Senate Report Language
Last week, the Senate Appropriations Committee approved, 26-3, the FY2004 Labor, Health and Human Services, and Education appropriations bill (S. 1356) (see The Source, 6/27/03). The measure would allocate $137.6 billion in FY2004, an increase of close to $5 billion over FY2003, but $389 million less than the President’s request and $445 million less than the bill approved by the House Appropriations Committee the same day. The Senate Appropriations Committee report accompanying the bill 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
The Department of Labor’s Women’s Bureau would receive $8.926 million in FY2004, $682,000 less than FY2003 and $300,000 more than the President’s request. 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.
Dislocated workers assistance would receive $1.4 billion, maintaining the FY2003 funding level and providing $48.7 million over the President’s budget request.
S. 1356 would provide $108 million for activities designed to end abusive child labor, an increase of $95.7 million above the President’s request. The committee notes that, “over the past decade, the United States has been the leader in helping to reduce abusive and exploitative child labor around the world. ILAB [International Labor Affairs Bureau] projects funded through the ILO [International Labor Organization] have given hundreds of thousands of children the opportunity to attend school rather than engage in hazardous work.” For this reason, the committee recommendation includes $108 million for the ILAB. Of this amount, $82 million would be provided for international child labor prevention activities, including $45 million for the U.S. contribution to sustain and extend to more “countries in waiting” the successful efforts of the ILO’s International Program for the Elimination of Child Labor (IPEC). Also within ILAB funds, $37 million would be provided for a Department program to ensure access to 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.
As requested by the President, the bill would not provide any earmarked funds for the Women in Apprenticeship and Nontraditional Occupations program. This program was funded at $993,000 in FY2003. The committee states that “this activity is continued with technical assistance funding under the Workforce Investment Act, to assist employers and unions in training, placing, and retraining women in nontraditional jobs and occupations.”
Department of Health and Human Services
Obesity Prevention and Nutrition Initiative: In the report, the committee notes that “obesity has become our Nation’s fastest rising public health threat with the disease affecting nearly one-third of the adult American population” and “obesity is more detrimental to health than smoking and alcohol abuse and leads to increased risk for chronic and life-threatening diseases such as heart disease, stroke, cancer and diabetes.” The disease affects many populations, and the committee further states “the prevalence of obesity in children and young adults has quadrupled over the past 25 years” and “problems with obesity and diabetes also disproportionately affect minority communities.”
The committee strongly believes “a commitment to improving physical activity and nutrition is imperative if we are to reduce chronic disease, premature deaths and related health care costs.” For this reason, S. 1356 would provide a total of $944 million for programs designed to increase physical activity, healthy lifestyles, and nutrition, an increase of $34 million over FY2003. The committee also notes that “obesity rates were significantly reduced among girls in grades 6-8 who participated in a school-based intervention program.” For this reason, $63 million would be provided for CDC’s coordinated school health programs that address risk behaviors such as tobacco use, unhealthy diets, and physical inactivity. This amount is an increase of $5.2 million over last year’s funding level.
Report language also encourages the Head Start Bureau to work with the National Head Start Association to “devise a plan for implementing a locally-determined but coordinated effort to achieve the goals of a stronger, more effective nutritional and physical activity component within Head Start programs.”
In addition, the bill would provide $70 million for the Carol M. White Physical Education for Progress (PEP) program. This program provides grants to local school districts and community-based organizations to initiate, expand, and improve physical education programs for students in kindergarten through 12th grade. Under the President’s request, this program would not have been funded. $59.7 million was provided for PEP in FY2003.
Preventing and Reversing Heart Disease Initiative: The report states that “nearly 63 million Americans, young and old, live with the effects of cardiovascular disease” and “the economic losses are more than any other disease costing society over $330 billion annually in medical costs and lost productivity.” To address this issue, S. 1356 would include $5.758 billion in addition to the amounts provided as part of the physical activity and nutrition initiative. The committee also encourages the Departments of Health and Human Services and Education to “coordinate the above programs and activities to address both initiatives.”
Health Resources and Services Administration (HRSA): Under the bill, HRSA would receive $5.906 billion, a $549 million decrease below the FY2003 level and $241 million above the President’s request. Community Health Centers would receive $1.627 billion in FY2004, a $122.3 million increase over FY2003.
$731.5 million would be provided for the Maternal and Child Health Block Grant, a $1.6 million increase above the FY2003 level, but $19.3 million less than the level requested by the President. Of this amount, an additional $1.6 million would be provided for mental health programs and activities. 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.”
The Healthy Start infant mortality initiative would be level-funded at $98 million, $383,000 less than the President’s request. The measure also would maintain current funding of $9.935 million for universal newborn hearing screening. Under the President’s request, this program would not have been funded, but instead would have been consolidated into the Maternal and Child Health Block Grant program.
Ryan White: The Ryan White Care Act would receive a $23.6 million increase over the FY2003 funding level to $2 billion, slightly more than the President’s budget request. Of this amount, $73.551 million would be provided to help children, youth, women, and families infected with, or affected by, HIV/AIDS.
Family Planning: Title X, the nation’s family planning program, would receive $283 million, $10 million more than FY2003 and $18.2 million more than the President’s request.
Report language states that the increase for clinics receiving Title X funds is necessary to “address increasing financial pressures in their effort to provide high-quality, subsidized family planning services and preventive health care to low-income and uninsured women. These pressures include rising medical costs of newer and longer lasting contraceptive methods, pharmaceuticals, and screening and diagnostic technologies.” The committee recognizes that, “due to financial pressures, it will be difficult for Title X clinics to serve the current number of patients without a significant funding increase” and “the increased availability of new contraceptive methods and screening technologies will improve women’s health and result in a decrease in unintended pregnancies nationwide.”
Abstinence-only Education: As requested by the President, the bill would provide $73 million for the abstinence education program in the Maternal and Child Health Block Grant, an $18.4 million increase over FY2003. The committee notes that “these programs are unique in that their entire focus is to educate young people and create an environment within communities that support teen decisions that postpone sexual activity until marriage.”
Centers for Disease Control and Prevention (CDC): The measure would allocate $4.4 billion in FY2004, $147.9 million above the FY2003 level and $83 million more than the level requested by the President. Of this total, $110 million would be provided for the prevention of birth defects, developmental disabilities, and disability and health activities. That would represent a $12 million increase over the FY2003 level and a $23 million increase over the President’s request. The total includes $1.2 million above the budget request for activities related to Fetal Alcohol Syndrome (FAS) and additional funding for the Folic Acid Education Campaign to Prevent Birth Defects.
Chronic disease prevention and health promotion would receive $801 million, a $12 million increase over FY2003, but $33 million below the President’s request. Within that amount, $45.9 million would be provided for heart disease and stroke, $316.6 million would be provided for cancer prevention and control, $53.9 million for safe motherhood, and $100.4 million for tobacco prevention initiatives. Of the amount provided for cancer prevention and control, $210 million would be provided for breast and cervical cancer and $4.9 million for ovarian cancer prevention.
No earmarked funds would be provided for the WISEWOMAN program, operated through the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP), but the committee notes that “the program has been effective in retaining participants and providing needed services.” The WISEWOMAN program builds on the NBCCEDP and screens women for heart disease, stroke and other cardiovascular risk factors. In FY2003, Congress appropriated $12.5 million for the WISEWOMAN program.
The committee is concerned that “25 million Americans suffer from urinary incontinence (UI)” and “1 in 4 women ages 30 to 59 have experienced an episode of UI.” For this reason, the committee urges the CDC to “formulate and implement an action plan for health care professional education in order to ensure those who suffer from UI will seek and receive treatment leading to healthier lives.”
The bill would provide $1.239 billion for HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis prevention at the CDC, an increase of $53 million over last year, but $50 million less than the President’s request. Of that amount, $232 million would be provided for global HIV/AIDS programs, $49 million more than FY2003, but $62 million less than the level requested by the President. In addition, $90 million would be provided for the International Mother and Child HIV Prevention Initiative.
The committee notes that “chlamydia is the most frequently reported disease in the United States” and “the number one cause of infertility in the Nation.” Although the CDC’s Infertility Prevention Program has reduced chlamydia rates by 66 percent and decreased treatment costs by 80 percent, the committee is concerned that “this prevention program still offers very limited coverage to women residing in more than half the States, and provides only minimal screening services to men.” In addition, the committee is concerned that syphilis is “one of the most glaring examples of racial disparities in health.” For these reasons, the committee urges CDC to “address these inequities by expanding the infertility screening program and providing support for State efforts to control syphilis” and “expand the infertility prevention project to provide screening and testing technologies for STDs and HIV, as well as other related women’s health services that are provided by recipients of these funds.”
National Institutes of Health (NIH): The NIH would receive $27.9 billion in FY2004, a $1 billion increase over FY2003 and $318.6 million more than the President’s request.
The committee is strongly supportive of efforts to study and educate the public and health professionals about the impact of exposure to the synthetic hormone diethylstilbestrol (DES). For this reason, the committee expects the National Cancer Institute (NCI) to “continue its support of research in this area, and to continue to consult with organizations representing individuals impacted by DES as they carry out DES research and education efforts.”
Report language also urges the NCI to “develop prophylactic and therapeutic human papilloma virus (HPV) vaccines to prevent cervical cancer and strengthen research in the biology of endometrial cancer in order to improve prevention and treatment, thus sparing the need to undergo hysterectomy and other cancer therapy.” In addition, the committee believes that “the NCI should partner with the National Institute of Child Health and Development (NICHD) Reproductive Sciences Program to investigate gynecological cancer.”
The committee encourages the National Heart, Lung, and Blood Institute (NHLBI) to “undertake research initiatives for the study of cause and treatment options for scleroderma, a chronic and progressive disease that predominately strikes women.”
The report addresses the field of salivary diagnostics and notes the potential to develop a diagnostic test for early detection of breast cancer. The committee recognizes that “considerable clinical research must be done before a test can be approved for use by health care professionals so that the women of this country will have a simple non-invasive, inexpensive procedure to alert them to the risk of breast cancer” and urges the Institute of Dental and Craniofacial Research (NIDCR) to “advance the field of salivary diagnostics.”
Report language commends the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for “its recent investment in IC-specific [interstitial cystitis] basic science research and continuation of the IC Clinical Trails Group,” but is concerned “about the current direction of the epidemiology studies on pelvic pain and bladder origin and IC currently being funded by the NIDDK.” For this reason, the committee urges the NIDDK to “pursue additional studies on bladder epithelium, bladder afferent nerve cells, and urinary markers of IC patients” and “work with the Interstitial Cystitis Association to undertake a national IC awareness campaign aimed at reducing the delay in diagnosing IC, which currently takes an average of 5 to 7 years.” In addition, the committee notes that “bladder diseases, such as interstitial cystitis, urinary tract infections, and urinary incontinence, disproportionately affect women” and urges the NIDDK to “develop a comprehensive program to address these and other urological needs of women.”
The committee “continues to place high priority on research to combat infertility and speed the development of improved contraceptives” and urges the NICHD to “continue aggressive activities in this area, including grants for individual researchers and for infertility and contraceptive research centers.” In addition, the committee recognizes the “outstanding contributions of the Maternal-Fetal Medicine Network (MFMU) in addressing clinical questions related to the care and treatment of high risk and complicated pregnancies” and urges NICHD to “continue to address these important research questions, with an emphasis on issues pertaining to pre-term births and low birth weight deliveries.” The committee also strongly urges NICHD to “allocate more funds to reveal the underlying causes of pre-term delivery and most importantly to identify prevention strategies.” Finally, the committee expects NICHD to “provide a significant increase in funding for vulvodynia,” a disorder of the female reproductive system.
Report language encourages the National Institute of Environmental Health Sciences (NIEHS) to “consider establishing centers to conduct multi-disciplinary and multi-institution research on environmental factors that may be related to breast cancer and to develop a national strategy to address this issue.”
The committee recognizes that “little is known about the pathophysiology of osteoporosis and Paget’s disease and the role of environmental and lifestyle factors associated with these diseases, particularly in men and women of diverse races and ethnicities” and urges the National Institute on Aging to “expand research in all of these areas.”
The committee urges the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) to “explore new avenues for cell- and gene-based therapies for the treatment of bone and cartilage diseases, such as osteoporosis, Paget’s disease, and osteogenesis imperfecta.” The committee also notes that “lupus is a widespread, debilitating autoimmune disease that affects up to 2 million Americans, most of whom are women in their late teens to early 40s” and urges NIAMS to “provide the highest possible funding level for lupus research and explore all possible scientific opportunities for prevention, treatment and cure of this devastating disease.” In addition, the committee urges NIAMS to collaborate with other Institutes to “generate additional research opportunities for scleroderma.”
The committee commends the National Institute of Nursing Research (NINR) and states that “NINR’s focus on early identification of risk factors and chronic diseases during pregnancy and on health promotion for pregnant minority women will be important to lower the unacceptably high number of low birth weight babies in this country.”
The report commends the NIH “for increasing the funds available for microbicide research” and urges the National Institute of Allergy and Infectious Diseases (NIAID) to “consider establishing a microbicides branch dedicated to research and development.”
The committee believes that “embryonic stem cell research offers enormous promise for more than 100 million Americans who suffer from chronic diseases” and urges the administration to “expand its embryonic stem cell research policy to allow additional stem cell lines to be available for research.”
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA would receive $3.2 billion in FY2004. This allocation is $62.8 million more than the FY2003 level but $200 million less than the President’s request.
Center for Mental Health Services: The committee recommends $855 million for mental health services, $700,000 less than last year’s level and $21 million more than the President’s request.
The Mental Health Performance Partnership Block Grant would be level-funded at $437 million, $4 million more than the President’s request. States use these funds to “support the development and implementation of innovative community-based services and maintain continuity of community programs.”
Center for Substance Abuse Treatment: The committee recommends $2.1 billion for substance abuse treatment programs. This allocation is $30 million more than last year’s level and $200 million less than the President’s request. Included in the report is language indicating that the committee is “concerned about the incidence of drug addiction among pregnant and parenting women” and therefore recommends $10 million for treatment programs for pregnant, postpartum, and residential women and their children. Of that amount, no less than the FY2003 funding level would be used for the Residential Treatment Program for Pregnant and Postpartum Women.
In addition, the Substance Abuse Prevention and Treatment Block Grant would receive $1.8 billion, a $100 million increase over last year and the President’s request. The Center for Substance Abuse Prevention would receive $194 million in FY2004. This level is $3 million less than last year’s allocation and $46 million more than the President’s request.
Agency for Healthcare Research and Quality (AHRQ): The bill would maintain the current funding level of $303.6 million for AHRQ in FY2004, $24.6 million more than the President’s request.
Administration for Children and Families
Child Care and Development Block Grant (CCDBG): The bill would grant the President’s request and provide $2.1 billion to CCDBG in FY2004, an increase of $14 million over FY2003.
Child Support Enforcement: S. 1356 would allocate $3.2 billion in FY2004 for payments to states for child support enforcement and family support programs. This amount is $500 million more than FY2003 and $47 million more than the President’s request.
Social Services Block Grant: The Social Services Block Grant would be level-funded at $1.7 billion as requested by the President. The committee report includes language to “allow states to transfer up to 10 percent of their annual allocations under the Temporary Assistance for Needy Families (TANF) program to the Social Services Block Grant program.” The committee also “recognizes that the block grant is a vital source of support for many vulnerable children.”
International Trafficking: Under the Refugee and Entrant Assistance account, a program to aid victims of trafficking would be level-funded at $9.935 million, $65,000 less than the President’s request.
Child and Family Services Programs: As requested by the President, Head Start would receive a $148 million increase over FY2003, bringing the total to $6.8 billion. This funding level would allow Head Start to maintain current service levels, while ensuring that quality improvements and training elements are fully implemented.
The committee recommendation does not include the $10 million that the President requested for the Maternity Group Homes program. Rather, the committee has deferred action on this program until language authorizing the program has been enacted.
The committee also recommends that $48.1 million be allocated for child abuse and neglect treatment and prevention activities. This amount is $7.6 million below FY2003 and $200,000 below the President’ request.
Programs to increase abandoned infant assistance would be level-funded at $12.12 million, $40,000 more than the President’s request.
Child welfare services would be level-funded at $290 million, $1 million less than the amount requested by the President.
The committee recommendation does not include the $20 million that the President requested for promoting responsible fatherhood and healthy marriage. Legislation has not been enacted to create this new program.
Adoption: The bill would level-fund adoption opportunities at $27.227 million, $116,000 less than the President’s request. The measure also would level-fund adoption incentives at $42.7 million and level-fund adoption awareness programs at $12.822 million, $84,000 less than the level requested by the President.
Mentoring Children of Prisoners: The bill would level-fund the Mentoring Children of Prisoners program at $9.935 million, more than $40 million less than the President’s request. This program is geared towards helping children while their parents are imprisoned and increasing “the chances that the family will come together successfully when the parent is released.”
Promoting Safe and Stable Families: The bill would level-fund the Promoting Safe and Stable Families program at $404.3 million, $100.6 million less than the President’s request. Funding for this program helps to support family preservation services, time-limited family reunification services, community-based family support services, and adoption promotion and support services.
Violence Against Women Act (VAWA): S. 1356 would fund several VAWA programs. The National Domestic Violence Hotline would receive $3 million as requested by the President. Last year, Congress allocated $2.562 million for the hotline. In addition, battered women’s shelters would be level-funded at $126.4 million, $2 million more than the President’s request.
Administration on Aging National Family Caregiver Support: The bill would level-fund the National Family Caregiver Support program at $149 million, an increase of $7.5 million above the President’s request.
Embryo Adoption Awareness: The committee report points to a study that shows that “there are nearly 400,000 frozen embryos in fertility clinics in the United States” and believes that, if educated, “many more couples may choose to adopt such embryos.” For this reason, the committee has provided $1 million for an embryo adoption awareness campaign.
Mammography: The committee report includes language urging the Department to “enter into an agreement with the Institute of Medicine to conduct a study and make recommendations on ways to improve the Mammography Quality Standards Act, mammography quality and access, and physicians’ interpretations of mammograms.”
Public Health Service’s Office on Women’s Health (PHS-OWH): The Office on Women’s Health would receive $29.7 million, $1.1 million more than FY2003 and $800,000 more than the President’s request. The committee remains “strongly supportive of the work done by the Office on Women’s Health in the Office of the Secretary. In addition to its own work advancing women’s health, it provides critical coordinating services with offices located in NIH, CDC, HRSA, FDA, SAMHSA, AHRQ, and CMS. In totality, these office assure that issues related to research, treatment, services, training, and education efforts by HHS reflect the distinct needs of women.” The committee requires the HHS Secretary to “notify the Committee in advance of any changes planned for the status, location, or reporting structure of this office or any of the offices numerated above.”
Public Health Service’s Office of Minority Health (PHS-OMH): The measure would allocate $48.7 million to the Office of Minority Health, $7.5 million less than the FY2003 level and $1.7 million more than the President’s request. The committee encourages the office to support annual conferences that “have a proven record of increasing the number of under-represented minorities entering health professions.”
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 an increase of $666 million, for a total of $12.3 billion in FY2004, as requested by the President. Report language indicates that, “since the No Child Left Behind Act was passed in 2001, the Committee has supported an increase of 41 percent in the appropriation for this program. These Federal resources represent the significant commitment this Committee has made to provide the resources necessary to help all children succeed in school.”
William F. Goodling Even Start Family Literacy Program: As requested by the President, S. 1356 would provide $175 million to the Even Start program, $73 million less than FY2003. The program provides grants for family literacy programs that serve disadvantaged families with children under the age of eight. The programs combine early childhood education, adult literacy, and parenting education.
Reading First and Early Reading First: The bill would fully fund the Reading First program at the requested level of $1 billion, a $6.5 million increase over FY2003. The Early Reading First program would receive $85 million in FY2004, $11 million more than last year, but $15 million less than the level requested by the President.
Teacher Quality: As requested by the President, the measure would allocate $2.8 billion for professional development programs to provide states and school districts with the tools to improve teacher quality. This amount is $100 million less than the FY2003 level. According to the report, districts may use these funds to “hire teachers to reduce class size” and therefore “have a positive impact on students.” The bill also would provide $41.7 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 FY2003 level, but $7.7 million less than the President’s request. Finally, S. 1356 would level-fund the Math and Science Partnerships at $100 million, $88 million more than the budget request.
21st Century Community Learning Centers: The bill would provide $1 billion for 21st Century Community Learning Centers in FY2004, $6.5 million more than FY2003 and $400 million more than the President’s request.
Loan Forgiveness for Child Care Providers: As requested by the President, the bill would not provide any funding for student loan forgiveness for child care providers. $994 million was provided in FY2003.
Individuals with Disabilities Education Act (IDEA): Total spending for special education in FY2004 would be $10.7 billion, a $999.5 million increase over FY2003 and $300 million more than the President’s request. Of this amount, $447 million would be provided for grants to the Infants and Families program that makes available early intervention services to all children with disabilities ages two and under, and their families. This funding level is the same as the President’s request and $12.8 million more than the FY2003 allocation.
Education for Homeless Children and Youth: The bill would provide $60 million for education for homeless children and youth, $5.4 million more than FY2003 and $10 million more than the President’s request.
Vocational Education: In FY2004, vocational education would be level-funded at $1.325 billion, $325 million more than the President’s request.
Adult Education: The measure would level-fund adult education at $587 million, $4 million less than the level requested by the President.
Pell Grants: The bill would level-fund Pell grants at $4.050 billion, $50 million more than the President’s request. These grants provide need-based financial assistance that helps low- and middle-income undergraduate students and their families to pay the costs of postsecondary education and vocational training.
Child Care Access Means Parents in School (CCAMPIS): In FY2004, the CCAMPIS program would be level-funded at $16.1 million, $1.1 million more than the President’s request. According to report language, this program helps support the “efforts of a growing number of non-traditional students who are struggling to complete their college degrees at the same time as they take care of their children.”
Office of Civil Rights: As requested by the President, $91.2 million would be provided to the Office of Civil Rights to enforce laws that prohibit discrimination on the basis of race, color, national origin, sex, disability, and age in all programs and institutions funded by the Department of Education. This funding level is $5.5 million more than FY2003.
House Report Language
On June 25, the House Appropriations Committee approved, 33-23, the FY2004 Labor-HHS-Education appropriations bill (as-yet-unnumbered) (see The Source, 6/27/03). The measure would allocate $138.04 billion in FY2004, a $5.68 billion increase over the FY2003 appropriations bill (P.L. 108-7) and $50 million more than the President’s request.
Department of Labor
The Department of Labor Women’s Bureau would receive $9.608 million in FY2004. This amount maintains the FY2003 funding level, but is $982,000 more than the President’s request. The committee intends that the Women’s Bureau “provide funding for Women Work! training and technical assistance services for programs that assist women in transition to enter/reenter the workforce” and expects Women Work! to “continue to refine measurable standards for training and technical assistance services in collaboration with the Women’s Bureau.”
Dislocated workers assistance would receive $1.461 billion, maintaining the FY2003 funding level and adding $78 million over the President’s budget request.
The bill would include $12.2 million for the Bureau of International Labor Affairs (ILAB). This amount is $134 million below FY2003 and equal to the President’s request. The committee urges ILAB to coordinate “the Department’s global responsibilities in 2004 and to provide expert support for many of the Administration’s international initiatives, including the promotion of core labor standards and the elimination of exploitative child labor.”
As requested by the President, the bill would not provide any funds for the Women in Apprenticeship and Nontraditional Occupations program. This program was funded at $993,000 in FY2003.
Department of Health and Human Services
Health Resources and Services Administration (HRSA): Under the bill, HRSA would receive $6.259 billion, a $203 million decrease below the FY2003 level and $587 million above the President’s request. Community Health Centers would receive $1.627 billion in FY2004, a $122.3 million increase over FY2003 as part of the President’s proposed expansion of health services through the Community Health Centers Program. In addition, $733 million would be provided for the Maternal and Child Health Block Grant, a $3 million increase above the FY2003 level, but $18 million less than the level requested by the President.
The Healthy Start infant mortality initiative would be level-funded at $98 million, $383,000 less than the President’s request. The measure also would maintain current funding of $9.935 million for universal newborn hearing screening. Under the President’s request, this program would not have been funded.
Ryan White: The Ryan White Care Act would receive a $5.6 million increase over the FY2003 funding level to $2 billion, slightly more than in the President’s budget. Of this amount, $70.9 million would be provided to help children, youth, women, and families infected with, or affected by, HIV/AIDS.
Family Planning: Title X, the nation’s family planning program, would be level-funded at $273 million, approximately $9 million more than the President’s request. Report language states that “these funds shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that these funds shall not be used to promote public opposition to or support of any legislative proposal or candidate for public office.”
Abstinence-only Education: The bill would provide $65 million for the abstinence education program in the Maternal and Child Health Block Grant, a $10 million increase over FY2003, but $8.04 million below the President’s request. The program “provides support to public and private entities for the development and implementation of community-based projects for abstinence education for adolescents aged 12 through 18.”
Centers for Disease Control and Prevention (CDC): The measure would allocate $4.55 billion in FY2004, $57 million above the FY2003 level and $233 million above the President’s request. Of this total, $106 million would be provided for the prevention of birth defects, developmental disabilities, and disability and health activities. That would represent an $8 million increase over the FY2003 level and a $19 million increase over the President’s request. Report language indicates that “funds have been provided above the request to expand the national public and health provisions education campaign designed to increase the number of women taking folic acid daily.”
Chronic disease prevention and health promotion would receive $862 million, a $72 million increase over last year and $28 million over the President’s request. Within that amount, a $4 million increase over FY2003 would be provided for heart disease and stroke, a $16 million increase would be provided for cancer prevention and control, and a $500,000 increase would be provided for arthritis and other chronic diseases. Within the amount provided for cancer prevention and control, the measure would provide $210 million for the National Breast and Cervical Cancer Early Detection Program. This amount is $11 million more than the FY2003 level and equal to the President’s request. Within the amount provided for arthritis and other chronic diseases, $1 million would be provided for the National Lupus Patient Registry.
The bill would provide $1.247 billion for HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis prevention at the CDC, an increase of $61 million over last year and $18 million more than the President’s request. Of that amount, $243 million would be provided for global HIV/AIDS programs, $60 million more than FY2003, but $51 million less than the level requested by the President. Report language indicates that, “within the amount provided for Global HIV/AIDS, not less than $100 million is for the International Mother and Child HIV/AIDS Prevention Initiative.” The committee also encourages the CDC to increase funding for the Minority HIV/AIDS Initiative to “fund grant applications from community based organizations with a history of providing services to communities of color to develop and expand HIV prevention intervention and services targeted to highly impacted minority men, women, youth, and sub-populations.”
National Institutes of Health (NIH): NIH would receive $27.664 billion in FY2004, a $681 million increase over the FY2003 appropriations bill and equal to the President’s request.
Report language indicates that the committee is “aware that research on saliva has progressed rapidly and holds the potential to be an inexpensive non-invasive diagnostic tool for early detection of breast cancer, osteoporosis, hepatitis, HIV, and Sjogren’s disease” and encourages the National Institute of Dental and Craniofacial Research (NIDCR) “to work cooperatively with the National Cancer Institute (NCI) and other appropriate institutes in pursuing research initiatives on the development of saliva as a diagnostic too.”
The committee points out that “bladder diseases, such as interstitial cystitis, urinary tract infections and urinary incontinence, disproportionately affect women” and urges the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to “develop a comprehensive program to address these and other urological needs of women.” Related to these problems “is the issue of obesity and incontinence, which particularly affects minority women and should be given priority in the Institute’s plans for the coming fiscal year.”
The report indicates that “pre-term labor and delivery is the leading cause of neonatal mortality, and many babies born prematurely have serious physical and mental disabilities.” For this reason, the committee encourages the National Institute of Child Health and Human Development (NICHD) to “increase its efforts in researching the underlying causes of pre-term delivery, to identify prevention strategies and to improve the treatment and outcomes for infants born pre-term.” In addition, the committee recognizes “the important contributions of the Maternal-Fetal Medicine Network (MFMU) in addressing clinical questions related to the care and treatment of high-risk and complicated pregnancies” and encourages NICHD to “strengthen its support of the network so that it can continue to address these important research questions, with an emphasis on issues pertaining to pre-term births and low birth weight babies.”
The committee commends the National Institute of Environmental Health Sciences (NIEHS) for “its recent efforts to bolster research aimed at discovering the environmental influences on breast cancer” and encourages NIEHS to “consider establishing centers to conduct multi-disciplinary and multi-institution research on environmental factors that may be related to breast cancer and to develop a national strategy to address this issue.”
The National Institute on Aging (NIA) is encouraged to “enhance research into the pathophysiology of osteoporosis and Paget’s disease and the role of environmental lifestyle factors associated with these diseases, particularly in men and women of diverse races and ethnicities.”
In addition, report language indicates that “the burdens and challenges of family caregiving are already substantial and are expected to become overwhelming as the ratio of elderly persons to children gets larger.” For this reason, the committee urges NIA to “intensify research activities to support rapid improvements in understanding human resources, service delivery arrangements, technology, and financing that would be most useful in ensuring comfort and dignity for individuals with fatal chronic illness, and in relieving the burdens borne by family and professional caregivers.”
The committee commends the National Institute on Nursing Research (NINR) for “longstanding support of research to reduce health disparities among minorities” and notes that NINR “plans to increase research to reduce the high rate of low birth weight babies.”
Office of Research on Women’s Health (ORWH): The committee remains “strongly supportive of the work done by the Office of Research on Women’s Health” and encourages the NIH Director to “providing adequate funding for ORWH so that it will be able to offer a second round of SCOR [Specialized Centers of Research on Sex and Gender Factors Affecting Women’s Health program] grants in FY04 and to expand the BIRCWH [Building Interdisciplinary Research Careers in Women’s Health] program.”
Report language indicates that “twenty to thirty percent of women in the U.S. of reproductive age suffer from uterine fibroids, a benign tumor that affects their reproductive health.” For this reason, the committee urges ORWH to work with the appropriate institutes to “intensify and coordinate programs to support research on uterine fibroids.”
The committee strongly supports “the development of new research initiatives to support interdisciplinary research mechanisms that will focus on scleroderma, that strikes mainly women and effects multiple systems including digestive, kidney, heart, lung, and skin often leading to premature death.”
The committee urges NIH to “continue implementation of the 5-year strategic plan for microbicide research and development, and to accelerate and strengthen efforts to coordinate research among institutes and other Federal agencies.”
Report language indicates that “lupus is an inflammatory autoimmune disease which affects more than 1.5 million Americans, 90% of whom are women.” For this reason, the committee encourages the NIH Director to “ensure that all relevant institutes are working closely and collaboratively to maximize the output of their investments in lupus research.”
Report language indicates that “Rett syndrome is a genetically inherited neurological disorder seen almost exclusively in females and found in many racial and ethnic groups worldwide.” For this reason, the committee encourages NIH to “promote continuity across Institutes in their Rett syndrome research.”
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA would receive $3.345 billion in FY2004. This allocation is $133 million more than the FY2003 level, but is $64 million less than the President’s request.
Center for Mental Health Services: The committee recommends $863 million for mental health services, $7 million above FY2003 and $29 million above the President’s budget request. The Mental Health Performance Partnership would receive $435 million, $2 million more than the President’s request and $2 million less than last year.
Center for Substance Abuse Treatment: The committee recommends $2.1 billion for substance abuse treatment programs. This allocation is $30 million more than last year’s level and $200 million less than the President’s request. Under the measure, the Substance Abuse Performance Partnership would receive $1.7 billion, $10 million less than the President’s request and $82.8 million more than FY2003.
Agency for Healthcare Research and Quality (AHRQ): The bill would maintain the current funding level of $304 million for AHRQ in FY2004, $25 million more than the President’s request.
Administration for Children and Families
Child Care and Development Block Grant (CCDBG): The bill would grant the President’s request and provide $2.1 billion for the CCDBG in FY2004, an increase of $14 million over FY2003.
Child Support Enforcement: The bill would allocate $4.625 billion in FY2004 for payments to states for child support enforcement; this amount is $588.5 million over the FY2003 level and equal to the President’s request.
Social Services Block Grant: The Social Services Block Grant would be level-funded at $1.7 billion as requested by the President. The bill includes a provision that modifies the percentage of funds that states may transfer between the Social Services Block Grant and the Temporary Assistance to Needy Families (TANF) program to 5.5%.
International Trafficking: Under the Refugee and Entrant Assistance account, a program to aid victims of trafficking would receive $10 million, $65,000 more than the FY2003 level and equal to the President’s request.
Child and Family Services Programs: As requested by the President, Head Start would receive a $148 million increase over FY2003, bringing the total to $6.8 billion. This funding level would allow Head Start to maintain current service levels, while ensuring that quality improvements and training elements are fully implemented.
The committee recommendation does not include the $10 million that the President requested for the Maternity Group Homes program. The committee report notes that, “pregnant and parenting youth are currently eligible for and served through the Transitional Living Program.”
For child abuse prevention and treatment, the committee would provide $48.3 million. This amount is $7.4 million less than FY2003 and equal to the President’s request.
Programs to increase abandoned infant assistance would receive $12.08 million, equal to the President’s request, but $40,000 below the FY2003 level.
Child welfare services would increase slightly to $291 million as requested by the President.
The committee recommendation does not include the $20 million that the President requested for promoting responsible fatherhood and healthy marriages. Legislation authorizing the program is pending Congressional action.
Adoption: The bill would provide $27.3 million for adoption opportunities, $116,000 more than the FY2003 level and the same amount as the President’s request. The measure also would level-fund adoption incentives at $43 million and would grant the President’s request of $12.9 million for Adoption Awareness programs, an increase of $84,000 over FY2003.
Mentoring Children of Prisoners: The bill would provide $25 million for a program to mentor the children of prisoners, an increase of $15 million over the FY2003 appropriations bill, but $25 million less than the President’s request.
Promoting Safe and Stable Families: As requested by the President, the bill would provide $305 million for the Promoting Safe and Stable Families program, maintaining the current FY2003 level.
Violence Against Women Act (VAWA): The measure would fund several VAWA programs. The National Domestic Violence Hotline would receive $3 million, maintaining current funding as requested by the President. In addition, battered women’s shelters would be level-funded at $126.4 million, $1.9 million more than the funding level requested by the President.
Administration on Aging: The Administration on Aging would receive $1.377 billion in FY2004, a $10 million increase over the FY2003 level and $33 million more than the President’s request.
National Family Caregiver Support: The bill would provide $168.5 million for the National Family Caregiver Support program, an increase of $13.266 million over the FY2003 level and $27 million above the President’s request.
Public Health Service’s Office on Women’s Health (PHS-OWH): The Office on Women’s Health would receive the current FY2003 funding level of $28.6 million, $250,000 less than the President’s request. The committee remains “strongly supportive of the work done by the Office on Women’s Health” and urges the Secretary of Health and Human Services to “notify the committee in advance of any changes planned for the status, location, or reporting structure of this office.” The committee also encourages the Office on Women’s Health to “fund the National Lupus Education Campaign aimed at reaching health care professionals and the general public.”
Public Health Service’s Office of Minority Health (PHS-OMH): The measure would allocate $48.3 million to the Office of Minority Health, $7.9 million less than the FY2003 level, but $1.3 million above the President’s request.
Adolescent Family Life: The Adolescent Family Life program would be level-funded at $30.9 million, $319,000 below the President’s budget request. The program provides comprehensive and integrated approaches to the delivery of care services for pregnant and parenting adolescents, and prevention services that promote abstinence from sexual activity among non-parenting teens.
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 an increase of $666 million, for a total of $12.350 billion in FY2004.
Reading First and Early Reading First: The bill would fully fund the Reading First program at the requested level of $1.05 billion, a $56.5 million increase over FY2003. According to the committee report, assistance would be provided to states and local school districts to establish “research-based reading programs for children in kindergarten through grade three.” The Early Reading First program would receive $100 million, $25 million less than last year as requested by the President. The program would support “the development of verbal skills, phonemic awareness, pre-reading development and assistance for professional development for teachers in evidence-based strategies of instruction.”
Even Start: The Even Start family literacy program would receive $250 million in FY2004, $1.6 million more than the FY2003 level and $75 million more than the President’s request. The program focuses on “the disadvantaged children, aged 1-7 years, who live in title I target school attendance areas, plus their parents who are eligible to be served under the Adult Education Act.”
Teacher Quality: The measure would allocate level funding of $2.93 billion for professional development programs to provide states and school districts with the tools to improve teacher quality, $80.8 million more than the President’s request. The bill also would provide $49.4 million for Transition to Teaching to assist eligible members of the armed forces and mid-career professionals to obtain certification as teachers. As requested by the President, this amount is $7.6 million more than FY2003. Math and Science Partnerships would be funded at $150 million, an increase of nearly $50 million over FY2003 to increase the number of teachers trained in the fields of math and science.
21st Century Community Learning Centers: The bill would provide $1 billion for 21st Century Community Learning Centers in FY2004, $6.5 million more than FY2003 and $400 million more than the President’s request. The committee report notes that “some research has shown that certain after-school programs, including those that engage young people in community service, can help reduce teen pregnancy” and encourages 21st Century Community Learning Center grantees to “build on the connection between after-school programs and reducing risky behavior.”
Loan Forgiveness for Child Care: As requested by the President, the bill would not provide any funding for student loan forgiveness for child care. $994 million was provided in FY2003. Under the program, borrowers who had earned a degree in early childhood education and who worked for two full years as a child care provider in a low-income community had a portion of their loan obligation forgiven.
Individuals with Disabilities Education Act (IDEA): Total spending for special education in FY2004 would be $11 billion, a $1 billion increase over FY2003 and $359.6 million more than the President’s request. Of this amount, $447 million would be provided for grants for the Infants and Families program that makes available early intervention services to all children with disabilities ages two and under, and their families. This funding level is the same as the President’s request and $12.8 million more than the FY2003 allocation.
Education for Homeless Children and Youth: The bill would provide $60 million for education for homeless children and youth, $5.4 million more than FY2003 and $10 million more than the President’s request.
Vocational Education: In FY2004, $1.2 billion would be provided for vocational education, $7.87 more than FY2003, and $200 million more than the President’s request.
Adult Education: The measure would provide $584.3 million for adult education, a $13 million increase over the FY2003 level and the same level requested by the President.
Pell Grants: The bill would level-fund Pell grants at $4.050 billion, $50 million more than the President’s request. These grants provide portable education vouchers to postsecondary students who may use them at any of over 6,000 eligible schools.
Child Care Access Means Parents in School (CCAMPIS): Funding for the CCAMPIS program would be reduced by $1 million to $15 million in FY2004 as requested by the President. States may use grants provided under this program to “establish a campus-based childcare program primarily serving the needs of low-income students enrolled at the institution.”
Office for Civil Rights: The bill would provide $91.2 million for the Office for Civil Rights to enforce laws that prohibit discrimination on the basis of race, color, national origin, sex, disability, and age in all programs and institutions funded by the Department of Education. This funding level is $5.5 million more than the FY2003 appropriation and the same amount requested by the President.
