DECISION REGARDING RECISION

Dr. JOHNSON. The basic decision for the recision is based on the determination of the President to maintain the budget of the United States at the $250 billion level.

As they look at the priorities or programs for Government, it was determined that the budget provided in the President's budget for Indian Health Services for fiscal year 1973 was the level that should be sustained.

Therefore, he is requesting that the items added to his budget by the Congress for fiscal year 1973 be rescinded in total. As an offset to that recision, he is requesting the reprograming of $1.5 million of that increase to pick up funds for Indian health manpower training which had previously been provided by the Department of Labor.

As you recall, the President in his Indian message of July 1970, had called for a significant series of initiatives in improving the health services for Indian people.

One of those that he emphasized at that time was the training of Indian health manpower. The Department of Labor initially made a contribution of $3 million to that effort, but because of certain problems with their authorizing legislation, they were unable to continue at the $3 million level and dropped back to $1.5 million. We are asking to have that picked up in regard to the Indian Health Service budget. That is the $6,208,000 congressional additions minus the $1.5 million Labor Department contribution. That makes up the $4.708 million request for recision.

Senator BIBLE. Very well; let me ask you this. Why are you asking to rescind? Normally the administration simply impounds the moneys. Dr. JOHNSON. It was the feeling of the President that the Congress should participate in this type of decision. None of the appropriations for HEW have been impounded. Either through a budget amendment or through request for recision, we have sent all of these budgets back to the Congress for reconsideration.

Senator BIBLE. If we don't grant the recision, will the administration impound the money anyway?

Dr. JOHNSON. I wouldn't be able to respond to that.

Senator BIBLE. Who will be able to respond?

Dr. JOHNSON. Mr. Forbush.

Senator BIBLE. Do you understand my question?

Mr. FORBUSH. I can't say explicitly at this time, but I think the difference between a recision and impoundment is rather subtle.

PROGRAM ADD-ON WORTHWHILE

Senator BIBLE. So subtle I can't tell the difference, in my honest opinion. I can't see the difference. I suppose what the administration is trying to tell the Congress is that the administration was dead right in the funds it asked for last year, and our add-ons were not right, and so we should rescind them.

All right; do you feel that the programs involved in the add-ons last year were worthwhile, Dr. Johnson?

91-414 O 73 pt. 2 - 2

Dr. JOHNSON. Mr. Chairman, we have shared with this committee for several years an understanding of the problems of Indian people and the needs that they have. I think the record stands for itself on the needs.

I would have to answer that question that certainly from a professional program, health management approach, yes, these are all worthwhile and identified needs.

The recision point here was made on broader national priority.

Senator BIBLE. That is the answer we get from all of the witnesses when we get to the congressional add-ons. And they say this is worthwhile when viewed in the total context. And looking at the total budget, it is necessary to impound or rescind as you wish.

How many years have you come up and testified before this committee, Doctor?

Dr. JOHNSON. About 7 years.

Senator BIBLE. You are always an influential and persuasive witness, and I think you have done a great amount of work in helping the Indian health program. I think you have made some headway in cutting down on their problems with tuberculosis and-what is the name of that other problem?

Dr. JOHNSON. Otitis Media.

Senator BIBLE. You have made some headway and I want to compliment you on that.

TABULATION OF PROGRAMS INTENDED FOR CUTBACK

The 14 programs that you intend cutting back are tabulated here and will be made a part of the record without objection.

They have the California Rural Indian Health Board. The health care communications in Alaska. Additional services at Belcourt, N. Dak., and so forth.

Without objection, that will be incorporated and made a part of the record at this point.

[The information follows:]

Indian health services.... 7,535 $166,540 7,535 $166,540 7,535 $166,540 7,535 $166,540

Note:

Pos. 7,678

Amount
$172,748

-$6,208

+1,500

-143

7,535

-4,708 168,040

-109

167,931

$2,734,000 for pay increase will have to be funded from sources
outside this appropriation.

UTLIIZATION OF RECISION

Senator BIBLE. If the total of $6.2 million involved in the recision were made available to you beginning May 1, would you be able to utilize the funds for the balance of the fiscal year?

Dr. JOHNSON. Mr. Chairman, some of the funds were provided for additional staff. And, of course, as the year has passed, that money would not be used. We do have a figure for the amount that could be used.

Senator BIBLE. What is your capability between now and the end of this fiscal year?

Dr. JOHNSON. Mr. Chadwick?

Mr. CHADWICK. The $2 million of the $6,208,000 would lapse; $4,208,000 would be the amount that could be utilized during that period of timė.

Senator BIBLE. Why would the $2 million lapse?

Mr. CHADWICK. For example, Mr. Chairman, there were 143 employees in total in that $6,208,000.

Senator BIBLE. That was 143?

Mr. CHADWICK. Yes; as of May 1 those employees would only be on duty about 6 weeks. So 101⁄2 months of the employees' salaries would be lapsed.

In the case of the items for the communications system in Alaska, the $300,000, we could utilize $70,000 of that to initiate the program. We could not complete that contract for $300,000 during the remainder of the year.

Senator BIBLE. You have answered this question, and maybe I am asking in a little different way.

Doctor, I would think this is properly asked of you. Can you tell the committee whether you will be permitted to utilize these funds should Congress refuse to rescind?

Dr. JOHNSON. I think that decision on the part of the Congress would put it back into the administration where they would have to consider this along with all of the other priority issues being considered.

Senator BIBLE. Where is that decision made? Is that an Office of Management and Budget decision?

Dr. JOHNSON. I would think so, Mr. Chairman. It is not our decision at all.

Senator BIBLE. It becomes an OMB decision, is that correct?

Mr. FORBUSH. Yes, we try it in concert with them. At the end of the year we will try to look at the overall budget situation.

Senator BIBLE. What if we refuse the recision, then what would you do?

Mr. FORBUSH. We would have to take that congressional action into account when we look at the overall situation at the end of the year. Senator BIBLE. We will take it up with the balance of the committee. We will evidence it any way that you think it appropriate, just so we get our message across. We will take it up with the full sub

committee.

Mr. FORBUSH. The best place might be in the report on the supplemental.

Senator STEVENS. That will be too late.

Mr. FORBUSH. I think it is pretty well ready to come out of the House.

CONGRESSIONAL ADD-ON FOR ALASKAN CONTRACT CARE PROGRAM

Senator STEVENS. One of the congressional add-ons was additional money in Alaska in contract care cases. How much additional money do you have for that?

Mr. CHADWICK. $220,000.

Senator STEVENS. How much did you have the year before?

Mr. CHADWICK. Ten percent less than that. I don't have the exact figure.

Senator STEVENS. Have you determined how much of that you could spend in the balance of the fiscal year if it were available?

Mr. CHADWICK. Yes, sir; specifically of that $355,000, $150,000 of that could be utilized for the remainder of the year. This is related to the contract dentists available and the amount of service you could buy from them in this period of time.

METHOD OF CONGRESSIONAL RESPONSE TO 1973 RECISION

Senator STEVENS. Do you have to wait for a congressional notice on this recision, is it associated with a supplemental, or can we just give you a letter as to our committee action on the recision?

Dr. JOHNSON. I will have to defer on that.

Mr. FORBUSH. I think the report language would be most appropriate. I think a letter from the committee would also do the job.

Senator BIBLE. I think you know what our decision is going to be, but we could formalize it if you want.

Senator STEVENS. A letter would be sufficient, you think, so far as the formalities are concerned?

PRESIDENT'S $10 MILLION INDIAN HEALTH ALLOCATION

Senator BIBLE. In your statement you mention President Nixon's message of July 1970, in which he specifies several Indian program initiatives, including a special $10 million effort relating to health. Please background us on this $10 million effort relating to health. How is it working?

PRESIDENTIAL EMPHASIS

Dr. JOHNSON. The President identified a number of areas in which he felt emphasis should be made in the field of Indian health.

One was Indian Health manpower training. Also part of it was an initiative of the National Institutes of Health, Bureau of Health Manpower, education to try to stimulate the entry of Indian people into professional health jobs, physicians, nurses, and so forth.

Mental health was another part of that particular initiative. There was the initiative for Otitis Media that you mentioned earlier. There was an initiative for Indian community development where we utilized the resources of other agencies of the Federal Government to help put into the hands of the Indian communities the health programs that they themselves could operate. Then there was a maternal and child health emphasis program, such things as the nurse midwife development program taking place on the Navajo Reservation and the special pediatric and infant program for the White Mountain Apaches.