S. HRG. 106±332 DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2000 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE ONE HUNDRED SIXTH CONGRESS FIRST SESSION ON H.R. 3037/S. 1650 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, 2000, AND FOR OTHER PURPOSES Department of Education Department of Health and Human Services Department of Labor Nondepartmental witnesses Printed for the use of the Committee on Appropriations Available via the World Wide Web: http://www.access.gpo.gov/congress/senate U.S. GOVERNMENT PRINTING OFFICE 54±221 cc WASHINGTON : 2000 For sale by the U.S. Government Printing Office Superintendent of Documents, Congressional Sales Office, Washington, DC 20402 ISBN 0±16±060071±5 COMMITTEE ON APPROPRIATIONS TED STEVENS, Alaska, Chairman THAD COCHRAN, Mississippi ROBERT C. BYRD, West Virginia ARLEN SPECTER, Pennsylvania DANIEL K. INOUYE, Hawaii PETE V. DOMENICI, New Mexico ERNEST F. HOLLINGS, South Carolina CHRISTOPHER S. BOND, Missouri PATRICK J. LEAHY, Vermont SLADE GORTON, Washington FRANK R. LAUTENBERG, New Jersey MITCH MCCONNELL, Kentucky TOM HARKIN, Iowa CONRAD BURNS, Montana BARBARA A. MIKULSKI, Maryland RICHARD C. SHELBY, Alabama HARRY REID, Nevada JUDD GREGG, New Hampshire HERB KOHL, Wisconsin ROBERT F. BENNETT, Utah PATTY MURRAY, Washington BEN NIGHTHORSE CAMPBELL, Colorado BYRON L. DORGAN, North Dakota LARRY CRAIG, Idaho DIANNE FEINSTEIN, California KAY BAILEY HUTCHISON, Texas RICHARD J. DURBIN, Illinois JON KYL, Arizona STEVEN J. CORTESE, Staff Director LISA SUTHERLAND, Deputy Staff Director JAMES H. ENGLISH, Minority Staff Director SUBCOMMITTEE ON DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES ARLEN SPECTER, Pennsylvania, Chairman THAD COCHRAN, Mississippi TOM HARKIN, Iowa SLADE GORTON, Washington ERNEST F. HOLLINGS, South Carolina JUDD GREGG, New Hampshire DANIEL K. INOUYE, Hawaii LARRY E. CRAIG, Idaho HARRY REID, Nevada KAY BAILEY HUTCHISON, Texas HERB KOHL, Wisconsin TED STEVENS, Alaska PATTY MURRAY, Washington JON KYL, Arizona DIANNE FEINSTEIN, California ROBERT C. BYRD, West Virginia (Ex officio) Professional Staff BETTILOU TAYLOR MARY DIETRICH JIM SOURWINE AURA DUNN ELLEN MURRAY (Minority) Administrative Support KEVIN JOHNSON CAROLE GEAGLEY (Minority) (II) CONTENTS TUESDAY, FEBRUARY 23, 1999 Page Department of Health and Human Services: Office of the Secretary ...................................................................................... 1 National Institutes of Health .......................................................................... 95 WEDNESDAY, MARCH 3, 1999 Department of Education: Office of the Secretary ................................................ 217 TUESDAY, MARCH 23, 1999 Department of Labor: Office of the Secretary ....................................................... 265 NONDEPARTMENTAL WITNESSES Department of Labor ............................................................................................... 325 Department of Health and Human Services ......................................................... 331 NIH/Health ....................................................................................................... 331 Health Issues .................................................................................................... 506 Low Income Home Energy Assistance Program (LIHEAP) .......................... 588 Department of Education ........................................................................................ 599 Related agencies ...................................................................................................... 648 Multiple agencies ..................................................................................................... 667 (III) DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2000 TUESDAY, FEBRUARY 23, 1999 U.S. SENATE, SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, Washington, DC. The subcommittee met at 9:30 a.m., in room SD±124, Dirksen Senate Office Building, Hon. Arlen Specter (chairman) presiding. Present: Senators Specter, Stevens, Cochran, Gregg, Kyl, Inouye, Hollings, Harkin, Kohl, and Feinstein. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF THE SECRETARY STATEMENT OF HON. DONNA SHALALA, SECRETARY OPENING STATEMENT OF SENATOR ARLEN SPECTER Senator SPECTER. Good morning, ladies and gentlemen. The hour of 9:30 a.m. having arrived, we will commence the hearing of the Subcommittee on Labor, Health and Human Services, and Edu- cation. Today we have a very important hearing on the budget of the Department of Health and Human Services, and we are pleased to be joined by the distinguished Secretary of Health and Human Services, the Honorable Donna Shalala. We have in the second facet of our hearing today the National Institutes of Health. This is always a special occasion, to have such an outstanding, extraor- dinary, great array of scientists come to a hearing. I am always re- luctant to have these hearings go very long with the NIH heads here because they have such important work to do. Of course, it is important as we take a look at what the budget will be for this im- portant branch. The Congress has been very dedicated to very substantial in- creases in NIH funding, as you all know, because of the extraor- dinary results which you have had. Last year we increased by $2 billion, which was an extraordinary sum of money considering the fact that the NIH funding comes from a common pool for health and human services generally, for the Department of Education, for the Department of Labor, worker safety, and very many very im- portant items. (1) 2 The Congress has consistently, whether the administrations are of one party or the other, taken a more generous look at NIH fund- ing than has the administration. This year it is going to be tougher than ever to find funding which will keep the kinds of applications rolling. I had a private meeting with Dr. Varmus, interrupted a bit of our hearings 2 weeks ago to get a thumbnail as to what is hap- pening. But I do know that if the funds are not very substantial, it will cut back on the kind of research projects you have. So we are going to do our utmost. But I would urge all of you and everyone in this room to communicate with the Chairmen of the Budget Committees on both houses, in both houses, and the Appropriations Committee Chairmen to have an allocation. That is what it takes for this sub- committee to make the baseline recommendations. The work in the field is so extraordinary that something is al- ways topical in the headlines. Today's media reports talk about the combination treatment of cervical cancer to cut mortality by half with a combination of chemotherapy and radiation. I am sure we will want to talk about that to some extent. There have been some remarkable advances on stem cells break- ing late last fall, and we have already had three hearings on that subject and I know it will be a matter of some concern again today, although the subcommittee will have a special hearing. The law has a prohibition as to NIH funding being used for the creation of a human embryo or embryos for research purposes or research in which a human embryo or embryos are destroyed. We have had opinion of counsel from HHS that where the fund- ing is private and the stem cells are extracted that it is then appro- priate for the National Institute of Health to fund the research on the stem cells. That is a matter of some concern in a number of quarters, with members of both the House and the Senate having registered dissents on that issue. It is something we will be taking a very close look at in part today, but really in subsequent hear- ings, to make a determination as to what the law does allow, al- though the administration has its legal opinion and they operate in that context, or whether there ought to be some modification as to that provision. We have quite a number of issues. We have just been joined by one of our ranking members of the Democrats in the absence of Senator Harkin, who I know is on his way. Let me yield, if I may, if it is not too suddenÐyou just arrived, Senator InouyeÐfor an opening statement. Senator INOUYE. It is always good to have you, Secretary Shalala. I just want to join my chairman in welcoming you back. Senator SPECTER. Senator Kyl, would you care to make an open- ing statement? Senator KYL. No, thank you, Mr. Chairman. Senator SPECTER. Senator Feinstein? Senator FEINSTEIN. Just to say welcome to the distinguished Sec- retary. I will have my remarks at the question time. Senator SPECTER. Thank you very much, Senator Feinstein. Well, welcome again, Madam Secretary. This is your seventh ap- pearance, I believe. You have a long run, a very successful one. We look forward to your testimony. 3 SUMMARY STATEMENT OF HON. DONNA SHALALA Secretary SHALALA. Thank you very much. Mr. Chairman, distinguished members of the subcommittee: I am pleased to be with you today to present the President's budget for the Department of Health and Human Services. With your permis- sion, Senator Specter, I have submitted a significantly longer copy of my testimony. Senator SPECTER. That will be made a part of the record in full and, as usual, to the extent you are able to summarize it would leave maximum time for questions and