------------
\8\ See e.g., National Energy Assistance Directors' Association,
2008 National Energy Assistance Survey, Tables in section IV, G and H
(April 2009) (to pay their energy bills, 32 percent of LIHEAP
recipients went without food, 42 percent went without medical or dental
care, 38 percent did not fill or took less than the full dose of a
prescribed medicine, 15 percent got a payday loan). Available at http:/
/www.neada.org/communications/press/2009-04-28.htm.
\9\ Mark Nord and Linda S. Kantor, Seasonal Variation in Food
Insecurity Is Associated with Heating and Cooling Costs Among Low-
Income Elderly Americans, The Journal of Nutrition, 136 (Nov. 2006)
2939-2944.
\10\ Deborah A. Frank, MD et al., Heat or Eat: The Low Income Home
Energy Assistance Program and Nutritional and Health Risks Among
Children Less Than 3 years of Age, AAP Pediatrics v.118, no.5 (Nov.
2006) e1293-e1302. See also, Child Health Impact Working Group,
Unhealthy Consequences: Energy Costs and Child Health: A Child Health
Impact Assessment Of Energy Costs And The Low Income Home Energy
Assistance Program (Boston: Nov. 2006) and the Testimony of Dr. Frank
Before the Senate Committee on Health, Education, Labor and Pensions
Subcommittee on Children and Families (March 5, 2008).
\11\ Colorado Interagency Council on Homelessness, Colorado
Statewide Homeless Count Summer, 2006, research conducted by University
of Colorado at Denver and Health Sciences Center (Feb. 2007).
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When people are unable to afford paying their home energy bills,
dangerous and even fatal results occur. In the winter, families resort
to using unsafe heating sources, such as space heaters, ovens and
burners, all of which are fire hazards. Space heaters pose 3 to 4 times
more risk for fire and 18 to 25 times more risk for death than central
heating. In 2007, space heaters accounted for 17 percent of home fires
and 20 percent of home fire deaths.\12\ In the summer, the inability to
keep the home cool can be lethal, especially to seniors. According to
the CDC, older adults, young children and persons with chronic medical
conditions are particularly susceptible to heat-related illness and are
at a high risk of heat-related death. The CDC reports that 3,442 deaths
resulted from exposure to extreme heat during 1999-2003.\13\ The CDC
also notes that air-conditioning is the number one protective factor
against heat-related illness and death.\14\ LIHEAP assistance helps
these vulnerable seniors, young children and medically vulnerable
persons keep their homes at safe temperatures during the winter and
summer and also funds low-income weatherization work to make homes more
energy efficient.
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\12\ John R. Hall, Jr., Home Fires Involving Heating Equipment
(Jan. 2010) at ix and 33. Also, 40 percent of home space heater fires
involve devices coded as stoves.
\13\ CDC, ``Heat-Related Deaths--United States, 1999-2003'' MMWR
Weekly, July 28, 2006.
\14\ CDC, ``Extreme Heat: A Prevention Guide to Promote Your
Personal Health and Safety'' available at http://emergency.cdc.gov/
disasters/extremeheat/heat_guide.asp.
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LIHEAP is an administratively efficient and effective targeted
health and safety program that works to bring fuel costs within a
manageable range for vulnerable low-income seniors, the disabled and
families with young children. LIHEAP must be fully funded at its
authorized level of $5.1 billion in fiscal year 2012 in light of
unaffordable, but essential heating and cooling needs of millions of
struggling households due to the record high unemployment levels.
In addition, fiscal year 2013 advance funding would facilitate the
efficient administration of the State LIHEAP programs. Advance funding
provides certainty of funding levels to States to set income guidelines
and benefit levels before the start of the heating season. States can
also better plan the components of their program year (e.g., amounts
set aside for heating, cooling and emergency assistance,
weatherization, self-sufficiency and leveraging activities) if there is
forward funding. Forward funding is critical to LIHEAP running
smoothly.
______
Prepared Statement of the National Council of Social Security
Management Associations
On behalf of the National Council of Social Security Management
Associations (NCSSMA), thank you for the opportunity to submit our
written testimony on the fiscal year 2012 funding for the Social
Security Administration (SSA) to the Subcommittee. I am the President
of NCSSMA and have been the District Manager of the Social Security
office in Newburgh, New York for 10 years. I have worked for the Social
Security Administration for 31 years, with 27 years in management.
NCSSMA is a membership organization of nearly 3,400 SSA managers
and supervisors who provide leadership in 1,299 community based Field
Offices and Teleservice Centers throughout the country. We are the
front-line service providers for SSA in communities all over the
Nation. We are also the Federal employees with whom many of your staff
members work to resolve problems and issues for your constituents who
receive Social Security retirement, survivors and disability benefits,
and Supplemental Security Income. Since the founding of our
organization over 41 years ago, NCSSMA has considered our top priority
to be a strong and stable Social Security Administration, one that
delivers quality and prompt locally delivered service to the American
public. We also consider it a top priority to be good stewards of the
taxpayers' moneys.
Appropriations to the Social Security Administration are an
excellent investment and return on taxpayer dollars. We are very
appreciative of the support for SSA funding the Subcommittee has
provided in recent years. The additional funding SSA received in fiscal
years 2008-2010 helped significantly to prevent workloads from
spiraling out of control and assisted with improving service to the
American public.
NCSSMA strongly supports the President's fiscal year 2012 budget
request for SSA. The total SSA budget request is $12.667 billion, which
includes $12.522 billion in administrative funding through the
Limitation on Administrative Expenses (LAE) account. We respectfully
request that the Subcommittee provides at the least the President's
full budget request for SSA in fiscal year 2012. Full funding of this
request is critical to maintain staffing in SSA's front-line
components, cover inflationary increases, continue efforts to reduce
hearing and disability backlogs, and increase deficit-reducing program
integrity work.
Current State of SSA Operations
NCSSMA has critical concerns about the dramatic growth in SSA
workloads, and the need to receive necessary funding to maintain
service levels vital to 60 million Americans. Despite agency strategic
planning, expansion of online services, significant productivity gains,
and the best efforts of management and employees, SSA is still faced
with many challenges to providing the service that the American public
has earned and deserves.
Over the last 7 years, SSA has experienced a dramatic increase in
Retirement, Survivor, Dependent, Disability, and Supplementary Security
Income (SSI) claims. The additional claims receipts are driven by the
initial wave of the nearly 80 million baby boomers who will be filing
for Social Security benefits by 2030--an average of 10,000 per day!
Concurrently, there has been a surge in claims filed due to poor
economic conditions and rising unemployment levels.
The need for resources in SSA Field Offices is critical to process
these additional claims and provide other vital services to the
American public. Field Offices are responsible for processing 2.4
million SSI redeterminations in fiscal year 2011, a 100 percent
increase compared to fiscal year 2008. Nationally, visitors to Field
Offices increased from 41.9 million in fiscal year 2007 to 45.4 million
in fiscal year 2010. SSA is also experiencing unprecedented telephone
call volumes, and in fiscal year 2010, SSA completed 67 million
transactions over the 800 number network--the most ever. In addition to
the transactions over the 800 number network, NCSSMA estimates that
Field Offices receive 32 million public telephone contacts annually.
SSA Funding for Fiscal Year 2011
NCSSMA strongly supported the President's fiscal year 2011 budget
request of $12.379 billion for SSA's administrative expenses. Much of
this increase was needed to cover inflationary costs for fixed
expenses. Funding at this level would have assured that SSA could meet
its public service obligations. Despite SSA's enormous challenges, with
the Federal deficit concerns, attaining this level of funding was not
possible. SSA's fiscal year 2011 appropriation for administrative
funding through the LAE account was $10.7755 billion, which is $25
million below the fiscal year 2010 enacted level and $275 million was
rescinded from SSA's Carryover Information Technology funds.
Inadequate funding of SSA in fiscal year 2011 and additional
rescissions will have major repercussions for SSA including a hiring
freeze, reduction of overtime, and postponements of initiatives to
improve efficiency. Reducing resources at the same time SSA workloads
are increasing is a prescription for making a very productive agency
that efficiently uses the taxpayers' moneys into one with significant
service delays and backlogs. Service deterioration and backlogs
resulting from inadequate fiscal year 2011 funding levels will have a
collateral negative impact on fiscal year 2012.
Field Office Service Delivery Challenges
SSA Field Offices are experiencing tremendous stress because of
increased workloads and additional visitors. The effect of funding SSA
in fiscal year 2011 below fiscal year 2010 levels exacerbates the
situation and has already had a significant impact on local Field
Offices around the country.
--Frontline feedback from our busiest urban offices indicates that
some have seen their visitor traffic explode with overflowing
reception areas and increased waiting times.
--Most of SSA has been under a hiring freeze because of the current
funding situation. A hiring freeze for all of fiscal year 2011
could result in a loss of over 2,500 SSA Federal employees.
--A November 2010, Office of the Inspector General (OIG) Report,
``Threats against SSA employees or Property,'' indicates, ``SSA
has experienced a dramatic increase in the number of reported
threats against its employees or property. The number of
threats . . . increased by more than 50 percent in fiscal year
2009 and by more than 60 percent in fiscal year 2010.''
--SSA projects 50 percent of its employees, including 66 percent of
supervisors, will be eligible to retire by fiscal year 2018.
Serious concerns exist about SSA's ability to sustain service
levels with the tremendous loss of institutional knowledge from
front-line personnel.
--Geographical staffing disparities will occur with attrition leaving
some offices significantly understaffed. This is problematic
for rural SSA Field Offices, whose customers often live vast
distances away, may have no Internet service, and lack access
to public transportation.
SSA Online eServices to Assist with Service Delivery Challenges
The expansion of services available to the American public via the
Internet has helped to alleviate the number of visitors and telephone
calls to SSA. However, the Internet is not keeping pace with the
increasing demand for service. High-volume transactions, such as Social
Security cards and benefit verifications are not available on the
Internet, or are only being used to a limited degree. This represents
over 40 percent of the 45.4 million visitors to SSA Field Offices.
NCSSMA believes that SSA must be properly funded in fiscal year
2012 and beyond so that it may continue to invest in improved user-
friendly online services to allow more online transactions. If
individuals were able to successfully transact their request for
services online, this would result in fewer contacts with Field
Offices, improved efficiencies, and better public service.
Disability Workload Processes
Nationwide, over 3.2 million new disability claims were filed and
sent to State Disability Determination Services in fiscal year 2010.
This surge of increased claims has created backlogs. At the end of
fiscal year 2010, the number of pending initial disability claims was
at an all-time high of 824,192 cases--a 46 percent increase from the
end of fiscal year 2008. SSA's largest backlogs are hearings, appealing
initial disability decisions processed by the Office of Disability
Adjudication and Review. Hearing receipts continue to rise, and through
April 2011, 734,666 hearings were pending which is over 29,000 more
hearings than at the end of fiscal year 2010.
Despite these unprecedented challenges, SSA continues to make
progress. In March 2011, the average processing time for a hearing was
359 days, the lowest level since December 2003. Unfortunately, the
number of claims and hearings pending is still not acceptable to
Americans who need Social Security to support their families. Progress
was undermined by the fiscal year 2011 budget impasse, resulting in the
suspension of opening eight planned Hearing Offices in Alabama,
California, Indiana, Michigan, Minnesota, Montana, New York, and Texas.
This significantly threatens to prevent SSA from eliminating the
hearings backlog by fiscal year 2013.
It is important to understand that annual appropriated funding
levels for SSA have a critical impact on the hearings backlog. One of
the most significant reasons for the increase in the hearings backlog
was the significant underfunding of SSA from fiscal year 2004 through
fiscal year 2007.
President's Proposed Fiscal Year 2012 SSA Budget
NCSSMA strongly supports the President's fiscal year 2012 budget
request for SSA and requests that Congress provide full funding to
sustain the momentum achieved to allow the agency to:
--Reduce the initial disability claims backlog to 632,000 by
processing over 3 million claims;
--Conduct disability hearings for 822,500 cases and reduce the
waiting time for a hearing decision below a year for the first
time in a decade;
--Reduce pending hearings to 597,000 from the fiscal year 2010 level
of 705,367; and
--Complete additional program integrity workloads yielding nearly
$9.3 billion in savings over 10 years, including Medicare and
Medicaid savings--process 592,000 medical Continuing Disability
Reviews (CDRs) and 2.6 million SSI redeterminations.
SSA issues $800 billion in benefit payments annually to 60 million
people and the agency takes its stewardship responsibilities seriously.
The fiscal year 2012 budget request includes $938 million dedicated to
program integrity. Investment in program integrity reviews saves
taxpayer dollars and is fiscally prudent in reducing the Federal budget
and deficit.
--CDRs determine whether an individual is still disabled, or if
benefits should be ceased because of medical improvement. SSA
has accumulated a backlog of nearly 1.5 million CDRs. Medical
CDRs yield $10 in lifetime program savings for every $1 spent.
--SSI redeterminations review nonmedical factors of eligibility, such
as income and resources, to identify payment errors. SSI
redeterminations yield a return on investment of $7 in program
savings over 10 years for each $1 spent, including Medicaid
savings accruals.
NCSSMA recommends consideration of legislative proposals included
in the fiscal year 2012 budget request, which can improve the effective
administration of the Social Security program, with minimal effect on
program dollars. We believe these proposals have the potential to
reduce operational costs and increase administrative efficiency. This
includes enacting the Work Incentives Simplification Pilot, requiring
quarterly reporting of wages, workers compensation automatic reporting,
and developing an automated system to report state and local pensions.
Conclusion
NCSSMA recognizes in the current budget environment that it will be
difficult to provide adequate funding for SSA. However, Social Security
is one of the most successful Government programs in the world and
touches the lives of nearly every American family. We are a very
productive agency and a key component of the Nation's economic safety
net for the aged and disabled, but sufficient resources are necessary.
A strong Social Security program equates to a strong America and it
must be maintained as such for future generations.
NCSSMA sincerely appreciates the Subcommittee's interest in the
vital services Social Security provides, and your ongoing support to
ensure SSA has the resources necessary to serve the American public. We
respectfully request your support of full funding of the President's
fiscal year 2012 budget request on behalf of our agency and the
American public we serve. We remain confident increased investments in
SSA will benefit our entire Nation.
On behalf of NCSSMA members nationwide, thank you for the
opportunity to submit this written testimony. We respectfully ask that
you consider our comments, and would appreciate any assistance you can
provide in ensuring the American public receives the critical and
necessary service they deserve from the Social Security Administration.
______
Prepared Statement of the National Head Start Association
Chairman Harkin, Ranking Member Shelby, and Members of the
Subcommittee, thank you for allowing the National Head Start
Association (NHSA) to submit written testimony in support of funding
for Head Start and Early Head Start. As the Head Start community's
voice, NHSA believes that Head Start centers nationwide need the
resources necessary to provide quality school readiness opportunities
for young children and their families. The essence of Head Start is a
national commitment to provide critical early education, health,
nutrition, child care, parent involvement and family support services
in return for a lifelong measurable impact on the low-income children
and families enrolled in Head Start. Today, as our Nation's children
face greater obstacles than ever before, there is a significant need to
prepare the next generation for success in school and later in life,
and Head Start has a proven track record of accomplishing this. The
Head Start community is pleased to offer the following recommendation
to Congress as it begins its consideration of fiscal year 2012 funding
levels.
NHSA is grateful that the President and Congress made a solid
commitment to quality early childhood education in the fiscal year 2011
Continuing Resolution by providing the funds necessary to at least
maintain services for children currently served by Head Start and Early
Head Start programs across the country. Quality early education
prepares the Nation's youngest children for a lifetime of learning. In
fact, studies show that for every $1 invested in a Head Start child,
society earns at least $7 back through increased earnings, employment,
and family stability; and decreased welfare dependency, crime costs,
grade repetition, and special education. NHSA supports President
Obama's fiscal year 2012 budget request for $8.1 billion for Head Start
and Early Head Start. These funds will enable Head Start and Early Head
Start centers to continue to serve the entire, increasingly vulnerable
Head Start community for an additional school year, and complete some
necessary program improvements both to ensure accountability and
quality, as well as meet the requirements of the 2007 Head Start
Reauthorization Act.
Increased Needs of an Increased At-Risk Population
One of Head Start's greatest challenges is an increasingly needy
population--both among those served and those eligible for service.
Today more than one in five children are born into poverty--less than
$22,050 per year for a family of four. In many areas, Head Start
directors are seeing a rapid increase of homeless families/children
enrolled. The Administration's request aims to address some of this
growing need by allocating a significant portion of the additional
funds to increasing the number of available Migrant and Seasonal, and
American Indian and Alaskan Native spaces.
Though funding for Head Start has increased in recent budget years,
the cost of serving families has risen at a much faster pace. When
surveyed, a full 83 percent of Head Start centers reported that their
costs have increased just over the past year--in fact, 25 percent of
those who responded report that their fixed costs, including
maintenance, transportation, and insurance, have increased by more than
11 percent over the last 12 months. This puts many local centers in the
awkward position of choosing between serving fewer children and
families better and according to the statutory quality standards, or
serving as many as possible with perhaps lesser quality.
Additionally, Head Start and Early Head Start centers often do not
have adequate resources during the enrollment process to perform a
comprehensive needs assessment on all potential enrollees.
Specifically, targeted funds would enable center directors to
coordinate more fully with families before enrollment to determine
their needs and match those needs with the capacity of the center, and
work with partner organizations that may be better equipped to handle
special issues. In Kansas City, Kansas, the Project EAGLE Community
Programs has implemented a sort of ``community triage'' system, whereby
families are assessed more fully, and dollars are spent much more
wisely. This approach may also enable many more at-risk families that
were previously on Head Start waiting lists to receive assistance from
a multitude of partnering organizations--placing perhaps a higher
income, yet still impoverished family to a more fitting type of service
provider and providing a waiting list slot for a needier family.
Though Head Start and Early Head Start centers are able to accept a
limited number of children from families with incomes slightly above
the poverty threshold (up to 130 percent, or $29,055 for a family of
four) and are required to accept children with special needs, the Head
Start community shares a commitment to identifying and targeting
resources, especially in these economic circumstances, to the absolute
neediest of families. Additional program funds to enable better
monitoring, needs-assessments, and collaboration will assist Head Start
providers in meeting this goal.
Necessary Accountability Improvements
Head Start and Early Head Start directors are also eager for the
Administration on Children and Families to fully implement the quality
improvement provisions included in the 2007 Head Start Reauthorization.
The law put in place new minimum education requirements for Head Start
and Early Head Start teachers and caretakers. Though employing highly
qualified individuals is a goal shared by the National Head Start
Association, the education requirements necessitate a higher salary
range in many areas to attract and keep these highly educated
professionals, putting a strain on the administrative budgets of Head
Start and Early Head Start Centers. Head Start directors, when
surveyed, report that they are having difficulty competing with other
educational entities in their services areas; in many cases, they
cannot match the salaries provided to qualified individuals in the K-12
system or in other private pre-schools.
One of the most anticipated provisions yet to be implemented will
require Head Start grantees designated as low-performing to compete for
continuation of their grant. This competition is an enormous
undertaking for the Office of Head Start and will certainly require
additional funds to design, fully staff, and execute.
However, the law also enables the creation of rigorous performance
standards for each Head Start and Early Head Start center. These have
not yet been publicly drafted or finalized, though the Head Start
community is eager to work with Office of Head Start to inform the
effective design and implementation of these performance standards.
Further, we hope that the centers can be evaluated against these new
standards, particularly as they relate to the impending recompetition/
redesignation. We very much hope that Congress includes report language
directing the Administration to ensure that Head Start and Early Head
Start grantees are given the opportunity to realign and monitor
themselves against the full set of new performance standards before
being judged as to whether they will be subject to a recompetition/
redesignation. This will ensure that all grantees, in all areas, are
judged on consistent standards in competitions going forward.
Maintenance of Quality
Lastly, the National Head Start Association supports the
Administration's proposal to provide $202 million for Training and
Technical Assistance Activities. Within those funds, we suggest that
Congress direct the Administration to continue supporting the 10
Centers of Excellence in Early Childhood that were named last year--in
the following localities: Greensburg, Pennsylvania; Baltimore,
Maryland; Mount Vernon, Ohio; Houghton, Michigan; Owensboro, Kentucky;
Morganton, North Carolina; Birmingham, Alabama; Denver, Colorado;
Albuquerque, New Mexico; and Dunkirk, New York. Head Start directors
very much value the advice of fellow practitioners, and the resources
and tools these Centers have designed and provided to the Head Start
community are considered effective, well-designed, and serve as models
for other Head Start and Early Head Start programs to emulate. Their
innovative practices and collaborative community approaches will be in
more demand as practitioners adjust to the requirements of the 2007
law.
Head Start Works
Since 1965, Head Start (and now Early Head Start as well) has been
providing a proven, evidence-based comprehensive program to prepare at-
risk children and families for a stable, successful life. Head Start
improves the odds and the options for at-risk kids for a lifetime. Kids
that have been through Head Start and Early Head Start are healthier,
more academically accomplished, more likely to be employed, commit
fewer crimes, and contribute more to society. Head Start is a smart
investment--one of the smartest and most effective we make. Study after
study has demonstrated that Head Start has yielded a benefit-cost ratio
as large as $7 to $1.\1\
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\1\ Ludwig, J. and Phillips, D. (2007). The Benefits and Costs of
Head Start. Social Policy Report. 21 (3: 4); Meier, J. (2003, June 20).
Interim Report. Kindergarten Readiness Study: Head Start Success.
Preschool Service Department, San Bernardino County, California.
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Head Start saves our hard-earned tax dollars by decreasing the need
for children to receive special education services in elementary
schools.\2\ For example, data analysis of a recent Montgomery County
Public Schools evaluation found that a MCPS child receiving full-day
Head Start services requires 62 percent fewer special education
services and saves taxpayers $10,100 per child annually.\3\ States can
save $29,000 per year for each prisoner that they incarcerate because
Head Start children are 12 percent less likely to have been charged
with a crime.\4\
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\2\ Barnett, W. (2002, September 13). The Battle Over Head Start:
What the Research Shows. Presentation at a Science and Public Policy
Briefing Sponsored by the Federation of Behavioral, Psychological, and
Cognitive Sciences.
\3\ NHSA Public Policy and Research Department analysis of data
from a Montgomery County Public Schools evaluation. See Zhao, H. &
Modarresi, S. (2010, April). Evaluating lasting effects of full-day
prekindergarten program on school readiness, academic performance, and
special education services. Office of Shared Accountability, Montgomery
County Public Schools.
\4\ Reuters. (2009, March). Cost of locking up Americans too high:
Pew study; Garces, E., Thomas, D. and Currie, J. (2002, September).
Longer-term effects of Head Start. American Economic Review, 92 (4):
999-1012.
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Head Start families with increased health literacy experience
immediate healthcare benefits, including lower Medicaid costs--on
average $232 lower per family. The program has also reduced mortality
rates for 5- to 9-year olds by as much as 50 percent.\5\ Studies have
shown that the program reduces healthcare costs for employers and
individuals because Head Start children are less obese, \6\ 8 percent
more likely to be immunized, \7\ and 19 to 25 percent less likely to
smoke as an adult.\8\
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\5\ Ludwig, J. and Phillips, D. (2007) Does Head Start improve
children's life chances? Evidence from a regression discontinuity
design. The Quarterly Journal of Economics, 122 (1): 159-208.
\6\ Frisvold, D. (2006, February). Head Start participation and
childhood obesity. Vanderbilt University Working Paper No. 06-WG01.
\7\ Currie, J. and Thomas, D. (1995, June). Does Head Start Make a
Difference? The American Economic Review, 85 (3): 360.
\8\ Anderson, K.H., Foster, J.E., & Frisvold, D.E. (2009).
Investing in health: The long-term impact of Head Start on smoking.
Economic Inquiry, 48 (3), 587-602.
---------------------------------------------------------------------------
And these benefits last a lifetime. Head Start produces measurable,
long-term results such as school-readiness, increased high school
graduation rates, and reduced needs for special education. And the more
than 27 million Head Start graduates are working every day in our
communities to make our country and our economy strong.
The Head Start community understands the budgetary pressures the
Federal Government is facing and while reductions in early childhood
education may produce short-term savings, as a Nation we cannot afford
the lasting impact such cuts would impose on our most vulnerable
children today and on our children's futures. The research shows that
the ``achievement gap'' is apparent as early as the age of 18 months--
we will spend substantially more downstream if these same young people
are not prepared to graduate high-school, attend college and lead
prosperous lives. We urge the Subcommittee to fully fund the
President's budget request of $8.1 billion for Head Start and Early
Head Start in fiscal year 2012.
Thank you for your time and consideration.
______
Prepared Statement of the National Health Council
The National Health Council (NHC) is the only organization of its
kind that brings together all segments of the healthcare community to
provide a united voice for the more than 133 million people with
chronic diseases and disabilities and their family caregivers. Made up
of more than 100 national health-related organizations and businesses,
its core membership includes approximately 50 of the Nation's leading
patient advocacy groups, which control its governance. Other members
include professional societies and membership associations, nonprofit
organizations with an interest in health, and major pharmaceutical,
medical device, biotechnology, and insurance companies.
The NHC is well aware of the challenging fiscal environment facing
the Subcommittee--indeed the entire country. We recognize that Federal
resources must be carefully targeted to ensure that such investments
produce the greatest good for the American people. This will involve
very tough decisions on healthcare priorities by the Subcommittee.
As work begins on the fiscal year 2012 Labor-HHS appropriations
bill, the NHC urges the Subcommittee to take a ``global'' view of the
healthcare system as it identifies funding priorities for the coming
year. The NHC and its membership, particularly those groups
representing the patient community, stress that no one aspect of the
healthcare system--research, public health, healthcare delivery--can be
considered as a separate, stand-alone component. For a true benefit and
service to the American people, especially those living with chronic
conditions, the healthcare system must function through the effective
and productive interaction of its many parts.
NHC's members have specific interests that span the entire
healthcare system. However, a recent survey of our members demonstrated
that they share a common concern for the entire continuum of the
healthcare system.
One aspect of the healthcare system that is of concern to the NHC
is patient access to care. With healthcare costs rising and a growing
number of uninsured Americans, far too many people living with chronic
conditions are not able to access the care needed to maintain their
health and productivity. This is a concern not just for each individual
patient but the health system as a whole, which will face greater costs
due to declining public health. While the NHC views the entire
healthcare system as important, we recognize that the most vitally
important piece is for patients to be able to obtain high quality,
patient-focused care. Without this, the various components are unable
to serve their intended function and the system as a whole falters.
Another large concern of the patient community is the lack of
effective cures and treatments. Too many people who are facing serious
and life-threatening conditions are doing so without the hope of a cure
or even a treatment for their symptoms. Funding for biomedical research
at the National Institutes of Health (NIH) offers this hope. But the
drug development pipeline does not end with the NIH. Many therapeutics
are taking longer to reach patients due to a backlog at the Food and
Drug Administration (FDA). While the scope of FDA regulation has grown
to the point that it is now regulating one-third of the U.S. economy,
the agency's funding has remained relatively consistent. This fact is
troubling to the patient advocacy organizations that represent people
who lack effective cures and treatments. Both NIH and FDA must be
adequately funded to increase the likelihood that these patients will
live longer, healthier, and more productive lives.
The NHC appreciates the opportunity to submit this written
testimony to the Subcommittee. We understand that you face many hard
decisions and again urge that you focus on the healthcare system as
continuum that patients must be able to access in order to best serve
the needs of Americans living with chronic conditions.
______
Prepared Statement of the National Healthy Mothers Healthy Babies
Coalition
Highlighting the urgent need to address the startling infant
mortality rates in the United States by strengthening programs at
HRSA's Maternal and Child Health Bureau.
Mr. Chairman and Members of the Subcommittee, thank you for giving
the National Healthy Mothers, Healthy Babies Coalition (HMHB) the
opportunity to provide testimony as the Subcommittee begins to consider
funding priorities for fiscal year 2012. My name is Judy Meehan and I
am the Chief Executive Officer of HMHB, an organization founded in
1981, prompted by the U.S. Surgeon General's conference on infant
mortality. Since its founding, HMHB has become a recognized leader and
resource in maternal and child health, reaching an estimated 10 million
healthcare professionals, parents, and policymakers annually through
its membership of over 100 local, State and national organizations.
Mr. Chairman, I would like to limit my testimony today to discuss
an exciting program of HMHB, referred to as the text4baby program. This
program is focused on improving the health outcomes of mothers and
babies and demonstrating the potential of mobile health technology to
reach underserved populations with critical health information. Of the
33 countries that the International Monetary Fund describes as
``advanced economies'' the United States now has the highest infant
mortality rate according to data from the World Bank. In 1980, we were
13th and in 2000 we were 2d. In the United States approximately 28,000
babies die before their first birthday, despite a volume of science
around behaviors that improve a baby's chances for a healthy birth and
opportunity to thrive. The text4baby program was launched to help
address this problem.
Though the text4baby program has been financed by generous funding
from Founding Sponsor Johnson & Johnson, with technical and in-kind
support from Voxiva and CTIA--The Wireless Foundation, we are hopeful
that with your leadership, the Health Resources and Services Maternal
and Child Health Bureau can commit to helping us expand this program in
two States where there is demonstrated and significant need. The
Maternal and Child Health Block Grant program provides a flexible
source of funding that allows States to target their most urgent
maternal and child health needs. The program supports a broad range of
activities including reducing infant mortality. HMHB recommends that
funding from within the base of the block grant's Special Projects of
Regional and National Significance (SPRANS) be provided to text4baby so
that enrollment in this program could be expanded to targeted and
special populations in Louisiana and Mississippi, the two States that
have the worst infant mortality outcomes. Mr. Chairman, HMHB also
recommends fiscal year 2012 funding for the Maternal and Child Health
Block Grant program of $695 million, an increase of $33 million or 5
percent above the level provided in the fiscal year 2011 continuing
resolution.
Text4baby Program
Text4baby, a free mobile information service designed to promote
maternal and child health, was developed to deliver evidence-based
health information to the women who need it most: the 1.5 million women
on Medicaid who give birth each year. While many of these women may
lack access to the Internet and other sources of health information,
the vast majority of them do have a cell phone, and a reported 80
percent of Medicaid beneficiaries are active texters. Text4baby
provides pregnant women and new moms with information they need to take
care of their health and give their babies the best possible start in
life. Women who sign up for the service receive free SMS text messages
each week, timed to their due date or baby's date of birth. Since its
launch in February 2010, text4baby has enrolled over 157,000 users and
delivered over 12 million evidence-based tips to help them women keep
themselves and their babies healthy. That's a great start but it's not
enough. Thanks to the grassroots efforts of more than 500 text4baby
partners across the country, we are on track to achieve our goal of
bringing the service to 1 million moms by 2012 and delivering over 100
million timely and relevant health messages.
The text4baby program was developed in collaboration with the
Centers for Disease Control and Prevention (CDC), Health Resources and
Services, Administration (HRSA), American Academy of Pediatrics (AAP),
and other experts. Text4baby messages cover topics like immunization,
nutrition, smoking cessation, safe sleep, and the importance of early
prenatal care. The content also connects women to services such as
health insurance, childcare, and toll-free ``quitlines'' for assistance
in becoming smoke- and drug-free. Text4baby has also delivered urgent
infant product alerts at the request of the Food and Drug
Administration and outbreak and immunization alerts at the request of
CDC. Just last month, text4baby moms saw: ``Breaking news! The American
Academy of Pediatrics announced new car seat guidelines. Kids should
now ride in rear facing-car safety seats until age 2.''
Evaluation of the Program
Mr. Chairman, we know that the program is effective. Over 96
percent of those enrolled in the program say they would refer a friend
to the service. Also, preliminary data analysis indicates that
text4baby is reaching the target audience: for example, analysis of
enrollment data in Virginia in October, 2010 showed that text4baby
utilization is highest in zip codes with lower income levels and higher
incidence rates of low birth weight babies. However, we also want to
understand if and how text4baby is improving knowledge and changing
behavior. There are currently six formal evaluations underway to
examine text4baby's impact. The largest study, funded by the Department
of Health and Human Services (HHS) and conducted by Mathematica Policy
Research, is a mixed mode study and includes a mobile survey of
text4baby users, focus groups, a community survey, electronic health
record review, and interviews with key partners. This study will assess
utilization of recommended care during prenatal and postpartum periods
(considering things such as prenatal visits, postpartum visit, well-
child visits, dental visits, and immunization); adherence to
recommended health practices (such as breastfeeding and infant sleep
position); and adoption of healthy behaviors (such as smoking
cessation, healthy eating and exercise).
Even before the formal study results are in, we know that
delivering over 12 million important evidence-based health tips to over
160,000 individuals (and, by the end of next year, 100 million messages
to 1 million moms) is an important national service.
Expanding the Program
Glaring disparities in infant mortality exist within certain
populations in the United States suggesting the need for a targeted
expansion of the program. For example, babies born to African American
mothers are most at risk with a rate of 13.5 deaths per 1,000 births.
The States with the highest rates of infant mortality are Louisiana (10
babies per 1,000 died before their first birthday) and Mississippi
(10.5 babies per 1,000 died before their first birthday). In order to
demonstrate the full impact of text4baby, HMHB proposes a targeted
outreach and support initiative in those two States. Specifically, HMHB
proposes to leverage its great array of activities at the national,
regional, State, and local level to meet the ultimate goal of seeing
that every woman in Louisiana and Mississippi who is pregnant or a
mother of a child less than 1 year enrolls in the service and receives
the valuable health information she needs. This targeted outreach will
include the development of state-wide implementation teams, technical
assistance in the way of event planning and media relations,
fulfillment of requests for information, speakers and promotional
materials, and support for local data and assessment activities. It
will also include targeted outreach for African-American and Hispanic
communities. HMHB's zip-code based analysis will allow tracking of the
impact of targeted outreach activities with enrollment in real time.
Mississippi and Louisiana Statistics
Since its launch in February 2010, text4baby has enlisted 1,276
users in Mississippi and over 2,768 users in Louisiana; however, in
2007, 46,491 babies were born in Mississippi and 66,301 babies were
born in Louisiana. So, clearly, there is work to be done to increase
enrollment in these States. Unfortunately, these two States are among
the bottom in the Nation in terms of preterm births, low birth weight,
and rates of death among children before their first birthday. They are
also among the top in terms of smoking and obesity rates (see table
below). These are two States in desperate need of a new way to receive
information to help them care for their health and give their babies
the best possible start in life.
[In percent]
----------------------------------------------------------------------------------------------------------------
Mississippi Louisiana National
----------------------------------------------------------------------------------------------------------------
Preterm......................................................... 18.3 16.6 12.7
Low birth weight................................................ 12.3 11.2 8.2
IMR............................................................. 10.5 10.0 6.7
Women smokers................................................... 21.9 22.1 19.6
Men smokers..................................................... 27.2 25.1 19.6
Obesity in women................................................ 37.1 31.5 24.4
----------------------------------------------------------------------------------------------------------------
Summary and Conclusion
Mr. Chairman, again we wish to thank the Subcommittee for the
opportunity to submit testimony and for your leadership in these
difficult times. While HMHB recognizes the demands on our Nation's
resources, we believe the continuing decline of our Nation's health and
the increase in infant mortality justifies a targeted and specific
effort. In conclusion, we specifically urge that funding from within
the Maternal and Child Health Bureau's SPRANS program be made available
for a targeted effort to increase program enrollment among
disproportionately impacted populations in Louisiana and Mississippi,
the two States with the worst overall outcomes. We also recommend that
$695 million be provided in fiscal year 2012 for the Maternal and Child
Health Block Grant Program, an increase of $33 million or 5 percent
over the fiscal year 2011 continuing resolution.
______
Prepared Statement of the National Hispanic Council on Aging (NHCOA)
Thank you for the opportunity to submit written testimony. The
National Hispanic Council on Aging (NHCOA) is the leading organization
working to improve the lives of Hispanic older adults, their families,
and caregivers--the fastest growing segment of the U.S.'s rapidly
expanding aging population. For more than 30 years, NHCOA has been a
strong voice dedicated to ensuring our Nation's Hispanic seniors enjoy
healthy and happy golden years. Alongside its nearly 40 local
affiliates across the country, NHCOA reaches ten million Hispanics each
year.
Hispanic older adults experience myriad challenges as they seek to
obtain a good quality of life in their later years, including health
inequities and economic insecurity. They are disproportionately
affected by several health afflictions--among them diabetes,
hypertension, obesity, and Alzheimer's disease. Exacerbating these
problems is the low rate of access to preventative care. Hispanics are
disproportionately employed in low-paying jobs that require low levels
of formal education or skills and often depend on Social Security as
their sole source of income later in life.
NHCOA writes to you today to urge an increase in the funding for
the Corporation for National and Community Service's Senior Corps and
the Administration on Aging's Older Americans Act Programs. Senior
Corps' three programs, the Retired Senior Volunteer Program (RSVP), the
Foster Grandparent Program, and the Senior Companion Program, keep the
elderly active and allow the community to benefit from their years of
wisdom and experience. RSVP connects seniors to volunteer opportunities
available in their communities. Foster Grandparents tutor and mentor
at-risk children. The Senior Companion Program provides support to
volunteers ages 55+ who provide care and friendship to frail elderly.
Increasing funding to Senior Corps would provide valuable services to
communities while saving Federal funds. According to Pamela Carre of
Senior Volunteer Services in Broward County, Florida, during fiscal
year 2009, the volunteer work provided by Senior Volunteer Services
valued $6.3 million. All of this work came from Senior Corps
volunteers. The Older Americans Act provides a wide variety of
nutrition, caretaking, and training programs to thousands of service
providers across the country.
The Older Americans Act's National Family Caregiver Support Program
and Senior Corps' Senior Companion Program are particularly effective
and beneficial for Hispanic older adults. Additional funding to these
programs will help meet the needs of Hispanic older adults in a
culturally sensitive and effective manner while also easing the
financial burden on Medicare and Medicaid.
The Senior Companion program reduces the isolation that can easily
trap an elderly person. The Program trains volunteers ages 55+ to
assist vulnerable elderly people. In addition to training and
placement, the Program also provides a stipend of $2.65 an hour,
reimbursed travel expenses, and accident and liability insurance.
Senior Companions assist the elderly, whether by accompanying them on
visits to the doctor or running their errands. Administrators of the
Senior Companion Program, like Ms. Carre, highlight the importance of
the flexible and individualized service these companions provide to
other older adults. The main service that all Senior Companions provide
is friendship.
The Senior Companion Program benefits the elderly and the economy.
Senior Companions provide assistance that allows elderly people to
remain independent and out of institutionalized care. Keeping the
elderly out of nursing homes and assisted living facilities reduces the
cost of healthcare and keeps people from using Medicaid funds.
According to Ms. Carre, it costs $4,800 to support one Senior Companion
annually, while one year in a nursing home costs over $70,000.
Additionally, Senior Companions can act as home health aides, providing
assistance in the basic activities of daily living. Senior Companions
are able to cook for elders, remind them to take their medication,
perform housekeeping, and keep family aware of their loved one's needs
and condition. This service, also offered by Medicaid and Medicare, can
be fulfilled in a cost-effective manner through the Senior Companion
Program. In a conversation about the value of senior volunteer
programs, Becky Snider, of Pacific Retirement Services in Medford,
Oregon, explained that State and local governments recognize the great
value these programs provide.
The Senior Companion program has the potential to effectively serve
Hispanic older adults in a way that other programs cannot. Many in this
group view formal service providers as impersonal and lacking in
cultural sensitivity. A dearth of services able to adequately provide
assistance to Hispanic older adults further exacerbates this problem.
The Senior Companion program can effectively serve Hispanic older
adults by offering them friendly and linguistically and culturally
sensitive services in their own homes. Senior Companions can help
Hispanic older adults manage their health while also providing
attention and friendship in a way that home health aides and doctors do
not. Ms. Leticia Martinez, the administrator of Senior Companion
Volunteer Service of Los Angeles, states that she has heard from many
older adults that Senior Companions are often the only people they see
on a regular basis and that, ``they wouldn't be around without their
Senior Companion.'' Instead of receiving treatment from a home health
aide, Senior Companions provide a daily visit from a good friend.
Like a good friend, Senior Companions advocate for, and protect,
the older adults with whom they interact. Ms. Martinez stressed that
many Senior Companions helped their clients identify and avoid
financial abuse. The Senior Companion Program saves money for our
seniors.
Although the Senior Companion program can improve the health of
seniors and our economy, it is underfunded. The Edward M. Kennedy Serve
America Act authorized $55 million to be appropriated in fiscal year
2010, however, only $46.9 million was appropriated that year. In fact,
the Senior Companion program has not received a substantial increase in
funding in at least 10 years. The Senior Companion program deserves an
appropriation of at least $55 million in order to carry out its
important duties.
Similar to the Senior Companion Program, the Administration on
Aging's National Family Caregiver Support Program (NFCSP) plays a vital
role in protecting older adults. The NFCSP provides grants to States to
create programs to assist people who care for elderly relatives. These
programs support family members in providing the best care possible.
The Administration on Aging grants funds for five broad categories: (1)
providing information to caregivers about effective caretaking methods
and available services; (2) assistance in accessing services; (3)
creation of caregiver support groups and training sessions; (4) funds
for home health aides to give respite to family caregivers; and (5) on
a limited basis, supplemental services.
The NFCSP reduces the financial strain on Medicare and Medicaid. By
focusing on maintenance of health and prevention of serious problems,
the NFCSP can keep Hispanic older adults out of nursing homes and off
Medicaid. Additionally, the ability of NFCSP to provide funding for
home health aides and training and respite for family caregivers makes
it less likely for older adults to require a Medicare-financed home
health aide.
The NFCSP is perfectly suited to help Hispanic older adults, their
families, and caregivers. There are valuable, effective programs
available to help older adults afford healthcare and nursing home
treatment, but many Hispanics feel that traditional healthcare and
nursing home programs are too impersonal. The NFCSP addresses this
problem by providing respite care and training for effective caregiving
and by improving access to caregiving services. Delivering effective,
personalized care for older adults in their homes can help manage
health issues in a comfortable setting. Furthermore, home health aide
services can provide enough respite care for a family caregiver to take
on a part-time job, reducing the likelihood that the family will have
to turn to Medicaid or other forms of public assistance.
The NFCSP provides support to people who are unexpectedly drawn
into helping an older family member. While cleaning and errands may be
the first help given to an elderly loved one, these tasks can quickly
multiply. The NFCSP teaches family members how to effectively care for
their elderly relatives and cope with the stress of such care.
Regarding the value of caregiver training and support groups, Mr. Jose
Perez, Executive Director of Senior Community Outreach Services in
Alamo, Texas says, ``I have seen people break down into tears because
the stress of caring for their father and how close it brought them to
physically abusing their loved one. Training and support groups help
them ease this burden.''
President Obama's fiscal year 2012 budget request recognizes the
importance of the NFCSP and requests a substantial funding increase. In
the last several years, the program has received between $153 million
and $155 million. For fiscal year 2012, President Obama has requested
over $192 million for the NFCSP. This increased funding will help to
reduce healthcare costs for seniors while also allowing them to
maintain their independence and receive effective treatment from those
who know them best. Hispanic older adults will benefit from increased
NFCSP funding due to the program's ability to deliver culturally
sensitive care to a group that traditional healthcare providers have
thus far struggled to adequately serve.
Mr. Perez describes the effectiveness of these two programs with a
simple phrase: ``Everybody wins.'' Senior Companions win the
satisfaction of helping their fellow citizens and the pride of earning
wages for productive work. The elderly win by receiving the care and
attention that they deserve. Families win when they learn how to care
for their loved ones. The government wins because these programs keep
the elderly healthy, independent, and off Medicaid.
NHCOA urges you to appropriate at least $55 million for the
Corporation for National and Community Service's Senior Companion
Program. Additionally, we request that you follow President Obama's
recommendation and appropriate at least $192 million for the
Administration on Aging's National Family Caregiver Support Program.
These two programs will not only effectively serve Hispanic older
adults in a way other programs do not, but they will also ease the
financial strain on Medicare and Medicaid. Thank you for your
consideration, and please feel free to contact NHCOA with any questions
or concerns.
______
Prepared Statement of the National Kidney Foundation
In 2008, the number of Americans with End Stage Renal Disease
(ESRD), which requires dialysis or a kidney transplant to survive,
reached 535,000. In that year alone, 110,000 progressed to ESRD.
Medicare covers dialysis or transplantation regardless of age or other
disability, the only disease-specific coverage under the program.
Despite this social and economic impact, no national public health
program focusing on early detection and treatment existed until fiscal
year 2006, when Congress provided $1.8 million for the first of 5 years
of support to initiate a Chronic Kidney Disease Program at the Centers
for Disease Control and Prevention (CDC). Congressional concern
regarding kidney disease education and awareness also is found in Sec.
152 of the Medicare Improvements for Patients and Providers Act of 2008
(MIPPA, Public Law 110-275), in which it directed the Secretary to
establish pilot projects to increase screening for Chronic Kidney
Disease (CKD) and enhance surveillance systems to better assess the
prevalence and incidence of CKD. Treatments exist to potentially slow
progression of kidney disease and prevent its complications, but only
if individuals are diagnosed before the latter stages of CKD.
The CDC program is designed to identify members of populations at
high risk for CKD, develop community-based approaches for improving
detection and control, and educate health professionals about best
practices for early detection and treatment. The National Kidney
Foundation respectfully urges the Committee to maintain line-item
funding in the amount of $2.1 million for the Chronic Kidney Disease
Program in the CDC's Division of Diabetes Translation. We are
encouraged by the fiscal year 2011 Operating Plan for CDC, which
recommends only a $39,000 reduction from the fiscal year 2010
appropriation for the CKD program. Continued support will benefit
kidney patients and Americans who are at risk for kidney disease,
advance the objectives of Healthy People 2020 and the National Strategy
for Quality Improvement in Health Care, and fulfill the mandate created
by Sec. 152 of MIPPA.
The prevalence of CKD in the United States, when last measured, was
higher than a decade earlier. This is partly explained by the
increasing prevalence of the related diseases of diabetes and
hypertension. It is estimated that CKD affects 26 million adult
Americans \1\ and that the number of individuals in this country with
CKD who will have progressed to kidney failure, requiring chronic
dialysis treatments or a kidney transplant to survive, will grow to
712,290 by 2015 \2\. Furthermore, a task force of the American Heart
Association noted that decreased kidney function has consistently been
found to be an independent risk factor for cardiovascular disease (CVD)
outcomes and all-cause mortality and that the increased risk is present
with even mild reduction in kidney function.\3\ Therefore addressing
CKD is a way to achieve one of the priorities in the National Strategy
for Quality Improvement in Health Care: Promoting the Most Effective
Prevention and Treatment of the Leading Causes of Mortality, Starting
with Cardiovascular Disease.
---------------------------------------------------------------------------
\1\ Josef Coresh, et al. ``Prevalence of Chronic Kidney Disease in
the United States,'' JAMA, November 7, 2007.
\2\ D.T. Gilbertson, et al., Projecting the Number of Patients with
End-Stage Renal Disease in the United States to the Year 2015. J Am Soc
Nephrol 16: 3736-3741, 2005.
\3\ Mark J. Sarnak, et al. Kidney Disease as a Risk Factor for the
Development of Cardiovascular Disease: A Statement from the American
Heart Association Councils on Kidney in Cardiovascular Disease, High
Blood Pressure Research, Clinical Cardiology, and Epidemiology and
Prevention. Circulation 2003: 108: 2154-69.
---------------------------------------------------------------------------
Despite the extent of the problem, CKD is an under-recognized and
under-treated public health challenge in the United States.
Accordingly, Healthy People 2020 Objective CKD-2 is to ``increase the
proportion of persons with chronic kidney disease (CKD) who know they
have impaired renal function.'' One reason CKD is neglected is that it
is often asymptomatic, especially in the early stages, and, therefore,
laboratory testing is required to detect it. Increasing the proportion
of persons with CKD who know they are affected requires expanded public
and professional education programs and screening initiatives targeted
at populations who are at high risk for CKD. Thanks to the interest
that this Committee has expressed in CKD in the past, through directed
appropriations, the National Center for Chronic Disease Prevention and
Health Promotion at CDC has instituted a series of projects that could
assist in attaining the Healthy People 2020 objective. However, this
forward momentum will be stifled and CDC's investment in CKD to date
jeopardized if line-item funding is not continued.
As noted in CDC's Preventing Chronic Disease: April 2006, Chronic
Kidney Disease meets the criteria to be considered a public health
issue: (1) the condition places a large burden on society; (2) the
burden is distributed unfairly among the overall population; (3)
evidence exists that preventive strategies that target economic,
political, and environmental factors could reduce the burden; and (4)
evidence shows such preventive strategies are not yet in place.
Furthermore, CDC convened an expert panel in March 2007 to outline
recommendations for a comprehensive public health strategy to prevent
the development, progression, and complications of CKD in the United
States.
The CDC Chronic Kidney Disease program consists of three projects
to promote kidney health by identifying and controlling risk factors,
raising awareness, and promoting early diagnosis and improved outcomes
and quality of life for those living with CKD. These projects include
the following:
-- Establishing a surveillance system for Chronic Kidney Disease in
the United States.
--Demonstrating effective approaches for identifying individuals at
high risk for chronic kidney disease through State-based
screening (CKD Health Evaluation and Risk Information Sharing,
or CHERISH).
--Conducting an economic analysis by the Research Triangle Institute,
under contract with the CDC, on the economic burden of CKD and
the cost-effectiveness of CKD interventions.
Pursuant to CHERISH, individuals at high risk for CKD have been
screened in eight locations in four States. The goals of the
demonstration project have been:
--To educate providers and the public that simple tests can be used
to identify CKD in the target population and to assess risk
factors for intervention (obesity, hypertension, cardiovascular
disease, lipid disorders, diabetes, and glycemic control).
--Evaluate whether providers change practice patterns after being
consulted by a person who went through the detection program.
The demonstration project should be replicated at eight sites in
four additional States in order to confirm initial findings. If we fail
to do so, we could be forfeiting the valuable insight that has been
gained thus far.
We believe it is possible to distinguish between the CKD program
and other categorical chronic disease initiatives at CDC, because the
CKD program does not provide funds to State health departments.
Instead, CDC has been making available seed money for feasibility
studies in the areas of epidemiological research and health services
investigation. Because the CKD program does not provide funds to State
health departments, we maintain it should be exempted from the changes
in the structure and budget of the National Center for Chronic Disease
Prevention and Health Promotion, at least until surveillance planning,
and studies of detection feasibility and economic impact are completed.
Thank you for your consideration of our testimony.
______
Prepared Statement of the National League for Nursing
The National League for Nursing (NLN) is the premiere organization
dedicated to promoting excellence in nursing education to build a
strong and diverse nursing workforce to advance the Nation's health.
With leaders in nursing education and nurse faculty across all types of
nursing programs in the United States--doctorate, master's,
baccalaureate, associate degree, diploma, and licensed practical--the
NLN has more than 1,200 nursing school and healthcare agency members,
34,000 individual members, and 24 regional constituent leagues.
The NLN urges the subcommittee to fund the following Health
Resources and Services Administration (HRSA) nursing programs:
--The Nursing Workforce Development Programs, as authorized under
Title VIII of the Public Health Service Act, at $313.075
million in fiscal year 2012; and
--The Nurse Managed Health Clinics, as authorized under Title III of
the Public Health Service Act, at $20 million in fiscal year
2012.
Nursing Education is a Jobs Program
According to the U.S. Bureau of Labor Statistics (BLS), the
registered nurse (RN) workforce will grow by 22 percent from 2008 to
2018, resulting in 581,500 new jobs. This growth will be much faster
than the average for all occupations. The April 1, 2011 BLS Employment
Situation Summary--March 2011 likewise reinforces the strength of the
nursing workforce to the Nation's job growth. While the Nation's
overall unemployment rate was little changed at 8.8 percent for March
2011, the employment in healthcare increased in March with the addition
of 37,000 jobs (i.e., a 36.6 percent rise from February 2011) at
ambulatory healthcare services, hospitals, and nursing and residential
care facilities.
Nursing is the predominant occupation in the healthcare industry,
with more than 3.78 million active, licensed RNs in the United States
in 2009. BLS notes that healthcare is a critically important industrial
complex in the Nation. Growing steadily even during the depths of the
recession, healthcare is virtually the only sector that added jobs to
the economy on a net basis since 2001. Over the last 12 months,
healthcare added 283,000 jobs, or an average of 24,000 jobs per month.
The Nursing Workforce Development Programs provide training for
entry-level and advanced degree nurses to improve the access to, and
quality of, healthcare in underserved areas. These Title VIII nursing
education programs are fundamental to the infrastructure delivering
quality, cost-effective healthcare. The NLN applauds the subcommittee's
bipartisan efforts to recognize that a strong nursing workforce is
essential to a health policy that provides high-value care for every
dollar invested in capacity building for a 21st century nurse
workforce.
Yet, the current $243.872 million in fiscal year 2010 for the Title
VIII programs falls short of the healthcare inequities facing our
Nation. Absent consistent support, recent boosts to Title VIII will not
fulfill the expectation of paying down on asset investments to generate
quality health outcomes; nor will episodic increases in funding fill
the gap generated by a 13-year nurse shortage felt throughout the
entire U.S. health system.
The Nurse Pipeline and Education Capacity
Although the recession resulted in some stability in the short-term
for the nurse workforce, policy makers must not lose sight of the long-
term growing demand for nurses in their own districts and States. For
the complete perspective, the NLN's findings from the Annual Survey of
Schools of Nursing--Academic Year 2009-2010 cast a wide net on all
types of nursing programs, from doctoral through diploma, to determine
rates of application, enrollment, and graduation. The survey creates a
true picture of nursing education. Key findings include:
--Expansion of nursing education programs impeded by shortage of
faculty and clinical placements. The overall systemic capacity
of prelicensure nursing education continues to fall well short
of demand. Fully 42 percent of all qualified applications to
basic RN programs were met with rejection in 2010. Associate
degree in nursing (ADN) programs rejected 46 percent of
qualified applications, compared with 37 percent of
baccalaureate of science in nursing (BSN) programs. Notably,
the Nation's practical nursing (PN) programs turned away 40
percent of qualified applications.
--Yield rates continued to grow. Yield rates--a classic indicator of
the competitiveness of college admissions--remain
extraordinarily high among both pre- and post-licensure nursing
programs. A stunning 94 percent of all applicants accepted into
ADN programs, and 93 percent of those accepted in PN programs,
went on to enroll in 2010. Yield rates among the other program
types were nearly as high, averaging 89 percent for RN-to-BSN
programs; 86 percent for RN diploma programs, master's in
nursing (MSN) programs, and doctoral programs; and 84 percent
for BSN programs.
Nurse Shortage Affected by Faculty Shortage
A strong correlation exists between the shortage of nurse faculty
and the inability of nursing programs to keep pace with the demand for
new RNs. Increasing the productivity of education programs is a high
priority in most States, but faculty recruitment is a glaring problem
that likely will grow more severe. Without faculty to educate our
future nurses, the shortage cannot be resolved.
The NLN's findings from the 2009 Faculty Census show that:
--Shortages of faculty and clinical placements impeded expansion. A
shortage of faculty continues to be cited most frequently as
the main obstacle to expansion by RN-to-BSN and doctoral
programs--indicated by 47 and 53 percent, respectively. By
contrast, prelicensure programs are more likely to point to a
lack of available clinical placement settings as the primary
obstacle to expanding admissions.
--Inequities in faculty salaries added to shortage difficulties.
Despite a national shortage of nurse educators, in 2009 the
salaries of nurse educators remained notably below those earned
by similarly ranked faculty across higher education. At the
professor rank nurse educators suffer the largest deficit with
salaries averaging 45 percent lower than those of their non-
nurse colleagues. Associate and assistant nursing professors
were also at a disadvantage, earning 19 and 15 percent less
than similarly ranked faculty in other fields, respectively.
Title VIII Federal Funding Reality
Today's undersized supply of appropriately prepared nurses and
nurse faculty does not bode well for our Nation. The Title VIII Nursing
Workforce Development Programs are a comprehensive system of capacity-
building strategies that provide students and schools of nursing with
grants to strengthen education programs, including faculty recruitment
and retention efforts, facility and equipment acquisition, clinical lab
enhancements, and loans, scholarships, and services that enable
students to overcome obstacles to completing their nursing education
programs. HRSA's Title VIII data below provide perspective on a few of
the current Federal investments.
Nurse Education, Practice, Quality, and Retention Grants (NEPQR).--
NEPQR funds projects addressing the critical nursing shortage via
initiatives designed to expand the nursing pipeline, promote career
mobility, provide continuing education, and support retention. In
fiscal year 2010, NEPQR funded 108 infrastructure grants, including the
launching of 22 nurse-managed health centers, four nurse internships,
and five new accelerated baccalaureate programs. Also in fiscal year
2010, the program expanded with the Nursing Assistant (NA) and Home
Health Aide (HHA) program awarding grants to 10 colleges or community-
based training programs.
Comprehensive Geriatric Education Program (CGEP).--CGEP funds
training, curriculum development, faculty development, and continuing
education for nursing personnel who care for older citizens. In
academic year 2009-2010, 27 CGEP grantees provided education and
training to 3,030 RNs/RN students; 260 advanced practice registered
nurses (APRNs); 221 faculty; 110 HHSs; 483 LPNs/LPN students; 730 NAs;
810 allied health professionals; and 929 laypersons, guardians,
activity directors.
Advanced Nursing Education (ANE) Program.--ANE supports
infrastructure grants to schools of nursing for advanced practice
programs preparing nurse-midwives, nurse anesthetists, clinical nurse
specialists, nurse administrators, nurse educators, public health
nurses, or other advanced level nurses. In addition, the Advanced
Nursing Education Expansion (ANEE) program provides grants to schools
of nursing to accelerate the production of primary care advanced
practice nurses. In fiscal year 2009, 151 schools of nursing received
grants through the ANE Program and enrolled 7,518 advanced nursing
education students. In fiscal year 2010, 26 schools of nursing received
grants under ANEE to support the production of over 600 primary care
APRNs.
Nurse Managed Health Clinics (NMHC)
Most leading authorities recognize that there will be a shortage of
primary care providers over the next decade. With the recent growth of
NMHCs, APRNs have demonstrated their flexibility as they practice
independently or collaborate with physicians in both primary care and
specialty areas. This shift suggests that professionals' practice can
be directed to changing workforce and population needs as the increased
use of APRNs holds the potential for improving access, reducing costs
for high-value care, and changing patterns of care.
NMHCs deliver comprehensive primary healthcare services, disease
prevention, and health promotion in medically underserved areas for
vulnerable populations. Approximately 58 percent of NMHC patients
either are uninsured, Medicaid recipients, or self-pay. The complexity
of care for these patients presents significant financial barriers,
heavily affecting the sustainability of these clinics.
In fiscal year 2010, HRSA awarded $15,268,000 for 10 3-year
infrastructure grants to community-based NMHCs. While providing access
points in areas where primary care providers are in short supply, the
expansion of the NMHCs also increased the number of structured clinical
teaching sites available to train nurses and other primary care
providers. These clinics funded by HRSA in fiscal year 2010 expect to
train 900 primary care nurse practitioners during their 3-year grants.
Appropriating $20 million in fiscal year 2012 to NMHCs would increase
access to primary care for thousands of uninsured people in rural and
underserved urban communities. The funding of additional NMHCs likewise
will enable schools of nursing to increase innovative clinical teaching
site opportunities for nursing students, which will directly expand the
capacity of nursing school enrollments.
The NLN can state with authority that the deepening health
inequities, inflated costs, and poor quality of healthcare outcomes in
this country will not be reversed until the concurrent shortages of
nurses and qualified nurse educators are addressed. 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 who will need
our care. Without national efforts of some magnitude to match the
healthcare reality facing our Nation today, a calamity in nurse
education and in healthcare generally may not be avoided.
The NLN urges the subcommittee to strengthen the Title VIII Nursing
Workforce Development Programs by funding them at a level of $313.075
million in fiscal year 2012. We also recommend that the Nurse Managed
Health Clinics, as authorized under Title III of the Public Health
Service Act, be funded at $20 million in fiscal year 2012.
______
Prepared Statement of the National Marfan Foundation
Mr. Chairman, thank you for the opportunity to submit testimony
regarding the fiscal year 2012 budget for the National Heart, Lung and
Blood Institute, the National Institute of Arthritis, Musculoskeletal
and Skin Diseases, and the Centers for Disease Control and Prevention.
The National Marfan Foundation is grateful for the subcommittee's
strong support of the NIH and CDC, particularly as it relates to life-
threatening genetic disorders such as Marfan syndrome. Thanks in part
to your leadership we are at a time of unprecedented hope for our
patients.
It is estimated that 200,000 people in the United States are
affected by Marfan syndrome or a related condition. Marfan syndrome is
a genetic disorder of the connective tissue that can affect many areas
of the body, including the heart, eyes, skeleton, lungs and blood
vessels. It is progressive condition and can cause deterioration in
each of these body systems. The most serious and life-threatening
aspect of the syndrome is a weakening of the aorta. The aorta is the
largest artery carrying oxygenated blood from the heart. Over time,
many Marfan syndrome patients experience a dramatic weakening of the
aorta which can cause the vessel to dissect and tear.
Early surgical intervention can prevent a dissection and strengthen
the aorta and the aortic valves. If preventive surgery is performed
before a dissection occurs, the success rate of the procedure is over
95 percent. If surgery is initiated after a dissection has occurred,
the success rate drops below 50 percent. Aortic dissection is a leading
killer in the United States, and 20 percent of the people it affects
have a genetic predisposition, like Marfan syndrome, to developing the
complication.
Fortunately, new research offers hope that a commonly prescribed
blood pressure medication might be effective in preventing this
frequent and devastating event.
fiscal year 2012 appropriations recommendations
National Institutes of Health
Mr. Chairman, hope for a better quality of life for patients with
Marfan syndrome and related connective tissue disorders lies in NIH-
sponsored biomedical research. With that in mind, NMF joins with other
voluntary patient and medical organizations in recommending an
appropriation of $35 billion for the National Institutes of Health in
fiscal year 2012. , This level of funding will ensure continued
expansion of research on rare diseases like Marfan syndrome and build
upon the significant investment provided to the NIH in the American
Recovery and Reinvestment Act.
National Heart, Lung, and Blood Institute
Pediatric Heart Network Clinical Trial
NMF applauds the National Heart, Lung and Blood Institute for its
leadership in advancing a landmark clinical trial on Marfan syndrome.
Under the direction of Dr. Lynn Mahoney and Dr. Gail Pearson, the
institute's Pediatric Heart Network (PHN) has spearheaded a multicenter
study focused on the potential benefits of a commonly prescribed blood
pressure medication (losartan) on aortic growth in Marfan syndrome
patients.
Dr. Hal Dietz, the Victor A. McKusick Professor of Genetics in the
McKusick-Nathans Institute of Genetic Medicine at the Johns Hopkins
University School of Medicine, and the director of the William S.
Smilow Center for Marfan Syndrome Research, is the driving force behind
this groundbreaking research. Dr. Dietz uncovered the role that the
growth factor TGF-beta plays in aortic enlargement, and demonstrated
the benefits of losartan in halting aortic growth in mice. He is the
reason we have reached this time of such promise and NMF is proud to
have supported Dr. Dietz's cutting-edge research for many years.
After 4 years of recruitment and patient screening, the PHN trial
reached its enrollment target of 604 subjects on February 2, 2011.
Marfan syndrome patients (age 6 months to 25 years) are enrolled in the
study. Patients are randomized onto either losartan or atenolol (a beta
blocker that is the current standard of care for Marfan patients with
an enlarged aortic root).
We anxiously await the results of this first-ever clinical trial
for our patient population. It is our hope that losartan will emerge as
the new standard-of-care and greatly reduce the need for surgery in at-
risk patients.
Mr. Chairman, NMF is proud to actively support the losartan
clinical trial in partnership with the Pediatric Heart Network.
Throughout the life of the trial we have provided support for patient
travel costs, coverage of select echocardiogram examinations, and
funding for ancillary studies. These ancillary studies will explore the
impact that losartan has on other manifestations of Marfan syndrome.
Evaluation of Surgical Options for Marfan Syndrome Patients
Mr. Chairman, we are grateful for the subcommittee's previous
recommendations encouraging NHLBI to support research on surgical
options for Marfan syndrome patients.
For the past several years, the NMF has supported an innovative
study looking at outcomes in Marfan syndrome patients who undergo
valve-sparing surgery compared with valve replacement. Initial findings
were published last year in the Journal of Thoracic and Cardiovascular
Surgery. Some short term questions have been answered, most importantly
that valve-sparing can be done safely on Marfan patients by an
experienced surgeon. The consensus among the investigators however is
that long-term durability questions will not be answered until patients
are followed for at least 10 years.
Confirming the utility and durability of valve sparing procedures
will save our patients a host of potential complications associated
with valve replacement surgery. We hope to partner with the NIH on this
important work moving forward.
NHLBI ``Working Group on Research in Marfan Syndrome and
Related Conditions''
In 2007, NHLBI convened a ``Working Group on Research in Marfan
Syndrome and Related Conditions.'' Chaired by Dr. Dietz, this panel was
comprised of experts in all aspects of basic and clinical science
related to the disorder. The panel was charged with identifying key
recommendations for advancing the field of research in the coming
decade. The recommendations of the Working Group are as follows:
Scientific opportunities to advance this field are conferred by
technological advances in gene discovery, the ability to dissect
cellular processes at the molecular level and imaging, and the
establishment of multi-disciplinary teams. The barriers to progress are
addressed through the following recommendations, which are also
consistent with Goals and Challenges in the NHLBI Strategic Plan.
--Existing registries should be expanded or new registries developed
to define the presentation, natural history, and clinical
history of aneurysm syndromes.
--Biological and aortic tissue sample collection should be
incorporated into every clinical research program on Marfan
syndrome and related disorders and funds should be provided to
ensure that this occurs. Such resources, once established,
should be widely shared among investigators.
--An Aortic Aneurysm Clinical Trials Network (ACTnet) should be
developed to test both surgical and medical therapies in
patients with thoracic aortic aneurysms.
--The identification of novel therapeutic targets and biomarkers
should be facilitated by the development of genetically defined
animal models and the expanded use of genomic, proteomic and
functional analyses. There is a specific need to understand
cellular pathways that are altered leading to aneurysms and
dissections, and to develop robust in vivo reporter assays to
monitor TGFb and other cellular signaling cascades.
--The developmental underpinnings of apparently acquired phenotypes
should be explored. This effort will be facilitated by the
dedicated analysis of both prenatal and early postnatal tissues
in genetically defined animal models and through the expanded
availability to researchers of surgical specimens from affected
children and young adults.
We look forward to working closely with NHLBI to pursue these
important research goals and ask the Subcommittee to support the
recommendations of the Working Group.
National Institute of Arthritis and Musckuloskeletal and Skin Diseases
NMF is proud of its longstanding partnership with the National
Institute of Arthritis and Musculoskeletal and Skin Diseases, which is
celebrating its 25th anniversary this year. Dr. Steven Katz has been a
strong proponent of basic research on Marfan syndrome during his tenure
as NIAMS director and has generously supported several ``Conferences on
Heritable Disorders of Connective Tissue.'' Moreover, the Institute has
provided invaluable support for Dr. Dietz's mouse model studies. The
discoveries of fibrillin-1, TGF-beta, and their role in muscle
regeneration and connective tissue function were made possible in part
through collaboration with NIAMS.
As the losartan trial continues to move forward, we hope to expand
our partnership with NIAMS to support related studies that fall under
the mission and jurisdiction of the Institute. One of the areas of
great interest to researchers and patients is the role that losartan
may play in strengthening muscle tissue in Marfan patients. We would
welcome an opportunity to partner with NIAMS on this and other
research.
Centers for Disease Control and Prevention
Mr. Chairman, one of the most important things we can do to prevent
untimely deaths from aortic aneurysms is to increase awareness of
Marfan syndrome and related connective tissue disorders.
Last year, the American College of Cardiology and the American
Heart Association issued landmark practice guidelines for the treatment
of thoracic aortic aneurysms and dissections. The NMF is promoting
awareness of the new guidelines in collaboration with other
organizations through a new Coalition known as TAD; the Thoracic Aortic
Disease Coalition. We hope to partner with the CDC in fiscal year 2012
to increase awareness of the guidelines so all patients will be
adequately diagnosed and treated. For fiscal year 2012, NMF joins with
the CDC Coalition in recommending an appropriation of $7.7 billion for
CDC's core-programs.
______
Prepared Statement of the National Minority AIDS Council
The National Minority AIDS Council (NMAC) represents a coalition of
over 3,000 community based organizations and AIDS service organizations
delivering HIV/AIDS services in communities of color nationwide. Our
constituents are on the front lines of the HIV epidemic and are the
most affected when funding for HIV/AIDS programs are reduced or
eliminated.
Our Nation is facing difficult decisions on how to stabilize the
economy and pass a sensible Federal budget. Although we support
efficient, cost-effective spending, we cannot support reducing
healthcare funding which would adversely affect the health and well
being of the most vulnerable: minority communities, with higher rates
of poverty where poor health outcomes are often linked to poor access
to care. While budget negotiations often focus on cold numbers, it is
easy to lose sight of the fact that human lives are at stake.
Cost-effective research and prevention programs that prevent life-
threatening diseases such as HIV/AIDS, as well as life-saving access to
care and medications for those already infected are critical in
preventing avoidable infections, serious illness, and deaths. Although
funding has failed to keep up with demand, it is impossible to deny the
strides in prevention, research, and treatment of HIV/AIDS that has
been supported by previous appropriations.
We now have a National HIV/AIDS Strategy which sets attainable
goals in reducing the devastation caused by this epidemic. The Strategy
calls for a reduction of new infections by 25 percent in the next 5
years as well as improved access to care for those already infected. As
we continue to move forward in trying to reduce new infections and
saving precious lives through the Strategy, it is imperative that the
existing public health and safety net infrastructure be adequately
funded.
Health Care Reform
In addition to the Strategy, implementation of healthcare reform
offers a monumental opportunity to make progress in reducing the impact
of the domestic HIV epidemic by greatly increasing the number of
Americans eligible for healthcare access. As such, we request full
funding of the President's fiscal year 2012 budget request for
healthcare reform programs aimed at reducing health disparities. Many
of the programs under the Patient Protection and Affordable Care Act
(ACA) are funded through discretionary budgets. Increased access to
medical care through venues such as Community Health Centers are
welcomed as they provide care in cost effective settings when compared
to the emergency room, which are too often the primary source of
medical care for communities of color.
Minority AIDS Initiative (MAI)
MAI programs seek to improve HIV-related health outcomes for racial
and ethnic minority communities that are disproportionately affected by
HIV/AIDS. Central to these goals is the MAI's focus on efforts to
strengthen the organizational capacity of community-based providers, in
particular minority providers; improve the quality of HIV services; and
expand the pool of HIV service providers. NMAC strongly recommends this
Committee fund MAI programs at $610 million for fiscal year 2012 as
minority communities continue to carry a disproportionate burden of the
epidemic. NMAC does appreciate the President's fiscal year 2012 budget
request of $430.7 million as a minimum budget for MAI.
HIV/AIDS Bureau of the Health Resources and Services Administration
(HRSA)
The number of people living with HIV in the United States has grown
to over 1.1 million people. That fact coupled with the skyrocketing
costs of medical care creates a dire need for substantial increases in
funding for care and treatment. We urge you to increase funding for the
Ryan White program by $350 million in fiscal year 2012. At minimum, we
strongly urge you to support the President's proposed fiscal year 2012
increase of $69.3 million for the Ryan White program over fiscal year
2010.
As a payer of last resort, Ryan White provides critical access to
treatment and medications to under-insured and uninsured people. Part A
funds are used to provide a continuum of care for people living with
HIV disease. To support this critical component, we request an increase
of $74.2 million when compared to fiscal year 2010. Part B funds are
provided to States to improve their capacity to provide medical care.
It also funds the AIDS Drug Assistance program (ADAP), which currently
has a wait list of over 8,100 people with no other means to access
medications. Eleven States have implemented waiting lists and many
others have implemented cost containment strategies since funding is
not keeping up with demand. We request an increase of $76.8 million in
funding to States as compared to fiscal year 2010 and an increase of
$106 million for ADAP.
Centers for Disease Control and Prevention's (CDC) National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
With over 56,000 new infections annually, a renewed emphasis on
prevention and early HIV screening is critical at this juncture. NMAC
urges total fiscal year 2012 funding of $1,983.9 million for the CDC's
NCHHSTP. This includes funding of $1,325.7 million for HIV prevention
and surveillance, $59.8 million for viral hepatitis and $231 million
for tuberculosis prevention. We appreciate that the President proposed
a $1,178.5 million budget for HIV prevention at the CDC, and at a bare
minimum we urge the Committee to meet this request.
National Institutes of Health (NIH)--Office of AIDS Research
HIV/AIDS research has made great strides in understanding and
improving HIV treatment, viral suppression, and various prevention
tools. Continued commitment to a thorough AIDS research portfolio is
necessary to build on past innovation. In order to build on this
research and continue to see how these interventions affect communities
of color, NMAC requests $3.5 billion to support the Office of AIDS
Research. Additionally, NMAC believes that $35 billion to fund NIH's
overall programs and infrastructure.
Investments in prevention, treatment and research for HIV, as well
as co-morbidities, must keep pace with the epidemic if we are to see
real progress in reducing new infections, disease burden, and untimely
deaths due to this devastating disease.
______
Prepared Statement of the National Minority Consortia
The National Minority Consortia (NMC) submits this statement on the
fiscal year 2014 Advance appropriation for the Corporation for Public
Broadcasting (CPB). The NMC is a coalition of five national
organizations dedicated to bringing the unique voices and perspectives
from America's diverse communities into all aspects of public
broadcasting and to other media, including content transmitted
digitally over the Internet. The role we fulfill in this regard has
been crucial to public broadcasting's mission for over 30 years. We are
unique as organizations and as a coalition of organizations in the
services we provide in access, training and support for important and
timely public interest content to our communities and to public
broadcasting. We ask the Committee to:
--Direct CPB to increase its efforts for diverse programming with
commensurate increases for minority programming and for
organizations and stations located within underserved
communities;
--Direct CPB to establish a percentage basis for biennial funding of
the National Minority Consortia to permit long range financial
and strategic planning;
--Direct CPB to establish an annual ``report card'' on diversity to
track efforts to better represent the full breadth of the
American people and their experiences through public
television, public radio and non-profit media online;
--Direct CPB to publish on the Internet clear and enforced guidelines
for all CPB-directed funding, including funds jointly
administered by PBS and NPR, and end the closed-door funding
processes historically in place, especially as the current
practices favor existing relationships and can be seen as
biased against minority applicants, in particular.
Report Language.--We ask for report language, which recognizes the
contribution of the NMC and directs that the CPB partnership with us be
expanded. Specifically:
``The Committee recognizes the importance of the partnership CPB
has with the National Minority Public Broadcasting Consortia, which
helps develop, acquire, and distribute public television programming to
serve the needs of African American, Asian American, Latino, Native
American, Pacific Islander, and many other viewers. As many communities
in the Nation welcome increased numbers of citizens of diverse ethnic
backgrounds, the local public television stations should strive to meet
these viewers' needs. With an increased focus on programming to meet
local community needs, the Committee encourages CPB to support and
expand this critical partnership.''
Fiscal Year 2014 Appropriation.--We support a fiscal year 2014
advance appropriation for CPB of $495 million, which recognizes the
need to develop content that reaches across traditional media
boundaries, such as those separating television and radio. However, we
feel strongly that should CPB receive this appropriation, CPB should be
directed to engage in transparent and fair funding practices that
guarantee all applicants equal access to these public resources. In
particular, we urge Congress to direct CPB to insert language in all of
its funding guidelines that encourages and rewards public media that
fully represents and reaches a diverse American public.\1\
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\1\ According to the 2008 Public Radio Tech Survey, 90 percent of
public radio listeners are white. Of those, 84 percent are college-
educated, with 48 percent having graduate degrees. This compares to
just 9 percent of Americans who have postgraduate degrees. It is
therefore mandatory that we prioritize actually ``reaching'' a diverse
audience of Americans and not simply reflecting diverse and often
misleading staffing numbers to measure public media's effectiveness in
serving all of the American taxpayers that fund CPB.
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While public broadcasting continues to uphold strong ethics of
responsible journalism and thoughtful examination of American history,
life and culture, including the ways we are a part of a global society,
it has not kept pace with our rapidly changing public as far as
diversity is concerned. Members of minority groups continue to be
underrepresented on both the programming and oversight levels within
public broadcasting as well as on the content production side. There
are fewer than five executives of diverse background at the highest
levels in the three leading organizations within public broadcasting.
This is unacceptable in America today, where minorities comprise over
35 percent of the population.
Public broadcasting has the potential to be particularly important
for our Nation's growing minority and ethnic communities, especially as
we transition to a broadband-enabled, 21st century workforce that
relies on the skills and talent of all of our citizens. 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 sphere where minority communities and producers should
have more access and capacity to produce diverse high-quality
programming for national audiences. We therefore, urge Congress to
insert strong language in this act to ensure that this is the case and
that these opportunities are made available to minorities and other
underserved communities.
About the National Minority Consortia.--With primary funding from
the CPB, the NMC serves as an important component of American public
television as well as content delivered over the Internet. By training
and mentoring the next generation of minority producers and program
managers as well as brokering relationships between content makers and
distributors (such as PBS, APT and NETA), we are in a perfect position
to ensure the future strength and relevance of public television and
radio television programming from and to our communities. However,
these efforts are vulnerable because of chronic underfunding and lack
of meaningful and ongoing representation within CPB's decisionmaking
processes. This instability, coupled with what is essentially a
decrease in our funding over time, are the primary reasons that have
led to a public media that has become less diverse over the past 5
years.\2\
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\2\ CPB funding for the NMC remained flat for 13 years until fiscal
year 2008, at approximately $1 million per year per consortia. At that
time, we received a one-time increase of $150,000 per organization. In
fiscal year 2009, we received another one-time increase of
approximately $500,000 each, but have been told that does not reflect a
permanent increase. Over this same 13-year period, CPB's budget nearly
doubled.
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This is obviously not the case in the rest of America. With
minority populations already estimated at over 35 percent of the U.S.
population, it is more important that our public institutions reflect
this reality.
Individually, each Consortia organization is engaged in cultivating
ongoing relationships with the independent producer community by
providing technical assistance and program funding, support and
distribution. Often the funding we provide is the initial seed money
for a project, thus allowing it to develop. We also provide numerous
hours of programming to individual public television and radio
stations, programming that is beyond the production reach of most local
stations. To have a real impact, we need funding that recognizes and
values the full extent of minority participation in public life.
While the Consortia organizations work on projects specific to
their communities, the five organizations also work collaboratively. An
example of a joint production in which the NMC provided the initial
seed money is ``Unnatural Causes: Is Inequality Making Us Sick?'', a
multi-part series that uncovers the roots of racial and socio-economic
disparities in health and spotlights community initiatives to achieve
health equality. Our seed money enabled the project to go forward and
to attract additional funding. We are also co-producers of and
presenters in this series. Additionally, we jointly funded an online
initiative around the Presidential Election in 2008 and continue to
explore as a group other topics of national importance.
CPB Funds for the National Minority Consortia.--The NMC receives
funds from two portions of the CPB budget: organizational support funds
from the Systems Support and programming funds from the Television
Programming funds. The organizational support funds we receive are used
for operations requirements and also for programming support activities
and for outreach to our communities and system-wide within public
broadcasting. The programming funds 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 funds. A brief description of our organizations
follows:
Center for Asian American Media (CAAM).--CAAM's mission is to
present stories that convey the richness and diversity of Asian
American experiences to the broadest audience possible. We do this by
funding, producing, distributing and exhibiting works in film,
television and digital media. Over our 25-year history we have provided
funding for more than 200 projects, many of which have gone on to win
Academy, Emmy and Sundance awards, examples of which are Daughter from
Danang; Of Civil Rights and Wrongs: The Fred Korematsu Story; and Maya
Lin: A Strong Clear Vision. CAAM presents the annual San Francisco
International Asian American Film Festival and distributes Asian
American media to schools, libraries and colleges. CAAM's newest
department, Digital Media is becoming a respected leader in bringing
innovative content and audience engagement to public media. CAAM is
partnering with Pacific Islanders in Communications on a documentary
about YouTube ukulele sensation Jake Shimabukuro.
Latino Public Broadcasting (LPB).--LPB supports the development,
production and distribution of public media content that is
representative of Latino people, or addresses issues of particular
interest to Latino Americans. Since 1998, LPB has awarded over $6
million to Latino Independent Producers, provided over 120 hours to
public television, funded over 200 projects and conducted over 150
professional development workshops. LPB also produces Voces, the only
Latino anthology series on public television, which showcases the
impact of Latino culture on American life through music, sports,
education and public service. In addition, LPB had several high profile
programs on PBS including the concert special, In Performance at the
White House: Fiesta Latina, that was re-broadcast on Telemundo and V-me
and Latin Music USA, a four part series about the history and impact of
Latino music on American culture which reached 14.7 million viewers, 16
percent of whom were Hispanic households (well above the PBS average).
This past year, LPB launched the Equal Voice Community Engagement
Campaign using the documentary film Raising Hope: The Equal Voice
Story, a film about strategies to overcome poverty. The community
engagement campaign helped PBS stations demonstrate how they too can
become advocates for their communities. Currently, LPB is working on a
6 hour series titled The Latino Americans, about the history of Latinos
in the United States.
The National Black Programming Consortium (NBPC).--NBPC develops,
produces and funds television and more recently audio and online
programming about the black experience for American public media
outlets. Since its founding in 1979, NBPC has provided hundreds of
broadcast hours documenting African American history, culture and
experience to public television and launched major initiatives that
have brought important public media content to diverse audiences. In
2010, the National Black Programming Consortium launched an ambitious
new project designed to re-engineer public media to better involve and
inform diverse users in the digital era: The Public Media Corps (PMC).
The PMC is a new national public media service that helps local
stations to forge relationships with underserved communities through
content production, local events, and digital media training. By
recruiting, training and supporting the work of young, tech savvy
``fellows'' from these communities the PMC provides both stations and
community partner organizations with a blueprint for not only
connecting with audiences who have traditionally not found public
broadcasting relevant to their lives, but also by providing them with
access to emerging participatory platforms.
Native American Public Telecommunications (NAPT).--NAPT shares
Native stories with the world through support of the creation,
promotion and distribution of Native media. Founded in 1977, through
various media--public television and radio, and the Internet--NAPT
brings awareness of Indian and Alaska Native issues.
In 2010 NAPT presented eight Native American documentaries to PBS
stations nationwide and launched a search capable educational micro-
site featuring educational guides, post-viewer discussion guides,
digital media clips, and interactive time lines. NAPT offered producers
numerous workshops related to media maker topics such as preparation
for broadcast, marketing your film on a budget, station carriage,
online promotional tools, podcasting and more through nationwide media
maker training offerings and conference attendance opportunities. In
addition NAPT launched the Multimedia Fellowship Program, where two
full-time Native American journalists wrote and produced multimedia
projects about national Native American issues. Through our location at
the University of Nebraska-Lincoln, we offer student employment,
internships and fellowships. Reaching the general public and the global
market is the ultimate goal for the dissemination of Native-produced
media.
Pacific Islanders in Communications (PIC).--Since 1991, PIC has
delivered programs and training that bring voice and visibility to
Pacific Islander Americans. PIC produced the award winning film One
Voice which tells the story of the Kamehameha Schools Song Contest.
Other PBS broadcasts include There Once Was an Island, about the
devastating effects of global warming on the Pacific Islands and
Polynesian Power: Islanders in Pro Football. Currently PIC is
developing a multi-part series, Expedition: Wisdom, in partnership with
the National Geographic Society. PIC offers a wide range of development
opportunities for Pacific Island producers through travel grants,
seminars and media training. Producer training programs are held in the
U.S. territories of Guam and American Samoa, as well as in Hawai`i, on
a regular basis.
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 we thank
Congress for support of our work on behalf of our communities.
______
Prepared Statement of the National Multiple Sclerosis Society
Multiple sclerosis (MS), an unpredictable, often disabling disease
of the central nervous system, interrupts the flow of information
within the brain, and between the brain and body. Symptoms range from
numbness and tingling to blindness and paralysis. The progress,
severity, and specific symptoms of MS in any one person cannot yet be
predicted, but advances in research and treatment are moving us closer
to a world free of MS. Most people with MS are diagnosed between the
ages of 20 and 50, with at least two to three times more women than men
being diagnosed with the disease. MS affects more than 400,000 people
in the United States.
The National MS Society recommends the following funding levels for
agencies and programs that are of vital importance to Americans living
with MS in fiscal year 2012.
Lifespan Respite Care Program
Respite care services are a critical part of ensuring quality home-
based care for people living with MS. Because of the importance of
these services, the National MS Society requests the inclusion of $50
million in the fiscal year 2012 Labor-HHS-Education appropriations bill
to fund lifespan respite programs. The Lifespan Respite Care Program,
enacted in 2006, provides competitive grants to states to establish or
enhance statewide lifespan respite programs, improve coordination, and
improve respite access and quality. States provide planned and
emergency respite services, train and recruit workers and volunteers,
and assist caregivers in gaining access to services. Perhaps the most
critical aspect of the program for people living with MS is that
Lifespan Respite serves families regardless of special need or age--
literally across the lifespan. Much existing respite care has age
eligibility requirements and since MS is typically diagnosed between
the ages of 20 and 50, Lifespan Respite Programs are often the only
open door to needed respite services.
Up to one-quarter of individuals living with MS require long-term
care services at some point during the course of the disease. Often, a
family member steps into the role of primary caregiver to be closer to
the individual with MS and to be involved in care decisions.
Approximately 65 million family caregivers in the Nation are
responsible for 80 percent of long-term care. The value of
uncompensated family care giving services keeps growing and is
currently estimated at $375 billion per year--more than total Medicaid
spending and almost as high as Medicare spending. Family caregiving,
while essential, can be draining and stressful, with caregivers often
reporting difficulty managing emotional and physical stress, finding
time for themselves, and balancing work and family responsibilities.
The impact is so great, in fact, that American businesses lose an
estimated $17.1 to $33.36 billion each year due to lost productivity
costs related to caregiving responsibilities. Providing $50 million for
Lifespan Respite in fiscal year 2012 would provide the critical
infrastructure to states to improve access to respite services,
allowing family caregivers to take a break from the daily routine and
stress of providing care, improve overall family health, and help
alleviate the monstrous financial impact that caregiver strain
currently has on American businesses.
National Institutes of Health
We urge Congress to continue its investment in innovative medical
research that can help prevent, treat, and cure diseases such as MS by
providing $35 billion for the National Institutes of Health (NIH) in
fiscal year 2012.
The NIH conducts and sponsors a majority of the MS related research
carried out in the United States. Approximately $151 million of fiscal
year 2010 and Recovery Act appropriations were directed to MS-related
research. An invaluable partner, the NIH has helped make significant
progress in understanding MS. NIH scientists were among the first to
report the value of MRI in detecting early signs of MS, before symptoms
even develop. Advancements in MRI technology allow doctors to monitor
the progression of the disease and the impact of treatment.
Research during the past decade has enhanced knowledge about how
the immune system works, and major gains have been made in recognizing
and defining the role of this system in the development of MS lesions.
These NIH discoveries are helping find the cause, alter the immune
response, and develop new MS therapies that are now available to modify
the disease course, treat exacerbations, and manage symptoms. The NIH
also directly supports jobs in all 50 States and 17 of the 30 fastest
growing occupations in the United States are related to medical
research or healthcare. More than 83 percent of the NIH's funding is
awarded through almost 50,000 competitive grants to more than 325,000
researchers at over 3,000 universities, medical schools, and other
research institutions in every State. To continue the forward momentum
in the ability to aggressively combat, treat, and one day cure diseases
like MS, the National MS Society requests Congress provide $35 billion
for the NIH in fiscal year 2012.
Centers for Medicare & Medicaid Services
Medicare
Medicare programs are a lifeline for people living with MS, as
approximately one-quarter of people living with MS rely on Medicare for
access to essential medical care. These programs ensure that
individuals living with MS have access to doctors, diagnostic
equipment, durable medical devices, MRIs, and prescription drugs among
other lifesaving treatments. Medicare also ensures full access to home
healthcare, which is vital for keeping individuals with disabilities,
like MS, in their communities and in their homes. Without Medicare,
people living with MS may not have access to some forms of medical care
and their quality of life may decrease.
The National MS Society is concerned about recent budget proposals
that would essentially convert Medicare from an entitlement program to
a voucher-type program. While proponents of these proposals believe
that they will cut costs of the program, in reality the voucher system
would primarily shift costs from the Medicare program to patients and
consumers. In fact, the Congressional Budget Office has estimated that
by 2030, the typical Medicare beneficiary would be required to pay more
than two-thirds of their medical costs. Additionally, according the
Kaiser Family Foundation, a typical 65-year-old retiring in 2022 would
be expected to devote nearly half their monthly Social Security checks
toward healthcare costs, more than double what they would spend under
current Medicare law.
Beginning in 2022, the proposed system would give new beneficiaries
money to purchase insurance from the private market, under the
assumption that beneficiaries can make better and more cost-effective
decisions about healthcare than the government and that this open
market will create competition that will help keep costs down. However,
the size of Medicare allows the program to impose lower rates on
medical services and thus, private plans on average are more expensive.
Therefore, the proposed voucher system may reduce costs within the
Medicare program but not within the overall healthcare system because
it will shift more cost to some of the most vulnerable patients in the
healthcare system. In order to continue to provide the adequate and
necessary care individuals with MS and other disabilities require,
Medicare must maintain its status as an entitlement program.
Medicaid
The National MS Society urges Congress to maintain funding for
Medicaid and reject proposals to cap or block grant the program.
Approximately 10 percent of people living with MS rely on Medicaid.
The program has a strong track record of providing services that grant
individuals with disabilities access to employment, cost-effective
health services, home- and community-based services, and long-term
care.
Capping or block-granting Medicaid will merely shift costs to
states, forcing states to shoulder a seemingly insurmountable financial
burden or cut services on which our most vulnerable rely. Capping and
block-granting could result in many more individuals becoming
uninsured, compounding the current problems of lack of coverage, over
flowing emergency rooms, limited access to long term services, and
increased healthcare costs in an overburdened system. By capping funds
that support home- and community-based care, such proposals would also
likely lead to an increased reliance on costlier institutional care
that contradicts the principles laid forth in the 1999 U.S. Supreme
Court Olmstead decision of integrating and keeping people with
disabilities in their communities.
While the economic situation demands leadership and thoughtful
action, the National MS Society urges Congress to remember people with
MS and all disabilities, their complex health needs, and the important
strides Medicaid has made for persons living with disabilities,
particularly in the area of community-based care and not modify the
program to their detriment.
Social Security Administration
The National MS Society urges Congress to provide $12.522 billion
for the Social Security Administration's (SSA) Limitations on
Administrative (LAE) Expenses to fund SSA's day-to-day operational
responsibilities and make key investments in addressing increasing
disability and retirement workloads, in program integrity, and in SSA's
Information Technology (IT) infrastructure.
Because of the unpredictable nature and sometimes serious
impairment caused by the disease, SSA recognizes MS as a chronic
illness or ``impairment'' that can cause disability severe enough to
prevent an individual from working. During such periods, people living
with MS are entitled to and rely on Social Security Disability
Insurance (SSDI) or Supplemental Security Income (SSI) benefits to
survive. People living with MS, along with millions of others with
disabilities, depend on SSA to promptly and fairly adjudicate their
applications for disability benefits and to handle many other actions
critical to their well-being including: timely payment of their monthly
benefits; accurate withholding of Medicare Parts B and D premiums; and
timely determinations on post-entitlement issues, e.g., overpayments,
income issues, prompt recording of earnings.
With an expected increase in disability claims of nearly 29 percent
between fiscal year 2008 and fiscal year 2010, SSA faces an
unprecedented backlog in unprocessed disability claims. The average
processing time is fortunately improving due to recent investments in
and appropriations to SSA and as of March 2010, was approximately 437
days or a little more than 14 months. This progress must continue.
Providing at least $12.522 billion for the SSA is necessary to
continue these programs and advancements, which are integral parts of
efficiently and effectively getting benefits to individuals with
disabilities, including those with MS.
Food and Drug Administration
Because of the tremendous impact the FDA has on the development and
availability of drugs and devices for individuals with disabilities,
the National MS Society requests that Congress provide a 15 percent
increase over the fiscal year 2011 budget.
Advancements in medical technology and medical breakthroughs play a
pivotal role in decreasing the societal costs of disease and
disability. The FDA is responsible for approving drugs for the market
and in this capacity has the ability to keep healthcare costs down.
Each dollar invested in the life-science research regulated by the FDA
has the potential to save upwards of $10 in health gains. Breakthroughs
in medication and devices can reduce the potential costs of disease and
disability in Medicare and Medicaid and can help support the healthier,
more productive lives of people living with chronic diseases and
disabilities, like MS. The approval of low-cost generic drugs saved the
healthcare system $140 billion last year and nearly $1 trillion over
the past decade. However, recent funding constraints have resulted in a
2 year backlog of generic drug approval applications and could
potentially cost the Federal Government and patients billions of
dollars in the coming years. The potential for these cost-saving
medical breakthroughs and overall healthcare savings relies on a
vibrant industry and an adequately funded FDA. Therefore, Congress is
urged to provide the FDA with a 15 percent increase to address this
backlog.
Conclusion
The National MS Society thanks the Committee for the opportunity to
provide written testimony and our recommendations for fiscal year 2012
appropriations. The agencies and programs we have discussed are of
vital importance to people living with MS and we look forward to
continuing to working with the Committee to help move us closer to a
world free of MS.
______
Prepared Statement of the National Network to End Domestic Violence
Introduction
I am submitting testimony to request a targeted investment of $196
million in the Family Violence Prevention and Services Act (FVPSA) and
the Violence Against Women Act (VAWA) programs administered by the U.S.
Department of Health and Human Services fiscal year 2012 budget
(specific requests detailed below).
Labor, Health and Human Services Chairman Harkin, Ranking Member
Shelby, Chairman Inouye, Ranking Member Cochran and distinguished
members of the Appropriations Committee, thank you for this opportunity
to submit testimony to the Committee on the importance of investing in
FVPSA and VAWA programs. I sincerely thank the Committee for its
ongoing support and investment in these lifesaving programs. These
investments help to bridge the gap created by an increased demand and a
lack of available resources.
I am the President of the National Network to End Domestic Violence
(NNEDV), the Nation's leading voice on domestic violence. We represent
the 56 State and territorial domestic violence coalitions, including
those in Iowa, Alabama, Hawaii and Mississippi, their 2,000 member
domestic violence and sexual assault programs, as well as the millions
of victims they serve. Our direct connection with victims and victim
service providers gives us a unique understanding of their needs and
the vital importance of continued Federal investments.
Incidence, Prevalence, Severity and Consequences of Domestic and Sexual
Violence
The crimes of domestic and sexual violence are pervasive, insidious
and life-threatening. Nearly one in four women are beaten or raped by a
partner during adulthood \1\ and 2.3 million people are raped and/or
physically assaulted by a current or former spouse or partner each
year.\2\ One in six women and 1 in 33 men have experienced an attempted
or completed rape.\3\ Of course the most heinous of these crimes is
murder. Every day in the United States, an average of three women are
killed by a current or former intimate partner.\4\In 2005 alone, 1,181
women were murdered by an intimate partner in the United States \5\ and
approximately one-third of all female murder victims are killed by an
intimate partner.\6\
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\1\ AU.S. Department of Justice, National Institute of Justice and
Centers for Disease Control and Prevention. (July 2000). Extent,
Nature, and Consequences of Intimate Partner Violence: Finding from the
National Violence Against Women Survey. Washington, DC. Tjaden, Pl., &
Thoennes., N.
\2\ Ibid.
\3\ U.S. Department of Justice, Prevalence, Incidence, and
Consequences of Violence Against Women: Findings from the National
Violence Against Women Survey (1998).
\4\ Bureau of Justice Statistics (2008). Homicide Trends in the
U.S. from 1976-2005. Dept. of Justice.
\5\ Ibid.
\6\ Bureau of Justice Statistics, Homicide Trends from 1976-1999.
(2001)
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The cycle of intergenerational violence is perpetuated as children
are exposed to violence. Approximately 15.5 million children are
exposed to domestic violence every year.\7\ One study found that men
exposed to physical abuse, sexual abuse and adult domestic violence as
children were almost 4 times more likely than other men to have
perpetrated domestic violence as adults.\8\
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\7\ McDonald, R., et al. (2006). ``Estimating the Number of
American Children Living in Partner-Violence Families.'' Journal of
Family Psychology, 30(1), 137-142.
\8\ Greenfield, L. A. (1997). Sex Offences and Offenders: An
Analysis of Date on Rape and Sexual Assault. Washington, DC. Bureau of
Justice Statistics, U.S. Department of Justice.
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In addition to the terrible cost domestic and sexual violence have
on the lives of individual victims and their families, these crimes
cost taxpayers and communities. In fact, the cost of intimate partner
violence exceeds $5.8 billion each year, of which $4.1 billion is for
direct medical and mental healthcare services.\9\ Research shows that
intimate partner violence costs a health insurance plan $19.3 million
each year for every 100,000 women between the ages of 18 and 64 who are
enrolled.\10\ Domestic violence costs U.S. employers an estimated $3 to
$13 billion annually.\11\ Between one-quarter and one-half of domestic
violence victims report that they lost a job, at least in part, due to
domestic violence.
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\9\ National Center for Injury Prevention and Control. Costs of
Intimate Partner Violence Against Women in the United States. Atlanta
(GA): Centers for Disease Control and Prevention; 2003.
\10\ Ibid.
\11\ Bureau of National Affairs Special Rep. No. 32, Violence and
Stress: The Work/Family Connection 2 (1990); Joan Zorza, Women
Battering: High Costs and the State of the Law, Clearinghouse Rev.,
Vol. 28, No. 4, 383, 385; Supra, see endnote 10.
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Despite this grim reality, we know that when a coordinated response
is developed and immediate, essential services are available, victims
can escape from life-threatening violence and begin to rebuild their
shattered lives. Funding these programs is fiscally sound, as they save
lives, prevent future violence, keep families and communities safe, and
save our Nation money. While Federal funding cannot meet all the needs
of victims, it leverages State, private and local dollars to provide
consistent funding streams to lifesaving services. To address unmet
needs and build upon its successes, VAWA/FVPSA should receive targeted
investments in fiscal year 2012.
Family Violence Prevention and Services Act (FVPSA) (Administration
for Children and Families)--$140 million request. Since its passage in
1984 as the first national legislation to address domestic violence,
FVPSA has remained the only funding directly for shelter programs. For
more than 25 years, FVPSA has made substantial progress toward ending
domestic violence. Despite the progress and success brought by FVPSA, a
strong need remains for FVPSA-funded services for victims.
Domestic violence is more than a crime--it is a public health
issue. To address this issue, there are more than 2,000 community-based
domestic violence programs for victims and their children
(approximately 1,500 of which are FVPSA-funded through State formula
grants). These programs offer services such as emergency shelter,
counseling, legal assistance, and preventative education to millions of
women, men and children annually and are at the heart of our Nation's
response to domestic violence.\12\ These effective programs save and
rebuild lives. A recently released multi-state study conclusively shows
that the Nation's domestic violence shelters are addressing victims'
urgent and long-term needs and are helping victims protect themselves
and their children. This same study indicated that, if shelters did not
exist, the consequences for victims would be dire, including
``homelessness, serious losses including children [or] continued abuse
or death.''
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\12\ National Coalition Against Domestic Violence, Detailed Shelter
Surveys (2001).
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According to a report by the National Network to End Domestic
Violence, in one day in 2010, more than 70,000 victims of domestic
violence received services, of which 50 percent found refuge in
emergency shelters and transitional housing. Of the 23,743 victims in
emergency shelter that day, more than 50 percent were children.
However, on that same day, more than 9,500 requests for services by
adults and children were unmet due to lack of funding.
Addressing the Needs of Children and Breaking the Intergenerational
Cycle of Violence
In addition to providing crisis services to adults fleeing
violence, FVPSA helps to break the intergenerational cycle of violence.
Approximately one-half to two-thirds of residents in domestic violence
shelters are children. In 2010, Congress reauthorized FVPSA that
included a newly authorized program, Specialized Services for Abused
Parents and Their Children. In fiscal year 2010, Congress appropriated
nearly $131 million for FVPSA, which for the first time triggered
spending dedicated to specialized service for children who witness
domestic violence.
The newly authorized Children's program is an important step in the
Federal Government's response to domestic violence. It will build an
evidence base for services, strategies, advocacy and interventions for
children and youth exposed to domestic violence. Although many domestic
violence programs currently serve children, this program will expand
the capacity of domestic violence programs to address the needs of
children and adolescents coming into emergency shelters. To ensure that
children's needs are met in the community, the program will create
statewide and local improvements in systems and responses to children
and youth exposed to domestic violence. Finally, the program will
eventually lead to nationwide dissemination of lessons learned and
strategies for implementation in communities across the country.
Currently, four States have received modest funding grants to build
upon their work and lay groundwork for the national project. The New
Jersey Coalition for Battered Women will expand an established model
program, Peace: A Learned Solution (PALS), which provides children ages
3 through 17 with creative arts therapy to help them heal from exposure
to domestic violence. The Wisconsin Coalition Against Domestic Violence
will launch the Safe Together Project, which will increase the capacity
of Wisconsin domestic violence programs, particularly those serving
under-represented or culturally specific populations, to support non-
abusing parents and mitigate the impact of exposure to domestic
violence on their children. The Alaska Network on Domestic Violence and
Sexual Assault will improve services and responses to Alaska's families
by addressing the lack of coordination between domestic violence
agencies and child welfare systems. Together, grantees will serve as
leaders for expanding a broader network for support; developing
evidence-based interventions for children, youth and parents exposed to
domestic violence; and building national implementation strategies that
will lead to local improvements in domestic violence program and
community systems interventions.
Unfortunately, the rescission in the final fiscal year 2011 budget
cut all funding for the new children's program. If the funding is not
restored to at least $140 million in fiscal year 2012, these innovative
and cost-saving projects will be in jeopardy.
The Increased Need for Funding
Many programs across the country use their FVPSA funding to keep
the lights on and their doors open. We cannot overstate how important
this is: victims must have a place to flee to when they are escaping
life-threatening violence. Countless shelters across the country would
not be able to operate without FVPSA funding. As increased training for
law enforcement, prosecutors and court officials has greatly improved
the criminal justice system's response to victims of domestic violence,
there is a corresponding increase in demand for emergency shelter,
hotlines and supportive services. Additionally, demand has increased as
a result of the economic downturn and victims with fewer personal
resources become increasingly vulnerable. Since the economic crisis
began, three out of four domestic violence shelters have reported an
increase in women seeking assistance from abuse.\13\ As a result,
shelters overwhelmingly report that they cannot fulfill the growing
need for these services.
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\13\ Mary Kay's Truth About Abuse. Mary Kay Inc. (May 12, 2009).
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In the current economic climate, the demand for domestic violence
services has increased precisely at the time when programs are
struggling to maintain State and private funding to meet the demand. In
fact, the National Domestic Violence Census found that in 2010, 1,441
(82 percent) domestic violence programs reported a rise in demand for
services, while at the same time, 1,351 (77 percent) programs reported
a decrease in funding.\14\ Between 2009 and 2010, domestic violence
programs laid off or did not replace nearly 2,000 staff positions
including counselors, advocates and children's advocates, and a number
of shelters around the country closed. In 2009, although FVPSA-funded
domestic violence programs provided shelter and nonresidential services
to more than 1 million victims, an additional 167,069 requests for
lifesaving shelter went unmet due to lack of capacity. In Alabama, the
problem reflects the rest of the Nation. More than 30 percent of
Alabama programs reported that they did not have enough funding for
needed programs and services and 17 percent reported no available beds
or funding for hotels. In Iowa, nine programs statewide have already
closed their doors due to funding shortages and many other programs
have been forced to reduce the types of services provided, including
eliminating child advocate positions and prevention programs dedicated
to breaking the cycle of violence.
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\14\ Domestic Violence Counts 2010: A 24-Hour census of domestic
violence shelters and services across the United States. The National
Network to End Domestic Violence. (Jan. 2011).
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We cannot allow the gap between available resources and the
desperate need of victims to widen. For those individuals who are not
able to find safety, the consequences can be extremely dire, including
continued exposure to life-threatening violence or homelessness. It is
absolutely unconscionable that victims cannot find safety for
themselves and their children due to a lack of adequate investment in
these services. In order to meet the immediate needs of victims in
danger and to continue to break the intergenerational cycle of
violence, FVPSA funding must be increased to at least $140 million in
fiscal year 2012.
Additional Requests
National Domestic Violence Hotline (Administration for
Children and Families)--$5 million request
For the past 15 years the Hotline has provided 24-hour, toll-free
and confidential services, immediately connecting callers to local
service providers. During this economic downturn, crisis calls to the
Hotline have increased. Additionally, to address the specific needs of
dating violence victims, the Hotline launched the National Dating Abuse
Helpline, which has seen increased traffic recently.
DELTA Prevention Program (Centers for Disease Control and
Injury Prevention)--$6 million request
DELTA is one of the only sources of funding for domestic violence
prevention work. The program supports statewide projects that integrate
primary prevention principles and practices into local coordinated
community responses that address and reduce the incidence of domestic
violence. Currently, DELTA funds 56 Coordinated Community Response
Coalitions nationwide. In the first 3 years that DELTA funded these
projects, the primary prevention activities in communities increased
ten-fold. Nineteen States, including Alabama and Iowa, are currently
funded as DELTA Prep states by the Robert Wood Johnson Foundation.
Without additional DELTA funding, these States, ready in 2012 to fully
participate, may not be able to access CDC funding.
Rape Prevention and Education (RPE) (Centers for Disease
Control and Injury Prevention)--$42.6 million
request
This VAWA program administered through CDC strengthens national,
State and local sexual violence prevention efforts and the operation of
rape crisis hotlines. RPE funding provides formula grants to States and
territories to support rape prevention and education programs conducted
by rape crisis centers, State sexual assault coalitions and other
public and private nonprofit entities. Funding also supports the
National Sexual Violence Resource Center, which provides up-to-date
information regarding sexual violence to policymakers, Federal and
State agencies, college campuses, sexual assault and domestic violence
coalitions, local programs, the media, and the general public. Despite
its critical work, RPE has faced funding decreases since fiscal year
2006.
Violence Against Women Health Initiative (Office of Women's
Health)--$2.3 million request
This eight State and two tribe initiative promotes public health
programs that integrate domestic and sexual violence assessment and
intervention into basic care. Congress has included the program in the
last 3 fiscal years, but after the first year, the funding has not been
on top of the agency's overall budget. As a result, HHS has been forced
to cut other violence prevention activities to fund the program.
Funding is needed to identify best practices, conduct general
evaluation and disseminate the results to the field so that victims
nationwide can benefit.
Conclusion
Together, these LHHS programs work to prevent and end domestic and
sexual violence. While our country has made continued investments in
the criminal justice response to these heinous crimes, we need an equal
investment in the human service, public health and prevention response
in order to holistically address and end violence against women. We
know that our Nation is facing a difficult financial time and that
there is pressure to reduce spending. Investments in these vital, cost-
effective programs, however, help break the cycle of violence, reduce
related social ills and will save our Nation money now and in the
future.
______
Prepared Statement of the National Postdoctoral Association
Thank you for this opportunity to testify in regard to the fiscal
year 2012 funding for the National Institutes of Health (NIH). We are
writing today in regard to support for postdoctoral scholars,
specifically in support of the 4-percent increase in the NIH Ruth L.
Kirschstein National Research Service Awards (NRSA) training stipends,
as requested in the President's budget.
Background: Postdocs are the Backbone of U.S. Science and Technology
According to estimates by The National Science Foundation (NSF)
Division of Science Resource Statistics, there are approximately 89,000
postdoctoral scholars in the United States\1\. The NIH and the NSF
define a ``postdoc'' as: An individual who has received a doctoral
degree (or equivalent) and is engaged in a temporary and defined period
of mentored advanced training to enhance the professional skills and
research independence needed to pursue his or her chosen career path.
The number of postdocs has been steadily increasing. The incidence of
individuals taking postdoc positions during their careers has risen,
from about 25 percent of those with a pre-1972 doctorate to 46 percent
of those receiving their doctorate in 2002-05 \2\. Moreover, the number
of science and engineering doctorates awarded each year is steadily
rising with doctorates awarded in the medical/life sciences almost
tripling between 2003 and 2007 \3\.
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\1\ National Science Foundation Division of Science Resource
Statistics. (January 2010). Science and engineering indicators 2010.
Arlington, VA: National Science Board.
\2\ Ibid.
\3\ Ibid.
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Postdocs are critical to the research enterprise in the United
States and are responsible for the bulk of the cutting edge research
performed in this country. Consider the following:
--According to the National Academies, postdoctoral researchers
``have become indispensable to the science and engineering
enterprise, performing a substantial portion of the Nation's
research in every setting.'' \4\
---------------------------------------------------------------------------
\4\ COSEPUP. (June 2001). Enhancing the postdoctoral experience for
scientists and engineers. Washington, D.C.: National Academy Press. p.
10.
---------------------------------------------------------------------------
--Postdoctoral training has become a prerequisite for many long-term
research projects.\5\ In fact, the postdoc position has become
the de facto next career step following the receipt of a
doctoral degree in many disciplines.
---------------------------------------------------------------------------
\5\ COSEPUP. (June 2001). Enhancing the postdoctoral experience for
scientists and engineers. Washington, D.C.: National Academy Press. p.
11.
---------------------------------------------------------------------------
--The retention of women and under-represented groups in biomedical
research depends upon their successful and appropriate
completion of the postdoctoral experience.
--Postdoctoral scholars carry the potential to solve many of the
world's most pressing problems; they are the principal
investigators of tomorrow.
Unfortunately, postdocs are routinely exploited. They are paid a
low wage relative to their years of training and are often ineligible
for workman's compensation, disability insurance, paid maternity or
paternity leave, employer-sponsored medical benefits, and retirement
accounts.
The National Postdoctoral Association (NPA) advocates for policies
that support and enhance postdoctoral training. NPA members advocate
for policy change on the national level and also within the research
institutions that host postdoctoral scholars. To date, more than 150
institutions have adopted portions of the NPA's recommended practices,
but low compensation remains one of the serious issues faced by the
postdoctoral community.
Problem: NRSA Stipends are Low and Don't Meet Cost-of-Living Standards;
For Better or Worse, Postdoc Compensation is Based on NRSA
Stipends
The NIH leadership has been aware that the NRSA training stipends
are too low since 2001, after the publication of the results of the
National Academy of Sciences (NAS) study, Addressing the Nation's
Changing Needs for Biomedical and Behavioral Scientists. In response,
the NIH pledged (1) to increase entry-level stipends to $45,000 by
raising the stipends at least 10 percent each year and (2) to provide
automatic cost-of-living increases each year thereafter to keep pace
with inflation. Most recently, the 2011 NAS study, Research Training in
the Biomedical, Behavioral, and Clinical Research Sciences, called for,
among other recommendations, increased funding to support more NRSA
positions and to fulfill the NIH's 2001 commitment to increase pre-
doctoral and postdoctoral stipends.
Without sufficient appropriations from Congress, the NIH has not
been able to fulfill its pledge. In 2007, the stipends were frozen at
2006 levels and since then have not been significantly increased. The
stipends were increased by 1 percent each year in 2009 and 2010 and by
2 percent in 2011. The 2011 entry-level training stipend remains low,
at $38,496, the equivalent of a GS-8 position in the Federal Government
(NIH Statement NOT-OD-10-047), despite the postdocs' advanced degrees
and specialized technical skills. Furthermore, this stipend remains far
short of the promised $45,000. Certainly, it is not reflective of any
cost-of-living increases (please see Figure 1).
Figure 1
It is not only the NRSA fellows who remain undercompensated; the
impact of the low stipends extends beyond the NRSA-supported postdocs.
The NPA's research has shown that the NIH training stipends are used as
a benchmark by research institutions across the country for
establishing compensation for postdoctoral scholars. Thus, an
unintended consequence is that institutions undercompensate all of
their postdocs, who must then struggle to make ends meet, which in turn
affects their productivity and undermines their efforts to solve the
world's most critical problems. Additionally, many are leaving their
research careers behind because of the low compensation. In order to
keep the ``best and the brightest'' scientists in the U.S. research
enterprise, the NPA believes that it is crucial that Congress
appropriate funding for the 4-percent increase in training stipends, as
a moderate yet substantial step toward reaching the recommended entry-
level stipend of $45,000.
Solution: Keep the NIH's Original Promise to Raise the Minimum Stipends
We ask the Subcommittee to appropriate $794 million for the 4-
percent stipend increase, as requested in the President's proposed
budget (http://www.nih.gov/about/director/budgetrequest/
NIH_BIB_020911.pdf): As part of the President's initiative in fiscal
year 2012 to emphasize support for science, technology, engineering,
and mathematics (STEM) education programs, the budget proposes a 4
percent stipend increase for predoctoral and postdoctoral research
trainees supported by NIH's Ruth L. Kirschstein National Research
Service Awards program. A total of $794 million is requested in fiscal
year 2012 for this training program. The proposed increase in stipends
will allow NIH to continue to attract high quality research trainees
that will be available to address the Nation's future biomedical,
behavioral, and clinical research needs.
The NPA believes it is fair, just, and necessary to increase the
compensation provided to these new scientists, who make significant
contributions to the bulk of the research discovering cures for disease
and developing new technologies to improve the quality of life for
millions of people in the United States. Please do not hesitate to
contact us for more information. Thank you for your consideration.
______
Prepared Statement of the National Primate Research Centers
The Directors of the eight National Primate Research Centers
(NPRCs) respectfully submit this written testimony for the record to
the Senate Appropriations Subcommittee on Labor, Health and Human
Services, Education and Related Agencies. The NPRCs appreciate the
commitment that the Members of this Subcommittee have made to
biomedical research through your support for the National Institutes of
Health (NIH) and recommend that you provide $31.987 billion for NIH in
fiscal year 2012, which represents a 3.4 percent increase above the
fiscal year 2011 level. Within this proposed increase the NPRCs also
respectfully request that the Subcommittee provide strong support for
the NPRC P51 (base grant) program, which is essential for the
operational costs of the eight NPRCs. This support would help to ensure
that the NPRCs and other animal research resource programs continue to
serve effectively in their role as a vital national resource.
The mission of the National Primate Research Centers is to use
scientific discovery and nonhuman primate models to accelerate progress
in understanding human diseases, leading to better health. The NPRCs
collaborate as a transformative and innovative network to support the
best science and act as a resource to the biomedical research community
as efficiently as possible. There is an exceptional return on
investment in the NPRC program; $10 is leveraged for every $1 of
research support for the NPRCs. It is important to sustain funding for
the NPRC program and the NIH as a whole to continue to grow and develop
the innovative plan for the future of NIH.
NPRCs Contributions to NIH Priorities
The NPRCs activities are closely aligned with NIH's priorities. In
fact, NPRC investigators conduct much of the Nation's basic and
translational nonhuman primate research, facilitate additional vital
nonhuman primate research that is conducted by hundreds of
investigators from around the country, provide critical scientific
expertise, train the next generation of scientists, and advance
cutting-edge technologies. The NPRCs currently are engaged with NIH
staff in a comprehensive strategic planning process to further enhance
the capabilities of the NPRCs to serve as a resource across all NIH
institutes and centers. The NPRC consortium strategic plan has as its
center and driving force the scientific priorities that drive
translational work into better interventions and diagnostics for
improved human health. Outlined below are a few of the overarching
goals of the plan, including specifics of how the NPRCs are striving to
achieve these through programs and activities across the centers.
Advance Translational Research Using Animal Models.--Nonhuman
primate models bridge the divide between basic biomedical research and
implementation in a clinical setting. Currently, seven of the eight
NPRCs are affiliated and collaborate with NIH Clinical and
Translational Science Awards (CTSA) program through their host
institution. Specifically, the nonhuman primate models at the NPRCs
often provide the critical link between research with small laboratory
animals and studies involving humans. As the closest genetic model to
humans, nonhuman primates serve in the development process of new
drugs, treatments, and vaccines to ensure safe and effective use for
the Nation's public.
Strengthen the Research Workforce.--The success of the Federal
Government's efforts in enhancing public health is contingent upon the
quality of research resources that enable scientific research ranging
from the most basic and fundamental to the most highly applied.
Biomedical researchers have relied on one such resource--the NPRCs--for
nearly 50 years for research models and expertise with nonhuman
primates. The NPRCs are highly specialized facilities that foster the
development of nonhuman primate animal models and provide expertise in
all aspects of nonhuman primate biology. NPRC facilities and resources
are currently used by over 2,000 NIH funded investigators around the
country.
The NPRCs are also supportive of getting students interested in the
biomedical research workforce pipeline at an early age. For example,
the Yerkes NPRC supports a program that connects with local high
schools and colleges in Atlanta, Georgia, and invites students to
participate in research projects taking place at their field station
location.
Offer Technologies to Advance Translational Research and Expand
Informatics Approaches to Support Research.--The NPRCs have been
leading the development of a new Biomedical Informatics Research
Network (BIRN) for linking brain imaging, behavior, and molecular
informatics in nonhuman primate preclinical models of neurodegenerative
diseases. Using the cyberinfrastructure of BIRN for data-sharing, this
project will link research and information to other primate centers, as
well as other geographically distributed research groups.
Translational Science at the NPRCs
Animal models are an essential tool for translating basic
biomedical research to treatments and cures for patients, and the NPRCs
are a national resource instrumental to this effort. The network of the
eight NPRCs collaborates across many disciplines and institutions, with
the goal of advancing biomedical knowledge to understand disease and
improve human and animal health. Below are specific examples of
translational research conducted at each of the eight NPRCs.
In work conducted at the California National Primate Research
Center, Immunoglobulin G (IgG) antibodies purified from mothers of
children with autism and mothers of typically developing children were
injected into pregnant rhesus monkeys. The offspring were then
evaluated both neurologically and behaviorally. Offspring of mothers
who received IgG from mothers of children with autism demonstrated
significantly higher levels of repetitive behaviors than the offspring
who received control antibodies. There are currently no diagnostic
tests for autism. This research identifies one potential autoimmune
cause of autism. Moreover, detection of the maternal autoantibodies may
become an early diagnostic test for increased risk of having a child
with autism. This research, which relied on treating pregnant rhesus
monkeys, could not have been conducted without the facilities provided
by the national primate center.
Rhesus monkeys are widely used as animal models across many fields
of biomedical research because of their genetic, physiological,
behavioral, and anatomical similarities to humans. Scientists at the
New England National Primate Research Center are taking advantage of
the genetic similarity between rhesus monkeys and humans to create the
first monkey model of alcoholism genetics. Recent studies in human
alcoholics who are treated with naltrexone, a leading medication for
alcohol dependence, have shown that the medication works better in
people who have a specific genetic variant in the OPRM1 gene.
Scientists at the New England NPRC identified a similar genetic change
in the rhesus monkey OPRM1 gene, and have shown that monkeys with the
genetic change not only drink more alcohol but also have a comparable
genetically determined response to naltrexone to that seen in some
human alcoholics. This animal model gives scientists a new way to
create personalized medications for the treatment of alcoholism.
A new technique developed by a research team at the Oregon National
Primate Research Center offers a way for women with mitochondrial
diseases to have their own children without passing on defective
genetic material. According to the scientists, defective genes in
mitochondria can be passed to children at a frequency of 1 in 4,000
births and can lead to a variety of diseases. Symptoms of these
potentially fatal illnesses include dementia, movement disorders,
blindness, hearing loss, and problems of the heart, muscle, and kidney.
Following this successful study in a nonhuman primate model, scientists
believe that the technique could be applied quickly to humans to
prevent devastating diseases.
In 2005, researchers were looking for an animal model in which to
test a prototype device which might ameliorate degenerative disc
disease, a major cause of disability in working-age adults. The baboon
was chosen as an appropriate animal model for safety testing of the new
device because of its upright posture and the high magnitude of forces
placed on the vertebral column during the baboon's natural movement.
After a small pilot study, two subsequent pre-clinical studies were
performed at the Southwest National Primate Research Center. This was
an international effort in which specialists from Denmark, Canada, and
the United Kingdom visited the Primate Center on numerous occasions to
participate in the studies. The data from these studies along with data
from human clinical trials are now being assembled for submission to
the U.S. Food and Drug Administration for approval to use the
artificial disc in the United States as an alternative for the
treatment of degenerative lumbar spinal disease.
Testing the safety and efficacy of potential compounds in nonhuman
primates is virtually essential to advancing microbicide candidates to
clinical trials to prevent HIV transmission. There are far too many
microbicide candidates in development for all of them to be tested in
human trials. Over the years, the Tulane National Primate Research
Center has facilitated microbicide studies in nonhuman primates that
have led to human clinical trials, and have been the only successful
predictor of success or failure of compounds in these trials.
Furthermore, candidates that were not sufficiently tested in nonhuman
primates prior to human trials were shown to fail, and later studies,
once performed in macaques, confirmed they would have been predictive
of failure.
Studies completed at the Tulane NPRC have resulted in Merck
releasing one of these compounds to the International Partnership for
Microbicides (IPM) for microbicide development and human clinical
testing. Based on the positive results in macaque studies, the IPM also
has been granted license to pursue topical development of Pfizer's
Maraviroc as a microbicide. Nonhuman primate testing has resulted in a
wealth of information that has prevented expensive clinical trials in
humans that would have otherwise been fruitless.
Recovery of function after stroke, traumatic brain injury or spinal
cord injury is a significant medical challenge for millions of patients
in the United States. A promising new treatment for many of these
disabled survivors is an implantable recurrent brain-computer interface
(R-BCI). The Washington National Primate Research Center developed R-
BCI, a ``neurochip'' that records neural activity from the brain and
transforms that activity into stimuli delivered to the brain, spinal
cord, or muscles during free behavior. R-BCI technology has the
clinical potential to aid patients paralyzed by ALS or spinal cord
injury to regain some motor control directly from cortical cells and
may also be used to strengthen weak connections impaired by stroke.
Researchers and physicians are getter closer to a novel diagnostic
test for polycystic ovary syndrome (PCOS), which has staggering adverse
physiological, psychological, and financial consequences for women's
reproductive health. Scientists at the Wisconsin National Primate
Research Center are studying the profile of metabolites in both monkey
and patient samples of blood, urine, sweat, and breath molecules to
identify signals in the body's internal chemistry that are consistent
with the syndrome. From the vast pool of metabolites in their samples,
they have found a handful that rise to the surface as indicators of
PCOS. These telltale molecules could become the basis for the first-
ever diagnostic test for the syndrome.
A recent study based on work conducted at the Yerkes National
Primate Research Center with nonhuman primates illustrates the promise
of the Visual Paired Comparison (VPC) task for the detection of mild
memory impairment associated with Alzheimer's disease (AD). To
investigate this possibility, the Yerkes NPRC recently extended their
collaborations to include the Department of Computer Sciences at Emory
University. The results show that eye movement characteristics
including fixation duration, saccade length and direction, and re-
fixation patterns can be used to automatically distinguish impaired and
normal subjects. Accordingly, this generalized approach has proven
useful for improving early detection of AD, and may be applied, in
combination with other behavioral tasks, to examine cognitive
impairments associated with other neurodegenerative diseases.
Researchers at the Yerkes NPRC have developed two patents based on this
work.
The Need for Facilities Support
The NPRC program is a vital resource for enhancing public health
and spurring innovative discovery. In an effort to address many of the
concerns within the scientific community regarding the need for funding
for infrastructure improvements, the NPRCs support the continuation of
a robust construction and instrumentation grant program at NIH.
Animal facilities, especially primate facilities, are expensive to
maintain and are subject to abundant ``wear and tear.'' In prior years,
funding was set aside that fulfilled the infrastructure needs of the
NPRCs and other animal research facilities. The NPRCs ask the
Subcommittee to provide strong support for construction and renovation
of animal facilities through C06 and G20 programs. Without proper
infrastructure, the ability for animal facilities, including the NPRCs,
to continue to meet the high demand of the biomedical research
community will be unattainable.
Thank you for the opportunity to submit this written testimony and
for your attention to the critical need for primate research and the
continuation of infrastructure support, as well as our recommendations
concerning funding for NIH in the fiscal year 2012 appropriations bill.
______
Prepared Statement of the National Psoriasis Foundation
introduction and overview
The National Psoriasis Foundation (the Foundation) appreciates the
opportunity to submit written public witness testimony regarding fiscal
year 2012 Federal funding for psoriasis and psoriatic arthritis data
collection and research. The Foundation is the largest psoriasis
patient advocacy organization and charitable funder of psoriatic
disease research worldwide, and has a primary mission of finding a cure
for psoriasis and psoriatic arthritis. Psoriasis, the Nation's most
prevalent autoimmune disease, affecting as many as 7.5 million
Americans, is a noncontagious, chronic, inflammatory, painful and
disabling disease for which there is no cure. It appears on the skin,
most often as red, scaly patches that itch, can bleed and require
sophisticated medical intervention. Up to 30 percent of people with
psoriasis also develop potentially disabling psoriatic arthritis that
causes pain, stiffness and swelling in and around the joints. There are
other serious risks associated with psoriasis--for example, diabetes,
cardiovascular disease, stroke and some cancers. Of serious concern is
that, beyond its terrible physical and psychosocial toll on
individuals, psoriasis also costs the Nation $11.25 billion annually.
The Foundation works with the research community and policymakers
at all levels of government to advance policies and programs that will
reduce and prevent suffering from psoriasis and psoriatic arthritis. In
2009, after examining existing scientific literature, clinical practice
and other components of psoriasis and psoriatic arthritis research and
care, the Foundation's medical and scientific advisors recommended the
creation of a federally organized, public health research program for
psoriasis and psoriatic arthritis to collect the information necessary
to address the key scientific questions in the study and treatment of
psoriatic disease. Responding to this recommendation, recognizing the
significant economic and social costs of psoriasis and psoriatic
arthritis and acknowledging the sizeable gap in the understanding of
these devastating conditions, in fiscal year 2010, Congress provided
$1.5 million to the Centers for Disease Control and Prevention (CDC) to
commence the first-ever Government effort to collect data on psoriasis
and psoriatic arthritis. Following this initial investment, in its
fiscal year 2011 Labor, Health and Human Services, Education (LHHS)
funding bill, the Senate provided a second allocation of $1.5 million
to continue these critical public health efforts. While that measure
was not enacted, we want to thank you and your colleagues for
recognizing the importance of psoriasis data collection and ask for
your support again in fiscal year 2012.
Since the initial appropriation, considerable progress has been
made in developing this data collection program in a thoughtful and
deliberate manner, and we commend CDC for its excellent methodology and
undertaking of this important effort. Thus far, Federal investment in
this effort has allowed the CDC, along with other Federal stakeholders,
to identify the key gaps in psoriatic disease data, including:
prevalence, age of onset, health-related quality of life, healthcare
utilization, burden of disease (employment, work, etc.), direct and
indirect costs, health disparities (age, gender, racial and ethnic),
comorbidities and an understanding of the course of the disease over
time. To uncover these important public health issues, in 2010, CDC
researchers collaborated with the Foundation's scientific and medical
advisors to establish a process by which a common basis for defining
and diagnosing psoriasis will be created and validated. This work, in
turn, will provide the insight, information and tools CDC researchers
need to determine the key psoriasis and psoriatic arthritis public
health questions to be pursued.
While the Foundation acknowledges the fiscal realities currently
facing Congress and this Nation, scientific discovery, at this moment,
is poised to advance the understanding and treatment of psoriasis and
psoriatic arthritis. As such, we respectfully request that Congress
continue to support this important initiative by appropriating level
funding, $1.5 million, in fiscal year 2012, to enable CDC to refine and
implement the psoriasis and psoriatic data collection process that has
been defined with previous funding. With fiscal year 2012 funding, CDC
researchers will be able to build upon the initial investment and
integrate psoriasis and psoriatic arthritis questions into existing
federally funded public health surveys, allowing economies of scale and
leveraging scarce resources to maximum their utility. The information
gleaned from this effort will help improve treatments and disease
management, identify new pathways for future research and drug
development and inform efforts to reduce the burden of disease on
patients, their families and society in general.
In addition, the Foundation urges the Subcommittee to support
robust fiscal year 2012 funding for the National Institutes of Health
(NIH). Sustaining Federal investment in biomedical research will help
support new investigator-initiated research grants for genetic,
clinical and basic research related to the understanding of the
cellular and molecular mechanisms of psoriasis and psoriatic arthritis.
Epidemiologic research at CDC, coupled with biomedical investigations
through NIH, will help further the Nation's understanding of psoriasis
and psoriatic arthritis and contribute to the development of better
therapies, improved treatments and disease management and
identification of ways in which comorbid conditions (e.g., heart
attack, cancer and diabetes) can be prevented or mitigated, in turn,
helping to save money and lives.
the impact of psoriasis and psoriatic arthritis on the nation
Psoriasis requires steadfast treatment and lifelong attention,
especially since it most often strikes between ages 15 and 25. People
with psoriasis also have significantly higher healthcare resource
utilization, which costs more than that for the general population. Of
serious and increasing concern is mounting evidence that people with
psoriasis are at elevated risk for myriad other serious, chronic and
life-threatening conditions, including cardiovascular disease,
diabetes, stroke and some cancers. A higher prevalence of
atherosclerosis, chronic obstructive pulmonary disease, Crohn's
disease, lymphoma, metabolic syndrome and liver disease are found in
people with psoriasis, as compared to the general population. In
addition, people with psoriasis experience higher rates of depression
and anxiety, and people with severe psoriasis die 4 years younger, on
average, than people without the disease.
Despite some recent breakthroughs, many people with psoriasis and
psoriatic arthritis remain in need of effective, safe, long-term and
affordable therapies to allow them to function normally without both
physical and emotional pain. Due to the nature of the disease, patients
often have to cycle through available treatments, and while there are
an increasing number of methods to control the disease, there is no
cure. Many of the existing treatments can have serious side effects and
can pose long-term risks for patients (e.g., suppress the immune
system, deteriorate organ function, etc.). The lack of viable, long-
term methods of control for psoriasis can be addressed through Federal
commitment to epidemiological, genetic, clinical and basic research.
NIH and CDC research, taken together, hold the key to improved
treatment of these diseases, better diagnosis of psoriatic arthritis
and eventually a cure.
the role of cdc in psoriasis and psoriatic arthritis research
Despite our increased understanding of the autoimmune underpinnings
of psoriasis and its treatments, there is a dearth of population-based
epidemiology data on psoriatic disease. The majority of existing
studies of psoriasis are based on case reports, case series and cross-
sectional studies, which are likely biased toward more severe disease.
Several analytical studies have been performed to identify potentially
modifiable risk factors (e.g., smoking, diet, etc.) and some have
yielded conflicting, or inconsistent, results. Most case-control
studies looking for risk factors have been hospital-based, or specialty
clinic-based, and again may be biased toward more severe disease,
limiting their value for the larger population with psoriasis. Broadly
representative population-based studies of psoriasis reflecting the
full spectrum of disease are lacking and needed because there are still
wide gaps in our knowledge and understanding of psoriatic disease.
The CDC's psoriatic data collection effort will help to provide
scientists and clinicians with critical information to further their
understanding of: (a) how early intervention can prevent or delay the
development of comorbid conditions; (b) what can trigger relapses and
remissions; (c) some of the underlying causes of disease; (d) how
differentiating lifestyle and other environmental triggers might lead
to approaches that minimize exposure to these factors, thus reducing
the incidence and severity of disease; and (e) best practice
treatments, which in turn, would assist in streamlining appropriate
patient care and help reduce the use of ineffective, unnecessary and
costly treatments with challenging side effects.
psoriasis and psoriatic arthritis research at nih
It has taken nearly 30 years to understand that psoriasis is, in
fact, not solely a disease of the skin, but also of the immune system.
In recent years, scientists finally have identified some of the immune
cells involved in psoriasis. The last decade has seen a surge in our
understanding of these diseases, accompanied by new drug development.
Scientists are poised, as never before, to make major breakthroughs.
Within the NIH, the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) is the principal Federal
Government agency that currently supports psoriasis research. We
commend NIAMS for its leadership role and very much appreciate its
steadfast commitment to supporting psoriasis research. Additionally, we
are pleased that research activities that relate to psoriasis or
psoriatic arthritis also have been undertaken at the National Institute
of Allergy and Infectious Diseases (NIAID), the National Cancer
Institute (NCI), the National Center for Research Resources (NCRR) and
the National Human Genome Research Institute (NHGRI); however, the
Foundation maintains that many more NIH institutes and centers--such as
the National Heart, Lung, and Blood Institute (NHLBI) and the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)--have a
role to play, especially with respect to the myriad comorbidities of
psoriasis, as noted earlier. Although overall NIH funding levels
improved for psoriasis research in fiscal year 2010, and funding was
boosted through stimulus funding awards of $3 million in fiscal year
2009 and (an estimated) $2 million in fiscal year 2010, the Foundation
remains concerned that total NIH funding generally is not keeping pace
with psoriasis and psoriatic arthritis research needs. Our scientific
advisors believe a strong Federal investment in genetic, immunological
and clinical studies focused on understanding the mechanisms of
psoriasis and psoriatic arthritis is needed.
Given the myriad factors involved in psoriatic disease and its
comorbid conditions, the Foundation advocates increasing overall NIH
funding, with a focus on the aforementioned institutes. We recognize
and appreciate that the Nation faces significant budgetary challenges;
however, we maintain that an increased investment in the Nation's
biomedical research enterprise will help strengthen both the economy
and our understanding of psoriasis and psoriatic arthritis.
conclusion/summary
On behalf of the more than 7.5 million people with psoriasis and
psoriatic arthritis, I want to thank the Committee for affording us the
opportunity to submit written testimony regarding the fiscal year 2012
investments we believe are necessary to ensure that our Nation
adequately addresses the needs of individuals and families affected by
psoriatic disease. By sustaining the Nation's biomedical research
efforts at NIH, coupled with a specific allocation of $1.5 million for
the CDC's psoriasis data collection efforts, Congress will help ensure
that the Nation makes progress in understanding the connection between
psoriasis and its comorbid conditions; uncovering the biologic aspects
of psoriasis and other risk factors that lead to higher rates of
comorbid conditions; and identifying ways to prevent and reduce the
onset of comorbid conditions associated with psoriasis.
Please feel free to contact the Foundation at any time; we are
happy to be a resource to Subcommittee members and your staff. Again,
we very much appreciate the Committee's attention to, and consideration
of, our fiscal year 2012 requests.
______
Prepared Statement of the National REACH Coalition
The National REACH Coalition represents more than 40 communities
and coalitions in 22 States working to eliminate racial and ethnic
health disparities and improve the health of Native American/Native
Hawaiian, African American, Latino, and Asian/Pacific Islander
populations and communities. The coalition is an outgrowth of the
Racial and Ethnic Approaches to Community Health (REACH U.S.) 2010
initiative, launched in 1999 by the Centers for Disease Control and
Prevention (CDC). REACH programs are embedded in communities with
disproportionately higher rates of chronic disease, hospitalization,
and premature death than other cities and counties across the country.
They provide coordination and leadership for the advancement and
translation of community-based participatory research into evidence-
based practices, policies, and community engagement.
For the fiscal year 2012 funding cycle, the National REACH
Coalition requests the Labor, Health and Human Services, Education and
Related Agencies (Labor-HHS) Subcommittee to fully fund, at current
levels, the CDC's REACH program as a discrete line item in CDC's
National Center for Chronic Disease Prevention and Health Promotion or
as a specific initiative within the Public Health and Prevention Trust.
The NRC gratefully acknowledges the strong bipartisan support that
the Senate Labor-HHS Subcommittee has provided to the REACH U.S.
program over the years. Working in communities that are among the
hardest hit by the recession, REACH programs provide a cost effective
strategy to improve health outcomes and close the health gap. We
understand the purpose of the newly established Community
Transformation Grants (CTG) program to address health disparities in
addition to chronic disease. However, the severity of discrepancy in
health conditions among REACH-serving populations requires specific and
intentional interventions and it is not sufficient for this to occur
only through the CTG program. The generalized approach offered by CTG
has been used over the last several decades and has resulted in no
significant reduction in health disparities. Research data support the
conclusion that to effectively close the gap in health outcomes in our
country, there remains a definitive need for a program committed solely
to the elimination of racial and ethnic health disparities.
REACH programs have been successful in mobilizing community
resources, addressing policy, systems, and environmental change, and
creating a shared vision to achieve healthy communities for racial and
ethnic minorities. REACH programs focus on a variety of health issues,
most notably chronic diseases such as cardiovascular disease, diabetes,
HIV/AIDS, and cancer, as well as the contributors to these diseases,
which include smoking, low physical activity, obesity, poor screening
rates, and lack of prevention and disease management activities.
Chronic diseases account for the largest health gap among racial and
ethnic minority populations and are the Nation's leading cause of
morbidity and mortality, accounting for 70 percent of all deaths.
Collectively, chronic diseases are responsible for 75 cents of every
dollar spent on healthcare in the United States.
REACH U.S. programs are working hard to eliminate these health
disparities and many have seen successful outcomes in their
communities. REACH programs nationwide have engaged hundreds of local
coalition members and improved the lives of thousands of program
participants. As a result, REACH communities are testing, evaluating,
and implementing practice and evidence-based interventions that reduce
the human and financial cost of these preventable diseases and
associated risk factors. REACH has achieved significant policy and/or
systems change in public policy, healthcare and preventative services,
and health education.
Some of our recent successes in program intervention and policy
change include:
--In South Carolina, the REACH Charleston and Georgetown Diabetes
Coalition reports that a 21 percent gap in blood sugar testing
between African Americans and the general population has been
virtually eliminated. Amputations among African-American males
with diabetes have been reduced by over 33 percent.
--In Macon County, Alabama, the REACH Alabama Breast and Cervical
Cancer Coalition reports that disparities in mammography
screening between the general population and African American
women decreased from 15 percent to 2 percent within 5 years.
--In Lawrence, Massachusetts, Latino CEED: REACH New England improved
14 healthcare indicators and outcomes for over 3200 Latinos
with diabetes over the past decade, including four indicators
now on par with the U.S. general population. One significant
improvement was the percentage of Latino patients whose blood
sugar was controlled, increasing from 15 percent to 45 percent
as a result of REACH interventions.
--In New York City, Bronx Health REACH led local partners in the ``1
percent Or Less'' campaign to eliminate whole milk and reduce
the availability of sweetened milk in NYC public schools, where
25 percent of children in elementary schools are obese. By
eliminating whole milk, the NYC Department of Health and Mental
Hygiene calculated that per student per year almost 5,960
calories and 619 grams of fat were eliminated, or more than one
pound of weight per child per year.
--In South Los Angeles, Community Health Councils, a REACH grantee,
addressed the lack of healthy food options in a predominantly
African American community by advocating for local policy
changes. These included an incentive package to attract 3 new
grocery stores and sit-down restaurants into vulnerable
communities and the adoption of an ordinance by the city to
prohibit new stand-alone fast food restaurants within one half
mile of an existing fast food chain.
In addition to the individual community improvements, data from the
REACH national behavioral risk factor survey show that the REACH
program is having a significant impact in risk reduction and disease
management across communities and program wide. In 11 REACH communities
evaluated between 2003 and 2009, there was meaningful improvement for
all races in 34 out of 48 health risk factors, which include smoking
prevalence, diabetes management, vaccination, and physical activity.
REACH has demonstrated for the first time at a significant level that
the elimination of health disparities is a ``winnable battle''.
The success of REACH communities in reducing health risk and
improving patient compliance and disease management is particularly
striking when compared to overall U.S. trends. Some recent data trends
include:
--From 2001 to 2009, the smoking prevalence in REACH communities for
Asian men decreased from 30.5 percent to 13.8 percent in
contrast to the 16.9 percent of Asian men that smoke in the
U.S. overall. Smoking prevalence in Hispanic men decreased from
28.8 percent to 17.6 percent in contrast to the 19 percent of
Hispanic men that smoke in the U.S. overall.
--From 2001 to 2004, African Americans transitioned from being less
likely to more likely than the general population to have their
cholesterol checked.
--Health education interventions in REACH communities resulted in
larger rates (as much as 66 percent) of improvement across
racial and ethnic populations for smoking, physical activity,
consumption of fruits and vegetables, etc., than national
trends between 2001 and 2009.
In addition to improving health outcomes, REACH programs also build
capacity in the communities in which they operate. REACH programs train
community and coalition members to work at the grassroots level on
health issues, which can lead to employment opportunities at local
health centers or community outreach programs. REACH also builds the
capacity of local organizations and institutions to better serve their
communities by addressing disparities and distributing resources where
they are most needed. REACH is broadening the field of public health by
engaging the food retail industry, local parks and recreation
departments, city and regional land use, planning, housing, and
transportation agencies, as well as healthcare providers.
REACH communities across the United States have spent the last
decade leveraging CDC funding with public private partnerships in order
to effectively address health disparities. We have demonstrated through
our research and our community programs that health disparities in
racial and ethnic populations, once considered expected, are not
intractable. Though we have made significant progress since REACH's
inception, we could do a lot more. To move forward and eliminate health
disparities, we must continue our work within underserved communities
across the United States and build upon the successes achieved to date.
Without continued funding for REACH programs, communities with high
minority populations will continue to bear a disproportionate share of
the national chronic disease burden. This not only keeps vulnerable
communities at an increased disadvantage, but drives up healthcare
costs by requiring long-term and costly medical intervention to treat
chronic diseases that may have been prevented or better managed.
The success and cost effectiveness of the REACH program would
suggest it both practical and fiscally prudent to increase funding for
the program to expand into additional communities across the country.
However, given the current budget constraints we strongly urge the
Committee to fully fund, at current levels, the CDC's REACH program in
a discrete line item in CDC's National Center for Chronic Disease
Prevention and Health Promotion or as a specific initiative within the
Public Health and Prevention Trust. By doing so, we can continue our
work in underserved communities and achieve marked improvements in the
health of all Americans. We believe that our efforts will help to
decrease the approximately 83,000 deaths that occur each year as a
result of racial and ethnic health disparities, decrease the estimated
$60 billion a year we spend in direct healthcare expenditures as a
result of these disparities, and improve health access, quality, and
outcomes for many people.
We thank you for this opportunity to present our views to this
Subcommittee. We look forward to working with you to improve the health
and safety of all Americans.
______
Prepared Statement of the National Respite Coalition
Mr. Chairman, I am Jill Kagan, Chair of the ARCH National Respite
Coalition, a network of respite providers, family caregivers, State and
local agencies and organizations across the United States who support
respite. Thirty State respite coalitions are also affiliated with the
NRC. This statement is presented on behalf of the these organizations,
as well as the members of the Lifespan Respite Task Force, a coalition
of over 80 national and 100 State and local groups who supported the
passage of the Lifespan Respite Care Act (Public Law 109-442).
Together, we are requesting that the Subcommittee include funding for
the Lifespan Respite Care Program administered by the U.S.
Administration on Aging in the fiscal year 2011 Labor, HHS, and
Education Appropriations bill at $50 million. Given the serious fiscal
constraints facing the Nation, this request has been reduced by one-
half below the previous fiscal year's authorized and requested amount.
This will enable:
--State replication of best practices in Lifespan Respite to allow
all family caregivers, regardless of the care recipient's age
or disability, to have access to affordable respite, and to be
able to continue to play the significant role in long-term care
that they are fulfilling today;
--Improvement in the quality of respite services currently available;
--Expansion of respite capacity to serve more families by building
new and enhancing current respite options, including
recruitment and training of respite workers and volunteers; and
--Greater consumer direction by providing family caregivers with
training and information on how to find, use and pay for
respite services.
Who Needs Respite?
In 2009, a national survey found that over 65 million family
caregivers are providing care to individuals of any age with
disabilities or chronic conditions (Caregiving in the U.S. 2009.
Bethesda, MD: National Alliance for Caregiving (NAC) and Washington,
DC: AARP, 2009). Family caregivers provide an estimated $375 billion in
uncompensated care, an amount almost as high as Medicare spending ($432
billion in 2007) and more than total spending for Medicaid, including
both Federal and State contributions and both medical and long-term
care ($311 billion in 2005) (Gibson and Hauser, 2008).
Family caregiving is not just an aging issue, but a lifespan one
for the majority of the Nation's families. While the aging population
is growing rapidly, the majority of family caregivers are caring for
someone under age 75 (56 percent); 28 percent of family caregivers care
for someone between the ages of 50-75, and 28 percent are caring for
someone under age 50, including children (NAC and AARP, 2009). Many
family caregivers are in the sandwich generation--46 percent of women
who are caregivers of an aging family member and 40 percent of men also
have children under the age of 18 at home (Aumann, Kerstin and Ellen
Galinsky, et al. 2008). And 6.7 million children, are in the primary
custody of an aging grandparent or other relative.
Families of the wounded warriors--those military personnel
returning from Iraq and Afghanistan with traumatic brain injuries and
other serious chronic and debilitating conditions--are at risk for
limited access to respite. Even with enactment of the new VA Family
Caregiver Support Program, the need for respite will remain high among
all veterans and their family caregivers. Among family caregivers of
veterans whose illness, injury or condition is in some way related to
military service surveyed in 2010, only 15 percent had received respite
services from the VA or other community organization within the past 12
months. Caregivers whose veterans have PTSD are only about half as
likely as other caregivers to have received respite services (11
percent vs. 20 percent) (NAC, Caregivers Of Veterans--Serving On The
Homefront, November 2010). Sixty-eight percent of veterans' caregivers
reported their situation as highly stressful compared to 31 percent of
caregivers nationally who feel the same and three times as many say
there is a high degree of physical strain (40 percent vs. 14 percent)
(NAC, 2010). Veterans' caregivers specifically asked for up-to-date
resource lists of respite providers in their local communities and help
to find services--the very thing Lifespan Respite is charged to provide
(NAC, 2010).
National, State and local surveys have shown respite to be the most
frequently requested service of the Nation's family caregivers
(Evercare and NAC, 2006). Other than financial assistance for
caregiving through direct vouchers payments or tax credits, respite is
the number one national policy related to service delivery that family
caregivers prefer (NAC and AARP, 2009). Yet respite is unused, in short
supply, inaccessible, or unaffordable to a majority of the Nation's
family caregivers. The NAC 2009 survey found that despite the fact that
among the most frequently reported unmet needs of family caregivers
were ``finding time for myself'' (32 percent), ``managing emotional and
physical stress'' (34 percent), and ``balancing work and family
responsibilities'' (27 percent), nearly 90 percent of family caregivers
across the lifespan are not receiving respite services at all.
Together, these family caregivers provide an estimated 80 percent
of all long-term care in the United States. This percentage will only
rise in the coming decades with an expected increase in the number of
chronically ill veterans returning from war, greater life expectancies
of individuals with Down's Syndrome and other disabling and chronic
conditions, the aging of the baby boom generation, and the decline in
the percentage of the frail elderly who are entering nursing homes.
Respite Barriers and the Effect on Family Caregivers
Barriers to accessing respite include reluctance to ask for help,
fragmented and narrowly targeted services, cost, and the lack of
information about how to find or choose a provider. Even when respite
is an allowable funded service, a critically short supply of well-
trained respite providers may prohibit a family from making use of a
service they so desperately need. Lifespan Respite is designed to help
States eliminate these barriers through improved coordination and
capacity building.
While most families take great joy in helping their family members
to live at home, however, it has been well documented that family
caregivers experience physical and emotional problems directly related
to their caregiving responsibilities. A majority of family caregivers
(51 percent) caring for someone over the age of 18 have medium or high
levels of burden of care, measured by the number of activities of daily
living with which they provide assistance, and 31 percent of all family
caregivers were identified as ``highly stressed'' ((NAC and AARP,
2009). While family caregivers of children with special healthcare
needs are younger than caregivers of adults, they give lower ratings to
their health. Only 4 out of 10 consider their health to be excellent or
very good (44 percent) compared to 6 in 10 (59 percent) caregivers of
adults; 26 percent say their health is fair or poor, compared to 16
percent of those caring for adults. Caregivers of children are twice as
likely as the general adult population to say they are in fair/poor
health (26 percent vs 13 percent) (Provisional summary Health
Statistics for US Adults, National Health Interview Survey, 2008, dated
August 2009).
The decline of family caregiver health is one of the major risk
factors for institutionalization of a care recipient, and there is
evidence that care recipients whose caregivers lack effective coping
styles or have problems with depression are at risk for falling,
developing preventable secondary complications such as pressure sores
and experiencing declines in functional abilities (Elliott & Pezent,
2008). Care recipients may also be at risk for encountering abuse from
caregivers when the recipients have pronounced need for assistance and
when caregivers have pronounced levels of depression, ill health, and
distress (Beach et al., 2005; Williamson et al., 2001).
Supports that would ease their burden, most importantly respite,
are too often out of reach or completely unavailable. Even the simple
things we take for granted, like getting enough rest or going shopping,
become rare and precious events. Restrictive eligibility criteria also
preclude many families from receiving services or continuing to receive
services for which they once were eligible. A mother of a 12-year-old
with autism was denied respite by her State DD (Developmental
Disability) agency because she was not a single mother, was not at
poverty level, was not exhibiting any emotional or physical conditions
herself, and had only one child with a disability. As she told us, ``Do
I have to endure a failed marriage or serious health consequences for
myself or my family before I can qualify for respite? Respite is
supposed to be a preventive service.''
For the millions of families of children with disabilities, respite
has been an actual lifesaver. However, for many of these families,
their children will age out of the system when they turn 21 and they
will lose many of the services, such as respite, that they currently
receive. In fact, 46 percent of U.S. State units on aging identified
respite as the greatest unmet need of older families caring for adults
with lifelong disabilities.
Respite may not exist at all in some States for adult children with
disabilities still living at home, or individuals under age 60 with
conditions such as ALS, MS, spinal cord or traumatic brain injuries, or
children with serious emotional conditions. In Tennessee, a young woman
in her twenties gave up school, career and a relationship to move in
and take care of her 53 year-old mom with MS when her dad left because
of the strain of caregiving. Fortunately, she lives in Tennessee with a
State Lifespan Respite Program. Now 31, she wrote, ``And I was young--I
still am--and I have the energy, but--it starts to weigh. Because we've
been able to have respite care, it has made all the difference.''
Respite Benefits Families and is Cost Saving
Respite has been shown to be a most effective way to improve the
health and well-being of family caregivers that in turn helps avoid or
delay out-of-home placements, such as nursing homes or foster care,
minimizes the precursors that can lead to abuse and neglect, and
strengthens marriages and family stability. A U.S. Department of Health
and Human Services report prepared by the Urban Institute found that
higher caregiver stress among those caring for the aging increases the
likelihood of nursing home entry. Reducing key stresses on caregivers,
such as physical strain and financial hardship, through services such
as respite would reduce nursing home entry (Spillman and Long, USDHHS,
2007). The budgetary benefits that accrue because of respite are just
as compelling. Delaying a nursing home placement for just one
individual with Alzheimer's or other chronic condition for several
months can save thousands of dollars. In an Iowa survey of parents of
children with disabilities, a significant relationship was demonstrated
between the severity of a child's disability and their parents missing
more work hours than other employees. It was also found that the lack
of available respite appeared to interfere with parents accepting job
opportunities. (Abelson, A.G., 1999)
Moreover, data from an ongoing research project of the Oklahoma
State University on the effects of respite care found that the number
of hospitalizations, as well as the number of medical care claims
decreased as the number of respite care days increased (Fiscal Year
1998 Oklahoma Maternal and Child Health Block Grant Annual Report, July
1999). A Massachusetts social services program designed to provide
cost-effective family centered respite care for children with complex
medical needs found that for families participating for more than 1
year, the number of hospitalizations decreased by 75 percent, physician
visits decreased by 64 percent, and antibiotics use decreased by 71
percent (Mausner, S., 1995).
In the private sector, the Metropolitan Life Insurance Company and
the National Alliance for Caregivers found that U.S. businesses lose
from $17.1 billion to $33.6 billion per year in lost productivity of
family caregivers. (MetLife and National Alliance for Caregiving,
2006). A more recent study from the National Alliance on Caregiving and
Evercare demonstrated that the economic downturn has had a particularly
harsh effect on family caregivers. Of the 6 in 10 caregivers who are
employed, 50 percent of them are less comfortable during the economic
downturn with taking time off from work to care for a family member or
friend. A similar percentage (51 percent) says the economic downturn
has increased the amount of stress they feel about being able to care
for their relative or friend. Respite for working family caregivers
could help improve job performance and employers could potentially save
billions.
Lifespan Respite Care Program Will Help
The Lifespan Respite Care Program is based on the success of
statewide Lifespan Respite programs in Oregon, Nebraska, Wisconsin and
Oklahoma. The Federal Lifespan Respite program is administered by the
U.S. Administration on Aging, Department of Health and Human Services
(HHS). AoA provides competitive grants to State agencies in concert
with Aging and Disability Resource Centers working in collaboration
with State respite coalitions or other State respite organizations. The
program was authorized at $53.3 million in fiscal year 2009 rising to
$95 million in fiscal year 2011. Congress appropriated $2.5 million in
fiscal year 2009 and again in fiscal year 2010 and fiscal year 2011.
Twenty-four States have received 3-year $200,000 Lifespan Respite
Grants from AoA since 2009. Another 9 or 10 States are expected to
receive grants by August 2011.
The purpose of the law is to expand and enhance respite services,
improve coordination, and improve respite access and quality. States
are required to establish State and local coordinated Lifespan Respite
care systems to serve families regardless of age or special need,
provide new planned and emergency respite services, train and recruit
respite workers and volunteers and assist caregivers in gaining access
to services. Those eligible would include family members, foster
parents or other adults providing unpaid care to adults who require
care to meet basic needs or prevent injury and to children who require
care beyond that required by children generally to meet basic needs.
Lifespan Respite, which is a coordinated system of community-based
respite services, helps States use limited resources across age and
disability groups more effectively, instead of each separate State
agency or community-based organization being forced to reinvent the
wheel or beg for small pots of money. Pools of providers can be
recruited, trained and shared, administrative burdens can be reduced by
coordinating resources, and savings used to fund new respite services
for families who may not qualify for existing Federal or State
programs. For the growing number of veterans returning home with TBI or
other polytrauma, the shortage of staff qualified to provide respite to
this population is especially critical. Lifespan Respite systems can
make all the difference by ameliorating special barriers for this
population. The Government Accountability Office summarized the
innovative activities being taken by the 24 States to implement these
State Lifespan Respite Systems in its report to Congress, Respite Care:
Grants and Cooperative Agreements Awarded to Implement the Lifespan
Respite Care Act. GAO-11-28R, October 22, 2010.
The Administration recommended $10 million for Lifespan Respite in
fiscal year 2012. This is a doubling of the Administration's previous
request in fiscal year 2011 of $5 million as part of their Middle Class
Initiative. We are heartened to see that support for family caregiving
is recognized as a critical component of a typical family's economic
and social well-being and extremely grateful for the Administration's
support. Still, we must not neglect that fact that 90 percent of the
Nation's family caregivers are not receiving respite at all. More than
half of them are caring for someone under age 75 with MS, ALS,
traumatic brain or spinal cord injury, mental health conditions,
developmental disabilities or cancer. $10 million will not address the
need for respite. Based on expenditures by State funded Lifespan
Respite programs in the original best practice States, we estimate that
an average sized State will need at least $1 million to build a
Lifespan Respite System that can better coordinate its services and
funding streams, maximize use of existing resources, and leverage new
dollars in both the public and private sectors to build respite
capacity and serve the unserved.
No other Federal program mandates respite as its sole focus. No
other Federal program would help ensure respite quality or choice, and
no current Federal program allows funds for respite start-up, training
or coordination or to address basic accessibility and affordability
issues for families. We urge you to include $50 million in the fiscal
year 2012 Labor, HHS, Education appropriations bill so that Lifespan
Respite Programs can be replicated in the States and more families,
with access to respite, will be able to continue to play the
significant role in long-term care that they are fulfilling today.
______
Prepared Statement of the National Rural Health Association
The National Rural Health Association (NRHA) is pleased to provide
the Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee with a statement for the record on fiscal
year 2012 funding levels for programs with a significant impact on the
health of rural America.
The NRHA is a national nonprofit membership organization with more
than 20,000 members that provides leadership on rural health issues.
The Association's mission is to improve the health of rural Americans
and to provide leadership on rural health issues through advocacy,
communications, education and research. The NRHA membership consists of
a diverse collection of individuals and organizations, all of whom
share the common bond of an interest in rural health.
The NRHA is advocating for continued full funding for a group of
rural health programs that assist many rural communities in maintaining
and building a strong healthcare delivery system into the future. Most
importantly, these programs help increase the capacity of the rural
healthcare delivery system. Additional capacity that will be absolutely
necessary with the addition of many newly insured Americans under the
Patient Protection and Affordable Care Act. These programs have been
successful in increasing access to healthcare in rural areas, helping
communities create new health programs for those in need and training
the future health professionals that will give care to rural America.
With modest investments, these programs are able to evaluate, study,
and implement quality improvement programs and health information
technology systems.
While recognizing the constraints of the current economic and
budgetary climate, we would like to remind you of the critical
importance of these rural health programs and request modest increases
to ensure that these programs do not lose any ground. Even small
investments in these ``rural health safety net'' programs go a long way
and generate big returns in rural communities. Cuts to these programs
do more hard than good and in the long run the Federal government will
pay a much higher cost should these rural programs go away.
Some important rural health programs supported by the NRHA are
outlined below.
Rural Health Outreach and Network Grants provide capital investment
for planning and launching innovative projects in rural communities
that later become self-sufficient. These grants are unique in the
Federal system as they allow the community to choose what is most
important for their own situation and then build a program around that.
These grants have led to projects dealing with obesity and diabetes,
information technology networks, oral screenings, preventive services,
and many other health concerns. Due to the community nature of the
grants and a focus on self-sustainability after the terms of the grant
have run out--85 percent of the Outreach Grantees continue to deliver
services even 5 full years after Federal funding had ended. Request:
$59.8 million
Rural Health Research and Policy forms the Federal infrastructure
for rural health policy. Without these funds, rural America has no
coordinated voice in the Department of Health and Human Services (HHS).
In addition to the expertise provided to agencies such as the Centers
for Medicare and Medicaid Services, this line item also funds rural
health research centers across the country. These research centers
provide the knowledge and the evidence needed for good policy making,
both in the Federal Government and across the Nation. Additionally, we
urge the Subcommittee to include in report language instructions to the
Office of Rural Health Policy to direct additional funding to the State
rural health associations. The State associations serve to coordinate
rural health activities at the State level and have a strong record of
positive outcomes. Request: $10.76 million
State Offices of Rural Health are the State counterparts to the
Federal rural health research and policy efforts, and form the State
infrastructure for rural health policy. They assist States in
strengthening rural healthcare delivery systems by maintaining a focal
point for rural health within each State and by linking small rural
communities with State and Federal resources to develop long term
solutions to rural health problems. Without these funds, States would
have diminished capacity to administer many of the rural health
programs that are so critical to access to care. Request: $10 million
Rural Hospital Flexibility Grants fund quality improvement and
emergency medical service projects for Critical Access Hospitals across
the country. This funding is essential. CAHs are by definition small
hospitals with fewer than 25 beds; they do not have the size, volume or
the expertise to do the types of quality improvement or information
technology activities that they need to do. These grants allow
statewide coordination and provide expertise to CAHs. Also funded in
this line is the Small Hospital Improvement Program (SHIP), which
provides grants to more than 1,500 small rural hospitals (50 beds or
less) across the country to help improve their business operations,
focus on quality improvement and to ensure compliance provisions
related to health information privacy. Request: $43.46 million
Rural and Community Access to Emergency Devices assists communities
in purchasing emergency devices and training potential first responders
in their use. Defibrillators double a victim's chance of survival after
sudden cardiac arrest, which an estimated 163,221 Americans experience
every year. Request: $3.49 million
The Office for the Advancement of Telehealth supports distance-
provided clinical services and is designed to reduce the isolation of
rural providers, foster integrated delivery systems through network
development and test a range of telehealth applications. Long-term,
telehealth promises to improve the health of millions of Americans,
provide constant education to isolated rural providers and save money
through reduced office visits and expensive hospital care. These
approaches are still new and unfolding and continued investment in the
infrastructure and development is needed. Request: $12.3 million
National Health Service Corps (NHSC) plays a critical role in
providing primary healthcare services to rural underserved populations
by placing healthcare providers in our Nation's most underserved
communities. Invesment in our healthcare workforce is absolutely vital
to support the newly insured population resulting from health reform.
Programs like the NHSC help to maximize the capacity of our health
system to care for patients. The Patient Protection and Affordable Care
Act provided additional funding to the NHSC through the HHS Secretary's
Community Health Center fund. The NRHA is supporting the President's
request, which will ensure that the NHSC has access to the additional
dedicated funding through the CHC Fund. Request: $173.2 million
Title VII Health Professions Training Programs (with a significant
rural focus):
--Rural Physician Pipeline Grants will help medical colleges to
develop special rural training programs and recruit students
from rural communities, who are more likely to return to their
home regions to practice. Newly created under the Patient
Protection and Affordable Care Act, this ``grow-your-own''
approach is one of the best and most cost-effective ways to
ensure a robust rural workforce into the future. Request: $
--Area Health Education and Centers (AHECs) financially support and
encourage those training to become healthcare professionals to
choose to practice in rural areas. Without this experience and
support while in medical school, far fewer professionals would
make the commitment to rural areas and facilities including
Community Health Centers, Rural Health Clinics and rural
hospitals. It has been estimated that nearly half of AHECs
would shut down without Federal funding. The success of this
program was recognized through increased authorized levels in
the Patient Protection and Affordable Care Act. Request: $75
million
--Geriatric Programs train health professionals in geriatrics,
including funding for Geriatric Education Centers (GEC). There
are currently 47 GECs nationwide that ensure access to
appropriate and quality healthcare for seniors. Rural America
has a disproportionate share of the elderly and could see a
shortage of health providers without this program. Request: $
35.6 million
The NRHA appreciates the support throughout the fiscal year 2011
continuing resolution process and the opportunity to provide our
recommendations for your fiscal year 2012 appropriations bill. Our
request for continued funding for the rural health safety net is
critical to maintaining access to high quality care in rural
communities. We greatly appreciate the support of the Subcommittee and
look forward to working with Members of Congress to continue making
these important investments in rural health in fiscal year 2012 and
into the future.
______
Prepared Statement of the National Senior Corps Association
Mr. Chairman, Members of the Committee, I testify today on behalf
of the National Senior Corps Association, representing the interests
and ideals of 500,000 senior volunteers and the directors, staff, and
friends of local Foster Grandparent, Senior Companion, and RSVP
programs throughout the country.
The recent agreement for fiscal year 2011 appropriations included a
20 percent cut in funding for RSVP--a devastating setback that
threatens to deny 100,000 seniors the opportunity to serve their
communities. We urge that this funding be restored, first and foremost,
and that the Corporation for National and Community Service (CNCS) take
particular care to do so in protecting opportunities for senior
volunteers without interruption.
For fiscal year 2012, NSCA requests $111,100,000 for the Foster
Grandparent Program (FGP), $63,000,000 for RSVP, and $47,000,000 for
the Senior Companion Program (SCP). This is an aggregate increase of
$200,000 over the fiscal year 2010 enacted level. In addition, we
support an appropriation of $5 million for demonstration projects to
increase high school graduation rates through the Foster Grandparent
Program and to support independent living for veterans through the
Senior Companion Program.
SENIOR CORPS is a federally authorized and funded network of
national service programs that provides older Americans with the
opportunity to apply their life experiences to volunteer service.
Senior Corps is comprised of the Foster Grandparent Program, RSVP, and
the Senior Companion Program, through which Americans age 55 and older
provide essential services to cost-effectively address critical
community needs.
Foster Grandparent Program.--29,000 Foster Grandparents in 328
projects provide a cost-effective means to reach and support more than
280,000 at-risk children with special or exceptional needs annually who
otherwise may not have the opportunity to receive individual assistance
and attention from a caring adult. In 2009, Foster Grandparents
volunteered 24.3 million hours.
--81 percent of children served demonstrated improvements in academic
performance. Mentored children have reduced truancy resulting
in reduced school costs and, ultimately, reduced high school
dropout rates and increased lifetime earnings.
--90 percent demonstrated increased self-image. This includes
improved health outcomes such as reductions in teen pregnancy
and reduced or delayed use of tobacco, alcohol, or illicit
drugs.
--56 percent reported improved school attendance leading to increased
graduation rates, increased post-secondary education, and
higher lifetime earnings.
--59 percent reported reduction in risky behavior, including reduced
juvenile violence and property crimes, saving victim and court
expenses, costly treatment of juvenile offenders, costs of
adult crime, crime losses of victims and the societal costs of
prosecuting and incarcerating adult offenders.
--In 2009, FGP volunteers mentored 41,767 children and youth, of
which 5,400 were children of prisoners at high risk of
repeating their parent's path.
--FGP intervention reduced need for social services, both short-term
costs of counseling and long-term costs of public assistance.
--Based on conservative assumptions about outcomes and valuations,
studies indicate a return benefit of $2.72 for every dollar of
resources used for mentoring programs. (Analyzing the Social
Return on Investment in Youth Mentoring Programs, prepared by:
Paul A. Anton, Wilder Research; and Prof. Judy Temple,
University of Minnesota).
Foster Grandparent Program Profiles.--Foster Grandparent Birda
Dillon completed the ninth grade, worked doing factory assembly for 25
years, raised 20+ children--14 of her own as well as grandchildren. She
is a remarkable Foster Grandparent as the following remarks from her
teacher in Benton Harbor, Michigan begin to illustrate: ``Grandma is so
good with these students. She knows just how to work with them to get
them to read the words themselves. She is positive and knows how to get
the students to sound the words out. George is reading so much better.
I was surprised when he told me recently, 'I need another book!''' I
can't spend one-on-one time with them, and she can. Birda is one of the
best reading tutors I've encountered in my many years of teaching. She
knows all of the tricks and tools to help the students help themselves.
She said much of what she knows she has learned through her training as
a Foster Grandparent. I appreciate her giftedness very much. We hope we
can be together for a long, long time.'' From Professional Volunteer
who assists with site visits (a retired veteran teacher): ``I
complimented her on her teaching of reading and told her I was a
reading teacher, too. I told her she was a natural! She said she hadn't
had any formal training; she wished she'd been a teacher, and I told
her she was.'' Three of the children Birda tutors have incarcerated
parents.
Foster Grandparent Leila Williams: Leila serves in a first grade
classroom at Washington Elementary School in Coloma, Michigan. ``I had
no idea how rewarding it would be. And I feel so much better. I love
having a schedule, being busy, and I sleep so good at night. Thank you,
for making my life better. I'm 91 years old, and getting younger.''
Leila is matched with two children with parents in active military
service. Leila's teacher reports that as a result of Leila's one-on-one
attention, her two assigned students have developed positive
relationships with Leila, improved socialization skills and have both
improved reading skills, especially sight word recognition and fluency.
RSVP.--405,000 RSVP volunteers contributed 62 million hours of
service in 2009 through 741 projects nationwide working with more than
65,000 community organizations. The average cost to support one RSVP
volunteer is approximately $145 a year, whereas the average annual
value per volunteer is more than $3,000. RSVP volunteers saved local
communities $1.25 billion in 2009.
--RSVP is continually strengthening its leadership role in engaging
volunteers 55+ by providing nonprofit agencies with volunteers
trained to recruit and coordinate other community members in
support of the nonprofits mission and goals. In 2009, RSVP
volunteers recruited 38,000 additional community volunteers.
--RSVP projects demonstrate that their volunteer services increase
literacy scores for the 74,326 children they mentor--the
National Education Association states the lowest hourly rate
for teacher aides is $10.31 reflecting a savings of $16,858,623
in remedial reading assistance.
--24,370 RSVP volunteers increased the capacity of the organizations
where they serve by enhancing both the quality and quantity of
services.
--In 2009, RSVP volunteers mentored 6,400 children of prisoners at
high risk of repeating their parent's path.
--RSVP volunteers provided 23,300 caregivers with respite services. A
recent AARP survey of working caregivers reports that 30
percent of family caregivers either quit their jobs or reduce
their work hours to take on more care giving responsibilities.
--RSVP volunteers supported 509,000 with Independent Living Services.
--30 percent of RSVP volunteers provided at least one service in the
area of Health/Nutrition which includes in-home and congregate
meals, food distribution/collection, immunization, etc. valued
at more than $27 million.
RSVP Program Profile.--The Beginning Alcohol and Addictions Basic
Education Studies (BABES) program has been operating successfully for
many years in districts throughout the Portage County, Wisconsin RSVP
service area. Each year, hundreds of second graders in the various
districts learn from their puppet friends (via the RSVP volunteers)
about complex issues like peer pressure, good decisionmaking, and
asking for help.
In 2009, over 600 second graders participated in the program. The
intermediate outcome states that teachers in the second grade classes
will observe children using phrases from the presentations and
reminding others about the lessons they have learned. In 2009, the
target was exceeded as 21 teachers returned surveys and 90 percent (19)
reported they observed children using phrases from the BABES
presentations. Teacher comments included: (1) ``They have brought up
coping, decisionmaking, peer pressure and self image when we are
reading other stories. They have made a connection from these lessons
to what is going on in their world.'' (2) ``One student came in from
recess and said someone was peer pressuring her to do something on the
playground. It was great hearing the term used!''
The end outcome states that students in second grade classes who
complete the BABES program will show an increase in knowledge about
alcohol and drug use and abuse and seeking help as measured on a pre/
post test. In 2009, the target was exceeded as 74 percent (20 of 27
classes participating in BABES in 2009) of classes improved their
scores on the post test by at least 10 percent.
While the program is successful because volunteers are willing to
present the lessons, the coordination of the program is also an
important piece. The RSVP Intergenerational Coordinator provides annual
volunteer training, ensures volunteers have all the materials they
need, works with the schools to schedule the program, ensures the pre
and post tests are completed and returned and analyzes and reports the
date collected to all the stakeholders.
Senior Companion Program.--15,200 Senior Companions serving in 194
projects provided 12.2 million hours of service helping 68,200 frail,
homebound clients in need of assistance in order to remain living
independently. Senior Companion Program services prevented premature
and costly institutionalization at an annual savings well over $200
million. The national average cost for 1 year in a nursing home is
$72,270; the assisted living facility yearly average cost is $37,572.
One Senior Companion volunteer assists 2-6 homebound clients for the
annual investment of $4,800.
--Senior Companions offered essential respite to nearly 9,000 primary
caregivers who struggle to remain in the regular workforce
while caring for their loved one.
--The Family Caregiver Alliance reports that families with long-term
care responsibilities miss an average of 7.5 workdays each
year.
--The MetLife Caregiving Cost Study of July 2006 reports the
estimated cost to employers of full-time employed intense
caregivers at a total of $17.1 billion in lost productivity
annually as well as absenteeism, workday interruptions, costs
due to crisis in care, supervision costs associated with
caregiver employees, costs with unpaid leave and reducing hours
from full-time to part-time.
--Clients have significant, long-term mental health benefits and
reduced rates of depression saving $50-$75 a month in
medication.
--Cost of stress management therapy for one caregiver ($125 per
session) vs. respite provided by volunteer (4 hours of respite
care = $10.60 plus mileage average cost of $3).
--Cost for a home health aide after a client's release from the
hospital is $21 per hour as compared to $2.65 per hour for a
Senior Companion volunteer (at no cost to clients).
Senior Companion Program Profile.--Julia, an 80 year old woman who
is blind was faced with having to leave her home in Rochester, NY due
to her inability to see and complete the tasks of daily living needed
to stay independent. While she had home health aide service to help her
bathe, dress and clean her apartment, her family wasn't able to be with
her during the day and evening due to their work schedules and their
own family commitments.
Julia was given two Senior Companion (SC) volunteers. One came each
day mid-morning after the home health aide left and stayed until early
afternoon. The SC kept Julia company, escorted her to the bathroom when
needed, fixed lunch and ensured she was okay daily. The second SC came
about 5 p.m. each evening. She fixed dinner, visited, cleaned up after
dinner and helped Julia get ready and into bed each evening.
Between these two volunteers Julia was able to stay living at home
an additional 5+ years. At an average cost of $70,000 annually for long
term care compared to the cost of her SC services at approximately
$4,800 annually per companion, a savings of over $300,000 was saved.
It has been stated that baby boomer and senior volunteers represent
our Nation's single and fastest growing resource. During this
unprecedented economic crisis facing our Nation, the number of baby
boomer and senior volunteers should be greatly expanded and mobilized
as solutions to the problems facing our local communities. NSCA's 2012
budget request will provide the opportunity for thousands more older
adults to serve in their communities and enhance the lives of those
most in need, including children with special needs, the frail and
isolated elderly striving to maintain independence, and expanding the
services of local non-profit agencies.
The 2010 national value of one hour of volunteer service was
estimated at $21.36.
Senior Corps volunteers' 98.2 million service hours in 2010 = $2.1
billion savings.
______
Prepared Statement of the National Technical Institute for the Deaf
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 budget request for NTID, one of eight colleges of
RIT, in Rochester, New York. Created by Congress by Public Law 89-36 in
1965, we provide university technical and professional education for
students who are deaf and hard-of-hearing, leading to successful
careers in high-demand fields for a sub-population of individuals
historically facing high rates of unemployment and under-employment. We
also provide baccalaureate and graduate level education for hearing
students in professions serving deaf and hard-of-hearing individuals.
As of fall 2010, NTID served a total of 1,521 students from across the
Nation, including 1,263 deaf and hard-of-hearing undergraduate students
and 147 hearing undergraduate students. NTID students live, study and
socialize with more than 15,000 hearing students on the RIT campus.
NTID has fulfilled its mission with distinction for 43 years.
Budget Request
As shown below, NTID's fiscal year 2012 budget request was
$64,677,000 in Operations and $2,000,000 in Construction, as part of a
plan that would provide NTID with a total of $10,000,000 in
Construction over the next 5 years to fund needed capital projects. The
NTID request is a total of $66,677,000; the President's request is
$63,037,000 in Operations and $2,000,000 in Construction, for a total
of $65,037,000.
FISCAL YEAR 2012 BUDGET REQUEST STATUS
----------------------------------------------------------------------------------------------------------------
Operations Construction Total
----------------------------------------------------------------------------------------------------------------
NTID Request.................................................... $64,677,000 $2,000,000 $66,677,000
President's Request \1\......................................... 63,037,000 2,000,000 65,037,000
-----------------------------------------------
Difference................................................ 1,640,000 .............. 1,640,000
----------------------------------------------------------------------------------------------------------------
\1\ For fiscal years 2009, 2010 and most likely, 2011, NTID's Operations budget has been funded at $63,037,000;
the President's recommended Operations budget for fiscal year 2012 would mark four consecutive years of
funding at the same amount.
For the past 3 years, NTID has been able to absorb the same level
of funding in Operations primarily due to two factors: (1) a self-
initiated budget-reduction/revenue enhancement campaign from fiscal
year 2003 through fiscal year 2007; and (2) limited RIT-mandated salary
increases in recent years. However, realized savings from the campaign
now have been reallocated and are no longer available. Furthermore, the
limited increases from fiscal year 2009 through fiscal year 2011 mean
that NTID has fallen significantly behind its salary benchmarks. RIT
has mandated a 3 percent salary increase for all faculty and staff in
the coming fiscal year.
While NTID certainly would benefit from a budget increase to
support upcoming strategic initiatives (see below), we understand the
resource challenges facing the Committee this year. While an additional
$1,640,000 beyond the President's recommended Operations funding for
fiscal year 2012 is needed, we are amenable to meeting this need by
shifting funds designated in the President's 2012 budget from
Construction to Operations. This would ensure NTID stays within the
total allocation proposed in the President's 2012 budget of
$65,037,000, and will allow us to better meet our Operations needs. In
the meantime, we will continue to seek non-Federal funding to support
immediate construction/renovation needs while continuing to communicate
about critical long-term construction needs.
Enrollment
In fiscal year 2011 (fall 2010), we attracted the largest
enrollment in our 43-year history. Truly a national program, NTID has
enrolled students from all 50 States. Our current enrollment is 1,521.
Over the last 5 years our enrollment has increased 22 percent (271
students). For fiscal year 2012, NTID anticipates maintaining this
record high enrollment level. Our enrollment history over the last 5
years is shown below:
NTID ENROLLMENTS: FIVE-YEAR HISTORY
--------------------------------------------------------------------------------------------------------------------------------------------------------
Deaf/Hard-of-Hearing Students Hearing Students
--------------------------------------------------------------------------------------------
Fiscal Year Interpreting Grand total
Undergrad Grad RIT MSSE Subtotal Program MSSE Subtotal
--------------------------------------------------------------------------------------------------------------------------------------------------------
2007........................................... 1,017 47 31 1,095 130 25 155 1,250
2008........................................... 1,103 51 31 1,185 130 28 158 1,353
2009........................................... 1,212 48 24 1,284 135 31 166 1,450
2010........................................... 1,237 38 32 1,307 138 29 167 1,474
2011........................................... 1,263 40 29 1,332 147 42 189 1,521
--------------------------------------------------------------------------------------------------------------------------------------------------------
Student Accomplishments
For our graduates, over the past 5 years, an average of 93 percent
have been placed in jobs commensurate with the level of their education
(using the Bureau of Labor Statistics methodology). Of our fiscal year
2009 graduates (the most recent class for which numbers are available),
59 percent were employed in business and industry, 21 percent in
education/nonprofits, and 20 percent in Government.
Graduation from NTID has a demonstrably positive effect on
students' earnings over a lifetime, and results in a noteworthy
reduction in dependence on Supplemental Security Income (SSI), Social
Security Disability Insurance (SSDI) and public assistance programs. In
fiscal year 2007, NTID, the Social Security Administration, and Cornell
University examined approximately 13,000 deaf and hard-of-hearing
individuals who applied and attended NTID over our entire history. We
learned that graduating from NTID has significant economic benefits. By
age 50, deaf and hard-of-hearing baccalaureate graduates earned on
average $6,021 more per year than those with associate degrees, who in
turn earned $3,996 more per year on average than those who withdrew
before graduation. Students who withdrew earned $4,329 more than those
not admitted. Students who withdrew experienced twice the rate of
unemployment as graduates.
The same studies showed 78 percent of these individuals were
receiving SSI benefits at age 19, but when they were 50 years old, only
1 percent of graduates drew these benefits, while on average 19 percent
of individuals who withdrew or were not admitted continued to
participate in the SSI program. Graduates also accessed SSDI, an
unemployment benefit, at far lesser rates than students who withdrew;
by age 50, 34 percent of non-graduates were receiving SSDI, while 22
percent of baccalaureate graduates and 27 percent of associate
graduates were receiving them. Considering the reduced dependency on
these Federal income support programs, the Federal investment in NTID
returns significant societal dividends.
NTID clearly makes a significant, positive difference in earnings,
and in lives.
Strategic Initiatives Beginning Fiscal Year 2011
In 2010, NTID completed Strategic Decisions 2020, a strategic plan
based on our founding mission statement. This statement sets forth our
institutional responsibility to work with students to develop their
academic, career and life-long learning skills as future contributors
in a rapidly changing world. It also recognizes our role as a special
resource for preparing individuals who are deaf and hard-of-hearing,
for conducting applied research in areas critical to the advancement of
individuals who are deaf and hard-of-hearing, and for disseminating our
collective and cumulative expertise.
Strategic Decisions 2020 establishes key initiatives responding to
future challenges and shaping future opportunities. These initiatives,
which began implementation in fiscal year 2011, include:
--Pursuing enrollment targets and admissions and programming
strategies that will result in increasing numbers of our
graduates achieving baccalaureate degrees and higher, while
maintaining focus and commitment to quality associate-level
degree programs leading directly to the workplace;
--Improving services to under-prepared students through working with
regional partners to implement intensive summer academic
preparation programs in selected high-growth, ethnically
diverse areas of the country. Through this initiative, NTID
will identify those students demonstrating promise for success
in career-focused degree-level programs and beyond, and provide
consultation to others regarding postsecondary educational
alternatives;
--Expanding NTID's role as a National Resource Center of Excellence
regarding the education of deaf and hard-of-hearing students in
senior high school (grades 10, 11 and 12) and at the
postsecondary level. Components of this role as a National
Resource Center of Excellence will include:
--Center for Excellence in STEM Education.--NTID currently is
working to develop an externally funded Center of
Excellence on STEM Education for Deaf and Hard-of-Hearing
Students. This is an example of making our expertise
available nationally and enhancing deaf and hard-of-hearing
students' access to STEM fields.
--NTID Research Centers.--NTID will organize research resources
into Research Centers focused on the following strategic
areas of research: Teaching and Learning; Communication;
Technology, Access, and Support Services; and Employment
and Adaptability to Social Changes and the Global
Workplace.
--Outreach Programs.--Extending outreach activities to junior and
senior high school students who are deaf and hard-of-
hearing, many of who represent AALANA populations, to
expand their horizons regarding a college education. We
also support other colleges and universities serving
students who are deaf and hard-of-hearing, as well as post-
college adults who are deaf and hard-of-hearing.
--Enhancing efforts to become a recognized national leader in the
exploration, adaptation, testing, and implementation of new
technologies to enhance access to, and support of, learning by
deaf and hard-of-hearing individuals.
NTID Academic Programs
NTID offers high quality, career-focused associate degree programs
preparing students for specific well-paying technical careers. NTID
also is expanding the number of its transfer associate degree programs,
currently numbering seven, to better serve the higher achieving segment
of our student population seeking bachelor's and master's degrees in an
increasingly demanding marketplace. These transfer programs provide
seamless transition to baccalaureate studies in the other colleges of
RIT. In support of those deaf and hard-of-hearing students enrolled in
the other RIT colleges, NTID provides a range of access services
(including interpreting, real-time speech-to-text captioning, and note-
taking) as well as tutoring services. One of NTID's greatest strengths
is our outstanding track record of assisting high-potential students to
gain admission to, and graduate from, the other colleges of RIT at
rates comparable to their hearing peers.
A cooperative education (co-op) component is an integral part of
academic programming at NTID and prepares students for success in the
job market. A co-op gives students the opportunity to experience a
real-life job situation and focus their career choice. Students develop
technical skills and enhance vital personal skills such as teamwork and
communication, which will make them better candidates for full-time
employment after graduation. Over 250 students each year participate in
10-week co-op experiences that augment their academic studies, refine
their social skills, and prepare them for the competitive working
world.
Summary
It is extremely important that our funding be provided at the full
level requested by the President as we continue our mission to prepare
deaf and hard-of-hearing people to enter the workplace and society. We
ask only that the funds provided by the President for Construction be
moved into Operations.
Our alumni have demonstrated that they can achieve independence,
contribute to society, and find sustainable employment as a result of
NTID. Research shows that NTID graduates over their lifetimes are
employed at much higher rates, earn substantially more (therefore
paying significantly more in taxes), and participate at a much lower
rate in SSI, SSDI, and public assistance programs than those who
withdraw or who apply but do not attend NTID.
We are hopeful that the members of the Committee will agree that
NTID, with its long history of successful stewardship of Federal funds
and outstanding educational record of service with people who are deaf
and hard-of-hearing, remains deserving of your support and confidence.
fiscal year 2012 ntid budget request
FISCAL YEAR 2012 NTID BUDGET STATUS
----------------------------------------------------------------------------------------------------------------
Operations Construction Total
----------------------------------------------------------------------------------------------------------------
NTID fiscal year 2011 funding................................... $65,437,000 $240,000 $65,677,000
NTID original request........................................... 64,677,000 2,000,000 66,677,000
NTID updated request \1\........................................ 65,437,000 1,240,000 66,677,000
----------------------------------------------------------------------------------------------------------------
\1\ Note: Our updated request keeps within the limits of our original request; however, it moves money from our
Construction request to maintain our Operations funding at the 2011 level.
Context
Enrollment is the highest in NTID history with 1,521 students, a 22
percent increase over the past 5 years.
In an effort to maximize non-Federal revenues, NTID increased
tuition by 5 percent for fiscal year 2012. From fiscal year 2006-fiscal
year 2012, student tuition has increased by 40 percent.
Support for NTID is an investment with significant returns in the
form of increased employment and reduced dependence on Federal SSI and
SSDI payments for our students. NTID's employment rate in 2010 was 89
percent in spite of a challenging job market and averages to be 93
percent over the past 5 years.
Prior to fiscal year 2011, NTID had received $63,037,000 in
Operations for 2009 and 2010 and was slated to receive that sum again
in 2011. NTID was able to accommodate level funding in the past through
a combination of additional non-Federal revenues and targeted fiscal
control strategies with minimal impact on services and programs for
students. However, the $65,437,000 that NTID received in Operations for
fiscal year 2011 was crucial in order to offset record student
enrollment and use of access services, prevent enrollment caps, and
avoid the elimination of outreach programs, equipment purchases, and
matching endowments.
NTID's updated budget request for fiscal year 2012 maintains
Operations funding at the fiscal year 2011 level, to support our
increased enrollment, increased provision of services, and upcoming
strategic initiatives. It contains $1,240,000 requested for
Construction to begin major renovations to a building designed 30 years
ago that houses 3 major NTID programs.
Possible actions if less than fiscal year 2011 operations funding
received
Limit admission of new students for Fall 2012.--NTID has never
limited the number of qualified students who can enroll--to do so would
mean denying deaf and hard-of-hearing students the opportunity to
receive a state-of-the-art technical education with the unparalleled
access services found at NTID.
Hiring freeze and possible staff furloughs.--83 percent of NTID's
resources support salaries/wages--NTID would have to reduce
expenditures with a hiring freeze and possible furlough of staff,
leaving positions vacant while serving more students than ever before.
Substantial reduction or elimination of summer outreach programs.--
This would affect deaf and hard-of-hearing pre-college youth,
especially young women and African-American and Latino-American youth,
by eliminating programs that encourage them to continue on to college,
especially in the STEM fields.
Substantial reduction or elimination of equipment purchases.--
NTID's mission is to prepare deaf and hard-of-hearing students for
technical and professional careers in fields characterized by cutting-
edge technologies. Without the most technologically updated equipment
available, the education of our students will be impaired
significantly.
Substantial reduction or elimination of matching endowment funds.--
NTID would be unable to fulfill its commitment to match endowment
donations to the Institute, decreasing the level of scholarship support
for students.
______
Prepared Statement of Nemours
Nemours thanks Chairman Harkin, Ranking Member Shelby and members
of the Subcommittee for the opportunity to submit written testimony on
the fiscal year 2012 Labor, Health and Human Services, Education and
Related Agencies Appropriations bill. Nemours, one of the Nation's
leading child health systems, is dedicated to improving children's
health and well-being by offering a spectrum of clinical treatment,
research, advocacy, educational health, and prevention services
extending to families in the communities it serves.
About Nemours
Nemours has developed a model of care that integrates clinical
preventive and treatment services for children with population-based
prevention initiatives. No other health system in the Nation has made
the same level of investment in community-based prevention programs,
policies and practices to reach all children in the community, not just
those who cross our doors. Nemours Health and Prevention Services
(NHPS) has developed a comprehensive, multi-sector obesity prevention
initiative to reach all children in Delaware. To achieve the greatest
impact, NHPS considers the many places where children and families
spend their time: schools, child care, healthcare settings, community
centers and neighborhoods. The goal is to reinforce consistent messages
through policy and practice changes in each setting to help children
make healthy food and lifestyle choices and to stay physically active.
In school settings, NHPS works with district-level teams of
administrators, teachers, counselors, school nurses, parents and
students to encourage wellness policies and provide training and
educational tools that support policy and environmental changes to
encourage healthier eating and more physical activity on school
campuses. In the child care setting, Nemours worked with government
leaders to help Delaware become a frontrunner for policies that support
healthy eating and physical activity. NHPS provides training and
educational tools to help child care providers promote healthy
behaviors for young children.
In the primary care setting, Nemours convened pediatric primary
care providers from across the State to participate in a learning
collaborative focused on improving office-based weight management and
health promotion skills. Practitioners learned about new interventions
and received tools for use in the office setting, as well as take-home
materials for families. In the community, NHPS works with youth-serving
organizations to promote healthy eating and physical activity and to
develop champions who will model the behavior and help spread the
message. We also work to create an environment that promotes healthy
lifestyles.
Community-based Prevention
As an integrated health system that is very engaged with the
community, Nemours sees first-hand the impact of chronic disease on our
Nation's children. We treat obese young children at our clinics, and we
know that unhealthy habits that contribute to obesity are starting at a
very young age. In fact, nationally, over 24 percent of children ages
2-5 are already overweight or obese. Much of what influences their
health is outside the realm of the healthcare system, which is why we
have made and will continue to make significant investments in
community-based prevention. We believe that investing in clinical and
community-based prevention is an important way to ensure that children
grow up to be healthy adults. We are supportive of the Prevention and
Public Health Fund and urge the Committee to utilize the resources
provided from this Fund to support the integration of clinical and
community-based prevention and to evaluate the outcomes associated with
those investments. In particular, we are supportive of Community
Transformation Grants.
Community Transformation Grants draw upon the best of what we know
works: strong coalitions, multi-sector, public-private partnerships,
evidence-based approaches, and evaluation. In Delaware, Nemours has
successfully used this combination of approaches to stem the rising
childhood obesity curve between 2006 and 2008. These grants allow us to
build upon this foundation and spread what works to other communities.
The purpose of the grants is to support the implementation, evaluation,
and dissemination of evidence-based community preventive health
activities in order to reduce chronic disease rates, prevent the
development of secondary conditions, address health disparities, and
develop a stronger evidence-base of effective prevention programming.
In short, these grants would help us in our efforts to help children
grow up healthy. If we are serious about the commitment to improving
health, then we need to transform the places where children live, learn
and play, which is exactly what these grants are designed to
accomplish. We urge the Committee to provide $221.06 million for
Community Transformation Grants in fiscal year 2012, which is the level
requested by the President.
Children's Hospital Graduate Medical Education
Another important priority for Nemours is the healthcare workforce,
particularly the pediatric workforce. Children's hospitals care for
large numbers of children with complex health conditions. In order to
achieve high quality clinical care and outcomes, these specialty
hospitals need to have well-trained residents and physicians. The
Children's Hospital Graduate Medical Education program (CHGME) provides
support for graduate medical education to freestanding children's
hospitals that train resident physicians. The CHGME program was created
to correct an unintended inequity in the GME financing system, which is
tied to the number of Medicare beneficiaries being treated at a
hospital. Freestanding children's hospitals generally do not provide
care to Medicare-eligible patients, and were therefore largely left out
of the GME financing system. The CHGME program has addressed this
issue.
CHGME supports 55 freestanding children's hospitals that train
approximately 40 percent of all pediatricians, 43 percent of all
pediatric specialists, and many pediatric researchers and physicians
who require pediatric training. In 2009, CHGME supported the training
of 5,439 pediatric resident physicians. This is a very important
contribution to training our pediatric workforce, which continues to
experience shortages, particularly in pediatric specialty care. A 2009
survey by the National Association of Children's Hospitals and Related
Institutions (NACHRI) found that national shortages contribute to
vacancies in children's hospitals that commonly last 12 months or
longer for a number of pediatric specialties. These vacancies often
result in longer wait times for children to see pediatric specialists.
At the Alfred I. duPont Hospital for Children, over 300 residents
are trained each year. Under the supervision of physicians, these
residents provide care for inpatients and also provide primary and
specialty care in outpatient settings, including clinics. In 2010,
CHGME covered approximately 54 percent of the cost of the Nemours
residency program.
Unfortunately, the President's budget proposes to eliminate funding
for this critical program. We urge Congress to reject this short-
sighted cut and to continue to provide support for training the next
generation of pediatricians, pediatric specialists and pediatric
researchers. Nemours urges the Subcommittee to provide $317.5 million
for CHGME in fiscal year 2012, the same amount that was provided in
fiscal year 2010.
Conclusion
Nemours appreciates the opportunity to submit written testimony. As
an integrated child health system, we have prioritized investments in
clinical and community-based prevention and our workforce because we
believe that in the long-run these investments will bend the health
curve and the cost curve. We recognize that the Nation's fiscal
situation requires a close examination of the programs and priorities
that the Federal Government funds. As you make these critical funding
decisions, we hope that prevention and the healthcare workforce will
remain priorities of the Subcommittee in fiscal year 2012.
______
Prepared Statement of the Nephcure Foundation
Nephrotic syndrome (NS) is a collection of signs and symptoms
caused by diseases that attack the kidney's filtering system. These
diseases include focal segmental glomerulosclerosis (FSGS), Minimal
Change Disease (MCD) and Membranous Nephropathy (MN). When affected,
the kidney filters leak protein from the blood into the urine and often
cause kidney failure which requires dialysis or kidney transplantation.
According to a Harvard University report, 73,000 people in the United
States have lost their kidneys as a result of FSGS. Unfortunately, the
causes of FSGS and other filter diseases are very poorly understood.
FSGS is the second leading cause of NS and is especially difficult
to treat. There is no known cure for FSGS and current treatments are
difficult for patients to endure. These treatments include the use of
steroids and other dangerous substances which lower the immune system
and contribute to severe bacterial infections, high blood pressure and
other problems in patients, particularly child patients. In addition,
children with NS often experience growth retardation and heart disease.
Finally, NS caused by FSGS, MCD or MN is idiopathic and can often
reoccur, even after a kidney transplant.
FSGS disproportionately affects minority populations and is five
times more prevalent in the African American community. In a
groundbreaking study funded by NIH, researchers found that FSGS is
associated with two APOL1 gene variants. These variants are common in
African Americans but not in European Americans, and it is thought that
these variants developed as an evolutionary response to African
sleeping sickness.
FSGS also has a large social impact on the United States. FSGS
leads to end-stage renal disease (ESRD) which is one of the most costly
chronic diseases to manage. In 2007, the Medicare program alone spent
$24 billion, 6 percent of its entire budget, on ESRD. In 2005, FSGS
accounted for 12 percent of ESRD cases in the United States, at an
annual cost of $3 billion. It is estimated that there are currently
approximately 20,000 Americans living with ESRD due to FSGS.
Research on FSGS could achieve tremendous savings in Federal
healthcare costs and reduce health status disparities--both critical
and appropriate themes of the current administration. For this reason,
and on behalf of the thousands of families that are significantly
affected by this disease, we recommend the following:
--$35 billion for the National Institutes of Health (NIH) and a
corresponding increase to the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK).
--Continue to support the Nephrotic Syndrome Rare Disease Clinical
Research Network at the Office of Rare Diseases Research
(ORDR).
--Support continued expansion of the FSGS/NS research portfolio at
NIDDK and the National Institute on Minority Health and Health
Disparities (NIMHD) by funding more research proposals for
glomerular disease.
--Support awareness activities through the Centers for Disease
Control and Prevention Chronic Kidney Disease Program.
Encourage FSGS/NS Research at NIH
There is no known cause or cure for FSGS and scientists tell us
that much more research needs to be done on the basic science behind
FSGS/NS. More research could lead to fewer patients undergoing ESRD and
tremendous savings in healthcare costs in the United States.
With collaboration from other Institutes and Centers, ORDR
established the Rare Disease Clinical Research Network. This network
provided an opportunity for the NephCure Foundation, the University of
Michigan, and other university research health centers to come together
to form the Nephrotic Syndrome Study Network (NEPTUNE). NEPTUNE is a
relatively new collaboration and has tremendous potential to make
significant advancements in NS and FSGS research because it pools
resources and develops a database of NS patients who are interested in
participating in clinical trials. The addition of Federal resources, as
well as NIH coordination of this important initiative, is crucial to
ensuring the best possible outcomes for RDCRN and NEPTUNE.
The NephCure Foundation is also grateful to the NIDDK for issuing a
program announcement (PA) that serves to initiate grant proposals on
glomerular disease. This PA was issued in March of 2007 and utilizes
utilize the R01 mechanism to award funding to glomerular disease
researchers. In February, 2010 the PA was re-released and is now
scheduled to expire in 2013. We ask the subcommittee to encourage NIDDK
to continue to issue glomerular disease PAs.
Due to the disproportionate burden of FSGS on minority populations,
the NephCure Foundation feels that it is appropriate for NIMHD to
develop an interest in this research. However, NIMHD has not supported
any research on FSGS. We ask the Subcommittee to encourage ORDR, NIDDK,
and NIMHD to collaborate on research that studies the incidence and
cause of this disease among minority populations. We also ask the
Subcommittee to urge NIDDK and the NIMHD undertake culturally
appropriate efforts aimed at educating minority populations about
glomerular disease.
Raise Glomerular Disease Awareness at CDC
When glomerular disease strikes, the resulting NS causes a loss of
protein in the urine and edema. The edema often manifests itself as
puffy eyelids, a symptom that many parents and physicians mistake as
allergies. 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.
It would be of great benefit for CDC to begin raising public
awareness of the glomerular diseases in an attempt to diagnose patients
earlier.
We ask the Subcommittee to encourage CDC to establish a glomerular
disease education and awareness program aimed at both the general
public and healthcare providers.
______
Prepared Statement of Neurofibromatosis, Inc.
Thank you for the opportunity to submit testimony to the
Subcommittee on the importance of continued funding at the National
Institutes of Health (NIH) for Neurofibromatosis (NF), a terrible
genetic disorder closely linked to many common diseases widespread
among the American population.
On behalf of Neurofibromatosis, Inc., a national coalition of NF
advocacy groups, I speak on behalf of the 100,000 Americans who suffer
from NF as well as approximately 175 million Americans who suffer from
diseases and conditions linked to NF such as cancer, brain tumors,
heart disease, memory loss and learning disabilities. Thanks in large
measure to this Subcommittee's strong and enduring support, scientists
have made enormous progress since the discovery of the NF1 gene in 1990
resulting in clinical trials now being undertaken at NIH with broad
implications for the general population.
What is Neurofibromatosis (NF)?
NF is a genetic disorder involving the uncontrolled growth of
tumors along the nervous system which can result in terrible
disfigurement, deformity, deafness, blindness, brain tumors, cancer,
and even death. NF can also cause other abnormalities such as unsightly
benign tumors across the entire body and bone deformities. In addition,
approximately one-half of children with NF suffer from learning
disabilities. While not all NF patients suffer from the most severe
symptoms, all NF patients and their families live with the uncertainty
of not knowing whether they will be seriously affected because NF is a
highly variable and progressive disease.
NF is not rare. It is the most common neurological disorder caused
by a single gene and three times more common than Muscular Dystrophy
and Cystic Fibrosis combined, but it is not widely known because it has
been poorly diagnosed for many years. Approximately 100,000 Americans
have NF, and it appears in approximately 1 in every 2,500 births. It
strikes worldwide, without regard to gender, race or ethnicity.
Approximately 50 percent of new NF cases result from a spontaneous
mutation in an individual's genes and 50 percent are inherited. There
are three types of NF: NF1, which is more common, NF2, which primarily
involves tumors causing deafness and balance problems, and
schwannomatosis, the hallmark of which is severe pain. In addition,
advances in NF research stand to benefit over 175 million Americans in
this generation alone because NF is directly linked to many of the most
common diseases affecting the general population.
When a child is diagnosed with NF it means tumors can grow anytime,
anywhere on his/her nervous system, from the day he/she is born until
the day he/she dies with no way to predict when or how severely the
tumors will affect his/her body--and no viable way to treat the disease
outside of surgery--which often results in more tumors that grow twice
as fast. That same child then has a 50 percent chance to pass the gene
to his/her children. That is an overwhelming diagnosis and it bears
repeating: NF is one of the most common genetic disorders in our
country and has no cure and no viable treatment. But that is changing.
The immediate future holds real promise.
Link to Other Illnesses
Researchers have determined that NF is closely linked to cancer,
heart disease, learning disabilities, memory loss, brain tumors, and
other disorders including deafness, blindness and orthopedic disorders,
primarily because NF regulates important pathways common to these
disorders such as the RAS, cAMP and PAK pathways. Research on NF
therefore stands to benefit millions of Americans:
Cancer.--NF is closely linked to many of the most common forms of
human cancer, affecting approximately 65 million Americans. In fact, NF
shares these pathways with 70 percent of human cancers. Research has
demonstrated that NF's tumor suppressor protein, neurofibromin,
inhibits RAS, one of the major malignancy causing growth proteins
involved in 30 percent of all cancer. Accordingly, advances in NF
research may well lead to treatments and cures not only for NF
patients, but for all those who suffer from cancer and tumor-related
disorders. Similar studies have also linked epidermal growth factor
receptor (EGF-R) to malignant peripheral nerve sheath tumors (MPNSTs),
a form of cancer which disproportionately strikes NF patients.
Heart disease.--Researchers have demonstrated that mice completely
lacking in NF1 have congenital heart disease that involves the
endocardial cushions which form in the valves of the heart. This is
because the same ras involved in cancer also causes heart valves to
close. Neurofibromin, the protein produced by a normal NF1 gene,
suppresses ras, thus opening up the heart valve. Promising new research
has also connected NF1 to cells lining the blood vessels of the heart,
with implications for other vascular disorders including hypertension,
which affects approximately 50 million Americans. Researchers believe
that further understanding of how an NF1 deficiency leads to heart
disease may help to unravel molecular pathways involved in genetic and
environmental causes of heart disease.
Learning disabilities.--Learning disabilities are the most common
neurological complication in children with NF1. Research aimed at
rescuing learning deficits in children with NF could open the door to
treatments affecting 35 million Americans and 5 percent of the world's
population who also suffer from learning disabilities. In NF1 the
neurocognitive disabilities range includes behavior, memory and
planning. Recent research has shown there are clear molecular links
between autism spectrum disorder and NF1; as well as with many other
cognitive disabilities. Tremendous research advances have recently led
to the first clinical trials of drugs in children with NF1 learning
disabilities. These trials are showing promise. In addition because of
the connection with other types of cognitive disorders such as autism,
researchers and clinicians are actively collaborating on research and
clinical studies, pooling knowledge and resources. It is anticipated
that what we learn from these studies could have an enormous impact on
the significant American population living with learning difficulties
and could potentially save Federal, State, and local governments, as
well as school districts, billions of dollars annually in special
education costs resulting from a treatment for learning disabilities.
Memory loss.--Researchers have also determined that NF is closely
linked to memory loss and are now investigating conducting clinical
trials with drugs that may not only cure NF's cognitive disorders but
also result in treating memory loss as well with enormous implications
for patients who suffer from Alzheimer's disease and other dementias.
Deafness.--NF2 accounts for approximately 5 percent of genetic
forms of deafness. It is also related to other types of tumors,
including schwannomas and meningiomas, as well as being a major cause
of balance problems.
Scientific Advances
Thanks in large measure to this Subcommittee's support; scientists
have made enormous progress since the discovery of the NF1 gene in
1990. Major advances in just the past few years have ushered in an
exciting era of clinical and translational research in NF with broad
implications for the general population.
These recent advances have included:
--Phase II and Phase III clinical trials involving new drug therapies
for both cancer and cognitive disorders;
--Creation of a National Clinical and Pre-Clinical Trials
Infrastructure and NF Centers;
--Successfully eliminating tumors in NF1 and NF2 mice with the same
drug;
--Developing advanced mouse models showing human symptoms;
--Rescuing learning deficits and eliminating tumors in mice with the
same drug;
--Determining the biochemical, molecular function of the NF genes and
gene products; and
--Connecting NF to more and more diseases because of NF's impact on
many body functions.
Congressional support for NF research
The enormous promise of NF research, and its potential to benefit
over 175 million Americans who suffer from diseases and conditions
linked to NF, has gained increased recognition from Congress and the
NIH. This is evidenced by the fact that 12 institutes at NIH are
currently supporting NF research (NCI, NHLBI, NINDS, NIDCD, NHGRI,
NCRR, NIMH, NIGMS, NEI, NIA, NICHD, and OD), and NIH's total NF
research portfolio has increased from $3 million in fiscal year 1990 to
an estimated $24 million in fiscal year 2011. Given the potential
offered by NF research for progress against a range of diseases, we are
hopeful that NIH will continue to build on the successes of this
program by funding this promising research and thereby continuing the
enormous return on the taxpayers' investment.
We respectfully request that you include the following report
language on NF research at the National Institutes of Health within
your fiscal year 2012 Labor, Health and Human Services, Education
Appropriations bill.
Neurofibromatosis [NF].--NF is an important research area for
multiple NIH Institutes; therefore the Committee supports efforts to
increase funding and resources toward NF research and treatment. As NF
is connected to many forms of cancer in children and adults; the
Committee encourages the NCI to substantially increase its NF research
portfolio in pre-clinical and clinical trials by applying newly
developed and existing drugs. The Committee also encourages the NCI to
support NF centers, clinical trials consortia, patient databases, and
biospecimen repositories. The Committee also urges additional focus
from the NHLBI, given NF's involvement with hypertension and congenital
heart disease. Because NF causes tumors to grow on the nerves
throughout the body, the Committee urges the NINDS to continue
aggressive research on nerve damage and repair which has strong
implications not only for NF but for spinal cord and brain injury,
learning disabilities and attention deficit disorders. In addition, the
Committee continues to encourage the NICHD and NIMH to expand funding
of clinical trials for NF patients in the area of learning
disabilities. Children with NF1 are prone to the development of severe
bone deformities, including scoliosis; the Committee encourages NIAMS
to expand its NF1 research portfolio. NF2 accounts for approximately 5
percent of genetic forms of deafness; the Committee therefore
encourages the NIDCD to expand its NF2 research portfolio. The
Committee encourages NEI to expand its NF research portfolio to advance
the cause of treating Optic gliomas, vision loss and cataracts, major
clinical problems associated with NF. The Committee encourages the
NHGRI to expand its NF portfolio given that NF represents an ideal
model to study the genomics of cancer predisposition, learning and
behavior, and bone disease translatable to personalized medicine for
affected individuals.
We appreciate the Subcommittee's strong support for NF research and
will continue to work with you to ensure that opportunities for major
advances in NF research are aggressively pursued. Thank you.
______
Prepared Statement of the Nursing Community
The Nursing Community is a forum for professional nursing
organizations to collaborate on a wide spectrum of healthcare and
nursing issues, including practice, education, and research. These 56
organizations are committed to promoting America's health through
nursing care. Collectively, the Nursing Community represents over
850,000 Registered Nurses (RNs), Advanced Practice Registered Nurses
(APRNs--including certified nurse-midwives, nurse practitioners,
clinical nurse specialists, and certified registered nurse
anesthetists), nurse executives, nursing students, nursing faculty, and
nurse researchers. Together, our organizations work collaboratively to
increase funding for the Nursing Workforce Development programs
(authorized under Title VIII of the Public Health Service Act [42
U.S.C. 296 et seq.]), the National Institute of Nursing Research
(NINR), and to secure authorized funding for Nurse-Managed Health
Clinics so that American nurses have the support needed to provide high
quality healthcare to the Nation.
Nurses are involved in every aspect of healthcare, and if the
nursing workforce is not strengthened, the healthcare system will
continue to suffer. Currently, RNs comprise the largest group of health
professionals with approximately 3.1 million licensed providers. Nurses
offer essential care to patients as well as our Nation's active duty
military and veterans in a variety of settings, including hospitals,
ambulatory care clinics, long-term care facilities, community or public
health areas, schools, workplaces, and private homes. In addition, many
nurses pursue graduate degrees to assume roles as advanced practice
registered nurses who practice autonomously; become nurse faculty,
nurse researchers, nurse administrators, and advanced public health
nurses. Nurses also specialize in areas such as mental and women's
health, pain management, hospice and palliative care, nephrology,
oncology, rehabilitation, forensics, dermatology, urology, and care
coordination. They are critical team members in all departments such as
intensive and critical care, pediatrics, geriatrics, medical surgical,
and operating rooms. RNs and APRNs hold a holistic view of health.
With the Patient Protection and Affordable Care Act [Public Law
111-148] (ACA) focus on creating a system that will increase access to
quality care, emphasize prevention, and decrease cost, it is critical
that a substantial investment be made in our RN and APRN workforce, in
the scientific research that provides the basis for nursing practice,
and in the safety-net facilities they operate.
In an article published in the July/August 2009 issue of Health
Affairs, Dr. Peter Buerhaus, a noted health professions workforce
analyst, and colleagues confirmed that although the economic recession
has led to a temporary easing of the nursing shortage in some parts of
the country, the overall shortfall in the number of nurses needed is
expected to grow to 260,000 by the year 2025. Three major factors
contribute to this growing demand for nursing care. First, over 275,000
practicing RNs are over the age of 60 according to the 2008 National
Sample Survey of Registered Nurses. When the economy rebounds, many of
these nurses will seek retirement. Second, America's population is
aging. Older Americans will seek more healthcare services creating an
influx of consumers and necessitate the need for quality nursing care.
Finally, the ACA will expand the number of individuals seeking care by
32 million.
Furthermore, in a report released by the Institute of Medicine and
Robert Wood Johnson Foundation titled, The Future of the Nursing:
Leading Change, Advancing Health, clear and evidence based guidance was
provided on how to shape nursing's role in healthcare delivery as the
system undergoes considerable changes. The report's key messages
include:
--Nurses should practice to the full extent of their education and
training; scope of practice limitations should be removed.
--Nurses should achieve higher levels of education and training
through an improved education system that promotes seamless
academic progression.
--Nurses should be full partners with other healthcare professionals
in redesigning healthcare in the United States.
--Effective workforce planning and policymaking require better data
collection and an improved information infrastructure.
To achieve these goals, different levels of support will be needed
for all nurses and each of the funding requests outlined below will
help to meet not only the goals of the IOM report, but the larger
national goals of access to high quality, cost effective care.
addressing the demand: nursing workforce development programs
The Nursing Workforce Development programs, authorized under Title
VIII of the Public Health Service Act (42 U.S.C. 296 et seq.), helped
build the supply and distribution of qualified nurses to meet our
Nation's healthcare needs since 1964. Over the last 47 years, these
programs addressed all aspects of supporting the workforce--education,
practice, retention, and recruitment. The Title VIII programs bolster
nursing education at all levels, from entry-level preparation through
graduate study, and provide support for institutions that educate
nurses for practice in rural and medically underserved communities.
Today, the Title VIII programs are essential to ensure the demand for
nursing care is met. Between fiscal year 2006 and 2009, the Title VIII
programs supported over 347,000 nurses and nursing students as well as
numerous academic nursing institutions, and healthcare facilities.
Results from the American Association of Colleges of Nursing's
(AACN) 2010-2011 Title VIII Student Recipient Survey included responses
from 1,459 students who noted that these programs played a critical
role in funding their nursing education. The survey showed that 80
percent of the students receiving Title VIII funding are attending
school full-time. By supporting full-time students, the Title VIII
programs are helping to ensure that students enter the workforce
without delay. The programs also address the current demand for primary
care providers. Nearly one-third of respondents reported that their
career goal is to become a nurse practitioner. Approximately 80 percent
of nurse practitioners provide primary care services throughout the
United States. Additionally, the respondents identified working in
rural and underserved areas as future goals, with becoming a nurse
faculty member, a nurse practitioner, or a certified registered nurse
anesthetist as the top three nursing positions for their career
aspirations.
The Nursing Community respectfully requests $313.075 million for
the Nursing Workforce Development programs authorized under Title VIII
of the Public Health Service Act in fiscal year 2012 as recommended in
the President's fiscal year 2012 budget proposal.
building the science: the national institute of nursing research
As one of the 27 Institutes and Centers at the National Institutes
of Health (NIH), the NINR funds research that establishes the
scientific basis for quality patient care. Nurse researchers make
significant advances in and contributions to health prevention and
care. In addition, they work collaboratively as well as part of
multidisciplinary research teams with colleagues from other fields and
are vital in setting the national research agenda.
The Nursing Community respectfully requests $163 million for the
National Institute of Nursing Research in fiscal year 2012. Nursing
research is an essential part of scientific endeavors to improve the
Nation's health. Knowledge of care across the lifespan is critical to
the present and future health of the Nation. Research funded at the
NINR helps to integrate biology and behavior as well as design new
technology and tools. At a time when healthcare needs are changing,
nursing care must be firmly grounded in nursing science. The four
strategic areas of emphasis for research at NINR are promoting health
and preventing disease, eliminating health disparities, improving
quality of life, and setting directions for end-of-life research.
The science advanced at NINR is integral to the future of the
Nation's healthcare system. 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 for those with chronic illness, and care for individuals at the
end of life. NINR's research fosters advances in nursing practice,
improves patient care, and attracts new students to the profession.
supporting safety net facilities: nurse-managed health clinics
The ACA amended Sec. 330 of the Public Health Service Act to
provide grant eligibility to Nurse-Managed Health Clinics (NMHCs) to
support operating costs and authorized up to $50 million a year for
this purpose. NMHCs are defined as a nurse-practice arrangement,
managed by APRNs, that provides primary care or wellness services to
underserved or vulnerable populations and that is associated with a
school, college, university or department of nursing, federally
qualified health center, or independent nonprofit health or social
services agency. Nurse-Managed Health Clinics successfully engage
communities and address critical health needs for underserved
populations.
The Nursing Community respectfully requests $20 million for the
Nurse-Managed Health Clinics authorized under Title III of the Public
Health Service Act in fiscal year 2012 as recommended in the
President's fiscal year 2012 budget proposal.
NMHCs provide care to clients and patients in clinics located in
places like public housing, on blighted urban streets, on Native
American reservations, in rural communities, in senior citizen centers,
in elementary schools, in storefronts, and even in churches. The
services these clinics provide include primary care, health promotion,
and disease prevention. Furthermore, NMHCs also act as important
teaching and practice sites for nursing students.
The care provided in these sites directly contributes to positive
health outcomes and savings in the long term. In one U.S. city alone,
nurses at an NMHC see their patients almost twice as frequently as
other providers, and their patients are hospitalized 30 percent less
and use the emergency room 15 percent less often than those of other
healthcare providers. Providing funding for these centers is a direct
investment in the specific health needs of localized communities.
Without a workforce of well-educated nurses providing evidence-
based care to those who need it most, including our growing aging
population, the healthcare system is not sustainable. The Nursing
Community's request of $313.075 million in fiscal year 2012 for the
Title VIII Nursing Workforce Development programs, $163 million for the
NINR, and $20 million for NMHCs will help ensure access to quality care
provided by America's nursing workforce.
members of the nursing community submitting this testimony
Academy of Medical-Surgical Nurses
American Academy of Ambulatory Care Nursing
American Academy of Nurse Practitioners
American Academy of Nursing
American Assembly for Men in Nursing
American Association of Colleges of Nursing
American Association of Critical-Care Nurses
American Association of Nurse Anesthetists
American Association of Nurse Assessment Coordinators
American College of Nurse Practitioners
American College of Nurse-Midwives
American Holistic Nurses Association
American Nephrology Nurses' Association
American Nurses Association
American Organization of Nurse Executives
American Psychiatric Nurses Association
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
Association of Community Health Nursing Educators
Association of periOperative Registered Nurses
Association of Rehabilitation Nurses
Association of State and Territorial Directors of Nursing
Association of Women's Health, Obstetric and Neonatal Nurses
Commissioned Officers Association
Dermatology Nurses' Association
Gerontological Advanced Practice Nurses Association
Hospice and Palliative Nurses Association
Infusion Nurses Society
International Association of Forensic Nurses
International Nurses Society on Addictions
International Society of Psychiatric Nurses
National Association of Clinical Nurse Specialists
National Association of Nurse Practitioners in Women's Health
National Association of Pediatric Nurse Practitioners
National Black Nurses Association
National Coalition of Ethnic Minority Nurse Associations
National Nursing Centers Consortium
National Organization of Nurse Practitioner Faculties
Nurses Organization of Veterans Affairs
Oncology Nursing Society
Public Health Nursing Section, American Public Health Association
Society of Urologic Nurses and Associates
______
Prepared Statement of the Oncology Nursing Society
overview
The Oncology Nursing Society (ONS) appreciates the opportunity to
submit written comments for the record regarding fiscal year 2012
funding for cancer and nursing related programs. ONS, the largest
professional oncology group in the United States, composed of more than
35,000 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.
In 2010, an estimated 1.529 million Americans were diagnosed with
cancer, and more than 569,490 lost their battle to this terrible
disease; at the same time the national nursing shortage is expected to
worsen. Overall, age is the number one risk factor for developing
cancer. Approximately 77 percent of all cancers are diagnosed at age 55
and older.\1\ 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. Moreover, a recent survey of ONS members found that
the nursing shortage is having an impact in oncology physician offices
and hospital outpatient departments. Some respondents indicated that
when a nurse leaves their practice, they are unable to hire a
replacement due to the shortage--leaving them short-staffed and posing
scheduling challenges for the practice and the patients. These
vacancies in all care settings create significant barriers to ensuring
access to quality care.
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\1\ American Cancer Society. Cancer Facts and Figures 2010. http://
www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-
facts-and-figures-2010.
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To ensure that all people with cancer have access to the
comprehensive, quality care they need and deserve, ONS advocates
ongoing 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. ONS
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. We thank the Subcommittee for its consideration of our
fiscal year 2012 funding request detailed below.
securing and maintaining an adequate oncology nursing workforce
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 treatment education and counseling to patients and family
members, and engaging in myriad other activities on behalf of people
with cancer and their families. Cancer is a complex, multifaceted
chronic disease, and people with cancer require specialty-nursing
interventions at every step of the cancer experience. People with
cancer are best served by nurses specialized in oncology care, who are
certified in that specialty.
As the overall number of nurses is expected to decline in the
coming years, we likely will experience a commensurate decrease in the
number of nurses trained in the specialty of oncology. With an
increasing number of people with cancer needing high-quality
healthcare, 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.\2\ 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.
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\2\ Needleman J., Buerhaus P., Mattke S., Stewart M., Zelevinsky K.
``Nurse-Staffing Levels and the Quality of Care in Hospitals.'' New
England Journal of Medicine 346:, (May 30, 2002): 1715-1722.
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Of additional concern is that our Nation also will face a shortage
of nurses available and able to conduct cancer research and clinical
trials. With a shortage of cancer research nurses, progress against
cancer will take longer because of scarce human resources coupled with
the reality that 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, we are
concerned that our Nation may falter in its delivery and application of
the benefits from our Federal investment in research.
ONS joins our colleagues from all nursing sectors and specialties
to request $313.075 million for the Health Resources and Services
Administrations (HRSA) Title VIII programs in fiscal year 2012, as
recommended in the President's fiscal year 2012 budget. With additional
funding in fiscal year 2012, the HRSA Workforce Development Programs
will have much-needed resources to address the multiple factors
contributing to the nationwide nursing shortage. Advanced nursing
education programs play an integral role in supporting registered
nurses interested in advancing in their practice and becoming faculty.
As such, these programs must be adequately funded in the coming year.
ONS strongly urges Congress to provide HRSA with this amount to
ensure that the agency has the resources necessary to fund a higher
rate of nursing scholarships and loan repayment applications and
support 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. The National Coalition for
Cancer Research (NCCR), a nonprofit organization comprised of 23
national cancer organizations, and One Voice Against Cancer (OVAC), a
collaboration of 39 national nonprofit organizations, are also
advocating $313.075 million in fiscal year 2012 for the Nurse
Reinvestment Act. ONS and its allies have serious concerns that without
full funding, the Nurse Reinvestment Act will prove an empty promise,
and the current and expected nursing shortage will worsen, and people
will not have access to the quality care they need and deserve.
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
joined with the broader health community in advocating a $35 billion
for NIH in fiscal year 2012. This level of investment will allow NIH to
sustain and build on its research progress, while avoiding the severe
disruption to advancement that could result from a minimal increase.
Cancer research is producing amazing breakthroughs--leading to new
therapies that translate into longer survival and improved quality of
life for cancer patients. In recent years, we have seen extraordinary
advances in cancer research, resulting from our national investment,
which have produced effective prevention, early detection, and
treatment methods for many cancers. To that end, ONS calls upon
Congress to allocate $5.740 billion to the National Cancer Institute
(NCI), as well as $231 million to the National Center for Minority
Health and Health Disparities in fiscal year 2012 to support the 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
healthcare 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 others in the nursing community and NCCR in
advocating a fiscal year 2012 allocation of $163 million for NINR.
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. 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.
Therefore, ONS joins with our partners in the cancer community in
calling on Congress to provide additional resources for the CDC to
support and expand much-needed and proven effective cancer prevention,
early detection, and risk reduction efforts. Specifically, ONS
advocates the following fiscal year 2012 funding levels for the
following CDC programs:
--$275 million for the National Breast and Cervical Cancer Early
Detection Program;
--$65 million for the National Cancer Registries Program;
--$70 million for the Colorectal Cancer Prevention and Control
Initiative;
--$50 million for the Comprehensive Cancer Control Initiative;
--$25 million for the Prostate Cancer Control Initiative;
--$5 million for the National Skin Cancer Prevention Education
Program;
--$10 million for the Gynecologic Cancer and Education and Awareness
(Johanna's Law);
--$10 million for the Ovarian Cancer Control Initiative; and
--$6 million for the Geraldine Ferraro Blood Cancer Program.
conclusion
ONS maintains a strong commitment to working with Members of
Congress, other nursing and oncology groups, 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 in the
coming years. By providing the fiscal year 2012 funding levels detailed
above, we believe the Subcommittee will be taking the steps 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 Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance (the Alliance) appreciates the
opportunity to submit comments for the record regarding the Alliance's
fiscal year 2012 funding recommendations. We believe these
recommendations are critical to ensure advances to help reduce and
prevent suffering from ovarian cancer.
For 14 years, the Alliance has worked to increase awareness of
ovarian cancer and advocate for additional Federal resources to support
research that would lead to more effective diagnostics and treatments.
As an umbrella organization with approximately 50 national, State and
local organizations, the Alliance unites the efforts of survivors,
grassroots activists, women's health advocates and healthcare
professionals to bring national attention to ovarian cancer. The
Ovarian Cancer National Alliance is the foremost advocate for women
with ovarian cancer in the United States. To advance the interests of
women with ovarian cancer, the organization advocates at a national
level for increases in research funding for the development of an early
detection test, improved healthcare practices and life-saving treatment
protocols. The Ovarian Cancer National Alliance educates healthcare
professionals and raises public awareness of the risks, signs and
symptoms of ovarian cancer.
According to the American Cancer Society, in 2010, more than 22,000
American women were diagnosed with ovarian cancer and approximately
15,000 lost their lives to this terrible disease. Ovarian cancer is the
fifth leading cause of cancer death in women. Currently, more than half
of the women diagnosed with ovarian cancer will die within 5 years.
While ovarian cancer has symptoms, there is no reliable early detection
test. Most women are diagnosed in Stage III or Stage IV, when survival
rates are low. If diagnosed early, more than 90 percent of women will
survive for 5 years, but when diagnosed later, less than 30 percent
will.
Only a few treatments have been approved by the Food and Drug
Administration (FDA) for ovarian cancer treatment. These are platinum-
based therapies and women needing further rounds of treatment are
frequently resistant to them. More than 70 percent of ovarian cancer
patients will have a recurrence at some point, underlying the need for
treatments to which patients do not grow resistant.
For all of these reasons, we urgently call on Congress to
appropriate funds to find solutions.
As part of this effort, the Alliance advocates for continued
Federal investment in the Centers for Disease Control and Prevention's
(CDC) Ovarian Cancer Control Initiative. The Alliance respectfully
requests that Congress provide $10 million for the program in fiscal
year 2012.
The Alliance also fully supports Congress in taking action on
educating Americans about ovarian cancer through providing funding for
The Gynecologic Cancer Education and Awareness Act (Johanna's Law)
[Public Law 111-324]. The Alliance respectfully requests that Congress
provide $10 million to implement The Gynecologic Cancer Education and
Awareness Act (Johanna's Law) in fiscal year 2012.
Further, the Alliance urges Congress to continue funding the
Specialized Programs of Research Excellence (SPOREs), including the
five ovarian cancer sites. These programs are administered through the
National Cancer Institute (NCI) of the National Institutes of Health
(NIH). The Alliance respectfully requests that Congress provide $5.74
billion to the National Cancer Institute for fiscal year 2012.
centers for disease control and prevention
the ovarian cancer control initiative
As the statistics indicate, late detection and, therefore, poor
survival are among the most urgent challenges we face in the ovarian
cancer field. 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.
Congress established the Ovarian Cancer Control Initiative at the
CDC in November 1999 with bipartisan, bicameral support. 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.
The CDC's Ovarian Cancer Control Initiative conducts research about
early detection, treatment and survivorship nationwide to increase
understanding of ovarian cancer. Some of the Ovarian Cancer Control
Initiative's notable studies include: a study of women who died of
ovarian cancer within three managed care organizations to investigate
end-of-life care; the Ovarian Cancer Treatment Patterns and Outcomes
study, which attempted to determined how the stage of cancer, the
specialty of a surgeon and the success of the surgery contributed to
the survival of ovarian cancer patients diagnosed between 1997 and
2000; and a study to examine geographic access to subspecialists for
treating ovarian cancer.
the gynecologic cancer education and awareness act (johanna's law)
It is critical for women and their healthcare providers to be aware
of the signs, symptoms and risk factors of ovarian and other
gynecologic cancers. Often, women and providers mistakenly confuse
ovarian cancer signs and symptoms with those of gastrointestinal
disorders or early menopause. While symptoms may seem vague--bloating,
pelvic or abdominal pain, increased abdominal size and bloating and
difficulty, eating or feeling full quickly, or urinary symptoms
(urgency or frequency)--the underlying disease can be deadly without
proper medical intervention.
In recognition of the need for awareness and education, Congress
unanimously passed Johanna's Law in 2006, enacted in early 2007. This
law provides for an education and awareness campaign that will increase
providers' and women's awareness of all gynecologic cancers including
ovarian. Johanna's Law was reauthorized in 2010.
Thanks to funding under Johanna's Law, more women are learning how
to identify the signs and symptoms of gynecologic. From September 2010
to January 2011, the broadcast PSAs have been played 68,630 times,
generating 154,632,815 audience impressions (the number of times they
have been seen or heard), worth $7,491,846 in donated placements.
Additionally, since October 2010:
--there have been 25,706 plays of the TV PSAS, worth $2,800,805 in
donated airtime,
--there have been 9,701 plays of English TV spots,
--there have been 16,005 plays of Spanish TV spots,
--the PSAs have aired in the top markets, including Los Angeles,
Chicago, Philadelphia, San Francisco, Boston, Dallas/Fort
Worth, Atlanta, Tampa/St. Petersburg, Pittsburgh, PA, Salt Lake
City, Raleigh/Durham, Green Bay, Baltimore, Tucson, Cleveland,
Phoenix, Tulsa, Orlando, Hartford/New Haven, Houston, Spokane,
and Seattle/Tacoma, among others, and
--English spots have aired during popular programs such Today, Good
Morning America, CBS Morning News, Access Hollywood, Cold Case,
Real Housewives of Orange County, The Bachelor, The View, Dr.
Oz Show, Ellen DeGeneres Show, The Doctors, Entertainment
Tonight, and Late Night with David Letterman during the hours
of 8 a.m. to midnight.
With continued funding, the CDC will be able to continue to print
and distribute brochures, maintain and update the web resources,
develop additional educational materials such as posters for physician
offices, complete continuing education materials for healthcare
providers, and reach out to women beyond the original 40-60 year-old
initial target group.
cdc chronic disease program consolidation
The President's budget proposal for fiscal year 2012 recommends
consolidating all of the Centers for Disease Control and Prevention's
(CDC) chronic disease programs that are focused on heart disease and
stroke, diabetes, cancer, arthritis, nutrition, and other health-
related issues into one competitive grant program. It is our
understanding that the Gynecologic Cancer Education and Awareness Act
(Johanna's Law) and the Ovarian Cancer Control Initiative would be
included in this all-encompassing competitive grant program. These
programs, with congressional support, have been able to increase
understanding and raise awareness of ovarian and other women's cancers
that afflict Americans.
While we support efforts to improve the efficiency of Federal
programs, we oppose shifting control and funding of these programs away
from Congress. Moreover, given that ovarian cancer mortality rates have
remained virtually unchanged for decades and currently there is no
early detection test for the disease, we feel strongly that the CDC
should maintain dedicated efforts focused on reducing ovarian cancer
mortality and morbidity. As such, we recommend that Johanna's Law and
the Ovarian Cancer Control Initiative remain standalone line items in
the fiscal year 2012 Labor, Health and Human Services, and Education
(LHHS) appropriations bill.
national cancer institute
The National Cancer Institute is the chief funder of ovarian cancer
research in the United States and the world. In 2009, the National
Cancer Institute funded over 170 studies solely dedicated to bettering
our scientific understanding of ovarian cancer. These studies
investigated diverse topics such as the effect of Vitamin D on ovarian
cancer prevention and treatment, whether Prolactin is a risk biomarker
of ovarian cancer, and whether viruses can be converted into ovarian
cancer-fighting agents. Research investigators who receive funding from
the National Cancer Institute study cancer are located all across the
United States. According to Families USA, every dollar in Federal
research spending generates about $2 in economic activity in local
economies where funded projects are located.
specialized programs of research excellence in the national institutes
of health
The Specialized Programs of Research Excellence were created by the
NCI in 1992 to support translational, organ site-focused cancer
research. The ovarian cancer SPOREs began in 1999. There are five
currently funded Ovarian Cancer SPOREs located at the MD Anderson
Cancer Center, the Fred Hutchinson Cancer Research Center, the Fox
Chase Cancer Center, the Dana Farber/Harvard Cancer Center and the Mayo
Clinic Cancer Center.
These SPORE programs have made outstanding strides in understanding
ovarian cancer, as illustrated by their more than 300 publications as
well as other notable achievements, including the development of an
infrastructure between Ovarian SPORE institutions to facilitate
collaborative studies on understanding, early detection and treatment
of ovarian cancer.
clinical trials
The National Cancer Institute supports clinical research--the only
way to test the safety and efficacy of potential new treatments for
ovarian cancer. An example of NCI-funded clinical research is a new 5-
year study addressing the lack of knowledge about causes and risk
factors for ovarian cancer in African American women conducted by
University Hospitals Case Medical Center and Case Western Reserve
University School of Medicine. Another study funded by the National
Cancer Institute compared the efficacy and safety of a dose-dense
regimen of single-agent cisplatin with a standard 3-weekly schedule in
first-line chemotherapy for advanced epithelial ovarian cancer. The
study found that increasing dose intensity of cisplatin does not
improve PFS or OS compared with standard chemotherapy.
NCI supports the Gynecology Oncology Group, a more than 50-member
collaborative focusing on cancers of the female reproductive system.
From 2008 until present, the GOG has published 103 articles about
ovarian cancer. An important and recent finding from the GOG, the GOG
218 study, was that women with advanced cancer who received
chemotherapy followed by maintenance use of Avastin increased survival
time without their disease worsening compared to chemotherapy alone.
summary
The Alliance maintains a long-standing commitment to work with
Congress, the administration, and other policy makers and stakeholders
to improve the survival rate for women with ovarian cancer through
education, public policy, research and communication. Please know 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. We request your support for our
appropriations requests for fiscal year 2012 that include $10 million
for the CDC's Ovarian Cancer Control Initiative, $10 million for The
Gynecologic Cancer Education and Awareness Act (Johanna's Law) and
$5.74 billion to NCI.
______
Prepared Statement of the Pancreatic Cancer Action Network
Mr. Chairman and members of the Subcommittee: My name is Julie
Fleshman and I am submitting this testimony on behalf of the Pancreatic
Cancer Action Network.
Founded in 1999, the Pancreatic Cancer Action Network is a
nationwide network of individuals dedicated to advancing research,
supporting patients and fostering hope for the families and loved ones
affected by this disease.
Pancreatic cancer continues to be one of the deadliest cancers in
this country. In fact, it is the only cancer tracked by both the
American Cancer Society and the National Cancer Institute (NCI) that
still has a 5-year survival rate in the single digits. This is even
more astounding because the overall 5-year survival rate for all
cancers was 50 percent in the 1970s and is now 68 percent. Last year,
pancreatic cancer struck more than 43,000 Americans and resulted in
36,800 deaths. The similarity of these statistics underscores its
deadliness: indeed, most patients die within months of their diagnosis.
There is no question that we have made important progress in many
forms of cancer. There is also no question that this progress has been
lacking in pancreatic cancer. The fact remains that there are still no
early detection tools or effective treatments. A patient diagnosed
today generally hears the same words as a patient diagnosed 40 years
ago, ``I'm sorry, but there is not much that we can do for you. Go home
and get your affairs in order.'' The Pancreatic Cancer Action Network
believes that the time has come for bold action and has launched a new
mission to double the 5-year survival rate by 2020. This is an
ambitious but achievable goal.
Dismal as the picture is today, unless something is done soon, it
will only get worse. A recently published study in the Journal of
Clinical Oncology predicts that the number of new pancreatic cancer
cases will increase by 55 percent over the next two decades.
Why has there been so little change in the mortality rate
associated with pancreatic--and what can be done about it?
Progress has been slow in large part because the Federal
Government's investment in pancreatic cancer research has been weak.
The Pancreatic Cancer Action Network recently published a report,
``Pancreatic Cancer: A trickle of Federal funding for a river of
need'', analyzing the investment made by the NCI into this disease. The
analysis shows that pancreatic cancer is behind in nearly every
important grant category funded by the Federal Government.
--Currently, research dedicated to pancreatic cancer receives a mere
2 percent of the Federal dollars distributed by the NCI. By
contrast, the other four of the top five cancer killers in the
United States (lung, colon, breast and prostate cancer)
received 2.8 to 6.3 fold more NCI funding in 2009 than
pancreatic cancer.
--The average dollar amount of basic research (R) grants in
pancreatic cancer was 18 to 29 percent less than R grants for
the other four top cancer killers. The R grant mechanisms are
the mainstay of scientific discovery in cancer research.
--Training grant funding in pancreatic cancer decreased by 15 percent
from 2008 to 2009, a decline larger than in any other leading
cancer. Pancreatic cancer trainees were awarded between 2.4 and
6.5 fold less grant money in 2009 than young researchers
studying the other four top cancer killers.
--American Recovery & Reinvestment Act (ARRA) funding represented a
unique opportunity for the NCI to direct research monies toward
the deadliest cancers, including pancreatic cancer.
Unfortunately, this opportunity was missed, as pancreatic
cancer research received only slightly more than 1 percent of
the NCI ARRA budget.
As has been noted by this Subcommittee and others in Congress in
recent years, what is lacking is a well-defined, long-term
comprehensive strategic plan in place to: advance the understanding of
the biology of pancreatic cancer, examine its natural history and the
genetic and environmental factors that contribute to its development;
expand research on ways to screen and detect pancreatic cancer in much
earlier stages; and launch innovative clinical trials to test targeted
therapeutics and novel agents that will extend the survival and improve
the quality of life of patients.
In addition, there must be a robust and sustained commitment of
resources by the NCI and its sister institutes and centers at the
National Institutes of Health (NIH).
Thanks to you and your colleagues, Mr. Chairman, and under the
leadership of Dr. Harold Varmus, NCI has taken some encouraging steps
in the right direction.
In 2010 NCI convened an internal group to develop an action plan
for pancreatic cancer research and training. NCI brought together
pancreatic cancer researchers and program staff from within the
Institute to form the Pancreatic Cancer Action Planning Group, charged
with developing an Action Plan that summarizes the fiscal year 2011
research and training portfolio and identifies research gaps and
opportunities for collaboration within NCI and with other members of
the National Cancer Program, including advocacy groups, academia, and
industry. This Action Plan was developed based on discussions at a
Planning Group meeting held in July 2010 and continued interactions
following the meeting. While it was not the long-term comprehensive
strategic plan that we would still like to see the NCI develop for
pancreatic cancer, we do believe that it was a good first step.
In addition to the initiatives and activities already included in
the fiscal year 2011 portfolio, the Planning Group identified several
opportunities for NCI to advance pancreatic cancer research. Emphasis
was placed on activities with a high likelihood of improving survival
rates, which have remained low despite improvements in many other
cancer types. It was recognized that given the range of research
conducted within and funded by NCI, the Institute is uniquely poised to
support activities and provide services that other stakeholders are
unable or unwilling to do. The Planning Group identified several
opportunities for collaboration with advocacy organizations and the
private sector to gain momentum in pancreatic cancer research.
The Action Plan reviewed the research activities that were planned
for fiscal year 2011. We look forward to hearing from the NCI about the
outcome of these plans. It also identified a few potential new
initiatives such as a program announcement for R01 grants focused on
pancreatic cancer. We strongly believe that a program announcement
would be a positive step in the right direction and would urge you to
find ways to encourage NCI to implement this idea. We hope to have the
opportunity to work with NCI to implement the steps outlined in the
plan.
Some ideas that emerged--such as promoting interaction and
increased use of existing resources--will likely involve only modest
financial investment, while others, like new program announcements,
will require more resources. We therefore join with our colleagues in
the One Voice Against Cancer (OVAC) coalition in highlighting the
important role that NCI plays in our economy and in cancer research
worldwide and ask this Committee to do everything in its power to safe-
guard and expand this important resource.
Mr. Chairman, research is the only hope. We ask that you strongly
urge the National Cancer Institute to put in place a long-term
comprehensive strategic plan for pancreatic cancer research and ensure
that there is funding available to implement that plan.
Thank you.
______
Prepared Statement of the Physician Assistant Education Association
On behalf of its membership, the 156 accredited physician assistant
(PA) education programs in the United States, the Physician Assistant
Education Association (PAEA) is pleased to submit these comments on the
fiscal year 2012 appropriations for PA education programs that are
authorized through Title VII of the Public Health Service Act.
PAEA is a member of the Health Professions and Nursing Education
Coalition (HPNEC) and we support the HPNEC recommendation for funding
of at least $762.5 million in fiscal year 2012 for the health
professions education programs authorized under Title VII and VIII of
the Public Health Service Act and administered through the Health
Resources and Services Administration (HRSA). HPNEC is an informal
alliance of more than 60 national organizations representing schools,
programs, health professionals, and students and dedicated to ensuring
that the healthcare workforce is trained to meet the needs of the
country's growing, aging, and diverse population.
Need for Increased Federal Funding
Faculty development is one of the profession's critical needs. In
order to attract the best qualified to teaching, PA education programs
must have the resources to train faculty in academic skills, such as
curriculum development, teaching methods, and laboratory instruction.
The challenges of teaching are broad and varied and include
understanding different pedagogical theories, writing instructional
objectives, and learning and applying educational technology. Most
educators come from clinical practice and these skills are essential to
transitioning to teaching. Educators are a critical element of meeting
the Nation's demand for an increased supply of primary care clinicians.
Generalist training, workforce diversity, and practice in
underserved areas are key priorities identified by HRSA. It is
increasingly important that the health workforce better represents
America's changing demographics, as well as addresses the issues of
disparities in healthcare. PA programs have been successful in
attracting students from underrepresented minority groups and
disadvantaged backgrounds. Studies have found that health professionals
from underserved areas are three to five times more likely to return to
underserved areas to provide care.
Physician Assistant Practice
Physician assistants (PAs) are licensed health professionals who
practice medicine as members of a team with their supervising
physicians. PAs exercise autonomy in medical decisionmaking and provide
a broad range of medical and therapeutic services to diverse
populations in rural and urban settings. In all 50 States, PAs carry
out physician-delegated duties that are allowed by law and within the
physician's scope of practice and the PA's training and experience.
Additionally, PAs are delegated prescriptive privileges by their
physician supervisors in all 50 States, the District of Columbia, and
Guam. This allows PAs to practice in rural, medically underserved areas
where they are often the only full-time medical provider.
Physician Assistant Education
There are currently 156 accredited PA education programs in the
United States--a growth of 22 percent in less than 5 years; together
these programs graduate nearly 6,000 PA students each year. PAs are
educated as generalists in medicine; their flexibility allows them to
practice in more than 60 medical and surgical specialties. More than
one-third of PA program graduates practice in primary care.
The average PA education program is 27 months in length. Typically,
1 year is devoted to classroom study and approximately 15 months is
devoted to clinical rotations. The typical curriculum includes 400
hours of basic sciences and nearly 600 hours of clinical medicine.
As of today, approximately 20 programs are in the pipeline at
various stages of development, moving toward accredited status. The
growth rate in the applicant pool is even more remarkable. In March
2006, there were a total of 7,608 applicants to PA education programs;
as of March 2011, there were 16,112 applicants to PA education
programs. This represents a 112 percent increase in Centralized
Application Service (CASPA) applicants over the past 5 years.
The PA profession is expected to continue to grow as a result of
the projected shortage of physicians and other healthcare
professionals, the growing demand for professionals from an aging
population, and the continuing strong PA applicant pool, which has
grown by more than 10 percent each year since the year 2000. The Bureau
of Labor Statistics projects a 39 percent increase in the number of PA
jobs between 2008 and 2018. With its relatively short initial training
time and the flexibility of generalist-trained PAs, the PA profession
is well-positioned to help fill projected shortages in the numbers of
healthcare professionals.
The continued growth of the profession heightens the need for
additional resources to help meet the challenges of recruiting
qualified faculty, shortages of preceptors and clinical sites, and
increasing the diversity of faculty and program applicants.
Title VII Funding
Title VII funding is the only opportunity for PA programs to apply
for Federal funding and plays a crucial role in developing and
supporting PA education programs.
Title VII funding fills a critical need for curriculum development
and faculty development. Funding enhances clinical training and
education, assists PA programs with recruiting applicants from minority
and disadvantaged backgrounds, and funds innovative programs that focus
on educating a culturally competent workforce. Title VII funding
increases the likelihood that PA students will practice in medically
underserved communities with health professional shortages. The absence
of this funding would result in the loss of care to patients in
underserved areas.
Title VII support for PA programs has been strengthened with the
enactment of the Patient Protection and Affordable Health Care Act
(Public Law 111-148), which provides a 15 percent carve out in the
appropriations process for PA programs. This funding will enhance
capabilities to train a growing PA workforce and is likely to increase
the pool for faculty positions as a result of PA programs now being
eligible for faculty loan repayment. Huge loan burdens serve as
barriers for physician assistant entry into academia.
Here we provide several examples of how PA programs have used Title
VII funds to creatively expand care to underserved areas and
populations, as well as to develop a diverse PA workforce.
--One Texas program has used its PA training grant to support the
program at a distant site in an underserved area. This grant
provides assistance to the program for recruiting, educating,
and training PA students in the largely Hispanic South Texas
and mid-Texas/Mexico border areas and supports new faculty
development.
--A Utah program has used its PA training grant to promote
interprofessional teams--an area of strong emphasis in the
Patient Protection and Affordable Care Act. The grant allowed
the program to optimize its relationship with three service-
learning partners, develop new partnerships with three service-
learning sites, and create a model geriatric curriculum that
includes didactic and clinical education.
--An Alabama program used its PA training grant to update and expand
the current health behavior educational curriculum and HIV/STD
training. They were also able to include PA students from other
programs who were interested in rural, primary care medicine
for a 4-week comprehensive educational program in HIV disease
diagnosis and management.
--A South Carolina program has developed a model program that offers
a 2-year academic fellowship for recent PA graduates with at
least one year of clinical experience. To further enhance an
evidence-based approach to education and practice, two specific
evidence-based practice projects were embedded in the
fellowship experience. Fellows direct and evaluate PA students'
involvement in the ``Towards No Tobacco'' curriculum, aimed at
fifth graders, and the PDA Patient Data experience, aimed at
assessing healthcare services.
Recommendations on fiscal year 2012 Funding
The Physician Assistant Education Association requests the
Appropriations Committee to support funding for Title VII and VIII
health professions programs at a minimum of $762.5 million for fiscal
year 2012. This level of funding is crucial to support the Nation's
demand for primary care practitioners, particularly those who will
practice in medically underserved areas and serve vulnerable
populations. Additionally we encourage support for the new programs and
responsibilities contained in the Patient Protection and Affordable
Care Act (Public Law 111-148), including a minimum of $10 million to
support PA education programs. We thank the members of the subcommittee
for their support of the health professions and look forward to your
continued support of solutions to the Nation's health workforce
shortage. We appreciate the opportunity to present the Physician
Assistant Education Association's fiscal year 2012 funding
recommendation.
______
Prepared Statement of PolicyLink, The Food Trust, and The Reinvestment
Fund
Chairman and distinguished Senators of the Committee, thank you for
the opportunity to share our support for a Healthy Food Financing
Initiative (HFFI). PolicyLink is a national research and action
institute advancing economic and social equity by Lifting Up What
Works; The Food Trust is a nonprofit organization working to ensure
that everyone has access to affordable, nutritious food; and The
Reinvestment Fund is a Community Development Financial Institution that
creates wealth and opportunity for low-wealth people and places through
the promotion of socially and environmentally responsible development.
Our three organizations, along with a diverse coalition of
stakeholders, which includes representatives from the grocery industry,
health, civil rights, agriculture and the community development finance
community, support the creation of HFFI to address the problem of
``food deserts'' in urban and rural areas across the Nation. This
problem can be solved in many communities using a successful model that
is underway in the State of Pennsylvania and is now being replicated
throughout the country.
HFFI is a program worthy of investment as it promotes health,
creates jobs and sparks economic development. HFFI will provide loan
and grant financing to attract grocery stores and other fresh food
retail to underserved urban, suburban, and rural areas, and renovate
and expand existing stores so they can provide the healthy foods that
communities want and need. Over time, with continued investment, HFFI
could solve the problem of food deserts in urban and rural communities
across the country.
For decades, low-income communities, particularly communities of
color, have suffered from a lack of access to healthy, fresh food. USDA
research determined that more than 23.5 million Americans are living in
communities without access to high-quality, fresh food. Studies
repeatedly show that residents of many low-income neighborhoods must
travel long distances for healthy food, or rely on corner stores and
fast food outlets offering high fat, high sugar foods. For instance, a
recent multistate study found that low-income census tracts had half as
many supermarkets as wealthy tracts, and four times as many smaller
grocery stores. Another multistate study found that 8 percent of
African Americans live in a tract with a supermarket, compared to 31
percent of whites. Nationally, low-income zip codes have 30 percent
more convenience stores, which tend to lack healthy food, than middle
income zip codes.
And, a nationwide analysis found there are 418 rural food desert
counties where all residents live more than 10 miles from a supermarket
or a supercenter--this is 20 percent of rural counties. In rural
communities, inadequate transportation can be a particular challenge.
In Mississippi, which has the highest obesity rate of any State, over
70 percent of food stamp eligible households travel more than 30 miles
to reach a supermarket. Adults living in rural Mississippi food desert
counties are 23 percent less likely to consume the recommended fruits
and vegetables than those in counties that have supermarkets,
controlling for age, sex, race, and education.
Controlling for population density, rural areas have fewer food
retailers of any types compared to urban areas, and only 14 percent the
number of chain supermarkets. For instance, in New Mexico, rural
residents have access to fewer grocery stores than urban residents, pay
more for comparable items, and have less selection. The same market
basket of groceries costs $85 for rural residents versus $55 for urban
residents.
The results of this lack of healthy food options are grim--these
communities have significantly higher rates of obesity, diabetes, and
other related health issues. Over the past decade, obesity rates have
more than doubled in children and tripled in adolescents. In 2010,
PolicyLink and The Food Trust conducted a review of more than 130
studies on the issue of access to healthy food and found a direct
correlation between diet-related diseases and access. A California
study found that obesity and diabetes rates were 20 percent higher for
those living in the least healthy ``food environments.'' In
Indianapolis, a study found that BMI values corresponded with access to
supermarkets and fast food restaurants. Researchers estimated that
adding a new grocery store to a high poverty neighborhood translates
into a 3 pound weight decrease.
Fortunately, changing access changes eating habits. For every
additional supermarket in a census tract, produce consumption increases
32 percent for African Americans and 11 percent for whites, according
to a multistate study. A survey of produce availability in New Orleans'
small neighborhood stores found that for each additional meter of shelf
space devoted to fresh vegetables, residents eat an additional .35
servings per day. In fact, of 14 studies that examine food access and
consumption of healthy foods, all but one of them found a correlation
between greater access and better eating behaviors. This is also true
for food stamp recipients. Proximity to a supermarket was found to be
associated with increased fruit and vegetable consumption.
The problems associated with lack of access go beyond health. Low-
income communities are cut off from all the economic development
benefits that come with a local grocery store: the creation of steady
jobs at decent wages and the sparking of complementary retail stores
and services nearby. Grocery stores operate as important economic
anchors for communities, providing a vital service and bringing
customers that can also support other nearby business. Securing new or
improved local grocery stores can improve local economies and create
jobs.
President Barack Obama's proposed fiscal year 2012 budget includes
a proposal to invest $330 million, including $250 million in New
Markets Tax Credits, in a national HFFI. Specifically, the initiative
would provide:
--$35 million through USDA's Office of the Secretary, with additional
``other funds of Rural Development and the Agricultural
Marketing Service available to support the USDA's portion of
the Healthy Food Financing Initiative'';
--$25 million through the Treasury Department's CDFI Fund;
--$20 million through Health and Human Services; and
--$250 million through the Treasury Department's New Markets Tax
Credits Program.
A Healthy Food Financing Initiative would attract investment in
underserved communities by providing critical loan and grant financing.
These one-time resources will help fresh food retailers overcome the
higher initial barriers to entry into underserved, low-income urban and
rural communities, and would also support renovation and expansion of
existing stores so they can provide the healthy foods that communities
want and need. The program would be flexible and comprehensive enough
to support innovations in healthy food retailing and to assist
retailers with different aspects of the store development and
renovation process.
Grocery industry representatives find that there are obstacles to
grocery store development in underserved low-income communities, but
also that those obstacles can be overcome. The development process for
building a new grocery store is lengthy and complex, and retailers
often find that stores in low-income communities have high start-up
costs, appropriate sites are hard to find, and securing financing is
difficult. Grocery operators in both urban and rural areas cite lack of
access to flexible financing as one of the top barriers hindering the
development of stores in underserved areas.
HFFI is modeled after the successful Pennsylvania Fresh Food
Financing Initiative (FFFI), a public/private partnership launched in
2004. Using a State investment of $30 million, the program has led to:
--projects totaling more than $190 million;
--88 stores built or renovated in underserved communities in urban
and rural areas across the State;
--improved access to healthy food for more than 400,000 residents;
--more than 5,000 jobs created or retained;
--increased local tax revenues; and
--much-needed additional economic development in these communities.
Stores range from full-service 70,000 square foot supermarkets to
900 square food shops; and from traditional grocery stores to farmers'
markets, cooperatives, and corner stores selling healthy food.
Approximately two-thirds of the projects were in rural areas and small
towns with the remainder in urban areas.
HFFI is a viable, effective, and economically sustainable solution
to the problem of limited access to healthy foods. It can bring triple
bottomline benefits, achieving multiple goals: reducing health
disparities and improving the health of families and children; creating
jobs; and, stimulating local economic development in low-income
communities.
HFFI would incorporate the key components that allowed the
Pennsylvania program to be so effective at attracting private dollars,
garnering the commitment of store operators, getting fresh food retail
stores and markets successfully developed, and stimulating local
economies.
The Pennsylvania FFFI has been cited as an innovative model by the
U.S. Centers for Disease Control and Prevention, the National
Conference of State Legislatures, Harvard's Kennedy School of
Government, and the National Governors Association. There is
significant momentum in many States and cities across the country to
address the lack of grocery access in underserved communities. Several
States and/or cities are in the process of replicating the successful
Pennsylvania Fresh Food Financing Initiative Program, and many others
have begun to examine the needs and opportunities in their communities.
For example:
--The State of New York has launched the Healthy Food, Healthy
Communities Initiative, a business financing program to
encourage supermarket and other fresh food retail investment in
underserved areas throughout the State that will provide loans
and grants to eligible projects. New York City has launched a
complementary FRESH program that will encourage supermarket
development through tax and zoning incentives and a single
point of access to city government for supermarket operators.
--The City of New Orleans recently launched the Fresh Food Retailer
Initiative Program (FFRI) that will provide direct financial
assistance to retail businesses by awarding forgivable and/or
low-interest loans to grocery stores and other fresh food
retailers.
--The California Endowment, NCB Capital Impact, and other community,
supermarket industry, and government partners have been working
to create a supermarket financing program in California that is
expected to be launched in the first half of 2011.
A national Healthy Food Financing Initiative could amplify the
impact in each of these States and leverage the work already underway
to ensure swift implementation. Moreover, a national HFFI would insure
that all State and communities could solve their food desert problems
with new stores and other healthy food retail projects.
In the midst of our current economic downturn, the need for a
comprehensive Federal policy to address the lack of fresh food access
in low-income is critical. We urge the Committee to support full
funding for a Healthy Food Financing Initiative, for the benefit of
communities across the Nation. Thank you for the opportunity to share
our perspectives with you today. If you should need additional
information about HFFI please contact Judith Bell from PolicyLink
([email protected]), Pat Smith from The Reinvestment Fund
([email protected]), or John Weidman from The Food Trust
([email protected])
______
Prepared Statement of the Population Association of America/Association
of Population Centers
Background on the PAA/APC and Demographic Research
The Population Association of America (PAA) is a scientific
organization comprised of over 3,000 population research professionals,
including demographers, sociologists, statisticians, and economists.
The Association of Population Centers (APC) is a similar organization
comprised of over 40 universities and research groups that foster
collaborative demographic research and data sharing, translate basic
population research for policy makers, and provide educational and
training opportunities in population studies. Population research
centers are located at public and private research institutions
nationwide.
Demography is the study of populations and how or why they change.
Demographers, as well as other population researchers, collect and
analyze data on trends in births, deaths, and disabilities as well as
racial, ethnic, and socioeconomic changes in populations. Major policy
issues population researchers are studying include the demographic
causes and consequences of population aging, trends in fertility,
marriage, and divorce and their effects on the health and well being of
children, and immigration and migration and how changes in these
patterns affect the ethnic and cultural diversity of our population and
the Nation's health and environment.
The NIH mission is to support research that will improve the health
of our population. The health of our population is fundamentally
intertwined with the demography of our population. Recognizing the
connection between health and demography, the NIH supports extramural
population research programs primarily through the National Institute
on Aging (NIA) and the National Institute of Child Health and Human
Development (NICHD).
National Institute on Aging
According to the Census Bureau, by 2029, all of the baby boomers
(those born between 1946 and 1964) will be age 65 years and over. As a
result, the population age 65-74 years will increase from 6 percent to
10 percent of the total population between 2005 and 2030. This
substantial growth in the older population is driving policymakers to
consider dramatic changes in Federal entitlement programs, such as
Medicare and Social Security, and other budgetary changes that could
affect programs serving the elderly. To inform this debate,
policymakers need objective, reliable data about the antecedents and
impact of changing social, demographic, economic, and health
characteristics of the older population. The NIA Division of Behavioral
and Social Research (BSR) is the primary source of Federal support for
research on these topics.
In addition to supporting an impressive research portfolio, that
includes the prestigious Centers of Demography of Aging and Roybal
Centers for Applied Gerontology Programs, the NIA BSR program also
supports several large, accessible data surveys. One of these surveys,
the Health and Retirement Study (HRS), has become one of the seminal
sources of information to assess the health and socioeconomic status of
older people in the United States. Since 1992, the HRS has tracked
27,000 people, providing data on a number of issues, including the role
families play in the provision of resources to needy elderly and the
economic and health consequences of a spouse's death. HRS is
particularly valuable because its longitudinal design allows
researchers: (1) the ability to immediately study the impact of
important policy changes such as Medicare Part D; and (2) the
opportunity to gain insight into future health-related policy issues
that may be on the horizon, such as HRS data indicating an increase in
pre-retirees self-reported rates of disability. In August 2011, HRS
will release genotyping data, enhancing the ability of researchers to
track the onset and progression of diseases and conditions affecting
the elderly.
Currently, the NIA is paying grant applications requesting less
than $500,000 in direct costs through the 11th percentile, while grants
seeking $500,000 or more are being paid through the 8th percentile--
making it one of the lowest paylines at NIH. As research costs
increase, NIA faces the prospect of funding fewer grants to sustain
larger ones in its commitment base. With additional support in fiscal
year 2012, the NIA BSR program could fully fund its large-scale
projects, including the existing centers programs and ongoing surveys,
without resorting to cost cutting measures, such as cutting sample
size, while continuing to support smaller investigator initiated
projects
Eunice Kennedy Shriver National Institute on Child Health and Human
Development
Since its establishment in 1968, the Eunice Kennedy Shriver NICHD
Center for Population Research has supported research on population
processes and change. Today, this research is housed in the Center's
Demographic and Behavioral Sciences Branch (DBSB). The Branch
encompasses research in four broad areas: family and fertility,
mortality and health, migration and population distribution, and
population composition. In addition to funding research projects in
these areas, DBSB also supports a highly regarded population research
infrastructure program and a number of large database studies,
including the National Longitudinal Study of Adolescent Health (Add
Health), Panel Study of Income Dynamics, and National Longitundinal
Study of Youth.
NIH-funded demographic research has consistently provided critical
scientific knowledge on issues of greatest consequence for American
families: work-family conflicts, marriage and childbearing, childcare,
and family and household behavior. However, in the realm of public
health, demographic research is having an even larger impact,
particularly on issues regarding adolescent and minority health.
Understanding the role of marriage and stable families in the health
and development of children is another major focus of the NICHD DBSB.
Consistently, research has shown children raised in stable family
environments have positive health and development outcomes.
Policymakers and community programs can use these findings to support
unstable families and improve the health and well being of children.
One of the most important programs the NICHD DBSB supports is the
Population Research Infrastructure Program (PRIP). Through PRIP,
research is conducted at private and public research institutions
nationwide. The primary goal of PRIP is ``to facilitate
interdisciplinary collaboration and innovation in population research,
while providing essential and cost-effective resources in support of
the development, conduct, and translation of population research.''
Population research centers supported by PRIP are focal points for the
demographic research field where innovative research and training
activities occur and resources, including large-scale databases, are
developed and maintained for widespread use.
With additional support in fiscal year 2012, NICHD could sustain
full funding to its large-scale surveys, which serve as a resource for
researchers nationwide. Furthermore, the Institute could apply
additional resources toward improving its funding payline, which has
fallen from the 13th percentile in fiscal year 2010 to the 11th
percentile in fiscal year 2011. Additional support could be used to
support and stabilize essential training and career development
programs necessary to prepare the next generation of researchers and to
support and expand proven programs, such as PRIP.
National Center for Health Statistics
Located within the Centers for Disease Control (CDC), the National
Center for Health Statistics (NCHS) is the Nation's principal health
statistics agency, providing data on the health of the U.S. population
and backing essential data collection activities. Most notably, NCHS
funds and manages the National Vital Statistics System, which contracts
with the States to collect birth and death certificate information.
NCHS also funds a number of complex large surveys to help policy
makers, public health officials, and researchers understand the
population's health, influences on health, and health outcomes. These
surveys include the National Health and Nutrition Examination Survey
(NHANES), National Health Interview Survey (HIS), and National Survey
of Family Growth. Together, NCHS programs provide credible data
necessary to answer basic questions about the state of our Nation's
health.
Despite recent steady funding increases, NCHS continues to feel the
effects of long-term funding shortfalls, compelling the agency to
undermine, eliminate, or further postpone the collection of vital
health data. For example, in 2009, sample sizes in HIS and NHANES were
cut, while other surveys, most notably the National Hospital Discharge
Survey, were not fielded. In 2009, NCHS proposed purchasing only ``core
items'' of vital birth and death statistics from the States (starting
in 2010), effectively eliminating three-fourths of data routinely used
to monitor maternal and infant health and contributing causes of death.
Fortunately, Congress and the new Administration worked together to
give NCHS adequate resources and avert implementation of these
draconian measures. Nonetheless, the agency continues to operate in a
precarious state.
The Administration recommends NCHS receive $161.9 million in fiscal
year 2011; however, ultimately, the agency received $23.2 million less
than the Administration requested. This reduced amount has postponed
important initiatives to, for example, re-engineer collection of the
Nation's vital statistics, using standard birth and death certificate
items.
PAA and APC, as members of The Friends of NCHS, support the
Administration's request for fiscal year 2012, $162 million, in hopes
many initiatives proposed by the Administration in fiscal year 2011 can
proceed, including an effort to fully support electronic birth records
in all 50 States.
Bureau of Labor Statistics
During these turbulent economic times, data produced by the Bureau
of Labor Statistics (BLS) are particularly relevant and valued. PAA and
APC members have relied historically on objective, accurate data from
the BLS. In recent years, our organizations have become increasingly
concerned about the state of the agency's funding.
We are pleased the Administration has requested BLS receive a total
of $647 million in fiscal year 2012. According to the agency, this
funding level would enable BLS, for example, to add the Contingent Work
Supplement to the Current Population Survey, making more data available
on changing workplace arrangements and continue its work on developing
an alternative poverty measure.
Summary of fiscal year 2012 Recommendations
In sum, the PAA and APC support the Administration's fiscal year
2012 request for the National Institutes of Health, National Center for
Health Statistics and the Bureau of Labor Statistics. With respect to
the NIH, however, we support the Administration's request as a floor
and encourage the Subcommittee to consider providing the NIH with
funding as high as $35 billion. This amount, endorsed by the Ad Hoc
Group for Medical Research, reflects not only inflation, but also the
additional investment needed to sustain the new research capacity
created by the American Recovery and Reinvestment Act.
Thank you for considering our requests and for supporting Federal
programs that benefit the population sciences.
______
Prepared Statement of Prevent Blindness America
funding request overview
Prevent Blindness America appreciates the opportunity to submit
written testimony for the record regarding fiscal year 2012 funding for
vision and eye health related programs. As the Nation's leading
nonprofit, voluntary health organization dedicated to preventing
blindness and preserving sight, Prevent Blindness America maintains a
long-standing commitment to working with policymakers at all levels of
government, organizations and individuals in the eye care and vision
loss community, and other interested stakeholders to develop, advance,
and implement policies and programs that prevent blindness and preserve
sight. Prevent Blindness America respectfully requests that the
Subcommittee provide the following allocations in fiscal year 2012 to
help promote eye health and prevent eye disease and vision loss:
--Provide at least $3.23 million to maintain vision and eye health
efforts at the Centers for Disease Control and Prevention
(CDC).
--Support the Maternal and Child Health Bureau's (MCHB) National
Center for Children's Vision and Eye Health (Center).
--Provide additional resources for the National Eye Institute (NEI).
introduction and overview
Vision-related conditions affect people across the lifespan from
childhood through elder years. Good vision is an integral component to
health and well-being, affects virtually all activities of daily
living, and impacts individuals physically, emotionally, socially, and
financially. Loss of vision can have a devastating impact on
individuals and their families. An estimated 80 million Americans have
a potentially blinding eye disease, 3 million have low vision, more
than 1 million are legally blind, and 200,000 are more severely
visually blind. Vision impairment in children is a common condition
that affects 5 to 10 percent of preschool age children. Vision
disorders (including amblyopia (``lazy eye''), strabismus (``cross
eye''), and refractive error are the leading cause of impaired health
in childhood.
Alarmingly, while half of all blindness can be prevented through
education, early detection, and treatment, the NEI reports that ``the
number of Americans with age-related eye disease and the vision
impairment that results is expected to double within the next three
decades.'' \1\ Among Americans age 40 and older, the four most common
eye diseases causing vision impairment and blindness are age-related
macular degeneration (AMD), cataract, diabetic retinopathy, and
glaucoma.\2\ Refractive errors are the most frequent vision problem in
the United States--an estimated 150 million Americans use corrective
eyewear to compensate for their refractive error.\2\ Uncorrected or
under-corrected refractive error can result in significant vision
impairment.\2\
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\1\ ``Vision Problems in the U.S.: Prevalence of Adult Vision
Impairment and Age-Related Eye Disease in America,'' Prevent Blindness
America and the National Eye Institute, 2008.
\2\ Ibid.
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To curtail the increasing incidence of vision loss in America,
Prevent Blindness America advocates sustained and meaningful Federal
funding for programs that help promote eye health and prevent eye
disease, vision loss, and blindness; needed services and increased
access to vision screening; and vision and eye disease research. We
thank the Subcommittee for its consideration of our specific fiscal
year 2012 funding requests, which are detailed below.
vision and eye health at the cdc: helping to save sight and save money
The CDC serves a critical national role in promoting vision and eye
health. Since 2003, the CDC and Prevent Blindness America have
collaborated with other partners to create a more effective public
health approach to vision loss prevention and eye health promotion. The
CDC works to:
--Promote eye health and prevent vision loss.
--Improve the health and lives of people living with vision loss by
preventing complications, disabilities, and burden.
--Reduce vision and eye health related disparities.
--Integrate vision health with other public health strategies.
Integrating Vision Health into Broader Disease Prevention and Health
Promotion Efforts
One of the cornerstone activities of the vision and eye health work
at the CDC is its support and encouragement of efforts to better
integrate State-level initiatives to address vision and eye disease by
approaching vision health through other public health prevention,
treatment, and research efforts. Vision loss is associated with a
myriad of other serious chronic, life threatening, and disabling
conditions, including diabetes, depression, unintentional injuries, and
other health problems and behavioral risk factors such as tobacco use.
Leveraging scarce resources and recognizing the numerous connections
between eye health and other diseases, the CDC works to integrate and
connect vision health initiatives to other State, local, and community
health programs.
To advance State-based vision health integration, CDC funds are
supporting a joint effort between the New York State Department of
Health and Prevent Blindness Tri-State, focused on integrating vision-
related services at the State and local level. Working together, these
partners are promoting vision loss prevention strategies within the
State Department of Health. One initiative resulting from this
partnership has been the launch of a statewide tobacco cessation media
campaign highlighting the impact of smoking on potential vision loss.
Other examples include State-based programs to prevent and reduce
diabetes, including efforts to educate patients and healthcare
providers of the relationship between diabetes and certain eye
problems, such as diabetic retinopathy and cataracts. A similar effort
has recently been initiated in Texas.
The goal of these integration efforts is to ensure that vision loss
and eye health promotion are incorporated into all relevant local,
State, and Federal public health interventions, prevention and
treatment programs, and other initiatives that impact causes of--and
factors that contribute to--vision problems and blindness. By
integrating efforts and coordinating approaches in this manner, Federal
and State resources will be used more efficiently, eye health problems
and vision loss can be reduced, and the overall health and well-being
of individuals and communities will be improved.
Identifying and Preventing Vision Problems through Community-Based
Strategies
The CDC supports private sector efforts to develop and evaluate
better ways to identify and treat individuals with potential eye
disease, vision loss, and other ocular conditions. Among other efforts,
CDC funding is currently supporting:
--A study to assess the overall effectiveness and costs associated
with implementing an adult vision and eye health history and
risk assessment/referral program. This study, being conducted
by Johns Hopkins University, in partnership with Prevent
Blindness Ohio, is working in collaboration with the
Physician's Free Clinic in Columbus, Ohio and Akron Community
Health Resources to investigate the best methods for
identifying patients who need eye care services and providing
linkages to follow-up care.
--An initiative spearheaded by Duke University and Prevent Blindness
North Carolina to evaluate the benefit of pediatric and school-
based vision screening. The project identified the need to
ensure proper ongoing training and education of pediatricians
on vision screening. In collaboration with the American Board
of Pediatrics, the project has developed maintenance of
certification module to improve office-based preschool vision
screening.
Data Collection
Understanding the breadth and depth of vision and eye health issues
across the Nation is paramount to ensuring appropriate allocation of
resources and effective deployment of targeted interventions. Thus, the
CDC supports programs and systems that collect, evaluate, and
disseminate critical vision health data.
--The CDC developed the first optional Behavioral Risk Factor
Surveillance System (BRFSS) \3\ vision module, which collects
State-based information on access to eye care and the
prevalence of eye disease and eye injury. Early in 2011, the
CDC will publish a report describing visual impairment as a
serious public health issue affecting more than 2.9 million
Americans. Unfortunately, in part due to insufficient funding,
only 19 States currently use the vision module; this lack of
broad adoption precludes the CDC, Congress, and other
stakeholders from having the information they need to
understand and address the full scope of vision loss and eye
health problems facing the Nation.
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\3\ BRFSS is a State-based system of health surveys that collects
information on chronic disease and injury.
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--CDC funding is supporting a joint endeavor between Duke University
and Prevent Blindness America to conduct a systematic evidence
review to describe the delivery systems of vision-related
services and to identify new areas for policy evaluation or
clinical research. This information will help identify the most
at-risk populations and highlight gaps in care and service
delivery to ensure that public and private resources are
allocated to areas of greatest need.
To that end, Prevent Blindness America respectfully requests the
Subcommittee provide a $3.23 million allocation for vision and eye
health initiatives at the CDC. This level of investment will help the
CDC sustain its efforts to address the growing public health threat of
preventable vision loss among at-risk and underserved populations.
fiscal year 2012 resources will support strengthened State-based public
health integration efforts to address vision and eye health and the
development of additional evidence-based public health interventions
that improve eye health among the Nation's most at-risk and
underserved.
investing in the vision of our nation's most valuable resource--
children
While the risk of eye disease increases after the age of 40, eye
and vision problems in children are of equal concern. If left
untreated, they can lead to permanent and irreversible visual loss and/
or cause problems socially, academically, and developmentally. Although
more than 12.1 million school-age children have some form of a vision
problem, only one-third of all children receive eye care services
before the age of six.\4\
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\4\ ``Our Vision for Children's Vision: A National Call to Action
for the Advancement of Children's Vision and Eye Health, Prevent
Blindness America,'' Prevent Blindness America, 2008.
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In 2009, the Maternal and Child Health Bureau established the
National Center for Children's Vision and Eye Health, a national vision
health collaborative effort aimed at developing the public health
infrastructure necessary to promote eye health and ensure access to a
continuum of eye care for young children. Prevent Blindness America is
requesting ongoing support for the National Center for Children's
Vision and Eye Health.
With this support the Center, will continue to:
--Provide national leadership in the development of best practices
and guidelines for public health infrastructure, national
vision screening guidelines, and statewide strategies that
ensure early detection, vision screening, and a continuum of
vision and eye healthcare for children.
--Determine mechanisms for advancing State-based performance
improvement systems, screening guidelines, and a mechanism for
uniform data collection and reporting.
--Collaborate with States to develop and implement statewide
strategies for vision screening, establish quality improvement
strategies, and determine mechanisms for the improvement of
data systems and reporting of children's vision and eye health
services.
advance and expand vision research opportunities
Prevent Blindness America calls upon the Subcommittee to provide
additional support for the NEI to bolster its efforts to identify the
underlying causes of eye disease and vision loss, improve early
detection and diagnosis of eye disease and vision loss, and advance
prevention and treatment efforts. Research is critical to ensure that
new treatments and interventions are developed to help reduce and
eliminate vision problems and potentially blinding eye diseases facing
consumers across the country. In 2009, Congress commended the NEI's
leadership in basic and translational research through H. Res. 366 and
S. Res. 209 (111th Congress), which recognized NEI's 40 years as the
National Institutes of Health (NIH) Institute that leads the Nation's
commitment to save and restore vision. The Resolutions also designated
2010-2020 as the Decade of Vision in recognition of the increasing
health and economic burden of eye disease, mainly as a result of an
aging population.
Through additional support, the NEI will be able to continue to
grow its efforts to:
--Expand capacity for research, as demonstrated by the significant
number of high-quality grant applications submitted in response
to American Recovery and Reinvestment Act opportunities.
--Address unmet need, especially for programs of special promise that
could reap substantial downstream benefits.
--Fund research to reduce healthcare costs, increase productivity,
and ensure the continued global competitiveness of the United
States.
By providing additional funding for the NEI at the NIH, essential
efforts to identify the underlying causes of eye disease and vision
loss, improve early detection and diagnosis of eye disease and vision
loss, and advance prevention, treatment efforts and health information
dissemination will be bolstered.
conclusion
On behalf of Prevent Blindness America, our Board of Directors, and
the millions of people at risk for vision loss and eye disease, we
thank you for the opportunity to submit written testimony regarding
fiscal year 2012 funding for the CDC's vision and eye health
initiatives, the MCHB's National Center for Children's Vision and Eye
Health, and the NEI. Please know that Prevent Blindness America stands
ready to work with the Subcommittee and other Members of Congress to
advance policies that will prevent blindness and preserve sight. Please
feel free to contact us at any time; we are happy to be a resource to
Subcommittee members and your staff. We very much appreciate the
Subcommittee's attention to--and consideration of--our requests.
______
Prepared Statement of ProLiteracy
Chairman Harkin, Ranking Member Shelby, and members of the
Subcommittee, on behalf of the millions of adult learners working to
improve their basic reading, writing, math, and computer skills and
pursue greater economic opportunity for themselves and their families,
thank you for the opportunity to provide written testimony regarding
the President's fiscal year 2012 budget request for adult education and
family literacy, provided for under the Workforce Investment Act, Title
II. We would be pleased to testify and participate in any future
hearings regarding adult literacy and basic education.
We strongly urge you to approve at the very least, the President's
request of $658.3 million for Adult Basic and Literacy Education in
fiscal year 2012 to better assist the one in seven adults nationally
who struggle with illiteracy. At a time when millions of Americans are
struggling to find work, it is essential to invest in adult learning in
order to put more American families on the road to self-sufficiency and
economic security.
Background: ProLiteracy
ProLiteracy is the world's oldest and largest organization of adult
literacy and basic education programs in the United States. ProLiteracy
traces its roots to two premiere adult literacy organizations: Laubach
Literacy International and Literacy Volunteers of America. In 2002,
these two organizations merged to create ProLiteracy.
ProLiteracy represents more than 1,000 community-based
organizations and adult basic education programs in the United States,
and we partner with literacy organizations in 50 developing countries.
In communities across the United States, these organizations use
trained volunteers, teachers, and instructors to provide one-on-one
tutoring, classroom instruction, and specialized classes in reading,
writing, math, technology, English language skills, job-training and
workforce literacy skills, GED preparation, and citizenship. Our
members are located in all 50 States and in the District of Columbia.
Through education, training and advocacy, ProLiteracy supports the
frontline work of these organizations with regional conferences and
other training events; credentialing; and the publication of materials
and products used to teach adults basic literacy and English-as-a-
second-language and to prepare adults for the U.S. citizenship exam and
GED Tests.
The Urgent Need to Invest in Adult Education
In 2003, the U.S. Department of Education conducted the National
Assessment of Adult Literacy (NAAL) in order to gauge the English
reading and comprehension skills of individuals in the United States
over the age of 16 on daily literacy tasks such as reading a newspaper
article, following a printed television guide, and completing a bank
deposit slip. The results indicated that 30 million adults--14 percent
of this country's adult population--had below basic literacy skills;
that is, their ability to read was so poor, they could not complete a
job application without help or follow the directions on a medicine
bottle. An additional 63 million adults read only slightly better, for
a total of 93 million American adults who are considered low literate.
Because under-educated adults are more likely to be unemployed and
require public assistance, the high percentage of low-literate adults
is having an adverse affect on our Nation's efforts to reduce
unemployment and reduce the deficit. In 2009, 14.6 percent of those
without a high school diploma were unemployed compared to 9.7 percent
of high school graduates; 8.6 percent of those with some college; 6.8
percent with an associate's degree; 4.6 percent with a 4-year degree or
more.\1\ And the trends for these adults are not encouraging. For
example, while 67 percent of the service industry's jobs in 1983
required a high school diploma or less, this percentage is expected to
drop to zero by 2018.\2\
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\1\ http://www.bls.gov/cps/cpsaat7.pdf.
\2\ http://cew.georgetown.edu/(see Figure 4.17, pg. 86).
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In addition, we will fail to meet President Obama's goal of once
again leading the world in college degree attainment unless we support
more adults without college degrees to enroll in post-secondary
education. To meet the President's goal, it is estimated that the
United States will need to move at least 3.4 million adults with high
school diplomas but no college degrees into postsecondary education.\3\
Increasing the number of adults with high-school degrees or
equivalents, and with the skills to succeed in college, will help us
achieve this goal.
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\3\ http://www.womeningovernment.org/files/onemillion_letter.pdf.
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The bottom line is that a greater investment in adult education
will increase employment and postsecondary enrollments, move
individuals off of public assistance, and ultimately reduce the
deficit.
Despite the critical role that adult education plays in reducing
unemployment and increasing postsecondary attainment, the adult
education system currently only has the capacity to serve approximately
2.5 million of these 93 million adults each year. Adult education has
been basically flat funded for a decade, seeing only a modest overall
increase from 2001-2010.\4\ In fiscal year 2011, the number of
individuals served will almost certainly be reduced as a result of the
$32.1 million cut to Title II State grants in the final fiscal year
2011 CR. This cut comes at a time when many States are responding to
drastically declining revenues by slashing budgets for education,
training, and human services, including their investments in adult
education.
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\4\ http://www2.ed.gov/about/overview/budget/history/edhistory.pdf.
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The Proposed Adult Basic and Literacy Education Budget
The proposed fiscal year 2012 budget includes several significant
features that we strongly support. First, the President requested $635
million for State formula grants for adult education through the
Workforce Investment Act (WIA), Title II, an increase of $6.8 million
compared to the 2010 appropriation. As we have discussed above, the
need for increased investment in adult education is clear, and we
welcome the President's call for a modest increase.
We recognize that in the current fiscal environment, the
subcommittee will be reluctant to increase spending in many areas of
the budget above this year's level. If an increase is not possible, it
is critically important to hold spending for adult education and
literacy at current levels. An additional cut to Title II funding on
top of the $31 million cut in fiscal year 2011 would be devastating to
State adult education systems around the country, and, as we have
noted, would likely increase unemployment and contribute to the
deficit.
Workforce Innovation
The administration proposes to set aside $50.8 million from the
State formula funds to support a Workforce Innovation Fund (WIF), which
will also include $30 million in funding from the Rehabilitation
Services and Disability Research account, and almost $298 million from
the Department of Labor.
ProLiteracy applauds the administration's commitment to innovation.
We urge the Subcommittee to ensure that innovation funding will benefit
adults at all skill levels, particularly the millions who are estimated
to possess less than basic literacy skills served by community-based
organizations. We suggest, in fact, competitive priority for proposals
that will address those at the lowest levels of literacy and those with
significant barriers to learning.
However, we also caution that after experiencing a dramatic cut to
State formula funding in fiscal year 2011, care must be taken to ensure
that State formula funding is sufficient to ensure the survival of
existing programs. ProLiteracy urges the Subcommittee to ensure that
the WIF, if it moves forward, is funded on top of annual WIA formula
funds, rather than as a carve out of existing formula funds.
National Leadership
The President's proposal also includes an additional $12 million
for national leadership funds to the Department of Education that would
be used to evaluate the impact of college bridge programs that assist
adult learners in transitioning from adult basic education to
postsecondary education and training, and for building greater
technology infrastructure for adult learners and adult educators.
We believe these ideas reflect real needs in our field, and if
these initiatives lead to new resources and better services on the
ground for learners and the programs that serve them, than this could
be a very positive development. Again, however, we would urge that any
new programming that would not have an immediate, direct, benefit to
adult learners not come at the expense of State formula funds.
WIA Reauthorization and Use of National Leadership Funds
The President's budget request also supports the reauthorization of
WIA, and specifically calls for better alignment between Title I and
Title II. We share the administration's desire for more streamlined
service delivery systems that are more engaged with employers, and the
promotion of innovative career pathways models--but in particular for
those learners at the lowest levels of literacy.
We strongly urge, therefore, expanding funding opportunities for
community-based programs that have successfully implemented strategies
for delivering basic literacy instruction together with employment
training so that they may document and disseminate best practices
related to the integration of title I job training programs with title
II adult literacy programs.
Through both reauthorization of the Workforce Investment Act and
use of national leadership funding, we also recommend that the
Department examine and publish successful strategies and best practices
that can help adults with low literacy levels improve their overall
skills and employment opportunities.
We note that learners at the lowest levels of literacy often
receive literacy instruction at community-based organizations (CBOs)
that utilize trained volunteers. For decades, volunteers, and other
types of non-career instructors such as such as VISTA or AmeriCorps
members, have been a vital component in the delivery of education
services for adults with low literacy in the United States. Volunteers
serve in non-instructional roles as well such as mentoring, counseling,
recruiting students, and serving as teaching aides to paid instructors.
However, adult education career pathway programs are based largely
on traditional career pathways programs that connect secondary and
postsecondary students to further education and work in a specific
industry. As a result, the limited existing research on career pathway
approaches used with adult learners is largely focused on students with
higher-level literacy skills.
We therefore urge the subcommittee to ensure that CBOs that utilize
trained volunteers are integrated into the Department's career pathways
strategies. We suggest that the Department identify and disseminate
successful strategies and best practices that will assist community-
based organizations that utilize adult literacy volunteers to support
the Department's career pathways initiatives; and implement strategies
to increase participation by community-based organizations that utilize
trained volunteers in any related technical assistance efforts.
Thank you for the opportunity to present this testimony. We would
be happy to respond to any questions that you may have.
______
Prepared Statement of the Prostatitis Foundation
We are the unpaid volunteers at the Prostatitis Foundation
representing thousands of men nationwide with prostatitis. Our mission
for 15 years has been to:
--Educate the public about the prevalence of prostatitis by our
website www.prostatitis.org, our newsletters, and newspaper and
magazine articles. It is estimated that 10 percent of all males
suffer from chronic prostatitis/pelvic pain syndrome (CP/PPS)
and 50 percent of men will experience (CP/PPS) during their
lifetime. Symptoms can include severe pelvic pain, urinary and
sexual dysfunction and infertility. The possible connection of
prostatitis to prostate cancer is uncertain and not adequately
researched. Prostatitis is common in young men who are at an
age where they are reluctant to discuss such personal matters
as pelvic pain, voiding problems and sexual dysfunction with
family, friends or co-workers. The result has been an
unpublicized crisis and a costly, hopeless medical condition.
--Encourage research funding. We have worked with the NIH research
team personnel and research centers over three sets of multi-
year clinical trial programs going back to 1996. We are now
assisting with the fourth group of nationwide research centers.
The Map Network is a group of researchers who have been
assembled by National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) to include specialties besides urology
to get some basic scientific research that will lead to
determining a cause and cure for (CP/PPS). Everyone has too
much time and expense invested to let these efforts expire
without pushing to complete this search for a cause and cure
for (CP/PPS). If we do not build on the efforts of the three
previous accumulations of data to determine a cause and cure it
will be lost and the next group will have to start at the
beginning again.
We request continuing funding and direction through The National
Institutes of Health (NIH) to National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) who are over seeing this Mapp
Network of research centers.
______
Prepared Statement of the Pulmonary Hypertension Association
Mr. Chairman, thank you for the opportunity to submit testimony on
behalf of the Pulmonary Hypertension Association (PHA).
I would like to extend my sincere thanks to the Subcommittee for
your past support of pulmonary hypertension (PH) programs at the
National Institutes of Health, Centers for Disease Control and
Prevention, and Health Resources and Services Administration. These
initiatives have opened many new avenues of promising research, helped
educate hundreds of physicians in how to properly diagnose PH, and
raised awareness about the importance of organ donation and
transplantation within the PH community.
I am honored today to represent the hundreds of thousands of
Americans who are fighting a courageous battle against a devastating
disease. Pulmonary hypertension is a serious and often fatal condition
where the blood pressure in the lungs rises to dangerously high levels.
In PH patients, the walls of the arteries that take blood from the
right side of the heart to the lungs thicken and constrict. As a
result, the right side of the heart has to pump harder to move blood
into the lungs, causing it to enlarge and ultimately fail.
PH can occur without a known cause or be secondary to other
conditions such as: collagen vascular diseases (i.e., scleroderma and
lupus), blood clots, HIV, sickle cell, or liver disease. PH impacts
patients of all races, genders, and ages. Preliminary data from the
REVEAL Registry suggests that the ratio of women to men who develop PH
is 4:1. Patients develop symptoms that include shortness of breath,
fatigue, chest pain, dizziness, and fainting.
Unfortunately, these symptoms are frequently misdiagnosed, leaving
patients with the false impression that they have a minor pulmonary or
cardiovascular condition. By the time many patients receive an accurate
diagnosis, the disease has progressed to a late stage, making it
impossible to receive a necessary heart or lung transplant. PH is
chronic and incurable with a poor survival rate. Fortunately, new
treatments are providing a significantly improved quality of life for
patients with some managing the disorder for 20 years or longer.
In 1990, when three PH patients found each other with the help of
the National Organization for Rare Diseases, and founded the Pulmonary
Hypertension Association, 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 unacceptable, and formally established PHA, which is headquartered
in Silver Spring, Maryland. I am pleased to report that we are making
good progress in our fight against this deadly disease. Nine
medications for the treatment of PH have been approved by the FDA in
the past 16 years.
Today, PHA includes:
--More than 20,000 members and supporters.
--A network of 230+ patient support groups and an active patient-to-
patient telephone helpline.
--Three research programs that, through partnerships with the
National Heart, Lung and Blood Institute, American Heart
Association and the American Thoracic Society, have leveraged
our donors' funds to commit more than $10 million toward PH
research as of 2011.
--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.
--A state-of-the-art website(www.phassociation.org) dedicated to
providing educational and support resources to patients,
caregivers, and the public.
--A medical education website (www.phaonlineuniv.org), supported in
part by the CDC, providing accredited medical education and
resources to the medical community
fiscal year 2012 appropriations recommendations
National Heart, Lung And Blood Institute
Less than two decades ago, a diagnosis of PH was essentially a
death sentence, with only one approved treatment for the disease.
Thanks to advancements made through the public and private sector,
patients today are living longer and better lives with a choice of nine
FDA approved medications. Recognizing that we have made tremendous
progress, we are also mindful that we are a long way from where we want
to be in (1) the management of PH as a treatable chronic disease, and
(2) a cure.
We are grateful to the National Heart, Lung and Blood Institute for
their leadership in advancing research on PH. Our Association is proud
to jointly sponsor investigator training grants (K awards) with NHLBI
aimed at supporting the next generation of pulmonary hypertension
researchers.
Moreover, we were very pleased that NHLBI recently convened some of
the community's leading scientists for a Working on Group on Lung
Vascular Research. The panel produced recommendations that should guide
pulmonary vascular disease research and treatment, including PH
research, in coming years. Their recommendations, published in the
American Journal of Respiratory and Critical Care Medicine in October,
2010 are as follows:
--Advance basic scientific research in lung vascular biology
utilizing emerging technologies.
--Advance and coordinate basic and clinical knowledge of the
pulmonary circulation-right heart axis through novel research
efforts utilizing multidisciplinary teams.
--Define interactions between lung vascular components and
circulating elements and systemic circulations by fostering
novel collaborations.
--Encourage systems analysis to understand and define interactions
between lung vascular genetics, epigenetics, metabolic
pathways, andmolecular signaling.
--Develop strategies using appropriate animal models to improve the
understanding of the lung vasculature in health and in
conditions that reflect human disease.
--Enhance translational research in lung vascular disease by
comparing cellular and tissue abnormalities identified in
animal models to those in human specimens.
--Improve lung vascular disease molecular and clinical phenotype
coupling.
--Develop in vivo imaging techniques which assess structural changes
in lung vasculature, metabolic shifts, functional cell
responses and right ventricular function.
--Develop research consortia that advance basic, translational, and
clinical studies, allow for multi-center epidemiological study
feasibility, and support junior investigators' training in lung
vascularbiology and disease.
We encourage the Subcommittee to support the full implementation of
these recommendations by the National Institutes of Health.
Mr. Chairman, expanding clinical research remains a top priority
for patients, caregivers, and PH investigators. We are particularly
interested in establishing a pulmonary hypertension research network.
Such a network would link leading researchers around the United States,
providing them with access to a wider pool of shared patient data. In
addition, the network would provide researchers with the opportunities
to collaborate on studies and to strengthen the interconnections
between basic and clinical science in the field of pulmonary
hypertension research. Such a network is in the tradition of the NHLBI,
which, to its credit and to the benefit of the American public, has
supported numerous similar networks including the Acute Respiratory
Distress Syndrome Network and the Idiopathic Pulmonary Fibrosis
Clinical Research Network. We encourage the NHLBI to move forward with
the establishment of a PH network in fiscal year 2012.
For fiscal year 2012, PHA joins with other voluntary patient and
medical organizations in recommending an appropriation of $35 billion
for the National Institutes of Health. This level of funding will
ensure continued expansion of research on rare diseases like pulmonary
hypertension.
Centers For Disease Control And Prevention
Mr. Chairman, we are grateful to the subcommittee for providing
past support of PHA's Pulmonary Hypertension Awareness Campaign. We
know for a fact that Americans are dying due to a lack of awareness of
PH, and a lack of understanding about the many new treatment options.
This unfortunate reality is particularly true among minority and
underserved populations. More needs to be done to educate both the
general public and healthcare providers if we are to save lives.
To that end, PHA has utilized the funding provided through the CDC
to: (1) launch a successful media outreach campaign focusing on both
print and online outlets; (2) expand our support programs for
previously underserved patient populations; and (3) establish PHA
Online University, an interactive curriculum-based website for medical
professionals that targets pulmonary hypertension experts, primary care
physicians, specialists in pulmonology/cardiology/rheumatology, and
allied health professionals. The site is continually updated with
information on early diagnosis and appropriate treatment of pulmonary
hypertension. It serves as a center point for discussion among PH-
treating medical professionals and offers Continuing Medical Education
and CEU credits through a series of online classes.
In fiscal year 2012, we encourage the subcommittee to establish a
specific program at CDC to provide ongoing support for PH education and
awareness activities. This would make a tremendous difference in the
fight against this devastating disease.
``Gift Of Life'' Donation Initiative at HRSA
PHA applauds the success of the Health Resources and Services
Administration's ``Gift of Life'' Donation Initiative. This important
program is working to increase organ donation rates across the country.
Unfortunately, the only ``treatment'' option available to many late-
stage PH patients is a lung, or heart and lung, transplantation. This
grim reality is why PHA established ``Bonnie's Gift Project.''
``Bonnie's Gift'' was started in memory of Bonnie Dukart, one of
PHA's most active and respected leaders. Bonnie 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 has had a very successful partnership with HRSA's ``Gift of
Life'' Donation Program in recent years. Collectively, we have worked
to increase organ donation rates and raise awareness about the need for
PH patients to ``early list'' on transplantation waiting lists. For
fiscal year 2012, PHA recommends an appropriation of $26 million for
this important program.
Social Security Disability
Finally Mr. Chairman, PHA would like to thank the subcommittee for
its commitment to address the longstanding backlog of disability claims
at the Social Security Administration. We greatly appreciate this
investment as a growing number of our patients are applying for
disability coverage. On a related note, the SSA recently convened an
Institute of Medicine panel to recommend revisions to the disability
criteria for cardiovascular diseases. The IOM worked closely with our
medical experts to update the disability criteria for our patient
population and we were pleased to receive their recommendations earlier
this year. We encourage Congress to support this process moving
forward.
______
Prepared Statement of the Research Working Group of the Federal AIDS
Policy Partnership
Chairman Harkin, Ranking Member Shelby and members of the
Committee, thank you for the opportunity to provide testimony on the
National Institutes of Health (NIH) budget overall and for AIDS
research in fiscal year 2012. Tomorrow's scientific and medical
breakthroughs depend on your vision, leadership and commitment toward
robust NIH funding over the next year. To this end, the Research
Working Group (RWG) urges this Committee to support--at minimum--the
President's NIH budget request and also recommends a funding target of
$35 billion in fiscal year 2012 to maintain the U.S.'s position as the
world leader in medical research and innovation.
Investments in health research via NIH have paid enormous dividends
in the health and well-being of people in the United States and around
the world. NIH funded HIV and AIDS research has supported innovative
basic science for better drug therapies, evidence-based behavioral and
biomedical prevention interventions and vaccines which have saved and
improved the lives of millions and holds great promise for
significantly reducing HIV infection rates and providing more effective
treatments for those living with HIV/AIDS in the coming decade.
Despite these advances, the number of new HIV/AIDS cases continues
to rise in various populations in the United States and around the
world. There are over 1 million HIV-infected people in the United
States, the highest number in the epidemic's 30-year history;
additionally over 56,000 Americans become newly infected every year.
The evolving HIV epidemic in the United States disproportionately
affects the poor, sexual and racial minorities and the most
disenfranchised and stigmatized members of our communities. However,
with proper funding coupled with the promotion of evidence based
policies, 2012 will be a time of great scientific progress in
prevention science, vaccines and finding a cure for HIV as well as
addressing the co-morbid illnesses that affect patients with HIV such
as viral hepatitis and tuberculosis. Further, as Washington, DC is set
to host the International AIDS Conference in the summer of 2012, the
gains in science made by NIH funded research programs will reflect our
preeminence as the world's most powerful research enterprise fighting
this deadly epidemic.
Major advances over the last 2 years in HIV prevention
technologies--in particular with microbicides, HIV vaccines,
circumcision, antiretroviral treatment as prevention and pre exposure
prophylaxis using antiretrovirals (PrEP)--demonstrate that adequately
resourced NIH programs can transform our lives. Federal support for
AIDS research has also led to new treatments for other diseases,
including cancer, heart disease, Alzheimer's, hepatitis, osteoporosis
and a wide range of autoimmune disorders. Over the years, NIH has
sponsored the evaluation of a host of vaccine candidates, some of which
are advancing to efficacy trials. The recent successful iPrEx and HPTN
052 trials have shown the potential of antiretroviral drugs to prevent
HIV infection. Moreover increased funding will support the future
testing of new microbicides and therapeutics in the pipeline via the
implementation of a newly restructured, cross-cutting HIV clinical
trials network which translates NIH funded scientific innovation into
critical quality of life gains for those most affected with HIV.
Increased funding for NIH in fiscal year 2012 makes good bipartisan
economic sense, especially in shaky times. Robust funding for NIH
overall will enable research universities to pursue scientific
opportunity, advance public health, and create jobs and economic
growth. In every State across the country, the NIH supports research at
hospitals, universities, private enterprises and medical schools. This
includes the creation of jobs that will be essential to future
discovery. Sustained investment is also essential to train the next
generation of scientists and prepare them to make tomorrow's HIV
discoveries. NIH funding puts 350,000 scientists to work at research
institutions across the country. According to NIH, each of its research
grants creates or sustains six to eight jobs and NIH supported research
grants and technology transfers have resulted in the creation of
thousands of new independent private sector companies. Strong,
sustained NIH funding is a critical national priority that will foster
better health and economic revitalization.
Let's not jeopardize our future. Since 2003, funding for the NIH
has failed to keep up with our existing research needs--damaging the
success rate of approved grants and leaving very little money to fund
promising new research. The real value of the increases prior to 2003
has been precipitously reduced because of the relatively higher
inflation rate for the cost of research and development activities
undertaken by NIH. According to the Biomedical Research and Development
Price Index--which calculates how much the NIH budget must change each
year to maintain purchasing power--between fiscal year 2003 and fiscal
year 2011, the cost of NIH activities according to the BRDI will have
increased by 32.8 percent. By comparison, the overall budget of the NIH
increased by $3.6 billion or 13.4 percent over fiscal year 2003. So in
real terms, the NIH has already sustained budget decreases of close to
20 percent over the past 9 years due to inflation alone. As such, any
further cuts to NIH will have the clear and devastating effects of
undermining our Nation's leadership in health research and our
scientists' ability to take advantage of the expanding opportunities to
advance healthcare. The race to find better treatments and a cure for
cancer, heart disease, AIDS and other diseases, and for controlling
global epidemics like AIDS, tuberculosis and malaria, all depend on a
robust long term investment strategy for health research at NIH.
In conclusion, the RWG calls on Congress to continue the bipartisan
Federal commitment toward combating HIV as well as other chronic and
life threatening illnesses by increasing funding for NIH to $35 billion
in fiscal year 2012, including funds for transfer to the Global Fund
for HIV/AIDS, Tuberculosis, and Malaria. A meaningful commitment toward
stemming the epidemic and securing the well being of people with HIV
cannot be met without prioritizing the research investment at NIH that
will lead to tomorrow's lifesaving vaccines, treatments and cures.
Thank you for the opportunity to provide these comments.
______
Prepared Statement of Research!America
Thank you for the opportunity to submit testimony regarding fiscal
year 2012 appropriations for the Subcommittee on Labor, Health, and
Human Services, Education and Related Agencies. Research!America is the
Nation's largest 501(c)(3) alliance working to make research to improve
health a higher national priority. Research!America's member
organizations together represent the voices of more than 125 million
Americans. Our mission is grounded in strong and consistent expression
by the American public for robust funding and policies in support of
health research in the public and private sector. We use evidence-based
advocacy to demonstrate the benefits of research that improves public
health, productivity, longevity, and prosperity while solidifying
America's standing as the world's engine of innovation.
Our remarks will focus on funding for the National Institutes of
Health (NIH), the Centers for Disease Control and Prevention (CDC), the
Food and Drug Administration (FDA) and the Agency for Healthcare
Research and Quality (AHRQ)--agencies that play a pivotal role in
advancing the health of Americans and fueling economic growth across
our Nation. In addition to these agencies, Research!America also
advocates for the National Science Foundation (NSF), which fosters
basic science and discovery that also impacts the health of Americans.
Research!America appreciates the subcommittee's past support for
robust research funding conducted and supported by NIH, CDC, FDA, and
AHRQ. Health research is in our Nation's best short- and long-term
interests. Investing in research saves lives, saves dollars, produces
jobs across multiple sectors of our economy, and positions our Nation
for sustained global competitiveness.
The Nation is facing a debt crisis. Our debt burden will increase
if we underfund agencies that drive economic growth and the private
sector innovation critical to our global competitiveness. Robust
support for health research agencies is critical for solving the debt
crisis, reigning in the cost of medical care, and getting the economy
back on track.
NIH, CDC, AHRQ and FDA each contribute in multifaceted ways to
improved health and the economic growth our Nation.
--Research funded by the National Institutes of Health at research
institutions across the country provides the groundwork for new
product development in the private sector, which creates jobs
and pumps dollars into local economies.
--The Centers of Disease Control and Prevention engage in
epidemiological and public health research that stems deadly
and costly pandemics, bolsters our Nation's defenses against
bioterrorism, and addresses public health threats like drug-
resistant infections that increase hospital costs and threaten
lives.
--Research supported by the Agency for Healthcare Research and
Quality improves the efficiency and quality of healthcare in
this country by reducing duplication and waste and improving
healthcare outcomes;
--By ensuring the safety and efficacy of new medicines and medical
devices, The Food and Drug Administration plays a pivotal role
in translating health research into improved treatments for
patients.
As polling commissioned by Research!America clearly demonstrates,
the American public strongly supports robust investment in health and
medical research. A recent poll that surveyed a mix of self-described
conservatives (32 percent), liberals (32 percent) and moderates (36
percent) found that, as we emerge from the recession:
--78 percent of Americans think Federal funding for health research
is important for job creation and the economy;
--61 percent say accelerating our Nation's investment in research to
improve health is a priority;
--76 percent think global health R&D is important to the U.S.
economy;
--84 percent think it is important that the Government plays a role
in research for prevention and wellness; and
--53 percent of Americans think that spending cuts are necessary, but
the United States must invest strategically to improve the
health of the economy.
The poll also confirms that Americans value public/private
collaboration in order to rapidly build on discoveries made in
federally funded labs to bring new drugs and devices to market. Some 84
percent of Americans think it is important to invest in regulatory
science, an increasingly important area of focus at FDA and NIH, to
make the drug and device development process more efficient for
businesses and safer for patients.
Additional findings from Research!America polling include:
--91 percent of Americans think R&D is important to their State's
economy;
--83 percent agree that basic scientific research should be funded by
the Federal government;
--66 percent think research to improve health is part of the solution
to rising healthcare costs.
The American public knows that research not only saves lives, but
money. Disease and disability pose a major economic threat to our
Nation, as the aging of our population and rising obesity rates
increase the prevalence of heart disease, cancer, stroke, diabetes,
Parkinson's disease, Alzheimer's disease and other major illnesses. It
is estimated that chronic disease alone costs the United States $1.7
trillion each year.\1\ Research conducted by both the public and
private sectors is a potent weapon against rising healthcare costs. For
example:
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\1\ Partnership to Fight Chronic Disease, Almanac of Chronic
Disease, 2009.
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--An NIH-sponsored clinical trial showed treatment with aspirin could
reduce stroke in Atrial Fibrillation (AF) victims by 80
percent, resulting in a 10-year net benefit of $1.27
billion.\2\
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\2\ Johnston SC, Rootenberg JD, Katrak S, et. al. Effect of a US
NIH programme of clinical trials on public health and costs. The Lancet
2006;367:1319-1327.
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--A breast cancer diagnostic test developed by a private company
using data from the publicly funded human genome project saves
an estimated $2,000 per patient by reducing the number of women
who are prescribed chemotherapy.\3\
---------------------------------------------------------------------------
\3\ Lyman, G.H. et al. Impact of a 21-gene RT-PCR assay on
treatment decisions in early-stage breast cancer. Cancer. 2007;
109:1011-1118.
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--A recent NIH-funded study shows that vaccinating healthy, employed
adults (ages 18 to 50) against the flu saves as much as $31 per
person.\4\
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\4\ Lee, Patrick Y. ``Economic Analysis Of Influenza Vaccination
And Antiviral Treatment For Healthy Working Adults.'' Annals of
Internal Medicine 137 (2002): 225-31.
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U.S. research leading to the control and eradication of global
illnesses can dramatically increase global productivity, while helping
to protect Americans. In addition to benefiting our troops abroad, U.S.
research focused on global diseases is actually an investment in the
health of Americans. International travel means that it is not a matter
of if, but when, deadly global threats, such as multiple-drug resistant
tuberculosis reach the United States. Every year, 60 million Americans
travel to other countries and 50 million people from abroad travel to
the United States.\5\
---------------------------------------------------------------------------
\5\ ITA (International Trade Administration), Office of Travel and
Tourism Industries, ``Total International Travelers Volume to and from
the U.S. 1995-2005,'' available online at http://tinet.ita.doc.gov/
outreachpages/inbound.total_intl_travel_volume_1995-2005.html.
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In an interconnected world, U.S. global research helps grow our
economy and saves lives at home and abroad.
Both the NIH and the CDC work closely with other agencies, like the
U.S. Agency for International Development (USAID) to support the
development of new biomedical, diagnostic, and other global health-
related technologies. Through public private partnerships (PPP),
including product development partnerships (PDP), these agencies
leverage expertise from academia, private sector, and others to create
new tools to combat neglected diseases throughout the world. This
innovative collaborative PDP model has resulted in 12 novel products
that could prove transformative for global health. We urge the
committee to provide continued and robust support for these programs
that touch every corner of our world, save lives, and strengthen the
U.S. economy.
Whether the goal is to save lives, bend the cost curve by
progressively reducing the cost of treating chronic and life-
threatening health conditions, or promote the kind of innovation that
positions our Nation for global economic leadership now and in the
future, ample funding for NIH, CDC, FDA, and AHRQ is a cost-effective
investment. Research!America appreciates the difficult task facing the
subcommittee and urges that you recognize the return on investment that
these four Federal agencies bring to our country. Investing in these
agencies is the right, and smart, choice.
______
Prepared Statement of Rotary International
Chairman Harkin, members of the Subcommittee, Rotary International
appreciates this opportunity to submit testimony to the in support of
the polio eradication activities of the U.S. Centers for Disease
Control and Prevention (CDC). The Global Polio Eradication Initiative
is an unprecedented model of cooperation among national governments,
civil society and U.N. agencies to work together to reach the most
vulnerable through a safe, cost-effective public health intervention,
and one which is increasingly being combined with opportunistic,
complementary interventions such as the distribution of life-saving
vitamin A drops, oral rehydration therapy, zinc supplements, and even
something as simple as the distribution of soap. The goal of a polio
free world is within our grasp because polio eradication strategies
work even in the most challenging environments and circumstances.
progress in the global program to eradicate polio
Thanks to this committee's leadership in appropriating funds,
progress toward a polio-free world continues.
--Only 4 countries (Nigeria, India, Pakistan and Afghanistan) are
polio-endemic--the lowest number in history.
--The number of polio cases has fallen from an estimated 350,000 in
1988 to less than 1300 in 2010--a more than 99 percent decline
in reported cases.
--As of April 21, 2011, Uttar Pradesh (UP) in India celebrated 1 year
without reporting a single case of polio. The state has
traditionally been a major exporter of virus to other parts of
India and the world, and has been described as one of the most
difficult places to eradicate polio.
--The number of polio cases in the polio endemic countries of India
and Nigeria declined by more than 90 percent in 2010 as
compared to 2009. As of 2011, India has reported only 1 case;
Nigeria--5 cases.
--Incidence of type 3 polio, which accounted for 70 percent of all
polio cases in 2009, decreased significantly in 2010 accounting
for only 8 percent of all cases.
--Bivalent oral polio vaccine, which was introduced at the end of
2009, has proven to effectively target both of the remaining
strains of polio, and has been a major factor in the progress
made in 2010.
--A shortfall in the funding needed for polio eradication activities
in polio affected and at-risk countries continues to pose a
serious threat the achievement of a polio free world.
In summary, significant operational progress was made in 2010
despite funding challenges and outbreaks which, will continue to
threaten polio free countries until polio eradication is achieved.
Rotary, as a spearheading partner of the GPEI, will continue to pursue
aggressive progress as outlined in the Strategic Plan for 2010-12 which
has already demonstrated results in terms of reducing the number of
cases in 2010 and into 2011.
The ongoing support of donor countries is essential to assure the
necessary human and financial resources are made available to polio-
endemic countries to take advantage of the window of opportunity to
forever rid the world of polio. Access to children is needed,
particularly in conflict-affected areas such as Afghanistan and its
shared border with Pakistan. Polio-free countries must maintain high
levels of routine polio immunization and surveillance. The continued
leadership of the United States is essential to ensure we meet these
challenges.
the role of rotary international
Rotary International, a global association of more than 32,000
Rotary clubs in more than 170 countries with a membership of over 1.2
million business and professional leaders (more than 365,000 of which
are in the United States), has been committed to battling polio since
1985. Rotary International has contributed more than US$1 billion
toward a polio free world--representing the largest contribution by an
international service organization to a public health initiative ever.
Rotary also leads the United States Coalition for the Eradication of
Polio, a group of committed child health advocates that includes the
March of Dimes Foundation, the American Academy of Pediatrics, the Task
Force for Global Health, the United Nations Foundation, and the U.S.
Fund for UNICEF. These organizations join us in thanking you for your
staunch support of the Polio Eradication Initiative.
the role of the u.s. centers for disease control and prevention (cdc)
Rotary commends CDC for its leadership in the global polio
eradication effort, and greatly appreciates the Subcommittee's support
of CDC's polio eradication activities. The investment in this global
effort has helped to make the United States the leader among donor
nations in the drive to eradicate this crippling disease. Due to
congressional support, in fiscal year 2010 and fiscal year 2011 CDC was
able to:
--Support the international assignment of more than 358 long- and
short-term epidemiologists, virologists, and technical officers
to assist the World Health Organization and polio-endemic
countries to implement polio eradication strategies while on
temporary duty travel from Atlanta, and 31 technical staff on
direct 2-year assignments to WHO and UNICEF to assist polio-
endemic and polio-reinfected countries.
--Perform the lead technical monitoring role for the Global Polio
Eradication Initiative (GPEI) Strategic Plan 2010-2012 released
in May 2010. On a quarterly basis, beginning in Q4, 2010, CDC
provided a detailed epidemiologic report and risk assessment on
the progress toward achieving the goals outlined in the
Strategic Plan to the Independent Monitoring Board (IMB) for
policy and decisionmaking.
--Provide $53.4 million in fiscal year 2010 to UNICEF for
approximately 292 million doses of polio vaccine and $7.3
million for operational costs for NIDs in all polio-endemic
countries and other high-risk countries in Asia, the Middle
East and Africa. Most of these NIDs would not take place
without the assurance of CDC's support.
--Collaborate with WHO, UNICEF, Rotary International, U.N. Foundation
and the Bill and Melinda Gates Foundation to facilitate World
Bank financing through its buy-down mechanism for the purchase
of OPV. In 2010, this mechanism provided $14.1 million to
Nigeria and $37.3 million to Pakistan. For 2011, Nigeria has
been approved for $60 million, 1-year credit and Pakistan is
eligible for a $41 million, 1-year credit.
--Provide $30.9 million in fiscal year 2010 to WHO for surveillance,
technical staff and NIDs' operational costs, primarily in
Africa. As successful NIDs take place, surveillance is critical
to determine where polio cases continue to occur. Effective
surveillance can save resources by eliminating the need for
extensive immunization campaigns if it is determined that polio
circulation is limited to a specific locale.
--Train virologists from around the world in advanced poliovirus
research and public health laboratory support. CDC's Atlanta
laboratories are a global reference center and training
facility.
--Provide, as the leading specialize polio reference lab in the
world, the largest volume of operational (poliovirus isolation)
and technologically sophisticated (genetic sequencing of polio
viruses) lab support to the 145 laboratories of the global
polio laboratory network.
--Provide scientific and technical expertise to WHO on research
issues regarding: (1) laboratory containment of wild poliovirus
stocks following polio eradication, and (2) when and how to
stop or modify polio vaccination following global certification
of polio eradication.
--Provide critical support for post-polio-eradication planning
through research, new product development, strategy formulation
and policy development.
--Train and deploy public health professionals to improve AFP
surveillance and to help plan, implement, and evaluate
vaccination campaigns, communications, etc. through CDC's Stop
Transmission of Polio (STOP) program. Since 1999, more than
1,000 STOP team members have participated in 3-month
assignments in 60 countries, providing 262 person-years of
support at the national and State levels. In 2010, the STOP
program deployed 185 professionals to 69 countries.
--Launch a customized N (national)-STOP initiative in March 2011 in
collaboration with the Pakistan Ministry of Health, WHO and the
USAID Mission in Islamabad. Sixteen national epidemiologists
from CDC's Field Epidemiology Training Program (FETP) were
trained and deployed to the highest risk districts for
circulation of wild polio virus in an effort to help improve
the quality of disease surveillance and immunization activities
there and to strengthen routine immunization systems.
--Deploy E (enhanced)-STOP initiative teams to Nigeria, S. Sudan,
Angola, Chad, and DRC. Those serving in E-STOP are assigned to
support efforts in strategic areas, are more experienced, and
serve for a longer durations. As part of E-STOP in 2010, 28
professionals were deployed to Nigeria, 35 to South Sudan, 7 to
Angola, 5 to Chad, and 5 to DRC. This initiative was
facilitated by an expanding partnership with the Organization
of Islamic Conference (OIC) facilitating outreach to Muslim
states and the Pan American Health Organization facilitating
Brazilian and Southern Cone support for Angola. With available
funding, CDC plans to expand the number of participants in E-
STOP in 2011.
--Support global polio eradication by participating in technical
advisory groups, EPI manager and other key meetings. The CDC
also published 14 updates on progress toward polio eradication
in the Morbidity and Mortality Weekly Report (MMWR) and other
peer-reviewed journals.
fiscal year 2012 budget request
For fiscal year 2012, we respectfully request that this
subcommittee include $112 million for the targeted polio eradication
efforts of the Centers for Disease Control and Prevention, the same
level included in the President's fiscal year 2012 request. The funds
we are seeking will allow CDC to continue intense supplementary
immunization activities in Asia and to improve the quality of
immunization campaigns in Africa to interrupt transmission of polio in
these regions as quickly as possible. These funds will also help
maintain certification standard surveillance. This will ensure that we
protect the substantial investment we have made to protect the children
of the world from this crippling disease by supporting the necessary
eradication activities to eliminate polio in its final strongholds--in
South Asia and sub-Saharan Africa.
The United States' commitment to polio eradication has stimulated
other countries to increase their support. Other countries that have
followed America's lead and made special grants for the global Polio
Eradication Initiative include the United Kingdom ($900.03 million),
Japan ($418.65 million), Germany ($390.94 million), and Canada ($289.53
million). Since 2002, the members of the G8 have committed to provide
sufficient resources to eradicate polio. G8 member states, many of
which were already leading donors to the Polio Eradication Initiative,
have encouraged other donors to provide support, and have emphasized
the importance of polio eradication when meeting with leaders of polio-
endemic countries. As a result, the base of donor nations that have
contributed to the Global Polio Eradication Initiative has expanded to
include Spain, Sweden, Saudi Arabia, and even contributions from United
Arab Emirates, Kuwait, Hungary, and Turkey.
Endemic nations are also providing funds to support polio
eradication activities. It is noteworthy that India has provided US$692
million in funding for polio eradication activities there since 2003
and Nigeria provided approximately US$61.75 million, and Pakistan has
provided US$50 million.
benefits of polio eradication
Since 1988, over 5 million people who would otherwise have been
paralyzed will be walking because they have been immunized against
polio. Tens of thousands of public health workers have been trained to
manage massive immunization programs and investigate cases of acute
flaccid paralysis. Cold chain, transport and communications systems for
immunization have been strengthened. The global network of 145
laboratories and trained personnel established for polio eradication
also tracks measles, rubella, yellow fever, meningitis, and other
deadly infectious diseases and will do so long after polio is
eradicated. NIDs for polio have also been used to distribute essential
vitamin A, thereby saving the lives of over 1.25 million children since
1988.
A study published in the November 2010 issue of the journal Vaccine
estimates that the global polio eradication initiative to eradicate
polio could provide net benefits of at least $40-50 billion if
transmission of wild polio viruses is stopped within the next 5 years.
Polio eradication is a cost-effective public health investment, as its
benefits accrue forever. On the other hand, more than 10 million
children will be paralyzed in the next 40 years if the world fails to
capitalize on the more than $8 billion already invested in eradication.
Success will ensure that the significant investment made by the United
States, Rotary International, and many other countries and entities, is
protected in perpetuity.
______
Prepared Statement of the Ryan White Medical Providers Coalition
Introduction
I am James Raper, a nurse practioner and Director of the 1917 HIV/
AIDS Outpatient Clinic at the University of Alabama at Birmingham. I am
submitting written testimony on behalf of the Ryan White Medical
Providers Coalition.
Thank you for the opportunity to discuss the important HIV/AIDS
care conducted at Ryan White Part C funded programs nationwide.
Specifically, the Ryan White Medical Provider Coalition, the HIV
Medicine Association, the CAEAR Coalition, and the American Academy of
HIV Medicine estimate that approximately $407 million is needed to
provide the standard of care for all Part C program patients. (This
estimate is based on the current cost of care and the number of
patients that Part C clinics serve.) Because these are exceptionally
challenging economic times, we request $272 million for Ryan White Part
C programs in fiscal year 2012, the amount that Congress authorized for
Part C programs in its 2009 reauthorization of the Ryan White Program.
The Ryan White Medical Providers Coalition was formed in 2006 to be
a voice for medical providers across the Nation delivering quality care
to their patients through Part C of the Ryan White program. We
represent every kind of program, from small and rural to large urban
sites in every region in the country. We speak for those who often
cannot speak for themselves and we advocate for a full range of primary
care services for these patients. Sufficient funding for Part C is
essential to providing appropriate care for individuals living with
HIV/AIDS.
Part C of the Ryan White Program funds comprehensive Early
Intervention Services (EIS) for HIV care and treatment, that are
directly responsible for the dramatic decreases in AIDS-related
mortality and morbidity over the last decade. The Centers for Disease
Control and Prevention estimate that there are more than 1.1 million
persons living with HIV/AIDS, and approximately 240,000, or almost 1 in
4, of these individuals received services from Part C medical
providers--a dramatic 30 percent increase in patients in less than 10
years.
The Cost of Care Is Reasonable; The Reimbursement for Care Isn't
On average it costs $3,501 per person per year to provide the
comprehensive outpatient care and treatment available at Part C funded
programs (excluding medication costs), including lab work, STD/TB/
Hepatitis screening, ob/gyn care, dental care, mental health and
substance abuse treatment, and case management. Part C funding covers
only a small percentage of the total cost of this comprehensive care,
with some programs receiving $450 (12 percent of the total cost) or
less per patient per year to cover the cost of care.
Part C Programs Save Both Lives and Money
Investing in Part C services improves lives and saves money. In the
United States, nearly 50 percent of persons living with HIV/AIDS who
are aware of their status are not in continuing care. Early and
reliable access to HIV care and treatment both helps patients with HIV
live relatively healthy and productive lives and is more cost
effective. One study from my Part C Clinic at the University of Alabama
at Birmingham found that patients treated at the later stages of HIV
disease required 2.6 times more healthcare dollars than those receiving
earlier treatment meeting Federal HIV treatment guidelines.
Patient Loads Are Increasing at an Unsustainable Rate
Patient loads have been increasing at Part C clinics nationwide,
despite the fact that there has not been significant new Federal
funding, and in most cases, State and/or local funding has been cut. A
steady increase in patients has occurred on account of higher diagnosis
rates and declining insurance coverage resulting in part from the
economic downturn. The CDC reports that the number of HIV/AIDS cases
increased by 15 percent from 2004 to 2007 in 34 States.\1\
---------------------------------------------------------------------------
\1\ Centers for Disease Control and Prevention. HIV/AIDS
Surveillance Report, 2007. Vol. 19. U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention; 2009:5.
www.cdc.gov/hiv/topics/surveillance/resources/reports/.
---------------------------------------------------------------------------
For example, at a clinic in Greensboro, North Carolina, the number
of patients has more than doubled from 321 patients in 2002 to more
than 800 in 2009. The clinic continues to deliver care in the same
space with the same staffing as in 2002 despite the 250 percent
increase in patients. In Sonoma County, California, funding became so
scarce that the Part C clinic there closed its doors, and had to patch
together new medical homes in other locations for 350 patients. In New
York, when St. Vincent's Hospital in New York City closed, including
the HIV/AIDS clinic, a Part C clinic at St. Luke's-Roosevelt Hospital
had to absorb almost the entire St. Vincent's clinic, approximately
1,000 patients, over the course of just a few days.
Our patients struggle in times of plenty, and during this economic
downturn they have relied on Part C programs more than ever. While
these programs have been under-funded for years, State and local
economic pressures are creating a crisis in our communities. Clinics
are discontinuing primary care and other critical medical services,
such as laboratory monitoring; suffering eviction from their clinic
locations; operating only 4 days per week; and laying off staff just to
get by. Years of nearly flat funding combined with large increases in
the patient population and the recent economic crisis are negatively
impacting the ability of Part C providers to serve their patients.
The following graph demonstrates the growing disparity between
funding for Part C and the increasing patient population. I refer to
this gap between funding and patients as the ``Triangle of Misery''
because it represents both the thousands of patients who deserve more
than we can offer and the Part C programs nationwide that are
struggling to serve them with shrinking resources.
Conclusion
These are challenging economic times, and we recognize the severe
fiscal constraints Congress faces in allocating limited Federal
dollars. The significant financial and patient pressures that we face
in our clinics at home propel us to make this funding request for
fiscal year 2012 funding of Ryan White Part C programs. This funding
would help to support medical providers nationwide in delivering
appropriate and effective HIV/AIDS care to their patients. As the
survey below of Part C providers nationwside shows, this Federal
support is urgently needed.
Thank you for your time and consideration of our request. If you
have any questions, please do not hesitate to contact me at the 1917
HIV/AIDS Outpatient Clinic, University of Alabama at Birmingham,
Birmingham, Alabama 35294-2050, e-mail at [email protected].
rwmpc survey: budgetary constraints continue to drive cutbacks in hiv
care
In January 2011, the Ryan White Medical Providers Coalition, which
represents Ryan White Part C programs nationwide that provide
comprehensive HIV medical care and treatment, asked members to indicate
their top three concerns as well as their frontline experiences
providing HIV care and treatment in the current, constrained economic
environement. The results of the brief survey included:
--The top three concerns (in order of importance):
--Funding cuts/shortfalls
--Sustaining the Ryan White Program and Part C programs and
preparing for health reform
--Clinic management issues, including:
-- HIV medical workforce recruitment and retention
-- Access to medications for patients (including the amount of
work that clinics are doing to secure this access now that
the ADAP crisis has worsened)
-- Increasing patient loads and the fact that clinics are
reaching the limits of what they can do within their
current financial and workforce resources.
--For those who are worried about funding cuts and shortfalls, 57
percent are worried about cuts to Federal funds.
--More than 56 percent of respondents have made cuts or changes to
their programs because of funding cuts or shortfalls (both
state and Federal).
--The types of cuts or changes that have been made include:
--More than 32 percent of clinics have either reduced or cut the
services they provide.
--21.5 percent have either frozen their hiring or laid off staff
--13.5 percent have reduced coverage for lab monitoring
These survey results indicate the need to support and increase the
investment in Part C programs, a valuable, effective and cost efficient
resource that provides medical homes to tens of thousands of persons
with HIV nationwide. Unless Part C programs receive additional funding,
more services and infrastructure will be lost during this critical time
period before the implementation of healthcare reform in 2014. Loss of
such resources and infrastructure would reduce the availability of
quality HIV care and treatment at just the time when the National HIV/
AIDS Strategy is hoping to increase access to these life-saving
services.
______
Prepared Statement of the Scleroderma Foundation
fiscal year 2012 appropriations recommendations
Funding for the National Institutes of Health (NIH) at a level of
$35 million.
An increase for the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) concurrent with the overall
increase to NIH.
Committee recommendation encouraging the Centers for Disease
Control and Prevention to partner with the Scleroderma Foundation in
promoting increased awareness of scleroderma among the general public
and healthcare providers.
Mr. Chairman, I am Cynthia Cervantes, I am 12 and in the ninth
grade. I live in Southern California and in October 2006 I was
diagnosed with scleroderma. Scleroderma means ``hard skin'' which is
literally what scleroderma does and, in my case, also causes my
internal organs to stiffen and contract. This is called diffuse
scleroderma. It is a relatively rare disorder effecting only about
300,000 Americans.
About 2 years ago I began to experience sudden episodes of
weakness, my body would ache and my vision was worsening, some days it
was so bad I could barely get myself out of bed. I was taken to see a
doctor after my feet became so swollen that calcium began to ooze out.
It took the doctors (period of time) to figure out exactly what was
wrong with me, because of how rare scleroderma is.
There is no known cause for scleroderma, which affects three times
as many women as men. Generally, women are diagnosed between the ages
of 25 and 55, but some kids, like me, are affected earlier in life.
There is no cure for scleroderma, but it is often treated with skin
softening agents, anti-inflammatory medication, and exposure to heat.
Sometimes a feeding tube must be used with a scleroderma patient
because their internal organs contract to a point where they have
extreme difficulty digesting food.
The Scleroderma Foundation has been very helpful to me and my
family. They have provided us with materials to educate my teachers and
others about my disease. Also, the support groups the foundation helps
organize are very helpful because they help show me that I can live a
normal, healthy life, and how to approach those who are curious about
why I wear gloves, even in hot weather. It really means a lot to me to
be able to interact with other people in the same situation as me
because it helps me feel less alone.
Mr. Chairman, because the causes of scleroderma are currently
unknown and the disease is so rare, and we have a great deal to learn
about it in order to be able to effectively treat it. I would like to
ask you to please significantly increase funding for the National
Institute of Health so treatments can be found for other people like me
who suffer from scleroderma. It would also be helpful to start a
program at the Centers for Disease Control and Prevention to educate
the public and physicians about scleroderma.
overview of the scleroderma foundation
The Scleroderma Foundation is a nonprofit organization based in
Danvers, Massachusetts with a three-fold mission: support, education,
and research. The Foundation provides support for people living with
scleroderma and their families through programs such as peer
counseling, doctor referrals, and educational information, along with a
toll-free telephone helpline for patients.
The Foundation also provides education about the disease to
patients, families, the medical community, and the general public
through a variety of awareness programs at both the local and national
levels. Over $1 million in peer-reviewed research grants are awarded
annually to institutes and universities to stimulate progress in the
search for a cause and cure for scleroderma.
who gets scleroderma?
There are many clues that define the susceptibility to develop
scleroderma. A genetic basis for the disease has been suggested by the
fact that it is more common among patients whose family members have
other autoimmune diseases (such as lupus). In rare cases, scleroderma
runs in families, although for the vast majority of patients there is
no other family member affected. Some Native Americans and African
Americans suffer a more severe form of the disease Caucasians. Women
between the ages of 25-55 are more likely to develop scleroderma.
causes of scleroderma
The cause of scleroderma is unknown. However, we do understand a
great deal about the biological processes involved. In localized
scleroderma, the underlying problem is the overproduction of collagen
(scar tissue) in the involved areas of skin. In systemic sclerosis,
there are three processes at work: blood vessel abnormalities, fibrosis
(which is overproduction of collagen) and immune system dysfunction, or
autoimmunity.
research
Unfortunately, support for scleroderma research at the National
Institutes of Health over the past several years has been flat funded
at $19 million since fiscal year 2009, and is again estimated at $19
million for fiscal year 2012. This absence of increase is extremely
frustrating to our patients who recognize biomedical research as their
best hope for a better quality of life. It is also of great concern to
our researchers who have promising ideas they would like to explore if
resources were available.
types of scleroderma
There are two main forms of scleroderma: systemic (systemic
sclerosis, SSc) that usually affects the internal organs or internal
systems of the body as well as the skin, and localized that affects a
local area of skin either in patches (morphea) or in a line down an arm
or leg (linear scleroderma), or as a line down the forehead
(scleroderma en coup de sabre). It is very unusual for localized
scleroderma to develop into the systemic form.
Systemic Sclerosis (SSc)
There are two major types of systemic sclerosis or SSc: limited
cutaneous SSc and diffuse cutaneous SSc. In limited SSc, skin
thickening only involves the hands and forearms, lower legs and feet.
In diffuse cutaneous disease, the hands, forearms, the upper arms,
thighs, or trunk are affected.
People with the diffuse form of SSc are at risk of developing
pulmonary fibrosis (scar tissue in the lungs that interferes with
breathing, also called interstitial lung disease), kidney disease, and
bowel disease. The risk of extensive gut involvement, with slowing of
the movement or motility of the stomach and bowel, is higher in those
with diffuse rather than limited SSc. Symptoms include feeling bloated
after eating, diarrhea or alternating diarrhea and constipation.
Pulmonary Hypertension (PH) is high blood pressure in the blood
vessels of the lungs. It is totally independent of the usual blood
pressure that is taken in the arm. This tends to develop in patients
with limited SSc after several years of disease. The most common
symptom is shortness of breath on exertion. However, several tests need
to be done to determine if PH is the real culprit. There are now many
medications to treat PH.
Localized Scleroderma
Morphea
Morphea consists of patches of thickened skin that can vary from
half an inch to 6 inches or more in diameter. The patches can be
lighter or darker than the surrounding skin and thus tend to stand out.
Morphea, as well as the other forms of localized scleroderma, does not
affect internal organs.
Linear scleroderma
Linear scleroderma consists of a line of thickened skin down an arm
or leg on one side. The fatty layer under the skin can be lost, so the
affected limb is thinner than the other one. In growing children, the
affected arm or leg can be shorter than the other.
Scleroderma en coup de sabre
Scleroderma en coup de sabre is a form of linear scleroderma in
which the line of skin thickening occurs on the forehead or elsewhere
on the face. In growing children, both linear scleroderma and en coup
de sabre can result in distortion of the growing limb or lack of
symmetry of both sides of the face.
______
Prepared Statement of Senior Service America, Inc.
We urge the subcommittee to restore funding for the Senior
Community Service Employment Program (SCSEP), currently administered by
the Department of Labor, to no less than $600 million for fiscal year
2012. would return funding for this proven and unique Federal
employment and training program to pre-ARRA levels.
SCSEP is the only Federal program targeted at assisting low income
workers over the age of 55 either regain employment or provide minimum
wage employment through community service in communities across the
Nation. A restoration of funding for SCSEP to $600 million would
provide community service employment to an additional 24,000 unemployed
and low-income older workers and at least 7 million lost staffing hours
in participants' community service to local government agencies and
nonprofit organizations meeting basic human needs.
We estimate that the public return on investment is more than
double its appropriations level. The value of the community service by
SCSEP participants would exceed $900 million. In addition to the value
of the this service, SCSEP produces savings to the Federal Government
by helping many thousands of vulnerable older adults to avoid becoming
totally dependent on government transfer payments, including Medicaid,
Supplemental Security Income, and early receipt of Social Security
benefits.
SCSEP's severe cut in fiscal year 2011 will have devastating impact
on older workers and communities.--Restoring funding in fiscal year
2012 would lessen the impact of the 45 percent reduction in SCSEP as a
result of the fiscal year 2011 year-long Continuing Resolution, The cut
of $375 million from fiscal year 2010 is larger than the WIA core
funding cut. As a result, during the year starting July 1, 2011, nearly
50,000 fewer jobless older adults will be employed and almost 35
million staff hours will be lost by over 30,000 local agencies and
programs throughout the 50 States. Using tables from the Independent
Sector, the value of these lost SCSEP community service hours exceeds
$740 million.
SCSEP currently supports a wide range of community services and
local government programs. For example, in 2011 over 1,100 public
libraries (at least one in every State, most in rural areas) employed
at least one SCSEP participant in a variety of library-related
assignments. About one-fourth of all SCSEP community service hours are
performed in service to other older adults, such as senior centers,
nutrition, Meals on Wheels, and adult day care centers.
SCSEP is a unique Federal workforce development program.--According
to a January 2011 GAO report on multiple employment and training
programs, SCSEP is one of only three Federal workforce development
programs that do not overlap with any other program. Since 1998, it is
the only Federal program targeted to assist older adults return to the
workforce and serves almost twice the number of adults 55 and over who
receive training under WIA. Previous research by GAO and others have
documented that WIA has consistently underserved older jobseekers.
Older adults, especially those eligible for SCSEP, continue to
suffer in the current economy. Older workers have been described as the
``new unemployables'' in a recent report by Rutgers University. The
current jobless rate for all older workers continues to be lower than
the rate for all workers, but in 2010 the unemployment rate of older
adults 55-74 years of age eligible for SCSEP was 23 percent, more than
three times the national average for all adult workers. Among displaced
workers 55 and older, the reemployment rate was only 38 percent, the
lowest of any age group, with those from lower income households and
with less than a college education faring the worst. Finally, the
average duration of unemployment among adults 55 and over continued to
increase in April 2011 to 53.6 weeks, with more than half of all older
jobseekers out of work for 27 or more weeks, also an increase from the
prior month. (More information is available from AARP and Senior
Service America websites.)
The job market is not likely to improve significantly for most of
these low-income and disadvantaged older job seekers in the foreseeable
future. Too many will remain out of work and be forced to sustain
themselves by becoming totally reliant on government transfers such as
Medicaid, Supplemental Security Income, and early receipt of Social
Security income benefits. Many will be highly unlikely to return to the
labor force. Restoring SCSEP appropriations to pre-ARRA levels is a
wise investment in a program of demonstrated effectiveness operated by
a network of proven performers.
DOL's SCSEP grantee network consistently achieves its performance
measures.--According to official statistics, in PY2009 the aggregate
performance of the 18 national grantees and 56 State and territorial
grantees achieved 98 percent or more of each of the common performance
measures established for the program by DOL. For example, the grantee
network achieved a 46.2 percent Entered Employment Rate (compared to
the goal of 47 percent established by DOL); 70 percent Retention (68
percent goal); and $6,900 6 month earnings ($6,229 goal). For
comparison, the Entered Employment Rate achieved was 48.1 percent in
PY2008 and 52.4 percent in PY2007.
In addition, ratings by SCSEP participants and participating host
agencies using the American Customer Satisfaction Index have been
consistently higher for SCSEP than for WIA. In PY2009, participants
gave SCSEP an ACSI score of 82.7 and host agencies gave a score of
81.3. Additional information from these independent national surveys:
SCSEP Participants (number of respondents=24,358)
ACSI score of 82.7 (about the same as prior year's score)
Nearly 92 percent of respondents reported that, compared to the
time before they entered SCSEP, their physical health is the same or
better, 73 percent reported that their outlook on life is a little more
positive or much more positive.
Participants were in moderate to strong agreement (7.9 on a scale
of 1 to 10) with the statement that their community service wages have
made a substantial improvement in their quality of life.
SCSEP Host Agencies (number of respondents=10,567)
ACSI score of 81.3 (nearly identical to prior year's score)
75 percent indicated that participation in SCSEP increased their
ability to provide services to the community either ``somewhat'' or
``significantly.''
The impact of the fiscal year 2011 cuts to SCSEP will be felt in
every State. For example:
Impact on Iowa: Loss of nearly $5 million in SCSEP funding and over
$7 million in services.
During fiscal year 2010, about 490 local programs in 153 Iowa towns
and cities hosted at least one SCSEP participant, including: 171 local
and State government agencies; 71 programs serving older adults,
including at least 20 senior centers; 36 schools and post-secondary
institutions; 31 workforce development offices; 24 public libraries and
11 museums; and 10 community action agencies.
----------------------------------------------------------------------------------------------------------------
Current fiscal Final fiscal
year 2010 year 2011 Impact
appropriations funding level
----------------------------------------------------------------------------------------------------------------
Funding Allocation for Iowa (all SCSEP grantees).......... $10.5 million $5.6 million -$4.9 million
Number of Participants in Paid Community Service 1,520 persons 880 persons -640 persons
Employment in Iowa.......................................
Number of SCSEP Hours Serving Iowa Communities............ 944,700 hours 507,700 hours -437,000 hours
Value of SCSEP Hours Serving Iowa Communities @$16.77/hour $15.8 million $8.5 million -$7.3 million
(www.independentsector.org/volunteer_time)...............
----------------------------------------------------------------------------------------------------------------
The U.S. Department of Labor awards SCSEP funding for Iowa to the
AARP Foundation, Experience Works, Senior Service America, Inc., and
the Iowa Dept. on Aging. Local agencies in Iowa that operate SCSEP are
Community Action Agency of Siouxland, Generations Area Agency on Aging,
Hawkeye Area Community Action Program, and West Central Community
Action.
Impact on Alabama: A loss of $6.4 million in SCSEP funding and $10
million in services.
During fiscal year 2010, more than 600 local government and
nonprofit programs hosted at least one SCSEP participant, including:
--Nearly 300 local government agencies and programs, including 35
libraries and 31 senior centers, and
--More than 220 nonprofit organizations, including the American Red
Cross, Boys and Girls Clubs, and Chambers of Commerce.
Starting July 1, 2011, the fiscal year 2011 cut in SCSEP funding
will mean over 800 fewer job opportunities and 568,000 fewer community
service hours to Alabama agencies (valued at least $10 million,
according to tables provided by the Independent Sector).
----------------------------------------------------------------------------------------------------------------
Current fiscal Final fiscal
year 2010 year 2011 Impact
appropriations funding level
----------------------------------------------------------------------------------------------------------------
Funding Allocation for Alabama (all SCSEP grantees)....... $14.5 million $8.1 million -$6.4 million
Number of Participants in Paid Community Service 2,090 persons 1,280 persons -810 persons
Employment in Alabama....................................
Number of SCSEP Hours Serving Alabama Communities......... 1,302,000 hrs. 734,000 hrs. -568,000 hrs.
Value of SCSEP Hours Serving Iowa Communities @$17.70/hour $23 million $13 million -$10 million
(www.independentsector.org/volunteer_time)...............
----------------------------------------------------------------------------------------------------------------
The U.S. Department of Labor provides SCSEP funding to the Alabama
Department of Senior Services, Easter Seals, and Senior Service
America, Inc.
The following local government agencies in Alabama receive SCSEP
funding: Alabama-Tombigbee Regional Commission, East Alabama Regional
Planning and Development Commission, Jefferson County Commission,
Middle Alabama Area Agency on Aging, North-central Alabama Regional
Council of Governments, Northwest Alabama Council of Local Governments,
South Central Alabama Development Commission, Southeast Alabama
Regional Planning and Development Commission, Top of Alabama Regional
Council of Governments, and West Alabama Regional Commission.
Summary
We recognize that these are challenging times for the Subcommittee
and difficult funding decisions must be made. A partial restoration of
SCSEP funding to $600 million will ensure that an additional 24,000 of
the hardest to reemploy, low income older workers will be able to
provide an additional 7 million hours in service to communities across
the Nation, with a return on investment double the appropriations
provided to SCSEP. Thank you for considering this funding request.
About Senior Service America, Inc.
Senior Service America, Inc. (SSAI) has been awarded a national
SCSEP grant from DOL since 1968, including competitive grants in 2003
and 2006. As the third largest national grantee, SSAI operates SCSEP
exclusively through subgrants to 81 local organizations that serve 430
counties in 16 States. Its diverse network of subgrantees includes 25
area agencies on aging, 11 community action agencies, 10 regional
councils of government, 13 workforce development agencies, eight faith-
based organizations, two community colleges, and one local United Way.
For more information, please visit www.seniorserviceamerica.org. or
contact Tony Sarmiento, Executive Director, at 301-578-8469,
[email protected],
______
Prepared Statement of the Sickle Cell Disease Association of America
Mr. Chairman and distinguished Members of the Subcommittee, my name
is Sonja L. Banks. I was recently elected President and Chief Operating
Officer of the Sickle Cell Disease Association of America, Inc (SCDAA).
Since 1971, SCDAA has served as the Nation's only volunteer
organization working full time on a national level to resolve issues
surrounding sickle cell disease. We have grown to approximately 55
community-based member organizations focused on serving the needs of
individuals with Sickle Cell Disease or Sickle Cell Trait, their
families, and over 300 communities nationwide and in Canada.
On behalf of the organization, I am honored to submit this
testimony to your Subcommittee as a public witness in conjunction with
your consideration of fiscal year 2012 Appropriations legislation.
SCDAA respectfully urges the Subcommittee to support President
Obama's continuation of funding for the Sickle Cell Anemia
Demonstration Program, and the Registry and Surveillance System for
Hemoglobinopathy and Hemoglobinopathy Program Initiative. We also urge
the Subcommittee to restore funding to the Sickle Cell Disease and
Newborn Screening Program, a crucial program to fulfilling Secretary
Kathleen Sebelius' charge to the Department of Health and Human
Services (HHS) to make SCD a priority area of focus.
SCD is an inherited blood disorder that is a major problem in the
United States. An estimated 72,000 Americans live with the disease.
More than 2.5 million Americans have the Sickle Cell Trait (SCT),
including 1 in 12 African Americans. The average life span of an adult
with SCD is only 45 years.
Common complications include early childhood death from infection,
stroke in young children and adults, infection of the lungs similar to
pneumonia, pulmonary hypertension, chronic damage to organs such as the
kidney resulting in chronic kidney failure, and frequent severe painful
episodes. These unpredictable, intermittent, devastating pain events
can begin as early as six months of age and can span a lifetime,
impacting school and work attendance.
As the Nation addresses issues associated with healthcare reform, a
real and rare opportunity exists to support, a population in dire need
of treatment and care through innovative research and improved care.
First, we respectfully request that the Subcommittee provide
$4,740,000 for the Sickle Cell Anemia Demonstration Program and Data
Coordination Center. In fiscal year 2011, the Program received an
appropriation of $4,750,000, and for fiscal year 2012 the President's
budget recommends $4,740,000. Funding this national program will
improve the lives of SCD patients through disease management programs
to help them live longer, healthier lives while supporting research
toward a comprehensive cure and providing community education about
this disease and its treatment options.
Second, we respectfully request that the Subcommittee include
$20,165,000 for the Public Health Approach to Blood Disorders Program.
The President's fiscal year 2012 budget request consolidates existing
budget sub-lines into one line called ``Public Health Approach to Blood
Disorders.'' As part of this coordinated effort, a Hemoglobinopathy
Data Center will operate surveillance and registry program entitled
RuSH (Registry and Surveillance System for Hemoglobinopathies) in seven
States for 2 years.
The RuSH health data systems will provide researchers, policy
makers, and the public with imperative information about SCD and SCD-
related diseases that is currently unavailable. The lack of this type
of data system for Sickle-Cell-related diseases limits the research and
treatment communities' ability to fully understand the impact of the
disease and to develop healthcare planning at the local, State, and
national levels. Additionally, funding also will support a multi-agency
collaboration to form an HHS Hemoglobinopathy Program Initiative to
offer more effective care and lower societal and medical costs for
individuals affected by blood disorders such as SCD.
Finally, we respectfully request that the Subcommittee restore
$3,774,000 for the Sickle Cell Disease and Newborn Screening Program
(SCD-NBS). Unfortunately, the President has proposed to eliminate this
program in fiscal year 2012. On the other hand, Secretary Sebelius has
launched an SCD initiative aimed at increasing access to and improving
care. We believe that continuing the SCD-NBS program is critical to the
initiative's goal, and invaluable to families and individuals suffering
from this debilitating disease.
The SCD-NBS Program provides a continuity of medical services,
education and counseling from birth to adulthood for persons afflicted
with Sickle Cell Disease and Sickle Cell Trait. Since 2002, the project
has supported a National Coordinating and Evaluation Center and 17
community-based demonstration sites across the country. Because of
changes in the eligibility requirements for demonstration sites due
next month, we also ask that report language be included in the fiscal
year 2012 Subcommittee bill to direct the Program's funding to
community-based or faith-based organizations involved with Sickle Cell
Disease.
Thank you for considering these requests. We look forward to
working with the Senate Appropriations Subcommittee on Labor, Health,
and Education to fund these three critical programs that will help
African Americans and other historically underserved children and
families with Sickle Cell Disease live longer and healthier lives.
______
Prepared Statement of the Society for Maternal-Fetal Medicine
Mr. Chairman and Members of the Committee: The Society for
Maternal-Fetal Medicine is pleased to have the opportunity to submit
testimony on behalf of the fiscal year 2012 budget for the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development (NICHD). We urge the Committee, as you move forward with
your deliberations on the fiscal year 2012 budget for the National
Institutes of Health (NIH), to keep in mind the enormous lost
opportunities that the NIH, and in particular the NICHD, will
experience if the level of funding is not sustained.
Established in 1977, the Society for Maternal-Fetal Medicine (SMFM)
is dedicated to improving maternal and child outcomes; and raising the
standards of prevention, diagnosis, and treatment of maternal and fetal
disease.
Maternal-fetal medicine specialists, also known as MFM specialists,
perinatologists, and high-risk pregnancy physicians, are highly trained
obstetrician/gynecologists with advanced expertise in obstetric,
medical, and surgical complications of pregnancy and their effects on
the mother and fetus.
The most common medical illnesses managed by MFM's include
hypertension, diabetes, seizure disorders, autoimmune diseases, and
blood clotting disorders. We also provide care for women who are at
increased risk for preterm birth, including multiple gestations, women
with cervical insufficiency who may require a surgery to prevent
preterm birth, and women with placental problems such as bleeding from
premature separation. In addition, MFM specialists are often
responsible for the management of preterm labor, premature rupture of
membranes, and other complications during labor that have the potential
to impact newborn and long-term infant outcomes.
The special problems faced by these mothers may lead to death,
short-term or in some cases life-long problems for their babies. For
example:
--Pre-term birth (birth before the fetus is at 37 weeks'
gestation).--Over half a million children are born preterm each
year. Preterm infants are at high risk for a variety of
disorders, including mental retardation, cerebral palsy, and
vision impairment. These infants are also at risk for long-term
health issues, including cardiovascular disease (heart attack,
stroke, and high blood pressure) and diabetes. The annual cost
to society (medical, educational, and lost productivity) of
preterm birth is at least $26 billion (in 2005 dollars).
--Hypertension.--High blood pressure during pregnancy endangers the
health of both the mother and the baby and is increasingly
common as women delay pregnancy until they are older, and as
they are more frequently overweight. Chronic hypertension
complicating pregnancy is associated with a risk of fetal
growth restriction and a risk of preterm birth. Hypertension in
pregnancy is also the second leading cause of maternal death in
the United States.
--Diabetes.--The hormonal changes of pregnancy often bring about a
diabetic state (gestational diabetes) in predisposed women or
can seriously worsen preexisting diabetes. Whether diabetes
mellitus existed before conception or gestational diabetes
develops during pregnancy, maternal glucose intolerance can
have significant medical consequences. Poorly controlled
diabetes is associated with miscarriage, congenital
malformations, abnormal fetal growth, stillbirth, obstructed
labor, increased cesarean delivery, and neonatal complications.
NICHD's commitment to basic, clinical and translational research
has lead to new ways to treat and improve the health of pregnant women
and infants. One of the most successful approaches for testing research
questions is the NICHD Maternal-Fetal Medicine Units (MFMU) Network
which allows researchers from across the country to coordinate clinical
studies to improve maternal, fetal and neonatal health. The studies to
date have not only identified new therapies and evaluated technologies
used in maternal fetal medicine, but also have helped to abolish
practices that are not useful.
--Researchers supported through the MFMU were responsible for the
groundbreaking finding related to preterm birth and
progesterone. Following a series of studies in the 1970s and
1980s, a national clinical trial showed that progesterone
treatment resulted in a substantial reduction in the rate of
preterm delivery among women who had a previous preterm birth,
reduced the risk of newborn complications, and was effective in
both African American and Non-African American women. This
preventive therapy has been translated into practice. The drug
was widely available through compounding pharmacies at a cost
of $15-$30 per injection or $300 for a 20 week treatment
course. However, in February 2011 the FDA granted KV
Pharmaceutical orphan status for its drug named Makena, a
manufactured version of the identical compound drug. After
which, KV Pharmaceutical increased the price of the drug to
$1,500 per injection, and later reduced it to $690 per
injection. (SMFM is actively engaged in efforts to ensure that
this medication is accessible and affordable to every pregnant
woman who is at risk for recurrent preterm birth.)
--Until recently, there was no evidence to show whether treating the
mild form of gestational diabetes benefited or posed risks for
mothers and infants. A recent Network study found women who
were treated for mild gestational diabetes were half as likely
to have an unusually large baby, and their babies were half as
likely to experience shoulder dystocia, an emergency condition
in which the baby's shoulder becomes lodged inside the mother's
body during birth. Treated women in the study also had fewer
caesarean deliveries. In addition, they had fewer problems with
hypertension and preeclampsia, a life-threatening complication
of pregnancy that can lead to maternal seizures and death.
Research supported by the MFMU provided the first conclusive
evidence that treating pregnant women who have even the mildest
form of gestational diabetes can reduce the risk of common
birth complications among infants, as well as blood pressure
disorders among mothers. These findings will change clinical
practice.
--Recent research conducted by the network found that antenatal
magnesium sulfate, when administered to women at risk of
delivering preterm, reduces the risk of cerebral palsy in
surviving preterm infants by 45 percent. This finding has been
translated into clinical practice.
Cerebral palsy refers to a group of neurological disorders
affecting control of movement and posture and which limit
activity. The brain may be injured or develop abnormally during
pregnancy, birth or in early childhood. The causes of cerebral
palsy are not well understood. Both economically and
emotionally, the burden of cerebral palsy is enormous. The
Centers for Disease Control and Prevention (CDC) estimates the
lifetime costs including direct medical, direct non-medical,
and indirect for all people born with cerebral palsy in 2000 to
be $11.5 billion (in 2003 dollars).
Research that disproves a current therapy or treatment can also
provide valuable guidance to clinicians and their patients.
--Translational research in the 1990s found that the use of
corticosteroids in pregnancies at risk of preterm birth
improved the outcomes for infants born preterm, reducing rates
of breathing problems, bleeding into the brain, and problems
with the intestines. However, NICHD sponsored research that
evaluated the use of repeated doses of corticosteroids found
that repeated doses resulted in smaller birth weights and head
circumstances. Researchers also found a concerning increase in
cerebral palsy in children who were exposed to four or more
courses of corticosteroids. This study, along with an NIH
Consensus Development Conference to pull together all available
data, stopped the routine use of repeated courses of antenatal
corticosteroids.
NICHD is at the forefront of several novel and important research
areas, but there are still many areas about maternal health, pregnancy,
fetal well-being, labor and delivery and the developing child that are
not close to being understood. The challenges of the NICHD to
investigate these problems remain. For example:
--Preterm Birth and Stillbirth.--Preterm birth and stillbirth
represent two of the most important complications of pregnancy.
Prevention of preterm birth and stillbirth depends on
identifying women at risk and understanding the mechanisms of
disease. It is imperative that NICHD take advantage of high
throughput technologies to understand the causes of preterm
birth and stillbirth and support genomics, proteomics, and
metabolomics studies focusing on prediction and prevention of
preterm birth and stillbirth, as well as the use of existing
biobanks. The promise of these new technologies is that a
better understanding of the biologic processes involved in
pregnancy and pregnancy complications will lead to improved
prediction, prevention, and treatment strategies that will
improve maternal and infant health.
--Severe, Early Adverse Pregnancy Outcomes.--Women with severe, early
adverse pregnancy outcome, such as multiple losses, demises,
and severe preeclampsia, are at increased risk for long-term
chronic health problems, including hypertension, stroke,
diabetes, and obesity. Studies have shown that women who have
had preeclampsia are more likely to develop chronic
hypertension, to die from cardiovascular disease and to require
cardiac surgery later in life. In addition, approximately 50
percent of women with gestational diabetes will develop
diabetes later in life. Studies to identify women at risk for
long term morbidity, and to develop strategies to prevent long
term adverse outcomes in these women are urgently needed.
--Maternal Fetal Medicine Units Network.--Vigorous support of the
MFMU Network is needed so that therapies and preventive
strategies that have significant impact on the health of
mothers and their babies will not be delayed. Until new options
are created for identifying those at risk and developing cause
specific interventions, preterm birth will remain one of the
most pressing problems in obstetrics.
SMFM applauds NICHD efforts to move forward with the development of
a scientific vision process for the Institute that will set an
ambitious agenda and inspire the Institute, the research community, and
its many partners to achieve critical scientific goals and meet
pressing public health needs.
Mr. Chairman, we understand the budgetary constraints that are
facing the Congress, but as providers of care for women with high-risk
pregnancies we have seen emerging technologies that have provided
greater opportunity to evaluate and treat the complicated problems
involving the mother and fetus. Without a sustained investment in the
critical medical research being conducted by the National Institutes of
Health, and the National Institute of Child Health and Human
Development in particular, the health of pregnant women and their
babies will be at risk and NICHD's mission of promoting healthy
development throughout the lifespan will be hindered.
Recommendation
The Society for Maternal-Fetal Medicine joins with the Ad Hoc Group
for Medical Research in urging the Committee to provide an
appropriation of $35 billion in fiscal year 2012 for the National
Institutes of Health.
The Society joins with the Friends of the National Institute of
Child Health and Human Development in support of a fiscal year 2012
budget of $1.352 billion for the National Institute of Child Health and
Human Development.
Thank you for the opportunity to submit our concerns to the
Committee.
______
Prepared Statement of the Society for Neuroscience
Introduction
Mr. Chairman and Members of the Subcommittee, my name is Susan
Amara, Ph.D. I am the Thomas Detre Professor of Neuroscience and Chair
of the Department of Neurobiology as well as Co-Director of the Center
for Neuroscience at the University of Pittsburgh and President of the
Society for Neuroscience. My major research efforts have been focused
on the structure, physiology, and pharmacology of a group of proteins
in the brain that are the primary targets for addictive drugs including
cocaine and amphetamines, for the class of therapeutic antidepressants,
known as reuptake inhibitors, and for methylphenidate, which is used to
treat attention deficit hyperactivity disorders.
On behalf of the more than 41,000 members of the Society for
Neuroscience (SfN) and myself, I would like to thank you for your past
support of neuroscience research at the National Institutes of Health
(NIH). Over the past century, researchers have made tremendous progress
in understanding cell biology, physiology, and chemistry of the brain.
Research funded by NIH has made it possible to make advances in brain
development, imaging, genomics, circuit function, computational
neuroscience, neural engineering and many other disciplines. In this
testimony, I will highlight how these advances have benefited taxpayers
and why we should continue to strengthen this investment, even as the
Nation makes difficult budget choices.
Fiscal Year 2012 Budget Request
The Society respectfully requests that Congress provide a fiscal
year 2012 appropriation in the amount of $35 billion for NIH. This
level of funding will enable the field to serve the long-term needs of
the Nation by continuing to improve health for the benefit of the
American people and the world, advance science, and promote America's
near-term and long-range economic strength. This level will build on
the research activities supported under prior year appropriations,
enabling neuroscience-related NIH institutions to aggressively fund
strategic plans that will significantly advance the understanding of
the brain and the nervous system. In so doing, these investments will
contribute to economic growth in hundreds of communities nationwide, as
more than 83 percent of NIH funding is distributed to more than 3,000
institutions in communities in every State. Moreover, it will help
preserve and expand America's role as leader in biomedical research,
which fosters a wide range of private enterprises in the
pharmaceutical, biotechnology, medical device, hospitality industries
as well as many others.
SfN hopes that such an appropriation will be the first step on the
path to providing a consistent and reliable long-term investment in the
NIH and in particular the field neuroscience. This will ensure that
there is not a dramatic drop in research activity or a loss of jobs,
and serve as an inducement to keeping our young researchers in the
training pipeline.
What is the Society for Neuroscience
SfN is a nonprofit membership organization of basic scientists and
physicians who study the brain and nervous system. The SfN mission is
to:
--Advance the understanding of the brain and the nervous system by
bringing together scientists of diverse backgrounds, by
facilitating the integration of research directed at all levels
of biological organization, and by encouraging translational
research and the application of new scientific knowledge to
develop improved disease treatments and cures.
--Provide professional development activities, information and
educational resources for neuroscientists at all stages of
their careers, including undergraduates, graduates, and
postdoctoral fellows, and increase participation of scientists
from a diversity of cultural and ethnic backgrounds.
--Promote public information and general education about the nature
of scientific discovery and the results and implications of the
latest neuroscience research. Support active and continuing
discussions on ethical issues relating to the conduct and
outcomes of neuroscience research.
--Inform legislators and other policymakers about new scientific
knowledge and recent developments in neuroscience research and
their implications for public policy, societal benefit, and
continued scientific progress.
What is Neuroscience?
Neuroscience is the study of the nervous system. It advances the
understanding of human function on every level: movement, thought,
emotion, behavior, and much more. Neuroscientists use tools ranging
from computers to special dyes to examine molecules, nerve cells,
networks, brain system, and behavior. From these studies, they learn
how the nervous system develops and functions normally and what goes
wrong in neurological and psychiatric disorders.
Neuroscience is now a unified field that integrates biology,
chemistry, and physics with studies of structure, physiology, and
behavior, including human emotional and cognitive functions.
Neuroscience research includes genes and other molecules that are the
basis for the nervous system, individual neurons, and ensembles of
neurons that make up systems and behavior. Through their research,
neuroscientists work to demonstrate normal functions of the brain and
determine how the nervous system develops, matures, and maintains
itself through life. They seek to prevent or cure many devastating
neurological and psychiatric disorders.
As the committee works to set funding levels for critical research
initiatives for fiscal year 2012 and beyond we need to do more than
establish a budget that is ``workable'' in the context of the current
fiscal situation. We ask you to help establish a national commitment to
advance the understanding of the brain and the nervous system--an
effort that has the potential to transform the lives of thousands of
people living with brain-based diseases and disorders. Help us to
fulfill our commitment to overcoming the most difficult obstacles
impeding progress, and to identifying critical new directions in basic
neuroscience.
Brain Research and Discoveries
The power of basic science unlocks the mysteries of the human body
by exploring the structure and function of molecules, genes, cells,
systems, and complex behaviors. Every day, neuroscientists are
advancing scientific knowledge and medical innovation by expanding our
knowledge of the basic makeup of the human brain. In doing so,
researchers exploit these findings and identify new applications that
foster scientific discovery which can lead to new and ground-breaking
medical treatments. Basic research funded by the National Institutes of
Health continues to be essential to ensuring discoveries that will
inspire scientific pursuit and medical progress for future generations.
The funds provided in the past have helped neuroscientists make
tremendous strides in diagnosing and treating neurological and
psychiatric disorders. Due to federally funded research, scientists and
healthcare providers now have a much better understanding of how the
brain functions.
As we look ahead to the long-term trajectory for NIH funding,
steady, sustainable growth is essential to maintaining a continuous
research pipeline that spans from basic science to clinical outcomes.
Without a long-term sustainable plan for investing in research,
dramatic swings in the funding cycle have a stifling, often
irreversible impact on progress, shutting down laboratories, driving
away talented young investigators and disillusioning students who have
just discovered a passion for biomedical research. As support declines,
gaps emerge between levels of funding and the need for scientific
advance. There are two kinds of gap--the ones you see and the ones you
don't. In times of limited resources, it is easier to deal
strategically with the gaps you know. For example, with an aging
population it makes sense to maintain support for research on
Alzheimer's and other chronic neurodegenerative diseases. But it's the
gaps we are unaware of that I also worry about. We know from past
experience that it is not always clear where the next critical
breakthrough or innovative approach will come from--progress in science
depends on imaginative curiosity-driven research that makes leaps in
ways no one could have anticipated. Where would neuroscience and cell
biology be without a rainbow of fluorescent proteins from jellyfish,
which are now illuminating neurological diseases and disorders? Where
would cutting edge work in systems neuroscience be today without
research on channel rhodopsins from algae, which now hold promise for
novel, noninvasive treatments for brain disorders? When resources are
limited, balancing support for high-risk high-payoff ideas with
disease-driven translational research presents a huge challenge--it is
easy to see why the latter is important, yet ultimately both kinds of
research have the potential to contribute to the development of life
changing therapies and cures for different diseases. More than ever is
it important to support and fund research at many levels from the most
basic to translational. The following are just two of the many basic
research success stories in neuroscience research emerging now thanks
to strong historic investment in NIH and other research agencies:
Nicotine Addiction
Although tobacco has been used legally for hundreds of years,
nicotine addiction takes effect through pathways similar to those
involving cocaine and heroin. During addiction, drugs activate brain
areas that are typically involved in the motivation for other
pleasurable rewards such as eating or drinking. These addictions leave
the body with a strong chemical dependence that is very hard to get
over. In fact, almost 80 percent of smokers who try to quit fail within
their first year. The lack of a reliable cessation technique has
profound consequences. Tobacco-related illnesses kill as many as
440,000 Americans every year, and thus the human and economic costs of
nicotine addiction are staggering. One out of every five U.S. deaths is
related to smoking.
Past Federal funding has enabled scientists to understand the
mechanisms of nicotine addiction, enabling them develop successful
treatments for smoking cessation. The discoveries that lead to these
findings started back in the 1970's, when scientists identified the
substance in the brain that nicotine acted on to transmit its
pleasurable effects. They found that nicotine was hijacking a receptor,
a protein used by the brain to transmit information. This receptor,
called the nicotinic acetylcholine receptor, regulates the release of
another key transmitter, dopamine, which in turn acts within reward
circuits of the brain to mediate both the positive sensations and
eventual addiction triggered by nicotine consumption. This knowledge
has been the basis for the development of several therapeutic
strategies for smoking cessation: nicotine replacement, drugs that
target nicotine receptors, as well as drugs that prevent the reuptake
of dopamine have all been shown to increase the long-term odds of
quitting by several fold.
More recently, using mice genetically modified to have their
nicotinic acetylcholine receptors contain one specific type of subunit,
scientists determined that some kinds of receptor subunits are more
sensitive to nicotine than others, and because each subunit is
generated from its own gene, this discovery indicated that genetics can
influence how vulnerable a person is to nicotine addiction. Further
research to spot genetic risk factors and to generate genetically
tailored treatment options is ongoing. Other studies are also testing
whether a vaccine that blocks nicotine's effects can help discourage
the habit. Since people who are able to quit smoking immediately lower
their risk for certain cancers, heart disease and stroke, reliable and
successful treatments are clearly needed. Today's continued research
funding can make it possible for these emerging therapies to ultimately
help people overcome the challenges of nicotine addiction.
Brain-machine interface
The brain is in constant communication with the body in order to
perform every minute motion from scratching an itch to walking.
Paralysis occurs when the link between the brain and a part of the body
is severed, and eliminates the control of movement and the perception
of feeling in that area. Almost 2 percent of the U.S. population is
affected by some sort of paralysis resulting from stroke, spinal cord
or brain injury as well as many other causes. Previous research has
focused on understanding the mechanisms by which the brain controls a
movement. Research during which scientists were able to record the
electrical communication of almost 50 nerve cells at once showed that
multiple brain cells work together to direct complex behaviors.
However, in order to use this information to restore motor function,
scientists needed a way to translate the signals that neurons give into
a language that an artificial device could understand and convert to
movement.
Basic science research in mice lead to the discovery that thinking
of a motion activated nerve cells in the same way that actually making
the movement would. Further studies showed that a monkey could learn to
control the activity of a neuron, indicating that people could learn to
control brain signals necessary for the operation of robotic devices.
Thanks to these successes, brain-controlled prosthetics are being
tested for human use. Surgical implants in the brain can guide a
machine to perform various motor tasks such as picking up a glass of
water. These advances, while small, are a huge improvement for people
suffering from paralysis. Scientists hope to eventually broaden the
abilities of such devises to include thought-controlled speech and
more. Further research is also needed to develop non-invasive
interfaces for human-machine communication, which would reduce the risk
of infection and tissue damage. Understanding how neurons control
movement has had and will continue to have profound implications for
victims of paralysis.
A common theme of both these examples of basic research success
stories is that they required the efforts of basic science researchers
discovering new knowledge, of physician scientists capable adapting
those discoveries into better treatments for their patients and of
companies willing to build on all of this knowledge to develop new
medications and devices.
The future of American science
Finally, as the subcommittee considers this year's funding levels
and in future years, I hope that the members will consider that
significant advancements in the biomedical sciences often come from
younger investigators who bring new insights and approaches to bear on
old or intractable problems. Without sustained investment, I fear that
flat or falling funding will begin to take a toll on the imagination,
energy and resilience of younger investigators and I wonder about the
impact of these events on the next generation. America's scientific
enterprise--and its global leadership--has been built over generations,
but without sustained investment, we could lose that leadership
quickly, and it will be difficult to rebuild. When we undermine a
research enterprise--whether a single lab or a national infrastructure
built through decades of Federal funding--it is a loss to us all and
difficult to recover. In the United States--traditionally a pacesetter
for strong investment--threatened cuts in science funding jeopardize a
global training system that fosters and encourages scientific
creativity, flexibility, and enterprise. As a young girl interested in
science, I was inspired by the idea that the United States was a place
where anyone with imagination, drive, and a passion for research could
come, learn, and potentially do something great. Without funding, that
culture of entrepreneurship and curiosity--driven research could be
hindered for decades.
Conclusion
We live at a time of extraordinary opportunity in neuroscience.
When I read an exciting research article, I get a sense of awe and
pride at the extraordinary progress in our field. A myriad of questions
once impossible to consider are now within reach as a consequence of
new technologies, an ever-expanding knowledge base, and a willingness
to embrace many disciplines.
As a result of NIH investments, the field of neuroscience research
holds great potential for making great progress to understand basic
biological principles and for addressing the numerous neurological and
psychiatric illnesses that strike more than 100 million Americans
annually. And we have entered an era in which knowledge of nerve cell
function has brought us to the threshold of a more profound
understanding of behavior and of the mysteries of the human mind.
However, continued progress can only be accomplished by a consistent
and reliable funding source.
An NIH appropriation of $35 billion for fiscal year 2012 and
sustained reliable growth is required to take the research to the next
level in order to improve the health of Americans and to maintain
American leadership in science worldwide. As a field we look forward to
realizing that goal. Thank you for this opportunity to testify.
______
Prepared Statement of the Society for Women's Health Research
The Society for Women's health Research (SWHR) and the Women's
Health Research Coalition (WHRC), is pleased to have the opportunity to
submit the following testimony in support of ongoing Federal funding
for biomedical research--specifically sex differences and total women's
health research--within the Department of Health and Human Services
(HHS) at the National Institutes of Health (NIH), Centers for Disease
Control and Prevention (CDC), and the Agency for Healthcare and
Research Quality (AHRQ).
SWHR and WHRC believe that sustained funding for biomedical and
women's health research programs conducted and supported across the
Federal agencies is absolutely essential if the United States is going
to meet the health needs of women and men. A well-designed and
appropriately funded Federal research agenda does more than avoid
dangerous and expensive ``trial and error'' medicine for patients--it
advances the Nation's research capability, continues growth in a sector
with proven return on investment, and takes a proactive approach to
maintaining America's position as world-wide leader in medical
research, education, and development.
SWHR and WHRC believe that sustained funding for biomedical and
women's health research programs conducted and supported across the
Federal agencies is absolutely essential if the United States is to
meet the health needs of women, and men, and advance the nation's
research capability.
As President Obama stated in his State of the Union Address,
investment in biomedical research ``will strengthen our security,
protect our planet, and create countless new jobs for our people''.
Proper investment in health research will save valuable dollars that
are currently wasted on inappropriate treatments and procedures.
Further, SWHR and WHRC want targeted research into sex differences that
will help in determining targeted treatments that will help women and
men to receive quality appropriate care.
National Institutes of Health
Past Congressional investment for the NIH positioned the United
States as the world's leader in biomedical research and has provided a
direct and significant impact on women's health research and the
careers of women scientists over the last decade. In recent years, that
investment has declined along with America's place as the Number 1 in
biomedical research. These two facts are interrelated. Cutting NIH
funding threatens scientific advancement, substantially delays cures
becoming available in the United States, and puts the innovative
research practices and reputation that America is known for in
jeopardy.
When faced with budget cuts, NIH is left with no other option but
to reduce the number of grants it is able to fund. The number of new
grants funded by NIH had dropped steadily with declining budgets,
growing at a percent less than that of inflation since fiscal year
2003. Cuts to investments in biomedical research also negatively impact
the economy. A shrinking pool of available grants has a significant
impact on scientists who depend upon NIH support to cover both salaries
and laboratory expenses to conduct high quality biomedical research,
putting both medical advancement and job creation at risk. More than 83
percent of NIH funding is spent in communities across the Nation,
creating jobs at more than 3,000 universities, medical schools,
teaching hospitals, and other research institutions in every State.
Reducing the number of grants available to researchers further
decreases publishing of new findings and decreases the number of
scientists gaining experience in research, both reducing a scientist's
likelihood of achieving tenure in a university setting. New and less
established researchers are forced to consider other careers, or take
positions outside the United States, and results in the loss of the
skilled bench scientists and researchers so desperately needed to
sustain America's cutting edge in biomedical research.
While the U.S. deficit requires careful consideration of all
funding and investments, cutting relatively small discretionary funding
within the NIH budget will not make a substantial impact on the
deficit, but will drastically hamper the ability of the United States
to remain the global leader in biomedical research. SWHR and WHRC
recommend that Congress set, at a minimum, a budget that matches the
administration's request for a $1 billion increase for NIH for fiscal
year 2012.
Study of Sex Differences
It has only been within the past decade that scientists have begun
to uncover the significant biological and physiological differences
between women and men and its impact health and medicine. Sex-based
biology, the study of biological and physiological differences between
women and men, has revolutionized the way that the scientific community
views the sexes. Sex differences play an important role in disease
susceptibility, prevalence, time of onset and severity and are evident
in cancer, obesity, heart disease, immune dysfunction, mental health
disorders, and many other illnesses. Medications can have different
effects in woman and men, based on sex specific differences in
absorption, distribution, metabolism and elimination. It is imperative
that research addressing these important differences be supported and
encouraged.
SWHR recommends that NIH, with the funds provided, report sex/
gender differences in all research findings. Further, NIH should seek
to expand its inclusion of women in basic, clinical and medical
research to Phase I, II, and III studies. By currently only mandating
sufficient female subjects in Phase III, researchers often miss out on
the chance to look for variability by sex in the early phases of
research, where scientists look at treatment safety and determine safe
and effective dose levels for new medications. By mandating that sex
differences research occur in earlier phases of clinical research
studies, the NIH can continue to serve as a role model for industry
research, as well as other nations. Only by gaining more information on
how therapies work in women will medicine be able to advance toward
more targeted and effective treatments for all patients, women and men
alike.
Office of Research on Women's Health
The NIH's Office of Research on Women's Health (ORWH) serves as the
focal point for coordinating women's health and sex differences
research at NIH, advising the NIH Director on matters relating to
research on women's health and sex differences research, strengthening
and enhancing research related to diseases, disorders, and conditions
that affect women; working to ensure that women are appropriately
represented in research studies supported by NIH; and developing
opportunities for and support of recruitment, retention, re-entry and
advancement of women in biomedical careers. In September 2010, ORWH
celebrated its 20th anniversary and unveiled a new strategic plan for
women's health and sex difference research, Moving Into The Future With
Dimensions and Strategies: A Vision For 2020 For Women's Health
Research.
BIRCWH and SCOR
The Building Interdisciplinary Research Careers in Women's Health
(BIRCWH) and Specialized Centers of Research on Sex and Gender Factors
Affecting Women's Health (SCOR) are two ORWH programs that benefit the
health of both women and men through sex and gender research,
interdisciplinary scientific collaboration, and provide tremendously
important support for young investigators in a mentored environment.
The BIRCWH program, created in 2000, 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. Each BIRCWH receives
approximately $500,000 a year, most from the ORWH budget. To date, 407
scholars have been trained in 41 centers, and 80 percent of those
scholars are female. The BIRCWH centers have produced over 1,300
publications, 750 abstracts, 200 NIH grants and 85 awards from industry
and institutional sources.
SCORs, established in 2003, are designed to increase innovative,
interdisciplinary research focusing on sex differences and major
medical problems that affect women through centers that facilitate
basic, clinical, and translational research. Each SCOR program results
in unique research and in 2010, resulted in over 150 published journal
articles, 214 abstracts and presentations and 44 other publications.
Additionally, ORWH has created several additional programs to
advance the science of sex differences research and research into
women's health. The Advancing Novel Science in Women's Health Research
(ANSWHR) program, created in 2007, promotes innovative new concepts and
interdisciplinary research in women's health research and sex/gender
differences. The Research Enhancement Awards Program (REAP) supports
meritorious research on women's health that otherwise would have missed
the IC pay line.
In addition to its funding of research on women's health and sex
differences research, ORWH has established several methods for
dissemination information about women's health and sex differences
research. ORWH created the Women's Health Resources web portal in
collaboration (http://www.womenshealthresources.nlm.nih.gov) with that
National Library of Medicine, to serve as a resource for researchers
and consumers on the latest topics in women's health and uses social
media to connect the public to health awareness campaigns.
To allow ORWH's programs and research grants to continue make their
impact on research and the public, Congress must direct that NIH
continue its support of ORWH and provide it with $1 million budget
increase, bringing its fiscal year 2012 total to $43.9 million.
Health and Human Services' Office of Women's Health
The HHS Office of Women's Health (OWH) is the Government's champion
and focal point for women's health issues. It works to redress
inequities in research, healthcare services, and education that have
historically placed the health of women at risk. Without OWH's actions,
the task of translating research into practice would be only more
difficult and delayed.
Under HHS, the agencies currently with offices, advisors or
coordinators for women's health or women's health research include the
Food and Drug Administration, Centers for Disease Control and
Prevention, Agency for Healthcare Quality and Research, Indian Health
Service, Substance Abuse and Mental Health Services Administration,
Health Resources and Services Administration, and Centers for Medicare
and Medicaid Services. It is imperative that these offices are funded
at levels which are adequate for them to perform their assigned
missions, and are sustainable so as to support needed changes in the
long term. We ask that the committee report reflect Congress's support
for these Federal women's health offices, and recommend that they are
appropriately funded on a permanent basis to ensure that these programs
can continue and be strengthened in the coming fiscal year.
It is only through consistent funding that the OWH will be able to
achieve its goals. The budgets for theses offices have been flat-lined
in recent years, which results in effectively a net decrease due to
inflation. Considering the impact of women's health programs from OWH
on the public, we urge Congress to provide an increase of $1 million
for the HHS OWH, a total $34.7 million requested for fiscal year 2012.
Centers for Disease Control and Prevention
SWHR supports the national and international work of the CDC,
especially the work of CDC's Office of Women's Health (OWH). While SWHR
is delighted that the CDC's OWH is now codified in statue, we are
concerned that proposed cuts to the CDC budget by the administration
will significantly jeopardize programs that benefit women, leaving them
with even fewer options for sound clinical information. Research and
clinical medicine are still catching up from decades of a male-centric
focus, and when diseases strike women, there remains a paucity of basic
knowledge on how diseases affect female biology, a lack of drugs that
have been adequately tested in women, and now even fewer options for
information through the many educational outreach programs of the CDC.
The OWH within CDC is fundamental to promoting and improving the
health, safety, and quality of life of women across their lifespan. The
office led the CDC in the collaboration and development of text4baby,
which sends free text messages on health and pregnancy issues, to
pregnant women and new moms. In the year since its launch, over 135,000
subscribers have signed up for the service and millions of text
messages have been sent. More than 300 outreach partners, including
national, State, business, academic, nonprofit, and other groups, help
to promote the service.
With its small budget, the OWH actively participated with others in
CDC, HHS, and the State Department in the early development of the
Global Health Initiative, and routinely collaborates with other
agencies to advance the knowledge and research into women's health
issues. This year, OWH worked closely with HHS OWH on the development
of the Action Agenda on Women's Health: Beyond 2010 and with NIH on the
development of the research conference on Advances in Uterine
Leiomyoma. SWHR and WHRC recommend that Congress provide the CDC OWH
with a 1.06 percent increase for fiscal year 2012, bringing their total
to $478,000.
Agency for Healthcare and Research Quality
The Agency for Healthcare Research and Quality'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 healthcare. Through AHRQ's research projects, lives have
been saved. For example, it was AHRQ who first discovered that 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, which have improved diagnostic accuracy and dramatically
increased the timely use of ``clot-dissolving'' medications in women
having heart attacks. As efforts to improve the quality of care, not
just the quantity of care, progress, findings such as these coming out
of AHRQ reveal where relatively modest investments can offer
significant improvement to women's health outcomes, as well as a better
return on investment for scarce healthcare dollars.
While AHRQ has made great strides in women's health research, its
budget has been dismally funded for years, though targeted funding
increases in recent years for dedicated projects, including funds from
the American Recovery and Reinvestment Act (ARRA), moved AHRQ in the
right direction. ARRA funds more than doubled AHRQ's investment in
patient-centered research relevant to women. AHRQ is now supporting
studies that examining comparative effectiveness in diabetes and breast
cancer prevention in women, and comprehensive care for adults with
serious mental illness.
With the ARRA funds, total investment in women's health increased
from $52 million to $109 million, however, more core and sustained
funding is needed to help AHRQ continue doing the research that helps
patients and doctors make better medical decisions. Lack of investment
in AHRQ will hinder advancements that will improve medical
decisionmaking of doctors and patients and will result in improved
health outcomes. Any decreased level of funding seriously jeopardizes
the research and quality improvement programs that Congress mandates
from AHRQ.
SWHR and WHRC recommend Congress fund AHRQ at $405 million for
fiscal year 2012, an increase 2 percent over 2010 enacted levels. This
investment ensures that adequate resources are available for high
priority research, including women's healthcare, sex- and gender-based
analyses, and health disparities--valuable information that can help to
better personalize treatments, lower overall medical spending, and
improve outcomes for female and male patients nationwide.
In conclusion, Mr. Chairman, we thank you and this Committee for
its strong record of support for medical and health services research
and its 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 Spina Bifida Association
Background and Overview
On behalf of the estimated 166,000 individuals and their families
who are affected by all forms of Spina Bifida--the Nation's most
common, permanently disabling birth defect--Spina Bifida Association
(SBA) appreciates the opportunity to submit public written testimony
for the record regarding fiscal year 2012 funding for the National
Spina Bifida Program and other related Spina Bifida initiatives. SBA is
a national voluntary health agency, working on behalf of people with
Spina Bifida and their families through education, advocacy, research
and service. SBA stands ready to work with Members of Congress and
other stakeholders to ensure our Nation mounts and sustains a
comprehensive effort to reduce and prevent suffering from Spina Bifida.
Spina Bifida, a neural tube defect (NTD), occurs when the spinal
cord fails to close properly 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 increasingly becomes 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 occurring 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 NTD is that most people 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 seeks to ameliorate their condition by
helping to relieve cranial pressure associated with spinal fluid that
does not flow properly. As we have testified previously, the good news
is that after decades of poor prognoses and short life expectancy,
children with Spina Bifida are now living into adulthood and
increasingly into their advanced years. These gains in longevity,
principally, are due to breakthroughs in research, combined with
improvements generally in healthcare and treatment. However, with this
extended life expectancy, our Nation and people with Spina Bifida now
face new challenges, such as transitioning from pediatric to adult
healthcare providers, education, job training, independent living,
healthcare for secondary conditions, and aging concerns, among others.
Individuals and families affected by Spina Bifida face many
challenges--physical, emotional, and financial. Fortunately, with the
creation of the National Spina Bifida Program in 2003, individuals and
families affected by Spina Bifida now have a national resource that
provides them with the support, information, and assistance they need
and deserve.
As is discussed below, the daily consumption of 400 micrograms of
folic acid by women of childbearing age, prior to becoming pregnant and
throughout the first trimester of pregnancy, can help reduce the
incidence of Spina Bifida, by up to 70 percent. The Centers for Disease
Control and Prevention (CDC) calculates that there are approximately
3,000 NTD births each year, of which an estimated 1,500 are Spina
Bifida, and, as such, with the aging of the Spina Bifida population and
a steady number of affected births annually, the Nation must take
additional steps to ensure that all individuals living with this
complex birth defect can live full, healthy, and productive lives.
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. Efforts to reduce and
prevent suffering from Spina Bifida will help to not only save money,
but will also save--and improve--lives.
Improving Quality-of-Life through the National Spina Bifida Program
Since 2001, SBA has worked with Members of Congress and staff at
the CDC to help improve our Nation's efforts to prevent Spina Bifida
and diminish suffering--and enhance quality-of-life--for those
currently living with this condition. With appropriate, affordable, and
high-quality medical, physical, and emotional care, most people born
with Spina Bifida will likely have a normal or near normal life
expectancy. The CDC's 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 National Spina Bifida Program established the National Spina
Bifida Resource Center housed at the SBA, which provides information
and support to help ensure that individuals, families, and other
caregivers, such as health professionals, have the most up-to-date
information about effective interventions for the myriad primary and
secondary conditions associated with Spina Bifida. Among many other
activities, the program helps individuals with Spina Bifida and their
families learn how to treat and prevent secondary health problems, such
as bladder and bowel control difficulties, learning disabilities,
depression, latex allergies, obesity, skin breakdown, and social and
sexual issues. Children with Spina Bifida often have learning
disabilities and may have difficulty with paying attention, expressing
or understanding language, and grasping reading and math. All of these
problems can be treated or prevented, but only if those affected by
Spina Bifida--and their caregivers--are properly educated and given the
skills and information they need to maintain the highest level of
health and well-being possible. The National Spina Bifida Program's
secondary prevention activities represent a tangible quality-of-life
difference to the estimated 166,000 individuals living with all forms
of Spina Bifida, with the goal being living well with Spina Bifida.
An important resource to better determine best clinical practices
and the most cost effective treatments for Spina Bifida is the National
Spina Bifida Registry, now in its third year. Nine sites throughout the
Nation are collecting patient data, which supports the creation of
quality measures and will assist in improving clinical research that
will truly save lives, while also realizing a significant cost savings.
SBA understands that the Congress and the Nation face unprecedented
budgetary challenges. However, the progress being made by the National
Spina Bifida Program must be sustained to ensure that people with Spina
Bifida--over the course of their lifespan--have the support and access
to quality care they need and deserve. To that end, SBA respectfully
urges the Subcommittee to Congress allocate $6.25 million (level
funding) in fiscal year 2012 to the program, so it can continue and
expand its current scope of work; further develop the National Spina
Bifida Patient Registry; and sustain the National Spina Bifida Resource
Center. Sustaining 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--and the costs of--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-five
million women of child-bearing age are at-risk of having a child born
with Spina Bifida. As mentioned above, the daily consumption of 400
micrograms of folic acid prior to becoming pregnant and throughout the
first trimester of pregnancy can help reduce the incidence of Spina
Bifida, by up to 70 percent. There are few public health challenges
that our nation can tackle and conquer by nearly three-fourths in such
a straightforward fashion. However, we must still be concerned with
addressing the 30 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 prior to becoming
pregnant.
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. The good news is
that progress has been made in convincing women of the importance of
folic acid consumption and the need to maintain a diet rich in folic
acid. This public health success should be celebrated, but still too
many women of childbearing age consume inadequate daily amounts of
folic acid prior to becoming pregnant, and too many pregnancies are
still 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.
The goal is to increase awareness of the benefits of folic acid,
particularly 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 continued funding in
fiscal year 2012, CDC's folic acid awareness activities could be
expanded to reach the broader population in need of these public health
education, health promotion, and disease prevention messages. SBA
advocates that Congress provide adequate funding to CDC to allow for a
targeted 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 $6.25 million fiscal year 2012 allocation for the
National Spina Bifida Program, SBA urges the Subcommittee to provide
$5.126 million for the CDC's national folic acid education and
promotion efforts to support the prevention of Spina Bifida and other
NTD; $26.342 million to strengthen the CDC's National Birth Defects
Prevention Network; and $144 million to fund the National Center on
Birth Defects and Developmental Disabilities.
Improving Health Care for Individuals with Spina Bifida
As you know, Agency for Health Research and Quality's (AHRQ)
mission is to improve the outcomes and quality of healthcare, reduce
healthcare costs, improve patient safety, decrease medical errors, and
broaden access to essential health services. AHRQ's work is vital to
the evaluation of new treatments, which helps ensure that individuals
living with Spina Bifida continue to receive state-of-the-art care and
interventions. To that end, we request a $405 million fiscal year 2012
allocation for AHRQ, to help improve quality of care and outcomes for
people with Spina Bifida.
Sustain and Seize Spina Bifida Research Opportunities
Our Nation has benefited immensely from our past Federal investment
in biomedical research at the NIH. SBA joins with other in the public
health and research community in advocating that NIH receive increased
funding in fiscal year 2012. 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,
SBA respectfully requests that the Subcommittee include the following
language in the report accompanying the fiscal year 2012 L-HHS
appropriations measure:
``The Committee encourages NIDDK, NICHD, and NINDS to study the
causes and care of the neurogenic bladder in order to improve the
quality of life of children and adults with Spina Bifida; to support
research to address issues related to the treatment and management of
Spina Bifida and associated secondary conditions, such as
hydrocephalus; and to invest in understanding the myriad co-morbid
conditions experienced by children with Spina Bifida, including those
associated with both paralysis and developmental delay.''
Conclusion
Please know that SBA stands ready to work with the Subcommittee and
other Members of Congress to advance policies and programs that will
reduce and prevent suffering from Spina Bifida. Again, we thank you for
the opportunity to present our views regarding fiscal year 2012 funding
for programs that will improve the quality-of-life for the estimated
166,000 Americans and their families living with all forms of Spina
Bifida.
______
Prepared Statement of The AIDS Institute
The AIDS Institute, a national public policy research, advocacy,
and education organization, is pleased to comment in support of
critical HIV/AIDS and Hepatitis programs as part of the fiscal year
2012 Labor, Health and Human Services, Education and Related Agencies
appropriation measure. We thank you for your past support of these
programs and hope you will do your best to adequately fund them in the
future in order to provide for and protect the public health.
hiv/aids
HIV/AIDS remains one of the world's worst health pandemics in
history. According to the CDC, over 617,000 people have died of AIDS in
the United States and there are 56,300 new infections each year. At the
end of 2007, an estimated 1.1 million people in the United States were
living with HIV/AIDS. Persons of minority races and ethnicities are
disproportionately affected. African Americans account for half of the
cases. HIV/AIDS disproportionately affects the poor and about 70
percent of those infected rely on publicly funded healthcare.
The vast majority of the discretionary programs supporting HIV/AIDS
efforts domestically are funded through your Subcommittee. The AIDS
Institute, working in coalition, has developed funding requests for
each of these programs. We ask that you do your best to adequately fund
them at the requested level.
We are keenly aware of budget constraints and competing interests
for limited dollars, but programs that prevent and treat HIV are
inherently Federal, as they help protect the public health against a
highly infectious virus, which if left untreated will most likely lead
to death and increased infections. Federal funding is particularly
critical at this time since State and local budgets are being severely
cut during the economic downturn.
National HIV/AIDS Strategy
President Obama released a comprehensive National HIV/AIDS Strategy
(NHAS) which seeks to reduce new HIV infections, increase access to
care and improving health outcomes for people living with HIV, and
reduce HIV-related health disparities. The Strategy sets ambitious
goals and seeks a more coordinated national response with a focus on
those communities most affected and on programs that work. In order to
attain the goals, additional investment will be needed and health
reform must be implemented.
The budget proposed by the President requests that up to 1 percent
of HHS discretionary funds appropriated for domestic HIV/AIDS
activities be provided to the Office of the Assistant Secretary for
Health to foster collaborations across HHS agencies and finance high
priority initiatives in support of the NHAS. Such initiatives would
focus on improving linkages between prevention and care, coordinating
Federal resources within targeted high-risk populations, enhancing
provider capacity, and monitoring key Strategy targets. The AIDS
Institute supports this provision and encourages you to include it in
the fiscal year 2012 appropriation measure.
Centers for Disease Control and Prevention--HIV Prevention and
Surveillance
Fiscal year 2011--$800.4 million
Fiscal year 2012 community request--$1,325.7 million
The United Staes allocates only about 4 percent of its domestic
HIV/AIDS spending on prevention. Investing in prevention today will
save money tomorrow. Preventing all the new 56,000 cases in just one
year would translate into an astounding $20 billion in lifetime medical
costs.
The CDC is focused on carrying out several goals of the NHAS by
2015. Specifically, they are seeking to lower the annual number of new
infections by 25 percent, reduce the HIV transmission rate by 30
percent, and increase from 79 to 90 the percentage of people living
with HIV who know their serostatus.
While it is estimated that an increase of over $500 million would
be needed to achieve the goals of the NHAS, The AIDS Institute supports
an increase of at least the $57.2 million over fiscal year 2011 as the
President has proposed, including $30.4 million from the Prevention and
Public Health Fund. We are also supportive of a transfer of $40 million
from the Chronic Disease Prevention and Public Health Promotion for HIV
school health programs to achieve closer coordination of CDC's HIV
prevention programs.
With this funding, the CDC would improve surveillance and use of
community viral load, enhance prevention among most affected
communities, integrate care and prevention, expand HIV testing and
linkage to care, build capacity, develop social marketing campaigns,
and improve monitoring.
Ryan White HIV/AIDS Programs
Fiscal year 2011--$2,336.7 million
Fiscal year 2012 community request--$2,687.0 million
The centerpiece of the Government's response to caring and treating
low-income people with HIV/AIDS is the Ryan White HIV/AIDS Program,
which currently serves over half a million low-income, uninsured, and
underinsured people. In fiscal year 2011, almost all parts of the
Program experienced funding cuts at a time of increased need and
demands on the program. Consider the following:
--Caseloads are increasing. People are living longer due to
lifesaving medications, there are over 56,000 new infections
each year, and increased testing programs identify thousands of
new people infected with HIV. With rising unemployment, people
are losing their employer-sponsored health coverage.
--State and local budgets are experiencing cutbacks due to the
economic downturn. A survey by the National Alliance of State
and Territorial AIDS Directors found that State funding
reductions totaled more than $170 million in 29 States during
fiscal year 2009.
--States are cutting and the Federal Government is proposing massive
cuts to Medicaid. As the payer of last resort cuts to
entitlement programs, such as Medicaid, place further pressure
on the Ryan White Program.
--There are significant numbers of people in the United States who
are not receiving life-saving AIDS medications. An IOM report
concluded that 233,069 people in the United States who know
their HIV status do not have continuous access to Highly Active
Antiretroviral Therapy.
Specifically, The AIDS Institute requests the following funding
levels for each part of the Program:
Part A provides medical care and vital support services for persons
living with HIV/AIDS in the metropolitan areas most affected by HIV/
AIDS. We request an increase of $74.2 million, for a total of $752
million.
Part B base provides essential services including diagnostic, viral
load testing and viral resistance monitoring, and HIV care to all 50
States, District of Columbia, Puerto Rico, and the territories. We are
requesting a $76.8 million increase, for a total of $495 million.
The AIDS Drug Assistance Program (ADAP) provides life-saving HIV
drug treatment to over 200,000 people, or about one in four HIV
positive people in care in the United States. The majority of whom are
people of color and very poor. ADAPs are experiencing unprecedented
growth and are in crisis. Over the course of 1 year, HRSA reported an
increase of over 30,000 new people to the program. Because of a lack of
funding, there are currently 8,100 people in 13 States on waiting
lists, thousands more have been removed from the program due to lowered
eligibility requirements, and drug formularies have been reduced.
According to NASTAD's recent annual ADAP monitoring report, State
funding for ADAPs increased 61 percent in fiscal year 2009 to a total
of $346 million, and drug company rebates grew 5 percent to $522
million. The Federal share of the overall ADAP budget has decreased to
less than 50 percent.
The AIDS Institute is very appreciative of the $50 million increase
to ADAP in fiscal year 2011, but it is far from what is currently
required to meet the growing number of new people needing ADAP
medications in the coming year. The true need is an increase of $360
million. The AIDS Institute requests that you provide an increase that
is as close as possible to that amount. We note the President has
requested an increase of $55 million, which would only provide
medications to fewer than 4,800 people.
Part C provides early medical intervention and other supportive
services to over 248,000 people at over 380 directly funded clinics. We
are requesting a $66.6 million increase, for a total of $272 million.
Part D provides care to over 84,000 women, children, youth, and
families living with and affected by HIV/AIDS. We are requesting a $5.8
million increase, for a total of $83.1 million.
Part F includes the AIDS Education and Training Centers (AETCs)
program and the Dental Reimbursement program. We are requesting a $15.4
million increase for the AETC program, for a total of $50 million, and
a $5.5 million increase for the Dental Reimbursement program, for a
total of $19 million.
National Institutes of Health--AIDS Research
Fiscal year 2011--$3.07 billion
Fiscal year 2012 community request--$3.5 billion
The NIH conducts research to better understand HIV and its
complicated mutations, discover new drug treatments, develop a vaccine
and other prevention programs such as microbicides, and ultimately
develop a cure. The critically important work performed by the NIH not
only benefits those in the United States, but the entire world. This
research has already helped in the development of many highly effective
new drug treatments, prolonging the lives of millions of people. NIH
also conducts the necessary behavioral research to learn how HIV can be
prevented best in various affected communities. We ask the Committee to
fund critical AIDS research at the community requested level of $3.5
billion.
Comprehensive Sexuality Education
Since the vast majority of HIV infection occurs through sex, age
appropriate education on how HIV is transmitted and HIV prevention is
critical. It is for this reason, The AIDS Institute is supportive of
funding the Teen Pregnancy Prevention Initiative for a total of $135
million and we oppose funding of abstinence only education programs,
which have proven not to be effective.
Minority AIDS Initiative
The AIDS Institute supports increased funding for the Minority AIDS
Initiative, which is funded by numerous Federal agencies to address the
disproportionate impact that HIV has on communities of color. For
fiscal year 2012, we are requesting a total of $610 million.
Policy Riders
The AIDS Institute is opposed to using the appropriations process
as a vehicle to repeal or prevent the implementation of current law or
ban funding for certain activities or organizations, such as the
Affordable Care Act and syringe exchange programs which are
scientifically proven to be effective in the prevention of HIV and
Hepatitis.
viral hepatitis
The Institute of Medicine (IOM) report Hepatitis and Liver Cancer:
A National Strategy for Prevention and Control of Hepatitis B and C
outlines recommendations on how the incidence of Hepatitis B and C
infections can be decreased. They include increased public awareness
campaigns, heightened testing and vaccination programs, continued
research, along with improved surveillance. The Administration recently
announced the first ever national strategy to eliminate Viral
Hepatitis.
In fiscal year 2011, Congress funded CDC's Viral Hepatitis Division
at only $19.8 million. Given the huge impact that Hepatitis B and C
have on the health of so many people, and the large treatment costs,
and to begin to implement the IOM recommendations and the national
strategy, The AIDS Institute urges the Federal Government to make a
greater commitment to Hepatitis prevention. For fiscal year 2012, we
request a total of $59.8 million.
The AIDS Institute asks that you give great weight to our testimony
as you develop the fiscal year 2012 appropriation bill. Should you have
any questions or comments, feel free to contact Carl Schmid, Deputy
Executive Director, The AIDS Institute or [email protected].
Thank you very much.
______
Prepared Statement of The Endocrine Society
The Endocrine Society is pleased to submit the following testimony
regarding fiscal year 2012 Federal appropriations for biomedical
research, with an emphasis on appropriations for the National
Institutes of Health (NIH). The Endocrine Society is the world's
largest and most active professional organization of endocrinologists
representing more than 14,000 members worldwide. Our organization is
dedicated to promoting excellence in research, education, and clinical
practice in the field of endocrinology. The Society's membership
includes thousands of scientists and clinicians who receive Federal
support for their research and, in turn, contribute greatly to the
Nation's scientific and healthcare advances.
A half century of sustained investment by the United States Federal
Government in biomedical research has dramatically advanced the health
and improved the lives of the American people. The NIH specifically has
had a significant impact on the United State's global preeminence in
research and fostered the development of a biomedical research
enterprise that is unrivaled throughout the world. As the world's
largest supporter of biomedical research, the NIH competitively awards
extramural grants and supports in-house research. However, with the
continued decline in real dollars allocated to biomedical research each
year by the Federal Government, the opportunities to discover life-
changing cures and treatments have already begun to decrease.
Biomedical research funds allocated by the Federal government
support both basic and translational research, ensuring that the
discoveries made in the laboratory become realistic treatment options
for patients suffering from debilitating and life-threatening diseases.
Diabetes is a devastating condition that affects an increasingly large
number of Americans and requires a large proportion of the Nation's
healthcare spending. Almost 26 million people (8.3 percent of the U.S.
population) have diabetes, and the estimated cost of diabetes was $174
billion in 2007.\1\
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\1\ Centers for Disease Control and Prevention. National Diabetes
Fact Sheet, 2011.
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No new diabetes medications would have been developed without
federally supported basic and clinical research. The discovery of
insulin and the collaborative research effort of basic and clinical
scientists eventually led to the approval of a new class of medications
for diabetes, essentially the first new treatments of diabetes in the
past 80 years. Without the continued support of both basic and clinical
research in diabetes, these medications would have never been
developed. Now, with this broadened portfolio of treatments, it is
possible to help most people with diabetes achieve optimal blood sugar
control.
Beyond the multitude of health benefits that result from NIH-funded
research, national and local economies benefit from the dollars that
flow out of NIH into the communities. Researchers in all 50 States and
90 percent of congressional districts receive funding from NIH, and
these funds stimulate local economies through salaries and purchase of
equipment, laboratory supplies, and vendor services. For instance, for
each dollar of taxpayer investment, UCLA generates almost $15 in
economic activity, resulting in a $9.3 billion impact on the Los
Angeles region. The estimated economic impact of Baylor on the
surrounding community in Houston is more than $358 million, generating
more than 3,300 jobs.\2\ The governors of 25 States acknowledged the
economic impact that NIH-funded research has on their States in an
April 2010 letter to House and Senate Budget Committee members. The
letter states,
\2\ Federation of American Societies for Experimental Biology. NIH
Advocacy Slides: California, Texas.
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``During a time of recession, investment in biomedical research
makes sense because it leads to cures and treatments for debilitating
diseases while at the same time generating significant economic
activity for local communities throughout the country.''
The Endocrine Society remains deeply concerned about the future of
biomedical research in the United States without sustained support from
the Federal Government. The Society strongly supports the continued
increase in Federal funding for biomedical research in order to provide
the additional resources needed to enable American scientists to
address the burgeoning scientific opportunities and new health
challenges that continue to confront us. The Endocrine Society
recommends that NIH receive at least $35 billion in fiscal year 2012 to
ensure the steady and sustainable growth necessary to continue building
on the advances made by scientists and physicians during the past
decade.
______
Prepared Statement of The Humane Society of the United States
On behalf of The Humane Society of the United States (HSUS) and the
Humane Society Legislative Fund (HSLF), and our joint membership of
over 11 million supporters nationwide, we appreciate the opportunity to
provide testimony on our top NIH funding priorities for the Senate
Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee in fiscal year 2012.
breeding of chimpanzees for research
The HSUS requests that no Federal funding be appropriated for the
breeding of chimpanzees for laboratory research. The basis of our
request is as follows:
--The National Center for Research Resources (NCRR) of the National
Institutes of Health (NIH), responsible for the oversight and
maintenance of federally owned and supported chimpanzees,
placed a moratorium on breeding federally owned and supported
chimpanzees in 1995, primarily due to the excessive costs of
lifetime care of chimpanzees in laboratory settings. NCRR
extended the moratorium indefinitely in 2007. As a result, none
of the 500 federally owned chimpanzees should have given birth
or sired infants since 1995.
--There is evidence, however, that at least one laboratory has used
millions of Federal dollars in recent years to support breeding
of government owned chimpanzees. There are major financial
implications to the Federal Government and taxpayers if this
breeding continues. Therefore, we seek to simply reinforce NIH
policy and ensure that no laboratory can use funding provided
by NIH or any other HHS agency for breeding of government-owned
or supported chimpanzees.
--According to records provided by the New Iberia Research Center
(NIRC) and the National Institutes of Health 123 infants were
born to a federally owned mother and/or federally owned father
at NIRC between 2000 and 2009.
--The cost of maintaining chimpanzees in laboratories is exorbitant,
up to $67 per day per chimpanzee; over $1,000,000 per
chimpanzee over an individual's approximately 60-year lifetime.
Breeding of additional chimpanzees into laboratories will only
perpetuate and increase the burdens on the government in
supporting and managing the chimpanzee research colony.
--The U.S. currently has a surplus of chimpanzees available for use
in research due to overzealous breeding for HIV research and
subsequent findings that they are a poor HIV model.\1\
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\1\ NRC (National Research Council) (1997) Chimpanzees in research:
strategies for their ethical care, management and use. National
Academies Press: Washington, D.C.
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--Expansion of the chimpanzee population in laboratories only creates
more concerns than presently exist about their quality of
care--an issue of great public concern.
Background and history
Beginning in 1995, the National Research Council (NRC) confirmed a
chimpanzee surplus and recommended a moratorium on breeding of
federally owned or supported chimpanzees,\1\ which includes nearly all
of the approximately 1,000 chimpanzees available for research in the
United States. On May 22, 2007 the NCRR of NIH indefinitely extended
its moratorium on breeding federally-owned and supported chimpanzees.
Further, it has also been noted that ``a huge number'' of chimpanzees
are not being used in active research protocols and are therefore
``just sitting there.'' \2\ If no breeding is allowed, it is projected
that the government will have almost no financial responsibility for
the chimpanzees it owns within 30 years due to the age of the
population--any breeding today will extend this financial burden to 60
years.
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\2\ Cohen, J. (2007) Biomedical Research: The Endangered Lab Chimp.
Science. 315:450-452.
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There is no justification for breeding of additional chimpanzees
for research; therefore lack of Federal funding for breeding will
ensure that no breeding of federally owned or supported chimpanzees for
research will occur in fiscal year 2012.
Concerns regarding chimpanzee care in laboratories
A nine month undercover investigation by The HSUS at University of
Louisiana at Lafayette New Iberia Research Center (NIRC)--the largest
chimpanzee laboratory in the world--revealed some chimpanzees living in
barren, isolated conditions and documented over 100 alleged violations
of the Animal Welfare Act at the facility regarding conditions for and
treatment of chimpanzees. The U.S. Department of Agriculture (USDA) and
NIH's Office of Laboratory Animal Welfare (OLAW) launched formal
investigations into the facility and NIRC paid an $18,000 stipulation
for violations of the Animal Welfare Act.
Aside from the HSUS investigation, inspections conducted by the
USDA demonstrate that basic chimpanzee standards are often not being
met. Inspection reports for other federally funded chimpanzee
facilities have reported violations of the Animal Welfare Act in recent
years, including the death of a chimpanzee during improper transport,
housing of chimpanzees in less than minimal space requirements,
inadequate environmental enhancement, and/or general disrepair of
facilities. These problems add further argument against the breeding of
even more chimpanzees into this system.
Chimpanzees have often been a poor model for human health research
The scientific community recognizes that chimpanzees are poor
models for HIV because chimpanzees do not develop AIDS even after being
infected with HIV. Similarly, chimpanzees do not model the course of
the human hepatitis C virus yet they continue to be used for this
research, adding to the millions of dollars already spent without a
sign of a promising vaccine. According to the chimpanzee genome, some
of the greatest differences between chimpanzees and humans relate to
the immune system, \3\ calling into question the validity of infectious
disease research using chimpanzees.
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\3\ The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen,
TS, et al.,(1 September 2005) Initial sequence of the chimpanzee genome
and comparison with the human genome, Nature 437, 69-87.
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Ethical and public concerns about chimpanzee research
Chimpanzee research raises serious ethical issues, particularly
because of their extremely close similarities to humans in terms of
intelligence and emotions. Americans are clearly concerned about these
issues: 90 percent believe it is unacceptable to confine chimpanzees
individually in government-approved cages (as we documented during our
investigation at NIRC); 71 percent believe that chimpanzees who have
been in the laboratory for over 10 years should be sent to sanctuary
for retirement \4\; and 54 percent believe that it is unacceptable for
chimpanzees to ``undergo research which causes them to suffer for human
benefit.'' \5\
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\4\ 2006 poll conducted by the Humane Research Council for Project
Release & Restitution for Chimpanzees in laboratories.
\5\ 2001 poll conducted by Zogby International for the Chimpanzee
Collaboratory.
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We respectfully request the following bill or committee report
language:
``No funds made available in this Act, or any prior Act, may be
used for ``The Committee directs that no funds provided in this Act be
used to support the breeding of federally owned or federally supported
chimpanzees for research.''
We appreciate the opportunity to share our views for the Labor,
Health and Human Services, Education and Related Agencies
Appropriations Act for Fiscal Year 2012. We hope the Committee will be
able to accommodate this modest request that will save the government a
substantial sum of money, benefit chimpanzees, and allay some concerns
of the public at large. Thank you for your consideration.
high throughput screening, toxicity pathway profiling, and biological
interpretation of findings--national institutes of health--office of
the director
In 2007, the National Research Council published its report titled
``Toxicity Testing in the 21st Century: A Vision and a Strategy.'' This
report catalyzed collaborative efforts across the research community to
focus on developing new, advanced molecular screening methods for use
in assessing potential adverse health effects of environmental agents.
It is widely recognized that the rapid emergence of omics technologies
and other advanced technologies offers great promise to transform
toxicology from a discipline largely based on observational outcomes
from animal tests as the basis for safety determinations to a
discipline that uses knowledge of biological pathways and molecular
modes of action to predict hazards and potential risks.
In 2008, NIH, NIEHS and EPA signed a memorandum of understanding
\6\ to collaborate with each other to identify and/or develop high
throughput screening assays that investigate ``toxicity pathways'' that
contribute to a variety of adverse health outcomes (e.g., from acute
oral toxicity to long-term effects like cancer). In addition, the MOU
recognized the necessity for these Federal research organizations to
work with ``acknowledged experts in different disciplines in the
international scientific community.'' Much progress has been made,
including FDA joining the MOU, but there is still a significant amount
of research, development and translational science needed to bring this
vision forward to where it can be used with confidence for safety
determinations by regulatory programs in the government and product
stewardship programs in the private sector. In particular, there is a
growing need to support research to develop the key science-based
interpretation tools which will accelerate using 21st century
approaches for predictive risk analysis. We believe the Office of the
Director at NIH can play a leadership role for the entire U.S.
Government by funding both extramural and intramural research.
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\6\ http://www.genome.gov/pages/newsroom/currentnewsreleases/
ntpncgcepamou121307finalv2.pdf.
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We respectfully request the following committee report language,
which is supported by The HSUS, HSLF, Procter & Gamble, and the
American Chemistry Council.
``The Committee supports the implementation of the National
Research Council's report ``Toxicity Testing in the 21st Century: A
Vision and a Strategy'' to create a new paradigm for chemical risk
assessment based on the incorporation of advanced molecular biological
and computational methods in lieu of animal toxicity tests within
integrated evaluation strategies, and urges the National Institutes of
Health to play a leading role by funding a coordinated, long-term
program of relevant intramural and extramural research. Current
activities at the NIH Chemical Genomics Center, National Institute of
Environmental Health Sciences, the Environmental Protection Agency and
the Food and Drug Administration show considerable potential and the
NIH Director should explore opportunities to augment this effort by
identifying additional resources that could be directed to priority
research projects. The Director shall report on the NIH funding of and
progress on these activities to the Committee commencing September 30,
2012 and annually thereafter.''
______
Prepared Statement of the University of Virginia Medical Center
Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to submit testimony on behalf of the University of Virginia
Medical Center. As members of this committee you have jurisdiction for
funding the agencies responsible for the delivery of healthcare in the
United States. As a healthcare provider in Virginia and a
representative of a major institution responsible for training the
healthcare providers of tomorrow, I want to use this opportunity to
discuss the vital importance of Federal funding for Graduate Medical
Education (GME) in the United States. I urge you to support an increase
in the number of appropriately trained physicians in the United States
while protecting the integrity and structure of the GME program.
Overview of the University of Virginia Health System
The University of Virginia Health System is an academic medical
center composed of the Hospital and its satellite facilities and
programs, the School of Medicine, School of Nursing, other allied
health programs, and faculty physicians. The University of Virginia
Health System plays a critical role in the Nation's healthcare
structure as well as the healthcare structure of Virginia. We have
multiple key missions: training the next generation of healthcare
workers, caring for the sickest patients and the underserved who have
nowhere to turn, providing innovative treatments with state-of-the-art
technology, and performing medical research. Our key missions are what
distinguish us from regular community hospitals.
The University of Virginia Medical Center and its Graduate Medical
Education training programs provide an essential bridge for medical
school graduates to become well-trained practicing physicians. At the
University of Virginia Medical Center, we continuously provide an
environment of excellence in which our trainees gain the necessary
experience to practice in their specialties in a setting that
emphasizes quality and patient safety.
Our training programs have been recognized by the Accreditation
Council for Graduate Medical Education for their compliance in meeting
the necessary training standards and for their innovative educational
techniques. We currently sponsor 68 accredited core specialty and
subspecialty training programs. All of our programs are fully
accredited, and many have been awarded the maximum accreditation cycle
length.
Our programs are well positioned to meet the growing national
workforce shortages in primary care (Family Medicine, Internal Medicine
including General Medicine, Obstetrics and Gynecology, Pediatrics, and
General Surgery), as well as in those specialties where workforce
shortages have been identified in the Commonwealth of Virginia
(Emergency Medicine, Child and Adolescent Psychiatry).
We have excellent training programs that are well-suited to train
physicians who will care for our aging population, including
Geriatrics, Palliative and Hospice Medicine, Orthopedic Surgery
(including Reconstructive Spine), Endocrinology (Diabetes, Obesity, and
Osteoporosis), Cardiology and Cardiothoracic Surgery, Oncology, and
Neurology (Alzheimer's Disease).
Funding of Graduate Medical Education
Training of future physicians is a core mission that distinguishes
academic medical centers and teaching hospitals like the University of
Virginia Medical Center from other healthcare institutions. Congress
has recognized the critical role that teaching hospitals play in the
training of America's physicians; however, this key endeavor is very
expensive. Consequently, Congress has agreed that teaching hospitals
should be paid for their increased patient care expenses as well as for
their costs associated with GME training programs. This is accomplished
through two mechanisms: Direct Graduate Medical Education (DGME)
payments and the Indirect Medical Education (IME) adjustment.
The Direct Graduate Medical Education payment (DGME) is a Medicare
payment intended to reimburse teaching hospitals directly for resident
stipends, the costs of teaching by attending physicians, the expenses
incurred with educational classrooms and the administrative costs of
the residency program office. Medicare DGME payments are based upon the
number of residents and the number of Medicare beneficiaries in the
hospital (i.e., it does not cover the entire cost of teaching to the
institution.) Currently UVa Medical Center is reimbursed under DGME for
approximately 38 percent of the cost of training each resident.
The Indirect Medical Education adjustment (IME) was created in 1983
by Congress. ``This adjustment is provided in light of doubts . . .
about the ability of the DRG case classification system to account
fully for factors such as severity of illness of patients requiring the
specialized services and treatment programs provided by teaching
institutions and the additional costs associated with the teaching of
residents . . . . The adjustment for indirect medical education costs
is only a proxy to account for a number of factors which may
legitimately increase costs in teaching hospitals.'' (House Ways and
Means Committee Report, No. 98-25, March 4, 1983 and Senate Finance
Committee Report, No. 98-23, March 11, 1983).
The IME adjustment is based on a complex formula that was
empirically determined to be related to the ratio of residents to beds
(IRB). The hospital's IME payment is determined by its individual
intern/resident-to-bed ratio in a formula established under the
Medicare statute. For every Medicare case paid, a teaching hospital
receives an additional IME payment, calculated as a percentage add-on
to the basic price per case. In 1983, payments added 11.59 percent to
each DRG amount for every 10 percent increase in the IRB. The IME
adjustment as originally calculated, in conjunction with DGME payments,
more satisfactorily reimbursed teaching hospitals for the cost of
training the next generation of doctors. However, the Balanced Budget
Act of 1997 (BBA) caused the IME adjustment to substantially decline.
Over time, Congress has periodically reduced the adjustment--by 30
percent since 1997--to the current 5.5 percent adjustment.
According to the American Association of Medical Colleges (AAMC),
the Medicare program annually provides about $3 billion in DGME
payments and $6 billion in IME payments to nearly 1,100 teaching
hospitals. While these payments represent less than 2 percent of total
Medicare payments, for teaching hospitals they are extremely important
in supporting the mission of training physicians. These payments
provide the backbone for our Nation's healthcare system, and they
ultimately contribute to better patient care by providing the support
necessary for excellent training programs.
The BBA also capped the number of resident slots that Medicare will
support. It limited the number of allopathic and osteopathic resident
physicians who may be counted for purpose of calculating IME and DGME
reimbursement to the number that the teaching hospital reported on its
1996 Medicare cost report. This cap is preventing academic medical
centers and teaching hospitals from expanding the number of residents
and fellows even while the Nation continues to suffer a physician
shortage. At a time when we should be producing more physicians,
especially in the key areas mentioned previously, this outdated rule is
thwarting our efforts.
The University of Virginia Medical Center trains more than 750
residents and fellows each year. It is significantly over its Medicare
limit or cap for training slots. For purposes of Direct Graduate
Medical Education, the University of Virginia's cap is 538 residents,
and it is 121 positions over its cap; for purposes of Indirect Graduate
Medical Education, the University of Virginia's cap is 508 residents,
and it is 131 positions over its cap. The cost of training a resident
is approximately $100,000 per year, thus, the University of Virginia
Medical Center is spending about $12,100,000 per year on resident
positions over the cap.
Graduate Medical Education training helps ensure that healthcare
delivery in the United States continues to be the highest quality. The
additional costs incurred at teaching hospitals for the training of
tomorrow's doctors are real and should be reimbursed at a level
commensurate with the expense. Without specific appropriate
reimbursement from Medicare, teaching hospitals will run deficit
budgets and be forced to cut the very programs that differentiate them
and allow them to provide the best and most innovative care.
Challenges Facing Graduate Medical Education
Recently, the National Commission on Fiscal Responsibility and
Reform recommended reducing the IME adjustment from 5.5 percent to 2.2
percent annually, which represents an approximate two-thirds cut in the
IME payment. The potential loss of approximately two-thirds support
from the Federal Government would severely compromise the ability of
the University of Virginia Medical Center, and other academic medical
centers, to fund this crucial educational mission. The estimated impact
of this reduction on the University of Virginia Medical Center is
approximately $26,700,000 per year.
Although we recognize the importance of a balanced Federal budget
and the need to control healthcare spending, reducing the funds
available for training future physicians will lead to a severe lack of
access to healthcare in the near future. This will occur at the very
time that hospitals are being asked to expand access to care.
For example, the Patient Protection and Affordable Care Act (i.e.,
the healthcare reform law) will provide health insurance coverage to 32
million more Americans; however, health insurance does not guarantee
timely access to care. There must be a well trained workforce to care
for the additional patients to ensure that implementation of the new
healthcare reform law is successful. Unfortunately, the United States
is already experiencing a shortage of physicians. As healthcare reform
is fully implemented and the population of the United States continues
to age, the shortage of physicians is expected to worsen. By 2020 the
demand for physicians will significantly outweigh the supply. According
to the AAMC's Center for Workforce Studies, by 2020 there will be a
shortage of 45,000 primary care physicians, and a shortage of 46,000
surgeons and medical specialists.
Only 700 Medicare-funded training slots were awarded during the
most recent reallocation authorized by the healthcare reform law. Most
teaching hospitals, including the University of Virginia, did not
receive any additional Medicare-funded residency slots. Unless the cap
is increased or lifted, it is expected that there will be more medical
school graduates than residency positions in the near future. Indeed,
in its April GME e-letter (http://www.ama-assn.org/resources/doc/med-
ed-products/gmee-04-2011.pdf) the American Medical Association stated
that we may have already reached the point where U.S. medical school
graduates are not able to find a residency position because there are
now more graduates than available GME slots.
Specifically, the University of Virginia School of Medicine, along
with dozens of medical schools nationally, has increased class size to
meet the needs of the impending workforce shortages. However, medical
students looking to join a residency program have begun to face a
significant bottleneck after graduation. While institutions like the
University of Virginia are graduating exceptional medical students, the
University of Virginia Medical Center can only accept a finite number
Medicare-funded residency positions due to the cap. Thus, the shortage
of open residency positions for medical students creates another
barrier to the supply of well-trained physicians.
To address the severe doctor shortage crisis facing the United
States and to ensure that there is a well-trained healthcare workforce
to successfully care and treat the increasing number of patients in the
future, it is critical that Congress support Graduate Medical Education
by increasing the number of resident slots available for medical
students, and continue to invest in Graduate Medical Education. I
respectfully request that this committee do everything within its
jurisdiction to achieve these important goals.
______
Prepared Statement of the Tri-Council for Nursing
The Tri-Council for Nursing, comprised of the American Association
of Colleges of Nursing, the American Nurses Association, the American
Organization of Nurse Executives, and the National League for Nursing,
respectfully request $313.075 for the Nursing Workforce Development
programs authorized under Title VIII of the Public Health Service Act
(42 U.S.C. 296 et seq.) in fiscal year 2012. This is the amount
requested in the recommended funding levels for the President's fiscal
year 2012 budget.
The Tri-Council is a long-standing nursing alliance focused on
leadership and excellence in the nursing profession. This marks the
13th year of the nurse and nurse faculty shortages which have eroded
the ability of the nursing profession to provide the highest quality of
care that all patients rightfully desire and morally deserve. As the
Nation looks toward restructuring the healthcare system by focusing on
expanding access, decreasing cost, and improving quality, a significant
investment must be made in strengthening the nursing workforce, a
profession which The U.S. Bureau of Labor Statistics expects a 22
percent growth in employment through 2018.
______
Prepared Statement of the United Negro College Fund
Mr. Chairman and distinguished Members of the subcommittee, I am
Dr. Michael L. Lomax, President and CEO of UNCF--the United Negro
College Fund. I want to thank you for allowing me to submit funding
recommendations and priorities relevant to the fiscal year 12 Labor-
HHS-Education Appropriations bill.
Statistically, HBCUs graduate a preponderant share of all black
Americans receiving postsecondary degrees. While comprising only 3
percent of the Nation's 4,197 institutions of higher learning, the 106
HBCUs are responsible for producing approximately 25 percent of all
bachelor's degrees, 10 percent of all master's degrees and 26 percent
of all first professional degrees earned by African Americans annually.
UNCF institutions are a critical component and significant subset
of the larger community of HBCUs. Specifically, UNCF is the national
fundraising and advocacy representative for 38 private historically
black colleges and universities. There are more than 350,000 persons
who are counted as alumni of UNCF member colleges and universities. Our
alumni include persons such as Rev. Dr. Martin Luther King, Jr., Brown
University President Dr. Ruth Simmons, three former surgeon generals,
numerous current Members of Congress and a host of noted authors,
poets, attorneys, professors and philanthropists.
UNCF--the Nation's oldest and most successful minority higher
education assistance organization--fulfills its primary goal by
increasing opportunities for access to higher education. During its 66-
year existence, UNCF has raised more than $3 billion to support its
historically black college and university member institutions and
administered nearly 400 programs, including scholarships, mentoring
programs, summer enrichment, study abroad, curriculum, faculty, and
leadership development. Today, UNCF supports more than 65,000 students
at over 900 colleges and universities across the country.
We recognize that working with the Administration and Congress will
continue to be particularly challenging in a budget-constrained
environment where more diverse students with unique academic and
familial circumstances are dependent upon need-based aid. The face of
our Nation is changing and nowhere is the change more evident than in
education. Compared with the last century, we are increasingly changing
with more of us being born in other nations, speaking other languages
and carrying different cultures. Minority
populations are growing more quickly than the U.S. population as a
whole. In keeping with this, UNCF continues to endorse the following
policies and positions as the focal point of its legislative agenda for
fiscal year 2012. These recommendations continue a basic commitment to
enrolling, nurturing, and graduating students, some of whom lack the
social, educational, and financial advantages of other college bound
populations. This agenda reflects what is needed to level the playing
field for both UNCF member schools and students as we continue to
pursue educational excellence.
The following fiscal year 2012 programs are of particular relevance
and importance to UNCF.
Title III, Part B, Strengthening Historically Black Colleges and
Universities--$267 million (Section 323)
Because of its flexibility, this program is the fundamental source
of institutional assistance for HBCUs and is used to support strategic
planning initiatives, academic enhancements, administrative and fiscal
management, student services, physical plant improvements, and general
institutional development.
The current level of funding to Title III, Part B must be
maintained in order to continue to enhance and sustain the quality of
HBCUs, and to meet the national challenges associated with global
competitiveness, job creation and changing demographics. For fiscal
year 2012, UNCF requests $267 million to support Section 323.
Title III, Part D, HBCU Capital Financing Program--a minimum of $20.58
million, plus increase the statutory cap to at least $1.7
billion. Bill language is needed to make funding available to
institutions that have a need but fall into a category that has
exhausted resources within the current cap of $1.1 billion.
Funded through Title III, Part D of the Higher Education Act, the
HBCU Capital Financing Program is intended to provide low-interest
capital financing loans to historically disadvantaged institutions
throughout the HBCU community. In light of economic hardships and
challenges confronting several of our member institutions, UNCF has
worked with national stakeholders, officials at the Department of
Education, and Congressional leadership to propose a comprehensive
revision of the capital financing provisions.
For fiscal year 2012, UNCF requests at least $20.58 million to
allow the Secretary to support the administration of additional loans
through the Capital Financing Program. Further, we request the
assistance of Federal leaders in working with the HBCU Capital
Financing Board to ensure that recommendations made to Congress will
promote increased participation within the program among all eligible
institutions.
The Hawkins Centers of Excellence Program--$40 million
Under this budget proposal, the Administration proposes giving
grants to minority-serving institutions to prepare teachers by
providing extensive training, creating a system for tracking program
graduates and raising exit standards. The Centers are named after the
recently deceased Augustus F. Hawkins in honor of his historic
leadership as a champion for expanding education as well as job
opportunity.
For fiscal year 2012, UNCF requests $40 million to implement the
Hawkins Centers of Excellence Program. This program would help expand
the pool of effective minority teachers thus working to close the
achievement gap for minority students.
Pell Grants Program--$5,550 (current maximum reward)
This program assists so many deserving students in getting into
college. As college costs increase, the amount of jobs available to
solely high school graduates is rapidly decreasing. It is imperative to
preserve the maximum award of $5,550 and continue to fund Pell at the
appropriate level. The budget would call for a cut of $100 billion in
Pell grants over 10 years, paid for by eliminating the ``Two Pell''
benefits and the in-school interest subsidy for graduate and
professional student loans.
For fiscal year 2012, UNCF requests the current maximum awards of
$5,550 to continue the support of the Pell Grants Program. Maintaining
the maximum Pell award is critical to ensure that the growing pool of
first generation and low income college students are provided much
needed financial support to access higher education and minimize the
burden of costly education loans.
UNCF and our member schools have, among them, many years of
experience in making the dream of a college education a reality for
low-income students and the colleges they attend. My staff and I, as
well as the presidents of our member schools, stand ready to continue
to work closely with your committee to formulate and craft a plan that
will work for all the young people who are seek and deserve college
education.
______
Prepared Statement of the United Network for Organ Sharing
Highlighting the urgent need to address the ever-growing waiting
list for organs for transplantation and the number of people that die
every day just waiting for an organ, by strengthening programs at HRSA,
the National Institutes of Health and within the Office of the
Secretary.
Mr. Chairman and Members of the Subcommittee, thank you for giving
the United Network for Organ Sharing (UNOS) the opportunity to provide
testimony as the Subcommittee begins to consider funding priorities for
fiscal year 2012. My name is Mary Ellison and I am the Acting Executive
Director of UNOS, the organization with the Federal contract to
coordinate the Nation's organ transplant system, providing vital
services to meet the needs of men, women and children awaiting
lifesaving organ transplants. Based in Richmond, Virginia, UNOS is a
private, nonprofit membership organization. UNOS members encompass
every transplant hospital, tissue matching laboratory and organ
procurement organization in the United States, as well as voluntary
health and professional societies, ethicists, transplant patients and
organ donor advocates.
Transplantation has saved and enhanced the lives of more than
450,000 people in the United States. It is the leading form of
treatment for many forms of end-stage organ failure. With this success,
however, has come increasing demand for donated organs. Living donation
(transplanting all or part of an organ from a living person) has
increased dramatically in the last few years, helping increase the
number of transplants performed. In addition, UNOS has enacted a number
of policies to encourage more efficient use of available organs, such
as ``splitting'' livers from deceased donors to allow two recipients to
be transplanted. The only long-term solution to the organ shortage,
however, is for more people to agree to become organ donors. UNOS works
closely with medical professionals to increase their understanding and
support of the organ donation process.
Mr. Chairman, as you know the primary Federal agency with
jurisdiction over organ transplantation issues is the Health Resources
Services Administration. However, as we will describe below, the Office
of the Secretary and NIH also have important roles to play to help
people in need of an organ transplant.
Health Resources Services Administration
Even with advances in the use of living liver donors, the increase
in the demand for organs needed for transplantation will continue to
exceed the number available. The need to increase the rate of organ
donation is critical. On April 11, 2011 there were 110,676 men, women
and children on the national transplantation waiting list. Last year an
average of 74 patients were transplanted each day; however a daily
average of 18 patients died because the organ they needed did not
become available in time to save them. HRSA's Division of
Transplantation has a proven track record of successfully increasing
the rate of organ donation with limited resources.
Recognizing the importance of this issue, Congress passed, and the
President signed, the Organ Donation and Recovery Improvement Act of
2004 (Public Law 108-216) authorizing an increase of $25 million for
organ donation activities in the first year, and such sums as necessary
in following years, and yet, it was only last year that additional
funding of $1 million has been provided to implement this legislation.
To address these needs, UNOS recommends that the Division of
Transplantation receive a $2 million increase in fiscal year 2012, to
allow the Division to more aggressively pursue program efforts to
increase the supply of organs available for transplantation.
In addition, the shortage of organs for donation can be positively
impacted by healthcare professionals, particularly physicians, nurse,
and physician assistants that are frequently the first to identify and
refer a potential donor. These professionals also have an established
relationship with the family members that weigh the option to donate
their loved one's organs. In order to improve the knowledge and skills
of the several key health professions, UNOS requests funding to develop
curriculum and continuing medical education programs for targeted
health professions. To launch a new 5 year effort to improve the
competency of health professionals to help meet the goal of increasing
the number or organs available for transplantation $450,000 is
requested for the United Network for Organ Sharing (UNOS) to be made
available from within the base funding of the Division of Health
Professions based on the authority provided in Section 765 of Title VII
to improve the workforce.
Office of the Secretary
On March 3, 2008 the Department published a request for information
in the Federal Register to gather information to assist the Department
to determine whether it should engage in a rulemaking with respect to
vascularized composite allografts (VCAs). Three years later, the
Department still has not finalized this decision. As it currently
stands, the Food and Drug Administration has jurisdiction over VCA
transplants, as they are currently defined as human tissue. However, as
the numbers of these transplants are growing, finalizing the decisions
associated with this issue and allowing HRSA's Division of
Transplantation to have jurisdiction over VCA's will permit this
category of transplants to benefit from the policy oversight and
expertise of the Organ Procurement Transplant Network (OPTN).
Worldwide there have been more than two dozen limb transplants, a
growing number of transplants of portions of the face, and a small
number of transplants of other anatomical parts. Although the body
parts vary significantly, they share important common characteristics
with organ transplantation. As with organs, the VCA graft is subject to
damage or death from the lack of blood flow and the need for
revascularization is done through a surgical reconnection of blood
vessels. Additionally, all the expertise and skills of healthcare
professional trained to work with families, individuals and hospitals
in the organ donation and procurement process are also needed in the
donation and procurement of VCAs. All of these vital activities are
already performed and overseen by the organ transplant community.
Further, for 25 years the OPTN has overseen the processes and crafted
policies to regulate them under Federal contract. It therefore seems
logical, efficient and will serve the best interests of patients and
the Nation's transplant system to bring VCAs under the umbrella of the
OPTN.
UNOS urges the Office of the Secretary to take action on this
decision, and issue the rule and begin the necessary process of
amending the definition of human organs. This is especially critical
given the recent activities of private entities that, lacking Federal
leadership, have begun taking the necessary steps to form registries
for VCAs. As we learned over 20 years ago when the OPTN was
established, it is crucial to have Government oversight over registries
such as this in order to establish fair and ethical distribution of
body parts.
National Institutes of Health
Mr. Chairman, as you know, the National Institute of Allergy and
Infectious Diseases has jurisdiction over transplantation research at
the NIH. Recent research funded by NIAID has resulted in the
development of desensitization protocols related to kidney
transplantation that have shown remarkable progress in helping allow
the most vulnerable of patients live with a transplant. Up to 30
percent of the people on the renal transplant waiting list--without
special intervention--will likely never have the chance to receive a
transplant due to an inability to find a compatible donor. These
patients have become ``sensitized'' to human antigens (HLA) through
pregnancy, transfusions, or prior transplants and therefore must wait
significantly longer for a compatible donor. This added time on the
wait list directly increases both their disease-related complications
and mortality.
To improve access to transplantation for most these broadly
sensitized patients, desensitization protocols have evolved to decrease
the breadth and strength of their antibodies. Survival rates are
excellent, equaling or exceeding the rates for kidney transplantation
generally. It is reasonable to estimate that if these protocols were
confirmed to be as safe and effective as early peer reviewed data has
suggested, a large number of these long-suffering people could be
successfully transplanted and removed from the waiting list each year.
UNOS recommends that NIAID support a multi-center initiative with a
companion data collection and analysis center to facilitate the use of
this protocol at an increasing number of transplant centers across the
country.
Summary and Conclusion
Mr. Chairman, again we wish to thank the Subcommittee for the
opportunity to submit testimony and for your leadership in these
difficult times. While UNOS recognizes the demands on our Nation's
resources, we believe the ever-growing waiting list for organs for
transplantation, and the number of people that die every day just
waiting for an organ, continue to justify higher funding levels for
HRSA's Division of Transplantation.
In conclusion, we specifically request the following for fiscal
year 2012:
--A $2 million increase for HRSA's Division of Transplantation;
--$450,000 from within the base funding of the Division of Health
Professions to develop curriculum and continuing medical
education programs for targeted health professions;
--Report language urging the Office of the Secretary to finalize a
decision to amend the definition of human organs to include
vascularized composite allografts, and allow this category to
come under the umbrella of the OPTN; and
--Report language within the National Institute of Allergy and
Infectious Disease to support a multi-center initiative focused
on ``desensitizing ``patients previously found incompatible
with most human organs.
______
Prepared Statement of the United Tribes Technical College
For 42 years, United Tribes Technical College (UTTC) has provided
postsecondary career and technical education, job training and family
services to some of the most impoverished, high risk Indian students
from throughout the Nation. We are governed by the five tribes located
wholly or in part in North Dakota. We are not part of the North Dakota
State college system and do not have a tax base or State-appropriated
funds on which to rely. We have consistently had excellent retention
and placement rates and are a fully accredited institution. Section 117
Carl Perkins Act funds represent about half of our operating budget and
provide for our core instructional programs. The requests of the United
Tribes Technical College Board for fiscal year 2012 is for the
following authorized Department of Education programs:
--$10 million for base funding authorized under Section 117 of the
Carl Perkins Act for the Tribally Controlled Postsecondary
Career and Technical Institutions program (20 U.S.C. Section
2327). This is $1.8 million above the fiscal year 2010 level
and the President's requests for fiscal years 2011 and 2012.
These funds are awarded competitively and are distributed via
formula.
--$30 million as requested by the American Indian Higher Education
Consortium for Title III-A (Section 316) of the Higher
Education Act (Strengthening Institutions program).
--Maintain Pell Grants at the $5,550 maximum award level.
authorization
United Tribes Technical College began operations in 1969. We
realized that in order to more effectively address the unique needs of
Indian people to acquire the academic knowledge and skills necessary to
enter the workforce we needed to expand our curricula and services. We
were scraping by with small amounts of money from the Bureau of Indian
Affairs, and so decided to work for an authorization in the Department
of Education. That came about in 1990 when the Carl Perkins Act was
reauthorized and it included specific authorization for what is now
called the Tribally Controlled Postsecondary Career and Technical
Institutions program (Section 117). The Perkins Act has been
reauthorized twice since then--in 1998 and in 2006, with Congress each
time continuing the Section 117 Perkins program.
Some Important Facts About United Tribes Technical College.--We
have:
--A dedication to providing an educational setting that takes a
holistic approach toward the full spectrum of student needs--
educational, cultural, necessary life skills--thus enhancing
chances for success.
--Services including campus security, a Child Development Center, a
family literacy program, a wellness center, area
transportation, a K-8 elementary school, tutoring, counseling,
and family and single student housing.
--A semester completion rate of 80-90 percent.
--A graduate placement rate of 94 percent (placement into jobs and
higher education).
--A projected return on Federal investment of 20-1 (2005 study).
--Highest level of accreditation from the North Central Association
of Colleges and Schools.
--Over 30 percent of our graduates move on to 4-year or advanced
degree institutions.
--A student body representing 87 tribes who come mostly from high-
poverty, high unemployment tribal nations in the Great Plains;
many students have children or dependents.
--81 percent of undergraduate students receive Pell Grants, the
highest percentage of Pell Grant recipients of any North Dakota
college.
--21 2-year degree programs, eight 1-year certificates, and 3
bachelor degree programs pending final accreditation this
spring.
--An expanding curricula to meet job-training needs for growing
fields including law enforcement, energy auditing and health
information management. We have also broadened our online
program offerings.
--A critical role in the regional economy. Our presence brings $31.8
million annually to the economy of the Bismarck region.
--A workforce of over 300 people.
--An award-winning annual powwow which last year had participants
from 70+ tribes, featuring over 1,500 dancers and drummers, and
drawing over 20,000 spectators. We annually feature indigenous
dance groups from other countries.
funding requests
Section 117 Perkins Base Funding.--Funds requested under Section
117 of the Perkins Act above the fiscal year 2010 level are needed to:
(1) maintain 100 year-old education buildings and 50 year-old housing
stock for students; (2) upgrade technology capabilities; (3) provide
adequate salaries for faculty and staff (who have not received a cost
of living increase for the past 2 years and who are in the bottom
quartile of salary for comparable positions elsewhere); and (4) fund
program and curriculum improvements, including at least three 4-year
degree programs.
Acquisition of additional base funding is critical as UTTC has more
than tripled its number of students within the past 8 years while
actual base funding, including Interior Department funding, have not
increased commensurately (increased from $6 million to $8 million for
the two programs combined). Our Perkins funding provides a base level
of support while allowing the college to compete for desperately needed
discretionary contracts and grants leading to additional resources
annually for the college's programs and support services.
Title III-A (Section 316) Strengthening Institutions.--We support
Title III-A funding for tribal colleges. Among its statutorily
allowable uses is facility construction and maintenance. We are
constantly in need of additional student housing, including family
housing. We work hard to cobble together various sources for housing
construction. We would like to educate more students but lack of
housing has at times limited the admission of new students. With the
completion this past year of a new Science and Math building on our
South Campus on land acquired with a private grant, we urgently need
housing for up to 150 students, many of whom have families. New housing
on the South Campus could also accommodate those persons we expect to
enroll in a new police training program.
While UTTC has constructed three housing facilities using a variety
of sources in the past 20 years, approximately 50 percent of students
are housed in the 100-year-old buildings of the old Fort Abraham
Lincoln, as well as in duplexes and single family dwellings that were
donated to UTTC by the Federal Government along with the land and Fort
buildings in 1973. These buildings require major rehabilitation. New
buildings for housing are actually cheaper than trying to rehabilitate
the old buildings that now house students.
Pell Grants.--We support maintaining the Pell Grant maximum amount
to at least a level of $5,550. As mentioned above, 81 percent of our
students are Pell Grant-eligible. This program makes all the difference
in the world of whether these students can attend college. We also
support the continuation of appropriations to fund two scheduled award
years per year, as this has helped many of our students shorten the
time to obtain their degrees.
government accountability office report
As you know, the Government Accountability Office (GAO) in March of
this year issued two reports regarding Federal programs which may have
similar or overlapping services or objectives (GAO-11-318SP of March 1
and GAO-11-474R of March 18). Funding from the Bureau of Indian
Education (BIE) and the Department of Education's Perkins Act for
Tribally Controlled Postsecondary Career and Technical Institutions
were among the programs listed in the supplemental report of March 18.
The GAO did not recommend defunding these or other programs; in some
cases consolidation or better coordination of programs was recommended
to save administrative costs. We are not in disagreement about possible
consolidation or coordination of the administration of these funding
sources so long as funds are not reduced.
Perkins funds represent about 46 percent of UTTC's core operating
budget. The Perkins funds supplement, but do not duplicate, the BIE
funds. It takes both sources of funding to frugally maintain the
institution. In fact, even these combined sources do not provide the
resources necessary to operate and maintain the college. Therefore,
UTTC actively seeks alternative funding to assist with academic
programming, deferred maintenance of its physical plant and scholarship
assistance, among other things.
Second, as mentioned, UTTC and other tribally chartered colleges
are not part of State educational systems and do not receive State-
appropriated general operational funds for their Indian students. The
need for postsecondary career and technical education in Indian Country
is so great and the funding so small, that there is little chance for
duplicative funding.
There are only two institutions targeting American Indian/Alaska
Native career and technical education and training at the postsecondary
level--United Tribes Technical College and Navajo Technical College.
Combined, these institutions received less than $15 million in fiscal
year 2010 Federal funds ($8 million from Perkins; $7 million from the
BIE). That is not an excessive amount of money for two campus-based
institutions which offer a broad (and expanding) array of programs
geared toward the educational and cultural needs of their students and
toward job-producing skills.
UTTC offers services that are catered to the needs of our students,
many of whom are first generation college attendees and many of whom
come to us needing remedial education and services to address the
sociobehavioral, socioeconomic, and academic characteristics that pose
problems. Our students disproportionately possess more high risk
characteristics than other student populations. We also provide
services for the children and dependents of our students. Although BIE
and Section 117 funds do not pay for remedial education services, UTTC
must make this investment with our student population through other
sources of funding to ensure they succeed at the postsecondary level.
Federal funding for American Indian/Alaska Native employment and
training is barely 1 percent of the annual Federal employment and
training budget but has an enormous impact on the people and
communities it serves.
Perkins funds are central to the viability of our core
postsecondary educational programs. Very little of the other funds we
receive may be used for core career and technical educational programs;
they are competitive, often one-time supplemental funds which help us
provide the services our students need to be successful. We cannot
continue operating without Carl Perkins funds. Thank you for your
consideration of our requests.
______
Prepared Statement of the U.S. Hereditary Angioedema Association
Thank you for the opportunity to present the views of the U.S.
Hereditary Angeioedema Association (USHAEA) regarding the importance of
hereditary angioedema (HAE) research.
USHAEA was founded in 1999 with the express purpose of helping
those living with HAE and their families to live healthy lives, provide
support, and find a cure. The Association provides patient services to
those living with HAE, including referrals to knowledgeable healthcare
providers and information on the disease. USHAEA also provides research
funding to scientific investigators to increase the knowledge base on
HAE. Additionally, USHAEA also provides research materials and forums
to educate the patients and their families, healthcare providers, and
the general public on HAE. Finally, USHAEA acts as a voice for those
living with HAE to the world at large.
HAE is caused by a genetic defect which controls C1-Inhibitor blood
protein, causing an inability to regulate complex biochemical
interactions in blood-based systems involved in disease fighting,
inflammatory response, and coagulation. Episodes of HAE are
characterized by swelling in the body including the hands, feet,
gastrointestinal tract, face, and airway. During an episode, HAE
patients experience abdominal pain, nausea, vomiting, and airway
swelling, which can lead to asphyxiation. Episodes are often caused by
infections, minor injuries or dental procedures, emotional or mental
stress, and certain hormonal or blood medications. HAE impacts
approximately 1 in 10,000 to 1 in 50,000, making proper diagnosis
difficult. Many of the initial HAE episodes occur in children and
adolescents. In families were one parent has HAE, there is a 50 percent
probability that their children will inherit this condition. HAE has an
annual cost which can exceed $500,000 per year per patient in addition
to the human and economic burdens associated with the disease.
Research Through the National Institutes of Health
In years past, HAE research was conducted at the National
Institutes of Health (NIH) through the National Institute of Allergy
and Infectious Diseases, the National Institute of Neurological
Disorders and Stroke, the National Heart, Lung, and Blood Institute,
the National Institute of Child Health and Human Development, National
Center for Research Resources, and the National Institute on Diabetes
and Digestive and Kidney Diseases. However, NIH has not engaged in any
basic or clinical research on HAE since 2009, nor is there any Federal
research as it relates to HAE. As a rare disease, HAE stands to benefit
from from recent NIH commitments such as the Cures Acceleration Network
and the Therapeutics for Rare and Neglected Diseases program, as well
coordination with the Office of Rare Diseases Research.
In order to enable research to resume on HAE, it is vital that NIH
receive increased support in fiscal year 2012. USHAEA recommends an
overall funding level of $35 billion for NIH in fiscal year 2012 and
the inclusion of recommendations emphasizing the importance of HAE
research.
Thank you for the opportunity to present the view of the HAE
community.
______
Prepared Statement of YWCA USA
Thank you Chairman Harkin, Ranking Member Shelby and members of the
Subcommittee for the opportunity to submit testimony. My name is Gloria
Lau, and I am the Chief Executive Officer of the YWCA USA. As Congress
works on the appropriations and priorities for the fiscal year 2012
Federal budget, I am here to speak about one priority in particular
under the jurisdiction of this subcommittee: the critical need for
childcare for women and families.
The YWCA USA is a national not-for-profit (501(c)(3)) membership
organization committed to social service, advocacy, education,
leadership development, economic empowerment and racial justice. The
YWCA is dedicated to eliminating racism, empowering women and promoting
peace, justice, freedom and dignity for all. We represent more than 2
million women and girls, and we can be found in many communities in the
United States. With nearly 300 local associations nationwide, we serve
thousands of women, girls, and their families annually through a
variety of programs; including violence prevention and recovery
programs, housing programs, job training and employment programs,
childcare and early education programs, and more. Our clients include
women and girls from all walks of life, including those escaping
violence, low-income women and children, women veterans, elderly women,
disabled women, and homeless women and their families.
The YWCA is one of the largest providers of childcare in the United
States. Many of our associations provide accessible, affordable, and
high-quality childcare services to working families nationwide. In one
example close to the Nation's Capital, the YWCA of Baltimore, Maryland,
an association committed to providing quality childcare for all
children, serves more than 600 children annually. At this and other
YWCA childcare centers, the day is designed to meet the developmental
needs and the interests of each child. Each day includes a variety of
intellectual, physical, social, emotional, and creative activities as
well as opportunities to interact with other children and adults. In
another example, the childcare program at the YWCA in Lawrence,
Massachusetts has been ranked in the top 10 childcare programs in
Massachusetts by Root Cause, an organization that encourages social
innovation and helps corporations source exceptional programs. Starting
with this program, many children join YWCA as infants or toddlers and
stay in programming into their teen years, which provides continuity of
care for children and siblings. Finally, at the YWCA Greater
Cincinnati, the State of Ohio has recognized that association's
programs with a three-star rating for having met all State benchmarks
for quality. If members of the Subcommittee wish, we can provide you
far more examples of how YWCAs are providing quality childcare critical
to the country's children and their families.
As a major provider of childcare throughout the United States, the
YWCA is a strong supporter of the Childcare Development Block Grant
(CCDBG). Across the country, YWCAs use CCDBG funding for a variety of
programs, including childcare for infants and toddlers, and before- and
after-school care for children in school. CCDBG also provides childcare
subsidies for low-income and moderate-income YWCA clients who attend
our job training programs, live in our housing facilities, or are
served by domestic violence and sexual assault programs. Every day, in
communities across this country, we witness the important role CCDBG
plays in helping parents find and keep employment and in helping
children learn and grow.
Because of our strong support for the CCDBG, the YWCA asks the
Subcommittee to concur--at a minimum--with the President's fiscal year
2012 funding request, which includes $2.9 billion for the CCDBG in the
Department of Health and Human Services. This call for support comes
directly from communities across the country, as local YWCA
associations surveyed in December 2010 identified this vital block
grant as one of their most critical funding sources. We also support
Head Start and Early Head Start, which the President has requested for
fiscal year 2012 at $8.1 billion and which rounds out the continuum of
services for young children and their families.
The YWCA wholeheartedly supports the core purpose of the CCDBG,
which is to help make quality childcare affordable for low-income and
moderate-income women and families, through block grant funding for
States and tribes. CCDBG is not a cookie-cutter/one size fits all
program: it provides States flexibility in developing childcare
programs and policies most appropriate to fulfill the needs of children
and parents within that State, as well as empowers working parents to
make their own decisions on childcare services that best suit their
family's needs. CCDBG helps keep parents educated about their childcare
options through consumer information so that they can make informed
choices, while helping them to achieve economic stability and
independence.
The need is simple--if working parents do not have access to
affordable, quality childcare for their children, they cannot be full
contributors to the economy. Each week, more than 11 million children
under 5 years of age are in some type of childcare setting \1\.
---------------------------------------------------------------------------
\1\ U.S. Census Bureau, 2006-2008 American Community Survey. U.S.
Census Bureau. (2008, March). Who's minding the kids? Childcare
arrangements: Spring 2005: Detailed tables. Retrieved April 19, 2010,
from http://www.census.gov/population/www/socdemo/child/ppl-2005.html.
---------------------------------------------------------------------------
The problem is: childcare costs are high--compared to family income
and household expenses--and they are growing. The average amount
parents paid for full-time care for an infant in a center ranged from
more than $4,560 in Mississippi to more than $18,773 a year in
Massachusetts ($5,356 in Alabama and $8,273 a year in Iowa) \2\.
Furthermore, the average center-based childcare fees for an infant
exceeded the average annual amount that families spent on food in every
region of the country. In addition, childcare fees per month for two
children of any age exceeded the median monthly amount for rent, and
were nearly as high, or even higher than, the average monthly mortgage
payment in every State. YWCAs offer quality childcare at a low cost to
the families they serve, but many of them would have to turn people
away or simply end programs without State CCDBG funds. This, in turn,
would result in parents losing childcare which would impact their
ability to work and could possibly result in children being placed in
unfit or unsafe childcare situations, further impacting their ability
to learn and grow.
---------------------------------------------------------------------------
\2\ Parents and the High Cost of Childcare: 2010 Update from the
National Association of Childcare Resource and Referral Agencies
(provides average costs of childcare for infants, 4-year-olds, and
school-age children in centers and family childcare homes in every
State), http://www.naccrra.org/publications/naccrra-publications/
parents-and-the-high-cost-of-child-care.php.
---------------------------------------------------------------------------
Investments in early education are critical to our effort to build
a smarter and stronger country, even in economic times that call for
budget-cutting measures. Quality, affordable early childhood care and
education result in positive outcomes for children, such as preparing
them for school and helping parents find and keep jobs. It also
benefits taxpayers and enhances economic vitality. Research\3\--by
Nobel Prize-winners and Federal Reserve economists, in economic studies
in dozens of States and counties, and in longitudinal studies spanning
40 years--demonstrate that return on public investment in high quality
childhood education is substantial.
---------------------------------------------------------------------------
\3\ Early Childhood Education for All: A Wise Investment. U.S.
Census Bureau (2005, April). ``The Economic Impacts of Childcare and
Early Education: Financing Solutions for the Future;'' a conference
sponsored by Legal Momentum's Family Initiative and the MIT Workplace
Center. Retrieved April 7, 2011, from http://web.mit.edu/
workplacecenter/docs/Full%20Report.pdf.
---------------------------------------------------------------------------
Specifically, it was found that, in the short term, quality,
affordable childcare provides significant return as an industry:
employing nearly 3 million people nationwide; providing employees wages
to spend, pay taxes and purchase goods and services; and enabling
employers to attract and retain employees and increase productivity. In
the long term, quality, affordable childcare has been found to result
in lower costs for remedial and special education and grade repetition;
higher rates of completing school and building skills; improved job
preparedness and ability to meet future labor force demands; and higher
incomes and tax payments from those who complete school.
As stated in a letter to both of you and the Chair and Ranking
Member of the Senate Appropriations Committee signed by 17 Senators on
February 24, 2011, ``noted economists agree that investing in early
childhood education is fiscally responsible because it yields a
tremendous return on investment, ranging from $3 to $17 for every
dollar invested.'' The letter goes on to state, ``Given these gaps and
the importance of early learning to our country's economic success, the
American Recovery and Reinvestment Act (ARRA) included a prudent and
essential expansion of these programs. We strongly believe that
Congress must build on this progress, not reverse it.'' \4\ The YWCA
strongly believes that as Congress focuses on effective and efficient
uses of Federal funds, Congress should not overlook the benefits of
allocating Federal dollars toward childcare and early education
programs, particularly to cultivate younger generations.
---------------------------------------------------------------------------
\4\ The letter includes support for Head Start and Early Head
Start.
---------------------------------------------------------------------------
Congress and several Presidential administrations have historically
shown strong bipartisan support for CCDBG. Even so, for the 21 years
CCDBG has been in existence, the program has always been underfunded
and supply has never met demand. Even before the current economic
downturn, it was estimated that only 1 in every 7 children who were
eligible for CCDBG received assistance. It was also not uncommon for
children and their families to be put on waiting lists, to see their
assistance cut, or to see it eliminated altogether. The economic
downturn has exacerbated this already alarming situation as States
continue to cut back social service programs more than they had been
scaled back, prior to economic collapse.
In a positive response, as referred to in the joint Senate letter
to the Appropriations Committee referenced earlier, the ARRA made a
major, $2 billion investment in childcare. The significant increase for
CCDBG included in the President's fiscal year 2012 budget request would
allow children served by ARRA funding to continue receiving services.
This level of funding would allow 1.7 million children to receive
childcare assistance, an increase of 220,000 children--at great relief
to their working parents. The $1.3 billion increase would translate
into an increase of $800 million for discretionary funding (which does
not require a State match) and $500 million for mandatory funding
(which requires a State match. Approving the President's proposed level
of funding will ensure positive impact to the working women and
families that are an essential part of our Nation's economic recovery.
The need for and importance of investments in childcare and early
childhood education, including CCDBG funding, to the viability of our
country is now greater than ever. In addition, the current budget
crises facing States across this Nation illustrate why Federal
investments in quality childcare and early educations programs are both
necessary and vital. For example, the National Women's Law Center
(NWLC) reported on April 7, 2011 \5\, States have begun to cut back on
childcare assistance:
---------------------------------------------------------------------------
\5\ Additional Childcare Funding Essential to Prevent State Cuts
from the National Women's Law Center. Retrieved April 8, 2011, from
http://www.nwlc.org/resource/additional-child-care-funding-essential-
prevent-state-cuts.
``Until recently, most States have managed to maintain their
childcare assistance programs, largely thanks to an additional $2
billion in Childcare Development Block Grant (CCDBG) funding for fiscal
year 2009 and fiscal year 2010 from the American Recovery and
Reinvestment Act (ARRA). However, as States exhaust these funds, and as
State budget gaps persist, many will be forced to scale back childcare
assistance for families unless additional Federal funding is provided.
Already, a number of States and communities have begun to cut back on
childcare assistance''. . . .
--California's governor is proposing to eliminate childcare
assistance for 11- and 12-year-olds, lower the income
eligibility limit for childcare assistance from 75 percent of
State median income to 60 percent of State median income, and
reduce reimbursement rates to childcare providers serving
children receiving childcare assistance--which would likely
result in families being forced to make up the difference.
--Florida's waiting list for childcare assistance increased from
approximately 67,000 children in early 2010 to 89,000 children
as of December 2010.
--Maryland will place all families who apply for childcare assistance
after February 28, 2011 on a waiting list.
--North Carolina's waiting list for childcare assistance increased
from approximately 37,900 children in early 2010 to nearly
45,700 children in December 2010.
--New York City's mayor is proposing to cut childcare assistance to
more than 16,600 children.
YWCA childcare programs in these States, and many more States
across the country, are already being impacted by State cutbacks. These
cutbacks will be amplified, and their impacts will be amplified, if
CCDBG funding does not continue at the levels requested by the
President's fiscal year 2012 budget request. For the YWCA, this means
our associations will have to cut vital programs and services, reduce
the number of families served, and possibly even close YWCA facilities
leaving many women and families without affordable, quality, childcare
to allow them to work and provide their children a safe,
developmentally appropriate environment.
The YWCA recognizes these are unique times in our Nation's history
and we agree that our Nation must address its deficit and debt. Yet,
the YWCA believes strongly that investments in childcare and early
education programs are wise uses of Federal funds that provide
substantial returns to our Nation. Childcare and early education
programs help not only our Nation's current workforce, but also help
prepare the next generation our Nation's children. On behalf of YWCAs
nationwide and the many women, children and families we serve, we look
to you for a continued commitment to women and families through the
provision of essential childcare resources. That is why we respectfully
ask you to support the President's fiscal year 2012 budget request for
$1.3 billion in additional funding for CCDBG. Thank you once again for
the opportunity to provide testimony in support of childcare services,
and CCDBG especially, to your Subcommittee. Your attention and
assistance are greatly appreciated.
.................................................................
LIST OF WITNESSES, COMMUNICATIONS, AND PREPARED STATEMENTS
----------
Page
Ad Hoc Group for Medical Research, Prepared Statement of the..... 505
ADAP Advocacy Association, Prepared Statement of the............. 502
Adult Congenital Heart Association, Prepared Statement of the.... 511
AIDS:
Healthcare Foundation, Prepared Statement of the............. 507
United, Prepared Statement of................................ 508
Alexander, Senator Lamar, U.S. Senator From Tennessee, Questions
Submitted by I60143, 411.......................................
Alliance for Aging Research, Prepared Statement of the........... 513
Alliance of Information and Referral Systems, Prepared Statement
of the......................................................... 516
Alluviam LLC, Prepared Statement of.............................. 517
Alving, Barbara M., M.D., Director, National Center for Research
Resources, National Institutes of Health, Department of Health
and Human Services, Prepared Statement of...................... 277
American:
Academy of:
Family Physicians, Prepared Statement of the............. 518
Physician Assistants, Prepared Statement of the.......... 520
Sleep Medicine, Prepared Statement of the................ 522
Association for:
Cancer Research, Prepared Statement of the............... 525
Dental Research, Prepared Statement of the............... 528
Geriatric Psychiatry, Prepared Statement of the.......... 530
Association of:
Colleges of Nursing, Prepared Statement of the........... 533
Colleges of Osteopathic Medicine, Prepared Statement of
the.................................................... 535
Colleges of Pharmacy, Prepared Statement of the.......... 537
Immunologists, Prepared Statement of the................. 540
Nurse Anesthetists, Prepared Statement of the............ 543
Congress of Obstetricians and Gynecologists, Prepared
Statement of the........................................... 546
Dental Education Association, Prepared Statement of the...... 549
Dental Hygienists' Association, Prepared Statement of the.... 551
Diabetes Association, Prepared Statement of the.............. 553
Foundation for Suicide Prevention, Prepared Statement of the. 556
Geriatrics Society, Prepared Statement of the................ 559
Heart Association, Prepared Statement of the................. 562
Indian Higher Education Consortium, Prepared Statement of the 565
Institute for Medical and Biological Engineering, Prepared
Statement of the........................................... 568
Lung Association, Prepared Statement of the.................. 571
National Red Cross, Prepared Statement of the................ 574
Nurses Association, Prepared Statement of the................ 576
Physical Therapy Association, Prepared Statement of the...... 578
Psychological Association, Prepared Statement of the......... 581
Public:
Health Association, Prepared Statement of the............ 584
Power Association, Prepared Statement of the............. 586
Society for:
Microbiology, Prepared Statements of the...............587, 590
Nutrition, Prepared Statement of the..................... 594
Pharmacology & Experimental Therapeutics, Prepared
Statement of the....................................... 595
Society of:
Nephrology, Prepared Statement of the.................... 597
Plant Biologists, Prepared Statement of the.............. 599
Tropical Medicine and Hygiene, Prepared Statement of the. 601
Thoracic Society, Prepared Statement of the.................. 603
Americans for Nursing Shortage Relief, Prepared Statement of the. 606
Arthritis Foundation, Prepared Statement of the.................. 609
ASME International, Prepared Statement of........................ 611
Association for:
Professionals in Infection Control and Epidemiology (APIC),
Prepared Statement of the.................................. 614
Research in Vision and Ophthalmology, Prepared Statement of
the........................................................ 616
Association of:
Academic Health Sciences Libraries, Prepared Statement of the 733
American Cancer Institutes, Prepared Statement of the........ 619
American Medical Colleges, Prepared Statement of the......... 621
American Veterinary Medical Colleges, Prepared Statement of
the........................................................ 624
Independent Research Institutes, Prepared Statement of the... 626
Maternal & Child Health Programs, Prepared Statement of the.. 627
Minority Health Professions Schools, Prepared Statement of
the........................................................ 629
Public Television Stations, Prepared Statement of the........ 631
Rehabilitation Nurses, Prepared Statement of the............. 634
Astrue, Michael J., Commissioner, Social Security Administration. 1
Introduction of.............................................. 5
Prepared Statement of........................................ 7
Summary Statement of......................................... 5
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,
Prepared Statement of.......................................... 298
Berg, Jeremy M., Ph.D., Director, National Institute of General
Medical Sciences, National Institutes of Health, Department of
Health and Human Services, Prepared Statement of............... 321
Birnbaum, Linda S., Ph.D., D.A.B.T., A.T.S., Director, National
Institute of Environmental Health Sciences and Health Services,
National Institutes of Health, Department of Health and Human
Services, Prepared Statement of................................ 303
Brain Injury Association of America, Prepared Statement of the... 636
Briggs, Josephine P., M.D., Director, National Center for
Complementary and Alternative Medicine, National Institutes of
Health, Department of Health and Human Services, Prepared
Statement of................................................... 274
Brown, Senator Sherrod, U.S. Senator From Ohio, Questions
Submitted by.................................................207, 481
CAEAR Coalition, Prepared Statement of the....................... 638
Centers for Disease Control and Prevention (CDC) Coalition,
Prepared Statement of the...................................... 640
Charles R. Drew University of Medicine and Science, Prepared
Statement of the............................................... 643
Children's Environmental Health Network, Prepared Statement of
the............................................................ 645
Coalition for:
Health Funding, Prepared Statement of the.................... 648
Health Services Research, Prepared Statement of the.......... 650
International Education, Prepared Statement of the........... 653
The Advancement of Health Through Behavioral and Social
Science Research, Prepared Statement of the................ 658
Workforce Solutions, Prepared Statement of the............... 656
Coalition of Heritable Disorders of Connective Tissue, Prepared
Statement of the............................................... 661
Cochran, Senator Thad, U.S. Senator From Mississippi:
Prepared Statements of......................................81, 154
Questions Submitted by................................142, 409, 487
Collins, Dr. Francis S., Director, National Institutes of Health,
Department of Health and Human Services........................ 221
Prepared Statement of........................................ 259
Summary Statement of......................................... 225
Commissioned Officers Association of the U.S. Public Health
Service, Prepared Statement of the............................. 663
Consortium for Citizens With Disabilities, Letter From the....... 62
Corporation for Public Broadcasting, Prepared Statement of the... 495
Council of Academic Family Medicine, Prepared Statement of the... 664
Council on Social Work Education, Prepared Statement of the...... 667
Crohn's and Colitis Foundation of America, Prepared Statement of
the............................................................ 670
Cystic Fibrosis Foundation, Prepared Statement of the............ 672
Digestive Disease National Coalition, Prepared Statement of the.. 676
Duncan, Hon. Arne, Secretary, Office of the Secretary, Department
of Education................................................... 417
Opening Statement of......................................... 421
Prepared Statement of........................................ 423
Durbin, Senator Richard J., U.S. Senator From Illinois:
Prepared Statement of........................................ 453
Questions Submitted by................................133, 399, 475
Dystonia Medical Research Foundation, Prepared Statement of the.. 678
Elder Justice Coalition, Prepared Statement of the............... 679
Eldercare Workforce Alliance, Prepared Statement of the.......... 680
Fauci, Anthony S., M.D., Director, National Institute of Allergy
and Infectious Diseases, National Institutes of Health,
Department of Health and Human Services........................ 221
Federation of American Societies for Experimental Biology,
Prepared Statement of the...................................... 686
Friends of the:
Health Resources and Services Administration, Prepared
Statement of............................................... 688
National Center on Birth Defects and Developmental
Disabilities Advocacy Coalition, Prepared Statement of..... 689
National Institute on Aging (NIA), Prepared Statement of the. 691
FSH Society, Inc., Prepared Statement of the..................... 682
Futures Without Violence, Prepared Statement of.................. 693
Garcia, Dr. A. Isabel, D.D.S., M.P.H., Director, National
Institute of Dental and Craniofacial Research, National
Institutes of Health, Department of Health and Human
Services,Prepared Statement of................................. 300
Glass, Roger I., M.D., Ph.D., Director, Fogarty International
Center, National Institutes of Health, Department of Health and
Human Services, Prepared Statement of.......................... 285
Global Health Technologies Coalition, Prepared Statement of the.. 696
Goodwill Industries International, Prepared Statement of......... 699
Grady, Patricia A., Ph.D., RN, FAAN, Director, National Institute
of Nursing Research, National Institutes of Health, Department
of Health and Human Services, Prepared Statement of............ 312
Graham, Senator Lindsey, U.S. Senator From South Carolina,
Questions Submitted by..................................148, 414, 489
Green, Eric D., M.D., Ph.D., Director, National Human Genome
Research Institute, National Institutes of Health, Department
of Health and Human Services, Prepared Statement of............ 280
Guttmacher, Alan E., M.D., Director, Eunice Kennedy Shriver
National Institute of Child Health and Human Development,
National Institutes of Health, Department of Health and Human
Services, Prepared Statement of................................ 294
Harkin, Senator Tom, U.S. Senator From Iowa:
Opening Statements of..........................1, 79, 151, 221, 417
Questions Submitted by...........................112, 176, 352, 458
Harlem Children's Zone, Prepared Statement of the................ 701
Health Professions and Nursing Education Coalition, Prepared
Statement of the............................................... 704
Hepatitis B Foundation, Prepared Statement of the................ 707
HIV Medicine Association, Prepared Statement of the.............. 710
Hodes, Richard, M.D., Director, National Institute on Aging,
National Institutes of Health, Department of Health and Human
Services, Prepared Statement of................................ 283
Howard University, Prepared Statement of......................... 713
Inouye, Chairman Daniel K., U.S. Senator From Hawaii:
Prepared Statement of........................................ 81
Questions Submitted by...........................115, 198, 383, 464
Insel, Thomas R., M.D., Director, National Institute of Mental
Health, National Institutes of Health, Department of Health and
Human Services, Prepared Statement of.......................... 305
International:
Foundation for Functional Gastrointestinal Disorders,
Prepared Statement of the.................................. 715
Myeloma Foundation, Prepared Statement of the................ 717
Interstate Mining Compact Commission, Prepared Statement of the.. 719
Interstitial Cystitis Association, Prepared Statement of the..... 720
Iowa Statewide Independent Living Council, Prepared Statement of
the............................................................ 721
Joint Advocacy Coalition of the: Association for Clinical
Research Training, Association for Patient-Oriented Research,
and Clinical Research Forum, Prepared Statement of the......... 722
Katz, Stephen I., M.D., Ph.D., Director, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National
Institutes of Health, Department of Health and Human Services,
Prepared Statement of.......................................... 289
Kohl, Senator Herb, U.S. Senator From Wisconsin, Questions
Submitted by.................................................122, 394
Landis, Story C., Ph.D., Director, National Institute of
Neurological Disorders and Stroke, National Institutes of
Health, Department of Health and Human Services, Prepared
Statement of................................................... 310
Landrieu, Senator Mary L., U.S. Senator From Louisiana, Questions
Submitted by.......................................131, 204, 396, 471
Lindberg, Donald A.B., M.D., Director, National Library of
Medicine, National Institutes of Health, Department of Health
and Human Services, Prepared Statement of...................... 314
Lions Clubs International, Prepared Statement of................. 724
March of Dimes Foundation, Prepared Statement of the............. 727
Meals On Wheels Association of America, Prepared Statement of the 731
Medical Library Association, Prepared Statement of the........... 733
Meharry Medical College, Prepared Statement of the............... 737
Mikulski, Senator Barbara A., U.S. Senator From Maryland,
Statement of................................................... 4
Moran, Senator Jerry, U.S. Senator From Kansas, Question
Submitted by.................................................415, 491
Morehouse School of Medicine, Prepared Statement of the.......... 740
Murray, Senator Patty, U.S. Senator From Washington, Questions
Submitted by............................................125, 200, 467
National:
AHEC Organization, Prepared Statement of the................. 742
National Alliance for Eye and Vision Research, Prepared
Statement of the........................................... 742
Alliance of State & Territorial AIDS Directors, Prepared
Statement of the........................................... 745
Association for Public Health Statistics and Information
Systems, Prepared Statement of the......................... 748
Association of:
Community Health Centers, Prepared Statement of the...... 751
County and City Health Officials, Prepared Statement of
the.................................................... 753
Nutrition and Aging Services Programs, Prepared Statement
of the................................................. 756
State Comprehensive Health Insurance Plans, Prepared
Statement of the....................................... 757
State Head Injury Administrators, Prepared Statement of
the.................................................... 757
Workforce Boards, Prepared Statement of the.............. 760
Coalition for:
Cancer Survivorship, Prepared Statement of the........... 761
Osteoporosis and Related Bone Diseases, Prepared
Statement of
the.................................................... 763
Consumer Law Center, Prepared Statement of the............... 765
Council of Social Security Management Associations, Prepared
Statement of the........................................... 767
Head Start Association, Prepared Statement of the............ 770
Health Council, Prepared Statement of the.................... 773
Healthy Mothers Healthy Babies Coalition, Prepared Statement
of the..................................................... 774
Hispanic Council on Aging (NHCOA), Prepared Statement of the. 776
Kidney Foundation, Prepared Statement of the................. 779
League for Nursing, Prepared Statement of the................ 780
Marfan Foundation, Prepared Statement of the................. 783
Minority AIDS Council, Prepared Statement of the............. 785
Minority Consortia, Prepared Statement of the................ 786
Multiple Sclerosis Society, Prepared Statement of the........ 789
Network to End Domestic Violence, Prepared Statement of the.. 792
Postdoctoral Association, Prepared Statement of the.......... 795
Primate Research Centers, Prepared Statement of the.......... 797
Psoriasis Foundation, Prepared Statement of the.............. 800
REACH Coalition, Prepared Statement of the................... 803
Respite Coalition, Prepared Statement of the................. 805
Rural Health Association, Prepared Statement of the.......... 808
Senior Corps Association, Prepared Statement of the.......... 810
Technical Institute for the Deaf, Prepared Statement of the.. 813
Nemours, Prepared Statement of................................... 818
Nephcure Foundation, Prepared Statement of the................... 820
Neurofibromatosis, Inc., Prepared Statement of................... 821
Nursing Community, Prepared Statement of the..................... 823
Oncology Nursing Society, Prepared Statement of the.............. 826
Ovarian Cancer National Alliance, Prepared Statement of the...... 829
Pancreatic Cancer Action Network, Prepared Statement of the...... 832
Pettigrew, Roderic I., Ph.D., M.D., Director, National Institute
of Biomedical Imaging and Bioengineering, National Institutes
of Health, Department of Health and Human Services, Prepared
Statement of................................................... 292
Physician Assistant Education Association, Prepared Statement of
the............................................................ 833
PolicyLink, The Food Trust, and The Reinvestment Fund, Prepared
Statement of................................................... 835
Population Association of America/Association of Population
Centers, Prepared Statement of the............................. 838
Prevent Blindness America, Prepared Statement of................. 840
ProLiteracy, Prepared Statement of............................... 843
Prostatitis Foundation, Prepared Statement of the................ 846
Pryor, Senator Mark, U.S. Senator From Arkansas, Questions
Submitted by............................................137, 403, 478
Pulmonary Hypertension Association, Prepared Statement of the.... 846
Railroad Retirement Board, Prepared Statement of the............. 498
Inspector General, Prepared Statement of the................. 500
Reed, Senator Jack, U.S. Senator From Rhode Island, Questions
Submitted by............................................136, 206, 476
Research Working Group of the Federal AIDS Policy Partnership,
Prepared Statement of the...................................... 848
Research!America, Prepared Statement of.......................... 850
Rodgers, Dr. Griffin, Director, National Institute of Diabetes,
Digestive and Kidney Diseases, National Institutes of Health,
Department of Health and Human Services........................ 221
Prepared Statement of........................................ 270
Rotary International, Prepared Statement of...................... 852
Ruffin, John, Ph.D., Director, National Institute on Minority
Health and Health Disparities, National Institutes of Health,
Department of Health and Human Services, Prepared Statement of. 307
Ryan White Medical Providers Coalition, Prepared Statement of the 854
Scleroderma Foundation, Prepared Statement of the................ 857
Sebelius, Hon. Kathleen, Secretary, Office of the Secretary,
Department of Health and Human Services........................ 79
Prepared Statement of........................................ 85
Summary Statement of......................................... 83
Senior Service America, Inc., Prepared Statement of.............. 859
Shelby, Senator Richard C., U.S. Senator From Alabama:
Statements of..................................3, 81, 153, 223, 419
Questions Submitted by.......................29, 139, 212, 403, 485
Shurin, Susan B., M.D., Acting Director, National Heart, Lung,
and Blood Institute, National Institutes of Health, Department
of Health and Human Services................................... 221
Prepared Statement of........................................ 267
Sickle Cell Disease Association of America, Prepared Statement of
the............................................................ 861
Sieving, Paul A., M.D., Ph.D., Director, National Eye Institute,
National Institutes of Health, Department of Health and Human
Services, Prepared Statement of................................ 279
Society for:
Healthcare Epidemiology of America (SHEA), Prepared Statement
of
the........................................................ 614
Maternal-Fetal Medicine, Prepared Statement of the........... 862
Neuroscience, Prepared Statement of the...................... 865
Women's Health Research, Prepared Statement of the........... 868
Solis, Hon. Hilda L., Secretary, Office of the Secretary,
Department of Labor............................................ 151
Prepared Statement of........................................ 158
Summary Statement of......................................... 155
Spina Bifida Association, Prepared Statement of the.............. 872
Tabak, Lawrence A., D.D.S., Ph.D., Principal Deputy Director,
National Institutes of Health, Department of Health and Human
Services, Prepared Statement of................................ 319
The AIDS Institute, Prepared Statement of the.................... 874
The Endocrine Society, Prepared Statement of..................... 877
The Humane Society of the United States, Prepared Statement of... 878
Tri-Council for Nursing, Prepared Statement of the............... 883
U.S. Hereditary Angioedema Association, Prepared Statement of the 889
United:
Negro College Fund, Prepared Statement of the................ 883
Network for Organ Sharing, Prepared Statement of the......... 885
Tribes Technical College, Prepared Statement of the.......... 887
University of Virginia Medical Center, Prepared Statement of the. 881
Varmus, Harold, M.D., Director, National Cancer Institute,
National Institutes of Health, Department of Health and Human
Services....................................................... 221
Prepared Statement of........................................ 265
Volkow, Nora, M.D., Director, National Institute on Drug Abuse,
National Institutes of Health, Department of Health and Human
Services, Prepared Statement of................................ 296
Warren, Dr. Kenneth, Ph.D., Director, National Institute on
Alcohol Abuse and Alcoholism, National Institutes of Health,
Department of Health and Human Services, Prepared Statement of. 287
Whitescarver, Jack, Ph.D., Director, Office of AIDS Research,
National Institutes of Health, Department of Health and Human
Services, Prepared Statement of................................ 317
YWCA USA, Prepared Statement of.................................. 890
SUBJECT INDEX
----------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Page
A New Era in the Fight Against Health Disparities................ 309
Academia-Industry Collaboration to Repurpose Drug Compound....... 345
Accelerating:
Basic Discovery.............................................. 301
Progress Through Technology.................................. 311
Additional Committee Questions................................... 352
Advances in:
Knowledge.................................................... 250
Toxicology and Exposure Assessment........................... 303
Advancing:
Innovative Biomedical Technologies........................... 278
Translational Science......................................263, 310
Affordable Hearing Healthcare.................................... 298
Alcohol and Healthcare--Transforming the Landscape............... 287
Antiviral Development for Flu.................................... 398
Applying Genetics, Genomics, and Other Cutting-edge Research to
New Treatments................................................. 290
Average Cost of Research Project Grants.......................... 323
Basic and Applied Research Balance............................... 404
Biomedical Research Resources and Workforce...................... 331
Broadening the IdEA Program...................................... 406
Budgetary:
Constraints on:
Universal Flu Vaccine.................................... 377
Vaccine Research......................................... 378
Effects on the NCI Programs.................................. 415
Building:
A Framework for Translation.................................. 281
Clinical and Translational Research Capabilities............. 277
On a Decade of Progress...................................... 308
CAM Research Challenges.......................................... 276
Cancer:
Clusters..................................................... 340
Prevelance and Research in Hawaii............................ 390
Cardiovascular Disease Research.................................. 411
Challenges and Changes in an Aging Population.................... 313
Childhood and Adolescence: Risk and Resilience................... 313
Chronic Obstructive Pulmonary Disease (COPD) Research............ 380
Clinical Trial Process........................................... 408
Clinical Trials Cooperative Group Program Reorganization Impact
on the Gynecological Cooperative Group......................... 381
Clyde, Ohio Cancer Cluster....................................... 341
Comparison of Age-related Macular Degeneration Treatments Trials. 394
Congenital Heart Disease (CHD)................................... 401
Cost of:
De-Risking Pharmaceuticals................................... 326
Pharmaceuticals.............................................. 339
Creation of SUAA................................................. 382
CTSA Program Mission............................................. 412
Cystic Fibrosis.................................................. 347
Research..................................................... 407
Developing:
New Clinical Treatments...................................... 302
Tools to Diagnose and Monitor Disease........................ 290
Diabetes......................................................... 324
Disaster Information Management.................................. 316
Disseminating Research Results to Improve Public Health.......... 271
Division of Program Coordination, Planning, and Strategic
Initiatives (DPCPSI)........................................... 319
DNA Databanks.................................................... 412
Early Opportunities for Genomic Medicine......................... 282
Economic Benefits of Biomedical Research......................... 399
Effects of:
A Government Shutdown........................................ 336
Reseach on Healthcare Costs.................................. 350
Emerging:
And Re-emerging Infectious Diseases.......................... 273
Psychoactive Threats to Public Health........................ 297
Enabling Research................................................ 281
Encouraging New Investigators and New Ideas...................... 312
End of Life: Supporting Individuals and Families................. 313
Energizing Research Communities.................................. 277
Enhancement of Evidence Base for:
Healthcare Decisions........................279, 286, 306, 310, 323
Oral Health Care............................................. 302
Eosinophilic:
Associated Disorders Research................................ 402
Disorders Working Group...................................... 414
Epigenetics, Endocrine Disrupters, and Environmental Health...... 304
Expanding Research Capabilities to Address Human Health.......... 278
Extramural Research Budget....................................... 403
Fiscal Year 2012 Scientific Priorities........................... 318
Flu Vaccine...................................................... 341
Future:
Directions in Nursing Science................................ 314
Of R01 Funds................................................. 405
Generating Research Opportunities................................ 271
Genetics and Genomics............................................ 268
Geographic:
Distribution of Small Business Innovative Research (SBIR)
Grants..................................................... 397
Health Disparities for Stroke and Obesity.................... 410
Global Competitiveness........................................... 328
The Importance of U.S. Leadership in Science and Innovation
for the Future of Our Economy and Our Health............... 244
Global Health.................................................... 272
Guidance for Use of Class B CATS................................. 379
Gulf Oil Spill Health Effects Research........................... 407
Health:
Data Standards and Electronic Health Records................. 315
Improvements................................................. 250
Messages for the Native Hawaiian Population.................. 388
Preparedness and Obesity..................................... 327
Healthcare Spending Policy Options............................... 348
Hereditary Angiodema Research Support............................ 389
Immune-mediated Disorders........................................ 274
Impacts on U.S. Economy.......................................... 247
Improving:
Healthcare for Women and Children............................ 294
Patient Care Through Research................................ 270
Public Healthcare--Delivery and Performance.................. 297
Industry Investment in Genome Sequencing......................... 413
Inflation Effects on Purchasing Power............................ 337
Information Services for the Public.............................. 315
Inter-Agency Collaborations...................................... 346
Interdisciplinary Research....................................... 332
Interim Status of IdEA Program................................... 396
Investing in Basic Science....................................... 262
Jackson Heart Study Impacts...................................... 409
Kidney Disease and Diabetes Research in Hawaii................... 392
Leveraging Basic Science to Improve Patient Care................. 290
Loan Repayment and Scholarship Programs.......................... 321
Lupus Research................................................... 379
Medical Milestones............................................... 343
Molecular Libraries Program as Part of the NCATS................. 405
National Center for Advancing Translational Sciences (NCATS)..... 263
And Preventative Medicine.................................... 377
Budget Amendment............................................. 325
National Center for Complementary and Alternative Medicine
(NCCAM) Advisory Council....................................... 352
National Institutes of Health.................................... 253
AIDS Research Program........................................ 317
And Economic Growth.......................................... 260
Turning Discovery Into Health................................ 244
NCI Priorities................................................... 399
New:
And Better Treatments Through Animal Models.................. 278
Investigators................................................ 338
New Ideas..........................280, 285, 293, 298, 307, 323
Scientific Advances and Opportunities........................ 317
Strategic Plan for NIDCD..................................... 300
Technoliges Advance Hope for Autism and Parkinson's.......... 295
NIC:
And the National Blood Cord Registry......................... 329
Volker Treatment Details..................................... 329
Olfactory Deficits Early Warning of Alzheimer's Disease.......... 300
Pain and Symptom Mangement....................................... 275
Pediatric Research............................................... 329
Personalized Medicine............................................ 412
As a Priority................................................ 403
Placement of:
IdEA Within the National Institute of Minority Health
Disparities (NIMHD)........................................ 396
National Center for Research Resources (NCRR) Programs....... 396
Planning for the Future.......................................... 305
Process Innovation and the NCATS................................. 406
Proposed National Center for Advancing Translational Sciences.... 253
Providing a Catalyst for Research Collaboration.................. 278
Provocative Questions............................................ 267
Public Health Burden of Mental Illness........................... 305
Rare and Neglected Diseases...................................... 351
Regenerative Medicine............................................ 268
Reorganization of:
National Center for Research Resources (NCRR) Programs.....403, 411
The Comparative Medicine Program............................. 406
Research Information Resources................................... 315
Return on Investment: Technologies to Speed Discovery............ 296
Revitalizing the Cancer Clinical Trials System................... 266
Scope of the Problem............................................. 287
Staffing the Jackson Heart Study................................. 409
Strategies for Promoting Health and Well-being................... 276
Stroke:
Disparities in the United States............................. 393
In Women..................................................... 398
Stuttering....................................................... 300
Support of NIH................................................... 334
Technologies to Accelerate:
Discoveries.................................................. 293
Discovery...................................279, 284, 286, 306, 322
Technologies to Improve Evidence-based Clinical Decisions........ 293
The AIDS Pandemic................................................ 317
The Cancer Genome Atlas.......................................... 401
The Clinical and Translational Science Awards (CTSAS) and the
National Center for Advancing Translational Sciences (NCATS)... 397
The National Children's Study (NCS).............................. 295
The National Institute of Nursing Research (NINR) Support for
End-of-Life Care and Health Disparities Research............... 388
The National Institute on Minority Health and Health Disparities
(NIMHD) Centers of Excellence (COE) in Hawaii.................. 389
The National Institutes of Health (NIH) Research Support to
Hawaii Academic Institutions................................... 383
The NCCAM Research:
Approaches................................................... 376
Successes.................................................... 353
The NIH, Academia, and Industy Relationship...................... 405
The NIH-FDA Collaborations....................................... 408
The Office of:
AIDS Research................................................ 320
Behavioral and Social Sciences Research...................... 320
Disease Prevention........................................... 320
Research on Women's Health................................... 320
Science Education............................................ 321
Strategic Coordination and the Common Fund................... 320
Tinnitus......................................................... 299
Training the Next Generation of Scientists....................... 314
Trans-NIH Plan and Budget........................................ 318
Transfer of the IdEA Program to the National Institute of General
Medical Sciences (NIGMS)....................................... 409
Translating:
Basic Science Into Improved Public Health.................... 301
Science to Advance Rehabilation.............................. 295
Translation--Therapeutics Development............................ 298
Translational:
Medicine..................................................... 269
Sciences and Therapeutics Development..279, 283, 287, 292, 306, 322
Uncovering the Genetic and Environmental Causes of Disease to
Inform Therapy and Prevention.................................. 270
Use of Chimpanzees in Biomedical Research........................ 382
Using Science to Inform Health Care Reform....................... 284
Vestibular Prosthesis............................................ 299
Vision for the Future............................................ 296
Workforce Pipeline............................................... 335
Working Collaboratively to Combat Suicide........................ 307
Office of the Secretary
Additional Committee Questions................................... 112
Adoption of Best Practices by Healthcare Professionals and Their
Patients....................................................... 116
Advance Scientific Knowledge and Innovation...................... 87
Advance the Health, Safety, and Well-being of the American People 88
Affordable Care Act.............................................96, 109
Centers for Disease Control...................................... 128
Environmental Health (Healthy Homes/Lead Poisoning
Prevention)................................................ 137
State Cancer Registries (Pediatric Cancer Surveillance)...... 136
Chafee Foster Care Independence Program.......................... 132
Child Welfare Finance Reform..................................... 131
Children's Hospital Graduate Medical Education.............95, 101, 105
Chronic Disease Grant Program.................................... 107
CLASS Act..................................................92, 106, 139
Community Health Centers......................................... 92
Congressional Requests for Information........................... 108
Federal Funding for Planned Parenthood........................... 126
Funding for the National Institute for Occupational Safety and
Health's:
Agriculture, Fishing and Forestry Program.................... 131
Education and Research Centers............................... 127
Grants for Occupational Safety and Health Educational Resource
Centers........................................................ 128
Head Start....................................................... 91
Immunization--Section 317 Funds.................................. 100
Impact of a Federal Government Shutdown.......................... 103
Increase Efficiency, Transparency, and Accountability of HHS
Programs....................................................... 90
Independent Payment Advisory Board............................... 110
Low Income Home Energy Assistance Program........................ 99
Makena, KV Pharmaceutical........................................ 101
Medicare Sustainable Growth Rate................................. 111
Mississippi State Department of Health Funding................... 142
NCATS and the Effect on CTSAS.................................... 123
NINR's:
Participation in Programs to Keep Up the Supply of Nurse
Researchers................................................ 116
Plans in Research on Autism, Cancer and Alzeimer's Disease... 117
Role in the National Center for Advancing Translational
Sciences (NCATS)........................................... 115
Pediatric Cancer................................................. 102
Prevention and Public Health Fund................................ 141
Program Guidelines............................................... 128
Rural Access Hospitals........................................... 98
Strengthen the Nation's Health and Human Service Infrastructure
and Workforce.................................................. 89
The Effect of Reducing NIH Funding to 5 Percent Below Fiscal Year
2010........................................................... 133
Title X Funding.................................................. 125
Transform Healthcare............................................. 86
Trauma Funding................................................... 125
Waste, Fraud and Abuse........................................... 94
In Medicare.................................................. 105
DEPARTMENT OF EDUCATION
Office of the Secretary
Academic Year Calandar........................................... 446
Access to 4-Year Institutions.................................... 465
Accreditation and Transparency of For-Profit Schools............. 452
Additional Committee Questions................................... 458
Alabama and Race to the Top Competition.......................... 419
Ayp Waiver Request............................................... 481
Bipartisanship Approach to Education Bill........................ 439
Budget:
Request in Current Economic Conditions....................... 421
Savings...................................................... 419
Career and Technical Education.......................467, 470, 489, 493
In Hawaii.................................................... 467
Carol M. White Physical Educaton Program......................... 465
Charter Schools.................................................. 445
College Completion............................................... 426
Common:
Core State Standards......................................... 480
Standards Benefit Military Families.......................... 446
Cost Savings:
And Efficiencies Initiated by the Department of Education in
Fiscal Year 2009 and Fiscal Year 2010...................... 463
Planned for Fiscal Year 2011 and Fiscal Year 2012............ 463
Distance:
Education Regulations........................................ 467
Learning and State Authorizations............................ 420
Early Childhood Education........................................ 467
Education:
Accountability............................................... 448
And Employment............................................... 479
And Job Demands of Next Decade............................... 429
Priorities--Cradle-To-Career Continuum....................... 431
Reform....................................................... 431
Support for Children of Military Families.................... 445
Educational Stability for Foster Youth........................... 474
Elimination of:
In-School Subsidy for Undergraduate Students................. 481
Two Pells and In-School Subsidies............................ 428
Emergency Preparedness in Schools................................ 472
Ensuring Achievement Gains Within Flexibility.................... 450
ESEA Title I Accountability Structure............................ 493
Ethnic and Immigrant Student Performance......................... 464
Expanding Charter School Opportunities........................... 446
Extended-Day and After-School Programs........................... 468
Family Engagement in Educational Outcomes for Children........... 483
FAPE--A Constitutional Requirement............................... 455
Federal:
Assistance to States in Provision of FAPE.................... 455
Direct Student Loan Origination Fees......................... 437
Funds as Percent of Kansas Education Budget.................. 438
Partnerships and Need-based Student Grant Aid................ 477
Role in Education..........................................434, 449
TRIO Programs..............................................473, 482
Final Fiscal Year 2011 Appropriation............................. 423
First:
Generation Students--College Dropout Rate.................... 435
In the World--Building a College Completion Culture.......... 436
Fiscal Year 2012 Department of Education Budget Request.......... 419
Flexibility in Exchange for Results.............................. 439
For-Profit Schools............................................... 451
Formula Grant Programs Form Majority of ED Budget................ 432
Funding Increase for Teach for America........................... 441
Funds for Implementing Academic Standards and Assessments........ 481
Geography Education.............................................. 489
Great Teachers and Leaders....................................... 425
Growth in Rate of Student Indebtedness........................... 451
Helping First Generation Students Graduate....................... 436
High School:
Dropout Recovery/Prevention Programs......................... 475
Graduation Initiative and the College Pathways and
Accelerated Learning Program............................... 486
Impact Aid:
Funding...................................................... 470
Payment Process.............................................. 470
Impact of:
Competitive-based Funding on Rural Areas..................... 456
The ESEA on Student Achievement.............................. 492
Improving:
Competitive Stance of Rural Communities for Education Funding 488
Partnerships With States and LEAS............................ 438
Inadequacy of Education for Current High Skill Jobs.............. 429
Incentive Compensation Regulations............................... 489
Increased:
Demand for Pell Grants....................................... 427
Efficiency Through Program Consolidation..................... 439
Increasing College Completion Rates.............................. 433
Initiatives and Investment in Educational Technology............. 469
Innovative Strategies in Early Learning.......................... 488
Institutional Participation in the TEACH Program................. 466
Investing in:
Community Colleges........................................... 436
Education.................................................... 418
Programs That Work........................................... 421
Job and Education Requirements of Next Decade.................... 429
Key Investments in Fiscal Year 2012 Budget Request............... 421
Large-Scale Competitive vs. Formula-based Grant Programs......... 431
Level Playing Field for Rural Areas in Grant Competitions........ 478
Leveraging Power of Teach for America............................ 441
Literacy:
Funding...................................................... 468
Through School Libraries..................................... 434
Longer School Year Needed........................................ 447
Maintaining Access Through Pell Grants........................... 436
Making Tough Choices............................................. 424
Mathematics and Science Partnerships............................. 457
Maximizing Public and Private Partnerships....................... 462
Maximum Pell Grant............................................... 428
Measuring Student Academic Growth................................ 491
Mississippi's Gains in Literacy in Early Grades.................. 434
Misuse of Student Aid by For-Profit Institutions................. 454
National:
Impact of Fiscal Year 2011 Budget Cuts on CIBERS............. 491
NFP Organizations Set-Aside Competition...................... 487
Nonprofit Competitions and ESEA Reauthorization.............. 488
Not-for-Profit Organizations and the Improving Teacher
Quality State Grants Program............................... 487
Need for:
Full Range of Student Aid Programs........................... 432
Library Programs............................................. 431
Recognizing, Funding More Promising Programs................. 443
Need to Keep Education Support in Tough Economy.................. 422
No Child Left Behind............................................. 439
Flexibility and Accountability............................... 449
Requirements Flexibility Plan................................ 481
Pell:
Grant Program................................................ 422
Grants....................................................... 458
And Total Education Budget Request....................... 427
Funding.................................................. 485
Growth in Cost........................................... 420
How Do We Pay for Them?.................................. 430
Integral to Education Budget and Goals................... 430
Versus Student Loans..................................... 451
Maximum Grant................................................ 428
Shortfall After Elimination of Year Round Pell............... 428
Plan for CIBER Program Funding in Fiscal Year 2012............... 491
Possible Waivers of ESEA Requirements............................ 491
President Obama's 2012 Budget Request............................ 424
Presidential Teaching Fellows.................................... 467
Projects Funded Under Teacher Quality Partnership Grants......... 477
Promise Neighborhoods............................................ 462
Applicants and Awards........................................ 444
Applications................................................. 484
Competition--Absolute Priority for Rural Communities......... 488
Funding....................................................443, 485
Program...................................................... 443
Public-Private Partnerships as Tool in Ensuring College- and
Career-Readiness............................................... 480
Race to the Top:
Accountability............................................... 442
Amendments................................................... 442
Application Process and Rural District Applicants............ 479
Application Scoring Process.................................. 456
Budget Request............................................... 419
Competition.................................................. 457
Early Learning Challenge Program............................. 482
Funding:
And Vendors.............................................. 478
Competition.............................................. 471
Phase 3...................................................... 472
Reauthorization of Perkins Act--Career and Technical Education... 470
Recovery Act of 2009 and the Education Jobs Fund of 2010......... 462
Reducing Pell Grants Costs....................................... 485
Repayment of Student Loan Debt................................... 453
Savings From Eliminating Two Pells and In-School Subsidy......... 430
School:
Libraries.................................................... 476
Turnaround Program........................................... 422
School-based Counseling Programs................................. 484
Science, Technology, Engineering and Mathematics................. 444
Special Education:
Free, Appropriate Public Education........................... 455
Maintenance of Effort Waivers................................ 454
State:
And Local Flexibility........................................ 438
Authorization of Distance Education Programs................. 486
Flexibility.................................................. 450
And Waivers.............................................. 438
To Innovate.............................................. 420
STEM Teacher Shortage............................................ 444
Strengthening Literacy in the Early Grades....................... 433
Strong Education Support Needed Despite Tough Economy............ 429
Student:
Health Initiatives........................................... 465
Loan Conversion.............................................. 481
Study Abroad and Foreign Language Instruction.................... 475
Supplemental Educational Services:
Evaluation................................................... 480
Oversight.................................................... 480
Support for:
At-risk Students and Adults.................................. 426
Innovation and Achievement................................... 432
Literacy Programs............................................ 433
Sustaining Reform Momentum....................................... 425
Targeting of Title I Funds to Local Educational Agencies......... 487
Teach for America..............................................440, 471
And Stem Instruction......................................... 441
Funding....................................................441, 442
Leadership Development Benefits.............................. 441
TEACH Grants and Proposed Presidential Teaching Fellows Program.. 466
Teacher:
And Student Classroom Experience............................. 438
Incentive Fund............................................... 450
Vanderbilt and Rand Studies on Performance-based Pay..... 460
Preparation and Classroom Innovation......................... 422
Quality Partnership Grants................................... 476
Quality Partnerships......................................... 432
Tech Prep Program................................................ 482
Technical Assistance to Promise Neighborhoods Grantees........... 485
Title:
I Rewards Program............................................ 435
VI:
Centers for International Business Education (CIBER)
Program................................................ 490
Culture and Foreign Language Programs.................... 437
2011 Continuing Resolution Impact on Education Budget............ 417
21st Century Community Learning Centers........................466, 468
Unemployment Impact on Pell Grant Program........................ 427
Waiver for McPherson USD School District 418..................... 440
Well-Rounded:
Classroom and After School Programs.......................... 422
Education.................................................... 458
Working to Ensure Efficacy of Federal Student Aid................ 452
Workload of Direct Loan Program.................................. 459
DEPARTMENT OF LABOR
Office of the Secretary
Additional Committee Questions................................... 176
Administrative Structures........................................ 203
Adult Employment and Training Activities......................... 194
African-American Unemployment.................................... 168
Budget Deficit................................................... 215
Bureau of International Affairs (ILAB)........................... 189
Bureau of Labor Statistics (BLS)................................. 186
CFTC............................................................. 213
Community Service Employment for Older Americans (CSEOA)......... 198
Davis-Bacon Act.................................................. 200
Dislocated Worker Employment and Training Activities............. 194
Department of Labor's:
Civil Rights Center (CRC).................................... 192
Fiduciary Rules.............................................. 212
Performance Measures......................................... 171
Duplication in Department of Labor Training Programs............. 153
Emerging Industries and High Growth Occupations.................. 192
Employee Benefits Security Administration........................ 176
Employment of People With Disabilities........................... 160
Evaluations and Performance...................................... 200
Expansion of Trade Adjustment Assistance......................... 169
Fiscal Year:
2011 Appropriations Bill..................................... 151
2012......................................................... 152
Government Accountability Office Report........................153, 170
Getting America Back to Work..................................... 158
Helping Workers Provide for Their Families and Keep What They
Earn........................................................... 159
International Labor Comparisons (ILC)............................ 212
Investing in the Future.......................................... 158
Investment Compared to Need...................................... 202
Job Corps........................................................ 197
Center, Gulfport, Mississippi................................ 165
Evaluation................................................... 174
Program...................................................... 164
Keeping Workers Safe............................................. 159
Mine Safety and Health Administration (MSHA)..................... 184
National Labor Relations Board................................... 163
National Longitudinal Youth Survey............................... 211
Occupational Safety and Health Administration (OSHA)............. 184
Office of:
Disability Employment Policy (ODEP)........................167, 191
Federal Contract Compliance Programs......................... 179
Labor-Management Standards (OLMS)............................ 181
The Solicitor (SOL).......................................... 188
Workers' Compensation Programs (OWCP)........................ 182
Payroll Fraud Prevention Act..................................... 210
Program Effectiveness............................................ 218
Recovery Efforts in Alabama...................................... 162
Return on Investment............................................. 175
Trade Adjustment Assistance Community College Training Grants.... 214
Transition Assistance Program.................................... 172
2012 Budget Resolution Passed By House........................... 168
Unemployment:
Compensation (UC)............................................ 199
Rate for African Americans................................... 207
Voluntary Protection Programs (VPP).............................. 204
Wage and Hour Division (WHD)...................................161, 177
Women Vets....................................................... 174
Women's Bureau (WB).............................................. 191
Worker Protection................................................ 156
Workforce:
Innovation Fund.............................................. 197
Investment Act.............................................156, 215
Reauthorization.......................................... 207
Workforce Innovation Fund................................ 198
Training Strategies.......................................... 209
Workshare........................................................ 206
YouthBuild....................................................... 197
Youthbuild Program............................................... 166
RAILROAD RETIREMENT BOARD
Agency Staffing.................................................. 498
Budget Request................................................... 500
Financial Status of the Trust Funds.............................. 499
Information Technology Improvements.............................. 499
Office of Audit.................................................. 500
Office of Investigations......................................... 501
Operational Components........................................... 500
Other Requested Funding.......................................... 499
Proposed Funding for Agency Administration....................... 498
SOCIAL SECURITY ADMINISTRATION
Additional Committee Questions................................... 29
Adequate Resources Needed for SSA................................ 27
Administrative Funding for Social Security....................... 17
Annual Earnings Statements....................................... 17
Continuing to Reduce the Disability Backlogs..................... 12
Cost-Benefit Analysis of Hearing Versus Approving a Case
Initially...................................................... 23
Disability:
Waiting Times................................................ 18
Work Incentives Simplification Pilot (WISP).................. 16
Effects of Continuing Resolutions................................10, 24
Funding Need to Run an Efficient, Effective SSA.................. 24
Improving Service to the Public.................................. 13
Ongoing Funding--Fiscal Years 2011 and 2012...................... 11
Possible Effects of Government Shutdown.......................... 25
Program Integrity................................................ 18
Recent Accomplishments........................................... 8
Recovery Act Funding for SSA..................................... 19
Reversal Rate for Disability Decisions........................... 20
SSA Administrative Overhead...................................... 26
Saving Taxpayer Dollars.......................................... 14
Service Cuts Due to a Lack of Funding............................ 27