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Executive Summary

Rep. Waxman (D-Calif.) is calling for $50 mil. in additional FY 1990 funding for non-AIDS programs at FDA. The California democrat supports funding the increase in FDA's budget authority through government appropriations and dropping the idea of user fees. "FDA's budget ]for non-AIDS programs[ should be increased above the President's request by $50 mil., and there should be no reliance on user fees to offset this funding increase," Waxman advised the House Budget Committee's Task Force on Human Resources at a March 7 hearing. Waxman maintained that the President's budget for FDA is "flawed" in two ways. First, he said, while the budget provides an additional $57 mil. for AIDS activities, thus raising total funding by 11% (from $513 mil. to $570 mil.), "the number of full time equivalent employees not involved in the AIDS effort will actually decrease by 26." The second problem, Waxman continued, "is the President's reliance on 'user fees' to offset the need for $100 mil. of appropriations." According to Waxman, the effect of the user fee provision is a proposed FY 1990 appropriation that is $43 mil. below the FY 1989 appropriation. Waxman maintained that user fees "should never be employed to reduce the deficit ]because[ they are an unreliable source of funds for an agency that cannot just delay doing its job until next year." He noted that user fees can be "unfair for small business" and create "conflicts of interest for FDA product reviewers." Commenting on repeated efforts by the Reagan Administration, and now the Bush Administration, to insert user fees into the budget, Waxman declared that user fees "should not be considered in the budget process until the Congress has decided that they are acceptable from a policy standpoint." Waxman recommended that the Public Health Service AIDS budget for fiscal 1990 needs an additional $575 mil. above the Administration's request to adequately handle the AIDS epidemic. He testified that 70% of this figure ($416 mil.) was money the Public Health Service had requested, "but that the OMB ]Office of Management and Budget[ turned down for inclusion in the budget." Waxman said the remaining $160 mil. should be used for such programs as the AZT (Burroughs Wellcome's Retrovir) subsidy program and home health block grants to states. Arthur Ammann, MD, Genentech collaborative research director and chairman of the scientific advisory board of the American Foundation for AIDS Research, also recommended increased AIDS funding at HHS in testimony before the committee. Ammann suggested that $500,000 go toward funding a federally sponsored and funded national advisory group consisting of experts in various fields, including medical and nursing care, education, social services, drug development, and health care delivery, as well as representatives from FDA, the American Academy of Pediatrics and the National Institutes of Health. Waxman further criticized President Bush's budget proposal as it related to Medicare and Medicaid. On Medicare cuts proposed, he said: "$5 bil. in cuts in one year is much higher than we have ever attempted in the past and is much higher than is reasonable. It represents a disproportionate hit on Medicare after years of constant cuts. We have had enough large indiscriminate cuts." Waxman also objected to Bush's proposal to pay for an expansion of Medicaid to cover pregnant women and infants up to 130% of the poverty level by reducing federal Medicaid matching payments to states for "administrative" functions.

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