WikiLeaks Document Release http://wikileaks.org/wiki/CRS-RS22438 February 2, 2009 Congressional Research Service Report RS22438 Health Professions Programs in Title VII and Title VIII of the Public Health Service Act: Appropriations History (FY2002-FY2009) Bernice Reyes-Akinbileje, Domestic Social Policy Division; Mary Venetta Wright, Knowledge Services Group February 27, 2008 Abstract. The health professions programs in Titles VII and VIII of the Public Health Service Act provide grants, scholarships, and loans to support institutions and individuals in the education and training of health professionals (Title VII) and the nursing workforce (Title VIII). Funding for Title VII programs declined by about one-third from $295 million in FY2002 to $194 million in FY2008. The President's FY2009 budget proposes to eliminate funding for all Title VII programs. Statutory authority for the Title VII programs expired at the end of FY2002. Funding for the Title VIII programs increased by about two-thirds from $93 million in FY2002 to $156 million in FY2008. The President's FY2009 budget requests $110 million for Title VIII programs. This report provides a history of appropriations for the various Title VII and Title VIII health professions programs. ¢ ¢ http://wikileaks.org/wiki/CRS-RS22438 ¢ ¢ ¢ Prepared for Members and Committees of Congress ¢ The health professions programs in Titles VII and VIII of the Public Health Service (PHS) Act provide grants, scholarships, and loans to support institutions and individuals in the education and training of health professionals (Title VII) and the nursing workforce (Title VIII). During the period from FY2001 through FY2008, funding for Title VII programs decreased by about 30%, from $276 million to $194 million. President George W. Bush's FY2009 budget proposed to eliminate funding for all Title VII programs. In contrast, funding for Title VIII programs, during the same period, increased by 86%, from about $84 million to $156 million. President Bush's FY2009 budget requested nearly $110 million for Title VIII programs. Legislative authority for most of the programs established in Title VII and Title VIII expired at the end of FY2002. This report provides a history of appropriations for the various Title VII and Title VIII of the PHS Act. It will be updated as FY2009 appropriation actions occur. http://wikileaks.org/wiki/CRS-RS22438 Background ..................................................................................................................................... 1 Title VII, Health Professions Education Appropriations ................................................................. 2 Title VIII, Nursing Workforce Development Appropriations.......................................................... 2 Table 1. Appropriations for Title VII, Health Professions Education Programs, FY2001 through FY2009 (Est.).................................................................................................................. 3 Table 2. Appropriations for Title VIII, Nursing Workforce Development Programs, FY2001 through FY2009 (Est.) ................................................................................................... 5 Table 3. Total Appropriations for Title VII and Title VIII Programs, FY2001 through FY2009 (Est.) ............................................................................................................................... 6 http://wikileaks.org/wiki/CRS-RS22438 Author Contact Information ............................................................................................................ 7 In 1963, Congress enacted the Health Professions Educational Assistance Act (P.L. 88-129) to create education and training programs for various health and nursing professionals. The programs, which are found in Titles VII and VIII of the Public Health Service (PHS) Act, provide grants, scholarships, and loans to individuals and institutions in order to increase the supply of health professionals, primary care providers, and nurses. Title VII programs support individuals who study to become primary care physicians, dentists, and allied health professionals. Also, institutions that train these individuals are eligible for grants to support the development of education and training opportunities through endeavors such as multidisciplinary collaborative efforts, and community partnerships. Title VIII programs support individuals who are training to work in the nursing profession, and institutions that create nursing workforce programs. All Title VII and VIII programs are administered by the Health Resources and Services Administration (HRSA) in the Department of Health and Human Services (HHS). Funding for Title VII and VIII programs is provided in the annual appropriations for the Departments of Labor, HHS, and Education. Detailed program information is available online at the website for HRSA's Bureau of http://wikileaks.org/wiki/CRS-RS22438 Health Professions at http://bhpr.hrsa.gov/. The 1963 Act has been amended and reauthorized on several occasions since its initial passage.1 The most recent reauthorization of Title VII programs occurred in 1998 (P.L. 105-392). Legislative authority for these programs expired at the end of FY2002 although Congress has continued to appropriate funds. In 2002, the Nurse Reinvestment Act (P.L. 107-205) extended existing programs in Title VIII for Basic Nurse Education and Practice Grants, and Nurse Faculty Loans, and added the following new programs: National Nurse Corps, Nurse Loan Repayment and Scholarship Program, Public Service Announcements, and Comprehensive Geriatric Education. Legislative authority for these programs expired at the end of FY2007, yet Congress has continued to appropriate funds. Authority for the Advanced Education Nursing program, and the Nursing Workforce Diversity program, which were established in the Health Education Partnerships Act of 1998 (P.L. 105- 392), expired at the end of FY2002. On December 26, 2007, President George W. Bush sent his FY2009 budget to Congress in which he eliminated funding for all Title VII programs, but proposed $110 million in funding for selected title VIII programs. On July 8, 2008, the Senate Appropriations Committee recommended FY2009 funding levels of about $196 million for Title VII programs and about $168 million for Title VIII programs.2 In a draft bill that did not receive full committee action, the House Appropriations committee, Subcommittee on Labor, Health and Human Services, and Education (L-HHS-ED) included FY2009 funding of about $244 million for Title VII programs, and more than $174 million for Title VIII programs. It is expected that sometime in 2009 not only will Congress deliberate budget matters, but it will also consider the reauthorization of these 1 The Health Professions Educational Assistance Act of 1963 (P.L. 88-129) was amended in 1965 (P.L. 89-290), 1968 (P.L. 90-490), 1971 (P.L. 92-157), 1976 (P.L. 94-484), 1981 (P.L. 97-35), 1985 (P.L. 99-129), 1988 (P.L. 100-607), 1992 (P.L. 102-408), and 1998 (P.L. 105-392). 2 S.Rept. 110-410, accompanying S. 3230. programs. This report summarizes funding for the Title VII and VIII programs for FY2001 through FY2008, and the President's FY2009 budget request (see Table 1, Table 2, and Table 3). During the period from FY2001 through FY2008, the overall appropriation for Title VII programs declined by about one-third, from $295 million to $194 million. Throughout much of this period, the Bush Administration sought to eliminate funding for most Title VII programs, only to have Congress restore funding. At least three programs have remained unfunded since FY2006: Health Education and Training, Quentin Burdick Program for Rural Interdisciplinary Training, and Health Administration Traineeships and Special Projects. President Bush's FY2009 budget proposed to eliminate funding for all Title VII programs. Table 1 provides Title VII appropriations for the period from FY2001 through FY2008, and includes President Bush's FY2009 budget request, and recommendations from the House and Senate for FY2009. http://wikileaks.org/wiki/CRS-RS22438 During the period from FY2001 through FY2008, the overall appropriation for Title VIII programs increased by 86%, from $93 million to $156 million. President Bush's FY2009 budget request proposed a 30% decrease in title VIII programs. Table 2 provides Title VIII appropriations for the period from FY2001 through FY2008, and includes President Bush's FY2009 budget request and recommendations from the House and Senate for FY2009. Some congressional committees typically show a single table that combines appropriations for Title VII and Title VIII. Table 3 combines total appropriations for Title VII and Title VIII programs for those same fiscal years. 0 0 0 0 0 0 670,6 521,6 459,6 699,6 889,5 )757 ,457( gniniarT laruR/margorP kcidruB .N nitneuQ 799,03 799,03 0 799,03 845,13 0 845,13 508,13 818,72 004,02 014,21 )757 ,357( smargorP cirtaireG 0 0 0 0 0 0 028,3 158,3 173,4 004,4 046,4 )757 ,257( sretneC gniniarT dna noitacudE htlaeH 009,63 081,82 0 081,82 186,82 166,82 179,82 602,92 649,23 643,33 521,33 )757 ,157( sretneC noitacudE htlaeH aerA segakniL desab-ytinummoC yranilpicsidretnI 899,74 158,84 0 899,74 158,84 328,04 618,88 719,18 234,29 200,39 840,19 )847 ,747( yrtsitneD/deM eraC yramirP/gniniarT 979,301 607,96 0 607,96 687,36 247,36 686,711 046,811 753,911 549,411 532,901 ytisreviD rof gniniarT ,latotbuS 044,82 528,9 0 528,9 069,3 759,3 646,53 061,63 351,63 116,43 440,33 )937( margorP ytinutroppO sreeraC htlaeH 662,1 662,1 0 662,1 982,1 882,1 203,1 313,1 123,1 033,1 033,1 )837( pihswolleF ytlucaF ytironiM dna tnemyapeR naoL 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363,492 144,803 111,592 104,672 SNOISSEFORP HTLAEH IIV ELTIT ,LATOT 372,8 000,9 0 372,8 029,7 519,7 761,01 842,01 228,11 307,11 907,01 tnempoleveD ecrofkroW htlaeH cilbuP ,latotbuS 0 0 0 0 0 0 070,1 870,1 222,1 032,1 132,1 )967( stcejorP laicepS dna seeniarT/nimdA htlaeH 372,8 000,9 0 372,8 029,7 519,7 790,9 071,9 006,01 374,01 874,9 )077 ,867-667( enicideM/latneD/htlaeH cilbuP tnempoleveD ecrofkroW htlaeH cilbuP http://wikileaks.org/wiki/CRS-RS22438 0 0 0 0 0 0 617 227 918 428 438 )167( sisylanA dna noitamrofnI ecrofkroW 798,38 089,76 0 089,76 981,46 816,23 861,28 638,28 110,48 736,47 585,46 segakniL ytinummoC yranilpicsidretnI ,latotbuS 000,61 308,8 0 308,8 069,3 759,3 357,11 948,11 229,11 594,9 224,8 )757 ,557( senilpicsiD rehtO dna htlaeH deillA .buS .mmoC .qeR .tcanE lautcA lautcA lautcA lautcA lautcA lautcA lautcA )noitceS tcA SHP( esuoH etaneS 90YF 80YF 70YF 60YF 50YF 40YF 30YF 20YF 10YF margorP 90YF 90YF .stnemecnuonnA ecivreS cilbuP lacoL dna etatS ,258 noitceS dna 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Bernice Reyes-Akinbileje Mary Vennetta Wright Analyst in Health Resources and Services Information Research Specialist breyes@crs.loc.gov, 7-2260 mwright@crs.loc.gov, 7-7541 http://wikileaks.org/wiki/CRS-RS22438