DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1993 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPEOPEIATIONS HOUSE OF KEPKE SENT ATIVE S ONE HUNDRED SECOND CONGRESS SECOND SESSION SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES WILLIAM H. NATCHER, Kentucky, Chairman NEAL SMITH, Iowa CARL D. PURSELL, Michigan DAVID R. OBEY, Wisconsin JOHN EDWARD PORTER, Illinois EDWARD R. ROYBAL, California C. W. BILL YOUNG, Florida LOUIS STOKES, Ohio VIN WEBER, Minnesota JOSEPH D. EARLY, Massachusetts STENY H. HOYER, Maryland ROBERT J. MRAZEK, New York Michael A. Stephens, Robert L. Knisely, Susan E. Quantius, Mark J. Mioduski, and Joanne L. Orndorff, Subcommittee Staff PART 2 Page DEPARTMENT OF HEALTH AND HUMAN SERVICES Testimony of the Secretary 1 Tables and Special Reports 165 Health Resources and Services Administration 249 Centers for Disease Control 1417 Alcohol, Drug Abuse, and Mental Health Administration 583 Office of the Assistant Secretary for Health 1063 Agency for Health Care Policy and Research 1293 Printed for the use of the Committee on Appropriations DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1993 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED SECOND CONGRESS SECOND SESSION SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES WILLIAM H. NATCHER, Kentucky, Chairman NEAL SMITH, Iowa CARL D. PURSELL, Michigan DAVID R. OBEY, Wisconsin JOHN EDWARD PORTER, Illinois EDWARD R. ROYBAL, California C. W. BILL YOUNG, Florida LOUIS STOKES, Ohio VIN WEBER, Minnesota JOSEPH D. EARLY, Massachusetts STENY H. HOYER, Maryland ROBERT J. MRAZEK, New York Michael A. Stephens, Robert L. Knisely, Susan E. Quantius, Mark J. Mioduski, and Joanne L. Orndorff, Subcommittee Staff PART 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES Page Testimony of the Secretary 1 Tables and Special Reports 165 Health Resources and Services Administration 249 Centers for Disease Control 1417 Alcohol, Drug Abuse, and Mental Health Administration 583 Office of the Assistant Secretary for Health 1063 Agency for Health Care Policy and Research 1293 Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE 53-6340 WASHINGTON : 1992 For sale by the U.S. Government PrintingPffice Superintendent of Documents, Congressional Sales Office, \f a shington, DC 20402 ISBN 0-16-038596-2 COMMITTEE ON APPROPRIATIONS JAMIE L. WHITTEN, Mississippi, Chairman WILLIAM H. NATCHER, Kentucky, JOSEPH M. McDADE, Pennsylvania Vice Chairman JOHN T. MYERS, Indiana NEAL SMITH, Iowa CLARENCE E. MILLER, Ohio SIDNEY R. YATES, Illinois LAWRENCE COUGHLIN, Pennsylvania DAVID R. OBEY, Wisconsin C. W. BILL YOUNG, Florida EDWARD R. ROYBAL, California RALPH REGULA, Ohio LOUIS STOKES, Ohio CARL D. PURSELL, Michigan TOM BEVILL, Alabama MICKEY EDWARDS, Oklahoma BILL ALEXANDER, Arkansas BOB LIVINGSTON, Louisiana JOHN P. MURTHA, Pennsylvania BILL GREEN, New York BOB TRAXLER, Michigan JERRY LEWIS, California JOSEPH D. EARLY, Massachusetts JOHN EDWARD PORTER, Illinois CHARLES WILSON, Texas HAROLD ROGERS, Kentucky NORMAN D. DICKS, Washington JOE SKEEN, New Mexico MATTHEW F. McHUGH, New York FRANK R. WOLF, Virginia WILLIAM LEHMAN, Florida BILL LOWERY, California MARTIN OLAV SABO, Minnesota VIN WEBER, Minnesota JULIAN C. DIXON, California TOM DeLAY, Texas VIC FAZIO, California JIM KOLBE, Arizona W. G. (BILL) HEFNER, North Carolina DEAN A. GALLO, New Jersey LES AuCOIN, Oregon BARBARA F. VUCANOVICH, Nevada BERNARD J. DWYER, New Jersey JIM LIGHTFOOT, Iowa STENY H. HOYER, Maryland BOB CARR, Michigan ROBERT J. MRAZEK, New York RICHARD J. DURBIN, Illinois RONALD D. COLEMAN, Texas ALAN B. MOLLOHAN, West Virginia LINDSAY THOMAS, Georgia CHESTER G. ATKINS, Massachusetts JIM CHAPMAN, Texas MARCY KAPTUR, Ohio LAWRENCE J. SMITH, Florida DAVID E. SKAGGS, Colorado DAVID E. PRICE, North Carolina NANCY PELOSI, California PETER J. VISCLOSKY, Indiana Frederick G. Mohrman, Clerk and Staff Director Notes: The Honorable Silvio O. Conte was Ranking Minority Member of the Committee until his death on February 8, 1991. The Honorable William H. Gray til resigned from the Committee on September 11, 1991. (ID DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELAT- ED AGENCIES APPROPRIATIONS FOR 1993 Wednesday, February 19, 1992. DEPARTMENT OF HEALTH AND HUMAN SERVICES FISCAL YEAR 1993 BUDGET PROPOSAL WITNESS LOUIS W. SULLIVAN, M.D., SECRETARY OF HEALTH AND HUMAN SERV- ICES Mr. Natcher. The committee will come to order. At this time, we begin the hearings on the budget request for the fiscal year 1993 for the Departments of Labor, Health and Human Services, and Related Agencies. We have before the committee at this time our Secretary of the Department of Health and Human Services, Dr. Louis Sullivan. Dr. Sullivan, it is always a pleasure to have you appear before our committee. You are a good Secretary. It is a pleasure to have you. I believe this is your fourth appearance before our committee as Secretary — you are the 17th Secretary of the Department. I be- lieve that is correct; you are the 17th Secretary. It is a pleasure to have you. But before you start, as I said to you last night at the dinner honoring you and Joe Early and others, the budget that you have presented to us, bringing it up through OMB, and maybe through the White House on one or two occasions, is a good budget to start with, and we appreciate it. You know, Mr. Secretary, long before you were Secretary, you know the problems that we have had at different times in securing enough money for these three departments. We still believe on this subcommittee — and we are all friends on both sides on this subcom- mittee— we still believe when you take care of the health of your children and educate your children, you are going to live in the strongest country in the world. It will be a pleasure to hear from you. Secretary's Opening Statement Secretary Sullivan. Thank you, Mr. Chairman. It is a pleasure to appear before you and your colleagues on this subcommittee. I appreciate very much the very good working relationship we have with the members of this subcommittee as we work to address the health and social welfare needs of our citizens. (1) 2 Before we start today, I would like to take this opportunity to recognize the many accomplishments of Representative Roybal, who announced his retirement this past week. As you know, Mr. Roybal's advocacy for our Nation's senior citizens and minority citi- zens, and his leadership on behalf of our Social Security and Medi- care programs are worthy of the greatest respect and admiration. I am not alone when I say we will miss his very important, knowl- edgeable voice on these issues. Also, Mr. Chairman, later this year there will be two events on the NIH campus that are very important to this Department to which we invite all the members of this subcommittee to attend. On November 9 of this year will be the dedication of the Silvio Conte Building on the NIH campus. November 9 is the birthday of the late Mr. Conte. Hee was a very strong supporter of biomedical research, and the programs that this subcommittee has considered. The ground-breaking for the William Natcher Building is planned for the 11th of September of this year on the NIH campus. I am told, Mr. Chairman, that this also is your birthday. We hope you will be able to attend on that date, and I will lead the chorus of singing "Happy Birthday to You" as we break ground for that facility. We very much look forward to those two events. The President's budget will enable the Department to realize a $41 billion or 8 percent growth over 1992, for total outlays of $585 billion. Our appropriation request for HHS programs considered by this Committee totals $198 billion. This is $19 billion over 1992, an increase of almost 11 percent. In order to operate within the constraints of the budget agree- ment, we have made choices in this budget that focus funding ex- pansions on proven and targeted interventions, while reducing funding in some areas of more general assistance, such as the Low- Income Home Energy Assistance Program and the Community Services Block Grant Program. In this way, we opt for concentrat- ed and effective action where it is needed most. The President's budget carefully directs additional resources to five strategic priorities. The first is a priority which this body has heard me speak of many times before, and which is gaining more and more recognition as central to America's future. This priority is improving the health and lives of America's children. The 1993 budget for HHS includes $76 billion for health, service, and income programs benefiting our children, an increase of almost 10 percent for 1992. As only one of many proposals to help children, we are request- ing the largest expansion in the history of Head Start by seeking an additional $600 million. President Bush has made clear his strong commitment to this program by more than doubling Head Start funding since he took office in 1989. Our unprecedented in- crease for the Head Start program will mean that every eligible child whose^ parents want them to participate will be able to re- ceive ay ear's Head Start experience before entering school. Expanding access to health care for the disadvantaged and un- derserved is another major priority. We take a multifaceted ap- proach toward improving the availability of health services with a special emphasis on minority and underserved populations. This