September 29, 1975
Page 32550
Mr. MUSKIE. Mr. President, so far this year, the Senate has passed a dozen bills that fall into the health function of the Federal budget.
To date, we have approved $3.4 billion in authorizations for fiscal year 1979 which, if fully funded, would result in outlays of $1.2 billion.
As reported by the Human Resources Committee, S. 2474, the Health Services Extension Act, authorizes $798 million in fiscal year 1979 and $3.3 billion over the period fiscal years 1979-1983 to support the continuation of many vital health service programs. I understand that amendments which have not yet been brought before us could add another $856 million over the period 1979-82 to the authorization levels in this bill.
These authorization levels for S. 2474 and the proposed amendments can be accommodated within the second budget resolution ceilings. For this reason, and because this legislation will provide many needed services; I support both the bill and the proposed amendments.
Let me note, Mr. President, that the Human Resources Committee is exercising admirable budgetary restraint by offering an amendment to reduce the total authorization levels in S. 2474 to $1.9 billion over the period fiscal years 1979-1981. I would like to commend Senator KENNEDY and the Human Resources Committee for this action.
However, Mr. President, I do have a concern which extends beyond this particular bill. In general, the congressional approach to health problems has been to create a separate program to solve each health problem. This policy has caused an enormous proliferation of categorical health programs, authorized for longer and longer periods of time at ever higher levels of funding.
Each program develops its own Federal bureaucracy and its own local constituency. Repeal becomes impossible — even if the objectives the program was designed to meet are actually achieved.
There are those who believe that we are exercising budgetary restraint by designing these specific, inflexible authorizations to meet individual health problems. The thinking has been that spending will be curbed due to the specificity of these authorizations, and we continue to create new programs which, in many instances, duplicate existing activities and force spending ever higher.
Let me give an example. The primary care center proposal in S. 2474 will provide grants to hospitals to expand their outpatient departments. These expanded departments are to provide a wide range of primary medical services to generally indigent and medically under-served people who now use the hospital emergency room because they lack access to a private physician.
The importance and need for this type of service is indisputable. Forty-nine million people live in medically under-served areas — and are potential beneficiaries of this new program.
However, existing programs could solve the problems this new program is addressing. The Health Planning Act provides project grants that hospitals could use to renovate space for their "primary care center" and medicaid would pay the bills for many of those eligible for the new program. Alternatively, funding for community health centers could be increased to reach more medically under-served populations.
Let me provide another example of the effect of our policy of creating specific new authorities for each health problem. We have enacted no less than seven different programs to assist pregnant teenagers. Because these programs operate in isolation under separate authorizations providing very specific types of services, the pregnant teenager is not getting the kind of comprehensive assistance that she needs. The seven existing programs whose purpose is to help pregnant teenagers use none of their funds to avoid duplication or to refer teenagers to other programs with different services.
I understand that an amendment may be offered authorizing $210 million over a 3-year period to link together these disparate programs, all of which share the same goal — helping pregnant adolescents.
The concerns I am raising are not new to Senator KENNEDY. One of the amendments that I understand he will offer today authorizes a program of grants to State and local governments which allows the States to plan and then provide comprehensive preventive care services. This new non-categorical program exemplifies the kind of flexibility that I believe will result in more efficient spending in health programs and I urge Senators to support it.