In a move aimed at providing better health services to minorities in areas where there are no doctors, Secretary of Health and Human Services Louis W. Sullivan is attempting to revive the National Health Services Corps, which was deeply cut by the Reagan administration.
As part of his minority-health initiative, Sullivan is seeking a sharp boost in appropriations to train new doctors for the program, and his request was included in the president's fiscal 1991 budget. Some Democrats pressed for even larger increases but settled on the $55 million increase suggested by Sullivan after he declined to back a higher number.
The program, a sort of domestic medical Peace Corps, was started almost 20 years ago. The basic idea is that the government gives students scholarships or helps them repay loans to go to medical schools. Once they are ready to go into practice, they need not repay the loan or scholarship in cash but instead must agree to work for two or more years in an area that the government designates as lacking in medical services, such as an Indian reservation, inner city or a remote rural area.
According to the HHS, the average doctor serving in such areas earns about $55,000 annually plus benefits.
During the Carter administration, there was a large buildup of funds for scholarships and for the costs of doctors working in the field. In fiscal 1980, the peak year of appropriations, $153.6 million was provided for scholarships and for the cost of putting doctors into the underserved areas, with the money split about equally between the two functions. In fiscal 1979, new scholarships awarded reached 3,150.
But toward the end of the Carter administration and increasingly in the Reagan administration, critics argued that the program wasn't needed because the nation faced a surplus of doctors. With the Reagan administration taking the lead, appropriations were slashed to about $40 million for maintenance of field operations (salaries, transportation, equipment) and $7.9 million for scholarships by fiscal 1989. By 1990, new scholarships awarded plummeted to 41.
And the number of doctors, professionals, and volunteers that had risen to 3,127 in 1986 dropped to 1,900 by fiscal 1990 as a result of the drop in funding and scholarships.
Despite projections of a doctor surplus, Sullivan, who as president of Morehouse School of Medicine trained many black youths to work in communities with little medical service, is making the argument that the doctors are not where they are needed most -- remote and poor areas.
As part of what he calls his minority-health initiative, he has sent to Capitol Hill a request to raise funds for scholarships from $8.9 million in fiscal 1990 to $63.9 million in fiscal 1991. The $55 million increase would be for scholarship and loan aid to disadvantaged and minority youth who want to train in health professions.
Rep. Henry A. Waxman (D-Calif.), chairman of the House health and the environment subcommittee, proposed that new legislation be written to provide potentially larger increases, not limited to $55 million, and to keep the money available to anyone willing to serve, not just minority youth, but Waxman aides said Sullivan demurred and said a $55 million increase would be enough.