[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2017
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
________
SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES,
EDUCATION, AND RELATED AGENCIES
TOM COLE, Oklahoma, Chairman
MICHAEL K. SIMPSON, Idaho ROSA L. DeLAURO, Connecticut
STEVE WOMACK, Arkansas LUCILLE ROYBAL-ALLARD, California
CHARLES J. FLEISCHMANN, Tennessee BARBARA LEE, California
ANDY HARRIS, Maryland CHAKA FATTAH, Pennsylvania
MARTHA ROBY, Alabama
CHARLES W. DENT, Pennsylvania
E. SCOTT RIGELL, Virginia
NOTE: Under Committee Rules, Mr. Rogers, as Chairman of the Full
Committee, and Mrs. Lowey, as Ranking Minority Member of the Full
Committee, are authorized to sit as Members of all Subcommittees.
Susan Ross, John Bartrum, Jennifer Cama,
Justin Gibbons, Kathryn Salmon, and Lori Bias,
Subcommittee Staff
________
PART 5
Page
Department of Health and Human Services........................ 1
Corporation for National and Community Service................. 185
Substance Abuse and Mental Health Services Administration...... 223
Department of Labor............................................ 295
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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Printed for the use of the Committee on Appropriations
________
U.S. GOVERNMENT PUBLISHING OFFICE
21-342 WASHINGTON : 2016
COMMITTEE ON APPROPRIATIONS
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HAROLD ROGERS, Kentucky, Chairman
RODNEY P. FRELINGHUYSEN, New Jersey NITA M. LOWEY, New York
ROBERT B. ADERHOLT, Alabama MARCY KAPTUR, Ohio
KAY GRANGER, Texas PETER J. VISCLOSKY, Indiana
MICHAEL K. SIMPSON, Idaho JOSE E. SERRANO, New York
JOHN ABNEY CULBERSON, Texas ROSA L. DeLAURO, Connecticut
ANDER CRENSHAW, Florida DAVID E. PRICE, North Carolina
JOHN R. CARTER, Texas LUCILLE ROYBAL-ALLARD, California
KEN CALVERT, California SAM FARR, California
TOM COLE, Oklahoma CHAKA FATTAH, Pennsylvania
MARIO DIAZ-BALART, Florida SANFORD D. BISHOP, Jr., Georgia
CHARLES W. DENT, Pennsylvania BARBARA LEE, California
TOM GRAVES, Georgia MICHAEL M. HONDA, California
KEVIN YODER, Kansas BETTY McCOLLUM, Minnesota
STEVE WOMACK, Arkansas STEVE ISRAEL, New York
JEFF FORTENBERRY, Nebraska TIM RYAN, Ohio
THOMAS J. ROONEY, Florida C. A. DUTCH RUPPERSBERGER, Maryland
CHARLES J. FLEISCHMANN, Tennessee DEBBIE WASSERMAN SCHULTZ, Florida
JAIME HERRERA BEUTLER, Washington HENRY CUELLAR, Texas
DAVID P. JOYCE, Ohio CHELLIE PINGREE, Maine
DAVID G. VALADAO, California MIKE QUIGLEY, Illinois
ANDY HARRIS, Maryland DEREK KILMER, Washington
MARK E. AMODEI, Nevada
CHRIS STEWART, Utah
E. SCOTT RIGELL, Virginia
DAVID W. JOLLY, Florida
DAVID YOUNG, Iowa
EVAN H. JENKINS, West Virginia
STEVEN M. PALAZZO, Mississippi
William E. Smith, Clerk and Staff Director
(ii)
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2017
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Thursday, February 25, 2016.
BUDGET HEARING--DEPARTMENT OF HEALTH AND HUMAN SERVICES
WITNESS
HON. SYLVIA BURWELL, SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES
opening statement
Mr. Cole. Good morning, Madam Secretary. It is my privilege
to open up the hearing.
I just want to begin by telling you what a personal
pleasure it is to have you here, and I mean that with all
sincerity. I think you have--you are an exceptional public
servant in your skill and your dedication and your
bipartisanship.
And so I look forward to working with you. We will
certainly have some, you know, challenging questions for you
this morning on both sides of the aisle, as we always do. But
again, I know how seriously you approach the job and the effort
that you put in, and I appreciate it personally very, very
much.
So my pleasure again to welcome you to the Subcommittee on
Labor, Health and Human Services, and Education for our first
hearing of the year. Looking forward to hearing your testimony.
Madam Secretary, your responsibilities are many. There are
many things in your budget that I think we can all agree are
priorities and that we can collectively support. There are
other areas we may disagree upon. The challenge that we'll be
facing this subcommittee is how we can support the most
critical programs and make the very best use of every taxpayer
dollar entrusted to us.
Unfortunately, your budget assumes many areas of tax
increases, new user fees, changes in mandatory spending, and
other spending sources that are beyond the purview of this
subcommittee. I was especially disappointed to see your
proposal to cut the National Institutes of Health.
Your proposal to divert $1,000,000,000 of biomedical
research funds to the mandatory side of the budget ledger and
rely on new and perhaps unlikely authorizations to continue the
advances we have made in increasing research funding were
disheartening to me.
I look forward to having a discussion with you this morning
on the impact of these proposed cuts. I will also be asking
some tough questions this morning about the ongoing management
challenges at HHS. Problems of substandard quality in hospitals
within the Indian Health Service and a continued slow-walking
of investigations into alleged violation of the law as it
relates to conscience protections continue to concern me
greatly. I hope to learn more this morning on what you are
doing to take positive steps in these areas.
Finally, we are all keenly aware of the many external
challenges facing your agency. The worldwide concern
surrounding the Zika virus is but the latest example of this,
and I hope you will be able to update us on this situation
today as well.
As a reminder to the subcommittee and our witnesses, we
will abide by the 5-minute rule so that everyone will have a
chance to get their questions asked and answered.
Before we begin, I would like to yield the floor to my good
friend from Connecticut, my ranking member, Ms. DeLauro.
opening statement
Ms. DeLauro. Thank you very much, Mr. Chairman.
Can I first say that this is very impressive, the dais and
the high-tech communication. But I am looking around the room
and the redo here, I like it, but it is very beige, Mr.
Chairman, and--but it is good. It looks good. It has got a nice
tone to it.
I deal with a little bit more color, but it is very good.
It is calming. So, anyway, thank you again, Mr. Chairman.
Madam Secretary, welcome back to the Labor, HHS
Subcommittee. I believe it is exactly one year to the day since
you last appeared here. I, too, want to express my gratitude
for the great work that you do and the commitment that you have
to the mission of health and human services, but also your
commitment to this country and making sure that people are well
taken care of.
I want to thank the chairman. I think together we were able
to make many great investments in the labor, health and human
services bill last year. In many ways, last year's omnibus
moved the Federal budget in the right direction, began to leave
behind the shortsighted policies of austerity that have slowed
our economic recovery. We made real progress on funding for NIH
research, the antibiotic resistant bacteria initiative, medical
countermeasures, and access to high-quality early childhood
education.
I do continue to be disappointed that we did not do better
for other programs under the subcommittee's jurisdiction, and I
am troubled that the labor, HHS bill received only a fraction,
about one-half, of its fair share of the $66,000,000,000
increase provided by last year's budget deal. While the other
non-defense subcommittees received an average increase of 6.9
percent last year, the labor, HHS bill increased by only 3.4
percent. In my view, that needs to change this year.
One year ago, we were in the midst of a worldwide response
to the Ebola outbreak in West Africa. Now we find ourselves
confronting two public health crises, the Zika virus and the
tragedy in Flint.
First, the Zika virus, which may be causing thousands of
babies in Latin America to be born with severe birth defects,
is infecting travelers returning to the United States and is
even being transmitted sexually. We should act quickly on the
administration's request for emergency supplemental
appropriations to defend against this serious threat.
Some of my colleagues have expressed a desire to shift
unobligated funds that Congress provided for Ebola to respond
to Zika. I strongly oppose that idea. The threat of Ebola is
not over. I would be anxious to know what activities we would
have to forego if we shift funds away from Ebola to Zika.
We need to be able to respond to multiple health threats at
the same time, and Congress must act quickly to protect
Americans from the Zika virus.
At the same time, HHS is the lead Federal agency on the
ground in Flint, Michigan, where we have learned that thousands
of children have been exposed to lead poisoned water for more
than a year. Not only did the State of Michigan fail to protect
its people from lead poisoning, the Government created this
crisis and magnified its effects with delayed response.
I will just give you--this is from an article dated 9/25/
05. This is Katrina. The reporter is Michael Ignatieff at
Harvard. He said, ``The broken contract, it was not blacks or
the poor, but citizens whom the Government betrayed in New
Orleans.''
One can make the same application here, and he says, ``A
contract of citizenship defines the duties of care that a
public official owes to the people of a democratic society. It
is a tacit understanding that citizens have about what to
expect from their government. Its basic term is protection,
helping citizens to protect their families and possessions from
forces beyond their control.''
When the State made the decision to turn off the spigot and
turn it on in the Flint River, they broke that contract with
the people, and now it is our responsibility to provide people
with the kinds of help that they need in order that they may
succeed.
It is imperative that we resolve the crisis immediately,
provide health and education interventions that these children
and their families will need going forward. And it is my hope
that the State, the administration, and the Congress will do
that.
These emergencies demonstrate that our Federal system needs
to respond more rapidly as threats arrive, which is why this
Congress and last Congress, I proposed funding the Public
Health Emergency Fund to enable the Federal Government to
immediately respond to public health threats. It is modeled on
the Disaster Relief Fund, which we have, which is
$8,000,000,000.
It enables a rapid Federal response following a natural
disaster. If we can act quickly to respond to floods, fires,
other natural disasters, we should be able to act quickly to
respond to public health emergencies.
We also need to strengthen our investments in HHS programs
through annual appropriations, which brings me to the topic of
today's hearing, your budget, HHS budget request for fiscal
2017.
I strongly believe, as you know, that programs in the HHS
budget are among the most important responsibilities that the
Federal Government has. They support lifesaving research, State
and local public health infrastructure, community health
centers, and home heating assistance for low-income families.
Literally, you work at saving lives.
Madam Secretary, there are a lot of good proposals in this
budget. Particularly, I applaud the President for his continued
commitment to Head Start, child care, and preschool. I will say
that I was disappointed to see cuts to cancer screenings and
public health programs at the CDC and that funding for HIV
research remains level at $3,000,000,000 for 2016 and 2017.
I am also concerned that other important programs rely on
mandatory funding. The budget includes $1,800,000,000 in
mandatory funding for NIH research, $115,000,000 in mandatory
funding to support early interventions for individuals with
serious mental illness, and $500,000,000 in mandatory funding
to help individuals who are addicted to prescription drugs and
opioids.
We need to increase this committee's allocation. That is
the answer to this issue, to support NIH research, to address
the opioid epidemic in this country, rather than relying on
mandatory funding that may not materialize, which is why the
subcommittee allocations that will be released next month will
be so critically important. And I hope my colleagues on my side
of the aisle and on the other side of the aisle will join us in
making sure that we have an increase for Labor, HHS in 2017.
And that is for the good of the children and good of the
families that depend on these services. We need to make an
increase in this allocation a priority.
Thank you very much for being here and I look forward to
the discussion and your testimony.
Mr. Cole. Thank you very much.
Ms. DeLauro. Thank you, Mr. Chairman.
Mr. Cole. But before we begin with your testimony, we have
been joined by our ranking member, Mrs. Lowey from New York. So
I certainly want to recognize her for any opening remarks she
would care to make.
Mrs. Lowey. And I want to thank Chairman Cole, my good
friend, and my good friend Rosa DeLauro for your hard work on
this committee. It has been an honor for me to be part of this
committee for a long time, for almost my whole congressional
career, and we know how important this is.
And this may be your last occasion to testify before this
committee, and I want to first thank you for your service as
Director of OMB, now as Secretary of Health and Human Services.
And I must say if every person in Government would put their
heart and soul and their brains to work the way you do, we
would move forward much more quickly.
So I really do want to thank you very much. It has been a
pleasure for me to work with you and to know you.
Now in terms of the substance, with recent emerging
threats, your remaining year as Secretary will not be easy. Our
mission to eradicate Ebola is not yet complete. New outbreak of
dangerous diseases such as Zika are pushing Federal public
health infrastructure resources to the breaking point. Congress
has a request for supplemental funding to combat Zika. I urge
this committee, and Congress as a whole, to meet this need
without delay.
While outbreaks require significant attention, we cannot
turn our backs to manmade public health emergencies at home,
and I struggle to find the words to describe the criminal
incompetence that jeopardize thousands of American citizens in
Flint, Michigan. I look forward to hearing about actions the
department is taking in coordinating the Federal response to
address the short-term and long-term healthcare needs that will
be required.
It is truly amazing to me because this is an issue I have
been working on, again, for a very long time, and how this
could have been ignored, the incompetence of the officials
involved is really quite extraordinary. So I am hoping we can
take action very quickly.
The budget request includes increases for vitally important
initiatives such as early childhood education, biomedical
research, substance abuse treatment and prevention. As an
appropriator, the department's requests for substantial sums in
mandatory funding is of concern, particularly the fact that
without this mandatory request, your budget amounts to a
decrease in discretionary funding of 1.5 percent.
With that said, there are significant improvements that I
would like to highlight. One of the major obstacles to economic
security for low-income working Americans is access to
affordable, high-quality child care and early learning, such as
Head Start. While this committee has increased funding for
these initiatives in recent years, we are not meeting our
commitment to the public.
In fact, the value of Federal funding for child care has
lagged well behind inflation and increases in child care cost.
As a result, the Federal share for child care has decreased by
approximately 20 percent since 2003. And there are more than 14
million American children that are eligible for child care
subsidies, yet only 15 percent receive Child Care and
Development Fund assistance.
These funding constraints do not exist in a vacuum, and by
not making investments in child care, hard-working parents may
have to reduce their hours, leave their jobs altogether, or
delay education programs that could allow them to invest in
their family's economic security.
An increase of $201,000,000 for child care is desperately
needed, but this alone will not be enough. Federal support for
child care and early learning programs for low-income Americans
must be increased nationwide to meet this demand and chart our
children on a path to success from an early age.
Your budget includes targeted investments in biomedical
research, which, to me, must continue to be a top priority. And
I was so pleased with the work of this committee increasing the
money for the National Institutes of Health. The Cancer
Moonshot is very exciting, increases in the BRAIN Initiative
that will deepen our understanding of the human brain to combat
diseases and disorders, including Alzheimer's, Parkinson's, and
autism. These investments not only fund research that eases
suffering for patients, they could greatly reduce ballooning
costs associated with treatment down the line.
So, again, thank you for your leadership, and thank you to
the chair and our ranking member for your important work on
this bill, and I look forward to your testimony.
Thank you, Mr. Chairman.
Mr. Cole. Thank you. It is always a pleasure when our good
friend is able to join us.
And with that, Madam Secretary, the committee would love to
hear your testimony.
OPENING STATEMENT
Secretary Burwell. Great. Thank you so much.
Mr. Chairman, Ranking Member DeLauro, Mrs. Lowey, and
members of the committee, I want to thank you all for this
opportunity to discuss the budget of the Department of Health
and Human Services.
I think, as many of you know, I believe that all of us
share common interests, and therefore, we can find common
ground. And last legislative session, as has been mentioned,
this Congress made timely investments in programs to improve
the health and welfare of the American people, and thank you
for the role that you all played in that.
The budget before you today is the final budget for this
administration and my final budget. It makes critical
investments to protect the health and well-being of the
American people. It helps ensure that we can do our job to keep
people safe and healthy.
It accelerates our progress in scientific research and
medical innovation and expands and strengthens our healthcare
system, and it helps us continue to be responsible stewards of
the taxpayer dollars. For HHS, the budget proposes
$82,800,000,000 in discretionary budget authority.
Our request recognizes the constraints in our budget
environment and includes targeted reforms to Medicare,
Medicaid, as well as other programs. Over the next 10 years,
these reforms to Medicare could result in a net savings of
$419,000,000,000.
Let me start with an issue that we have been working on
here at home and abroad, and as we work aggressively to combat
the spread of Zika, the administration is requesting
$1,900,000,000 in emergency funding, including $1,500,000,000
for HHS to enhance our ongoing efforts, both domestically and
internationally. We appreciate Congress' consideration of this
important request as we implement essential strategies that are
time-sensitive to prevent, detect, and respond to this virus.
I know the rise in opioid misuse and abuse and overdose has
affected many of your constituents. Every day in America, 78
people are dying of opioid-related deaths, and that is why this
budget proposes a significant increase in funding, over
$1,000,000,000, to fight the opioid epidemic.
Research shows that early learning programs can set a
course for a child's success throughout his or her life, and
that is why over the course of this administration, and
together with congressional support, we have more than doubled
access to Early Head Start and services for infants and
toddlers. Our budget proposes an increase of $434,000,000 for
the Head Start program and an investment in child care services
that would allow us to serve over 2.6 million children.
Today, too many of our Nation's children and adults with
diagnosable mental health disorders don't receive the treatment
that they need. So the budget proposes $780,000,000 in new
mandatory and discretionary resources over the next 2 years to
try and close this gap.
While we invest in the safety and health of Americans
today, we must also relentlessly push forward on the frontiers
of innovation and research. Today, we are entering a new era in
medical science. With a proposed increase of $107,000,000 for
the Precision Medicine Initiative and $45,000,000 for the
administration's BRAIN Initiative, we continue that progress.
But for all Americans to benefit from these breakthroughs
in medical science, we need to ensure that all Americans have
affordable healthcare. And the Affordable Care Act has made
progress, historic progress, in that space. Today, more than 90
percent of Americans have health coverage. That is the first
time in our Nation's history that that has happened.
The budget seeks to build on that progress by improving the
quality of care that patients receive, spending our health
dollars more wisely, and putting an engaged, empowered, and
educated consumer at the center of their care. By advancing and
improving the way we pay doctors, the way we coordinate care
and use health data and information, we can build a system that
is better, smarter, and healthier.
Finally, I just want to thank the employees of HHS. In the
past year, they have helped end the Ebola outbreak in West
Africa. They have advanced the frontiers of medical science.
They have helped millions of Americans enroll in health
coverage and have just done the day-to-day quiet work that
makes our Nation healthier and stronger, and I am honored to be
a part of that team.
As members of this committee, I think, know, I personally
am committed to working with you all closely, with you and your
staff, to find common ground so that we can deliver impact for
the American people. And with that, I welcome your questions.
Thank you.
[The prepared statement and biography of Secretary Burwell
follow:]
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MANDATORY PROPOSALS IN FY 2017 BUDGET REQUEST
Mr. Cole. Thank you very much, Madam Secretary. And again,
it is a pleasure to have you here.
The President's budget is being touted as adhering to
spending caps agreed on last year, but it does so by the
inclusion of gimmicks which shift funding onto the mandatory
side of the budget ledger. For example, as you know and has
been mentioned here actually by both sides, NIH discretionary
level is reduced by $1,000,000,000 from fiscal year 2016
levels.
Let me just tell you up front that is not going to happen.
We are not going to be cutting $1,000,000,000 out of the NIH,
and frankly, we are unlikely to be able to get mandatory
funding of $1,800,000,000. Again, we have no jurisdiction in
that area, but I will make a prediction that we are unlikely to
be able to get that.
Having said that, that means--and that would probably apply
to the other mandatory areas that you called on as well,
although we will look at each one of them individually,
obviously. Given that, you know, we are going to have to
shuffle money around to maintain programs because we don't have
our allocation yet, but the entire discretionary side of the
budget, I think, was increased by 0.1 percent under last year's
agreement.
So there is not a lot extra there. So we are going to have
to make some really tough decisions. It would be very helpful
to us if you would tell us what are your top three or four
priorities within the budget and that you think are absolutely
critical to being funded?
Secretary Burwell. So as we think about the issue of tough
decisions, I think you appropriately reflected, when we look at
the second year of the deal, it is a very, very small increase,
and with other things that happened naturally that, you know,
the question of ``Is it an increase at all?'' for most of the
bills I think is an important one.
And I think that is a reflection of where our discretionary
levels are. In this budget, by 2019, we will have one of the
lowest levels of our discretionary-to-GDP ratios that we have
seen as a nation. And so I think the question about priorities
and tough decisions, I think we feel we made those because
everything is paid for.
And that is the issue when we talk about the budgeting. In
terms of the mechanisms that we use, discretionary or
mandatory, I think what we are all focused on is how much we
spend and how that affects and impacts the deficit. And the
budget overall keeps us on a downward trajectory.
We made decisions that may not be the ones that folks agree
with, and we understand and appreciate that, but we do pay for
everything, and we do continue on our path of deficit reduction
and making sure our debt-to-GDP ratio is on a declining path,
as well as our deficit.
So in making the tough choices and the prioritizing, we
have done that in the means by which we pay for these things.
FY 2017 BUDGET REQUEST PRIORITIES
Mr. Cole. Well, I am the last person to cross swords with a
former OMB Director about the budget, but I don't think we are
on a downward trajectory. Certainly, in gross dollar terms, the
deficit is going to be higher this year than it was last year.
And I think this is off our topic, but I think one of the
great missed opportunities of the President's second term was
real entitlement reform. There was a couple of times he was
close. I mean, he put, to be fair to him, change CPI on the
table, and he put means testing for Medicare on the table.
But he also put--demanded tax increases, a lot of other
things with those. We could have probably passed those things,
and I think they would have been a material improvement on
where we are now.
But that aside, we are unlikely to be able to do that in
the short term and the amount of time that we have left, and
what we do have to do and want to achieve is to actually give
you a real budget. So I am going to return again, of the budget
itself, what are the three or four top things of what you have
submitted that you think are absolutely critical to the
functioning of health and human services?
Secretary Burwell. So, as I said, I think we have put
together the budget in a way that reflects our priorities. I
think we have heard criticisms, and I am sure I am going to
hear them today, in terms of the cuts that we have made to
other areas, places where we have not fully funded and had to
make choices. And I am sure we are going to talk about those,
whether that is, you know, the issues of REACH or the issues of
BARDA. I am sure that we will talk about those today and have
made a number of those choices.
The other thing I would just reflect, as we think about the
overall budget picture, is the question of demographics in our
country. And we know that healthcare is one of the most
fundamental drivers of the costs causing these issues. But I
think we also know that the basic demographics in our country
with regard to we are going to have more people who are in that
Medicare band, and so how we think about a balanced approach.
And that gets to this question of revenues versus cuts
because the problem isn't simply a problem of a set number, you
know? It is that increase. And I keep my eye on per capita
healthcare costs, and in Medicare, we have seen those be very
low for six consecutive years.
And so, as we continue to think about it, I think that is
an important part of the conversation, which I think you know I
welcomed in my OMB job and I welcome here.
Mr. Cole. You did. And you have always been a good person
to have that dialogue with. With that, I want to move to my
ranking member for whatever questions she cares to put to you.
Thank you.
FLINT, MI WATER CRISIS
Ms. DeLauro. Thank you very much, Mr. Chairman.
I just would like to remind everyone that Labor, HHS has 32
percent of the nondefense discretionary budget. If we had
received an allocation that was commensurate with our portion
of discretionary spending, we would have received an additional
$5,200,000,000 to what we have had. If that happens this time
with our allocation, yes, in fact, we can accomplish what we
want to accomplish in this budget.
And that is our portion of discretionary spending, and we
were shortchanged last time. And we should not be shortchanged
this time. And with that, Madam Secretary, let me just say that
and let me talk about Flint for a second.
Unbelievable tragedy, 8,000 kids. Doctors, everyone tells
us lead poisoning is irreversible, OK? But it is the short
term, we need to ensure Flint's drinking water is safe. We also
need to think about medium term and long term, and I know you
are the lead agency here, and I just want to run down a few
things to find out where you are overall in addressing this
issue.
What is HHS doing to ensure that every child who has been
exposed to lead has a case manager to ensure they receive the
services they need? You provided $500,000 to two community
health centers. That is a start.
I would like to know how we are going to ensure that Flint
has sufficient capacity to treat these kids for years to come.
It is the longevity of the Federal response here.
Head Start serves about 1,000 kids in Flint. Another 150
are enrolled in Early Head Start. According to the
Administration for Children and Families, more than 1,000
income-eligible children are not enrolled in a Head Start
program. Nearly 3,000 income-eligible children are not enrolled
in Early Head Start. How do we ensure that these kids, when the
two areas that we have been told by doctors and scientists,
that where we can make a difference in mitigating this lead
poisoning for these children, is in good nutrition and early
nutrition and in early childhood education. These are the two
areas where we can play a role.
So how do we ensure that they don't fall behind and suffer
the effects of lead exposure for the rest of their lives? Let
me ask you to answer those questions.
Secretary Burwell. So as you mentioned, the Department of
Health and Human Services has been asked to lead the Federal
response in Flint, MI. As we lead that response with our
objective of supporting the State and local community in
getting to a better place, there are two main goals.
The first is clean and safe water in the short term, in the
medium term, and the long term. And then the second is
understanding the damage that has occurred and then working to
mitigate that in support of the State and local community.
With regard to the specifics of your question, a number of
them, two of them, I think, come together--the case management
question, as well as the question of the capacity and how
things come together for those children who may have damage.
And I think probably the most important thing, which we are in
the process of doing, we will improve a Medicaid waiver in
Michigan. The Governor has asked. I met with the Governor. I
was in Flint--was it last week, was in Flint, met with the
Governor, had these conversations.
There are two very important elements to the Medicaid
waiver. The first is expansion to pregnant women and children
in terms of the expansion, which we will do. The second,
though, is comprehensive case management, which will be a very
important part. And the funding to do that will help us in that
space.
With regard to the issues of the programs that you
mentioned, a number of those programs had conversations also
with the Governor and others about how we make sure that those
services are going to reach those children.
Ms. DeLauro. Are we examining the opportunity for Head
Start for all eligible children?
Secretary Burwell. That has been a part of the
conversation.
Ms. DeLauro. We have got, what, about 38 seconds. So we are
going to continue this, I think, for a while. So I won't
overstep my bounds, Mr. Chairman, but will come back on some
other things.
Mr. Cole. I thank the gentlelady greatly for staying within
the time limit.
With that, we go to my good friend from Arkansas, Mr.
Womack.
ELECTRONIC HEALTH RECORDS
Mr. Womack. Thank you, Mr. Chairman.
And my thanks to the Secretary also for her service to our
Federal Government and our friendship that dates many years.
Secretary Burwell, Congress enacted the High Tech Act with
the intention to encourage providers to adopt electronic health
records, and today, over 80 percent have them. However, as the
meaningful use program has been developed, its regulations have
grown far beyond the intent of Congress and have put layers of
new requirements on the backs of our doctors. Not only have
these requirements become so onerous that it is darned near
impossible to comply, but ultimately, they force providers to
spend more time on the computer than with the patient.
It seems to me that there has been more of an emphasis on
ensuring compliance by providers in achieving meaningful use
than there has been on ensuring our providers can comply and
that EHR use is actually meaningful. That is very concerning to
me.
I have heard these concerns from Arkansas providers
frequently. In fact, as of yesterday, another round of visits
yielded the same, and I was encouraged to learn that the CMS
Acting Administrator and the National Coordinator of Health IT
are using the tools provided by the passage of the Medicare
Access and CHIP Reauthorization Act of 2015 to transition the
Medicare EHR Incentive Program for physicians towards a reality
of where we want to go next.
On the eve of these changes to electronic health record
meaningful use, can you help me understand how the changes will
shift emphasis from the rigid enforcement to making the program
truly meaningful to patients and providers? Will the changes
provide flexibility for providers? Will they ensure EHR
interoperability? And when can we expect these improvements to
be released and implemented?
Secretary Burwell. So I think, as you have heard, we have
taken the comments and feedback that we have received and, even
as we were doing rulemaking in the fall, announced changes.
Acting Administrator Slavitt, as well as Karen DeSalvo at the
Office of the National Coordinator, have talked specifically
about that.
In terms of the specific things that we will do, MACRA is
giving an opportunity to make changes as we go forward. Some of
those, though, we already have put in place. One is we have put
out standards. And historically, we hadn't taken the step to
articulate what we believe are the correct standards that
people should use because that gets us to interoperability.
The second thing, and you will be seeing more on this as
soon as Monday, I will be--I am trying to think which day, but
I will be speaking to a gathering of 4,000 technology providers
in the private sector that are the people who are providing
this software. And we will be talking specifically about steps
that we are taking forward--together forward in partnership
with those companies.
And so what we are trying to do is in the places where we
can lead and we give directions, such as setting standards and
an interoperability roadmap, that we take those actions, and
where we can work with the private sector and where they need
to lead to do that. So it is the combination of the two things,
and part of that will also be the implementation of MACRA,
which we are pleased to do.
It is aggressive. Everyone, I think, should know what you
all passed is aggressive. We are excited about that and think
that gives us a tool. At the same time, we need the private
sector with us, and we are working with them, and you will hear
about that on Monday.
Mr. Womack. How soon can we see change on this front? How
soon can the wheels of progress turn and actually bring some
relief to the essence of my question?
Secretary Burwell. So this was a meeting I had, actually,
with the team on Tuesday in specific terms because, for me, the
answer to that question has to be 10 months and 20-some days in
terms of real change that providers can feel. And I think what
providers and consumers are both going to feel, and this is
something that you all will probably also work on, is at a
minimum, when we take away data blocking, and two things have
happened.
We have been clear that we are going to take action in any
way we can against data blocking and that we are articulating
it. When the Congress articulated that it would act--and data
blocking is where these providers of the technology, they can
do it either, it can be omission or commission. They can
actually do things that block an ability of consumers to get
that data, or they can do things that don't really completely
block it but make it harder in terms of not providing.
There are things that are happening in that space that we
are going to feel a difference within the year.
Mr. Womack. One of the real concerns I have, we have a
number of providers that fall into this category that are
getting to the age now where they either have to comply or they
may choose to just leave the profession. There are a number of
providers out there that still have a lot to offer in terms of
medicine, but yet are just leaving the enterprise. So is that
of concern to you?
Secretary Burwell. It is, and that is why--yes, it is,
which is why we have got to get it to where the value of this
outweighs the difficulty in doing it. And I would just ask
everyone to watch for that when you all conference on 21st
Century Cures, the Senate side will put in provisions that are
related to this very issue.
And as it comes back, my expectation, there will be a
conference, please watch there because that is a place where
legislation may help us.
Mr. Womack. Thank you.
Mr. Chairman, I yield back.
Mr. Cole. Thank you.
With that, I move to my good friend, the gentlelady from
New York.
GUN VIOLENCE RESEARCH
Mrs. Lowey. Thank you again, Mr. Chairman.
Thank you, Secretary Burwell.
According to the Brady Campaign, 31 Americans are murdered
with guns each day. One hundred fifty-one are treated in an
emergency room due to a gun assault. That is not all. The U.S.
firearm homicide rate is 20 times higher than the rates of 22
of our peers in wealth and population combined.
So I really think about it and wonder why. For instance, is
it possible there are societal trends or other factors
unrelated to gun purchases and ownership that may be important
to study to reduce gun deaths? The Federal Government and in
particular agencies within your department, such as the
National Institutes of Health, Centers for Disease Control, are
some of the leading public health research institutions in the
world.
So I am baffled that rather than arm them with the
scientific knowledge to save lives, some on the other side have
supported efforts to stifle this research. Now I just want to
say I worked with former Representative Dickey, and I remember
when that amendment about 20 years ago was put on the bill. And
he has already spoken out against it and said we should do the
research.
So I would like to ask you, are there public health reasons
why the CDC should not be conducting research into injury
prevention due to gun violence? If the committee were to fund
the President's request of $10,000,000 to study injury
prevention due to firearms, what type of research could be
funded?
Secretary Burwell. We believe that we should do the
research, and it is a matter of funding. So for us at the
Centers for Disease Control and Prevention, if we had those
monies, we would do the kind of research that you described in
terms of trying to understand why they occur, and as you said,
it can be a range of reasons, societal reasons and other
reasons. But we actually don't know because we haven't been
able to do the research.
So as we have proposed in our budget, we would like to see
that money so that we can start that work.
Mrs. Lowey. Thank you. And I hope we can make that happen,
Mr. Chairman. It would be a good thing for the country.
EBOLA VIRUS RESPONSE
We have made great progress since the Ebola epidemic
reached historic proportions in 2014, but we are not yet done
combating the Ebola threat, and our public health
infrastructure, including researchers, hospitals, physicians on
the front line, have not yet completed the mission to eradicate
this deadly disease and protect the public. In short, rather
than continue to wipe out Ebola, my friends on the other side
seem prepared to declare mission accomplished when cases may
still emerge.
What remaining Ebola efforts would be prevented or delayed
if funding were to be used for the Zika virus, and in
particular, are there medical countermeasures that could be
impacted as a result of using Ebola funding for the Zika virus?
Secretary Burwell. With regard to the countermeasures, yes,
there are a number of things. We should be hearing from the
WHO. I will be meeting with Margaret Chan tomorrow morning at
7:00 a.m. because we need the results of the ring trial that
was done on the Ebola vaccine.
We are also seeing the work on ZMapp, which was one of the
issues, and I read this morning there will be another study
coming out in terms of some of the types of tools that we can
use even in the treatment space, which we haven't historically
seen. So we are going to be seeing a number of things that
would come online that we will use those monies and ask for
BARDA and Bioshield to move forward if we can.
The other thing that I think is extremely important in
terms of those monies is the Global Health Security Agenda.
Right now, in Nigeria, we have Lassa and measles. But because
we are investing those monies in prevention, detection, and
response, that is what the Global Health Security money that
you gave us to spend over 5 years for countries to put together
plans, we are exercising those monies.
Three hundred individuals were at CDC, and I will not go
through all of the outbreaks that are occurring or the fact
that last year, we had the most cases of Middle East
Respiratory Syndrome coronavirus--respiratory, these are the
ones that really spread quickly--out of the Middle East, Saudi
Arabia, that we have ever had as a nation.
MERS was controlled because Korea had the capability to do
it. We supported them. We sent people from CDC. But it
happened, and no one even knows about that, which would have
been like Zika, if it had grown.
And so those are the things the money is being used for,
and we think those are priorities. As you probably know,
yesterday we sent up letters. I have done a reprogramming of
existing monies from the Prevention Public Health Fund to keep
CDC going, and we have sent you all a letter on two transfers.
And so we are doing everything we can to keep our efforts
going right now on Zika, but the demand is great. Today, I got
my numbers this morning. There are 155 cases in the United
States. You have seen the numbers, and you have seen the sexual
transmission.
In Puerto Rico, we think those cases--because we depend on
a set number, I think the cases are actually higher. So those
numbers will continue to rise quickly.
Mrs. Lowey. Thank you. And thank you, Mr. Chair.
Mr. Cole. Thank you.
The gentleman from Tennessee, Mr. Fleischmann, is
recognized.
SPECIAL ENROLLMENT PERIODS
Mr. Fleischmann. Thank you, Mr. Chairman.
Madam Secretary, thank you for being before us today and
appreciate your phone calls and all of your hard work and hard
efforts. Thank you.
Madam Secretary, I have got some questions. I am concerned
that the recent news indicates too much instability in the
individual market. Although you are highlighting a 90 percent
coverage rate, enrollment expansion in the individual market
are far below initial projections.
Consumers who are willing to do their part by paying a full
year of premiums are paying higher rates because the exchanges
allow people to sign up for just-in-time medical services
during what are designated as special enrollment periods.
I am also concerned about the ever-moving and expanding
open enrollment period. The original ACA regulations had open
enrollment periods that ended in early December. Allowing
individuals to continue to enroll after the current policy year
can encourage anti-selection and letting purchasers pay for
only a partial year of coverage while still receiving a full
year of coverage.
My two questions, Madam Secretary, are does the HHS plan to
significantly eliminate more SEPs in the near future, and does
HHS plan to limit or expand the open enrollment period?
Thank you.
Secretary Burwell. So with regard to the issue of the
special enrollment periods, we have announced that we have
gotten rid of a number of those special enrollment periods, as
your question reflects. So, yes, we have gotten rid of them.
In addition to that, we have put out clearer guidelines
with regard to making sure people know so that we narrow that
frame in terms of people doing it. And yesterday, we actually
put out information that you will have to provide
documentation, which is one of the issues that the issuers have
talked to us about, in order to promote a more stable market.
So we are taking those steps in terms of those that were in
your suggestion.
With regard to the broader question of numbers, I do think
it is important that when we think about what the objective
here was, the objective was access to insurance and then moving
to coverage when we think about the Affordable Care Act. And
with regard to the CBO numbers, in the original CBO numbers, as
we look at the tracking of the number of the uninsured--the
reduction is slightly higher than CBO projected.
What we know is that not as many people have moved from
employer-based care into the marketplace, and we actually think
that is fine in terms of the marketplace not growing by taking
employer-based care in. And so we think that is an acceptable
thing.
Having said that, we want to make sure we are listening,
and that is why the issues you raised are a number of issues
the issuers have raised with us, and we have taken action on
those as they go into this period to determine their
participation in the next open enrollment.
COMMUNITY HEALTH CENTERS
Mr. Fleischmann. Thank you. I would like to shift to
community health centers, if I may?
Madam Secretary, I would like to discuss the funding cliff
that community health centers face. As you know, mandatory
funding is due to end after fiscal year 2017. It is my
understanding that a large portion of this funding supports
basic, ongoing health center operations. Can you share with us
what the alternatives are if the authorizers do not act on your
request for an additional 2 years of mandatory funding?
I know these centers have been a source of medical care for
the uninsured. Can you explain to us the implementation of the
Affordable Care Act and how it is affecting the health center
financial model, given that nearly everyone ought to have some
form of insurance coverage by now that the health centers can
bill.
Secretary Burwell. So we are hopeful that we can get the
extension because it serves so many people, as you articulated,
in terms of the millions and millions of folks. I think it is 1
in 14 Americans are served by a community health center in the
country. And so the amount of services those are providing is
extremely important.
With regard to the issue of the finances, when I go and
meet with federally qualified health centers, their finances
are improving. They are improving in two cases. One, they are
improving because people have coverage now, and they use that
to expand their services. And whether that is in the issue of
dental or other services that they can provide, behavioral
health and that sort of thing. So they are using that money.
And in Medicaid expansion States, that is the other place
where they are getting those benefits. These health centers are
going to be the backbone of everything from some of our
behavioral health work to increasing our medication-assisted
treatment programs with opioids, and in our budget right now,
we have proposed that we can start using telemedicine. So they
can be the centers, and this is important for rural America in
terms of issues in rural settings where telemedicine can be a
real opportunity for both quality improvements and cost
reduction.
So those are some of the reasons we think it is extremely
important to continue.
Mr. Fleischmann. Thank you, Madam Secretary.
Mr. Chairman, I will yield back.
Mr. Cole. I thank the gentleman.
My good friend from Philadelphia is recognized next, Mr.
Fattah.
BRAIN INITIATIVE
Mr. Fattah. Thank you.
And Madam Secretary, it is good to see you this morning.
Your focus on the Affordable Care Act and its implementation
has led to an historic level of participation. And particularly
in Philadelphia, and you came personally to my district and
helped launch an enrollment effort.
And I think we lead the country. We might still be in a
competition with Miami. I am not sure. But I will just claim
the victory and credit your great leadership with it.
There is so much that I want to ask you about. We only have
a few minutes. Let me start with our work on the neuroscience
front, on the BRAIN Initiative.
NIH's participation and leadership in it is obviously
critical. I want to thank the chairman. Working with us last
year, we were able to fully fund these initiatives. And as the
administration comes to the end of this period, it is going to
be important that this work not be interrupted.
We have some 50 million Americans suffering from a brain-
related illness. The efforts of NIH, along with the National
Science Foundation and DARPA and a host of a dozen other
Federal agencies, the VA and so on, this work is critically
important.
So be interested in your thought about how to make sure
that we can structure the baton pass correctly and that this
work can go forward.
Secretary Burwell. So I think one of the most important
things is that it is housed at NIH, which I think under any
administration will continue. And I think the BRAIN work and
the demand around the BRAIN work, whether that is concussions,
Alzheimer's, is great. And so I think we are hopeful that this
will continue to be a priority.
I think the other way we get the continuity is already
happening. Thank you all for the support that you provided last
year. We have already issued 125 awards. So those scientists
are doing their work to provide the input, and I think, as you
know, it is not one effort. It is about research in a number of
different areas and places because the brain, right now, our
knowledge is pretty limited, and there are so many conditions
and diseases that are related.
And so those 125 awards are out, and I think that is the
other place and way that we will be able to continue this
effort and get results.
Mr. Fattah. Thank you.
COMMUNITY HEALTH CENTERS
And the--in your testimony, you talked about the community
health centers, and my colleague has already asked you because
we are going to arrive at an important challenging moment for
the community health centers. Now this is my priority and a
number of our other colleagues, I know Barbara Lee and others.
In the Affordable Care Act, we provided a very significant
ramp-up for federally qualified community health centers. The
last thing we want to do is have one out of every nine
Americans being able to use those centers now and then get to a
point in 2017 to have a problem.
So we want to work with the authorizers and the
administration and get what we think is a modest request. Your
request is for a 2-year?
Secretary Burwell. Yes.
Mr. Fattah. Right. To make sure that that happens. So this
is very, very important.
PRECISION MEDICINE INITIATIVE
And then you have a very significant increase in the
precision healthcare portion of the budget. We provided money
last year, and this is an area that is vitally important and
builds on the work of the Human Genome Project and a host of
things.
So if you could talk a little bit about how you see the
progress from last year's funding. I know you just started to
move that money, but if you could talk to us a little bit about
that.
Secretary Burwell. So two places in terms of specifics
where the Precision Medicine Initiative, and thank you all for
the support for the funding, in terms of where the progress is
being made.
The first is, I would say, in the cancer area. That is the
place that is the most ripe and where we are moving the dollars
through the National Cancer Institute to continue to do
research in the genomic space. And this is about the genomics
of the tumor. And so that we can actually instead of saying,
``You have kidney cancer,'' we look at your tumor.
And I met the gentleman at NIH who his family had had a
number of members die. He lost one kidney. He had over 30
tumors removed, and they kept growing back. But once we
analyzed his tumor genetically and treated it in that form,
versus treating kidney cancer, we were able to make progress.
And so those are the kinds and types of examples.
The other place where that money is going to come to
fruition is, and I think the President is doing an event either
now or this afternoon on Precision Medicine, we will be working
with the private sector on some of their engagement. But I
think the big thing is getting the cohort, the group of people
who will come in and be a part of creating a broad group of
people where research can be done.
And so we have put in place some of the privacy
recommendations, some of the security recommendations, so that
we build the right platform as people want to and can come in.
Mr. Fattah. Thank you.
Thank you, Mr. Chairman.
DEFICIT REDUCTION
Mr. Cole. Thank you. And we next move to Dr. Harris.
Mr. Harris. Thank you very much.
And thank you, Madam Secretary, for being here today.
First, I just got to clear up a question I have got because
somehow you talk about the budget being--showing deficit
reduction. And I have got to tell you, I--because I just pulled
up the President's budget, and am I correct that the
President's budget projects a deficit in 2026 of
$793,000,000,000?
Secretary Burwell. With regard to the specifics of that
number, I will trust if you have the budget in front of you
because----
Mr. Harris. OK. It says $793,000,000,000, Madam Secretary.
And the CBO estimates this year's is $541,000,000,000. And I
got to tell you, this is why people don't trust Washington.
This is why we look at the presidential race, and we
wonder. We scratch our heads like, ``Why is it going the way it
is?'' Because only in Washington, honestly, could a Secretary
come before a committee and say that raising the deficit from
$541,000,000,000 this year to $793,000,000,000 in 2026 is
deficit reduction.
This is the problem, and this is not a question. This is
comment. This is the problem with Washington.
That being said, we got a problem because we project and
the President's budget actually projects a debt of
$21,300,000,000,000 in 2026, 21.3 the publicly held debt. This
is a real problem.
So we got to look at how we fund things, and first question
I have is the Zika funding request. Is that above the caps?
Secretary Burwell. It is an emergency supplemental, yes.
Mr. Harris. So it is above the caps.
Secretary Burwell. Correct.
Mr. Harris. So, actually, we are sitting on a
$541,000,000,000 deficit, and we are--the administration comes
in and says this is emergency funding. Now I will tell you,
when I was in the Navy, we had a saying that the Navy went from
crisis to crisis unimpeded by plans.
Within one year, we have had requests, I think the last
request for Ebola, someone can correct me, $6,000,000,000? I
mean, it is just billions and billions of dollars. That was an
emergency request. Now we have got an emergency request.
Is there a plan somewhere? And then I go, oh, my gosh.
There is a plan. It is called BARDA. It is actually called--we
actually have a plan to fund projected problems into the
future. And what did the administration do? They come and say,
yeah, we got a plan, and we need a certain amount of money, and
we are only going to spend half of that.
We are going to ask you for emergency funding, but actually
one of the plans we have so that we are not going crisis to
crisis so that, for instance, when there is anthrax outbreak,
we actually have the medications to treat it. When there are
the--or I can go down the whole list of BARDA. So that actually
we don't end up with a crisis, the administration chooses to
underfund that program.
Where is the plan?
Secretary Burwell. So----
Mr. Harris. Because Zika and Ebola are actually, you know,
although they are different viruses, they are actually the idea
that we should have a plan and say we have to develop a method
to rapidly react without emergency funding.
So, for instance, could you describe the plan to rapidly
develop vaccines and get them approved and how much we are
spending on that plan?
Secretary Burwell. So, Dr. Harris, I think that the
fundamental cost in both Ebola and in Zika actually has to do
with public health for the American people and not the actual
cost, the amounts of money needed in terms of vaccine
development and deployment, if you have them. But with regard
to the cost for both Ebola and Zika, right now what we need to
do is make sure that we are getting the right information and
doing the diagnostic testing.
Right now, the Governor of Florida, I read this morning in
the newspaper, he has asked me for more tests. Right now, with
regard to that is a CDC function. The questions of Ebola and
Zika, right now we know in this country, 14 women are pregnant
who have had the virus. We don't want that to continue. We
don't want more.
We don't know. I can't tell you how long Zika lasts in
semen. Neither can Dr. Frieden, neither can Dr. Fauci.
Mr. Harris. Madam Secretary, I absolutely agree, and I have
a list of questions.
Secretary Burwell. Those are the funds----
Mr. Harris. So I am just going to keep on going.
Secretary Burwell. Those are the funds that I think you are
asking for.
Mr. Harris. Is the public health--you have a public health
prevention fund in your department, don't you, started by the
ACA?
Secretary Burwell. We do.
Mr. Harris. How much of that money is appropriated to Zika
for next year?
Secretary Burwell. In terms of that fund, as I mentioned
earlier, we have asked--in terms of the prevention fund?
Mr. Harris. That is right. How much in your budget of that
prevention fund is going toward it because that----
Secretary Burwell. There is no prevention fund. I just sent
up a letter that actually we are using some of the monies for
those in terms of other carryover balances. Now which
prevention fund you are talking about----
Mr. Harris. Now how, Madam Secretary, the public health----
Secretary Burwell [continuing]. Because there is a
Prevention and Public Health Fund that you all told us----
Mr. Harris [continuing]. Prevention fund. The Public Health
and Prevention Fund that is funded--that was established by the
ACA for the purpose including vaccines. So we are told, well,
we have to develop a Zika vaccine. Are we using currently
available funds before we ask for emergency funds?
Secretary Burwell. Those fundings have been allocated by
Congress. It happened 2 years ago. In the first year I was in
the administration, the administration had choice. After that,
the Congress, in the last 2, maybe 3 years--I will ask the
chairman. But in the last 2 at least, you all have given us
very specific allocations for those monies.
Mr. Harris. And have you asked for the Zika funding to come
from that allocation instead of an emergency allocation that is
outside the budget caps?
Secretary Burwell. Dr. Harris, we believe in terms of the
tradeoffs that we need to make in an emergency situation, where
babies are being born with microcephaly that we believe it is
an emergency.
Mr. Harris. I yield back.
Mr. Cole. Thank you very much.
We will next go to my good friend from California, the
gentlelady, Ms. Lee.
Ms. Lee. Thank you very much. Good to see you, Madam
Secretary.
Secretary Burwell. Thank you.
DIVERSE WORKFORCE
Ms. Lee. And I just want to remind this committee, you
know, I think our allocation right now continues to be, what is
it, 10 percent below pre-sequestration levels? And so we need
to really recognize that and try to understand the fact that
this allocation at this level continues to really hamper our
ability to address our Nation's current and emerging health
needs. It is really too bad, and hopefully, we can get a better
allocation this year.
A couple of things I would like to ask you about. Of
course, you know the Health Careers Opportunity Program, I have
been calling for years now to make sure that we fund it. So I
am really glad to see that there are resources in this budget
for that.
But I want to ask you about why you are eliminating the
area health education centers, which are really critical for
minority and low-income families, according to--in terms of
ensuring medical school training and healthcare training. There
is a statistic I want to raise at this committee during this
hearing that the Association of American Medical Colleges put
forward.
There were fewer African-American males enrolled in medical
school now than in 1978, and so by eliminating this program, I
want to see how you are going to really address the emerging
needs of diversity in the health workforce and halt this
disturbing trend.
Secondly, as it relates to the Asian Pacific American
Caucus, I serve as the co-chair of CAPAC, and we have many,
many issues we have been addressing, and thank you for your
assistance and leadership on this. But the Racial and Ethnic
Approaches to Community Health, that is the REACH program, it
has historically provided direct support to the AAPI community.
Of course, with higher rates of health morbidity and
mortality, this initiative is so important. REACH has
documented success in engaging Asian Pacific Americans in
healthcare, healthcare prevention, but yet this budget proposes
to cut $20,000,000 out of REACH. And so this is a very
specific, unique program that really helps with the healthcare
needs of the AAPI community.
So I wanted to ask you why the cut? And do we see that
somewhere else in the budget at this point and just emphasize
the importance of that to the AAPI community.
Secretary Burwell. So the issues of diversity, both in two
forms, in terms of making sure we have healthcare providers
that are diverse as one of our priorities, as well as the issue
of making sure we are serving communities and communities that
sometime have disproportionate needs.
With regard to the overall educational issue, I think you
know and as you stated in your beginning comment, we are in a
state of a limited budget. And with regard to the specifics of
the program, what we have chosen to do to try and work on those
numbers that you said, the 1978 to now----
Ms. Lee. Really big numbers, yeah.
Secretary Burwell. What we are hopeful is, is by focusing
on the programs that actually are closer to that point of
getting the people in. And so the funding that you see in terms
of our Public Health Service Commissioned Corps, and that is
not the Commissioned Corps, but the Public Health Service
Commissioned Corps in terms of that has over one-third
minorities. And by investing there, we are getting those folks
in at that point at which they are so close, and they are at
the point at which they are making decisions.
And so trying to focus on the point where we would have the
most leverage with limited resources.
Ms. Lee. Is that why you eliminated the area health
education centers?
Secretary Burwell. Yes. Because in terms of trying to
figure out in a world of limited resources where our dollars
can have the most impact, those were the choices that we made.
With regard to the broader overall issue, our investments
in community health centers has been articulated as well as
they are very important to serving and providing monies for
diverse communities. In addition, the Affordable Care Act and
the issue of getting people insurance is one of the most
important things that we believe and we are deeply focused on
in terms of changing the dynamic of the disproportionate and
the inequities in minority populations.
We know that getting people coverage is not enough, and we
have to move that coverage to care, and in the last year, you
have seen efforts in that place through CMS, as well as through
the community health center.
Ms. Lee. OK. But the cut, the $20,000,000 cut in terms of
the REACH program, because it has been so successful in
addressing the Asian Pacific American community, why the cut
and where do we see that focus again in another line item?
Secretary Burwell. I think what we want to do with the
proposal that we have in front of us is to be able to do some
of that evaluation to understand how we can make that program
as strong as we possibly can. And when we do that, think about
then where and how are the places that we can expand it.
Ms. Lee. OK, not expand it, but why would you cut it? I am
just trying to understand the cut.
Secretary Burwell. In a world of limited resources, as I
said----
Ms. Lee. That is limited resources. So once again--so
ethnic minorities, again, are getting cut in this budget like
everybody----
Secretary Burwell. Across the board, I think--well, like
everyone. Because I think what we have tried to do in terms of
care for these populations, there are a number of other areas
where we have tried to make sure that we have either maintained
or increased because we know the disparities are great.
Ms. Lee. OK. And then viral hepatitis, I have time? Any
more time?
Mr. Cole. I would ask you to look at the time.
Ms. Lee. OK. I will get it next time around.
Mr. Cole. Thank you. Just with the indulgence of the
members of the committee, I will say for the record, I know 12
cardinals and 12 ranking members that are convinced that their
allocations are too low, and I can say with certainty that the
cardinals and ranking members on Interior, Defense, and this
committee are absolutely correct.
[Laughter.]
Mr. Cole. With that, I am going to move to my good friend
and, sadly, retiring Member. So it is also his last appearance
here, and Mr. Rigell, you have made great contribution to this
committee. You will be greatly missed in Congress.
ALZHEIMER'S DISEASE
Mr. Rigell. Thank you. Even though I am way down here on
the end.
Listen, and what a privilege it is to serve on your
committee and with the ranking member and just the individuals
that we get to interact with. And I join the others in thanking
you for your service. I want to talk about something that is
affecting so many American families, Alzheimer's.
I have a kind of a little window into it just because of
the fact that my parents are still living. They are doing so
well. They are 93 and 88, and we Facetime every Sunday morning
at 8:00 a.m. And sometimes the conversation pivots over to
their friends, and they start describing--they start naming
names, and well, they are the names of my childhood friends,
their parents, of course. Their parents.
So I know them, and they just--they have to talk about how
painful it is because they don't know where they are and all
those other symptoms of that horrific disease. And I know that
we increased research by 60 percent, and I am so supportive of
that.
But as I think about how we have extended the length of
life and not the quality of life, and I think about how
organizations from time to time miss real critical moments,
like the housing crisis of 2008-09. You know, we missed that.
We didn't really see that coming, at least most people didn't.
And it was like the Challenger disaster, if you look back
at it from a managerial standpoint, they could see where they
went wrong. And I feel like we are in that same boat with
respect to Alzheimer's.
I am a fiscal conservative, and yet embraced in all of
this, and I also brought my heart to Washington, my mind, and
my calculator and everything else. But I really would submit to
the committee that I think we are far lower than we need to be.
And I say this as a nonmedical professional.
But, so I have two questions for you. The first one is how
have we managed that 60 percent increase? And please don't
spend too much time on that because our time runs out so
quickly. But I want to ask a hypothetical question. I think you
will appreciate the question.
But if you could invest in that particular area not to the
detriment of the other areas--I am giving you a hypothetical.
If you could just--because at some point, the water starts to
flow out of the glass. I mean, there is just more money than we
can really apply to the research.
But what is that theoretical limit of what you would want
to apply to research to Alzheimer's? Because I think this is
the number-one challenge facing our country for a host of
reasons--quality of life and, indeed--and indeed, fiscal, the
fiscal aspect of it. So could you walk us through that, please?
Secretary Burwell. So with regard to that answer, I
actually would want to consult with NIH, and here is why. And
it actually gets to a part of what Dr. Harris raised. In terms
of our BARDA monies, in terms of managing the taxpayers' money
well, those monies that we took down were Bioshield monies, and
it is because the science is not ready and our contracting
ability in terms of negotiating, we won't negotiate more. And
so we have carryover balances.
And so how I would answer that question actually is related
to where the science is because I wouldn't just want to put out
a number. I actually would want to know that we believed that
we could spend the money well.
And so I am happy to talk to our colleagues at NIH and get
back to you with that because I actually think that is
important that when we care deeply about things and are
passionate about them, I still think we have to use some
methods of standards of with regard to using the money.
Mr. Rigell. Oh, I absolutely support that.
Secretary Burwell. And I am sure you agree with that. Yes.
Mr. Rigell. As a business person who--and whether in office
or out of office, I am going to continue to advocate for this
because I think it is the right thing for our country, and I
think I will do so as a fiscal conservative.
It may surprise the chairman, but I was actually called out
just a little bit in the Financial Services Committee by one of
our colleagues on the other side, accusing--well, saying that I
was like raising my voice, I believe, or something because it
was an Office of Management and Budget Director there, and I
was actually pressing this whole point about our fiscal
situation.
And I share the views that have been expressed here,
particularly on our side here, that I don't believe the
administration has fully grasped the threat of our fiscal--the
risk that we have, and he is not fighting for it. I didn't see
him fight for it in the State of the Union, for example.
I walked out just really stunned at the lack of attention
to this matter, and I acknowledge easily and quickly that both
sides have contributed to it. But I am \1/435\th of \1/2\ of
\1/2\ of this part of the Government that actually works on all
this. He is one-half. And I am just going to take this
opportunity to share with you, as I did with Director Donovan,
that I don't think we are grasping the severity of our fiscal
situation.
I want my President in his remaining term of office here--I
am not expecting much, actually--but to really bring a clarion
call to this and to do what is needed to set our country on a
better fiscal path for a host of reasons.
And I want to respect the time, and Madam Secretary, I
appreciate your service, and I share the respect that all of us
here have for you.
Thank you.
Secretary Burwell. Thank you. Thank you.
Mr. Cole. Thank you.
RACIAL AND ETHNIC HEALTH DISPARITIES
We will next go to my other friend, the gentlelady from
California, Ms. Roybal-Allard.
Ms. Roybal-Allard. Thank you, Mr. Chairman.
And welcome, Madam Secretary.
Let me begin, first of all, by expressing my concern also,
as Ms. Lee did, with the $21,000,000 cut to the REACH program.
And I can't help but question that even though there have been
150 journal articles documenting the achievements of REACH in
reducing health disparities, that there is a need for another
study. So I just want to put that on for the record.
ADULT IMMUNIZATION
But I have another question regarding adult immunization.
As you know, this country is falling woefully behind in our
progress toward reaching the Healthy People 2020 goals for
adult immunization. And the recently released 2014 National
Health Information Survey data confirms very little change in
adult immunization rates over the last 4 years, with fewer than
45 percent of adults receiving recommended influenza vaccines
and barely 20 percent of adults age 18 to 64 being immunized
against pneumonia.
Especially concerning is the fact that immunization
coverage among minority populations is even lower. The 2014
data revealed that racial and ethnic disparities persisted for
all seven recommended adult vaccines and worsened for both
herpes zoster and TDaP.
For these reasons, I was pleased to see that your National
Vaccine Program Office recently finalized the National Adult
Immunization Plan----
Secretary Burwell. Yes.
Ms. Roybal-Allard [continuing]. With four goals centered on
improving infrastructure, access, and demand for immunizations,
as well as fostering innovation in vaccine development. Could
you please describe the short- and long-term steps that your
department will take to move the NAIP implementation forward?
Specifically, how does the plan address immunization
disparities in minority communities, and how will HHS measure
progress in bringing adult immunization rates closer to the
Healthy People 2020 goals over the next 4 years?
Secretary Burwell. So I think those four steps that you
outlined, especially the access, the infrastructure, and
demand, and in terms of when one is thinking about all three of
those steps, making sure that we are going to the population
that is most underserved in those spaces in terms of the
minority populations. And that will guide our communication
strategy, as well as how we reach people.
And I think you know some of the tools that we have used in
the marketplace, in terms of understanding how to reach
consumers where they are, are tools that we will transfer and
are learning from throughout the entire department to make sure
we are communicating. Because one of the things that we have
found is often our communications don't reach people. And often
they are not done by people who are trusted.
And so these are two very important lessons that I think
from the marketplace that we are going to try and apply. It is
why this year, in terms of the places I went for open
enrollment, I went to barber shops. I went to beauty shops. We
went to churches. Those are the places where people get the
information that they trust and use.
And so I think we need to shift some of our approaches to
how we do this. Welcome your thoughts specifically on how we
can reach the community and the ways that we are reaching them
that you think are working and the ways that we have tried that
aren't, so that we can quickly--because I think that consumer
feedback, which I hope you are hearing, can help us get to a
place where we can be much more effective because it is the
larger part of the population with regard to these adult
vaccinations that people don't do.
The other thing that I would ask for your help and
assistance, in Medicare, one of the things the Affordable Care
Act did was it created, you know, preventive services for free.
These are included. We have seen some increase in uptake, but
not enough.
And so this idea of our targeting needs to be across all
age groups and especially adults in that band. Because some of
these adult vaccines are especially important as you get older.
MULTI-DRUG RESISTANT TUBERCULOSIS
Ms. Roybal-Allard. Before he went into politics, my father
was a public health educator, responsible for educating the
Latino communities in California about the spread and
prevention of TB. And because of that experience, I grew up
with a healthy respect for the dangers of this disease and have
been closely following the case of the 35-year-old man in Los
Angeles who has been battling extremely drug-resistant TB for 3
years.
And I was pleased to see the December 2015 White House
release of the National Action Plan for Combating Multi-Drug
Resistant Tuberculosis, and I want to commend you for this, a
thoughtful and very comprehensive 5-year plan to develop new
tools for diagnosis and treatment of the new research
investments for an effective TB vaccine.
But I am skeptical that the plan will be successful in
reducing MDR-TB infection in the United States and abroad
without any designated funding for its implementation in your
fiscal year 2017 budget proposal. Why was there no funding
request for the National Action Plan----
Mr. Cole. I would ask the gentlelady wrap her question up
and a quick response, please.
Ms. Roybal-Allard. Can you provide information on the
implementation and the cost?
Secretary Burwell. Yes, we will provide information on
that, as well as the combating antibiotic resistance funding,
too, which will be a part of it as well.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Roybal-Allard. OK. Thank you.
Mr. Cole. Thank you very much.
I now recognize my good friend, the gentlelady from
Alabama, Mrs. Roby.
UNACCOMPANIED CHILDREN
Mrs. Roby. Thank you, Mr. Chairman.
And thank you, Madam Secretary, and I am sorry that we were
unable to connect----
Secretary Burwell. I apologize.
Mrs. Roby [continuing]. Prior to today. On Tuesday, the
chief of the U.S. Border Patrol testified before the Senate
that border agents are seeing a dramatic surge in the number of
unaccompanied minor illegal immigrants arriving at our southern
border. In fact, the border agents have apprehended over 20,000
children from October 2015 to January 2016. That is double the
number from the same period last year.
And let me just be clear to my colleagues here today and to
the people that I represent, I feel nothing but compassion
towards these children, and I think the most compassionate
thing that we can do is return these children to their families
in their country of origin.
Unfortunately, that is just not happening. Only 4 percent
of these children, according to a statement made by my
colleague Senator Jeff Sessions, are actually returned to their
families in Central America. And as the mother of an 11-year-
old girl and hearing the stories about what is happening to
these children in this treacherous journey to the United States
is horrifying, quite frankly. It is the worst of human
trafficking.
And so I don't feel as though there is discouragement
coming from the Obama administration. I don't feel like we are
sending a very clear message, and I have a real concern about
the fact that there is consideration, continued consideration,
to house these children on active military bases.
We received a letter between Christmas and New Year's--a
week where most people aren't paying attention, but we were--
that in fact, Maxwell-Gunter Air Force Base in Montgomery,
Alabama, was under consideration to house these children. I met
with your Office of Refugee Resettlement recently. We went over
all the criteria about why and how this should be done with the
military liaison that was there as well.
And I am deeply concerned that any of our military bases
remain on the list to house these children. I can share with
you, I have a map that shows the buildings where these children
are going to potentially be housed at Gunter. And for those who
don't know, what happens is the space on these military
installations where these children are to be housed is fenced
off, and an outside contractor then comes in, most of the time
armed, onto a military base. And these children are fenced in
an area, a small area, mind you, right next to a neighborhood.
And this is on a military base, Gunter Annex, where
everything they do is at top secret clearance. This is a lot of
cyber warfare going on. These buildings are just adjacent to
the very buildings where our active military personnel are
doing very important missions on behalf of the United States
military.
So I share all of this with you. I know we might do a
second round, I hope. In the last remaining 1:45, I would like
for you to first engage on this, and maybe we can follow up in
the next round.
But I just want you to know that I have a very strong
opposition. We need to get these children home, and in the
meantime, we certainly don't need to have them housed at a
military base.
Secretary Burwell. So I think you know our job is to--once
the child is in the United States, make sure that they have
appropriate care and are placed in an appropriate and safe
setting. And that is the role of HHS.
With regard to the discouragement issue that you raised,
which I think is an important one, what we have seen is you are
right about the numbers. Of that 20,000, we received 17,000,
the 20,000 that they saw, 3,000 never came to us, which mostly
usually means they go back immediately through DHS.
But those that came to us, we now have seen a drop-off in
January, which is a good thing. But we don't know if that will
stay. And so my job is to make sure we have enough facilities
that the children don't back up at the border, as we had in
that one situation. And this gets to the issue of do we have a
plan? Yes, we have a plan.
But in order to have a plan, we have to have an ability to
open facilities as quickly as we need them because it is a
balance of the taxpayers' money with regard to maintaining
empty beds versus when you can bring beds on line.
We appreciate your engagement in helping us review the
bases. The bases are an important part of this because the
process--and we are looking at other private sites across the
country. But as you said, finding sites that can meet the
conditions that will work for the city, the community, and the
children, both the children's safety, the community's safety,
we weight all of those considerations.
Mrs. Roby. But would you agree with me--and we will
continue discussing this. But would you agree with me that a
military base is the last place that we want to house these
children?
Secretary Burwell. The issue with the military bases is
that they actually have housing and facilities that are needed.
When I go and get GSA buildings, the millions and millions of
dollars that it will take me to refit, you know, most of the
GSA buildings that I would go and try and get in terms of
accessing. The other issue, to be honest, is when I access a
nongovernment facility, it has to do a process in every State
for approval.
Mrs. Roby. Sorry.
Mr. Cole. I know we got you with a question right at the
end. I would just ask----
Mrs. Roby. I am sorry.
Mr. Cole. That is quite all right. I understand the passion
around these issues.
We have had the good fortune to be joined by who we
affectionately call ``the big chair,'' and so I am going to
move directly to him for whatever statement he cares to make
and whatever questions he would care to ask.
Mr. Chairman.
Chairman Rogers. The big what?
Mr. Cole. The big chair. [Laughter.]
Chairman Rogers. Well, thank you, Mr. Chairman.
Madam Secretary, it is good to see you. Welcome to the
Subcommittee.
Secretary Burwell. Nice to see you.
OPENING STATEMENT
Chairman Rogers. I apologize for being late, but we have
got 21 hearings this week across our 12 subcommittees, and I
had to attend the one across the hall with the Secretary of
Defense for a period of time. But I wanted to be here to hear
your testimony and be able to chat with you.
As you know, the Congress and the administration set
discretionary budget caps for fiscal 2016 and 2017 in the
Bipartisan Budget Act, and I am proud to say that the 2016
omnibus stayed within that agreed-upon cap. The budget proposal
put forth by the administration for HHS is also touted as
adhering to those spending caps, but it is really just an
illusion, to be frank with you.
This year, HHS requested $75,680,000,000. But that number
does not include an estimated $3,800,000,000 that you proposed
in mandatory funds to support what are traditionally
discretionary programs.
While I very much enjoy our collaboration over time in the
immediate past on a host of issues, I am disappointed that the
important goals that we share for your department are
undermined, frankly, by what I consider a partisan nature of
that request. We both know that these figures and budget
gimmicks are unrealistic, and frankly, it makes the already
very difficult job that we have even more challenging.
We all know that the mandatory side of the budget, and that
is three-fourths of Federal spending is mandatory entitlements,
growing out of control. We only appropriate a little less than
a third of all Federal spending, and we have cut that. We have
cut that for the last 5 years back by almost $200,000,000,000.
We have cut discretionary, but mandatory just grows willy-
nilly.
And so you are proposing switching some money over to
mandatory and outside the jurisdiction of this committee to
oversee. That is why it is a difficult thing for us to have to
contend with.
There are two areas in particular that see astronomical
growth in mandatory spending under your request. First, NIH.
National Institutes of Health play an important role in
groundbreaking medical research. NIH projects often result in
lifesaving medical treatments that impact people all over the
world.
This committee understands the importance of NIH. We are
all personally committed to NIH and demonstrated that support
through an increase of $2,000,000,000 over fiscal 2015 that we
put in the omnibus, thanks to the great work of your chairman,
Chairman Cole. It was a bipartisan achievement.
And for the administration to propose its well-publicized
$1,000,000,000 Cancer Moonshot through mandatory spending
outside the terms of the BBA, outside the scope of this
committee's jurisdiction, it is simply disingenuous. We are all
committed to cancer research, all forms of medical research,
but we still are governed by the laws of nature. We have got to
make tough choices about how and where to spend taxpayer
dollars, and when you thrust this money into mandatory, it puts
extra burdens on us to try to find money on discretionary to
fund the things that you are displacing.
The same can be said for the $1,000,000,000 proposal to
address our Nation's raging opioid epidemic. Madam Secretary, I
sincerely appreciate your efforts to keep the national
spotlight on prescription drug and heroin abuse, and you and I
have talked about this time and again, month after month, year
after year. And you are a soldier in that cause.
I know your roots in neighboring West Virginia. My district
and your area are next-door neighbors, and the battle has been
waged there for a decade or longer. It has been a source of
personal motivation that you have dedicated to that cause, and
you have taken, indeed, strong, decisive action to eradicate
abusive prescription practices, educate our communities about
the dangers of these drugs, and treat those suffering from the
grips of addiction.
We undoubtedly share those same goals, and I believe we
have made some real progress together. But I also believe this
request exposes our diverging paths to the promised land. We
have got to continue to provide States the support they need to
defeat the epidemic, but we have also got to do so within the
reasonable confines of our budget.
Supplementing existing funding with mandatory dollars to
fight substance abuse only hurts our ability to address the
problem in the near and distant future. While the ideas behind
this budget request merit consideration, the President's
request is simply not feasible as written. So I hope we can
work together to address my concerns because the stakes here
are far too high for us not to.
Before I close, let me--I would be remiss if I didn't
mention that rural hospitals across the country are struggling
financially, and it is across the board. Many of them are on
the brink of having to shut their doors, and I have several in
my district that are at that stage, leaving these small
communities without a dependable source of emergency and
hospital care.
Instead of working with these hospitals to make sure rural
Americans have affordable, reliable care close to home, some of
the proposals in the President's budget will compound their
financial troubles. These harmful proposals range from adding a
user fee for hospitals that utilize the 340B drug pricing
program to cutting the reimbursement levels for critical
hospitals that oftentimes serve the chronically ill and
elderly.
While to most it may seem like a few dollars here and a few
dollars there, each proposal chips away at the sustainability
of these rural hospitals. So I hope we can talk to you about
that as time passes to solve a problem that is really crippling
rural America fast.
I thank you for your work, and thanks for being here.
Secretary Burwell. Thank you, Mr. Chairman. Thank you.
Mr. Cole. With that, I want to go to Mr. Dent, but before I
do, after Mr. Dent enjoys a full 5 minutes, with unanimous
consent, I am going to move us to 2 minutes. The Secretary has
to get out of here. I know she has an engagement. We want to
try and help her.
But also there is a lot of questions here, and I want to
give everybody a chance. So please, again, after Mr. Dent, we
will try and hold it to 2 minutes. So thank you very much.
And with that, my good friend from Pennsylvania is
recognized.
COLORECTAL CANCER SCREENING
Mr. Dent. Thank you, Mr. Chairman.
And good morning, Madam Secretary. We didn't get to hook up
either, appreciated your phone call, though.
As you know, for several years, I have been working on
legislation that waives co-insurance for colorectal cancer
screening test for Medicare beneficiaries when the screening
results in removal of tissue or a polyp. I am encouraged this
year that the budget includes a recommendation to do just that.
How can we on the subcommittee continue to work with you
and CMS to implement this common sense policy that we can
further encourage more people to be screened for----
Secretary Burwell. I think we are----
Mr. Dent [continuing]. Colon cancer, and what was the
impetus for including this in this year's budget?
Secretary Burwell. Thank you for your leadership and effort
in this space. And I think we are hopeful that this is
something that is a change that people could agree on as part
of the budget process, and when we have put it in the budget,
it is because we believe we need to help to get it done.
Mr. Dent. Well, good. I am pleased to see it in there, and
it is something that we need to correct.
Secretary Burwell. We look forward to working with you on
it.
NIH FY 2017 BUDGET REQUEST
Mr. Dent. And my second question deals with the NIH issue,
and I would like to discuss the discretionary funding cut the
NIH faces in the proposed 2017 budget request. We provided NIH
with a $2,000,000,000 discretionary increase in 2016, and I was
more than a little surprised that the 2017 NIH request reverses
this with a $1,000,000,000 decrease from NIH discretionary
funds.
The request presumes to backfill these dollars with
mandatory funds, which are outside the jurisdiction of this
committee room. And we believe that is a truly unacceptable
budget gimmick.
Further, it only assumes the mandatory funding for one
year. In other words, it creates an out-year mandatory funding
cliff of $1,000,000,000 in fiscal year 2018 that our committee
would have to address. Mandatory funding cliffs are one reason
we appropriators do not support switching discretionary
programs into mandatory funding.
The bill always comes back to rest at the doorstep for this
committee to fix, and I certainly urge all NIH supporters, like
myself, to avoid efforts to swap discretionary funding for
mandatory funding streams. On top of this gimmick, the budget
presumes to add another $825,000,000 in mandatory funds for NIH
to support the Cancer Moonshot, Precision Medical Initiative,
and the BRAIN Initiative, all good programs.
Please discuss the impact on NIH if the authorizers don't
act to provide mandatory funding. And specifically, how will
this impact extramural investigator grants, success rates, and
NIH's ability to sustain research supported with the
$2,000,000,000 increase provided this year.
Secretary Burwell. So we are appreciative of the increase
that we received, and I think this is about putting the overall
budget together in terms and why we took these steps.
And I think in a world where--and this gets to Dr. Harris
and some of his comments. In a world where we have a--one of
the lowest discretionary as a percentage of GDP, which, when
one thinks about your spending, thinking about the size of your
economy, seems like an important way to measure.
And as we think about that, the question is if that is the
path we want to choose in terms of our discretionary levels,
and that is--part of that is in terms of what deal we did on
the sequestration and the replacement of it, and do we think we
are at the right discretionary level?
If we think we are at the right discretionary level, I
think we wanted to stick with the agreement that we believe and
have paid for. And one of the things that happens even when we
do the agreements to raise the discretionary caps, often the
pay-fors that we have in our budget are those that end up
getting used.
And so I think the real question, and I am very
appreciative, as my former role in OMB, of the issue with the
discretionary and mandatory. So I am very appreciative of the
concern and the questions that you are raising. I respect
those.
But I think the larger question for all of us is do we
believe that as a nation we are supporting the things that we
need to support? And I think you know I came back to OMB with
regular order, and I am so appreciative to Mr. Rogers and Ms.
Mikulski for getting the first omnibus since 1987 in terms of
regular order.
And so I prefer regular order in a world where that may not
be people's first choice because they have concerns with
discretionary levels. That is part of why we are doing it.
So I think what I am hopeful is that we, together, can have
a real conversation. And that part of the conversation I think
we can have because I think everybody is hopeful. I am so glad
to hear all the hearings are going on. To me, that means
regular order.
And so that means that, hopefully, we will get this done in
a June/July timeframe, and this can be a part of that broader
conversation in terms of, and it relates--NIH is one piece of
the issues that Mr. Rogers raised.
Mr. Dent. I just want to conclude right now just to say
that this is just one area where we are seeing mandatory
programs--where funding is being diverted to mandatory
programs. I have the same problem with the Veterans Choice Act.
That funding is going to expire. It is going to fall on the
Appropriations Committee to make it up in discretionary funds
next year, but that is a subject for another day.
Thank you. I yield back.
Secretary Burwell. But I think it does get to the broader
issue and why I think we should have the broader conversation.
Mr. Cole. Thank you very much.
As my chief clerk adroitly reminded me, the chairman had
not had 5 minutes. So, Mr. Chairman, whatever time you care to
consume, you are welcome to consume. Everybody else will be
confined to the 2 minutes when their turn comes.
CRITICAL ACCESS HOSPITALS
Chairman Rogers. I will try to be very, very brief. The
critical access hospitals, these hospitals face a unique set of
challenges. In my rural district, we have seven critical access
hospitals. Many of them are already struggling to keep their
doors open.
What do you believe will be the impact of these
reimbursement cuts that you are proposing will have on these
hospitals?
Secretary Burwell. So with regard to the issue of rural
health care and rural hospitals, I think you know because of
where I come from, this is an important issue overall. And so
there are a number of places in the budget in terms of A&R
regulations where the issue of what it does to rural
communities, and we can go into some of those places. But with
regard to this specific question, I think it is our thought
that because these hospitals actually are receiving more in
terms of Medicare payments than noncritical access hospitals,
they will be in a place where the impact of this change is not
something that overburdens them too much, and that is why the
proposal is as it is.
But I think the broader question of how we support our
rural hospitals is one that I think is an extremely important
one. And throughout our budget, whether that is how we are
thinking of providers in terms of some of our support for
people that will tend to go to rural hospitals in terms of the
public health funds that we do, to providers, whether it is how
we are thinking about doing telemedicine and having Medicare
Advantage.
One of our proposals is that Medicare Advantage would be
reimbursed in terms of telemedicine so that we can use those
facilities, and those rural hospitals can benefit from that.
And so we are trying to think about the issue of rural
hospitals overall.
Chairman Rogers. Good.
Secretary Burwell. And the other thing, while it is not an
issue in your State, in other States, we have seen a larger
closure of rural hospitals in those that have an expanded
Medicaid. That is not, you know, an issue in your State.
PREVENTION OF OPIOID MISUSE, ABUSE, AND OVERDOSE INITIATIVE
Chairman Rogers. Yes, thank you. Your opioid proposal is
sweeping----
Secretary Burwell. Yes.
Chairman Rogers [continuing]. To say the least, and I am
pleased that the request clearly recognizes and acknowledges
the importance of our fight against drug abuse. But I am
interested to hear your views on how these new pieces of the
puzzle fit together.
Specifically, the degree to which the request relies on new
mandatory spending, that part troubles me. For example, the
budget allocates $1,000,000,000 in new mandatory funding to
SAMHSA and HRSA for treatment programs. Fifteen to 20 years
ago, Oxycontin was just rearing its head in Appalachia.
Certainly, my district was the headquarters of that.
Ten years ago, heroin was just a blip on the radar, but
today opioid abuse has spread to every corner of the country.
Cheap heroin is being laced with fentanyl, so strong that
unsuspecting users die every day from overdose.
With the fight against drugs changing at the speed of
light, it seems irresponsible to tie our hands with inflexible
mandatory funding. We need to be agile and move with the times,
adapting to the needs as they arise. The only vehicle that
makes that possible really is discretionary spending so that we
can help you adjust to whatever takes place as we march down
this path.
What is your take on that idea?
Secretary Burwell. First, thank you for your partnership
and leadership. As you mentioned, we have worked on these
issues together for a long time.
And with regard to the specific issue because we put most
of the money in treatment, specifically medication-assisted
treatment. I think you and I have discussed the strategy. I
think it is a bipartisan agreement. That is important. Those
monies will all go to States and communities mostly in terms of
improving their infrastructure and ability.
Some of that is to train providers that would be--you know,
you would want to continue, but that may be more one-time
money. I think the question fundamentally, with regard to the
medication-assisted treatment and the behavioral health issues,
is historically in our country, we actually have had a
situation where those are funded at the local level. And that
is one of our biggest challenges right now, 85 percent of rural
counties don't have behavioral health, and that is because
often it is funded at the State and local level.
And so I think, as we think through this question about
discretionary, mandatory, short-term, long-term, we actually
need to answer whose responsibility do we believe that is? And
I think we are going to face these questions. We face these
questions in Flint, as Ms. DeLauro mentioned. We face these
questions in behavioral health.
And whether that is the money we have put in for the 223
waivers that are part of that proposal or this. And so that, I
think, is a part of the conversation we are going to need to
have. Do we believe it should be the Federal Government's
responsibility over the long term? And if we do, let us think
about how we can find space on the discretionary side or lift
those caps.
Chairman Rogers. Well, we can continue to talk.
Secretary Burwell. Thank you.
Chairman Rogers. Thank you, Mr. Chairman.
Mr. Cole. Thank you, Mr. Chairman.
INDIAN HEALTH SERVICE
Madam Chairman, I am next, and I am going to be very brief
in my questions, almost code, to give you as much time of my 2
minutes I can to respond. I will warn you these are matters I
will be bringing up with you multiple times probably in the
months ahead.
The first one, as you know, recently CMS flagged three
Indian Health Service hospitals as ``posing an immediate
jeopardy to the health and safety of their patients.'' Those
hospitals are under the jurisdiction of your department. I take
this very, very seriously. I have raised it with the Director
of Indian Health this morning at an earlier hearing. I wanted
to know that you are focused on this and you have a plan to
deal with it.
WELDON AMENDMENT
The second question is the Weldon amendment. I am for a
year and a half asked about--we get constant complaints that
the State of California is not or is forcing institutions
against their own conscience and creeds to perform procedures,
abortions, that they don't believe in.
We have been told there is an ongoing investigation. It
shouldn't take that long. They either are or they aren't. But I
would like you to respond to that and tell me where we are in
the investigation.
With that, I yield the balance of my time to you, Madam
Secretary.
Secretary Burwell. With regard to the second issue, when
you and a number of your other colleagues contacted me and
asked for an investigation to be opened, we opened that
investigation. As you indicated, we are still in the middle of
the investigation, and as I stated in the hearing yesterday, it
has taken longer than I would like.
Because the investigation is still open and has not come to
closure, I am not able to comment in terms of that. And in
terms of setting a timeline, I am not able at this point to do
that.
INDIAN HEALTH SERVICE
With regard to the Indian Health Service issues, it is a
priority, and I look for your support as we work through it.
Right now, we have changed the regional leadership. We have
added a deputy for quality and a deputy for management, both at
IHS.
And I have asked the Acting Deputy Secretary, Dr. Mary
Wakefield, who ran HRSA, to have a cross-department effort so
that we are bringing the best experiences of CMS, HRSA, SAMHSA,
and any of the other best practices we have to increase the
quality of the service that is being delivered at IHS because
it is not satisfactory.
Mr. Cole. I appreciate that very much. This is an area we
have actually increased funding since 2008 by 54 percent. It
has been a really good bipartisan effort to try----
Secretary Burwell. Yes.
Mr. Cole [continuing]. And get at the problems in Indian
Country and, frankly, one that the administration can be very
proud of its role. So I look forward to working with you on
that.
And with that, I want to recognized my good friend, the
distinguished ranking member from Connecticut.
Ms. DeLauro. Thank you, Mr. Chairman. Just a couple of
points.
Labor, HHS is 32 percent of nondiscretionary spending. With
that and our allocation last year, it should have been
$10,500,000,000. If we were to get the additional
$5,200,000,000 this time, we could avoid dealing with mandatory
funds.
Very quickly, secondly, the prevention fund, Secretary has
no flexibility over that prevention fund because for the last 3
years, the Congress has made those allocations. We just ought
to read the table.
OPIOID MISUSE, ABUSE, AND OVERDOSE INITIATIVE
Medication-assisted treatment. You are talking about your
opioid initiative. I would like to have you talk about that. I
had the opportunity to witness it firsthand at the New Haven
Correctional Center a week ago.
PRESCRIPTION DRUG COSTS
Secondly, you have got some proposals on prescription drug
costs, bringing that cost under control. I would like to have
you just expand on that for a moment. The floor is yours.
Secretary Burwell. I will do those backwards. As far as
rising cost of prescription drugs, in this budget proposal,
what you will see is we would like to move to close the donut
hole faster, which will mean benefits. Right now, we have seen
$20,000,000 in benefits to 10 million seniors. We would like to
speed that up as one of the things to help with the costs for
individuals.
With regard to the overall cost, we have asked for
authorities for specialty and high-cost drugs that we would
have the authorities to negotiate.
OPIOID MISUSE, ABUSE, AND OVERDOSE DEATH
With regard to our opioid/heroin strategy, there are three
main parts, and that is what the funding goes towards, these
evidence-based strategies. The first is prescribing. We need to
reduce the prescribing. You will be seeing CDC guidelines that
will come out about prescribing. That is one of the things.
There is some funding in the FY 2017 Budget Proposal to help
support the implementation of those.
The second is medication-assisted treatment. That is where
the vast majority of the funding goes because we know as an
evidence base, that is the place. There are supplemental
proposals in our budget that include things like who can
prescribe buprenorphine. We hope you will review those budget
proposals as well.
And the third element is naloxone or Narcan. And sadly,
when people get to the place where overdosed, we must have
tools for people to help them not die.
Ms. DeLauro. Mr. Chairman, I would hope we could have a
hearing on the high cost of prescription drugs in this
committee and during this period of time.
Thank you.
Mr. Cole. Thank you.
I next go to my good friend from Tennessee, Mr.
Fleischmann.
CYBERSECURITY THREATS
Mr. Fleischmann. Thank you, Mr. Chairman.
Madam Secretary, I am very concerned about the recent
accounts of American hospitals and doctors' offices being the
victim of ransomware and other cybersecurity attacks that have
the potential to compromise or delete patients' personal health
information and other critical and sensitive data that our
healthcare delivery system relies on.
I have two questions. What is the department doing in
conjunction with other Federal agencies to address cyber
threats to our healthcare system? And as a follow-up to that
is, in your opinion, how serious is the ransomware threat, and
what resources are you devoting to protect Medicare data from
criminal security breaches?
And with that, I will yield the balance of my time to you,
Madam Secretary, so you can address that.
Secretary Burwell. So an extremely important issue, and
actually, HHS is one of the--I think it has been stated even
this week has been recorded as one of the lead departments on
cybersecurity. We need to do it across the whole department,
but I think you are focused specifically on CMS.
Some of the funds in our budget this time are very
important funds to continuing our effort in cybersecurity. To
answer your question about how important and how concerned we
are about these issues, when I was confirmed on--for this job
and had my first meeting with the issuers, everyone--it was
June 9th, and so everyone thought I was going to talk about
technology and the marketplace, which, of course, was a topic I
should touch on, making sure we get that right.
But actually, the topic I also wanted to talk on was
cybersecurity, and that was in June of 2014. I think this is an
extremely important issue that we need to all work together on.
I think we need the best practices from the private sector to
learn from them, but I also think making sure we have a close
tie and connection because when this happens, there are
questions of breaches of information that could be HIPAA
violations for individuals, depending on what those are.
And so making sure that we are working in a forum that we
are doing our part as we can, learning from the private sector
and making sure we are sharing as well. And that is not just at
HHS. To your point, we coordinate with the FBI and others
because when there is information that is important through
DHS, we need to make sure that industry has information as
appropriate around these issues.
Mr. Fleischmann. Thank you, Madam Secretary. Appreciate
your testimony today.
Mr. Chairman, I yield back.
Mr. Cole. Thank you very much.
I now go to my good friend from Philadelphia, Mr. Fattah.
EARLY CHILDHOOD EDUCATION
Mr. Fattah. Madam Secretary, if we could turn our attention
now to another part of your testimony today is around the Head
Start and early education. So in Philadelphia, over
$300,000,000 in Federal--mostly Federal funds are used to
provide Head Start and early childhood education, but we are
still only reaching something slightly less than 40 percent of
the children, and there is more to be done.
I appreciate the fact and will support the administration's
request for $9,600,000,000 in Head Start funds. I also note
that you want to create a $350,000,000 fund to work with States
in terms of preschool development grants. Can you talk a little
bit about how those dollars would be used and distributed?
Secretary Burwell. So as we think about this continuum and
our early education home visiting. Thank you for the support in
MACRA in terms of home visiting. But we think about home
visiting, early education, preschool, and child care and Head
Start. They are together--Head Start serves a particular
population, but we want to make sure certainly in our child
care proposal we are serving more.
In that early education money, those are monies that are
generally targeted to more low-income communities through the
States. And so some of those are for broader communities like
child care, and Head Start and others are targeted more towards
the low-income communities.
Mr. Fattah. Thank you very much.
Can you talk a little bit about where you think--because
you know the Pew Foundation, which is based in Philadelphia,
has done a lot of work with States, and in fact, many of our
State governments have been at the very forefront of this work.
And I know the administration has taken a leadership around
these first 1,000 days of a child's life. It is critically
important in terms of the networking for the brain and for all
of the health-related issues that are very, very important.
Talk about how you see the department's work now in
conjunction and in working alongside of some of your colleagues
like at the Department of Education and other----
Mr. Cole. Madam Secretary, you can talk about it, but be
brief.
Mr. Fattah. Oh, I am sorry. I forgot we were cutting it to
2 minutes. I will withdraw the question.
Secretary Burwell. Thank you.
Mr. Cole. OK. Thank you very much. I appreciate that.
Dr. Harris, I don't know if you were here, but we are at 2
minutes.
Mr. Harris. Two minutes.
Mr. Cole. OK.
NATIONAL CANCER INSTITUTE
Mr. Harris. All right. Three very brief things. One, I am
concerned, and I won't ask you to address it now. You know, we
are almost one year out from--from the NCI Director announcing
his retirement, and we still don't have an NCI Director. That
is of concern for me, you know, when we are talking about
Cancer Moonshots that, you know, the leading cancer person, his
replacement hasn't been appointed.
Let me just mention one other thing. You know, the rosy
assumption in the President's budget, of course, is 4 percent
GDP growth. We haven't had 4 percent GDP growth in 10 years. In
fact, as you know, the last quarter was 0.7 percent GDP growth.
So that is a really rosy assumption.
And one of my concerns is that part of the Medicare
savings, correct me if I am wrong, that is projected in your
budget, that, you know, comes in under all--you know, balances,
whatever you want to call it, is the change in the target rate
growth from GDP plus 1 to GDP plus 0.5.
Is that right? That does achieve some of the savings?
Secretary Burwell. With regard, I will have to go back----
Mr. Harris. The Medicare----
Secretary Burwell. I will have to go back and check,
Congressman. Some of these questions in terms of those are--are
no longer----
Mr. Harris. Well, I am assuming, since it triggers the
IPAB, the Independent Payment Advisory Board, at a lower rate,
you must be making that to achieve savings, I would imagine. My
concern again is with the Independent Payment Advisory Board.
No one has been appointed to it.
It is going to be a rationing device, and I just hope
Medicare beneficiaries realize what the--what your budget does
to Medicare over the next few years.
ZIKA VIRUS RESPONSE
Finally, with regards to the Zika request, is it my
understanding the administration said they actually want to use
some of the Ebola leftover money for malaria last week?
Secretary Burwell. Well, with regard to that, that is a
question that would go to the State Department or USAID. Those
are funds that are in their areas, not in mine.
Mr. Harris. So if that is true, the administration has
already made a decision to use some of the Ebola monies for
other diseases. And I would just suggest that that is what the
State Department thinks they ought to do, that is what you
ought to do for the Zika and not come in with a budget-busting
$1,800,000,000 request.
And I yield back the time.
Mr. Cole. Thank you.
The gentlelady from California is recognized for 2 minutes.
UNACCOMPANIED CHILDREN
Ms. Roybal-Allard. Madam Secretary, in your response to a
question that was asked by my colleague Mrs. Roby, you said
that it was your job to make sure unaccompanied children were
safe. And so I was truly shocked to read about the release of
unaccompanied minors from ORR in care into the hands of human
traffickers, as was documented by the Permanent Subcommittee on
Investigations in the U.S.
Can you tell me how much money is ORR requesting for home
studies, which investigates the background of sponsors before
children are released to them and post release services in
which HHS can continue to check in on a child? And is the
amount requested sufficient to take care of the anticipated
number of unaccompanied children?
And if you have the time, if you could comment on the
department's plan to continue and expand the pilot program
where home studies are now required for all unaccompanied
children 12 and under placed in Category 3.
Secretary Burwell. The issue in Ohio is a tragic one of
people breaking the law, and we will work with the Justice
Department to do everything we can to the full extent of the
law in terms of that tragic circumstance.
With regard to the overarching question of how we do this,
there have been a number of improvements that we have made over
time with regard to the safety of the children. And whether
that is background checks on all adults who might be in the
home, whether that is follow-up calls, whether that is 1-800
numbers, there are a series of those steps. I am happy to get
those to you.
With regard to the funding issue, because of the
unpredictability of the flows, as we discussed with
Congresswoman Roby, our ability to do certain parts of this is
dependent on the funding flows. Our ability to answer the
question you asked would be enhanced greatly by having
$400,000,000--the contingency fund that we have put in. Because
that way we could actually focus on if there is a flex, we
would know where we would get that money, and we wouldn't use
it unless we needed to flex. And then we could have surety of
our money for the other services we provide.
Mr. Cole. Thanks very much.
The gentlelady from Alabama is recognized.
OFFICE OF REFUGEE RESETTLEMENT
Mrs. Roby. Madam Secretary, I would appreciate, based on
that last line of questioning, the opportunity to discuss that
further with you. The GAO issued a report of the ORR, and it is
quite concerning. They uncovered myriad problems regarding the
handling of the detained minors--abuse, lack of oversight, a
lack of control over the whereabouts and livelihoods of these
minors.
So what I read in the Washington Post certainly, and I am
sure you saw that article as well, doesn't give me any
confidence about what is actually happening within the
department, particularly if we have another influx, as is being
predicted.
So what are your comments on GAO's findings, and how is
your agency addressing the concerns that were outlined in the
GAO report?
Secretary Burwell. With regard to the specifics, as I said,
we have made a number of improvements. But I would have to see
which report at this point, in terms of the GAO report, the IG
report, and I want to make sure I am referencing the right
report. And so we can come back on that.
But a number of improvements are made with regard to the
children. What I would say that is so important is our ability
to focus on those issues is extremely important. We want that,
and I think you know I came to the committee and asked for
additional funding for this year, the year we are currently in,
the fiscal year we are in, not the budget conversation we are
having.
I asked. I sent letters. I talked to all four corners, all
of those, because this ability to have standardized funding
that we know we can depend on is a part of our ability to
manage these problems well. And so that is the one thing as we
are having this conversation especially around the budget that
I think is extremely important.
We want to hear if people have suggestions for things we
can do more. I think you have heard we have made a number of
changes to make sure that we are checking the children, things
are checked before.
You know, many of these children go to their parents here,
and that is one of the issues that I think is an important one
to recognize, that they are children. They make the journey,
and they actually are placed with their parents. We still do
checks in terms of that as well.
Mrs. Roby. I yield back.
Mr. Cole. Thank you very much.
And for the last questions of the morning, I recognize the
good gentleman from Pennsylvania, Mr. Dent, for 2 minutes.
BIOMEDICAL ADVANCED RESEARCH AND DEVELOPMENT AUTHORITY
Mr. Dent. I will keep it real quick. Thank you again, Dr.
Burwell.
Just on the issue of BARDA, and I just wanted to make, I
guess, a quick comment. It is my understanding that a vaccine
platform, these technologies or these platform technologies
could now be called upon to quickly develop a Zika vaccine and
in general respond more expeditiously to the next outbreak or
threat.
What is BARDA or HHS doing to support and facilitate
platform-based technologies against known and emerging threats?
And I mentioned Zika, but you know, there are other threats
that are out there, obviously, from SARS, Ebola, H1N1 and H5N1,
et cetera. So could you comment on that?
Secretary Burwell. Right now, BARDA is a part of
conversations that we are having with the private sector, and
it is not just in the vaccine space. It is in the diagnostic
space as well. Certainly for Zika, but for many other things as
well, and so--and in the treatment place.
Mr. Dent. CDC, right? CDC doing the diagnostics or----
Secretary Burwell. Ah, yes. CDC is doing the diagnostics,
but we are really looking for private companies to actually
take over manufacture of it because right now, it is all
happening through CDC.
We also would like to see the private sector improve the
technology. We have a technology. This is one of the difficult
things about Zika. The diagnostic that is for you have the
full-blown disease, it works pretty well. We know that you have
Zika if you are symptomatic and we test you.
If you have passed and we want to test you--you went to
Mexico, you came back. Eighty percent of people don't have
symptoms, and we want to test you for that, that is a problem
because we could show a positive, but you actually could have
had chikungunya or dengue instead.
And so, our ability on that, so we are looking to the
private sector as we advance. We will move as quickly as we
can, but we are happy if the private sector can. So BARDA is
playing an important role. In the supplemental, you will see
funding asked for for that.
Mr. Dent. Thank you. I will yield back my last 18 seconds.
[Laughter.]
Mr. Cole. I thank the gentleman for his generosity.
Madam Secretary, I want to--this is probably your last
appearance before this subcommittee, although we will certainly
have the opportunity to continue to work together for the
balance of the year, which I look forward to a great deal.
And again, I want to echo and reinforce the sentiments of
everybody on this committee on both sides of the aisle about
how much we appreciate your service, what you have done, what I
know you will do in the next year, what a delight it is to work
with you. Frankly, how thorough and professional you are and,
frankly, how much we will miss you in front of this committee,
although I suspect you will not miss us very much. [Laughter.]
Mr. Cole. You have hardly been able to wipe the smile off
your face as the minutes have ticked down. So I recognize that,
but you will be missed by both sides of the aisle.
And thank you very, very much for your distinguished
service to our country in a variety of capacities under two
different administrations. It is something that you can take a
great deal of personal pride in. It is something that, again,
every Member on this dais certainly respects.
Secretary Burwell. Thank you, Mr. Chairman. Thank you.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, March 1, 2016.
BUDGET HEARING--CORPORATION FOR NATIONAL AND COMMUNITY SERVICE
WITNESS
WENDY SPENCER, CHIEF EXECUTIVE OFFICER, CORPORATION FOR NATIONAL AND
COMMUNITY SERVICE
INTRODUCTIION OF WITNESS
Mr. Cole. I will go ahead and convene us, and I will get to
my opening statement, but before I do, as we were discussing,
Ms. Spencer, in the back, it has been 16 years since this
committee has had the opportunity to hear about some of the
wonderful things you are doing at the Corporation for National
and Community Service, but it hadn't been 16 years since any of
us have seen you. We see you regularly around the country and
across our districts, and so I appreciate very much the manner
in which you run your agency, and frankly, how accessible you
have been to every member of this committee, quite frankly. So
it is a genuine pleasure to have you here.
Good morning. Again, my pleasure to present Ms. Wendy
Spencer, the CEO of the Corporation for National and Community
Service to the Subcommittee on Labor, HHS, and Education to
discuss the agency's fiscal year 2017 budget request.
We are looking forward to hearing your testimony,
especially since it has been quite a while since this
subcommittee has held a hearing on the Corporation's budget. We
tried to have you up last year, but unfortunately, we had to
cancel because of conflicting schedules. So we are very happy
that you are able to be here today and join us.
America has a long and rich history of service and
volunteerism. About one in four Americans formally volunteered
with an organization in 2014, contributing in ways ranging from
tutoring to preparing meals for the homeless to assisting their
neighbors in the wake of natural disasters.
The Corporation's programs support, enhance, and expand
upon these efforts through helping to build capacity at the
State and local level and by awarding grants to place
volunteers where they are needed across the country. Both the
Corporation and Congress have a responsibility to conduct
oversight of the Corporation's approximately $1,000,000,000 in
budget authority to ensure that taxpayer funds are being spent
wisely. We look forward to hearing about the Corporation's
accomplishments over the past years and plans for the upcoming
fiscal year.
As a reminder to the subcommittee and our witnesses, we
will abide by the 5-minute rule so that everyone will have a
chance, but we may be a little more generous on the 5-minute
rule than normal. So anyway, again, we are very anxious to have
you here.
And with that, I would like to yield now to my ranking
member, the gentlelady from Connecticut, for her opening
remarks.
Ms. DeLauro. Thank you so much, Mr. Chairman. And my
apologies for being late, but great to be here. And as I said,
listen, if it is the two of us, it is the two of us. Why not,
you know? So here we go.
I want to say thank you for holding the hearing because I
think we share the view that the programs we speak of this
morning tap into one of the best attributes that we have as a
nation. National service is a core American value. It makes
this country exceptional. Service provides an unparalleled
richness for those that participate and gives citizens the
greatest potential to change the face of the communities that
they serve.
So I welcome you, Ms. Spencer. I look forward to talking
with you. And yes, it has been 16 years, and we know we tried
last year, so delighted you are here today. But fortunately,
your work over these years has demonstrated how valuable these
efforts are.
The Corporation for National and Community Service was
founded on the idea that government can and should play a role
in giving citizens the opportunity to address pressing problems
across the country. It is a powerful idea that carries on
despite whatever happens in this institution on both sides of
the aisle.
Last year, we were able to make important investments in
the Labor, HHS bill, including a small, much-needed increase
for the Corporation. We provided an additional $50,000,000 for
AmeriCorps, an additional $10,000,000 for the National Service
Trust. We supported an increase of more than 10,000 new
AmeriCorps members to serve and created new opportunities in
communities across the country. And in many ways, last year's
omnibus moved the Federal budget in the right direction.
The chairman has heard me say this last week, and he will
continue to hear me say this. With Labor, HHS, we received a
fraction of what I believe is our fair share last year of the
$66,000,000,000 increase that was provided by the budget deal.
Other nondefense subcommittees received an average increase of
6.9 percent. Labor H was about 3.4 percent. And we do have 32
percent of the nondefense discretionary budget.
So the issue for me is how we continue to try to move in a
direction that allows us to get increased resources in order to
meet the needs, your needs and our needs. Because if we take a
look at what happened last year and we reversed it, we had a
House mark that slashed the Corporation's funding by
$367,000,000. It was a cut of 35 percent. And that would have
really decimated programs that serve millions of our most
vulnerable citizens. And fortunately, really, and I mean that
very sincerely because it was hard-fought to get an agreement
and to avoid what were harmful cuts.
So again, it is the richness of the experience that these
programs provide. It makes young people really become engaged
in the fabric of our society so they are not little islands by
themselves, but they understand that they have a
responsibility, that they are not out there for himself or
herself, that we share a responsibility for what happens in our
country. And that helps us to move the needle on the great
issues of the day.
Volunteers today are preserving our parks, our public
lands, mentoring our students, providing job training for
veterans, responding to national disasters, and as I said,
supporting our most vulnerable citizens.
Communities want programs like AmeriCorps. In 2015, CNCS
was only able to fund a third of all grant applications that it
received. Last week in our hearing with Secretary Burwell, we
talked about the tragic situation in Flint. Thousands of
children have been exposed to lead-poisoned water for more than
a year. Your folks have responded to this crisis working with
Michigan agencies, nonprofit organizations for the past few
months to address the crisis. They are boots on the ground.
They are there. Nine members of AmeriCorps National Civilian
Community Corps are on the ground in Flint. They are going door
to door. They are trying to educate residents on using water
filters appropriately, providing information on nutrition
related to lead exposure. I am going to be in Flint on Friday,
and I would love to talk with you about trying to get to meet
some of your folks there.
Senior Corps volunteers and other CNCS member volunteers
are assisting in public education, providing bottled water,
managing donations, helping to process hundreds of non-CNCS
volunteers, placing them where they are most needed. This is
why our investment here is essential. You connect volunteers to
communities in their hour of need.
I am pleased in the budget to see a request for a modest
increase to the VISTA programs, an additional 230 full-time
VISTA members who commit to serve for a year in some of our
most impoverished communities. I am disappointed to see level
funding for the National Senior Volunteer Corps and that the
budget request is more than $50,000,000 below the agency's
budget. As I have said, this is a smart investment in these
programs. You help Americans graduate. You help people pursue
higher education and find work.
So, again, every dollar invested in national service
results in a return to society of nearly $4 in terms of higher
earnings. I will repeat something that I have said, and that is
these programs are so important, and that is why I will
continue to fight for a higher allocation for this subcommittee
for the good of the communities who depend on us.
Thank you so much, and we look forward to your
participation and your discussion. Thank you, Mr. Chairman.
Mr. Cole. Before we move to you, I know my friend from
Connecticut will know that while I appreciate her efforts, I am
always happy to see level funding because that is probably what
I am going to get. So I am very grateful that you have come in
the door that way. That is a good start. [Laughter.]
Mr. Cole. But with that, if we may, Ms. Spencer, let's turn
to you for your opening remarks and then we will move to
questions and answers from the committee and obviously from
yourself.
WITNESS OPENING STATEMENT
Ms. Spencer. Thank you so much, Chairman Cole and Ranking
Member DeLauro, Congresswoman Lee. It is really great to be
here, and this is a wonderful opportunity for us to testify.
We are grateful for the funding increase Congress provided
last year to support our vital work. And I want that to be
noted. We are very grateful and very appreciative.
Our 2017 budget request is $1,100,000,000, which is almost
level funded, as you mentioned, from last year. This budget
will support our mission to improve lives, expand opportunity,
and tackle some of the Nation's most important needs.
Allow me to describe some of our work to you. First, we
empower citizens to solve problems. Senior Corps and AmeriCorps
members serve at more than 50,000 locations across the country.
These dedicated Americans serve in tough conditions to meet
local needs like tutoring and mentoring youth, eliminating
hunger, responding to disasters, supporting veterans and their
family members, just to name a few, all while recruiting
millions of Americans to serve alongside them, multiplying the
impact.
Second, we leverage substantial outside resources. I am
very pleased to share with you today that for the first time in
our agency's history we were able to report that our local
support has exceeded our Federal appropriation, a goal of mine
since I started 4 years ago. Last year, our programs generated
$1,260,000,000 in required match, additional resources from
corporations, foundations, local community organizations, and
also resources raised by our members. This local support boosts
our impact and stretches the return on the taxpayer dollar, so
I am very, very proud of this announcement, which we have just
been able to make.
Third, we really recognize and support local control.
Governors play a very key role in deciding where AmeriCorps
resources go through State service commissions, as an example.
Local groups recruit, select, and supervise their members. This
is done at the local level. Mayors and county leaders also see
us as a key partner. In fact, last year, just shy of 2,800
mayors and local leaders and tribal leaders representing 150
million Americans united to recognize AmeriCorps and Senior
Corps on a single day.
And fourth, we expand opportunity in so many ways like
keeping students on track to graduate, housing homeless
veterans, helping seniors live independently, and connecting
people to jobs. Plus, AmeriCorps members provide valuable
skills and scholarships to help themselves. These scholarships
pay back college and student loans or help them go to college
for the first time. It is a great benefit if you want to serve
and you can receive a benefit to increase your higher education
goals.
Our 2017 budget builds on this foundation to meet community
needs with greater impact, accountability, and efficiency. Our
budget request supports the following: 88,400 AmeriCorps
members serving in programs that depend on their skills and
their leadership, programs like Habitat for Humanity, Teach For
America, City Year, Catholic Charities, Veteran Corps,
conservation corps, and in tribal communities. It also supports
270,000 older Americans in Senior Corps programs while
introducing competition to Foster Grandparents and Senior
Companion.
It will help support evidence-based programs through our
Social Innovation Fund, including our Pay for Success pilot.
And it will support investments in our IT systems to increase
accountability, efficiency, and provide first-rate support to
our grantees and partners, something we need and it is overdue.
So, Mr. Chairman and members of the committee, our programs
empower citizens. They bolster civil society, expand
opportunity, encourage personal responsibility, strengthen our
communities, and I contend they unite us as Americans.
Thank you for your support. Thank you for inviting me
today. It is a true honor to serve in this role to help engage
Americans in service and help support our local organizations.
I am happy to answer your questions. And as always, I seek your
guidance and advice. Thank you.
[The prepared statement and biography of Wendy Spencer
follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
SOCIAL INNOVATION FUND
Mr. Cole. Thank you very much for your testimony. If we
can, I want to have a couple of questions that will focus
around the Social Innovation Fund in particular. In your budget
justification, you mentioned several examples of positive
outcomes that stem from efforts supported by the Social
Innovation Fund such as improving employment retention for
individuals that participate in job-training programs and
increasing reading proficiency among K to 12 students. However,
the process and criteria by which grantees and especially the
sub-grantees are chosen in this program is a little unclear to
me. So would you just elaborate about how you go about making
the decisions on grantees and sub-grantees?
Ms. Spencer. Thank you for that question. So the Social
Innovation Fund is something we are very proud of. It is one of
our newer programs in our 21-year history. We have been working
on this for 6 years now, so it is a new program. And we are
always looking for ways to improve it. But what I like most
about the Social Innovation Fund, two things. One, it really
does a deep dive on some of our nation's most difficult
problems, addressing chronic homelessness, chronic
unemployment, third-grade reading level for our students. So it
really goes after some of the toughest problems with a surge of
investment both at the Federal level and even more so at the
local level.
The financial match for this program is really rigorous. It
is almost three to one. The minimum grants are $1,000,000 to
the intermediary. It has to be matched by cash, dollar for
dollar. And then when that intermediary is selected, they then
have to subgrant out their grants in $100,000 minimum
increments and that has to be matched at the local level dollar
for dollar.
So it is a very, very significant investment from the
private sector. In fact, over the last 6 years, the Federal
investment is about $270,000,000, and the local investment is
exceeding $580,000,000. Now, let me just make this, you know,
to a personal one, a couple that I visited, and I really like
this example.
REDF is a program that focuses on chronic homelessness and
unemployment. One of the sub-grantees is called Chrysalis. And
I went in and met some individuals who have been unemployed and
homeless virtually all of their adult lives, grown men in their
40s and 50s. And for the first time in their lives, they now
have housing and a job, and the way they have it is the
Chrysalis organization worked closely with them to provide a
job through what they call a social enterprise. They have pest
control services, they do corporate cleaning, they do wonderful
training in addition to this.
And the one gentleman that I met who had been virtually
homeless his entire life, he said this is the first time that I
have had a job that I feel confident in and that I can do. One
was working in pest control services, something that he could
train for easily and be on time for and be prepared for. And
the other gentleman is now driving a garbage truck for the
local county.
So how do we get there? We get there through a rigorous
competition. We had great interest in our applications. But it
is difficult because you have got to have so much match from
the local level, and it is hard for intermediaries to do that,
especially when we started, which was right in the beginning of
the recession.
But one of the things that I asked these intermediaries, I
said how have we been able to scale your program? And they said
the thing about partnering with the Federal Government is that
this was a seal of approval. We were able to get to the table
new funders for the first time from foundations in the private
sector because we were qualified to meet your rigor. We were
also able to increase existing investments from organizations
and foundations that we haven't been able to do in the past. So
that is what they have told me, and it has been consistent.
So I do believe the process is very rigorous, but I always
welcome improvements. It is new to us, so we are always trying
to grow.
Mr. Cole. Thank you. I will have some other questions, but
in the interest of time, let me go to the gentlelady from
Connecticut for her opening questions.
EARLY CHILDHOOD EDUCATION
Ms. DeLauro. Thank you very much, Mr. Chairman.
And I would just say I think that we helped to restore
funds in that program last year, and I think the explanation
that Ms. Spencer has given us about the value of the program
moves us in the direction of looking at really public
investment and private investment and making it work. And that
is a goal that we really all have here.
Let me ask about early childhood education and your work.
Six million kids ages 5 and younger living in poverty in the
United States. Deficits lower-income kids face during early
years leads to unbelievable struggles later with academics,
behavior, absenteeism. Between birth and age 6, children from
more affluent families will have spent as many as 1,300 more
hours than poor children on child enrichment activities, music
lessons, travel, summer camp. Without early learning, low-
income kids enter kindergarten as much as 60 percent behind
their more affluent peers, and that gap just persists through
adulthood.
In your testimony, you referred to the support that CNCS
provides to schools through tutoring and mentoring programs. I
am particularly interested in programs that support our
youngest kids who are living in poverty. What early childhood
programs do you all partner with? What percentage of your
resources go to these programs? Is there a waiting list of
early childhood programs that would like to work with you? And
is there more you could do if you have additional resources?
Ms. Spencer. Thank you so much for that question. This is
an area that I am very passionate about. And let me tell you
our footprint so you have a real clear picture, as you asked.
We have six areas that we focus on: environment, education,
economic opportunities, disasters, veterans and military
families, and healthy futures. We could legitimately make a
case to you to divide our funding six ways because those are
all very important areas. But we have decided not to do that.
Half of our budget and half of our resources are focused on
education. And I do contend that many of those other problems
in the other areas can be supported through education and
having a better-educated America as well. So it is very
important that we are focused on this.
Our footprint is we looked and we counted between our
Senior Corps, AmeriCorps and the Social Innovation Fund. We are
serving of at least unduplicated grant and resources in 11,714
schools. That is huge. With 100,000 public schools in America,
that is right at 10 percent. Of those schools that we are
serving in, one in four of those are persistently low-achieving
schools. So I feel like we have got them in the right places.
Now, early childhood examples, one of my favorites is the
Minnesota Reading Corps. We did a rigorous third-party
evaluation recently on the Minnesota Reading Corps, which was
started in Minnesota and now is in 12 States, including DC, so
it is being replicated, which is another passion of mine. Let's
find what works and let's replicate it across the country.
Here is what it told us: This program is enrolling full-
time AmeriCorps members as tutors, full-time, key word. They
are tutoring in schools everything from preschool,
kindergarten, first, second, and third grade. This study was
really focused on kindergarten and early childhood, and here is
what the study told us, that those students who had the access
to the training and tutoring by the AmeriCorps members, the
Minnesota Reading Corps AmeriCorps members, outperformed
students that did not have access to AmeriCorps tutors, almost
twice as much. And they outperformed in all five literacy
testing areas that they looked at, all five. So this showed us
that it is working. And I was so happy to be able to provide
this evaluation, which I am happy to provide to you and your
staff----
Ms. DeLauro. Yes.
Ms. Spencer [continuing]. In full. But that tells us we are
doing the right thing. And we have learned over the years that
education really is the sweet spot for service. It is a great
way for us to increase volunteerism as well. And I serve as a
volunteer each week in an AmeriCorps program myself, and it is
a curriculum-based program. It is not just I walk in and read
to a student. I work through a curriculum. So it is working and
we are focused on it.
Ms. DeLauro. Thank you. Do you deal with the HIPPY program,
the Home Instruction for Parents of Preschool Youngsters
program?
Ms. Spencer. I feel that we do, but I can get back to you
more but----
Ms. DeLauro. Please do because, Mr. Chairman, let me just
tell you, my stepdaughter, who is now married with two
children, she came home after she finished, you know, and she
was in school and she said after college she was going to get a
job and she was going to go work for the HIPPY program. Well,
Stan and I were not quite sure what she was really going to do
at that juncture----
[Laughter.]
Ms. DeLauro [continuing]. But it is the Home Instruction
for Parents of Preschool Youngsters. This is working with
parents and their children and using parents as a vehicle for
reading and for their kids being able to be literate, and it
follows a very strong curriculum, et cetera, to move forward on
so----
Ms. Spencer. Right.
Ms. DeLauro [continuing]. A good investment. Thank you very
much.
Ms. Spencer. Thank you.
Mr. Cole. You may have dated all of us who laughed so----
Ms. DeLauro. Right, exactly.
Mr. Cole. All right, good. We will go to my friend from
California, the gentlelady, Ms. Lee.
COMPUTER SCIENCE AND TECHNOLOGY TRAINING
Ms. Lee. Thank you very much, Mr. Chairman.
First, welcome, and thank you very much for your testimony
and for your service.
Programs like AmeriCorps VISTA, I mean, the taxpayer gets a
heck of a lot for our investment, and I, too, believe we need
to increase the budget, flat funding, fine, but for what you do
and for what these volunteers do, we are saving a lot of money
and providing real pathways out of poverty at a very cost-
effective rate.
And so I think overall our committee is still 10 percent
below pre-sequestration levels, so of course I join with our
ranking member in wanting to see more funding for your very
important agency.
A couple of things just as related to my district and how I
know AmeriCorps VISTA, and what you are doing, the Reading
Partners, you partner with local districts. And in my area,
Oakland, Berkeley, San Leandro, you all help, the volunteers
help lifelong readers, you provide critical one-on-one
tutoring, and really ensure that children receive the literacy
skills that they need to reach their fullest potential. It is
still mind-boggling to think we have a literacy problem in
America. And so what your volunteers are doing really makes it
very clear what the benefits are by enrolling them in Reading
Partners. It doubled their rates of learning, I know, in my
district.
I chair the Congressional Black Caucus's Tech 2020
Initiative, which is an initiative to ensure that all
Americans, including African Americans and people of color, are
included in the levels of technology that we see booming in our
country. And we are way under in terms of parity in the tech
field.
So I am pleased to see that the President's budget includes
$135,000,000 in existing funds under the STEM AmeriCorps
program, which is in partnership with the National Science
Foundation, to help teachers learn computer science
fundamentals and to really teach and inspire the next
generation of STEM teachers.
So how do you see this through this partnership and the
training of computer science teachers? Because they are
directly building a pipeline for everyone, including
communities of color, into the STEM and tech workforce, yet
teachers need this training.
And so, once again, I think we need more resources for
this, but I know in my district, again, in the city of Oakland,
we care much about ensuring that all young people have access.
And this is clearly a pathway out of poverty, but again, I
don't think the budget is adequate enough for that.
Ms. Spencer. Well, let me talk about Computer Science for
All, a brand-new initiative we just announced, and also share a
comment about Reading Partners. That is the program that I am a
volunteer with. So the way Reading Partners works is there is
an AmeriCorps member who is well-trained in a very rigorous
science-based, research-based reading curriculum program. So
one AmeriCorps full-time member is in a school, and in my case
here in DC, it is at Shaw Elementary School, and Elizabeth
Strader is the AmeriCorps member. She has 83 of us, so there
are 83 volunteers. We all go through training. We are matched
with our mentee. Mine is a first grader. I have been doing this
for 4 years, a different child every year, and I hate breaking
up with them because I love, I love my children.
But what is great is, as I work through that rigor, at the
end of the year I get a report card on my student and I see her
gains in her literacy levels. That is a really good program. So
Reading Partners is a great example of leverage, right? One
AmeriCorps member is leveraging 83 volunteers. We are all
committing and working with the students. So I am glad we have
a great presence at Oakland.
Computer Science for All is exciting for us. So this is
where we try to get very creative and figure out here is a
problem. What can we do with our resources to do something
different and unique? And I am always willing to experiment,
especially when it is in the education arena.
So what we have done is we have set aside $17,000,000 in
our education awards, college scholarships. That is going to be
set aside for up to 10,000 teachers over the next couple of
years for them to use that towards training to learn coding, to
learn computer science, to be able to maybe have them teach
afterschool, summer courses. Some of our teachers need extra
income. And so they are going to be able to do some service, in
exchange for the service get scholarship money from us, they
learn to teach these afterschool programs and summer programs,
and integrate it into their classroom if that is appropriate.
We have got to get more teachers in the STEM area, and I
don't know if this is perfect, but I am willing to try
anything. So this is our first shot at this, and I think it is
going to be exciting.
Ms. Lee. Thank you. Mr. Chairman, I would just say that if
the Department of Ed. funded this, it would probably be
millions more than what this budget suggests. And so once
again, big bang for our bucks.
Ms. Spencer. Thank you.
Ms. Lee. And thank you very much.
Ms. Spencer. Thank you.
Mr. Cole. Thank you. We will next go to my friend, the
gentleman from Philadelphia, for any questions he cares to ask.
Mr. Fattah. [Audio malfunction in hearing room.]
Mr. Cole. Actually, you were here before Congressman Dent
so----
Mr. Fattah. Well, let me proceed then. Let me thank the
chairman and thank you for your great service. You have a long
line of people, you know, playing an extraordinary role in
building this organization, and I think the storm clouds have
passed and the Nation has fully embraced AmeriCorps under your
stewardship. So thank you----
Ms. Spencer. Thank you.
Mr. Fattah [continuing]. Because I think it means so much
for improving the life chances of young people throughout the
country. And the service they provide, you know, I am convinced
that they get more out of it than the very-needed service that
they are providing to others.
So I visit schools regularly, and in dozens and dozens of
schools in my district in Philadelphia in which when you show
up, the AmeriCorps volunteers, corps members who are there both
in our City Year program and community, there has been Learn to
Serve efforts. You get older students working with younger
students, which has been quite an extraordinary lift because
both sets of grades go up----
Ms. Spencer. That is right.
Mr. Fattah [continuing]. Both for the tutor and the young
people who are receiving the tutoring.
I met a young man who is in PowerCorps now, and he had
recently been engaged in some antisocial activity and then had
an epiphany, Mr. Chairman, and decided to move in the right
direction and now is just doing great work at a community
level.
So, you know, our job here is to dispense, you know,
discretionary dollars. I can't think of a better place for us
to be investing them.
And I got a chance to speak at a graduation, conclusion of
a training session for some of your VISTA AmeriCorps members in
Philadelphia, but they were from around the country and we were
glad to host them.
So I don't know, as we go forward, because there is going
to be a change in administrations, but I think one constant
will be national service and AmeriCorps. And as you think
about, you know, what is going on in the country--today is the
founding of the Peace Corps in 1961 by John Kennedy--I know
that you are now 22 years old. I know this because I was
around, one of the cosponsors when we created this program. And
there were some challenges, Eli Segal in Harris Wofford's
period, and I was with Harris on Martin Luther King Day, that
day of service and we had tens of thousands of volunteers----
Ms. Spencer. Right.
OPPORTUNITIES TO GROW NATIONAL SERVICE
Mr. Fattah [continuing]. In Philadelphia for that activity.
But as you think about the bigger picture now for the Nation,
not about, you know, whether or not we are going to, you know,
be able to deal with small incremental bites, but if you would
talk to the committee about what you see as, you know, the
opportunities to further build on national service for whoever
may be coming in as the next President and the next
administration. I would be interested in your insights. You
have seen the country, you have seen what is going on out
there. If you would share with the committee--the chairman is
interested in big picture and not just small picture issues. It
will be helpful to us as we go forward to get a sense of what
you think is doable.
Ms. Spencer. Thank you so much for that very thoughtful
question. And you mentioned two giants in the national service.
Eli Segal, sadly, is deceased, but Senator Harris Wofford, he
is doing fantastic. And no coincidence I was inducted into this
job on his birthday, April 9, so we share a great bond in many
ways.
I would like to share with the committee that this year we
will induct the one millionth AmeriCorps member. It is pretty
exciting, just 21 years ago when this idea was conceived so
that we will have one million.
So where does that take us? I am seeing these AmeriCorps
alums all over the country. I went to a national conference on
volunteerism that had some of the strongest nonprofits in the
country in Houston last year, several thousand people, and the
question was asked, how many of you are AmeriCorps alums? And
half the audience raised their hand. They are now running
nonprofits. They are engaging volunteers. They have taken what
they have learned in their year of service and they are using
that for the greater good of communities.
A longitudinal study tells us that 60 percent of AmeriCorps
alums pursue public service. That is a great need. While we do
need our young people pursuing STEM, we can't overlook
teachers, public service, law enforcement, nonprofits, the
faith community. We need leaders in these careers as well. So I
am so pleased that national service helps influence young and
old and how they can contribute back.
And one thing that excites me, too, is the number of young
men who join AmeriCorps for lots of different reasons. Some are
between college and high school or after college or trying to
figure out their way and they serve in an education program.
And so many of them have told me I have decided to change my
major from business to education, from engineering to
education, from this to education. And I ask them why? And they
say when I am in the classroom, as a male figure, I can tell
that these young boys are starved for attention and leadership
in role models, and I am so drawn to the influence that I can
give to them and I want to be in a position to do so. So I
think there is a great future in attracting men to join as
teachers as well.
So I am excited about the future. One thing from our
research we know is that if you volunteer, especially at an
older age, you live longer. This is research-based. You are
happier. You reduce your stress. It has health benefits,
physical health benefits.
As many of you may have seen, the 106-year-old who was in
the White House last week and was dancing in the White House--
--
Mr. Fattah. Dancing with the President, yes.
Ms. Spencer. That is Grandma Virginia McLaurin, who I call
a friend, who will be 107 in a week and we will celebrate her
birthday. She is a current Foster Grandparent. She is a current
Foster Grandparent, and she does a great job. She walks to her
service, her school, and she says oftentimes people offer to
give her rides; she says no, I need the exercise. [Laughter.]
Ms. Spencer. But what is great is she is still
contributing. And I have talked with her, and it is amazing.
So it is an opportunity for our young and our old. My
challenge to young Americans in particular, is that everyone
should give a year of their life either to our military or
pursuing public service, joining AmeriCorps, doing an
internship at a nonprofit, serving with your faith community,
but give something back.
And I think that that is the direction we need to go in
because I know it bonds America. When you serve with people
from different walks of life on a common purpose, you become
more tolerant of their ideas, their religion, their background,
and that unifies Americans. In fact, it unifies the world. So I
hope that is the direction we go in.
Mr. Cole. Mr. Fattah has managed to use your enthusiasm to
get an extra 2\1/2\ minutes. That is very clever----
[Laughter.]
Mr. Cole [continuing]. Very well done, but for a good
cause.
Mr. Fattah. Thank you, Mr. Chairman.
Ms. Spencer. Thank you.
Mr. Cole. Yes. I want to go to my good friend from
Allentown, Mr. Dent.
Mr. Dent. Thank you, Mr. Chairman.
Well, it was worth the extra 2\1/2\ minutes. It was a good
discussion. [Laughter.]
VETERANS AND MILITARY FAMILIES
Mr. Dent. In addition to serving on this subcommittee, I
have the honor to serve as a chair of the subcommittee dealing
with military construction and the VA. And recognizing that one
of the focus areas of CNCS is veterans and military families,
can you share with us how you are working with the VA at the
Federal level and with individual State veterans' agencies that
best coordinate those types of efforts to ensure that your
investments are augmenting underserved areas or populations
instead of creating redundancies?
Ms. Spencer. Thank you so much. You have hit on something
very personal to me. I am the daughter, granddaughter, wife,
and stepmother all to men who served in all areas of the
military, so it is very personal to me that we make this a
focus of our agency.
And just to give you a little bit of the footprint, we love
to count, and we have been able to determine that of our 75,000
AmeriCorps members and 270,000 Senior Corps volunteers, that
23,000 veterans are serving today in our programs. I am very,
very proud of that because I do think it is an opportunity for
veterans to continue to serve, and we welcome their expertise
and what they bring to nonprofits and to solving problems.
Last year, we were able to support 780,000 veterans and
military family members in our programs, in hundreds of
programs that are focused on this either as a core part of the
mission or as a part of their overall efforts.
So a couple of areas that we are working on, one is with
Veterans Affairs that you mentioned that I think is something
of great interest to them is to make sure that every veteran
has the opportunity to use the G.I. Bill to the fullest extent.
This is a great benefit that we provide our veterans. But
sadly, not all of our veterans are successful in their
experience in attending college and graduating. Far too few
than should be graduate from college because they run into
obstacles. Now, sometimes, these obstacles are returning back
from war. It is a difficult transition not for all but for
some, and it is hard to get right into going to classes and
being free of maybe physical and mental needs and support at
the local level.
So one of the ways that we decided to tackle this if you
will is with a program called the Washington Vet Corps. And I
love this program, and I have met these AmeriCorps members in
Washington, in the State of Washington. The idea is that you
take a veteran, and they become an AmeriCorps member, and they
are placed in a college. And all the State schools in the State
of Washington have this access to this program. That AmeriCorps
member who is now a veteran is the key person for the veterans
attending that public college to go to for any problem they
have. It is a safe place for them to go and seek counseling,
support, tell their stories, tell their needs, and then that
veteran, who is an AmeriCorps member, can connect them in
overcoming their problems.
And I will give you one very, very serious example. I met
one of the AmeriCorps members who said that a veteran enrolled
in college, female, mother of several children, came to her and
said I am abused and homeless but I am using my G.I. Bill to
help get ahead, but I have got to find housing and I have got
to get away, you know, and have a safe place. That AmeriCorps
member connected her to the resources that she needed. Those
are the kind of issues that we are working on.
PENNSYLVANIA NATIONAL SERVICE MODELS
Mr. Dent. That is good to hear that. I also just wanted to
mention, too, that I am pleased with the G.I. Bill benefits. It
is a portable benefit. A lot of family members of veterans are
taking advantage of it, and that is a very good thing. But
thank you for that comment.
My final question deals with in your testimony you mention
how national service investments, you know, helps the local
communities, solutions, I guess, both in my district and across
the Commonwealth of Pennsylvania where we are fortunate to have
a number of very active volunteers and civil servants who make
valuable contributions to our communities. Could you elaborate
further on some of the programs that have been successfully
implemented in Pennsylvania that may serve as a model for other
States?
Ms. Spencer. Well, I think one that was mentioned earlier
is Power Corps. It is a great program, and this program takes
mostly young people between the age of 18 and 28 who are having
difficulties. They are out of school and not connected to jobs,
and they need someone to give them a chance. And so what the
program does is allow them to enroll as AmeriCorps members so
they get the living stipend, the opportunity to go to college
when they complete their term, but they get to learn skills.
They get to learn about working in the environment. They get to
learn trades while they are helping the community. That is a
dual benefit because the individual is supported, and it may be
the first time anyone has given them an opportunity.
But the community has helped with local needs as well like
transforming a brownfield into a park maybe. So I am real
pleased with that. It is something that I hope we can replicate
around the country, and I think there is great demand for that.
PAY FOR SUCCESS
Mr. Cole. If I could, I would like to return again to an
aspect of the Social Innovation Fund. And if I am correct, I
think the Corporation is one of just a handful of agencies that
has made awards using the Pay for Success contracting model in
which private investors support initiatives to, for example,
prevent homelessness or support youth development, and the
Federal Government provides payment to the investors only if
they achieve agreed-upon outcomes. Could you please tell me
more about what you have done specifically in this area, how
you evaluate the model, and what you are looking forward to in
the next fiscal year?
Ms. Spencer. Great, thank you. This is again exciting, and
we are glad to be one of the first Federal agencies diving in
to the Pay for Success-type model.
So the process, the way it works is our grants are helping
organizations set up the model so that they can put together
these Pay for Success models. And here is a great example of
one that I have had a personal connection with. The Green and
Healthy Homes Initiative in Baltimore, their goal is to go into
these houses that are traps for asthma and other allergies.
These houses have mold; they have other things that are harmful
to children.
And one example that I heard about recently was a mother
and her son. The son has a case of asthma. They lived in a
house with mold, and this was in Baltimore. That son, a child,
went to the hospital six times in one year. He missed 14 days
of school. She is a hardworking mother. She missed 14 days of
work.
So Green and Healthy Homes goes in and they do the full
remediation work on that house and they get the mold out and
they get the house healthy again. They spent $7,000 doing this.
The cost to the community is $25,000 for the young boy to go to
those medical visits and hospitals.
So the idea is that the health care organizations, the
hospital will repay--when they set this up, they will repay
Green and Healthy Homes Initiative that $7,000 they invested in
remediating that home, and it saved the hospital and the
community $25,000. But they only get repaid if the work is
done, completed, and worked.
And how do they know it actually worked? Because the next
year this young boy, after living in the healthy home, did not
go to the hospital one time and he only missed one day at
school and his mother only missed one day of work. It worked,
but it was evaluated.
So we are going to set up all kinds of programs like this
where the nonprofit can prove that they can solve the problem
but don't get paid until they do so and it is evaluated. So our
work right now is setting up the models, and I am really
excited to watch this over the coming years. I think this is
something that we all ought to look at in government.
Mr. Cole. Yes, it is a fascinating concept. Can you give me
some idea of the scale you are talking about? I know you are
testing this out and looking at things, so I am just curious
about the size of the program that you mentioned.
Ms. Spencer. We have eight grants right now, about
$12,000,000 investing today in setting up these systems, so it
is brand new to us but it is very exciting. Jobs is another
one, you know, getting jobs for people. I mean, it is a hard
thing to get a job for a chronically unemployed individual who
has been unemployed for two decades or so. But that is the
exact kind of problem this Pay for Success should look at. And
so it is not a big part of our portfolio yet, but I think it is
a good part, and I think we are going to learn a lot from it.
Mr. Cole. I would ask you to keep the committee advised as
you progress through this because it really is a pretty--this
is an area where it is very difficult to measure success, and
it appears to me at least in some ways you have and, you know,
very tangibly, and that is just helpful to know.
Ms. Spencer. Thank you. We will do so.
RESILIENCE AMERICORPS AND DISASTER RESPONSE
Mr. Cole. OK. One quick question and then we will move on.
You know, I have seen what you guys are capable of doing after
a disaster in my own hometown where AmeriCorps deployed and put
people on the ground. It was a tremendous help to us after the
tornadoes in 2013. But your request also includes a new program
called Resilience AmeriCorps that is intended to help
communities respond, you know, to extreme weather and other
disasters. Define for me the difference a little bit. And I am
assuming this is sort of a preemptive effort to prepare places,
but just give me a little background on this if you would.
Ms. Spencer. It certainly is. And I was leading volunteer
and donations management under three Governors in Florida and
one under the horrific storms of 2004 and '05. As we traveled
the State, I saw so many ways that we could have done a better
job in preparing the most vulnerable citizens. So this program
Resilience AmeriCorps is about better preparedness and plans
for cities.
It is a wonderful public-private partnership, so we are
partnering with the Rockefeller Foundation, who is investing
nearly $2,000,000. Cities of Service across the Nation, 10
cities to start with, 20 AmeriCorps VISTAs, we are going to go
to 15 cities soon, and these two AmeriCorps VISTAs in each of
these cities will work with the mayor and his or her key team
to put together a strong resilience plan with local nonprofits,
business leaders, other organizations around a holistic plan in
whatever their community is vulnerable of. Some communities are
more vulnerable in certain perils, more vulnerable for floods,
more vulnerable for tornadoes or hurricanes. Whatever is unique
to that community, that is what they are going to focus on, so
it is going to be a very individual case.
I think this is going to be a national model that we are
going to want to scale, and I think mayors and county officials
are going to be calling us and saying when can I get my
AmeriCorps VISTAs to come in? Mayors tell me something all the
time. They say, Wendy, I want to end veteran homelessness or
have a resilience plan or make sure that every third-grader is
on reading level in my community, but I don't have anyone else
that I can commit to on my team to see this through. That is
where AmeriCorps members can step in in a mission-driven way,
take over, lead the effort, be the instigator, coordinate the
working groups. And they are doing it in a mission-driven way,
getting experience and passion for it.
So you know what I ask AmeriCorps members? I say what is
your biggest obstacle in your service? And you would think they
would say the living stipend is not enough, the hours are too
long. You know the one thing they say to me? I don't have
enough time to meet all of my objectives. I wish there were
more time. Because they approach their service in a 10-month
window or a 12-month window like I have got to meet these
objectives in this amount of time. And that is what I like
about Resilience AmeriCorps. They are going to come up with
great plans for these communities. So we are looking forward to
it, and I will keep you apprised of its progress.
Mr. Cole. Thank you. I used Mr. Fattah's trick, so you
might want to try it as well. I recognize the gentlelady from
Connecticut.
FLINT WATER EMERGENCY
Ms. DeLauro. Thank you, Mr. Chairman. And let me play off
of your comments, and this has to do specifically with Flint,
about which I shudder when I think of 9,000 children who have
lead poisoning, which is irreversible.
But your Pay for Success program and your Resilience
AmeriCorps--and I want to get a sense of what--you know, we
talked a little bit about what your folks were doing there now,
but one of the great problems in Flint is looking at--two
things. In your Resilience AmeriCorps, what I have found out
about Flint is that the city itself and the mayor, she has no
staff. There is nobody home. So she is trying to deal with this
unbelievable crisis with an infrastructure that is nonexistent
in terms of personnel, so forth. And the other issue is
engaging nonprofits and others to be able to work with these
families and these homes and these children about what their
future is about.
Does this make sense to you in terms of what your mission
is and where you can provide help in both of these areas? And I
don't know the extent to which there have been conversations
about any of this with, you know, the folks in Flint.
Ms. Spencer. Well, we are working very closely with Flint.
In fact, I met the mayor recently. She was attending a meeting
here in Washington, and we almost shed a tear together over
this because it is a horrific problem, and I can't imagine what
they are going through.
But there are so many ways that we can help and are helping
and working on a task force, working very closely with the
United Way of Genesee County there, who is taking a great lead.
We sent in immediately, as you mentioned earlier, a team of
AmeriCorps NCCC members. Now, these are the 18- to 24-year-olds
that can work circles around any of us, and I was delighted to
see a local television reporter about 2 weeks ago shadow the
team members for an afternoon and go door-to-door as they were
delivering water and filters and information about their health
and what they needed to do.
So we are getting supplies delivered to people, we are
recruiting volunteers, we are managing volunteers. We have
another about 30 AmeriCorps members who are either serving in
schools or other areas who are being cross trained so that they
can be a part of the education component.
I am also looking at putting an AmeriCorps member in every
school who is a nutritionist because we can----
Ms. DeLauro. The two areas----
Ms. Spencer [continuing]. Overcome this with----
Ms. DeLauro [continuing]. Are nutrition----
Ms. Spencer. Yes.
Ms. DeLauro [continuing]. Education.
Ms. Spencer. Yes.
Ms. DeLauro. And that is where--and I am going to work like
hell to be able to get the Department of Agriculture to be able
to take these kids and get them WIC help from age 5 to 10
instead of just----
Ms. Spencer. Right.
Ms. DeLauro [continuing]. Up to age 5. But those are the
areas, nutrition and education, where we can bring some----
Ms. Spencer. We can put a trained AmeriCorps member from
one of our programs like FoodCorps and others, nutritionists
literally in every school there teaching the children, their
parents, the faculty, the community leaders. That is going to
help mitigate some of this. And this is a long problem, but we
have got to make a surge and we have got to do it now. And we
are prepared to help.
Ms. DeLauro. OK. I really do want to talk to you before I
go to Flint on Friday with the direction that you would like to
go in, what we can----
Ms. Spencer. Thank you.
Ms. DeLauro [continuing]. Talk about, what is there, et
cetera, because we need to move on these things.
Ms. Spencer. Thank you.
OPIOID CRISIS
Ms. DeLauro. These kids are already suffering.
Now, I don't have to tell you about an opioid problem that
we have, so let me get right to it. And I know you have people
in correctional facilities, you have people everywhere. Do you
have a strategy about leveraging your program in terms of that
opioid crisis? And are your folks getting trained on abuse, et
cetera?
Ms. Spencer. It is a crisis, and every time I meet with a
Member of Congress, a Mayor, a Governor, it seems like now they
are bringing it up. And that is a unique, different trend. And
I think we have all got to focus on it. And this is an all-
hands-on-deck. There is not one sector that should not be
involved in this.
Let me give you one example that I think is a shining
example, and it is in one of the toughest areas in the country,
and it is in eastern rural Kentucky.
Ms. DeLauro. Yes.
Ms. Spencer. It is actually in Chairman Hal Rogers'
district.
Ms. DeLauro. Right.
Ms. Spencer. He had the vision several years ago to start
an organization called Operation UNITE to focus on this
problem. And what we did early on is co-invest with his
nonprofit, and we have 44 full-time AmeriCorps members serving
each year in Operation UNITE to focus on two things: anti-drug
activities at the earliest ages in elementary school and also
focus on education because a smarter child and someone who is
interested in education and focused on that is not going to be
focused on things like drugs and things that get them in
trouble.
So we focused on math, and they are tutoring thousands. The
math scores, I am pleased, on our evaluation have increased by
34 percent since we have been working on them, and that is up
actually a point over last year, so we measure it every year.
But the number of children that are joining these anti-drug
clubs, I have gone with the chairman to tour these schools, I
have seen rallies. These things work because it gets it into
the young people's minds early that you must be focused on
something positive and that drugs are bad for you. You have to
have a strong drumbeat all the time. This can't be occasional,
it can't be--you know, it has got to be a part of the school's
culture, the community's culture.
And these AmeriCorps members who are from eastern rural
Kentucky--and I have met many of them who lost family members
and friends to drugs who died from them, and they are very
passionate about it.
So Chairman Rogers has asked me to come talk about this at
his annual conference in March, his prescription drug
conference. And I am going to head up the panel, and we are
going to talk about how service can provide a solution. And it
is about intervention.
Ms. DeLauro. Right.
Ms. Spencer. We have got a lot of areas we need to work on,
but we have got to work on intervention first and foremost, and
that is something that AmeriCorps members, Senior Corps
volunteers, and volunteers like you and me can do as well.
Ms. DeLauro. Thank you. Thanks very much.
Thanks, Mr. Chairman.
Mr. Cole. We have all caught on to Mr. Fattah so it is----
[Laughter.]
TRAINING AND TECHNICAL ASSISTANCE
Mr. Cole. Ms. Spencer, in fiscal year 2016 omnibus we
reinstated the authority of the Corporation to support
training, including at the State and local levels, through set-
asides in AmeriCorps. Would you describe what plans you have
for the Corporation to use this authority in the coming fiscal
year?
Ms. Spencer. Well, training is so important for a lot of
reasons. I mean, one is there are a lot of rules and
regulations now, more requirements on Federal grantees than
there were when we started 21 years ago, and we have to keep
pace with that. There are a lot of reporting requirements. We
have got to make sure that we are collecting the appropriate
data so that we can make sure that our investments are in the
right areas.
We have got to make sure that it is working because if we
invest Federal resources, match it at the local level, and it
is not working at the scale that it should, that is okay. You
need to know, you know, what areas you are best at. You can't
be good at everything, but you should focus on things you are
good at.
So it is important that we are training our grantees, our
intermediaries. We work very closely with 52 Governors'
Commissions on service and Volunteerism. They are managing
three-fourths of our AmeriCorps grants. So once that grant goes
to them, we can't just trust that it is going to be managed
well; we have got to partner with them to provide training for
them. And I ran a Governor's Commission on Volunteerism in
Florida, and I was a recipient of the funds from this agency,
so I know how important it is to have the resources for
training.
So it is something that not everybody wants to fund, but if
you don't do it smartly, you won't do it well. So that is why I
am a big proponent of training funds. We are very smart in how
we do it, very cost-effective, and I am very pleased with the
direction. We are holding four regional training conferences
throughout the country where we will have probably 2,000--the
vast majority of our grantees who are running the largest
programs and middle-sized programs will be attending this year.
I will attend every one of those, and we will talk about the
need for criminal history checks, on time every time, my new
theme. We will talk about the reporting, we will talk about
prohibited activities, we will talk about what it means to
manage a Federal resource, the public tax dollars' resource and
do so with efficacy.
So I am passionate about it. I think we ought to continue
with this, and I appreciate the investment that you have given
us with this.
EVALUATIONS
Mr. Cole. Somewhat related, let me ask you, your budget
asked for very little in the way of increases, but one area it
did was $2,000,000 for evaluations. So that is a fairly
substantial increase. I think it was 50 percent over what you
have done in the past. So tell us how you intend to use those
dollars. How much of it stays with your headquarters? Is any of
it distributed out through the organization so some of the
evaluations if you will are local if----
Ms. Spencer. It is a combination, and I would be happy to
provide you and your staff with a detailed list, but one is
going to be with the Social Innovation Fund as well. I mean we
have got a lot of Federal dollars and also private dollars
invested, and we have got to make sure, especially since this
program is one of our newer ones, that it is working well. So
certainly some of that is going to go into that area.
It also allows us the opportunity to select some of our
largest grantees and do a full-on random control trial, third-
party evaluation like we did with the Minnesota Reading Corps.
That is a large program. It is in 12 States, millions of
dollars invested in that. I would like to do another evaluation
like that. So that will be really co-investing with one of our
large grantees, yet to be determined, but that is important,
especially when you have an area like early childhood education
that you want to learn from and you want to replicate and you
want to scale it. So unless we do evaluations, we are not going
to know full on if that is something we should replicate.
So with the Social Innovation Fund, with our goal to select
other large grantees, I think that combination is going to be a
wise investment.
Mr. Cole. Well, no question in my mind it is a worthwhile
use of the money. Again, you know, one of the tougher things is
being able to measure outcomes and produce evidence, quite
frankly. It is tight times for budgets everywhere, and so any
time you have got something that can show you something works
or, frankly, saves you money by saying this is really a dead
end for us, money spent figuring that out is still well worth
it so you can redirect the resources instead of, you know,
misdirecting them, quite frankly.
Let me, with that, go back to my friend, the gentlelady
from Connecticut.
Ms. DeLauro. Thank you very much, Mr. Chairman.
Let me ask a question about the Senior Corps in which you--
--
Ms. Spencer. Yes.
SENIOR CORPS
Ms. DeLauro [continuing]. Have talked about their work as
Foster Grandparents, tutors, mentors, et cetera. And I just
know that there are about 3,000 Senior Corps volunteers in
Connecticut, so----
Ms. Spencer. That is right.
Ms. DeLauro [continuing]. I am grateful for that effort.
And, look, we have got more and more people retiring every day
and baby boomers, et cetera, so it looks like there would be a
large population of people who will knock at your door.
The budget, though, for Senior Corps programs is lower than
it was in 2010, and the budget request has been flat for the
past several years. So this sounds like one of the best
bargains for the Federal Government, Ms. Spencer. How much does
it cost to support a Senior Corps volunteer? What kind of
support do we need to provide in order to ensure that they are
continuing to serve our communities?
Ms. Spencer. Well, you may have hit on that there could be
a very strong argument that the Senior Corps program may be the
best value in the Federal Government. It is a wonderful
opportunity. In addition to the health benefits of seniors
volunteering--and, by the way, next month, I will be qualified
to be a Senior Corps volunteer as I turn 55. So there is hope
for me in my volunteer life in the future, and I am proud of
that.
The two ways we operate these programs, Foster Grandparents
and Senior Companions, fairly similar. These two programs are
actually means-tested programs, so these are for seniors. This
particular program is in great need, living at the poverty
level. They receive $2.65 an hour as a stipend to defray some
of their costs for serving. On average, they serve in the
Senior Companion program about 15 to 20 hours per week, and in
the Foster Grandparent program closer to 30, 35 hours per week.
Foster Grandparents are generally in schools. There are
some exceptions to that like in juvenile detention centers. And
Senior Companions are serving in homes doing one of two things:
keeping other seniors living longer because they are there to
help them with some of the basic needs and also providing
respite care for family members who can't get out of their home
unless they have some respite to do so during the week.
While $2.65 doesn't sound like a lot, to someone who is
elderly, doesn't have a lot of resources to depend on, doesn't
have a good retirement but does have the physical ability and
great nurturing ability to get into schools, it has something
to offer, which all of our Foster Grandparents and our Senior
Companions do. That $2.65 can mean a lot to them. It can help
them with their basic medical needs, transportation, some basic
things like food, their utility bills.
So we are solving two problems here. We are providing
caring and nurturing adults in schools, which the teachers are
so grateful for, but we are also providing a benefit to the
senior.
Now, the other program is RSVP. That is not a means-tested
program, but that has the largest participation--about 230,000
seniors are serving in RSVP. So think of it like a mini
volunteer center, if you will, for seniors. And they show up
and say ``I would like to serve in education'' or ``I would
like to work in the environment'' or ``I would like to do tax
returns for the poor.'' So we connect them with this.
Those grants average about $75,000 to each organization--
the individuals don't get a stipend--to the organization, and
the organization uses our funds to manage and coordinate
volunteers, many of them, hundreds of them. So that is a really
great bargain as well.
SUMMER OPPORTUNITY AMERICORPS
Ms. DeLauro. So we are getting great return on a very
minimal investment in this program.
Let me ask you about summer youth programs. You have got
Summer Opportunity AmeriCorps, you are going to create up to
20,000 positions for low-income students, high school age in
the next 3 years, help them build skills and earn money for
college. Can you tell us a little bit about this program and
how they are going to deal with low-income kids?
Ms. Spencer. So our young people are really faced with a
lot of tragedy in communities across the country today and
obstacles that get in their way from being successful. But one
of the ways that we have found to do an intervention is to get
them engaged in something positive. Service can be the one
thing that our young people--and this is targeted at high
school students in the summer who have a lot of time on their
hands and can get in trouble while their parents are working
and they are left at home alone. But if we can coordinate
activities and work with great organizations who work on summer
learning loss, summer programs, Boys and Girls Clubs, YMCAs,
these great programs that are proven that they can manage young
people in something positive.
We are going to set aside some college scholarship money as
a carrot, if you will, so that they can use these funds, serve
during the summer, get involved in all kinds of great
activities, run and managed by these programs that do it so
well, and then set aside a scholarship for them that they can
look to and say, you know, I now am going to go to college
because there is a fund with my name on it. I can't tell you
how many young people I have met who have said I wasn't going
to college until I earned my college scholarship from
AmeriCorps and I said why not? It is sitting there waiting on
me. I hope that same incentive will be there for these young
high school students.
Ms. DeLauro. Thank you, Mr. Chairman.
Mr. Cole. Thank you. Mr. Harris, we haven't given you a lot
of time, but we are prepared to go or I can take some questions
if you are sort of getting your----
Mr. Harris. If you could, I would appreciate it.
SELF-SUFFICIENCY OF GRANTEES
Mr. Cole. OK. No, I would be more than happy to, and then
we will go to you next.
CNCS, you support an enormous number of services conducted
by tens of thousands of organizations across the country, so
you probably have more experience in dealing with different
types of volunteer and civic groups literally than anybody else
in the Federal Government. When you are making your decisions
on grants, do you look at whether or not these particular
organizations are self-sufficient, have the potential to become
self-sufficient? Is there sort of best practices, if you will,
that you can extend to these organizations so that, you know,
over time they sort of stand up on their own? It doesn't mean
we wouldn't continue as the Federal Government or your agency
to have a relationship with them, but obviously, the more they
can do for themselves, the more you can spread your services
into other areas.
Ms. Spencer. You know, that is a great question, thank you.
And it is a bit of a blend, and I had a lot of experience with
this working at the Governor's Commission on Volunteerism in
Florida because you want to do two things. You want to find
nonprofits who have new, innovative ideas that may not be
tested yet but they want to tackle a problem in the community,
and you also want to blend it with very experienced nonprofits
who really know how to engage citizens in service. And I think
it is important that we have a good blend.
We also--it is important to look at vulnerable populations,
Native Americans you know we are leaning in. We have invested
the highest amount in our tribal communities this year, in the
last 10 years. It may be the largest in our agency's history
but we know in the last 10 years, there are great needs in our
tribal communities. Over $5,400,000 we are investing now. Rural
areas, our assessment about 42 percent of our grants are in
rural areas. It is very important to support rural communities.
This youth opportunity that we talked about, these young people
who are out of school and out of work, seniors, and others.
So we look at organizations who are tackling difficult
problems, have a plan, have an ability to scale what works if
they have been in the business for a while, but they also can
demonstrate that they have strong local support. That is
important to us. This is not, you know, just a public program.
As, you know, I shared in my opening remarks, we have been able
to now exceed our Federal funding for the first time ever with
local support. And so now we can call it a private-public
instead of a public-private partnership. And we look at that.
What do you have at the local level that says that we believe
in your cause so much so that we are going to invest locally?
We are also using evidence. This is relatively new. We are
looking at preliminary evidence or any evidence that they have
a plan that actually works. But I also don't want to go too
far. I always want to increase the opportunity for applications
to bring us ideas that are untested. That is OK. We need to be
a breeding ground for new ideas. But we also need to make sure
that we are monitoring that very closely so that we make good
decisions.
So I think our application process, while solid, we are
always looking at new ways to review it. But those things are
important, local support, evidence it works, or a new idea that
you want to test, and you are addressing the problem that
really needs to be addressed in the highest and best use.
PROMISE ZONE INITIATIVE
Mr. Cole. Related to that, would you please describe the
Corporation's role in the Promise Zone Initiative and how much
funding is allocated this year? What are you expecting to be
doing in 2017?
Ms. Spencer. I love place-based initiatives because it is
where we get to really work with the community leaders and
focus very clearly on a problem. I will get you the exact
number of the--not only the number of grants but the number of
members or volunteers who are serving and also the amount of
funding we are investing in that, and we will follow up with
you.
But this is an area that I feel like the administration has
leaned in on, and I really appreciate the opportunity for the
Federal Government to be able to actually shift. We need to be
flexible. We need to be able to turn on a dime like Flint,
which was mentioned. I mean, we had AmeriCorps members moving
in before it was declared a disaster. We have got to respond
quickly. We have got to try to make sure that our processes
don't inhibit us from being able to turn in to problems that
arise in local communities no matter what that is.
So we have got a great--I personally did an announcement in
Indianapolis with the Promise Zone there, great local community
needs there. And we are able to be a very good coordinator.
Sometimes, that is all it takes is--we have committed to
providing AmeriCorps VISTAs--those are our capacity-builders--
to go in and be able to coordinate organizations in a community
around the need. If they need to double-down with direct
service like AmeriCorps and NCCC and send in teams of young
people or do a grant application for an AmeriCorps program like
I mentioned with Operation UNITE in eastern rural Kentucky,
whatever the need is, working with the faith community, that
may be a real important part of the fabric of the community
that needs to be better engaged. We can coordinate that. So
Promise Zones is an important area, and I think it is one way
the Federal Government is showing flexibility.
Mr. Cole. Thank you.
Mr. Harris.
GRANT MONITORING
Mr. Harris. Thank you very much. And thank you. As I am
sure the chairman said, we have multiple hearings so I am
sorry. I was down the corridor at one.
Let me just ask a couple questions. First, just a kind of
administrative question because on--and I apologize if you
covered it before, but on page 59 of the book, you go over the
CNCS strategic goal operation measures, and curiously, you set
a goal of, you know, a monitoring activity having to do with
``complete all grant monitoring activity as identified in the
annual monitoring plan and follow up with grantees where
necessary,'' where you would think that your goal would be 100
percent of doing that.
You know, you started 89 percent in 2013 and then it
actually went down to 85 percent for all the years with the
goal of fiscal year 2016 to be 85 percent. Why wouldn't it be
100 percent your goal? I just have--you know, as we look at
these grants, and they are widespread, and believe me, I have
had a Habitat for Humanity, you know, singing your praises in
my office the other day. I get it. But why would we want 100
percent accountability? Why are we happy with 85 percent
accountability?
Ms. Spencer. Well, thank you so much for the question. And
I am not sure we would ever be happy with anything under 100
percent if we have the ability to do so. We have got about
$740,000,000 invested in around 4,000 grants around the
country, and 50,000 locations is where we have a presence where
we have at least one AmeriCorps member, Senior Corps member, or
one of our grants enrolled in a location. So I think it is a
matter of balance and what we are capable of doing. And this is
where we talked earlier about training and leaning on our
intermediaries, our Governors' Commissions on Volunteerism, and
some of our larger programs to help us.
So monitoring is very important. We are constantly working
on it. It is our checkpoint. It is how we find out if it is
working. It is where we find problems if we need to address
those. So I share your frustration that, you know, should we be
at 100 percent? I think that would be great, but I know it is
probably just a matter of balance. And we will continue.
And as you have practices from your seat, observe in other
Federal agencies or the private sector, please share this with
me. I am always looking for practices to improve our monitoring
processes.
DRUG ABUSE PREVENTION
Mr. Harris. And, OK, like I say, this is not my specialty
but I would say that in the private sector I would be surprised
if they didn't have controls that actually looked at 100
percent of their shareholder dollars being protected this way.
And, you know, these are taxpayer dollars, so I would just say,
you know, I wish your goal were 100 percent, you know, not 85
percent for fiscal year 2017.
Let me just ask because one of the areas that you are
supposed to be encouraging community service in is the health
area. And I have looked through the book and I can't find
examples. Maybe you know of some. The drug abuse and drug use
is a huge problem, every community, every community. I go to a
town hall meeting, I will tell you people don't talk about, you
know, gee, it is the--because I see one of the things Baltimore
is, you know, tree canopy, they don't want to know about tree
canopies. They want to know about why did I have, you know,
five people overdose in the local emergency room last week.
So I want to know what you are projecting in fiscal year
2017 to address that specific issue about health because I
think their role for volunteers and their role for new
graduates and things. So what specifically are you doing in
order to address that issue?
Ms. Spencer. Thank you. And we did talk a little bit before
you were able to come in about a great program that we have
partnered with Chairman Hal Rogers on in eastern rural Kentucky
that could be a fantastic model for the country. And I have
been sharing that with Members of Congress who are very focused
on this and Governors and mayors as well. And it is having
full-time AmeriCorps members focused at early ages, in
elementary schools, middle schools, anti-drug movements, drug
rallies, Safe Sons for young people to talk about their
observations and the positions they are in, where they are
affected by drugs. And sadly, these children, unlike when I was
raised, have actually seen family members and neighbors die.
And it is tragic. And I do agree with you. I think this is an
area for service. I think volunteers in the faith community can
do more.
We also have Community Health Corps. It is probably our
largest organization. And I would love to provide details to
you personally at a later time, but a little over 500 full-time
AmeriCorps members, many of which are going to pursue the
health sector as a career, but they are testing it through
AmeriCorps. They are serving in community health clinics, they
are learning about health needs, nutrition, and other things,
and they are making a great impact as well. So I would love to
meet with you and share that with you.
Mr. Harris. Thank you. One just brief question if I might,
Mr. Chairman. Do you have a zero tolerance policy for your
volunteers with regards to drug use?
Ms. Spencer. Yes, we do.
Mr. Harris. Any kind of drug, including marijuana where it
is legal----
Ms. Spencer. Yes, we do.
Mr. Harris [continuing]. In the States? OK. Thank you very
much.
Mr. Cole. Next go to the gentlelady from Connecticut.
SUPPORTING VETERANS AND MILITARY FAMILIES
Ms. DeLauro. Thank you, Mr. Chairman.
I want to just look at the veterans' area again if I might.
Connecticut has a large population of veterans and active
military personnel, and you support military families and
veterans. And you talked about the number of those who have
joined your effort, so I think it is a win-win.
Now, you have a Veterans and Military Families Steering
Committee, and I understand that was convened recently to look
at more services that you all can provide. What were the
recommendations of your steering committee? Do you have waiting
lists for services? And just in terms of--I know you talked
about the G.I. Bill and other areas in here--how can we in this
area provide increased support and effort by both increasing
the number of veterans who are engaged in the effort again and
looking at the kinds of services that they might be able to
provide?
Ms. Spencer. Let me share with you two ideas we are working
on, and I think we are very close to making this happen. It is
on the front end and on the back end of military service. When
someone leaves the military service, they are handed a great
tool from their service to transition them out of service. What
we are trying to do is get in the manual the opportunity for
them to serve in AmeriCorps written down, I mean, in that book
so they can see that joining AmeriCorps could be one of many
opportunities.
Many of our veterans have the ability to go right in and
get a job in the private sector or the public sector. Many are
going right into college, but some need a little more
transition, and I say that from a point of talking to these
veterans who have told me this. And what AmeriCorps does for
them is it gives them that opportunity to transition gently to
a sense of normalcy from the war zone to stateside while we get
to take advantage of their great coordinating skills. They
offer great skills to us and organizations. So it is a win-win.
So if I can get that opportunity in the formal book, that is
going to be one way.
Another way is--and this is a little loosely connected, but
think about what it takes for a young American to step into the
recruiter's door of what has gone on in their mind they have
said I am going to join the Army? Only to find out oftentimes
that they cannot join because they are overweight, test scores,
physical limitations. At that moment I want the recruiter to
hand them an AmeriCorps brochure and say we are not a good fit
for you, but you have great skills and assets. Would you
consider joining AmeriCorps? And here is the pathway to do so.
Because we don't have any restrictions. In fact, we encourage
people with disabilities to serve with us, people with limited
education. We want all Americans. So it is a little bit
different, but you see where there is an opportunity there.
Ms. DeLauro. Right. What are the veterans' organizations
that you tap into?
Ms. Spencer. Like American Legion Auxiliary----
Ms. DeLauro. Yes----
Ms. Spencer [continuing]. Is a great one, I mentioned the
Washington Vet Corps.
Ms. DeLauro. Right. Right. Right.
Ms. Spencer. There is a veterans' program in Virginia. I
mean, there are a lot of them around the country, and they are
local. You know, these are local grants. Most of them are going
through their Governor's State commission, and the commission
is selecting them at the local level. And some are not national
nonprofits. Some are local organizations that have decided to
focus on veterans in the community. And a lot of them are in
areas where you just happen to have large military bases so
they have a higher population of veterans.
Ms. DeLauro. Do you think that they know what a resource
you are to their effort?
Ms. Spencer. Not enough.
Ms. DeLauro. OK. Yes, I am just trying to think of----
Ms. Spencer. No, not enough.
Ms. DeLauro. Are even----
Ms. Spencer. We need more help in getting that word out.
Ms. DeLauro. Or even when we are dealing with the issue of
substance abuse and so forth.
I would on that point just say that the specific areas that
you function in, I think there needs to be a lot more
understanding, marketing of where you are and what you are
doing because I think that that helps us to avoid, you know, in
years past, folks who wanted to eliminate these kinds of
services and serious cutbacks in the mission that you have laid
out.
I don't believe there is enough of an understanding of, you
know, the functions that you are providing. I think there are
many folks, and I don't know if you share this view, Mr.
Chairman, that are here who think, OK, well, this is a large
sum but you can go off and stay on the public--you know, get,
you know, a stipend and so forth, and why should we be doing
that and not understand the gap that is being filled in this
whole range of services, you know, that you provide. And we
would love to talk to you more about that.
And just let me say I was so honored to be able to receive
the--and it is not in a self-serving way. I can't tell you how
much it means to me----
Ms. Spencer. The Kennedy Lifetime Leadership Award.
Ms. DeLauro. The Kennedy award, it really means so much to
me personally, and I can't thank you enough for what you are
doing or how we can expand what you are doing and tap into
these resources, so thank you very much.
Mr. Cole. Would the gentlelady yield for just a moment----
Ms. DeLauro. I would be happy to.
Mr. Cole [continuing]. Just to respond to your remark? And
this is something certainly Ms. Spencer ought to be aware of.
You would be amazed at the number of very conservative Members
that I have that come and visit with me about your programs and
what they have seen in their districts. You know, you really
would. And, you know, it is kind of like cut everything else in
government but you have got to leave this, you know----
Ms. DeLauro. That is correct.
Mr. Cole [continuing]. Particularly--what is it--is it
Bright Lights, the education program you have in cities that--I
had a number of Members who had seen that in action in their
districts and felt like it just really made a dramatic
difference. And you in particular would be shocked----
Ms. DeLauro. I would not--right.
Mr. Cole [continuing]. At the names.
[Laughter.]
Ms. DeLauro. I would be happy to know that, Mr. Chair.
Mr. Cole. I have a whole secret list of allies for you----
[Laughter.]
Mr. Cole [continuing]. But I am afraid to put them in your
hands. But, no----
Ms. DeLauro. Let's list them.
Mr. Cole. These really are programs because I think----
Ms. DeLauro. Unbelievable.
Mr. Cole [continuing]. People see them very directly in
their communities in a way that they don't see other parts.
Ms. Spencer. Yes.
Mr. Cole. Look, you don't see the National Institutes of
Health directly in your community, you know, in a way that you
will see a group of kids immediately after a disaster or you
are going just as a Member visiting in a local school district
and here is this program and teachers and kids alike are
bringing it up to you.
So, no, your best advocates, frankly, are obviously your
AmeriCorps members and then the people whom they serve.
Ms. Spencer. Yes.
Mr. Cole. I mean, you see it a lot so--anyway, I will yield
back to my friend, the gentlelady.
EMPLOYERS OF NATIONAL SERVICE
Ms. DeLauro. I would just end with this. There is always a
quote I use that comes from a woman who served in this
institution who I have a great regard for, and that is Shirley
Chisholm, the first African-American woman who served in this
body. And she said, ``Public service is the rent you pay for
space on this Earth.'' Thank you for the public service that
you give and that you are inspiring young people to give as
well. Thank you.
Ms. Spencer. Thank you. Well, it is actually carried over
now to America's employers, and they are taking notice. A year
ago we announced Employers of National Service, and we asked
employers all over the country to lean in and recruit
AmeriCorps and Peace Corps alums, give them an opportunity.
They have given to their community. Give them an opportunity. I
am so pleased to report today that we have 339 employers from
all over the country who represent 1,777,000 jobs. These are
employers like Delta Airlines; Disney; Comcast NBC Universal;
the States of Montana and Virginia; cities like Phoenix, city
of New York, Philadelphia, Nashville; colleges like Arizona
State University, of course nonprofits galore, and they are
telling us we are not doing this to get on some list. We
actually hope they apply. We value the fact that these
AmeriCorps members have a mission-above-self, organization-
above-self sort of DNA. They work with a team. They are the
kind of people we want to bring in our organizations. And many
of our workforce are an aging workforce, so they are looking to
replace their aging out and their retiring employees.
So I am so thrilled that America's employers are seeing the
value of AmeriCorps and Peace Corps, which is our sister in
service, does a great job. So, you know, it is getting noticed.
And I am so glad to hear, Mr. Chairman, that your colleagues
are talking about it. It tells us that our education work, to
demonstrate, asking you to come out and see firsthand is
working. So I am really thrilled with that, and we want to do
more.
Mr. Cole. Unless my friend from Connecticut has further
questions, that, I think, is the perfect note to end this
particular hearing on. Ms. Spencer, I want to thank you very
much for being able to come and participate with us this year.
We will try and promise it is not 16 years----
[Laughter.]
Ms. Spencer. Thank you.
Mr. Cole [continuing]. Until you come back. Then you will
be a fully fledged member of Senior Corps.
Ms. Spencer. That is right.
Mr. Cole. And thanks for the great work that you and your
colleagues do all across the country and the sheer number of
ways that you have been able to, you know, bring out what is
best in us as a people and sometimes institutionalize it and
expand it. It is something you should be very, very proud of.
And obviously, the people that work with you and preceded you
have been doing this for a lot of years as well, so just thanks
for your effort on behalf of the American people.
Ms. Spencer. Thank you. This is a true honor to serve in
this role, and it is an honor to support you and your goals in
your districts. And we really appreciate the support from
Congress. Thank you so much.
Mr. Cole. Thank you. With that, we are adjourned.
Wednesday, March 2, 2016.
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
WITNESS
KANA ENOMOTO, ACTING ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION
OPENING STATEMENT
Mr. Cole. Welcome. It is wonderful to have you here, and we
will go ahead and open the hearing. Today, we are here to
discuss the budget request from the Substance Abuse and Mental
Health Services Administration, an agency in the Department of
Health and Human Services.
I want to thank Acting Administrator Kana Enomoto very much
for having you here today, and I look forward to hearing your
testimony.
I will start by saying I very much appreciate the increases
the administration put forward improving access to mental
health services, targeting suicide prevention funding for the
most at-risk groups, particularly tribal populations, and
increasing vital substance abuse treatment and prevention
programs. I think these are all areas we can agree need
attention.
But I share the concerns expressed last week at our hearing
with Secretary Burwell that mandatory funding is not a
realistic option. I must stay honestly within the jurisdiction
of this committee and address these problems through available
discretionary resources.
I share the sentiment expressed by Chairman Rogers last
week that we must find solutions to the opioid epidemic within
the confines of the appropriations process. As many of you
know, rising rates of opioid abuse and death are alarming. Drug
overdose was the leading cause of injury-related death, and
among those 25 to 65 years of age, drug overdose caused more
deaths than motor vehicle crashes.
So we are deeply committed to finding better approaches to
stop the growing epidemic of heroin use and prescription drug
abuse. Last year, we made several investments in this area, and
I look forward to working with you to continue this work in the
coming year.
But I do want to stress--and I will be asking you
questions--this whole question of mandatory funding is one that
troubles me greatly because, frankly, we don't have the
jurisdiction in this committee to do that. And my political
judgment at this point is that that is unlikely to happen.
But you know, there may be discussion going in this place
that I know nothing about. That happens all the time. But, so
if you are involved in some, I want to know about that. And if
not, then we have got to figure out other ways to help you
achieve the objectives you outline because, again, they are
worthy goals.
With that, I want to yield to my subcommittee ranking
member, the gentlelady from Connecticut, Ms. DeLauro.
Ms. DeLauro. Thank you very much, Mr. Chairman. Thank you
for holding this hearing.
And I want to welcome Ms. Enomoto. We look forward to
talking with you today about, as the chairman pointed out, the
critical programs that fall under the Substance Abuse and
Mental Health Services Administration purview, as well as the
budget proposal for next year.
I want to start by saying a thank you to Chairman Cole
because last year we were able to make important investments in
the Labor, HHS bill altogether, including an increase of
$160,000,000 for SAMHSA. We were able to secure a $50,000,000
increase to the mental health block grant, and a $38,000,000
increase to the substance abuse prevention and treatment block
grant program for 2016. Many families without healthcare
coverage or whose insurance will not cover mental health or
recovery programs rely on the services that are funded by the
grants.
We were able to more than double the funding for
medication-assisted treatment for prescription drug and opioid
addiction through your targeted capacity expansion program. But
I do have a worry that we are not going to be able to make
these kinds of increases again without a stronger allocation.
Last year's omnibus moved the Federal budget in the right
direction. We raised the caps on defense and nondefense
discretionary spending, and we increased what was much-needed
funding for programs that support our economy and the quality
of life of citizens across the country.
The chairman has heard me say this before, but I am
troubled that Labor, HHS, that our bill received only a
fraction of its fair share of the $66,000,000,000 increase
provided in last year's budget deal. While the other nondefense
subcommittees received an average of 6.9 percent last year,
Labor, HHS increased by only 3.4 percent.
This subcommittee represents 32 percent of nondefense
discretionary spending, and in my view, our allocation should
be proportional to that figure. So I hope that we will see that
realized this year.
SAMHSA's programs aim to reduce the impact of substance
abuse and mental illness on our communities through prevention,
treatment, and support during recovery. The programs are more
important now than ever. As the chairman alluded to, we face a
public health crisis in opioid abuse. The rise in that abuse
across the country is sounding off alarms that we need to pay
attention to.
We face an epidemic that requires a response from all
levels of government. Every day over 100 Americans die from
drug overdoses. It outnumbers the deaths from gunshot wounds or
vehicle crashes.
The rise in opioid abuse across the country is distressing.
Of the over 47,000 drug overdose deaths in 2014, heroin was a
factor in over 10,000 deaths. Opioids were involved in almost
21,000. Sadly, the deaths are likely undercounted. Thousands
more people are addicted or in recovery.
We also need to expand access to naloxone in our community.
I have urged the Food and Drug Administration to reclassify
naloxone from a prescription to an over-the-counter medication
so that more will have access to this lifesaving drug.
Supporting SAMHSA's work is essential to the well-being of
our citizens. We can't afford to wait to act when addiction
affects the lives of so many of our neighbors, our brothers,
our sisters, our community members. We need to invest in
programs that put Americans on the road to recovery, which
brings me to the topic of today's hearing, the SAMHSA budget
request for 2017.
There is so much good in this budget proposal and I support
those efforts. I especially want to highlight the proposed
increases to the President's Now is the Time initiative, which
began in the aftermath of the tragedy at Sandy Hook Elementary
School, still so fresh in all of our minds.
The budget request includes an increase of $7,000,000 for
Project AWARE, which helps to identify high school kids with
mental illness and refer them to treatment, and it includes a
request of $10,000,000 for a new program to train peer
professionals.
On the substance abuse side, I was glad to see that the
request included $460,000,000 for opioid use disorder
treatment. Treatment of opioid abuse is critical. However, I am
wary that all the funding comes on the mandatory side of the
budget, which is unlikely to happen.
Which is why I will be introducing a bill that would
authorize an additional $1,000,000,000 in discretionary dollars
per year toward substance abuse to support community clinics,
and expand access to treatment for individuals with substance
abuse disorders. Treatment seems to have the biggest shortages
throughout the country. That is what I have heard from the
folks all over the country.
It is the responsibility of this committee to fund SAMHSA
programs. We need to increase the subcommittee's allocation to
support mental health, and to address the opioid epidemic in
this country rather than rely on mandatory funding that will
not materialize, which is why the subcommittee allocations that
will be released in the next few weeks will be so important.
I hope my colleagues on the other side of the aisle will
join us in urging an increase for Labor, HHS in fiscal year
2017. And with that, I look forward to your testimony and to
our discussion this morning.
Thank you, Mr. Chairman.
INTRODUCTION OF WITNESS
Mr. Cole. I thank the gentlelady.
And now, Ms. Enomoto, you are recognized for your
testimony.
OPENING STATEMENT
Ms. Enomoto. Well, good morning, Chairman Cole. Good
morning, Ranking Member DeLauro and members of the House
Appropriations Committee.
I would like to begin by thanking you. Thank you for
inviting me here today. Thank you for shining the light on
these important issues related to substance use disorders and
mental illnesses in this country. And thank you for the
tremendous support the committee showed to the Substance Abuse
and Mental Health Services Administration in the Consolidated
Appropriations Act of fiscal year 2016.
You made important investments in the work that SAMHSA
does--helping communities in crisis, confronting the epidemic
of opioid overdose, expanding treatment for people with serious
mental illnesses, and preventing suicide and substance use
among our tribal youth. By doing so, you sent a clarion call to
the Nation that behavioral health is, indeed, essential to
overall health.
We are honored by your faith in us to do this important
work for the Nation, and we are committed to executing your
charge with the utmost attention to financial integrity,
operational efficiency, and programmatic outcomes. Working
together, we will save lives and we will strengthen
communities. This is what makes me enjoy coming to work every
day.
That is why in fiscal year 2017, we hope to build on the
momentum you have provided. The President's budget outlines a
$4,300,000,000 investment in SAMHSA. It is an increase of
$590,000,000. It is also an increase to ensure that every State
can implement the full array of science-based services that we
know are needed to serve young people just emerging from the
fog of a first episode of schizophrenia.
It is an increase that will ensure that every person with
an opioid addiction, whether that is heroin, prescription
drugs, fentanyl, every person who seeks treatment will find an
open door. It is an increase that will help that father, that
daughter, that veteran, spouse, or friend to know that help is
available and suicide is not the answer.
SAMHSA'S FY17 PRIORITIES
In fiscal year 2017, SAMHSA proposes to focus on four
urgent public health priorities for the President, for the
Secretary, and I believe for this committee--engaging
individuals with serious mental illness into quality care,
addressing the opioid crisis, preventing suicide, and
maintaining the behavioral health safety net.
We can gain traction on these issues. We have the science.
We know how to do it, but we need to get the resources on the
ground. The President's budget provides what we need to advance
this critical work.
SERIOUS MENTAL ILLNESS
Thanks to expanded coverage provided by the Affordable Care
Act and the Mental Health Parity and Addiction Equity Act, over
60 million Americans have access to increased behavioral
health--increased access to behavioral health services.
Unfortunately, less than half of children and adults with a
diagnosable mental illness seek treatment, and for those who do
seek treatment, even with the most serious conditions, the
delay between first onset and help-seeking can be more than a
year.
That is unacceptably long. For conditions as serious and
potentially disabling as bipolar disorder, major depression,
PTSD, or schizophrenia, every day counts. So to address this
gap, the budget proposes a new $500,000,000 2-year mandatory
funding investment to improve access to mental health services
and engage people into high-quality care as early as possible.
For SAMHSA, this initiative includes $230,000,000 over 2
years for evidence-based early intervention services. As I
mentioned, this would enable every State to establish one early
intervention program. It builds on a body of work by the
National Institute of Mental Health, including their RAISE--or
their RAISE research initiative that found that coordinated
special care delivered early in the course of an illness can
decrease future episodes, the likelihood of future episodes of
psychosis. It can reduce long-term disability, and it can help
people get their lives back on track, which at that age is so
incredibly important. It can bend the curve.
So this 2-year program will supercharge the efforts already
under way with the mental health block grant 10 percent set-
aside for early SMI. To complement this effort, the budget
proposes a new 10 percent set-aside within the Children's
Mental Health Initiative to focus on youth and young adults at
clinical high risk for developing psychosis.
The potential value of this preventive intervention during
the prodrome phase when we can actually have a chance to stave
off a psychotic disorder is incredible. So SAMHSA proposes to
test implementation of this promising approach in community
practice settings to foster innovation and take advantage of
emerging science to change and even save lives.
Because we know already what can happen when we wait too
long. ER visits by individuals in behavioral health crisis have
been on the rise for over a decade. They often result in long
waits and unnecessary inpatient care. And for too many people
with mental illnesses and substance use disorders, they are
being seen in ERs. They are being seen in homeless shelters.
They are being seen in jail. These are not systems well
equipped to meet their needs.
So in fiscal year 2017, we also propose the Increasing
Crisis Access Response Effort, or ICARE, program to help
communities build and sustain integrated crisis response
systems to prevent and mitigate, respond to, and ensure follow-
up to behavioral health crises like we see so often in this
country.
To complement this effort, we are maintaining funding for
the assisted outpatient treatment program that you appropriated
to us for the first time in fiscal year 2016. This program will
support communities to implement and evaluate assisted
outpatient treatment and its impact on health and social
outcomes, hospitalizations, criminal justice involvement,
homelessness, and other important outcomes for people with SMI.
To advance this program, SAMHSA is partnering with NIMH and
ASPE to design and evaluate it. And yet each day, opioid
overdoses are claiming the lives of Americans from every walk
of life. Whether we live in Oklahoma City; Oakland, California;
Oakridge, Tennessee; or Oglala Lakota County, America's
obsession with opioid painkillers and illicit drugs poses a
major public health crisis.
ADDRESSING THE OPIOD CRISIS
The fiscal year 2017 budget makes a bold commitment to face
this challenge head on, a $1,000,000,000 2-year investment in
new mandatory funding to build the addictions workforce and
bolster the continuum of services--prevention, treatment, and
recovery--to address the opioid crisis. Of the $1,000,000,000,
$920,000,000 over 2 years will come to SAMHSA for State
targeted response cooperative agreements to support community
prevention, build the workforce, use telehealth for addiction
treatment, and expand the availability of MAT, including needed
psychosocial services and recovery supports.
The initiative also includes $30,000,000 over 2 years for
SAMHSA to evaluate the effectiveness of MAT programs under
real-world conditions to help identify opportunities to improve
treatment outcomes. In addition, on the discretionary side,
SAMHSA proposes to double our MAT program, our MAT targeted
prescription drug and opioid addiction grants from $25,000,000
to $50,000,000, and that would support 23 States, enabling us
to reach a total of 46 States with these grants.
And as we expand funding availability to pay for MAT, we
have to ask ourselves who is going to provide these services?
And that is why we are requesting $10,000,000 in funds for a
buprenorphine prescribing authority demonstration to test the
safety and effectiveness of expanding the pool of professionals
who might prescribe buprenorphine to include advanced practice
providers, such as advanced practice nurses and physician's
assistants.
In a parallel effort, SAMHSA is preparing to propose a new
regulation to increase the highest patient limit for physicians
who already have a waiver to prescribe buprenorphine. And these
efforts will complement our ongoing SAMHSA activities,
including courses for healthcare professionals on prescribing
opioids for pain, enhancement of prescription drug monitoring
programs, and expanding access to naloxone, disseminating our--
this is our opioid overdose prevention toolkit, which is, in
fact, the most often downloaded item on SAMHSA.gov.
PREVENTING SUICIDE
Unfortunately, drug overdose is not our only problem. In
2014, nearly 43,000 Americans died by suicide. Five thousand
five hundred of these deaths were among young people under the
age of 24. Thankfully, SAMHSA had $57,000,000 to dedicate to
preventing suicide in this vulnerable age group.
By contrast, however, 37,000 deaths occurred among adults
over 25. Currently, people ages 45 to 65 and those 85 and older
are at highest risk for suicide, yet in fiscal year 2015 and
fiscal year 2016, SAMHSA had only $2,000,000 to address adult
suicide prevention, and this was an increase over 2014.
So the 2017 budget proposes--gives us the opportunity to
follow a true public health approach and allocate resources to
focus interventions where we are losing the most lives. In the
case of suicide, that means increasing our focus on middle age
and older adults while maintaining our substantial investment
in preventing youth suicide.
It is important to note that in our $30,000,000 proposal
for National Strategy for Suicide Prevention, we are including
a tribal set-aside of $5,200,000, and we look forward to
working with our colleagues at IHS on the implementation of
National Strategy for Suicide Prevention in both SAMHSA and
IHS.
MAINTAINING THE BEHAVIOR HEALTH SAFETY NET
Furthermore, the President's budget highlights SAMHSA's
commitment to maintaining the behavioral health safety net by
continuing to invest in the mental health and substance abuse
block grants at $532,000,000 and $1,900,000,000, respectively.
Since 2013, the mental health block grant has grown by
$100,000,000, and the substance abuse block grant has grown by
$150,000,000. We appreciate those increases, and they are
important gains for us to maintain. As the entire healthcare
system pivots to value-based purchasing and delivery system
reform, we must maintain funding to ensure a smooth transition
for people with mental illnesses and substance use disorders.
The behavioral health safety net provides access to those
evidence-based practices not covered by insurance that research
has told us are essential to help people achieve and maintain
meaningful recovery. At the same time, it is critical to note
that the SABG prevention set-aside is the major funding of
primary substance abuse prevention in this Nation.
Finally, it wouldn't be a conversation about behavioral
health if we didn't talk about workforce development. We must
act swiftly to ensure that the behavioral health workforce is
sufficient to meet growing demand.
This expanded workforce includes prescribing and
nonprescribing professionals--psychiatrists, psychologists,
social workers, nurses, counselors, therapists, peers, youth,
adults, and families. A skilled and diverse workforce is
critical.
Toward this end, we are requesting $10,000,000 to support
peer professional workforce development, and in addition, we
will work closely with our colleagues at HRSA and IHS as they
implement complementary efforts to expand the number and grow
the competency of the behavioral health workforce. We are
grateful for the administration's and Congress' support in this
crucial area as well.
Members of the committee, thank you for your time. We know
all too well that substance use disorders and mental illnesses
come at a great cost to society. The impact of untreated or
untreated behavioral health conditions on the labor market,
criminal justice system, businesses, schools, and communities
is tremendous, but above all, the impact is greatest on
individuals and families.
Thank you very much for your willingness to talk to me
today about this, and I am happy to take any questions.
[The information follows:]
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MANDATORY FUNDING PROPOSAL
Mr. Cole. Well, thank you very much for your testimony, and
thank you very much for you and your colleagues' professional
efforts to deal with what we all agree is genuinely a national
crisis. And I think, you know, the subcommittee showed again
last year that it is very interested in trying to work with the
administration on this.
As you are aware, as I mentioned in my opening remarks,
most of the initiatives you are proposing are not within our
jurisdiction. Literally, I am mystified by this because there
is considerable support for two proposals that the President
and the administration generally put forward.
The Cancer Moonshot, we were all out at NIH, or a number of
us, earlier this week to discuss that. We want to find a way to
work with the administration on that. This initiative, again,
we would agree is a very important initiative. But we are
simply not going to have the ability to do that.
Do you know, are there any discussions under way between
the administration or with the relevant committees of
jurisdiction about the mandatory funding issue?
Ms. Enomoto. Not that I am a part of, but I do know that
the view on the mandatory funding is that it is fully offset by
the President's budget and that we are hoping that this can be
a down payment or a supercharge to some--some important
efforts, some of which are already under way and some of which
really need to get jump-started in order to make progress on
the important health issues that we are talking about.
FY17 DISCRETIONARY FUNDING INCREASE
Mr. Cole. I am not aware of any either, and I will be in
some meetings later today and this week where I will seek to
see if that is happening. But in the absence of that, and you
know, I think it is very unlikely that that is going to come to
pass. I mean, I appreciate the optimism of the administration.
But I just--I don't see it. And if I am wrong, so be it.
So given that, you have really only asked us for a
$60,000,000 increase on your discretionary line. Can you tell
us how that $60,000,000 would be used and whether, in your
view, that is enough to deal with the problem?
Ms. Enomoto. Well, I think we would welcome a conversation
about the balance between mandatory and discretionary, as well
as the short-term and long-term goals, because I would agree
that in order to achieve the goals that we have outlined for
ourselves to make sure that everyone who is addicted to opioids
who seeks treatment finds an open door. That will take a major
infusion of funds.
Mr. Cole. Well, we will keep waiting for that discussion to
happen. Maybe you and I will actually be invited to it on some
occasion, but the people that I know that are supposed to make
those decisions haven't heard anything either at this point.
FUNDING BEYOND MANDATORY PROPOSAL
So let me ask you this because the other challenge that
this committee would have--let us assume that this occurred,
and we were able to do this for 2 years--we are going to have
some sort of fiscal cliff then 2 years down the road.
You won't be here, but unless the voters of Connecticut and
Oklahoma change their mind, my ranking member and I may well
still be here. So how would we fund those programs?
I don't think you are--I am sure you are not suggesting
that in 2 years we could take care of this if we spent
$960,000,000 to take care of it. So those programs then would
have to go on, and we have no assurance what our allocation
would be, or that is the advantage of building something in the
discretionary budget.
Once it is in that budget, there is a very good chance that
we may reshape it, we may change it, but that funding stream is
going to continue and States can count on it. In my own State,
if we were to do something like you suggest here, and we were
fortunate enough to win some grants. They are in the middle of
a budget crisis themselves right now. So I can promise you they
can't pick it up and sustain it.
So we would have set up a program that 2 years down the
road, unless we found some other funding source for, would
collapse, and how would you address that if you were sitting in
our places?
Ms. Enomoto. Well, I think the thought behind this is that
what we are talking about in the State cooperative agreements
is across the spectrum. So it is prevention, treatment, and
recovery. So remember that we would be investing in your
prevention system so that you would have fewer cases of opioid
use disorder knocking on your doors in 2 years.
You would be investing in the workforce so that after the
money goes away, you will still have the people who have been
trained, who have been certified, who have been given greater
access or providing greater access to people who are seeking
treatment. And you have invested in a telehealth infrastructure
so that you can get--that those professionals who aren't
available in rural and remote areas can actually reach folks
without a 2-hour drive or a $50 bus fare to try to get to a
service provider that is in a big city.
So I think there are some investments available through
these State grants that would actually carry on through the end
of--or through into the next phase where things could be picked
up by the block grants or could be picked up by third-party
payers.
Mr. Cole. Well, that is an excellent point. I have no doubt
there would be some residual benefits and carryover, but I
still think we would face a problem.
But I can't enforce a 5-minute clock if I don't keep it
myself. However, we have been joined by we affectionately call
him ``the big chairman.'' Do you want me to give you time to--
--
OK. In that case, if we can, I will just move to my ranking
member for whatever questions she cares to offer.
[Pause.]
Ms. DeLauro. Lovely. Thank you. Thank you very much, Mr.
Chairman.
And Mr. Big Chairman, thank you very much.
Ms. Enomoto, last week, I participated in a series of
events on drug treatment programs in Connecticut. I was with
Michael Botticelli, Director of the National Drug Control
Program at the White House, and talking about solutions to this
devastating epidemic that we face.
In addition to talking to medical experts and public health
leaders about opioid addiction, I talked to families who have
the firsthand knowledge of the heartbreak and the havoc that is
caused by addiction, and I visited a methadone maintenance
program at the New Haven Correctional Center. The message that
emerged from these discussions and site visits was that there
was a critical need for greater access to treatment,
particularly medication-assisted treatment.
Too many individuals don't seek treatment. They can't
afford it. It is not available or because of the stigma
attached to addiction.
A recent study found that over 80 percent of individuals
with opioid use disorders do not receive treatment, with little
difference in the rate of treatment during the past decade. You
would agree that that has to change.
EXPANDING MEDICATION-ASSISTED TREATMENT AND HEALTH IT
My questions to you on this effort are in the budget. Your
budget has a significant new initiative, $1,100,000,000 over 2
years to address opioid use. How is SAMHSA proposing to expand
access to medication-assisted treatment for millions of
individuals who are trying to break their habit?
And a second question is your proposal highlights, and you
mentioned, telehealth and health IT systems as activities that
would be eligible for funding. Can you talk about those
activities, both telehealth and health IT, to opioid treatment
strategies and your capacity to be able to do that?
EXPANDING HEALTH IT
Ms. Enomoto. Thank you very much, Ranking Member DeLauro.
Your leadership in shedding light on this issue, your
commitment to speaking with families, to visiting our
providers, is so greatly appreciated because the scope and
depth of the crisis is really measured in human terms.
What we hope to do with our State capacity expansion grants
or cooperative agreements would be to ask those States to focus
on the communities that are hardest hit by the opioid crisis.
So focus on where you have the biggest numbers and address the
deaths from overdose and fallout by addressing prescribing
practices.
EXPANDING MEDICATION-ASSISTED TREATMENT
Ms. DeLauro. What about the medication-assisted treatment,
which seems to be a good road to follow?
Ms. Enomoto. Yes.
Ms. DeLauro. How are we expanding that?
Ms. Enomoto. Well, we have a number of routes doing that
right now. So we have our medication-assisted treatment
prescription drug opioid addiction grants that are on the
discretionary side. So, again, we went from $12,000,000, thanks
to the committee went to $25,000,000 with an increase of
$13,000,000, and now proposing an increase up to $50,000,000.
So those are already grants targeted to States with the
highest rates of opioid admissions, and we are working with
States to implement any one of three FDA-approved medications,
together with--when we say medication-assisted treatment, that
means it is medication plus necessary psychosocial treatment
and recovery support services because that is what the science
tells us is most likely to get the best outcome.
People with opioid use disorder who have had medication-
assisted treatment are most likely to achieve longer-term
recovery. So, absolutely, that is what we are doing in the
discretionary grant. That is what we are doing by training
providers.
We are--under DATA 2000, SAMHSA operates the buprenorphine
waiver program with the DEA, and so we have expanded our
access--expanded our efforts to provide training to physicians
who are interested in providing buprenorphine to their
patients. For example, in Scott County, Indiana, we were
involved in the response last summer to make sure that we could
increase access in the immediate term to help stem the tide of
the spread of HIV in that community.
EXPANDING TELEHEALTH AND HEALTH IT
Ms. DeLauro. Your telehealth and IT stuff, tell me quickly.
My time is running out.
Ms. Enomoto. So, so as I mentioned, we would want to make
sure that providers who are in central areas or urban areas are
able to reach those patients who are in either medically
underserved or behavioral health underserved areas. They don't
have access to a clinician who could prescribe buprenorphine,
Vivitrol, or although for methadone, we will still need to----
Ms. DeLauro. Do you have the capacity to do that?
Ms. Enomoto. Not right now.
Ms. DeLauro. Not right now. Well, I have got 11 seconds. So
I will finish up here. Let us go, 10, 9, 8. Okay. Thank you.
Mr. Chairman, thank you. Yield back.
Mr. Cole. Thank you. And thank you for adhering to the
clock, and we will certainly have an opportunity to get back to
you, I am sure.
So if we can, we have been joined, as you know, by the
chairman of the full committee, who has been a national leader
in this area and has really, frankly, brought our attention on
it and, I think, done a lot to make sure that we were able to
do what we did do last year in this area. So, Mr. Chairman, I
would call on you for whatever statement you would care to make
and then, obviously, any questions you would care to put to our
witness.
Naturally, I will extend that same courtesy to our ranking
member of the full committee when she arrives, if she can make
it. So, Mr. Chairman?
Chairman Rogers. Mr. Chairman, thank you for yielding.
Thanks for the courtesy.
Welcome, Madam Administrator, to your first hearing before
the committee in this role.
I will keep my remarks brief. I am pleased that the
President's budget recognizes the scope of opioid abuse in
America and prioritizes treatment for those suffering from
addiction. We have heard it often. We even heard it today. We
have more deaths from opioid abuse overdoses than car accidents
and growing. It is getting worse every day.
Of the 2.5 million Americans who need treatment for opioid
use disorders, less than 1 million are receiving it. That is a
serious problem, and we have got to do something about it.
I am pleased that you will be discussing these and other
issues at the National Prescription Drug Abuse and Heroin
Summit in Atlanta the week after Easter. We look forward to
hearing from you at that time down there.
That has become, by the way, the premier organization in
the country bringing together the whole gamut of aspects of
opioid abuse--treatment, education, recovery, and law
enforcement--all in one place. And it is an amazing--this is
the fifth annual summit, and we thank you for coming.
It is important to note that there is no one size fits all
approach to treatment. We have got to foster a regimen which
tailors and personalizes a patient's treatment to his or her
individual needs, and certainly medication-assisted treatment
are a piece of the puzzle. If provided under the care and
supervision of a medical professional trained in addiction, MAT
can help a patient turn his or her life around and move forward
in a positive direction.
This committee has repeatedly communicated to SAMHSA that
there is a full spectrum of options that we ought to be
considering for every patient who walks through the door
looking for help, and doctors ought to be trained in all of
them to decide what is best for that particular patient.
Unfortunately, I am not sure that message has been received.
If the chairman will indulge me, let me ask a few brief
questions.
UTILIZING NON-OPIOID MEDICATIONS
Buprenorphine has been a useful tool for many doctors, but
it seems that HHS and SAMHSA have held this drug up as a silver
bullet, focusing on prescribing caps and access to it. However,
there are also non-opioid medications available to treat
patients struggling with addiction, and our committees
encourage you to look at these products as another tool in the
box. Are you making progress on looking in that toolbox?
Ms. Enomoto. Absolutely. We recently issued a guidance on
the use of long-acting injectable naltrexone and strongly
believe that all patients, that this is a decision between
patients and their clinician. And so all three options for
medication-assisted treatment for opioid use disorder should be
available.
And we have actually received guidance previously. So we
are doing a thorough review of our technical assistance
materials regarding medication-assisted treatment and updating
them to make sure that we are inclusive of all the FDA-approved
medications, including antagonist and agonist therapies. And so
we absolutely agree with you that there are multiple pathways
to recovery and that antagonist therapies are often the right
choice for people.
ABSTINENCE-BASED TREATMENT
Chairman Rogers. Medication-assisted therapies may not work
for everyone. So what will you do to ensure that faith and
community-based abstinence treatment programs have a space in
the big picture as well?
Ms. Enomoto. You know, since 2005, SAMHSA led in the space
of recovery support services and the engagement of faith and
community-based organizations in the provision of both clinical
care and recovery support services. Through that program, we
have served thousands of Americans and helped them achieve
long-term recovery.
Then we have since then rolled recovery support services
into what is expected to be provided under the substance abuse
prevention and treatment block grant, and we have also worked
with the Centers for Medicare and Medicaid Services to better
understand how recovery support services provided by
traditional providers or faith-based or community providers can
be supported by third-party payer.
So we are looking for the inclusion because we have seen
with our data that people can and do recover when they receive
services that resonate with them in different ways, and
particularly providers from a shared faith or other kind of
community can reach people in ways that touch them very deeply.
EXPANDING ACCESS TO TREATMENT IN RURAL AREAS
Chairman Rogers. Cities have facilities that rural areas do
not, and rural areas are really, really hurting because they
just simply don't have the capability to deal with it. I have
spoken on a number of occasions with Secretary Burwell about
the importance of access to treatment, especially in rural
communities.
How would your budget proposal address the shortfall of
residential facilities in rural parts of the country?
Ms. Enomoto. Well, as I mentioned earlier, one of the
aspects of the opioid proposal would include the use of
technology, and I think that can be done in multiple ways. One
way would be through traditional telehealth. So we can get
providers who are located in cities who would be able to
connect one-on-one with an individual who is located in a rural
area.
Another way is through a collaborative care model, such as
Project ECHO, where we can get experts who are located at
academic centers or advanced practice centers, provider
organizations who can convene on a regular basis and provide
training, support, supervision, and collaborative case
management with providers who are located across the country.
So sometimes there are providers who would be willing to see a
person with a substance use disorder, simply don't have that
specialty training or that expertise, but with the support of
an expert who is available to them on a regular basis, they can
actually manage that kind of complex care.
And there is research to show that this works on all kinds
of conditions from depression to hepatitis to cancer care,
diabetes. And we also know that it can work for substance use
disorders as well.
Chairman Rogers. Well, thank you, Madam Administrator, for
the hard work you are doing. We will see you in Atlanta.
Mr. Cole. Thank you, Mr. Chairman.
I am going to move to my good friend from California, Ms.
Roybal-Allard, for 5 minutes. And then, if I may, I am going to
ask my friend, the vice chair of the committee, to take the
chair while I go to another hearing, and I will be back at some
point.
Thank you.
[Pause.]
UNDERAGE ALCOHOL CONSUMPTION
Ms. Roybal-Allard. Acting Administrator Enomoto, I have a
hearing conflict today. So I want to apologize in advance for
having to leave right after this round of questions, and I will
be submitting several others for the record.
But I wanted to take a few minutes to talk with you about a
bipartisan issue that I have been working on with Congresswoman
DeLauro for over 15 years, and that is the issue of underage
drinking in this country. Ten years after passage of the Sober
Truth on Preventing Underage Drinking, it is clear that the
STOP Act's comprehensive approach is making a difference.
According to the 2015 Monitoring the Future survey, alcohol
use by 8th, 10th, and 12th graders are at their lowest level in
decades. SAMHSA has been a great partner in the fight against
underage drinking by leading the ICCPUD, producing the annual
report, and administering the community grants, and the
progress we have made is very, very encouraging.
But sadly, as you know, underage alcohol consumption in the
United States remains a widespread and persistent public health
and safety problem. And the most recent Monitoring the Future
survey tells us that alcohol is still the number-one drug of
choice among our youth.
So I have been working very hard with Congressman Mike
Fitzpatrick and Congresswoman Rosa DeLauro to reauthorize the
STOP Act so its critical programs will continue into the next
administration, and I am hoping that all my committee
colleagues will join me in this effort.
2015 STOP ACT REPORT
But in the meantime, I wanted to ask you about your plans
for the fiscal year 2017 STOP Act programs. When do you expect
to release the 2015 report on the STOP Act?
Ms. Enomoto. So, Congresswoman Roybal-Allard, first let me
start by saying thanking you for making the time to be here
today and thank you for your and Congresswoman DeLauro's
incredible leadership on the issue of underage drinking
prevention. It has been--it has yielded real results for our
country that is saving lives and creating safer families, safer
communities for everybody.
I want to make sure that I get you complete and accurate
information about the fiscal year 2015 report. So I would have
to get back to you with your staff.
Ms. Roybal-Allard. Okay. I would appreciate that.
Ms. Enomoto. Absolutely.
Ms. Roybal-Allard. Because I think the reports have been
very, very valuable.
Ms. Enomoto. Absolutely. Happy to do that.
UPCOMING ICCPUD MEETINGS
Ms. Roybal-Allard. Also, will you convene the ICCPUD
principals and stakeholders meeting one last time before this
Congress and administration ends, and when will that take
place?
Ms. Enomoto. March 31.
Ms. Roybal-Allard. March 31, that is great. And the reason
I am happy to hear that, because those meetings have been
extremely valuable in evaluating the conversation about
underage drinking prevention and encouraging high-level
strategizing and coordination of the best ideas and practices
to achieve that goal. So that is very good news.
FY18 STOP ACT GRANTS
Evaluation of the STOP Act community grants have twice
shown their success in lowering underage drinking rates in
participating communities. In fiscal years 2015 and 2016,
SAMHSA awarded 97 grant continuations, but your budget
justification states that you will award 79 new STOP Act
grants. Will you also be proposing new grants in fiscal year
2018 to help meet this backlog of community seeking STOP
grants?
Ms. Enomoto. I would--I think that depends on the grant-
making cycle. So I am sorry I don't have the fiscal year 2018
data. I do know that we are planning to award 80 grants in
fiscal year 2016. Happy to follow up and get you the 2017 and
2018 data.
Ms. Roybal-Allard. OK. I appreciate that. And also do you
know what the backlog was of all those that had applied for
grants? How many were you not able to----
Ms. Enomoto. Oh, how many--how many were unfunded----
Ms. Roybal-Allard. Yes.
Ms. Enomoto [continuing]. And fundable? I am sorry. I don't
have that data, but happy to get that to you.
Ms. Roybal-Allard. OK. My time up? No? OK.
Mr. Womack [presiding]. You still have the better part of a
minute left.
Ms. Roybal-Allard. OK. Well, then I just want to close by
saying it seems to me the STOP Act programs are a perfect
example of a small Government investment yielding a huge return
in behavior change and subsequent improved health, and
communities who have STOP Act grants are showing significant
improvement in underage drinking rates, and more and more
communities each year are recognizing underage drinking
prevention as a priority.
So I thank the chairman and my colleagues for continuing to
support and fund the STOP Act.
Mr. Womack. Next we will move down to the other end of the
dais, and the gentleman from Virginia is recognized. Mr.
Rigell?
Mr. Rigell. I thank the chairman.
And thank you, Ms. Enomoto, for being here today, for your
testimony.
And let me first say that we share a common commitment to
reducing substance abuse and improving mental health. With that
said, I want to walk us through just a couple of things that
concern me.
And so if I think of Congress in some ways as playing a
role of board of directors here, if we come at things from a I
hope it is a constructively critical approach to these
questions, the first is that I want to associate myself with
the remarks of the chairman, Chairman Cole, when he talked
about his objection to increasing the number of accounts that
are placed in the mandatory side. I have found in my 5-plus
years here that the institution, this institution, and then
even collectively with the administration, we have been unable
thus far to make any substantial progress on reforming the
mandatory side.
One could argue that we have made--it has been rough, but
we have reduced the discretionary side. So just as an American
concerned about our fiscal trajectory, I couldn't support that.
Also I have always questioned the wisdom of the grant
program generally, and I am not saying I am in opposition to
all grants. But I fail to see the wisdom oftentimes of taking
money from citizens in a State, sending it to DC, and then
having other fellow Americans decide, you know, they will
develop a program and then have fellow--their fellow citizens
then again compete for that money. And to get the money, they
have to shape their State's programs and bend it to the will of
DC.
ADMINISTERING GRANTS TO STATES
So there are some things that are absolutely essential, can
only be done at the Federal level. I get that. But what is the
inherent wisdom and logic of when you meet men and women who
have education equal to your own, are also subject matter
experts in the States, and yet we believe that it is the wisest
course is to bring the money up and then have to reallocate it?
And indeed, some States don't get any of that money, or
they don't get as much as others, and it is inherently
inefficient if for no other reason every time you meet, every
time you have a memo, every time you promulgate directors, it
is not money going to help a mentally ill person. So help me
with that philosophically, Okay?
Ms. Enomoto. So at SAMHSA, less than 10 percent of our
overall appropriation goes to administrative costs, such as
salaries or rent or overhead, and 90 percent of our money does
go back out to States and communities. And over half of that
money goes directly to States through the block grants.
So I agree with you that it is--it is the States and the
communities who can best decide what is useful to them. At the
same time, if you follow a public health model, it is not
necessarily the wisest course of action to put an equal amount
of money everywhere because the problems are not distributed
equally. And so when we--just in a basic infectious disease
model or even with a chronic disease model, you want to focus
on where those diseases are striking the hardest or where you
have an evidence-based practice that has the greatest
opportunity to make traction to bring it down, to reduce risk,
or to stop spread.
And so, I think that is the value that the Federal
programming does add, as well as I think the Appropriations
Committee setting priorities for us. You identify problems that
are key to this Nation, to the health of the Nation, to the
health of families, to the health of the economy. And I think
you allocate funding to us in ways--in places where you see the
greatest need, and that is how we then turn it back to the
community.
Mr. Rigell. I thank you for your answer. I just would be
careful. You know, I would just be cautious in terms of trying
to tighten up how much more is put into those programs versus
just let the States, you know, invest in the areas that they
think directly, keep the taxes as low as they possibly can.
There is just a natural sense. I think Mr. Jefferson, you
know, talked about it, President Jefferson. But just this
natural tendency for government to grow. It is just a natural
tendency of the beast.
SAMHSA'S HIGHEST EFFICIENCY PROGRAM
But I have 25 seconds left. I am going to give you an easy
one here. Of all the programs that you think need investment,
among them, which is the one that shows the most promise in
terms of efficiency per dollar?
Ms. Enomoto. I think our proposal for expanding access to
medication-assisted treatment is very efficient. We have--
again, we have the data. We have strong data that shows that if
you provide these interventions, you can--you can help people
achieve recovery. You can reduce the risk of overdose death,
and you can increase public safety, reduce the risk of
transmission of HIV. There is value in so many different places
there.
Mr. Rigell. Thank you.
And I thank the chairman.
Mr. Womack. Welcome to the hearing. It is great to see you.
My question is going to be centered around targeted capacity
expansion grants, and I appreciate your review of SAMHSA's plan
for reversing the ongoing epidemic of opioid abuse. Our Nation
has successfully faced other public health epidemics in the
past, and with your partnership, we will hopefully put an end
to this one as well.
Excessive use of opioids has been identified by a number of
Federal agencies. We all know that CDC has raised it, the CMS,
Veterans Health Administration, and all are taking measures to
prioritize non-opioid alternatives for pain management.
These other Federal agencies are actively working to reduce
the overprescribing of opioids because opioids are associated
with overdose deaths, addiction, drug diversion, and the rising
incidence of newborns requiring opioid withdrawal management,
all very serious public health concerns. And I share Chairman
Rogers' concern about that and commend him for his leadership
down through the years. He has been a real leader on that
front.
Unlike other agency efforts to prioritize the use of non-
opioid alternatives for the management of pain, SAMHSA seems to
prioritize the use of opioids, especially buprenorphine, for
the treatment of opioid addiction, even though there are non-
opioid alternatives that are evidence-based and approved by the
FDA.
Under targeted capacity expansion, both the fiscal year
2016 House and fiscal year 2016 conference reports directed the
Center for Substance Abuse Treatment to use medication-assisted
treatments for two specific purposes--to achieve and maintain
abstinence from all opioids and heroin and to prioritize
treatment regimens that are less susceptible to diversion for
illicit purposes.
TARGETED CAPACITY EXPANSION GRANTS
Specifically, two questions. And I will give you both
questions, and then you can take the time necessary to answer.
Specifically, how is SAMHSA planning to address these two
conditions that were placed on targeted capacity expansion
grants? And when will the RFA for these grants be released, and
will it reflect the direction that Congress gave to SAMHSA in
the appropriations bills?
And I will yield to you for the answer.
Ms. Enomoto. That is actually very easy. So the funding
announcement is not yet out, but it will be out prior to March
15th is the expectation. And absolutely, we plan to reflect the
directions that we received in the report language, that we
will be prioritizing those medications that are less
susceptible to diversion, and we will be encouraging our
grantees or focusing our grantees on achieving those
interventions which can lead to abstinence.
So that is the easy part. We appreciate your investment,
your time, your attention, and we listen well. So, and I guess
I want to maybe just a point of clarification that in terms of
non-opioid alternatives for the management of pain, SAMHSA
actually has PCSS, so Physician Clinical Support System, that
provides technical assistance to providers as they are
considering prescribing opioids for pain management, as well as
for the substance use disorder treatment.
And that work absolutely includes alternatives, both
alternative pain management strategies that are not opioid
based, as well as alternative--or not even alternative, but the
full spectrum of addiction treatment options--with medication,
without medication, agonist, and antagonist. So I think we are
trying to follow the science and trying to give the people of
this country who have opioid use disorders access to the best
treatment available, and that means for different people
different pathways to recovery.
Mr. Womack. Thank you. And I still had a minute left. So,
no, I am going to yield to the gentlelady from--oh, I am sorry,
the gentlelady from California since Ms. DeLauro has already
gone once.
So, Ms. Lee, the floor is yours.
Ms. Lee. Well, thank you very much. I apologize for being
late. I had another hearing, but I am really happy to see you
here, and thank you for your testimony.
I am, by profession, a clinical social worker. So I am
really aware of how--the role that you play in terms of
substance abuse and mental health services. I am pleased to see
the increase in attention to drug addiction, but it is not a
new one. Heroin has been around for a while.
In the 1980s, when the crack epidemic ravaged African-
American communities, addicts were, you know, thrown into jail,
right, and cast off as moral failure thugs.
And so as substance abuse has evolved, now we are faced
with a new look at this drug addiction, especially through
heroin addiction and opioids. And I hope that you had a chance
to read this article, New York Times article, ``When Addiction
Has a White Face.'' Because I don't want to see us make the
same mistakes that we made in the past where we were, you know,
ending up putting people--we have lost a whole generation of
African Americans and Latinos because we did not put resources
into rehabilitation. We put people addicted to drugs into jail,
okay?
REDUCTION IN CRIMINAL JUSTICE ACTIVITIES
Now this budget in some ways is really troubling because
there is a large cut to your criminal justice activities
program that work to address the epidemic, the drug epidemic in
communities of color. So how are you going to coordinate with
the Department of Justice and other agencies to develop a
comprehensive strategy to ensure that drug offenders are
provided with treatment rather than being thrown in jail with
this budget cut?
I think you request a $16,100,000 cut to the criminal
justice activities. Yet, you know, the increase for addressing
heroin and opiate addiction has grown. And I don't want you to
rob Peter to pay Paul because we need to be able to treat
everyone and provide alternatives in terms of rehabilitation
and not cut one and put--one account and put money in the
other.
Ms. Enomoto. Thank you very much for that question, and it
is a very important topic to focus on.
The good news about our criminal justice line and the
reduction that we are taking there is that it will not--it will
not entail the elimination or the reduction of any current
grants. So we will be able to continue the portfolio that we
have, the grants that we have, and I think we have a very
robust program, a very robust partnership with the Department
of Justice already. We work very closely with OJP, with OJJDP,
BJA, and we are in lockstep with them as we look for
alternatives to criminal justice and as we----
Ms. Lee. Well, how does this happen with the $16,100,000
cut in this budget? How are you going to keep doing--we need to
do more in the criminal justice system's budget, not less.
Ms. Enomoto. I appreciate that, and we--we recognize that
we cannot--we cannot jail our way out of this problem. You are
absolutely right. We have to find ways to get people into
treatment. We hope that our continued criminal justice
involvement--criminal justice portfolio will help to do that
for many Americans.
Ms. Lee. Well, we do, too. But there is a $16,100,000 cut
in this proposed budget.
Ms. Enomoto. Right.
Ms. Lee. So I am trying to figure out how that is going to
happen.
Ms. Enomoto. Well, because of the cycle of some grants
ending and the availability of funds in fiscal year 2017, we
would be able to continue our current portfolio so no grants
would be cut. I am not sure if we might still be able to do
actually a small number of new grants still, but not as much as
we--as we would have if we didn't have to take the cut.
MINORITY AIDS PROGRAM
Ms. Lee. OK. I hope this committee can look at that
because, once again, you are looking to cut $6,700,000 from the
minority AIDS program, OK? And systematically, across this
budget, I see cuts that are going to impact communities of
color, which have been disadvantaged and disproportionately hit
by a lot of what we are trying to address now and provide some
equity. And you are cutting all of these programs.
And so how do you intend to address the minority AIDS
program in a way that we are going to move towards seeing an
AIDS-free generation? And when HIV and AIDS heavily impacts
minority communities, and yet you are cutting $6,700,000 there.
Ms. Enomoto. I think on the HIV, we are trying to keep a
top-line number of HIV that is the same in MAI. But that it is
a balancing between our substance abuse and our----
Ms. Lee. Huh? It is cut by $6,700,000.
Ms. Enomoto. That doesn't plus up?
Ms. Lee. Well, I thought the minority AIDS budget in this
budget was cut. If not, I stand corrected, but I would like to
verify that. Do you have that?
Staff, could I ask you, is there a cut? Is that accurate?
OK. So, so we believe that there in this budget is--I don't
have it in front of me, but we think that there is a $6,700,000
cut to the SAMHSA's minority AIDS program.
Ms. Enomoto. So, so if you look over on the mental health
appropriation, so the minus 6.7 is offset by a plus 6.7 in the
mental health appropriation.
Ms. Lee. OK, but it is in the mental health?
Ms. Enomoto. For minority AIDS because we know that both
the mental health and the substance use problems are so
important to people with or at risk for HIV that we are trying
to have a balanced approach that lets us look at both mental
health and substance abuse together for people with or at risk
for HIV.
Ms. Lee. OK. Well, thank you, Mr. Chairman. I would like to
pursue that a little bit more.
Mr. Womack. I thank the gentlelady.
BEST PRACTICES IN CRIMINAL JUSTICE ACTIVITIES
Back to me. You know, I appreciate what you said just a
minute ago about we can't jail our way out of these problems.
Just curious, is there some State, some agency, some group,
some organization doing a better job in, say, within the
criminal justice framework around our country that seems to
probably have not broken the code, but at least established
some best management practices and/or alternatives to the
incarceration of people addicted?
Is there--can you point to anybody around the country that
we should be more like?
Ms. Enomoto. You know, I had the opportunity to talk with
the National Organization of Correctional Health Systems a few
months ago, and I heard actually community after community,
warden after warden coming up, talking about here is how the
drug court in our community has reduced our census, and we are
seeing more and more people returning to health, returning to
their families and not adding to our rolls.
And so I think there are a number of communities where you
can see that and happy to put you in touch with them. I am sure
there are some in your State or in your district. But we have
also seen the criminal justice system, the correctional system,
police, jails be engaged with the naloxone issue, doing amazing
work to make sure that we have our first responders equipped to
reduce--to reverse overdose when they come upon it, as well as
educated to understand the nature of addiction as a disease and
the benefits for the individual and for the community and for
public safety to get that person into treatment rather than
move in a rush to incarcerate.
So I think there are a number of communities around the
country that we could point to.
Mr. Womack. So, but you mentioned specifically drug courts,
and I agree. I think there are many effective drug courts going
on, including my district, that are reasonable approaches and
alternatives. Are there any other types of alternatives aside
from drug courts within the community frameworks out there that
you are beginning to see are paying some dividends on this
front?
Ms. Enomoto. Oh, yes. So in our--we have a strategic
initiative on trauma and justice, and so in that initiative, we
are looking at a sequential intercept model. So there are six
different points in the potential engagement with the criminal
justice system, criminal and juvenile justice system, that
there are opportunities to intervene. So that includes things
like crisis intervention training for police officers, includes
things like reentry programs for people that are going back
into the community.
So I think all along the points in the continuum, there are
promising practices and evidence-based practices that can bring
down the burden of mental illnesses and substance use disorders
in that population.
BEHAVIORAL HEALTH IN SCHOOLS
Mr. Womack. What about our schools?
Ms. Enomoto. As it relates to, for example, is it expulsion
the problem that----
Mr. Womack. The identification of problems, the--you know,
I know there are some schools that probably would like to wish
the problem away or pretend that the problem doesn't exist. Are
we doing a better job in our schools identifying either those
at risk or those obviously so afflicted?
Ms. Enomoto. Oh, absolutely. And I think that is what you
will see in our Now is the Time proposal, Project AWARE. That
is exactly what you describe. It is a partnership.
We worked very closely from the inception of the proposal
to the execution of the program with the Department of
Education, as well as OJJDP, to make sure that we are
connecting school districts, schools, families, community-based
organizations, law enforcement, as well as the behavioral
health system, so that we are raising everyone's awareness. We
are introducing evidence-based practices to change school
climate, as well as to help people increase their mental health
literacy and so that teachers can identify teachers and other
staff and other students, and community members can identify
those children who are most at risk for mental illness or might
be showing signs of a mental illness.
And then making sure that we are making those warm
handoffs. So that instead of going to jail, instead of getting
expelled, a child might get access to an assessment or to a
counseling or to actual services if they actually have a
disorder.
ALTERNATIVES TO INCARCERATION
Mr. Womack. All right. So here is a softball in my last 20
seconds. An individual, particularly a young individual, that
has a substance abuse-type disorder, with proper treatment, we
can make that individual, instead of an incarcerated person
because of a lot of other crimes that are a manifestation of
the underlying problem, but we can turn that individual into a
productive citizen and give them the self-esteem back, reengage
them with their families, and make it a victory, could we not?
Ms. Enomoto. Absolutely. Some of my best friends and
closest colleagues are people in long-term recovery, and I have
the highest esteem and the highest ambition for what is
possible for people.
Mr. Womack. I thank the gentlelady.
Ms. DeLauro.
Ms. DeLauro. Thank you very much, Mr. Chairman.
And just two comments on some of your comments. One, the
last point is that, oftentimes, we take a look at this issue,
particularly with young people, and that the answer is
incarceration. The answer is not incarceration. The answer is
treatment.
And secondly, with regard to communities, I point to New
Haven, Connecticut. I was at the correctional center, as I said
to you, and they are dispensing methadone. And there is a line
of people there. They put their ID up there. They get the
methadone. They take the orange juice afterward because it is
so bitter tasting.
I then had the chance to talk to those folks, and this is
providing them with this medication-assisted treatment program,
which you are putting your emphasis on, which is the direction
in which to go in. What I have found, though, in my
conversations with these folks is that, in fact, yes, they are
ready to go out and they are ready to leave, and many of them
do not have a job. Many of them don't have a home. So they wind
up back on the street and without employment because they can't
get employment because no one wants to hire them, and then we
are back in the cycle again.
So those are--that is the realities of what we are dealing
with here.
INCREASING ACCESS TO NALOXONE
I have two questions. One is with the access to naloxone.
Pharmacies are beginning to dispense it without an individual
prescription. It greatly expands access to a lifesaving drug
that reverses the effects of an opioid overdose.
Access is increasing, but the price is increasing as well
for naloxone. The omnibus, we provided SAMHSA with $12,000,000
to help high-need communities mitigate overdosing, including
training and equipping first responders with naloxone.
How will the rising cost of naloxone impact the amount of
naloxone your grantees are able to purchase? What can we do to
increase access to naloxone? Should the program be expanded to
other communities? In addition to first responders, do
community-based organizations have affordable access to
naloxone?
Ms. Enomoto. So I would acknowledge that the pricing of
prescription medications is sort of outside of our authorities.
However, you are correct that as the price goes up, with a
fixed amount of money, people can't buy as much.
Ms. DeLauro. OK.
Ms. Enomoto. We agree that it is important to increase
access to naloxone, and while we defer to physicians and their
patients in terms of what the individual decision is in terms
of the prescribing of naloxone, in our opioid overdose toolkit,
we talk about the practice of co-prescribing for those patients
who are at greatest risk for overdose, that we want to make
sure that naloxone, we know it works. But it doesn't work if
you don't have it.
And so we need to make--we are looking at opportunities to
educate providers about the naloxone and its lifesaving value
and to ask them to have those conversations with their patients
to decide whether or not that is the right thing for them if
they are getting prescriptions of opioids.
Ms. DeLauro. Well, we ought to take a look at how we can
make it more accessible and do that in a way, since we know
what it does. And instead of looking at a whole bureaucracy, we
ought to just figure out the best way to do it and what are the
resources to be able to get to community organizations the
training that is necessary, to pharmacists, et cetera, get them
trained and get them to dispense it so that we can mitigate
against this crisis.
Overall with mental health, this is a very big issue for
me. Surgeon General's report, mental illnesses in this country
are more common than cancer, diabetes, or heart disease. It
affects people of all ages, income, gender, ethnicity.
ACCESS TO MENTAL HEALTH CARE
Many of the most serious mental illnesses--bipolar,
schizophrenia--occur in childhood and adolescence. One half of
all chronic mental illness begins by age of 14. Three quarters
by age 24. Suicide is the second-leading cause of death for
ages 15 to 24 years old. Staggering statistics.
And the statistics regarding treatment for mental illness
are just as staggering. In 2013, almost 50 percent of children
ages 8 to 15 with a mental illness received no mental health
services. Rates are not much better for adults, with 40 percent
receiving no treatment.
This is cost effective if we deal with this in our society,
and the barriers include cost, availability, and, yes, stigma.
Let me ask you this. Do we have the systems and the capacity in
place to care for a significantly larger number of children and
young adults if we are successful in getting them referred for
treatment?
If not, what is it going to take us to build that capacity?
Talk to us about the shortages of mental health providers. How
large are those shortages? Are they increasing? Which
professions are most effective? What other strategies are
available for increasing the number of mental health
professionals?
Ms. Enomoto. That was a lot of questions.
Ms. DeLauro. A lot of questions. [Laughter.]
Mr. Womack. That is a lot of stuff. We are going to give
you about 30 seconds.
Ms. DeLauro. Mr. Chairman, I would hope with so few Members
here that we can allow more than 30 seconds. I think the
chairman would be happy to do that, and I request that of you,
if I might? These are critical issues, and we don't have any
other Members here. It is just the three of us.
Mr. Womack. A reasonable time, but I was about to yield to
Ms. Lee, and we are already 30 seconds into her time. So we
will get there.
Ms. DeLauro. I think Ms. Lee would bear with me. Thank you,
Ms. Lee. Thank you.
Ms. Enomoto. Thank you, Ranking Member DeLauro.
I think you are again on point about the--the distressing
lack of access for so many children and adults with mental
illness to services, and the need to expand, the demand to
expand we hope will be assisted by the Affordable Care Act and
the Mental Health Parity and Addiction Equity Act. More people
will have ways to pay for services. Twenty million people
insured, thanks to the ACA.
At the same time, there are barriers. There are barriers
because people don't know where to go to care--get care. And
people don't think they can afford care, and people are afraid
of what other people might think of them if they--if they do
receive care or they have a diagnosis.
And I think all of those, the negative attitudes, finding
out--helping make care more affordable, helping make sure that
care works for everybody, and helping all Americans understand
that taking care of your mental health, treating an addiction
is no different from treating any other chronic condition or
medical illness.
Do we have the workforce to do it now, to treat everybody
who needs it? No. I mean, we are fairly busy as we are, and we
are only seeing half of the people with a mental illness, 1 out
of 10, maybe 2 out of 10 people with a substance use disorder.
So were everyone to walk in the door tomorrow, we don't have
enough providers. We don't have enough professionals. We don't
have the infrastructure.
That being said, we do have the science. We have the
technology. We have the will. I think we have the ability to
get there. But as I said earlier, we need to get the resources
on the ground.
Ms. DeLauro. It would appear to me that we don't have the
resources to get us there.
So thank you very much, Mr. Chairman.
Mr. Womack. Ms. Lee.
MINORITY AIDS PROGRAM
Ms. Lee. Thank you, Mr. Chairman.
That is the point. The budget of this subcommittee is
woefully, way, way, way too low to meet the needs of your
agency and to meet the needs of the American people. That is
the point.
Let me go back now to the cut in the Minority AIDS
Initiative. It is being cut, the $6,700,000, from the substance
abuse account. Now that doesn't make much sense to me because
when you address HIV and AIDS, you have got to address, yes,
the mental health needs of those living with the virus, but you
have also got to address this in a comprehensive fashion, which
means substance abuse.
So you can't cut from the substance abuse account and put
it into the mental health account, and then cut the criminal
justice substance abuse program also. Because what you are
doing is in many ways, you are vamping on minority communities
with these cuts, with people who have issues around substance
abuse.
And so, for the life of me, I can't figure out why you
would rob Peter to pay Paul because that is what it is doing.
We need that $6,700,000 restored into this account, as well as
the mental health services.
Ms. Enomoto. Thank you, Congresswoman.
I couldn't agree with you more that we need a comprehensive
approach to help people who have HIV/AIDS. I just had the
opportunity to participate in a PEPFAR visit in South Africa,
where we saw people struggling mightily at the center of the
epidemic there. And I will tell you that the population at
great risk, the population of young women that we are focused
on with PEPFAR is at risk not only because of substance abuse,
but also because of mental illness.
If we cannot help manage people and their substance use, if
we cannot help--help people manage their substance use, if we
cannot help people manage their depression, their PTSD, it is
very hard for us to make sure that they get tested, they know
their status, that they are on ART and that they are managing
nondetectable--to a nondetectable viral load.
And so that comprehensive approach is what we are trying to
achieve. I am happy to work with you on a way that we can do
that----
Ms. Lee. Yes.
Ms. Enomoto [continuing]. That doesn't disadvantage those
communities who are the most vulnerable.
Ms. Lee. Yes, and so let us find the $6,700,000 somewhere
else, Okay?
SYRINGE SERVICES PROGRAM GUIDANCE
Secondly, as it relates to the entire syringe exchange
issue, I co-chair the HIV/AIDS Caucus with Congresswoman Ileana
Ros-Lehtinen. It is a bipartisan caucus. And I am pleased that
this budget provides a bit more flexibility on how Federal
funds can be used to support syringe exchange programs, which
are a critical, once again, continuum of substance use services
and an important bridge to treatment.
So how are your plans written to incorporate this
flexibility across its grants and cooperative agreements,
including the substance abuse prevention and treatment block
grant?
Ms. Enomoto. I think we are preparing to issue guidance to
States with our colleagues at CDC in coordinated fashion to all
the States that, once again, they are able to use their Federal
funds for syringe exchange programs and happy to see that this
strongly evidence-based public health intervention is once
again available.
Ms. Lee. Thanks very much because it is really remarkable
progress. But the progress only began when this epidemic got
out of hand. I believe it was in Indiana, and your Governor,
the Governor was bold enough to say, you know, syringe exchange
really can help mitigate against this terrible disease.
So thank you very much.
Thank you, Mr. Chairman.
Mr. Cole. [Presiding] Thank you very much.
And as you know, I just arrived back. So, Mr. Womack, have
you had an opportunity to ask some questions?
Mr. Womack. I have had a couple of opportunities, and I
will take another one.
Mr. Cole. Well, I will give you that opportunity while I
get myself reoriented here. Thank you.
TRANSLATING RESEARCH INTO EVIDENCE-BASED PRACTICES
Mr. Womack. Absolutely. Ma'am, we often hear about the time
lag between translating research into practice. It can take
years for those suffering from a mental illness to receive
treatment based on research evidence.
What efforts is SAMHSA taking to ensure the evidence-based
practices learned from research is reaching those who work most
directly with individuals suffering from a mental illness? In
addition, is there a feedback loop in place between researchers
and practitioners where practitioners provide potential areas
of research to SAMHSA, and SAMHSA puts those ideas forward for
consideration?
And then as you ponder the answer to that, let me reflect
back on a trip that our chairman took us on this week to the
National Institutes of Health, and one of the more impressive
things I have seen in a while was a discussion about the use of
ketamine as a treatment protocol for mental illness, suicide
prevention, and a person who has been immensely helped by this
trial. And so trying to figure out how long does it take for us
to get from something that we now believe is beginning to work
in a trial to actually effective use in a protocol that can be
in place?
In this particular case, Mr. Chairman, what struck me as
odd was the fact that in this case, the individual had to go
across country to get the treatment. The treatment or the vial
for treatment was a very small--like a dollar, but yet the
infusion, if you will, was thousands of dollars.
So help me break this down and understand why we can't do
something faster and more cost efficient when it concerns
something as serious as that.
Ms. Enomoto. Those are several great questions. Thank you
very much.
I agree with you that shortening the time from bench to
bedside or research to practice is absolutely essential. That
is why we are so excited about both the early serious mental
illness set-aside as well as the prodrome proposal.
So for early serious mental illness, FEP, you have a well-
established intervention or a set of interventions that have
already been tested by NIMH in community practice settings that
we are ready to take to scale, and that is a very short time.
These RAISE trials and the RAISE papers have only just come out
in the last few years, and so that is a very quick turnaround,
a very quick scaling up.
On the prodrome side, the NAPLS study, the North American
Prodrome Longitudinal Study, and NAPLS--NAPLS 1, NAPLS 2--those
are still, we are just getting those findings. We are still at
the preliminary stages of the findings, and yet we are already
proposing this pilot program in our CMHI because the sea change
that is possible with this kind of intervention.
So it is early, but the potential to change the lives, to
keep someone from actually getting a diagnosis of
schizophrenia, what kind of impact could that have? It is
incredible, the potential of that, it saves a life. It saves a
family.
And so we are proposing to make that investment, put that
down payment into adopting, taking the chance to do something
innovative.
EVIDENCE-BASED PRACTICES
The challenge that you rightfully point out is because we
don't always do that. There are a number of interventions that
are strongly evidence-based that we don't see used with
widespread adoption, and there are some other innovations,
which were not available to test readily. I think that is
something that I would be happy to work with you on.
But it is a challenge of the way this process works because
on the one hand, you know, we get--we get encouraged to do
things that are evidence-based or things that we have done
before. And then we sometimes have challenges if, well, ``What
is the evidence base behind this? What is the evidence base
behind that?'' When we are really trying to do something that
is new or that is emerging.
And so it is that balance between practice-based evidence,
you know, the provider saying this is what is working for us
now. And not just providers, but also communities, tribal
communities would say this is indigenous practice. We have
1,000 years of evidence.
Or where a community of color that has done an adaptation
of something that has been working for them. How do we help
that make its way into the mainstream system? How do we wrap
ourselves around that?
So we have--we are really excited that at SAMHSA, we
relaunched our National Registry for Evidence-Based Programs
and Practices, and in that, we did two things that are relevant
to your question.
One thing is that we asked--we asked our stakeholders--we
put it out for open comment and voting--what are the areas that
we should be focused on? So give us that feedback. What is the
feedback of what are the science-based interventions that you
want to see on this registry?
And if the public identifies things, we will go look at the
research literature, and if it is there, we will start running
it through so that we can examine whether or not these
interventions should be on the registry. If it is not there, we
can message that back to the institute, saying our providers,
our consumers, our advocates, our family members, people in
recovery are telling us that they want to see evidence-based
interventions in this space, and we don't have it yet.
At the same time, we built a learning center, and that
gives us space for those model developers or those communities
that say we have a promising model. We have got something that
is innovative, and we would like to find out if there is
someone who wants to evaluate it. Is there a researcher that we
can get matched up with that is interested in testing this out
and helping us take it to the next level?
Because while there is a list as long as my arm of
interventions that have a good evidence base that we need to
get out more, it is not enough to do everything that we need to
do because mental health and substance use disorders touch so
many parts of our lives.
Mr. Womack. Thank you.
Mr. Cole. Thank you. I am going to take a quick point of
personal privilege here. I have been informed by our ever-
capable staff that it is my ranking member's birthday today.
Ms. DeLauro. Yes.
Mr. Cole. And you know, Steve and I could give you a
stirring rendition of the Boehner birthday song, but we are on
television, and we don't want to subject you to that, nor
ourselves to the ridicule that comes. So happy birthday.
Ms. DeLauro. Well, thank you very, very much. Thank you,
Mr. Chairman. Thank you for that.
Mr. Womack. Happy birthday, Rosa.
Ms. DeLauro. Thank you very much.
Mr. Womack. Good to have you.
Ms. DeLauro. I am trying to forget some of them these days.
[Laughter.]
Mr. Cole. Well, you know, only you would be dedicated
enough to be interested in talking about suicide and drug abuse
on your birthday. I mean, it just tells you something about
your devotion, and I mean that in all sincerity. You couldn't
have a better person to work with.
Let me, if I may, Madam Secretary, just ask a couple of
quick questions in areas that I am very interested in your
efforts to refocus SAMHSA on the most at-risk groups and some
of the things you have been doing to identify those groups and
refocus the agency.
ZERO SUICIDE PROGRAM
In particular, I would like to hear about your Zero Suicide
program and your tribal set-aside.
Ms. Enomoto. Thank you very much for that question.
So the Zero Suicide program is one that has some very solid
data behind it. We have seen that health systems have--many
people who end up dying by suicide have been seen within the
last month by a primary care provider. Many people who are
admitted who receive a--or are admitted for a suicide attempt
are the ones who actually complete suicide.
And we have seen in a number of systems, like the Henry
Ford Health System in Michigan, that they can by collecting the
data of suicide attempts and suicide, death by suicide, by
ensuring that there is follow-up to individuals who have been
admitted, that there is immediate follow-up and a connection to
community services, that there are evidence-based
interventions. Evidence-based interventions not just for
treating depression, but for actually addressing the
suicidality.
If we do I think it is about six different activities, we
know we can reduce a suicide rate within a fixed system by 50
percent, 75 percent, 80 percent. These are real numbers that we
have seen.
We have seen them in White Mountain Apache Tribe, who have
done an outstanding job of setting up a monitoring system and
providing these interventions and training. Training providers,
community members about the signs and symptoms of suicide and
the ways to respond adequately and then making sure that those
connections happen, and there are warm handoffs.
And that there is follow-up, there is follow-up because
people who end up--who complete suicide often have been touched
very recently by our system. So that is what we are hoping to
do with that.
We will do a Zero Suicide that is focused in the health
system, and then we are looking at ways to do comprehensive
multi-sector community approaches as we know prevention, with
so many things, it is you can't just prevent it once. Or you
can't just do preventive intervention once. It has got to be
over time and across systems, and that is what we hope to do.
And we would like to work--we will work with IHS, who also
has a Zero Suicide initiative. That will be focused in the IHS
facilities, and I think we are going to use our funding working
with IHS to figure out how do we wrap this around in whole
tribal communities?
TRIBAL SUICIDE PREVENTION
Because, as you know better than I do, that this is such a
tremendous problem not only among tribal youth. It is terrible
and is tragic among tribal youth, but we recently had our
SAMHSA Tribal Advisory Council, and they said we are seeing
this in our youth, but we are also seeing it in our middle age
and older adults. It is growing. It is a growing problem.
And there is a will. I think people want to do this. We
have our tribal behavioral health grants. Those do both suicide
prevention and substance use prevention. They allow tribes--and
we have a thank you for the expansion of that. We are up to
$25,000,000 and 100 new grants this year to tribes.
And we are really focusing on having community-defined
outcomes so that the tribe says this is the outcome that is
meaningful for us. This is the outcome that we commit to be
accountable for, that we are going to deliver on to SAMHSA.
Because so often, we hear from tribes is that you have these
prescribed outcomes with data that we don't collect or systems
that we don't have or outcomes like homelessness that don't
really exist in our community because that is not how we are
structured. And so you are measuring us on things that aren't
meaningful.
And we are committed to working with the tribes to identify
those things that--because then you get into this negative
cycle of holding them accountable for things that don't mean
anything to me, and then taking away funding. And that is not
what we want to do.
At the same time, we take seriously our responsibility as
responsible stewards of the Federal taxpayer dollar, and so you
know, we are going to work with the tribes to say this is what
you want to do, this is how you are telling us you are going to
do it, and this is how we are going to be in agreement about
the accountability for the use of these funds. But we want them
to be able to find a sustainable and meaningful way to address
the dual problems of suicide and substance use in the
community.
Mr. Cole. Well, I do want to commend you very much for the
efforts in this regard. It is a unique population. And
particularly reservation based, it is very different than any
place else. And there is a lot of often, as you would know, I
mean, some of these reservations are very bleak in terms of
quality of life and facilities.
At the same time, there is a connection between people that
is also very unique, and there ought to be a way we can do a
better job. But I really want to commend you and commend the
administration through you for making a special effort here.
With that, let me move to my good friend the ranking
member.
Ms. DeLauro. Thank you, Mr. Chairman.
CHILDREN'S MENTAL HEALTH
I would commend to you, and I know it is level funded, but
it is something called the National Child Traumatic Stress
Network. And it is level funded at $47,000,000. But this is a
program that provides trauma services for over 48,000 kids and
adolescents. It trains over 200,000 individuals.
And I would just submit to you that I think that what we
ought to do is to look at that program as an expansion with
regard to the reservations. And specifically with regard to
reservations, given the nature of the serious problems that
exist there because of environment or certain circumstances.
So after Sandy Hook and the Umpqua Community College
tragedy, we started to take a look at what we might do in these
areas to protect our kids. So I am heartened by the $15,000,000
funding for Now is the Time, for that initiative.
And I am concerned, however, the program allows for, as you
know, access to mental health services for children and young
adults. I am concerned that the increase is being offset by
eliminating the youth violence prevention program and cutting
in half the budget for primary and behavioral healthcare
integration.
Your budget includes $10,000,000 for new peer professional
workforce development, increasing the number of trained peers
working with young people 16 to 25, particularly at community
colleges. Tell us a little bit more about the program, how it
complements your Healthy Transitions program, which is focused
on 16- to 25-year-olds.
And by cutting youth violence prevention and the primary
behavioral health center healthcare integration, what are we
losing since the need, in my view, I think you might agree, is
still there. So----
[Pause.]
Ms. Enomoto. Forgive me. I am trying to make sure I am
getting that all down. It is a very rich question. Thank you.
First of all, with the National Child Traumatic Stress
Initiative and its potential value to tribes, we do have tribal
grantees within the National Child Traumatic Stress Initiative.
That network has been responsible for the development and
promulgation of evidence-based practices for dealing with
complex trauma in American Indian and Alaska Native youth.
It is--it really is a national resource. The network is a
national resource with incredible experts, incredible providers
and provider groups that are really moving the field ahead not
only for the United States, but for the world. And so I
appreciate the contributions of the NCTSI across its diverse
portfolio.
With respect to our peer workforce proposal and how that
dovetails with Healthy Transitions, it is, together with the
Minority Fellowship Program and the Behavioral Health Workforce
Education and Training program, those are all part of the Now
is the Time workforce proposals, which we continue to believe
strongly are added value to the Nation's behavioral health
system.
In addition to that, and I wanted to note I think to an
earlier question about the different types of providers and
where they are and what is valuable, we are partnering with the
Health Resources and Services Administration on a behavioral
health workforce research center so that we can do a better
job, and I can get you better data on exactly the questions
that you are asking me. But if you have to ask me, all the
providers are good, and they are all necessary because we know
that interdisciplinary, multidisciplinary treatment teams and
recovery teams, prevention teams, that is what works.
But, so we think that the peer workforce component is so
critical. For one thing, work is recovery. I think it has been
mentioned. People get out of jail. People get out of the
hospital. If they don't have a purpose, then it is very hard to
get galvanized for everything else that needs to happen.
So that and the peer workforce is a complement to the
professional workforce. It is not a replacement. It is not an
either/or. But what we hope to do is to start building a career
ladder by partnering with community colleges and States to get
certified, a certified peer workforce established so that that
can become a regular part of the behavioral health workforce to
complement the clinical professionals that are trained in other
professional schools.
Ms. DeLauro. Youth violence?
YOUTH VIOLENCE AND CHILDREN'S MENTAL HEALTH
Ms. Enomoto. Youth violence, that is obviously a very sharp
observation. The Safe Schools/Healthy Students program is what
was funded out of the youth violence line for over a dozen
years. In over a dozen years, we saw tremendous outcomes in
terms of reduction of violence, school violence, perceptions of
violence, increased referrals to mental health services, and
reduced substance use among youth, and perceptions of safety,
increased perceptions of safety for teachers and students.
So the Safe Schools/Healthy Students model was fantastic.
But in those dozen years, we never got a State that implemented
the Safe Schools/Healthy Students model statewide, and so that
is why we went to Project AWARE with the State. We had a pilot
early on the youth violence line. We had a State educational
agency grant, and then in Project AWARE, we really went to
scale, where we are trying to scale up this intervention that
we know works, this model.
So I think actually the elimination of the youth violence
line is an effort for us to be, again, those responsible
stewards to reduce two lines that are sort of duplicative and
doing so much of the same thing and that we are trying to
consolidate those resources into one place because we think
that that Project AWARE model, which came out of Now is the
Time really is the next level of where Safe Schools/Healthy
Students was.
Ms. DeLauro. Thank you.
Ms. Enomoto. And PBHCI, I just have to say the--we have
enjoyed the success of that program for a number of years. We
are seeing very positive outcomes in terms of improving both
the health status and the behavioral health status of people
with serious mental illness by bringing those primary care
services--the screenings, the smoking cessation, the blood
pressure checks--into the mental health center.
And with this reduction, the very positive news is, is that
we don't have to eliminate or reduce any grants to do that. And
we will continue to make use of the great work of that program
and our Center for Integrated Health Solutions.
Ms. DeLauro. Thank you.
Mr. Chairman, I am going to take my last couple questions
and submit them for the record because at 11:45 a.m., I have
to--I have to be someplace else. So I will--this is one on
primary prevention.
Mr. Cole. Well, we would hardly deny somebody on their
birthday something that they requested.
Ms. DeLauro. And the Medicaid screening of children and
adolescents and what we are doing to work with CMS on that. But
I will submit those.
Ms. Enomoto. Happy birthday.
Mr. Cole. I will actually follow your example. I have got a
couple things that I wanted to ask and will follow up with you.
But you have been very generous with your time, and we
appreciate it very much.
I am sorry. As you know, we have a lot of hearings going
on, and Members are having to come and go and cover different
things. But we appreciate all the excellent work. We really do.
We appreciate the bold initiative because I think it is a
genuine crisis. We want to find a way to help you if we
possibly can, but we will have that talk about mandatory
funding because I kind of doubt that is going to be the way.
But anyway, it is something on a bipartisan basis I know we
all feel strongly about. So thank you again, and thank your
team for being here.
The hearing is adjourned.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, March 15, 2016.
BUDGET HEARING--DEPARTMENT OF LABOR
WITNESS
HON. THOMAS E. PEREZ, SECRETARY, DEPARTMENT OF LABOR
OPENING STATEMENT FROM REPRESENTATIVE COLE
Mr. Cole. We will go ahead and call the session to open.
Good morning, Mr. Secretary, and welcome. It is good to
have you here, as always. I want to thank you for your service.
And the committee recognizes the demanding role you have, and I
appreciate your work on behalf of the American people.
This hearing is to review the Department of Labor's fiscal
year 2017 budget request. The department's request for
$12,800,000,000 in discretionary appropriations is a 5 percent
increase over the fiscal year 2016 enacted level.
That is a substantial increase when compared to the
increase authorized under the bipartisan budget deal for fiscal
year 2017 agreed to last fall and signed by the President. As
you know, that is essentially a flat funding top line for us.
Although as I told you in the back, you know, we occasionally
rob Peter's to pay Paul. And if you are lucky, you may be a
Paul in all this.
Increases are requested across the department, which makes
the committee's task of prioritizing the programs that need
additional funding from those that would be nice to have to
even more difficult. In the budget, there are areas of
agreement. The committee is pleased to see the Governor's
Reserve proposed at the authorized level of 15 percent after
several years of reduced allocations.
I am also personally interested in the appropriately scaled
Native American youth pilot proposal. I hope the department
will continue to work with this committee to find ways to more
effectively serve this population.
The committee also appreciates the department's focus on
serving the job training and employment needs of the Nation's
veterans and particularly the department's requested increase
for the Homeless Veterans' Reintegration Program. No veteran
should have to live on the streets after serving our country,
and we hope the department will continue to work with the
committee and with Congress to eliminate veterans homelessness.
Last, but certainly not least, the committee strongly
supports the OSHA Voluntary Protection Program. We look forward
to receiving the report requested in last year's House
committee report and hope that the department will continue to
work with us and with the Education and Workforce Committee to
secure the resources necessary to expand the reach of and the
participation in this program.
MANDATORY BUDGET INCREASES
Though there are numerous areas where we believe we can
work with the department, the committee continues to have
serious concerns with many of the proposals in this budget. The
budget proposes $17,600,000,000 in new mandatory spending.
These proposals exceed the entire discretionary budget for the
department by over $5,000,000,000.
Furthermore, Congress is unable to effectively assess these
proposals because there is no proposed legislative language.
Frankly, we wonder why these proposals are even before this
committee, which does not have jurisdiction over mandatory
funding. If they are anything more than a budgetary gimmick,
they should go before the appropriate committees of
jurisdiction.
DEPARTMENTAL ENFORCEMENT PROGRAMS
The committee also continues to have concerns with the
department's overreliance on punitive labor enforcement. The
budget requests a substantial increase for Wage and Hour
Division, OSHA, MSHA, and other enforcement programs despite
clear direction from the committee to adopt a more balanced
approach that places more emphasis on cooperative compliance
and assistance efforts.
The committee recognizes that enforcement is an important
part of worker safety programs. We continue to believe that
worker safety should be the goal of these programs, not
generating revenue from excessive penalties and fines. Many
employers who want to do the right thing and protect their
employees' safety are frustrated with the unforgiving and
punitive approach the department has taken toward enforcement
programs, especially the budget increases proposed to support
politically motivated and controversial regulatory proposals.
DEPARTMENTAL REGULATORY PROPOSALS
The committee also remains deeply concerned by the recent
trend of making major changes in policies through
administrative interpretation. Those efforts circumvent the
intent of Congress in the Administrative Procedures Act to
interpret and implement the law of the land through the formal
regulatory process.
Despite clear bipartisan direction from Congress to
implement such policy changes through the proper regulatory
process, the department continues to issue controversial
administrative interpretations to impose policies in an
expeditious and disingenuous manner that circumvent the role of
Congress in policy development and deprives employers and the
public of their legal right to information and opportunity to
comment on the record.
In addition, the department continues to pursue
controversial and partisan regulatory proposals on the
definition of fiduciary, overtime, crystalline silica, injury
and illness reporting, and reporting requirements for legal
advice regarding unionization and continues to dismiss the
concerns of many Members of Congress in both parties, as well
as affected employers. We hope that the department will engage
with the committee and the Congress to address these policy
issues on a bipartisan basis.
I know Members have many questions to ask, and this is a
full morning of hearings in a compressed time schedule. So you
will see Members, as I know you are aware, coming in and out,
but we will certainly try to get as many of these questions in
as we can.
I want to yield now to Chairman Rogers for any opening
statement that he would care to make.
OPENING STATEMENT FROM REPRESENTATIVE ROGERS
Chairman Rogers. Mr. Chairman, thank you very much for
yielding me this time.
As you say, we have got a lot of hearings going on. I have
got to go to three different ones this morning. So I am going
to say something and then have to leave to go to two more
hearings.
At the outset, Mr. Secretary, I want to thank you for your
interest and your travel to my congressional district in recent
months. As you are aware, over the last 7 years, eastern
Kentucky has been hit hard with the loss of over 10,000 coal
mining jobs and related jobs and, more recently, the temporary
shuttering of the AK Steel plant in Ashland due to steel
dumping by other countries.
SOAR INITIATIVE
As a result, we have worked at the local level to establish
a bipartisan regional community development initiative, known
as Shaping Our Appalachian Region, SOAR, designed to help
diversify and grow the economy almost from anew. So thank you,
Mr. Secretary, for speaking at the SOAR summit last year.
Around 2,000 leaders from around the region listened to you as
you highlighted the importance of education and job training.
As you saw during your visit, SOAR is partnering with
workforce development groups like the Eastern Kentucky
Concentrated Employment Program to help create jobs and
opportunities in what I like to call ``Silicon Holler.''
Important pieces of this initiative include innovation,
workforce development, job creation. And I appreciate your
continued support of those programs in the budget, as well as
your continued interest in SOAR in Kentucky.
DOL FY 2017 BUDGET REQUEST
Turning to your budget request as a whole, regretfully, I
must repeat a message I have conveyed at nearly every budget
hearing we have had to date. As you know, last year Congress
and the President reached an agreement setting discretionary
budget caps for fiscal 2016 and 2017, and I am proud that the
omnibus bill that we passed in 2016 adhered to the terms of
that bipartisan agreement. Congress made the tough choices
necessary to live within our means, and we will do it again for
fiscal 2017.
That said, I am very disappointed that the President has
put forth a budget request in order to avoid the very same
budget caps he signed into law last year. For fiscal 2017,
Labor requested $12,790,000,000 in discretionary funding, a 5
percent increase over fiscal 2016 enacted levels. That number
proposes increases for nearly every program at the department.
This proposal is unrealistic, given current law under the
bipartisan budget agreement. In particular, I am particularly
extremely troubled by the department's proposal to create
unauthorized new mandatory grant programs with no proposed
legislative language or justification, as pointed out by the
chairman.
Your mandatory funding proposals include $3,000,000,000 for
the American Talent Compact, $5,500,000,000 for the Open Doors
for Youth program, and the list goes on. Combined, these
mandatory proposals are larger than the entire Department of
Labor's discretionary budget. Not only are these proposals
functionally unworkable, but this committee, we don't have the
jurisdiction over mandatory programs.
DOL REGULATORY AGENDA
Finally, the department's partisan regulatory agenda is
also very disturbing. A final Department of Labor rule is
anticipated soon relating to the definition of fiduciary.
I, along with Speaker Ryan and a majority of Members of
Congress, have repeatedly laid out the horrible impact this
regulation will have on small businesses and individuals saving
for retirement. Yet this agency has pushed full steam ahead
with this regulation that will force financial advisers to stop
working with individuals that have small retirement accounts.
Along with the fiduciary rule, you are also working on
rules on overtime requirements, minimum wage, and paid leave
for Federal contractors. This agency is a prime example of
rulemaking gone amok, and I hope that we can have a discussion
about how to rein in these activities in the future.
In the meantime, thank you for joining us today, Mr.
Secretary. Look forward to hearing your testimony.
And I have to leave shortly to attend two other hearings,
but don't let that reflect on my willingness to work with you.
Thank you.
Mr. Cole. Thank you, Mr. Chairman.
If I could now go to my working partner, the good lady from
Connecticut, for any remarks she cares to offer.
OPENING STATEMENT FROM REPRESENTATIVE DELAURO
Ms. DeLauro. Thank you very much, Mr. Cole.
And thank you, Secretary Perez, for joining us this morning
and for your leadership on behalf of American workers and their
families.
The Department of Labor exists to represent the workers who
form the backbone of our economy and are the engine of its
growth. It helps provide them with stability by protecting
their wages, working conditions, health benefits, and
retirement security.
The department also supports a nationwide workforce
development system, which partners with private employers to
train a skilled workforce for the high-growth, high-demand
industries of the future. And our economy has seen significant
gains in the past year. We have added 225,000 jobs per month,
the unemployment rate is below 5 percent, and we are seeing
improvement in the labor force participation rate.
But too many working families today are still not being
paid enough to make ends meet. So these broad economic gains do
not manifest in the everyday lives of working people. Hourly
earnings are barely increasing at the rate of inflation. A mere
13 percent of the workforce has paid family leave through their
employers. And at least 39 percent of the workforce does not
have access to paid sick days.
And that is why the department's mission of fighting for
working Americans has never been more important than it is now.
Last year, we were able to make important investments in the
Labor, HHS bill, including an increase of $86,000,000 for job
training grants under the Workforce Innovation and Opportunity
Grant and $90,000,000 for a new apprenticeship grants program.
We were able to secure a much-needed boost of $17,000,000 for
the Bureau of Labor Statistics.
CUTS TO DOL BUDGET IN FY 2016
But I am disappointed that despite these gains, the 2016
enacted level was still $1,400,000,000 below the 2010 level, a
cut of 10 percent. I am also disappointed at the overall
increase of less than 2 percent for Labor in 2016, especially
because this reflects a failure to provide additional funds for
worker protection agencies. OSHA, MSHA, the Wage and Hour
Division, and EBSA were flat funded, and the OFCCP was cut by
$1,000,000.
ILAB was cut $5,000,000. ILAB is one of the main tools that
we have to root out and combat the causes of these inhuman
labor practices worldwide. And as we consider new trade
agreements with major implications for labor at home and
abroad, we cannot slash funding to this crucial resource.
I am also disappointed that we were unable to fund a modest
request of $35,000,000 for State Paid Leave. Paid family and
medical leave is an idea whose time has come. It is fair, it is
humane, and it is popular.
This is a national issue that has been raised by members of
both parties. The discourse at the national level is about paid
family leave. Families who work hard deserve our support to get
through tough periods in their lives. Helping them keep their
jobs and hanging onto their paychecks will boost our economy.
There really is no reason not to enact paid family and medical
leave.
RECEIVING PROPORTIONAL 302(B) ALLOCATIONS
Last year's omnibus moved the Federal budget in the right
direction, raising the caps on defense and nondefense
discretionary spending and increasing much-needed funding for
programs that support our economy and the quality of life of
citizens across the country.
Chairman Cole has heard me say this before, but I am
troubled that the Labor, HHS bill received only a fraction of
its fair share of the $66,000,000,000 increase provided by last
year's budget deal. While the other nondefense subcommittees
received an average increase of 6.9 percent last year, the
Labor, HHS bill increased by only 3.4 percent.
This subcommittee represents 32 percent of nondefense
discretionary spending. Our allocation should be proportional
to that figure, and I hope to see that realized this year.
FY 2017 PRESIDENT'S BUDGET
That brings me to the topic of today's hearing, the budget
request for the Labor Department. I might add with regard to an
increased allocation by this committee, that would mean we
would have to put less emphasis on mandatory spending if we had
an appropriate allocation for what needs to get done through
this committee.
The budget request for the Labor Department. Mr. Secretary,
there is a lot of good in the request, and particularly, I
applaud $255,000,000 increase for job training programs,
including increases for State grants under the Workforce
Innovation and Opportunity Act, Job Corps, and Reintegration of
Ex-Offender programs.
I'm also pleased to see an increase of $12,000,000 to help
homeless veterans return to the workforce. I want to note that
last year Connecticut became the first State to end chronic
homelessness among veterans, a significant achievement, and we
can all agree that military veterans deserve to have a job
waiting for them when they transition back to civilian life.
I am pleased to see an increase of $15,000,000 for ILAB. In
my view, ILAB should receive a much, much larger increase to
carry out the essential work that they do, but this increase is
a welcome proposal.
But I am disappointed that there is no request for
discretionary funding for State paid leave. I realize this is a
heavy lift in this environment, but we need to keep fighting
until working families do not have to forego pay or lose a job
when serious medical or care giving needs arise.
In order to do what we need to do to support programs that
provide job training opportunities and enforce laws that
protect low-wage workers, this subcommittee needs additional
funds in fiscal year 2017.
FINALIZING REGULATIONS
Finally, let me urge the Department of Labor to finalize
the regulations that you have been developing over the last few
years, including the silica rule, fiduciary rule, and overtime
regulations. Hard-working Americans deserve safe workplaces.
They deserve to have their retirement funds protected from
self-interested advisers, and they deserve fair pay for their
work. This is precisely what the Department of Labor exists to
do, to represent and to protect working Americans.
I thank you, and I look forward to our discussion this
morning
Thank you, Mr. Chairman.
Mr. Cole. I thank the gentlelady.
And now, Mr. Secretary, we would recognize you for any
opening remarks you would care to make to the committee.
OPENING STATEMENT FROM SECRETARY PEREZ
Secretary Perez. Thank you, Mr. Chairman.
It is an honor to be here with you and Ranking Member
DeLauro and all the members of this committee. I look forward
to discussing our 2017 request for discretionary funding that
is pending before this subcommittee. I am very grateful for the
constructive dialogue that we have had throughout my tenure,
and I have profound respect for your leadership and our ability
to collaborate together.
As we prepare for the final 10 months of this
administration, I think it is worth reflecting on where we have
been, where we are, and where we need to go. President Obama,
as you know, inherited an economy in freefall. In the 3 months
before he took office, the economy hemorrhaged roughly 2.3
million jobs. Seven years later, we have made tremendous
progress, climbing out of the worst economic crisis in
generations.
We are now in the middle of the longest streak of private
sector job growth on record, 6 straight years to the tune of
14.3 million new jobs. Unemployment is down from 10 percent to
now 4.9 percent. Auto sales reached a record high last year.
While we have considerable unfinished business, we have
made undeniable progress, and I am proud to say that the Labor
Department has played an important role in helping this
recovery. Our work is critical to fortifying the basic pillars
of the middle class--an education and training that allows you
to move up the ladder of success in your job, healthcare that
is affordable and accessible, a fair day's pay for a hard day's
work, a roof over your head, a mortgage that won't go
underwater, and the opportunity to save for a secure and
dignified retirement.
PLANS FOR THE FY 2017 BUDGET REQUEST
These pillars took a beating during the great recession,
but I have never felt more confident in the resilience of our
economy, our workers, and our employers. I believe that our
fiscal 2017 budget request will help us continue this important
work to sustain this recovery while helping us to address the
unfinished business of ensuring shared prosperity for everyone.
For instance, despite a major decline in the number of
long-term unemployed, there are still 2.2 million people who
have been out of work for 27 weeks or more. To get them the
help they need, we want to continue to strengthen the
Reemployment Services and Eligibility Program, which has a
proven return on investment.
Our budget builds on the increased investments made by
Congress last year, adding $70,900,000, for a total of
$185,000,000. These dollars will expand services to all
veterans receiving benefits through the unemployment
compensation for ex-service members, as well as one-third of
the unemployment insurance claimants most likely to exhaust
their benefits and become long-term unemployed.
I am also grateful for Congress' bipartisan support in
passing WIOA a couple of years ago and providing the resources
to make that promise of the law a new reality and a wonderful
reality. Our fiscal 2017 budget builds on this foundation by
bringing WIOA formula funding programs to their fully
authorized amount while continuing the 15 percent Governor's
set-aside for statewide activities that I made great use of
when I was a State labor secretary, and which I strongly
support.
We are also proposing modest increases specifically to help
dislocated coal industry workers and to pilot better ways to
serve Native American youth who don't live on reservations,
something I know has been a longstanding priority of yours, Mr.
Chairman.
Apprenticeship has been one of the cornerstones of our
workforce development efforts. As I mentioned this morning, a
recent independent study showed that for every Federal dollar
invested in apprenticeship, that is a $27 return on investment.
That is real money, and I applaud and appreciate the
$90,000,000 investment that you made in the most recent budget.
We are hoping to leverage that to literally upwards of a couple
billion dollars in return.
Apprenticeship is making a comeback in this country, and we
had a $175,000,000 grant program that was through H-1B funds
that has been wildly successful and is increasing the footprint
of apprenticeship.
The department's mission isn't simply to help people find
good jobs, but to ensure that there are strong labor standards
that give them the best possible quality of life, and that is
why our enforcement offices play such a critical role. So, for
instance, our Wage and Hour Division has been able to secure
back wages totaling nearly $1,600,000,000 for 1.7 million
workers.
PERSUING AN ACTIVE REGULATORY AGENDA TO PROTECT WORKERS
All told in fiscal year 2017, we are requesting
$1,900,000,000 to continue to safeguard the health, safety,
wages, working conditions, and retirement security of our
workers. We continue to pursue an active regulatory agenda in
this space in consultation with all stakeholders, including
Members of Congress.
In recent decades, the erosion of overtime standards, for
instance, has undermined the economic stability of many white
collar workers who I have met--some of whom I have met. They
work 60, 70 hours a week while earning as little as $24,000 a
year.
So we have proposed a new rule that will expand overtime
pay to millions of people potentially, and the value
proposition is simple. People who work extra should be paid
extra. This rule, the proposed final rule, was sent to OMB for
final review yesterday.
I believe it is a false choice to suggest that we can
either have economic growth or workplace safety. We can and
must have both, and that is why our Occupational Safety and
Health Administration is close to issuing an updated rule that
will significantly reduce workers' exposure to silica dust and
save many lives each year.
Given an aging population, the department's retirement
mandate has never been more important. For the last several
years, we have been working on a conflict of interest rule
which we expect to finalize soon based on a common sense
principle. If you want to give financial advice, you have to
put your clients' best interests first. That conflicted advice
costs families billions of dollars each year, and this is one
of the most important steps we can take to enhance retirement
security.
CHALLENGES FOR THE REMAINING TERM
I love my job, Mr. Chairman, and in this job, I make sure
that I make house calls. In my house calls, I have seen both
the remarkable progress we have made and the unfinished
business.
Last year, I met a guy named Bruce Ives, who was a Missouri
man who was laid off from his client services job. He lost his
home. He lost his dignity. At age 60, Bruce faced some
remarkable challenges getting back to the workforce.
But ``Match.com,'' which is what I often call the
Department of Labor, stepped in. He was able to enroll in a
State program called Reboot U, which helped him get computer
programming skills that led to a job making $36 an hour as an
IT analyst at the University of Kansas Hospital. It was a joy
to meet him and to see the hop in his step and the dignity in
his voice.
I have seen so many inspiring stories like this, but I have
also visited with all too many people whose boat has not been
lifted yet by the rising tide and who are still on the outside
looking in. Like the fast food worker in Detroit who was
sleeping in her car with her three kids because she had been
evicted from her apartment. Or the school bus driver I met in
Connecticut--when I was with Congresswoman DeLauro--who had to
take her newborn baby on her bus route because she doesn't have
paid leave.
Or a gentleman named Alan White, whom I met in Buffalo last
week on a visit, whose life is in the process, frankly, of
being cut short by silicosis. These challenges that they
confront keep me up at night, and the opportunity to help them
and create shared prosperity and an economy that works for
everyone is what gets me out of bed in the morning each day
with a hop in my step.
I look forward in these remaining 311 days until the
weekend to working every day to make every day count and to
working together with you whenever possible, and I appreciate
the bipartisan spirit that you have approached everything that
you have done, Mr. Chairman, and I look forward to any
questions that you and other members of the committee may have.
[The information follows:]
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Mr. Cole. Well, thank you, Mr. Secretary.
And just so the committee knows, we extended you a little
extra time. We are not going to extend any of us any extra
time. So we will----
Secretary Perez. You are very kind. Thank you, sir.
Mr. Cole. No, no, that is fine. And we will adhere by the
5-minute rule.
PROPOSED NEW MANDATORY PROGRAMS IN THE 2017 BUDGET
I do want to go back to this issue of mandatory programs,
as I told you, because it causes me great concern, and I have
seen a pattern of this, if you will, across a number of
departments that we have jurisdiction over on this committee.
In your fiscal year 2017 budget, you provided minimal detail on
proposed new mandatory programs, again totaling, as both the
chairman and I pointed out, over $17,600,000,000.
The committee notes that these proposals exceed the total
discretionary funding for the entire Department of Labor for
fiscal year 2016 by over $5,000,000,000. These proposals seem
to rely exclusively on creating new grant programs that are
neither tested nor authorized by the appropriate committees of
jurisdiction.
In fiscal years 2014 and 2015, the department went ahead
without authorization or approval of appropriations with
similar proposals to create the job-driven training and sector
partnerships grant program using excess discretionary funds
from the Dislocated Workers National Reserve, amounts intended
to support the National Emergency Grant program, technical
assistance for efforts such as WIOA implementation, capacity
building, and true demonstration projects to test new
strategies to improve effectiveness and efficiency of taxpayer
investments the across the workforce.
It is unclear from the budget what these proposals intend
to achieve and how they would be implemented, and without
proposed legislative language or appropriate justification in
the department's budget, the committee must assume these
proposals are sort of gimmicks, you know, in a budgetary sense.
So can you tell me why are these mandatory proposals before
this committee, where we have no jurisdiction, rather than the
appropriate committees of jurisdiction, and do you plan to
present them at some point to the appropriate committees of
jurisdiction?
Secretary Perez. Well, Mr. Chairman, many of the proposals
would require authorization by the HELP Committee or Education
and Workforce, but I don't think it is outside of the regular
budget process to include legislative proposals in a budget. I
know when I worked on the Senate during Republican
administrations, we saw that as well during the budget.
I will note that our discretionary budget stayed within the
caps. It focuses on our programs that I think we have a lot of
shared interest in, investing in skills, making sure we keep
the 15 percent reserve authorized, making sure we redouble our
investments on homeless veterans' reintegration, making sure we
continue to do the work for Native American youth, remarkable
work that has been done in ex-offender reentry, which is
really, I think, a remarkably exciting bipartisan issue.
Our investments in IT are part of our discretionary budget
increase, and we had OMB come in and do a review of our IT
system. There are two agencies that have invested less in IT
than the Department of Labor, and we see it day in and day out.
You know, duct tape is not a viable IT strategy, and all too
frequently that is what we are at.
So our discretionary budget seeks additional funding for
that, as well as additional funding for enforcement. I talk to
employers all the time who are trying to bid on contracts, and
they can't because other employers are cheating, and they are
not playing by the rules. So enforcement helps that.
WORKING TOWARD AUTHORIZING NEW MANDATORY PROGRAMS
Mr. Cole. Well, again, your discretionary proposals are
largely within the caps, as you suggest, and there are many
areas, as I have tried to point out in many opening statement,
that we will be working with you. But again, you have got
mandatory proposals that are beyond the budget of your entire
department. None of them have been authorized.
You know, are you going to submit legislation that would
actually be authorized because we literally, if we wanted to do
that, would not have the ability to give you that kind of
authority.
Secretary Perez. Well, I would welcome the opportunity to
work with you. And let me give you an example.
I mean, we are trying to take apprenticeship to scale, and
we very much appreciate the $90,000,000 that we received. One
of the mandatory proposals is to take apprenticeship to
dramatic scale because we know apprenticeship works. I have
traveled to multiple countries to steal their good ideas and
bring them back home. We have developed remarkable opportunity
here.
But the reality right now of apprenticeship in America is
some States are really moving forward and some States need
help. So I would love to work with you on the mandatory budget
proposal on that to take it to scale.
Mr. Cole. Well, I have never had any problem on working
with you on anything, quite frankly. You are a very willing
partner.
But again, you need to work with me. You need to work with
Chairman Kline or somebody else because, literally, we don't
have that authority here, and I have seen a pattern of this in
administration proposals. And I mean, I am perplexed as to why
we are setting up expectations for things, particularly in
front of this committee, that we simply don't have the
authority to do.
So I would just say that as an early warning that I would
expect some disappointment from this committee where mandatory
spending is concerned because we can't do it, and we just don't
have that authority.
With that, I would like to move, if I could, to my good
friend, the ranking member, for any questions she cares to ask.
Ms. DeLauro. There was a campaign called ``lift the caps.''
``Lift the allocation'' is where I am going with this effort.
HOMELESS VETERANS' REINTEGRATION PROGRAM
But, Mr. Secretary, I want to ask about the Homeless
Veterans' Reintegration Program. I talked about Connecticut and
what I believe is really a great accomplishment and ending
chronic homelessness amongst our veterans, and we should be
proud of that. And nationwide, homelessness, veteran
homelessness has dropped by about 36 percent between 2010 and
2015, a great effort by Federal, State, and local officials.
But if we want veterans to maintain stable housing in the
long term, they need an income. That requires a job. Happy to
see the $12,000,000 for homeless, the program Homeless
Veterans' Reintegration Program. Can you discuss your plans for
increased funds for homeless veterans for the program? What
kind of progress have you seen in reducing homelessness in our
veteran population?
And let me throw in the follow-up question to this, which
is the budget also requests a $71,000,000 increase for
reemployment services----
Secretary Perez. Right.
Ms. DeLauro [continuing]. For UI claimants, and a program
that deals with wraparound services for veterans who have
exhausted their unemployment benefits. And if you can just tell
us about the UCX initiative, how it complements the work you
are doing with homeless vets?
Secretary Perez. Well, I have traveled the country on this
issue because I have had the privilege, until about a couple
months ago, for almost 2 years of chairing the Interagency
Council on Homelessness. Together with the Secretary of
Veterans Affairs and the Secretary of HUD, we traveled the
country, shining a light on this. I want to thank all of you
for your leadership.
I was out in Phoenix--there is an annual count that is
done, a point in time survey. I spent the morning out in the
desert with a formerly homeless veteran who had a criminal
record, who turned his life around, and has now literally
helped hundreds of veterans get work as a result of your
investments. So we see it, day in and day out, the work that we
have done.
We have seen cities like Salt Lake, New Orleans, and
elsewhere, who have eliminated chronic veterans homelessness.
We have seen States like Connecticut, who have made progress,
and now we have this healthy competition that is going on where
we go to one city and say, ``Hey, Salt Lake did it. Why can't
you?'' Or, ``Hey, Connecticut did it. Why can't you?''
So we have a series of investments, including the Homeless
Veterans' Reintegration Program. My wife works with homeless
people here in the District, many of whom are veterans, and
what they tell her repeatedly is, you know, ``I need a job, and
that is one of my best ways to self-sufficiency.'' That is why
those investments are great.
I also want to give a shout-out to a former colleague of
yours, Mike Michaud, who is our Assistant Secretary for
Veterans' Employment and Training. Mike hit the ground running
and has been going gangbusters. When you talk about
homelessness, and we have a budget request of $286,000,000 for
our Veterans' Employment and Training Program, all of that
money is put to great use.
OTHER COLLABORATION EFFORTS TO HELP UNEMPLOYED VETERANS
You mentioned the reemployment money, that--one thing we
know about REA, the reemployment assistance, it works. What we
have been doing, if you look at our budget request, we are
taking things we know that work and trying to scale them up.
Apprenticeship, we know there is an ROI on that. We know
there is an ROI on this reemployment assistance because what
people who have been out of a job for a long time need is
intensive case management, and that is what this program does.
We can cover every veteran who needs it if we can get this
budget request enacted, and I can tell you, having worked in
partnership with Bob McDonald, Julian Castro, the DOL, DOD, and
State and local governments. State and local governments have
been so integral to this, and I want to commend as well
employers.
I have worked very closely with the U.S. Chamber of
Commerce and with labor unions, the Helmets to Hardhats
Program. This has been an ``all hands on deck'' enterprise, and
it is Government as facilitator. Our investments are paying a
real return.
Ms. DeLauro. I would just say that I would think that given
the scale of and the size of the issue with regard to homeless
vets and some of the attendant problems, that an opportunity
where we have seen success would be where we would want to
place some priorities on making sure that we can continue with
this kind of successful effort and demonstrate that, you know,
we have asked these people to make the sacrifice. They did.
They have come back. And now it is our opportunity to be able
to--it is not a thank you. It is here is a job so that you can
be a productive member of society, which is what you want to
be. You do not want to be without a job.
Thank you very much, Mr. Secretary.
Secretary Perez. Thank you.
Mr. Cole. We will next go to my good friend, the gentleman
from Arkansas, Mr. Womack.
Mr. Womack. Thank you, Mr. Chairman----
Secretary Perez. Good morning, Congressman.
Mr. Womack [continuing]. For yielding time. Mr. Secretary,
always good to see you.
Secretary Perez. You, too.
PROPOSED CHANGES TO OVERTIME EXEMPTION RULE
Mr. Womack. And thanks for your testimony this morning.
Let me just say first that I think I can say pretty
confidently that we can all agree that enabling more Americans
to reach the middle class is a very laudable goal. However, we
must acknowledge if there comes a point where Federal
regulations maybe are a little short in accomplishing their
stated goal and, in fact, hurt some employers. But across the
board, it is usually the employees or customers they serve that
get hit the hardest.
And I fear personally that a ``one size fits all,'' ever-
increasing, top-down proposal or answer or regulation affects
our job creators. So I want to take some time here this morning
to express concerns with the dramatic changes your agency
proposed to overtime exemptions, including an unprecedented 113
percent increase in the salary threshold in automatic annual
updates.
It would be challenging for any employer to quickly adjust
to such an astronomical increase, but especially those running
on fixed budgets or thin margins, such as nonprofits, small
businesses, and State and local governments. As you know,
nonprofits and for-profits have very different business models.
In fact, in Arkansas, there are many nonprofit CEOs that don't
even make $50,440, which I would argue goes a lot further in
Arkansas than it does, say, in California due to the vast
differences in the cost of living.
There is a nonprofit in my district, Independent Living,
who does terrific work with developmentally disabled adults in
the town of Harrison, Arkansas. Right now, they are struggling
to find ways to meet the Affordable Care Act's employer
mandate, along with the reality that 80 percent of their
employees can no longer use the companionship exemption. Now
they will have to face the added burden of complying with new
overtime thresholds.
In the comments they submitted to your agency, they noted
that if the rule stands as is, they will have to convert
salaried employees to hourly, and ultimately, there will be a
reduction in services. How can a nonprofit serving adults and
children with developmental disabilities in a rural community,
Mr. Secretary, continue to provide vital services when faced
with drastic increases in administrative costs and few exempt
staff?
Secretary Perez. The overtime rule stands for the simple
proposition that when you work extra, you should be paid extra.
I can't get into too many of the details of where it is because
of where we are in the process. But what I can tell you is what
we did beforehand, which is we spent about a year and a half
reaching out, building a large table of inclusion, because I am
a big believer that if you are going to do this job well, you
have got to be a good listener, and you have to approach the
enterprise with a healthy degree of open-mindedness and
humility.
So we heard from a lot of different employers. During the
comment process as well, we got comments from nonprofits, some
of which expressed concern about the proposal, some of which
expressed support for the proposal.
I can assure you that I think we got roughly 300,000
comments overall, something like that. We looked at every
single one of them and continue to look at every one of them
very, very carefully so that we can craft a rule that is
consistent with the purpose of the Fair Labor Standards Act,
which says that if you work extra, you should be compensated
extra.
I spoke to many people who have been working 60, 70 hours a
week, and as a result of a change that was made in 2004, they
are making effectively the minimum wage because they are not
eligible for overtime, even though 99 percent of their work is
nonmanagerial in nature. So I am thinking about them as well as
we craft a final rule, and I can assure you that when we reach
a final rule, we will continue to do what we have done
throughout the process, which is aggressively engage all
stakeholders, including employers large and small, profit and
nonprofit, and explain to them.
Because I learned--and I spoke to a lot of the people who
were involved in the 2004 rulemaking during the Bush
administration, and I think it is very important in the
aftermath to be out there explaining the various options for
compliance because my goal is always to facilitate compliance.
OVERTIME REGULATION IMPACT ON SPECIFIC INDUSTRIES
Mr. Womack. Real quickly, and I have got a half a minute
left, did the agency take into account the disparate impact it
would have on, say, like urban versus rural or businesses or
nonprofits that have far-ranging hours, differences in hours
from week to week or month to month?
Secretary Perez. Again, we received comments from folks all
over the country, comments from nonprofits in urban areas,
comments from nonprofits and for-profit businesses in suburban,
ex-urban, and rural areas as well, making the point that you
are trying to make. That is why the notice and comment period
is so important, and we got, again, something like 300,000, and
we have reviewed them very, very carefully.
Mr. Womack. I thank the gentleman.
Thank you, Mr. Chairman.
Secretary Perez. Thank you, sir.
Mr. Cole. Thank you.
We will next go to the gentleman from Philadelphia, my good
friend, Mr. Fattah.
Mr. Fattah. Thank you, Mr. Chairman.
Secretary Perez. Good morning, sir.
Mr. Fattah. Thank you, Mr. Chairman.
Mr. Secretary, it is good to see you again.
Secretary Perez. Always good to see you again.
URBAN TECHNOLOGY PROJECT
Mr. Fattah. And I join with you in commenting that the
chairman has worked well to try to make sure that the
department's efforts can be supported and on our ranking
member. I want to thank you for your extraordinary period of
public service, and particularly in terms of your work at the
Labor Department. Philadelphia has benefited greatly by your
work.
I want to point out in particular a program that you not
only found a way to be supportive of, but you have championed
around the country, and I want to mention it because I think it
is something that other cities and other communities can look
at, the Urban Technology Project, which is taking out of school
youth and train them to be computer techs and put them back in
the schools to fix computers so that the educational process
can go forward.
And you not only--I want to thank you particularly for the
$2,900,000 or almost $3,000,000 grant out of the pool of
dollars that you talked about a few minutes ago, the
$170,000,000-plus in apprenticeship. And you are right that
these apprenticeship programs, and you funded a host of them
around the Nation, have created an impulse that I think won't
go away again in our Nation, which is that we need to give
young people hands-on experience so that they can, you know,
learn what it is to accomplish something and to do difficult
tasks, but to understand that they, indeed, can do it.
So I want to thank you for that and so much more. Time
won't allow. But I do want to say that I did on social media
this morning applaud the department for the work you are doing
around this overtime issue that was just discussed with my
friend from Arkansas. And I do think that these 5 million
Americans who are working more have every right to have the
Labor Department take a look at their circumstance to make sure
that we are applying the rules as they should be applied, and
we know that for a fair day's work you should get a fair day's
pay.
So I want to thank you and look forward to continuing to
bring you to Philadelphia and bring more checks with you. All
right? [Laughter.]
Thank you.
TECHHIRE APPRENTICESHIP PROGRAM
Secretary Perez. Mr. Chairman, the program he is referring
to is we have been very involved nationwide in a TechHire
program. I was with former Mayor Nutter in Philadelphia when we
rolled out an apprenticeship proposal, and we have invested
$175,000,000 not only with the purpose of doubling the number
of apprenticeships and facilitating partnership, but also
diversifying access to apprenticeship. Making sure that
apprenticeship is available in IT, in cyber, in health.
We were out in Illinois with Zurich Insurance, one of the
Fortune 500 company. They are now having an apprenticeship
program for claims adjusters because apprenticeship model has
application everywhere, and we want to make sure that
apprenticeship is available in every ZIP code in this country.
There are literally 5.5 million job openings right now, and
roughly 10 percent of them are in IT, and only a fraction
require a college degree or above.
So whether it is with Chairman Rogers in his district,
where we took coal miners who were displaced, at the company
called Bit Source and developed the ``Silicon Holler''--and
their motto is ``From coal to code''--or whether we are with
kids from the Philadelphia public school system.
When my iPhone goes on the fritz, I don't call Apple. I go
to my 13-year-old. Similarly, these teenagers who have fluency,
we are taking that fluency and turning it into a middle-class
career.
So in literally dozens of cities across this country, this
program is taking off. It is a partnership with businesses,
with educators, with nonprofits, with schools, and our
investments are having a catalytic force. We have another grant
program that is out on the street now that is going to take
that to further scale, and I am very, very excited about what
we are doing there.
Mr. Fattah. Well, we are excited, too. We want you to come
to Philly and announce that one also. So----
[Laughter.]
Mr. Fattah. But let me just say that these 5.5 million jobs
that you mentioned that are open and available in our country,
you know, we talk a lot about the 72 months, which is great in
terms of private sector job growth. The administration has done
an extraordinary job.
But we don't count in the jobs created this 5.5 million
that are open now. We only count a job created by this
administration when someone fills it, and maybe in some future
administration, we will see that if there is a job open, that
that is an important notice to our economy and the strength of
our economy. But we need to do more, and apprenticeships are a
way to get more young people ready to take on these job
opportunities.
So thank you, and keep up the good work.
Secretary Perez. Thank you.
Mr. Cole. The chair would ask that Members not monopolize
all the Secretary's travel time and all of his----
Mr. Fattah. Chairman----
[Crosstalk.]
Mr. Cole. We have multiple districts we would like you to--
--
Mr. Fattah. We have direct flights to Oklahoma City right
out of Philadelphia. I made that offer the other day. Mr.
Chairman, I made that offer the other day. [Laughter.]
Mr. Cole. You are a popular man, Mr. Secretary.
If I can, we will next go to my good friend from Maryland,
Dr. Harris.
Mr. Harris. Thank you very much.
Good to see you, Mr. Secretary. Always good to see a fellow
Marylander.
Secretary Perez. Good seeing you, sir. Yes, absolutely.
H-2B VISA PROCESSING
Mr. Harris. But the first issue I am going to bring up, it
just seems like Groundhog Day. I mean, every time you come
before the committee, I ask you about the H-2B visas. You know,
you--coming from Maryland, you know how important those H-2B
visas are, especially to our seafood processing industry in my
district.
And unfortunately, I am told, and I just want to know if it
is true, that, first of all, are these applications supposed to
receive a notification--notice of approval or notice of denial
within 7 business days? I mean, is that the goal of the
department?
Secretary Perez. Well, there are two phases of that. There
is a lengthy process. You first have to seek a prevailing wage
determination, and our goal there is 30 days. Then, once you
get a prevailing wage determination, then you seek to have the
labor certification. Our goal there is 7 days.
In the day before the budget was passed, in December, in
our processing of the H-2B applications, the 70 percent of
the--on the prevailing wage determinations, it was taking 30
days. So we were right at our goal.
Mr. Harris. And that is you said it is 70 percent?
Secretary Perez. No, no. Then with the labor
certifications, the other aspect of the process, the average
amount of time it was taking was 9 days. Seventy percent were
done within the 7-day period.
Then, when the rider passed and the program was
dramatically increased, CBO estimated that it was at a minimum
doubled, we saw a dramatic increase, and frankly, we fell
significantly behind. Because in the middle of a busy season,
we were given a whole new set of rules, and told to implement
them immediately. We had to stop the program so that we could
read the rider, put out guidance, get the new guidance out, get
OMB approval, and then implement your new direction.
Mr. Harris. Right.
Secretary Perez. So that was right in the middle of our
busiest season.
Mr. Harris. Okay. But you realize that it is getting worse?
I mean, in the week of February 5th, the survey from the H-2B
Coalition said 12 percent had no determination after 30 days.
By the week of February 16th, it was up to 51 percent. By the
week of February 22nd, it is 67 percent.
You are not getting better. You are getting worse.
Secretary Perez. It absolutely got worse.
Mr. Harris. Each season----
Secretary Perez. It absolutely got worse. It got worse
because of the rider----
Mr. Harris. Well, Mr. Secretary----
Secretary Perez [continuing]. That was passed, Mr. Harris,
sir.
Mr. Harris [continuing]. You are spending time to make an
overtime regulation, which is something that, honestly, I
understand the administration wants to do it. But this is
hurting the economy in my district. Your department is hurting
the economy in my district by dragging your feet on these
regulations.
Now you have a huge budget. You have a $12,700,000,000
budget. You ought to be able to do what we ask you to do and
what the department has set as its goal, which is a 7-day
process.
Now April 1st is coming up. If we don't have these seasonal
employees by April 1st, either those businesses are going to
not do business and not contribute to the GDP, or they are
going to go and get illegal people to do, undocumented people
to do these, neither of which is a good alternative.
Secretary Perez. With all due respect, sir, I do----
Mr. Harris. Let me turn to----
[Crosstalk.]
Secretary Perez. With all due respect, when you say that we
are dragging our feet----
Mr. Harris. That was not a question. Mr. Secretary----
Secretary Perez [continuing]. I cannot allow that to go
unsaid.
Mr. Harris [continuing]. That was not a question. It is my
time.
Secretary Perez. Because we are not dragging our feet, sir.
We are trying to follow the new rules you put in in the middle
of the process. That is your right.
Mr. Harris. Mr. Secretary, I am going to reclaim my time. I
understand filibustering, and I reclaim my time. You explained
it once. I get it. You are late. You are not getting them done.
I get it.
NEW OVERTIME REGULATION
Let me talk about the overtime regulation because you said
work extra, get paid extra. What percent of the new--of the
employees who are going to be subject to this are getting pay
past 40 hours, and what percent are getting--I am not talking
overtime pay. I am talking about any pay for the extra hours.
What percent? What is it?
Secretary Perez. I am not sure I understand your question,
sir.
Mr. Harris. Well, if you work more than 40 hours, what this
new rule says is you have to be paid time and a half.
Secretary Perez. Unless you are an exempt employee.
Mr. Harris. Are these businesses paying time, but just not
time and a half? Are they paying nothing? What percent of these
businesses are paying nothing? What percent are paying time or
do not pay time and a half?
Secretary Perez. Well, again, I don't have specific
percentages. I can go back to our NPRM so I get you precise
answers.
Mr. Harris. What was your gut feeling, Mr. Secretary? And I
am actually going to get to a point here. What is your gut
feeling?
Secretary Perez. Well, there is a substantial number of
folks----
Mr. Harris. The majority?
Secretary Perez [continuing]. Who work. And again, the
typical example that we heard was the person working up to 70
hours a week----
Mr. Harris. Okay. I am going to reclaim my time once again.
Secretary Perez [continuing]. Many making $24,000 a year--
--
Mr. Harris. Because you said you don't know the answer,
which is striking to me that you made a claim if you work
extra, you get paid extra, and you can't tell me how many
people are actually getting paid extra right now. Not time and
a half, but paid extra.
So I am going to just pose a problem here because I have
got fast food franchisees come to me and say, you know, the
ladder up for some of these people who are from--the typical
entry person is from poor neighborhood. They become a manager.
They work at the restaurant.
Are we going to have a second round, Mr. Chairman?
Mr. Cole. I would expect so.
Mr. Harris. I hope so. Look, then I will yield back the
time, and we will get to it in a second round.
Mr. Cole. Okay. I will go to my good friend, the gentlelady
from California, Ms. Lee.
Ms. Lee. Thank you, Mr. Chairman.
Good morning, Mr. Secretary. Just on my time, would you
like to respond?
Secretary Perez. No, I mean, one thing that Congressman
Harris and I can agree on, the day of the week. We have seldom
agreed on anything else. And I mean that very respectfully, and
I will always aspire to disagree without being disagreeable.
But dating back to our interactions in State government, we
have seen the world very differently, and I respect that.
Ms. Lee. Okay.
Mr. Cole. If we could, let us--there will be another round,
and you guys will have an opportunity to have another exchange.
So let us try and keep it focused.
Ms. Lee. Thank you, Mr. Chairman.
Thank you, Mr. Secretary.
Once again, congratulations to you. You have done a fine
job.
Secretary Perez. Thank you.
DOL'S BUDGET FOR FY 2017
Ms. Lee. And hopefully, within the next few months, we will
be able to do even more under your leadership. I wanted to
associate myself with the remarks of our ranking member and
just make a note that this subcommittee, once again, we are 10
percent below pre-sequestration level.
And so recognizing that, the choices that we make are very,
very difficult. And some of the choices, you know, I question
also, again associating myself with Congresswoman DeLauro's
remarks.
I am pleased, though, to see the increase for Job Corps
funding for $27,000,000. Also the funding stream of
$5,500,000,000 to connect disconnected youth to more
educational and workforce opportunities, which is an increase
also for the it is called the Workforce Innovation and
Opportunity Act. That is an increase of $7,000,000 for the very
successful Reintegration of Ex-Offenders Program.
I wanted to ask you a couple of things with regard to the
unemployment insurance, the wage insurance, because I think
that is a very important part of the recovery for those who
have not benefited from the recovery from the great recession.
In the February jobs report, 242,000 private sector jobs were
created and a decrease in unemployment rate to 4.9 percent.
That is phenomenal.
COMBATING MINORITY UNEMPLOYMENT
But I am also concerned, consistently concerned that the
African-American unemployment rate continues to be more than
double the rate of white Americans, as well as the Latino
unemployment rate at 5.4 percent. So in revamping this
unemployment insurance initiative, how will individuals,
especially those from communities of color and those who have
not benefited from the recovery, how will they gain access to a
good-paying job and stay gainfully employed? And how are you
looking at the stark disparities in the racial and ethnic
unemployment rates for African Americans and Latinos?
Secretary Perez. Sure. That is a very important question.
As you know, during the depths of the recession, the
unemployment rate for African Americans actually peaked at 16.8
percent. It has now fallen to roughly 8.8 percent, which is
obviously far better, but not nearly where we need to be.
Latino unemployment is also higher than the national
average, and that is why when Congressman Fattah was talking
about investments in apprenticeship, we are not only trying to
expand the scope of apprenticeship, we are trying to diversify
apprenticeship because the program that we visited in the Bay
area that day, when we expand opportunity to develop those
pipelines to the middle class. I have had conversations with
folks at PG&E. You know, the utility industry is undergoing a
remarkable transformation. Those are opportunities for middle-
class jobs, and we have got to make sure that everybody from
every ZIP code has those opportunities.
The President's investments in the My Brother's Keeper
initiative is a reflection of the fact that there are chronic
opportunity gaps for young men of color that we need to focus
on, and I have been very proud to be involved in that.
The work that we have been doing in the RExO grants is some
of the most exciting work that I am involved in because, you
know, one of the best ways to reduce recidivism is to give
people the skills and the job opportunities so that folks
coming out of prisons can become part of the community fabric
again.
So these are examples of investments, and my parents always
taught me that education is the great equalizer, and we have
got to make sure that every school in every ZIP code is
providing that remarkable opportunity for folks.
Ms. Lee. And Secretary Perez, on the--I am pleased to see
the Reintegration of Ex-Offenders, the $7,000,000 increase,
because I think DOL has a good model, and it is successful.
Secretary Perez. It is bipartisan.
TARGETED FUNDING TO POVERTY-STRICKEN COMMUNITIES
Ms. Lee. I actually note it is bipartisan. Also targeted
funding, the importance of targeted funding into poverty-
stricken communities is very important. So what is your take on
that?
And come back to Oakland. We are a TechHire city, and
Mandela Training Center is the one you were--we want you back.
Secretary Perez. If you didn't have a plan in the
apprenticeship grant applications to make sure that
apprenticeship was available to historically underserved
communities, you weren't going to get a grant.
Ms. Lee. Mm-hmm, okay. Thank you.
Poverty-stricken, I have 8 seconds left. Targeted funding
into poverty-stricken communities, is that----
Secretary Perez. Well, again, the apprenticeship
investments, our summer youth job investments, things of that
nature are examples of our efforts to get money where we have
chronic opportunity gaps. Like Baltimore City last summer,
where we were able to get $5,000,000 of DOL dollars targeted to
the zip codes that needed that most.
Ms. Lee. Okay, thank you.
Secretary Perez. Good morning.
Mr. Cole. Would you like to revise your budget to get
additional travel money so you can----
[Laughter.]
Secretary Perez. I would very much appreciate that. I will
take the bus----
Mr. Cole. That makes bipartisan sense, Mr. Secretary.
Secretary Perez. I will take the bus if necessary if we can
get to more Members.
Mr. Cole. If we next can go to my good friend from
Virginia, who, sadly, we will be losing. I regret that every
time I have the opportunity to call on him that he is not going
to remain in Congress past this year. But he will make every
minute count. So my friend from Virginia is recognized.
Mr. Rigell. Well, thank you, Mr. Chairman. It is good to be
here.
Secretary Perez. Thank you for your service.
MANDATORY VS. DISCRETIONARY SPENDING
Mr. Rigell. It is a privilege to serve on this committee.
Secretary Perez. Thank you for your service, sir.
Mr. Rigell. Thank you, Mr. Secretary. Good to see the
passion for your work, and I respect and I appreciate it.
I do try to start out generally with what do we have in
common, and there is much that we do have in common. I think
the apprentice program, I really respect that. I have seen it
work, and so I applaud you for that.
I do need to quickly pivot to something that there is a
serious disagreement on, and that is this--this propensity to
shift things over into mandatory spending. Just like we are all
in this room here today, we are all in this together with
respect to our country's fiscal situation. And I really don't
think it can be overstated.
And I think both parties, it is not--this isn't a time and
place to debate how we got there, but I really think we have
got about a 10-year window to get this right, and it is
closing. And it really sobers me. And so the voting card that I
have in my pocket, there is almost a fixation in this
institution on the discretionary side that we largely can't
address the mandatory side.
And it may surprise my colleagues on the other side, but as
a business person who has transitioned into public service, I
really don't see that the discretionary side is what is driving
our fiscal situation. And I would be willing to lift them to a
reasonable degree, provided, of course, that we had substantive
and real, genuine reforms, as President Obama himself has said
need to be done, if that could be implemented.
So I just say that as a word to all of us. That has to be
done. But for that reason, I wouldn't support the transition
and the movement of spending into the mandatory side. We just--
we have demonstrated an inability to do what must be done to do
what is right for the next generation.
FIDUCIARY RULE
Let me pivot to something that has really come up
consistently in Virginia's Second Congressional District, and
that is the fiduciary rule. I rarely have seen an issue
generate so much attention in, frankly, meetings with me across
our district and, indeed, up in Washington about this.
And there is just a troubled look in the advisers that I
see. They are good men and women. They love our communities.
And you know, we go to church with them or we see them in the
grocery store, and they are out there in our communities, and
they are deeply troubled by this fiduciary rule.
And I think, for example, when we see that Morningstar, the
organization, that rating group, they have actually more than
about doubled their estimate as to what your own Department of
Labor said the impact would be on that.
So I think that you are underestimating the impact of it,
and would you address specifically, if you are familiar with
it, the outside group's assessment that the impact is far
greater than what Department of Labor has indicated that it
would or believes it to be?
Secretary Perez. Well, first of all, again, thank you for
your dedicated service. It has been an honor to interact with
you.
There are few issues that I have spent more time on in my
tenure than the conflict of interest rule. When I was
nominated, I was asked a lot about this, and I made a
commitment, and the commitment was this. I would slow the
process down. I would build a big table, and we would listen
and listen long and hard.
I can look you in the eye with a fair degree of confidence
and say every time I got a call from a Member of Congress,
Republican or Democrat, who said, ``Can you talk to so and so
from my district?'' we did that. It was either me or someone
from my staff, and more frequently, it led to more than one
conversation because we always got smarter as a result of those
interactions.
The conflict of interest rule is a reflection of the fact
that in our Ozzie and Harriet era of our parents, this
conversation was irrelevant because people worked 30 years.
They had a defined benefit plan. They would get a pen, a party,
and a pension when they retired. And now in the world of IRAs
and 401ks, people have to take control of their universe.
I very much agree with you when you said that the folks who
are in this industry are good people. This is not about folks
who wake up with malice in their heart in the morning. This is
about a system where the incentives are not properly aligned
with the best interests of the consumer.
Mr. Rigell. Well, I have----
Secretary Perez. And that is what we have heard
consistently. And I welcome----
Mr. Rigell. I have got maybe about 40 seconds left. Let me,
if you would, pivot over to the difference between Morningstar,
for example, outside respected groups and their assessment of
the fiscal--I mean, the financial impact of this versus
Department of Labor's. There is a great disparity between the
two.
And it has been my experience and I think just by
observation we can conclude that generally the impact of
Federal regulations are underestimated, not overstated. So here
we go again, I believe.
So in the 10 seconds, go ahead.
Secretary Perez. Sure. Real quickly, we have received a
voluminous amount of comments, both in the formal comment
period and before, including from Morningstar, including from
other folks who are already fiduciaries who support this rule.
What we are in the process of doing right now, and it was over
300,000 comments there as well, is taking all of those comments
into account to craft a solution, and we have made a commitment
to doing that outreach.
Mr. Rigell. I thank you. I am a little over, and I want to
respect the chairman's commitment to the 5-minute rule. But I
thank you for your testimony.
Mr. Cole. It is thoughtful questions like that in a manner
like that is exactly why my friend should reconsider and run
for reelection. [Laughter.]
Mr. Rigell. You should talk to Mrs. Rigell. [Laughter.]
Mr. Cole. I think I would lose that debate.
Next I would like to go to my good friend from Alabama,
Mrs. Roby, for whatever questions she would care to offer.
Secretary Perez. Good morning, Congresswoman.
Mrs. Roby. Thank you, Mr. Chairman. Good morning.
Secretary Perez. Good to see you again.
PAID LEAVE PARTNERSHIP INITIATIVE
Mrs. Roby. You as well. The fiscal year 2017 budget for the
Department of Labor requests $2,200,000,000 in funding for the
administration's Paid Leave Partnership Initiative. They are
going----these funds are going to be used to fund five States
selected to implement this paid leave program to support leave
requests under the Family Medical Leave Act.
It would provide 50 percent of the cost to launch these
paid leave programs for 3 years. The grant could be used to
cover family, parental, or medical leave programs that provide
up to 12 weeks of benefits.
So the Department of Labor mentions that grants will be
awarded competitively to States that are well positioned--
``well positioned to proceed with full implementation of a paid
leave program.'' Please explain to us what ``well positioned to
implement a paid leave program'' means.
And to follow up with that, explain how these well
positioned States will cover the entire cost of the program
after the 3 years.
Secretary Perez. Well, thank you for your question.
The United States is the only industrialized nation on the
planet that doesn't have some form of Federal paid leave, and
we have seen the consequences of this. People talk about the
need for higher labor force participation rates. If we had a
paid leave system like Canada did, we would have more women in
the workplace.
Mrs. Roby. What does it mean to be well positioned to----
Secretary Perez. Well positioned means you have the
partnerships in place. You have the political will to move
forward. You have begun the actuarial analysis.
A number of States that have put in place paid leave
systems, California was the first, and employers don't pay
anything. It comes out of the employee. They use the temporary
disability insurance system. So----
Mrs. Roby. What about the other 45 States? To me, this
seems like another bait-and-switch scheme where you are going
to fund these programs for 3 years, and then what happens to
sustain it after?
Secretary Perez. No, it is--actually, for instance, the
State of Connecticut is looking right now at building a paid
leave system, and we have been providing technical assistance
to them. They are well placed to, I think, move forward,
whether it is this year or next year. It is not at all a bait-
and-switch system. It is a system that provides an incredibly
important benefit for parents who are oftentimes giving birth
on a credit card because they have got to go right back to work
after.
WORKING FAMILIES FLEXIBILITY ACT
Mrs. Roby. Well, this is a great opportunity, as I have
mentioned to you before, to bring out the Working Families
Flexibility Act, which is legislation that I have introduced in
the past two Congresses, which would amend the Fair Labor
Standards Act to allow employers and employees to enter into a
voluntary agreement whereby hourly wage employers could convert
overtime pay to compensatory time off.
My proposal is not an unfunded entitlement, which I believe
is what the Paid Leave Partnership Initiative is. But my
legislation allows hard-working families the flexibility to use
their hard-earned money in ways that they see fit. And if they
need time off, it is there, and there is cash out provisions
that protect the employee to ensure that they can get the cash,
if that is what they ultimately determine.
So, Mr. Chairman, I know that you and many others on this
committee have supported H.R. 465. I hope we can all understand
that commonsense solutions, like the Working Families
Flexibility Act, are the best options given our fiscal outlook
as a Nation, not unfunded entitlement schemes like the Paid
Leave Partnership Initiative.
And I want to quickly pivot here to ask you about the
voluntary--hold on just a second so I don't spill my coffee.
[Laughter.]
Secretary Perez. That is very important.
Mrs. Roby. It is. It is.
Secretary Perez. Been there, done that.
OSHA VOLUNTARY PROTECTION PROGRAMS
Mrs. Roby. The VPP programs, and I have discussed this with
you before. The fiscal year 2017 Department of Labor budget
request states that OSHA will continue to improve the Voluntary
Protection Program in fiscal year 2017, with special emphasis
on program consistency and oversight, data integrity, and
reevaluation of policies for VPP sites with injury and illness
rates higher than industry averages.
So has the Labor Department produced a report, which
evaluates the effectiveness of these OSHA compliance programs?
Secretary Perez. Well, we very much support the program,
and what we have done now, we have 1,400 Federal VPP sites. In
fiscal year 2015, we exceeded our goal, and we approved 315
sites and brought 70 new sites into the program. We have worked
with folks in Republican and Democratic districts because this
isn't red or blue. This is red, white, and blue.
Mrs. Roby. With 5 seconds left, I just want--I want a
commitment that you will submit a report to this committee.
Secretary Perez. Sure. I will also have OSHA, you know, the
head of OSHA come and visit you and talk about where we are at
in the program so that you can get not only a specific
accounting of where it is going, but where it is going in your
particular district as well as the Nation.
Mrs. Roby. I would appreciate that. I yield back.
Thank you.
Mr. Cole. Thank you.
We next go to my good friend from Tennessee, Mr.
Fleischmann, for any questions he would care to submit.
Mr. Fleischmann. Thank you, Mr. Chairman.
Secretary Perez. Good morning. Good to see you.
Mr. Fleischmann. Good morning, Mr. Secretary. I am sorry I
was late. I was at another hearing.
Secretary Perez. No, that is multitasking.
Mr. Fleischmann. We have got multitasking, but it is always
good to see you.
Secretary Perez. Good to see you, sir.
PROPOSED RULE CHANGES TO EEOICPA
Mr. Fleischmann. And I thank you for your service, sir.
Mr. Secretary, the Office of Workers' Compensation Program
has published the Notice of Proposed Rule Changes to the Energy
Employees Occupational Illness Compensation Program Act. This
affects a lot of our workers in Oak Ridge----
Secretary Perez. Right.
Mr. Fleischmann [continuing]. Who from the Manhattan era
have been exposed to a lot of things during the years, and
there is a lot of chronic illnesses, sir. I would like to ask a
series of questions to clarify these proposed changes.
Secretary Perez. Sure.
Mr. Fleischmann. The proposed rule changes alerts medical
providers that the Department of Labor may adopt the home
health prospective payment system, which was devised by the
Centers for Medicare and Medicaid Services within HHS. First
question, sir. How would the proposed rule change, if
implemented, alter the existent method of paying for home
health services, and how will it affect the quality of care?
In other words, will the payments to healthcare providers
be less than they are currently, or will fewer services be
authorized? Will payments for the same services be delayed,
sir?
Secretary Perez. Right now, we are in the middle of the
rulemaking process on that precise rule, sir. We have received
a number of comments on that, including issues relating to your
questions. So, at the moment, we are reviewing that because it
is a very important question, and we have gotten a lot of
feedback from a number of key stakeholders.
So I don't have an answer to that right now because we are
reviewing the feedback to figure out how we put the rule, the
final rule in place. But our overall goal in this is to build a
fair system that helps the workers who have suffered and
improves the adjudication process to make it, you know, again
fairer and more efficient.
Mr. Fleischmann. Would you agree with me, Mr. Secretary,
that if you altered it in the way that I alluded to in the
first question that it would be a disincentive for providers to
participate in the healthcare and management of sick workers,
many of whom have several chronic medical problems?
IMPACTS OF PROPOSED EEOICPA RULE CHANGE
Secretary Perez. Sure. Sir, I have personally met with a
number of folks who have suffered as a result of workplace
exposures in various contexts. We owe it to them to make sure
that we build a system that works for them and a system,
frankly, that works for providers as well, because it is hollow
to say you have a right if you can't get to a provider.
Mr. Fleischmann. Thank you, sir.
Some providers in the area do not accept Medicare. Does it,
therefore, make sense to apply Medicare payment standards to a
program which is supposed to supplement medical services for
disease-ridden atomic energy workers?
Secretary Perez. Sure. Well, again, that is another one of
the comments that we received and we are reviewing, and I think
it is a very, very important question, which is why we take it
very seriously. Because we are in the rulemaking process right
now, I can't get too much further down the road, other than to
say that we take that very seriously and we very much
appreciate--I know you have had a continuing--you have been a
great leader for folks in the community on this, and we have
appreciated your engagement.
Mr. Fleischmann. Thank you. Thank you.
If I may, Mr. Secretary, what input, if any, did the
Department of Labor receive from local doctors, for example, in
the east Tennessee area, if you know, or from home health
agencies in formulating any of the proposed rules relating to
medical services? Does the Department of Labor know if such
providers would be willing to agree to provide services under
the home health prospective payment system, sir?
Secretary Perez. Well, I don't know--what I do know is that
we always aspire and I think we do a pretty good job of
building a big table so that we hear from everyone.
What I would offer to do is to make our head of the Office
of Worker Compensation Program available to come and talk to
you and, to the greatest extent that he can, you know, talk
with real granularity about the situation, especially as it
affects your community. Because you obviously have strong
equities in the resolution of this.
Mr. Fleischmann. Thank you.
And I am cognizant of the fact that you are in the
rulemaking process, but are there any provisions in the
proposed rule changes which would limit physician choices by
beneficiaries? Section 30.405(b) appears to do that. This is
concerning because some of the beneficiaries have multiple
health conditions, which require treatment from multiple
specialists, sir.
Secretary Perez. Well, sometimes there are proposals that
are out there that people perceive as having an impact one way
or another, and that was one example that you cite. And so we
are certainly aware of that concern and in our rulemaking
process very much attuned to that. And again, I think our
director, if you want him to come by, we can have a much longer
conversation about that and so many other issues.
Because here is the bottom line. We want to get this right.
We want to do right by the folks who spent their career in
public service and now have some serious health issues. We owe
it to them to make sure that we have a system that treats them
fairly. And you have remarkable insights into how we accomplish
that goal, and so I want to take advantage, frankly, of your
perspective.
Mr. Fleischmann. Thank you. Well, Mr. Secretary, I want to
thank you for your commitment to working with me and to help
our affected workers in Oak Ridge because they have sacrificed.
They are suffering.
And with that, I thank you. And Mr. Chairman, I yield back,
sir.
Mr. Cole. Thank you very much.
WORKFORCE INNOVATION AND OPPORTUNITY ACT
Mr. Secretary, one of the challenges we often have in
government at all levels and all departments is, you know, we
focus on a lot of different things, and sometimes we don't get
some of the tasks that we need to get done in a timely manner.
The Workforce Innovation and Opportunity Act, as you have
mentioned several times, was enacted in July of 2014,
overwhelming bipartisan support. Really one of the great work
products Congress and the administration working together
produced, and I certainly appreciate your role in that. The act
included many reforms intended to consolidate and improve the
workforce development system.
The committee is concerned that the department continues to
miss statutory implementation deadlines despite the fact that
appropriations for technical assistance funds to implement the
law have actually been provided in excess of the amounts
requested by the department. In addition to funds already
provided totaling $25,000,000, the department requests an
additional $26,000,000 in technical assistance funds for the
fiscal year 2017 budget.
Can you tell me whether or not the department will be able
to finalize the regulations implementing WIOA before the end of
the year? And then what is the proposed use of the technical
assistance funds in fiscal year 2017 if the law is, indeed,
fully implemented?
Secretary Perez. Let me say at the outset, WIOA is one of
my favorite pieces of legislation to have had the privilege of
being involved in. It is a game changer. And it is a bipartisan
game changer.
We expect to have the final rules in place by the end of
June, and the process that led us to there has been a
remarkably inclusive process. I used to work in local and State
government, and the instruction I gave to my team is we need to
listen and then listen some more and listen some more to our
State partners because they are going to have a lot of
insights.
The rules are voluminous, 1,800 pages. We built a big
table. Our career folks, they worked through Thanksgiving and
Christmas of last year to get all those things out. The vast
majority of the act, Mr. Chairman, is actually already
implemented as of July of last year.
FINAL WIOA IMPLEMENTATION
What remains to be implemented are the accountability
systems there put in place and the State plans, and the good
news there is because we have been working throughout with the
States, over half the States already have draft plans. The big
purpose of WIOA was to implode silos and stovepipes, make sure
that the workforce people and the education people and the HHS
people are working together.
So today, for instance, 40 States, 4 outlying areas, they
already have the new State boards that WIOA called for. We have
shared 41 pieces of operating guidance, 28 webinars that we
have conducted. I just went to the conference that I used to go
to in D.C. about 8 weeks ago in the middle of the storm. Every
State except one was able to make it, and there is a tremendous
energy out there.
I want to say thank you to you and your staff because we
have been working on this together with Republican and
Democratic staffers in the House and Senate. I am excited about
where we are. The silo busting is in full force, both in the
Federal Government, where we have been working better than ever
with Department of Education and HHS and others, and now at
State and local governments.
That is good because people don't have a labor issue or an
education issue. They just want a good job, and they want the
skills to compete. So I am excited, and we will have the final
rules in place by end of June.
Mr. Cole. That is good to hear because I think finishing
this up, I mean, as you pointed out, the administration has
only got about 10 months. I think it would be----
Secretary Perez. Three hundred eleven days, but who is
counting?
Mr. Cole. Yes, but you would want to get this done.
Secretary Perez. I absolutely do.
TECHNICAL ASSISTANCE BUDGET REQUEST
Mr. Cole. If that is the case on that, what are the
additional employees--I think you asked for 17 additional folks
and $26,000,000 additional. Is that necessary?
Secretary Perez. Oh, the work--yes, I mean, the work is--I
mean, we have done a lot, but the work is just beginning. So,
for instance, we are trying to build data systems now so that
the data system in the State Department of Education can talk
to the data system in the State Department of Labor, can talk
to the data system elsewhere.
Because we want to track, for instance, wage data. And we
did that in our programs, but the adult ed folks didn't do
that. And so the work that we are doing and the resources that
we seek is to make sure that we can continue the stovepipe
implosion process, and it is--it is a formidable challenge when
you are trying to build one big sandbox.
Mr. Cole. Well, good luck on that. I have seen Department
of Veterans and Department of Defense work on this my entire
career and not get it done. So----
Secretary Perez. I hear you.
Mr. Cole [continuing]. I wish you well in the technical
endeavor.
With that, I want to go to my good friend, the gentlelady,
for the next round of questioning.
Ms. DeLauro. Thank you very much, Mr. Chairman.
DOL APPRENCTICESHIP AND REEMPLOYMENT PROGRAMS
Just a couple of comments, and then a question that I have
on wage theft. Let me congratulate you on the apprenticeship
program. Europeans have been doing this for years. It not only
is a vision for what we should do, but what we can do with
Federal resources in this area.
Secondly, Reintegration of Ex-Offenders. I was at the New
Haven Correctional Center just about 2 weeks ago, and soon they
are going to open up through the funding, through the Workforce
Alliance, the opportunity for the Department of Labor and these
offenders, who are ex-offenders who are getting ready to leave
and how we can help to get them employed and be able to pay
taxes.
H-2B VISA PROGRAM
A short word on the H-2B visa program. The Labor, HHS bill
added several riders, which made the program more complicated
to implement, weakened protection for workers in those H-2B
industries. First, riders that require the department to use
private wage surveys to set prevailing wages caused a delay in
processing H-2B applications. We should not shift the blame for
the backlog that was caused by this Appropriations Committee.
Another rider blocks the department's ability to audit an
employee's H-2B application. The Inspector General has said
that this rider will make it more likely that fraud will exist
in the H-2B program through no fault of the department.
Let us be real. This is a problem that was caused by the
Congress and by this committee. It is not the Department of
Labor's fault.
WAGE THEFT
Now my question on wage theft. It has become an epidemic,
Mr. Secretary. According to a recent three-city survey
conducted in Los Angeles, New York, Chicago, two-thirds of
workers in low-wage industries experienced at least one pay-
related violation in any given week.
Research estimates the loss per worker over the course of a
year, $2,634 out of total earnings of $17,616. This is
particularly harmful when workers are already economically
distressed. Tomorrow, I will introduce a comprehensive bill to
address wage theft with Senator Murray.
Can you tell us how widespread this problem is, resources
needed at Wage and Hour to tackle the wage theft? You propose
hiring an additional 300 investigators to staff the Department
of Labor's Wage and Hour Division. Is that enough? And what
about the fines? Are they sufficient enough to deter folks from
making these unwise decisions to violate the law?
Secretary Perez. Wage theft is a huge problem across this
country, and let me give you one example. We commissioned an
independent study that focused on two States, California and
New York, and found that just in those two States, the amount
of wage theft approached $1,000,000,000 a year, just in those
two States. Not surprisingly, heavily concentrated on lower-
income workers.
These are folks who are not making enough money to feed
their family in a good week, and then to have your wages
stolen, effectively, adds insult to injury. That is why we have
had a very concentrated focus on making sure that we are doing
our level best in this context.
By the way, we hear from employers all the time who say
thank you because they are playing by the rules. They are
paying their folks above the table, and their competitors
aren't. That creates an unlevel playing field. So this is not
only good for workers, but this is rewarding employers who play
by the rules.
That is why our budget request seeks an increase so that we
can do more in the Wage and Hour enforcement context. Because
it is critically important. It is a chronic challenge in
sectors across America, and that is why we have been so laser
focused on this.
Ms. DeLauro. My understanding is that the fine for
violations and repeated violations is about $1,000.
Secretary Perez. Well, we have been using--we have been
making more use of liquidated damages, but all too frequently,
I mean, the challenge that we encounter is it is a cost of
doing business enterprise. Actually, what we will do sometimes
is we will conduct an investigation, and we work very closely
with a number of State partners.
Then, at the end of the day, we may have our State partner
move forward because sometimes the State law actually is better
than the Federal law. More often than not, it is not.
And frankly, in the State of Florida, under former Governor
Bush, they actually eliminated the wage and hour enforcement.
So there is no State partner down in Florida, which puts more
onus on us to be moving forward. That is why this work is so
critically important.
Ms. DeLauro. Thank you, Mr. Secretary. Let me just say I am
glad to hear you say that Connecticut was well positioned in
terms of their paid family leave.
Secretary Perez. Very hopeful.
Ms. DeLauro. Very hopeful. Thank you.
Mr. Cole. Would you like to invite him to come to
Connecticut? [Laughter.]
Ms. DeLauro. I have, and he has come to the State of
Connecticut.
Secretary Perez. You can invite me to Oklahoma, too, sir.
Mr. Cole. Absolutely. Absolutely. We are going to--you
know, you are going to have a lot of frequent flyer miles when
you leave.
Secretary Perez. That is right.
Mr. Cole. Next we will go to my friend Mr. Harris from
Maryland for the next round.
Mr. Harris. Thank you. Thank you very much, Mr. Chairman.
Okay. I will just make one comment, and it is not a
question. Last year, because I was trying to reflect, what were
we talking about last year about H-2B, and it was the court's
fault last year. So you came in and said, look, it is the
court's fault. We had this court case, the court's fault.
So let me see. Last year, it is court's fault. This year,
it is Congress' fault. Does it go back to court's next year, or
does the Labor Department--and this is a rhetorical question.
Does the Labor Department ever take responsibility for the
delays in the H-2B program?
I just have to ask. There is an emergency--and this is a
question. There is an emergency procedure. You can submit an
application in an emergency procedure.
I am going to assume that if it is under an emergency
procedure, you might really want to try to hit the 7-day
processing deadline or goal. But in the latest survey, 46
percent of the emergency applications weren't completed, didn't
receive a notice of approval or notice of denial within 7 days.
So how does an--I just have to ask you. How does an
employer get their employee in place for an April 1st seasonal
start? If the regular procedure has 67 percent more than 30-day
wait, the emergency procedure is almost half, 7 days, and 7
days the goal, does the department have a plan on this?
I mean, or it is just we really don't care about H-2Bs
because there are other special interests that don't want H-2B
workers in the country?
Secretary Perez. We do care about H-2B, and we care about
the full and effective enforcement of H-2B. When we get the
assembly line doubled or as much as tripled on December----
Mr. Harris. Mr. Secretary? Mr. Secretary?
Secretary Perez. Sir, okay----
Mr. Harris. Mr. Secretary, let me just back you up here
because I am going to have to stop you when you say things
like, you know, work extra, pay extra. Double or triple.
Secretary Perez. Sir?
Mr. Harris. Do you have a tripling in the number of
applications this year?
Secretary Perez. I will give you the specific data on the
number of applications that we got, okay?
Mr. Harris. Did it triple?
Secretary Perez. Absolutely. I will tell you the exact----
Mr. Harris. Did it triple?
Secretary Perez. Double or triple is what I said. I will
get you the precise data. The problem, sir, is you told us to
do twice as much work with the same amount of resources.
Mr. Harris. So it is twice the number of applications?
Secretary Perez. I will get you the numbers, as I stated,
sir.
Mr. Harris. Is that your testimony today? The number is
twice?
Secretary Perez. I told you--my answer for the third time
is that I will get you the precise data. The applications
doubled over late December and early January. We had the same
resources to process those applications.
I accept responsibility for the fact that we are trying to
do our best, and sometimes we have issues like IT. But you know
what, sir? I think there is rather than playing the blame game,
I think what we should try to do is fix the system because we
did make a commitment a year ago that we would have a rule in
place by the middle of April.
I made that commitment to Senator Mikulski and others. And
guess what? We made that commitment, and we put a rule in place
by the middle of April. And Congress gave us a new rule on
December 16th, told us, you know, implement immediately. No new
resources, but implement immediately.
We read it. We put a new system in place something like 17
days later because we did want to read what you told us to do.
When we did that, it absolutely resulted in delays. Delays will
result in mistakes because we have the assembly line moving
faster.
The Bush administration rule had an audit function in 2008
because they understood that you needed to make sure you had an
audit system in place so that it was a check on the fact that
the assembly line was moving fast. This was taken away.
So when we have folks who get those certifications and they
were in error, the audit function, we can't correct that when
it is done. That is the reality of our world.
Mr. Harris. The reality of my world is, is that my
employers are not going to have workers in place because the
hang-up was DOL, period, full stop. The hang-up was DOL.
PROPOSED FY 2017 MANDATORY BUDGET
Now let me ask you about because I also have concerns what
the full committee chairman said about this tendency to go to
mandatory, to expand the number--the last thing this country
needs are more mandatory expenditures, the last thing. So I
have got to ask, so I look at some of these programs, say, you
know, for some things, maybe mandatory makes sense because you
got to even out, you know, the year-by-year variation.
But one program is the mandatory funding to provide
summer--I am sorry, yearlong first jobs to 150,000 opportunity
youth. Now these are yearlong jobs. These are not 4-year jobs
or 5-year jobs.
So to the untrained eye, it would look that the only
purpose of making this a mandatory expenditure not subject to
annual appropriations is to get around the spending caps
because these are yearlong jobs. These are not 2-year long
jobs. These are not 5-year science, cancer science research
projects. These are yearlong jobs.
Simple question, Mr. Secretary. Why can't that be subject
to annual appropriations?
Secretary Perez. Well, sir, we have a serious youth
unemployment problem. Congresswoman Lee asked a very important
question about the fact that zip codes all too frequently are
determining destiny in this country. When you look at the
history of this Congress' investment in young people, it was a
far more robust history and a bipartisan history in recent
years, and we have to ensure that we address these issues of
chronic poverty and the absence of opportunity.
I respect the fact that we have a different perspective on
that, but that is certainly my strongly held view.
Thank you very much.
Mr. Harris. Thank you.
Mr. Cole. I would ask that we, in fairness to the
Secretary, not push the questions to 2 seconds before the
expiration of time because he deserves a chance to answer. And
we have got few enough people here. We will have an opportunity
to go around again if we need one.
With that, let me go to my friend Mr. Dent from
Pennsylvania and for whatever questions he cares to pose.
Secretary Perez. Good morning, sir.
Mr. Dent. Good morning. And thank you, Mr. Chairman. I
apologize for being late. I had another hearing this morning.
OSHA RETAIL EXEMPTION RULE
Mr. Secretary, in December, Congress--and the Congress
passed and the President signed into law the omnibus
appropriations bill, which included language in the joint
explanatory statement that prohibited OSHA from using funds to
enforce the July 22, 2015, retail exemption memo unless OSHA
went through notice and comment rulemaking.
On December 23, 2015, just 6 days later, OSHA issued a memo
that delayed enforcement of the memo until the first day of
fiscal year 2017, which is a good thing. However, simply
delaying enforcement is not what Congress directed the agency
to do. Why has OSHA decided not to go through a proper public
notice and comment rulemaking on this so-called retail
exemption?
Secretary Perez. Congressman, I think we did comply with
the rider, and we did extend the effective date to October 1.
The context of this issue, and I very much appreciate your
question, is the horrific incident that occurred in west Texas,
where there was a dramatic explosion that killed 15 people,
mostly first responders. If it had occurred in the middle of
the day, there would have been schoolchildren who died because
it leveled the school. Fortunately, nobody was there.
As a result of that incident and other recent chemical
plant catastrophes, the President issued an executive order
that directed us to enhance safety and security in our chemical
facilities.
So we were very motivated by the fact that we had first
responders whose lives were taken there, and we wanted to
prevent such a thing in the future. We carefully considered,
and by the way, we did receive comment on the guidance that we
put out because we certainly valued that.
But the first responders were very much on our mind, and
you know, we have had other litigation that addresses the
question that you ask about whether we can--whether we have the
ability to do guidance here. The Supreme Court in the mortgage
bankers case did uphold our ability to do guidance, and the
matter is in litigation. We will obviously respect whatever the
outcome of that case is.
But I wanted to give you an understanding of why we chose
this route. We wanted to make sure that we could prevent as
soon as possible another catastrophe.
IMPACT OF PSM COMPLIANCE
Mr. Dent. Yes, and certainly safety is on the forefront of
all of our minds in respect to this tragedy in Texas and
elsewhere. But I have been hearing from a lot of my farmers and
agricultural retailers who tell me that they are getting out of
the anhydrous ammonia business because of the significant cost
and burdens of complying with the process safety management,
the PSM.
My concern is that fewer facilities carrying anhydrous
ammonia could actually have adverse safety effects. Farmers and
retailers are going to be forced to travel much longer
distances on the road to get this anhydrous ammonia to the farm
and/or anhydrous ammonia will be stored at entities which are
not going to be regulated by OSHA.
That is my concern on the safety, that this stuff is going
to be stored elsewhere. People are making--the farmers and the
agricultural sector making much longer trips to move this
stuff, to get it to the farm. And I am not sure that that is
going to lead to greater safety. So I would be curious to hear
your comments on that.
Secretary Perez. Well, we heard a number of different
comments during our period when we were soliciting comments,
and we heard from a lot of first responders who indicated that
a big concern of theirs was what I have described. We have
continued to work very close with industry, and I would be more
than happy to, if there are folks in your district, I want to
make sure--we have a shared interest in getting it right.
Nobody has a monopoly on the commitment to safety----
Mr. Dent. We want to do the right thing.
Secretary Perez [continuing]. And we all want to do the
right thing here. So I would be more than willing to figure out
a way to work with you to see if there are things that we
should know that we don't know because I am never--again, you
have got to bring some humility to the enterprise. So if you
have other things to bring to our attention.
Mr. Dent. That would be very helpful because the PSM
standard requires manufacturers and distributors to develop and
implement a PSM program any time they have at least a minimum
amount of highly hazardous chemicals involved in a process,
including storage. So I guess what the question is, and you
just offered it, that would be great if OSHA could hear from
some of the stakeholders through the public comment and review
period.
That would be very, very helpful. I think they need to be
heard on this because, I said, we want everybody to be safe.
But I am worried about farmers going greater distances, going
to remote locations to pick up this material, and we are going
to have safety issues.
Secretary Perez. Well, then we are committed to not
enforcing it in this fiscal year, and we are also committed to
continuing to work very closely with industry and with other
stakeholders like yourself because we all want to get it right.
IMPACTS OF OVERTIME RULE
Mr. Dent. Just a final comment, too, and my time is up.
Just--you don't have to respond. I know you talked about the
overtime rule. I just wanted to mention that this issue is
creating a lot of hardship for my not-for-profit sector in my
district. When my YMCAs call me and say doubling that exemption
to $50,000 a year is creating real hardships in terms of
managing small nonprofits. I just want you to be aware of that.
Thank you.
Secretary Perez. Thank you, sir.
NPRM FOR DRUG SCREENING OF UI CLAIMANTS
Mr. Cole. Okay, Mr. Secretary, on February 22, 2012,
President Obama signed Public Law 112-96. It is the Middle
Class Tax Relief and Job Creation Act of 2012. It is bipartisan
legislation authorizing drug screening and testing of
unemployment insurance claimants in very limited cases.
Nearly 20 months after the President signed the law, the
Department of Law issued the Notice of Proposed Rulemaking,
NPRM, pertaining to this provision. It is my understanding that
the NPRM falls significantly short of achieving the intended
purpose of the statutory provision.
It places significant limitations on when drug screening
and testing can occur, all but ensuring that the law will not
be implemented as intended. I know that members of the Ways and
Means Committee have repeatedly raised similar concerns
regarding the NPRM and have received, in their view, limited
communications from the department. Could you tell us what your
plan is for actually finalizing the rule, and will the final
rule address the concerns and recommendations raised by other
Members of Congress submitted formally through the public
comment period?
Secretary Perez. We certainly take seriously our obligation
to uphold the integrity of the UI program. We got a lot of
feedback, and it was all very constructive feedback. We did a
lot of review, and the final rule, the proposed final rule was
sent over to OMB yesterday.
So that process now begins over at OMB because I remember--
I had a whole list of things that I knew that we needed to get
done. This was a mandate that Congress gave us, and we take
that responsibility very seriously. So it went over, I think,
yesterday, if my memory serves me. But it is over at OMB.
Mr. Cole. Did the hearing have any force in triggering----
Secretary Perez. Oh, come on, Mr. Chairman.
[Laughter.]
Secretary Perez. The overtime rule went over yesterday as
well. So----
Mr. Cole. Yes.
Secretary Perez [continuing]. You know, one could argue
that maybe one should wait until the end of a hearing to send
that over, but that is not what we do. When we are ready to
send something over----
Mr. Cole. No, no, I just----
Secretary Perez [continuing]. We send them over.
Mr. Cole. Deadlines sometimes are helpful.
Secretary Perez. There is nothing like a deadline to focus
the mind.
Mr. Cole. Yes, we are not going to have too much time left.
So I am going to stop my questioning at that point to make sure
that every Member has an opportunity to get at least one more
question in, if we may?
Secretary Perez. Okay. Great.
Mr. Cole. With that, I will go to the gentlelady from
Connecticut.
Secretary Perez. Thank you, sir.
ENDING LONG-TERM UNEMPLOYMENT
Ms. DeLauro. Thank you very much, Mr. Chairman.
A quick question, if I might, on long-term unemployment. We
talked about expanding reemployment services for UI. I just
wanted to bring to your attention, I think you know about it,
the Platform to Employment Program, the P2E program that
Connecticut has undertaken and, I might add, quite
successfully.
Nearly 80 percent of Connecticut participants who complete
the preparatory program take the next step into a work
experience at a local company. Of this population, nearly 90
percent have moved to employer payrolls.
How does your budget deal with leveraging these public-
private partnerships to help a P2E program succeed?
Secretary Perez. Sure. When you look at the success,
whether it is Oklahoma, Maryland, or Connecticut in the
workforce space, it is a joint venture of Federal, State, and
local governments and the private sector, educators,
nonprofits, faith communities, tribes and others. This is no
different.
The work we have made and the progress we have made on
long-term unemployed has been a function of the fact that there
has been remarkable innovation. We know--we have a much better
idea today of what works than we did 5 years ago, and let me
give you one quick example.
There is a tool in our toolbox in the workforce system. We
call it on-the-job training. What it really is, is we will
subsidize your wage for a certain period of time. So an
employer looks at a worker who has got an 18-month gap on her
resume. Katherine Hackett from Connecticut----
Ms. DeLauro. Right.
Secretary Perez [continuing]. Is an example. Remarkably
talented, but you know, but for the grace of God could have
been any of us who lost their job. This employer looked at her
and said, you know, she has like 70 percent of what I need.
Then we give them that final push. So we subsidize the wage for
a certain period of time, and then at the end, it is the
employer's choice whether they keep them or not.
We have an over 90 percent success rate with this program,
and we have targeted it in many communities to the long-term
unemployed, and it has been tremendously successful across
different sectors. So unemployed engineers who are in their
fifties and confronting a number of barriers, but with
remarkable talent.
So we have learned so much. You know, a crisis does create
opportunities to learn and then move forward.
DOL WORKER PROTECTION AGENCIES
Ms. DeLauro. Let me ask about worker protection agencies at
the department. OSHA and MSHA protect workers from health and
safety hazards. Wage and Hour makes sure workers aren't cheated
out of their wages. OFCCP enforces rules for Federal
contractors against discrimination on race, sex, religion,
disability. EBSA ensures retirement savings and health benefits
are secure.
These programs, Mr. Secretary, were flat funded last year,
despite the $66,000,000,000 increase in defense and nondefense.
It is not just the refusal to fund the initiatives. Agencies
rely on personnel. Flat funding means absorbing small pay
raises, annual increases in healthcare costs by reducing staff
levels, or foregoing necessary procurements. You can't do more
with less. You can only do less with less.
So I won't go into the numbers here, but you have got OSHA
built-in cost last year, $17,000,000. MSHA, $9,000,000. Wage
and Hour, $6,000,000. OFCCP, about $5,000,000. Total
$40,000,000, and yet the cumulative increase for these five
agencies last year was negative $1,000,000.
How does the funding freeze affect your agencies, and how
it is affecting the ability to protect low-income workers?
Secretary Perez. Well, it affects safety. I mean, OSHA, in
the best of days, I think would take over 100 years to visit
every employer in America. So we have got to be strategic about
it. When we have less resources, we have more potential for
danger, and that not only hurts workers, but it hurts employers
who play by the rules.
Because if you have a speed limit sign that says ``speed
limit 40 miles an hour,'' but underneath it, it says ``self-
enforcement,'' you are going to end up with a lot of speeders
and a lot of accidents. That is why we have done our level best
to partner with States, and we do so on misclassification with
States--Utah, Texas, Massachusetts. We are doing partnerships
with local governments.
But the reality is it hurts, and we know that there are
low-wage workers who are getting abused, and we do our level
best to help, but there is only so much help we can do. There
are only so many hours in a day.
Ms. DeLauro. Thank you.
DOL REGULATORY SCHEDULE
I just want to get final assurance to the subcommittee that
the administration is finalizing several of these long-awaited
rules that protect worker safety and ensure that workers keep
their hard-earned money. I would like to know if we will see
finalized rules in the near future for the following three
regulations--silica, fiduciary rule, and you mentioned overtime
pay, which was you said went to OMB yesterday.
Secretary Perez. Thank you.
Ms. DeLauro. Final, are we----
Secretary Perez. Oh, yes. We are moving forward----
Ms. DeLauro. The fiduciary rule?
Secretary Perez. The conflict of interest rule was sent to
OMB.
Ms. DeLauro. It went to OMB?
Secretary Perez. Over a month ago. Overtime was sent
yesterday. The UI one was sent yesterday.
Ms. DeLauro. Silica?
Secretary Perez. Silica was sent in December, I believe.
Ms. DeLauro. Okay.
Secretary Perez. They are all under review at OMB. Then
there was an NPRM on the regulation to implement the executive
order on paid leave----
Ms. DeLauro. Paid leave.
Secretary Perez [continuing]. That went over to OMB I want
to say 2, 3 weeks ago.
Ms. DeLauro. Okay. Mr. Secretary, many thanks.
Mr. Cole. Mr. Secretary, I am glad you know that you drive
the GW Parkway on a regular basis as well. So----
[Laughter.]
Mr. Cole [continuing]. With that, I go to my good friend
Mr. Harris for what is probably the last question of the
hearing.
OSHA RULEMAKING
Mr. Harris. Thank you very much.
Just to follow up on the gentleman from Pennsylvania with
regards to the retail facilities language in the omnibus, you
know, it also had other directives--for OSHA to establish new
classification code for retailers, carry out all notice and
comment rulemaking procedures, which I would--I don't know if
that is--you know, maybe in a QFR, you will--you can respond as
to where that stands.
The other thing, just from a chemical point of view, you
bring up west Texas. But you know, all ammonia--I am sorry,
ammonia and ammonium is not the same. You know, it is anhydrous
ammonia in west Texas, highly dangerous. And yet the new retail
rule is going to deal with the sale of ammonium nitrate, which
is a fertilizer, which again is my concern because of a rural
area.
But let me just follow up with the silica, a question about
the silica. And this should be a pretty straightforward one, I
think--I hope--for you to answer is that the new silica rule is
going to set up where the employers have 180 days to test for
exposure and to determine how they are going to comply with the
rule. And obviously, that new rule is going to result in
thousands and hundreds of thousands of samples having to be
sent to reference labs to determine silica levels.
But OSHA is going to give the labs 2 years to be in
compliance with the lab improvement requirement. So you have
got the labs, which have 2 years to kind of demonstrate that
they can actually do this, and yet the employers have only 180
days to actually do this and implement the changes.
So if an employer--if a lab does not--is not OSHA certified
its compliance with the lab improvement requirements, is OSHA
still going to use those lab results from the noncertified
compliant lab in order to enforce employer regulations? I mean,
if you get the disconnect?
I mean, employers have 180 days, but they are going to use
labs that may not be compliant for 2 years.
Secretary Perez. Well, you are referring to issues that
were in the NPRM, the proposed rule. We had a very lengthy
process, and now we are--we have been in the process of
reviewing all the rules and issuing a final rule. So I can't
comment on the specifics. But what I can say is when we publish
a final rule, we will be happy to explain how we resolved that
and any other issue that you might have.
Mr. Harris. See, I knew you could hit that one out of the
ballpark.
Thank you very much, Mr. Secretary. [Laughter.]
Mr. Cole. The gentlelady from Connecticut asked for an
additional question. So she is recognized to pose it.
Ms. DeLauro. It really isn't an additional question, but I
just wanted to say with regard to silica, which has a
devastating effect on workers' health, as we know--classified
as a carcinogen--Department of Labor has been trying to address
the dangers for 80 years. In 1937, Secretary of Labor Frances
Perkins announced the findings of a report linking silicosis to
workplace exposure.
1938, Frances Perkins held a national silicosis conference
and initiated a campaign to ``stop silicosis,'' stating, and I
quote, ``Our job is one of applying techniques and principles
to every known silica dust hazard in American industry. We know
the methods of control. Let us put them into practice.''
Mr. Secretary, thank you, thank you, thank you for this
effort and helping to make a difference in the health and
safety of American workers.
Secretary Perez. We have the grainy video of----
Ms. DeLauro. I want it.
Secretary Perez [continuing]. Frances Perkins, by the way.
She wears hip hats, just like Congresswoman DeLauro.
[Laughter.]
Secretary Perez. I don't know if she was called a hipster
back then, but----
CLOSING STATEMENTS
Mr. Cole. Mr. Secretary, this won't be our last opportunity
to work with you, but it is probably your last appearance
before this committee in a formal setting. So I just want to
take the opportunity to publicly thank you. You have always
been responsive to our questions.
And even when we have disagreed on issues, you have always
been agreeable and professional in arguing your case and the
administration's case. And I just appreciate the years of
public service, both before you arrived here and in this
capacity and look forward to working with you for the remainder
of your tenure.
Secretary Perez. Me, too. It is a privilege to be with you.
In a town where all too frequently, we lose sight of things
like civility, you are a remarkable example of how to get
things done and get things done in a manner that is respectful
and really moves the ball forward. So it is always a privilege.
Mr. Cole. You are very kind. So we are now adding a trip to
Oklahoma to your travel. [Laughter.]
Mr. Cole. With that, we are adjourned.
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W I T N E S S E S
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Burwell, Hon. Sylvia............................................. 6
Enomoto, Kana.................................................... 225
Perez, Hon. Thomas E............................................. 300
Spencer, Wendy................................................... 188
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