[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2018
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Wednesday, March 1, 2017.
MEMBERS' DAY
Mr. Cole [presiding]. Good morning. It is my pleasure to
welcome you all to the Subcommittee on Labor, Health and Human
Services, and Education for our first hearing of the year.
We are looking forward to taking testimony from members of
Congress this morning. This sort of member day has not been
held on this subcommittee in at least a decade. And the idea to
return to this practice is one that was suggested by our new
full committee chairman, Rodney Frelinghuysen, and, frankly, I
think it is a good idea. And if I did not think so, I would
still say I thought it was a good idea. [Laughter.]
But I actually do think it is a great idea, and he does
deserve credit for it. It is an opportunity for any member of
Congress to come before the panel and draw our attention to
particular issues of importance in both their districts as well
as across the Nation. I look forward to hearing from my
colleagues about the challenges they see and how this
subcommittee can help address them.
As a reminder to everyone, we really will abide by the 5-
minute rule so that we are able to keep closely to the schedule
we outlined for members. Before we begin, though, I would like
to turn to my ranking member for any remarks that she would
care to make.
Ms. DeLauro. Thank you very much, Mr. Chairman, and I
concur. I think this is a wonderful opportunity to hear from
our colleagues on the issues they care about in this, what I
view as an extraordinary subcommittee of appropriations. And I
am happy to see Mr. Thompson here. This is the second time we
have gathered this morning. We were just earlier at the
Submarine Industrial Base Council meeting.
I am heartened that so many of our colleagues are going to
testify here this morning, and looking forward to hearing from
them about how the programs that are part of the portfolio that
we have jurisdiction over affects your constituents.
I have to add, though, that we have heard that the
Administration wants to cut non-defense by about
$54,000,000,000, and I think we would agree that this could
have a very profound negative impact on the Labor, HHS,
Education programs. Our bill comprises nearly one-third of the
non-defense discretionary spending, so if you take a look at
what that proposed reduction would do, it would cut nearly
about $18,000,000,000 from this subcommittee.
There is a very good reason that the Labor-H Committee has
been called the people's bill because it does provide an
opportunity for people to help meet their needs. When we do
lifesaving biomedical research, we equip our Nation to deal
with public health emergencies. We level the playing field for
low-income children looking to learn. We help Americans get the
skills that they need to find a job in a tough economy.
So, these efforts all impact the lives of our constituents
and Americans all over this Nation. And, therefore, these kinds
of cuts would impact each and every American, especially
children, families, and seniors.
So, looking forward to listening to all of our colleagues
here today and what their priorities are to ensure that we keep
our promise to the American people. Thanks very much.
Mr. Cole. Thank you for your remarks. And with that, Mr.
Thompson, it is good to have you here, my friend. And you are
recognized for 5 minutes for whatever remarks you would care to
make.
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Wednesday, March 1, 2017.
WITNESS
HON. GLENN THOMPSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
PENNSYLVANIA
Mr. Thompson. Well, thank you. Chairman Cole and Ranking
Member DeLauro, it is a privilege and an honor to be able to be
before you this morning. Thanks for this opportunity. I want to
thank you for your dedication to the House Appropriations
Subcommittee on Labor, Health, and Human Services, Education,
Related Agencies.
In our current fiscal environment, I recognize the
challenges placed before the subcommittee, and I appreciate
your ongoing leadership and efforts to provide quality
education and health-related services to millions of Americans.
It makes a difference to the folks that I serve.
As co-chair of the House Career and Technical Caucus, and a
senior member of the House Committee on Education and
Workforce, I would like to use my time today to highlight the
importance of dedicating strong resources to programs
authorized by the Carl D. Perkins Vocational and Technical
Education Act, or the Perkins Act, in Fiscal Year 2018. Career
and technical education provides students of all ages with the
academic and technical skills necessary to become career and
college ready.
According to the most recent data from the Office of
Vocational and Adult Education, approximately 12 million
students participated in CTE programs during the 2013-2014
school year. While quality CTE programs are available to a
number of students, we have to work to make them even more
accessible, and doing so will ensure that future and current
members of our Nation's workforce have the opportunity to excel
in high wage, high-skill, and high-demand career fields, the
very fields that keep our Nation competitive in the global
economy.
Employers across the United States, especially those in
skilled trades, are faced with difficulty as they search for
qualified workers. According to a recent poll conducted by the
Society for Human Resource Management, more than half of all
employers reported that they are unable to recruit workers for
open positions. And human resource professionals predict a lack
of workforce readiness will impact employers for years to come.
Today, more than one million positions remain in trade,
transportation, and the utility sector, and 315,000
manufacturing jobs go unoccupied. By training a competitive
workforce to fulfill the 21st century demands, CTE programs can
help employers fill those jobs and close the skills gap.
Last Congress, the House reached a bipartisan consensus on
the importance of CTE when we voted to pass H.R. 5587, the
Strengthening Career and Technical Educational for the 21st
Century Act, by a vote of 405 to 5. As the individual who
introduced and sponsored this legislation, you know, this bill
would have reauthorized the Perkins Act, and I was encouraged
by its passage, and certainly look forward to advocating for
similar legislation in the 115th Congress.
In addition to taking steps to improve CTE-related policy,
we must also support CTE through the appropriations process.
Now, despite its importance, the Perkins Act funding has
declined by 13 percent, or $170,000,000 over 10 years. Today,
more than 20 States receiving a Perkins basic State allocation
is at or below the level that they obtained in 1998.
Chairman and Ranking Member, this concerning trend does not
reflect the needs of the students, the workers, and employers,
the backbone of the American economy. We must do better by
them. With this in mind, I urge the subcommittee to robustly
fund Perkins Act programs for Fiscal Year 2018, and I want to
thank you for your commitment to this issue and all the issues
under your jurisdiction. It really is a privilege and honor to
be before you this morning.
Mr. Cole. Well, it is good to have you, and you actually
have a little time because whoever is next, we started early,
or started on time, and the first person could not be here. So,
the next witness is not up, so I will yield to my friend if she
has any questions or comments she cares to----
Ms. DeLauro. Well, I would just say that I could not agree
with you more just in terms of the statistics. 2015, we have
States reporting that 7,300,000 high school students
participated, took at least a course in CTE. The National
Center for Education Sciences, 85 percent of the Nation's
3,900,000 high school kids have completed one or more
occupational CTE courses. 19 percent concentrators earned at
least 3 credits in that field. That is to say nothing about
post-secondary.
For 2017, the House number is exactly what is funded. It is
$1,100,000 as is the Senate. So, we will wait to see what
happens in the movement on this bill in that direction. For
now, we do not know what 2018 looks like, but I would just say
continue advocating anyway. It is a wonderful program, and it
provides real opportunity for our youngsters.
Mr. Thompson. And it is a great program with a return on
investment.
Ms. DeLauro. Yes.
Mr. Thompson. And I know we largely think of our kids,
secondary education. But the fact is that Perkins serves people
of all ages. It is people who just want a greater opportunity
for them and their families. They want to be able to make more
money, and, therefore, they will contribute more in taxes for
the tax base. And so, this is for any American at any point in
their life that Perkins allows him a pathway to greater
opportunity, with a return on investment for employers and for
the Nation.
And I do appreciate the time.
Mr. Cole. Oh, it is all right. You still have got a minute
or two. [Laughter.]
But let me chime in here, too, because it is actually a
very important program in my State. Oklahoma and Ohio have the
two most robust career tech systems in the country, so it has
been a staple for us, a big part of our education system. So,
it is money well spent.
I think the fact that it has not had the increases is
largely a reflection, as my friend knows, of the strains we
have on the budget. And her opening comments about, look, we
will obviously live within the allocation we are given by the
Budget Committee. That is where the final decision rests, or
the top line, and then the allocation that our chairman gives
us. And I am very supportive of whatever that is.
But if we were to have cuts of the size that have been
reported, then, yeah, there will be consequences to that. There
is no part of this budget that can escape unscathed if we have
$18 to $20,000,000,000.
Mr. Thompson. Yeah.
Mr. Cole. It will just change everything, and I told that
to various members and probably will say it a couple more times
as people come in and out. And, again, we can always disagree
about different things, but actually there is a remarkable
consensus on this subcommittee about these kinds of programs.
They have been very bipartisan. We are all for putting young
people to work. We are all for giving people whatever age the
skills they need to be successful in the workplace. Not very
many programs have done it as well as Carl Perkins.
Mr. Thompson. I think, I mean, this serves the young lady
who got up this morning who did not want to get out of bed to
go to school because she does not learn in a conventional way.
She learns by maybe with wrenches, or a welder, or a
stethoscope. But it also serves the folks who have been stuck
in poverty, maybe intergenerational poverty for decades to be
able to work their way away from that government dependency.
And so, certainly under the, and I do not pretend to
understand how we score thing around this town, but this is one
where just a little bit of an investment, and to be able to
have somebody wake up and to no longer be, you know, be
dependent upon the TANAF Program, or the SNAP Program, or, you
know, you go down the line of what could be tens of thousands
of dollars of support. And to be able to just have that
American Dream of opportunity, to wake up one day and to no
longer be government dependent?
This is, well, if we could look at it from a dynamic
scoring financially, this strengthens our position as a Nation.
Ms. DeLauro. Let me suggest that you take a look at
something, a study that the Markle Foundation recently did
along with Pew. It is Jobs in a Digital Economy, but it is
about, you know, people. And you made the very good point that
folks at NEH can access the program. But that there is 70
percent of folks today in this country without a college
degree. That does not mean that they do not have skills or they
do not need to be able to have courses, which would allow them
to succeed.
It is a very, very interesting study and I think we ought
to act on because you combine what we are doing with Perkins,
with what you do with community colleges, with apprenticeship
programs, with others in which to get people gainfully
employed.
Thank you, Mr. Chairman.
Mr. Cole. You are most welcome. Got another issue you would
like to bring up, G.T.?
Mr. Thompson. Not at this time. [Laughter.]
I had better go show up for Chairman Fowlkes' Educational
Workforce hearing.
Mr. Cole. Well, thanks for coming by, and we appreciate the
testimony very much. And, again, it is something the committee
looks on with a great deal of interest and genuine bipartisan
support. So, thanks for highlighting it.
Mr. Thompson. I appreciate it. Thank you.
Mr. Cole. With that, Mr. Polis, if we could have you next.
We are actually moving along pretty fast here. Hey, Jared,
thank you. Appreciate you being here.
[The statement of the Hon. Glenn Thompson follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. JARED POLIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
COLORADO
Mr. Polis. Thank you very much.
Mr. Cole. You bet. The gentleman is recognized for 5
minutes to deliver whatever remarks he cares to the committee.
Mr. Polis. Thank you, Chairman Cole, Ranking Member
DeLauro. Thank you both, and particularly since this bill has
not come to the floor as much as some others, it is great to
have this opportunity to provide some feedback.
What could be more important than public education? I think
we all value that. Our constituents value it. I am honored to
serve as the ranking Democrat on the Subcommittee on Early
Childhood, Elementary, and Secondary Education, so I am very
involved with education here. In prior service, I was chairman
of our State board of education. I have been very active in
this area, providing opportunity and hope for kids.
It is impossible to highlight every education program I
support in 5 minutes, so I will focus on a few that I think are
important from a funding perspective.
The first one I want to mention is the Federal Charter
School Program. In the 2015-2016 school year, public charter
schools educated more than 2,900,000 students in 6,800 schools.
43 States and the District of Columbia have enacted charter
school laws. Over half the students served by public charter
schools are free and reduced lunch students. Over half are
minorities, 17 percent limited English proficient.
Public charter schools continue to grow and deliver
outstanding educational outcomes for students nationwide, and
particularly the Federal support piece is so important because
it focuses on quality. Separate studies by the Center of
Reinventing Public Education and Mathematics, a policy
researcher found that charter school students are more likely
to graduate from high school, go on to college, stay in
college, and have higher earnings in early adulthood.
Charter school program funds are critical to continue this
success. Nearly every public charter school that is successful
got off the ground because of this Federal Charter School
Program.
I strongly encourage the committee to continue that
investment in the next Fiscal Year by investing a minimum of
$350,000,000, which would fund Federal charter school expansion
programs. And, again, this ties into quality, but is, of
course, like any public school, not all charter schools are
good. It is certainly not a silver bullet. But with a lot of
the equality indicators authorized for practices, this is very
important.
The next item I want to hit upon in the Education
Innovation and Research, or EIR, Grant Program, which is the
successor to the Investing in Education, which we used to call
the I3 Grant Program. Very, very important program. It was
modeled after the successful Small Business Innovation
Research, or SBIR, Program, which has been around for several
decades. And it has been funded in over $2,000,000,000 across
11 Federal agencies.
EIR would apply the successful SBIR approach in the field
of social spending and would really shift to evidence-based
outcomes for experimental, innovative policies. On June 7th,
2016, the House Republican Task Force on Poverty, Opportunity,
and Upward Mobility introduced a Better Way blueprint, released
by Speaker Ryan, which included support for EIR type programs,
which is a tiered evidence program.
Early research has shown evidence that the I3 program, the
successor to EIR, is working. A report by Patrick Lester at the
Social Innovation Center released in January found that many
programs demonstrated positive impacts in reading and literacy.
Evidence-based programs truly should have the highest intention
and investment with our limited Federal resources.
And I would be remiss if I did not reiterate my strong
support for the core programs within our public education
system that are Federal; that is, Title I and ESE, ESEA. Title
I funding, absolutely critical in addressing some of the
disparities in funding and in poverty in our country. ESEA, I
would remind the committee that the Federal government has
never lived up to its commitment to fully fund special
education, and we are appreciative of any progress that can be
made in that regard.
In addition to education, I want to mention my strong
support for other programs under the jurisdiction of this
subcommittee, notably, programs that provide adequate
healthcare for individuals living with HIV and AIDS, mostly
notably the Ryan White HIV/AIDS Programs and the AIDS Drug
Assistance Program, both housed in HHS. These programs help
ensure that people with HIV and AIDS receive the services they
need, so it is an important contribution to the overall piece,
which is very important for this committee so it does not make
solving problems elsewhere even more complicated and costly.
Finally, on the labor side, I wanted to highlight the
importance of employee-owned companies in providing major
economic benefits to communities and addressing some of the
income and equity disparities in our country. A lot of data
around employee-owned companies, higher rates of employee
retention, better able to weather turbulent markets.
Many great employee-owned companies, including some in my
district, like New Belgium Brewery, many in other areas of the
country as well, like Cliff Dansko, King Arthur, Flower. These
are very important companies where the workers can share in the
value that is created for the shareholders.
And the Department of Labor shares regulatory oversight of
ESOPs with the IRS, but could do more to help businesses try to
convert to employee ownership structures. Labor could and
should be doing more to support employee-owned businesses, and
I am asking this committee to include report language that
would require the Department of Labor to work with the IRS and
the SBA to develop guidance and tools available to those
interested in employee ownership structures.
And, again, since we will not have the opportunity to do
that on the floor, maybe we will, but if we do I would
encourage you to include that in the committee mark. I do not
think it is terribly controversial, but it would be a very good
thing for the Department of Labor to take on.
I look forward to working with each of you on these
programs. Happy to answer any questions.
Mr. Cole. Well, we will not have much time for questions,
so we are moving along. But I do want to make a couple of
comments and reassure you on a couple of things. And very much
agree with very many parts of your testimony.
On charter schools, actually we made last year a very
substantial increase, and, again, very bipartisan. Particularly
congratulate my friend, Senator Blunt, who was a big pusher on
that on the other side of the Rotunda. And obviously, you know,
while we may have different views about the Secretary of
Education, we do have somebody that cares a lot about charter
schools there.
So, it would be interesting to see what the Administration
wants to do, but there is bipartisan commitment.
Also, you know, this committee frankly for 2 years in a row
had proposed more for IDEA than the Administration has
requested, and we proposed $500,000,000 in the 2016 budget, and
the Administration proposed $170,000,000. That an increase in a
$11 to $12,000,000,000 program. We settled at $410,000,000, so
I thought that was a pretty reasonable compromise. And they
were flat last year, but we, again, included an increase.
If we can get our 2017 bill to the floor ever, you know, in
one form or another, I think we would like to do more, but you
will see that the House on a bipartisan basis actually led in
doing IDEA. That is actually one of the most efficient programs
we have. Every school district in America needs it. So, I
really thank you for highlighting those and, frankly, the rest
of your remarks as well.
My friend has a comment. I will yield to her.
Ms. DeLauro. Just quickly, I would associate myself with
the Chairman's remarks, but I would also talk about Title I
where this committee on a bipartisan basis has increased the
funding for Title I, understanding its need. And that was,
quite frankly, in opposition to what was proposed by the prior
Administration.
I am excited about your EIR Program, knowing something
about how SBIR has been so critically important. And I know in
my own district, the research, the innovation, everything that
has come out of that has been very, very successful. So, we
will try to reiterate that here as well.
And with regard to Ryan White, our budget in the House is
the same as it was in 2016. Well, it is less in the Senate, but
we will see if the House can prevail if we ever get the
document. Thanks.
Thank you very much.
Mr. Cole. Does my friend from California care to make any
remarks quickly? Okay. We can. Thank you very much. Appreciate
you being here, Representative Polis.
And, Jim, you are next up, so we have the distinguished
gentleman from Rhode Island. It is good to have you here, my
friend, and you are recognized for 5 minutes for whatever
remarks you care to make to the committee.
[The statement of the Hon. Jared Polis follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. JAMES LANGEVIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
RHODE ISLAND
Mr. Langevin. Thank you, Chairman Cole, and Ranking Member
DeLauro, and distinguished members of the committee. I
appreciate your time today, and thank you for holding the
hearing and inviting members of Congress to testify.
So, I appreciate the opportunity to highlight three
initiatives that would not only positive impact my State of
Rhode Island, but to also help to improve the lives of people
across the Nation.
Number one is the funding of the Lifespan Respite Care Act;
two is investing in the Carl D. Perkins Career and Technical
Act; and three is supporting the Adoption Opportunities
Program.
First, I respectfully request $5,000,000 for the Lifespan
Respite Care Act Programs. When I first championed the
enactment of this law back in 2006, it was a bipartisan effort
with then Congressman Mike Ferguson from New Jersey. He and I
partnered up, and it is an important bill that became law. And
for me, it was with the firsthand knowledge of the tremendous
difference that a dedicated caregiver can make in the life of a
person with a disability or chronic condition.
The Lifespan Respite Program is the only Federal initiative
that exclusively concentrates on respite and does not restrict
program eligibility based on the age or veteran status. So,
basically respite is when someone is a family caregiver and is
caring for a sick child, someone with a disability, or an
elderly parent. The caregiver themselves often need some backup
and support.
If you have someone coming in for an hour a day or a couple
of hours a week just so that the person can go and do the other
things they need to do for the family, whether it is going to
the doctors themselves, or going grocery shopping, or taking
the kids to the ball game, or what have you. These are
important things that make a family work, but the caregiver can
get burned out very easily. So, this helps to coordinate a
patchwork system that different States have so that we are most
effectively using resources to have the most effective system
for respite.
So, more than 35 States and the District of Columbia have
received grants under this program, bolstering a coordinated
community systems that are often the only resource for
struggling families caring for a loved one. Caregivers need and
deserve relief from the physical and emotional responsibility
of caring for a person with a chronic illness or disability.
Lifespan Respite Programs often help caregivers manage
stress, thereby mitigating the development of physical and
mental health issues associated with the strain of their roles.
Respite care programs also help to delay or, in some instances,
avoid nursing home entry, which strengthens families and
improves the wellbeing of all parties.
Reducing the strain on institutionalized care facilities
also alleviates pressure on our healthcare system. For example,
caregivers provided an estimated $470,000,000,000 in
uncompensated care--uncompensated care--if you had to put a
dollar figure on it that family caregivers provided in 2013,
more than the total Federal and State Medicaid spending for
that year.
Respite is about more than providing caregivers a chance to
recharge. The Lifespan Respite Program reinforces the
healthcare infrastructure that allows people with a disability
or illness to remain at home and supports families who are
willing to provide quality care.
I also respectfully request strong support for the Carl D.
Perkins Career and Technical Education Act. Career and
technical education ensures students are career and college
ready, and Perkins provides the largest Federal investment in
CTE across the country.
In the 2013-2014 school year, more than 12 million students
participated in CTE programs. According to the Bureau of Labor
Statistics, many of the fastest-growing jobs through 2022 will
be CTE fields, including STEM, skilled trades, and IT. However,
half of employers report that they unable to recruit workers
for open positions.
Perkins grants ensure students learn the skills needed for
these jobs. They development strong educational pathways for
students in careers and strengthen career counseling, provide
professional development for educators, and purchase vital
equipment for classrooms. This bipartisan deserves strong
support for 2018.
Lastly, I respectfully request $50,000,000 for programs
under the Adoption Opportunities Act. Every day, over 427,000
children are living in foster care across the country.
Unfortunately, children who enter the child welfare system
after age 14 are much more likely to age out of foster care
than be adopted. Already at a disadvantage, these children end
up without a network of support, especially in times of crisis.
More than half of children who age out of foster care
experience episodes of homelessness, and 25 percent do not
receive a high school diploma or GED. Only 6 percent complete a
2- or 4-year college degree.
Adoption Opportunities grants support permanent solutions
for foster children. They encourage the adoption of older
children, minorities, and children with special needs, and
provide post-adoption support. So, I urge you to support the
Adoption Opportunities because, quite simply, every child
deserves a family.
So, thank you for listening to my testimony and taking my
requests into consideration for the Fiscal Year 2018 Labor,
Health and Human Services, and Education bill. Each program I
highlighted provides American families with crucial tools to
achieve success in today's society.
From finding loving homes for foster children to providing
crucial career, and education service, to ensuring caregivers
who serve those in need receive care themselves, these programs
matter. They strengthen our communities, and they uphold our
Nation's promise of compassion, equality, and opportunity.
Mr. Cole. I want to thank my friend for his testimony, one
of my fellow former secretary of state. We served together at
the same time.
Mr. Langevin. Yes, sir.
Mr. Cole. And always thoughtful as usual. You will be happy
to know that your good friend, Mr. Thompson from Pennsylvania,
was in here also pushing for Carl Perkins money earlier, so
bipartisan on that.
Just so the members know because we have got several that
have arrived. We are not going to normally do questions, but at
the end of each person, if there is a comment or question that
you want to make, I am just going to throw that open to the
committee. But we will try to move on schedule, but, again, I--
--
Mr. Langevin. Mr. Chairman----
Mr. Cole [continuing]. Everybody is free to make a comment
or ask a question.
Mr. Langevin. I was remiss in not acknowledging G.T. and
his great work, G.T. Thompson from Pennsylvania. We have been
great bipartisan partners in career and technical education
programs, and I thank him for his leadership. Thank you.
Mr. Cole. Well, we thank the gentleman for his testimony. I
see my friend--oh, I am sorry.
Ms. DeLauro. No, no, I just want him to just keep fighting.
Mr. Cole. My friend, the gentlelady from Kansas is here,
and she is next up on our agenda. As she is working her way, I
am going to take personal privilege as chairman to chastise her
for announcing that she is not going to be running again next
time. This is one of our most thoughtful and best leaders on
our side of the aisle and, I think, in Congress. And there is
nobody I am going to miss more around this place than my good
friend from the neighboring State, so.
[The statement of the Hon. James Langevin follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. LYNN JENKINS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
KANSAS
Ms. Jenkins. Well, thank you, Mr. Chairman. Thank you,
Chairman Cole, Member DeLauro, and honorable members of this
committee.
In December of 2016, Congress passed the 21st Century Cures
Act, which contained the Mental Health First Aid Act, which was
on the top priorities of mine since coming to Congress back in
2009. And today, I simply ask that that funding level of nearly
$15,000,000 be fully appropriated in the Fiscal Year 2018
budget.
Section 9010 reauthorizes grants to States and
municipalities, Indian tribes, and nonprofit groups to train
teachers and school personnel, emergency service personnel, and
others to recognize the signs and symptoms of mental illness,
to become familiar with resources in the community for people
with mental illness, and to safely de-escalate crisis
situations involving someone with a mental illness.
This grant program has been included in appropriations
bills in years past and has enjoyed broad bipartisan support
from Congress and the public. I cannot overstate how important
these grants are to law enforcement and first responders.
The first step to helping someone suffering with a mental
illness to get the help he or she needs is to be able to
quickly spot the signs of that mental illness and know where to
point that friend, the colleague, neighbor, or family members.
These funds will help police officers, first responders,
veterans advocates, and educators, and other spot the signs
that get people the help that they need.
We hear about the state of our mental health system every
day and the state of the VA dealing with injured veterans. We
hear about police and first responders called to a scene where
someone has become dangerous and they are not sure of the best
way to respond. Section 9010 will help those people know
instinctively how to respond so that the situations stay in
control, and the risk of harm is decreased.
The kinds of education programs that this legislation will
fund have been shown to be effective and efficient in teaching
people the signs of mental illness and how to drop the stigma
of that illness so that the people they live and work with can
receive the appropriate help necessary.
I am thankful for the opportunity to address you here today
and ask that the stated funding level be given to SAMHSA so
that it may in turn help those that need the training the most.
I appreciate your time and the opportunity to address the
committee. Thank you, Mr. Chairman.
Mr. Cole. Great to have you here, and acknowledge the
gentlelady's great work on Cures and on the mental health
component of that that our mutual friend, Mr. Murphy, did such
great work on and you reported out in such wonderful bipartisan
fashion, I think unanimously, out of your committee. So, I
think he will be here later to talk about that.
Ms. Jenkins. Great. Thank you.
Mr. Cole. Any questions or comments from anybody else on
the committee?
[No response.]
Mr. Cole. Well, I see my good friend, Ms. Kelly, has
arrived. I am sorry I did not see you over there when you first
got in, and good to have you here on the committee. I want to
thank you for coming before, we will just call it the Labor-H
Committee because it is a mouthful if you try to get it all
out.
But we are delighted to have you here, and the gentlelady
is recognized for 5 minutes for whatever testimony she cares to
give.
[The statement of the Hon. Lynn Jenkins follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. ROBIN KELLY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Ms. Kelly. Thank you, Mr. Chair, and Ranking Member, and
all the committee members. I would like to thank you for the
opportunity today to speak before you and testify on behalf of
the families of Illinois' 2nd Congressional District, and on
behalf of millions of Americans whose livelihoods are adversely
impacted due to health inequities that exist in our Nation.
To those who do not know me, my name is Robin Kelly, and I
chair the Congressional Black Caucus Health Brain Trust. I have
never been of the belief that the zip code you are born in
should never determine how long you live in this country or how
healthy you are. Grandmothers have to decide between paying
their electrical bill or paying for their diabetes medicine.
Parents should not have to decide between food in their
refrigerator or paying for an $80 dental procedure. But those
are decisions that are being made every day for far too many
Americans, and too often they have devastating and fatal
consequences.
Last Congress, I authored a report, the Kelly Report on
Health Disparities in America, an official congressional
analysis of the state of African-American health in the United
States, that offers a blueprint for reversing negative health
trends in communities of color. The Kelly Report outlines the
grim state of black health in America and remedies to reverse
the negative health statistics plaguing communities of color.
Consider this, African-Americans have higher rates of
mortality than any other racial or ethnic group for eight of
the top 10 causes of death. African-American cancer rates are
10 percent higher than white Americans. Blacks are nearly twice
as likely to have diabetes than whites. African-Americans are 6
times more than likely than whites to be victims of homicide,
and black youth especially do not have consistent access to the
culturally sensitive trauma-informed mental healthcare that
would alleviate their burden.
While blacks account for just 13 percent of the total U.S.
population, they account for nearly half of all new HIV
infections. Those are startling facts. In a broader public
health context, there is still much to be done to address the
fact that an estimated 1.5 million Americans suffer from Lupus.
There is no reason we should not be able to find the root cause
of Lupus and a cure.
We also must invest in and address the fact that mental
illness is the leading cause of disability in developed
countries like the United States. And we must address the often
overlooked problem of oral health in America. People of color
suffer from disproportionate rates of tooth loss, untreated
dental care, and untreated tooth decay.
This committee has a tall task in ensuring that our
appropriations priorities reflect the health needs of the most
vulnerable in this Nation. It is a worthy goal, but it should
be our mission. I ask that the committee support my request to
invest in our most vulnerable. Fund health delivery sites in
medically underserved areas whether they are urban, suburban,
or rural, and my district is all three, and place support
programs that encourage primary care providers to practice in
communities with shortages.
The request you will receive from me will ask that you
prioritize health professional training programs, like the
Minority Centers of Excellence and Health Careers Opportunities
Program. Additionally, my office has put together a list of
what we see as the most beneficial and impactful health
programs for you to appropriate funds for this Labor, HHS
cycle.
I thank the committee for the opportunity to testify today.
Mr. Cole. I want to begin by just thank the gentlelady for
testifying not only behalf of her district, but on behalf of
the Congressional Black Caucus as well. As I know the
gentlelady recognizes, we actually have a champion on this
committee from California, who has done probably more than----
Ms. Kelly. My mentor.
Mr. Cole [continuing]. Anybody in this Congress to focus on
racial disparities, and treatments, and outcomes. My good
friend, Ms. Lee, has been a leader in that for a long time. So,
but we are delighted to have you there. Does anybody else care
to make a comment or ask a question?
Ms. DeLauro. Just I would love to have the list of what
your office put together on what the priorities are.
Ms. Kelly. We will get to that you.
Ms. DeLauro. Thank you very much. Thank you.
Mr. Cole. We thank the gentlelady, and I see my good friend
from Pennsylvania, Mr. Fitzpatrick. You are next up. It is good
to have you here.
[The statement of the Hon. Robin Kelly follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. BRIAN FITZPATRICK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
PENNSYLVANIA
Mr. Fitzpatrick. Thank you, Mr. Chairman, Ranking Member
DeLauro, and members of the subcommittee. Thanks for your time
today.
And I wanted to take the opportunity to address the
subcommittee, and I know there are a lot of challenges that we
face as a Congress. One of the most significant ones affecting
our district and I know affecting so many of our districts is
the grip of opioid abuse and heroin addiction, overdose deaths.
And I just wanted to thank the committee first and foremost
for your time, and strongly encourage full funding for this
opioid epidemic and related cancer research programs. The
provision in the CARA Act, the Comprehensive Addiction and
Recovery Act, as well as NIH Innovation Projects and state
responses to opioid abuse in the 21st Century Cures Act are in
need of full funding, as well as the NIH.
Mr. Chairman and Ranking Member, prescription opioid misuse
continues to devastate Americans nationwide. According to the
Centers for Disease Control and Prevention, drug overdoses
involving prescription opioid and heroin overdoses have
quadrupled since 1999, and it continues to claim lives in all
of our districts. I know from north to south in our district,
just last year alone we saw a 50 percent increase in heroin-
related overdose deaths, which is unbelievable.
And at the same time, while we have seen this significant
increase, law enforcement officials and first responders have
tirelessly worked to save lives. Diana Rosati, who is the head
of the Bucks County Drug and Alcohol Commission in our
district, recently reported that police departments throughout
our district saved 263 residents in our district through the
use of Narcan, which is an opioid overdose emergency treatment.
And her statement was, ``While the number of lives saved
from accidental overdose is an amazing number, it speaks to the
magnitude of this issue and the need for treatment to follow
through.'' And many of our police chiefs have likened it to
putting a band-aid on a bleeding artery. Narcan is a great
treatment to save lives, but prevention is really the key, and
that's why I am here to talk to you today.
Thoughtfully designed, the CARA statute utilized a balanced
strategy encompassing six pillars: prevention, treatment,
recovery support, criminal justice reform, overdose reversal,
and law enforcement. Within the jurisdiction of the
subcommittee, authorized funding by CARA for HHS included
grants that will significantly aid States with much-needed
resources and tools.
Just to name a few things that grant funding will
accomplish, first it would reduce the number of opioid-related
deaths by assisting States and expanding access to opioid
overdose reversal drugs, such as Narcan, and also educating
healthcare professionals by developing and providing training
manuals and developing new strategies for pharmacists to
dispense opioid overdose reversal medication.
It will also help accomplish reducing relapses and help
fully recover patients by expanding availability of evidence-
based medication, assisted treatment, and other clinical
appropriated services to areas with high rates of rapid
increases of heroin or opioid abuse. And it will also, through
building connections between recovery community organizations
that will strengthen outreach, reduce substance abuse disorder
stigma, and reduce substance abuse cases in pregnant or
postpartum women by demonstrating a pilot program that will
better support family-based services, identify gaps along the
continuum of care, and encouraging new approaches for service
delivery.
In addition, the 21st Century Cures Act also contained
funding to combat the opioid epidemic. Specifically, the
remaining $500,000,000 would supplement opioid abuse prevention
and treatment activities by providing funding for States to
improve prescription drug and monitoring programs, implement
prevention activities, train healthcare providers, and expand
access to treatment programs.
And I just want to thank the committee for their time today
and just bring to your attention this really important issue
that is affecting all of our districts. Certainly it is
affecting mine in a staggering way.
Thank you, Mr. Chairman, and thank you, Ranking Member
DeLauro.
Mr. Cole. Thank you. I want to thank you for your
thoughtful testimony, and particularly in the areas that you
focused on. Probably as a former FBI agent, you saw the opioid
crisis up close and personal, the way that a lot of us have
not. We did, you know, appropriate the Cures portion of that
and the continuing resolution, I think, on the opioid issue.
And if we can ever get our bill out. It is something I will
continue to harangue on, and I know my good friend shares my
frustration.
This year, we had a very substantial increase in NIH
funding. We will have a very substantial increase again if we
can just get the bill out in some form and across the floor.
So, we appreciate you highlighting them because on a bipartisan
basis, this committee shares those priorities.
Ms. DeLauro. Mr. Chairman, just to tell you that just to
increase what the chairman has said. In our 2017 budget
request, there is a rural opioid overdose reversal. It is
$10,000,000. There are several SAMHSA programs, Medicaid
Assistance Treatment Program, $50,000,000. You have got opioid
treatment programs. SAMHSA, while it did not do the
buprenorphine program, grants to present prescription opioid
drug overdose. There is that effort under SAMHSA, strategic
prevention for prescription drugs.
And CDC is what you spoke about in terms of helping States
to set up this monitoring. I just would add one more point to
you. Take a very hard look at what may be coming down the pike
with regard to Medicaid and Medicaid expansion and overall
Medicaid funds, because Medicaid is one of the prime ways in
which people are getting the opportunity to have their
treatment and it being insured and covered.
Thank you, Mr. Chairman.
Mr. Cole. Would anybody else care to ask a question or make
a comment?
[No response.]
Mr. Cole. Well then, my good friend is excused. Thank you
very much for your testimony.
I see my good friend and fellow Appropriations Committee
member, Mr. Price from North Carolina, is here. And, Mr. Price,
it is always a pleasure to have you on either side of the dais
under any circumstances. So, we look forward to whatever
testimony you care to give us.
And my good friend is recognized for 5 minutes.
[The statement of the Hon. Brian Fitpatrick follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. DAVID PRICE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NORTH
CAROLINA
Mr. Price. That is a rather expansive welcome, so thank
you. I appreciate the chance to be here.
Ranking Member DeLauro, colleagues on both sides, thank you
so much for this chance to testify on behalf of the National
Service Program. I am a co-chair along with Doris Matsui of the
National Service Caucus. That is a bipartisan group of nearly
80 members, and I bring Doris' regrets for not being able to
testify with me here today.
National Service has a proud history in the U.S. President
Kennedy first called for a domestic volunteer program to
complement the Peace Corps in the early 1960s, and that
inspired President Johnson to create the Volunteers in Service
to America, VISTA, under the Economic Opportunity Act of 1964.
VISTA quickly expanded and was codified by Congress in the
early 70s with the bipartisan Domestic Volunteer Service Act,
legislation that outlined the specific mission and goals of
national service in relation to the needs of the country.
Some years later, the Corporation for National and
Community Service, or CNCS, was founded to consolidate these
efforts, support the programs that we are familiar with today:
AmeriCorps, Senior Corps, and what was formerly known as Serve
America.
Today, the Corporation for National Service is guided by
the principles of putting the needs of local communities first,
strengthening public/private partnerships, and assisting with
the accessibility of grant funding to rural. And I know there
are economically distressed communities.
Most colleagues are familiar with the benefits and success
of AmeriCorps, a program established to provide opportunities
for motivated and dedicated Americans to specifically engage in
State and local projects. Every year, over 80,000 Americans
immerse themselves in these programs that address community
needs or respond to disasters.
And I say most colleagues are aware of this. I actually do
not think the general public is necessarily aware of the reach
of AmeriCorps, and the extent to which local organizations they
participate and value are undergirded by AmeriCorps support.
Habitat for Humanity would be a good example. You can scarcely
imagine those Habitat projects being organized in the efficient
way they are without the support of AmeriCorps.
Senior Corps, largely developed under President Nixon, has
connected our Nation's older generations with people and
organizations in need across the country. Senior Corps members
become coaches, mentors, contributing their career skills and
expertise to the community. Here, the trademark program is
Foster Grandparents, and most of us have heard of that, and we
know that it enriches the lives of young people with volunteers
age 55 and over serving local organizations committed
particularly to the betterment of children.
And then finally, the Social Innovation Fund catalyzes and
mobilizes public and private funds to transform the impact that
local nonprofits have on communities. As of March of last year,
the Social Innovation Fund leveraged $295,000,000 of Federal
investment to reach commitments of more than twice that value.
So, National Service works by engaging young people,
providing services to military families, helping communities
succeed. Through service, and we need to understand the benefit
this has to those who serve as well as those who are served.
Through service, highly motivated young Americans can
participate in career-related service opportunities, such as
working with the Community Health Corps, increasing their
experience, their earning potential, as they give back to the
community.
Additionally, a generation held back by increasing student
debt can now seek alternatives to paying for their education.
And we know National Service leverages substantial private
investments from a small public investment.
In my district, we host over 350 AmeriCorps volunteers, 162
Senior Corps volunteers, working with local universities,
housing authorizes, various nonprofits. The young people who
serve and the not so young people who serve have a lasting
impact on my district and on the State, sustaining communities,
allowing them flourish for future generations.
So, my colleagues, in this time of political uncertainty,
we need to remember that National Service is not partisan. Its
roots are not partisan, and the way it operates is not
partisan. Republican Presidents from Nixon to George W. Bush
supported these programs, and President Bush encouraged all
Americans to devote 4,000 hours of their lives to service in
the aftermath of September 11th.
So, I believe this a goal implemented by a series of
programs that we can agree on, give a new generation of young
people a means to make a difference for their country.
So, thank you for the opportunity to advocate on behalf of
the Corporation for National Service and its good works and to
support the funding. Thank you.
Mr. Cole. Good to have my friend's testimony as always, and
just to make a quick point, reinforce a quick point that he
made on the bipartisanship of this program. The last director,
who has since retired, Wendy Spencer, I think is known by this
committee very well, and served under both Democratic and
Republican administrations with great distinction in a very
bipartisan way. So, I thank my friend for his testimony.
Are there any other comments or questions?
Ms. DeLauro. Just to say thank you. Thank you for your
continued support and advocacy for a program that really helps
our young people understand what their responsibilities are and
the moral responsibility they have to their communities and to
their country. We both have lived through a time when this
money was eliminated, but we saw the light on both sides of the
aisle to make sure that the funding is there and it continues
to be there, and including the Social Innovation Fund because
of what it does with third parties.
And our hope is that we have got, I think except for the
Senate on the Social Innovation Fund, the House side is very
much in support of what you are doing, Mr. Price. And we will
wait to see what 2018 is about, and we will advocate again, and
I know you will be. Thank you so much.
Thank you.
Mr. Cole. Any other questions or comments?
[No response.]
Mr. Cole. With that, Mr. Price, thank you very much for
your testimony.
I see my good friend, Mr. Long, from Missouri is arriving,
and so he is recognized and is next up. It is good to have my
friend here, and the gentleman is recognized for 5 minutes to
make whatever remarks he cares to to the committee.
[The statement of the Hon. David Price follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. BILLY LONG, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MISSOURI
Mr. Long. Good morning, Chairman Cole, and Ranking Member
DeLauro, and members of the subcommittee. Thank you for
allowing me to come before the subcommittee today to speak in
support of AmeriCorps.
A lot of you all have met my oldest daughter, Kaleen, who
is a pediatrician, and I know Rosa helped her along the way.
And she was born on May the 22nd, my oldest daughter.
On May 22nd, 2011, we were celebrating her birthday party,
along with another friend of ours who had a birthday on the day
before or the day after hers. And we were over at some friends'
home that did not have a basement in it. And it came over the
news that there was a tornado right outside of town,
Springfield, Missouri.
There were debris, so we said, hey, this house does not
have a basement, we need to run home. So, we went to our house
with a basement. It was not a tornado right outside of
Springfield. It was a tornado that had struck an EF-5 70 miles
away from Springfield. But there were hospital X-rays that
traveled 70 miles and set down right outside of Springfield, so
that was the power and strength of this tornado.
That was May 22nd, 2011, a devastating EF-5 tornado. And
the tornado killed 161 people, injured over a thousand,
destroyed 7,000 homes. This is in a town of 50,000 people with
a population of more than 50,000, and 1,500 square miles of
tornado. It affected a considerable part of the city.
People did not know how to get around. The first thing the
city did was go out and write street names and names on the
street. People who lived in Joplin, Missouri their whole lives
could not find their way around. There were no trees. There
were no landmarks, nothing left. The tornado tore a path 22
miles long, 6 miles wide, majored EF-4 to EF-5. It resulted in
the greatest death toll from a single tornado in 6 decades, 7th
worse in recorded history. Last night, we had another tornado
in Missouri that killed at least one individual.
I will never forget this catastrophic event, and I am here
today to testify to the subcommittee on how AmeriCorps and the
Corporation for National and Community Services resources
helped my congressional district recover. And I have got to
tell you that this event changed my attitude on a congressman's
role, a senator's role, a President's role, a governor's role
because before I had always thought, when I see a natural
disaster and the President rolls in, or the governor rolls in,
or the senator rolls in, or the congressman, my attitude was I
bet the local people wish the President had not come, and the
senator had not come, and the congressman because they are
right in the middle of the way trying to fix things.
But I was 180 degrees wrong on that. My role as a
congressman was cemented in my mind that week. I spent 8 days,
I missed a full week of votes here in Washington. I stayed
home. I was on the ground for 8 days in a row there in Joplin,
Missouri.
AmeriCorps. As many of you know, the Corporation for
National and Community Service, CNCS, is an independent Federal
agency and one of the largest programs is AmeriCorps. CNCS acts
much like a foundation and is the Nation's largest grant maker,
investing in locally-driven service and volunteering efforts
focused on several high priority areas, including disaster
relief.
CNCS funds more than 3,000 organizations and is constantly
expanding their reach and impact. The result of this investment
are more engaged citizens, greater economic opportunity, less
dependence on government and stronger communities.
National Service has a strong bipartisan history as you
know. National Service is a historically bipartisan,
politically popular, and cost-effective strategy for engaging
citizens, strengthening communities, creating jobs, and uniting
the Nation.
Over the past 8 decades, Presidents from both political
parties have proposed and created with Congress programs that
have enabled Americans to serve local communities for a
significant period of time. National Service helps local
leaders solve community challenges. Through participation in
AmeriCorps, National Service members help communities recover
after natural disasters, just like they did in Joplin,
Missouri.
National Service is extremely cost effective. In 2015, CNCS
generated $1,260,000,000 in outside resources from private
businesses, foundations, and other sources, an amount exceeding
the Federal appropriation. Every Federal dollar invested in
AmeriCorps is matched by more than 2 dollars from donations and
in-kind support from non-CNCS sources, including business and
philanthropy.
For every $1 the Federal government invests in National
Service, there is a nearly $4 return on the investment. Federal
agencies can utilize National Service Corps members to perform
duties that align with the Agency's mission, a low cost, like
FEMA Corps, which is estimated to save $60,000,000 annually.
AmeriCorps members and volunteers were indispensable in the
recovery efforts after the Nation's deadliest tornado in nearly
60 years ripped through Joplin, Missouri in my district. Within
hours after the tornado struck, AmeriCorps members arrived in
Joplin to begin working with local authorities assisting in
every way possible. They established a missing persons hotline,
removed tons of debris, provided homeowner assistance and case
work, operated donation and distribution warehouses,
coordinated donations, and managed a large-scale volunteer
operation.
I would like to share some fast facts about AmeriCorps and
the Joplin tornado. 359 AmeriCorps members served in Joplin.
76,000 hours served by AmeriCorps members. 75,000 volunteers
coordinated through the AmeriCorps Recovery Center. 520,000
volunteer hours reported by AmeriCorps Recovery Center. 2,200
volunteer groups registered. 2,200 completed homeowner
requests. 6,000 damaged or need assessments completed. 20,000
meals served in the disaster area. 732 homes mucked or gutted.
130,000 total volunteers, including volunteers serving through
other groups. 798,000 total volunteer hours, including
volunteers serving through other groups.
In addition to all of this, Joplin city officials reported
that the city received donations, resources, and volunteer
hours totaling $17,700,000. AmeriCorps members were
instrumental in coordinating this influx of volunteers and
donations, which effectively aided the recovery and saved the
city more than $17,700,000 in disaster costs. As you can see,
the impact AmeriCorps members and volunteers had in my
congressional district after this devastating tornado were
indispensable to recovery efforts in Joplin.
Again, I appreciate the committee's continued willingness
to listen to the views of members like myself. I know the full
Appropriations Committee will face some tough decisions on
spending priorities. For this reason, I respectfully ask for
support of continued level funding to AmeriCorps and
Corporation for National and Community Service.
Mr. Cole. I want to thank the gentleman for his testimony,
and just note for the record, as he knows, 2 years later,
almost to the day, my community went through precisely the same
experience that yours did in Joplin. And we got the same
tremendous, splendid help from AmeriCorps that you did. They
deployed dozens of people on the ground who were absolutely
invaluable in the recovery.
So, I appreciate you being here and making that statement.
It is very important to the committee to hear things like that.
Mr. Long. Thank you.
Mr. Cole. Any other comments?
Ms. DeLauro. No.
Mr. Cole. Okay.
Mr. Long. Thank you all.
Mr. Cole. We appreciate it very much.
I am going to recognize my good friend from Maryland just
in the order of people who have arrived. Next up, good to have
you here.
Just so the committee knows, we got the joint host Red
Bear, you know, the new splendid book on Eisenhower, so a
little plug there.
Mr. Delaney. Thank you again for that, Mr. Chairman.
Mr. Cole. And someday you guys need to look at Mr.
Delaney's bill and my bill on social security so we can fix
that problem, too. It is a very bipartisan approach that I
think would be well advised for the Administration and Congress
to pick up and move along.
But with that, it is good to have my friend here. He is
recognized for 5 minutes for whatever remarks he cares to make.
[The statement of the Hon. Billy Long follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. JOHN DELANEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MARYLAND
Mr. Delaney. Thank you, my good friend from Oklahoma and
the chairman of this committee, and I want to also thank the
ranking member. And I want to applaud the whole committee for
doing a members' day like this. I am not sure what other
committees do such a thing, but under the category of someone
who always seeks best practices, this is obviously a best
practice that every committee should pursue.
I come here today to speak about the topic of basic
research in general and funding for the NIH in particular. I
think everyone knows that NIH is really a singular institution.
There is nothing quite like it in the United States, and, quite
frankly, there is nothing quite like it in the world. And it is
very important to my State, the State of Maryland, and it is
very important to my district. But it really is very important
for the country and the world for that matter.
And our country faces very serious and significant issues
as it relates to public health, human health, and disease. And
while we have made significant progress across the last several
decades, I think much of that progress would fall under the
category of incremental progress, and we have not really been
able to make the transformative progress we really need to do
against some of these conditions, such as cancer, Alzheimer's,
autism, the opioid addiction crisis, terrible crisis in this
country, and so many rare diseases that go unnoticed, although
the President did point one out yesterday, and I thought that
was a high point of his remarks.
And we are at a unique moment in time if you think about
the opportunities to really make transformative progress
against these conditions because several positive things are
converging in the scientific community right now. Computing
power, big data, technologies that have emerged from the Human
Genome Project really position the research community to be
probably in the best position they have been in a long period
of time to really make some of those transformative gains that
we need to make.
Unfortunately, the private sector, which makes very
important investments in research, is somewhat constrained
right now because what has happened in corporate America,
driven by the dynamics of a market-based system, which I am not
drawing any judgments against, but it has clearly encouraged
corporate America to have a much shorter time horizon as it
relates to the investments that they make.
So, if you think about it in the context of a time when it
has never been better to make investments because of the
technologies that are available, yet the private sector in many
ways is in the worse position to make investments than they
have ever been. It feels to me like this is an opportune time
for the government to really increase its investment in basic
research, which is what I am encouraging us to do here today.
And the good news is we have an institution that has a
remarkable track record, not only in terms of the scientific
discovery that they make, and that is really their role. They
really take scientific discovery and they translate it into
human health, and public health, and disease solutions. So, we
have an institution that has an unbelievable track record in
doing this both in terms of improving the lives of the people
who are affected by these conditions, but also in terms of
producing actionable research that has really transformed our
economy.
In fact, if you look back over 50 years of data, the number
one investment the United States government has made in terms
of anything that is material in terms of our budget, the best
investment has been the investment in basic research. It has an
economic multiplier of almost 3 to 1, and that is only counting
the direct investment.
So, not only is investment in research the humane thing to
do, the moral thing to do, the thing it will do that will
change the lives of so many people who are affected by these
diseases and their families and their communities, but it also
makes good bottom line sense for the country. If we actually
scored this differently, if we scored it dynamically, I think
it would clearly be the conservative thing to do because to the
extent you can make investments that save money down the line,
those are generally viewed as prudent, fiscally conservative,
and smart things to do.
So, again, I want to thank the chairman for giving me this
opportunity, the ranking member. I want to thank the whole
committee for giving members the chance to talk about things
they care about. Again, NIH is very important.
I think we are at a unique moment in time when you think
about externalities that have contributed to a dynamic where
research can probably have the highest return on scientific
discovery and investment in our lifetimes. And I think we will
miss this golden opportunity to really make not the incremental
progress, not the small steps that so many fabulous
researchers, and investigators, and physicians, and scientists
have made across the last 10 years based on what has been
available to them, but to really make transformative progress,
move the ball far down the field. And it could really transform
our society and economy in many ways.
So, that is what I wanted to chat with you here today
about, and I appreciate again, Mr. Chairman, you giving me this
opportunity. And, again, I applaud the committee for creating
these chances for members.
Mr. Cole. Well, first of all, we appreciate the testimony.
And in full, you know, full disclosure, we want to give
Chairman Frelinghuysen credit here because he is the one that
mandated that we do this in every subcommittee, and I think it
is an excellent suggestion on his part, and we benefit from it.
You are preaching to the choir on NIH here, but it is a
sermon we like to hear over and over and over again. This
committee for 3 years in a row on a bipartisan basis has made
regular visits out to the NIH. Last year we had the largest
increase in funding for NIH in a dozen years. That sounds like
a big deal, but we have been flat funded basically. So, we are
just catching up. We also had the largest increase in
Alzheimer's funding ever, and very much agree with you. I mean,
we are spending $170,000,000,000-odd a year taking care of
Alzheimer's patients. And if we could either cure or just slow
down----
Mr. Delaney. Yes.
Mr. Cole [continuing]. That disease, we could save billions
of dollars, and obviously, much more importantly, improve
millions of lives. So, it is something this committee takes
seriously.
If we can get the 2017 bill out, the good news is that we
will have another substantial increase for NIH. And I want to
compliment, frankly, my good friend, Roy Blunt, in the Senate
and Patty Murray, his ranking member, because they have worked
hand-in-hand with us on that, and been a leader. So, it has
been an area of bipartisan cooperation.
And, believe me, my friend's points are well made, and
agreed with on a bipartisan basis in this committee.
Mr. Delaney. Thank you, Mr. Chairman.
Ms. DeLauro. Thank you very much, Mr. Chairman. And to my
colleague, this committee has had a history on a bipartisan
way, several years under the chairmanship of John Porter we
doubled the amount of money for the NIH. As the chairman
pointed out, subsequently we have seen, you know, that those
numbers decreased, but there was a substantial $2,000,000,000
increase in 2015.
But so that you do know, and, you know, your comments are
appropriate that we are still $7,500,000,000 below where we
were in 2010. And that means those discoveries, those young
researchers that you are speaking about may not have an
opportunity, and we are very mindful of that on this committee.
And advocacy from people like yourself and others will help us
to close that gap. But as importantly, to get a larger
allocation for the subcommittee that is one-third of the non-
defense discretionary budget in this country.
Thank you.
Mr. Delaney. Great. Thank you again.
Mr. Cole. Thank you. I see my good friend from New Jersey
is here, so Mr. MacArthur, you are recognized. It is great to
have you here to appear before this committee. And look forward
to your testimony.
The gentleman is recognized for 5 minutes for whatever
remarks he cares to make.
---------- --
--------
Wednesday, March 1, 2017.
WITNESS
HON. THOMAS MACARTHUR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW JERSEY
Mr. MacArthur. Thank you, Mr. Chairman. Well, thank you
again, Mr. Chairman. I am here today as the co-chairman of the
bipartisan Heroin Task Force, and I appreciate the opportunity
to testify today.
I am here basically to strongly urge the subcommittee to
remember and to take to heart the dire urgency of our heroin
and opioid epidemic. It is claiming 33,000 American lives a
year. We have taken important steps in authorizing funding in
the Comprehensive Addiction and Recovery Act, CARA, and in 21st
Century Cures.
I have seen, as I am sure some of you have, this epidemic
up close and personal. In my county, Ocean County, New Jersey,
and New Jersey has a death rate from overdose 3 times the
national average, and my home county is the epicenter in my
State. We are losing somebody from an overdose every 43 hours
in my county. My constituents are losing friends, loved ones,
colleagues. I have lost people that I know as well, and perhaps
you have as well.
The damage that this crisis causing is no respecter of
geography, demographic differences, age, race, ethnicity. It
does not discriminate.
As the co-chairman of the bipartisan Heroin Task Force, I
am very grateful for the work that has already been done to
address the heroin and opioid epidemic. With the passage of
CARA and 21st Century Cures, we took great steps forward to
help our communities. Both of these landmark pieces of
legislation authorized funding to combat the epidemic, and I am
grateful that we recognize the extreme importance of these
appropriations by including both funding for CARA and 21st
Century Cures as budget anomalies in both continuing
resolutions last year.
Let me talk about CARA just for a moment. It authorized
funding for numerous grant programs, including helping States
purchase opioid reversal drugs, like Narcan; helping States
train pharmacists in how to dispense opioid reversal drugs;
helping States improve their substance monitoring programs;
helping States train their first responders in how to
administer opioid overdose reversal drugs; helping States,
local governments, nonprofits, Indian tribes, any group and
area that has a high rate of heroin or opioid abuse expand
their evidence-based treatment and intervention activities,
including medication assisted treatment, or MAT, services.
CARA helped recovery community organizations to develop and
expand their services. It helped States treat pregnant and
postpartum women who suffer substance abuse disorders. It
helped education efforts, drug monitoring programs. I could go
on. CARA funded and supported a lot of State and local programs
that help with prevention, treatment, and recovery. And I am
grateful again for the work that we have done.
I would add as an aside that last year in our continuing
resolution, we included $37,000,000 for CARA grant programs.
$20,000,000 went to the Department of Justice, and $17,000,000
went to HHS, specifically the Substance Abuse and Mental Health
Services Administration, or SAMHSA. That $17,000,000 has yet to
get out to the communities, and I would encourage us to urge
HHS to get past the bureaucratic delays and get these funds.
They have already been appropriated. Let us get them out to the
communities where they can do some good.
And then, 21st Century Cures also authorized a billion
dollars over 2017 and 2018 to support State responses to the
opioid abuse crisis. Congress appropriated $500,000,000 of that
in our CR budget anomaly last year. It is critically important
that we appropriate the remaining $500,000,000 of those funds.
144,000,000 Americans die every day to a drug overdose. Of
those, 91 are dying from heroin or opioid-related overdose.
Drug abuse is killing our communities, and heroin and opioid
abuse is driving the problem.
On behalf of myself, my bipartisan Heroin Task Force, co-
chair, Representative Annie Kuster from New Hampshire, which
has also been hit hard by this, on behalf of the over 80
members of the Heroin Task Force, and on behalf of all of the
communities we represent, I beg you to consider fully funding
the Comprehensive Addiction and Recovery Act and the 21st
Century Cures Act as it relates to opioid and heroin addiction
in 2018.
And with that, I thank you for the opportunity to be here
and to make my case. It is really a disturbing problem,
Chairman, and we all need to do everything we can.
Mr. Cole. Well, I thank the gentleman for his testimony.
And, again, this is an area that this subcommittee does have
tremendous interest in, tremendous bipartisan support for. We
were happy to do what we did last year. We would prefer a
regular order bill where we could do more.
And as my good friend from Connecticut has pointed out,
appropriately and correctly, a lot of what we can do will
depend on what kind of allocation we get. It really is that
simple. We cover a wide range here, and, you know, if we have a
very substantial cut in our top line funding in some of the
things that I know that my friend would want to do and this
committee would want to do, it simply will not be possible. So,
we are waiting to see how that all plays out.
But your advocacy makes a big difference, and we are
delighted you came to make the case that, again, the committee
very much on a bipartisan basis agrees with.
Ms. DeLauro. Thank you very much, Mr. Chairman, and thank
you for your testimony. Earlier today, Congressman Fitzpatrick
testified on this issue. And I would just let you know that as
the chair has said, there are several initiatives in the 2017
Labor, HHS budget that deal with mental health services through
SAMHSA and the CDC, and taking a look at assisting and trying
to deal with monitoring programs with regard to opioids.
I would be remiss if I did not mention this as I did to
him. You need to take a hard look at what may be coming down
the pike with regard to Medicaid and Medicaid expansion. There
has been a lot of discussion about that. Sometimes people do
not realize all that that includes, including the opportunity
for people who are in these circumstances with regard to
addiction to be able to get treatment. That is the way they are
getting their healthcare.
And if that is curtailed or cut back, that we may see
larger numbers of people who are untreated. Certainly that is
not the direction you want to go or this committee wants to go
in. And so, I would just mention that to you as well.
Thank you very much.
Mr. MacArthur. I share your concern on Medicaid.
Ms. DeLauro. Thank you.
Mr. Cole. The chair recognizes for her first words in an
official session here, a new member of our committee, the
gentlelady from Massachusetts.
Ms. Clark. Thank you, Mr. Chairman. And I just want to
again thank you for your advocacy and your work in picking up
the leadership role on the caucus that none of us want to
belong to, but we are forced to because this is really is an
equal opportunity killer. And we will work with you in any way
we can to help open up treatment and help our neighbors and
community members who are dying in our States.
And I also associate myself with the comments of the
ranking member because Medicaid really is a lifeline for many
of the families who are struggling.
So, thank you again for coming today. Thank you, Mr.
Chairman.
Mr. Cole. With that, the gentleman is excused. Thank you
again for your testimony.
The gentlelady from Texas. It is wonderful to have our good
friend here, so we look forward to Ms. Jackson Lee's testimony.
The gentlelady is recognized for 5 minutes for whatever
comments she cares to make to the committee.
[The statement of the Hon. Thomas MacArthur follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. SHEILA JACKSON LEE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS
Ms. Jackson Lee. Mr. Chairman, thank you. To the ranking
member, thank you. To all of the members, thank you very much.
The evidence of your selection on this committee already
indicates your understanding and your passion on these issues.
I am a fan of Hubert Humphrey, so just allow me to just
offer his words: ``The moral test of government is how it
treats those who are in the dawn of life, the children, those
who are in the twilight of life, the aged, and those in the
shadows of life, the sick, the needy, and the handicapped.''
And you have both the joy and pain, having a committee that
deals with all of these issues.
I want to highlight this morning educational opportunity,
health research, and security, economic opportunity, and
workforce safety, and other programs that I think that are very
important.
Over the past 48 hours, the President has met with
historically black colleges. I would imagine that they speak
for a number of colleges that serve underserved individuals.
And so, the whole idea of having access to year-round Pell
Grants, it really meets people where they are in life. And so,
I would hope that, as you said, Chairman Cole, it is all in the
allotment, the appropriation that you get as a committee, but
if you would consider that. And as I understand it, the
President indicated his interest in year-round Pell Grants.
$370,000,000 for strengthening historically black and
universities and PBIs, which, again, deals with opportunity,
preparing the workforce for the 21st century. There are a
hundred historically black colleges in America, and we believe
each of them has found its niche of serving people who are
really first time generation students, along with, coming from
Texas, Hispanic-serving institutions as well.
And I know your both affection and advocacy for Native
Americans. We need to be able to include them in the
educational stairs. Certainly in Texas, they have a strong
presence there as well.
I support the robust funding for the Child Care Development
Block Grant, and I thank you, Congresswoman DeLauro, for your
advocacy on those issues. The Federal TRIO Program, which is
low-income and serves about 760,000.
I would like to emphasize $500,000,000 for individuals for
disabilities. I am a strong advocate of community colleges and
those with disabilities are able to access those colleges.
$25,000,000 for minority centers of excellence, provide health
professional schools, magnet school assistance. It is the only
Federal education grant program designed to reduce racial and
socioeconomic segregation. There have been some questions about
magnet programs, but I have seen them bring people of disparate
economic backgrounds together.
$25,000,000 for construction for historically black
colleges, a huge commitment. My daughter is on the Harris
County School Board, and there was a rumor that they were going
to get rid of Head Start. And they had more people in their
board meeting than they have ever seen in their life of service
fighting to not eliminate Head Start. And so, I vigorously
support it. It is 50 years old plus, but there is such evidence
that it works. $10,000,000,000 for Head Start.
$5,100,000,000 for community health centers. I want to
focus a little bit on that. I cannot tell you how effective
federally qualified health community centers are. I do not
think I have enough in my congressional district or the State
of Texas, and I remember President Bush and I, G.W., had a
debate about how many were in Texas. And I think he found out
that I won, that at that time of his leadership that we had not
grown them. They are growing now, and they really do serve in
the capacity that we want them to do.
The National Institutes of Health, there is no doubt about
medical research. Last evening, the President spoke about rare
disease. $34,500,000,000 I think with the Cures Act and a
number of other advocacies that we need to get in front of the
healthcare system. I just heard a report this morning of more
people born in the 1990s have the rectal cancer, and we are
seeing new diseases every day. So, I would appreciate your
consideration.
$302,000,000 for the National Institute of Minority Health
and Health Disparities. One of the first amendments I offered
as a new member of Congress was around the health disparities
and that agency or that area in HHS. $35,000,000 to fully
support the CDC's Childhood Lead Poisoning, which still exists.
$10,000,000 for the Violence Against Women.
I am a strong supporter for school-based health clinics.
They have sort of, some that go up, some go down. Some schools
are doing it, some are not, but 2 million students nationwide
are being helped. And there are many students in schools where
school nurses can detect conditions at home, and also school-
based clinics can help the family have access to healthcare.
$50,000,000 for the Homeless Veterans Reintegration
Program. That is one of the major areas on behalf of veterans
is particularly homelessness. Once they get housing, how do
they get reintegrated, their health conditions, and all that is
important.
$327,000,000 for family planning, of course, in compliance
with the law, 4,200 health centers nationwide. Provides
important screening for cancer, HIV, family planning services.
On the economic opportunity and workforce, I am a big
supporter, and I hope that you will consider it. It has been
around for 50 years, but that is the Job Corps Program. I think
more of our youth need to be in the Job Corps Program as
opposed to the gang corps program. And Job Corps, of course, is
people go away, 126 campuses in 50 States. I do not know
whether we have an ability to expand them, but I would just say
that they generate more than it might seem in terms of cost.
If you can get people out of their element and give them
skills, this $1,700,000,000. It is an amazing reformation to
get a city kid and put him in a rural area, and focus on
changing their life, their skills, and what their commitment.
Certainly, the support of the Nursing Workforce. I support
$600,000,000 for OSHA. We are known for a safe workplace.
Finally, let me offer the support for services for
survivors of torture, $400,000,000 for our trafficking victims,
and $2,000,000 for refugee and entrant assistance.
So, I close with two points, and that is on the refugee
resettlement. We have been dealing with refugees in my
community for decades. Let me be very frank. In the course of
all of the discourse and hysteria, my State is not
participating, but my agencies are, and they are settling
Syrian refugees. They are settling over the years Vietnamese
refugees. They are settling refugees from Somalia. They are
settling refugees from China to a certain extent, people who
are fleeing persecution, but the point is that they are very
important.
And I hear the gavel, so the last point is, Mr. Chairman,
is this is not the authorization committee, but I am absolutely
opposed to the repeal of the Affordable Care Act, and I think
there will be a greater burden on the Appropriations, HHS
Subcommittee if the Affordable Care Act is repealed and we are
without the safety net for the American people.
And I thank you for your indulgence. I yield back.
Mr. Cole. No, I thank the gentlelady as usual. Her
testimony is thoughtful and comprehensive, and we are very
grateful to have it.
Ms. DeLauro. Just many, many thanks. The programs you
mentioned have a profound effect on people's lives, and that is
what this committee does, so we are mindful. Thank you very
much.
Mr. Cole. Appreciate it.
Ms. Jackson Lee. Thank you.
Mr. Cole. The gentlelady from New Hampshire is now
recognized. It is good to have you here, Ms. Kuster. You are
recognized for 5 minutes to address whatever concerns or make
whatever remarks you care to make to the subcommittee.
[The statement of the Hon. Sheila Jackson Lee follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. ANN KUSTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
HAMPSHIRE
Ms. Kuster. Thank you so much, Mr. Chair. I appreciate it.
And to our ranking member and all my colleagues, thank you so
much. Now, it is an honor to be before all of you, and my
remarks will be succinct.
I am here to request full funding of all addiction programs
across all agencies within Department of Health and Human
Services. And I also ask the committee to ensure full funding
for both the Comprehensive Addiction and Recovery Act and the
21st Cures Act.
I am the founder and co-chair, and I think you just heard
from my co-chair, Mr. MacArthur, of the very successful
bipartisan Heroin Task Force. We represent more than 85 members
of Congress, both sides of the aisle, and we are very proud of
the work that we did last year passing 18 bills in the House.
And the funding in CARA, thank you for all your work on that,
and 21st Century Cures. But these programs are incredibly
important to address really what has become a nationwide crisis
around substance use disorder, and particularly opiate abuse
and misuse.
In 2015, the Centers for Disease Control and Prevention
found that over 50,000 people died due to drug overdoses, and
the primary driver is opiates and heroin use. This crisis is
not showing any signs of slowing down. In fact, the National
Institute on Drug Abuse reports that opiate misuse is on the
rise, and at a rate that overshadows all over controlled
substances.
The epidemic transcends all demographics at this point and
all regions of the country, not just in urban areas by any
means, but rural communities, red States, blue States. I
frequently say to my colleagues, the heroin does not choose the
R's and D's, and neither can we.
My largely rural home State of New Hampshire has become a
new focal point for the crisis. In 2015, the Granite State
suffered the second most overdoses per capita in the Nation for
opioid overdoses. And I include in that a new drug synthetic
opioid known as Fentanyl that has given a new cause for
concern.
Our Task Force has a hearing just two weeks ago on
synthetic drugs, and Fentanyl is known for extreme potency, 10
times or more stronger than heroin, and we are suffering the
largest loss of life per capita.
We have become truly a trafficking corridor, and it has led
to many tragic deaths, including my constituent, Carl
Messinger, who was a young man, just finished college. He
actually had been to treatment and was in recovery, but sadly
he got a chest cold and took a medication that contained the
opiate codeine. And unbeknownst to him or his family, that
triggered drug seeking behavior, and he ended up within 24
hours reaching out, calling a dealer. His mother, who is with
us in D.C.--she was my guest last night--found him on the
bathroom floor from a death due to overdose of 100 percent
Fentanyl.
So, we have a bill that is unrelated to your committee, but
called Carl's Law about labeling. But I do bring that up just
because the funding in the Comprehensive Addiction and Recovery
Act and the 21st Century Cures Act is so important. Education,
prevention, expanding, treatment, long-term recovery, and, of
course, the law enforcement.
In CARA, Congress authorized dozens of new grant programs
designed specifically to address this crisis. And in total,
CARA authorized $181,000,000 in annual funding. In the Cures
Act, Congress authorized an unprecedented $1,000,000,000 over 2
years, dedicated specifically to combating this public health
crisis. And the money would be given straight to the States and
provided flexibility to design programs best suited for the
response in their community.
And I am pleased to note last week the Granite State
submitted its request for over $3,000,000 in funding allocated
to New Hampshire for 2017, but 2018 will need to be
appropriated by this committee. Of course, CARA and Cures
represent only a part of the coordinated response.
Organizations like SAMHSA, the CDC, the FDA, and certainly NIH
are critical for addressing the crisis.
And while opiates are the most clear and present danger
surround substance abuse today, it is certainly not the only
danger, and, more importantly, it does not occur in a vacuum.
And I want to point out that the testimony to our task force
from the CDC is that 4 out of every 5 heroin users has a co-
occurring mental health disorder. And so, I also urge you to
fully fund mental health treatment as well.
And I thank you, and I have ended up on time. [Laughter.]
Ms. Kuster. Thank you so much. I appreciate it.
Mr. Cole. Exactly. Thank you for your very good work in
this area on a bipartisan basis and your advocacy. Again, in a
contentious Congress, this has made us united, Republicans and
Democrats, as you appropriately pointed out in your testimony.
And this committee will continue to work on a bipartisan to try
and address those concerns which all of us share, and all of us
have in our respective districts. It is just a tragedy
unfolding before us, and it would be a tragedy if the committee
did not have the means to do what needs to be done in this
area.
Ms. Kuster. Thank you very much.
Ms. DeLauro. Many, many, many thanks for your advocacy, and
they are not just words. You are what they call operational.
You make things happen, which is outstanding. And I to say to
you, and I know Congresswoman Clark is on the Task Force and
others, you need to help us with calling for what is a bigger
allocation for this subcommittee----
Ms. Kuster. Yes.
Ms. DeLauro [continuing]. So that we can address some of
the incredibly serious needs that you have outlined, including
mental health services and other kinds of services that we are
addressing.
Ms. Kuster. And this notion of long-term recovery. And I
was pleased last night that the President mentioned treatment.
He and all the other candidates got quite an education in our
first in the Nation primary. I do not think they expected to
come to New Hampshire and talk about heroin, but they learned a
lot.
And I just had a meeting this week with the interim
director of the Office of Drug Policy. I am hoping we will get
the director soon. So, we will continue to work with you.
Thank you very much for your kind words. Thank you.
Mr. Cole. We appreciate it very much. Next, my good friend
from New York, Mr. Faso, is recognized. It is great to have you
here. And the gentleman is recognized for 5 minutes for
whatever comments he cares to make.
[The statement of the Hon. Ann Kuster follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. JOHN FASO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK
Mr. Faso. Thank you, Mr. Chairman, and Ranking Member
DeLauro, and members of the committee. It is a pleasure to be
here.
I have prepared remarks, which I will just ask to be
submitted for the record.
And I would just like to, recognizing the committee's time
constraints, so I would just like to summarize my remarks.
And this relates to the Low Income Home Energy Assistance
Program funded through the Department of HHS. As you know, this
program was created in 1991. It is really important in the
northeast, in areas of our State in New York, and I know many
other areas of the northeast. Rural do not have access to lower
cost natural gas. Home heating oil, and propane, or wood are
often the primary sources of heating one's home.
A recent of LIHEAP, the Low Income Home Energy Assistance
Program, participants showed that these households are the most
at risk in the Nation. According to HHS, more than 70 percent
of LIHEAP recipient households contained at least one
vulnerable person. This includes seniors over 60, children
under 5, or individuals with disabilities. Many of these
recipients have a history of just simply not being able to pay
their home energy needs in the northeast for the winter. Nearly
50 percent skipped or paid less their entire bill, and almost
40 percent received a notice to disconnect or to discontinue
their electricity or their home heating fuel.
Two years ago, we had a ferocious winter. It was very cold
in the northeast. And it has been a bitter winter, although our
ski areas perhaps are not as happy as that in the last winter
certainly. This winter they had a little bitter of a reprieve
on that.
But home heating oil is an extraordinarily expensive form
of energy. It was nearly $4 a gallon 2 years ago. I know
because I pay it myself at our home in Kinderhook. And it is
vitally important the committee take cognizance of this
important program for our low-income residents, and seniors,
and disabled people throughout the Nation, but particularly in
the northeast.
So, I would appreciate the committee's consideration and
serious thought about the funding level for LIHEAP, and make
sure that we have a level that is adequate and sufficient to
meet the needs for folks in the winter.
And with that, I will conclude my testimony and give you an
extra 2 minutes and 30 seconds, Mr. Chairman.
Mr. Cole. Well, of course, we will take advantage of your
generosity. And just I want to first begin by thanking the
gentleman for his testimony. It is an important issue. And,
frankly, the prior Administration actually reduced LIHEAP
funding in its budget request by about $3 to $400,000,000. We
restored that in our bill on this committee and added
$100,000,000 beyond it because, again, on a bipartisan basis we
do think it is a serious problem. And so, the gentleman's
advocacy is certainly noted and appreciated.
And at the end of the day, number one, help us get the 2017
bill out. If we do, you will like what is in it, and then from
this perspective certainly. And then beyond that, you know,
what we can do next year ultimately depends on what our
allocation is going to be.
Ms. DeLauro. Thank you so much, and thank you for telling
the tale of the northeast. We both have experienced the case
where we are looking at particularly older Americans, seniors,
where they do not heat their food to the temperature that is
healthy. They are putting towels in front of doors in order to
keep the cold out. And LIHEAP is so critically important, and
it really is a lifeline for so many.
So, I appreciate your advocacy. If we can get the 2017 bill
out, we want you to get to your friends on the Senate side and
tell them to accede to the House number, which is a higher
number. [Laughter.]
So, you have got your job cut out for you there, and help
us get a higher allocation for 2018, my friend.
Mr. Faso. Well, Ms. DeLauro, I have only been here 2
months, but I will do my best. [Laughter.]
Ms. DeLauro. All right. Hear, hear. Thank you.
Mr. Cole. And just for the record, I spent 2 years in the
gentlelady's district going to college actually, so it is cold
in the north----
Ms. DeLauro. It is cold.
Mr. Cole. It is cold. We thank the gentleman.
Mr. Faso. Thank you so much.
Mr. Cole. Thank you.
Ms. DeLauro. Wisconsin, too.
Mr. Cole. With that, I see my good friend from Pennsylvania
has arrived, and we want to recognize him for whatever
testimony he cares to give. And on his way, I want to thank him
for his extraordinary advocacy for the mentally ill and what he
was able to accomplish in the Cures bill, and making sure that
his legislation was merged into that, and this country begin to
address a problem that, frankly, at the Federal level we have
long ignored.
So, my friend is recognized for 5 minutes for whatever
testimony he cares to give.
[The statement of the Hon. John Faso follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
PENNSYLVANIA
Mr. Murphy. Well, you have laid out the problem that is
before us, and we still have far to go.
We should all remember that innocence was shattered on that
cold day in Connecticut just over 4 years ago in Sandy Hook
Elementary School in Connecticut. But out of that darkness, the
darkest of tragedies, has arisen a glimmer of hope as we did
pass that landmark mental health reform signed into law on
December 13th, 2016 as part of the 21st Cures Act.
As I wrote in the Pittsburgh Post Gazette back in 2012
following the Newtown tragedy, I said, ``The common factor in
too many mass tragedies is an underlying mental illness. The
lessons for Americans from a horrifying tragedy is that we had
better take off our blinders and deal with such illnesses, or
we are sure to face the same problem again. It is not only
what's in a person's hands that make their acts violent, it is
what is in their mind.''
Against that backdrop, in 2013 the Committee on Energy and
Commerce, spearheaded by the Subcommittee on Oversight and
Investigation, which I chair, began a national conversation,
jump starting the process which resulted in the enactment of
the first comprehensive reforms in 50 years. Our multi-year
bipartisan, bicameral effort revealed a broken system, and
informed our legislative response to overhaul the antiquated
patchwork of ineffective programs.
Mental illness is no longer a subject whispered in hushed
tones in the shadowy silence, but while more remains,
tremendous strides have been made to help families and
individuals in mental health crisis.
At the end of November 2016, while bill language was still
being finalized, I made the observation that these problems are
too large and the work so dear that we will not solve the mess
of our mental health system with one bill. But the final bill
came a long way. We did not get everything we wanted, but we
wanted everything we got. And it was my pledge to the patients
and families in mental health crisis now that I will not stop
fighting to deliver treatment before tragedy.
And that is why I am here this morning to ask your help to
translate the historic promises we made to families in mental
crisis and to commitments and actions that will improve and
save lives. The top changes are the improvements it makes to
leadership and accountability at the Federal level for mental
health and substance abuse programs being with the new office
of the assistant secretary of mental health and substance abuse
disorders. It is a position that I hope and trust will be
filled by a doctor, psychiatrist, or a psychologist.
Now, helping families in mental crisis, the act authorizes
a number of existing programs. They will be at SAMHSA or in
HHS. These include support for the Assisted Outpatient
Treatment Grant Programs, which is a court-ordered treatment
for individuals with serious mental illness who meet very
strict legal criteria.
Often they are too ill to recognize they need medical care,
but assuring timely and effective treatment, we have found that
while protecting their right, we also find it reduces re-
arrests, and re-hospitalizations, and homelessness, and other
negative outcomes by over 70 percent. Studies have shown how
court-ordered treatment in the community reduces taxpayer costs
and cuts them in half. With that in mind, the legislation
increases and extends an existing authorization for a grant
program at AOT at SAMHSA for some $20,000,000. It is essential
we do this.
In addressing pressing concerns there is a shortage of
qualified mental health professionals. Half the counties in
this country have no psychiatrists, no psychologists, no
clinical social worker. And where there is no help, there is no
hope. This bill also strengthens the mental and behavioral
network workforce through education and training grants,
clarification on eligibility for loan repayment programs, and
codification of the Secretary's Minority Fellowship Program.
And it acts decisively to strengthen programs supporting
mental health and substance abuse disorders, care for women,
children and adolescents; an area that is a priority for all of
us, including the White House.
Now, these are a few of the programs I mentioned. I will
hand things over to you, Mr. Chairman, for this. But I do want
to say that I understand budgets are tight, but with over
350,000 people dying in this country last year related to
mental health problems, that is more people than have died in
the combined U.S. combat roles in World War I, Vietnam, Korea,
Bosnia, Desert Storm, Iraq, and Afghanistan. This investment of
money will save lives.
And with that, I will take any questions.
Mr. Cole. Well, I want to again thank my good friend for
his distinguished advocacy here. You have pushed Congress in
the right direction in this area probably more than anybody
that has served here in half a century. So, believe me, we take
what you have to say very seriously.
And if the means are available, we are going to do what we
can to address the problem. And we will hopefully begin to do
in a sustained, ongoing fashion because it is a problem that
obviously you do not solve in a year. And we are going to have,
you know, problems in perpetuity, but my friend has made a
really good start in focusing congressional interest on this,
and, frankly, educating the rest of us about this with your own
distinguished background in psychology.
So, I thank my friend.
Mr. Murphy. I wish my parents would have been here to hear
you say that. Thank you. [Laughter.]
Ms. DeLauro. I very much thank my colleague, who many years
ago when I had a stress fracture of my hip, at the time of
right after 9/11, we were told to evacuate the Capitol, who,
Mr. Chairman, along with another member, literally picked me up
and got me out of the building and on to where we needed to be.
That having happened 3 times, I figure the next time I was just
going to stay and take my chances. [Laughter.]
But thank you. Thank you for your great work and your
commitment to this effort. Over and over again the issue
becomes there are not enough services, not enough treatment
centers, not enough places for people to get the kind of
treatment that they need. And it is particular true for
children, in my view. And this is a public health crisis, and
we need to treat it that way.
I would ask your help with regard to advocacy for the
Mental Health Block Grant. And in this case, Mr. Chairman, the
Senate is higher than the House is in this regard, but we know
that this block grant, which is a mainstay for States and the
services that they can provide, is historically below levels
which it has been. And we need to look at that in a way that
prioritizes the resources for the biggest problems that we have
in this Nation. And this is clearly one of the biggest problems
in this Nation.
So, I thank you for your great work and your advocacy.
Mr. Murphy. Thank you. And I will continue in my capacity
and to my commitment to do that. I know I have met with some
governors and told them that outpatient care for the mentally
ill is 20 times cheaper than jail. And so, but I should also
tell you the Energy and Commerce Committee, what we found out
is States are not keeping that data. They simply do not know
what they do not know.
As they do that, I think they will do a better job of this,
and I believe as part of the legislation we need----
Ms. DeLauro. Do we require that?
Mr. Murphy. No. They have got to start collecting data on
individuals to look at their lifetime of the illness costs
because when they go into emergency rooms at $2 or $3,000 a day
versus outpatient care, which is a few thousand a year, a
couple thousand a year, versus jail, which could be $40,000 a
year. That does not even include all the other criminal justice
activities that goes with it, and really turning mental illness
into a criminal justice problem.
It is not a crime to be mentally ill. We make it a crime,
and that is a despicable thing we do in this country. These are
small grants. Like I said, you can reduce arrests and
incarcerations by 70 percent. And this is not to do all of it,
but it is to get States to start that, then I believe they will
discover themselves.
Ms. DeLauro. Well, maybe we can talk about how, you know,
not talking about unfunded mandates on States, et cetera,
because we cannot go down that road. That is always a problem.
But to think about how we might be able to look at collecting
the data then which allows us to make determinations----
Mr. Murphy. Absolutely.
Ms. DeLauro [continuing]. That are beneficial. I would love
to talk with you about it.
Mr. Murphy. I would be happy to work with you on that.
Ms. DeLauro. Thank you.
Mr. Murphy. Thank you.
Mr. Cole. We thank the gentleman for his testimony.
Mr. Murphy. Thank you. I will leave these other materials
here.
Mr. Cole. Thank you very much. And we have our last witness
of the day, Mr. Panetta. Welcome to the committee. You must get
tired of hearing this, but we all admire your father so much
that, you know, we are always going to mention his
distinguished service in this institution before he went on to
serve the country so well as White House chief of staff, and
director of the CIA, and obviously Secretary of Defense. Just
an extraordinary career, and a heavy burden for you, I am sure.
But, you know, what a wonderful mentor and role model you have,
so we are delighted to have you here.
Mr. Panetta. Thank you, Chairman Cole. I appreciate that.
Mr. Cole. And then recognized for 5 minutes for whatever
testimony he cares to give.
[The statement of the Hon. Tim Murphy follows:]
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Wednesday, March 1, 2017.
WITNESS
HON. JIMMY PANETTA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Panetta. Thank you very much, Chairman Cole and Ranking
Member DeLauro. I appreciate those opening comments. It is
something I have grown up with. I am used to it. And I admit
there are some pretty big shoes to fill, but I just look at it
that it makes me a better person and it makes me work harder.
So, thank you.
As you know, I am new to Congress, although I grew up with
my father in this position for 16 years. It is still new to me,
and it quite an honor that I get the chance to sit here in
front of you and provide this testimony. So, thank you for this
opportunity.
I hail from, I grew up on the Central Coast of California,
the 20th Congressional District in California, a place where
you may know John Steinbeck hailed from. He wrote a lot about
that area, and he also wrote in his writings a lot about the
quest for the American Dream.
Today I submit to you that that dream and our values are
best served when we fund our educational programs. That is why
I am here to urge you to provide strong funding for Title I,
Head Start, CAMP and HEP, and the TRIO Programs. In districts
like mine that have large gaps in educational attainment, these
programs are crucial to supporting student development so that
every child may write their own version of that American Dream.
The Head Start Program serves children who would not
otherwise benefit from early education, with hands-on learning
and wraparound services. That is why I respectfully request no
less than the Fiscal Year 2017 funding level for that program.
In my district, Head Start operates seven programs and
serves 2,680 children from infancy to age 5. Head Start's
community engagement in particular lifts families up from
poverty. For example, there is a family in my district that
started their own daycare business after receiving job training
from Head Start. That is an excellent example of leveraging a
modest investment in Head Start into an economic livelihood for
a formerly low-income family.
Before I came to Congress, I was a gang prosecutor in
Monterey County. I saw firsthand the effects of limited access
to a quality education and wraparound services. I saw too many
kids appear in front of me in the courtroom when they should
have stayed and been in the classroom. Title I levels the
disparities between schools that are overwhelmed by a diverse
set of students, like limited proficiency learners.
I represent 47 Title I school districts, and I do firmly
believe that the kids in those kids need to be better served. I
urge this committee to increase Title I funding above the
Fiscal Year 2017 level and to also fund up to $1,000,000,000
for the student support and the academic enrichment grants. I
believe that those two complementary funds target the
underserved schools, and that can ensure an equitable education
for all students.
The Central Coast is also appropriately named, not just the
most beautiful district in the Nation, but also the salad bowl
of the world. There is a lot of agriculture there, and it
relies and directly benefits from seasonal worker populations.
I realize that many of them are from Latin America, but I have
to tell you that their roots are now in our communities. They
work hard. They pay taxes. And, yes, they do it in the pursuit
of the American Dream.
One of my local community colleges, Hartnell College, has
close to 800 students who can be called DREAMers, who fall
under the DACA Program. CAMP HEP and the TRIO Programs serve
those populations with the targeted support that they need,
including one-on-one counseling to ensure at-risk students stay
in school, and the financial aid assistance to ensure high
school students graduate, attend, and succeed in college.
These programs drive economic mobility for these first
general low-income students, as well as their families. That is
why I request no less than the Fiscal Year 2017 funding level
for those critical programs.
And finally, I come before you today to promote student
loan forgiveness through public service. I am the grandson of
Italian immigrants, and we learned that the American Dream is
to give your children a better life. We were always told in my
family, though, because we were allowed to live the reality of
that dream, that we darn well better give back to the country
and community that gave us so much.
That sentiment is why I am in front of you today. I believe
that firmly. And I believe that young people want to live up to
that ideal and to serve as well, yet I believe that they are
hindered by the cost of their own education, including an
enormous student loan debt. That is why I would like to see the
expansion of student loan forgiveness through public service,
so I urge the committee to strengthen and expand the public
service programs that fall under that jurisdiction.
As members of Congress, all of us strive to improve the
wellbeing of our constituents and, of course, our country.
Education is the incubator of American innovation, prosperity,
and economic quality. Education builds a foundation of success
for our future generations. All of the programs I have
referenced are crucial not only to my district, but to our
country because all of the programs helps our children and our
families achieve the American Dream.
Thank you very much.
Mr. Cole. I want to thank the gentleman for his testimony.
I do know some of your areas because I read your dad's book,
Worthy Fights. It is actually one of the best one of these
things that there is to read. And so, I know a little bit about
your roots and your community through that.
And I want to thank you for your advocacy here for these
programs. Frankly, you know, the prior Administration put an
emphasis on early childhood. We could not always match every
dollar, but we increased every year. And particularly where
early Head Start was concerned, I think they broke some new
ground that--the research is pretty clear on this--that needed
to be broken. And I think at that level we matched them dollar
for dollar or pretty close. I know we did at least last year.
The TRIO Program, I share your admiration for. This
committee actually has gone well above the prior Administration
and the Senate both last year, and if we can get that 2017 bill
out, we will again at some level. I have seen the same thing. I
represent a district that has these same kind of challenges in
terms of a lot of first generation kids that nobody has ever
gone to college before, so things like GEAR UP and things like
TRIO that prepare them so that if they get the opportunity, and
obviously if they are in the TRIO Program, they have the
opportunity, they go ahead and succeed because they need a
level of support and mentorship, frankly, that with the best
will in the world, the most supportive family. If nobody has
ever gone to college before knowing exactly how to prepare to
get there and exactly what you need to succeed there is, you
know, terra incognita for a lot of our young people.
So, these are great programs. These are things this
committee believes in very strongly on a bipartisan basis, and
we look forward to working with you to try and do them. And,
you know, again, what we can do, and I am going to say this in
my closing remarks and then allow my good friend to say
whatever she cares to, really does depend on the allocation
that we get. And we are still in a little bit of suspense about
that. We will be for a while.
But, again, if we get a good allocation, then a lot of the
concerns that my friend has expressed in the programs that he
has championed are programs that you will find bipartisan
support for on this committee. But, you know, that will be the
big issue for us. We will live within the allocation we have,
but, you know, higher is better. It is a little bit easier for
us to make this.
You know, we try to prioritize appropriately on this
committee, and we try to do it in a bipartisan way. But, you
know, again, these are tough decisions sometimes we have
competing goods out there. We do not think we have a lot of bad
programs to fund. We just think we have competing needs and a
limited amount of resources.
But, you know, I thank my friend for being here.
Mr. Panetta. Thank you.
Mr. Cole. I want to recognize my good friend, the ranking
member for whatever remarks she cares to make in closing the
committee hearing.
Ms. DeLauro. Thank you very, very much. It is really a
delight to have before the subcommittee.
I want to thank you for your eloquence. We share a common
heritage, and I can recall vividly visiting my mother, and I
did not realize the method to her madness until I was an adult
when she worked in the old sweatshops as a garment worker in
the City of New Haven. She had me go up to see her and what it
was about, and she would admonish me and say, get an education
so that you do not have to do this.
Those words ring in my head every day as I know that they
do with you and with your family background. And it is so true
of so many families of our ethnic heritage and others.
And the chairman is right. This has been a committee that
has been a strong supporter of Title I, of TRIO, of GEAR UP,
all of these efforts. And I think we both fought with or at
least had discussions with the prior Secretary of Education,
and the role of early childhood education, and how we ought to
spend substantial amounts of money on early childhood
education.
I would just say this to you, and we mentioned this
earlier, and the chairman did as well. If we are going to be
looking at a $54,000,000,000 increase in defense, and I come
from a defense dependent State, I say this, that that means
that this subcommittee, which is about one-third of non-defense
discretionary spending. So, after defense, we are the committee
with the largest portfolio.
That means we are looking at about $18,000,000,000 in a cut
if that were to occur. That just would be truly devastating. We
could not sustain the needs of the programs that are under our
jurisdiction.
So, I think we have to look very, very carefully at our
budgets in terms of our values and our priorities, and
education, in my view, has to be the highest priority that we
are engaged in, in a commitment because it is the great
equalizer. It really does not focus on your background, your
income, your religion, your political party. It is about your
God-given talent. That is what it is about.
And I think we have to look very carefully at the benefits
of the budget and largesse of the budget and where those
dollars are going, and education should not be short changed.
So, as the chairman pointed, we look for your advocacy when
we are talking about what the share of the Labor, HHS
Subcommittee should receive in terms of an allocation in order
to meet the needs, so many of which you have outlined here this
morning.
So, thank you so much for being here. I appreciate it.
Mr. Cole. Will the gentlelady yield for just one quick
comment?
Ms. DeLauro. Yeah, be happy to.
Mr. Cole. I hate to hand you more ammunition, but, you
know, you talk about defense and non-defense----
Ms. DeLauro. I will use it wisely.
Mr. Cole. I know you will. Actually, that is why I am
handing the clip over to you. But, you know, it is not like we
are going to cut veterans or homeland, so actually the share
that would fall on this committee would be greater probably
than even my friend has suggested.
And, you know, I say again, we will live within our
allocation. We will do our job with what we have. But, yeah,
you cannot balance the budget on the back of non-defense
discretionary, and veteran-related, and homeland. There is just
not enough money there. We could take every single dime of all
the other subcommittees, and you would still be running. We are
really talking about roughly a $400,000,000,000 pot of money
here. It is a lot of money, but you could eliminate it all, and
you would still be running deficits of about $200,000,000,000 a
year. So, we are going to have to look to other ways, in my
view.
But, again, governing is about making choices, and choices
are made, we will live within those choices. But I want to tell
my friend that I appreciate her advocacy. We do not always
agree on everything, but we agree more than most people around
here realize. And I appreciate the passion with which she
approaches her job and the manner in which she represents the
interests of the people that this committee is really important
to because they are in many, many cases the most vulnerable
people, the most needy people amongst us. And my friend's
passion and concern is genuine and well placed.
Ms. DeLauro. Thank you very much.
Mr. Cole. With that, we close the hearing.
Mr. Panetta. Thank you.
Mr. Cole. Thank you.
[The statement of the Hon. Jimmy Panetta and Members of
Congress follow:]
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TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS
----------
Wednesday, March 8, 2017.
CONNECTICUT CHILDREN'S MEDICAL CENTER
WITNESS
JAMES E. SHMERLING, PRESIDENT AND CEO, CONNECTICUT CHILDREN'S MEDICAL
CENTER
Mr. Cole [presiding]. Good morning. It is my pleasure to
welcome everyone--thank you--to the Subcommittee on Labor,
Health, Human Services, and Education for a very special
hearing. This is our public witness day, and it provides an
opportunity for members of the public to come before this panel
and draw our attention to particular issues of importance to
them. I always look forward to hearing from our public
witnesses as we learn as much about the challenges facing our
people and what this subcommittee can do to help solve them.
Before we begin, I want to remind everyone that we need to
strictly adhere to the 5-minute rule so that we will be able to
keep closely the schedule and hear from everyone before votes
are called. For our witnesses a 5-minute minute block will
count down on the microphone box in front of you. When you have
one-minute remaining, the light will turn yellow and you should
begin to wrap up your testimony at that point. Remember that
your full written statement will appear in the hearing record.
And just for purposes of the committee, this will obviously
not be a question and answer and dialogue, although at the end
of each witness I will certainly allow anybody that wants to to
make a remark or ask a quick question. But let us try and move
along just for the convenience of all the folks who have come a
long way to be with us and to offer testimony.
And with that, I would like to turn to our ranking member,
who has laryngitis today, so you guys be kind.
Ms. DeLauro. Thank you. Thank you, Mr. Chairman. This is
really a delight to have this public witness hearing this year,
express my gratitude as well to all of the witnesses. And thank
you for taking the time to speak to us, but for all the work
that you do on behalf of American families. And we are eager to
hear from all of you, so I will be brief and I apologize for my
voice. Nineteen witnesses, all aspects of the committee's
jurisdiction: education, healthcare, programs that benefit
everyone from infants to seniors, universities, STEM education,
and much more.
The Labor HHS bill is called the people's bill. The reason
for that is because it is about providing constituencies and
people with opportunities to be able to get ahead. And they are
the programs that directly impact the lives of Americans. So, I
say thank you to you.
And I just want to make a point, that the range of programs
here are so important, but you are all tireless in your
advocacy on these issues, and we thank you for that.
The hearing that we had last week, both the chairman and I
mentioned that we have got the potential for a $54,000,000,000
cut to non-defense discretionary spending. This would have a
profound effect on the programs under the portfolio of Labor,
Health, Education, and Human Services, because Labor HHS is
one-third of non-defense discretionary spending, so that could
potentially be a cut of about $18,000,000,000.
The chairman said last week, and I agree with him and I
know he has been saying this, is that we cannot afford to
balance the budget on the back of non-defense discretionary
efforts. So, I think you will explain why you believe that the
programs that you are espousing or the efforts that you are
espousing are worthy and why we should be reinvesting urgently
in your priorities.
So, I very, very much look forward to hearing your
testimony this morning. Many thanks.
Mr. Cole. I thank the gentlelady, and with apologies ahead
of time I may well mispronounce names. Feel free to correct me.
We have as our first public witness, is it Shermie?
Mr. Shmerling. Shmerling.
Mr. Cole. Shmerling, okay. James Shmerling, the president
and chief executive officer of the Connecticut Children's
Medical Center. Sir, you are recognized for 5 minutes to offer
whatever remarks you care to the committee.
Mr. Shmerling. Thank you. Chairman Kohl, Ranking Member
DeLauro, and members of the subcommittee, thank you for the
opportunity to testify in support of the Children's Hospital
Graduate Medical Education Program, or CHGME.
I am Jim Shmerling, president and CEO of Connecticut
Children's Medical Center in Hartford, Connecticut. On behalf
of Connecticut Children's and the Children's Hospital
Association, I respectfully request that the subcommittee
provide $300,000,000 for the CHGME Program in Fiscal Year 2018.
A robust pediatric workforce is essential to ensuring that
all children can access high-quality medical care. CHGME
supports this goal by providing funding for the training of
pediatric providers at independent children's hospitals. Much
as Medicare supports training and teaching hospitals that
primarily serve adults, CHGME benefits children across the
Nation by supporting the training of doctors who go on to care
for children living in every State.
Since the program's beginning, CHGME has enjoyed strong
bipartisan support in Congress under both Republican and
Democratic leadership. For Fiscal Year 2016, Congress provided
$295,000,000 for CHGME, the program's first funding increase
since Fiscal Year 2010. For Fiscal Year 2017, both the House
and Senate Labor Health and Human Service Appropriations
Subcommittees recommended $300,000,000 in funding for CHGME.
Furthermore, bipartisan legislation reauthorizing CHGME
through Fiscal Year 2018 was enacted in 2014, demonstrating the
high level of ongoing support among lawmakers for the program.
Children's hospitals are extremely grateful for the strong
commitment to the health of America's children.
Congress created CHGME in 1999 because it recognized that
the absence of dedicated CHGME funding for freestanding
children's teaching hospitals created gaps in training of
pediatric providers, potentially threatening children's access
to care. At that time, independent children's hospitals, like
Connecticut Children's, were effectively left out of the
Federal GME support provided through Medicare because we treat
children, not the elderly.
Since 1999, the CHGME Program has had a tremendous impact.
Although the 58 hospitals that currently receive CHGME funding
compromise only 1 percent of all hospitals, they train half of
all pediatric residents, more 7,000 annually, including 44
percent of all general pediatricians and 57 percent of all
pediatric specialists.
To provide an example of the impact from my own hospital,
Connecticut Children's is the academic home for the Department
of Pediatrics at the University of Connecticut School of
Medicine, and we serve as the principal training site for the
university's pediatric residency program, the pediatric
fellowship programs, and medical student pediatric education.
We have 63 pediatric residents at any given time. They are
engaged in learning onsite and in the Greater Hartford area.
CHGME funding supports the provision of their curriculum
under the expertise of a highly-qualified faculty with a
diverse population of patients and health needs. In 2016, 126
of our residency and fellowship program graduates were
practicing in Connecticut. While many of their colleagues have
moved on to practice all over the country, America's children
rely on the training provided by hospitals like ours that
receive CHGME funds.
CHGME has allowed children's hospitals to develop training
programs in highly-specialized disciplines that target the
unique needs of children. Some examples include pediatric
surgical oncology, radiation oncology, pediatric pathology, and
bone marrow transplantation. Only a small number of
institutions provide training in those areas. CHGME is vital to
maintaining and expanding programs focused on those sub-
specialties.
However, while much has been achieved in strengthening the
pediatric workforce, still more remains to be done. The
national population of children continues to increase, and the
number of children with complex medical conditions is growing
at a faster rate than the overall child population, requiring
an increasing number of specialty care providers. Nationwide,
serious pediatric workforce shortages persist, most acutely
among pediatric sub-specialties. Localized shortages of
pediatric primary care providers also continue particularly in
certain rural areas. Strengthening funding for CHGME will help
all children and their families, including those with rare and
complex conditions.
Even with CHGME, children's hospitals incur significant
additional costs in support of their teaching missions. Without
CHGME, hospitals will be at risk of having to cut back training
experience in patient care services. This would negatively
impact children's access to care and the future of the
pediatric workforce.
We recognize that the current budget climate is
extraordinarily challenging and Congress has a responsibility
to carefully consider the Nation's spending priorities.
However, continued needs of the pediatric workforce, in
particular with respect to specialty shortages, point to the
necessity of strengthening funding for the program. Now is the
time to take a step forward in pediatric medicine to ensure our
children have access to health services they need.
On behalf of Connecticut Children's Medical Center, the
Children's Hospital Association, and the children's families we
serve, thank you for your past support for this critical
program. We request we respectfully request that the
subcommittee continue its bipartisan support of children's
health and CHGME at its authorized funding level of
$300,000,000 in the Fiscal Year 2018 Labor Health and Human
Services Appropriations Bill. Thank you.
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Mr. Cole. Thank you. That is pretty good, only 12 seconds
over. [Laughter.]
You set the bar high for everybody else. We thank you very
much for your testimony.
Mr. Shmerling. Thank you.
Mr. Cole. We will hear from our next witness, please.
Welcome.
We have, is it Erin, is it Shiffring?
Ms. Siefring. Siefring.
Mr. Cole. Siefring. Thank you very much. Again, forgive me
for butchering names, to testify on behalf of the Computer
Science Education Coalition. So, the gentlelady is recognized
for 5 minutes, and we would be delighted to receive your
testimony.
----------
Wednesday, March 8, 2017.
COMPUTER SCIENCE EDUCATION COALITION
WITNESS
ERIN SIEFRING, CHAIR, COMPUTER SCIENCE EDUCATION COALITION
Ms. Siefring. Thank you. Chairman Cole and Ranking Member
DeLauro, I am Erin Siefring, chair of the Computer Science
Education Coalition. Thank you for the opportunity to testify
before you and all the members of the subcommittee today on a
critical issue that greatly impacts the economic
competitiveness and national security of the United States, K
through 12 computer science education.
Our country is falling far behind in this area with real
impacts to our homeland security and our economic base.
Prioritizing funding at the Department of Education for
computer science education by the subcommittee can address this
problem and give Americans the tools they need to protect our
country and grow the economy.
Computer science is a foundational skill for 21st century
jobs. This skill is in high demand in our military and
throughout the private sector. However, the United States is
failing to take the necessary steps to equip our current and
future workforce with the computer science skills needed to
fill these positions to remain globally competitive.
The crisis in computer science funding extends to defending
the homeland against cyber threats. Cybersecurity attacks
against the United States are on the rise. But as the Center
for Strategic and International Studies explains, there are
only about a thousand security specialists in the United States
who have the specialized skills to operate effectively in
cyberspace. However, the United States needs about 10,000 to
30,000 such individuals.
This shortage decreases our country's ability to defend
itself in a time where a single bad actor with an advanced
knowledge of computers, networks, and cybersecurity can do
immense damage to the United States just by hitting the enter
key on their laptop. To reverse this trend and bolster our
national security, an investment in computer science education
is needed now. Failure to make this investment in a timely
manner will only compound the problem going forward and
increase the national security risk to the United States.
Already less than half of K through 12 classrooms in the
United States teach computer science. Yet according to
Code.org, computer science-based employment will make up two-
thirds of all projected new jobs in the science, technology,
engineering, and mathematics, or STEM, fields. The United
States K through 12 education system simply is not graduating
students with the computer science skills needed to meet the
current or growing demand for computer science jobs.
Today's students need to be learning about algorithms, how
to make an app, code, or do robotics. These are the critical
thinking skills today's students need to become the innovators
and cyber warriors of tomorrow. These skills are needed
throughout the economy. There are currently over 50,000 good
paying computing jobs unfilled across the country. They are
unfilled in large part because we are not making the investment
necessary in computer science education. Indeed, computing jobs
are the number one source of new wages in the United State.
To fill these job openings in recent years, American
companies have often had to import talent from across the
globe. In fact, the majority of high-skilled immigration is for
computer scientists, and almost 60 percent of skilled worker
visas granted were for computer science operations. Our failure
to invest in our future has forced U.S. businesses to recruit
overseas for positions that could be filled domestically.
To address this issue, last year America's leading CEOs,
educators, and nonprofit leaders united with 28 Republican and
Democrat governors, including then Governor Mike Pence, to send
a letter to Congress asking for funding to provide every
student in every school the opportunity to learn computer
science. The signatories included Fortune 100 CEOs across
multiple industries, which illustrates how many sectors of our
economy are impacted by the current skills gap in computer
science.
State and private efforts are vital, but not enough on
their own to fix the skills gap in computer science. We are
lagging behind other nations that have prioritized the teaching
of this critical subject. A Federal investment is necessary to
amplify and accelerate the work already being done around this
issue in the United States.
Since the Computer Science Education launched a year ago
today, there has been significant bipartisan support for
computer science education in both the House and the Senate.
The coalition appreciates the robust demonstration of
bipartisan leadership.
An investment in computer science education by this
subcommittee will be an investment in our country's future. The
Computer Science Coalition urges the members of this
subcommittee and Congress to prioritize an investment in
computer science education to help defend the homeland and keep
our economy strong.
Thank you for your time and attention to this critical
matter.
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Mr. Cole. You might care to comment quickly on this or ask
a question.
Mr. Fleischmann. Thank you, Mr. Chairman, and Ms.
Siefring. I appreciate this, and to my Democratic colleagues as
well. This is an area where we've had tremendous bipartisan
cooperation and support.
Just about a week and a half ago in Chattanooga, my
hometown, we went over to the Howard High School. The members
of your coalition were there. I went to an elementary school
where second graders actually taught me how to code. It is
really incredible the enthusiasm that the students have.
Employers need this. The students need it, and I am going to be
working with Ms. Lee, my colleague from the other side of the
aisle--she is not here yet today--from Oakland.
One of the other areas, too, that I would respectfully
suggest we all work together is in the inner city because we
have a lot of underserved schools in the inner city. I was just
so impressed again at Howard High School.
But thank you for your efforts. I am going to continue to
be an advocate and look forward to the bipartisan cooperation
on this key issue. And I thank the chairman for his continued
support as well.
Mr. Cole. Certainly well-behaved second graders could
teach this Congress a great deal actually. [Laughter.]
Ms. DeLauro. Mr. Chairman, just for the record----
Mr. Cole. Certainly.
Ms. DeLauro [continuing]. Ms. Lee is at the MilCon hearing
this morning, so otherwise she would be here joining Mr.
Fleischmann. Thank you.
Mr. Cole. Absolutely. We want to thank you for your
testimony, and we will certainly take it under consideration.
And next witness, please.
Welcome. Good to have you here, you bet. Ms. Pyper Davis,
the executive director of Educare, Washington, D.C. The
gentlelady is recognized for 5 minutes to deliver remarks.
----------
Wednesday, March 8, 2017.
EDUCARE WASHINGTON, D.C.
WITNESS
PYPER DAVIS, EXECUTIVE DIRECTOR, EDUCARE WASHINGTON, D.C.
Ms. Davis. Thank you. Chairman Cole, Ranking Member
DeLauro, and members of the subcommittee, thank you for the
opportunity to testify today on the critical need for all
children, especially low-income children, to have access to
affordable, high-quality early learning and care.
My name is Pyper Davis, and I am the executive director of
Educare of Washington, D.C., a nonprofit just across the
Anacostia River serving children and families living in poverty
with a high-quality early childhood education program.
For context about me, I grew up in Michigan, earned an
M.B.A. from Harvard Business School, and worked in the private
sector for 15 years both on Wall Street and in the television
industry. In 2003, I decided to leave the private sector and
harness my business experience to work on improving education
outcomes for low-income children. This is what brings me here
today.
Educare D.C. opened nearly 5 years ago and offers full-day,
year-round, high-quality early childhood education services to
children as young as 6 weeks old through age 5. The ounce of
prevention, which includes the First Five Years Fund, opened
the first Educare in Chicago in 2000. Today Educare D.C. is a
part of a 21-school high-quality research-based network across
the country, a network which includes two Educare programs in
your home State of Oklahoma, Chairman Cole, one in Wisconsin,
and one in California as well.
All Educare schools braid together Federal Head Start and
child care grants with State, local, and philanthropic dollars
to create true public/private partnerships. Private funds
account for about one-third of Educare D.C.'s funding, and the
other two-thirds come from public funding streams that I have
mentioned.
Of the 160 children at Educare D.C., 15 percent experienced
homelessness in the past year, and 73 percent live in a family
with reported annual income of $9,000 or less. We know these
risk factors can derail a child's physical, social, emotional
and cognitive development. Without intervention, these factors
often lead to a lack of school readiness and are linked to
illiteracy, teen pregnancy, high dropout rates, and
unemployment later in life.
According to Nobel Laureate economist, James Heckman, every
dollar invested in high-quality early learning for
disadvantaged children provides a 13 percent yearly return on
investment. As brain science and multiple longitudinal studies
show, investing these dollars in our youngest children is smart
policy and smart economics.
I would like to share just one example of success from the
programs that you support. A few years ago, one of our teen
moms was encouraged to enroll her infant in Educare so that she
could finish high school. Last June, not only did mom complete
high school, but she graduated as valedictorian, and she is now
a full-time college student. Mom told me that she was able to
focus on her own education because she knew that her daughter
was safe, healthy, and learning at Educare. This is just one
real illustration of that 13 percent return on investment, with
two generations, both child and parent transformed.
Educare is able to serve these families because of the
funding we receive, especially from the Federal government.
More and more Federal investments in high-quality early
childhood education programs are being matched by governors and
legislatures in blue and red States alike. But States and
private investors cannot do it alone. This is hard work, and
only by having nationally coordinated efforts and national
talent helping to lead can we continue to make progress.
We appreciate the bipartisan support that you have shown
these programs, and we hope that will continue as you wrap up
Fiscal Year 2017 and work on Fiscal Year 2018, because access
to high quality early learning programs can close the
achievement gaps. I am requesting that the subcommittee
continue to increase support for early childhood programs for
Fiscal Year 2018.
Specifically, it took bipartisan support to reauthorize the
Child Care Development Block Grant, and it will take bipartisan
efforts to fund the reforms that the new law requires.
Implementing this law without reducing slots for children will
require an increase of $1,200,000,000, and I ask that you
increase the appropriation in line with this need.
Head Start and Early Head Start are only able to serve 41
percent of eligible 3- and 4-year-olds and 4 percent of
eligible infants and toddlers. I urge the subcommittee to
support funding for Head Start above current levels to ensure
that the new outcomes-driven Head Start performance standards
are implemented with fidelity.
Additionally, I request that the subcommittee help put
Early Head Start on a path to reach 10 percent of eligible
children over 4 years, starting with an increase of
$500,000,000 in Fiscal Year 2018 to expand Early Head Start and
Early Head Start child care partnerships.
The Every Student Succeeds Act authorizes a new preschool
development grant program within HHS. I request that you
provide sufficient funding to allow for new preschool
development grant competition. These grants will improve
collaboration and coordination at the State and local level.
Parts B and C of the IDEA make early intervention services
available to children with disabilities. Thanks to Part B,
753,000 children with disabilities were able to access
necessary services in Fiscal Year 2015. I request that you
consider increase in funding for both Part B and Part C to
ensure that all young children with disabilities have access to
vital services.
Access to high-quality early childhood education helps low-
income children enter kindergarten ready to learn, and offers
entire families greater opportunities and a pathway out of
poverty.
Thank you for the opportunity to testify today. I extend an
open invitation to all of you to visit Educare D.C., which is
just down the road. Thank you.
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Mr. Cole [continuing]. Testimony, and I loved the
testimony. And my one suggestion would be get one of those
Educare centers open someplace in Connecticut, you know. It
would probably help us a lot. [Laughter.]
Ms. Davis. Happy to. Happy to.
Ms. DeLauro. My further suggestion, Mr. Chairman, is given
the prospect both the chairman and I know is very real of
serious cuts, make your voices heard loud and clear. This is an
institution that responds, especially to something that is
successful. But please come to Connecticut.
Ms. Davis. Thank you.
Mr. Cole. The gentlelady, as always, is correct.
If we could, we will have our next witness, please.
Welcome. Good to have you here. Mr. Ted Cornelius, the
executive director of the Tennessee State Alliance of YMCAs.
You are recognized for 5 minutes for whatever testimony you
care to offer.
----------
Wednesday, March 8, 2017.
TENNESSEE STATE ALLIANCE OF YMCAS
WITNESS
TED CORNELIUS, EXECUTIVE DIRECTOR, TENNESSEE STATE ALLIANCE OF YMCAS
Mr. Cornelius. Thank you. So, thank you, Chairman Cole and
Ranking Member Fleischmann of Tennessee, and the rest of the
members of the subcommittee. I am very thankful for the
opportunity to talk with you today about some of the exciting
work that the YMCA is doing.
I am the executive director of the Tennessee State Alliance
of YMCAs. And on behalf of the 2,700 YMCAs across the country,
I am here to talk about some of the work that the Tennessee
YMCAs and also YMCAs across the country are doing to prevent
diabetes and also save millions of lives, and also save
billions of dollars.
So, I am specifically here to ask for $25,000,000 to go
towards the Center for Disease Control and Prevention's
National Diabetes Prevention Program. We have supported the
priority of Congress placing on the National Institutes of
Health to be able to look at investing in medical
breakthroughs. And I am here to tell you about an investment
that the National Institute of Health made in 1996. That was a
clinical research trial, and it actually aimed at delaying the
onset of type 2 diabetes through weight loss and also the
treatment with the drug Metformin. I am here to tell you that
the outcomes were extremely successful. We showed 58 percent
lost 5 to 7 percent weight loss, and over 60 years of age
reduced by 71 percent.
So immediately, Secretary Tommy Thompson called off the
trial and urged the Nation to scale the program immediately.
The barrier was that it was expensive, and so we were not able
to do that. But fast forward a couple of years, the academic
institution that was involved in the trial came to the YMCA. We
looked at Indianapolis and the local Y's, and we were able to
identify delivering this at a 10 to 20 percent reduction, some
of the cost.
So, with that then the United Health Group in 2010 were
able to start paying for the program for Y's to scale. So then,
fast forward 7 years later, we are now in 1,700 community
sites, 47 States. 30 private insurers are covering the program.
10 State employee programs are now covering it as well. And I
am here to say that we are extremely confident in this program,
and that it works, and that we operate in a pay for performance
basis, and receive payment only when outcomes are achieved.
So, I just want to emphasize that we could not do this
without the partnership with the Centers for Disease Control.
It is a public/private partnership that is absolutely critical
to this work.
So, we urge Congress to continue to support the CDC's
National Diabetes Prevention Program so more of the community
organizations, like the YMCA, can go ahead and continue to
scale this extremely important program. We do understand that
there are challenging budget times right now. We are urging you
to invest in taxpayer dollars where you get the most return.
And I can tell you this has been a proven program. So
again, we are asking for support for $25,000,000 into the CDC,
and here is why. We are spending $322,000,000,000 annually. In
Tennessee specifically, $6,600,000,000 is being spent on this
disease. And then $1 out of every $3 is being spent on Medicare
spending for the care of diabetes.
So, CDC absolutely needs these resources in order to build
capacity with organizations to be able to scale this, to
educate the 86 million that are in a pre-diabetic condition who
sometimes do not even know that they are in a pre-diabetic
condition. And then also to run the CDC Recognition Program.
Fast forward to 2012, the YMCA of the USA had a CMMI
Innovation Grant Award with CMS and demonstrated cost savings
of $2,650 per Medicare patient as far as a return on
investment, and marks the first time in history that a
community intervention produced a cost savings from a
prevention service. Then fast forward to November 2016, CMS
finalized a rule enabling scale of program for Medicare with
pre-diabetes, which really includes half of all seniors
nationwide. So, this benefit will be available starting January
1 of 2018.
So, for the many community organizations like the Y and the
CDC Recognition is essential and another reason why funding the
Center for Disease Control's Diabetes Prevention Program is so
critically important. So, we urge Congress to support a robust
investment in diabetes, in chronic disease prevention at the
CDC. Thank you.
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Mr. Cole. Thank you for your testimony. I understand my
friend from California, Ms. Roybal-Allard, has a question or
comment.
Ms. Roybal-Allard. Okay. Thank you very much Mr. Chairman.
Mr. Cornelius, thank you for highlighting a program that is
prioritizing real proven prevention efforts in the community.
You did not mention that in your testimony, but I recall
that the National Diabetes Prevention Program was originally
funded by the Prevention and Public Health Fund, and the NDPP
was given its own line item within the CDC. Since the
Prevention and Public Health now back fills approximately 12
percent of the CDC budget, what would be the impact for the
NDPP if that fund is eliminated as part of repealing the ACA?
Mr. Cornelius. Thank you for your question. It would be a
great impact. So, it would be about 40 percent to the CDC's
budget, which is extreme. And I will tell you, chronic disease
in our country is one of the number one killers of disease,
costs us an extreme amount of money. That is why I would say it
is absolutely critical that we continue to keep having
appropriations and this investment into the Centers for Disease
Control's budget in order for us to continue to keep scaling
this program. Thank you for your question.
Mr. Cole. I thank the gentleman for his testimony, and we
will certainly take it under advisement. Thank you again.
Mr. Cornelius. Thank you.
Mr. Cole. If we could, next witness. Welcome, sir. It is
good to have you here.
Mr. McPherson. Yes, sir. Nice to be here.
Mr. Cole. Good.
Mr. McPherson. Mr. Chairman----
Mr. Cole. Peter McPherson, president of the Association of
Public and Land Grant Universities. The gentleman is recognized
for 5 minutes.
----------
Wednesday, March 8, 2017.
ASSOCIATION OF PUBLIC AND LAND-GRANT UNIVERSITIES
WITNESS
M. PETER MCPHERSON, PRESIDENT, ASSOCIATION OF PUBLIC AND LAND-GRANT
UNIVERSITIES
Mr. McPherson. Good to be here. Thank you.
My association is a group of 194 universities systems
around the country representing the universities that are in
every one of your States. They educate over 5 million students,
$40,000,000,000 research. It is a large public and the land
grants around the country.
I am here to talk about Pell and about NIH funding.
A few comments about college and Pell. Since the Great
Recession, almost all the jobs, the new jobs, were taken by
people that had some college, and some 72 percent of those new
jobs went to people with a 4-year degree. It is clear that
these are very important degrees to get for our population.
A few comments about Pell, of course. The low-income
minority students in our country simply are not getting the
degrees anywhere near the percent that higher-income people
are. We certainly applaud getting something like 85 percent or
more of the top quintile of income in this country get college
degrees. But at the lowest quintile, it is like 8 percent, and
it gradually moves up. Pell is just so key to make this work.
When you look at who gets the jobs, we cannot have income
people not have some post-secondary education, and those 4-year
degrees are very important for so many people. Certainly, they
are competent to get them when you look at income distribution.
Well, I look at Oklahoma, for example, where Oklahoma,
Oklahoma State, and Langston have 12,000 Pell students.
University of Connecticut has 4,000. And I could around the
room and give the figures for every one of the States here.
They are doing impressive work these are public institutions,
and we need to support them. We need to have this discretionary
mandatory minimum. I hope you can keep it, it if not increase
it, realizing that certainly is difficult in these days.
We think that the yea-round Pell is just central. I know
every one of you understand year-round Pell, and I really think
you would love to do it. I appreciate the chairman when it was
included in the markup last year for up 2017. You said, well,
maybe it can be worked out in the final agreement. We hope so.
And I appreciate the ongoing interest here.
The NIH funding is, of course, very critical, and you have
all been so supportive of it. We hope that there can be a
$2,000,000,000 increase for 2017. And, of course, we think that
you need to continue to build us up. I am struck by how often I
say to my wife, you know, when some friend is ill or has a
problem, you know, they would not have been able to deal with
that a few years ago. When you think about it, it is really
true. We just sometimes forget how much medical technology has
advanced, and so much of that is NIH founded.
When we think about our economy, we have all had the
benefits of this information technology that has changed our
lives, but also changed the economy of this country. There are
many people who think that the information technology is going
to build and expand upon the biotech nature of this. I believe
that in 15 years or so, the investment here is just not only
key for the health of every one of us actually, but for the
growth of this economy.
So, Mr. Chairman, the ranking minority, friends, members, I
hope these are helpful to you.
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Mr. Cole. I appreciate the comments very much, and I know
you will help us. If we got the 2017 bill out, I think you
would be very happy with some of your requests.
Mr. McPherson. We will work hard. Our members are
intensely interested, as you know. They are happy to chat with
you and whatever could be helpful. And, more important, members
beyond this table I am sure.
Ms. DeLauro. Thank you very much for your testimony. You
are spot on. And I would say that, as Connecticut being one of
the oldest land grant colleges in the country. So, thanks for
all you do.
Mr. McPherson. Well, I know it well.
Ms. DeLauro. Thank you.
Mr. McPherson. I have been up there. It is a strong
institution. Susan is doing nice job.
Ms. DeLauro. Right. Thank you for your support of Pell. It
makes a difference. Thank you.
Mr. McPherson. You bet.
Mr. Cole. Thank you very much for your testimony.
Our next witness? I believe, Mr. Kingston? Chairman
Kingston, are you here? Why do you not come on up to the dais
as well?
Mr. Kingston. Thank you, Mr. Chairman.
Mr. Cole. Well, as many of you here know, Mr. Kingston is
the former chairman of this committee, my good friend and
colleague. To all of us here, it is a particular pleasure to
have you back, and I know you have got a witness that you would
like to speak as well. But I wanted to recognize you for the
wonderful work you did here and what a terrific friend you
were, and allow you to make any remarks you care to make as you
introduce the next witness.
Mr. Kingston. Well, thank the chairman for that, and the
ranking member, and my friends on the committee. I wanted to
say I did have an opportunity to tour the room right after you
renovated it, and I looked up and I saw the Native American
artwork with the Italian Renaissance influence. [Laughter.]
And I said to the clerk, I said, Ms. Ross, this is
obviously the work of Mr. Cole and Ms. DeLauro. And she said,
no, it came from the U.S. Capitol. [Laughter.]
But I thought, you know what? I am still right because it
still was Italian Renaissance and Native American influence
that helped shape that. But the room looks great, and I am glad
to be here.
As you know, Job Corps has 50,000 grads a year. 80 percent
of them find work. It is focused on really disadvantaged and
sometimes troubled youth, dropouts, and so forth, and many
times homeless people. They have trained 3 million people, and
one of them is here today.
And if the committee will indulge, Thomas Franklin, if you
could just stand up. Let them see what a fine young man you
are. [Laughter.]
And Thomas is on his way to be a railroad clerk and
studying all things transportation, logistics, and railroad.
But the witness who is here today that I am going to
introduce is Susan Fallon. And rather than have somebody from
the Job Corps to tell you how great they are, I thought it
would be more effective to have one of their partners, a
business, Monster, Inc., who works very closely with them in
helping people. And, Ms. Clark, you will recognize where they
are located as your hometown.
And so, our witness is Susan Fallon, and I am going to
introduce her. She is one of the vice presidents of Monster,
Inc. But if the name rings a bell, her father, Bill Fallon, has
been a witness. You know Admiral Fallon has testified before
many of our committees on appropriations in the Department of
Defense for many years.
So, with that, I will yield the floor.
Ms. DeLauro. Mr. Chairman if I might just before the
witness comes, I thought that was you in the back row there,
Jack, and I said maybe I am not, you know, seeing correctly.
But former Congressman Kingston chaired and co-chaired the Ag
Committee, and we did the same with Labor-H. And there are
always the discussion about how people on both sides of the
aisle cannot get along but Jack Kingston I have gotten along
for many, many, many years whether it's on the floor of the
House or serving in these positions.
It is great to see you here this morning, Jack.
Mr. Cole. See, Jack, you make me feel like the second
husband that cannot quite measure up----
[Laughter.]
Ms. DeLauro. We have been through a lot of battles. We
were each chair of the Message Committee in the early, early
days.
Mr. Kingston. We came together over conflict.
Ms. DeLauro. Conflict, right.
Mr. Kingston. We bonded, and we horrified both Democrats
and Republicans with our lasting friendship.
Ms. DeLauro. And now he is the star of stage, screen, and
television. We see him all the time. Thanks, Jack.
Mr. Cole. It is good to----
Mr. Kingston. It is great to be with you.
Mr. Cole. Good to see my friend again. Ms. Fallon, if you
would come up, we would love to have you. That was a very
clever twofer, you know? [Laughter.]
But it is a delight to have you here, and the gentlelady is
recognized for 5 minutes to deliver her testimony.
----------
Wednesday, March 8, 2017.
MONSTER GOVERNMENT SOLUTIONS
WITNESS
SUSAN FALLON, VICE PRESIDENT OF GLOBAL STRATEGY AND BUSINESS
DEVELOPMENT, MONSTER GOVERNMENT SOLUTIONS
Ms. Fallon. Great. Thank you, Mr. Chairman, Ranking Member
DeLauro, members of the Subcommittee for inviting me to
testify.
Monster is headquartered in western Massachusetts, which is
located in the district of your subcommittee colleague,
Congresswoman Katherine Clark. I am thrilled to see our
hometown congresswoman here today. And, of course, thank you,
Chairman Kingston for that kind introduction.
I am honored to have the opportunity to speak to you on
issues that are of critical importance not only to Monster
Government Solutions, but also to millions of employers across
the country. And those are the issues of jobs, our youth, and a
skilled workforce.
According to the U.S. Chamber of Commerce, there are 5.6
million jobs that remain unfilled because employers simply
cannot find workers with the right set of skills. Some
estimates show that this skills gap cost our economy
$160,000,000 annually. These are essentially lost jobs in our
communities that we could easily reclaim through upskilling and
investing in workforce development.
At the same time, there are 5.5 million young Americans
aged 16 to 24 who are out of work and out of school. These
youth are untapped economic assets who could potentially
provide returns of as much as $5,000,000,000,000 dollars to our
communities in terms of wages and activity, as well as a
reduced dependence on taxpayer support. But these young people,
many like Thomas, are not just a statistic. They are our
future.
We at Monster, like the dozens of national employers
participating in the Hundred Thousand Opportunities Initiative,
believe it is a critical priority for our Nation to invest in
these young men and women. Towards that end, last year we
worked with the Job Corps Program to launch an initiative we
call Youth Opportunities 2020.
As you know, Job Corps offers training in more than 100
different high demand occupations in 125 rural and urban
communities nationwide. In Program Year 2015, nearly 80 percent
of students left with an industry-recognized credential. The
result: 86 percent of graduates secured jobs or enrolled in
higher education. The bottom line? Job Corps works.
We have learned that small business trust Job Corps to meet
their talent needs, which is why over 100 local chambers of
commerce, from Connecticut to Oklahoma to Washington, have
signed letters of support for the program. Building on this
interest, Monster worked with Job Corps last year to launch the
Youth Opportunities Portal, which provides students with online
career tools and resources, and employers with the tools to be
matched to thousands of skilled young Americans at no cost.
For example, our data shows that last month in your
district, Mr. Chairman, there were 15,131 job openings
published. Last month in New Haven, Ranking Member DeLauro,
there were more than 22,126 job openings published. Many of
these are middle-skilled jobs that require the technical
skills, industry-recognized certifications and training that
our youth are receiving from the Job Corps Program. These
include transportation and material moving occupations, which
account for more than a quarter of the job postings in the
chairman's district, to nursing and other healthcare related
professions that account for the largest share of postings in
the ranking member's district.
We at Monster are mission driven to expand employment
opportunities for job seekers, and to help employers find the
skills- and work-ready employees they need to grow their
businesses. We urge the subcommittee, which has provided
incredible bipartisan support to Job Corps for more than 50
years, to continue to provide sufficient funding in Fiscal Year
2018, and help as many of these young people and the employers
that need their skills as possible.
Thank you.
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Mr. Cole. The gentlelady from Massachusetts is recognized
for her comments.
Ms. Clark. Thank you, Mr. Chairman, and thank you for
being here today. Mr. Chairman, I am glad you noticed the
twofer approach. That is how we roll in CD-5. [Laughter.]
Ms. Clark. And we are just delighted to be here, and thank
you for making the connections. Creating jobs, allowing people
to have that matched with good employment is the most critical
function we can have. And thank you for your work and being
here today to underline the importance of this line item.
Ms. Fallon. Thank you, Congresswoman.
Mr. Cole. Thank you very much for your testimony.
Ms. Fallon. Thank you, sir.
Mr. Cole. Next witness, and it is good to have my good
friend, Robert Egge, the chief public policy officer for the
Alzheimer's Association. In full disclosure, we have done a lot
of work together. Appreciate his good work. And the gentleman
is recognized for whatever testimony he cares to deliver to the
committee.
---------- --
--------
Wednesday, March 8, 2017.
ALZHEIMER'S ASSOCIATION
WITNESS
ROBERT EGGE, CHIEF PUBLIC POLICY OFFICER, ALZHEIMER'S ASSOCIATION
Mr. Egge. Thank you very much. Good morning, Chairman
Cole, Ranking Member DeLauro, and members of the Subcommittee.
On behalf of the more than 5 million Americans living with
Alzheimer's disease and their 15 million caregivers, thank you
for the opportunity to testify before you today.
I would like to begin by thanking you for the extremely
important leadership the subcommittee demonstrated in
addressing Alzheimer's during the 114th Congress. You were
integral to delivering a much-needed historic increase in
Alzheimer's funding in Fiscal Year 2016. And for Fiscal Year
2017, you completed the work to do so again. On that note, we
ask you to continue to pursue this very important Alzheimer's
research funding over the coming 2 months.
The Alzheimer's community is very grateful for your work.
You have given new hope to Americans that the realities that
define this disease today can and will change in the years
ahead. As you are well aware, however, today the realities that
define this disease remain grim.
Alzheimer's is a terminal disease with no survivors. Recent
failures of high-profile Alzheimer's trials underscore that
Alzheimer's retains the unacceptable distinction of being the
only one of the top 10 causes of death in America without a way
to cure, prevent, or even slow progression. It should be no
surprise then that Alzheimer's has become a top priority of
Americans. In fact, those middle-aged and older identify
Alzheimer's by a significant margin as the disease they fear
most.
Alzheimer's is also very costly. Another regrettable
distinction held by Alzheimer's is that according to the NIH
funded study conducted by Rand economists and published in The
New England Journal of Medicine, Alzheimer's has grown to
become the most expensive disease in America. More than two-
thirds of this cost is paid for by Medicare and Medicaid.
As if all this were not enough to justify an urgent
response, America's Alzheimer's crisis is set to grow much
worse in the years ahead. Because Alzheimer's is predominately
a disease associated with aging and America is predominantly an
aging society, these numbers will skyrocket between now and
2050. By 2050, those with Alzheimer's will as much as triple,
and the associated costs will quadruple to $1,100,000,000,000
per year, unless, that is, we can change the trajectory through
the development of effective treatments and a means of
prevention.
These facts underscore that America urgently needs this
subcommittee's continued decisive leadership. But all these
facts make only half a case. We understand that you not only
must ensure that you direct limited resources to where the
needs are great, but also to where the opportunities are great.
What is more, you need to decide not just whether funds are
warranted, but how much funding is warranted. These are
important and difficult questions to answer. Fortunately, in
the case of Alzheimer's specifically, Congress has put in place
a policy framework that has provided you with this exact
information for Fiscal Year 2018, and we urge you to rely on
it.
In 2011, the bipartisan National Alzheimer's Project Act
became law, requiring the creation of a comprehensive national
Alzheimer's plan. The U.S. Department of Health and Human
Services released this plan in 2012, containing the lead goal
to prevent and effectively treat Alzheimer's by 2025.
Then in 2014, Congress enacted the Alzheimer's
Accountability Act. This Act requires the National Institutes
of Health prepare for Congress and the President an annual
professional judgment budget, sometimes called a bypass budget.
In this bypass budget for Fiscal Year 2018, NIH director,
Francis Collins, has stated that the NIH will require
additional $414,000,0000 in funding to remain on track to
achieve the plan's 2025 goal. The NIH has done excellent work
carefully detailing a plan-based budget to decisively address
this disease. We ask you to fund this plan for the coming
Fiscal Year.
When coupled with the facts about the burden of this
disease that I outlined earlier, we believe that together those
arresting facts and this thorough NIH budget do make for a
complete and compelling case for this subcommittee to stay the
course, a course that has every potential to change the future
of Alzheimer's disease.
In sum, on behalf of the Alzheimer's Association and our
sister organization, the Alzheimer's Impact Movement, we
commend Congress for creating a process that has equipped this
subcommittee in an unusually thorough way to answer the
question of what to provide for Alzheimer's research in Fiscal
Year 2018. Following this process, NIH scientists have
indicated to you that they require an increase of $414,000,0000
in Alzheimer's research funding for the coming year. The
Alzheimer's Association and the Alzheimer's Impact Movement are
pleased to adopt this determination by the NIH as our request
for this subcommittee.
Thank you.
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Mr. Cole. Thank you. I thank the gentleman very much for
his testimony, and reiterate two points that he made that I
suspect my good friend from Connecticut would also agree with.
The first one is we do need to finish up the 2017 bill. And I
am very worried that the temptation when we hit the deadline on
April 28th will be to simply continue a CR. If that happens, we
will lose the opportunity for a significant boost in funding
for NIH in general, Alzheimer's in particular.
So, I know you are working hard on this, and so, I do not
need to urge you to do it, but I want to thank you for doing
it. And this is a really critical thing. We are thinking a lot
about 2018, but we need to literally get the work done because
both the Senate and the House have agreed to prioritize both
the NIH and Alzheimer's funding.
So, if we do not get the 2017 bill and we CR, we will spend
exactly the same amount of money. It just will not go to the
NIH and Alzheimer's. So, this is something we need to work on
together. And, again, I know what my friend has been a tireless
advocate on this as well on her side of the aisle.
The second thing is, the 2018 budget, as my friend would
point out, and I will agree with her again, only happens if we
have, you know, an appropriate allocation level. And, you know,
I am all in favor of the defense buildup. I am not critical of
that at all. I think it needs to happen.
But this is not the place to fund it in my view because,
you know, I did not think it was particularly good policy when
President Obama argued that if defense goes up, domestic has to
go up exactly the same amount. It is just as bad to say if
defense goes up, domestic spending has to go down exactly. We
should evaluate each of them independently in my viewpoint,
sort of break that chain.
But, again, I thank my friend for making a good case not
only for the particular cause, but for the larger case of just
the general allocation this committee receives.
Does my friend from Connecticut care to----
Ms. DeLauro. Well, I think this is an institution that has
a lot of very well-meaning people on both sides of the aisle to
do things, but it really moves when there is external pressure.
I will say this to everybody in the audience. You are the
external pressure.
And, you know, I think Chairman is right. We would do well
if we did 2017. There would be an increase, and then we are
both very concerned about 2018 and what this might mean. And it
would be, to say the least, devastating to your interests and
others here as well.
So, you need to go back to your groups and associations,
people who hear from you.
Mr. Egge. We will do so.
Ms. DeLauro. Thank you.
Mr. Cole. Again, appreciate the gentleman's testimony. And
with that, we will move to the next witness.
Welcome. It is good to have you here.
Mr. Longmire. Good to be here.
Mr. Cole. Mr. Joseph Longmire. He is a student with the
Council for Opportunity in Education, better known around here
as TRIO. There is no cause that has probably been more
bipartisan on this committee than that. We have worked hard on
this program, and we appreciate you very much being here to
testify.
The gentleman is recognized for 5 minutes.
---------- --
--------
Wednesday, March 8, 2017.
COUNCIL FOR OPPORTUNITY IN EDUCATION
WITNESS
JOSEPH LONGMIRE, JR., STUDENT, COUNCIL FOR OPPORTUNITY IN EDUCATION
Mr. Longmire. I want to start by thanking Chairman Cole and
all of the members of the subcommittee for the opportunity to
be here today to discuss TRIO. I would be remiss if I did not
also acknowledge my congresswoman, Representative Martha Roby,
and express my thanks for her support.
I am a witness to the fact that TRIO is making a huge
difference in shaping the future of students like me across the
2nd District of Alabama. TRIO has led so many firsts for me,
including this visit to Washington, D.C., which marks my first
experience flying on an airplane and my first time visiting the
Nation's Capital.
I grew up in Greenville, Alabama as the oldest of four
children ranging from ages 8 to 20. My parents have always
worked extremely hard to provide for my siblings and me. My
father maintains several jobs, including full time as an order
filler at the Walmart Mart Distribution Center, as well as a
barber, mechanic, and handyman. My mother works at a childcare
center. My parents always encourage my siblings and me to
achieve as much education as possible.
Despite their enduring love and support, I had to look
beyond my immediate family for help in pursuing my higher
education goals. This is where TRIO stepped in and became like
another family for me.
In order to save money, I decided to begin my college
career at Lurleen B. Wallace Community College. During my early
days as a student there, I met with the counseling services
provided by the college, but found that I needed more
consistent and personalized support. Thankfully, I stumbled
upon a flyer inviting students to come to an orientation for
the TRIO Student Support Services Program.
I did not realize it at the time, but that first meeting
was my welcome to an educational family that would push me to
excel. My first year in TRIO was amazing. The director, staff,
and fellow students consistently proved to be reliable sources
for help. TRIO's tutoring services were especially critical.
Even though they performed well academically in high school, I
struggled with several of my college courses and, at times,
fear that I would receive failing grades. This was especially
true of my English class. However, because of the academic
assistance provided by TRIO, I not only passed these classes,
but I also earned a few A's along the way.
As my graduation from community college approached, I found
myself frustrated about what I wanted to do next. While I knew
I wanted to be an occupational therapist, I did not know how to
get there. Once again, it was my TRIO family that helped me
find my way. The program director and the staff helped me
navigate the complicated process of transferring to a 4-year
institution. From deciding where to go to waiving my
application fees, they were there every step of the way.
Without their help. I would have found myself among the 72
percentage of low-income first generation community college
students who failed to transfer without additional support.
Nationally, TRIO Student Support Services participants
chance or at a rate that is 46 percent higher. Thanks to the
assistance of the TRIO Program at Lurleen B. Wallace Community
College, last fall I enrolled as a junior at Alabama State
University where I majored in health rehabilitation. The change
to a 4-year institution has been dramatic. Coming into a
situation where I did not know anyone, I felt like a guppy in a
huge ocean of fish.
On my first day of classes, I found the TRIO office, and I
felt like a weight was lifted off my shoulders. I knew that I
had found my life support for the rest of my college career.
Today, the TRIO Program at Alabama State continues to give
me the academic and social support I need in order to succeed.
This support system has been extremely critical for me as I
must juggle both my studies and my finances. In addition to
benefiting from TRIO, I am also a Pell Grant recipient.
However, financial aid alone does not fully meet my needs.
So, my course load as a student, I work 30 hours a week as
an office clerk at Super Foods Grocery Store and as a
merchandiser for a magazine retailer. While my schedule can be
overwhelming at times, I know that these years of struggle and
sacrifice will be worth it. When I graduate, I will be the
first person in my family to earn a bachelor's degree. However,
I know with certainty that I will not be the last.
Because TRIO played such a big role in my college life, I
made sure that my younger brother, who is now a freshman at
Lurleen B. Wallace, also got involved with the TRIO Program on
campus. I can truly say that becoming part of TRIO is one of
the best decisions that I have made while attending college.
I would enthusiastically recommend participation in TRIO to
every college student. It can truly be the difference between
failing or passing classes, dropping out or persevering to see
another semester, succumbing to overwhelming pressures or
learning to thrive amidst adversity.
I hope this subcommittee will do everything possible to
increase funding for TRIO so that more students like me will
have the opportunity to achieve their college dreams.
Thank you again for the opportunity to testify here today.
[Applause.]
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Mr. Cole. We want to thank the gentleman for his testimony,
welcome him to Washington for his first trip up here. I
certainly hope it is not his last. And just make the point,
which I know this committee knows well, but since its
inception, TRIO has produced over 5 million college graduates.
And I would suggest that is one terrific investment for the
United States of America to have made because I can assure you,
those 5 million grads have paid a lot more taxes than we have
ever spent on Trio.
This is a program that has a great return for us. Thank you
for offering such compelling personal testimony for the
difference it has made in your life, and through you and your
family's life. It is a very powerful reinforcement for a very
important program.
Ms. DeLauro. I would just say thank you very, very much,
Joseph. What you do is to provide for us and for everyone here
the veracity that the Federal government has a role in people's
lives, that it can create, help to create opportunity. And that
is why this institution of the United States Congress exists.
And we need to continue to provide opportunity so that we can
have just remarkable young men like yourself, who will work
hard not only for yourself, but for your family as well.
Our congratulations to you, and thank you for being such a
great role model. Thank you.
Mr. Cole. Thank you very much. The gentleman is excused. If
we could have our next witness.
Welcome. Good to have you here.
Ms. Campbell. Thank you. Thank you for----
Mr. Cole. You bet. This is Ms. Autumn Campbell, a former
caregiver, speaking on behalf of the Older Americans Act. The
gentlelady is recognized for 5 minutes.
----------
Wednesday, March 8, 2017.
OLDER AMERICANS ACT
WITNESS
AUTUMN CAMPBELL, FORMER CAREGIVER, ON BEHALF OF THE OLDER AMERICANS ACT
Ms. Campbell. Great. Thank you, Chairman Cole, Ranking
Member DeLauro, and members of the committee. My name is Autumn
Campbell, and I sincerely appreciate the opportunity to discuss
my support for the Older Americans Act.
I am here today to share my experience as a caregiver for
my mother and the importance of OAA services in helping me keep
her at home. However, I should note that my caregiving
experience also deepened the passion for aging issues, and I
currently work for the National Association of Area Agencies on
Aging, on behalf of local aging agencies that coordinate and
deliver OAA programs across the country.
So, I always knew that at some point I was going to take
care of my mom. I am an only child, and she was a single parent
for most of my life. As she approached her 60s on a teacher's
salary, I knew that she did not have the financial resources to
live out her retirement independently, and that I would
eventually have to meet her care needs. However, I never
thought that would come when I was 32.
Unfortunately, shortly after my mom turned 60, she
developed a quickly progressing and devastating
neurodegenerative disorder that robbed her of her physical and
cognitive capacities. This diagnosis also sent me scrambling to
figure out how to take care of her. After moving her in with me
and securing Social Security Disability support, I knew that I
was ultimately facing a choice of quitting my job to care for
her or putting her in institutional care under Medicaid.
I called on the local area Agency on Aging, funded in part
through the Older Americans Act, and they connected me to a
number of services that helped me keep my mom at home and
allowed me to continue working full time. For example, 3 days a
week I dropped my mom off at an adult daycare center where I
knew she would be loved, fed, entertained, and cared for while
I went to work.
The local Aging Agency also provided caregiver respite when
I desperately needed a break. When my mom's needs became too
severe to take her to adult daycare, the Aging Agency helped me
navigate the complicated world of Medicaid, and the local
ombudsman office, also funded by the Older Americans Act,
ensured that her application for a Medicaid home and community-
based services waiver was shepherded through the cumbersome
approval process so that she was not facing institutional
placement. I could not have navigated my caregiver role without
Older Americans Act services and the local aging agency. There
is no doubt that without them I would have left the workforce
to care for my mom or put her in institutional care funded by
Medicaid.
My mom passed away in late 2015, but I am forever grateful
that I was able to be there for her when she needed me, and
that OAA programs made this possible. But my story is just one
of millions about how critical Federal Older Americans Act
programs are to seniors and caregivers. These essential
programs help us as a country keep our promises to previous
generations and care for the people who cared for us.
OAA is the cornerstone of the Nation's non-Medicaid Home
and Community-Based Services System. There are dozens of OAA-
funded services that enable seniors to age at home and in the
community, and a few examples that show the range of the help
that OAA provides are: in-home care to help with bathing and
dressing; home delivered meals and congregate meals that
prevent malnutrition and social isolation; transportation such
as rides the doctor or the grocery store, information or
referral assistance; case management and care coordination
assistance; adult day care to relieve family caregivers; legal
services to prevent abuse and exploitation; and support and
training for often overwhelmed family caregivers such as
myself.
These services are in high demand nationally, but they have
very limited Federal resources. Meanwhile, we're facing an
unprecedented demographic shift as the Nation's baby boomers
age at a historic pace. Every day 10,000 people turn 65, and by
2030, 73 million people, or 1 in 5 Americans, will be 65 or
older.
For years, funding for Older Americans Act programs has not
kept pace with annual inflation, let alone a growing need. This
rapid erosion of funding coupled with this growing need has
made it increasingly difficult, or even impossible, for local
agencies to even maintain existing services. As a result, local
waiting lists are long and they are growing longer.
This dire situation only intensifies the need for Federal
investment, especially considering that OAA programs help
offset future mandatory spending. When seniors are healthier,
Medicare saves money. When frail older adults get the in-home
services and support that prevent or delay nursing home
admission, Medicaid saves money. Why would we not invest in
flexible, targeted, cost-effective, person-centered care on the
front end to avoid greater longer-term costs among a growing
population?
So, I urge appropriators to carry out the promise that your
colleagues on both sides of the aisle made last year by
reauthorizing OAA, and ensure that OAA programs are protected
from brutal funding cuts. Specifically, I ask that you focus on
restoring funding to critical programs, such as OAA Title 3(b),
Supportive Services, and Title 3(e), National Family Caregiver
Support Program, which have had little to no relief from
previous cuts despite recent budget deals.
So, on behalf of the millions of older Americans and their
caregivers in every community, on behalf of the hundreds of
local agencies coordinating and delivering services, on behalf
of one daughter trying to do her best to care for her mother, I
urge you to protect investments in the Older Americans Act that
are in the best interests of a rapidly aging population and our
fiscal health as a country.
Thank you.
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Mr. Cole. I thank the gentlelady for her compelling
personal testimony as well as the very persuasive case she
makes. Thank you for being here and testifying today.
Ms. Campbell. Thank you.
Mr. Cole. I will call on our next witness, please.
Welcome. Good to have you here. I hope I do not butcher the
name. It is Ms. Victoria, is it Kitchyan?
Ms. Kitchyan. Kitchyan.
Mr. Cole. Kitchyan. Thank you. Great, and actually for me
that was pretty good, though. That was not bad. [Laughter.]
Great Plains Area Board of Representative of the National
Indian Health Board. The gentlelady is recognized for 5 minutes
for testimony.
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--------
Wednesday, March 8, 2017.
NATIONAL INDIAN HEALTH BOARD
WITNESS
VICTORIA KITCHYAN, GREAT PLAINS AREA BOARD REPRESENTATIVE, NATIONAL
INDIAN HEALTH BOARD
Ms. Kitchyan. Good morning, Chairman Cole, Ranking Member
DeLauro, and members of the subcommittee. Thank you. On behalf
the National Indian Health Board, thank you for allowing me to
testify on the Fiscal Year 2018 Health and Human Services
budget. My name is Victoria Kitchyan, and I am a member of the
Winnebago Tribe in Nebraska, and I am also a tribal council
member. I serve as Treasurer.
First, I would like to thank the subcommittee for the great
work that it has done to increase the profile of American
Indian and Alaska Natives health issues over the last several
years. Your commitment to these issues has been enormously
helpful to the tribes, and it has allowed us to work directly
with the agencies and have some of these hard discussions. So,
we thank you for that.
As you are aware, a Federal promise was to provide Indian
Health Service was made long ago. Our ancestors entered into
these treaties and agreements, and part of these treatment
agreements were to provide health service in exchange for
tribal land and peace. The land and peace was given by the
Federal government has yet to live up to its trust
responsibility.
Our people live sicker. We die younger, on average, 4.5
five years earlier, and, in some States, up to 20 years
younger. So, the time has long since passed to address some of
these shortcomings.
Though the Indian Health Service continues to serve as the
primary health provider for American Indians and Alaska
Natives, funding for that Agency has always been far below the
need. Additionally, IHS was never designed to be a public
health system; rather, direct primary care. So, agencies like
the Center for Disease Control and Prevention, Substance Abuse
and Mental Health Services Administration, and Centers for
Medicare and Medicaid Services, all play a crucial and critical
role in this trust responsibility, and should offer a
complementary role to Indian Health Service to uphold that
trust responsibility.
Public health infrastructure in Indian country is one of
the most severely underfunded and underdeveloped areas. Like
States and territorial governments, tribes have both the rights
and responsibilities to offer vital public health services for
the communities. Currently tribes are regularly left out of
these opportunities. State-run health programs simultaneously
were left and overlooked at the Federal level when agencies
have opportunities. So, these health initiatives are needed and
not funded or overlooked.
One example of this in my tribe is with the Community
Health Representative Training Program. We are very thankful to
have that opportunity and to have that funding, but the program
is driven by the State of Nebraska. It is not tribal
priorities. So, the grant supports one position where in our
community we know that cohorts are more successful. Cohorts
work better, yet we have one position. So, the tribe and other
tribal have to supplement that where they can and if they can
to be successful and increase those positions.
So essentially, we are trying to fit into someone else's
program, and it is just not working for Indian Country. So
rather, we would like programs to be designed for the tribe.
Government should respond to the local needs, and this means
empowering tribes to have the ability to make their own funding
decisions on programs like this CHR one I am talking about.
One way we could do this and help support public health
infrastructure is supporting direct funding from CDC. NIHB
requests on behalf of all tribes that in Fiscal Year 2018
Congress create base funding for tribal communities through the
Public Health and Health Service Block Grant by allocating at
least 5 percent directly to tribes. This will enable the public
health systems in Indian Country to develop consistent,
sustainable healthcare infrastructure dollars that are driven
by the tribal interests and the tribal parties, and what
communities know best are their needs, and not so much an
opportunity that we try to navigate through, and fit into, just
for funding purposes. It does not work.
So, it is well time that tribal communities catch up to
other Americans when it is the expectation of public health.
Nowhere is the lack of solid infrastructure and support more
acute than when it comes to the Mental and Behavioral Health
Service. American Indians and Alaska Natives grapple with
complex behavioral health issues. Restructured Federal policy
through the years, changing political climate, unresponsive or
harmful human services systems have created unresolved
historical trauma, intergenerational trauma.
These wounds created by kill the Indian, save the man,
these things have left scars, and without the proper resources
or flexibility to design the programs that we need, we are just
going to continue to perpetuate this problem and never achieve
healthier outcomes.
Tribes request that automatic direct funding go to the
Mental Health Service Grant and the Substance Abuse Grant. At
the very minimum, we would like statutory requirements that
would require the States to consult with the tribes, and also
show how that is going to roll out and benefit our communities.
We also request they give priority to Circles of Care
Program and tribal behavioral health programs. These are some
of the only ones that are going to tribes, so we would also
like to protect those and ensure that those continue.
And last but not least, I would like to touch on CMS and
the over 40 years the acknowledgment to support tribes with
CMS, within CMS. So, we need to authorize Medicaid
reimbursement at IHs and the tribally-operated facilities, and
to help these facilities continue to provide that 100 FMAP
where available. And we are pleased to see that this week the
House healthcare reform legislation included that, so we
appreciate that, and we look forward to, you know, those
continue discussions.
However, with Medicaid given more authority, we also want
to ensure that the committee has oversight over CMS so that any
of the applications submitted, waivers are consulted with the
tribes, and that any of the barriers, like, work, life, time
limits, or work requirements do not affect the American Indians
and Alaska Natives, because these barriers only force a bigger
burden on the Indian Health Service that I also said was
underfunded.
So, in conclusion I would just like to reiterate our
appreciation for the bipartisan commitment. Chairman Cole is
very active in our issues. And I just want to say that the
National Indian Health Board believes that with a few dedicated
resources and a few targeted investments, we can begin to
address this persistent disparity that is prevalent in Indian
Country.
Thank you.
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Mr. Cole. I want to thank the gentlelady for her
testimony. As she knows, this is something I care very deeply
about, and we have made significant progress on. But we are so
far behind that we could make progress for a lot of years and
not catch up.
You know, the direct funding, even though it is
administered by HHS, comes out of the Interior Subcommittee for
many of these programs, a great majority, Indian Health Service
in particular, and they have exactly the same challenge we do.
If we have the kind of allocation for non-defense
discretionary, they are going to face the same sort of pressure
in the Interior Committee where I sit as a member. And Chairman
Calvert, who has been very supportive of these issues is there,
and our ranking member, Betty McCollum, also is very
supportive.
So, your testimony is very timely. The problems are
terrific. We made a little progress, not enough. And I would
say it is at risk if we do not do the right thing. So, I
appreciate the gentlelady's work. I certainly appreciate my
friends at the Indian Health Board, including my former
staffer, Catrons, back there who worked for me and has gone on
to bigger and greater things, but has continued to advance
important issues in an effective way. With that, I would
recognize my friend.
Ms. DeLauro. Thank you very much, Mr. Chairman. And thank
you so much for your testimony. And the chairman, this is an
issue that is near and dear to his heart, and I think you know
that. But there is also bipartisan support for these efforts.
And I think one of the other areas that you need to take a
hard look at is, and I do not know the numbers and I would like
to know the numbers, of folks who are dependent on Medicaid in
the community, because I think there is going to be a serious
challenge with regard to Medicaid as we see with, at least the
early stage of the healthcare proposal, both to the Medicaid
Expansion Program, but overall to Medicaid. And if we are not
careful in that regard, if you are going to shift those funds
or those responsibilities to our States, and I know that people
talk about the flexibility of States, but oftentimes what the
results can be is a rationing of care with regard to this
effort.
And so, I think we have to be very, very careful in looking
at that. And I know you will do that because the need is so
great in the community that you represent. And we should not go
back on some of the gains that have been made, but only try to
move forward.
So, thank you for your commitment. Appreciate it.
Mr. Cole. Again, thank you for your testimony. The next
witness please.
Hi. It is great to have you here. This is Jazmin Goodwin, a
GEAR UP alumni and Howard University student, National Council
for Community and Education Partnership. The gentlelady is
welcome and is recognized for 5 minutes to deliver whatever
testimony she cares to give to the committee.
Wednesday, March 8, 2017.
NATIONAL COUNCIL FOR COMMUNITY AND EDUCATION PARTNERSHIPS
WITNESS
JAZMIN GOODWIN, GEAR UP ALUMNUS AND HOWARD UNIVERSITY STUDENT, NATIONAL
COUNCIL FOR COMMUNITY AND EDUCATION PARTNERSHIPS
Mr. Goodwin. Chairman Cole, Ranking Member DeLauro, and
distinguished members of the subcommittee, thank you for
inviting me to testify on the Gaining Early Awareness and
Readiness for Undergraduate Programs, or GEAR UP Initiative. I
am honored to be able to share how GEAR UP transformed my life.
GEAR UP is a competitive grant program administered by the
U.S. Department of Education that serves 635,000 students 2,800
low-income schools across 46 States. GEAR UP empowers local and
State leaders from K-12, higher education, and community
organizations to develop partnerships to increase the number of
low-income students who are prepared to enter and succeed in
higher education.
In a nutshell GEAR UP provides students with academic
interventions, supports families along the complex path to
college and career, and builds the capacity of schools to
strengthen the quality of instruction and counseling.
GEAR UP begins early in the 7th grade, then follows entire
classes of students through high school graduation and often
through the first year of post-secondary education. Most
importantly, the GEAR UP is succeeding. 77.3 percent of the
GEAR UP class of 2014 enrolled in a post-secondary immediately
following high school graduation, a rate nearly 32 percentage
points higher than low-income students nationally.
My parents were in the U.S. Army. I was born on a base in
Germany, and my family eventually settled at Fort Jackson in
Columbia, South Carolina. My mother and grandmother valued
education, and they made it clear that an education beyond high
school was critical. My mom even went back to school while
raising me and working full time, becoming the first in our
family to earn a college degree.
Yet, in school not everyone was perceived as college
material, myself included. I struggled to find my footing in
middle school and had a very low GPA in 9th grade. The idea of
higher education seemed out of reach. Yet the GEAR UP staff
helped change the culture of our schools. They helped me
discover my talents and interests, challenged me to reach for
goals I would not have thought possible, and provided me with
tutoring, mentoring, and support to help me and my family make
my goals a reality.
Looking back, GEAR UP changed my trajectory. In the 10th
grade, my future came into focus when I met admissions officers
from Howard University through GEAR UP. I made my mind up that
Howard was my goal, but my path there was not a clear one. Were
it not for that in-school, after school, and summer programs
that GEAR UP offered, I likely would not have had the academic
qualifications to be admitted or to even know how to finance my
education.
With GEAR UP, I turned my grades around and made it to
Howard University where I applied my GEAR UP mindset to pursue
every opportunity I can. I have earned $31,000 in academic
scholarships this year, and I am planning on attending law
school following my graduation in 2018. I remain active in the
GEAR UP community and met GEAR UP alumni from nearly all the
States represented by this distinguished committee.
I have learned that my story is not the exception. GEAR UP
is improving outcomes in rural and urban communities alike.
GEAR UP truly works everywhere.
As students, we frequently hear from policymakers that we
need to prepare more young people for the complex skills and
knowledge required by employers. We know that this requires
education beyond high school, and, frankly, we are ready to
rise to the challenge. GEAR UP is closing the opportunity,
preparation, and attainment gap. At an annual investment of
$505 per student served, GEAR UP pays huge dividends.
I urge the subcommittee to consider a modest increase for
GEAR UP to $350,000,000 for Fiscal Year 2018. This will bring
54,000 new students into the program, continue transforming the
lives of students and families, and help ensure that our great
Nation is better prepared for the demands of tomorrow.
Thank you for the opportunity to speak with you this
morning.
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Mr. Cole. Well, I want to begin by thanking you. Judging
from your testimony, you are going to be a pretty formidable
lawyer someday. [Laughter.]
It is great to have you here. This is a program where we
did in 2016 increase the investment, and if we can get that
2017 bill, there will be another increased investment. And
then, obviously 2018 depends on the overall allocation.
But you are exactly right. I have seen this program in
action. It is very heavily involved in my State, and has
delivered tremendous gains for students, frankly, that absent
this would not have had the preparation, the opportunity to
pursue a degree. So, again it is a wonderful, wonderful
program, and you are a terrific example of the kind of people
that come out of this program.
So, the committee very much appreciates your testimony.
Ms. DeLauro. I would just say what he said to Joseph, Mr.
Chairman. You know, some days we wonder what we do here. I am
serious. And the TRIO Program and the GEAR UP Program really
allow for people to realize their dreams. So, that is a noble
goal of the Federal government to help to realize people's
dreams.
Thanks for being here.
Mr. Cole. And speaking only for myself, I wonder what I am
doing here every day. [Laughter.]
It is not just some days. But, again, thank you very much
for your testimony.
Our next witness, please. Thank you very much. Good to have
you here.
Mr. Webb. Good morning.
Mr. Cole. You bet. This is Mr. Edwin Webb, the associate
executive director of the American College of Clinical
Pharmacy. The gentleman is recognized for 5 minutes to deliver
whatever testimony he cares to the committee.
----------
Wednesday, March 8, 2017.
AMERICAN COLLEGE OF CLINICAL PHARMACY
WITNESS
C. EDWIN WEBB, ASSOCIATE EXECUTIVE DIRECTOR, AMERICAN COLLEGE OF
CLINICAL PHARMACY
Mr. Webb. Thank you, Chairman Cole, Ranking Member
DeLauro, members of the Subcommittee for this opportunity to
address the subcommittee.
In my statement and written testimony, we urge your
continued support of funding for the Agency for Healthcare
Research and Quality. In addition, I wanted to discuss briefly
how the comprehensive medication management services of the
Nation's clinical pharmacists will help Federal healthcare
programs, such as Medicare and others, deliver better value and
quality for patients and for our healthcare system. These, of
course, are goals that we all share.
ACCP is the professional society for the Nation's leading
clinical pharmacists. We are the professional home for clinical
pharmacy practitioners, residents, scientists, and others
practicing in more than 60 countries. Like our members, we are
committed to excellence in clinical pharmacy practice and
patient pharmacotherapy.
Unlike pharmacists with which you are likely most familiar,
clinical pharmacists generally do not engage in the dispensing
of medications. While the safe and efficient distribution of
medications is an important component of pharmacy practice,
clinical pharmacists' practice commonly occurs directly with
physicians and other health professionals on the patient's
healthcare team to ensure that the medications prescribed for
those patients actually achieve the best possible clinical
outcomes.
To prepare for this practice, clinical pharmacists are
educated and trained in team-based direct patient care
environments. They are frequently granted patient care
privileges by collaborating physicians and health systems.
These privileges allow them to perform a full range of
medication decision making functions and management functions
for their patients. These privileges are granted on the basis
of demonstrated knowledge of medication therapy and clinical
experience gained through post-graduate residency training and
specialist board certification, both of which are expected in
addition to standard training for pharmacist licensure.
An important word about the Agency for Healthcare Research
and Quality. ACCP strongly supports the mission and goals of
AHRQ. We urge the subcommittee to protect the AHRQ budget by
providing at least $334,000,000 in budget authority consistent
at least with current Fiscal Year levels.
AHRQ is the only Federal agency with the sole purpose of
evaluating and disseminating research that determines how to
make care as effective, efficient, and affordable as possible.
The work of AHRQ is vital to the work of clinical pharmacists
and their colleagues, in hospitals, clinical practices, and
other health care delivery settings.
Our members are dedicated to helping transform healthcare
delivery in America by adopting patient-centered, collaborative
healthcare approaches that deliver better care, smarter
spending, and healthier people. AHRQ supports research and
communication programs that help reinforce the value of that
approach. Therefore, we urge you to support AHRQ and its
mission through adequate funding.
As this subcommittee and all of Congress consider ways to
strengthen and improve the Nation's healthcare system, ACCP
also urges support for comprehensive medication management
services. It is practiced by clinical pharmacists as members of
inter-professional teams. It is a collaborative process that
helps ensure that all medications taken by the patient are
effectively coordinated, achieve their intended clinical goals,
and improve patient outcomes. In short, CMM helps get the
medications right.
Top healthcare experts recognize CMM as a significant
advance in quality of care. It is fully supported by the
Patient-Center Primary Care Collaborative. It is emerging as a
standard of care for integrated private sector health systems,
like the Cleveland Clinic, Geisinger Health System, Kaiser
Permanente, and others. And it is also recognized within
important Federal programs, such as the Public Health Service,
State Medicaid programs, and the VA.
It can be effectively operationalized under collaborative
drug therapy management agreements that have been duly
authorized in 49 States, or through credentialing and
privileging systems established by individual health systems.
We believe that coverage for CMM and Medicare is a key part
of helping move all of healthcare to a more value-based,
collaborative, and efficient system. We fully understand that
the Medicare statutes are not within the subcommittee's
specific jurisdiction, but we know that you are vitally
interested as a committee and a subcommittee on efficiency and
value in our Federal healthcare programs. We, therefore, urge
your support for the dialogue that is beginning two floors down
today and going forward to advance this notion of quality of
care.
Congress has focused many years on addressing problems
associated with suboptimal and inefficient medication use. We
believe the time is opportune to truly help patients get their
medications right by making sure that team-based and patient-
centered care around their medications is part of the care that
they are being offered.
Thank you so much for this opportunity.
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Mr. Cole. I thank the gentleman very much for his
testimony and being very patient. You have been here from the
very beginning, so thank you very much.
I would be remiss, I want to take a point of personal
privilege. I see in the back room my good friend, Arnold
Mitchem, who is the president and founder of the, what is it,
Council for Economic Opportunity.
Dr. Mitchem. Council for Opportunity in Education.
Mr. Cole. There you go. And nobody has done more to help
create these TRIO graduates that you have seen around here that
gave such compelling testimony earlier today than the gentleman
in the back of the room. So, it is a pleasure to have my friend
here.
With that, thank you very much. Next witness?
Welcome.
Ms. Artiga. Good morning.
Mr. Cole. Good to have you here.
Ms. Artiga. It is an honor to be here. Thank you for
having me.
Mr. Cole. It is an honor to have you. Ms. Samantha, is it
Artiga?
Ms. Artiga. Artiga.
Mr. Cole. Artiga, okay. Very good. I would like to take
credit, but my capable clerk corrected my mispronunciation
immediately. Ms. Artiga is director of Disparities Policy
Project at the Henry J. Kaiser Family Foundation. The
gentlelady is welcome and recognized for 5 minutes to deliver
her testimony.
---------- --
--------
Wednesday, March 8, 2017.
THE HENRY J. KAISER FAMILY FOUNDATION
WITNESS
SAMANTHA ARTIGA, DIRECTOR, DISPARITIES PROJECT, THE HENRY J. KAISER
FAMILY FOUNDATION
Ms. Artiga. Chairman Cole, Ranking Member DeLauro, thank
you so much for having me here and for the opportunity to
testify.
The Kaiser Family Foundation is a nonprofit health policy
organization, so I am not taking the advocacy position or
requesting any specific funding. But I did want to use this as
an opportunity to emphasize the importance of continuing to
support efforts to address health and healthcare disparities in
our Nation. This is a particularly important and timely issue
to address given the transformation of healthcare in recent
years under the Affordable Care Act and the changes being
considered to healthcare right now by this Congress.
Health and healthcare disparities are differences between
groups in their health status and their ability to obtain the
medical care that they need, which are rooted in historic
economic, social, and racial disadvantages. Addressing
disparities is not only important from a social justice
standpoint, but also for improving our overall Nation's health,
and for reducing unnecessary healthcare costs. With the
projections estimating that we will be a majority/minority
nation by 2044, it is increasingly important that we address
these disparities.
Today many groups face disparities. People of color and low
income individuals face more barriers to obtaining the care
they need and experience poor health outcomes compared to
whites and those with higher incomes. As an example, blacks
have higher rates of chronic disease, like asthma and diabetes,
and their infant mortality rate is more than twice as high as
the rate for whites. Although disparities are often viewed
through the lenses of race and income, they also occur across
other dimensions, including language, location, and sexual
orientation.
In recent years, there have been advancements in reducing
disparities that reflect an increased Federal focus on
disparities as well as provisions within the Affordable Care
Act. Specifically, ACA investments through discretionary
programs to support public health and prevention services and
enhance the healthcare workforce and delivery system supported
reduction of disparities. For example, the ACA boosted funding
for community health centers, included initiatives to increase
the number of providers, and created the Prevention and Public
Health Fund, which I believe was already mentioned this
morning.
In addition, the Affordable Care Act's Medicaid and
marketplace health coverage expansions led to large gains in
health insurance among low-income individuals and people of
color which helped to narrow the longstanding disparities they
face in health coverage. If maintained, coverage gains will
help reduce disparities in access to care as well as health
outcomes over the longer term.
Despite this progress, challenges remain. Differing state
decisions to implement the ACA Medicaid expansion to low-income
adults widen geographic disparities in coverage. States that
have expanded have experienced larger gains in coverage and
more improved access to care than the States that have not. And
those States that have not expanded are largely concentrated in
the South, a region home to many people of color that has high
rates of chronic disease and poor health.
Moreover, although disparities in coverage by race and
income have narrowed, low-income people and people of color
remain significantly more likely to be uninsured, and these
disparities persist among our Nation's children. For example,
Hispanic children are twice as likely as white children to be
uninsured, and the uninsured rate among American Indian and
Alaskan Native children is nearly 5 times as high as the rate
for white children.
As we look forward, there is much at stake for health and
healthcare disparities as this Congress considers future
funding decisions and broader healthcare reforms. The newly
released American Health Care Act would likely erode recent
progress and have significant negative effects on disparities.
The changes to Medicaid would disproportionately affect people
of color and low-income people for whom the program is a
central source of coverage. Notably, more than half of all our
Nation's children of color rely on Medicaid.
Its proposal to cap Federal Medicaid financing would lead
to a fundamental shift in the Federal commitment to States to
support care for individuals with the greatest health needs and
lowest incomes. The cap would limit growth to a pre-set amount,
and if State costs exceed capped amounts, they would need to
increase State spending or make program cutbacks. Capped
funding would also lock in historic differences across States
and benefits and spending. Moreover, the elimination of the
enhanced Federal funding for the expansion would likely result
in eligibility reductions and losses in coverage that would
disproportionately affect low-income people on people of color.
Reductions in health coverage would also increase strains
on other parts of the healthcare system, including community
health centers and public health programs. However, the act
would also eliminate funding for the Prevention and Public
Health Fund, which several governors have cited as a key
component to support their public health and prevention
activities.
Amid this uncertainty to changes in health insurance,
coverage support for public health and prevention services, and
a healthcare workforce and delivery system that can adequately
meet the needs of our increasingly diverse population, is more
important than ever.
Thank you again for this opportunity. I hope you find these
remarks useful for your future deliberations and work.
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Mr. Cole. I thank the gentlelady very much for coming and
testifying before the committee. We do not often get people to
come and do not ask for money. [Laughter.]
Mr. Cole. You know, you are a delightful witness to have.
Ms. DeLauro. And I just wanted to just add, thank you for
the information and the data. Oftentimes we speak anecdotally,
and we cannot where it really will affect the healthcare people
in this Nation and what the elimination of the Prevention Fund
would do, and, again, I mentioned earlier what the cutbacks in
Medicaid would do. But that is based on sound data and
research, and that is the basis on which we can proceed.
So, I very much thank you.
Ms. Artiga. And that is the business of our foundation is
data.
Ms. DeLauro. Thank you very, very much.
Ms. Artiga. So, if we can ever be of assistance, please let
us know.
Ms. DeLauro. Thank you. Appreciate it.
Ms. Artiga. Thank you.
Mr. Cole. Thank you. Thank you for your testimony. Next
witness please?
Our order has changed. Mr. William Kohlhepp, president of
the Physician Assistant Education Association. I hope I did not
butcher your name too bad.
Dr. Kohlhepp. Very nicely done.
Mr. Cole. Okay, I appreciate that. You have already scored
points with the chair, whether it is true or not. The gentleman
is recognized for 5 minutes for whatever testimony he cares to
deliver to the committee.
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Wednesday, March 8, 2017.
PHYSICIAN ASSISTANT EDUCATION ASSOCIATION
WITNESS
WILLIAM KOHLHEPP, M.D., PRESIDENT, PHYSICIAN ASSISTANT EDUCATION
PROGRAM
Dr. Kohlhepp. Great. Chairman Cole, Ranking Member DeLauro,
and members of the subcommittee, thank you for the opportunity
to speak to you today and to ask for your continued support of
Title 7 primary care training and enhancement grants. These
grants provide funding for curricular innovations, faculty
development, access to care for underserved areas, and
workforce diversity in the physician assistant profession,
which I will refer to as PA.
I am also here today to inform the committee about a
critical situation that PA education programs face in accessing
sufficient clinical education sites to train our students with
patients.
My name is Dr. William Kohlhepp, and I am president of the
Physician Assistant Education Association, PAEA, and dean of
the School of Health Sciences at Quinnipiac University. I speak
to you today to underscore the importance of PA education and
how PAs enhance inter-professional teams in our evolving
healthcare system. We recommend $12,000,000 in funding to
support PA education in Fiscal Year 2018 to enhance program
innovation and the recruitment, training, and development of
students and faculty at PA programs nationwide.
The PA Program was created 50 years ago in response to a
shortage of primary care physicians. PAs are educated as
generalists, and we have a unique flexibility to fill gaps in
both primary care and in specialties. PAs spend 2,000 hours in
clinical training, second only to our physician colleagues in
time devoted to training with patients. PAs enter primary care
more than any other specialty.
Increasing demand for PAs has meant rapid growth of the
profession. We have grown from three graduates to more than
110,000. PAs are now licensed to practice medicine, including
prescriptive authority, in every State and D.C. The pipeline to
our profession is strong with the Bureau of Labor Statistics
projecting a 30 percent increase in the number of PA positions
between 2014 and 2024.
PA programs are well positioned to continue increasing our
output of PAs who can help meet the changing healthcare needs
of the nation. However, efforts to increase the number of PA
graduates must contend with one major barrier: the critical
shortage of clinical training sites. We are trapped in somewhat
of a vicious cycle. Projected shortages of clinicians have led
to health professions to try to increase numbers of clinicians
they graduate, which in turn increases pressure on clinical
sites. At the same time, clinicians are facing new demands for
increased productivity and implementation of new electronic
health records, which has forced many potential preceptors to
reduce their commitment to education.
Finally, supply and demand pressures have led some programs
to pay for clinical sites. More than a third of programs report
paying for some or all sites, an increase of 14 percentage
points since 2012. Surveys indicate that 95 percent of program
directors are concerned about clinical site opportunities, and
that nearly half report that the payment trend has negatively
affected plans to increase enrollment.
Federal investments can help break this cycle. Title 7
funds help improve clinical education and help programs to
recruit applicants from disadvantaged and minority backgrounds.
But Federal funding has not kept pace with program growth.
Today there are 218 PA programs, yet the most recent training
and primary care program competition funded only 13 programs
out of that 218.
PAEA's request for $12,000,000 to expand the capacity of PA
education is an investment in improving access to primary care,
which can reduce future healthcare costs. Federal incentives to
encourage clinicians to precept PA and other students are a
promising strategy for relieving the clinical site crisis, and
would also promote inter-professional education.
PAEA welcomes the opportunity to work with you to explore
policies that will create a supportive environment for
preceptors and lower barriers to accepting students into their
practices. The number of PA programs in the congressional
districts represented by this subcommittee total 55 out of the
218. This committee has a real interest in PA program
education. We invite you to see those programs in person.
Regardless of how healthcare reform plays out, the Nation's
need for highly-trained will remain. Thank you for the
opportunity to testify today.
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Mr. Cole. I want to thank the gentleman very much for his
testimony and for highlighting a really important issue that we
have, which is simply the lack of personnel to cover the needs
of our population, whatever our system of health care delivery
happens to be. Very valuable and very timely.
Dr. Kohlhepp. Thank you.
Ms. DeLauro. Let me just say thank you to you, Bill, for
the work that you do and for the work that Quinnipiac does.
Dr. Kohlhepp. Thank you, Congresswoman.
Ms. DeLauro. Really are outstanding. And as the Chairman
would point out, if we could get the 2017 bill out, we could
have the opportunity for some increased or for some, you know,
flat funding. But nevertheless, we would have some, you know,
some resources there to deal with. But thank you very, very
much for your testimony.
Mr. Cole. Well, on a totally unrelated issue, thank you for
the polling at Quinnipiac. [Laughter.]
As an old pollster, I love that stuff, and actually one of
my friends, Peter Brown, is associated with your program. It is
very----
Ms. DeLauro. Mr. Chairman, that program was established
many, many, many, many, many years ago by a wonderful
individual, whose name was Paul Falcigno. He has since passed
on, but he served on the New Haven Board of Alderman with my
mom all those years ago. So, I feel very proprietary about
Quinnipiac, the polling, and the great work they do here.
Thanks.
Dr. Kohlhepp. Our School of Health Sciences does great
work.
Ms. DeLauro. Amen.
Dr. Kohlhepp. But I will give the prop out to the hockey
team and to the poll.
Ms. DeLauro. Amen. Amen.
Dr. Kohlhepp. Thank you for the opportunity to testify.
Ms. DeLauro. Thank you.
Mr. Cole. Thank you very much. Our next witness please?
Welcome.
Ms. Renner. Good morning.
Mr. Cole. Good. Megan Renner, good to have you here. The
executive director of the U.S. Breastfeeding Committee. And the
gentlelady is recognized for 5 minutes for whatever testimony
she cares to give the committee.
----------
Wednesday, March 8, 2017.
U.S. BREASTFEEDING COMMITTEE
WITNESS
MEGAN RENNER, EXECUTIVE DIRECTOR, U.S. BREASTFEEDING COMMITTEE
Ms. Renner. Thank you. Chairman Cole, Ranking Member
DeLauro, and members alert and members of the subcommittee,
thank you for the invitation to present public witness
testimony today. My name is Megan Renner, and I am the
executive director of the U.S. Breastfeeding Committee, an
independent, nonprofit coalition of more than 50 national
organizations, with a network of State and local coalitions in
all 50 States working collaboratively to create a landscape of
support for breastfeeding families across our Nation.
Breastfeeding is a proven primary prevention strategy, and
the first food of breast milk builds a foundation for lifelong
health and wellness. The evidence for the value of
breastfeeding to children's and women's health is scientific,
solid, and continually being reaffirmed by new research.
Compared with formula fed infants, we know that those who are
breast fed have a reduced risk of several acute illnesses in
infancy as well as of SIDS and the debilitating disease of
necrotizing enterocolitis that preemies can suffer from.
In the longer term, mothers and children have a reduced
risk of several chronic diseases, including obesity, diabetes,
and asthma in children, and diabetes, cardiovascular disease,
and breast and ovarian cancers in women. Yet these impacts
beyond families, of course, also benefiting our Nation's
employers and our economy.
An updated and consolidated study just published in 2016 of
both the maternal and pediatric health outcomes and associated
costs showed that if 90 percent of our Nation's infants were
breastfed according to medical recommendations, annually we
would prevent 3,340 deaths, $3,000,000,000 in medical costs,
and $14,200,000 in the costs of premature death.
Everyone can, of course, agree that the decision to
breastfeed is a personal one, and a mother should not be made
to feel guilty when she cannot or chooses not to breastfeed.
Yet we know the great majority of pregnant women and new
mothers want to breastfeed, and 81 percent start out
breastfeeding in the hospital. Despite this initial success,
however, 6 in 10 breastfeeding mothers stop earlier than they
intend. They are unable to reach their own personal goals due
to a number of identified key barriers to breastfeeding.
These obstacles, dubbed the booby traps by one of our
member organizations, can be addressed through simple cost-
effective interventions. And that is why in 2011, Surgeon
General Regina Benjamin launched the Surgeon General's Call to
Action to support breast feeding, outlining 20 concrete action
steps that would have the greatest impact across six different
sectors of society.
So, our priority recommendations address several of the
surgeon general's 20 action steps by a robust collective action
that cuts across multiple sectors. We believe there is great
promise in the coordinated and collaborative approaches used by
the Centers for Disease Control and Prevention to further cost-
effective public health actions to increase healthy eating and
physical activity.
So, on behalf of the more than 3 million U.S. families that
choose to breastfeed their newborns every year, I respectfully
urge the subcommittee to sustain the bipartisan support for
effective and innovative initiatives to support breastfeeding
families, especially by a continuation of this funding for the
CDC's Division of Nutrition, Physical Activity, and Obesity,
supporting Breastfeeding Families Program at the original
requested amount of $50,000,000 a year. Congress has dedicated
funding to this program for more than 5 years, and the impact
of these investments has already been substantial with a
special emphasis on maternity care practice improvement and
continuity of care.
We know the maternity care experience can influence both
breastfeeding initiation and later infant feeding behavior, and
the CDC collects data every 2 years through a national survey
of maternity practices. The results of the 2015 survey showed
that on average, U.S. hospitals scored 79 out of a possible 100
points, which is an increase from an overall national score of
just 63 in 2007 and 70 in 2011. By another measure over the
same period, the percentage of hospitals implementing a
majority of the recommended practices has increased from 29
percent in 2007 to 62 percent in 2015.
These current CDC breastfeeding initiatives are also
addressing the need to ensure healthcare professionals have
sufficient knowledge and skills to increase access to
professional and peer lactation support, and to support
employers and child care providers to implement breastfeeding
supports that have a critical impact when families return to
work or school.
Additional recommendations that we would like to put forth
include directly funding the HHS Office of Women's Health,
breastfeeding support programs, especially the initiatives to
provide resources to employers to support nursing mothers in
the workplace, and to support and inform breastfeeding mothers
via the Your Guide to Breastfeeding, the It's Only Natural
Campaign, and the OWH Women's Health Help Line.
We also urge the subcommittee to address obstacles to
greater availability of safe banked donor human milk for
fragile infants by funding the Agency for Healthcare Research
and Quality, to conduct a systematic review of evidence and a
study on federal regulation and support of donor milk banks,
and by funding the Health Resources and Services Administration
to establish evidence-based clinical guidelines.
Finally, we would like to also express support for
continued funding of several affiliated programs, and ensuring
incorporation and expansion of breastfeeding support within
them, including the Reach Program, Racial and Ethnic Approaches
to Community Health, the National Early Care and Early Care and
Education Collaboratives under CDC, and within HRSA, the Title
5 Maternal and Child Health Block Grant, especially the special
projects of regional and national significance, Healthy Start,
and the MIECHV Home Visiting Program.
Thank you again for this opportunity to share our
recommendations. We are extremely grateful to the subcommittee
for your sustained efforts to support these programs. Thank
you.
Mr. Cole. Thank you very much, the gentlelady, for her
testimony. Next witness please.
Welcome.
Dr. Dalal. Thank you.
Mr. Cole. Good to have you here.
Dr. Dalal. Nice to be here.
Mr. Cole. You will have to bear with me. Dr., is it Mehul
Dellah?
Dr. Dalal. Dr. Mehul Dalal.
Mr. Cole. Mehul Dalal. Well, thank you very much for your
indulgence, and it is great to have you here as a witness. The
gentleman is the president of the National Association of
Chronic Disease Directors. The gentleman is recognized for 5
minutes for whatever testimony he cares to present to the
committee.
----------
Wednesday, March 8, 2017.
NATIONAL ASSOCIATION OF CHRONIC DISEASE DIRECTORS
WITNESS
MEHUL DALAL, M.D., PRESIDENT, NATIONAL ASSOCIATION OF CHRONIC DISEASE
DIRECTORS
Dr. Dalal. Thank you, Chairman Cole, Ranking Member
DeLauro, and members of the committee for allowing me to
testify on behalf of the National Association of Chronic
Disease Directors, which I will refer to NACDD.
My name is Mehul Dalal. I am currently serving my term as
the president of board of directors for NACDD, and I am the
State chronic disease director in Connecticut. Specifically, I
want to express our strong support for increased funding for
key chronic disease programs at CDC. Simply put out the grant
and support of the CDC, most States would have an extremely
limited ability to address these critical public health issues.
These investments, as detailed in our written testimony,
work to prevent disease in the first place, which in turn
contributes to the economic productivity of the workforce,
educational outcomes for children, and fitness levels for
military recruits, and helps counteract the skyrocketing
healthcare costs.
NACDD is a nonprofit public health organization that serves
chronic disease program directors of each State and U.S.
jurisdiction, and connects more than 6,000 chronic disease
practitioners across the country. We represent a core sector of
governmental public health, and we work closely with our
executive and State territorial health agency leaders as well,
as our governors and state legislatures.
Poor health of the population can exert a tremendous force,
unemployment rates, interest costs, and other tangible factors
that ultimately affect our ability to maintain a strong global
economic position. The primary driver of costs in healthcare is
chronic disease. According to the CDC, chronic disease accounts
for approximately 75 percent of the Nation aggregate healthcare
spending, or an estimated $5,300 for every individual in the
U.S.
Treatment of chronic disease constitutes an even larger
portion of spending, 96 cents per dollar for Medicare and 83
cents per dollar for Medicaid. As the American population ages,
more people are categorized as high risk for multiple chronic
diseases, and these health care costs are projected to continue
their rise.
State public health chronic disease prevention and control
programs are key in improving the Nation's health and
counteracting the rise in healthcare costs. States are
implementing diverse and cost-effective strategies that worked
to prevent diabetes, reduce heart disease and stroke, and
promote fitness and nutrition in order to reduce the disability
and costs associated with these conditions. As an example, in
the New Haven area, CDC resources have supported us to work
with community health centers and identify over 16,000 at-risk
patients, and implement programs in the clinics and in the
communities that educate and empower hundreds of patients to
take charge of their own conditions.
In one instance, a community health worker identified a 55-
year-old woman with diabetes who did not have a primary care
physician. In addition to linking her to a primary care doctor,
our program provided her with a gym membership and health
coaching services. And with this support, she herself developed
her own individualized fitness plan where she focused on Zumba
and weightlifting. Over time she reduced her need for diabetes
medications pills from six pills a day to a half a pill a day,
and she dropped in size from a size 12 to a size four. And from
the physician's standpoint, what I am interested in, she
reduced her blood pressure by 10 percent, blood cholesterol by
23 percent, and her blood sugar by 31 percent. Her family was
so impressed by the success that she now is a source of
encouragement and advice to her brother, her sister, her
sister-in-law, who have all gone on to adopt healthy life
changes.
Multiply these examples by the tens of thousands across the
Nation, and you can see how by working with large groups of
people outside of the more expensive medical settings of
clinics and doctors' offices, we are a good investment that
saves healthcare dollars for Medicaid and Medicare and the
entire health care system. Many of our program's approaches
were developed by this committee's investments in NIH and the
CDC, and without the work of my colleagues some of the
wonderful findings of Federal research would sit on the shelf
and never realize its full potential to improve health.
The Prevention and Public Health Fund, also known as the
Prevention Fund authorized on the Affordable Care Act, supplies
more than 12 percent of the CDC budget, providing essential
funds to help States keep communities healthy and safe. The
Prevention Fund supports programs like the 317 Immunization
Program, chronic disease prevention programs, and the entire
Preventive Health Block Grant, which is the only source of
flexible funding for the States and U.S. territories to
American Indian tribes and the District of Columbia to tailor
preventive and health promotion programs to their population's
specific needs.
Today only a small fraction of the United States
governmental health investment supports prevention and health
promotion. Substantial investment in the CDC and the state
health departments are necessary for a real impact to be made.
These programs must include increased resources for every State
to address State-specific public health challenges, diabetes
prevention and control, heart disease prevention, and improving
physical activity and nutrition.
Public health programs work to improve care, prevent
disease, and prevent complications of disease. An investment in
chronic disease prevention and control programs saves lives,
improves the quality of life, and saves healthcare dollars.
Thank you for allowing me this opportunity to appear before
you.
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Mr. Cole. I want to thank the gentleman very much for his
testimony and particularly for the focus on CDC. We get a lot,
and appropriately, a lot of focus on NIH and the splendid work
they do. But I always like to say, you know, the CDC is every
bit as important in defending the lives of Americans as the
Pentagon is, and in some ways more. You are more likely to die
in a pandemic than you are in a terrorist attack.
And these long-term contributions of changing lifestyle are
really priceless investments. As you pointed out in your
testimony, the money saved on the back end in Medicare and
Medicaid is just unbelievable. So, I thank the gentleman for
his focus on a very important issue for this committee.
Dr. Dalal. Yeah, thank you for your support.
Ms. DeLauro. Thank you, Mr. Chairman, and welcome, Dr.
Dalal. Thank you very, very much for the work that you do. I
think that the chairman talked about the work of the CDC in
this area. And what this is about is the strengthening of our
States and their ability to cope with the issue of chronic
disease. And it is not situated here, but it is in the States,
and providing those funds to the States is critical.
The other point that you make, I think we have to be very,
very careful if we are looking at eliminating the Prevention
Fund albeit in 2017. And in addition to that, actually the
Prevention Fund was a backup and a way in which we could look
to provide critical funding in a number of areas which the CDC
has laid out over the years. But if we are going to be in the
business of cutting back on appropriations, Mr. Chairman, and
if we are going to eliminate the Prevention Fund, we are really
going to put people at grave risk and not take advantage of the
expertise and the dedication of folks who are trying to deal
with chronic disease when we know that 70 percent of the
population is dealing with a chronic illness.
So, thank you very, very much. Where do you live in New
Haven?
Dr. Dalal. In the East Rock neighborhood.
Ms. DeLauro. All right. Okay. Thank you.
Dr. Dalal. I think we are neighbors.
Ms. DeLauro. We are neighbors. Thank you.
Mr. Cole. Next witness, please.
This is Ms. Lynnetta, is it Kopp?
Ms. Kopp. Kopp.
Mr. Cole. Kopp. Thank you for correcting me. President of
the National Senior Corps Association. The gentlelady is
recognized for 5 minutes to deliver whatever testimony she
cares to the subcommittee.
----------
Wednesday, March 8, 2017.
THE NATIONAL SENIOR CORPS ASSOCIATION
WITNESS
LYNNETTA KOPP, PRESIDENT, THE NATIONAL SENIOR CORPS ASSOCIATION
Ms. Kopp. Thank you. Chairman Cole, Ranking Member DeLauro,
members of the subcommittee, thank you for the opportunity to
appear before you today to discuss funding for the three Senior
Corps programs administered by the Corporation for National and
Community Service. Those programs are the Foster Grandparent
Program, the RSVP Program, and the Senior Companion program.
The funding levels we are requesting today are as follows:
for the Foster Grandparent Program, $107,702,000; RSVP,
$63,000,000; and Senior Companion Program, $45,512,000.
My name is Lynnetta Kopp, and I testified today as
president of the National Senior Corps Association,
representing the interest of Senior Corps directors,
volunteers, and the people and communities we serve. I also
bring regards from my colleagues in the leadership of the
National Association of Foster Grandparent Directors and the
National Association of RSVP directors, who also embrace this
request.
Senior Corps is a federally authorized and funded network
of National Service programs that provide individuals age 55
and better an opportunity to share their life experience
through volunteer service, meeting unmet community needs in our
community. I have had the pleasure of being an RSVP director
and a foster grandparent director in Lacrosse, Wisconsin for
the past 14 years. I come before you today advocating for
funding for the continuance of these three Senior Corps
programs.
The requested funding would restore the level to 20 percent
of the cut, which RSVP lost over 100,000 volunteer positions.
This funding would also provide sufficient funding to sustain
the Foster Grandparent Program and Senior Companion Programs at
their current levels.
The new Administration will be presenting the Fiscal Year
2018 budget shortly, which may eliminate funding for the
Corporation of National Community Service. And to coin a
phrase, this would be penny wise and pound foolish. Not only
have these programs enjoyed bipartisan support from members of
Congress, including those of you who are serving on this
committee, these programs are incredibly cost-effective. For
every $1 spent on volunteer service in our Nation, our
communities reap a nearly tenfold return in the Foster
Grandparent Program and the Senior Companion Program, and even
more so from a return on their investment in the RSVP Program,
given the low cost per volunteer for this program.
The two stipend programs, Foster Grandparent and Senior
Companion Program, provide low-income seniors with an
opportunity to serve. And in the case of the Foster Grandparent
program, it allows them to serve at-risk students and
disadvantaged youth and homebound and frail seniors through the
Senior Companion Program. There is not a day that goes by that
our Senior Corps directors do not receive testimonials on the
value of the service that this program provides.
RSVP matches individuals' personal interests with those
skills and volunteers with opportunities to fill these unmet
community needs. As the largest senior volunteer organization
in the Nation, RSVP has been improving the lives of their
neighbors and friends since 1971, meeting the unmet needs in
our communities, whether it is helping prepare tax returns,
provide transportation services, offer respite to caregivers,
tutor children, repair homes, support veterans and military
families, or assist victims of disaster areas. These are just a
few of the things that these programs help to do.
RSVP volunteers served 329,000 veterans through
transportation and employment services, referrals and
mentored--I am sorry--more than 78,000 children, provided
independent living services to 797,000 adults, and primarily
those were frail seniors. Also, provided respite services to
20,300 families, engaged 20,100 veterans who serve as RSVP
volunteers, and leveraged an additional 18,500 volunteers to
support RSVP activities.
All told, roughly $200,000,000, which funds the Senior
Corps, provides a $2,300,000,000 return on investment. And
according to data compiled by the independent sector, more than
25,000 foster grandparents supported by this request would
contribute 24 million hours of service. This is valued at over
$565,000,000. This would enhance 62 million hours of service,
which is valued at over $1,000,000,460 based on the independent
sector data, which averages a volunteer hour at $23.56. And the
more than 12,000 senior companions underwritten by this budget
would provide 12.2 million hours or service, valued at
$287,432,000, helping roughly 61,000,000 older frail seniors in
our community.
The Senior Corps has over 45 years of successful
performance measurement, and we do have a return on our
investment. While great value is derived by the beneficiaries
of senior service, the benefit to those who serve is tangible
and measurable. By keeping seniors active and involved, Senior
Corps keeps older Americans vibrant and in their communities,
avoiding the cost of institutionalization, keeping bright the
social connections seniors need to remain vital and truly what
we define as community in a country too frequently measured by
our differences these days than by our commonalities.
Chairman Cole, Ranking Member DeLauro, and members of the
committee, the commitment that you have previously given to our
programs is indeed appreciated. On behalf of the thousands of
volunteers, organizations, and agencies who rely on Senior
Corps, we ask you to continue your support and join us in
championing our budget request for these vital programs.
But on a more personal note, thank you for your public
service, and remember you do not have to be retired to be an
RSVP volunteer. Thank you. [Laughter.]
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Mr. Cole. Very good. I want to thank the gentlelady for
her testimony, and I am sure most members of this committee,
probably every member, can testify to the value of these
programs.
Ms. DeLauro. Absolutely. Thank you.
Ms. Kopp. Next witness. Welcome. Dr. Jeffrey Shell?
Dr. Chell. Chell.
Mr. Cole. Chief executive officer of the National Marrow
Donor Program and To Be Matched. So, welcome. It is good to
have you here. The gentleman is recognized for 5 minutes for
her testimony he cares to deliver to the committee.
----------
Wednesday, March 8, 2017.
NATIONAL MARROW DONOR PROGRAM/BE THE MATCH
WITNESS
JEFFREY W. CHELL, M.D., CEO, NATIONAL MARROW DONOR PROGRAM/BE THE MATCH
Dr. Chell. Thank you, Chairman Cole, and other
distinguished members of the committee. My name is Jeffrey
Chell, and I am proud to serve as the chief executive officer
of the National Marrow Donor Program/Be The Match.
We also proudly operate the C.W. Bill Young Cell
Transplantation Program through three competitively bid
contracts with the Health Resource Service Administration.
These contracts include a single point of access and Office of
Patient Advocacy, the Bone Marrow Coordinating Center, and the
Cord Blood Coordinating Center. Collectively these contracts
allow NMBP to operate the National Be The Match Registry and
provide lifesaving, unrelated transplants using individual
altruistic adult donors and cord blood units. We also work
closely with the cord blood banks that receive critically
important funding directly through the National Cord Blood
Inventory.
I would like to thank Chairman Cole, Ranking Member
DeLauro, and all the members of the Committee for inviting me
to speak. On behalf of Be The Match and our 565 network
partners, we want to thank you for maintaining the
congressional commitment to patients fighting blood cancers and
other disorders, for the only possible cure is an unrelated
transplant.
For each $1,000,000 that Congress adds to the program,
10,000 donors are added to the program. For each million it
adds to the NCBI, an additional 667 cord blood units will be
collected and stored. As you can see, these dollars go directly
to saving lives.
Because our funding has been flat for over a decade, for
Fiscal Year 2018, we ask that Congress modestly increase our
funding by $5,000,000 for the program. That allows us to
replenish the registry as donors age off the registry, and also
increase our efforts to add diversity to the registry as
patients are most likely to find a donor with someone that they
share a common ancestry.
We also ask Congress to increase the NCBI funding by
$5,000,000 over previous years, consistent with last year's
numbers from this subcommittee, to fund the additional
collection of cord blood units. These units have been
exceedingly helpful in providing lifesaving transplants for
patients who are difficult to match who are also members of our
ethnic minority communities. Congress has authorized both the
national registry and NCBI, most recently unanimously for
another 5 years, in December of 2015.
As I testify before you today, I am reminded of the
foresight that this committee had in the mid-1980s that created
the program on which Americans rely today. Through the
leadership of late Congressman Bill Young, the Congress decided
to establish the national registry where men, women, and
children with leukemia and other fatal disorders could find
that unrelated donor that could save their lives. Since
Congress made this important decision to establish the registry
30 years ago, Be The Match has formed a highly successful
public/private partnership and has made tremendous progress. We
are honored to continue to serve as the steward of this
critical national resource.
Today we remain the single point of access for both cord
blood units and adult volunteer donors, and again provide the
only hope of cure for 70 different medical conditions,
including blood cancers and sickle cell disease. The Be The
Match Registry has grown to nearly 16 million donors and more
than 238,000 cord blood units, including 93,000 collected
through the National Cord Blood Inventory. We have facilitated
more than 80,000 transplants since our founding, and currently
are track facilitating 60 to 100 transplants per year.
Because we collect data on all of these transplants, we
have been able to improve patient outcomes and reduce the
complication rates of transplants. During the past 20 years,
the 1-year survival rate from these transplants has gone from
40 percent now to over 70 percent.
But there really is so much more that we can do. The need
for transplant is increasing, particularly for older Americans,
and we are currently only meeting half the need in the United
States. New indications, such as curing sickle cell disease,
also drive the need for more volunteer donors and cord blood
units. With the Federal dollars that you allocate to the
program, we continue our efforts to expand the diversity of the
registry and increase the number of minority cord blood units
listed on the registry.
Federal funding remains critical to continue us to provide
access to transplant, and the funds for the program and NCBI
continue to allow us to increase the likelihood that each and
every American can receive that lifesaving transplant.
We thank you for your ongoing support of the program and
the NCBI, and while we understand the very difficult budget
situation, we know that any additional funding for these
programs will go directly to helping us cure more patients in
need.
Thank you very much.
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Mr. Cole. Thank you. I want to thank you for your very
valuable testimony, and thank you particularly for mentioning
our late good friend Mr. Young, who, when he left us, was the
longest-serving Republican in Congress and, of course, on this
committee for many years. Chaired the full committee. He is
often known obviously for the extraordinary work he did on
defense issues in the capacity of chairing that. But he touched
this committee and a lot of different ways over many decades,
and this is a worthy legacy for him. So, thank you very much
for mentioning his name.
Dr. Chell. He often shared with me that one of the things
he was most proud of in his service was helping develop this
program and the 80,000 lives that he has helped to save.
Mr. Cole. He had a lot to be proud of over many decades.
Dr. Chell. Thank you so much.
Mr. Cole. Thank you. And our last witness of the morning,
the early afternoon, but it is early afternoon. We are pretty
much on schedule. Welcome. Good to have you here.
Ms. DeLauro. Good afternoon.
Mr. Cole. Susan Ruzenski. I hope I got that right.
Ms. Ruzenski. Yes.
Mr. Cole. Executive director of the Helen Keller National
Center for the Deaf-Blind Youth and Adults. So, welcome to the
committee. The gentlelady is recognized for 5 minutes for
whatever testimony she cares to give.
----------
Wednesday, March 8, 2017.
HELEN KELLER NATIONAL CENTER FOR DEAF-BLIND YOUTH AND ADULTS
WITNESS
SUSAN RUZENSKI, EXECUTIVE DIRECTOR, HELEN KELLER NATIONAL CENTER FOR
DEAF-BLIND YOUTH AND ADULTS
Ms. Ruzenski. Thank you, Chairman Cole, and Ranking Member
DeLauro, and members of the Subcommittee for providing me with
this opportunity to testify on behalf of the Helen Keller
National Center. I am Sue Ruzenski. I have been the executive
director since 2014, and I am proud to say I have been working
with Helen Keller National Center for the last 38 years.
Our mission is to enable each person who is deaf and blind
to live, work, and thrive in their community of choice. And my
objective this morning is to provide you with clear and
specific justification why the Helen Keller National Center is
requesting an increase in funding of $4,700,000 in Fiscal Year
2018.
And why is this funding vital for HKNC's ability to meet
our five congressional mandates that was set forth 50 years ago
this past October, as we were made an act of Congress. Our
current annual appropriation is $10,300,000, and the increase
is a request that will bring us to $15,000,000 annually in
2018.
The five mandates that were set forth in the HKNC Act are:
to provide specialized and intensive services to any deaf-blind
person in the United States; to train and support family
members; to train professionals and equip them with the
competencies to work effectively with individuals who are deaf-
blind; to conduct applied research and, with respect to best
practices, disseminate those practices throughout the country;
and maintain a national registry of individuals who are deaf-
blind.
We strive to accomplish our mission through three avenues.
We are the only national vocational rehabilitation program that
is working exclusively with youth and adults who are deaf-
blind. We have 10 regional offices throughout the United
States, and we have an information research and professional
development department.
Our vision is to solidify a network of qualified service
providers nationwide who can address the training needs of
people who are deaf-blind in their local areas throughout the
United States. The foundation of this national infrastructure
has already been established over the past 50 years, but now it
is essential for us to secure adequate resource to ensure that
the standards of practice of professionals are implemented at a
national level, and the collaborative efforts in a coordinated
and sustainable national service delivery.
HKNC is ready to lead this charge given the $50,000,000
annual appropriation. Essentially, HKNC has been level funded
for 16 years. In 2016, we received a $1,200,000 increase, and
for that we are very grateful. The critical need, however,
still exists, and the level of funding to commensurate with the
scope and the importance of this work remains.
With level of funding spanning over that 16-year period, we
had to really make some tough decisions. We had to eliminate
and suspend some of our programs. The comprehensive
rehabilitation program now serves fewer people on an annual
basis, and we have more than a 1-year waiting list for people
coming to the program. For a person who has an experience of a
sudden change, a loss in vision and hearing, a 1-year waiting
period is not acceptable.
I can share with you a story about a gentleman named
Carlos. He was an ex-Marine, and this happened to Carlos. He
had tumors which caused a sudden change, total loss of vision
and hearing. When he arrived at the program, his only way of
communicating was the use of block letters printed on his back,
and we would spell out the words to him.
Through training over a 2-year period, he was able to learn
Braille, tactile sign language, the use of adaptive equipment.
He is now living in his own apartment in California and
attending college on a part-time basis. The provision of those
timely, quality services made a profound difference to Carlos'
quality of life.
HKNC has taken steps. Given that increase of 1,200,000 in
2016, we conducted five statewide needs assessments in
collaboration with Mississippi State University and the States
of Georgia, Arizona, Missouri, Oregon, and New York. And the
results became the basis of how we develop modules for an array
of professionals, including VR counselors as well as mental
health professionals.
We address many of the training priority areas that were
identified in adaptive technology, self-advocacy, haptics
orientational ability, just to name a few. We also established
a National Community of Practice. We have 38 partner agencies,
both State and private, who are working with us who are
interested in strengthening the vocational rehabilitation
options for people who are deaf-blind. And together we share
learning, conduct research, and disseminate and implement best
practices.
In 2011, Westat Corporation did a 2-year evaluation of
HKNC, and that was on behalf of the Department of Education the
Rehabilitation Services Administration. We were identified as
the gold standard by those that are familiar with our work. And
what this study did reveal, however, is that most States lack
services and the resources, reconfirming HKNC's goal to build
this national sustainable infrastructure.
The Federal government's 50-year investment has made a
tremendous impact. We have touched the lives in the past 10
years of over 16,000 deaf-blind individuals. For those
individuals with a desire to work, 51 percent are competitively
employed.
In summary, we have a plan. For this $4,700,000, what would
we do? We would maximize the effectiveness of this National
Community of Practice. We would replicate our community
services program in four States. We deploy 20 deaf-blind
specialists, two in each region around the country, boots on
the ground, working with people who are deaf-blind with our
field staff. We provide and coordinate further research to
propel this field, and increase the capacity of our ability to
offer comprehensive vocational and rehabilitation services to a
greater number of individuals on an annual basis.
Congressional leaders 50 years ago shared our commitment
and our vision for services for people who are deaf-blind, and
the Helen Keller National Center is at a critical moment in
their history. The time has come for national service delivery
to be created so that all American citizens who are deaf-blind
have an equal opportunity to live self-actualized lives and
contribute as members of their community.
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Mr. Cole. I thank the gentlelady her testimony and her
appearance here today, our last witness. And let me just say in
conclusion before I recognize my friend from Connecticut for
whatever remarks she cares to make, we appreciate each and
every one of you, the witnesses in particular, that traveled a
long way and came here to offer your valuable testimony. We
certainly will take them under advisement.
As my friend has pointed out, a lot of this depends on,
frankly, what kind of allocation the subcommittee gets, and
that has yet to be decided. We will not know that for several
weeks yet. But anyway, this really does help us a great deal,
and we would urge those of you that can to help us persuade our
colleagues to get the 2017 bill done, and then obviously make
sure that we have an adequate allocation to meet some of these
really pressing national needs and priorities as we look
forward to 2018.
I recognize my friend for one little comment she cares to
make.
Ms. DeLauro. Thank you very much Mr. Chairman, and thank
you for your commitment to, you know, making sure we get out
the 2017 bill, and that we are ready to advocate for an
increased allocation for 2018 because as you have remarked, the
array of witnesses this morning demonstrate again, I think, for
the two of us the expansive role that the Federal government
has in these various areas that help to make a difference in
people's lives. And they are all worthy causes.
And as an adjunct to that, to all of you who spend your
lives and your professional careers to advocate on behalf of
people who need the services that your organizations are
providing to the young people who are making their way, but
without the continued resources in some of these areas other
youngsters will not be able to realize their own dreams and
aspirations.
But that is why at the outset, I said this is a bill that
affects every single aspect of a person's life. And after
defense today, but in the subsequent days, to make sure that we
have the resources in our allocation to be able to meet your
needs. We cannot meet every need. The Federal government cannot
do everything, but its role is to be an advocate, the same way
that you are advocates for what you do.
Thank you for being with us today, and I know we will
continue our contact over the next month. Many thanks. Thank
you, Mr. Chairman.
Mr. Cole. I must say in closing, the dedication of our
ranking member could not be more obvious. [Laughter.]
The fact that she was here the entire hearing when
obviously this was not the easiest day for her to be here. And,
you know, I just once again want to express my admiration and
appreciation for my friend for her tireless advocacy. She never
misses a chance to make a point, even when it is difficult for
her to make that point as it was today, but always does it very
well.
So, you know, I thank you all for attending. We are
adjourned.
[Applause.]
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