Office of Management and Budget Click to print this document
May 9, 2000

H.R. 4365 - Children's Health Act of 2000
(Reps. Bilirakis (R) FL and Brown (D) OH)

The Administration does not object to House passage of H.R. 4365, which is primarily designed to promote increased support for research on children's health problems. The Administration does, however, have serious concerns with numerous flaws in H.R. 4365 and will work with the Senate to address them. The most significant flaws are discussed below.

The Administration will seek an amendment to delete Title XII, Subtitle A (Infant Adoption Awareness) because it is unnecessary. The grants for adoption awareness training in Title XII, Subtitle A are unnecessary because Title X of the Public Health Service Act already allows training activities on a wide range of service delivery fronts, including training on adoption information as part of non-directive pregnancy options counseling. While the Administration strongly supports adoption, Title XII, Subtitle A of the bill, regarding the Title X family planning program, unduly emphasizes adoption information and referral training, in a context where pregnant women are entitled to expect to be informed of all of their pregnancy-related options in a balanced manner and in a non-directive fashion, as well as to be referred for services as requested.

The Administration is very supportive of efforts to improve autism surveillance and education activities and advance autism research. In recent years, NIH has significantly enhanced its investment in autism research. Unfortunately, H.R. 4365 contains a number of specific mandates that would limit the flexibility of NIH to effectively conduct, support, and respond to the needs for autism and autism spectrum disorders. For example, requiring: (1) the conduct of activities through specified components of NIH limits the agency's ability to respond to changing research needs and to take advantage of future scientific opportunities and discoveries; and (2) the funding of a specific number of extramural Centers of Excellence with specific research activities is wasteful and ineffective. Funding should be based on the quality of the research center applications received rather than on a statutorily-prescribed minimum number.

The Administration is also concerned about: (1) the creation of a National Center on Birth Defects and Developmental Disabilities, which will cause significant scientific, programmatic, and administrative problems for the delivery of essential public health services; and (2) provisions affecting the programs of the Health Resources and Services Administration that will duplicate existing programs and inhibit the agency's ability to effectively provide much needed public health services.

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