Labor, Health and Human Services, Education, and Related Agencies
On July 14, the Senate Appropriations Committee approved, 27-0, the FY2006 Labor, Health and Human Services, Education, and Related Agencies spending bill (H.R. 3010). A Senate Appropriations subcommittee approved the measure by voice vote on July 12.
H.R. 3010 would allocate $145.69 billion in FY2006, a $2.23 billion increase over FY2005, $3.77 billion above the administration’s request, and $3.19 billion more than the amount approved by the House on June 24 (see The Source, 6/24/05).
During consideration of the bill, the committee approved, by voice vote, an amendment offered by Sen. Arlen Specter (R-PA) that would include report language stating, “It has come to the Committee’s attention that an independent study reviewed 4parents.gov, the Department’s website created to help parents counsel their teenagers about risky health behaviors. While noting positive aspects about the website, the study found numerous examples of inaccurate information. The Committee is aware that this website was designed by outside contractors, not by the Department’s public health experts. The Committee directs the Department to review the findings of the study, undertake a review of the website by Department public health and scientific experts, and make any necessary changes to conform with scientific evidence. The Committee also directs the Department to include scientifically accurate information about underage drinking and tobacco use.”
Report Language
The Senate Appropriations Committee report accompanying H.R. 3010 includes language detailing a number of programs affecting women and their families. Although report language is not binding, federal agencies give careful consideration to such language as it indicates programs or initiatives that are particularly important for appropriators.
Department of Labor
As requested by the administration, the Department of Labor Women’s Bureau would receive $9.76 million in FY2006, $286,000 more than FY2005. According to the report, “The Committee encourages the Women’s Bureau to support effective programs such as ‘Women Work!’, to provide technical assistance and training on programming for women in transition to reenter the workforce.”
Dislocated workers assistance would receive level funding of $1.48 billion in FY2006, $132.5 million above the administration’s request. The report states that the committee “was pleased to learn from the Secretary that the administration has established an interagency effort to address our Nation’s nursing shortage. The shortage is especially critical in rural America and within various ethnic minority populations, such as native Hawaiians. The Department is accordingly strongly urged to work with nursing programs serving such populations, and in particular, to ensure that summer employment opportunities exist for nursing students.”
The measure would provide $1.58 billion for Job Corps, a $30.1 million increase over FY2005 and $65 million more than the administration’s request. The report notes that “the mission of Job Corps is to attract eligible young adults, teach them the skills they need to become employable and independent, and place them in meaningful jobs or further education. Participation in the program is open to economically disadvantaged young people in the 16 to 24 age range who are unemployed and out of school.”
Under the bill, $125 million would be provided for the administration’s Community College Initiative, $1 million more than FY2005, but $125 million less than the budget request. Of that amount, no less than $10 million would be dedicated to community college partnerships with Job Corps Centers. The committee “expects this portion to be designated to 1) develop strategic partnerships with community colleges, business and industry leaders, and Job Corps centers to train students in high growth, high demand industries and 2) design ‘dual enrollment’ programs based on reciprocal agreements between Job Corps and community colleges.”
H.R. 3010 would include $93.2 million for the International Labor Affairs Bureau (ILAB), $50,000 more than FY2005 and $80.78 million above the administration’s request. The total would include $45 million for the International Labor Organization’s International Program for the Elimination of Child Labor. In addition, $37 million would be provided “to help ensure access to basic education for the growing number of children removed from the worst forms of child labor in impoverished nations where abusive and exploitative child labor is most acute.”
The report states that the committee “is aware that the administration is aggressively pursuing multiple trade agreements that will depend upon the United States’ ability to provide technical assistance on labor standards, including but not limited to the eradication of child labor. ILAB is the division of the U.S. Government with the mission and authority to provide that assistance. A budget request that eliminates all funding for multilateral and bilateral technical assistance, child labor, permanent reporting capacity, and HIV/AIDS in the Workplace promotes a lack of confidence in the United States’ trade efforts.
“The Committee commends the Department of Labor on its report ‘Investing In Every Child,’ which found that the average economic benefit of eliminating child labor around the world exceeds the cost of those efforts by a ratio of 6.7 to 1. The study also found that each year of additional education beyond the age of 14 yields an 11 percent increase in that individual’s earning power resulting in just over $5 trillion in global benefits. The Committee views the investment made by the United States and the programs run by the Department of Labor to eliminate child labor as a proven method for improving the economic infrastructure of developing nations and providing a market for U.S. goods.”
Department of Health and Human Services (HHS)
Health Resources and Services Administration (HRSA): Under the bill, HRSA would receive $7.42 billion in FY2006, $600 million more than FY2005 and $1.43 billion above the administration’s request.
Community health centers would receive $1.84 billion in FY2006, an increase of $105 million above FY2005, but $198.6 million less than the administration’s request. According to the report, “The Committee recognizes the cultural differences inherent in addressing family violence prevention among minority populations, such as Native Hawaiians. Additionally, many victims of domestic violence seek care through safety net providers in community health centers rather than present to costly emergency departments. The Committee encourages the Department to fund demonstration projects that combine integrated family violence prevention models focused on minority populations with primary care delivery.”
The bill would provide $710 million for the Maternal and Child Health Block Grant in FY2006, $13.93 million less than FY2005 and the budget request. Of this amount, $4 million would be provided to continue the sickle cell newborn screening program and its locally based outreach and counseling efforts, $1 million for a fetal alcohol syndrome demonstration program, and $2 million for mental health programs and activities. The report states, “The Committee expects that the programs will include mental health grants for prevention and early intervention services for children and youth ages 0 to 24 years and for women’s mental health as it relates to their role in the family, particularly for women diagnosed with postpartum depression (PPD). One out of every ten new mothers suffers from PPD, a treatable condition that presents a range of emotional and physical changes. Unfortunately, half of these women never get help. The Committee encourages the [Maternal and Child Health] Bureau to utilize this funding to focus on low-income women and mothers of children with low birthweight. The Committee recommends that funding be used on science-based programs or models such as the Starting Early Starting Smart Program that was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Casey Family Programs to specifically target early intervention and prevention.”
H.R. 3010 would allocate $2 million for newborn and child screening for heritable disorders. The report states, “Newborn screening is a public health activity used for early identification of infants affected by certain genetic, metabolic, hormonal and/or functional conditions for which there is effective treatment or intervention. Screening detects disorders in newborns that, left untreated, can cause death, disability, mental retardation and other serious illnesses.”
The committee “recognizes the critical role of hemophilia treatment centers in providing needed comprehensive care for persons with bleeding disorders and the expanded role of these centers in addressing the needs of women with bleeding disorders and persons with clotting disorders such as thrombophilia.”
The Healthy Start infant mortality initiative would receive $104 million in FY2006, a $1.45 million increase above the FY2005 level and $6.25 million more than the administration’s request. The measure would provide level funding of $9.79 million for universal newborn hearing screening. Under the administration’s budget request, this program would not have been funded. The report states that the committee “has included sufficient funding to continue the initiative begun several years ago to provide grants to States to establish universal newborn hearing screening and early intervention programs. The Committee is pleased by the success of the initiative and the substantial response from States.”
Ryan White: The Ryan White CARE Act would receive a $10 million increase over the FY2005 funding level to $2.08 billion as requested by the administration. Of this amount, $72.5 million would be provided to help children, youth, women, and families infected with, or affected by, HIV/AIDS. The committee “intends that Ryan White AIDS activities that are targeted to address the growing HIV/AIDS epidemic and its disproportionate impact upon communities of color, including African Americans, Latinos, Native Americans, Asian Americans, Native Hawaiians, and Pacific Islanders continue with at least the level of funding provided in FY2005.”
National Cord Stem Cell Bank: The bill would provide level funding of $9.86 million for the National Cord Stem Cell Bank program. Under the budget request, the program would not have been funded. The committee “continues to be supportive of the effort to build the Nation’s supply of cord blood stem cells available for therapy and research. The Committee notes that the Institute of Medicine study…has been completed and submitted to the Committee and HRSA. The Committee expects HRSA to begin implementation of this program as soon as possible.”
The report also states, “The Committee is concerned that pregnant women and their families are unaware of the benefits of umbilical cord blood in treating many congenital and genetic diseases. The Committee encourages HRSA to consider adding umbilical cord blood to organ and tissue donation education programs operated by HRSA to provide education on all options for umbilical cord blood storage including public donation and private banking.”
Family Planning: Title X, the nation’s family planning program, would be level-funded at $286 million as requested by President Bush. The committee “is aware of the findings of a recent HHS Inspector General’s report, which documents efforts by the Office of Population Affairs to inform and periodically remind Title X grantees of their responsibilities regarding State child abuse and sexual abuse reporting requirements. The report notes that OPA includes State reporting requirements in its reviews and site visits of grantees, and cites an extensive amount of effort and training that goes on within the program to ensure that clinicians are conversant with State reporting requirements, and trained to both recognize signs of sexual coercion and sexual violence and follow appropriate procedures when dealing with such cases.”
Centers for Disease Control and Prevention (CDC): The measure would allocate $6.25 billion for the CDC in FY2006, a $1.47 billion increase over FY2005 and $1.94 billion more than the administration’s request. The total would include an additional $75,000 over FY2005 for the national spina bifida program.
The report states that the committee “is concerned about the prevalence of Fetal Alcohol Spectrum Disorders (FASD) in the United States and notes that drinking during pregnancy is the nation’s leading known preventable cause of mental retardation and birth defects. FASD affects 1 in 100 live births or as many as 40,000 infants each year, and an individual with fetal alcohol syndrome can incur a lifetime health cost of over $800,000. To publicize and promote awareness of this critical updated public health information, the Committee has provided sufficient resources to continue these activities.”
The CDC “has reported that fetal deaths at 20 weeks gestation or greater account for nearly as many deaths as those that occur to infants during the first year of life. In FY2005, the Committee included funding to implement a demonstration project with several States to link existing birth defect surveillance systems and fetal death registries and to use that data to help develop strategies to reduce fetal deaths. The Committee is aware that the first year of the demonstration project was highly successful. A review of the public health burden of fetal deaths, identification of data gaps related to surveillance and risk factors, and a plan to expand broader birth defects surveillance to include surveillance of fetal deaths were produced. The Committee supports continued funding of the project at the same level in FY2006 to develop a detailed protocol for the surveillance project, which should include identifying possible data sources, developing and testing data collection instruments and standard methods for surveillance of fetal deaths, and pilot testing and evaluating the surveillance project.”
The committee “recognizes that Spina Bifida is the leading permanently disabling birth defect in the United States. While Spina Bifida and related neural tube defects are highly preventable through proper nutrition, including appropriate folic acid consumption, and its secondary effects can be mitigated through appropriate and proactive medical care and management, such efforts have not been adequately supported or coordinated to result in significant reductions in these costly conditions. Also, the Committee supports the Memorandum of Understanding between CDC and the Agency for Healthcare Research and Quality to examine clinical treatment of Spina Bifida and improve quality of life.”
Chronic disease prevention and health promotion would receive $974.1 million in FY2006, $46 million below FY2005 and $9.7 million above the budget request. Within that amount, an additional $300,000 over FY2005 would be provided for heart disease and stroke, and an additional $404,000 over FY2005 would be included for cancer prevention and control.
The report states, “The Committee commends the CDC for creating partnerships to address the early detection of breast cancer, particularly in historically underserved communities including the Native American, Hispanic, Asian Pacific Islander, and African American populations. As part of this initiative, the Committee is very interested in the innovative approaches, such as that of the Men Against Breast Cancer Partners In Survival Program, which focuses on the role of the male support-giver as an integral component of the early detection, patient care and survivorship of breast cancer.”
The Committee “is concerned by the toll that the twin epidemics of diabetes and obesity are taking on the health of minorities. An effective culturally-sensitive response is urgently needed to address this escalating epidemic. The Committee encourages CDC to fund initiatives of national and community organizations that have the capacity to carry out coordinated health promotion programs that will focus on diabetes and obesity in minority communities. The Committee encourages CDC to seek out organizations directed by and serving individuals from communities with disproportionate diabetes and obesity rates. “The high incidence of diabetes among Native American, Native Alaskan, and Native Hawaiian populations persists. The Committee is pleased with the CDC’s efforts to target this population, in particular, to assist the leadership of Native Hawaiian and Pacific Basin Islander communities. It is important to incorporate traditional healing concepts and to develop partnerships with community health centers. The Committee encourages CDC to build on all its historical efforts in this regard.”
The report notes that the committee “recognizes that lupus is a serious, complex, debilitating chronic autoimmune disease that can cause inflammation and tissue damage to virtually any organ system in the body and impacts between 1.5 and 2 million individuals. The Committee is concerned by the lack of reliable epidemiological data on the incidence and prevalence of all forms of lupus among various ethnic and racial groups. The Committee encourages CDC to consider modifying the National Lupus Patient Registry to create a common data entry and management system across all study sites, to collaborate with a consortium of academic health centers with an expertise in lupus epidemiology, and to ensure that study sites represent different geographic regions of the United States that have a sufficient number of individuals of all racial and ethnic backgrounds disproportionately affected by lupus, including Hispanics, Asians, Native Americans, and African Americans.”
According to the report, “Obesity is rampant in the United States. Between 1980 and 1994, the prevalence of obesity in the United States has increased by 100 percent in children and adolescents. More than 20 percent of the adult population is 30 pounds or more overweight and 10 to 15 percent of children and adolescents are overweight. Risk factors associated with obesity physical inactivity and unhealthy eating account for at least 300,000 preventable deaths each year and increase the risk for many chronic diseases like diabetes, heart disease and cancer. The Committee is aware that the CDC’s own statistics show that Native Americans, including Native Alaskans and Native Hawaiians suffer higher rates of obesity than other Americans. The Committee has included sufficient resources to provide the same level of support provided in fiscal year 2005 for Nutrition, Physical Activity, and Obesity related activities.
“The multiple factors contributing to the overweight and obesity epidemic took years to develop. Reversing the epidemic will require a long-term, well-coordinated, concerted approach to reach Americans where they live, work, play, and pray. Effective collaboration among the public, voluntary, and private sectors is critical to reshape the social and physical environment of our Nation’s communities and provide the necessary support, information, tools, and realistic strategies needed to reverse the current obesity trends nationwide. “To reduce consumer confusion about the myriad of health messages about obesity, diabetes, and cardiovascular disease, the Committee encourages CDC to design and develop mechanisms for fast-tracked translation of research into reasoned guidance for the American public.”
The report states that the committee “is aware of the Surgeon General’s report on Bone Health and Osteoporosis. The Surgeon General calls for a national action plan for bone health. The Committee encourages CDC to collaborate with a leading national voluntary health organization focused on osteoporosis and bone health to confer with other relevant Federal agencies and public and private stakeholders to develop a National Action Plan on Bone Health and Osteoporosis.”
The committee “continues to be interested in pulmonary hypertension (PH), a rare, progressive and fatal disease that predominantly affects women, regardless of age or race. PH causes deadly deterioration of the heart and lungs and is a secondary condition in many other serious disorders such as scleroderma and lupus. Because early detection of PH is critical to a patient’s survival and quality of life, the Committee encourages CDC to consider supporting a cooperative agreement with the pulmonary hypertension community to foster greater awareness of the disease.”
According to the report, “The Committee is concerned about the growing incidence and health consequences of eating disorders among the population. The extent of the problem while estimated by several long-term outcome studies as being high remains unknown. The Committee urges the CDC to research the incidence and morbidity and mortality rates of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified across age, race, and sex.”
The committee “urges CDC to increase research on the psychological sequelae of violence against women and expand research on special populations and their risk for violence including adolescents, older women, ethnic minorities, women with disabilities, and other affected populations.”
The bill would provide $957 million for HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis prevention at the CDC, a decrease of $3.67 million below FY2005 and $750,000 more than the budget request. Of that amount, $123 million would be provided for global HIV/AIDS programs, $85,000 less than FY2005. In addition, the Global Fund to Fight AIDS, Tuberculosis, and Malaria would receive $100 million in FY2006.
According to the report, “The Committee notes that CDC is charged legislatively with instituting programs to help prevent infertility. CDC’s current program activities in this matter are undertaken by the division of HIV/STD/TB and are limited to the prevention of venereal diseases. The Committee understands that there are numerous additional causes of infertility beyond sexually transmitted diseases, such as delayed child bearing, smoking, low or excessive body weight, exposure to hazardous environmental toxins, drug and alcohol abuse and, particularly for men, exposure to high temperatures. The Committee encourages CDC to consider expanding the scope of this program and provide greater support to public education on the risks to fertility.”
National Institutes of Health (NIH): The NIH would receive $29.42 billion in FY2006, $1.05 billion more than FY2005 and $905 million above the administration’s request.
The report states, “The Committee continues to be concerned that the current administration policy relating to human embryonic stem cell research is so narrow that it is stifling the pace of stem cell research. The Committee strongly believes that embryonic stem cell research holds enormous potential for the treatment of cardiovascular disease, Parkinson’s, spinal cord injury and a vast array of other diseases and injuries. After convening 16 in-depth hearings on the subject, the Committee believes that with the proper safeguards in place, this field of investigation ought to be widened. While it originally appeared that 78 embryonic stem cell lines would be available for research under the Federal policy, now, nearly 4 years after the President’s announcement on August 9, 2001, only 22 lines are available to researchers. Moreover, scientists have told the Committee that all available stem cell lines were grown with mouse feeder cells, making their therapeutic use for humans uncertain. The Committee strongly urges the administration to modify the current embryonic stem cell policy so that it provides this area of research the greatest opportunity to lead to the treatments and cures for which we are all hoping.
“The Committee also strongly urges that the NIH explore all avenues of stem cell research including adult stem cells and alternative methods of establishing human embryonic stem cell lines that do not involve the destruction of an embryo.
“The Committee is also deeply concerned with the slow pace of implementation of the current stem cell policy. The Committee was informed by NIH this year that anticipated spending on human embryonic stem cell research is just $24.3 million. The Committee strongly urges the NIH to commit a substantial amount of resources to all methods of human embryonic stem cell research.”
According to the report, “Breast cancer’s toll continues to threaten the lives and the quality of life of thousands of women across all walks of life. In addition to ongoing research activities underway at the National Cancer Institute, the Committee strongly urges the NCI to give increased attention to areas of research that focus on helping women to more fully restore and improve their quality of life after treatment, including further breast cancer research on lymphadema, stress, nutrition, exercise, weight, and the environment.
“The Committee remains concerned about missed opportunities in breast cancer screening, detection, prevention, control, and early diagnosis, including those in mammogram detection, reading and analysis. The Committee strongly urges the NCI to further accelerate advances in breast cancer screening technology and to capitalize on existing [technology] and create new technologies that improve early diagnosis, health outcomes, and survival.”
The report states that “in the last 5 years, approximately 130,000 women in the United States have lost their lives to gynecologic cancer. The Committee commends the NCI for creating a cervical cancer and endometrial cancer SPORE [specialized program of research excellence], bringing the total number of gynecologic cancers SPORES to six, and expects that the NCI will expand the number of centers in the future. Unfortunately, 70 percent of ovarian cancer patients continue to be diagnosed in advanced stages when 5-year survival rates remain less then 25 percent. The Committee encourages continued research by the four ovarian SPORES that will lead to a better understanding of prevention and the development of a screening tool offering women earlier diagnosis when this cancer is more curable. The Committee also supports the expansion of NCI’s collaboration with the NICHD [National Institute of Child Health and Human Development] for faculty development of gynecologic oncologists.”
Congress “remains concerned that mortality rates associated with ovarian cancer have not seen the decreases that other cancer sites have experienced in the past 5 years. As the deadliest of all gynecologic cancers, ovarian cancer takes the lives of three-quarters of all women diagnosed with it within 5 years. Congress commends the National Cancer Institute for its recognition of the importance of studying this deadly women’s disease and appreciates the NCI’s recent investment that is helping to increase the understanding of the unique molecular pathways associated with ovarian cancer through its SPORE program. As such, Congress strongly encourages NCI to sustain and strengthen its commitment to and investment in ovarian cancer and maintain the SPORE initiatives directed toward ovarian cancer in FY2006.”
The committee “is encouraged by NHLBI’s [the National Heart, Lung, and Blood Institute] growing interest in scleroderma, a chronic and progressive disease that predominantly strikes women. Scleroderma is disfiguring and can be life-threatening, affecting multiple systems, including the heart and lungs. The Committee commends the NHLBI for funding the Scleroderma Lung Study, a large multi-center trial whose focus is to find a therapy that may alter the course of the inflammation of the lungs that occurs in approximately 40 percent of those diagnosed with systemic scleroderma. The Committee also commends NHLBI for its commitment to finding a cause and improved therapies for pulmonary arterial hypertension. Pulmonary arterial hypertension occurs in approximately 50 percent of those diagnosed with systemic scleroderma. More research is needed to identify the causes of the complications of scleroderma that include pulmonary fibrosis, pulmonary hypertension, myocardial fibrosis, cardiac arrhythmias, pericarditis, and Raynaud’s Phenomenon.”
The committee encourages the National Institute of Diabetes and Digestive and Kidney Diseases to sponsor a scientific symposium on IC [interstitial cystitis] in 2006…The Committee also urges the NIDDK to hold a separate meeting of leading international opinion leaders involved in IC research to seek clarity on the definition of IC. The absence of a uniform definition which accurately captures the condition and the affected population is negatively affecting patients in terms of diagnosis and treatment as well as researchers in terms of literature review. The Committee was encouraged to learn that NIDDK is launching an IC awareness campaign and hopes that NIDDK will continue to work closely with the IC patient community on both developing the content and executing the campaign.”
The NIDDK “is encouraged to support research targeting new technologies and therapies to increase bone mass and combat osteoporosis through a focus on: 1) genetics, environmental and lifestyle factors, and 2) the effects of disease, in order to address the research questions highlighted in the Surgeon General’s Report on Bone Health and Osteoporosis.”
According to the report, “The Committee remains concerned at the level of funding dedicated toward research into the genetic cause of Rett syndrome, an incurable childhood neurological disorder that is the leading cause of severe neurological impairment in females and the only autism spectrum disorder that is known to have a genetic cause. While once considered rare, increased diagnosis suggests that the prevalence of Rett syndrome may be much greater than the current estimated incidence of 1 in every 10,000 females. The discovery of the specific genetic cause of Rett syndrome could help elucidate a host of other disorders, including autism, schizophrenia, Parkinson’s, anxiety and autonomic nervous system disorders. Accordingly, the Committee strongly urges NIH to dedicate enhanced resources to research on the genetic cause of Rett syndrome. The Committee also encourages NIH to coordinate with private organizations supporting research initiatives in this area in order to ensure the most efficient use of resources.”
The report also states, “Families constitute the key environment for children’s development, and parents are crucial to children’s health and academic outcomes. The Committee encourages research on effective ways to promote and sustain healthy family formations, particularly for low-income families and families of color. Additional research is encouraged on the immediate and long-term impact of chronic and acute exposures to violence on child health and development. The institute is encouraged to include research related to family, community and cultural factors that serve as risk or protective factors and promote resilience from exposure to violence in the home, communities, and schools.”
The committee “is pleased that NICHD has launched a major new initiative to address the public health problem of premature birth, which affects one in eight babies born in this country and is the leading cause of newborn death. NICHD is encouraged to move forward with this initiative, which focuses on genomic and proteomics, in an effort to accelerate knowledge in the mechanisms responsible for premature birth. The Committee intends to closely monitor this effort because it assigns a high priority to promoting the birth of healthy infants.”
The committee “notes that infertility is a disease which affects over 6 million people in the United States and is concerned that the number appears to be growing as age, lifestyle, and environmental factors increasingly impact reproductive health outcomes. The Committee urges that additional research be undertaken to improve reproductive health intervention outcomes, as this research will not only increase the efficacy and effectiveness of reproductive health interventions but will significantly lower costs by reducing the number of interventions necessary to achieve a successful outcome.”
In addition, “The Committee understands that the NICHD is planning to merge its National Cooperative Program for Infertility Research with its Specialized Cooperative Centers Program in Reproduction Research to form the Specialized Cooperative Centers Program in Reproduction and Infertility Research. The Committee understands that the merger of these center programs will allow a greater focus on human infertility research by permitting more efficient translation of knowledge from non-human animal models to humans. This will ensure the rapid development of novel approaches for the diagnosis, treatment and amelioration of such reproductive diseases and disorders as polycystic ovarian syndrome, endometriosis, hypogonadotropic hypogoandism and idiopathic male infertility.”
According to the report, the committee “recognizes the efforts of NICHD, through its maternal fetal medicine units network (MFMU), to achieve a greater understanding of…effective treatments for the prevention of pre-term births, low birthweight infants, and medical complications during pregnancy such as pregnancy-related hypertension and diabetes. The Committee is pleased to learn that NICHD is proceeding with a competitive renewal of the MFMU network in 2006 and encourages a sustained research investment in this program to facilitate resolution of these problems and promote the birth of healthy infants.”
The report notes that “last year, the National Center for Health Statistics reported the first increase in the U.S. infant mortality rate since 1958; 61 percent of this increase is attributed to an increase in the birth of premature and low birthweight babies. An analysis of Agency for Healthcare Research and Quality data conducted by the March of Dimes Perinatal Data Center estimated that the total national hospital bill for premature babies was $15.5 billion in 2002. The financial burden of prematurity is expected to continue to worsen until prevention of preterm births is better understood and clinical interventions are developed. The Committee is pleased that NICHD is one of the sponsors of an Institute of Medicine study now underway to define and address the health-related and economic consequences of premature birth.”
The committee “believes that it is essential to support research on environmental factors that may be related to the etiology of breast cancer. The Committee recognizes the important first step the Institute [National Institute of Environmental Health Sciences] has taken with its recently awarded grants to four research centers to begin to study the prenatal-to-adult environmental exposures that may predispose a woman to breast cancer. However, the recent awards are only a small down payment in terms of dollars, process, and focus on the comprehensive and collaborative research that is needed. The need for more funding and a comprehensive research strategy, as outlined by the Breast Cancer and Environmental Research Act, is clear. The Committee understands that the Institute will establish an advisory board to make recommendations to the Director with regard to the development of the research centers. The Committee is pleased that the board will include representatives from the breast cancer community who have had the disease. The Committee asks that the director provide an update in the fiscal year 2007 appropriations justification on the progress of the centers.”
The committee “encourages studies on quality of life in patients with osteoporosis before and after treatment, and strategies for optimizing treatment of frail nursing home patients at high risk of osteoporotic fracture. The Committee also encourages NIA [the National Institute on Aging] to expand research on the role of environmental and lifestyle factors associated with osteoporosis and Paget’s disease and to work in conjunction with NIAMS [the National Institute of Arthritis and Musculoskeletal and Skin Diseases] on models for Paget’s disease.”
In addition, the committee “commends NIA’s systematic attempts to build a research agenda to help understand racial and ethnic health disparities in later life. NIA is encouraged to build on its behavioral genetics research program in order to assess genetic and environmental factors in racial and ethnic differences simultaneously, in studies that permit identification of main effects and of interactions.”
According to the report, “Psoriasis is associated with elevated rates of mental disability, depression and suicidal ideation. The Committee urges NIMH [the National Institute of Mental Health] to conduct research into the mental health aspects of psoriasis, especially as it relates to quality of life and burden of the disease. Furthermore, a 2005 study of 44 autoimmune diseases found that only psoriasis, when present in women around the time of pregnancy, was significantly associated with autism, doubling the risk of autism spectrum disorder in their children. The Committee urges NIMH to support further study of the link between psoriasis and autism.”
The report states that the Office of Research on Women’s Health (ORWH) “works in collaboration with the Institutes and Centers of NIH to promote and foster efforts to address gaps in knowledge related to women’s health through the enhancement and expansion of funded research and/or ensuring the inclusion of women in clinical research funded by NIH, including the development of a computerized tracking system and the implementation of guidelines on such inclusion. This office also promotes the number of women in biomedical science careers.”
The committee “is pleased with the increased focus on irritable bowel syndrome (IBS) at the ORWH. It is estimated that between 25 and 45 million Americans, disproportionately women, suffer from IBS.”
The report notes that “As the second leading cause of death among women worldwide, stroke is a major health problem. Stroke kills more than twice as many women as do breast cancer and AIDS combined. Acute care of women stroke victims is often delayed, and 61 percent of all stroke-related deaths occur in women. Recognizing that women are the single largest group at risk for death from stroke, the Committee believes that special attention should be focused on better understanding the gender-related differences in stroke. Studies suggest that significant gender differences occur in the evaluation and treatment of stroke patients, with women often receiving fewer diagnostic tests and intervention procedures. Increased research is needed to understand these differences and provide a means to optimize stroke care for all patients. Some aspects of the disease unique to women include strokes related to pregnancy and the use of oral contraceptives; stroke in younger women requires increased attention. Stroke is additionally a leading cause of serious disability among women and may contribute to late-life cognitive decline. The Committee supports the funding of new and continuing NIH studies that investigate the impact of postmenopausal hormone replacement therapy on stroke risk. Continued support of clinical and basic research on hormone physiology in women is necessary to understanding the impact of hormones on women’s vascular systems. The Committee urges NIH to increase research in stroke among women of all ages, with specific attention to gender-related differences in stroke risk, and to stroke prevention interventions, acute stroke management, post-stroke recovery, long-term outcomes, and quality of care. The Committee further urges NIH to increase research into new therapies for stroke in women as well as into ways of enhancing the vascular health of all Americans.”
The report also states, “Since fiscal year 1998, the Committee has highlighted the need for research on the prevalence, causes and treatment of vulvodynia, a painful and often debilitating disorder of the female reproductive system. The Committee is pleased that some progress has been made since that time. For example, the NICHD has supported a major study of the prevalence of this disorder. The published results of this study found that as many as 6 million women suffer from vulvodynia, making it one of the most prevalent chronic pain conditions affecting women. The ORWH was crucial in supporting an important 2003 research conference on vulvodynia. These efforts have both clearly demonstrated the need for substantial additional research and served to heighten the research community’s level of interest in studying vulvodynia. The Committee calls upon the Director to build upon these initial successes by coordinating through the ORWH an expanded and collaborative extramural and intramural research effort into the causes of and treatments for vulvodynia. This expanded effort should involve ORWH, NICHD, NINDS [the National Institute of Neurological Disorders and Stroke] and other relevant ICs [NIH institutes and centers] as well as the NIH Pain Consortium. In addition, the Committee notes that as many as 40 percent of women with vulvodynia remain undiagnosed after visiting three or more physicians. To address this shortcoming, the Committee urges that NIH include information about vulvodynia on its website and that it work with the National Vulvodynia Association, the American College of Obstetricians and Gynecologists and other relevant groups to implement a national education program for primary care health professionals, patients and the general public on vulvodynia’s symptoms, diagnosis and treatment options. Finally, the Committee encourages the Director to work with the Center for Scientific Review and ICs to ensure that experts in vulvodynia and related chronic pain and female reproductive system conditions are adequately represented on peer review panels.”
With regard to HIV/AIDS, the report states that “given current scientific advancements, an effective microbicide could be developed by the end of the decade, and once available, could well change the course of the epidemic. According to NIH, ‘the U.S. Government is firmly committed to accelerating the development of safe and effective microbicides to prevent HIV’ because microbicides may provide ‘one of the most promising prevention interventions that could be inexpensive, readily available, and widely acceptable’ (U.S. Government Strategic Plan for Microbicides). Despite these statements, NIH continues to spend barely 2 percent of its HIV/AIDS research budget on microbicides. The Committee strongly urges greater funding for microbicide research and development at NIH. In addition, this Committee has long advocated that NIH establish a dedicated microbicide unit with clearly identified leadership to accelerate and coordinate federally supported microbicide research, and is concerned that no significant progress has been made towards this goal. Greater leadership and coordination on this issue is especially critical given that consideration is being given to the possibility of a microbicide-specific clinical trial network. If this evolves, the notion of a dedicated microbicide unit at the NIH would be essential.
“There is an urgent need to expand the development pipeline with more microbicide candidate products, particularly those that target HIV in new ways. In addition to candidates that may arise from basic research efforts, the best possibilities may be found within pharmaceutical companies where there are dozens of potential compounds already developed as therapeutics that could move into clinical development as microbicides if made available. As outlined in the NIH Roadmap, NIH has mechanisms in place to encourage partnerships among researchers in academia, government and the private sector. The Committee strongly urges the leadership at NIH to support the microbicide field by encouraging the pharmaceutical industry to allow its drug candidates to be developed as microbicides. In the past year, the International Partnership for Microbicides has entered into innovative agreements with leading pharmaceutical companies to jointly test and develop leading AIDS drugs as microbicides. More partnerships like these between the pharmaceutical industry and the non-profit community will be critical, and should receive the active support of NIH leadership.”
According to the report, “The Committee is pleased that the Surgeon General has submitted the report on bone health requested in the FY2002 Appropriations bill. The Surgeon General calls for a national action plan to achieve improved bone health. To this end, the Committee encourages the NIH to establish a ‘Bone Health Research Blueprint’ to achieve the Surgeon General’s objectives through enhanced cooperation between and among the NIH research institutes. The Blueprint should place particular emphasis on osteoporosis, osteogenesis imperfecta, Paget’s disease, other metabolic bone diseases and rare bone disorders such as osteopetrosis. The Committee requests a report on the status of the Bone Health Blueprint by May 1, 2006.”
The committee “remains very interested in efforts to find a cure and treatments for LAM [lymphangioleiomyomatosis], a progressive and fatal lung disease that strikes women, usually in their childbearing years. Currently, there are no effective treatments. The Committee understands that recent scientific findings have presented new treatment approaches for clinical testing, and that experimental trials with the drug sirolimus have begun. The Committee urges the NHLBI, as well as the NCI, the Office of Rare Diseases, and the NINDS to fund clinical treatment trials through both intramural and extramural means and to use all available mechanisms as appropriate, including support of state-of-the-science symposia, request for applications, and facilitating access to human tissues to stimulate a broad range of clinical and basic LAM research.”
The committee also “is concerned that the NIH does not have trans-NIH information regarding the amount of infertility and reproductive health research that is conducted in many Institutes including NICHD, NCI, NIDDK, NIAID [the National Institute of Allergy and Infectious Diseases], and NIEHS. The Committee is concerned that until NIH has accurate trans-NIH information, it is not possible to lead and coordinate this area of research to help ensure scientific and research progress. The Committee therefore urges that the Office of the Director ensure that such information is available in order to permit a vigorous scientific leadership with regard to this category of diseases that has devastating physical, social, financial and psychological consequences.”
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA would receive level funding of $3.39 billion in FY2006, $49 million more than the budget request.
Center for Mental Health Services: H.R. 3010 would provide $901.3 million in FY2006 for mental health services, a $17,000 increase above FY2005 and $64.1 million more than the administration’s request.
Center for Substance Abuse Treatment: The measure would provide $2.18 billion for substance abuse treatment programs in FY2006. This allocation is $10.3 million less than FY2005 and $35 million below the administration’s request. The total would include $11 million for treatment programs for pregnant, postpartum, and residential women and children, an increase of $1.08 million over FY2005.
The report states that the committee “continues to be concerned about the incidence of drug addiction among pregnant and parenting women. The unavailability of family-based treatment is manifested in the overrepresentation of substance-abusing mothers in the child welfare system. Up to 80 percent of the families who come to the attention of child welfare agencies are substance abusing. The absence of treatment opportunities for families has also extended to the criminal justice system. Nearly 70 percent of the women behind bars are suffering from untreated addiction. Most of these women offenders are mothers: approximately 65 percent of women in State prisons, and 59 percent of women in Federal prisons have young children.
“SAMHSA’s evaluation of both the Residential Women and Children (RWC) and Pregnant and Postpartum Women (PPW) programs showed significantly reduced alcohol and drug use, as well as decreased criminal behavior. Rates of premature delivery, low birthweight, and infant mortality were improved for participating women. In addition, treatment costs were offset three to four times by savings from reduced costs of crime, foster care, Temporary Assistance to Needy Families (TANF), and adverse birth outcomes. The Committee believes that increased capacity for family-based treatment programs is imperative.”
Agency for Healthcare Research and Quality (AHRQ): The bill would provide $323.7 million for AHRQ in FY2006, $5 million more than FY2005 and the budget request. According to the report, “The Committee remains disturbed by the March 2002 Institute of Medicine report regarding the disparities of medical care delivery to minorities. The Committee encourages AHRQ to carefully evaluate the analysis, findings, and recommendations of this study in order to pursue creative ways to improve health care delivery for all minority populations, including African-Americans, those of Hispanic and Asian origin, Native Americans, Alaskans and Native Hawaiians.”
Administration for Children and Families
Child Care and Development Block Grant (CCDBG): Under the bill, the CCDBG would be level-funded at $2.08 billion in FY2006 as requested by President Bush.
Social Services Block Grant: As requested by the administration, the Social Services Block Grant also would be level-funded at $1.7 billion in FY2006.
International Trafficking: Under the Refugee and Entrant assistance account, a program to aid victims of trafficking would be level-funded at $9.92 million in FY2006 as requested by the administration.
Unaccompanied Minors: The measure would provide $78.1 million for the unaccompanied minors program, $24.3 million more than FY2005 and $15 million above the budget request. The report states that the committee “is deeply concerned that accompanied children, even as young as nursing infants, who are apprehended by the Department of Homeland Security [DHS] are being separated from their parents and being placed in the unaccompanied alien children program while their parents are held in separate adult facilities. The Committee is pleased that ORR [the Office of Refugee Resettlement] has taken the initiative to work with DHS to correct this problem and anticipates a prompt resolution.”
Child and Family Services Programs: Head Start would receive a $31.2 million increase over FY2005, bringing the total to $6.87 billion in FY2005. This amount is $30.3 million less than the administration’s request.
Consolidated runaway and homeless youth programs would receive $88.73 million in FY2006, $4 million more than FY2005 and equal to the administration’s request. The bill does not include the administration’s request of $10 million for maternity group homes.
According to the report, “It is the Committee’s continued expectation that current transitional living program grantees will continue to provide transitional living opportunities and supports to pregnant and parenting homeless youth, as is their current practice. To further ensure that pregnant and parenting homeless youth are able to access transitional living opportunities and supports in their communities, the Committee encourages the Secretary, acting through the network of federally funded runaway and homeless youth training and technical assistance providers, to offer guidance to grantees and others on the programmatic modifications required to address the unique needs of pregnant and parenting youth and on the various sources of funding available for residential services to this population.”
As requested by President Bush, H.R. 3010 would provide level funding of $42.9 million in FY2006 for child abuse and neglect treatment and prevention activities.
Programs to increase abandoned infant assistance would be level-funded at $12 million in FY2006 as requested by the administration.
The bill would provide level funding of $289.65 million for child welfare services in FY2006, equal to the administration’s request.
Adoption: The measure would provide level funding of $27.12 million for adoption opportunities and $12.8 million for adoption awareness programs. Both funding levels are equal to the administration’s request. In addition, the bill would provide $22.8 million for adoption incentives, $9 million less than FY2005 and the budget request. The report explains that “fewer resources were needed in FY2005 to make bonus payments to States for the full amount for which they were eligible under this program, so the reduction recommended by the Committee will not have any impact on this program.”
Abstinence-only Education: H.R. 3010 would provide $105.5 million for the abstinence education program in FY2006, $1.8 million more than FY2005, but $33.5 million less than the administration’s request. Of the total, up to $10 million could be made available for a national abstinence media campaign.
Violence Against Women Act (VAWA): The National Domestic Violence Hotline would receive $3 million in FY2006, $224,000 less than FY2005 and equal to the administration’s request. In addition, battered women’s shelters would receive $126 million as requested by the administration. This amount is $361,000 more than FY2005.
Mentoring Children of Prisoners: As requested by the administration, the Mentoring Children of Prisoners program would receive $50 million in FY2006, $395,000 more than FY2005.
Promoting Safe and Stable Families: H.R. 3010 would provide $395 million for the Promoting Safe and Stable Families program in FY2006, $8.6 million less than FY2005 and $15 million below the budget request.
Administration on Aging: The Administration on Aging’s National Family Caregiver Support program would receive $160.7 million in FY2006, $5 million more than FY2005 and the administration’s request.
Office of the Secretary
Public Health Service’s Office on Women’s Health: As requested by President Bush, the Office on Women’s Health would receive $28.72 million in FY2006, $103,000 less than FY2005. According to the report “The PHS Office on Women’s Health (OWH) develops, stimulates, and coordinates women’s health research, health care services, and public and health professional education and training across HHS agencies. It advances important crosscutting initiatives and develops public-private partnerships, providing leadership and policy direction, and initiating and synthesizing program activities to redress the disparities in women’s health.
“The Committee is impressed with the efforts of the OWH to address the growing problem of negative body image and eating disorders through the Bodywise Project. This has been a widely successful project and the Committee urges the Secretary to continue this educational initiative and broaden the efforts by collaborating with the Department of Education to disperse the educational materials resulting from Bodywise and expand the educational project to target all levels of education from elementary to high school.
“The Committee understands that lupus is a serious, complex, debilitating chronic autoimmune disease that can cause inflammation and tissue damage to virtually any organ system in the body and impacts an estimated 1.5 and 2 million individuals. The Committee is aware that public and professional recognition and understanding of lupus is extremely low, contributing to misdiagnoses or late diagnoses that can result in disability or death. The Committee strongly urges OWH to develop and implement a sustained lupus awareness and education campaign aimed at reaching health care professionals and the general public, with an emphasis on reaching women at greatest risk for developing lupus.
“The Committee has great interest in women’s health and wants to encourage further health research, education, and services for women. The Committee also recognizes that the Offices of Women’s Health within the Department, the Food and Drug Administration, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Agency for Healthcare Research and Quality provide critical services in support of these needs. The Committee strongly encourages the Secretary to see that these offices continue to receive sufficient funding to assure their ability to continue to meet their missions.”
Public Health Service’s Office of Minority Health: The measure would provide $51 million for the Office of Minority Health, $462,000 above the FY2005 level and $3.7 million more than the amount requested by the administration.
Minority HIV/AIDS: As requested by the administration, minority HIV/AIDS prevention and treatment activities would be level-funded at $52.4 million in FY2006.
Adolescent Family Life: The Adolescent Family Life program would receive $30.74 million in FY2006, $158,000 less than FY2005 and equal to the administration’s request.
Afghanistan: Health care assistance for Afghanistan would be level-funded at $5.95 million in FY2006, equal to the budget request. The report states that the funding “will be used in partnership with the Department of Defense for medical training activities at the Rabina Balkhi Women’s Hospital in Kabul, and for support of maternal and child health throughout Afghanistan.”
Embryo Adoption Awareness Campaign: Under the bill, $2 million would be provided for the embryo adoption awareness campaign, approximately $1 million more than FY2005 and the budget request.
Department of Education
No Child Left Behind: Grants to local educational agencies under the No Child Left Behind Act (P.L. 107-110) would receive $12.84 billion in FY2006, $100 million more than FY2005, but $502.74 million less than the administration’s request.
William F. Goodling Even Start Family Literacy Program: H.R. 3010 would provide level funding of $225.1 million for the Even Start program in FY2006. Under the administration’s budget request, the program would not have been funded.
Reading First and Early Reading First: The measure would level-fund the Reading First program at $1.04 billion in FY2006 as requested by the administration. In addition, the Early Reading First program would be level-funded at $104.2 million, also equal to the administration’s request.
High School Intervention: No funding would be provided for a proposed high school intervention initiative. The administration requested $1.24 billion for the program in FY2006. According to the report, “The Committee is supportive of the administration’s goal of preparing all students for postsecondary education and the high-technology economy. However, the Committee notes that this initiative has not been acted on by the appropriate authorizing committees of Congress and would have been funded by the elimination of GEAR-UP, certain TRIO activities and the Perkins Vocational and Technical Education program, each of which have been restored to their FY2005 funding levels.”
Teacher Quality: Under the bill, level funding of $2.92 billion would be provided for teacher professional development programs in FY2006 as requested by the administration. The bill would provide level funding of $44.93 million for the Transition to Teaching program to assist eligible members of the armed forces and mid-career professionals to obtain certification as teachers. This amount is equal to the administration’s request. In addition, the Math and Science Partnerships would be level-funded at $178.6 million in FY2006, $90.4 million less than the budget request.
21st Century Community Learning Centers: As requested by the administration, H.R. 3010 would provide level funding of $991.1 million in FY2006 for 21st Century Community Learning Centers.
Individuals with Disabilities Education Act (IDEA): Total spending for special education would be $11.8 billion in FY2006, a $100 million increase over FY2005, but $300 million less than the administration’s request.
Education for Homeless Children and Youth: Under the bill, level funding of $62.5 million would be provided for education for homeless children and youth, equal to the administration’s request.
Women’s Educational Equity: H.R. 3010 would provide $3 million for the women’s educational equity program, an increase of $44,000 over FY2005. Under the administration’s budget request, the program would not have been funded.
Carol M. White Physical Education for Progress Program: The bill would include $74 million for the Carol M. White Physical Education for Progress Program, $590,000 more than FY2005 and $19 million above the budget request. According to the report, “obesity has increased by 100 percent among children and adolescents. The National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development found that third grade children in the study received an average of 25 minutes per week in school of moderate to vigorous activity, while experts in the United States have recommended that young people should participate in physical activity of at least moderate intensity for 30 to 60 minutes each day. While not nationally represented, this information is consistent with the 2002 Youth Risk Behavior Surveillance System which found that only roughly one-half of all students report attending a physical education class one or more times a week. The Committee believes Federal funding is critical to the effort to reducing these trends and helping improve the health of the American public.”
Vocational Education: The measure would provide $1.31 billion for vocational education in FY2006, $14.21 million less than FY2005. Under the administration’s budget request, the program would not have been funded.
Adult Education: In FY2006, funding for adult education would be level-funded at $585.41 million, a $369.67 million increase over the administration’s request.
Pell Grants: The bill would provide $13.18 billion for Pell Grants in FY2006, $812 million more than FY2005, but $20 million below the budget request. The maximum Pell Grant would be level-funded at $4,050, $100 less than the amount requested by President Bush.
Minority Science and Engineering Improvement: As requested by the administration, the Minority Science and Engineering Improvement Program would be level-funded at $8.82 million in FY2006.
