March 1, 2002

The Honorable Robert C. Byrd
Chairman
Senate Committee on Appropriations
S-128 Capitol Building
Washington, DC 20510-6025

Dear Mr. Chairman:

The Coalition for Health Services Research, representing over 3,500 members and 115 organizational affiliates, is deeply concerned by the breadth of reductions in health service research programs found in the President's proposed FY2003 budget. These reductions will severely limit the ability of the field of health services research to inform public and private sector decision makers regarding the key health policy issues facing the nation. Among the most critical policy issues facing our country are how to structure and fund a pharmaceutical benefit for Medicare beneficiaries; how to increase health insurance coverage for working Americans; what approaches both public and private purchasers can use to moderate rising health care costs while maintaining quality; and how to move the discoveries made at the National Institutes of Health into improved medical services for all Americans.

We are concerned not only about the cuts proposed for the Agency for Healthcare Research and Quality, the principal agency established by Congress to support health services research, but also for cuts being proposed in the research budgets for the Centers for Medicare and Medicaid Systems, and the Centers for Disease Control and Prevention. A brief summary of the cuts and their impact is provided below:

• The Agency for Healthcare Research and Quality (AHRQ), currently funded at $300 million, would be reduced to $251 million - a cut of over 16 percent. If this budget were enacted, except for a slight increase for patient safety grants, AHRQ will be unable to award any new grants in 2003. Current unprotected grant commitments would need to be cut by nearly 50 percent. Key priorities set by Congress for this agency will need to be cut substantially. The Coalition urges a funding level of $390 million to ensure adequate funding for high priority research needs including: understanding the causes of and solutions to medical inflation; promoting improvements in health care quality; eliminating medical disparities based on race and ethnicity; and increasing appropriate access to medical technology.
  
• The Centers for Medicare and Medicaid Systems (CMS) will see their research budget cut almost in half from $55.3 million to $28.4 million. After subtracting $12.4 million for the Medicare Beneficiary survey, and $6 million for CMS to meet other statutory requirements, CMS will have only $10 million in discretionary research funding. However, their FY2003 commitments for funding projects already underway is $17 million. This means CMS would have to cut existing research by $7 million. The Coalition supports a funding level of $60 million to ensure that CMS can meet its current obligations and expand research into areas such as quality care for those with chronic illnesses; plan and beneficiary participation in managed care; approaches to educating beneficiaries through use of the Internet (e-health); and the impact of technological changes on Medicare and Medicaid.
  
• The Centers for Disease Control and Prevention (CDC) $17 million extramural prevention research budget - the only extramural health services research program at the CDC - would be eliminated. CDC developed this program to move knowledge about effective strategies for preventing disease and disability from research to implementation in diverse community practices and programs. The program uses a model of community-based participatory prevention research, and has supported over 50 projects based in states and localities throughout the country. Cutting this program will eliminate the second round of projects designed and initiated by community-based research collaborations. The Coalition urges restoration of the $17 million so that CDC can conduct the second round of projects and collaborate with others to accelerate the dissemination of research results to professionals and communities who can put the results into practice.

In a time of rising health care costs and increasing numbers of uninsured, we should be increasing, not cutting, the federal government's investment in the research that the public and private sectors will need to address these challenging health system problems. We urge your support for increased research funding.

Sincerely,

W. David Helms, Ph.D.
President and CEO