[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2020
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
____________________
SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
RELATED AGENCIES
ROSA L. DeLAURO, Connecticut, Chairwoman
LUCILLE ROYBAL-ALLARD, California TOM COLE, Oklahoma
BARBARA LEE, California ANDY HARRIS, Maryland
MARK POCAN, Wisconsin JAIME HERRERA BEUTLER, Washington
KATHERINE M. CLARK, Massachusetts JOHN R. MOOLENAAR, Michigan
LOIS FRANKEL, Florida TOM GRAVES, Georgia
CHERI BUSTOS, Illinois
BONNIE WATSON COLEMAN, New Jersey
NOTE: Under committee rules, Mrs. Lowey, as chairwoman of the full
committee, and Ms. Granger, as ranking minority member of the full
committee, are authorized to sit as members of all subcommittees.
Robin Juliano, Stephen Steigleder, Jared Bass, Jennifer Cama,
Jaclyn Kilroy, Laurie Mignone, Philip Tizzani, and Brad Allen
Subcommittee Staff
____________
PART 5
Page
Department of Health and Human
Services.......................................................... 1
Department of Education Budget Request
for
Fiscal Year 2020.................................................. 101
National Institutes of Health Budget
Request for Fiscal Year 2020...................................... 233
Department of Labor Budget Request for
Fiscal Year 2020.................................................. 333
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
____________
Printed for the use of the Committee on Appropriations
Part 5
DHHS
DEBR
NIHBR
DLBR
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION,
AND RELATED AGENCIES APPROPRIATIONS FOR 2020
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2020
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
____________
SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
RELATED AGENCIES
ROSA L. DeLAURO, Connecticut, Chairwoman
LUCILLE ROYBAL-ALLARD, California TOM COLE, Oklahoma
BARBARA LEE, California ANDY HARRIS, Maryland
MARK POCAN, Wisconsin JAIME HERRERA BEUTLER, Washington
KATHERINE M. CLARK, Massachusetts JOHN R. MOOLENAAR, Michigan
LOIS FRANKEL, Florida TOM GRAVES, Georgia
CHERI BUSTOS, Illinois
BONNIE WATSON COLEMAN, New Jersey
NOTE: Under committee rules, Mrs. Lowey, as chairwoman of the full
committee, and Ms. Granger, as ranking minority member of the full
committee, are authorized to sit as members of all subcommittees.
Robin Juliano, Stephen Steigleder, Jared Bass, Jennifer Cama,
Jaclyn Kilroy, Laurie Mignone, Philip Tizzani, and Brad Allen
Subcommittee Staff
_____
PART 5
Page
Department of Health and Human
Services........................................................... 1
Department of Education Budget Request
for
Fiscal Year 2020................................................... 101
National Institutes of Health Budget
Request for Fiscal Year 2020....................................... 233
Department of Labor Budget Request for
Fiscal Year 2020................................................... 333
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
__________
Printed for the use of the Committee on Appropriations
U.S. GOVERNMENT PUBLISHING OFFICE
37-623 WASHINGTON : 2019
COMMITTEE ON APPROPRIATIONS
----------
NITA M. LOWEY, New York, Chairwoman
MARCY KAPTUR, Ohio KAY GRANGER, Texas
PETER J. VISCLOSKY, Indiana HAROLD ROGERS, Kentucky
JOSE E. SERRANO, New York ROBERT B. ADERHOLT, Alabama
ROSA L. DeLAURO, Connecticut MICHAEL K. SIMPSON, Idaho
DAVID E. PRICE, North Carolina JOHN R. CARTER, Texas
LUCILLE ROYBAL-ALLARD, California KEN CALVERT, California
SANFORD D. BISHOP, Jr., Georgia TOM COLE, Oklahoma
BARBARA LEE, California MARIO DIAZ-BALART, Florida
BETTY McCOLLUM, Minnesota TOM GRAVES, Georgia
TIM RYAN, Ohio STEVE WOMACK, Arkansas
C. A. DUTCH RUPPERSBERGER, Maryland JEFF FORTENBERRY, Nebraska
DEBBIE WASSERMAN SCHULTZ, Florida CHUCK FLEISCHMANN, Tennessee
HENRY CUELLAR, Texas JAIME HERRERA BEUTLER, Washington
CHELLIE PINGREE, Maine DAVID P. JOYCE, Ohio
MIKE QUIGLEY, Illinois ANDY HARRIS, Maryland
DEREK KILMER, Washington MARTHA ROBY, Alabama
MATT CARTWRIGHT, Pennsylvania MARK E. AMODEI, Nevada
GRACE MENG, New York CHRIS STEWART, Utah
MARK POCAN, Wisconsin STEVEN M. PALAZZO, Mississippi
KATHERINE M. CLARK, Massachusetts DAN NEWHOUSE, Washington
PETE AGUILAR, California JOHN R. MOOLENAAR, Michigan
LOIS FRANKEL, Florida JOHN H. RUTHERFORD, Florida
CHERI BUSTOS, Illinois WILL HURD, Texas
BONNIE WATSON COLEMAN, New Jersey
BRENDA L. LAWRENCE, Michigan
NORMA J. TORRES, California
CHARLIE CRIST, Florida
ANN KIRKPATRICK, Arizona
ED CASE, Hawaii
Shalanda Young, Clerk and Staff Director
(ii)
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2020
----------
Wednesday, March 13, 2019.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
WITNESS
HON. ALEX AZAR, SECRETARY, UNITED STATES DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Ms. DeLauro [presiding]. Good afternoon, Secretary Azar,
and welcome. Welcome to the subcommittee. This is our first
budget hearing of the year. However, I think you probably do
know that it is our fourth hearing on programs related to the
Department of Health and Human Services.
First, what we did at the first hearing is we examined the
Administration's intentional policy choices, in my view, to
undermine the Affordable Care Act. These were policies that
have raised prices for Americans already struggling with
skyrocketing healthcare costs. We examined the policies
specifically with regard to affordability, the increasing
number of uninsured, and the quality of benefits that are
available to people. And honestly, the President's budget makes
clear that the Administration has not abandoned its attacks on
the Affordable Care Act or protections for those with
preexisting conditions, and providing them with what I view as
junk insurance plans.
We also held an oversight hearing on the Unaccompanied
Children Program, a manufactured crisis of policy. Over the
past 2 years, this Administration has separated thousands of
children from their parents, and we continue to hear reports of
family separation still occurring despite a judge's order to
stop it. We are learning that it may have started earlier than
previously known, in July of 2017. The Administration may have
separated thousands more children before Congress and the
public learned of this immoral policy.
And as I have said repeatedly, I believe separating
children from their parents is government-sponsored child
abuse, and HHS is complicit. The memorandum of agreement
between HHS and the epartment of Homeland Security since last
April has turned HHS into a de facto extension of ICE. As a
result, children are languishing in custody, inflicting mental
and physical trauma, all at considerable costs to the taxpayer.
We know based on legal precedent that separation as a
deterrence policy is illegal.
HHS needs to return the Unaccompanied Children Program to
its core mission of taking care of vulnerable children and
placing them with sponsors rather than being an immigration
enforcement agency. We have to understand how this happened,
why it happened. Who is responsible? Is it happening now? What
has been the impact on children? What are its long-term
consequences, including mental health and trauma? How do we
stop this? How do we fix it? What are the resources that are
necessary? I am more than willing to provide resources. What I
cannot do is to condone policies that put children at grave
risk at considerable cost to taxpayers, especially when there
hasn't been any real accountability. We cannot throw good money
after bad.
I want everyone to know that we plan to hold additional
hearings on the Unaccompanied Children Program, and we expect
HHS to send the senior officials who were in charge at the time
of the family separation policy. That includes the former
acting assistant secretary for administration for children and
families, and the former director of the Office of Refugee
Resettlement. We need to question those individuals who
directly implemented these policies, senior officials that have
twisted and perverted the mission of the Department of Health
and Human Services.
Finally, last week we held a hearing on gun violence
prevention research. Gun violence is a public health emergency.
In 2017 alone, guns killed nearly 40,000 Americans. That same
year, opioid overdoses killed 47,000 Americans. We have
dedicated immense public dollars, especially in this
subcommittee, to addressing and examining one but not the
other.
And suicides by firearms accounted for nearly 24,000 deaths
in 2017 and is an epidemic in our veteran community. They are
twice as likely to die by suicide as a general population, and
two-thirds of those veterans who died used a gun. Last week
President Trump announced an executive order, a Road Map to
Empower Veterans and End a National Tragedy of Suicide. It
establishes a task force that includes the VA, Defense, HHS,
and Homeland Security. CDC, the Centers for Disease Control and
Prevention, must be involved because it is our foremost public
health agency.
Let me also touch on the barrage of attacks on Title 10,
the program which ensures that people have access to
reproductive healthcare. I want to note my strong opposition to
the Administration's proposed changes to Title 10. That
includes the Trump Administration's domestic gag rule. It would
ban any healthcare provider from receiving Title 10 funding if
they even talk about abortion or abortion-related services with
their patients.
Mr. Secretary, yesterday, as I understand it, you made a
comment at the House Energy and Commerce Committee that I would
like to address. You said, ``Title 10 subsidizes abortions.''
That is inaccurate. It flies in the face of decades of Federal
law with regard to the Hyde Amendment, and it is simply not
true. So I want to correct the record. We will continue to
oppose these attacks on Title 10 funding.
Now, let me turn to the 2020 President's budget for the
DHHS. I am encouraged by the Administration's HIV initiative
and the request for additional HIV funding in the Health
Resources and Services Administration and the Centers for
Disease Control and Prevention. At the same time, I strongly
opposed the President's proposed cuts to the National
Institutes of Health HIV research portfolio, and the CDC Global
AIDS Program and to PEPFAR, which I will note was a priority
of, Secretary Azar, your former boss, President George W. Bush.
And along with deep cuts to Medicaid and the proposed repeal of
the Affordable Care Act, these reductions will be
counterproductive to the goal of reducing HIV infections.
So despite a few areas that appear to be bright spots,
including your efforts with regards to pediatric cancer, I
think we need to take a hard look at the budget because of its
deep cuts. Many of these budget proposals are retreads of bad
ideas that Congress has already rejected on a bipartisan basis.
The Administration is not shy about spending, of course,
including its $1.5 trillion tax law that was rigged for
corporations and for the richest Americans. No, the
Administration opposes spending when it aids the vulnerable,
when it promotes the common good, or when it makes opportunity
real for people.
Your budget proposes to cut HHS agencies under the purview
of this subcommittee by $12,700,000 billion. It is a 14 percent
cut. It cuts NIH research by $5,000,000,000, as I mentioned. It
cuts the Centers for Disease Control and Prevention by
$750,000,000. That includes cuts to lead poisoning prevention,
food safety, laboratory capacity, and dozens of others. It cuts
$1,000,000,000 from HRSA, including hundreds of millions from
programs to train low-income and minority populations for
careers in the health profession, like nursing, and eliminates
the Low-Income Home Energy Assistance Program. LIHEAP helps
low-income households, predominantly elderly households, in
cold northern States to heat their homes in the winter months,
and low-income elderly households in the hot southern States to
cool their homes in the scorching summer months.
Let me also touch base on the cuts on the mandatory side as
well because, again, it is important that we are looking at
this in totality. The President's budget cuts mission-directed
reassignment by $845,000,000,000. It cuts the Supplemental
Nutrition Assistance Program, the SNAP Program, by more than
$20,000,000,000 per year. It cuts Temporary Assistance for
Needy Families, TANAF, by more than $2,000,000,000 per year. It
eliminates the Social Services Block Grant, cutting
$1,700,000,000 per year. And it advances another Republican
repeal and replace plan, known as Graham-Cassidy-Johnson, that
would undermine strong existing protections for Americans with
preexisting conditions. And there is a cut of
$1,000,000,000,000 of Medicaid coverage for Americans with
disabilities or who are struggling to overcome an opioid
addiction.
But areas you identify as priorities are those which the
committee has previously funded, including $50,000,000 to
address the national crisis of maternal mortality, a
``priority'' of yours that you have level funded. We passed
this increase in 2019. It appears the Administration's
priorities are not areas that you support. They are the areas
that you spare.
It is the obligation of this subcommittee to ensure that
the middle class, working families, and low-income families are
not harmed by reckless cuts. We will reject these cuts to
health programs, medical research, public health, home heating
assistance, and so many others. Instead, we are going to invest
in health, education, and protections for the middle class.
Mr. Secretary, I look forward to finding out whether you
support these reckless cuts, and I truly hope not. Thank you,
and I look forward to the discussion. And now I would like to
yield to the ranking member of this subcommittee, my colleague
and my friend, Congressman Cole.
Mr. Cole. Thank you very much, Madam Chair. Good morning,
Mr. Secretary, or good afternoon I should say. You can tell
this testimony is a little bit out of date I guess. I look
forward to hearing from you today. As I was looking over the
budget documents released this week, I was struck by one fact
that I want to point out to those who may be watching us. Your
Agency is responsible for over $1,000,000,000,000 of budget
outlays each year. That is almost a quarter of the entire
Federal budget and larger than the Department of Defense. It is
an incredible range, reach, and responsibility that we have and
the President has placed in your control. Yet discretionary
spending, which this subcommittee controls and oversees, makes
up only about 8 percent of those total outlays.
The cuts proposed in your budget this year are deep, and I
believe several, in my view, are shortsighted. You simply
cannot balance our national budget by chipping away at 8
percent of total spending. We have to look, in my view, for
broader entitlement reform to achieve those larger goals. While
small compared to your total outlays, the discretionary
component of your budget that we are going to talk about today
plays an important role in our country and literally touches
the lives of every American.
For example, the research conducted at the National
Institutes of Health has unlocked the human genome and holds
the promise for cures for cancer and treatments for diseases
that were thought to be untreatable just a few decades ago. As
my chair knows, we have worked together in a bipartisan manner
and with the other body over the last 4 years to make steady,
solid growth in the NIH budget. And that process has not been a
one-time infusion that might spend a lot of money, but not be
sustainable, but a responsible, steady investment that will
attract bright young researchers and assure them that Congress
is serious about continuing our investments in biomedical
research. I believe this process of steady, sustained
inflation-plus increases is necessary to build the biomedical
infrastructure we will need going forward, and which I think,
frankly, may help us with some of those entitlement problems
down the road.
A cut of $5,000,000,000, as the budget proposes, would
reverse this trend and send the wrong signals to young
scientists. I know the budget numbers were not of your own
making, and I know you have worked hard to advocate for your
Agency with OMB. You are the President's appointee, and it is
certainly your job to defend the President's budget, and I want
you to know I certainly recognize and accept that. However, the
final result is something that I hope this Congress will not
adopt in those particular areas, and I believe we won't.
I also think that the CDC cut of $1,300,000,000 is
literally a risky mistake. You know, we spend, and the
President I think rightfully proposed a very substantial amount
of money for Defense. I consider this every bit as much as
Defense budget as anything as DOD. I mean, as I have said on
many, many occasions, we are much more likely to die in
pandemics than in terrorist attacks. So this is really the
front line of defense, I think, for the American people. And in
an era of Ebola and Zika and goodness knows what else, I think
this is not a place that we want to be reducing spending.
I do want to commend you for your investment in programs
that protect our Nation against bioterror and certain pandemic
events. The Strategic National Stockpile, BARDA, Project
Bioshield, the Infectious Disease Rapid Reserve Fund, are all
either level funded or increased, and I think this is a wise
decision on your part. Our country needs to be ready to respond
to any event to protect our people.
And there are many other parts of your budget I am also
pleased with. I particularly am pleased with the reforms you
have made in the individual insurance market. I particularly
favor the efforts you have made to lower the costs of
prescription drugs. I think they are already having an impact.
I think the statistics suggest that. I very much, like the
chair, favor your initiative to end the HIV epidemic in
America, and I am particularly pleased, even though it is not
this subcommittee's jurisdiction, some of the moves that you
have made in one of the more troubled agencies that you
supervise, the Indian Health Service, and the additional funds
there, I think, you know, are gratefully received, and,
frankly, I think the new leadership there that you have put
into place will do a good job as well.
In addition to your numerous responsibilities, you also
have to respond to the humanitarian crisis on the southern
border. You are responsible for the care of thousands of
unaccompanied children who continue to stream across our
southern border. I look forward to hearing from you today about
how your Agency resources have been strained by your
responsibility to care for every child that comes to you from
the Department of Homeland Security, an important thing that
can't be emphasized too much. I think you were given the
challenge of dealing with these children. You are not
responsible for their apprehension or the decisions that were
initially made in that regard.
I want to thank you for the commitment you have made to
helping ensure each child is kept safe, healthy, and is placed
with a sponsor in a stable home as quickly as possible while
they await immigration proceedings in our country.
Finally, I want to personally thank you for the efforts you
have undertaken in your Agency to protect the life of innocent
children. I support your efforts to align the Title 10 Family
Planning Program with current law, and ensure a separation
between family planning services and abortion. I support your
efforts to allow for the free exercise of conscience in health
insurance coverage. I support your efforts to enforce existing
law with respect to taxpayer funding of services, such as
abortion, that many Americans feel are morally objectionable.
Again, I look very much forward to your testimony, and I
want to again thank you. I have had the good fortune in this
job to work with really some excellent people in your capacity.
I really believe you are the best, and I think that the
President made a very wise decision when he chose you have more
than sustained and demonstrated that it was a good decision and
sustained his confidence in you. So I look forward to working
with you going forward.
With that, Madam Chair, I yield back my time.
Ms. DeLauro. I thank the gentleman and recognize the chair
of the Appropriations Committee, my colleague, the gentlelady
from New York, Congressman Nita Lowey.
The Chairwoman. Thank you, Chairwoman DeLauro. Honorable
Alex Azar, I welcome you, and I thank Chairwoman DeLauro and
Ranking Member Cole for holding this hearing, and I look
forward to having a serious discussion about many of these
issues which are so serious and where we may have difference of
opinion, different opinions.
Secretary Azar, you come before us with a budget that is
both incomplete and is an attack on public health. I am
concerned that your budget would lead to a weakened public
health system that cannot come close to meeting the needs of
the public. For example, a year after an estimated 80,000
Americans died from the flu, your budget would cut funding for
CDC's immunization activities by $78,000,000. On one hand,
President Trump pretends he believes in deficits and proposes
cutting $2,000,000,000,000 from Medicare and Medicaid, yet your
budget would slash funding for CDC's Center for Chronic Disease
Prevention by a whopping $237,000,000, even though investing in
the prevention of chronic health illness is one of the best
long-term fiscal decisions we can make.
It would also cut the NIH by 13 percent. I really find it
hard to believe because as you heard from former Chairman Cole,
this has been a bipartisan effort as far as back as I can
remember. And I even remember when a Republican member of this
committee doubled the money at the NIH. So to cut the NIH by 13
percent, reducing our ability to develop cures for debilitating
diseases, and harming the ability of our first-rate scientists
to compete against foreign research initiatives, and it would
leave people most in need quite literally out in the cold by
eliminating LIHEAP's heating assistance programs.
There are so many cuts, too many cuts to name, but I am
just going to mention a few more that are particularly
egregious. The proposed elimination of pre-school development
grants, particularly at a time when millions of families are in
need of quality, affordable early education, and proposed
reductions in the health training workforce. Both would come at
a cost to hardworking families who need good jobs and
affordable childcare to make ends meet. I really can't
understand that at all. I am such a supporter of these
programs, and my three children, my eight grandchildren
benefitted from those. So I can't possibly understand how you
would want to eliminate preschool development grants.
And the proposed elimination of the Teen Pregnancy
Prevention Program is quite perplexing. By the way, I don't
know if you know the history, but I was a chair, co-chair of
the Teen Pregnancy Task Force. It was bipartisan. It is an
issue we are focused on, Democrats and Republicans. So I don't
know why you want to eliminate it. I would be interested in
knowing.
If a budget is a reflection of our values, it is very clear
that President Trump's values--building a wall that he said
Mexico would pay for--more than investing in our public health
and workforce, this is all very puzzling. So I hope your
testimony will address these deep concerns about this proposed
budget. Thank you for appearing here today.
Ms. DeLauro. Thank you, Mr. Secretary. Welcome once again,
and we appreciate your being here. Your full written testimony
will be entered into the record, and you are now recognized for
5 minutes.
Secretary Azar. Chairwomen Lowey and DeLauro, and Ranking
Member Cole, thank you very much for inviting me to discuss the
President's budget for Fiscal Year 2020. It is an honor to have
spent the year since I last appeared before this committee
leading the Department of Health and Human Services.
The men and women of HHS have delivered remarkable results
since then, including record new and generic drug approvals,
new affordable health insurance options, and signs that the
trend in drug overdose deaths is beginning to flatten and
decline. The budget proposes $87,100,000,000 in Fiscal Year
2020 discretionary spending for HHS, while moving toward our
vision for a healthcare system that puts American patients
first. It is important note that HHS had the largest
discretionary budget of any non-defense department in 2018,
which means that staying within the caps set by Congress has
required difficult choices that I am sure many will find quite
hard to countenance.
Today I want to highlight how the President's budget
supports a number of important goals for HHS. First, the budget
proposes reforms to help deliver Americans truly patient-
centered, affordable healthcare. The budget would empower
States to create personalized healthcare options that put you
as the American patient in control and ensure you are treated
like a human being, not a number. Flexibilities in the budget
would make this possible while promoting fiscal responsibility
and maintaining protections for people with preexisting
conditions.
Second, the budget strengthens Medicare to help secure our
promise to America's seniors. The budget extends the solvency
of the Medicare Trust Fund for 8 years while the program's
budget will still grow at a 6.9 percent annual rate in three
major ways. The budget lowers costs for seniors and tackles
special interests that are currently taking advantage of the
Medicare Program. First, we are proposing changes to discourage
hospitals from acquiring smaller practices just to charge
Medicare more. Second, we address overpayments to post-acute
providers. Third, we will take on drug companies that are
profiting off of seniors and Medicare. Through a historic
modernization of Medicare Part D, we will lower seniors' out-
of-pocket costs and create incentives for lower list prices. I
want to note that I believe there are many areas of common
ground on drug pricing where we can work together to pass
bipartisan legislation to help the American people.
We also protect seniors by transferring funding for
graduate medical education and uncompensated care from Medicare
to the General Treasury Fund so all taxpayers, not just our
seniors, share these costs. Finally, the budget fully supports
HHS' 5-point strategy for the opioid epidemic: better access to
prevention, treatment, and recovery services; better targeting
the availability of overdose-reversing drugs; better data on
the epidemic; better research on pain and addiction; and better
pain management practices. The budget builds on appropriations
made by this committee and provides $4,800,000,000 towards
these efforts, including the $1,000,000,000 State Opioid
Response Program, which we focused on access to medication-
assisted treatment, behavioral support, and recovery services.
The budget also invests in other public health priorities,
including fighting infectious disease at home and abroad. It
proposes $291,000,000 in funding for the first year of
President Trump's plan to use the effective treatment and
prevention tools we have today to end the HIV epidemic in
America by 2030.
I also want to highlight a public health announcement from
HHS. Today, with my full support, FDA is advancing new policies
designed to dramatically limit the ability of kids to access
flavored tobacco products, and e-cigarettes in particular. FDA
is proposing to end the current compliance policy as it applies
to certain flavored e-cigarettes or electronic nicotine
delivery system products, meaning these products would face FDA
enforcement if sold without authorization.
FDA proposes to prioritize enforcement based on criteria
aimed at reducing the access and appeal of these products to
kids, such as sale of these products in circumstances without
heightened age verification or where they are targeted to
minors. HHS supports a comprehensive balanced policy to close
the on ramp for kids to become addicted to nicotine through e-
cigarettes, while allowing for the promise of an off ramp for
adult smokers.
I want to conclude by saying that this year's budget will
advance American healthcare and help deliver on the promises we
have made to the American people, and I look forward to working
with this committee on our shared priorities. And I look
forward to your questions today. So thank you, Chairwoman.
Ms. DeLauro. Thank you, Mr. Secretary. I am going to try to
get a whole bunch of questions in, and so some of them may be
absolutely yes or no, and please understand that because there
is a time commitment here, and we have a full complement of
folks here today.
This is with regard to unaccompanied children. Mr.
Secretary, when did you personally learn that DHS was
implementing separation? I need a quick answer.
Secretary Azar. Well, there is not a quick answer, so we
have to do it in writing, or I can give it to you.
Ms. DeLauro. Okay.
Secretary Azar. So I learned when others did in April when
the attorney general announced that he was going to pursue zero
tolerance. And then when the attorney general announced on May
7th that he was implementing zero tolerance and the 100 percent
referral policy around that time, I would have been aware of
those. But in all candor, I did not connect the dots at that
point to the full implications and operational challenges that
were----
Ms. DeLauro. I understand----
Secretary Azar [continuing]. In terms of children for our
program.
Ms. DeLauro. Mr. Secretary, when did you learn that
Commander Johnson, why it was warning Scott Lloyd, Steve
Wagner, and Maggie Wynn as early as March 2017 that capacity
issues would become a problem if DHS moved forward with family
separation?
Secretary Azar. I would have learned of those about when
you did. I don't exactly when, but essentially when they would
have come out in the course of testimony, I believe.
Ms. DeLauro. Okay. Yes or no, if ORR would have prepared
for the influx, would it have spared thousands of children from
what you referred to yesterday as ``significant child welfare
issues?''
Secretary Azar. We were on the receiving end. We didn't
decide the policy to implement zero tolerance, so.
Ms. DeLauro. I understand that. I understand that. But
apparently you were all warned as early March 2017 that there
was a capacity issue, and that that, in fact, was ignored. Yes
or no, do these officials--Scott Lloyd, Steve Wagner, Maggie
Wynn--still work in senior positions at HHS?
Secretary Azar. They work in positions at HHS, but none of
them are directly in the ORR Program anymore.
Ms. DeLauro. But they are in senior positions at HHS.
Secretary Azar. They are still in different roles. They are
in various roles because ORR is now run by someone else who
reports directly to our new commissioner who reports the dep
sec and me.
Ms. DeLauro. I understand that, but they are still in
senior positions at HHS. DHS was separating children long
before they announced it as a formal policy. If senior
officials at HHS didn't push back on Homeland Security, despite
warnings from ORR career officials, then they were complicit in
what was an illegal, immoral family separation. It is your job
to hold these people accountable, and it is my job, it is our
job, to hold you accountable.
OIG says that the family separation is still happening. A
January reports says that it has been happening since 2017.
Since Judge Sabraw has ordered the class to include families
separated as early as July 1st, 2017, I expect you to make this
task a priority.
Budget requests. You have asked for $1,300,000,000, the
same amount you asked for in Fiscal Year 2019. Last week you
notified this committee of intentions to move up to
$385,000,000 of funds from other parts of the budget, in
essence, robbing Peter to pay Paul. And if you think the
proposal to increase the transfer authority to 20 percent next
year is happening, let me be crystal clear, Mr. Secretary. Not
on my watch. Not on my watch. I was opposed to going from 10 to
15. Is $1,300,000,000 for the UAC Program a realistic proposal
for Fiscal Year 2020?
Secretary Azar. $1,300,000,000 is not the exclusive
proposal. It is $1,300,000,000 plus 20 percent transfer
authority up to $361,000,000, and a Mandatory Contingency Fund
of $2,000,000,000 for 3 years, which we would estimate at
$738,000,000,000 for this year, so.
Ms. DeLauro. Mandatory Contingency Funds are outside of the
scope of this committee's jurisdiction, and no indication that
you have worked with the appropriate committees to pursue that
appropriation. And 20 percent, as I said, is maybe a wish, but
it isn't going to happen.
UAC improvements that can be made. Let me finish up by
covering issues I believe are preventing HHS from restoring the
Unaccompanied Children Program to its core mission, and, again,
yes or no. Have you completely rescinded the MOA to restore
trust in unification process so that HHS is no longer
jeopardizing sponsors who want to come forward to claim
children? Yes or no?
Secretary Azar. We continue to take fingerprints of parent
sponsors as part of the MOA.
Ms. DeLauro. And other information, is it transferred?
Secretary Azar. That information is transferred to ICE, and
we get information back on their criminal background checks and
other background checks----
Ms. DeLauro. Is the MOA still in place?
Secretary Azar. It is still in place.
Ms. DeLauro. Okay.
Secretary Azar. But that is the only portion that remains
effectuated. I have actually stopped the effectuation of other
provisions, as you know, last December.
Ms. DeLauro. I understand on the fingerprinting. Are you
pushing back when DHS refers separated children to HHS without
providing cause for separation, yes or no?
Secretary Azar. So we actually are asking for enhanced
information from DHS so we know the basis for the separation.
Ms. DeLauro. Is that just a check-off box or is there----
Secretary Azar. No, no, no, no. No, not at all. So
separations happen, always have happened for child welfare, but
I would like better information from DHS.
Ms. DeLauro. Okay.
Secretary Azar. And I think there is a common agreement why
was a child separated? Was it child welfare? Was it a felony
conviction----
Ms. DeLauro. We are all for child welfare, but we know that
that hasn't always been the guiding principles in the past.
Have you removed new politically-motivated barriers to
reunification, like job requirements for sponsors, so that
children can be released to sponsors in time frames compliant
with Flores?
Secretary Azar. I am not aware of job requirements for
sponsors. I am not aware of that as part of the----
Ms. DeLauro. You might want to take a look at that.
Secretary Azar. The case managers do a full child welfare
check on deciding sponsors. It is always a balance. I am sure
you don't want us sending kids out to unsafe environments
either.
Ms. DeLauro. No, no, no. Mr. Secretary, none of us on this
subcommittee want children to be put in harm's way.
Secretary Azar. That is right. Of course not. I think we
all agree.
Ms. DeLauro. Children have been put in harm's way because
of the policies by the Agency. Are all workers at Homestead
receiving appropriate background checks?
Secretary Azar. All workers at Homestead----
Ms. DeLauro. At Homestead, background checks. There are no
waivers involved.
Secretary Azar. There shouldn't be any waivers. Homestead,
of course, as the temporary influx is not State licensed, but
will go through the ORR background check.
Ms. DeLauro. I understand that. We are fingerprinting
parents. We are fingerprinting others. But let's make sure that
we are fingerprinting those people who are taking care of our
kids.
Secretary Azar. They all should have been fingerprinted and
run----
Ms. DeLauro. Final comment. Influx shelter beds are 3 times
as expensive as permanent beds. Yes or no, are you increasing
permanent bed capacity so that you can move away from
unlicensed and expensive influx shelters?
Secretary Azar. We are, and I would appreciate you actually
supporting and helping that effort. It would be a nice----
Ms. DeLauro. I would happy to do that.
Secretary Azar. Thank you.
Ms. DeLauro. Thank you, and I beg the indulgence of the
committee.
Mr. Cole. Thank you, Madam Chair. Just on that point just
real quickly, you may not know this because obviously you
weren't there at the outset, what kind of capacity did you
inherit from the last Administration since this isn't a new
problem that we are dealing with?
Secretary Azar. Mr. Cole, I don't remember what the actual
capacity numbers would have been at the beginning of this
Administration. I would be glad to be informed if you happen to
know them. We currently have 11,688 children in our census, and
I believe about 460 or so open beds available. So we are quite
tight right now as we are.
Mr. Cole. Yeah. I would appreciate it. I don't know off the
top of my head, so if you could get back to us some time
because I would like to know where we started from in this
process.
[The information follows:]
UAC Capacity Numbers at the Beginning of the Administration
The attached spreadsheet shows summary UAC data by month from
October of 2014 through May of 2019.
Column C shows average bed space capacity from the beginning of the
Administration. In January of 2017 there were 13,037 beds, however, by
February 2017 the number of beds dropped 11,036. These bed figures
include both permanent beds and influx beds (in months where there were
influx beds).
As you can see, bed capacity has not increased steadily during the
Administration. Bed capacity is driven by the number of UAC needing
care.
Column F shows the average number of UAC in care. In January 2017,
there were on average 9,554 UAC in care. This trend continued until May
2017 when the average number of UAC in care began to increase.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cole. I would like to move now to a very different
topic, and obviously Congress has worked really hard with the
Administration and passed a number of pieces of legislation on
the opioid crisis that we have in this country. We have also,
as you kindly pointed out, in a bipartisan way put considerable
funds at the disposal of the Department. Give us sort of an
update in your view of where we are at in this crisis because
your remarks were even more encouraging than I would have
hoped. We may have seen a peak and making significant progress
here.
Secretary Azar. Thank you for asking for about that. I
don't want to be overly rosy. We did not get into the opioid
crisis overnight, and we will not get out of it overnight
either. But I am pleased to report that on basically every
leading indicator on the opioid crisis, we are headed in the
right direction.
We have the prescribing of legal opioids is down
approximately 20 percent since January 2017 in terms of
prescribing. I believe the MME, the morphine equivalent levels,
are down about 26 or 27 percent. Naloxone prescribing is up
over 200 percent. MAT capacity has radically increased. And as
I mentioned, we have seen an actual flattening of the curve of
drug overdose deaths, very far from anything like victory. This
will be a long, long, long campaign, but everything is trending
in the right direction here.
Mr. Cole. Well, I appreciate you recognizing that, but I
want to thank you through the President who, frankly, is the
one that declared a national emergency in this particular area,
and I am proud Congress has acted on that working on with you.
Also, your budget proposes to reduce new HIV diagnoses by 90
percent over the next 10 years. What investments specifically
are you proposing to end the HIV epidemic?
Secretary Azar. We have asked in this budget for
$291,000,000, but of course that comes on top of the
$3,400,000,000 that we already spent on HIV/AIDS in the United
States. It is really a historic moment. I think we are at a
point now where all of the strands are coming together. It is a
positive, perfect storm where we have the tools to diagnosis.
We have the tools to put on treatment those who have HIV. And
if we put you on treatment and if you remain on compliant on
treatment and reduce your viral burden, you cannot transmit.
And if you are at risk, if you are engaged in risky behaviors
with individuals who might be infected, if we can get you on
this drug PrEP, you won't get the disease.
And so if we can just follow through on all of those, and
that is where our targeted investments are is especially
focused in the 48 counties where 50 percent of new infections
are happening, seven rural areas, the District of Columbia, and
San Juan. So if that new money is really focused there and on
those interventions through proven methods that we have, we
will get this done.
Mr. Cole. Well, I appreciate that effort. And I would also
like to talk a little bit about the Administration's initiative
in pediatric cancer, how you see that unfolding. While I would
like more at the NIH, I do want to really encourage and
appreciate this particular effort.
Secretary Azar. Yeah. So we have a historic investment of
$50,000,000 that is part of a 10-year program of $50,000,000
per year on pediatric cancer issues. You know, as part of this
initiative, one of the challenges is that unfortunately,
pediatric cancer is often neglected more compared to adult
cancer. And so what we are trying to do first is build the data
sets. We want to make sure we are collecting all data around
pediatric cancer because with the modern genomic approaches to
cancer, treatment, and therapies, we need that data. So very
robust systems, comprehensive prospective data collection
protocol for pediatric cancer cases.
We are establishing a pilot of a consortium of institutions
to accelerate development of capabilities and analyze clinical
information required to build registries. So that would be gene
tissue registries as well as information. So just some of the
examples of a real renewed focus here on pediatric oncology.
Mr. Cole. Finally, I don't have a lot, and it is not
directly under this subcommittee's jurisdiction. But as you
know, I have a great interest in the Indian Health Service, and
it has been a very troubled service. And I would like you to
take the last part of your testimony to tell us what you are
planning to do there.
Secretary Azar. Well, we continue the investment, as you
mentioned in your opening, on the Indian Health Service. It is
a direct service delivery that we are providing to our Alaska
Natives and American Indians. And so we invest $5,900,000,000
in discretionary funding for IHS. That is actually an increase
of $391,000,000 above the CR or $140,000,000 above enacted,
increasing patient services, supporting ending the HIV epidemic
in Indian Country, and investing in quality care. We have
created a Quality Office under the IHS director. We are very
focused on how can we ensure a quality, safe environment of
constant quality system improvement there.
Mr. Cole. Well, I am out of time, but I just want to go on
record and thank you very much for that. I know you had a tough
budget year, and I was very pleased when I turned to that line
and saw the increase instead of what I feared I would see. So
thank you very much.
I yield back, Madam Chair.
Ms. DeLauro. Congresswoman Lowey.
The Chairwoman. Thank you, Secretary Azar, for appearing
here today. I appreciate your comments on e-cigarettes. I think
we have let this go on much too long. And I want to know will
you commit to only support nominees for FDA commissioner who
would take an aggressive stance on combatting e-cigarette use
by children?
Secretary Azar. Absolutely. That is my agenda, so I am
certainly not going to support putting someone in as FDA
commissioner who doesn't share my agenda on tackling this e-
cigarette epidemic.
The Chairwoman. Thank you. The domestic gag rule is an
attack on the 4,000,000 Americans who rely on Title 10 family
planning funding for birth control and reproductive health
services, which direct aim on those who rely on Planned
Parenthood. I strongly believe that this policy is an
unconstitutional violation of the freedom of speech of
physicians, and would vastly undermine the doctor-patient
relationship, jeopardize public health, and continue the
Administration's assault on women's health.
Major medical groups have raised the alarm on the danger of
the domestic gag rule and have opposed this terrible policy. In
fact, the American Medical Association is suing to stop this
proposal. That is how dangerous they believe it to be. Given
the dangers the domestic gag rule poses to the doctor-patient
relationship and women's health, the Administration must have a
review process before embarking on such an extreme proposal.
Mr. Secretary, which public health groups and experts did
your Department meet with in consultation of this proposal
before the announcement?
Secretary Azar. I don't know which groups were met with. We
followed a notice of proposed rulemaking and public rulemaking
process. Our intent here is to implement the statutory
prohibition on funding programs where abortion is a method
family planning. I did want to clarify. This is not the Reagan
Administration gag rule with which you would be familiar. We do
not prohibit non-directive counseling, including regarding
abortion or the provision of information regarding providers,
those whom may provide abortion. Simply you may not actually
directly refer them or provide directive counseling for
abortion.
We are trying to effectuate the intent of the statute here
to not support the actual provision of family planning programs
where abortion is a method of family planning. But we are
trying otherwise to have that kind of information flow.
The Chairwoman. Well, it looks we have to have a longer
discussion on this issue because I want to be very clear. There
was no such consultation with the public health community
because it seems the Administration didn't care about what the
experts had to say or what impact this would have on women's
health. This was a political decision, correct?
Secretary Azar. This was a decision to implement Congress'
statutory prohibition on funding programs where abortion is a
method of family planning. The previous administrations had
actually had a requirement of referral for abortion. I find
that rather ironic given that the statute says you shouldn't be
funding programs where abortion is a method of family planning,
and you are supposed to be non-directive. Actually that's the
requirements in the statute. I think this is a legal
conclusion, a legal approach to what Congress has set up in the
structure of the system.
The Chairwoman, I think we need to have a further
discussion because the Hyde Amendment is the law of the land,
and it seems to me this directive, this requirement is a direct
affront to Mr. Hyde. I know Mr. Hyde. I worked with Mr. Hyde.
And this was not consistent with the Hyde Amendment. We can
have further discussion on that.
Throughout my time in Congress, Federal funding for the NIH
has been among my top priorities. The NIH is the world's
premiere research institution. Its researchers are developing
cures and treatments for some of the world's most debilitating
diseases. Now, although it has been discussed by my colleagues,
how many grants would have to be cut for the NIH to operate
based on a 13 percent cut?
Secretary Azar. I don't know the exact number of grants
that it would be. It would depend on the size of the grants to
get there. I do want to note I share your concern about cuts to
NIH. We are trying to operate within a cap's framework here. We
have tried to provide a pathway forward. This is the largest
discretionary part of our budget on meeting discretionary caps.
I appreciate if you have got a different view about ways to get
there, and we are happy to work with the committee on
alternatives.
This is an approach. It is the way we submitted something,
from our perspective, what we were called upon to do to support
compliance with discretionary caps.
The Chairwoman. I have an idea: $8,600,000,000 for the
border wall? How about that?
Secretary Azar. That would be something for you--you are in
Congress, I am not--for you to consider. I have got a 12
percent change we had to make. We tried to make these. We made
these changes here. We believe that there are certainly
efficiencies in NIH's budget that can be gotten. We have spent
a lot of money, increased a lot of money there year over year,
and we believe we can get efficiencies out of. I share concern,
though. We are making tough choices. It is a tough, tough
budget.
The Chairwoman. Oh, excuse me, sir, but I have listened
very carefully. I understand your sincerity. But you are going
to cut the NIH and put $8,600,000,000 in the border wall? I
have nothing else to say. This is absurd, and I hope [off
audio]. My friend, Mr. Cole was there. I was here when it was a
Republican initiative to double the money at the NIH. So I will
just leave it at that. My time is up. Thank you.
Ms. DeLauro. Thank you. Congressman Herrera-Beutler.
Ms. Herrera-Beutler. Thank you, Madam Chair. Thank you, Mr.
Secretary, for being here. I have a couple quick questions on
kidney care, but I wanted to first say I applaud the
Administration's efforts with regard to drug pricing. This is
one of the biggest issues my constituents talk to me about, and
I think that your moves here, while shaking some on the
proverbial right, it needs to be done. And I think this has
some real potential. I would love to help with this.
The increases and the focus on GME is also very critical
for our Nation, making sure that we have providers out there on
the front lines. And then I noticed a piece in the Wall Street
Journal with regard to the Trump Administration is sounding out
the medical industry on requiring hospitals, doctors, and other
healthcare providers to publicly disclose the secretly-
negotiated prices they charge insurance companies for services,
a move that would expose for the first time the actual cost of
care. What a novel concept.
We have been running around this bush, Republicans and
Democrats, forever, and unless we know the actual cost of care,
we cannot drive that down. Again, I think this is something
that will probably rock votes on both sides. It needs to be
done, and I am very excited about it, and I would love to be of
assistance in this area. So I thank you for your leadership on
that.
I also want to applaud you for your recent remarks on
transforming kidney care. Now, I don't know if you. I am a lead
sponsor on the Living Donor Protection Act with Congressman
Nadler, and kidney care has been a consistent priority for me
here in Congress. And the issue of immunosuppressant drug
coverage after transplant is an issue that I have been focusing
on for several years. I have been looking at these policies to
extend Medicare coverage for those drugs to patients post-
transplant because what happens is despite the best intentions
of the ACA, folks get their transplant, they can't get
something covered, and then oftentimes we see people who lose
their transplants, get back on dialysis because Medicare will
cover it. And the costs and quality of life issues are
ridiculous. It is a lose-lose.
So I was wondering if the Office of the Actuary has taken a
look at the budgetary effects of extending immunosuppressive
coverage because it is more expensive to dialyze and then
transplant someone a second time. And if not, may I ask that
you take a look and maybe provide that analysis?
Secretary Azar. So as I mentioned in my recent remarks, we
are very focused on ways we can incentivize towards
transplantation and working with you on the living donor
issues, et cetera, that you focused on. Extending coverage of
immunosuppressant drugs could help patients avert dialysis in
the future, supporting transplantation, which of course is a
better health outcome at a lower cost.
So while the savings would be specific to the design of any
actual policy, our preliminary Office of the Actuary analysis
indicates that the savings generated by averting dialysis would
be greater than the cost required to extend coverage for
immunosuppressant drugs. And we are happy to follow up with you
and other interested members on this issue.
Ms. Herrera-Beutler. Great. Wonderful. Similar area. Next
question is organ procurement organizations. By some estimates,
every year nearly 2,000 kidneys are discarded that have could
have been suitable for transplant. And what can HHS do to
ensure that these organs are not chucked overboard, while over
100,000 men, women, and children are waiting for life-saving
transplantation.
Secretary Azar. Absolutely. Too many organs are being
sacrificed now that are based on policies dating from an era
when our understanding of infectious disease and treatments for
infectious disease were radically different. And I have called
for in my remarks, and then we are working on updating those
standards because many more kidneys now could be usable,
especially compared to dialysis and death.
Ms. Herrera-Beutler. Yes, absolutely.
Secretary Azar. And we need to advance that and change the
approaches to that, and we are working on that.
Ms. Herrera-Beutler. Awesome. One more piece on this. I
recently joined with Representative Cartwright on other members
in sending you a letter on the National Living Donor Assistance
Center to cover lost wages and other expenses incurred by
living donors. And we certainly appreciate the ongoing demo at
HRSA on this, but beyond the demo, how has HHS committed to
expanding this center?
Secretary Azar. So we are looking at ways in which we can
further support living donors in terms of lost wages, and I
mentioned that I my remarks. So that is part of the agenda that
I expect in the next several months that we try to roll out.
Ms. Herrera-Beutler. Great.
Secretary Azar. Either with our own work or recommending to
Congress actions you can take.
Ms. Herrera-Beutler. Yeah, I appreciate that, and I
appreciate your approach. You mentioned the e-cigarette piece
and some of the drug pricing stuff. I appreciate your
willingness to rock the boat because we really want to get to
the bottom of health costs and get more people covered and
increase their quality of life, so I thank you. And with that,
I yield back.
Ms. DeLauro. Congressman Pocan.
Mr. Pocan. Thank you, Madam Chairman, and thank you, Mr.
Secretary, for being here. First off, congratulations on the e-
cigarette thing. I have heard that through the various
committees over the years and glad to see some activity on
that.
I would like to try to hit three areas if I can. One, I
noticed you didn't bring up in your remarks family separation.
You know, this is big issue for many of us, especially those of
us who have gone down to the border. I have been to the Super
Walmart detention center down in Texas where there are 1,500,
you know, boys packaged in or kids packaged in--it is boys in
that facility--packaged in to a, what, 6 by 10 area for each
person is allocated. They get outside two hours a day. When I
was there, they told me they couldn't hire 90 needed medical
health professionals at the facility.
Just so you know, a super max prison cell is 8 by 12, so
they allotted spaces even less than what we give to supposedly
some of the worst inmates in the country. So, yeah, this is a
big concern to many of us as we look at this issue, and yet the
inspector general's report talked about the policy of the
separation and that there is not an integration that tracks
separated families. We couldn't figure out which children met
the definition of ``separated.'' What substantial, because I
didn't see it, in the budget is there to deal with this issue?
Secretary Azar. So, of course, we don't have an ongoing
program other than just the normal family separations that
would happen because of child welfare done by DHS. We have a
very small number currently. I think approximately 200-plus
children who came across the border were detained and DHS sent
us a child from either a parent or a putative parent. Usually
that is because the parent ended up not being a parent, so DHS
separated and sent to us as an unaccompanied child, or it is a
TBBPRA violation, like a felony conviction, for something like
violence towards children.
Mr. Pocan. The question is what you are doing to address
the bigger----
Secretary Azar. Well, because we don't have a bigger issue
right now----
Mr. Pocan. Before----
Secretary Azar [continuing]. In terms of separation. We
receive a relatively small number, which are according to
standards that are fairly consistent with the long-time history
of the program. I am trying to increase information flows. That
is the biggest issue. I demanded back in June, we put a box on
the intake form of if there is any indication of separating so
that we have an easy way to track that that has happened. We
have asked for more information from DHS, as I mentioned to the
chairwoman earlier, on any rationale or reason why there was a
separation just because that can be useful to us.
We don't decide or get to veto a separation, but it helps
us decide whether there is a reunification or a sponsorship
issue on information we just may not know about or uncover
through our child welfare checks on those same individuals.
Mr. Pocan. What is the average time on the separations
right now?
Secretary Azar. Average time on separations? The average
time that all children are with us is 71 days before we place
them with sponsors. So, again, it is about 200 kids, 200-plus
kids that would count as separated, but they are separated, I
think, for reasons you would want them separated for. They are
with individuals who are violent, have bad felonies, are not
parents. So I think we are talking about the past and the
present a little bit differently here.
Mr. Pocan. Okay. Well, anything that separates a child for
71 days from their parents is a problem. I mean, when I was
down there----
Secretary Azar. Even if the parent is a child abuser or a
violent felon?
Mr. Pocan. You know, some of the B.S. that is coming from
the Administration on this. I have been down to the facilities.
You know what? If you want, I will go down with you and let's
visit some of the facilities together.
Secretary Azar. I visit our facilities----
Mr. Pocan. I know. I would love to go with you because I
would like to ask more specific questions, because that day we
couldn't get all of our questions answered. I went down with
Senator Merkley and some other folks. But, you know, the intake
facility is not your department. You know the cages? That is
the same material as the dog running around in my backyard. It
is the exact same material and construction. You all say they
are not cages. That is part of this policy, right, from the
very intake. You are 5 years old, you are separated from your
parents. That is this Administration's policy. I know it is not
your Department's policy. It is this Administration's policy.
So if you want to invite me, I will go with you, and we can
have some questions on this. But I don't find anything
acceptable anywhere close to the conditions that we have been
doing on this.
Let me ask you about prescription drug prices real quickly.
I don't think I am going to get to all three areas. We are
allowed to negotiate for prescription drug prices through
Medicaid, through veterans, and many of us think we should do
it for Medicare. Would you be supportive of that?
Secretary Azar. So right now we do negotiate----
Mr. Pocan. That question is kind of a yes or a no, sir.
Secretary Azar. It is not a yes or no.
Mr. Pocan. Okay. So we----
Secretary Azar. Nor is it a yes or no answer. It is you get
a more sophisticated approach in thinking about how we do----
Mr. Pocan. I said do you support that. So actually the
question was a yes or no answer. Your answer may not be a yes
or no answer. Do you support being allowed to negotiate for
drug prices----
Secretary Azar. We do negotiate using PBMs.
Mr. Pocan [continuing]. For Medicare like we do with
Medicaid and veterans?
Secretary Azar. We use PBMs to negotiate. If we were to
have the Federal government negotiate, you would have to be
willing to have a single national formulary excluding senior
access to drugs. You may have Humira. You may not have Enbrel.
That is the only way we get the power.
Mr. Pocan. Should I take that as a no?
Secretary Azar. That is something I would like to keep
talking with you about it, but you need to consider all the
ramifications----
Mr. Pocan. Okay.
Secretary Azar [continuing]. About the beneficiary access
and choice issues associated with that.
Mr. Pocan. All right.
Secretary Azar. But I am open to anything that solves the
drug pricing problem.
Mr. Pocan. So apparently you aren't here to answer
questions. I will just add I think a cut to NIH at the level
you have is serious. It is going to impact thousands of grants,
and it is going to have a negative effect, so I just want to
throw that out there. Thank you.
Ms. DeLauro. Congressman Graves.
Mr. Graves. Thank you, Mr. Chair. Mr. Secretary, thanks for
being with us today, and I appreciate your indulgence with all
the questions. I have to admit, Madam Chair, on the onset here,
I sort of find it comical that there is a faux outrage about
the spending cuts. That outrage comes from the very people who
voted to impose these spending cuts on this Agency here, this
Department. And yet when the Secretary abides by the law, which
I assume you are because that is the law, all of a sudden you
are the target of such bad policymaking. But you are not the
policy branch, are you, or do you just follow the law as a
legislative body?
Secretary Azar. Well, we certainly work with OMB, and OMB
on behalf of the President felt the need to submit a budget
that complied with the discretionary caps that this Congress
passed under President Obama and are in force unless and until
Congress and the Administration agree to relieve those caps.
Mr. Graves. And I think that is what you should be doing. I
do. I think if had had another agency head here before us in
the previous Administration and with us in the majority who did
not agree with the spending levels as proposed by Congress, we
would have and had spent above them, I would hope we would have
outrage that an Administration was not abiding by the laws.
So what makes this somewhat amusing is that I read in the
papers that even the new majority has no budget. They don't
plan on passing a budget out of committee. I know we have a
member on this subcommittee here who is a part of the Budget
Committee on our side, and yet they direct their outrage at you
for their inability to pass a budget out of a committee, to
give you further discretion to do what I know you would want to
do, invest in these critical areas. In the meantime, you must
abide by the law. So I appreciate your willingness to make
courageous, tough decisions in the absence of others being able
to do the same.
So moving on to the CDC, thank you for your investment
there. I am sure you would want to do more, but you have not
near as much to work with. It is a 12 percent reduction in
overall spending that you get to work with, so you have had to
make some strategic decisions. I know Mr. Cole brought up the
CDC as well earlier, and he has had an opportunity to visit the
facility as I have, and I would encourage all members to do
that. It is an amazing investment for our country. But can you
just share with us a little bit about your vision for the CDC
and how you expect that they will do more with less, and some
of their priority and mission focuses in the near horizon?
Secretary Azar. Sure. Thank you. Thank you very much. So
what we have tried to do with the CDC budget, again in a
difficult budget environment and according to the constraints
that you mentioned, is prioritize flexibility for States. We
really partner with States and State public health departments.
So often the CDC budget is sliced and diced by category, by
disease type, by initiative, by priority, and actually try
through a grant program to reform it in a way to give States
the abilities to actually target monies in the highest-burden
areas and the greatest emerging infectious disease throughout.
So that has been one of the core approaches that we have taken.
We have tried to really double down on the Ending HIV
Initiative at CDC. So we would add $140,000,000 new there at
CDC on the Ending HIV Initiative, and that includes testing and
linking persons to treatment, augmenting public health staff in
local jurisdictions, and supporting surveillance, and that
would be on top of the approximately $789,000,000 CDC already
has for HIV/AIDS prevention and research.
Mr. Graves. I know the Administration and presently
yourself have a very laudable goal the eradication HIV/AIDS. If
you could forecast when that might occur or your hope for that.
Is there a way to just sort of date that and say you know, our
goal is in year 2 or 3.
Secretary Azar. Yes. So we have laid a stake in the ground
that within the next 5 years we would reduce new infections by
75 percent and by 90 percent within the next 10 years. I hope
and believe we can do it even faster than that with the right
tools. What is nice is we have the tools, and we actually have
a focused target because of where the new infections are
happening, that we really can stop this in its tracks with just
quality execution and a bit of funding from Congress.
Mr. Graves. Well, thank you, Mr. Secretary. Let me just
close by saying I do appreciate your hard work, your
Department's hard work, OMB's hard work and courageous
decisions on ways to do more with less in the absence of
Congress making any changes. But I will again point out that it
was Congress just 8 years ago who said if you let us raise the
debt limit, if you let us spend more, we promise to keep
spending under control. But year after year after year that
limit and cap has been raised time and time again. A false
promise 8 years ago, and yet we hear the outrage today that you
are actually complying with it. So thank you, Mr. Secretary.
Ms. DeLauro. Congresswoman Lee.
Ms. Lee. Thank you very much. Thank you, Mr. Secretary.
Good afternoon. A couple of questions I would like to ask, and
I will ask you all in one swoop. First of all, with regard to
HIV and AIDS, you know many of us have worked on this for many,
many years, both domestic and international, and we have been
trying actually to make sure that our AIDS proposals and
strategies are global, not bifurcated. And it is my
understanding now that this budget proposes a 22 percent cut in
funding to PEPFAR and a reduction of the Global Fund while
increasing the domestic strategies and programs by about
$291,000,000. So it is really robbing Peter to pay Paul.
So one point I want to raise with regard to your budget as
it relates to Medicaid expansion, I don't know if you recognize
this, but the largest source of coverage for people with HIV,
over 40 percent, is through Medicaid. And the budget includes
1,500,000,000,000 in Medicaid cuts over 10 years. So once
again, I don't know how we are going to address age HIV and
AIDS when you are going to cut 40 percent of the people who
rely on Medicaid.
Secondly, with regard to the elimination of the racial and
ethnic approaches to community health, the REACH Program, it is
the only program really that is funded to address racial health
disparities. Once again I think you proposed this last year.
Why would you eliminate this, and generally, what is your
commitment to ending racial disparities in chronic healthcare,
because this is a program that has worked. It addresses people
of color, minority communities. Yet once again you guys are
trying to zero it out.
Finally, just on the separation of children, I just have to
ask you, as a result of this policy, did you look at the mental
health consequences of separating children from their parents?
As secretary of health, and I wanted to ask you this question
over and over and over again if you knew the data on the
generational trauma associated with the Middle Passage in
slavery and the current effects right now of separating
children from their parents on African-Americans. And for the
life of me, if you understood and this Administration
understood the history of what this does to children and
families over the years, you never would have done this. And I
wonder if any healthcare professional, yourself, looked into
this before you decided to make that decision.
Secretary Azar. So several areas there. With regard to
PEPFAR and the Global Fund for AIDS, I would have to obviously
refer you to the State Department on their budget and the
prioritization there. I do believe part of the focus on PEPFAR
has been, of course, it has been a historic and wonderful
program achieving just incredible results for humanity. But I
think part of the focus there has been now are there countries
where they have achieved a level of infrastructure, stability,
and basically have learned to walk and run on their own, and we
can reprioritize elsewhere and focus on new areas and burdened
areas. But I would have to defer to the Secretary of State or
Ambassador Birx on that.
On the Medicaid expansion and HIV care within Medicaid, you
know, we have in our budget a proposal to actually reform and
restructure healthcare to the States, giving them grants to the
States, a 1,200,000,000,000 program that would replace the
Medicaid expansion and the Affordable Care Act in the States,
giving them actual flexibility to target individuals that most
need it. One of the real challenges with the Affordable Care
Act expansion has been a bias in favor of able-bodied adults in
terms of even just the match rate over the traditional
populations of the pregnant, blind disabled, aged, children
populations. And we think this actually can allow a greater
focus there, and I would hope that would be a real focus in
HIV/AIDS.
Ms. Lee. You do know Medicaid is the largest source of
coverage for people.
Secretary Azar. Well, Medicaid and then also access to the
Ryan White Program and community health centers are, of course,
vital for individuals with HIV/AIDS, absolutely there. Right.
And then in terms of in terms of ORR Program and
Unaccompanied Alien Children Program, I did want to, if I
could, just for the chairwoman to clarify something that I am
just informed of by staff. I just was not well informed on
this. I think you had asked about Homestead and background
check waivers. I do believe that ORR directors Bob Kerrey under
the Obama Administration and Scott Wood did grant waivers for
the Florida Child Abuse and Neglect Check, the State-based
checking system. In 2016 and 2018 those checks were waived
because the fingerprint background checks would show relevant
information. All staff at Homestead have undergone FBI
biometric fingerprinting and FBI background checking. But I
just wanted to clarify that the State child Abuse Check System
there was waived in 2016 and 2018. I apologize. I didn't have
that front of mind when I answered you earlier.
Ms. DeLauro. Mr. Secretary, I will answer you directly.
Secretary Azar. I just wanted to clarify. I just didn't
want to----
Ms. DeLauro. The fact of the matter is there is massive
fingerprinting of people who are going to be sponsors, and we
have waived those things and mental health services.
Secretary Azar. And I apologize, Congresswoman.
Ms. Lee. Madam Chair, could I ask him to respond to my
question in terms of did you all look at the generational DNA
changes and other changes of trauma from slavery to now,
separating children from their parents.
Secretary Azar. Yeah. So we did not create the policy of
zero tolerance and 100 percent referral. That was done at other
departments. We are the recipient of the kids.
Ms. Lee. But you are the Secretary of Health. Did you all
raise red flags?
Secretary Azar. I can't raise flags on what I do not know
about until it is----
Ms. Lee. You need someone to study the trauma associated
with children being separated from their parents.
Secretary Azar. Let me very clear. There is no dispute
between us that children being away from their parents is a bad
thing, that it imposes mental health issues. There is no
dispute at all between us on that point. I was clear about that
in June if you look at even public statements that it is a bad
thing, and that is why we encourage people do not come across
the border illegally at non-border crossings because you will
be arrested.
Ms. Lee. Mr. Chairman, that is not the issue. The issue is
the kind of services and what are you going to do for these
children who are going to see the trauma and feel the trauma
through generations now, such as African-Americans still do
from 400 years of slavery.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thanks very much, and thanks very much, Mr.
Secretary, for being here. And first of all, you know, placing
these children with criminal parents is actually bad for the
children, and I applaud actually seeking to see if these are
criminals because actually the data shows that if you that if
you are raised by a criminal, you are twice as likely to be a
criminal. That is the fact. So I think it is totally
appropriate to check whether or not the people you are sending
these, you know, you are responsible for these children and you
should know to whom you are giving these children.
Now, I'm going to associate myself with the remarks from
the gentleman from Georgia. Mr. Secretary, Congress actually
set the budget cap levels. I looked back a bill, and I didn't
vote for it. I know a lot of people did. I didn't vote for
those caps because I knew it was going to happen. But, in fact,
let me get it straight. The Administration set a budget
according to the law, the current law. Is that right? I mean,
it is current law.
Secretary Azar. That is correct. We endeavored to comply.
Mr. Harris. The BCA of 2011 is still the law of the land,
so it is, in fact, Congress' failure that resulted in the
Administration having to put forth a budget that actually lives
within the law. Amazing.
Let's talk about living within the law. This gag whatever
you want to refer to, is actually a congressional statute,
right? I mean, actually the statute, Title 10 says that that it
is for birth control, not abortion or not abortion as the
method of birth control. That hat is a congressional policy. It
is not the Administration's policy. And look, I understand
other Administrations didn't care what the law was, you know.
The Department of Justice couldn't care less, you know, when
they obtained FISA warrants, whether or not they were following
the letter of the law. I get it. They couldn't care less. It is
good to have an Administration that actually cares what the law
is. So, I mean, so I understand that. And look, great. We have
gages in the crowd. Look, I will tell you, I don't want a FISA
warrant issued on me by a rogue Department of Justice and a
rogue FBI that is going after partisan politics.
Now, let's talk about policy because I do want you to
answer. I know that, you know, the people who want the yes or
no answer, we are talking health policy, you know. And the old
adage is, you know, for every complex problem there is a right
answer, you know, there is a simple answer and it is wrong. The
PBMs under Medicare Part D, because they negotiate not only for
Medicare Part D, but for non-Medicare Part D, and, again, again
about half the population is not Medicare. They actually
negotiate for a pretty large number of patients. Is that right?
Secretary Azar. Absolutely.
Mr. Harris. So that, in fact, if you just say, well, let's
let Medicare negotiate, the fact is the government rarely
negotiates. I mean, I know because I'm a physician. I don't
negotiate what I get paid for by Medicare. Medicare, I hate to
tell you, but CMS tells me what I am going to be paid. There is
no negotiation that occurs. It is price fixing, and the result
of price fixing with physicians is that you can't find
specialists, especially the sub-specialist who will take care
of Medicare patients, without limiting the number of Medicare
patients they take care of. And this is what I fear will happen
if we actually go to price fixing for drugs. However, I am
going to tend to support what you are trying to do with the
Medicare Part B drug setting because we do have to level the
playing field there.
I want to thank the Administration for making affordable
healthcare policies available once again because they weren't.
They are not available under Obamacare. Unless you get a
subsidy it is not affordable. So the short-term policies and
association plans the Administration has advocated I think are
good.
Let me just add, and in terms of prior authorization, the
Step Therapy 2, things that make the work of the physician and
healthcare practitioner much more difficult. I would hope the
Department could simplify in some way by making insurers have
pretty standard guidelines, and make sure those providers know
those guidelines and the providers operate within those
guidelines. They don't have to go through the rigamarole of
step therapy and prior authorization.
I hope the Strategic National Stockpile gets attention
because it is appropriate. But I did want to just ask you,
look, Medicare Part D is a popular program. It is actually one
where the cost is actually less than was predicted when it is
passed 15 years ago. Are there other reforms that we should do
to make it even a better program for seniors?
Secretary Azar. Absolutely. It is a great program. We are
securing discounts and most of it comparable to what Europeans
get by way of discounts through the PBMs. We have parts of the
programs there where we disabled the PBMs from negotiating, and
we have proposed ways to free up the plans to negotiate to get
commercial-level kind of discounts there. In addition, we would
like to have an out-of-pocket cap, the first-ever out-of-pocket
cap for seniors so that when they hit catastrophic coverage,
they would pay nothing out-of-pocket for their drugs. We would
also like our low-income beneficiaries to have free biosimilar
and generic drug coverage in the benefit package, and to
require that the drug company payments not be used to progress
people rapidly to catastrophic care. And finally, have the PBMs
bear more of the share of the reinsurance and catastrophic.
Right now we bear 80 percent of the cost of catastrophic
coverage. We would like that to be the PBM being the ones to
actually bear that cost. We could bear 20 percent, and we could
save our seniors, have them pay zero percent in the
catastrophic. So very important structural reforms to Part D,
whose time we think is due now.
Mr. Harris. Thank you very much. I yield back.
Ms. DeLauro. Just as a comment, Mr. Secretary, you claim to
be living within the budget caps. I would note that the
President's budget, and my colleagues should note, an increase
of $96,000,000,000 for defense through the overseas contingency
operations. That is OCO, which we all know is a budget gimmick.
So I disagree that the Administration is living within the
caps. Congresswoman Clark.
Ms. Clark. Thank you, Madam Chairwoman. Thank you, Ranking
Member Cole. Good to be with you, Secretary Azar. We are
heading home tomorrow, and whenever I go home, whether it is
for a weekend or for a district work period like we are heading
into, I will invariably run into families who are devastated by
the opioid crisis. And I appreciate that you have mentioned
this crisis and it continues to be something that you put in
your testimony. And I appreciate that you have mentioned this
crisis and it continues to be something that you put in your
testimony. And I think we can agree on some basic facts, that
we still have 100 Americans a day dying from substance use
disorder. And I take your nod as agreement.
Secretary Azar. Yes. I don't know if that is the exact
number, but it is too many too many.
Ms. Clark. Too many. Seventy thousand people died in 2017
alone from opioid overdoses, and the estimates are by 2025,
half a million Americans will die from opioid overdoses.
Secretary Azar. I believe it may be 70,000 drug overdose
deaths, and within that, of course, the opioid deaths, but we
will get you that. I just want to make sure we are----
Ms. Clark. I think it is opioid, but we can check each
other's work on that.
Secretary Azar. Not to cry. I just wanted to make sure you
have got the best data possible.
Ms. Clark. The estimates are also that 10 percent of those
suffering from SUD receive treatment. Ten percent. But those
with Medicaid are 2 time as likely as those with private
insurance or no insurance to receive treatment. And the rates
are much better for inpatient treatment under Medicaid than
under private or having no insurance. Are you familiar with the
Urban Institute study that came out in February, just last
month?
Secretary Azar. I don't believe so.
Ms. Clark. It is one that I recommend to you. It
demonstrates that States with Medicaid expansion tripled access
between 2014 and 2016 to opioid treatment compared to States
that did not have expanded Medicaid. But we know that despite
that success, we are still not meeting the demand for
treatment.
So my question comes from your testimony. You say Medicare
and Medicaid policies and funding will also play a critical
role in combating the opioid crisis. And you also say that
HRSA, the Health Resources and Services Administration will
continue to make investments. And I think we can agree that
Candidate Trump said at least 11 times under my count that
there would be no cuts to Medicare, Medicaid, and Social
Security under his Administration, but here we are:
$1,500,000,000,000 cut proposed in Medicaid, and that is done
through block grants, which, in essence, puts a cap on eligible
patients and care, which we don't have if it is not up to the
State block grants.
How can you assure me and the folks that I will be meeting
at home, the folks at home that I already know who have been so
devastated by this, that if these plans for cuts in Medicaid--
you say you are proposing minimum standards that will allow for
postpartum women diagnosed with substance use disorder to
access benefits for 1 year. We applaud that. But if the money
is not there in Medicaid, how can I assure anyone they will be
able to have this treatment, which is how nearly half of all
Americans suffering from addiction access treatment, through
Medicaid.
Secretary Azar. So Medicaid does play an important role
obviously. That is why we have the IMD exclusion that we have
been doing waivers on. That is the institutions for mental
disorders to allow, as you said, increased inpatient capacity.
So we have been granting waivers to States that are willing,
and we are still open for business to have more than 15-bed
capacity. And have actually seen that can actually inspire
construction or opening of new facilities as a result because
it makes it more economically viable to have these IMDs for
inpatient.
Ms. Clark. Are you willing to guarantee that with the
proposed cuts, $1,500,000,000,000 with a ``T,'' half trillion,
in Medicaid and the cuts that you have in HRSA, which you say
in your testimony, you know, they will continue to provide
services. Maybe they will, but you have $37,000,000 from
behavioral health workforce programs, $15,000,000 from National
Health Service Corps, $129,000,000 from rural health programs.
So can you guarantee that we are not going to cut treatment
if we block grant Medicaid so that you can save
$1,500,000,000,000? Will you guarantee they will be able to
have the treatment?
Secretary Azar. So you have to look at this in combination.
So we have got the $1,400,000,000,000 of changes to Medicaid
which involves repealing the Medicaid expansion, and also then
the option of either block or----
Ms. Clark. Which has been----
Secretary Azar [continuing]. Block or per capita change.
Ms. Clark. Allowed a tripling in access to treatment.
Secretary Azar. But so we also have in there the block or
per capita capping for States, and then other eligibility
verification integrity provisions in there. But then we add a
$1,200,000,000,000 program with flexibility for States. I just
don't believe that we are spending too little money on
healthcare or we are spending too much, but we are spending it
in the wrong way.
Ms. Clark. I am out of time. A quick yes or no. Will you
today guarantee that people will not lose treatment for opioid
addiction under Medicaid?
Secretary Azar. Our plan would defer to States to make
those choices. States would make those choices.
Ms. Clark. That is a no. Thank you.
Ms. DeLauro. Congressman Moolenaar.
Mr. Moolenaar. Thank you, Madam Chair, and thank you, Mr.
Secretary. I appreciate you being here with us today, and I
also appreciate your efforts to promote State flexibility and
encourage States to step up in this way and give them the tools
they need to be effective.
I wanted to talk with you about a couple things related to
opioids, one in rural America with the opioid epidemic. These
communities struggle with access to healthcare in many ways,
and I wonder if you could talk a little bit about rural opioid
situation, also access to overdose reversal drugs because I
noticed that was one of the points that you made in terms of
the policy, and to me I think that is a very important step
forward.
Secretary Azar. Great. Thank you very much. So with regard
to rural care and opioids, it is obviously a core issue. We
propose $120,000,000, which is flat with Fiscal Year 2019,
which in the budget environment is a significant prioritization
and commitment, of course, for the Rural Communities Opioids
Response Program, RCORP. This supports treatment and prevention
of substance use disorder, including opioid abuse, in the
highest-risk rural communities. We are going to target some of
this funding to specific initiatives, such as maternal and
child health and telehealth activities focused on reducing
opioid abuse.
In terms of naloxone access, so overdose reversing drugs,
this has really been incredible. Since January of 2017 the
number of naloxone prescriptions has increased by 323 percent.
And that, of course, is in addition to literally millions of
doses that were bought directly from manufacturers by State and
local health and law enforcement agencies. So we are getting
this product out there, and I think that is really contributing
to the flattening and potentially declining of overdose deaths
here.
Mr. Moolenaar. Great. Thank you. I wanted to shift gears a
little bit. As you know, over the last years, BARDA and Project
Bioshield have created a market for medical countermeasures
against the most serious threats we face, such as Anthrax,
smallpox, nuclear radiation. When it comes to some of these
countermeasures, it is more important than ever that we have
the Strategic National Stockpile having sustained funding. And
I wondered if you could comment. I noticed that you have
increased funding in this area significantly, and just if you
could talk a little bit about why that is important for the
Administration, and also how this relates to our national
security.
Secretary Azar. Absolutely. Thank you. So the Strategic
National Stockpile is important, I think not, for the
Administration, but for the American people, and we propose a
$10,000,000 increase for the SNS. That is going to allow us to
stockpile this new, first time ever, a smallpox antiviral drug,
so actual treatment for smallpox which we approved at the FDA,
the first-ever ever treatment for smallpox in addition, of
course, to having a vaccine. In addition, it will allow us to
purchase a newly-developed thermal burn bandage.
You mentioned BARDA. BARDA has been a real success story of
our national security enterprise at HHS. BARDA does research
and development of projects that would otherwise be neglected
by the commercial sector, the drug and device space. That has
successfully led to 43 FDA approvals since 2006 and nine FDA
approvals since 2018 alone. I think it is a real success story
of how we can work in a public/private partnership for national
security purposes.
Mr. Moolenaar. And then also, you mentioned, talked a
little bit about the CDC earlier, the surveillance data
platform. Do you have a timeline for the completion of the
surveillance data platform, and kind of how is the effort going
on in that area?
Secretary Azar. I don't have a timeline for you on that,
but I would be happy to have Dr. Redfield get you information
on that if that would be helpful.
Mr. Moolenaar. Thank you very much. I would appreciate it.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Moolenaar. And then, you know, we are running out of
time here soon, but a couple other things I wanted to ask you
about is some of the threats we face today is the rise of
antimicrobial resistance, and wondered if, you know, how the
Federal investments in this might encourage more industry
investment and stabilize a long-term development in this area.
Secretary Azar. What I'm working on right now is thinking
about this actually in that kind of BARDA context we just spoke
about. You might think that there would be all the natural
incentives for the private sector to develop anti-bacterials to
solve the AMR crisis, that there is clearly a market
opportunity. The challenge is actually what we need to have
happen is antibiotics to be developed that sit on the shelf
because we have to hold them in reserve, we need them not to
become anti-microbial resistant out there.
So we are asking the private sector to develop something
that you don't want to get used and create a marketplace for.
So we have to solve this essentially market failure question.
BARDA, Project Bioshield are exactly the types of vehicles. So
I am working with our team looking at how we might be able to
use tools like that to incent the production of the antibiotics
that we need for the future and for our defense.
Mr. Moolenaar. Thank you very much. Thank you, Madam Chair.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Thank you for being here. Lois Frankel from
Florida. Secretary Azar, should the government be allowed to
force a woman to have a child?
Secretary Azar. Should the government be allowed to force a
woman to have a child? We are a pro-life Administration, and we
certainly don't believe government money should be used to fund
abortions.
Ms. Frankel. Should the government be allowed to force a
woman to have a child?
Secretary Azar. We are here at our Department following the
laws and constitutional restraints implemented by the courts of
the United States. I don't have a policy position for you on
that.
Ms. Frankel. I would hope your position would no government
should be able to force a woman to have a child, but I will
move on. Okay. Would you agree that a frequent consequence of
unintended pregnancy could be abortion?
Secretary Azar. I think it would depend on the culture and
the legal environment in which one----
Ms. Frankel. Are you aware of any research? There is a lot
of research that shows that consequences of unintended
pregnancies often lead to abortion.
Secretary Azar. I think we all share the goal of decreasing
unwanted pregnancies and decreasing teen pregnancies. I think
we all actually share that goal. The question becomes whether
programs that claim to be evidence-based are in fact evidence-
based, and where does the evidence point us in terms of
reducing teen pregnancy.
Ms. Frankel. So, well, since you brought up the question of
teen pregnancy, you would be aware that teen pregnancy is the
number one reason that teenage girls drop out of school.
Secretary Azar. And the teen pregnancy program we don't
believe is evidence-based and actually leading to a reduction
in teen pregnancy.
Ms. Frankel. Well, you don't have any teen pregnancy
program, do you?
Secretary Azar. Well, we would be happy to work with you if
there is one that would actually provide good results.
Ms. Frankel. Okay.
Secretary Azar. The one that we have right now that we have
proposed eliminating, the Obama Administration's own data
showed that in 37 funded and evaluated products, 73 either had
a neutral or negative effect on teen pregnancy, including
encouraging unprotected sex, becoming pregnant, or encouraging
teenagers to become more likely to have sex.
Ms. Frankel. Well, if a teen is active sexually, don't you
think that if they don't have access to safe birth control, it
will likely lead to an unintended pregnancy?
Secretary Azar. Well, that is what this Administration is
fully supportive of the Title 10 Program for comprehensive
family planning services and a fully-funded Title 10 at a flat
level even in an environment where we are making significant
cuts across the other programs.
Ms. Frankel. Thank you. I am glad we are talking about
Title 10 now. Title 10, if I understand, offers cancer
screening, STD testing, birth control, other services that
cover and support women's health. Abortion is not covered by
Title 10. Is that correct?
Secretary Azar. It should not be.
Ms. Frankel. Well, it is not, and I want to ask you a
question. You have a new rule. The current law requires
financial separation, correct, between a service provider
providing an abortion and these other health services that I
just mentioned.
Secretary Azar. The regulation that we are now implementing
requires financial separation.
Ms. Frankel. Well, let me ask you this. Can you give me any
example where money has been misused under Title 10, for any of
the Title 10 providers using Federal money for abortion? Do you
have one example for me?
Secretary Azar. So 10 of Title 10's 96 grantees are Planned
Parenthood organizations, and one of the common complaints
raised by folks who are opposed to our Title 10 rule is they
claim that with if you require the fiscal and physical
separation of abortion services from Title 10, that you will
cause those other services to go away. Almost by definition in
making that argument, one concedes that we have been
subsidizing the abortion enterprise by the lack of appropriate
fiscal and physical separation.
Ms. Frankel. I am going to reclaim my time to have you
please just answer my question. Do you have any evidence, any
facts, to show that any current Title 10 provider is using
Title 10 money to perform an abortion?
Secretary Azar. I would have to get back to you in writing
on that.
Ms. Frankel. Well, I will tell you your answer. Your answer
is no. So you would agree then that with a physical separation,
that that is going to actually require providers, if a provider
of Title 10 provides general health services and also either
does counseling, a referral to abortion, or performs abortion,
that if you also now require physical separation, that is going
to require new building, rent, and some extra expenses for that
provider. Is that correct?
Secretary Azar. Exactly.
Ms. Frankel. And exactly your intention is to drive Planned
Parenthood out of business. Is that your----
Secretary Azar. Not at all. Not at all. Planned Parenthood
may comply with these rules, but exactly the point you just
made. We are currently inappropriately subsidizing
infrastructure, physical plant, and staffing of abortion
services which we believe is in violation of what you and
Congress have put in the Title 10 provision to not provide
funding to support abortion as a method of family planning.
Ms. Frankel. Well, just with all due respect--I think my
time is running out--I would respectfully request that you
bring to us any evidence, any fact, showing that a Title 10
provider has misused funds and used it for abortion. And I
await your evidence. And I yield back.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you, Mr. Secretary, for being
here. First of all, I want to say that the budget for the
Department of Health and Human Services is continuing to cut
critical programs addressing minority health disparities, and I
find that very disconcerting. The Office of Minority Health,
nearly $5,000,000 is cut. The National Institute of Minority
Health and Health Disparities has a $44,000,000 cut, and the
REACH Program has a $55,900,000 cut. These are all very
important programs that address the unique needs of communities
of color, particularly African-American communities. And so it
is very disconcerting to see what this budget does to it.
In 2010 because of the Affordable Care Act, we have seen
the uninsured rate for African-Americans to be cut in half,
from 20 percent to 11, and for black mothers in particular
provide lower health quality maternal care even when they are
able to access healthcare has been being critical that the ACA
requires plans that include these essential benefits, like
pregnancy, maternity, in addition to newborn. Sometimes
pregnancies aren't planned, so I have a bill called the Healthy
Moms Act that allows women to access insurance when they find
out that they are pregnant.
But I just found out that the short-term plans, also known
as junk plans, that the President Fiscal Year 2020 budget touts
does not include maternal care as a benefit. No junk plans will
cover this. Given that the average cost for a hospital day for
a delivery is about $3,500, can you speak to the impact that
this change in the Administration policy would have on families
across the country? Question number one. I am going to ask my
questions.
I just met with my State health commissioner today who was
extremely concerned about the $70,000,000 cut to the National
Center for Immunization and Respiratory Diseases, its cut of
$68,000,000. He is particularly concerned how it impacts adults
and their immunizations. As the uninsured rate has increased
for the first time since implementation of the ACA, we see
outbreaks of hepatitis A and B across the country. How can you
say the budget addresses the opioid epidemic when it fails to
support preventive health measures that will counteract
consequences of using opioids? I am going to with those two
questions first.
Secretary Azar. So on short-term limited duration plans and
maternal care, we are very transparent as was the Obama
Administration that in offering short-term limited duration
plans, they do not cover all of the essential health benefits.
They don't have to. They can. They can. We are seeing some
plans that do have, for instance, preexisting coverage within
them, but if I were a woman of childbearing age, for instance,
and concerned about maternal coverage and getting pregnant,
that would be precisely why one would want to get a regular
comprehensive insurance plan through the exchanges.
We are making these options available for others for whom
the basic coverage may be unaffordable in the Affordable Care
Act exchanges. These can be 50 to 70 percent cheaper. It is a
lifeline to people who may be shut out of the insurance market
and for whom the ACA plans don't work. But they have to go in
with their eyes open, and we have tried to enhance actually
consumer warnings there to be sure they know what they are
getting.
Mrs. Watson Coleman. Well, with regard to that comment
about enhancing consumer warnings, the Administration has
reduced money that is available to be used to make known what
is covered when coverage is available and how you can get
covered. So, I mean, that is also disconcerting that you would
say that they need this education so that they can go into
these situations with eyes wide open, but at the same time we
cut some of the money that is available to them to educate
them. With regard to the immunizations, adult immunizations in
particular.
Secretary Azar. Right. So if I understand the program you
are referring to, which is the CDC's 317 Immunization Program,
that mostly is for infrastructure and operations to States
which has a $78,000,000 reduction in it. We have actually
Increased Vaccines for Children Program, which is for mostly
low-income vaccine purchase and delivery, and that is increased
by $586,000,000 in the budget.
Mrs. Watson Coleman. My commissioner was particularly
concerned about the impact on adults, and particularly since
the changes that are taking place in the ACA, there seems to
have been an outbreak of hepatitis A and B in the country
actually.
Secretary Azar. So I don't know. Hepatitis A and B
outbreak, I would want to get back to you on that. I don't
speak off the cuff there. Happy to get you information. I have
not received reporting about an A and B outbreak. Of course, we
are very concerned about hep C issues involved connected to the
opioid epidemic of course. Happy to get back to you on that,
though, if that would be helpful.
Mrs. Watson Coleman. Yes, it would. Thank you.
Secretary Azar. Okay.
Mrs. Watson Coleman. My time is up.
Ms. DeLauro. What I want to do is to move rapidly for a
second round and make the questions just 3 minutes and hold to
it, and then allow for wrap up because I know the Secretary has
a commitment as well.
You made reference to a Global Pricing Index for drugs on
Medicare Part B. The President says Americans pay more so than
other countries. Secretary, the International Drug Pricing
System has put America in last place. Your testimony is silent
about the Administration's plan to link Medicare Part B
payments to prices paid in other wealthy countries, such as
France or Germany. The status of that program, when will it go
into effect? Are you backing away from it?
I don't understand why the U.S. doesn't use its own cost-
effectiveness determination to set Medicare drug prices. Will
the Administration apply the same International Price Index to
Part D? Why not? What makes Part B drugs special?
Secretary Azar. Yeah. So I don't believe it is referred to,
at least in the budget, in brief. It may be in the longer
congressional justification that comes next week. But, no, we
did the advance notice of proposed rulemaking, got a, I think,
a lot of useful feedback on that, and that we will be working
towards preparing a notice of proposed rulemaking to implement
that program with appropriate modifications if need be. But we
are very committed to that in Part B. Why not Part D?
Ms. DeLauro. Why not Part D? Yeah.
Secretary Azar. Again, and these are points that we are, I
don't mean to be closed-minded. We are happy to discuss these
with you.
Ms. DeLauro. Okay. That is fine.
Secretary Azar. We want a bipartisan solution on drug
pricing.
Ms. DeLauro. Right. Right.
Secretary Azar. We want to work together, so please don't
take anything that I am saying here as, you know, attempting to
be in any way closed-minded about.
Ms. DeLauro. Right.
Secretary Azar. But it is just I am trying to find
solutions where we are not getting the prices that would be
competitively reflected in D. Part D, we are getting European-
level discounts where we let them negotiate. The problem is we
actually have areas like the six protected areas. We have
disabled them from being able to negotiate.
Ms. DeLauro. Let me just add to this. I was going to say
something about antimicrobial resistance, which my colleague
mentioned. But I hope you will take a very, very hard look at
the renegotiated NAFTA treaty. And there, whatever you are
going to do, there is an enormous giveaway to the
pharmaceutical industries. They are going to lock in a 10-year
patent exclusivity for biologics. By your own words, two-thirds
of Part B drugs are biologics. Secondly, they are going to
expand the definition of ``biologics,'' thereby making more
drugs that may be at a 5-year patent exclusivity 10 years, and,
therefore, we are going to see prices increase here.
So we lock in the prices at the current rate, and they are
thousands and thousands of dollars, and that is in this
agreement. We expand the definition of ``biologics,'' and then
we cannot come around because of an international treaty. We
then cannot take exclusivity, move it from 12, 10, or whatever
it is because then we are in violation. No matter what you do,
no matter what you say, no matter what we say or do, if we move
in the direction of what is currently now in the NAFTA
agreement, you are not going to be able to get where you want
to go, nor will we be able to lower the cost of prices for the
American people. And we will lock in those high costs today.
So I ask you to please take a look at that agreement and
make your voice heard. And that this shouldn't be a part of a
trade agreement, nor should we be giving away a gold mine to
the pharmaceutical industry. Yield back. Mr. Cole.
Mr. Cole. Thank you very much, Madam Chair. I just have a
couple of quick things I wanted to do that is almost
housekeeping. But last year we put in something in the Disease
Rapid Response Fund, put about $50,000,000. You have not had to
tap that. Is that correct?
Secretary Azar. I am sorry. I am informed that is correct.
Mr. Cole. Okay.
Secretary Azar. I apologize.
Mr. Cole. And the reason why I asked, I was very pleased to
see you put it in again. And just for the record to
reemphasize, the idea was if we didn't have to use it, we would
carry it over. So, you know, hopefully, God willing and the
creek don't rise, if you won't have to use that money this
Fiscal Year, that would be available. Hopefully then that would
grow. And the idea was just to have a little bit of a savings
account and to give you flexibility in a real crisis situation.
The second thing was, I wasn't so fortunate to get one of
my ideas readopted, but I want to ask you about it, and it is
graduate medical education. We set aside $25,000,000 last year
with the idea of encouraging this competitive grant situation.
States that have a shortage of physicians, particularly in
rural, underserved areas, to try and encourage them. So far I
don't think you have issued any guidelines on how the States
could actually compete for that. Do you happen to know the
status of that right now?
Secretary Azar. I don't, but we will get you right away.
[The information follows:]
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Mr. Cole. I would appreciate that because I----
Secretary Azar. I apologize. I had not heard about that
particular program.
Mr. Cole. That is what I am afraid of, that this will slip
through. And, frankly, we will have a budget deal at some time
and then we will see what is available and where we are really
at in this. But that is one that particularly underserved rural
areas can really benefit from.
Finally, I want to--well, not finally. I am going to
squeeze in as much as I can. I wanted to really thank you on
Head Start. Again, I know you had to make really, really tough
budget choices. There are some of the other early childhood
education things that I would have liked to have seen. But I
think my colleagues, Mr. Graves and Mr. Harris, make a good
point. You are dealing from the budget that Congress has given
you. Our real problem is, of course, when set said that budget
out, the idea was it would be serious entitlement reform. We
set up a committee to do that, and this alternative was to be
so egregious that it would actually force Congress to deal with
where the real drivers of the debt is.
For the record, it is worth noting that non-defense
discretionary spending in Fiscal Year 2019 is less than it was
in Fiscal Year 2010. And defense and OCO spending in 2019 are
less than they were if you combine the two in 2010. So on the
discretionary side of the budget, we have actually done pretty
well.
The failure, and there are plenty of people to answer for
this on both sides of the aisle and on both ends of
Pennsylvania Avenue, is the failure to deal with entitlement
spending, you know. And I know you have been trying to wrestle
with that as best you can, and I appreciate that. But we won't
get to reasonable budget levels until we do that, until we
really get serious. And I know I have talked with the
Administration and the last Administration about that, and I
would urge you to do what you can to move us in that direction.
With that, Madam Chair, I will stay within 3 minutes and
yield back.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. Thank you, Madam Chair. I want to go back to our
discussion about treatment. One of the statistics you have
cited repeatedly today is the good news that naloxone has gone
up 123 percent. And certainly every single life saved is one
worth saving, and we are glad that Narcan or naloxone was
there. But you have to agree, I would think, Mr. Secretary,
that that is like saying we have gone up 123 percent in using
defibrillators to stop heart attacks, to revive patients having
a heart attacks. And without a treatment, without investing in
prevention, that Narcan alone does nothing to stem this crisis.
And I hope you will reconsider what you are doing here with
these cuts to Medicaid, that you are taking the most effective
way we have that millions of Americans rely on to get
treatment, and sort of cavalierly saying it is going to be up
to the States. The reason that decision is going to the States
is because you know caps will be imposed that your own budget
estimates will be at one-and-a-half or a little under
$1,000,000,000,000. That is not the way we treat a public
health crisis with urgency, and it belies the very national
emergency label that this Administration put on the opioid
crisis in March of 2017.
I hope you will think about these families at home, and I
hope you that you will reconsider this. And I hope that the
President or whoever talked the President into reversing his
promises to the American people, one, that he would address
this crisis, and, two, that he would not cut Medicaid, will
realize that he is turning his back on people who need help. We
are not meeting the treatment needs now. Medicaid is one of the
very best ways that people can access treatment, and I find
this an extremely disturbing part of this budget. And I know
the hallmark of this Administration is not consistency, but
this particular opioid crisis is too important to turn our
backs on people who are looking for treatment. Thank you.
Ms. DeLauro. Congressman Graves.
Mr. Graves. Thank you. Mr. Secretary, thank you again. A
lot of talk today about your policy as it relates to Title 10
and abortion. In your opinion, this new policy, will it result
in more life or less?
Secretary Azar. I believe that it will result in more life
and better life. It will result in more high-quality,
comprehensive family planning services to those who are
currently underserved or underserved, and it will ensure the
integrity of what Congress put in place, which is that the
taxpayer money should not be used to support programs in which
abortion is used as a method of family planning, even
indirectly through cross-subsidization, which, I think, as we
have heard from the types of examples and concerns that get
raised, almost prove the point that there is an acceptance that
we are cross-subsidizing the abortion enterprise. That doesn't
have to be the case. We can provide comprehensive Title 10
family planning services without subsidizing abortion.
Mr. Graves. So the policy promotes life, new life.
Secretary Azar. It promotes life.
Mr. Graves. Today versus what might have been in the past.
We should all be for that, and I applaud you and the
Administration for being one the most pro-life Administrations
that we have seen in many, many years. Quick question from a
science perspective. I am no doctor, as you and Dr. Harris and
others are. Does science currently recognize an unborn fetus as
life?
Secretary Azar. I like you am not a doctor, so I would
hesitate to ask a science question.
Mr. Graves. Okay.
Secretary Azar. This Administration takes the position that
the mission of HHS is to protect all life from the moment of
conception up until natural death.
Mr. Graves. Yeah, and I take the same position. And the
reason I am bringing that up is because I think there is a
large agreement here amongst this panel. It is just a matter of
in large agreement in life. I heard the chairwoman express her
concerns about suicide and the epidemic that it is, and that is
horrific, and it is the ending of a life. For me and Mr. Harris
and others, life is at conception for us, and anything that
ceases that is the taking of a life.
And so sometimes it is really about where do we place value
on life on that spectrum, and for me, I place that value very
early in a very safe spot, you know, a place in which I think
is very important. But I recognize the chair and others place
it at a different spot. And at some point, I hope we could be a
country that just values life in general from beginning to end,
its natural end, and that we could find some common ground on
that.
But let me thank you and the Administration for your
position and in taking a hard fast position on the promotion of
new life. Thank you, Mr. Secretary.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Oh my goodness. I mean, I hate to be
argumentative, but I would just say this. If you are for more
life and better life, then you should do something about these
family separations because you are ruining the lives of
thousands of children. Now, with that said, let me go on, get
back to this subject that we talked about before. Let me ask
you this. What does your research show to be consequences of
unintended pregnancies?
Secretary Azar. We would be happy to provide you with
research on the consequences of unintended pregnancies. But
like I said before, none of us want unintended pregnancies or
teen pregnancies. I think we all share that goal. We will
differ about methodology and programs and efficiency of them or
effectiveness of them. But I think there is no air between us
on that.
Ms. Frankel. Well, actually, I am actually happy to hear
that. So I just want to point out what I think is an unintended
consequence if you are of this position, which is there is a
new rule, I don't know it is going into effect or it is in
effect now, which is going to give a lot more leeway to
employers, to schools, to insurance companies, to opt out of
the ACA mandate of no co-pay for coverage. This is the rule
that allows some kind of moral or religious exception. So
wouldn't agree that that that rule will have the effect,
especially for poor women, of less access to birth control?
Secretary Azar. So this is the contraceptive mandate rules
which actually have gone final, just so you know.
Ms. Frankel. Okay. Thank you.
Secretary Azar. We believe that we can advance
simultaneously the goal of access for women to contraception
and still respect the right of conscience in healthcare and
employment. We believe this will have no impact on 99.9 percent
of women. The very few employers we expect will take us up on
this, I believe at most could affect 126,400 women. In
contrast, under the Affordable Care Act itself, 2,400,000 are
covered by grandfathered plans that don't have any
contraceptive mandate, but I don't hear anyone complaining
about the grandfathered plans there.
We don't prohibit employers from covering drugs. We simply
grant some of them who wanted an exception, and we have
actually taken any women who are at employers that take
advantage of that contraceptive mandate exception for
conscience and moral objection, they would be then in our Title
10 rule. We have actually made them eligible participants in
the Title 10 Program for free access to contraceptive care
there.
Ms. Frankel. Okay. Well, if that is true, let me just say
this. You are about to, and I really see this as a deliberate
effort on your part, Administration's part, to put Planned
Parenthood out of business, now covering $2,500,000 women. Oh,
I am done?
Ms. DeLauro. Yes.
Ms. Frankel. I am done. [Laughter.]
Ms. Frankel. I think the women of this country are going to
be done under your Administration, but thank you for being
here.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you very much, and I want to associate
again with the remarks of the gentleman from Georgia. I will
tell you as a doctor, one human being dies in every abortion.
One human being dies in every abortion. Look, I want to thank
you for the conscience protection rule. I mean, the Little
Sisters of the Poor should not have had to go to the Supreme
Court of the United States in order to get justice in this
country.
I mean, conceptualize this. The Little Sisters of the Poor,
you forced them to actually provide a medical service,
healthcare service--you can call contraception a healthcare
service--in contradiction, clear contradiction, to their
religious beliefs. I applaud the Administration for protecting
conscience. I would hope that everyone would.
With regards again, and I will just end. I want to applaud
the President for standing against the post-birth infanticide
that has been suggested by the New York law and by a Virginia
law that fortunately didn't pass. I would hope that Congress
gets a chance to vote on the Child Born Alive Act, and I would
hope every member of Congress would agree that a baby born
alive should actually be given a right to live. I would hope.
Let me just ask you, and I do want to mention just one
thing going through CMS, that we are dealing with CMS on is,
you know, approval for the use of oxygen for cluster headaches.
This is very interesting because I have had cluster headaches.
Oxygens work for me. In the setting where, you know, a small
group of patients has severe pain and we are in the middle of
an opioid crisis, why CMS drags its feet to provide coverage
for an alternate therapy because the therapy for cluster
headaches normally proceeds to opioids, it is such severe pain.
And yet oxygen exists, it works, and CMS won't cover it for
Medicare patients. If you could, you know, just scratch the
surface and look into that, I would appreciate it.
Finally, you have got the rebate rule, you know, for the
seniors, the recently-released rebate rule. Could you go
through how that is going to help our seniors?
Secretary Azar. It is going to help our seniors
immediately. What is happening now is these discounts and
rebates are going to middlemen, to the pharmacy benefit
managers, and when the patient shows up at the pharmacy, they
are paying off of the full freight price of the drug. If we can
get this through, and if you can help me get this rebate rule
through, we can bring $29,000,000,000 of rebates that are right
now going to PBMs, to our seniors when they walk in the
pharmacy starting January 1. And it will finally reverse this
incentive towards higher list prices.
We could see decreases, massive decreases, of list price on
some of the highly-discounted drug classes that we have in this
country at the point of sale. I think it is all good, and I
would love us to work together on a bipartisan basis to get
this done.
Mr. Harris. Could this help with the cost of insulin for--
--
Secretary Azar. This could help with classes like insulin
and others that are extremely highly-discounted products that
are 50, 60, 70 percent discounted to middlemen, but the patient
is not getting the benefit of it at the pharmacy.
Mr. Harris. Thank you very much. I yield back.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you. Secretary Azar, regarding
the immunization issue, my concern is that the hepatitis A, B,
and C often gets spread through needles, sharing of needles,
often are related to the opioid issue. And so that is why the
commissioner raised that issue. Secondly, one of the reasons
that we have access to legal abortions and safe abortions is
because so many women were dying when you didn't have access to
safe abortions. And so the decision was made that we wanted to
preserve life, not lose life unnecessarily.
Thirdly, I wanted to just bring your attention to something
that I kind of picked up: $55,900,000 to the REACH Program
because the REACH Program has been eliminated, but you never
answered Barbara Lee's question as to why. $44,000,000 has been
cut from the National Institute on Minority Health and
Disparities; $5,000,000 from the Office of Minority Health, and
an additional $1,000,000,000 plus to TANAF, which is relief to
families in welfare situations.
I guess the question here is that, from my perspective, it
doesn't seem that this budget here addresses the unique needs
of those in the poorest communities and in communities of
color. I distinctly remember the President saying to the black
community ``What have you got to lose?'' Well, according to
your budget, we have a lot to lose. I yield back.
Ms. DeLauro. Thank you. What we will do is to move to wrap
up, and let me ask the ranking member if he has any closing
remarks.
Mr. Cole. Thank you, Madam Chair. Mr. Secretary, I want to
thank you again for being here, being so generous with your
time. We ran a little bit late, but thank you for indulging us.
I want to thank you quite sincerely for the terrific job I
think you are doing for the country and the manner in which you
represent the Administration. We put a lot of knotty problems
at your feet or in your inbox. Dr. Harris and I were talking
about how pleased we are with some of the innovative policy
suggestions and provisions: this effort on drug pricing, the
effort to end HIV as an epidemic in this country, lots of other
things.
And I know, you know, you have done it within constrained
resources in the budget that the President has chosen to give
you, and I think those are all good things. There are a lot of
good things in here that I agree with. My hope is we arrive at
a budget so we don't end up giving you a CR. And so that is
above everybody's pay grade at this table unfortunately, but I
know we all work with you when that happy day arrives.
And, again, if we can ever be of assistance to you as you
go forward, please don't hesitate to call on this committee. We
may have differences in a number of areas, and there may be
differences in some individual members' points of view and your
own or the Administration's. But I think everybody recognizes
the talent and the integrity that you bring to the job and the
enormous service that, in my view, you are rendering to the
American people as you do it, I know at probably considerable
sacrifice. So thanks for taking on the burden. I look forward
to working with you going forward. Yield back, Madam Chair.
Ms. DeLauro. Thank you very much, and thank you, Mr.
Secretary, for being here. We are trying to meet your need to
be out of here, so I will try to be succinct in my final
remarks. But I do appreciate your being here and work that you
are doing.
I think that the notion that where we have to go is
entitlement reform, misses the big picture. It would appear
that we are looking at a $2,000,000,000,000 cut in Medicare and
Medicaid, and at the same time we have done $2,000,000,000,000
in tax cuts for the richest people in this Nation. It is
amazing how they equate with one another.
And in this budget, we are taking a look at a
$12,700,000,000,000 cut to HHS, 14 percent. NIH,
$5,200,000,000. HRSA, $1,000,000,000. CDC, $750,000,000; LIHEAP
eliminated. We didn't get to talk about the anti-microbials,
and my colleague, Mr. Moolenaar is gone. But we are looking
there at $120,000,000 cut at HHS for anti-microbial resistance.
Incredible. Community Services Block Grant is eliminated.
Medicare, $845,000,000,000 cut. SNAP, a $20,000,000,000 cut.
And, you know, I would also say this, and I read down that
list, you know, here what we have to do is that you can't talk
about voting for life and pick and choose those issues that you
believe are going to promote life. I would submit to you that
the NIH, HRSA, CDC, LIHEAP, anti-microbial resistance,
Community Services Block Grant, Medicare, SNAP, these are life
issues. And some of my colleagues just like to pick and choose
those that suit their own ideologies.
We don't have that luxury in this body. We have to consider
life issues across the board, and that extends to what we did
at the border. And my hope is that in that regard, Mr.
Secretary, that you will rescind that MOU agreement with ICE
and look at trying to assist people in getting a placement, a
child in a safe environment. We all want this.
And I am going to close with where I started. This is an
Administration that is not shy about spending, a
$1,500,000,000,000 tax law, rigged for corporations and the
richest Americans. This Administration opposes spending when it
aids the vulnerable, when it promotes the common good, or when
it makes opportunity real for people. That cannot be the
construct. I don't believe you believe that, but my hope is
that you would make the same kind of fights that we are to
protect the American people, their health and their welfare.
And let me draw this committee hearing to a close. Thank
you.
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Tuesday, March 26, 2019.
DEPARTMENT OF EDUCATION BUDGET REQUEST FOR FISCAL YEAR 2020
WITNESS
HON. BETSY DEVOS, SECRETARY, U.S. DEPARTMENT OF EDUCATION
Chairwoman's Opening Statement
Ms. DeLauro. Good morning. The Subcommittee will come to
order.
Good morning, Madam Secretary, and let me just welcome you
to the Subcommittee for what is our second budget hearing of
the year. And today we are examining the President's proposed
Budget for 2020 for the Department of Education.
You have heard me say this before so it is not new. I
believe that this Budget is cruel, and I believe that it is
reckless. I believe that it will hurt the middle class,
working, low-income families that most need our help. In fact,
the proposed Budget cuts nearly $9 billion from the Department
of Education, including the proposed $2 billion Pell Grant
rescission.
And meanwhile, it proposes a new $5 billion annual tax
scheme which is unregulated, unaccountable, in an effort to
fund private school voucher programs. That would undermine our
public schools. It would allow an unaccountability in that use
of taxpayers' funds. With provisions like that, I really am
left with a very serious question for you. How can you support
this Budget? I mean that genuinely. You are the Secretary of
the Department of Education. How can you support, and maybe
even take pride or boast about taking 10 percent, or more than
12 percent if you do count the Pell rescission, away from
teachers and away from students?
PRIOR HEARINGS ON SERVICING AND PROPRIETARY SCHOOLS
For me it is beyond the pale. You should know that
education is a top priority for everyone on this Subcommittee,
and today is our third hearing on programs related to the
Department of Education. First we scrutinized the $1.7 billion
the Subcommittee provides for loan servicing. We heard examples
of servicers putting students on the path to default by
misinforming them about their repayment options and the
Department's failures to hold servicers accountable.
We heard from the Office of the Inspector General, who
cited, in their recent audit report, about how the Federal
Student Aid, FSA, was asleep at the wheel in its oversight of
servicers and even relied on the memories of its own employees
for tracking recurring noncompliance with Federal law.
Sixty-one percent of all monitoring reports showed evidence
of servicer failures. FSA has said that it has, or will
implement, all of the IG's recommendations, and yet FSA has yet
to fully implement past recommendations from the Government
Accountability Office.
And while the Next Gen initiative has promise, the
Department needs to be taking into consideration the compliance
of contractors upholding the law, which is not currently the
case. In that regard, I find it alarming that within 3 months
of your confirmation you withdrew the Mitchell and King memos,
which would have addressed many of the system's current
failures.
Second, we held an oversight hearing on predatory for-
profit colleges. They enroll 9 percent of all students in
postsecondary education and yet for-profit colleges account for
34 percent of all student loan defaults. Their business model
relies on exploiting Federal financial aid, like Pell Grants.
These schools target the most vulnerable and our veterans. We
heard from a student veteran who was left with a worthless
degree and $100,000 in debt after being lured into thinking
that Pell and GI Bill would cover his costs.
Meanwhile, the Department is working to roll back critical
protection for students and taxpayers, specifically, the
Gainful Employment and Borrower Defense rules, and the
Department is currently working on efforts that could roll back
even more.
Before we get into the specifics of the Department of
Education Budget, let me say that the President's Budget
guiding principle, one that bolsters military spending while
sharply cutting funding in education and training, while
claiming that we simply cannot afford it, is an argument that I
wholeheartedly reject, and I am not alone.
NON-DEFENSE DISCRETIONARY SPENDING
Earlier this year, more than 300 military leaders wrote to
Congress asking for balanced investments in both defense and
non-defense spending. They say, and I quote, ``Non-defense
discretionary programs play a variety of roles in supporting
and enhancing our national security by contributing directly to
health, education, and development of our youngest
generation.'' They reached this conclusion because 71 percent
of young Americans cannot qualify for military service because
they are, and I quote again, ``too poorly educated, medically
or physically unfit, or have a disqualifying record of crime or
drug abuse,'' end quote.
I do appreciate that the President's Budget requests new
funding for science, technology, engineering, mathematics, STEM
programs. The carve-out initiated by this Subcommittee in the
Education Innovation and Research program, that is a commitment
that I share.
And while I am pleased that the President's budget request
abandons a previous proposal to shift $500 million from
neighborhood public schools, where 90 percent of our children
attend, to private school, I am disappointed that the
Administration is proposing a new $5 billion-a-year tax scheme.
PROPOSED BUDGET CUTS
Data we have strongly suggests that vouchers do not work,
and Institute of Education Sciences' gold-standard evaluation
of Washington, D.C., the only federally funded voucher program,
found that vouchers negatively impacted student achievement.
And I might add that you are also cutting funding for IES by 15
percent. This is the entity that your own budget documents say,
quote, ``provides valuable insight into how public dollars
could be better used to improve student outcomes.''
The three education budgets from this Administration have
proposed the largest cuts to education funding in four decades.
That is since the department was created in 1979. Madam
Secretary, I just say--I have to say, I mean, it is--shame on
you. This is your watch. You are Secretary of the Department of
Education. In your testimony you talk about freedom, but what
is happening here is that you and the President are proposing
to abandon middle-class families and those families who are in
need. This is not freedom.
Yet I will note the Administration is not shy about
spending and using government when it comes to benefitting
corporations and the richest, such as the $1.5 trillion tax
scam and crop insurance subsidies, which can go to the richest
of the rich since there are no eligibility caps. No, the
Administration only opposes spending when it aids the
vulnerable, when it promotes the common good, or when it makes
opportunity real for people.
Many of these cuts were rejected under a Republican
Congress for 2 years, yet here they are again. You have
eliminated 30 programs, totaling $7 billion, and you have cut
another $1 billion, eliminating the Impact Aid payments for
Federal properties, Special Olympics, after-school grants that
help people with disabilities find jobs, eliminating literacy
programs that build the foundation for a lifetime of learning,
and the main program, Title II, that helps to attract and
retain high-quality and diverse leaders while directing scarce
education resources to unproven, unaccountable private entities
through a new, quote, ``teacher voucher proposal,'' eliminating
a temporary fix for rejected borrowers who thought they
qualified for Public Service Loan Forgiveness, and slashing
adult education, Federal Work-Study, TRIO, and GEAR UP.
On the mandatory side that is outside of this Committee's
jurisdiction, the Budget again proposes to eliminate subsidized
student loans and the Public Service Loan Forgiveness program,
worsening the student debt crisis. In a rare move, the Trump
administration's own Department of Defense opposed the House
Republicans' Higher Education Act reauthorization bill last
Congress because it, too, eliminated PSLF, stating, and I
quote, ``DOD opposes this legislation because the Public
Service Loan Forgiveness program has been an important
recruitment and retention tool for the military to compete with
the civilian sector.''
SCHOOL SAFETY AND STUDENT SUPPORT AND ACADEMIC ENRICHMENT GRANTS
And even a boost to School Safety National Activities is
not what it seems. It seeks to make up for the proposed
elimination of $1.2 billion Student Support and Academic
Enrichment grants, which includes a set-aside for school
safety. The SSAE grants support mental health counselors and
services in addition to providing a well-rounded education by
providing exposure to music and to the arts. The new proposal
is still a poorly designed cut that does nothing to look at the
role of guns in school shootings, just like the Federal
Commission on School Safety failed to do as well.
At this point, let me just say that I also continue to
support--I continue to oppose your indefensible silence which
leaves the door open to states using Federal dollars to arm
teachers versus current law. Congress never contemplated that
the SSAE grants would be used for the purchase of firearms. In
fact, Congress denounced the presence of firearms in schools in
the Elementary and Secondary Education Act, Section 4102(5)(B),
which promotes programs that foster, quote, ``the creation and
the maintenance of a school environment free of weapons.'' And
the Congress reiterated our opposition to taxpayer-funded guns
in schools in the Stop Violence--Stop School Violence Act in
2018, in the omnibus. It explicitly prohibits program funds
from being used for the purchase of firearms or firearms
training.
I fought hard on this issue in last year's funding bill,
advocating that we make clear that Congress never contemplated
that such flexibility would allow for the purchase of firearms.
My proposal was simple--follow current law. But we could not
reach consensus, but I will keep up the fight.
CHARTER SCHOOL OVERSIGHT
This year, we are going to have an opportunity to review
charter schools with respect to accountability and
effectiveness. The OIG has raised some issues that we must
examine, including findings that states mismanaged charter
school closures and that the Department failed to provide
adequate guidance or oversight on the issue. We are an
appropriations committee, and we have appropriated serious
money, more than $400 million last year alone. We need to
conduct oversight.
ADMINISTRATION'S APPROACH TO EDUCATION FUNDING
The Trump administration would do well to take a page out
of the oath that doctors take, their first principle, which is
``do no harm.'' And yet this budget inflicts harm. That is why
I raise, again, I do not understand how you can support this
budget and be the Secretary of Education. This budget
underfunds education at every turn, from early childhood
education, K-12 education, postsecondary education, through
workforce training. Even programs you claim to support are
simply programs that you spare. Title I, IDEA--these are core
programs. They are level funded. That is not sufficient.
We have promised, and we owe our students and teachers
more, and I am not alone in the criticism here. Others--
National Center for Learning Disabilities, National Association
of Federally Impacted Schools, the School Superintendents
Association, Council for the Opportunity in Education, Council
for Education Funding, and others--I would hope that this would
be a real concern to you as well.
I look forward to further discussion of your budget request
and the other policy areas that are under your jurisdiction.
First let me turn the gavel--not the gavel. No, I am not
going to do that.
Mr. Cole. That is okay.
Ms. DeLauro. No. Not on my watch. But first let me turn to
my colleague and my friend, the ranking member from Oklahoma,
Congressman Cole.
Ranking Member's Opening Statement
Mr. Cole. I want to thank my friend, the chair, and, you
know, if you ever want to rethink that offer that is okay by
me. I just want you to know. We would step up and cooperate.
But, good morning, Madam Secretary. I look forward to
hearing your testimony today.
As a former educator myself I understand how important it
is for our children to have access to quality education, and as
the parent of a teacher who works with kids with special
challenges, I understand how important the charge that we have
given you is.
Without question, education is one of the most important
building blocks for success, and access to quality learning
directly impacts lifelong development and unlocks each
individual's potential. And I commend you for your efforts in
this arena, not only as Secretary but as a selfless advocate
for reform in the years before you assumed your current
position.
POSITIVE ELEMENTS OF PROPOSED BUDGET
I was pleased to see that your budget request continues to
prioritize resources to certain populations of children who
need additional support. I appreciate the continued investment
in these programs, such as for children with special needs and
disabilities, for Indian education and rural education, and to
support English learners.
I was also pleased to see your emphasis on charter schools,
school safety, and other initiatives that support innovation,
best practices, and school choice, and I continue to be a
strong supporter of career and technical education. I am proud
that my home state of Oklahoma is leading the way in innovative
models for delivering cutting-edge skills that can lead to
good-paying, rewarding careers for students who do not wish to
pursue a 4-year liberal arts degree. I thank you for your
support of those programs as well.
PROPOSED CUTS AND ELIMINATIONS
Madam Secretary, your Budget again proposes to eliminate,
consolidate, or change over two dozen programs. Many of those
proposals make sense in the context of a reauthorization or
consolidation, but I do believe others are somewhat short-
sighted. I am particularly concerned about the proposal to move
the successful TRIO program from a competitive grant model to a
formula grant to states.
I am also concerned about the proposal to consolidate
several Minority-Serving Institutions' funding into a single
stream. As you know, these institutions serve distinct
populations with different needs and I am not certain that such
a change makes sense, but I look forward to hearing your
discussion of it and, of course, your testimony.
Finally, I think that it may be time, in our country
especially we need more understanding of civics and our shared
history, so I was disappointed that, as a historian, to see the
American History and Civics Education line proposed for
termination. I know that you were faced with a difficult
challenge of making all the pieces fit into a tight budget, so
I do understand the need for some program terminations and
consolidations. However, I caution my fellow subcommittee
members that we need to take a hard look at the impact that
some of these cuts will have on our own local school districts
and students, and I am sure we will have a robust conversation
to that point.
ROLE OF MANDATORY SPENDING IN CONSTRAINING BUDGET
Since both my friend, the chairman--the chair, and, Madam
Secretary, you talked about the budget deficit and the wider
budget, I want to take--I am going to go off-script here for a
minute and talk just a little bit about that, because I think
this is one where we probably come from different perspectives,
but I think the numbers will drive us to similar conclusions.
Not widely known or appreciated, even in Congress, but, you
know, because we know the budget has two big components. It has
got a discretionary component and it has got an entitlement or
mandatory spending component. The discretionary component is
about 30 percent of the whole budget. The mandatory part is
about 70 percent.
This Congress is actually--if you look and broke down that
30 percent into two components, more than half of it is
actually the defense budget and oversees contingency
operations. Congress is actually spending less money on defense
and less money on overseas military operations than it was in
fiscal year 2010, in this year of fiscal year 2019. So that
suggests--frankly, I actually agree with the President's effort
to strengthen defense, and we live in a very dangerous world,
but we are not overspending in this area by any stretch of the
imagination.
I would also remind my colleagues the same thing is true
with non-defense. We are actually spending less in all these
programs, everything from Meals on Wheels to Head Start to the
education programs that you are in charge of than we were in
fiscal year 2010. And when you take into account inflation that
means we are spending less. So actually, on the discretionary
side of the budget, Congress has done a pretty good job of
holding spending flat and actually effectively reducing it as a
result of inflation.
So where is the deficit coming from? Well, it is pretty
easy. It is coming from the other side of the budget. In fiscal
year 2010, we were spending roughly $1.9 trillion in mandatory
programs. This year it will be close to $2.6 trillion. Then
throw in interest on the national debt and you move from about
$190 billion to a little bit over 300, I think about $320
billion.
So until we get serious about the non-discretionary side of
the budget, you know, that is--we are not going to ever have a
balanced budget and we are going to continue to see, as the
baby boomer generation retires and lives longer than any
previous generation, you know, a massive increase in spending
on that side of the budget.
Now it gives me no pleasure to say this, but neither the
current President or the last President addressed this. The
last person that tried to do anything about it was actually
President Bush, who proposed Social Security reform back in
2005, and it was summarily shut down by a less-than-courageous
Congress, on both sides of the aisle, I might say.
But we are going to have revisit those kinds of questions
if we are going to actually get there, and I think that is
important in the context of the programs that we are discussing
today, because much of the pressure that you face, and that
your fellow Cabinet secretaries face, is because neither
Congress nor the executive branch under both parties has been
willing to look at the other side of the budget and do the
things that are necessary over there to bring us toward
balance.
REACHING COMPROMISE ON EDUCATION FUNDING
I know that today we will have a very robust discussion,
and we will come at it from different points of view and that
is okay. I always like to point out to my good friend, the
Chair, that in the previous 4 years we started at different
points, but 4 years in a row we ended up voting for the final
bill, and in the last 2 years President Trump signed that bill.
So I think we will probably, you know, come at this from
different points of view again. That is okay. That is what the
legislative process is supposed to be about. But my goal will
be, at the end of the day, to produce a product that my friends
and I, on both sides of the aisle, can vote for, and that the
President can sign with a great deal of pride. And I suspect
that will call for a certain amount of compromise along the
way. That is the way the appropriations process has always
worked, and I suspect that is the way it will work again.
And with that, Madam Chairman, I will yield back my time
but again, I just want to thank the Secretary for being here
and thank you for holding the hearing.
Ms. DeLauro. Thank you very much.
And now it gives me pleasure to turn to our distinguished
Chair of the full Committee, Chairwoman Nita Lowey, for any
comments that she may have.
Mrs. Lowey.
Full Committee Chairwoman's Opening Statement
The Chairwoman. And I, too, want to thank Chairman DeLauro,
Ranking Member Cole for holding this hearing, and I want to
join them in welcoming you, Secretary DeVos, before the
Subcommittee.
We are not far into appropriations hearings season, but
frankly, I am tired of hearing about the Administration's so-
called tough choices. Secretary DeVos, your Budget request does
not reflect the reality in classrooms across the country, and
if enacted would cause structural damage to communities across
the nation.
Since you have taken over as Education Secretary, children
continue to be at risk of gun violence in their classrooms,
sexual assault continues to climb on college campuses, student
debt dictates almost every college graduate's professional
choices. Yet in your testimony you criticize a Republican-
controlled Congress for increasing your agency's resources. You
are criticizing your agency's resources.
This Budget relies on anecdotal evidence and false concepts
that you call choice and freedom. You propose complete
elimination of 21st Century Community Learning Centers, which
would leave more than 87,000 New York students without safe,
high-quality, after-school enrichment and significant cuts to
K-12 funding, and even the Helen Keller National Center for
Deaf-Blind Youths and Adults.
I will go on but I can't help but wonder--we are both
parents and I wonder if you have visited these centers and you
know what they are doing. I visit, by the way, the after-school
programs all the time, and to see those children getting the
extra support frankly makes me feel great. I would increase
them even more than they are now. So I am really puzzled about
that, among others.
While gutting these investments, the Administration's
budget calls for a new tax credit to support private school
vouchers, even though many of these schools are unequipped to
accommodate students with disabilities and English language
learners. Not only do you ignore racial and socioeconomic
disparities in our education system, you propose policies
proven to increase the divide. By cutting the Minority Science
and Engineering Improvement Program by $1,500,000 and the Child
Care Access Means Parents in School Program by 70 percent, your
budget would actually decrease the diversity of the STEM field
and exclude parents with financial need from access to a higher
education.
A couple of words about that. Maybe you noticed recently--I
am a graduate of the Bronx High School of Science, and you
notice there have been many articles about the lack of
diversity at Bronx Science or Stuyvesant High School in New
York City. I would be interested in knowing if you have any
solution to that. I think people deserve to have the
opportunity and I would look at after-school programs or other
concentrations so you can help these students, so you can
really say--and when I visit all these schools I say, ``You
have the opportunity to reach for the stars.'' But we are not
providing them with this kind of support, it seems to me we are
really, frankly, going off on tangents here, there, increasing
dollars, but not looking at the investments that are going to
help so many of these kids.
You propose an increase of $105 million for school safety
national activities with the hopes of implementing safety
practices that are proven to make schools less safe. The
Department of Education's budget request is just another
example of this Administration's disregard for facts and
disconnect from reality. With this budget request I am
receiving President Trump's message loud and clear--fund the
wall with money from our children's schools. I do hope your
testimony and response to our questions will address these deep
concerns.
And thank you. Thank you, Madam Chair.
Introduction of Secretary DeVos
Ms. DeLauro. Thank you very much. After the Secretary has
completed her testimony, which we will get to in a moment, we
will proceed to 5-minute rounds for questions. I will recognize
Members in order of seniority at the time of gaveling in the
hearing. Then I will call on Members in order of their
appearance.
Madam Secretary, we will be happy to place your full
testimony into the record.
If you would be kind enough to summarize your statement, I
want to make sure that we leave enough time for everyone's
questions.
So please begin when you are ready.
Opening Statement
Secretary DeVos. Chairwoman DeLauro, Ranking Member Cole,
Chairwoman Lowey, and members of the Subcommittee, thank you
for the opportunity to testify on the President's fiscal year
2020 Budget.
I thought it would be useful to begin by recalling
Congress' commitment when it created the U.S. Department of
Education 40 years ago. Then, Congress vowed that the move
would, quote, ``not increase the authority of the Federal
Government over education or diminish the responsibility for
education which is reserved to the states,'' and, I will add,
communities and parents.
This Budget reflects a commitment to that sentiment. It
also recognizes who actually funds the government's budget--
American taxpayers. And so we propose Congress spend their
money wisely, efficiently, and with restraint.
The President's fiscal year 2020 Budget would reduce
overall funding for department programs by $7.1 billion, which
is a 10 percent decrease from 2019's appropriated level. This
reduction is similar to last year's request and the year before
that as well.
I acknowledge that you rejected those recommendations. I
also acknowledge that it is easier to keep spending, to keep
saying yes, and to keep saddling tomorrow's generations with
today's growing debt. But as it has been said, the government
will run out of other people's money.
Over the past 40 years, Federal taxpayer spending on
education has increased about 180 percent, amounting to over
$1.2 trillion, cumulatively. And yet we are still 24th in
reading, 25th in science, and 40th in math, when compared to
the rest of the world. Doing the same thing, and more of it,
will not bring about new results.
EDUCATION FREEDOM SCHOLARSHIPS
I propose a different approach--freedom. This budget
focuses on freedom for teachers, freedom for parents, freedom
for all students. A great education should not be determined by
where you live or by who you know, and it should not be
determined by family income. And education should not be an
old-school, industrialized, one-size-fits-all approach. Every
student is unique, and everyone learns differently. Every child
should be free to learn where and how it works for them, where
and how it unlocks their potential.
That is why the President's 2020 Budget proposes a historic
investment in America's students, Education Freedom
Scholarships. Our bold proposal will offer a dollar-for-dollar
federal income tax credit for voluntary contributions to
501(c)(3) nonprofit organizations that provide scholarships to
school students, not school buildings. These students, their
families, teachers, schools, and states can choose to
participate in the program, or they can elect not to
participate. It is a choice.
And since the proposal relies entirely on voluntary
contributions to nonprofit organizations, it will not take a
single dollar from local public school teachers or public
school students. Indeed, our budget maintains current levels of
funding for Title I and IDEA.
Something else. Education Freedom Scholarships are not only
for students who want to attend private schools. In fact, some
states may choose to design scholarships for public school
options, such as apprenticeships or transportation to a
different public school. States have the opportunity to be
really imaginative and to serve the unique needs of their
students.
We don't have to look far to see that education freedom
works. Thanks to a menu of options and the D.C. Opportunity
Scholarship Program, embraced by teachers, parents, and
students alike, more than half of students in the district
attend schools other than their assigned one, and there is
still significant unmet demand. We propose Congress double the
D.C. Program's funding to $30 million to meet those students'
needs.
This Administration believes students of all ages should be
free to pursue multiple pathways to higher education and
successful careers. That is why this Budget proposes to expand
use of Pell Grants for quality short-term programs. It also
invests in career and technical education and streamlines
student loan repayment. The latter is urgently necessary,
because today Federal Student Aid holds $1.5 trillion in
outstanding loans, more than total auto debt and credit card
debt, and 43 percent of those loans are either in default, more
than 30 days delinquent, or are negatively amortized, and
taxpayers are on the hook for it all.
This Budget consolidates numerous repayment plans and
raises the cap on a borrower's monthly payment to 12.5 percent
of discretionary income. This is one way the Federal Government
can become a more responsible lender. Policies should not
entice students into greater debt, nor should they put taxpayer
dollars at greater risk.
TEACHER PROFESSIONAL DEVELOPMENT
Education freedom is not just for parents and students.
Teachers need greater freedom as well. We seek to empower
America's teachers and elevate their profession via this budget
with a new total investment of $370 million.
I regularly meet with a number of excellent teachers who
tell me they would like to choose their own professional
development and customize it for their needs. To that end, the
Budget requests an increase of $170 million to focus on
development that is controlled by teachers, not dictated by the
district office. These are teacher vouchers and they treat
teachers as the professionals they are.
Teachers also tell me about the value of mentors or
residency opportunities, so we are requesting $200 million to
enable new teachers more opportunities to learn from the best.
SCHOOL SAFETY
It is also essential that teachers and students be safe at
school. In the wake of tragic acts of school violence in our
country, President Trump asked me to lead a Federal Commission
on School Safety. To support the commission's recommendations,
we request $200 million to help communities develop their own
school emergency plans and to focus on counseling and healthy
behaviors for their students.
In the end, budgets are about priorities. Ours are
students, parents, teachers, and taxpayers. If our country is
to remain secure, strong, prosperous, and free, we need
students of all ages who are prepared to pursue successful
careers and lead meaningful lives.
Thank you for this opportunity to testify. I look forward
to your questions.
[The prepared statement and biography of Secretary DeVos
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
follows:]
OVERSIGHT OF CHARTER SCHOOLS PROGRAM
Ms. DeLauro. Thank you very much, Madam Secretary.
In a budget that, again, has been, in my view, full of
cruel cuts to education programs, it baffles me that you found
room for a $60 million increase to the Charter School Program,
or CSP, especially when you consider recent reports of waste
and abuse in that program. Just this morning, the Washington
Post published reports that up to $1 billion in CSP funding has
been wasted on charter schools that never opened or
precipitously closed due to mismanagement.
In September, the OIG found that the Department did not
provide effective oversight of processes performed by the
states that receive CSP funding when their charter schools
close. In response to the OIG's findings, the Department
stated, and I quote, ``The fundamental principle for guiding
states' implementation of charter schools is to provide charter
schools increased levels of autonomy so they may innovate in
exchange for in increased flexibility in implementing
applicable requirements,'' end quote. In other words, it sounds
like you are saying, quote, ``This is not our job.''
Can you explain how you think stopping known waste, fraud,
and abuse in the Charter School Program is not the Department's
job? Why cannot states both follow Federal laws and promote
innovation when it comes to charter schools?
Secretary DeVos. Chairwoman, we are very aware of the
issues that this report raised, and it actually covers
practices that long predate this Administration. The fact is,
Congress took action to address these concerns, and it was
prior to the reauthorization of ESEA, we are very keen to
ensure that the concerns raised are addressed, and we are also
looking to this body for more flexibility for charters to be
able to authorize the schools that are working for--that----
Ms. DeLauro. Madam Secretary, it would appear to me that
based on this report and other reports that the charter schools
have enormous flexibility. And there seems to be no one who is
overseeing how that flexibility translates into the use of
Federal dollars. You are also now proposing this increase of
$60 million--we are looking at $500 million--for entities that
they are just going their way. Let's be flexible. Let's let
them do what they want. They don't open. They close. No one has
concerns about any of the students.
That is irresponsible in terms of your job with regard to
oversight, and as it has to do with Federal taxpayers' dollars,
that is the charge of this Subcommittee, to make sure that
those monies are being monitored and that you are accountable,
and not asleep at the wheel for what is happening with charter
schools in this country. We have spent a lot of time and money
in this effort.
MANAGEMENT OF THE DEPARTMENT OF EDUCATION
Let me also talk to you about a K-12 education office.
Children and families count on your support to deal with the
ESSA. I am disappointed to hear reports about your
mismanagement of the Office of Elementary and Secondary
Education. In 2016, it would appear you merged OESE and the
Office of Innovation Improvement that had 328 employees. We are
down to OESE, has just 260 employees, nearly 21 percent staff
reduction.
There are a lot of press reports out there, and I quote,
``describe long waits for answers to technical questions,
hiring staffers, lack of overall support, technical know-how,
including when it comes to improving schools.''
Do you see it as your responsibility to help states
implement ESSA? What is your message to states complaining that
the lights are off at your Department of Education? I might
also add, I believe there was a contract awarded to look at
morale in the department.
CHARTER SCHOOLS
Secretary DeVos. Well, Chairman, let me just comment on
your previous question, and I would just say, with regard to
charter schools what we need is more charter schools and more
options for children, not less. And states are proving, time
and again, that there are wonderful options that are being
developed for children of every learning type and interest, and
we need more of them, not less.
And when you have experimentation you are always going to
have schools that don't make it, and that is exactly as what
should happen. They should close, and let's also look at how
many traditional public schools have closed because they are
not doing well for their students.
Charter schools are a great option for thousands and
thousands of students, and the demand for more of them remains
very high. So we need more of them, not fewer.
Ms. DeLauro. But----
MANAGEMENT OF DEPARTMENT
Secretary DeVos. With regard to the Department and our
organization there, we have undertaken an effort to organize
around ability to be cohesive and effective in the work that we
do for all of K-12 schools, and bringing in innovation and
ingenuity into elementary and secondary education needs to
happen, no matter when the education is taking place.
I am very proud of the work of the Department and the
Office of Elementary and Secondary Education in the
implementation of the Every Student Succeeds Act.
Ms. DeLauro. Madam Secretary----
Secretary DeVos. They have been doing a great job. We have
approved all of the----
CHARTER SCHOOLS
Ms. DeLauro. Madam Secretary, let me just say that you are
taking public dollars to open charter schools and you are
taking money away from the public schools, which is where 90
percent of our children are.
Secretary DeVos. Madam Chairwoman----
Ms. DeLauro. And what are you doing is short-changing----
Secretary DeVos [continuing]. Charter schools are public
schools.
Ms. DeLauro [continuing]. And I would just say, no, some of
them, if you take a look at the data and the information, we
are looking at the transference to private entities, private
corporate boards. They open, they close, they don't--some of
them don't even open, and we are spending good money after bad.
And in addition to that, you don't seem to think that there is
a necessity to oversee it, to claim any accountability for it,
that God's in his heaven, all is right with the world. It is
not true. We are wasting----
Secretary DeVos. That is a mischaracterization----
Ms. DeLauro [continuing]. Money there.
Secretary DeVos [continuing]. And charter schools are
public schools.
Ms. DeLauro. My time is up.
Mr. Cole.
SUCCESSES WITH CHARTER SCHOOLS
Mr. Cole. Thank you, Madam Chair.
If we may, I actually want to pick up on that, because I
want to ask you a little bit more about it. I am a big
supporter of charter schools, and we have had, working with
your office, frankly, substantial increases. So if you would,
why don't you report on some of the success that you have had
in this area?
Secretary DeVos. Well, thank you Chairman, or Ranking
Member Cole. Thank you for the question to elaborate a little
bit more on the value of charter schools to students today.
We are seeing, across the country, I think with the
exception of four states, charter schools have been able to
grow up in 46 out of the 50 states, and for students it has
been a wonderful alternative. We know that there are tens of
thousands, if not hundreds of thousands of students who want to
have an alternative to their assigned public school, and
charter schools often provide that opportunity.
I have visited all types of schools, and it doesn't really
matter how a school is organized, to me. What matters is
whether the students going to that school find the right fit
for themselves and are able to pursue their learning and
education in a way that really draws the best out of them. We
need to continue to build on that and that is why this budget
proposes an expansion in the commitment of funding to charter
schools, to continue to support high-quality options for
students.
Every state has high accountability provisions, varying
accountability provisions for their charter schools, and do a
good job, I think, of overseeing them at that level. We also
do, at the Department of Education. But the most important
point of accountability are the parents who have chosen to send
their child to whatever that charter school is. And we are
going to continue to see great results from students who are
able to pursue their education in those settings.
Mr. Cole. Well, I appreciate your work in this regard. I,
too, visit schools pretty frequently, public and charter. I
have got great public schools. I have got some great charter
schools. And I think you are right about allowing parents to
choose the best path and children participate in that decision.
CAREER AND TECHNICAL EDUCATION AND STEM
Let me ask you, one of the things that I was very pleased
with in the budget was your proposals in career and technical
education both. I hear more from employers in my district about
the need for folks with skills, and frankly I meet so many
children, and the young people, that this is the way they want
to go, as opposed to traditional 4-year college education.
So two areas I would ask you to elaborate on that you
proposed. The first is your $20,000,000 \1\ STEM competition
proposal and how you see that incentivizing and building into
career and technical, and second, this idea of using Pell
Grants for shorter-term credential programs. How would that
work? That is actually something I have always been supportive
of but never found a way to finance, because I think the demand
would be just tremendous. But I am interested in your proposals
in both those areas.
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\1\ The Department later corrected to $13 million.
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Secretary DeVos. Well thanks for those questions. Yes, this
Administration is a huge proponent of supporting alternative
pathways to higher education, and career and technical
education is a very important piece of that equation, and, in
fact, is an expanding area, I think.
I think one of the major hurdles is for us to
perceptually--and I say ``us'' speaking as a parent. Parents
often don't view career and technical opportunities as valid
as, because for decades we have been told only 4-year college
and university is the path to success. Well, we have got to get
beyond that, because today we have over 7 million jobs going
unfilled that require education beyond high school but not
necessarily a 4-year degree.
So to your question specifically about the $20,000,000
investment in STEM occupations and STEM pathways, we know that
there are huge opportunities, from a career perspective, in the
areas of math and science, and particularly in computer
science. So that also couples with the proposal for short-term
Pell. Short-term Pell would allow for high-quality certificate
and certification programs to be accessed, where today students
receiving Pell Grants cannot access them.
And the question around funding for them, I think there is
a little bit of presumption going on with the math that this
would be an additive program. I suspect there are a great many
Pell Grant-eligible students who would opt to take one of these
short-term Pell opportunities in lieu of perhaps a longer-term,
more traditional route. And so I think we would see a tradeoff
for many of those options, and I think we need to take that
step, I would argue, because there are so many great
opportunities for short-term.
Mr. Cole. Again, I want to work with you, and I am out of
time so we will pursue this another time. But I would be very
interested, as you go forward, in any information you have back
on the specifics, or are you going to limit it to, you know,
certain skill sets or whatever. But again, I think it is a
great idea, a great place to start.
Thank you, Madam Chair. I yield back.
Ms. DeLauro [continuing]. On this report. U.S. Government
wasted up to $1 billion on charter schools and still fails to
adequately monitor grants.
And I yield to the gentlelady from New York, Mrs. Lowey.
21ST CENTURY COMMUNITY LEARNING CENTERS
The Chairwoman. Madam Secretary, your agency recently
conducted a report on 21st Century Community Learning Centers
that concluded half of the students who participated in these
after-school activities improved their math and reading grades.
More than 68 percent improved their homework and class
participation, and three out of five improved their classroom
behavior.
Last year, much to my surprise, you proposed the
elimination of these after-school programs. Congress, under a
Republican majority, not only rejected the Administration's
cuts last year but increased after-school investments by $10
million. This year--I am puzzled--you are trying to cut it
again, completely ignoring the strong evidence that parents
support this program and, in fact, want more of it.
Could you tell me why does your budget yet again prioritize
cutting this very important program, and very popular program,
while your own study proves it is successful and Congress has
demonstrated its strong bipartisan support for it?
Secretary DeVos. Well, thank you, Chairwoman, for that
question.
Actually, the data that we have shows very differently and
the funds coming from the Federal level do not really show
significant impact on the students that the program is meant to
serve.
The dollars flowing out of the Federal program are not
getting to programs that are working really well on behalf of
the students and there are not great participation rates. In
fact, data from 2017 suggest that only 25 percent of elementary
school program participants improved in their reading, and only
19 percent of middle and high school students improved and made
gains in math.
The proposal in the budget is to--we had to make difficult
decisions in the budget, in our proposals, and remember they
are just proposals to you. But in doing so we have really
focused in on the things that we know are really yielding
results and are getting to the students that are most
vulnerable and need it most.
So our proposal to eliminate 21st Century Learning funding
doesn't speak to the program itself as much as it does to
priorities and also to the fact that the funding that we have
been required to make through this 21st Century Federal level
programming does not show the results for the students.
Perhaps some of the State and local community level support
does, and there is lots of philanthropic support around after-
school programs, but the funding from the Department of
Education has not shown to be as effective.
The Chairwoman.. Well, I am not going to get into a debate
with you now. I am glad that you said this is just a proposal,
because you could be sure that many of us who serve on this
committee and visit these local programs understand how
effective and how important they are. So, I wish you would give
some more thought to them and I wonder if you have visited many
of them. I have been a supporter of these for a long time and
they are really life-saving for many of these kids in the
communities.
CHILDCARE ACCESS MEANS PARENTS IN SCHOOL
Another important--in fact, for me it has been essential in
many of our schools. Your budget proposes to roll back
significant progress we have made in this Subcommittee, on a
bipartisan basis, to increase investments in Child Care Access
Means Parents in Schools, called CCAMPIS initiative, the only
Federal program that supports child care access on campus for
low-income parents working towards a higher education.
A year ago today the President's advisor, Ivanka Trump,
tweeted out her support for the CCAMPIS program. Now I am not
saying that Ivanka Trump is an expert in this, but her father
seems to respond favorably to her opinions.
Would you say that her tweet on this program signaled the
Administration's support for CCAMPIS?
Secretary DeVos. Well, we, again, had to make many
difficult decisions in presenting this budget and we have
suggested the elimination or reduction of a number of programs.
We have continued to stay focused on the ones that are really
serving the most vulnerable students. Title I funding has been
held even, IDEA funding held even, English language learner
funding held even. And those are funds that can be used also
for children that we are talking about, not in the same way,
granted, but there is definitely flexibility in how these funds
are used. And again, we have made choices in this budget and
are presenting our proposals to you for consideration.
The Chairwoman. Well, I have two other questions about
this, if I might ask them just quickly.
Maybe that is why you shouldn't be proposing a cut in your
overall Budget, because I wonder if you have seen these
programs and see how critical they are to many of our
communities. And I wonder, has the Department of Education
studied the impact these cuts would have on the 5,000 parents
who would lose access to on-campus child care? And I would like
to see the data to predict how this elimination would impact
degree completion.
My time is up but I would hope you can respond to me. I
have been to these schools. I have worked with these schools. I
see the impact. I see the impact on the parents and on their
kids, and this is such an invaluable program. I know we are
going to reconsider it and I would hope you would educate
yourself about this program as well.
Thank you. Thank you, Madam Chair.
Ms. DeLauro. Congressman Moolenaar.
CHARTER SCHOOLS
Mr. Moolenaar. Thank you, Madam Chair. Secretary DeVos,
thank you for being here with us, and I appreciated your
overview and the work you are doing.
A few things I wanted to just comment on. One is you have
done a great service today by clarifying that charter schools
are public schools. In Michigan law we call them public school
academies. I was a former charter school administrator, and I
think one of the biggest misconceptions is that somehow charter
schools are not public schools, and I thank you for doing that
today.
It is something that I have seen tremendous things in
Michigan. It is part of Detroit's comeback, some of the charter
schools there that are giving parents and their families
opportunities in an area where they are not being served. So I
appreciate your advocacy.
I wondered if you would speak a bit more about some of the
proposals you have on expanding options for school choice for
families, and also, if you would, explain to us who benefits
from that. What is the type of student? Who really benefits
from that?
EDUCATION FREEDOM SCHOLARSHIPS
Secretary DeVos. Well, thank you, Congressman. I appreciate
that question very much.
The main proposal that this Administration is advancing is
called Education Freedom Scholarships, and it would create a
Federal tax credit that--capped at $5 billion annually--that
states could elect to participate in or not. If they did elect
to participate, they would create programs, or augment programs
that they already have existing in their state, and would give
access to families as they decide.
So most programs today, in states, are means tested, and
most students that today are benefitting from school choice
Education Freedom programs are students that are vulnerable,
that have been stuck in schools that are not working for them,
but their families can't move somewhere else, like so many
others can. They cannot buy a home in the suburbs where a good
school is. And so it gives these children opportunities that
they have not had before.
And the beauty with the Education Freedom Scholarships
proposal and initiative is contributions to it are voluntary--
nobody is coercing anyone to give, nobody is coercing any state
to participate, and nobody is coercing any family to
participate in the programs that the states create. What it
will do is give a lot of children, hundreds of thousands of
children across the country the opportunity to find an
education fit that is going to be right for them.
SCHOOL CHOICE AND SCHOOL SAFETY
Mr. Moolenaar. And, you know, one of the concerns that was
raised earlier is, you know, school violence, you know, threats
to student safety, student achievement. I mean, if you are a
parent in an area where you don't have a school district that
you feel your children are safe, or they are not meeting the
needs academically, I would think that this would be a big
positive for them.
Secretary DeVos. It would, indeed. In fact, I would cite a
program that Florida recently enacted called--I think it is
called the HOPE Scholarships Program, for students who are
bullied in their assigned school and/or are--have acts of
violence committed against them. They are able to find a school
that will work for them through this HOPE Scholarships Program.
So states could elect to adopt something like this, and Florida
could elect to augment the program that they have.
But, again, giving parents and students options to find the
right educational fit for each child I think is an imperative.
SHORT-TERM PELL
Mr. Moolenaar. And then I wanted to also follow up, and Mr.
Cole was mentioning some of the, you know, ideas around the
Pell Grants and some of the short-term Pell. One of the things
I am experiencing in my district, as I meet with owners of
businesses, manufacturers, consistently they are saying, ``We
could hire more people. We just need to have people with the
right skills. We would, you know, love to have some kind of a
certificate training program.''
In my home area there is a company that--it is a chemical
company. They have a fast-start program with a community
college where it is an intensive, short-term program, and then
these are very good-paying jobs once they get out. Is this kind
of what you are looking out for the short-term Pell?
Secretary DeVos. Yes, indeed, and I think it is a great
opportunity in communities and regions for employers to work
with educators and really come up with proposals that are going
to work for the employer's needs, and that will--and that
educators will be able to come in alongside of them and help
create the kind of curriculum that is going to be absolutely
perfect for the situation that that particular community or
that region needs. And, yes, this is exactly what a short-term
Pell proposal could help to address.
Mr. Moolenaar. Thank you very much. Thank you, Madam Chair.
Ms. DeLauro. Thank you. Congresswoman Lee.
PRIVATIZING EDUCATION
Ms. Lee. Thank you very much. Thank you, Madam Chair and
ranking member for this hearing. Welcome, Madam Secretary.
Madam Secretary, you remember Steve Bannon, right? Steve
Bannon indicated that the Trump administration's goal was to
deconstruct the administrative state, and each Cabinet official
who comes to this committee presents a budget that really
reflects that agenda. And your budget reflects what exactly
Steve Bannon said--privatizing public education, getting rid of
the public sector, turning it over to the corporations and the
private sector to ensure the quality public education that our
young people deserve, and it is outrageous.
Your cuts here specifically target students of color. It is
unbelievable, low-income students. And I just have to say,
Madam Secretary, you have zeroed out Special Olympics once
again. I still can't understand why you would go after disabled
children in your budget. You zero that out. It is appalling.
SCHOOL DESEGREGATION
I want to ask you a couple of things which, again, reflects
exactly what I just said. Two years ago I wrote language into
the bill about school desegregation. The language asks for a
report from your department, in coordination with the Office
for Civil Rights, to submit to this Committee, detailing
recommendations on how to address the adverse impacts of
segregation, including Title VI school monitors, to ensure that
every student has the opportunity for an equal education.
Madam Secretary, this letter came--we wrote it June 7th. We
have called. We have asked for this report. We tried to reach
you over and over again. We have never received a response. I
wonder where this report is. Could you let us know when this
report will be coming to the committee? It is about students of
color. It is about school desegregation efforts.
Secretary DeVos. Congresswoman, yes. I am aware of that
request and that report and I know it is near completion, and I
commit to you that we will get that to you as soon as feasible.
Ms. Lee. Madam Secretary, this is almost 2 years we have
been waiting. These kids deserve, and the school districts
deserve an answer from our Secretary of Education. We can't
wait 2 years to get a report on school desegregation from you.
It should not be that hard to do. And the response has been
awful in terms of trying to get some sense of timing and why
this has been delayed.
SCHOOL DISCIPLINE
Next, let me ask you about the school disciplinary
practices that impact black and Latino students. According to
data released by the Department of Ed's Office for Civil
Rights, black K-12 students and Latino students are three times
as likely to be suspended or expelled as their white peers.
But now the Federal Commission on School Safety, which you
chaired, eliminated the 2014 school discipline guidance which
ensured that students of color are not subject to harsher
disciplinary practices than their white peers. The guidance
provided valuable resources for districts. It provided
continuous, vigorous Federal oversight and enforcement of our
civil rights laws to make sure that students' civil rights are
upheld. Seventy-five civil rights groups wrote you in January,
expressing opposition to the rescission of this guidance.
Why in the world would you blame--and I understand what the
rationale was, blaming school shootings, the tragic gun
violence that has taken place throughout the country, on the
civil rights protections for students of color? It doesn't make
any sense why that was part of this rescission. Can you explain
that?
Secretary DeVos. Congresswoman, no child should be treated
or disciplined differently based on his or her race or color or
national origin, and if and when they are, our Office for Civil
Rights will act swiftly, and has acted swiftly.
Children need to be treated as individuals, not as----
Ms. Lee. But they are not being treated as individuals.
That is why we had this order put in place, and you rescinded
that.
Secretary DeVos. Again, any student that is treated or
disciplined differently because of his or her color or race----
Ms. Lee. Madam Secretary----
Secretary DeVos [continuing]. Is going to be--that is not--
--
Ms. Lee [continuing]. The Department of Civil Rights----
Secretary DeVos [continuing]. Acceptable.
RACIAL DISPARITY IN SCHOOL DISCIPLINE
Ms. Lee [continuing]. Your own Department of Education
Office for Civil Rights indicated that students of color are
suspended three times more than white students. We put in to
place some requirements that would begin to turn this around.
You rescinded those requirements. So what message----
Secretary DeVos. No student----
Ms. Lee [continuing]. Do the school districts----
Secretary DeVos [continuing]. No student should be treated
or disciplined differently. They----
Ms. Lee. Madam Secretary, they are treated differently.
They are treated discipline--differently.
Secretary DeVos. If they are it is discrimination.
Ms. Lee. Well then, why in the world----
Secretary DeVos. The Office for Civil Rights----
Ms. Lee [continuing]. Rescind----
Secretary DeVos [continuing]. And the Office for Civil
Rights----
Ms. Lee [continuing]. The orders that would correct for
this?
Secretary DeVos. The letter amounted to quotas.
Ms. Lee. Madam----
Secretary DeVos. Children are individuals. They're not----
Ms. Lee [continuing]. Madam Secretary, this does not
involve quotas. This gave direction on how to correct this
horrible problem that we have throughout the country. You go to
any community of color where you have schools that are trying
to, with minimal resources, provide the best education they
can, and you will see what is taking place. So this did not
amount to quotas. This amounted to providing those tools and
guidance to make sure that students' civil rights are
protected, and you rescinded that.
Secretary DeVos. Every community needs to be able to handle
their classrooms and discipline in the way that works for them,
and if a child----
Ms. Lee. Madam Secretary, thank God we had Brown v. Board
of Education. The Federal Government----
Secretary DeVos [continuing]. And if a child is treated
differently----
Ms. Lee [continuing]. Gave us a chance to go to public
schools.
Secretary DeVos [continuing]. Because of his or her race--
--
Ms. Lee. We needed the Federal Government to provide that
oversight----
Secretary DeVos [continuing]. The Office for Civil Rights
will address----
Ms. Lee [continuing]. Of civil rights protection.
Ms. DeLauro. Congresswoman Herrera Beutler.
TONE OF DISCUSSION OVER POLICY DISAGREEMENTS
Ms. Herrera Beutler. Thank you, Madam Chair, and thank you,
Madam Secretary, for being here. You know, I have some
questions and I am excited to hear your answers. I do
appreciate your willingness to come and to share, when I feel
like, you know, there is a difference between asking a question
and being tough and being somewhat--oh, I mean, if I was
sitting there and I was asked about what my boss' daughter
thought about a proposal I was working on I would be a little
bit annoyed. If I was being asked how could you possibly be the
Secretary of Education by, and then there is a long list, I
just feel like I appreciate your willingness to do the job,
even though you are being undermined as you sit there, in many
different instances.
Again, vigorous disagreement. I think Chairman Cole shared
that he had some disagreements, and I would share some of the
disagreements, you know, with my friends on the other side of
the aisle, but it is all how you do it, I think. So I
appreciate your willingness very much.
MENTAL HEALTH AND SCHOOL CHOICE
The first piece I wanted to ask about has to do with mental
health. Teachers in my area, southwest Washington, have shared
with me that they see mental health, the crisis of mental
health, impacting individual students, classrooms, and
communities as a whole, and this cuts across wealthy
classrooms, you know, urban districts, rural districts, poor
and impoverished districts. I mean, this is no respecter of
person, so to speak. And we are seeing a critical need, really,
to provide mental and behavioral health support. And I say we,
the community. I mean all of us. This is the whole nation here.
But in your role, how do you--does the Department have any
emphasis on supporting schools and providing this support?
Secretary DeVos. Thanks for that question, Congresswoman.
Yes. So the School Safety Commission made a number of
recommendations and among them, that were specific to the
Department of Education, really had to do with improving the
school climate, social and emotional learning, mental health
issues, and one of the proposals in our Budget is a new $100
million School Safety State Grant program that could be used by
states and by communities to implement a mental health program
that is appropriate for their school, for their community. And
we know that this is an issue that is not unique to any one
type of community, and we know that the climate of a school is
so, so important.
And having visited many schools in the past couple of
years, you know when you enter the school if they are being
intentional about creating a positive school climate. And we
think that this is one important way that we can help states
really help their local communities meet specific needs,
specific to their communities.
Ms. Herrera Beutler. Thank you. Because I imagine it is
going to look differently, a solution. I think about some of my
different schools--small, rural, more urban, increasingly
suburban. The solutions might look a little different.
SECLUSION AND RESTRAINT
Seclusion and restraint. I was just reading an article in
my area where there are parents talking about having their 6-
year-old held down by the neck while the classroom is cleared,
and that was the school's solution to dealing with some of the
behavioral issues. And I know the department announced an
initiative on this, particularly when it comes to providing
care, education, safety for children with disabilities. Can you
tell me a little bit about the initiative?
Secretary DeVos. Well, let me just begin by saying that,
you know, every student needs to be able to go to school safe
themselves, and other students to be safe in their setting as
well. And we have initiated an effort to really help school
communities know and understand the law with regard to
seclusion and restraint, and then to help ensure that they have
the tools necessary to be able to carry out the law in a
fashion that is in line with what the intent of it is.
And we have also launched an investigation--and this is a
joint effort between our Office for Civil Rights and our Office
of Special Education Programs--and it is to go and look at some
areas where the numbers that have been reported just seem a
little bit out of line for some reason, and to really go and
understand whether these are accurate reports and if not, to
help them know and understand, again, what their obligations
are. We think that this is a really important initiative that
we have undertaken without having some kind of a mandate being
told to do so.
Ms. Herrera Beutler. I appreciate that and I yield back.
Thank you.
Ms. DeLauro. Congressman Pocan.
SEXUAL ORIENTATION AND GENDER IDENTITY
Mr. Pocan. Great. Thank you, Madam Chairman and our
committee chairman, thank you for being here.
Thank you so much, Secretary, for being here today. I would
like to try to get to three or four areas, so if we can be
concise, I would really appreciate it.
I do want to follow up on something Ms. Lee asked. When she
asked about suspensions you repeated a few times race,
religion, national origins. I noticed you never mentioned
sexual orientation or gender identity. Do you think it is all
right for a school to discriminate based on someone's sexual
orientation or gender identity?
Secretary DeVos. We have laws that cover discriminatory
efforts and our Office for Civil Rights has continued to be
very diligent in investigating any allegation of discrimination
and will continue to do so.
Mr. Pocan. So is that a yes or is that a no? I am trying to
get a yes or no, I guess, on that.
Secretary DeVos. We follow the law as this----
Mr. Pocan. So personally you don't have an opinion on it.
Secretary DeVos [continuing]. Body has defined, and----
CHARTER SCHOOLS
Mr. Pocan. Okay. Because you are giving money. Which leads
to my next question. You are giving money to some charter
schools that do discriminate, and that report, I would like to
follow up, from our chairwoman's question, where $1 billion has
been wasted with 1,000 schools, going to charter schools. One
out of every four have failed. And I know in your testimony you
thought we should have more charter schools, but when you have
a 25 percent failure rate, that would be like saying if one of
your car tires keeps going flat, rather than replacing it, you
are going to add more tires to a car. I don't know if that
makes a lot of sense.
But my question would be, what are you doing specifically
to get that $1 billion back for taxpayers? And you have, in
this Budget a $60 million increase, a 14 percent increase for
this program, when we have one out of every four failing. How
can you address those two aspects of that?
Secretary DeVos. Well, let me just refer again to the fact
that the report covered information from a longer period----
Mr. Pocan. Sure but my question, if I can, just because I
want to get a couple more subject areas in----
Secretary DeVos [continuing]. And----
Mr. Pocan [continuing]. Madam Secretary.
Secretary DeVos [continuing]. And I will go to the fact
again that we need more charter schools, not fewer of them, and
we need----
Mr. Pocan. Okay. So what are we doing to get money back----
Secretary DeVos [continuing]. And we need----
Mr. Pocan [continuing]. For taxpayers. Let's try that one
first.
Secretary DeVos [continuing]. We need traditional public
schools----
Mr. Pocan. Okay. Let's go--no, I am sorry.
Secretary DeVos [continuing]. Held to the same
accountability----
Mr. Pocan. Excuse me, Madam Secretary----
Secretary DeVos [continuing]. As the others.
Mr. Pocan [continuing]. Just because I am trying to save
time. So what are we doing to get the money back for taxpayers,
the $1 billion that got wasted?
Secretary DeVos. I am not sure that that is the ultimate
conclusion, but we will certainly look into----
Mr. Pocan. Are we going anything to get the money back?
Secretary DeVos [continuing]. We will certainly look into
that, and----
Mr. Pocan. So we are not doing anything to get the money
back.
Secretary DeVos [continuing]. In the context of that
report.
Mr. Pocan. This is interesting how we ask questions. I feel
like I am speaking a different language. I am sorry.
Okay. So then the second part of that is you have an
increase, yet we have the failure rate.
SPECIAL OLYMPICS
All right. So let me go to another area and I want to
follow up on the thing Ms. Lee mentioned about the cuts to
Special Olympics. Do you know how many kids are going to be
affected by that cut, Madam Secretary?
Secretary DeVos. Mr. Pocan, let me just say again, we had
to make some----
Mr. Pocan. Okay.
Secretary DeVos [continuing]. Difficult decisions with this
budget.
Mr. Pocan. Again, this is a question on how many kids, not
about the budget.
Secretary DeVos. I don't know the number of kids. I also
know that----
Mr. Pocan. Okay. It is 272,000 kids.
Secretary DeVos [continuing]. I----
Mr. Pocan. That is all. I will answer it for you. That is
okay. No problem. It is 272,000 kids----
Secretary DeVos. Let me just say that I think Special
Olympics----
Mr. Pocan [continuing]. That are affected----
Secretary DeVos [continuing]. Is an awesome organization,
one that is well supported by the philanthropic sector as well.
Mr. Pocan. Sure.
Secretary DeVos. And this is one----
Mr. Pocan. I will start reclaiming my time if I could,
Madam Secretary, because there are a couple more parts to this.
SPECIAL EDUCATION
So also we have cuts that go in the special education
grants to states from $3,000,000 to $2,200,000, a 26 percent
cut, and then also in this budget you have a $7,500,000 cut to
the National Technical Institute for the Deaf, a $13,000,000
cut for Gallaudet University, a $5,000,000 cut for a Federal
program for print books for blind students, and you recently
had a Federal judge rule against us on some areas around
special education.
I have two nephews with autism. What is it that we have a
problem with, with children who are in special education? Why
are we cutting all of these programs over and over within this
budget?
Secretary DeVos. Well, sir, we have continued to retain the
funding levels for IDEA and held that level. So in the context
of----
Mr. Pocan. I don't--I am sorry. I don't think I brought up
IDEA.
Secretary DeVos [continuing]. In the context----
Mr. Pocan. I believe I brought up Special Olympics, special
education grants to states, the National Technical Institute
for the Deaf, Gallaudet University, Federal program for
printing books. So if you could address those, that is the
question. I would really appreciate it.
Secretary DeVos. I will address the broader question
around----
Mr. Pocan. Or if you could actually address the question I
asked. That is even a better way to answer a question.
Secretary DeVos. Supporting students with special needs, we
have continued to hold that funding level--that funding at a
level amount, and in the context of a Budget proposal that is a
10 percent reduction----
[The information follows:]
Special Education Funding
Special Education Grants to States, which are authorized under Part
B, Section 611 of the Individuals with Disabilities Education Act
(IDEA), are often referred to as IDEA Grants to States.
The fiscal year 2020 budget requests a shift of $840,720,000 from
the annual appropriation for the Grants to States program to the
advance appropriation for that program. The request would shift the
timing of when States receive the funds, but the overall funding would
be level with the fiscal year 2019 appropriation.
Mr. Pocan. All right. I will reclaim my time. I will
reclaim my time. You are not going to answer the question.
Let me try one last one. Maybe I will do better than
charter schools if I get this one covered you.
DEPARTMENT OF EDUCATION SALARIES AND EXPENSES
You have got a cut to the Department that is a 12 percent
agency cut, but you have a 15.6 percent increase in your
executive salary appropriation. How can you justify that?
Secretary DeVos. So the Department funding includes a
building modernization piece.
Mr. Pocan. Yeah. I did not ask about buildings. I am----
Secretary DeVos. Well, it is all part of that--it is all
part of that budget.
Mr. Pocan. So you are okay with a 12 percent agency cut in
light of a 15.6 percent increase in executive salary, and, by
the way, I know it does not come out of this Budget, but $7
million security expense in the last year.
Secretary DeVos. So we are also funding the Next Gen
initiative through Federal Student Aid, which requires a lot of
investment now to save in the longer term. Same thing for the
building modernization piece. We are in the process of
shrinking down the footprint here from three buildings to two,
and all of that--the expenditures, they come up front, so that
the savings can be realized in the longer term.
Mr. Pocan. Madam Chairwoman, I am sorry I was not more
clear in my questions. Thank you.
Ms. DeLauro. Thank you. Congressman Harris.
BUDGET CAPS
Mr. Harris. Thank you very much, and good to see you again,
Madam Secretary.
Let me just--and again, I am trying to ask the secretaries
when they come before here to explain the President's Budget.
Now you have to work within the current statute, right, and the
current statute, we have to revert to the old caps. Is that
correct? Congress has not----
Secretary DeVos. Congressman, yes, that is my
understanding.
Mr. Harris. Yeah. Congress has not raised the caps. So
actually, why anyone up here, on this side of this--you know,
this wall here, would think that the blame is not on us for not
having given you the money, you know, to spend more, I mean,
the bottom line is Congress is failing again. I mean, that is
the bottom line.
FEDERAL ROLE IN EDUCATION
Look, I trust states and localities on education. Look,
there is a basic philosophy. Look, we are people, again, on
this side of the wall, and some of us are going to agree to
disagree that some people think the Federal Government knows
best how to educate people in Somerset County. I have one of
the two poorest counties in the state. And I like to think that
my board of education and my local county and my state knows
how to educate those students, and someone up here--I hate to
say it, you are part of the Federal Government, and I hate to
say it but I don't think the Federal Government knows best how
to educate those students. So I agree with you. The turning
over more things to the states, I think, is good.
I also think that freedom is an American principle. I think
freedom and choice are principles and I think that charter
schools embody that principle, to a large extent. So, you know,
I think that it was a great idea to highlight charter schools
in your Budget, and especially the State Facilities Incentive
Grants, because it always bothered me.
I used to sit on the Education Committee in the State
senate in Maryland. It used to bother me that we would talk
about charter schools and then we would say we will give you
money for the education, but we are not going to give you any
money for a facility. Well, it is kind of hard to educate
without a facility, but I guess that is the way the education
establishment discourages charter schools. That is the way they
do it. And good for you to point that out.
GLOBAL RANKINGS IN READING, MATH AND SCIENCE
Now you testified--and you are going to have to explain--
give me these numbers again--the reading, science, and math,
where we stand in the nation--I am sorry, in the world. Was it
24th in reading, 25th in science, 48th in math, or did I get
one of those numbers wrong?
Secretary DeVos. No--24th in reading, 25th in science, and
40th in math.
Mr. Harris. Fortieth in math. So this is after 40 years of
Federal involvement. And where did we stand in 1979, before the
Federal Government went in to help the states educate
Americans?
Secretary DeVos. Well----
Mr. Harris. If you could get back to me, if you could look
that up, I will bet you it wasn't----
Secretary DeVos. Yes. I know we were much, much higher in
the ranking and we have definitely continued to deteriorate.
[The information follows:]
International Standing of American Students
The data that Mr. Harris cited--that we are 24th in reading, 25th
in science, and 40th in math--are from the 2015 Program for
International Student Assessment (PISA), a system of international
assessments that allows countries to compare outcomes of learning as
students near the end of compulsory schooling. PISA, which began in
2000, measures the performance of 15-year-old students in mathematics,
science, and reading every 3 years. In 2015, more than 70 education
systems participated, and, as the rankings show, the United States is
not at the top.
Another source of our international standing is the Trends in
International Mathematics and Science Study (TIMSS). TIMSS data have
been collected on 4th and 8th grade students since 1995 and show that
the United States continues to lag behind top-performing countries. In
1995, American 4th graders ranked 12th out of 26 in math and 3rd out of
26 in science; 8th graders were 28th out of 41 in math and 17th out of
41 in science. Twenty years later, 4th graders were 15th out of 54 in
math and 11th out of 53 in science; 8th graders were 12th out of 43 in
math and 11th out of 43 in science.
FEDERAL ROLE IN EDUCATION
Mr. Harris. Right. So let's just step back to the big
picture. In 1979, we were better. The Federal Government says--
you know, it is the words of Ronald Reagan, you know, the nine
most dangerous--however many words it is, you know, ``I am here
from the Federal Government and I am here to help.'' So the
Federal Government came in to help education and now we are
much worse off.
Well, Madam Secretary, I want to thank you for thinking
outside of the box in how to--in how to reverse some of that,
and I do think some of the principles you have elucidated in
the Budget get to that.
I do want to commend you, actually, because I have gone and
spoken to teachers and parents in my district who worried a lot
about the disparate impact policies of the previous
Administration, worried a lot about that effect on school
discipline, and were very grateful that this Administration
took a new look at those disparate impact policies.
SCHOOL CHOICE AND ALTERNATIVE PATHWAYS
But I would like you to expand a little bit, because I do
think that one thing the Federal Government can do is expand
the ability of states to be forward-thinking in how they
provide alternative education for parents and students who
choose not to be in a conventional public school, and explain
the new approach you are going to take to encourage states to
have these foundations that fund alternatives for parents.
Secretary DeVos. Well, thanks, Congressman, for those
comments and the question.
This Administration continues to support alternative
pathways and acknowledges that more and more students are not
traditional students, and we are going to have regular
interface with education and learning throughout our adult
lives, particularly children born today, when you think about
the fact that a kindergartner today can look forward to
entering a workforce where 85 percent of the jobs don't yet
exist.
So we have to be supporting lifelong learning in a way that
is meaningful. That goes to some of the recommendations that we
made around the Pell--a short-term Pell program, around
expanding career and technical education opportunities, pre-
apprenticeship opportunities. So there is a proposal in the
Budget for $60 million to go to pre-apprenticeship programs
that will help prepare students to explore these alternative
pathways and give them a chance to earn while they are
learning.
We have a long way to go to really support all of these
different alternatives in a meaningful way, when you compare it
to how we have really weighted the--every equation around
traditional higher education, and we are proposing some small
steps in that direction.
Mr. Harris. Well, thank you very much, Madam Secretary. I
yield back.
Ms. DeLauro. Congresswoman Frankel.
SEXUAL ASSAULT ON COLLEGE CAMPUSES
Ms. Frankel. Thank you, Madam Chair, and thank you, Madam
Secretary. You have a very nice disposition, even though I
don't agree with some of these budget cuts but thank you so
much for being here.
I am going to try to find some things we can agree about,
okay?
So let me just start--I want to talk about sexual assault
on college campuses. The Department of Justice and CDC has
repeatedly documented that roughly 20 to 25 percent of women
have been sexually assaulted, most commonly by men, and I think
also men, maybe about a 16 percent rate, or something smaller
than that. But that women of college age are at the highest
risk.
So, first of all, I want to ask you this. I am assuming
that you agree that Title IX schools are required to respond to
acts of sexual violence that impact students' access to
education. Do you agree with that?
Secretary DeVos. I would, Congresswoman, but let me just
say that I have said before, and I wanted to emphasize again,
that one act of sexual violence is one too many, and one
student that does not have due process is one too many.
Ms. Frankel. Okay, well, let----
Secretary DeVos. We know that we are----
Ms. Frankel [continuing]. Let me just--I just--if you could
just let me reclaim my time, just to--and when we have time you
could talk about the perpetrators and so forth. But I just--do
you agree that, in practice, many schools are failing to
protect victims or hold perpetrators accountable?
Secretary DeVos. What I know is I have heard from students
and I have heard from institutional representatives that the
framework that they have had to operate under has not worked
for too many students, which is precisely why we are in the
process of rulemaking.
Ms. Frankel. Okay. Well, let me just--excuse me. Let me
just--I want to find some things we can agree on, and then we
can disagree.
I am assuming you would agree that people who are subjected
to sexual assaults experience terror, helplessness, profound
humiliation, and that sexual assaults are among the most
harmful, traumatic experiences. Can we at least agree on that
point?
Secretary DeVos. Certainly.
Ms. Frankel. Okay. That is great. And I think we can both--
we can all agree that the response of the survivors' community
is very important for their recovery. We can agree with that.
All right. That is good.
Okay. So I thought--I know we--honest, we are on a good
path here.
And I think we would also agree that authority figures in
schools are in a position of great social authority to help a
recovery.
All right. We are doing well.
Now, so I want to assume, for a moment, that this is a
classroom, and that we are meeting on a regular basis. All
right. Just take a look around. Well, you saw the people who
are here.
So let's assume--I am not going to pick any person out--
that one of the people in here--it could be a man or a woman--
has been sexually assaulted by another one that is in the room.
This is a classroom. Would you agree that a victim of sexual
assault should not be required to sit in a classroom with a
perpetrator, day after day?
I think--can't we agree with that?
Secretary DeVos. I would agree with that, but let me just
say----
Ms. Frankel. No. Let's keep going.
Secretary DeVos [continuing]. I appreciate----
Ms. Frankel. No. Wait a minute.
Secretary DeVos [continuing]. And respect your desire to go
down this pathway.
OFF-CAMPUS SEXUAL ASSAULT
Ms. Frankel. I am reclaiming my time to ask the next
question, because we are doing well. I mean, come on. We are
agreeing. All right.
Now, here is my next question. If a--let's say--this time I
will say a woman or a man is sexually assaulted at a fraternity
house, should that--by another classmate--should those--should
the victim be required to sit in the classroom with the
perpetrator of the sexual assault?
Secretary DeVos. Congresswoman, I appreciate and respect
your desire to continue down this path of questioning, but you
know that we are in the middle of the rulemaking on this
issue----
Ms. Frankel. But wait. Could you just answer my question?
Secretary DeVos [continuing]. And it would be
inappropriate--no, it would be----
Ms. Frankel. If a----
Secretary DeVos [continuing]. Inappropriate for me to
continue to comment and answer the questions----
Ms. Frankel. Okay.
Secretary DeVos [continuing]. In the way that you are
posing them.
Ms. Frankel. All right. But here is what I think.
Secretary DeVos. It is inappropriate. I am sorry.
Ms. Frankel. I think you agree with me that an assailant
shouldn't be allowed to sit next to a victim. And so I am--
since I am running out of time, I guess I have to get to my
final question, which maybe we don't agree on. But you have
proposed changes that if a student is sexually assault by a
classmate off--an off-campus frat--the school is not going to
be liable to investigate.
And I don't really understand that. If the frat is on the
campus or the frat is across the street, it seems to me that
the harm--the potential harm to the victim is the same, and
what that means is, for that victim, all that trauma, all that
humiliation, there is a likelihood that that victim may not go
to class, may drop out of school, and it seems to me the
university or the college would be subjecting themselves to a
violation of Title IX. Think about it.
Secretary DeVos. Thank you.
Ms. Frankel. You are welcome. I yield back.
Ms. DeLauro. Congresswoman Bustos.
STUDENT LOANS AND BORROWER DEFENSE
Mrs. Bustos. Thank you, Madam Chair, and thank you,
Secretary DeVos, for joining us today.
What I would like to talk about is the Borrower Defense
rule, if we could, please. After losing your latest court
battle to implement the Borrower Defense rule, your Department
issued guidance that no school could force a student into
mandatory arbitration over a dispute involving Federal student
loans. I think that is good. Yet your guidance stresses that
schools could continue to use mandatory arbitration as long as
the dispute did not involve a Federal student loan. Is that
correct? I think that--correct?
These enrollment contracts where schools hide these
mandatory arbitration clauses in fine print, which is standard,
students have to enter these contracts in order to attend
school. They don't have a choice.
So I am wondering, Madam Secretary, why this--you would
continue to encourage schools to take away students' right as a
condition of going to school.
Secretary DeVos. Well, Congresswoman, let me just speak
broadly on the question and the issue. We did not agree with
the Obama administration's approach to this. I am certainly
very aware of the court decision and we are in the process of
implementing that, while at the same time we are continuing to
work on revising the rules so that it is one that we think is
more fair to both students and taxpayers, ultimately.
Our partial relief formula is meant to be respectful of
taxpayers. There is no student that should--you know, should be
able to make a claim for Borrower Defense if they have not
truly been defrauded or if they are gainfully employed. And so
we are going to continue to work on this rule and implement, as
per the judge's orders.
MANDATORY ARBITRATION AND BORROWER DEFENSE
Mrs. Bustos. So I am wondering if you can talk about what
efforts your Department is taking to ensure that schools not
including arbitration clauses related to the student loans, as
part of their enrollment. Is your staff monitoring compliance?
Secretary DeVos. We are following the judge's decision in
implementing and at the same time continuing to work on
revising the rule. So that process continues to be ongoing.
Mrs. Bustos. Okay. And so I am going to drill down just a
little bit further. Have you asked accreditors to ensure that
schools are in compliance?
Secretary DeVos. We are following the 2016 rule and at the
same time continuing to work on revising the rule.
Mrs. Bustos. Okay. So I--okay. So you are rewriting the
rules. Is that correct?
Secretary DeVos. We are.
Mrs. Bustos. Okay. So will your rewrite include the
existing ban of forced arbitration for Federal student loan
disputes?
Secretary DeVos. That is all part of the consideration, and
it would be premature to actually comment on the rule before it
is actually released for comment.
Mrs. Bustos. What is your timeline on this?
Secretary DeVos. It is very soon, within the next few
months.
Mrs. Bustos. All right. Would you--I probably can predict
your answer on this, but would you be able to commit to act in
the best interest of students and uphold the ban on forced
arbitration?
Secretary DeVos. Well, I commit to acting in the best
interest of students--I do that every day in my job--and will
continue to commit to working on this rule so that it is one we
can be very supportive of and that is equally fair to students
and to taxpayers.
TEACHER SHORTAGES
Mrs. Bustos. Okay. Since I have got a minute left I am
going to address teacher shortage. So I am from the State of
Illinois and we have got a severe teacher shortage issue, about
1,000 positions that can't be filled. Number one is in Chicago,
which is outside my congressional district, but the other two
are in the cities of Peoria and Rockford, which are in my
congressional district. So this is an issue I have done
roundtables on this and have learned from teachers that they
feel undervalued, they feel underpaid, they feel overworked.
Your budget cuts a critical Department of Education program
that school districts can use to improve teacher recruitment
and retention, and I know that you have stated that you
consider teacher hiring a local issue. But you have also stated
that you wanted to help facilitate the sharing of best
practices to bring more teachers into schools. And I am
wondering if you can elaborate on some of the best practices
and share your next steps to help the states and districts with
teacher shortages. I will just leave it at that since we just
have a few seconds left here.
TEACHER PROFESSIONAL DEVELOPMENT VOUCHERS
Secretary DeVos. Thanks, Congresswoman. I too have met with
and talked with many teachers and know that way too many of
them do feel undervalued and underappreciated. That is why our
Budget has proposed to really give teachers an opportunity to
develop themselves in a way that works for them, through a
teacher voucher that they can use for their own professional
development.
One of the things I have heard consistently is that they
have been basically told what development to take, when and
where, whether it is relevant to their particular subject area
or their particular development need. And so we think that this
is a really good way to begin to get at that and to show the
kind of honor and respect that they should have, and to elevate
their profession.
We also think that through the investment in mentorship and
residency opportunities that teachers will--really great
teachers will find a way to continue to develop their own
career path and not have to leave the classroom, as too many of
them have to do today. In order to continue to develop their
own career path they go into administration and then they are
no longer in the classroom, and it doesn't need to be an
either/or like that. It can be a both/and. They can continue to
be in the classroom and develop a career path if they have the
opportunity to teach as teachers, to teach the teachers, and
the mentorship and residency program will allow that kind of
opportunity to develop well.
Mrs. Bustos. I will yield back. Thank you.
Ms. DeLauro. Congresswoman Watson Coleman.
CIVIL RIGHTS, DISPARATE IMPACT, AND GUIDANCE
Mrs. Watson Coleman. Thank you, Madam Chairman. Thank you,
Madam Secretary, for being here.
Number one, I want to follow up on a question that
Congresswoman Lee asked. Specifically what is your rationale
for having rolled back the guidance on dealing with
discrimination and civil rights issues in the schools? You
mentioned something about quotas. I read the rule, and it has
nothing to do with quotas. What is your rationale for having
taken that guidance and repealed it?
Secretary DeVos. Well, Congresswoman, thank you for that
question again. I will repeat again that I think we share the
same goal, that every student is treated as the individual that
they are----
Mrs. Watson Coleman. I just want to reclaim my time here--
--
Secretary DeVos [continuing]. And need to be respected.
Mrs. Watson Coleman [continuing]. Because I only want to
understand one thing. What is the rationale for repealing a
guidance with regard to how you address discrimination,
disparate impact, and all of those things on a--in a school
environment?
Secretary DeVos. Well, discrimination is wrong and it will
be pursued.
Mrs. Watson Coleman. Well, we agree with that.
Secretary DeVos. Indeed.
Mrs. Watson Coleman. So just tell me, if you don't mind,
why you felt it was okay to eliminate a guidance that was to
help understand how to process these things? How is that
helpful?
Secretary DeVos. Well, actually, the guidance--we heard
from many, many different quarters that the guidance was
actually harming schools' and individuals' opportunities to
discipline----
Mrs. Watson Coleman. You know what? Thank you. Reclaiming
my time. I almost want to ask you----
Secretary DeVos. Can I finish--may I finish the question?
PELL GRANT FLEXIBILITY
Mrs. Watson Coleman [continuing]. That every time you talk
about--every time you talk about your findings, your research,
your whatever, I would love to see that research. I honest to
God would love to see what you rely upon as you are making--
answering some of these questions about what to do.
Let me tell you something I really support very much in
your budget, and that is to expand access to Pell Grants for
apprenticeship programs, technical programs. I agree with you.
The route is not always a 4-year college education.
I want to know that in advance of doing that, since that is
an innovation on your part, what are you going to have in place
to ensure that something like a Trump University--that has
absolutely no academic relevance--is not--not an organization
that benefits from this new approach?
Secretary DeVos. Well, Congresswoman, this proposal is one
that we would like to work with Congress to ensure the
appropriate boundaries or guardrails are put into place----
Mrs. Watson Coleman. Okay. Thank you.
Secretary DeVos [continuing]. But I think it is an
important opportunity.
Mrs. Watson Coleman. Yeah. I think that Congress very much
would want to know what your parameters were and what your
accountability system is going to look like.
STATE AND FEDERAL ROLES IN OVERSIGHT OF PREDATORY SCHOOLS
I want to ask you a question. I have got a lot of questions
and I am going to probably get to them in a second round,
because I have a question with regard to your Department's
decision not to any longer work with State officials over the
redress of victims of for-profit colleges.
And this particular question was prompted by a letter that
my attorney general in the State of New Jersey sent to your
Department several months ago, asking why suddenly you are not
collaborating with them and sharing information with them so
that they could address the eligibility of students who went to
schools like the Corinthian schools that failed them, in any
way, shape, or form, and whose loans could be forgiven.
A, I would like to know why you haven't answered that
letter yet, and B, I would like to know what are you all doing
about recapturing that money and protecting those students and
informing them that they are eligible to have their loans set
aside?
Secretary DeVos. Well, Congresswoman, I certainly want to
make sure that we answer your inquiries and requests thoroughly
and promptly, and if you could just submit a specific question
for the record on what this particular matter is, we will be
happy to respond.
Mrs. Watson Coleman. I would really have no problem sending
it to you. I simply want you to know that the question that
this is prompted by is a letter dated May 17, to you, by our
attorney general, Gurbir Grewal. And so I would appreciate an
answer. I will send you the letter again. I would appreciate an
answer in a more timely fashion, and he hasn't gotten one.
I guess I have to yield back now. I have a second round's
worth of questions.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeLauro. I thank the gentlelady. Congresswoman Roybal-
Allard.
OVERSIGHT OF EDUCATION SPENDING
Ms. Roybal-Allard. Welcome, Madam Secretary.
Before I ask my first question I want to go back to the
issue that was raised by Congressman Pocan regarding the waste
of $1,000,000,000 on charter schools that never opened or
opened and then closed, and just suggest that if your
Department were to do due diligence, not only in terms of
oversight but in working to reclaim that $1,000,000,000,
programs such as the Special Olympics, there would be no need
or excuse for eliminating that and other important programs for
our children.
EXPANDING PELL ELIGIBILITY WITHOUT INCREASING FUNDING
Madam Chair, I want to talk about the Pell Grants. I agree
with your proposal to support career and technical education
but disagree on how you are going about it.
As you know, the Pell Grant is the cornerstone of our
national commitment to make higher education accessible and
affordable, but the purchasing of Pell Grants has significantly
dropped over the years, covering only about 30 percent of the
cost of college today.
Your Budget flat-funds Pell Grants and does not take into
account rising inflation cost to education, and, in addition,
you propose to expand the pool of eligible applicants by
opening Pell Grants to short-term programs.
How do you hope to finance the additional demands on the
program, given that you provide no additional funds for the
likely increase in Pell Grants?
Secretary DeVos. Well, Congresswoman, thanks for the
question. The proposal for short-term Pell, Congress may well
decide to expand the Pell funding. Our proposal is to continue
to hold Pell level, but acknowledging that many students that
might opt to take a short-term certification program may do so
in lieu of a more traditional, longer-term program, which, in
fact, could probably be less costly to both the students and
ultimately the taxpayer. But we are looking forward and happy
to work with you to set up those kinds of parameters and would
welcome the opportunity.
Ms. Roybal-Allard. Okay. Well, I would suggest that you are
not going to get enough students to switch from whatever
profession they are seeking that needs a 4-year degree to take
these shorter terms. So I am hoping that--and I am sure that
our chair, we will be, in fact, putting more money into the
Pell Grant program.
One second. I am just going to move on to my next question.
STUDENT SUPPORT AND ACADEMIC ENRICHMENT GRANTS
For the third year in a row your budget proposal has called
for complete elimination of the Title IV-A program, stating
that it is duplicative and ineffective. This is the same
program that your Department repeatedly touts as offering local
control and flexibility to districts, and even goes so far as
to suggest using these program funds to improve social-
emotional learning, school climate, and student safety, as
recommended in the report from the Federal Commission on School
Safety that you co-chaired.
So why are you ignoring your report's own recommendation
and calling for the elimination of a program that for thousands
of districts across the country is the only flexible funding
available for things like music, PE, STEM, mental health
services, school counseling, and violence prevention?
Secretary DeVos. Thanks for that question, Congresswoman.
We have proposed this particular program elimination because it
has been very thinly spread and has not been shown to be
particularly effective at any particular thing.
SCHOOL SAFETY
But with regard to school safety initiatives, the
Administration's budget proposal broadly, between the four
departments that are touched by school safety issues, is
proposing $700 million specifically around--to support
recommendations from the School Safety Commission report. And
the Department of Ed's budget includes $200 million, $100
million of which would be for supporting mental health and
social-emotional learning initiatives at the school level, at
the local level, and the balance of it for helping schools to
do emergency planning and assessments and take proactive steps
to really prevent any acts of violence.
Ms. Roybal-Allard. So you are actually disagreeing with
your own Department's recommendation and the Commission that
you co-chaired?
Secretary DeVos. No, not at all. In fact, we think that the
proposal of the Budget really helps get after some of the
things that the commission's report recommended and helps
support those initiatives.
CLASS SIZE
Ms. Roybal-Allard. In your testimony you stated the
following, and I quote, ``Students may be better served by
being in larger classes if by hiring fewer teachers a district
or state can better compensate those who have demonstrated
high-quality and outstanding results,'' end of quote.
This is contrary to decades of longstanding, credible
research like the Student/Teacher Achievement Ratio that
actually recommended, on average, student/teacher ratio to be
15-to-1. So what evidence-based research do you have to back
your statement?
Secretary DeVos. Well, that must be in my written
testimony, and I would just comment to the fact that given--you
know, given Education Freedom initiatives, there are different
kinds of environments in which students learn well. Some
students can learn better with larger classes, with more
students to collaborate with, to learn with, and others in----
Ms. Roybal-Allard. Can you give me----
Secretary DeVos [continuing]. In smaller----
Ms. Roybal-Allard [continuing]. Can you just cite what
research you are using to make that----
Secretary DeVos. There is plenty of research that will
undergird the fact that mandating a specific class size
doesn't----
Ms. Roybal-Allard. If you can just provide us with that
information----
Secretary DeVos [continuing]. Doesn't yield results. I
would be happy to have, if you submit a question for the
record, I will be happy to do so.
[The information follows:]
Class-Size Research
The Tennessee Student Teacher Achievement Ratio (STAR) study, which
was conducted 30 years ago, is often cited as evidence that smaller
classes lead to higher achievement. However, researchers have
questioned whether the STAR results are applicable to different
populations and settings and other studies of class-size reduction have
produced less positive findings.
For example, one review of the research on class-size reduction \1\
found that few studies were rigorous, none of the ones reviewed showed
the same size gains as the STAR intervention, and some showed no
effects at all. Furthermore, there can be unintended consequences: if
there is not a pool of highly qualified teachers seeking jobs,
districts may need to hire unqualified teachers, or they may lose their
best teachers to other districts. An examination of the Federal Class-
Size Reduction Program \2\ (a program last funded in fiscal year 2001)
found that recruiting a fully certified teacher was a problem in a
third of large districts, finding space for additional classrooms was a
problem for almost 60 percent of large districts, and many teachers in
class-size reduction classrooms used the same teaching strategies--
desks in rows, with the teacher lecturing from the front of the room--
as teachers in non-class-size reduction classrooms.
---------------------------------------------------------------------------
\1\ Class Size: What Research Says and What it Means for State
Policy, Grover J. ``Russ'' Whitehurst and Matthew M. Chinos, Brookings,
May 11, 2011.
\2\ https://www2.ed gov/rschstat/eval/other/class-size/index.html.
---------------------------------------------------------------------------
Finally, reductions of the magnitude in the STAR study--class sizes
were reduced from 22 to 15 students, on average--are expensive, and one
must weigh these costs against the costs of alternative strategies for
improving achievement.
Ms. DeLauro. Congresswoman Clark.
SCHOOL DISCIPLINE GUIDANCE RESCISSION
Ms. Clark. Thank you, Madam Chair, and thank you, Madam
Secretary, for being here today.
I want to go back to the school safety report. Within one
section of the school safety report your Commission did
recommend--we have discussed it earlier--rescinding the 2014
guidance entitled ``Rethink School Discipline Guidance.'' Is
that correct?
Secretary DeVos. Yes, that is correct.
Ms. Clark. And you, as Secretary of Education, you went
ahead and rescinded that in January of 2019. Is that correct?
Secretary DeVos. That timing might be about right. It might
be a little bit late.
Ms. Clark. But you did rescind it in your official
capacity. Is that right?
Secretary DeVos. Yeah.
Ms. Clark. In your words, the guidance was, quote, ``well
meaning'' to address the fact that black boys are three times
more likely to be suspended and black girls are six times as
likely to be suspended.
But the report goes on to say although well meaning, you
believe, the Commission believes, headed by you, that the
guidance resulted in teachers and schools not really carrying
out discipline because they were afraid of Federal action. Is
that correct?
Secretary DeVos. That has been--yes, that has been actually
spoken to me from a number of teachers.
Ms. Clark. Okay. And then you went on to lay out, in the
report, that although not specifically called for in the
guidance that there was a concern that the Commission had that
this guidance was creating quotas, or certainly pressure to
have quotas, meaning that you would look and have to discipline
white students at the same rates you were disciplining black
students, however unfairly. Is that what you mean by quotas,
that you would actually look and discipline white students to
make sure it was equal with the discipline of black students?
Secretary DeVos. Well, Congresswoman, if what you are
asking is about whether students can or should be treated
differently----
Ms. Clark. I am asking that--that is--that is what you
wrote in your report, that this was a concern that schools
would feel pressured to have discipline quotas. That was in
your report, right?
Secretary DeVos. Yeah. Every student is an individual----
Ms. Clark. Yeah----
Secretary DeVos [continuing]. And needs to be treated as
one.
Ms. Clark [continuing]. I am just asking because quotas was
a concern. Is that correct?
Secretary DeVos. Well, that has been suggested----
Ms. Clark. It is. It is.
Secretary DeVos [continuing]. By the discipline guidance.
Ms. Clark. Right, and you put it in your report, that was a
concern.
RESEARCH ON DISPARATE IMPACT
You also questioned the legal validity of the guidance on a
theory of disparate impact, and here is where my questions for
you come in. At the base of all of this, you wrote in your
report, the racial gap in suspensions--you cite a study and
say, quote, ``The racial gap in suspensions was completely
accounted for by a measure of the prior problem behavior of the
student, a finding never before reported in literature.''
Quote from your report, ``This research undermines the core
proposition in disparate impact theory that statistical
disparities necessarily demonstrate that classroom teachers and
administrators are motivated by race when disciplining
students.'' That is a quote from your report.
So I looked at the underlying research, and here is what it
shows. It says--and I am quoting from the report, ``Prior
Problem Behavior Accounts for the Racial Gap in School
Suspensions,'' that you cite in your school safety commission
report. This report says, ``Studies suggest that school
disciplinary rates may reflect the problematic behaviors of
black youth, problem behaviors that are imported into schools
and into classrooms.''
They go on to say, ``Difference in rates of suspensions
between racial groups appear to be a function of differences in
problem behaviors that emerge early in life, remain relatively
stable over time, and then materialize in the classroom.'' And
this report that you have cited, and based as your theory,
concludes by saying, ``The association between school
suspensions and blacks and whites reflects longstanding
behavioral differences between youth.''
That is the research that you have cited in your report in
concluding that apparently that it is not racial discrimination
in discipline but there are some characteristics of black
children that, from this report, start very early in life, well
before they get to the classroom. And, in fact, the author of
this report has many other writings where he says it is a
liberal fantasy that poverty and racism play into high rates of
incarceration and criminal behavior.
So my question for you is, when you talk about children
shall be treated individually, what are you saying? Are you
saying here, when you quote this research, that the problem
really is that black children are just more of a discipline
problem, because that is the research that you have quoted in
your report.
Secretary DeVos. Well, Congresswoman, I have said it before
and I will say it again. No student, no child should be treated
or disciplined differently based on their skin color, their
race----
Ms. Clark. And I think----
Secretary DeVos [continuing]. Or their national origin.
Ms. Clark [continuing]. Your report agrees with that. They
just say that by the very basis of being a black child you are
more likely to be a discipline problem. That is what the study
says that you quoted in your report and said that is why we now
think they may not be motivated by race. Black children are
just plain old more disruptive in the classroom. How did you
come to that conclusion?
Secretary DeVos. Children should never, ever be
discriminated against.
Ms. Clark. Well, I hope you take those words to heart----
Secretary DeVos. And if they are treated differently----
Ms. Clark [continuing]. And repeal your citing of this
research.
Ms. DeLauro. Congressman Graves.
EDUCATION FREEDOM SCHOLARSHIPS
Mr. Graves. Thank you, Madam Chair, Madam Secretary. Good
to see you.
Secretary DeVos. Good to see you.
Mr. Graves. First, let me just thank you for your many
years of commitment to children's education. Your personal
heart and your spirit that you have shown is amazing, and I
want to thank you for that. I know that has just been a driving
commitment of yourself and your family for many years. And
thank you for taking it to the public sector. It is not an easy
place to go but you were willing to do that, and didn't have
to, but you stepped up, and thank you.
Just sort of changing direction a little bit, and I know
you have plans for the agency in the days ahead, and we are
talking budgets and such as that. But I know you briefly talked
a little bit about the--I guess it was the Educational Freedom
Scholarship Program. And maybe you could just go a little
deeper on that, because I think that really gets to the heart
of what you are trying to do in this Department, and that is to
make sure that children have access to education that touches
them where they are in life as best as it can, and take them to
another place that better them and their family in the future.
If you can tell us a little bit about that, because I have
familiarity in some ways with--Georgia has an educational tax
credit. Is it similar to that, and how does that work, and, you
know, how would children benefit from this?
Secretary DeVos. Well, thanks, Congressman, for that
question, and to just elaborate a little bit more on what an
Education Freedom Scholarship tax credit could mean. We are
talking about a Federal tax credit that states could elect to
participate in or not. So Georgia could decide to participate
in that Federal pool of tax credit funds and implement a
different program than what they already have. They could
augment the one that they already have, the tax credit
scholarship program there, and really think very creatively
about how to address the unique needs of students in Georgia.
STUDENT BENEFIT FROM SCHOOL CHOICE
And, you know, just thinking about some of the lines of
questioning here today and some of the students that I have met
that have benefitted from being able to take--to have school
choice and take advantage of an opportunity like that, I think
about Denisha Merriweather, a young woman who was--she failed
the third grade twice. She grew up in the Jacksonville, Florida
area. She failed third grade twice, constantly got into fights
at school, had a mom who was not able to really be a full mom
for her.
Thankfully, she had a godmother who came and found this tax
credit scholarship, Florida tax credit scholarship opportunity,
and Denisha will tell you today she wasn't in that school, that
faith-based school that her godmom found for her, not even 2
weeks, and she was on a completely different trajectory. She
became the first in her family to graduate high school. She has
earned a college degree and a master's degree. And she is now
working with us at the Department of Education to continue to
talk about advancing these opportunities for kids.
And I think about so many students today who are stuck in
schools that just aren't working for them, and to give them the
kind of freedom and opportunity that the Education Freedom
Scholarships tax credit would allow is really inspiring to me.
And I would hope that those whose--who are--whose minds are
closed to that opportunity today would allow them to be open a
little bit and just talk to a couple of these students who have
been able to take--who have been able to make those choices and
to find the right place for them. You know, every child should
have those kinds of opportunities.
Mr. Graves. Well, thank you for your willingness to propose
that, because that is a bold proposal, and I know there is
always criticism and objection, oftentimes, to new concepts,
but it does work. And I don't know of an example where a
student has gotten a worse education as a result of taking on
opportunities such as this, and in fact, in some cases, you
know--and my wife is a schoolteacher, you know, pre-K, so I
come from that background too. But unfortunately it is not the
fault of the student. In fact, sometimes they are just tethered
to a mailbox. They go to school based on where their mailbox is
and not based on what is best for them and their family and
their spot, or their needs, in essence. So thank you for your
willingness to do that.
TRUE COST OF COLLEGE
And as we go through, I know we may have more questions, I
would like to take it all the way to the full spectrum of
college and how we can better prepare students with
understanding the true cost of college. You know, what is the
cost benefit of going to a school versus what the degree might
deliver on an income base, and how can we better assist
students in making college decisions based on facts and
finances and true costs? So when we come back around I would
like to touch on that a little bit, but thank you again.
Secretary DeVos. Thanks, Congressman, and please thank your
wife for the great work she does.
Mr. Graves. Thank you.
Ms. DeLauro. Thank you. We are going to embark on a second
round, but the time limit will be 3 minutes for each of us.
Okay. Thank you.
CLOSURES OF FOR-PROFIT COLLEGES
The Department of Education requires a letter of credit
from an institution if it determines a serious risk to
taxpayers. This includes things like the risk of a precipitous
school closure.
A couple of questions. Did the Department of Education give
back part of the Art Institute of Pittsburgh's, a for-profit
college, a letter of credit so that it could continue to
operate? This is $2 million. It is a yes or no.
Secretary DeVos. Well, Congresswoman, I am not familiar
with that specific issue with that specific school. More
broadly, yes, we do hold letters of credit----
Ms. DeLauro. Well, apparently there was a $2 million give-
back to the school, which you should check on.
Given that the Art Institute of Pittsburgh recently
announced it is going to close anyway, at the end of this
month, March 31st, it is going to close, I need an answer to
the question, why did the Department do this and what happened
to the money? You appear not to know anything about this, but I
would ask you to please check on it and get us an answer
quickly as to why it was done and where is the money. Where is
the money?
Secretary DeVos. Thank you, Congresswoman. I would be happy
to----
Ms. DeLauro. We have testimony----
Secretary DeVos [continuing]. Your question and I will
get----
STUDENT LOAN SERVICING
Ms. DeLauro [continuing]. From the Department's Assistant
Inspector General for Audit. This is about Federal Student
Aid's mismanagement of student loan servicers.
I also find it interesting that all the--all of your
commentary, even some of the folks on the other side of the
aisle, it is about state and localities that ought to have the
jurisdiction to go after--to take on education. That is where
it belongs--except when it comes to protecting our kids and our
borrowers. Then we don't want to look at the State, what they
are doing, and the loan servicers. We want Federal law to pre-
empt it.
RESCISSION OF MITCHELL AND KING MEMOS
That being said, and particularly we heard evidence of how
the department fails to consider a servicer's noncompliance
with Federal law and past performance. Were not these ideas
included in the Mitchell and King memos which you rescinded
following your first 3 months as Secretary of Education?
Secretary DeVos. Well, Congresswoman, we are--we have, as
you know, embarked on Next Gen.
Ms. DeLauro. I understand that. I know about Next Gen.
Secretary DeVos. Next Gen----
Ms. DeLauro. And I do know a lot about it.
Secretary DeVos [continuing]. If you would allow me to just
talk about that a moment, because it has----
Ms. DeLauro. What I want to know is why--no, my question
is, why were the Mitchell and King memos, which were
specifically laid out to address a servicer's noncompliance
with Federal law and past performance--I asked the question,
you rescinded the requirement that stated servicing contractors
should comply with Federal and State law, taking any necessary
steps to support oversight by Federal or State agencies,
regulators, or law enforcement officials.
Did you rescind that?
Secretary DeVos. Congresswoman, first let me just say that
we take loan servicing and the requirements thereof very
seriously.
Ms. DeLauro. I----
Secretary DeVos. We are continuing to enforce----
Ms. DeLauro. You do not. Loan servicers are getting away
with--putting at grave risk our students.
Mr. Cole.
EDUCATION FREEDOM SCHOLARSHIPS
Mr. Cole. Thank you, Madam Chair. I only have a short time
so I want to get two things on the record and then ask you a
question.
One, I agree with you on one. I really want to thank you
for this Freedom Scholarship initiative. I think that is a
really important thing and I agree very much with the idea of
injecting choice and freedom into the system and giving both
students and, frankly, donors the kind of flexibility that I
think would help the system and allow us to meet individual
needs.
TRIO, GEAR UP, AND PRE-APPRENTICESHIPS
I do want to go on record--and you and I have had this
discussion before--I disagree on TRIO. I certainly disagree
with the elimination of GEAR UP. TRIO has produced like 5
million college graduates for the United States, and these are
young people that usually come--not so young sometimes--come
from backgrounds that they may not have been able to make it.
I know in my state these are two really important programs.
I have this discussion frequently with our chancellor of higher
education, with the college presidents, and they think, like,
this has really helped the student population that we have a
lot of, which is a lot of first-generation.
One thing I do want to ask you about, though, that I was
pretty excited about. You have got--you know, and this sort of
works with--you know, the President proposed an apprenticeship
program. You have a pre-apprenticeship program and $60 million
new dollars for that. Can you tell me what the difference is,
how you would define a pre-apprenticeship program versus an
apprenticeship, how that would work out?
Secretary DeVos. So a pre-apprenticeship--first, thanks,
Mr. Cole. Let me just comment on the TRIO thing----
Mr. Cole. Sure.
Secretary DeVos [continuing]. One moment, because I know
while we have proposed combining GEAR UP and TRIO into one
program, and then a lesser amount for the TRIO program, what we
have also proposed is consolidating that into a state formula
grant so that states have the opportunity to get some of these
funds to institutions and to individuals that are more needy
around this.
What we have found is that 83 percent of the competitive
grants go to the same places and the same programs time after
time, and they don't necessarily help the students that are
most in need. So I would love to talk with you more about that.
Mr. Cole. We can have that dialogue another time.
Secretary DeVos. Yes. But with regard to the pre-
apprenticeship program, so this proposal is to really start
establishing apprenticeship programs that are outside of the
registered, more traditional sorts of apprenticeships that--the
building and trades apprenticeship programs--that this will
allow us to allow employers and educators to work together on
apprenticeship tracks and opportunities that are going to have
a more expansive appeal and more relevance to the market today.
Mr. Cole. Well, again, this has a lot of appeal to me. I
just want to get a little clarity as we go forward over what
the definition would be so we don't end up basically funding
the same thing twice.
Secretary DeVos. Well, and we would love to work with you
on that to make sure that is very well----
Mr. Cole. My career tech people are very excited about all
these kinds of proposals.
Thank you, Madam Chair. I yield back.
Ms. DeLauro. Congresswoman Lowey.
BUDGET DEVELOPMENT PROCESS
The Chairwoman.. Thank you again, Madam Secretary.
A quick question before I turn to my question with 3
minutes. Looking at these numbers again, the total cut to the
Department of Education compared to fiscal year 2019 is $8.8
billion, 12.5 percent. I am just curious. You could say yes,
no, whatever. Did you have any input--did Mr. Mulvaney or
President Trump ask you if you thought those cuts should be
made or should be rescinded? Did you have any input?
Secretary DeVos. Congresswoman, yes. This was an ongoing
discussion. But let me just correct you in your numbers. The
proposed cuts are $7.1 billion. I think you are also rolling in
the rescission around Pell, and that is not a cut.
The Chairwoman. It is pretty important, don't you think?
Secretary DeVos. That is not a cut to any existing program.
The Chairwoman. Yes. It is $2 billion----
Secretary DeVos. It is actually--no, it is the Pell
surplus. So it is the amount that continues to accrue because
not enough students are taking advantage of the Pell program so
the account accrues, and it is just essentially an accounting
adjustment to rescind part of that.
The Chairwoman. Madam Secretary, I am not going to be hours
late. I am not going to get into that. I just wondered if you
had any input, knowing your commitment to education. You
accepted this position as Secretary of Education. Does Mulvaney
say ``this is yours'' and ``this is yours''? But let's go on.
Secretary DeVos. This is a process, but let me just also
say that it is only at the Federal Government in Washington
that we judge the quality and effectiveness of something by the
amount of money we spend on it. And I think we have to get past
that notion.
The Chairwoman. Well----
Secretary DeVos. Quality and effectiveness does not equate
directly to dollars spent.
The Chairwoman. We can have a long discussion, but in many
of my schools, whether they are getting a Pell Grant or not,
does depend not just on the specific criteria but whether there
is enough money in the bank to pay for their Pell Grant or pay
for their scholarship or help them get through a job and
education at the same time. But I am not going to get into that
again. I hope we can continue that discussion.
SCHOOL SAFETY
What I wanted to ask you, in the past two--well, it is the
past week alone--two Parkland school shooting survivors and the
father of a Sandy Hook victim died by suicide. This came from
the gun violence at schools and highlights the critical
importance of mental health support in schools.
And while your Budget requests an increase for School
Safety National Activities it proposes the elimination, for the
third year in a row, of the $1.7 billion Student Support and
Academic Enrichment grant program. And in my judgment,
interacting with educators you need programs like this and
other important interventions that help keep communities safe.
Can you just tell us how is the Education Department
responding to this? Has there been any outreach? Has there been
any support services? And I have 6 seconds left, so maybe you
can just answer very quickly.
Secretary DeVos. Well, let me just say I was heartbroken to
hear about the students at Parkland, and we certainly have been
in continual contact with them around the immediate grants that
we can make in the wake of a tragedy, and will certainly be
again this time.
But, you know, the proposed--the Budget proposal does
include funds and initiatives specifically to help schools
elect to onboard social and emotional learning and mental
health programs to really work at ensuring prevention of these
sorts of tragedies.
The Chairwoman. Well, my time is up, so $100 million spread
out across the 50 states doesn't seem to be adequate.
Thank you.
Ms. DeLauro. Mr. Moolenaar.
REFORMING FEDERAL WORK-STUDY PROGRAM
Mr. Moolenaar. Thank you, Madam Chair, and again, Secretary
DeVos, thank you for your answering questions and just for your
patience with, you know, sometimes not even getting a chance to
answer the question you were asked. And I appreciate all you
have done.
And I wanted to ask you, on your Federal Work-Study
proposal, last year's Budget you had proposed reforms to the
Federal Work-Study program. You have done that again this year,
to better target the funding to low-income recipients. And I
wonder if you could comment on why do we need to--why does this
Federal Work-Study program need these reforms? How does it
assist low-income students better? And any other reforms in
your Budget to ensure that funds are best targeted to the
students who need the funds most?
Secretary DeVos. Well, thanks, Congressman. Yes. We believe
the Federal Work-Study program needs reforms because the way
the formula works today very often those funds go to the most
elite institutions, not the ones that are really serving the
students with the most need. And so that is issue one.
Secondly, work-study, as it is carried out today, often
involves students working in the college bookstore or in the
cafeteria, on-campus programs. We have proposed to expand those
options to allow students to potentially work with, in an
internship-type, apprenticeship-type opportunity, with
employers for whom they might ultimately move into a career
with. And we think that having relevant work opportunities for
students will be very meaningful in their learning career, and
so that is part of our proposal as well.
Mr. Moolenaar. I think that is a great idea. I think it
meets a short-term need as well as really helping someone
evaluate their future and what they might want to pursue long-
term.
What needs to happen to accomplish that? Is it legislative?
Is it something that you can do? You know, how do we accomplish
that?
Secretary DeVos. Well, it is part of our Budget proposal so
Congress can--you all can discuss and take that up in your
budget deliberations to allow the funds designated for that to
be able to be used for those sorts of purposes.
Mr. Moolenaar. Okay. Thank you.
PROFESSIONAL DEVELOPMENT AND TEACHER MENTORS
And then just one last question on the teacher mentors. Can
you talk a little bit more about that, because one of the
things you hear periodically is that teachers come into the
profession and many leave in the first 3 years. Is that
something that this will help with that?
Secretary DeVos. Good question. Thanks for asking that. We
believe that this is really a two-track opportunity. For new,
young teachers just coming into the profession to have a highly
qualified, seasoned professional to come alongside them and
help them, you know, to walk through their first few years in
the profession is a great opportunity for new teachers.
For those who are established and want to continue to
really expand their reach and their ability to reach students,
this gives them a really important career track and opportunity
to, you know, to do so and to continue to develop themselves
and a career track for themselves. The best of the best,
teaching young, new teachers is a great combination and we
should, I think, really embrace this wholeheartedly, because it
is ultimately going to be best for students.
Mr. Moolenaar. Okay. Thank you, and I yield back.
Ms. DeLauro. Congresswoman Lee.
RISK-SHARING AND STUDENT LOANS
Ms. Lee. Thank you.
Madam Secretary, your budget proposes to require
postsecondary institutions that accept taxpayer funds in any
way to have this, quote, ``skin in the game'' through a student
loan risk-sharing program. But this program is not quite
defined in the budget.
Now, Historically Black Colleges and Universities and
Minority-Serving Institutions enroll a large number of low-
income students. The point of the Higher Education Act was to
increase access to postsecondary education, and I want to
ensure that as we move forward we move toward increased access.
But from the proposal that we have seen there is a strong
argument that risk-sharing can incentivize institutions to only
enroll those students of a certain means in an effort to not
have to share in the risk if a student is unable to pay back
their loans. So again, it could negatively harm Minority-
Serving Institutions and minority students.
So how do you describe your proposal in the sense that it
would not create a perverse incentive to not enroll low-income
students?
SPENDING ON MEDIA AND COMMUNICATIONS
And then the second question I have, and you may need to
get back to me on this, is the Congressional Black Caucus, we
are deeply concerned about communications and advertising
dollars from each agency. And so I would like to know--and you
have $1 million for communications programs in your budget--how
this money is contracted out in terms of the vendors, the media
that you use to provide communications through Department of
Ed, in terms of minority, women-owned businesses in media. So
if you could just get back to us with that written response.
Secretary DeVos. Congresswoman, yes. If you could submit
that for the record we will be happy to respond on that one. I
can't respond on that right now.
[The information follows:]
Allocation of Communications Funding
Of the $1,088,000 in communication-related funds requested for
fiscal year 2020 under Program Administration, $1,042,000 is for the
Office of Special Education and Rehabilitation Services (OSERS). Of
this amount, $850,000 would support the Office of Special Education
Programs (OSEP) GRADS 360 and Customer Service Database, and $192,000
would support the Individuals with Disabilities Education Act (IDEA)
website.
The Department has partnered with small, minority-owned businesses
on both projects. 2M Research Services, LLC, a small business with
African American ownership, holds the contract for the GRADS 360 and
Customer Service Database. Collabralink Technologies, Inc., a small
business with Subcontinent-Asian American/Asian Indian American
ownership, holds the contract for the IDEA website.
Ms. Lee. Yeah.
INSTITUTIONAL RISK SHARING
Secretary DeVos. But as far as your first question and the
proposal around risk-sharing, it is a very broad proposal and
not defined at all yet. We would look forward to working with
you to develop a more concrete approach to ensuring that
institutions have some kind of commitment to the students they
are serving.
I share your concerns. We share your concerns about
ultimately impacting low-income students and, you know, more
high-risk students disproportionately. So I think that we,
again, would look forward to working with you and talking to
you about ensuring we don't have a--we don't ultimately come
forward with a proposal that would negatively impact the
students that most need to have the kind of access you are
talking about.
And with regard to HBCUs, I just want to say that this
Administration has a very strong commitment to continuing to
support HBCUs and their important work, and our Budget proposal
continues to fund all of the HEA Title III HBCU grant programs
at levels as appropriated in 2019. And so, again, in the
context of a reduced budget overall, I think it demonstrates
our commitment to these institutions.
Ms. Lee. Thank you, Madam Secretary. We will get to you in
writing some suggestions on how you can approach the risk-
sharing program.
Secretary DeVos. Thank you.
Ms. DeLauro. Congresswoman Watson Coleman. Oh, no. I am
sorry.
Mrs. Watson Coleman. Madam Secretary, how we spend our
money and propose to spend it is an absolute reflection of our
values, and as I look at this--did you say Watson Coleman?
Ms. DeLauro. Lack of confusion here, or more confusion.
Congressman Harris.
Mr. Harris. Thank you.
Ms. DeLauro. Okay. Then Congressman Graves.
EDUCATION INNOVATION AND RESEARCH AND TEACHER DEVELOPMENT
Mr. Harris. Thank you very much, Madam Chair.
And, Madam Secretary, you know, one of the things that I
have noticed in the President's Budget and of the things that
was mentioned is the professional development, and kind of a
different turn the Administration wants to take in professional
development.
And, you know, I liken it to a position--you know, we do
continuing medical education but obviously it is going to be
different for every person. I mean, every person is at a
different stage in their training, a different stage in their
experience. And, you know, a one-size-fits-a-few approach
doesn't work for that and I suspect it doesn't work for
professional development for teachers as well.
So could you just review, you know, the EIR program and
kind of the--you know, what your proposal is for it, and how it
would change the way we deal with professional development?
Secretary DeVos. Yeah. Thanks, Congressman. This is a
really important initiative. I think that in our goal to really
honor and respect the teaching profession and teachers we want
to give a couple of different tools to teachers specifically,
and give them more freedom to be the best they can be.
And the proposal that we have put forward is a teacher
voucher, where teachers could pursue their professional
development, customize it for their needs, and continue to
develop themselves, and, you know, perhaps share with their
peers what they have learned, but give them a lot more freedom
in that development.
I have talked with dozens--hundreds of teachers across the
country, and I hear repeatedly about, you know, with very few
exceptions, the area of personally developing, professionally
developing is one that they deeply want to do and yet they have
very few opportunities and very little latitude in how to do
that. And so this--we believe this is a really important
proposal that we hope that you will consider very seriously.
Mr. Harris. Why is it--because, you know, I have got one of
the studies that the National Center for Education Evaluation
and Regional Assistance produced, actually which was from the
Department of Education, that looked at middle school
mathematics professional development, you know, where they--and
I am sure you are aware of these studies--that show that, you
know, we do these things for teachers, these things called
professional development, but objectively they just don't
achieve the outcome.
Why is it, you think, that what we are currently doing--and
this is obviously important, mathematics is an important thing,
that, you know, we want to make sure our teachers teach
better--why don't these programs currently work?
Secretary DeVos. Well, I think very often they are a one-
size-fits-all approach, or one dictated by the district or the
school building, and there is very little latitude given to the
teacher themselves as to whether or not this particular program
to which they are assigned to go and learn from is going to
actually help them in their profession and in their particular
teaching style.
So I think being able to choose and customize themselves is
going to really allow them to really grow professionally in a
way that they have not been able to before.
Mr. Harris. Thank you very much, and, Madam Chair, I would
like to move, without objection, that, you know, this study be
entered into the record of the hearing.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Harris. Thank you. I yield back.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Are you sure?
Ms. DeLauro. Yes.
SCHOOL DISCIPLINE AND DISPARATE IMPACT RESCISSION
Mrs. Watson Coleman. Thank you, Madam Secretary.
First of all, I want to say something about this rule that
was rescinded. This was not supported by any of the civil
rights community and it would seem to me that that was a very
valuable entity to consider before you rolled that rule back.
EFFECT OF PROPOSED CUTS ON DISADVANTAGED STUDENTS
Number two is you have--you as the major advocate for
education in this country, admonished us in your statement for
giving you too much money. So I just find that absolutely
incredible.
Number three is that I look at where your priorities are at
the same time I look at where your decreases and program
eliminations are, and it is very plain to me that those
programs that are particularly hurt address the minority
populations, the poorer populations, the teachers in the
schools that are struggling more, the TRIO programs and
programs of that ilk that help young people get prepared for
college. All of those programs address the children and the
situations most in need, and there is more than a $7 billion
cut in your Budget from each one of those programs.
And finally, I am going to give you the copy that I have of
my attorney general's letter so that you will have it in your
possession now and be able to have your staff, who already has
it, respond in a more expeditious matter.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
TEACHER PROFESSIONAL DEVELOPMENT
Mrs. Watson Coleman. And I guess really, really finally, is
that you have eliminated a $200,000,000,000 teacher development
program and replaced it with a $2,000,000, or a $2,000,000,000
program--or $2,000,000--a $2,000,000,000 program you have
eliminated, replacing it with a $200,000,000 program to do the
things that you say will give teachers an opportunity for
development, personal development, innovative development, et
cetera. That just doesn't fly. That just doesn't fly.
It seems to me that a word that you use a lot in your
discussion here today was about freedom, and from my
perspective, from what I heard, freedom is not equal in your
mind.
I yield back.
Ms. DeLauro. Congressman Clark. No. Congressman Graves.
CONSTRAINTS IN BUDGET DEVELOPMENT
Mr. Graves. Yes, ma'am.
Madam Secretary, thanks again. Just sort of wrapping up
here, you know, I have been here a little while, this
afternoon, this morning and this afternoon, and I hear a little
bit of criticism about some spending decisions you have made.
And might I just point out to the Committee, on your behalf,
that you are complying with the law. I mean, the law says you
can only spend so much money, and until Congress changes that
number you have to make tough decisions and tough choices.
So I might refer to it as a little bit hypocritical
criticism, because I have yet to see a comparison budget by the
other side presented that would counter and show their spending
priorities as it complies with current law as well. And until
then I would suggest they restrain from some of their criticism
until they can compare it appropriately.
COSTS AND BENEFITS OF COLLEGE
Back to talking about college students. I am a father of
two college students, and we have been going through that
process of making decisions over the last year and two, and it
is difficult. It is really difficult to compel a student who
has a desire, an aspiration to go to a certain university with
a certain degree in mind and program, and to try to convey to
them that your potential income when you come out might not
match the expense of what you are going to incur, because there
is an expense.
What can we do, or what is your Department doing to help
educate very educated students who are going into very
demanding career potential--potential careers in the future,
that the expense of a $250,000 loan to get a degree that might
be very difficult to pay that off in the future--how do we get
that message to them and help them make informed decisions?
Maybe it is a disclosure. Maybe it is a--like might be done in
real estate. You understand you are signing an agreement and
you understand that this might be the salary, but this is the
cost, and here is your return on investment.
Secretary DeVos. Well, thanks for that question,
Congressman, and this is an area that we have been very focused
on making progress on behalf of both students that are the
customers and taxpayers.
The Next Gen initiative in Federal Student Aid is taking a
very antiquated, complicated framework that has been patched
together over the last couple of decades and bringing it into
the 21st century with a structure that is going to be a world-
class experience for the student, the customer.
Today you can complete your Federal Student Aid form on
your smartphone, through the MyStudentAid app. Very soon, we
are going to be adding really important information to that
through the College Scorecard. We are going to have program-
level data, by institution, so students can look, if they are
prospectively deciding between a number of institutions and a
number of programs that they are thinking about pursuing, they
are going to be able to find earnings data at the program level
from that institution.
And so it is going to give them a really important tool
that they can use when they decide to take on that student debt
to determine if that program is ultimately going to pay and
ultimately going to be worth the investment they are talking
about making.
COLLEGE COSTING RESOURCES
Mr. Graves. Do you anticipate this tool will indicate the
interest expense, the payment structure if a loan were to be
taken out, and income potential and growth over time, and how
long it would take? Because I feel like parents are having to
do a lot of that work on their own. And students get to the end
of their career--their college career to enter into their next
career and they realize, ``Wow, I have a lot of work to do but
I had other dreams. I wanted to start a family or buy a home
but now I can't. I wish I would have known 4 years ago.''
Secretary DeVos. Well, I think, in general, students need
to have a lot more tools at their fingertips to--and they need
to become much more financially literate as they make these
decisions about their higher education pursuits. And so we can
and will be providing a lot of data and a lot of tools for them
to be able to know and understand what those implications are.
You know, we have proposed, in this budget, simplification
of loan repayment, income-driven repayment program that would
be capped at 12.5 percent.
I think another area that is ripe for exploration in which
Mitch Daniels has instituted in a really important way at
Purdue University----
Ms. DeLauro. I am sorry, Madam Secretary.
Secretary DeVos [continuing]. Income sharing----
Ms. DeLauro. You are about a minute and a half over here.
Mr. Graves, I apologize but we are trying to----
Ms. Clark.
SCHOOL SAFETY AND MENTAL HEALTH
Ms. Clark. Thank you, Madam Chair.
Madam Secretary, last year you came before us in answer to
my question about a proposed budget cut to the Student Support
and Academic Enrichment grants, under ESSA. Since you had made
that budget proposal in 2018, we had had the shooting in
Parkland. And I know that you were just putting together this
Commission that has now made recommendations that mental health
treatment be provided and that we hire more school counselors
and social workers, recognizing that the services are most
effective when they are school based.
You said, when I asked you about it, that in light of what
had transpired, quote, ``I support Congress'' readdressing this
and looking at this budget item,'' because you said you
supported, quote, ``ensuring schools have the resources that
they need to keep kids safe.''
I understand your testimony today that the $3.8 billion in
cuts that you have proposed is somehow squared with the $100
million that you have put in your budget to go to mental
health. Could you explain your thinking, and has what you said
to me last year changed?
Secretary DeVos. Well, thanks, Congresswoman, for the
question about the Title IV-A proposed elimination from the
budget.
Ms. Clark. Yes.
Secretary DeVos. I mentioned earlier the fact that this
program has been very broad, very thinly spread, has not been
designed specifically for school safety activities. We think
that----
Ms. Clark. There was $234 million, though--correct--to Safe
and Healthy School Activities?
Secretary DeVos. Which were, again, very broad. We believe
the Budget proposal as we have submitted it today is one that
really helps target specific needs of states and local
districts to----
Ms. Clark. Can you really help make--this week we have
already mentioned the suicide of the Parkland student, which I
share your heartbreak over that. But it just puts such a
glaring light on the need for mental health services. And what
I hear you saying is that with less than half of what the Title
IV funds, somehow you think that is going to do a better job
because those funds are too broad. Is that what you are saying?
Secretary DeVos. Well, there--let's also take into account
the fact that there are other specific activities, including
mental health services, in the budgets of HHS and in DOJ and
DHS, and together $700 million specifically for school safety
activities. And there is actually more in those departments----
Ms. Clark. Can you----
Secretary DeVos [continuing]. That could be used for----
Ms. Clark [continuing]. So I am hearing your testimony
that, yes, reducing it by half is going to do it.
Can you just answer for me something that was raised? Are
any of that funding of the $200 million going to be allowed to
purchase guns?
Secretary DeVos. That is not the intention of the proposal.
Ms. Clark. Is that a no? Is that a no?
Secretary DeVos. That is not the intention of the proposal.
It is for mental health and----
Ms. Clark. Is that----
Secretary DeVos [continuing]. Social and emotional
learning.
Ms. Clark. Is that a no then?
Secretary DeVos. That would be totally up to this body to
decide conclusively one way or the other. It is not the
intention of our proposal.
Ms. DeLauro. Let me just now ask Ranking Member Cole, do
you have any further questions or any closing comments?
Ranking Member's Closing Remarks
Mr. Cole. I will close. I am prepared to close, Madam
Chair.
Madam Secretary, first I just want to thank you. You know,
I hope it is well known how many years of service you have
spent, and frankly, to try and make sure folks without access
got access to good quality education long before you took this
current job. And you certainly did not need this job and you
serve without pay. You travel at your own expense. And I
suspect you had better alternatives in front of you in terms of
being more enjoyable, but you chose this, and you chose it
because you care about young people and you care about
educational opportunities.
So we may have occasional differences. I don't think
anybody can doubt your commitment to the job and the
willingness to sacrifice time and forego, you know, again, if
you want to call them the perks of the job, I think there are
very few perks for the job that you have. And I want to thank
you for that.
And I think the mere fact you have stayed here again longer
than we normally go, because you wanted to be--answer
everybody's questions and concerns and present, you know, a
case, I think that is very important.
I think, on a note, too, while we have had differences
there are some places we can clearly work on together. It
seemed to me there was universal support for this idea of
short-term Pell Grants that you mentioned. There is certainly
strong support here for investments in career and vocational
education. And obviously you share a lot of the priorities.
I think as my friend, Mr. Graves, pointed out, you do have
to live within a constrained budget. You are writing your
Budget to the law. You know, we think there will probably be an
agreement at some later point. We don't know that. You don't
know that, and it would be pretty unwise for you to present a
budget. But even within that constrained budget, as you point
out, you made sure English learners, no cuts; IDEA, no cuts;
Title I, no cuts. Those are our most vulnerable students. And I
think with the dollars that you have I think you have put those
dollars where they reach people that are at the greatest risk
of falling through the cracks in our educational system, and I
want to thank you for that.
So again, just thank you for your service, thank you for
giving us extra time here today to ask tough questions, and I
look forward to continuing to work with you as we go forward.
Thank you, Madam Chair.
Chairwoman's Closing Remarks
Ms. DeLauro. Thank you very much and thank you as well,
Madam Secretary, for being here and for staying on and
continuing to answer questions.
I think--I just might say for a second that you get a sense
of frustration and it is particularly on our side of the aisle,
and that, quite frankly, frustration stems from oftentimes the
inability to get answers to questions, as it was demonstrated
here today.
CRITICISM OF PROPOSED BUDGET
Now I will--I started out, and I will not pull any
punches--this Budget, in my view, is cruel. I think it is
reckless. It is a 12 percent cut. It hurts middle-class
families. It hurts working families. It hurts low-income
families. And it is of concern to me--and again, as I laid out,
I would hope that it is of concern to you. You know, why, on
your watch as the Secretary of Education, do you want to be
complicit in shutting off public education opportunities, which
is the way, you know, that I see this?
And my colleague talked about criticisms that have to do
with the budget or so forth. No. We are all used to working
within a budget framework, but it is where you place your
resources, what are your values, what are your priorities. That
is what defines a budget and that is what is of concern to all
of us.
CHARTER SCHOOLS
I just want to just clarify a couple of things. With regard
to charters being public, you know, it is hard to compare
charters to public education as we know it, because far too
often what we see are charters siphoning away dollars from
public schools. They are operated privately, and they do lack
transparency, and we should expect--we expect that transparency
from our public institutions. We apparently don't with regard
to charters.
And I want to say to you this morning, or this afternoon,
find the billion dollars. Find that billion dollars that was
there.
INTERNATIONAL COMPETITIVENESS
My colleague who is now gone--and you had an exchange with
regard to international comparisons. You know, other countries
blow us out of the water with investments in early childhood,
wraparound services, which we know pay off in serious
dividends. We have one of the lowest rates of--lowest
enrollment rates in early childhood education. And just me just
tell you, the HHS budget proposes to eliminate Preschool
Development Grants. We have level-funded Head Start. You know,
we take on most of 15-year-olds in our school systems. Other
countries don't do that. They take the highest achievers.
So when you look at--you have to take that into
consideration. The National Assessment of Educational Progress
has shown large gains, which we should be proud of, for
children of color over the past three decades. We have made
gains. We continue to denigrate our public education system,
which leads me to the view that that is because of the decision
is to privatize this.
HIGHER EDUCATION ACCOUNTABILITY
I am sorry that you didn't answer the questions on the
mismanagement of the agency. With regard to short-term Pell,
which everyone is extolling, but there are some pieces around
that. What you failed to do is to talk about defining high
quality. We need to have guardrails so we don't wind up in a
Pell Grant program that is open to fraud, waste, and abuse. We
need to have programs that look at whether or not they are a
good return on our investment for students and for the Federal
Government.
With regard to Next Gen, you did rescind the requirement
that servicing contractors should comply with Federal and State
law, taking any necessary steps to support oversight by Federal
or State agencies, regulators, or law enforcement officials.
You rescinded the requirement around strengthening transparency
through expanded publication of aggregate data on student loan
and servicer performances, that would have required the
Department of Education to publish servicer-level data on
default. None of these rescinded provisions are currently part
of the Department's Next Gen effort.
COMMITTEE OUTLOOK ON BUDGET PROPOSAL
You know, you said, and you discussed that these are just
proposals. I am relieved. I am relieved that they are just
proposals, because the damage that your Budget would inflict on
children and on families, that I look forward to working with
my colleagues across the aisle to reject the cuts and act a
forward-looking agenda to improve the lives of American
families. And we have strived to do that over the last several
years on this committee.
So we will be reviewing what has been proposed, and you can
be assured--and I hope that we can--that we are going to reject
much of what is here, as we have in the past, because the
center of the Department of Education is the 90 percent of our
kids who are in public education. We ought to be focused like a
laser on their opportunities and their future, and yes, look at
innovation, test whether or not it is good, and be prepared to
say no when it is not working.
Thank you, and let me draw this hearing to a close.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 2, 2019.
NATIONAL INSTITUTES OF HEALTH BUDGET REQUEST FOR FISCAL YEAR 2020
WITNESSES
FRANCIS S. COLLINS, M.D., PH.D., DIRECTOR, NATIONAL INSTITUTES OF
HEALTH
DIANA W. BIANCHI, M.D., DIRECTOR, EUNICE KENNEDY SHRIVER NATIONAL
INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND
INFECTIOUS DISEASES
GARY H. GIBBONS, M.D., DIRECTOR, NATIONAL HEART, LUNG, AND BLOOD
INSTITUTE
DOUG LOWY, M.D., DEPUTY DIRECTOR, NATIONAL CANCER INSTITUTE
NORA VOLKOW, M.D., DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE
Ms. DeLauro. The subcommittee will come to order. I
understand--is our technical problem taken care of? Thank you.
Okay. About as much as I know about technical problems and what
one needs to do.
I always--and I use the comment again because I am a
diehard New York Yankee fan, and when you take a look at the,
you know, the array here this morning it really is Murderer's
Row, in the best sense of the word, is that you knock it out of
the park all of the time, and I thank you. We all thank you
here.
And good morning to you, Dr. Collins. Welcome back to the
Labor HHS Education Appropriations Subcommittee. Let me also
welcome the five institute and center directors joining Dr.
Collins today, Dr. Diana Bianchi, Director of the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development; Dr. Anthony Fauci, Director of the National
Institute of Allergy and Infectious Diseases; Dr. Gary Gibbons,
Director of the National Heart, Lung, and Blood Institute; Dr.
Doug Lowy, Deputy Director of the National Cancer Institute;
and Dr. Nora Volkow, Director of the National Institute on Drug
Abuse.
Let me also, if I might, acknowledge Frank Stephens, a--
fierce advocate for Special Olympics, athlete. Powerful
testimony, Frank, about the importance of research on Down
syndrome at the subcommittee's hearing on the topic that we
held in 2017. Thank you for being here today.
Today we will be discussing the 2020 budget request for the
National Institutes of Health. I also want to note that I
intend to hold hearings with additional institutes and center
directors later this year. There are many of the institutes
that have not testified here in many years. They have not come
before this subcommittee, and I think it is important for all
of us to hear from them, and it is important, I think, to the
NIH, because then it lays out the full spectrum of all of the
areas in which you are making discoveries.
The NIH is the leading biomedical research entity in the
world, and with each scientific discovery, each medical
breakthrough, its research advances human knowledge, improves
our quality of life, and saves lives. That breakthrough can
improve the life of not just a sick individual but it is the
lives of their loved ones, caretakers, and friends.
But it is not just the macro benefits. Local impacts are
substantial. Hundreds of millions of dollars are coming into
our community through NIH grants and contracts. That is why I
believe that funding this research has the power to do more
good for people than almost anything else within the purview of
this subcommittee or, for that matter, in the Federal
Government.
I am very proud--I want to welcome the chair of the
Appropriations Committee. Don't be silly.
The Chairwoman. There are about 10 hearings at the same
time.
Ms. DeLauro. Exactly. I am very proud that the Congress
increased NIH funding by $9,000,000,000, over 30 percent, over
the past four years. The committee has done this on a
bipartisan basis. The successes are laudable, and we all take
great, great pride in what we have been able to do in this
effort.
And now, the President's budget would take the NIH in the
opposite direction. The President's budget proposes to reduce
funding for NIH by $5,200,000,000, 13 percent below the 2019
level. At this funding level, NIH would be forced to make
nearly 3,800 fewer new research grants compared to 2019. That
is a reduction of 32 percent. That is the lowest level since
1998. At that level, NIH would be forced to drastically cut
back its critical research. It would mean less funding for
Alzheimer's research, less funding for cancer research, less
funding for infectious disease research. It would mean no new
funding for new areas of discovery. We would never even know
the important breakthroughs that we missed, and as I have said
before, you cannot do more with less. You can only do less with
less.
Let me just say right now--and I believe my colleagues on
both sides of the aisle will agree--we will not be doing that.
This committee will continue to invest in NIH research, despite
the Administration's short-sighted and, in my view, misguided
budget.
The Administration is also being short-sighted with regards
to HIV and AIDS. I appreciate their focus on combating domestic
HIV and AIDS. However, words alone are not enough. For example,
the Administration is not elevating the NIH to a prominent role
in that initiative nor providing the overall resources to make
real progress. Decades of research supported by NIH led to the
development of the very treatment and the prevention approaches
that have put achieving this goal within reach, specifically
the antiretroviral therapy and PrEP.
The NIH must be involved if we are to continue to make
progress in reducing HIV and AIDS domestically and abroad. That
just has to happen. Yet the President's budget proposes to cut
HIV and AIDS funding for the NIH by $424,000,000, 14 percent
below fiscal year 2019 level, and that cut of $424,000,000 is
nearly double the Administration's request for $291,000,000 to
reduce HIV transmission.
I said this to Secretary of the Department of Health and
Human Services, Alex Azar. The totality of this budget is
contrary to the needs of the American people and the very
promises of this administration, as it is evident with HIV and
AIDS.
In addition to cuts to NIH research, the Administration is
also proposing a $1,000,000,000,000 cut to Medicaid, which, as
we know, is the primary source of treatment for HIV/AIDS,
meaning that HIV drugs will be unavailable, and they are
proposing to cut the CDC's Global AIDS Program as well as
PEPFAR, which I will note was a priority of President George W.
Bush. What happens internationally impacts us here,
domestically, as well.
Further, they are proposing to repeal the Affordable Care
Act, which would take away health coverage for millions of
Americans.
So the sum of this budget is highly counterproductive for
the goal we all share of reducing HIV infections. HIV and AIDS
is not the only area where the President's budget does not
support the President's ambitious claims. He boasted about a
new $50,000,000 pediatric cancer initiative in his State of the
Union address, yet this budget proposes to cut nearly
$900,000,000 from cancer research.
For all of our greatest health crises we need our great
agencies to be fully involved in finding the solutions. In
recent years we have provided significant resources to address
the opioid crisis. I believe this approach is also necessary to
address the public health emergency of gun violence. Last month
I chaired the first appropriation hearing on gun violence in 20
years, in which experts confirmed that the epidemic of gun
violence is a public health emergency that demands public
research dollars through both the CDC and the NIH. NIH needs to
resume its Firearm Violence Prevention Research Initiative,
which funded grants from 2014 to 2016.
Americans are struggling with the skyrocketing cost of
prescription drugs. We need to be promoting research in order
to bring more drugs to the market, to provide better care for
patients as well as more competition, and thus better prices.
A study published in the Proceedings of the National
Academy of Sciences in February found that NIH-funded research
contributed directly or indirectly to every single one of the
210 drugs approved by FDA between 2010 and 2016. The
development of these drugs was associated with $100,000,000,000
of mostly basic NIH research over the six-year period. This
illustrates how damaging these proposed cuts would be to the
biomedical research on which America's health and their wallets
rely.
I believe my friend, the ranking member, Tom Cole, will
concur that biomedical research is one of the most important
investments a country can make because it gives the gift of
life. We must be supporting it and we will.
Thank you again for all that you do, and I look forward to
our conversation today.
And now let me turn to my good friend from Oklahoma, the
ranking member of the subcommittee, Mr. Cole, for any opening
remarks that he may have.
Mr. Cole. Thank you very much, Madam Chair. It is a
pleasure to have all of you back here again, and today we are
joined by one of the longest-serving directors of the National
Institutes of Health, Dr. Francis Collins. I always call Dr.
Collins the best politician in Washington. Anybody that can be
appointed by President Obama and then reappointed by President
Trump has exceptional political skills, to say the least, and,
frankly, as clearly, as all your colleagues are, a national
resource that I think the country quite genuinely treasures and
values.
I want to commend you for your long and distinguished
career. I have made no secret of the fact that increasing
funding for NIH is one of the proudest bipartisan
accomplishments of this subcommittee. A sustained, steady
commitment to increasing funding for NIH is critical to
ensuring our nation's future as a leader in biomedical research
and unlocking cures to so many diseases burdening our strained
health care system.
Leaders in the House and the Senate, Democrats and
Republicans, have been unified behind these increases over the
past four years. I ardently hope this trend continues for years
to come. While I appreciate and sympathize with the fiscal
restraint expressed in the President's budget, I do not think a
reduction of the magnitude this budget recommends for NIH is in
the best interest of the American people. To reduce NIH funding
at this juncture would erode the progress we have made in the
last four years, signal to the research community instability,
and quite possibly delay, by years or perhaps even decades,
advances in modern medicine including curing diseases, finding
better treatments for cancer, and unlocking the power of
precision medicine.
I also want to caution against the budget request's
proposed changes to the negotiation for indirect costs, or
funds included as part of a grant to cover facilities in
administration. This critical funding serves as a foundational
element for research, and I support the enacted bill language
which preserves how these costs are determined as part of the
grant's award. I certainly support administrative efficiencies,
but I think we need to look at other options here, and I hope
we can continue, on a bipartisan basis, to maintain this
important protection for the grants.
I look forward to hearing about several key initiatives,
but for a few minutes I want to focus on a particular
initiative that is especially important to this body and this
subcommittee, and that is Project Include. This work was
launched with funds provided by Congress in fiscal year 2018.
Those funds were given to the NIH as part of a response to
a hearing held by the subcommittee in October of 2017, which my
good friend, the chair, alluded to a moment ago.
Under the leadership of Dr. Tabak and Drs. Bianchi and
Gibbons, the project seeks to increase funding into Down
syndrome research across NIH. I am encouraged by the strong
leadership from the Office of the Director and the
participation by several institutes. I look forward to
increased involvement from the National Institute of Allergy
and Infectious Diseases, the National Cancer Institute, the
National Institute of Diabetes and Digestive and Kidney
Diseases, and others.
This project is not only going to result in a better
understanding of the impact of Down syndrome, better therapies
for those with Down syndrome, but also promises to help us
understand more about the connection between genes and disease.
The goal of this project is to increase basic biomedical
research with a focus on Down syndrome for many years to come.
The work within the Office of the Director should serve as a
launchpad to support an increased funding pipeline throughout
NIH.
I also believe research spanning all institutes, with each
one bringing their particular expertise, is the research model
of the future. NIH has shown us how complex the human system
is. Funding silos will not result in breakthroughs.
Partnerships and collaboration across specialties to tackle
multifaceted diseases is the type of difficult yet vital work
that the NIH is best suited to address.
I do not want to take a lot of time--additional time by
recognizing all the institute directors today, because, quite
frankly, I would rather hear from each of you about the
exciting research prospects in front of us. But I do want to
thank each of you and your colleagues and those institute and
center leaders who are not with us for their passion, their
dedication, and their hard work. I believe the work of the NIH
has and will change the course of disease detection and
treatment for generations to come, and I hope Congress
continues to be a supportive partner in those efforts.
Thank you, Madam Chair, for holding this hearing, and I
yield back the balance of my time.
Ms. DeLauro. I thank the gentleman and it gives me great
pleasure to yield to the gentlelady from New York, the chair of
the full Appropriations Committee, Nita Lowey.
The Chairwoman. Thank you, Madam Chair, and it gives me
great pleasure to be here. Dr. Fauci, Dr. Bianchi, Dr. Lowy,
Dr. Gibbons, Dr. Volkow, and, of course, my friend Dr. Collins,
I just want to tell you what an honor and privilege it has been
for me to serve on this committee, and now as chair of the full
committee.
We all know many people--relatives, friends, neighbors--who
suffer from cancer, who suffer from Alzheimer's, and I just
want to assure you, I was here, as was my friend, Ms. DeLauro,
as was our leader, Nancy Pelosi, and I served with John Porter
when we doubled the money of the NIH. So if you think that this
13 percent cut is even relevant to this discussion, I will tear
up my whole sheet. And I want to assure you, if it is up to me
and my friend--I do not want to say the left--well, my friend--
--
[Laughter.]
The Chairwoman [continuing]. My left, my friend, Mr. Cole,
my friend, Rosa DeLauro, and all the wonderful people on both
sides of the aisle, I would like to increase this budget as
much as we possibly can, because I feel we are not really
working on numbers here on this committee. There is a passion,
there is a commitment to all those people who are suffering,
who come to you, who come to local doctors, who travel across
the country trying to live. And I am going to work as hard as I
can, and share the full committee, to give you as much money as
we can, because you have the brilliance, you have the
commitment, and you have the determination. All you need is
more money.
So we are going to work together. I know there is a
bipartisan commitment and I look forward to hearing from you
all today.
Thank you so much for your service, your commitment to the
health of our country. Thank you.
Ms. DeLauro. Thank you, Mrs. Lowey.
Dr. Collins, again, welcome to the subcommittee. Your full
written statement will be entered into the record. You are now
recognized for five minutes for opening remarks.
Dr. Collins. Madam Chairwoman DeLauro, Ranking Member Cole,
members of the subcommittee, on behalf of my colleagues, the A-
Team from NIH, I want to thank you very sincerely for your
strong, consistent, and bipartisan support of NIH. In fiscal
year 2019, we received a most welcomed increase of
$2,000,000,000 from this Congress, enabling us to continue our
mission of turning scientific discovery into healing and hope.
There are several new members of this subcommittee and I
invite all of you who are new to come and visit us, and all of
you who are not new to come along as well. We are more
enthusiastic than ever today about the progress of biomedical
research.
And so today I thought, in my five minutes, I would
introduce you to just a few of the millions of people who, over
the years, have made that progress possible by volunteering to
take part in NIH-funded research. Without them we would be
nowhere.
Let me turn your attention to the screen and let's begin
with Richard Hochfelder. Six years ago, this retired aerospace
engineer had a blood test, called Hemoglobin A1c, that showed
he was at high risk of developing diabetes. So Richard took
some preventive steps, cutting down on carbs and exercising
more to get his health back on track.
That might have been the end of it but Richard decided to
help others and join NIH's All of Us Research Program, which is
building an unprecedented resource to explore what health
approaches work best for each individual and why. We are making
great progress towards our goal, supported by all of you, to
enroll 1 million or more people in All of Us. In less than a
year as you can see from the graph, more than 200,000 people
have begun enrollment, and half of them from underrepresented
racial and ethnic groups. This will be a wonderful resource for
health disparities.
All of the information they contribute will go into a
secure database that researchers can use to make new
discoveries. Success will depend on involvement of people from
all walks of life, so we invite you and your constituents to
join us as well.
Now let's turn to another story, and let me say thank you
to Frank Stephens, who is sitting behind me. Frank, maybe you
could stand up so everybody could see you.
[Applause.]
Dr. Collins. Frank belongs to a community with unique
biological characteristics that has been offering to volunteer
for research for years, but too often has not been given that
opportunity. I am talking, of course, about individuals with
Down syndrome. We need to do better for them, and many of you
heard about this directly from Frank when he testified right
here in 2017.
Down syndrome usually results from having an extra
chromosome 21. Each year, about 6,000 babies are born with this
condition in the U.S. The average lifespan for such
individuals, as you can see, has doubled in recent years, but
they still face significant health challenges. Those include
risks of heart defects, leukemia, immune problems, autism, and
Alzheimer's disease. But on the other hand, people with Down
syndrome actually have a lower risk of coronary artery disease
and many solid tumors, and because of this studying Down
syndrome may hold the key not only to helping folks like Frank
with that condition but to understanding common diseases in all
people.
Thanks to your support, NIH is stepping up our efforts to
do just that. And this should come as good news to Frank--you
see another picture of him here, on vacation with his mom,
Cornelia. As a person with Down syndrome, Frank knows that he
faces an increased risk of early onset Alzheimer's disease, but
that is not the only reason Frank is worked about that
condition. His mom already has it, and he wants to help
everyone in her situation. As Frank once put it, ``My extra
chromosome provides a blueprint for medical research that could
reveal answers to this heartbreaking disease.''
Now speaking of answers to heartbreaking diseases, last
year I told this subcommittee that we might be on the verge of
a cure for sickle cell disease, a life-threatening genetic
disorder that bends red blood cells into a sickled shape,
causing them to block small blood vessels. Today I am thrilled
to say that I think we have made good on that promise.
Allow me to introduce Jennelle Stephenson, one of the brave
research participants who helped make this happen and whose
story was recently featured on 60 Minutes. Throughout her young
life, Jennelle was often hospitalized, even at Christmas, as
you can see on the left, with wrenching sickle cell crises,
just about the worst pain a human can experience.
But a little more than a year ago, Jennelle took a bold
step for herself and for others with sickle cell, and enrolled
in a gene therapy trial at the NIH Clinical Center. In this
trial, Jennelle's own bone marrow stem cells were removed,
modified to compensate for the sickle cell mutation, and then
infused back into her body where they began producing healthy
red blood cells.
The transformation has been incredible. Here is Jennelle,
sitting alongside her father, Ray, in her white jiu-jitsu
uniform, somebody who was barely able to get through daily
experiences. And now here she is in action after her gene
therapy treatment.
[Video shown.]
Dr. Collins. I must caution, it is still early. The
treatment she went through was challenging to endure. But this
promise is now real for the nearly 100,000 Americans who suffer
from this devastating disease.
Our nation needs a lot more stories like these. Through the
generosity and courage of people like Richard, Frank, and
Jennelle, along with your strong and sustained support, NIH
research is making it possible for inspiring new stories to
emerge every day, and the world can look forward to a healthier
and happier future.
So thank you, Madam Chairwoman. We all welcome your
questions.
[The information follows:]
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Ms. DeLauro. What a place to pause, Dr. Collins, and for
those of us who have not been given a second chance at life,
God bless you and thank you, and thank you, Lord, as Jannelle's
dad said.
Dr. Collins, the United States has been the world's leader
in biomedical research for decades, largely as a result of the
robust funding for basic research through NIH. However, we risk
losing our edge as Federal funding for biomedical research
lagged behind inflation for years and other countries sharply
ramped up their investments in this research. We have made a
lot of progress in the last four years. I am worried that we
still risk losing the best and the brightest potential
researchers.
In your opinion, what do we need to maintain U.S. dominance
in biomedical research, keep the best and the brightest minds
in research? I know that overall funding for research is
important, but what other incentives do you think are
necessary?
Dr. Collins. Well, what a great question. I think the area
that all of us are most concerned about and feeling now, most
encouraged, thanks to the way in which the resources for NIH
have gone upward over the last four years, is for that next
generation of researchers, those early-stage investigators,
people who come to us for the first time with a grant
application as an independent researcher, and are seeking to
get their careers started. And we were quite worried about them
a few years ago when purchasing power had dropped and the
numbers of the early-stage investigators that we could fund
went down.
I just want to quickly show you a graph of what has been
possible over the last four years, thanks to what this
subcommittee and this Congress has done. You can see in 2013,
we funded a little less than 600 of those early-stage
investigators. Look where we are by 2018. We challenged all of
the Institutes to make this a high priority and said, ``If you
push really hard we should be able to get to 1,100.'' We got to
1,287, so we have more than doubled the number of new
investigators coming into the medical research workforce. Every
one of those is an investigator with an idea and a plan and an
encouragement about the future.
When I go out and visit universities and talk to these
people I sense this excitement, this increase in their sense of
promise, their willingness to take risks, the fact that the
morale of the whole enterprise has gone up substantially, and
we really want to thank you all for making that happen. Here is
the concrete example of what it can do.
Ms. DeLauro. Thank you, and that is why what we wanted to
do is to make sure that there will not be fewer research
grants, as we were able to accomplish over the last several
years.
I want to ask both Dr. Lowy and Dr. Collins a question.
Ninety-five percent of the 400 known forms of cancer meet the
American Cancer Society criteria of affecting fewer than 6 out
of 100,000 Americans a year. In 2018, nearly 80 percent of
cancer patients with no approved targeted therapeutic for their
cancer have a rare cancer. Many of these patients are faced
with decades-old treatment protocols that include harsh
chemotherapies, which are frequently ineffective to their
cancers.
Dr. Lowy, what is the NCI doing to develop more
therapeutics for these neglected, rare cancers, and then Dr.
Collins, or Dr. Lowy, what is the role of the National Center
for Advancing Translational Sciences in supporting this type of
research? We are talking about glioblastoma, spinal cord tumor,
leukemia, some of these bone cancers, et cetera.
Dr. Lowy.
Dr. Lowy. Thank you, Chairwoman DeLauro.
Rare cancers are really a critically important area, first
because of the people whom they affect and because there are so
many--there are so many different rare cancers that occur,
their aggregate number is high. In addition, there is not the
same kind of financial incentive to develop drugs in the
private sector for treating those diseases, and therefore the
NCI has a special responsibility for going in this direction.
Two years ago, we began, actually, a Rare Tumor Initiative
which is a collaboration that involves the intramural program
at Bethesda as well as many extramural individuals and also
extending to the United Kingdom, to study the rare tumors in a
variety of ways with the goal of developing more treatments.
In addition, the NCI Experimental Therapeutics Program
gives priority to childhood cancers, virtually all of which are
a rare tumor, as well as other rare tumors. And the President's
proposal for the $50,000,000 will go specifically to childhood
cancer.
Dr. Collins. With regard to the National Center for
Advancing Translational Sciences, NCATS, this is a place where
there is a strong focus on rare diseases of all sorts,
including cancers, and especially I want to mention, therefore,
the Rare Diseases Clinical Research Network which brings
together a lot of those researchers, as well as some very
exciting technology that is pioneered through NCATS, involving
both such things as medicinal chemistry but also using tissue
chips to try to understand, is a drug going to work? Is it
going to be toxic without exposing an individual to that same
drug?
So NCATS really is a partner to all of the institutes at
NIH.
Ms. DeLauro. So that we have to make up for what the
external community will not do because of financial
considerations, to make sure that we have that capacity at the
NIH.
Dr. Collins. That is our role.
Ms. DeLauro. Let me yield to my colleague from Oklahoma,
the ranking member, Mr. Cole.
Mr. Cole. Thank you very much, Madam Chair.
Dr. Collins, you mentioned in your opening remarks the
potential of this All of Us research, and I would like you to
elaborate on that a little bit, if you would. I would also like
to talk about any constraints that we have going forward. You
and I had a chance to visit but I think it is important for the
committee to know what some of the challenges are to actually
bring this program to where we want it to be.
Dr. Collins. Well, I really appreciate the question because
this is a flagship initiative for NIH, unlike anything we have
really quite tried to do at this scale, enrolling 1 million
Americans in a way that they are full participants in the
research and that they make available all kinds of information
about themselves, and find out medical information as a result,
and they take part in this national adventure over the course
of many years to come.
The goal here is really precision medicine--to understand
how the differences between us may have significant impact on
what works, both for prevention and for treatment, and if we
are really going to know that we need a very large and very
diverse group of participants.
The momentum behind this is substantial. I showed the graph
showing we have already enrolled more than 200,000 people in
just a little less than a year since the launch, but we really
want to sustain that momentum going forward. It will open to
researchers later this year. There is lots of additional data
coming on board, but we really want to push the accelerator
down on this.
I appreciate your question because there is a bit of an
issue here in terms of the dollar figures, because part of this
is funded by this appropriations committee and part by the 21st
Century Cures Act, and for some various reasons about the way
the budget for 21st Century Cures was put together there is
actually a decrease in funding for all of us going from 2019 to
2020. That would be an unfortunate sort of consequence, just as
the momentum is really building.
So I would love the chance to talk with any of you about
this, in terms of how we could be sure that this project, which
all of the institutes are going to tap into--it will be a
platform, a foundation for lots of clinical research we want to
do in the coming years--let's be sure that it gets put together
as quickly and effectively as possible.
Mr. Cole. I love 21st Century Cures but this is the problem
when appropriators are not involved in the appropriation
process and non-appropriators are.
Dr. Collins. Well, I am sorry I brought that up, and I
didn't mean to open the door to that.
Mr. Cole. No, no. This is a jurisdictional thing. We will.
We sort of collectively warned him this would happen at this
point in the process, so hopefully we will have the resources
to make good on that.
Let me ask you about another initiative. You have focused,
I think rightly, obviously, on younger researchers. But one of
the programs we have here, the so-called IDeA, is really about
expanding the number of institutions that can actually engage
in this, which I think is important for both bringing new
people. Could you tell us where we are at on that and how that
fits into your longer-term vision?
Dr. Collins. I would be happy to. I will tell you, back in
the day when I first arrived at NIH, which is quite a while
ago, I was a little bit of a skeptic about this program, in
terms of whether this was, in fact, the best way for NIH to
make investments. You can see, in the graph there, the IDeA
states that are part of this. These are all states that receive
relatively less in the way of NIH funding, oftentimes because
they don't have a very high-pressure kind of first-tier
research university located within their state. But they have
incredible talent.
And the IDeA program basically makes it possible for us to
fund really superb research that is going on in those states,
including such things as Centers of Excellence, the so-called
COBRE program, including networks and so on, and that has, in
my experience visiting many of those states, been a wonderful
investment of talent and energy. And you can see how trainees
or faculty in those situations, because of this additional sort
of support system, become, after a while, really very strong
investigators in our overall network.
The current funding for this is about in the neighborhood
of $361,000,000, about 1 percent of the NIH budget, but I think
it is a 1 percent that is extremely effective in terms of what
we get out of it.
Mr. Cole. Last question, and I don't have a lot of time
here, but I happened to see Dr. Hodes last night at the
Alzheimer's dinner. And I know we have had some setbacks in the
private sector, which, to me, actually make our investments
more critical here. Could you sort of give us a quick summary
of where we are at?
Dr. Collins. I think all of us were unhappy to read, a week
or so ago, that Biogen had decided to announce that the latest
trial of an amyloid monoclonal antibody in patients with early-
onset--early symptoms of Alzheimer's disease--did not seem to
be showing benefit.
But I want to assure this committee that while the amyloid
hypothesis continues to have a lot going for it, it is not the
only thing on the table. We have lots of other projects focused
on tau, which is another protein that deposits in the brain,
maybe even correlates more precisely with symptoms, and then
lots of other ideas coming out of genomics, out of cell
biology, that suggest inflammation is a big part of what is
going on in here, and approaching that therapeutically might
make a lot of sense.
One hundred sixty programs right now that the Aging
Institute is supporting, everything from preclinical all the
way to early Phase I and Phase II trials. We have a diversity
of approaches. It is a really good thing that the NIH is here
to pursue all of those because, frankly, a lot of the private
sector effort has been focused on the amyloid hypothesis
because that seemed to be so compelling. If that is not the
answer, or if that is only one of the answers, we have a broad
landscape of other activities going on.
Mr. Cole. That is great. Thank you, Madam Chair.
Ms. DeLauro. Congresswoman Lowey.
The Chairwoman. Thank you. I was going to ask that
question. In fact, recently--I will go on to others--recently I
was asked to speak at a group of 35 people at a local
institution that is doing a lot with Alzheimer's, and one of
the researchers stood up--it seems I was the only one asking
all the questions--and he said, ``Madam Chair, exercise and
nutrition, that is all we know.'' And I have heard that over
and over again, so I thank you for that question and I hope
there is a breakthrough, because the numbers of people that are
living with Alzheimer's and deteriorating with Alzheimer's
throughout the country is just astonishing. So nutrition and
exercise is good, but I wish you well and I hope you come up
with something else.
E-cigarettes. I have been an early, early person talking
about e-cigarettes, and finally the FDA is waking up a little
bit. But it is all over the place, and we see the major
cigarette companies just buying Juul, et cetera. When you look
at the numbers, I see that a study found that e-cigarette users
were 29 percent more likely to have a stroke, 25 percent more
likely to have a heart attack, 18 percent more likely to have
coronary heart disease.
So I am sick and tired and actually furious when people are
saying nothing is wrong with the e-cigarettes. It is a public
health risk and I think we are just trapping a whole new
generation in nicotine addiction.
So, Dr. Gibbons, can you tell us what we are learning about
the correlation of e-cigarettes and heart health, and Dr.
Volkow, what more should the public know about the harms of e-
cigarettes, in particular for those Americans who are currently
not smoking combustible tobacco products, what should they know
about the risk of e-cigarettes?
Dr. Gibbons. Thank you for that question. Certainly a
leading cause and risk factor for cardiovascular disease is
tobacco smoke, and one of the elements of promise for e-
cigarettes was the degree to which it could help in smoking
cessation from tobacco and enable individuals to stop and
reduce their risk of cardiovascular disease.
As you pointed out, one of the troubling elements is that
exposure, particularly to our young people, is a gateway to
nicotine addiction for those who are not in the process of
smoking cessation, that is where the risk is. And we still have
a lot to learn about what that exposure does to young people in
terms of their lung development, where we have some concerns,
as well as their whole cardiovascular system. We know that
nicotine has some problematic effects on the entire system,
particularly in developing young people. So we concerned about
this emerging epidemic.
I will defer to my colleague, Dr. Volkow.
Dr. Volkow. Dr. Gibbons, thanks for much, and indeed, it is
an area of great concern because have, actually, as of 2011, we
had not detected much vaping by teenagers, and then in 2018, we
have actually recorded 38 percent of 12th-graders had reported
vaping. So you can see how fast it has gone up.
And the other issue of great concern is that many of them
are endorsing that they are using it for nicotine. We already
know that nicotine is very addictive. And the rate at which the
increase is actually going up, from 2017 to 2018 it almost
doubled, in terms of vaping for nicotine.
So of course we are concerned, because as the research has
already shown, if you start with vaping then you are much more
likely to go to combustible tobacco, and we all know what the
consequences of combustible tobacco are.
So I think that we need to clearly make the message that
nicotine is addictive, that we already know that it actually
opens up the vulnerability for tobacco smoking but also for
other addictions, and to the other aspect that is very
relevant, just as the cardiovascular system, is how that
nicotine ultimately influences that development of the human
brain, which is something that we will be studying with the
ABCD Study.
Ms. DeLauro. Now I just wonder, because Altria bought Juul,
you see full-page ads, this could be dangerous for kids. What
are we doing here? Is there any way we can be more effective in
getting the information out that this is damaging to your
brain? You have said that before us for 10 years. Have you been
here 10 years?
Dr. Volkow. Sixteen.
The Chairwoman. Sixteen. But I know I go back and tell my
teenage grandkids, I bring them a copy of your testimony. We
are not getting this information out. So think if they are not
puffing on cigarettes the e-cigarettes are just easier for
them.
What can we do? Can we do more?
Dr. Volkow. Absolutely, and I think that the FDA has taken
a very strong stance----
The Chairwoman. Finally.
Dr. Volkow [continuing]. In terms of regulating it. But we
have also had--we have been able to dramatically reduce tobacco
smoking in teenagers and adults. Prevention efforts work and we
need to actually provide effective prevention evidence and
interventions to prevent the use of nicotine vaping as well as
vaping cannabinoids, because now one of the main ways teenagers
are smoking marijuana is through these vaping devices.
The Chairwoman. Well, let me just say this. I thank you for
your information--my time is up--but it is not working. The
numbers are increasing. I see it at the high school level. I
see at elementary school level. So it is not working. And the
FDA--and I have worked with the gentleman who, unfortunately,
is leaving now--they were a little late. And I don't know
exactly what we can do now, but the numbers are increasing and
increasing.
If it were up to me I would ban advertising. They have this
big ad for Juul and then, in little print, this is not for
kids, or whatever the heck it says.
So I think we have an absolute obligation to get tough on
it, and not say we should do this, what can we do together? And
I appreciate your comments.
Thank you, Madam Chair.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you very much. Dr. Volkow, good to see
you again.
One topic that I think is a timely topic, that I am not
sure, and maybe you can expand on what research has been done,
is actually the kind of global availability of CBD. I mean, I
walked into, you know, a small country store the other day and
it has got a rack of, you know, CBD-infused and whatever. You
know exactly what I am talking about. I mean, it is--we have, I
guess, CVS now saying, I guess, they are going to sell CBD.
And this is confusing to me because--and, you know, we will
deal with it in an FDA hearing tomorrow--but clearly it is a
drug, and now it is an FDA-licensed drug, but it is being sold
and widely available. You know, one of these, you know, it will
cure everything you have. But, you know, it is something that
works with the cannabinoid receptors. Yeah, I get it. It
doesn't bind like THC. It only, you know, it only stimulates
the receptors. But it would make sense to me that we need to do
some research before this neuroactive drug becomes widely
available.
What is the current state of research on what the long-term
effect of CBD is, because, you know, this rack didn't say, oh,
by the way, you have to be 21 to buy this stuff. I mean,
literally a child can go up and obtain this. So what is the
state of the research on that?
Dr. Volkow. And you are absolutely right. We should be
concerned that people are actually buying CBD with expectation
that it will have therapeutic effects, and in the process they
may forego medications that can be life-saving. So that is an
issue of major concern, when there is very little evidence
about potential therapeutic indication of CBD. There is some,
and clearly, for example, Dravet Syndrome is an example of
where CBD could have therapeutic benefits.
But many of the claims regarding the usefulness of CBD do
not have the data behind them. And one of them, for example, is
the use of CBD for the treatment of opioid addiction. We know
that opioid addiction has a very high mortality rate and there
are medications that protect you against dying. And so the
concept that people are moving towards CBD instead of
medication assisted treatment is one of tremendous concern.
As it relates to potential health, effects of CBD, we know,
for example, already, that excessive consumption can result in
hepatic toxicity, and yet people don't recognize this, and they
may be harming themselves by not knowing this.
We are interested, and the study that I just mentioned, the
ABCD study, and a newer study that we are hoping to initiate
soon, will look at the brain development in infancy and
forward, and will allow us to understand to what extent
exposures to CBD may influence the development of the human
brain.
Mr. Harris. Thank you, and I think that is very important
research to be done. You know, we are going to, once again, try
to advance legislation that just makes it easier to do, you
know, the research on, you know, cannabis.
Dr. Collins, let me ask you--and I am sorry, I had to step
out. I had another hearing at the same time, and you may have
talked about it--what is being done to deal with the
reproducibility issues of research?
Dr. Collins. We have not talked about it and I am glad you
raised it. We are intensely interested in making sure that the
money that the taxpayer provides through you all to NIH is put
into research that is well designed, rigorously conducted,
published quickly and accurately in a way that others can
understand the experiment well enough to reproduce it. This
whole focus on rigor and reproducibility has been a major part
of the emphasis that Dr. Tabak and I have particularly grabbed
onto over the course of the last five years.
I think we have come a long way there in terms of raising
consciousness of everybody to just how critical this is. We
have introduced new kinds of training programs for graduate
students and postdocs, which maybe had not really have had the
emphasis in this space that you would want to see in their
standard training programs, and now they are getting that.
An area that we are currently looking at, which I think
could be the next place to pay even closer attention, is animal
models. When you defend an animal model experiment, is that
animal model, first of all, a good model for the human
disorder, and then second of all, if it is an animal model
experiment where you are testing an intervention, have you
designed that trial so it has sufficient power, which may mean
you need to think carefully about how many animals--males,
females? Have you decided exactly what your endpoint is going
to be, not after the experiment but at the beginning? All of
that needs, I think, still another bit of attention, which we
are focused on right now. There may be more to say about that
in the coming months.
Mr. Harris. Okay. Well, thank you very much and I yield
back.
Ms. DeLauro. Thank you.
Congressman Pocan.
Mr. Pocan. Thank you, Madam Chair, and thank you,
everybody, for being here today. I appreciate it. My district
has a lot of NIH support coming in, University of Wisconsin-
Madison, a great, world-class research facility, so thank you.
Dr. Collins, as a quick follow-up on the question on early
researchers, I know when we had the Next Generation Researchers
Act we had a lot of efforts in there. One of the stats I
remember was the median age had raised from like 36 to 41 for a
first-time grant, and while you have doubled the grants, which
is amazing, anything on that first age of researchers right now
getting grants?
Dr. Collins. That is a slow process, I am sorry to say, to
try to change, and a lot of that is, well, based upon the
training pathway that many scientists go through. First of all,
many of our current students are not as likely to go straight
through from college to Ph.D. to postdoc to individual
independent positions. They have other things they are
interested in. They take a break and do a tour of the world or
something of that sort, which is great. They bring additional
expertise as a result.
But we still have a problem where Ph.D. programs often are
too long. Postdocs are too long. We are using the levers that
we have to try to affect that. And then we have some programs
that are specifically intended to shorten this, like the Early
Independence Award, where a particular class of graduate
students doesn't really need a postdoc. They are ready, they
are independent, and we give them a chance to apply, and if
they are successful, go directly into an independent program.
And those end up being folks maybe more like 30 instead of 42.
We are going to keep pushing on this, but it is a vexing
problem that is hard to turn around quickly.
Mr. Pocan. Gotcha. Also, there is a study, and it is a
little bit older, but it was between 2010 and 2016, and it said
every single drug during that period had gotten support from
NIH. Every single drug approved, 200-and, I think it was 10
drugs, or something like that, which is staggering to me. And a
lot of those were first time, a lot of those for drugs that
were going to be competitors, to try to lower the cost of
drugs.
Is there anything recent on that, since the 2016
statistics, because I love repeating the statistic.
Dr. Collins. We do too, believe me. That is a paper my
friend, Fred D. Ledley, in the Proceedings of National Academy
of Sciences, which was mentioned by the Chairwoman in her
opening remarks.
I don't know if there has been a systematic effort in the
last three years to redocument that paper's findings, but I
would be very surprised if the conclusion is substantially
different. When you look to see how new drug targets are
identified, a lot of that is basic science research, and in
this country it is mostly supported by NIH. And then,
ultimately, that finds its way into a real campaign to develop
a therapy, and ultimately FDA approves it. We are right in
there, more than ever.
And especially now, with the opportunities we have with the
molecular understanding of disease, more and more of those
targets are emerging, more and more companies are tapping into
that in order to develop the next generation of successes.
Mr. Pocan. Thank you.
Dr. Volkow, I have a question for you. So I know, over at
NIDA, you have had public hearings back in April of 2018, with
the FDA on new medications for opioid use disorder. I know that
with the public comments you have had a consider amount talking
about kratom, and, you know, the potential for a Schedule 1
ban. I have talked to many, many people who have been in my
office, and talked to otherwise, who kratom has helped to get
them off of opioids as opposed to the pharmaceutical company
producing the opioid and then they produce the pill to get you
off the opioid, which sounds like a very profitable enterprise.
Kratom has helped many people to do that, and I know
recently you awarded a $3,000,000 grant to University of
Florida researchers. Other people are applying for grants to
study kratom. My concern is there has been a lot of
conversation about making kratom a Schedule 1 drug. I was
wondering, if that were to happen what impact would that have
on the research and the grants you are making to try to see if
kratom actually can be a pathway for many people to get off of
opioids?
Dr. Volkow. Indeed, the moment that a drug gets a Schedule
1 designation, which is done in order to protect the public so
that they don't get exposed to it, it makes research much
harder, and this is because you actually have to go through a
registration process that is lengthy and cumbersome. It
restricts the source where you can get the particular drug that
you are interested in investigating. This is something that we
work with with cannabis. It is a perfect example, marijuana.
With kratom, if it were to become a Schedule 1 substance it
would make it very difficult for a researcher to be able to get
hold of the pharmacological compound itself. So what we have
been doing is working with the DEA and the FDA to try to create
a path that will allow researchers to work with Schedule 1
drugs in a safe way. So it doesn't delay areas of knowledge
where there is an urgency to understand the extent to which it
could be beneficial or detrimental.
Mr. Pocan. And if I could, just if we could also express
those agencies not going to Schedule 1 would also solve that. I
mean, there seems to be--you know, all the problems we are
trying to untangle right now around cannabis, marijuana
specifically, because of Schedule 1, I would hate to see us put
another drug there and then have to try to work backwards. If
we are not there already, it allows you to continue to do the
research.
I yield back. Thank you.
Ms. DeLauro. Congresswoman Herrera Beutler.
Ms. Herrera Beutler. Thank you. Madam Speaker----
Ms. DeLauro. Not yet. [Laughter.]
Ms. Herrera Beutler. It is a pleasure to have you all here.
I have a couple of questions and then I wanted to ask
something that is not on my planned questions.
The first one has to do with and this is really for the
panel, although I think it probably speaks to some of you more
than others--but I think the point is it is for the panel. Now
I know you all are aware of the unique needs that kiddos face,
and when it comes to NIH-wide initiatives that span multi-
institutes and centers, as well as high-priority initiatives--
the Brain Initiative, the Cancer Moonshot, I mean, we are
talking about the ABCD--there are all these different ones that
I think are--I mean, you were talking about ones that are
flagship.
Could you describe the inclusion of pediatric subjects in
these different initiatives, not just Dr. Bianchi's portfolio
but across the institutes, as well as how can NIH be more
proportionally targeted with regard to funds in pediatric--
pediatric research?
I have a lot of people come in and talk with me about
different types of cancers, and I agree with regard to rare
cancers, but if you distill down, you know, where everybody
gets into who gets how much money, and what institutes, and so
on and so forth, you know, it has behooved us to allow the
researchers and the doctors to make those decisions, and I
support that approach. But when I just look at numbers of
children, and the research done for pediatric breakthroughs in
each of those areas, it does cause me to say perhaps we need to
highlight that more, or you all.
So I just wanted, you know, whoever to take a whack at
that.
Dr. Collins. Let me start, but I will ask Dr. Bianchi to
summarize what is happening across all of NIH, because she is
leading a trans-NIH effort that is highly relevant here.
We do hear you and we do think, based on this whole effort
on inclusion, which includes children as well as pregnant
women, as well as the elderly----
Ms. Herrera Beutler. I have that on here as well.
Dr. Collins. Okay. We need to pay more attention to this,
and I think that has led, across NIH, to concerns about this,
and a willingness for us to report, not across all of our
portfolios, but study by study, how are we doing as far as that
kind of inclusion.
So you could look at this and see whether you think we are
actually living up to those expectations.
But let me ask Dr. Bianchi to say what she is doing across
all of NIH.
Dr. Bianchi. Thank you, Dr. Collins.
So when people hear about the National Institute of Child
Health and Human Development they think that our Institute only
funds research related to kids, and it is actually 50 percent
related to kids. We also have portfolios in obstetrics and in
rehabilitation.
So to address the issue of what is happening across NIH, in
terms of child health research, we have collected data and
formed this Trans-NIH Pediatric Research Consortium, and
virtually every Institute and Center has some portfolio in
child health research, and the total is about $4,400,000,000.
So that is a substantial investment.
And by working together we have already identified several
topics where we can make progress. For example, the transition
to adulthood is a difficult one for children with chronic
diseases. We all have interest in that and how can we ease that
transition.
We need to increase the number of pediatric scientists in
the workforce. We had a discussion just this week about that,
and there is about $280,000,000 right now that is invested from
NIH across all of the institutes.
We are also working to increase the number of pediatric
scientists on review panels, which is important, so that if you
are at a kidney review panel, if you do not have a pediatric
nephrologist or someone with expertise in that area--that just
came to mind, but--it is important because they need to
understand the specific developmental aspects of those
conditions.
Ms. Herrera Beutler. The one thing I have learned is that
it is just so different for kids, the way everything is applied
to them and in their world, and it changes over time, like you
said, up until they are going to age out and go into the adult
care population. It is different at every stage.
And I think the same holds true for women, in particular. I
know, in the last number of years, that we have made some
strides there with regard to studying--you know, our clinical
group isn't just a certain age of guys. It is also women, but
now including pregnant women and nursing moms. It is remarkable
to me just how much we have to go to make sure they are part of
everything that you all are doing.
Now I only have 10 seconds left.
Quickly, do you think we can still hit the 2019--and you
are talking about the 2020 funding, with regard to the pipeline
for our Down syndrome research? I just wanted for everybody's
understanding, where we are at with 2019.
Dr. Collins. We have worked really hard to try. Given this
commitment, which is strongly felt by myself, by Dr. Tabak, by
Dr. Bianchi, Dr. Gibbons, and 12 other institute directors--
there are 14 institutes and centers now engaged in this--to see
what we could do to try to up the funding level.
I just want to show you the curve here on the screen, of
what has been possible, and this is a direct response to the
way in which this subcommittee has really brought to attention
both the opportunity and the responsibility here.
So you will see, for this year--this is 2019--this is still
a midyear projection. We are at $77,000,000. We are waiting to
see what additional projects may come through peer review that
could also be added to this, so this is not the final answer.
But I do hope you can see we are more than tripling the support
for Down syndrome in 2019, compared to where we were a few
years ago, and we are all deeply excited about this. It is
going to teach us an amazing set of things, both about those
who have Down syndrome but also about other critical issues
that affect all of us, like Alzheimer's disease.
Ms. Herrera Beutler. Thank you.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Thank you. Let me just say I agree with our
chairs and our ranking member in terms of increasing, not
decreasing your budget, and thank you all for your great work.
I want to--a couple of questions. On the--all of your
research, the participant engagement, what percentage are your
volunteers women now?
Dr. Collins. So currently, at about 206,000 participants, I
believe we are slightly over 50 percent that are women. We have
focused also on racial and ethnic minorities. About 50 percent
of the participants are from those groups. If you include rural
participation, which has also tended to be underrepresented in
NIH research, where we have made a big push, we are up to about
75 percent of the people taking part in the All of Us research
program are from all of those, usually not so well-represented
groups.
Ms. Frankel. And then on the clinical trials, where it is
appropriate, what percentage of the participants are women now?
Dr. Collins. If you look at the aggregate across all of NIH
it is about 53 percent of clinical trial participants are
women. Obviously, it varies from study to study. If you look at
breast cancer it will be very close to 100, but not quite. If
you look at prostate cancer it will be zero. But when you
average across----
Ms. Frankel. That makes sense.
Dr. Collins. That makes sense, right?
Ms. Frankel. What is that in terms of pregnant and
breastfeeding women, in terms of their inclusion?
Dr. Collins. That is a great question, and, in fact, I am
going to ask Dr. Bianchi, because of this very important effort
that has just gotten renewed for another phase, to answer about
this.
Dr. Bianchi. So we know that over 2,400 pregnant women are
already in enrolled in the All of Us research program, so I
don't believe that they are specifically participating yet in
any trials that are associated with medications, for example.
But they represent a cohort who are actively involved and
engaged in the research.
Dr. Collins. And you might say something about PRGLAC,
which is an overall effort across NIH to try to be sure we are
including pregnant women.
Ms. DeLauro. Would the gentlelady just, for one second----
Ms. Frankel. Yes.
Ms. DeLauro [continuing]. About maternal, you know,
mortality, you know.
Ms. Frankel. Yes. I was going to ask about that.
Ms. DeLauro. Okay. Go. You go.
Ms. Frankel. All right, but if I don't get to it, since she
used up some of my time----
[Laughter.]
Ms. Frankel. I reclaim it from the chair.
A couple of things to follow up there. I know there is
some--there have been issues in terms of nursing mothers, in
terms of what can they do, what can they eat, what kind of
medication? Is there research going on there? And then let me
just--I will ask a question on the maternal. I know there has
been an increase on the mortality of women having babies, and
maybe you could tell us where you are on that.
Dr. Bianchi. Yeah. So those are two big, different
questions, so maybe I will start with the medications.
Ms. Frankel. I have more too.
Dr. Bianchi. Okay. I can only take one at a time.
Medications taken by pregnant and lactating women. So NIH
chaired a task force that, over the past year and a half,
examined, what is the status of knowledge known on the subject.
And the bottom line is very little is known. Pregnant women
take, on average, between three and five medications during
their pregnancies. The assumption is that it is safer not to
take those medications, but in fact we might be harming
pregnant women. For example, if they have asthma and they are
not taking their asthmatic medications their breathing is
affected and it will harm the baby.
So there is a great need to know more and to leverage
existing resources to find out what we know about pregnant
women during pregnancy. We need to change the culture, where
women are excluded from research to specifically including
them.
Ms. Frankel. Let me just ask you, do you need more funding
in that area?
Dr. Bianchi. Should I be honest and say we never got
funding? I mean, we never got funding for the task force.
Ms. Frankel. So I am just saying, so you would like to have
some funding in that area?
Dr. Bianchi. Of course. This is an important area.
Ms. Frankel. If I could, I am going to yield back in a
moment to our chair to ask about the mortality. But I want to--
but I do--okay, you want to ask it? I have one more question.
Ms. DeLauro. Ask your question.
Ms. Frankel. Okay, so--okay. That is fine.
I wanted to ask about heart disease. One in three--it is
the number one killer of women, claiming one in three deaths,
289,000, I believe, women died of heart disease last year. I
wanted to ask you a couple of things on that. Will proposed
budget cuts affect efforts in that, and what more could we be
doing--I am going to ask you also a positive--what more could
we be doing in funding in terms to start to reduce the
mortality?
Dr. Collins. Dr. Gibbons is on point for that.
Ms. Frankel. Thank you.
Dr. Gibbons. As you mentioned, heart disease is the leading
killer of women in this country, and for those women over 65,
make up a burgeoning population that is at high risk. Certainly
age is a factor, but the risk of cardiovascular disease among
women is also affected by race ethnicity. African American
women are at a twofold higher risk of developing disease and
mortality.
So this is a major problem that needs to be addressed. We
have learned a lot in the last few years from the Women's
Health Initiative, which has given us new insights into the
drivers of cardiovascular disease in this important patient
population. And we are seeing how we can prevent it,
recognizing that the type and form of cardiovascular disease is
different in women relative to men.
So we really need sex-specific strategies to prevent and
treat heart disease more effectively, and we are doing trials
to do that. One example I will mention quickly relates to the
WHISH study, where we have found that even modest activity in
women over 65--walking, gardening--reduces their risk of
developing heart failure. And so now we are doing a trial to
actually encourage women to undergo those lifestyle changes to
improve their health outcomes.
Ms. Frankel. Doctor, if you could--just may be when you
leave here or whatever, I would be interested in knowing if you
were offered more funding in this area, what kind of research
you would do.
Dr. Gibbons. Absolutely. There is more that could be done.
Ms. Frankel. Yes. Thank you. And I yield back, Madam Chair.
Ms. DeLauro. Congressman Graves.
Mr. Graves. Thank you, Madam Chair. Dr. Collins, thanks for
being here. Thanks for your many years of good work across
multiple administrations.
Just, I guess, to help us out a little bit, I know earlier
there was a little bit of outrage about your budget
presentation. I know it is a reflection of the Administration's
priorities. You have done a great job with that. But there are
constraints that have been placed upon you, and I don't think
they were self-imposed at all. They were imposed by this body.
So--and oftentimes this body gets mad at you for doing--for
something they have done to you.
So if you could, just maybe give us a glimpse into what
your vision would be if you did not have some of these
constraints. What would--how would you invest in priorities so
that you can, you know, just help us understand what the
Administration's true priorities would be had there not been
the budget constraints that you are presenting under.
Dr. Collins. I appreciate the question and the opportunity
to think about that. It would be worthwhile for us to
redistribute something we put together about three years ago,
which was a strategic plan for NIH, explaining how it is in
this very complicated agency, with this wide landscape, from
basic science to clinical trials, from every imaginable kind of
disorder to condition, how do we make those priority decisions?
And it is something that all of my colleagues and I sit around
the table every Thursday and try to figure out, are we doing
this is the best possible way?
Again, we try to depend on the incredible bright brains
that are out there in this country who bring us their grant
proposals and their best ideas, and we put them through the
most rigorous peer review system in the world, and then we try
to fund the ones that look most promising.
Traditionally, over the course of NIH's history, we have
found that funding about a third of those turns out to be
really about the right cut point. That still means it is pretty
tough. Two-thirds of the people get sent away without an award.
Unfortunately, as the amount of science has gotten even
more interesting, the cost of doing science has gone up, we are
now not able to fund a third. We are closer to one out of five
at the present time, although I say it is better than it was
four years ago, and again, the Congress has helped us a lot
with the last four years of an increase of $9,000,000,000.
If I could be king of the world and snap my fingers to do
what would be most important for the health of the biomedical
research operation in the U.S. and all that that does for human
health and for the economy, I would hope we could get back up
in that zone of about 30 percent success rates, but I recognize
that is a very heavy lift. But you did ask the question so I
guess I should answer it.
Mr. Graves. No. Well, thank you for answering that. I think
oftentimes it is unfair that you have to come before the
committee, living under certain constraints, and then you get
criticized for living under those constraints that have been
imposed upon you. My hope is that maybe this new majority will
present a budget, here in the next day or two or three, because
every day that goes by the more challenges that you are faced
with. But thank you for making difficult decisions and I wish
more of us could do that here.
Maybe something that has been affected by the constraints
you are under is sickle cell. I know you talked about that in
your opening statement a little bit, or it was addressed
earlier. You know, it has, I guess, been shared with me that
there are some investments in other, you know, diseases that
have more investment but lower, I guess, lower impact. You
know, sickle cell in Georgia, I think we have about 7,000 or so
impacted individuals.
How can we bring--there is that disparity, let's say, in
investment. How is that--how can we bring that back together a
little bit, or is that just truly an effect of the budget
constraints that you are living under at this time?
Dr. Collins. As I mentioned, we struggle every day with how
to set the priorities, and it is always a mix. What is the
burden, the actual public health impact of a particular
condition? We have to notice how many people are affected, how
serious is the disease. But it is also the scientific
opportunity. Just throwing money at a problem, if nobody has an
idea about what to do, is not likely to make rapid progress.
With sickle cell I will say, over the course of many
decades, there have been a lot of people motivated to try to
see what we could do for the first molecular disease, described
more than a century ago. And progress has been made, steadily,
over that time, with the development of a drug like
hydroxyurea.
But to get to where we are right now took bringing together
of a lot of research from areas that were not focused on sickle
cell per se. They were figuring out how you could do gene
therapy. And then ultimately, with the refinements in both the
efficacy and safety, we get to where we are right now. This new
development of gene editing with something called CRISPR-Cas
comes along, just five years ago, and it is clear that that,
which came out of the most basic science you can think of,
studying yogurt, for heaven's sake, ends up producing an
apparatus that is capable of making a change that could be
absolutely magical for people, not just with sickle cell but
maybe those other 6,500 genetic diseases that are still waiting
for answers.
So all of that kind of comes together, and then we say,
okay, we have got to really push this. It will happen
eventually, but we make it faster now that we see the pieces
being assembled. Dr. Gibbons has been leading this sickle cell
initiative at NIH that is working with the private sector
trying to figure out what are all the things NIH can do to be a
catalyst, to be an encourager, and to figuring out where the
resources can go to get those 100,000 people with sickle cell
disease, including 7,000 in your state, in a position where we
can offer them something absolutely magical.
Mr. Graves. Thank you. Thank you to you and your team for
your great work. Thank you all.
Ms. DeLauro. Congresswoman Lee.
Ms. Lee. Thank you very much. Thank you, Madam Chair, and
our ranking member for this hearing, and I want to associate
myself with the remarks that have been made with regard to the
budget, because I certainly am one who believes that your
budget needs to be increased. For many, many reasons, for many
people, your work is life-affirming. We have a long way to go
to catch up with closing health disparities, based on race and
ethnic backgrounds, and this committee really gives us a chance
to try to do the Lord's work.
Personally, as it relates to health disparities based on
race, and many of us have family members--my mother, COPD, my
sister, multiple sclerosis, my aunt, diabetes--so we know
personally about these diseases that you all are trying to
figure out how to help address. And so just personally I just
want to thank you for what you are doing on those fronts, and
others.
Dr. Fauci, 1.2 million people living with HIV in the United
States. We have made tremendous progress, because of you, in
many ways, in our fight against the virus, but we still have a
long way to go. Nearly 40,000 cases each year. Of course,
communities of color, LGBTQ community, urban areas in the South
of the United States continue to be disproportionately impacted
by the epidemic.
And so the budget proposed by the President includes
increased funding for the Centers for AIDS Research at the NIH
as part of the new end-the-HIV effort. But it still cuts
funding for HIV/AIDS research supported and conducted by NIH, I
believe it is by $424,000,000. And so I know you have spent
your entire career working on addressing the HIV/AIDS epidemic
in the United States and you have overseen some incredible
achievements as it relates to treatment and prevention,
including PrEP and antiretroviral drugs.
And so let me ask you, with regard to these cuts in
research, I think it is about 17 percent, what role will the
Centers for AIDS Research play in the end-the-HIV epidemic with
a percentage cut like that? And then what is the long-term
funding needs to begin to really reduce HIV infections by 75
percent over the next five years, and I think it is 90 percent
in 10 years?
Dr. Fauci. Well, let me take the second question first, and
that is the overall effort.--As you know, and said correctly,
we are at a point right now that is absolutely critical because
we have the capability to end the HIV epidemic as we described
in the recent plan that I had discussed with you previously.
The Centers for AIDS Research, which are components
supported by the NIH, are 19 centers throughout the country
playing an important part in connecting with the community and
facilitating implementation research to understand the best
strategies for getting out into the community, getting people
who are infected on therapy, and getting those who are at risk
and not on therapy, because they are uninfected, to get them on
PrEP. The CFARs, or the Centers for AIDS Research, are playing
a major role in allowing the CDC and HRSA to implement these
strategies.
I am as concerned as you are, Congresswoman Lee, about the
cuts in the NIH budget with regard to HIV/AIDS, because as you
know right now, if you look at the advances that we have made,
if you treat a person who is infected with HIV and you get
their viral load to below a detectable level, you make it
impossible, essentially, for that person to transmit the virus
to another person, and if you put someone at risk on PrEP you
decrease their risk of acquiring HIV by up to 97 percent.
So, the research that we are doing now outside of the CFARs
is to get better therapies. One area that we are focusing on is
long-acting prep, so you don't have to take a pill every single
day, but you can take an injection every few weeks to a few
months. If we do that, we will then get those individuals who
don't adhere to their therapy and get them under the umbrella
of protection.
So, we are doing the best we can with what we have. I am
concerned that if the cuts come, we will have to slow down,
which I think would be a shame, given everything we have been
able to do over the last couple of decades.
Ms. Lee. Thank you very much. And let me ask Dr. Gibbons a
question with regard to the action plan--the National Action
Plan for COPD. How that is going? How do the budget cuts, or
would they affect the plan? Of course, I mentioned earlier my
mother suffered from COPD, directly related, as many people of
color, related to living in a neighborhood in El Paso, Texas,
where there was a smelter that polluted the whole area where we
lived. And so COPD had not been something that I had looked at
until she became very ill. Now I am trying to see where we are,
and thank you for the action plan.
Dr. Gibbons. Well, I appreciate you sharing your mother's
story, and as you know we appreciated your support on the COPD
Action Plan, and we are encouraged by the advances that we have
been able to make in terms of understanding more about what
causes COPD. As you mentioned your mother, there might have
been exposures that injured her lung, and now we are
recognizing how to diagnose this disorder earlier, so we can
intervene earlier, such that we can do more than just offer
oxygen at the end of life, when the lung has failed.
And indeed, in this area we have actually been encouraged
by imaging modalities, new technologies using data science,
machine learning, artificial intelligence. They are now able to
analyze lung scans in ways that enable the earliest detection
of damage and changes in the lung. It is by intervening at the
earliest, preclinical onset, before even symptoms have evolved,
that we can really change the natural history of the disease.
That is the kind of promising research that we see on the
forefront.
Ms. Lee. Thank you very much, and I will follow up with
you.
Ms. DeLauro. Congresswoman Roybal-Allard.
Ms. Roybal-Allard. Dr. Bianchi, one of the legislative
priorities in Congress that I have had has been newborn
screening, and since its passage in 2008, this bipartisan bill
has supported critical Federal programs that assist states to
improve and expand their newborn screening programs, which
support parents through newborn screening education, and it
ensure laboratory quality and surveillance.
I will be introducing legislation in the next month to
reauthorize the Newborn Screening Saves Lives Act, and one of
the programs authorized by the bill was the Hunter Kelly
Newborn Screening Research Program.
What has the Hunter Kelly program accomplished since it was
authorized 10 years ago and what research most urgently needs
to be done going forward?
Dr. Bianchi. Thank you. We really appreciate your
reintroduction of this bill. Newborn screening is a success
story. More than 150 million infants in the United States have
been screened, and by becoming aware of these early-onset
conditions this allows us to treat them.
We are also gratified that there has been a change in the
common rule so that we can use the dried blood spots that are
taken as part of newborn screening for additional clinical
research which allows us to test out potential protocols for
screening for new disorders.
Currently the Health and Human Services Secretary Advisory
Committee recommends that every state perform newborn
screening. There are 35 conditions on the uniform panel and an
additional 26 conditions on the secondary panel. That does not
mean that every state screens the same way. It is up to the
state to decide.
But what we think needs to be done is to be more nimble in
adding conditions to the uniform screening panel, particularly
when there is a treatment available. So just this past year,
the recommendation was made to add screening for spinal
muscular atrophy to the panel, because there is now treatment
available. And as you heard last year from Dr. Collins, that
treatment really makes a huge difference in the lives of
children with this condition.
Ms. Roybal-Allard. Thank you.
Dr. Collins, according to the NIH, 95 percent of all new
drugs that test safe and effective in animals fails or cause
harm in human clinical trials. Studies also show that 90
percent of basic research, much of which involves animals,
fails to lead to therapies for humans within 20 years, and 89
percent of all studies can't even be reproduced.
You have stated that you agree NIH should move away from
animal-based models whenever scientifically sound, and yet 47
percent of NIH's funding supports animal experiments. What has
the NIH done to identify areas of research where animal models
have a poor history of helping develop treatments for that
human condition, and can you give us some examples of where
animal models have not been successful when applied to humans,
such as in Alzheimer's research?
Dr. Collins. That is a very important area and we are
looking intensely at it. It came up a little earlier in the
conversation in the area of rigor and reproducibility. Let's be
sure that if we are using animal models to try to understand,
particularly a therapeutic intervention, that the trials are
designed in a fashion that have maximum power and you can be
quite sure of the result having a reproducible outcome.
It is certainly true that there are some areas where animal
models have been disappointing. You mentioned Alzheimer's
disease as one. There has certainly been a lot of concern about
the immune system of mice, for instance, being rather different
than that for humans, and so conclusions drawn from one may not
apply as well as you would like to others.
On the other hand, I could certainly point to some animal
models that are quite faithful reproductions of a human
circumstance and give you an opportunity to do things in terms
of developing treatments that otherwise would take much longer.
So as in most things it is a balance.
I would say the National Center for Advancing Translational
Sciences, NCATS, and their tissue chip program, aims to try, in
as many places as possible, to come up with a way to test human
cells for safety and efficacy of some new intervention. Those
are not human cells that you are walking around with but
actually cells in a chip that could be utilized to assess
exactly what happens when you expose them to a particular drug.
That is a pretty exciting program. It has been in place now in
collaboration with DARPA and FDA for 10 years, and I think that
is beginning to make some inroads.
But we have to, since we are in a rush to find treatments
for many disorders, make sure that in every instance we are
picking the best possible model and then investing sufficiently
in it so that we know we can trust the results.
Ms. Roybal-Allard. Okay. Are there any measures right now
that NIH is currently using to encourage scientists to move
from costly and often inaccurate animal testing, again, when it
makes scientific sense to do so?
Dr. Collins. Certainly the NCATS program is constantly
looking for opportunities to try out tissue chips as an
alternative to animal models. I should also mention here, in
one particular animal model, namely chimpanzees, we made a
decision some years ago not to support any invasive research on
chimpanzees. So investigators who used to depend on that model
have been required to go elsewhere.
Ms. Roybal-Allard. Okay. And I appreciate that. And just
quickly, I will be introducing the HEARTS Act to incentivize
NIH with regards to applicants to use--not to use animals in
their research, again, when it makes sense. I would like to
talk to you more about that.
Dr. Collins. I would be delighted to spend time with you on
that.
Ms. Roybal-Allard. Okay. Thank you.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you, Madam Chairman. Thank you
for this amazing information that you are sharing. I really
appreciate it and sorry I missed out on your--initial
testimony.
I have got a number of questions. I am very concerned about
health disparities. I am very concerned about sickle cell
anemia. I am very happy to hear that there has been this major
breakthrough, yet there are issues with regard to living with
it and the pain associated with it and the deterioration of
organs. I need to know whether or not there is sufficient
research being done into those areas.
And I am going to throw it all out to you. I am interested
in autism. I have a grandson who is autistic, and I am not sure
what is happening, what kind of breakthroughs, whether or not
we have the kind of funding and research that is taking place.
I am also concerned about sarcoidosis and what is happening
with regard to research in that area. And then, in general, the
disparities in health care. I am very interested in maternal
mortality and what kind of research you all are doing to
identify the causes, why, between individuals similarly
situated in all ways black females have a mortality rate, a
maternal mortality rate much higher than their white
counterparts.
And I guess I want to say, finally--I think I have got all
my questions out--the issue with children and this uptick in
suicides and access to mental health, and the disparities in
the uptick in suicides with African American children. What are
we finding? What are we looking for?
And then my last, but most important question is, do you
not need more money to do all of these good things and other
things as well? I certainly think you do.
Thank you, Madam Chair.
Dr. Collins. My goodness. I am trying to figure out, in the
remaining three minutes, what we might do to try to answer one
or two of these, and obviously we can answer others for the
record if that would be helpful.
Mrs. Watson Coleman. It would be. Thank you.
Dr. Collins. Maybe I will try to pick a couple that have
not been brought up by other members in the course of this
conversation.
So, for instance, autism spectrum disorder has not been
talked about. We are deeply concerned about the fact that the
frequency of autism spectrum disorder, or ASD, has gone up over
the course of the past few decades. That clearly is an
indication of something that is going on. Some of it is
probably a sensitivity to condition and an increased likelihood
of making that diagnosis, compared to many decades ago where it
was less familiar to both parents and providers. But it
certainly requires deep investigation, and it is being looked
at from multiple perspectives.
We do think autism, in its most severe form, probably
begins prenatally. It is not something that starts at the time
that you make the diagnosis, maybe when the child is a year old
or so. We can certainly show in children younger than one year
that if you look at something as subtle as how they do eye
tracking that there is a distinct difference, and we can see,
actually, by scans, that the brain anatomy is different in a
child with autism than one that does not have it.
And from genetic perspectives we know there is an awful lot
of the autism risk that comes about through genetics, but not
in a very straightforward, simple way. There are a lot of
different genes involved.
One thing we know that is not a major cause of autism, not
a cause at all of autism, is vaccines. If you want to say what
we know, it is that MMR vaccines do not cause autism. A recent
study just a month ago, actually, showing this. It was a very
long-term study in Denmark.
But we are deeply interested in trying to take what we have
learned about the molecular and neuroscience of autism and now
begin to transform that into interventions. I will tell you we
do know that early diagnosis and early intervention, in terms
of both home and school activities, improves outcomes, so it is
really important that we have the ability to catch this kind of
circumstance early.
That is what I would say about autism. In terms of the
other things you brought up, we did talk about maternal
mortality briefly before, but health disparities, in general,
everybody at this table in their institute, has a concern about
health disparities and how we can, with the resources we have,
focus on that.
Maybe I will ask Dr. Gibbons if he would say another word
about where we are in terms of health disparities with heart,
lung, and blood disease, since that is his area of particular
focus.
Dr. Gibbons. Sure. So one of the elements of addressing
health disparities in communities close to where you are
representing, involves appreciating the social context in which
patients find themselves, and that raises the issue of
implementation science. How can we be sure that things we know
work are penetrating all the communities that are at highest
risk? We are, investigating that with sickle cell disease.
There is a recent paper out that acknowledges that blood
transfusions and hydroxyurea, are very effective, but in a
study of pediatric patients on Medicaid, only 20 percent
received hydroxyurea for more than a few moments.
And so we--have formed a network of implementation science
around sickle cell disease. It is all over the country, in
South Carolina, New York, California, and in Illinois, all of
which are looking at new models, new innovative strategies to
ensure that evidence-based care gets to all the patients who
are affected. That is a theme, I think, in all sorts of health
disparities research. That is relevant, as well, to the issues
of maternal mortality, where indeed, as you pointed out,
African American women are at a two-fold higher risk of death
related to childbirth.
Mrs. Watson Coleman. Even in the same socioeconomic and
education and everything else background.
Dr. Gibbons. That is correct. That is correct. And some of
that relates to other conditions that they have actually
preconception, more hypertension, more diabetes. All that
increases their risk. And so part of a trial that we are doing,
in conjunction with our colleagues at Child Health----
Ms. DeLauro. Dr. Gibbons, I have to ask you to----
Dr. Gibbons. Oh, sorry.
Ms. DeLauro. We are well over a minute and a half here, so
we have got--and I would love to have you and Congresswoman
Watson Coleman continue that conversation.
Congresswoman Clark.
Ms. Clark. Thank you so much. Thank you, Madam Chairwoman.
It is such a pleasure. I looked forward to this hearing. I have
learned so much in this brief period of time that we have, and
I appreciate the situation you are in and I am sorry that each
time you come before us you are facing significant budget cuts.
And I think that when we look at them in total, with also cuts
to Medicare, Medicaid, we are not only cutting off--we are
cutting off both ends of the pipeline, innovation and delivery
of health care. So I appreciate you being here and the
incredible spectrum of work that you do.
In my State of Massachusetts, in 2016, a third of all
deaths of people between the ages of 15 and 24, our young
people, were from opioid overdoses. And we are now finding a
new and disturbing trend within a very disturbing public health
crisis in this country. A survey--the National Survey on Drug
Use and Health found that there is a significant and growing
gap between treatment that white youth are receiving and those
versus color. Sixteen percent of white youths who abuse pain
relievers received treatment in 2016, and 9.5 percent of youths
of color received that same treatment in 2016.
Dr. Volkow, can you tell us, is NIDA currently doing any
work to better understand and find solutions for this growing
gap in disparities and treatment?
Dr. Volkow. Yes, and indeed as for any other medical
conditions we have found that the outcomes are much worse for
minority groups, and these reflect multiple factors, many of
them related to access to proper treatment and identification.
And it is not just that individuals that are African American
are less likely to be given access to medications that are
life-saving for opioid addiction, they are also, for example,
less likely to be given Naloxone, particularly if they are
women, if they overdose. So there is a disparity in the way
that we are actually approaching the treatment invention.
So what is that we are doing? We are actually funding
researchers to develop models that will enable laws to provide
evidence of care for the screening and treatment of individuals
with an opioid use disorder. That also includes areas that may
not normally be part of what we have been researching in the
past, like rural communities. So it also pertains to the
difficulties of actually bringing models of care.
So this is one of our key priorities for the use of the
$500,000,000 that Congress gave us to address the opioid crisis
that we are currently experiencing. The initiative has a pain
component and a component that relates to preventing and
treating opioid addiction, and we are emphasizing the
importance of research that will lead us to solutions to
actually decrease the gap in the outcomes between--I improve
the outcomes for everyone, but certainly no longer permit that
those disparities persist.
We have also always been very concerned about the
criminalization of individuals with an addiction, which is much
more likely to happen if you are African American than if you
are Caucasian. And so we are also developing models of care and
research that are targeting the justice setting to prevent this
from happening.
Ms. Clark. Great. That is a staggering fact that I had not
heard, and I just want to make sure I understand you correctly,
that Narcan is administered to African American women at
noticeably lower rates?
Dr. Volkow. A lower rate than it is for men.
Ms. Clark. Wow.
Another trend that we are seeing is a rise in mental health
issues for young adults. And do you believe that that--you
know, that we have comorbidities happening here? Are they tied,
and what sort of work are you doing on increasing substance use
disorders and increasing mental health issues for young adults?
Dr. Volkow. Yes, indeed, we are finding that there is more
frequency than the exceptions to have comorbidity with mental
illness. For example, a particular area of concern is that a
significant portion of people that are dying from overdoses
are, in fact, dying also from suicide, and it is estimated
between 20 and 30 percent, and that highlights, again, the
importance of one of the areas that we are incentivizing in the
HEAL Initiative, which is how do we address the treatment of
opioid use disorders that have a comorbid mental illness?
Ms. Clark. Thank you. Thank you, Madam Chairwoman.
Ms. DeLauro. Thank you. We are going to move to a second
round of questions, and I will ask members to do that in three
minutes. And I am just going to say this, and I am a guilty
party in this. Let us not ask a three-minute answer in the last
remaining 10 seconds of our time. So I will try to adhere to
that myself. Okay. Thank you very, very much.
With that I am going to say, very quickly, Dr. Collins, Dr.
Gibbons, I would like another conversation, a further
conversation about lymphatic disease research. We can't get to
it today. Ten million people, almost no treatment, a very
serious issue which I would like to try to pursue.
I would just say to Dr. Fauci, at a point I would love to
know more about PrEP in women and what is the nature of the
studies there so that we can see if there is a difference in
how effective it is. I just would throw in, at that juncture,
we seem to have a very big problem with PrEP in the South, in
which case we may deal with a whole variety of issues, some
having to do with Medicaid, et cetera, but clearly there.
Dr. Volkow, I would pursue with treatment disparities for
opioids between men and women, and what kind of research we are
doing in that area.
Let me just ask you, Dr. Fauci, about a universal flu
vaccine and where we are. We have done 140 million. That was an
increase. Where are you? What kind of progress are we making?
How close? Crazy question. How close are we, or how far are we
from universal flu vaccine?
Dr. Fauci. Well, first of all, thank you very much, Madam
Chairwoman, for the support of this committee, because it
really has resulted in some important advances that I am very
pleased to tell you about, from the last hearing we had last
year until today. And that is in the area of universal flu
vaccine research, where last year we had preclinical animal
modal and Phase I studies, we have now advanced to Phase II
clinical trials, namely looking at not only whether the vaccine
candidates are safe and immunogenic but whether they actually
do have a broader protection against more than just one strain
of influenza.
Both in our extramural program and in the Vaccine Research
Center at the NIH, we have more than one candidate. I think I
mentioned it to you when we discussed this topic. This is
something that we are very excited about because we are seeing,
for the first time, that you can vaccinate with a particular
component of the flu vaccine that is common among multiple
strains, as opposed to now where we have one strain, one
vaccine, another strain, another vaccine. I can't tell you
exactly how long it will be until we get a universal influenza
vaccine but I can promise you that we are going into Phase III
trials, and when we come back to a hearing next year, I will be
able to tell you a little bit about some of the data on that.
Ms. DeLauro. Thank you very, very much. It is very, very
encouraging as to when we go.
Another area that I would just mention, because I have got
12 seconds, is measles. You know, I am very, very concerned. I
understand medical exemptions. I understand religious
exemptions. There is also apparently a philosophical exemption.
I don't know what the dimension of that is, but I think we need
to do something about looking at vaccinating our children, and
I would love to pursue that conversation and how we do that.
Dr. Fauci. Definitely.
Ms. DeLauro. I have overstepped by about 10 seconds here.
Mr. Cole. There is such a thing as the chair's prerogative,
Madam Chair, so we certainly respect that.
And I want to associate myself with your remarks on
lymphatic disease. I would really like to have a longer look,
and I know we both met with folks this last week. It was a very
compelling presentation. So we would--I know that there would
be a bipartisan interest in that.
Dr. Collins, we have talked a lot, and appropriately so,
about health disparities, but the biggest disparities have
always been between the Native and the non-Native population in
the country. That is still the case. In 2015, NIH established a
Tribal Health Research Office to ensure meaningful input and
collaboration with tribal nations on NIH programs and policies.
Can you give us kind of an update on how that is going and
what kind of progress, if any, we are making on this front?
Dr. Collins. I am glad to. We are happy now to have this as
a focus at NIH. We did not have such an office until 2015, Dr.
David Wilson now leads this effort. I believe you have met him,
and he is really quite a thoughtful leader in this space. It
has given us an opportunity to do a much more thorough survey
across multiple different health disparities that affect Native
Americans and try to see, do we have our research portfolio
arranged to understand both what the causes are, but even more
importantly, what the interventions could be that would improve
those circumstances?
We formed a tribal advisory committee, which is populated
by each of the leaders from the 12 geographic areas that are
served by the Indian Health Service, and those folks meet quite
regularly, and they have very clear opinions about what we
should be doing to prioritize research that would affect them,
but also in respect of their tribal circumstances. They have
been particularly interested in the All of Us research program,
both in terms of what it is doing and also how it could be
brought forward in a fashion that would be consistent with
their tribal council rules, and we are paying attention to
that.
So I think, in this space, compared to where we were just
four years ago, there is a lot more focus across NIH, a lot
more opportunities to identify research that needs to be done,
and personally for me I think it is overdue and it is great to
have that chance, and I appreciate your leadership.
Mr. Cole. Well, thank you very much.
Dr. Lowy, I have not got a lot of time left, but, you know,
Dr. Collins talked earlier about some of the funding issues we
had with the All of Us program in terms of cliffs that sort of
get built in. I think we have got something similar to that in
the Cancer Moonshot. Could you give us sort of an overview of
things we ought to be thinking about so we can give you a
consistent stream of funding going forward?
Dr. Lowy. Yes. Thank you, Congressman Cole, for this really
important question. Thanks to the funding with the Moonshot for
the last three years, including this year, we have been able to
fund a lot of new initiatives, including in pediatric cancer
research for looking for new treatments, immunotherapy for
children as well as for adults, and cancer health disparities,
et cetera. But as you are pointing out, we are at the peak this
year for the funding and next year it will go down by
$200,000,000, and in 2024 it ends. And needless to say, thanks
to the strong support of this group we have been able to start
a lot of new things, and it would be easier to continue them if
we didn't have to worry about cliffs, et cetera.
Mr. Cole. Thank you, Madam Chair.
Ms. DeLauro. Thank you.
Congresswoman Lowey.
The Chairwoman. Thank you, Madam Chair. Dr. Lowy, you know,
and others probably know about my focus on early detection for
kidney cancer, and we also know with kidney cancer, and I have
another friend with advanced pancreatic cancer, that there is
very little--the end story is not good.
Someone I was talking to, as I was visiting, the doctor
came over to me, there are several people who believe, but it
is very expensive, that if you continue to get body scans you
can detect those cancers early.
Now some of us may remember Jack Murtha. He was on a real
tear. He wanted everyone to go get body scans every year. So,
on the one hand, there is no way to detect it unless you get a
body scan. On the other hand, body scans are very expensive. On
the other hand, is the expense something that we should
consider or is there a danger in excessive body scans?
Dr. Lowy. The question of screening for cancer is
critically important for all cancers. We have some approved
areas for cancer but not in kidney cancer.
We need to be sure that the benefits of what we do,
whatever the procedure is, will vastly outweigh the harms. And
there is always a concern, if you are looking for something
that is uncommon, that there will be serious side effects
because of finding incidental problems that need to be followed
up on.
Certainly imaging is one important area, but in addition,
for kidney cancer, the question of using urine tests, looking
for molecular abnormalities, or using blood tests, also looking
for abnormalities, there is a fair amount of research going on,
both in academia as well as in the private sector. I am
optimistic that some of this will lead to FDA approval in the
not-too-distant future.
The Chairwoman. So right now this is not a procedure--these
are not procedures, plurally.
Dr. Lowy. At the moment there is no FDA-approved
intervention for screening for kidney cancer.
The Chairwoman. So, in other words, if someone wakes up one
day and sees this, the size of an orange, there is nothing they
could have done to detect it earlier. Is that correct?
Dr. Lowy. Certainly imaging would be able to detect things
earlier, but you don't know who is going to have the positive
result. If you could identify a very high-risk population, for
example, people with familial kidney cancer at risk for that,
that is a different situation. But if you are just looking for
people at normal risk, it has not yet been demonstrated that
the benefits of the early detection substantially outweigh the
disadvantages.
The Chairwoman. I am out of time. Thank you all for your
service.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you very much.
One issue that came up last fall was the use, in HHS, of
fetal tissue for research, and I think that in December there
were articles that said that--I guess it was the UCSF grant,
you know, had another 90 days to fund and the decision was
going to be made on that. What was the decision?
Dr. Collins. That deadline was extended and at the present
time the intramural programs, three of them that require human
fetal tissue research--fetal tissue to do their research, are
linked up with that UCSF source, and we have not required any
slowdown in that effort.
As you know, the Department of Health and Human Services is
going through a detailed review of human fetal tissue research
to see whether it is, in fact, living up to all of those very
high standards.
Mr. Harris. Right. I am not sure I understand what--well,
first of all, how long has the deadline been extended to make
the decision on that?
Dr. Collins. I believe it is extended until June.
Mr. Harris. And why the extension? Why was the extension
necessary?
Dr. Collins. The review that the Department is doing is not
complete, and the Department, and this certainly reflects the
view of the secretary, want the research in the meantime to be
able to go forward, hence the extension until a decision gets
made for the longer term.
Mr. Harris. And the--what you said, the three studies going
on at NIH were linked up to that source. I am not sure what
that means.
Dr. Collins. I meant that UCSF agreed that they could, in
fact, meet the needs in terms of the fetal tissue that those
three studies needed to go forward, for instance, a study on
eye disease.
Mr. Harris. Where are they deriving the tissue from? Where
are they obtaining it?
Dr. Collins. I believe locally at UC San Francisco Medical
Center.
Mr. Harris. And is it true it is from their study, that
uses tissue from 17- to 24-week fetuses?
Dr. Collins. I don't know those details. I could get them,
for the record.
Mr. Harris. Well, you can get that. That is what has been
reported, so I would appreciate you get back to me that.
And what centers--where--exactly where? I mean, now--
because what you are saying is that the studies here, and I
take it when you mean NIH studies you mean intramural studies.
Dr. Collins. Yes.
Mr. Harris. So where--so exactly where is the tissue
obtained?
Dr. Collins. As I understand it, it is obtained in San
Francisco and then shipped to the intramural program at NIH.
Mr. Harris. Where in San Francisco? I mean, we are buying
tissue. We are cutting a check, I assume. Do we just say we are
sending money to UCSF and we let them figure out where it is
from?
Dr. Collins. There is a contract from the National
Institute of Allergy and Infectious Diseases.
Mr. Harris. This is a new contract; is that right?
Dr. Collins. It has been there for some time.
Mr. Harris. But you say we linked up to that source. You
imply that is recently, since the ban on spending intramural
monies.
Dr. Collins. We are still working through the logistics,
but basically this was an existing contract that was supplying
tissue, if I am correct, to the Rocky Mountain Laboratory, and
was asked, therefore, to take on a couple of other
circumstances during the time of this HHS review.
Mr. Harris. I hope you can get back to me in more depth on
that.
Thank you very much. I yield back.
Ms. DeLauro. Congresswoman Roybal-Allard.
Ms. Roybal-Allard. Dr. Fauci, I want to follow up on the
issue that the chairwoman raised about measles. According to
the CDC, as of March 21st, 314 cases of measles have been
confirmed in 15 states. Thanks to a robust vaccination effort,
starting in 1963, measles virtually disappeared from our
country and we forgot what a serious disease it is.
I have three questions, and in the interest of time I hope
you can cover them all. Are the cases of measles we are seeing
today more virulent or dangerous than a half century ago? Can
choosing not to vaccinate children for non-medical reasons
create a public health crisis? And does NIH have a role in
addressing this growing vaccine hesitancy and in helping
convince families not to put their children at risk for measles
and other vaccine-preventable diseases?
Dr. Fauci. There is no indication that the measles virus
right now is any more virulent than before the widespread use
of vaccines. However, I must point out that I think much to our
concern, there is this misperception that measles is not a
serious disease. When you get measles, 1 out of 10 children get
an ear infection that can lead to deafness, 1 in 20 get
pneumonia, 1 in 1,000 get encephalitis, and 2 to 3 out of 1,000
die. So the decision is no different than it was decades and
decades ago, but it is not a benign disease.
Number two, yes, the situation of not vaccinating children
is leading to the outbreaks that we are seeing. Right now, the
number is even higher, Congresswoman. There are now 387 cases,
and--the first three months of 2019 there are more measles
cases than the entire year of 2018. So it is a public health
issue and it is all related to under-vaccinating children and
lifting the umbrella of herd immunity.
Your question is what we are doing right now. We talk about
vaccination a lot. We use the scientific basis to get people
who are anti-vaccination, or who do not want to vaccinate their
children, to provide them with what sound evidence-based data
to indicate that the rationale for not getting vaccinated is
not based on scientific fact. It is misperception and
misinformation. So what we do is provide the scientific
information so that they can make the right choices and
vaccinate their children.
Ms. Roybal-Allard. Thank you. I yield back.
Ms. DeLauro. Is that vaccine acceptance research, what you
just made reference to, Dr. Fauci?
Dr. Fauci. Excuse me?
Ms. DeLauro. Is that vaccine acceptance research? Is that--
--
Dr. Fauci. No. We don't primarily do research on that. We
are doing research right now to understand, for example, if
there is waning of immunity with measles vaccination, so
sometimes if you have 100 people who get exposed, some who get
infected may have been vaccinated, because the vaccine is 97
percent effective. We are doing research to try and figure out
why that immunity wanes in a very small percentage of people.
Ms. DeLauro. By the way, the measles is at its second-
highest level since 2000, so lest we don't think it is a
crisis.
Congresswoman Clark.
Ms. Clark. Thank you, Madam Chairwoman.
Dr. Bianchi, I have a couple of questions for you. I am
going to lay them out and then you can answer them to make best
use of my time.
I am very interested in postpartum depression, as looking
at mental health as part of maternal health. I understand you
are hosting a community engagement forum on April 8th, coming
right up, and I wondered if you intend to have a focus on
mental health in that forum, and if it would be helpful, as we
look at coordinating with other agencies like SAMHSA and the
Office of Women's Health, if there are interagency discussions
that we can help support in Congress?
And my last question is specifically coming from a
constituent, a heartbreaking story about losing their nephew,
18 months old, to SIDS. And the constituent's question was
about the National Institute of Child Health and Human
Development released its five-year strategic plan and failed to
include Sudden Infant Death Syndrome and SUDC as a priority. I
wonder if you could explain how that got dropped out.
Dr. Bianchi. Okay. I will go in reverse order. We have not
released our strategic plan. What we released was six
overarching scientific themes that could be the focus of our
strategic plan, which we anticipate will be released in
September of 2019.
What we were trying to do was to get a reaction from the
community. What did they think about the themes that we had
selected? There were hundreds of conditions that were not
specifically mentioned in those themes, and I think some people
read it and thought that was the be-all and the end-all. We did
receive almost 1,000 comments in response to our request for
information, which we see as a great success because it means
that the community was engaged.
We are fully intending to continue our robust support of
sudden unexplained infant deaths, and so the community should
be reassured that that will continue, and I think that was a
misperception.
Ms. Clark. Oh, great. Thank you.
Dr. Bianchi. With regard to including postpartum depression
in our community engagement forum. Because of the disparities
in maternal mortality, NIH is having a community engagement
forum where members of the community, specifically the African
American community, are invited to share their stories, so that
we can hear directly from people who have been affected by
this.
So I can't say that specifically postpartum depression is a
topic because we don't know exactly what people are going to
bring up, but postpartum depression is an area that generally
is led by NIMH, but it is an important cause of maternal
morbidity and mortality, so we are certainly including it in
our research going forward.
Ms. Clark. Thank you.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Thank you. Just so you know I have been
listening to the hearing from the comfort of my office. Thank
you again.
A couple of questions. First, I would like to ask you about
biologics. And I know we talk a lot about reducing the cost of
health care by getting the cost of prescription drugs down and
so forth.
I just read an article that said that what we should be
looking at, what might change that dynamic is the use of the
specialized drugs aimed at a particular person's genetics, and
so forth. Can you comment on that, or can someone comment on
that?
Dr. Collins. Maybe I will start, but maybe Dr. Lowy would
like to comment because a lot of the biologics are relevant to
cancer.
Biologic is basically a therapeutic which is a complicated
molecule, generally a protein, to be distinguished from typical
drugs, which we call small molecules, which are basically
organic compounds. Biologics are more complicated to make, so
there is always an issue there in terms of the production, but
they can be very targeted, particularly, say, for instance, if
it is a monoclonal antibody.
And there is certainly this effort, and you can call it
precision medicine and you would be right, to try to identify
therapeutics that are right for that individual, as opposed to
a more one-size-fits-all approach, and cancer is right in the
very leading edge of that kind of transition.
Dr. Lowy, what would you want to say about this issue?
Dr. Lowy. Biologics really are one-half of our
armamentarium when it comes to cancer treatment, the other half
really being a combination of standard chemotherapy and
precision medicine, which are small molecule inhibitors and are
easier to manufacture.
As Dr. Collins says, the manufacturing of the antibodies
and verifying that they work, et cetera, is an extensive
process. And I think that in terms of--we were talking earlier
about pediatric cancer, for example, there was an indication
that a monoclonal antibody might be useful for certain children
with neuroblastoma. And because of the lack of the economic
incentive for doing this in the private sector the NCI actually
manufactured and had this monoclonal antibody tested. It turned
out that it did improve the outcome for children with high-risk
neuroblastoma. And then ultimately we transferred the
manufacturing to a production company.
If there are other questions I would be happy to answer
them, either offline.
Ms. Frankel. Okay. Thank you. And I guess I will just end
with a question that you probably will not be able to answer
because I am running out of time, but I was curious whether you
have heard of, and are you doing any research on what is called
gender bias in the medical profession.
Dr. Collins. Yes, we are very aware of that concern and
would be glad to talk with you about that.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you, ma'am.
So it is clear to me that there is a disparity in health
outcomes as it relates to race, in just about everything. So I
understand that there was a $44,000,000 cut to the National
Institute for Minority Health Disparities, 13 percent. I am
sorry--yeah, a 13 percent, $44,000,000 cut.
I want to know how does that affect your research and the
work you are doing in the areas that I was asking about--sickle
cell, how to live with it, medications to deal with it, and to
deal with the pain, mental health disparities in minority
children, and the uptick of suicide?
And I wanted to ask you if you have information on whether
or not there is any racial disparity in the incidence of the
reporting of autism?
Dr. Collins. Those are all great questions and I am glad
that Madam Chairwoman suggested there might be a future hearing
where other institute directors could appear, because if we had
the director of the National Institute on Minority Health and
Health Disparities, Dr. Perez-Stable, here, he would have a lot
to say about the question you just asked. If we had the
director of the National Institute of Mental Health here, Dr.
Joshua Gordon, he would also have a lot to say, about mental
health and about suicide. And if we had Dr. Walter Koroshetz,
who is head of the National Institute of Neurological Disorders
and Stroke, he could probably tell you quite a bit about autism
and differences in reporting.
All of those are serious issues, and all of those, of
course, will be affected by a decreased budget. We basically
would look at the things that we feel we have to do, and we
would have to more slowly with a 13 percent cut. Obviously, a
lot of things would have to wait.
Mrs. Watson Coleman. Thanks, Dr. Collins.
With regard to sickle cell anemia, I mean, how--is it 100
years we have known about sickle cell anemia?
Dr. Collins. More than that.
Mrs. Watson Coleman. So this--I would like to ask, through
the chairman, if it is possible. Those are the areas that I am
really concerned about--the organ damage, the treatment of pain
in sickle cell, the disparities in mental health, and youth in
particular, the uptick in suicide. I think there was another
one I asked, but, you know, it is that----
If I could get that information, the answer to that
question, what does the impact of a 13 percent cut to that
particular part of your budget mean in terms of your research
and your work in that area. And I thank you for the information
you have shared with me and I yield back.
Dr. Collins. I am glad to provide those for the record.
Mrs. Watson Coleman. Thank you.
Ms. DeLauro. Thank you very much and that would be very,
very helpful because it is cross-cutting, you know, in terms of
understanding what will suffer, and it is important to know
that.
Let me yield to the ranking member for any final questions
or comments.
Mr. Cole. Well, it has been a long hearing so thank all of
you for being here because it is incredibly helpful to,
frankly, our entire committee, and honestly, I think to the
public at large.
I want to go out on a limb and say that if this
subcommittee has much to do about it I suspect that you are
going to do pretty well this year for yet another year, because
certainly our chair is determined, and the big chair, as we
like to call her, is here and she is pretty determined, and we
know from experience our counterparts on the other side of the
Rotunda are pretty determined too.
So I think it really will get down to whether or not we can
have a larger deal, if you will, that really, you know, settles
the budgetary issues across the board. But there is not much
doubt that this committee believes very strongly on what it has
done on a bipartisan basis over the last four years and wants
to continue down that path, and that is because you and your
colleagues are producing for the American people, and frankly
for all of humanity, the kind of results that we want to see
for the investment. We really do think this makes an enormous
difference in the lives of tens of millions of Americans, and,
quite frankly, hundreds of millions of people all around the
world who benefit from the work that you do.
I want to thank the chair not only for this hearing but for
her wise decision, I think, to have some others up here so we
can delve a little more deeply into some of these issues as we
go forward. I know that that will benefit this committee and
hopefully benefit your bottom line going forward.
Last point, you know, I think that we actually had a
members day hearing just a few days ago, and one of our very
new colleagues came in to testify, and he happens to represent
the Mayo Clinic. And he was here to advocate on their behalf
and continued investments. And he had with him three young
researchers that just by happenstance happened to be in his
office to advocate for additional funding for the NIH. And he
brought them all down here.
And I remember, Dr. Collins, our very early discussions on
this a number of years ago. That was, I thought, the most
critical point you made, the signal we would send if we could
stay on a sustained course for younger researchers, what that
would do down the line, and a significant investment would make
a difference. And there, in front of it, there it was, and they
were all pretty excited to be here and they all believe very
much in their mission, and I think they were excited to see
this committee in a bipartisan way say this is a national
priority.
This is something I think Congress, frankly, in general,
can be proud of, because whether it was in the '90s, in the
early 2000s, or whether it has been more recently, frankly, the
Congress has been ahead of the Administrations, whether they
were Republican and Democrat, and I always say I think it is
because maybe we are a little bit closer to constituents that
are dealing with these real, live human problems.
So we look forward to working together. We thank you,
frankly, for providing us a national, and really an
international endeavor that really crosses partisan lines and
brings us together at a time that we have a lot of partisanship
and a lot of polarization.
This is not an area where that has occurred and I think
that is due to your leadership and your success, and frankly,
we all hear from constituents and it doesn't matter where they
are on the political spectrum. I always tell my colleagues, I
represent a pretty conservative district and I get lots of
ideas about where I could cut spending. Nobody has ever come to
me and said, ``Cut biomedical research. I think we can put off
that cancer cure a little longer. I don't think we really need
to deal with Alzheimer's.'' This is actually something that the
American people want us to do. They want us to do this on a
regular and continual basis, and sort of build it into the
system so that we have the appropriations muscle memory, if you
will, to stay at this for a good, long time to come.
So with that, Madam Chair, again, thank you for the hearing
and I look forward to working with you on this common endeavor.
Ms. DeLauro. Thank you very much, and we will work together
on this effort.
This is a hearing I think you can hear underlying the
sentiments of all of us on the subcommittee, on both sides of
the aisle. It is always an extraordinary hearing. It is about
the wonder of discovery, and, you know, I don't just say to
you, you know, I wish, on a day-to-day basis we were engaged
always on the wonder of discovery. But that is what you do with
your lives. Where it leads you, how it saves lives, and that
has to be.
Yes, sometimes the length of time may be frustrating but
the outcomes--you know, and I listen to where we might be on
HIV, and, you know, on a flu vaccine, or where we are in cancer
research or the kinds of things we can, you know, do to deal
with what are the health care crises in our country.
And what that reflects for me is the--which is astonishing,
what opportunity we all have here, and because we do get to
make decisions. And that is something that we do. I believe
this in my heart, that everyone on this committee and those
where we have served before together, when it comes to the
biomedical research, that we have a real understanding of the
broad dimension of its value.
And when you think about what we can do at the Federal
level there are some things we do not have control over, where
we can't, you know, really make the difference. This is the
area where we can, and I will just say to you that we will. We
can and we will.
So the testimony--thank you--is always so overwhelming. So
many exciting areas and what it is a reflection of. I mean, we
do know, and you say it very clearly, that we have a long way
to go in what we are trying to look at. You know, we both
talked about--we both heard from a community, Congressman Cole
and myself, about lymphatics and that, you know, you have no
place to go when you are dealing with this effort.
So the issues that are around, the issues that it regards,
you know, we have gone a long way in terms of women's health,
but what is the difference of pain in opioids and gender? What
was that about? The PrEP issue and what are the effects of all
of these efforts? So many explorations.
You know, the issue is maternal mortality. It is just
unbelievable, you know. You know, I was at a program in New
Haven--today is Tuesday. I was there Monday, you know, before I
got on the train to come down--which was what we did at the
Federal level of providing $5,300,000 to something called
Healthy Start, and that, in and of itself, is all about, you
know, childbirth and counseling and well-being, and addressing
that issue. You do that from, you know, another vantage point,
so that we have got to get these things to really connect and
to meld.
And I think it is clear, in some of the things that you
have said, you know, some would say that this is in the realm
of the private sector. Well, the private sector is not going to
be able to--nor, in some instances, does it want to. I am not
going to fault that. But they don't want to go that--but that
is where you go, and that is what we have to do, and that is
where we have to go along with you.
I think you have heard a consensus today. I mean, the
subcommittee in this area will reject the President's budget. I
expect that we will work on a bipartisan basis to continue to
support NIH research this year and going forward. And I know I
think we all look forward to hearing from the remainder of the
institutes that have not been able to come and to let us know
about all of the wonderment of their discoveries, as well.
So thank you very, very much. We appreciate your time. We
have gone on for a while, and let me bring this hearing to a
close.
Thank you very, very much.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Wednesday, April 3, 2019.
DEPARTMENT OF LABOR BUDGET REQUEST FOR FISCAL YEAR 2020
WITNESS
HON. ALEXANDER ACOSTA, SECRETARY, U.S. DEPARTMENT OF LABOR
Opening Remarks By Chairwoman Delauro
Ms. DeLauro. The hearing will come to order. Thank you.
Welcome, Mr. Secretary. Thank you very, very much. Good to
see you back at this subcommittee.
This is our fourth budget hearing this year, and today what
we are looking at is the President's 2020 budget request for
the Department of Labor.
I have to acknowledge, for a moment, that you do come
before the committee under a cloud of controversy regarding the
Epstein case and questions around the adequacy of your position
as a Cabinet official. But you are still the Labor Secretary,
who must answer for the proposed budget, and as such that is
where I intend to keep my attention today.
I want to highlight some facts about your budget and the
agency, where the country looks for worker protection and for
opportunity. My words may seem harsh, Mr. Secretary, but really
they are a response to 17 pages of testimony, which I read--I
read very carefully--that, in my view, were divorced from
reality and really read like propaganda.
Past administrations filled nearly 80 percent of senior
positions, but in the Trump administration it is 54 percent,
but at the bottom of that list is the Department of Labor,
along with, I might add, Interior and Justice, which filled
only 43 percent.
You have limited corporate liability when franchisees,
contractors, subcontractors, staffing agencies and the like
commit wage theft, hurting working people. You have allowed
child labor in health professions, putting teenagers at risk of
injury. And overall, since the beginning of the Administration,
enforcement activities in the workforce have been on a steady
decline.
You have blocked electronic reporting, preventing the
public from knowing detailed workplace injury information. You
have shortchanged 3 million Americans and workers from getting
their overtime. You have shuttered the Department of Labor. You
have weakened protections for construction and shipyard workers
from beryllium exposure. You have allowed contractors who cheat
their workers to continue with, quote, ``business as usual.''
In mine safety, a recent study in the American Journal of
Public Health found that black lung cases are at a 25-year high
in Appalachian coal-mining states. That is why the department's
Office of the Inspector General cited mine operator compliance
with the respirable coal dust rule in its 2018 top management
and performance challenges facing the Department of Labor. And
it alarms me that you would put the coal dust rule up for
public comment, given the IG's report.
So my question is, have you shuttered the Department of
Labor, is the Department of Labor no longer functioning, and
are you there just for industry to do whatever it wants? And
that is before we get to this budget.
FISCAL YEAR 2020 BUDGET
The President's fiscal year 2020 budget proposes to cut
$703,000,000 from Job Corps, that would shutter centers across
the country; $15,000,000 from re-entry employment opportunities
that provide employment and training services to youth and
adults with criminal records; $68,000,000 from the
International Labor Affairs Bureau, ILAB, the agency that
investigates labor violations and trade agreements with our
trading partners and reports on products that are made with
child or forced labor; $11,000,000 from the Office of
Disability Employment Policy, which would hurt Americans with
disabilities.
The following are eliminated entirely: $400,000,000, the
Senior Community Service Employment Program, which hurts our
seniors; $89,000,000 from the migrant and seasonal farmworkers
job training, which hurts vulnerable working people and their
families and often people of color; $11,000,000 from the Susan
Harwood Training Grant that provides training and education on
safety and health hazards in the workplace, hurting working
people.
I provide this information so we all understand the context
of what is occurring in the Department of Labor. And now let me
remind you and everyone else of the mission of the Department
of Labor. Its mission is to, quote, ``foster, promote, and
develop the welfare of wage-earners, job-seekers, and retirees
of the United States, improve working conditions, advance
opportunities for profitable employment, and assure work-
related benefits and rights.''
And since its inception, this department offered so much
promise for working people, yet I believe you are seeking to
shutter it for the working people who rely on the agency to
protect them and to provide them with opportunity. You are
taking the agency from enforcement. You are taking away from
weeding out bad actors to offering bad actors technical
assistance, taking away from being a tough cop on the beat to
being an ally of industry.
That is true of the President's proposed budget cuts to the
Department of Labor, a 10 percent cut amounting to
$1,200,000,000. I cited a number of those cuts earlier. Many
are recycled proposals which we handily rejected last year. I
expect we will again.
But--and my colleagues have heard me say this--I believe
this budget is cruel and reckless. This is an agency that has
been historically underfunded, and now we are looking at a 10
percent cut. And you say we can do more with less, but it would
appear that we are doing less with less, and a lot less with
less.
The result is that I believe that the Department of Labor
has become a shell of an agency. It is a pattern, though, for
this Administration. This is our last budget hearing, and as I
look across the different purviews of this subcommittee we have
seen this play out with for-profit colleges and loan services,
unregulated, unaccountable, corporate giveaways that hurt the
young and the old.
APPRENTICESHIP PROGRAMS
Let me take a look at registered apprenticeships, where we
would expect much more from the Department of Labor and this
budget. First, you propose to level fund registered
apprenticeships. It is not in the league with what is happening
in Europe, in Switzerland, Germany, where as many as half of
students go through strong, accountable apprenticeship
programs. It is not in line with that in size or scope or
accountability. And this Administration would prefer
unregulated and unaccountable programs and priorities.
A former staffer at the Department of Labor and the
Department of Education, who is now with New America, wrote an
excellent piece in Inside Higher Ed, on the risks of the Trump
administration's plans to deregulate apprenticeships. She said,
and I quote, ``Rather than focus its efforts on growing our
small but high-performing system of registered apprenticeships
the Administration has opted for building an entirely new
system of industry-recognized apprenticeship programs, or
IRAPs. These IRAPs have little to no accountability, much like
the predatory for-profit colleges.''
Ms. McCarthy makes that point in her piece, quote, ``The
Administration is copying the system used to ensure quality in
the lowest-performing and the most fraud-ridden sector of
higher education, a system that has repeatedly failed to
protect student and taxpayers for its new approach to
apprenticeship, and once Federal dollars are on the line the
risks and the scale of potential harm increase exponentially.''
It is not just favoring IRAPs. The Administration is
undermining the Women in Apprenticeship Program, the Workforce
Data Quality Initiative, which is supporting,
quote,``evaluation and research on the effectiveness of
workforce and education programs.'' Instead, the Administration
is pushing unregulated, unaccountable programs and policy. In
every area you are shuttering the Department of Labor.
ASSOCIATION HEALTH PLANS
So, too, with the department's push to expand association
health plans. These junk health insurance plans can circumvent
accountability and patient protection like the essential health
benefits to the detriment of patients. On a macro level, they
will lead to higher premiums in the individual and small group
markets. On the micro level, they will mean higher costs for
Americans who expect their plan to cover basic services, like
maternity, but may not. It is bad for patients and it is bad
for families, and it is just another salvo in the
Administration's political campaign to undermine the Affordable
Care Act.
I am not alone in being critical of these plans. The
Federal courts have stopped key provisions of your rule to
expand junk plans. On March 28th, a Federal judge, appointed by
President Bush, said that the Department's interpretation of
the law, the Employee Retirements Income Security Act of 1974,
is, quote, ``absurd'' and that the rule authorizing these
association junk plans, quote, ``does violence to the law.''
Does violence. And I believe you are doing violence to the
agency and its mission writ large.
DEPARTMENT OF LABOR MISSION
I want to quote one of my heroes and the longest-serving
labor secretary in our nation's history, Frances Perkins. And
she said, and I quote, ``The people are what matter to
government and a government should aim to give all the people
under its jurisdiction the best possible life.'' That is how I
view the mission of this department, and unfortunately I think
that this budget request and the litany of rollbacks you have
undertaken fail miserably in fulfilling that mission. Instead,
you are hollowing out the Department of Labor. It is a
fundamental failure to govern.
We will continue to oppose the cuts you have made, which
would hurt the young and the old. We will continue to oppose
the rollbacks you are pushing, which would take the cop off the
beat and abandon working people to bad-acting corporations. And
we will continue to oppose your attacks on this storied agency.
I would normally now turn this over to my colleague and
ranking member but Congressman Cole is testifying in another
committee, so, Mr. Secretary, we will go directly to your
testimony, and as you know, the entire testimony will be made--
will be put into the record, and I yield you five minutes of
time. Thank you.
Testimony of Secretary Acosta
Secretary Acosta. Madam Chair, thank you very much and
thank you to all the members of the subcommittee. I appreciate
the opportunity to appear before you to discuss the budget.
Let me just make a few preliminary points and then perhaps
respond to some of the comments that you made in your opening.
First, I think it is important to acknowledge our economy is
doing phenomenally well. In the past two years, our economy has
generated nearly 5 million new jobs, wage growth is finally on
the rise, increasing about 3.4 percent. Something that is
talked about less, but I think incredibly important, is wage
growth among the bottom decile of wage earners is up 6.5
percent, and unemployment measured in different ways, whether
it is by race or by other subgroups, for African Americans, for
Hispanic Americans, for women, have hit historic lows over the
past year.
But let me move rather quickly in my opening five minutes
to respond to some of your comments, Madam Chair.
DEPARTMENT OF LABOR APPOINTMENT CONFIRMATIONS
First, you cited that the Department of Labor was at the
bottom or near the bottom of the list in terms of the number of
Senate appointees confirmed. Those appointees were selected.
They were nominated. They have been pending in the Senate
because of what I think is a historic backlog in the Senate to
confirm individuals. And so, with respect, I would push back on
that, and I certainly would encourage you to speak to your
Senate colleagues who have holds on all of those nominees.
DEPARTMENT OF LABOR ENFORCEMENT
Second, you referenced enforcement being on the decline,
and in my testimony I presented some information that I would
like to highlight. The Employee Benefits Security
Administration recovered more than $1,160,000,000 in
enforcement dollars. That is a 70 percent increase over the
prior year. MSHA, Mine Safety and Health Administration, they
are doing a great job with inspections, and here is where we
see it. We see it in the results. The number of fatalities in
mining, despite the growth in mining, the number of fatalities
in mining in the last fiscal year was the lowest ever, and in
the calendar year was the second-lowest.
OSHA, for two years in a row, exceeded 32,000 inspections.
That is more than they did in 2016. Now, yes, they focused on
compliance assistance, but compliance assistance and
enforcement are not mutually exclusive. We should not assume
that everyone is necessarily a bad actor. We can help those
that have questions and we can enforce aggressively against the
bad actors.
And here is where you see the results in the OSHA space.
Reversing a multi-year trend, you saw 43 fewer workplace
fatalities in the past year, and we saw about 40,000 fewer
workplace injuries. The Office of Federal Contract Compliance
obtained more than $16,000,000 in monetary recoveries. The
Office of Labor Management Standards investigated 128 union
elections, conducted 223 criminal investigations resulting in
73 convictions.
The Wage and Hour Division, speaking of whether enforcement
is on decline or not, collected the most it ever has in its
history, exceeding $300,000,000 in back wages for 265,000
workers.
And so, with respect, I do take issue with that
perspective.
COAL DUST STUDY
Now, Madam Chair, you referenced the coal dust request for
information, and, yes, we did put that out and we put that out
pursuant to a congressional mandate, where the law that was
adopted by this Congress directed us to study, in the past
year, the coal dust, to begin a longitudinal study. And so that
request for information was pursued because of a congressional
mandate in the law. And so that wasn't because we thought it
would be a nice thing. It was, because you directed us to do
that.
EXPANDING APPRENTICESHIP
And finally, you mentioned expanding the registration--or
the registered apprenticeship program. Let me just say this.
The registered apprenticeship program is expanding rapidly. In
the past two years, our economy has generated almost half a
million registered apprenticeships. What we are looking to do
is to expand that model to other industries, industries that
have looked at that registered apprenticeship program and have
said it is too complicated, it is not right for our industry.
And so let me just say this. I noticed my time was up. I
look forward to your questions. I presented a number of facts
in what I would call a very detailed 17-page set of testimony,
and I am happy to address them.
Thank you very much.
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Ms. DeLauro. Thank you very, very much, Mr. Secretary. I
would just say there are facts and there are facts, and it is
reminiscent to me of reading, the 17-page testimony, of a
Robert Browning poem that says ``God's in this heaven. All's
right with the world,'' and that is not the case. All's right
with the world is not what is happening at the Department of
Labor today.
Yes. Now we are going to move to questions here. Thank you.
OVERTIME RULE
Let me start with the overtime rule, if I can. I am
concerned about the undue influence of outside corporate
entities on DOL. So let me start with a simple question. What
are you going to do to demonstrate greater independence from
the influences of corporate lobbyists and make sure that your
first priority is to the wage-earners of this country,
consistent with the mission of the Department of Labor?
Secretary Acosta. Madam Chair, our priorities are to the
wage-earners and to the various stakeholders at the Department
of Labor, including individuals that are retirees. Our goal is
to have good, safe jobs, and we have talked about that in so
many contexts. I just talked about our enforcement efforts, our
wage and hour efforts, record enforcement across the board,
compliance assistance to help more businesses comply.
And with respect to the overtime rule, the rule does
exactly what was discussed, which is it needs to be updated.
You know, times have changed. It is more expensive to live,
salaries have gone up----
Ms. DeLauro. If I might interrupt, because I have got two
or three questions and we do have a time constraint.
It is interesting to hear what you say, but Bloomberg
recently reported that former Bush Wage and Hour Administrator,
Tammy McCutchen, who often acts as outside counsel for the
Chamber of Commerce, commented on the possibility of automatic
salary threshold increases in the proposed overtime rule. And I
quote, ``I can tell you here today that if the DOL somehow
ignores us, they will be sued again by the business community
to challenge their authority to do that. And guess what? We
will bring it in Texas again.''
And, my gosh, lo and behold, your proposed rule which would
strip protections away from more than 3 million workers is
almost exactly what the Chamber of Commerce told you to do in
their comments submitted last year. It is a disturbing
coincidence, and I think it lays out the influence of the
Chamber of Commerce, which was a factor in your decision-making
with regard to the overtime rule.
Let me move to another question.
Secretary Acosta. May I respond briefly to that?
Ms. DeLauro. Very, very briefly, because I am limited in
time.
Secretary Acosta. The rule is actually almost entirely in
line with my comments at my confirmation hearing, going back
two years.
Ms. DeLauro. Well, it is very--well, maybe you had those
conversations earlier on with the U.S. Chamber.
Secretary Acosta. Or maybe that was my perspective.
Ms. DeLauro. Or maybe it was your perspective, but I think
it is highly coincidental.
APPRENTICESHIP FUNDING
Let me just--this is very, very quick. In terms of the
funding of apprenticeships, Congress provided $145,000,000 in
apprenticeship programs, that said you could use the money only
for registered apprenticeships. You testified before the Senate
last year. You confirmed that this money would be used to
support and expand registered apprenticeship programs.
Let me ask you this. Did you--and this is yes or no--did
you use $20,000,000 of this money to award a cooperative
agreement to support both registered and non-registered
apprenticeships?
Secretary Acosta. Registered apprenticeship dollars are not
going to establish IRAPs.
Ms. DeLauro. Did you use the $20,000,000 for both
registered and unregistered apprenticeships?
Secretary Acosta. All the money that was designated for
registered apprenticeships is going to support registered
apprenticeship programs and not to establish IRAPs.
Ms. DeLauro. Well, listen. It just says here--in the notice
you stated the Employment and Training Administration intends
to award a cooperative agreement to the American Association of
Community Colleges to create the AACC virtual apprenticeship
network to provide resources to America's community colleges
employers to create and conduct more high-quality, affordable,
inclusive, flexible, and industry-relevant registered and/or
industry-recognized apprenticeship programs in service to
industries and companies across the nation.
That is an unregistered, and it is in violation of what we
said that the money should be used for, and what you, in an
exchange with Congresswoman--with Senator Murray, said that the
money was not going for that effort.
JOINT EMPLOYER RULE
I am going to beg the indulgence of the committee because I
will go to the Budget Committee shortly. I want to ask a
question about joint employer, if I can. Help me understand how
your proposed rule on joint employer might add the department--
which I might add, I think the department failed to calculate
any regulatory savings from the joint employer rule, and how
this would work.
Say that you have workers who are on a loading dock. They
are in a distribution center and are employees of a staffing
agency. The staffing agency hired by the company--let's say the
Acme Corporation--sets the timing, the work standards, hours,
pay for the distribution center--but does not directly pay the
workers or keep payroll records itself.
If Acme compensates the staffing agency in a way that leads
the staffing agency to violate wage theft rules, thus shorts
its workers 10 hours of work each week, under your proposed
joint employer rule who is liable for the stolen wages? Who is
on the hook for the wage theft in this scenario?
Secretary Acosta. Madam Chair, as you are aware, the rule
is a proposed rule and it is not appropriate to address
hypotheticals. But let me say this. The rule adopts the
plurality position as a general matter of the courts of
appeals, decisions that for decades have interpreted----
Ms. DeLauro. It is my understanding that it would be only
the staffing agency, under your proposed rule, who would be
liable for the back wages. It doesn't make any sense. But your
testimony makes it clear. This rule is about benefitting big
corporations and not working people. We are in a workspace
today where corporations increasingly outsource activities and
services to contractors, subcontractors, franchisees or the
like, and your proposed rule would move us in the wrong
direction. As a matter of fact, it would exacerbate that race
to the bottom, and that lets companies off the hook and
transfers all of the liability to workers.
And I have gone over my time and let me recognize
Congressman Harris.
H-2B
Mr. Harris. Thank you very much, Madam Chair, and thank
you, Mr. Secretary, for being here with us today. I want to
thank the Administration, first of all, for making significant
headway on the H2-B issue, doubling the number of additional
visas to 30,000 from last year's 15,000. Still a little ways
you all can go, because I know the DOL certified more, you
know, more than those. So I am hoping it can go even further
from that, and I hope that we turn these around pretty quickly.
ASSOCIATION HEALTH PLAN COVERAGE
Anyway, let me talk a little bit about association health
plans, because there is an interesting Gallup survey published
April 1st, and this was not an April Fool's survey. It says
that 55 percent of Americans worry a great deal about health
care and the cost, and that number was 56 percent in 2010, the
year Obamacare, which was supposed to solve all of our
problems, was passed.
So an identical number of Americans actually still worry
about the cost of health care. So Obamacare did nothing to
relieve America's fears about the cost of health care. But I
think that those of us who believe that association health
plans do offer a lower-cost method--as I walk through this--so
the way the department structured it, they basically are
subject to the same rules that other ERISA plans are. Is that
right? Because you recategorized what an organization would be
for the purpose of ERISA.
Secretary Acosta. That is correct.
Mr. Harris. And how many millions of people are covered
under ERISA plans in this country now, these junk plans?
Because that is what they were referred to, I think, just a few
minutes ago, as junk plans.
Secretary Acosta. Every employee of any corporation with
more than 50 employees.
Mr. Harris. Sure. So I imagine, when I was employed at
Johns Hopkins, their plan was an ERISA plan, so I guess they
just gave me junk insurance. I just didn't realize it was junk
insurance at the time, but I guess it was junk insurance.
And how do you justify that with--that figure with the fact
that despite the fact that there are a lot of Democrats calling
for Medicare for All and eliminating private insurance, that,
in fact, Americans are pretty satisfied with private insurance.
So I imagine association health plans would be categorized
under private insurance. Is that right?
Secretary Acosta. They would, and the Congressional Budget
Office estimated that an additional 400,000 Americans would
receive coverage under AHPs.
Mr. Harris. Right. And I imagine most ERISA plans are
actually more generous than some of the Obamacare plans that
have, you know, $6,500 deductibles, high co-pays, things like
this. Because, in fact, more than three out of four Americans
worry that a significant--first of all, they think they pay too
much for a plan, and I think anything that can be done to lower
costs, like pooling risks in association health plans is a good
idea--and 45 percent of Americans--again, the same Gallup
survey--fear that bankruptcy with any major health event. So
actually, having a policy that might actually have greater
coverage than the average policy might actually relieve some of
those fears.
ADVANTAGES OF ASSOCIATION HEALTH PLANS
So what do you think the result is going to be of the
availability of association health plans across the nation?
Secretary Acosta. Well, first, Congressman, let me say, as
we have said publicly, we disagree with the district court's
ruling and are working with the Department of Justice to
consider all available options, including potentially a stay
and potentially appeal. Obviously, the ultimate decision will
be up to the Department of Justice on that.
More generally, I would like to note that the Washington
Post, twice, after the association health plans started rolling
out, after they were put in place, in fact, ran articles, and I
am happy to provide the committee with these. The headlines
were to the effect of experts hated these plans, dash-dash-
dash, they were wrong. And both Washington Post articles talked
about how under association health plans what was being offered
were quality plans, because ultimately what association health
plans did and do is say small businesses can band together and
play by the same rules as every large corporation. And so a
small business can play by the same rules as IBM, but they
simply have the economy of scale and the numbers to get the
rates that IBM has access to.
And so I think it is significant that once the plans were
implemented the concerns that were theoretical and hypothetical
were not, in fact, true.
Mr. Harris. Sure. And correct me if I am wrong. Union plans
are also--it is in the same category?
Secretary Acosta. Yes, it is.
Mr. Harris. So the union plans, in general, are not subject
to ACA requirements for essential health benefits?
Secretary Acosta. Association plans could be thought of as
a union of small businesses.
Mr. Harris. Sure. So are the union plans junk plans too? I
don't know. But, I mean, the union members I have, they would
go to the mat to preserve their plans, so I don't understand
that.
Anyway, I would move, Madam Chair, without objection, that
those two articles be entered into the record.
Ms. DeLauro. So ordered.
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Mr. Harris. Thank you, and I yield back.
Ms. DeLauro. Congressman Pocan.
Mr. Pocan. Thank you, Madam Chair, and thank you, Mr.
Secretary, for being here.
So from listening to the questions with Ms. DeLauro I know
you don't like yes-or-no ones and you don't want hypotheticals
so I will do my best to do neither.
MINIMUM WAGE
But if I can, let me just take it kind of at a 30,000-foot
level of being the Secretary of Labor. You know, you said that
the economy is doing phenomenally well, and I think for far too
many people it is not doing phenomenally well, especially those
making minimum wage.
In the biggest city in my district, Madison, Wisconsin, you
have to work 92 hours a week in order to, at minimum wage, in
order to be able to afford an average two-bedroom apartment,
and that would seem crazy, I think, to pretty much everyone you
offer that to. One in nine workers earn a wage too lot to keep
their family out of poverty. The minimum wage has less
purchasing power than it did in the '60s, and we know that it
hasn't been raised for a decade.
And I don't know if you know this or not but what the
minimum wage would be today if it kept up with the rate of
worker productivity, but it is about $19 an hour if we actually
were at that.
So I know you have said that you were opposing raising the
minimum wage because it would hurt job creation, but at $7.25
per hour, 10 years not increasing it, having to work 92 hours a
week to afford a two-bedroom apartment in Madison, Wisconsin,
can you talk to me a little bit about that statement please?
Secretary Acosta. Sure, Congressman. First, let me say, in
29 states the minimum wage is above the federal minimum wage,
and we are seeing more states increase it above the federal
minimum wage. And I think that is an acknowledgement that
different states, and even different cities, in some cases,
that have higher minimum wages have different wage structures.
As a percentage of our working wage-earning population are
hourly workers, depending which measure you use, between 0.5
percent and 2.5 percent of Americans are at minimum wage. I
understand your question because I pointed out that the bottom
decile is seeing wage growth much more quickly. But, you know,
it is interesting, because the Washington Post----
Mr. Pocan. Actually, if I can, just because I do want to
get to a couple of subjects----
Secretary Acosta. Sure.
Mr. Pocan [continuing]. And I guess what I am trying to
get, very specifically, so are you saying--are you arguing
there shouldn't be a federal minimum wage, period, that it
should be just left up to states?
Secretary Acosta. Not at all.
Mr. Pocan. Okay.
Secretary Acosta. The point that I am arguing is--and the
Washington Post, the editorial board at the Washington Post----
Mr. Pocan. I am more interested in your opinion than the
Washington Post.
Secretary Acosta [continuing]. Made the same point.
Mr. Pocan. I can read the Washington Post outside of my
five minutes.
Secretary Acosta. Sure. Sure. But it is the same
perspective, which is 29 states have a higher wage level. The
question is, should those 29 states impose their wage structure
on the 21 states that have chosen not to increase the minimum
wage because they have a lower wage and cost structure? And at
this point, for those 21 states that have chosen not to
increase the minimum wage----
Mr. Pocan. Sure.
Secretary Acosta [continuing]. That very possibly could and
would cost jobs, and that was the point the editorial board
made just this week.
IMPACT OF MINIMUM WAGE INCREASES
Mr. Pocan. Okay. I can just tell you, every time we have
increased minimum wage in Wisconsin, and I was in the state
legislature for 14 years, more people entered the workforce. It
has had a positive impact. I have been a small business owner
for 31 years. The reality is I think it is important that
someone would have to work 92 hours a week on minimum wage, and
that is one of the nine people living--working minimum wage in
poverty. It is not working out.
IMPACT OF NEW JOINT EMPLOYER RULE
Let me ask you a very specific question, following up on
Ms. DeLauro's question on joint employer. What really got me
was during the last administration, when we sat down with the
Wage and Hourly Division head, we know there has always been
about 30 million people who are independent contractors in like
five industries, including logistics and the trades and some
other areas. But we were told they think right now it is like
70 million people who are probably independent contractors,
which I think you and I both know is probably impossible to be
true.
To me, that is a huge problem because that means often they
are not getting any retirement benefits, health benefits. In
some cases, they do. In most cases, they don't. And we had a
joint employer rule, I think, that was trying to go after that.
It got taken down by this Administration. I would argue the
rule that is put out there now is quite weak.
But can you address that? I am really concerned by 70
million people who are independent contractors when you and I
both know that is probably largely due--or at least I would
like to know if you think it is--to misclassification?
Secretary Acosta. Gladly, Congressman. First, there were
two guidance documents that went out under the prior
administration, one having to do with joint employers and
another one having to do with independent contractors. And so
the joint employer guidance document and our joint employer
rule addresses those situations where you have two businesses
that are employing individuals, and where the business,
Business A----
Mr. Pocan. Thank you. I gotcha.
Secretary Acosta [continuing]. Would be liable----
Mr. Pocan. If could just--because we only have 18 seconds.
I am really curious. I am very curious about your thoughts on
this 70 million number, because to me that is alarming and we
are going to have problems.
ASSOCIATION HEALTH PLANS FOR INDEPENDENT CONTRACTORS
Secretary Acosta. Congressman, I agree entirely, and if I
could pivot to the association health plans, an important part
of that rule was to provide the ability of individuals who are
self-employed, who are independent contractors, to have access
to group health care. Because there are a number of individuals
that are independent contractors who don't have access, under
ERISA, to many of the traditional benefits of employment, and
part of the purpose of the association health plans was to say
``you are an independent contractor.''
MISCLASSIFICATION UNDER JOINT EMPLOYER RULE
Mr. Pocan. If I can, just because--if I could have 10
seconds to say, I wanted to get to not so much this, but I
really, honestly am curious. Do you think there is a lot of
misclassification going on when you have 70 million people, and
can we do something to address that, because I think that is
the problem I am worried about?
Secretary Acosta. Misclassification is absolutely, and it
is true, as well as benefits, which is why association
retirement plans, where association health care plans can help
individual contractors, because you are an employer and----
Mr. Pocan. You just got a note that might actually address
my question. If you want to take a quick look at that I would
really appreciate it.
Secretary Acosta. So if I am allowed to go over time----
Ms. DeLauro. Go ahead.
Secretary Acosta [continuing]. So the note that I had was a
particular case that is worth mentioning----
Mr. Pocan. I appreciate it.
Secretary Acosta [continuing]. Where a company was
employing individuals to clean a building, and, in essence,
said that every floor is a separate franchise.
Mr. Pocan. Gotcha.
Secretary Acosta. And we went after that company because we
said that is really not a franchise. That is an employee. And
don't tell us that every floor is separate franchise.
And so the point was it does exist. Where it exists in the
guise of let's try to, you know, play with the rules, I am
happy to enforce and enforce aggressively.
Mr. Pocan. I appreciate it. Thank you very much.
Ms. DeLauro. Thank you. I wanted to say to Congresswoman
Herrera Beutler, if you give me a second you can have extra
time here. There are just a couple of things here to clear the
record, if I can.
WAGE GROWTH
In your testimony, Mr. Secretary, you say, on page 2, that
``wage growth at the lowest decile earners is currently at
approximately 6.5 percent.'' I don't know where you got the
number from but it appears that the figure excludes part-time
workers and hourly earnings. When you look at real wage growth,
between 2017 and 2018, it is only 0.5 percent for workers at
the 10th percentile, according to analysis by the Economic
Policy Institute. In addition to association health care plans,
these are the services that are eliminated: emergency services,
mental health, maternity, prescriptions, and pediatric
services.
Congresswoman Herrera Beutler.
FMLA COVERAGE FOR ORGAN DONORS
Ms. Herrera Beutler. Thank you so much, Madam Chair, and
thank you, Mr. Secretary, for being here. I wanted to start by
saying a big thank you. Last year I led a bipartisan effort in
this committee to urge your department to clarify coverage for
living organ donors under the Family Medical Leave Act. And we
had been working on this for a while as part of legislation.
This impacts people all over the country, from all income
levels, all races, all backgrounds.
And I wanted to say thank you so much for heeding that call
and your leadership. Your department released a legal opinion
saying that individuals that choose to donate an organ are
covered, in fact, by FMLA, and should not have to fear losing
their jobs.
So your commitment is helping to remove those barriers to
people for living organ donation, and this is a significant
step forward for helping people, thousands and thousands of
people, get off of dialysis, or move into really a better
quality of life, one that is both cost-saving and life-saving.
So thank you so much for your diligence on that.
Secretary Acosta. Congresswoman, thank you for bringing it
to our attention. You know, this is an example of where
compliance assistance works, where bringing back opinion
letters work, because we were able to address that through an
opinion letter. And I want to thank you also for bringing it to
our attention because it really focused us on issues around
FMLA.
And so the American Association of Kidney Patients visited
last week to say thank you, because one of the impediments--
they had individuals that were prepared to donate kidneys and
were being told that the FMLA did not cover the donation
operation because that wasn't--they weren't sick. They were
donating an organ. And that is just the wrong----
Ms. Herrera Beutler. They consider it elective.
Secretary Acosta [continuing]. That is just the wrong
interpretation of the FMLA. That is not what it was about.
And as a result of this we have actually looked at a number
of other issues around the FMLA. One of them was the question
of whether an employer--if someone needs to take medical leave,
whether the employer can say, ``Yes, but not this week. Why
don't you take it next month or in three months when we have
got less of a demand?'' And in our position, in another opinion
letter, it was no. When you need to take medical leave you need
to take medical leave and the employer cannot dictate the time
at which you take that leave.
So thank you for pointing us in that direction. Those were
very important.
Ms. Herrera Beutler. Well, we appreciate your movement on
it because I think it is--it is how we read the law. But
sometimes it just takes someone enforcing and getting into it,
so we appreciate it.
CHANCE IN TECH ACT
A little pivot to tech training. Southwest Washington, my
home, is obviously--we are growing--I would like to say we are
growing silicon forests, but in terms of technology growth it
has been a regional priority. And there are a lot of technology
companies who specialize in producing lasers and all sorts of
things that I--I won't say that I am learning because I am more
in awe of them. They are on a different level than I am. But it
is really important to every area of our economy and our
security.
The rest of the country is seeing a similar boom and a
demand for tech jobs, and a bill I am co-leading, the Chance in
Tech Act, proposes to have DOL enter into contracts with
intermediaries, like the Washington Technology Association, to
help expand access to tech apprenticeships and training, and I
wanted to see if you could elaborate on what DOL is doing to
help expand those opportunities for people to obtain tech
training and apprenticeships for, really, what the demand it.
Secretary Acosta. Well, Congresswoman, thank you, and that
is the exact example of why industry-recognized apprenticeships
are so important, because it is important for businesses to
come together through third-party intermediaries and
associations to offer apprenticeships at a scale. It is
expensive to put together the curriculum. It is expensive to
offer these.
And those associations, working in conjunction with
community colleges and other groups, really are the right
level. And if one was to look at Europe, that is how they are
offered in Europe. They are offered through partnerships
between educational associations and industry associations, and
that is how it has worked well across the globe.
Ms. Herrera Beutler. And I think they are able to really
tailor to regions and communities more specifically than a one-
size-fits-all that is a big national stamp----
Secretary Acosta. That is right.
Ms. Herrera Beutler [continuing]. Which is exactly what we
need.
H-2A VISA APPLICATIONS
I have one more quickie, again switching--I was going to
mention AHPs, but I wanted to ask a quick--it is a farm labor
question. The Office--and this is, obviously, from my tree
fruit growers--the Office of Labor Certification will process
as many as 300,000 jobs this year under the H-2A temporary ag
worker program. Given that the funding has languished for the
program, and a one-time appropriation has lapsed as the
program's utility has skyrocketed, how or what can DOL do to
help ensure these farmers and ranchers--that their applications
for these temporary workers and job certifications will
actually get processed?
Secretary Acosta. Well, Congresswoman, this is an area
where we are working diligently to process these applications
as quickly as possible, but where this committee can help as
well. For at least one, maybe two years now, we have asked for
a fee, and the fee would be dedicated to updating our
processing system.
I understand that Congress does not like to have a fee in
perpetuity, and so even if there were a fee for a few years, so
that we can update the computer systems--the computer systems,
I can't remember off the top of my head, but I believe they are
at least--they date back to '08 or '09. They are phenomenally--
I am sorry. They date back to 2009, and these really can and
should be updated. No private sector business would have a 2009
computer system processing the kind of load that we are today.
And so a fee that would be dedicated entirely to updating
the system and to integrating it with DHS and State, because
right now folks will send it to us and we actually are putting
things in the mail sometimes, that they have to fill that out
and then mail it to DHS. This is not the way we should be
operating.
Ms. Herrera Beutler. Okay. Thank you. Thank you, Madam
Chair.
Ms. DeLauro. Thank you.
Opening Remarks by Ranking Member Cole
Let me now recognize the ranking member of the committee,
Congressman Cole, for any opening remarks and questions he
wants to make.
Mr. Cole. Well, first of all I want to thank the chair and
please accept my apology, and I apologize to the Secretary and
to everybody on the committee. I had a bill in another
committee that I have been working on nine years, and it is
finally getting heard, so I sort of needed to be there. But I
appreciate that.
FISCAL YEAR 2020 BUDGET LEVELS
Mr. Secretary, I was going to start out by saying I was
looking forward to your testimony, but I know you have already
given it. But I did have the opportunity to read it last night.
And I know that your agency, like many others, is proposing a
sizeable cut for next year, and frankly we all understand why.
You are living under the Budget Control Act and some of these
cuts are effectively mandated by that.
Hopefully, in time, we will have an agreement between the
Administration and the Senate and the House and we will come up
with some way to do that, but I think you clearly are doing the
right thing by operating within the monies that are available.
But, again, we hope we can do a little bit better for you than
your own budget would suggest that you need.
I was particularly pleased, though, to see despite the
tight budget you proposed level funding for the apprenticeship
program. I will have some questions for you about that a little
bit later today and how that program is operating.
I was also pleased to see increases proposed for Veterans
Employment and Training Services. Our veterans have so much to
offer employers and to contribute to our economy. And I am also
glad to see your proposal related to the course curriculum
development for military spouses transitioning with their
servicemember. Anything we can do to ease this transition, in
terms of making certifications and licensure transfers across
state lines more easily will reduce stress on families of
service men and women. I understand that you are also
continuing a pilot, a veterans apprenticeship program, and I
hope that effort is going well.
I am sure you will understand I was disappointed to see
that the budget proposes to eliminate the Indian and Native
American Training Program within the Employment and Training
Administration. As you know, the unemployment rate and lack of
job opportunities in Indian country is extraordinarily high, so
I don't think it makes sense to eliminate a rather small
funding stream dedicated--and I hope we come to agreement.
Maybe that is an issue that we can revisit.
CHANGES TO JOB CORPS
Finally, I will have some questions for you and your
proposals to change Job Corps program. While I support making
the program operate more effectively, again, operating within
your budget you have proposed some pretty aggressive steps and
I want to proceed very cautiously to ensure that the program
can continue to be successful with such big changes. I frankly
suspect I am the only person on this panel that has lived
through the closure of a Job Corps Center in his district, and
that was a sort of traumatic experience, so I would hope my
colleagues and their constituents can be spared that.
Again, Madam Chair, thank you very, very much for your
indulgence, and I yield back.
Ms. DeLauro. Does the gentleman want to ask a question at
this juncture?
Mr. Cole. If you don't mind. I can do whatever you want.
Ms. DeLauro. No, please go ahead.
Mr. Cole. I mean, I sort of got here----
Ms. DeLauro. Please go ahead. You didn't get a chance to do
that, and then we will move forward.
Mr. Cole. Please. Go ahead and I will ask my questions in
turn.
Ms. DeLauro. Go ahead.
Mr. Cole. All right. Very kind. I appreciate that. I will
try to keep them short.
RULE ON JOINT EMPLOYMENT
I wanted to talk to you about an area that you have made
some, I think, very impressive changes in. I am pleased to see
a proposed rule on joint employment this week. The joint
employer policy of the previous Administration would have made
businesses liable for the actions of their business partners,
even when they do not have direct control over their operations
or employment actions.
Issues caused great uncertainty, created unnecessary costs
for law-abiding small businesses in all industries, and
particularly, I think, is counterproductive in that quite often
these small business owners are entrepreneurs, they are leaders
in their community. This really is a pathway where this
country, through the franchising system in particular, has
provided opportunities across the board to people who would not
have otherwise had them. So it caused me, again, a great deal
of pleasure to see your department moving in this area.
Could you tell us how your rulemaking will simplify,
hopefully, the task for job creators and their workers?
Secretary Acosta. Congressman, thank you, and the matter is
a proposed rule and so I can certainly describe it in general
terms.
We rescinded the prior guidance but when I rescinded it I
said it is very important that any changes proceed through a
rulemaking. So what the rule does is it looks at the various
court decisions on this, and they varied by circuit. And, in
essence, we are adopting the plurality perspective as a general
matter, and this perspective has been the perspective of courts
for a long, long time.
And so this will provide stability, it will provide
clarity. It is important for employers to know when they are
liable and when they are not liable, and what actions are
appropriate for them to take, and what would cross the line and
make them liable for another employer's employees. And so that
clarity and that certainty is something that is incredibly
important.
Mr. Cole. Well, thank you again very much, and I will be
looking forward to seeing how this works going forward. But
again, I think you are to be commended for your department's
action.
OFFICE OF DISABILITY EMPLOYMENT POLICY
Secretary, I appreciate, again, in your comments and your
written testimony about the work that your agency and the
Office of Disability Employment Policy is doing to help
Americans with disabilities succeed in the workplaces. Despite
many strides that have been made, barriers to entry into the
job market for people with disabilities remain high. The lower
employment rates for people with disability is due, in part, to
discrimination, and in part to the way our entitlement programs
create disincentives to work. For example, many young people
with disabilities want to work but the reality of losing
essential federal benefits and medical coverage should they
lose their job creates an insurmountable barrier for many of
them.
Has DOL collaborated with the Social Security
Administration and the Centers for Medicare and Medicaid
Services to determine ways that we can encourage work by
allowing people to retain a meaningful level of assets and
health insurance coverage? And again, I realize three large
bureaucracies talking to one another and coordinating waivers
is no small task, but we certainly owe it to our citizens to
encourage cross-agency collaboration and not simply work in
agency silos. Would you be willing to do that kind of outreach?
Secretary Acosta. We would certainly be willing. This is an
incredibly important area, particularly in light of all the
technological advances that we have seen. We are, today, better
positioned than ever before to fully integrate individuals with
disabilities into the workplace.
OCCUPATIONAL LICENSING REQUIREMENTS
Mr. Cole. That is great. And let me just end with--I want
to ask you again, we hear often about the arcane hurdles that
exist in occupational licensing requirements, particularly when
someone is licensed in one state and maybe not be able to use
in another without being relicensed. State requirements, of
course, differ.
What is the Department of Labor doing to address
occupational licensing requirements that create artificial
barriers in the workforce, particularly those that affect
military families?
Secretary Acosta. Congressman, this is such an important
issue. It used to be that about 1 in 20 individuals needed a
license to work. Now nearly 1 in--actually, more than 1 in 4,
nearly 1 in 3 individuals need a license to work.
I was in one state where the license to install fire alarms
cost more than the license to join the bar, and not only do you
ask the why, but why are we putting such high fees on
individuals that may not be able to afford them?
Recently I had the opportunity to speak to governors, and I
asked them to--you know, it is incredibly difficult to change
this because it is such a state-by-state issue. But let's start
on something where I hope everyone can agree, and that is
military spouses. We ask military servicemembers to move from
state to state, and they are moving on orders, not by choice
but they are moving on orders. And their spouses are given a--
just a wrong decision to make, a decision they shouldn't have
to do. Do we maintain the integrity of the family unit or do we
keep a career?
And if you talk to military spouses, spouse after spouse
will tell you that they cannot maintain a career because if you
are in a state for two years, by the time you meet the
requirements and get your license you are moving to another
state. And I will provide one example. A woman in California
moved to Florida was told that even though diet advice was
being given to California clients using a California license
over the internet, she could not do that because she was not
licensed in Florida. That is just one example under thousands.
Mr. Cole. Thank you very much. My time is more than
expired. Thank you very much, Madam Chair.
Ms. DeLauro. Thank you.
Congresswoman Clark.
Ms. Clark. Thank you, Madam Chair. Thank you for joining
us, Secretary Acosta.
INTERNATIONAL LABOR AFFAIRS BUREAU
The Department of Labor is a member of the interagency task
force to monitor and combat trafficking in persons. Is that
correct?
Secretary Acosta. Yes.
Ms. Clark. In fact, the International Labor Affairs Bureau,
ILAB, within the Department of Labor, is responsible for
combating exploitive child labor, forced labor, and human
trafficking. Is that correct?
Secretary Acosta. That is correct.
Ms. Clark. So it is fair to say the Department of Labor
plays a very active role in combating human trafficking, and
the problem is a large one.
Secretary Acosta. The problem is a large one. When the
Department of Labor recently issued a report, and it actually
detailed 1,700 recommendations that could be looked at around
the world to address this. It also----
Ms. Clark. That is excellent, and I know that there are
hundreds of thousands of adults and children who are victims of
sex and labor trafficking in the U.S. Glad you are looking at,
glad you have detailed a comprehensive strategy.
But you have also proposed a budget cut of almost 80
percent--79 percent to ILAB, where this work is done, bringing
its budget from $68,000,000 to just $18,500,000.
I am sure you have come prepared to justify this cut to us,
but it does not go unnoticed. This is not the first time that
you have ignored human trafficking.
HUMAN TRAFFICKING
When you were the U.S. attorney for the Southern District
of Florida, your office investigated Jeffrey Epstein, and
found--your office found that there had been a sexual abuse
pyramid scheme that involved at least 36 underage girls,
ranging from age 14 to 17. This is horrifying and sick stuff.
Mr. Epstein raped and assaulted these girls. He recruited
them out of shopping malls. He had employees that helped with
this. And then he invited his friends to do the same, and there
is evidence that he transported these girls among his mansions
throughout the United States and abroad.
Epstein and his friends destroyed these girls' lives.
Senator Ben Sasse called Mr. Epstein a monster. Would you say
that is a fair characterization?
Secretary Acosta. He engaged in vile crimes, yes.
Ms. Clark. You are a law professor, besides many of your
other jobs that you have had, and I am sure you know there is
no such thing as child prostitution under Federal law, only
child sex trafficking, and each offense, under 18 U.S.C. 1591
carries a sentence ranging from 10 years to life in prison. So,
logically, Mr. Epstein, with the investigation of the Federal
U.S. Attorney's Office, should have been looking at a potential
sentence of 360 years, at a minimum.
But that is not what happened, because there was a power
dynamic here, wasn't there? We had teenage girls with no power,
who were rape and sexual assault victims, and we had Mr.
Epstein and his friends, extremely powerful, wealthy, and
connected people.
And in a ruling on February 21st of 2019, Judge Marra found
you illegally entered a non-prosecution agreement that allowed
Mr. Epstein to serve just 13 months in county jail, where he
received 12 hours a day on work release, six days out of the
week. The judge found you broke the law, Secretary Acosta, when
you chose not to tell the victims about this deal, and that you
gave them the impression that this investigation was ongoing.
And do you disagree with any of the facts that were found
in the opinion that Judge Marra issued?
Secretary Acosta. Congresswoman, first, let me say that the
Southern District of Florida has prosecuted sex trafficking
aggressively in the past and it is an incredibly important
issue, and it is something that needs to be aggressively
pursued.
Turning to the----
Ms. Clark. Do you disagree----
Secretary Acosta [continuing]. Turning to the----
Ms. Clark [continuing]. No, I get to ask the questions
here. Do you disagree with any of the facts as presented in the
opinion of Judge Marra?
Secretary Acosta. The Department of Justice, I think
rightly so, for the past 12 years, has defended the actions----
Ms. Clark. That is a yes-or-no question. I ask unanimous
consent to submit the opinion.
Ms. DeLauro. So ordered.
[The information follows:]
This question is similar in form or substance to questions
that are the subject of ongoing litigation. It is, thus,
appropriate to defer responses at this time. I commit to
revisit this decision at the conclusion of litigation upon
receipt of a request from this subcommittee.
Ms. Clark. The hideous truth has come out. You chose
wealthy and well-connected people, child rapists, over the
victims in this case. If you, as U.S. attorney, as a
prosecutor, where your job is to pursue justice, could not
fight for these girls, how, as Secretary of Labor, can you tell
this panel and the American people that you can responsibly
oversee this budget, the Department of Labor, including human
trafficking?
[Pause.]
Ms. Clark. Is there no answer?
Secretary Acosta. Is that a question?
Ms. Clark. That was a question.
Secretary Acosta. So as I was saying, the Department of
Justice, for the past 12 years, has defended the actions of the
office in this case. The facts in this case were presented to a
grand jury that initially recommended--not initially--that
actually recommended a charge that would have carried no jail
time at all. And at the end of----
Ms. Clark. Do you regret making this deal in secret?
Secretary Acosta [continuing]. And at the end of the day--
--
Ms. Clark. Do you regret making this deal in secret?
Secretary Acosta. Congresswoman, if I could finish--at the
end of the day, Mr. Epstein went to jail. Epstein was
incarcerated. He registered as a sex offender. The world was
put on notice that he was a sex offender, and the victims
received restitution.
Ms. Clark. Thirteen months in county jail, 12 hours a day
work release. You consider that justice for the devastation----
Secretary Acosta. Congresswoman----
Ms. Clark [continuing]. Of these girls?
Ms. DeLauro. Congressman Moolenaar.
H2-B VISA CAP
Mr. Moolenaar. Thank you, Madam Chair. Mr. Secretary, thank
you for being here. And I wonder if I could talk with you a
little bit about the rule of the H2-B visa and the importance
of that in my home state of Michigan. And, first of all, I want
to say your comments earlier about the economy I think are spot
on. I see that happening in Michigan, where the economy is
growing and people are, you know, under 4 percent unemployment,
and, you know, there are help wanted signs everywhere.
One of the challenges we have, and you may be familiar with
in this area, in Northern Michigan it is a great area for
tourism, especially in the summertime. You have got places like
Mackinac Island, which is kind of a unique place.
And I have heard, over the last few years, from, you know,
business owners and hotels, restaurants, bars on Mackinac
Island about the importance of the H2-B visas. And just to give
you some statistics, in the 2010 census, the island was noted
to have a year-round population of 492 people, so it has a
pretty small population. During the summertime, that population
swells as businesses hire short-term employees to accommodate
as many as 15,000 visitors per day. So it is a very intensive
summertime tourism. And these businesses provide excellent
service but they really struggle. You know, they try and find
local employees, but they aren't available, and then
seasonally, they are able to find employees, but it is through
the H2-B visas.
In the past few years there have been businesses that
didn't even open or had to severely restrict their operation. I
want to thank you and Secretary Nielsen for this additional
30,000 that was recently announced. I think that goes a long
ways.
I guess my question is, as you look at and forecast the
needs going forward, if that still is not enough to meet the
need throughout the United States, is there a process, short
of, you know, evaluating it months from now, where places like
this that are really starting to be in full swing now, and if
they don't have the employees they just can't make it, is there
a way to do kind of a mid-course evaluation as to whether we
have enough now or whether we need to go higher in the cap?
Secretary Acosta. Congressman, the reality is because,
initially, we would have to write a rule to further increase
the cap, and because after that rule there would have to be a
recruitment period, simply by operation of law, that is highly
unrealistic. I think the solution here, and it is a solution we
have encouraged Congress to look at, is to look at this visa
system. For the last two years, rather than come to a decision
as to what the right number is, Congress has simply chosen not
to act, and it is something that really needs to be looked at.
And I think it is not just the cap but it is what is truly a
seasonal visa? What is a seasonal job? Is an 11-month job a
seasonal job? You said on Mackinac Island, where the jobs are
not for 11 months but they are highly, highly seasonal, and
should those be treated differently because they are focused
for a short period of time and have high skill?
And so this is something that we have asked Congress to
look at, that Congress needs to look at, because every year
businesses can't plan. They don't know how many visas are going
to be available, and we owe them greater certainty.
Mr. Moolenaar. But do you feel, in your role, working with
Secretary Nielsen, you have additional flexibility on this?
Because I agree, that would be the ideal, that Congress would
take action.
Secretary Acosta. We do not have the flexibility to make
those distinctions under the current law.
Mr. Moolenaar. Can you raise the cap under existing law?
You chose 30,000 at this juncture--and again, I am grateful for
that, but let's say the need was, instead of 30,000 it should
have been 40,000. Do we have a way of knowing?
Secretary Acosta. So, Congressman, the logistical reality
of this, and it happened two years ago, when because the budget
was delayed--and thank you for not delaying the budget last
year for us--but when the budget was delayed, I believe about
two years ago the cap was not increased until June, and as a
result the visas were not available until August, by which
point there is really not much need for them.
Mr. Moolenaar. Right.
Secretary Acosta. And so, as a logistical matter, by the
time that that question would present itself, the need for the
visas would have become moot.
Mr. Moolenaar. Okay. Thank you, and I do appreciate the
30,000 very much.
Thank you, Madam Chair.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Thank you, Madam Chair, and thank you, Mr.
Secretary, for being here.
HUMAN TRAFFICKING
Just to make a comment on Ms. Clark's questions to you, I
come from Palm Beach County where that Epstein matter arose,
and I just--aside from the justice issue, I could tell you that
many people in my community are upset that it seems like a
sexual predator was allowed on the loose. And I am not going to
pursue more of the questions today but I think a lot of us have
a lot more questions, that we want to get to the bottom of
this.
I do have a request for you to help in the area of the
sexual trafficking, and you probably know this. There was a
study that said 71 percent of labor trafficking victims come
from--who come from outside the United States had entered the
country on temporary work visas. I have heard horrendous
stories. There was just one in--in fact, where I live, in Palm
Beach County, where women from China were being brought in.
They thought they were coming in to legitimate jobs and they
ended up in massage parlors, and they were exploited, put into
prostitution. People said, well, why would they do it? Because
they don't know the language, their families are threatened,
and people--their exploiters say ``we are going to kill your
family,'' they grab their papers. And this, unfortunately, is
very, very common.
VISA TRANSPARENCY ANTI-TRAFFICKING ACT
There will be a bipartisan bill--thank goodness it is
bipartisan--called the Visa Transparency Anti-Trafficking Act,
which would create a standardized reporting system across non-
immigrant visas that permit employment and make the information
available to the public.
There is a provision in it that is going to require some of
the information that the Department of Labor collects, because
we are trying to get--I think you even mentioned we have
Homeland Security and the Department of Labor, it seems like
things are not connecting. But I would just--I am asking you if
you would--I am bringing this to your attention, if you could
assign someone as to help us get this done.
Secretary Acosta. Congresswoman, I can absolutely assign
someone. And let me just say, on a variety of fronts, I was one
of the individuals that set up one of the first human
trafficking task forces, back when I was at Main Justice. This
was incredibly important.
The visas, the various agencies do not communicate with one
another as well as they could, in part it is because their
computer systems do not talk to one another. We are actually
communicating by paper. So whatever I can do to help on this
front, I will assign a senior-level individual to work with
your office.
PAID PARENTAL LEAVE PLAN
Ms. Frankel. Okay. Thank you very much for that.
I want to ask you--I think in your testimony there was a
mention of a paid parental leave plan, which I think a lot of
us here think is very important. In fact, I reference you to
take a look at Representative DeLauro's Family Act, which I
think really is a very good way to go.
The plan that you put forward, I am not really exactly sure
because there are just a few mentions of it. And then you put
$750,000,000 in mandatory funding for the paid parental leave
proposal. Could you just tell me how that would be used and how
you see your plan operating?
Secretary Acosta. Congresswoman, first, let me say the--you
know, if one looks at our labor force participation rate it has
fallen behind other nations.
Ms. Frankel. Yes.
Secretary Acosta. And one of the important reasons that we
need paid parental leave is so individuals can keep those
attachments to the workforce. Studies show that when
individuals leave the workforce they are less likely to return.
And let me also say that we want to support families, and
especially during that early time right after a baby is born,
providing the support by providing paid leave is important. So
the proposal looks to the UI trust funds, and as a first
instance, of course, states would be free to go in different
directions, but as a first instance would look at the UI trust
funds for funding for that paid parental leave.
Ms. Frankel. I don't have that much time, but I want to
just make a few respectful suggestions to you.
Secretary Acosta. Please.
Ms. Frankel. Number one, you need to look at times when
people leave the workplace for medical reasons, not just for
birth, because there are probably 100 million workers that
don't have access to any kind of leave here, and more don't
leave--more leave for medical reasons than just for childbirth.
So I urge you to look at that.
The other thing that really concerns me is that the
unemployment insurance system for the states are very
underfunded, and you are proposing a patchwork solution. And it
sounds to me like you understand why we need to do this. So I
really urge you to take a look at Representative DeLauro's
bill, the Family Act, because I think that is a much better way
to go.
And with that I guess I have run out of time and I am
yielding back.
Secretary Acosta. If I could--10 seconds--just say that
ultimately the funding is something that is going to--Congress
will need to act, and so the funding is something that will
have to be negotiated with this committee, among others.
Ms. DeLauro. Congresswoman Bustos.
Mrs. Bustos. Thank you, Madam Chair. Secretary Acosta,
thank you for being with us today.
DEPARTMENT OF LABOR BUDGET PRIORITIES
In your written testimony you make it very clear how proud
you are of your efforts to cut red tape at the Department of
Labor. I agree with reworking rules to make sure that we are
not having any regulations that are unnecessary anymore, and
that is an important part of the process. But there is nothing
that is, from a Department of Labor perspective, that is more
important than making sure that workers, American workers,
always come first.
So what I find concerning in your budget is you effectively
cut the budget for Occupational Safety and Health
Administration, and this comes at a time when workplace
fatality investigations are at a 10-year high, and the number
of health and safety investigators at the Department of Labors
is at an all-time low. Yet you provide a 19 percent increase to
the Office of Labor Management Standards. This is the office
that is charged with auditing and investigating labor unions.
This indicates to me that going after labor unions is more
important than keeping workers safe. Your philosophy of cutting
the red tape seems to apply to everyone except for labor
unions. I have real concerns about this.
Your request for funding to investigate--you request more
funding to investigate labor unions, but you cut funding for
worker safety. Further, you flatline funding for workforce
development programs. This should be a priority. Keeping
workers safe should be a priority.
So outside of deregulation, which, again, I think we
acknowledged, and you acknowledge in your written testimony is
very important, I am not clear exactly about your priorities,
specifically where does workplace safety fit into all of this?
Secretary Acosta. So, Congresswoman, first let me try to
take these in order.
OSHA BUDGET
With respect to OSHA, we are actually asking for an
increase, I believe, of--folks behind me will correct me if I
am wrong--but about $15,000,000 with respect to enforcement in
OSHA. The total decrease there is because of a reduction in a
category of grants called the Harwood Grants, that we have, in
the past, suggested is a place where money can be saved, and
where I understand that this committee, I believe for two years
now, has put the money back in.
But our enforcement budget is actually increasing. And I
would point out that according to my figures in front of me,
the enforcement budget for OSHA is actually increasing twice
the enforcement budget for OLMS, which is the organization that
focuses on unions, even though that organization's budget was
cut over the last 10 years quite, quite substantially.
And so I would take issue with the budget not reflecting an
enforcement priority because, in fact, it does, and every
enforcement agency shows some level of increase with respect to
enforcement.
OSHA INSPECTORS
Let me also, you mentioned that the inspectors are at a low
level. When I arrived at the department we didn't have
inspectors. They were called CSHOs, and we did not have enough
of those inspectors, and so there was a personnel freeze. And
the one area where I said I am lifting the personnel freeze,
the hiring freeze, was in OSHA so that we could hire more OSHA
inspectors. And, in fact, we hired 76 inspectors since then.
They are in the process of being trained, being educated.
Because OSHA is such a complex statute it takes months, and in
some cases a year or more, before they can go out into the
field individually.
And so the fact that our inspections are up, and we are
above 32,000 for two years in a row, despite that decrease in
inspectors I think is a testament to folks that were working
incredibly hard, and once these inspectors can go out in the
field independently, I fully expect, and I have told OSHA that
I expect the inspections to be up even more.
WORKFORCE DEVELOPMENT PROGRAMS
Mrs. Bustos. Can you address at all where workforce
development fits into your priorities?
Secretary Acosta. I think if there is one thing that should
be clear is this Administration is incredibly proud of the jobs
that are being generated by this economy, and skills
development and workforce development is an incredibly high
priority, both in government-funded programs as well as in
privately funded programs.
So for example, in the apprenticeship area, something that
I think is worth mentioning--and it has been the subject of
testimony by the building trades unions, before Congress in the
past, is they spent $1,000,000,000 of private-sector money as
part of the registered apprenticeship program. And so whether
it is through apprenticeships that we are advocating very
heavily, funded, in part, by the $160,000,000 that this
committee provides, or whether it is through private-sector
money, such as what the building trades negotiate with
management through their contracts, whether it is through
support of community college and vocational programs such as
the reauthorizations that we saw recently, that really
highlighted the importance of vo-tech, workforce education is
critical because we have, right now, 1 million more open jobs
than individuals looking for jobs.
And so I am happy to talk about this in more detail
privately, if you would like, but it is at the top.
Mrs. Bustos. Okay. I am out of time. I yield back, Madam
Chair.
Ms. DeLauro. Okay. I just--and I will compensate for the
time for Ms. Roybal-Allard, but the number of OSHA National
Employment Labor Project----
Ms. Frankel. I don't think I can hear you.
Ms. DeLauro [continuing]. National Employment Labor
Project, the number of OSHA inspections is down 3,000 over two
years. Enforcement unions are down 1,000 per year.
Congresswoman Lucille Roybal-Allard.
Ms. Roybal-Allard. Thank you, Madam Chair, and thank you,
Mr. Secretary.
ELIMINATION OF JOB TRAINING PROGRAMS
Let me just say that in your testimony you highlighted the
fact that unemployment was down among disadvantaged groups, and
I would venture to say that one of the reasons that is true is
because of the programs that you now have in place which you
are now proposing to eliminate.
For example, you are proposing to eliminate programs like
the migrant and seasonal farmworkers job training and the
Indian and Native American job training, that actually support
some of the most vulnerable and neediest workers who continue
to be exploited. So I would caution you about eliminating these
programs that are helping you to come this committee to talk
about the fact that you are able to keep unemployment low among
these groups.
GAO STUDY ON WORKPLACE FATALITIES
My question is about children--another group of children
that are vulnerable in the workforce. The GAO released a report
in November of 2018, on the working conditions of children in
the United States, and GAO's findings regarding the number of
fatalities due to a lack of enforcement really puts our country
at shame. And I, along with Chairwoman DeLauro, contacted the
Wage and Hour Division in your department and we requested a
comprehensive study to address the gaps in enforcement that the
GAO had found.
WHD responded saying that they intended to address the
GAO's recommendations. My question is, have you, in fact,
addressed those recommendations?
Secretary Acosta. Congresswoman, the GAO study came out, I
believe, a little over a month ago. I am familiar with it. I
have asked the Wage and--I am sorry.
Ms. Roybal-Allard. It was actually 2018, is my
understanding. Never mind. Just go ahead and answer the
question.
Secretary Acosta. I have asked the Wage and Hour Division--
may I ask what month in 2018, because I----
Ms. Roybal-Allard. I said November.
Secretary Acosta. Oh, November. So, yes. So my apologies. I
think I may have read it right over the break or the holiday
season. But I have asked the Wage and Hour Division to take a
look at that.
As I said earlier, the Wage and Hour Division, this past
year, had very strong enforcement--304,000, the highest amount
ever. And so I have asked them to go through the report to see
where we can focus our enforcement, where we can refocus our
enforcement. What is a statutory gap, if any? And so I am happy
to, once that is done, sit down with your office and provide
their recommendations, and if there is a need for legislation
we can certainly talk about that.
Ms. Roybal-Allard. Okay. Well, in the response it said that
you were, in fact, were going to be looking into this.
Secretary Acosta. I have asked them to do that. That is
correct.
Ms. Roybal-Allard. Okay.
CARE ACT PROPOSAL
I just want to point out that one of your core
responsibilities, as others have said, is the enforcement of
the labor laws, and particularly children. And in the
agriculture industry, that is where you have the highest
fatalities. What GAO found was that of the 400- and, I believe,
52 fatalities of children, that half were in the agriculture
industry. And the reason for that is children working in
agriculture are not equally protected under our child labor
laws.
So I am introducing a bill called the CARE Act to see what
we can do to better protect those children, and I would like to
work with you on that. There are a lot of exemptions. I
understand the issue of family farms and so on and so forth.
But we really need to do something to protect these children
better than they are at this point.
Secretary Acosta. Madam Vice Chair, I am happy to work with
you on that.
Ms. Roybal-Allard. Okay.
One of the--I am sorry. I want to go to another question.
CUTS TO ILAB BUDGET
In the 2018 Annual Child Labor Report that was released by
your department, you acknowledged that meeting the ambitious
goal of ending child labor, forced labor, human trafficking,
and all forms of modern slavery that requires, and I quote,
``accelerate very real progress that has been made over the
past quarter century.'' And as was mentioned by my colleague,
Congresswoman Clark, your budget proposes cutting the Bureau of
International Labor Laws by 79 percent.
It doesn't make sense to me how you can accelerate efforts
to address child labor when you are proposing a 79 percent cut
to the very agency that is responsible for that. These cuts
would also hinder the bureau's ability to monitor and enforce
the labor provisions outlined in the new and existing free
trade agreements.
How do you plan to ensure that American workers are
protected from international competitors that exploit workers
with this severe reduced budget?
Secretary Acosta. That is at least a three-part question.
Do I have time to answer?
Ms. DeLauro. Not all three parts.
Secretary Acosta. Okay.
Ms. Roybal-Allard. But you can, for the record--do what you
can and then the rest for the record.
Secretary Acosta. Fair enough.
[The information follows:]
The mission of the Bureau of International Labor Affairs (ILAB) is
to promote a fair global playing field for U.S. workers and businesses
by enforcing trade commitments; strengthening labor standards; and
combatting child labor, forced labor, and human trafficking. United
States trading partners receive an unfair subsidy when they fail to
comply with their trade-related labor commitments, including not doing
enough to prevent and address cases of forced labor and child labor.
This puts workers and businesses in the United States at a competitive
disadvantage. ILAB will use its expertise to address these issues and
ensure that U.S. workers and businesses are able to compete on a fair
global playing field.
ILAB will continue to monitor and enforce the labor provisions of
free trade agreements and trade preference programs. The Department's
approach will include prioritizing proactive monitoring of labor
conditions in key countries; reviewing trade complaints; using ILAB
experts to provide targeted, direct technical support to trading
partners to improve laws and enforcement; and aggressively engaging
with trade partners that are deemed to be out of compliance. We are
asking our trading partners to invest more of their own resources to
enforce their labor laws and fund initiatives to combat child labor and
forced labor. ILAB will also increase its impact by strengthening
partnerships with other U.S. government agencies, such as the Office of
the U.S. Trade Representative, the Department of State, and the
Department of Homeland Security, as well as with the private sector to
prevent the importation of goods made with forced labor and child labor
and make trade more fair for workers and businesses in the United
States.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you, Chairman. Good afternoon,
Mr. Secretary.
Secretary Acosta. How are you?
Mrs. Watson Coleman. I am well. Thank you.
ELIMINATING CSEOA
I think we both agree that the opioid epidemic has had a
severe impact on our families, and a lot of grandparents have
ended up becoming the breadwinners in the families because
their children, who have children, have become unable to take
care of themselves.
So I am disturbed that your proposal to eliminate the
program, the Senior Community Service Employment Program,
$400,000,000, I am concerned that you would eliminate that
program at a time where I think our grandparents are re-
entering in the workforce again, not because we want to but
because we have to.
Secretary Acosta. Congresswoman, thank you for the
question. The budget makes difficult calls with respect to
workforce development issues. So, for example, Congressman Cole
cited the program for Native Americans, and what we did there
was we said that we would set aside a certain amount under WIOA
to address that need in particular. And if there are particular
needs, I think that within the WIOA budget, focusing the
dollars on those needs is certainly appropriate.
Mrs. Watson Coleman. Well, it would--that--you are talking
about the Workforce Investment Act programs?
Secretary Acosta. That is correct.
Mrs. Watson Coleman. Okay, that are more geared to younger
folks----
Secretary Acosta. Well, that don't----
Mrs. Watson Coleman [continuing]. Programs----
Secretary Acosta [continuing]. That don't have to be. And
part of----
Mrs. Watson Coleman. Okay. Can I ask you this?
Secretary Acosta. Yes.
Mrs. Watson Coleman. What does your budget propose for the
Workforce Investment Act? Are you proposing an increase or a
decrease?
Secretary Acosta. The Workforce Investment Act budget----
Mrs. Watson Coleman. Because that would give me--tell me
whether or not I should have confidence that the senior program
has the light of day.
I don't want you to take up my time finding this. There you
go, a stickie.
Secretary Acosta. There we go. The WIOA funds are formula
funds that are determined outside of the budget.
Mrs. Watson Coleman. So is this a level funding you are
proposing?
Secretary Acosta. It is.
Mrs. Watson Coleman. So you are going to try to take care
of this particular aspect of the workforce needs with level
funding.
Secretary Acosta. We----
EXPLOITATION OF UNDOCUMENTED WORKERS
Mrs. Watson Coleman. I think that needs to be looked at and
I hope that our colleagues will look at that.
I want to go to another area. As the head of the Department
of Labor, do you think that American employers who take
advantage of undocumented workers should be held accountable?
That is a yes or no.
Secretary Acosta. Yes.
Mrs. Watson Coleman. Good. Thank you.
Does your Wage and Hour Division, in particular, do those
investigations if individuals have been coerced in their
working, have not been paid a decent wage, don't get sick time,
et cetera?
Secretary Acosta. Yes. Yes, we do.
Mrs. Watson Coleman. Thank you. Have you launched any
investigations into the Trump golf clubs that have been
documented to have had undocumented workers working in those
facilities, underpaid, no benefits, no overtime, no sick leave,
no nothing, and, in some instances, have actually been treated
very poorly?
Secretary Acosta. The career staff determines what is
investigated. I can certainly inquire and provide an answer for
the record.
Mrs. Watson Coleman. Okay. I specifically want to know how
many investigations have been launched. And if you are able to
tell me that none have thus been launched, will you commit to
doing those investigations?
[The information follows:]
The Wage and Hour Division (WHD) uses an evidence-based approach to
ensure that it prioritizes providing compliance assistance and using
enforcement resources in areas where the agency is most likely to
uncover violations in high violation industries. The process of
determining where to conduct investigations is led by career staff,
informed by data, research and evaluation, and allows the agency to
make the most of its resources.
A search of WHD's enforcement database shows no current or
previously concluded investigations of any Trump golf clubs in the
United States. Should there be a suspected WHD violation, workers and
their advocates are encouraged to file a complaint with the agency by
calling our toll-free number at 1-866-4US-WAGE or visiting our website
at www.dol.gov/whd/howtofileacomplaint.htm.
Secretary Acosta. Congresswoman, the career staff, and I
think it is very important that the career staff determine when
it is appropriate to launch these types of investigations. I
have been very careful as Secretary to not pick and choose what
organization should or should not be investigated. I don't
think that is the role of the political leadership. I think
that is the role of the career staff. I would defer to their
decisions on that.
Mrs. Watson Coleman. Well, then I would assume that these
career staffers would have engaged in rigorous investigations
of what have been very flagrant and numerous and consistent
violations of workers' rights.
Thank you. I yield back.
Ms. DeLauro. Congresswoman Lee.
Ms. Lee. Thank you very much. Hello, Mr. Secretary.
Secretary Acosta. How are you?
Ms. Lee. I apologize for being late. Hello, Mr. Secretary.
Secretary Acosta. How are you?
Ms. Lee. I apologize for being late. We are in a Budget
Committee hearing also. Thank you, Madam Chair, very much.
UNEMPLOYMENT RATES AMONG MINORITY GROUPS
Let me, and I apologize if this question is redundant, but
I wanted to just ask you about the unemployment rate as it
relates to the African-American and Latino communities. The
black unemployment rate is double that of whites at 6.6
percent, which is the highest among all racial groups
nationwide. The Latino unemployment rate is also high, around 5
percent compared to 4 percent, and 3.7 percent for whites.
WORKFORCE TRAINING PROGRAMS
Now, it is not just unemployment, Mr. Secretary. The median
net worth of white households is 10 times higher than that of
black households, and for every 100 black children who grow up
in the bottom 5th of the income distribution, less than 3--mind
you, 3--will make it to the top 5th as adults. So investments
in workforce training, closing the wage gap, and increasing the
minimum wage are all things that the Department of Labor could
do to help close these gaps. But this budget doesn't reflect
that you are doing that at all.
For example, your budget slashes Job Corps by 41 percent,
Dislocated Worker National Reserve by 39 percent. And I was
shocked to see the Reintegration of Ex-Offenders at 16 percent.
Youth Build is down 6 percent. Office of Disability Employment
Policy, minus 29 percent. The Women's Bureau, 74 percent down,
and the International Labor Affairs Department, 79 percent.
So I want to ask you, with the cuts that you are
presenting, how are we going to ever achieve parity and how are
we ever going to reduce the unemployment and the wage gap in
communities of color? And can you commit to increasing the
minimum wage? I mean, this would help tremendously. Also, why
would you make these cuts when you know these programs are what
lead people out of poverty into the middle class, especially
people of color?
Secretary Acosta. So, Congresswoman, thank you for the
question because workforce development, I think, is one area
where the return on investment is incredibly high, where
government investment in helping individuals develop a skill,
especially when they are young, that will last them a lifetime
is incredibly important.
I have talked in the past, for example, about expanding
Pell Grants to certificate programs, about the importance of
work study. And I would add to that the importance of programs
that are paid for by WIOA, programs within our Employment and
Training Administration that provides a lot of funding for the
States to focus on workforce. Now, we are operating within
budget constraints, and we are operating within budget caps.
And so I understand that this committee disagrees and last
year, in essence, looked at the budget and provided the money
right back in. But you have the authority to exceed those caps,
not the Department, and the Administration is being very
fiscally disciplined.
REENTRY EMPLOYMENT OPPORTUNITIES PROGRAM
And so let me just say I am happy to have discussions about
any one of these. I was at a reentry program earlier this week.
Reentry is incredibly powerful. Providing an individual who is
leaving prison the opportunity to work is transformative for
the individual. It is a way to keep the community safer. And
from a fiscal perspective, employing an individual who is
reentering makes so much sense because they become a member of
our economic base. They contribute, and that makes so much more
sense than the danger of them going right back to prison.
There are so many areas where we can help individuals find
jobs, and so I am happy to have a discussion as to whether we
should move some of these funds around. But we are operating
under budget constraints.
Ms. Lee. Mr. Secretary, based on what you just said, I
would have thought you would have put on a plus-up of 16
percent. You have decreased the Reintegration of Ex-Offenders
by 16 percent. But also this reflects, I think, a roadmap of
your priorities, and when we talk about communities of color
and people of color, if we are not a priority, we are just not
a priority. And based on the cuts that you have indicated that
you would recommend, that kind of shows me where you are going
with this, and that is not right, and you know that.
And if you care about reentering ex-offenders and their
reintegration, a priority should be to make sure that we not
only fully fund, but increase those funding levels. And so, you
know, it is a reflection, I think, of your priorities, and it
really is a shame and disgrace.
Secretary Acosta. Congresswoman, I have to disagree with
that characterization. Reentry is incredibly important and
something I am very, very----
Ms. Lee. Then you shouldn't recommend a cut, Mr. Secretary.
If this is important, why are you cutting it?
Secretary Acosta. There are budget realities,
Congresswoman.
Ms. Lee. Excuse me.
CHILD LABOR PROTECTIONS
Ms. DeLauro. No, that is okay. Mr. Secretary, I would just
like to follow up on two or three areas. This is a follow-up of
Lucille Roybal-Allard on child labor protections. Last fall,
the Department proposed to revise and repeal protections for
16- and 17-year-old workers and healthcare protections that
were based on the science-informed recommendation of the
government's health and safety experts. With no additional
scientific review, no public hearings or meetings, the Agency
decided it needed to repeal this child labor protection.
Let me just ask you a couple of questions about the scant
evidence that you cite. It is a 2012 SurveyMonkey poll done in
Massachusetts to support your claim that current child labor
protections are burdensome. These are ``yes'' or ``no''
questions. Are you aware that your evidence, the SurveyMonkey
poll, had just 20 respondents who answered the main questions,
and that almost half of the 20 respondents said that they were
unaware of what the current DOL policy was? Were you aware of
that?
Secretary Acosta. Congresswoman----
Ms. DeLauro. Yes or no.
Secretary Acosta. Madam Chair, that was not cited as
evidence. If one were to look at the proposed rule, that was
cited in a footnote as an example of the fact that this was an
issue across the country, and it was not cited as evidence of
the underlying rule.
Ms. DeLauro. This is 20 respondents. I know something about
polling. I lived with a pollster.
Secretary Acosta. That was not cited as evidence.
Ms. DeLauro. Twenty is not a sample size.
Secretary Acosta. That was not cited as evidence.
Ms. DeLauro. So maybe you were not aware of the number of
people that were polled. Are you aware that the Massachusetts
Department of Health that conducted the poll found that any
burdens in the placement of young of teens in healthcare
occupations were from misperceptions about the Agency's current
policy? Yes or no?
Secretary Acosta. That was not cited as evidence, Madam
Chair.
Ms. DeLauro. It appears, Mr. Secretary, that there is no
empirical evidence that the existing policy hurt employment,
and, therefore, no compelling justification for your regulatory
action. So I am going to ask you, and, again, it is yes or no.
Will you withdraw this proposal?
Secretary Acosta. We are in the process of considering the
comments received in the proposed rule.
Ms. DeLauro. Will you withdraw the proposal?
Secretary Acosta. We will consider the comments received.
OPINION LETTERS
Ms. DeLauro. Let me just ask you a quick question here.
This is based on something you said about opinion letters. Are
workers entitled to opinion letters? Again, yes or no?
Secretary Acosta. No stakeholder is entitled to an opinion
letter whether worker or business, but we have answered
requests from workers on opinion letters.
Ms. DeLauro. Can you provide us with the number of opinion
letters that have been issued or this effort for workers versus
employers?
Secretary Acosta. We can provide that to the committee.
Ms. DeLauro. Okay. That is fine. Thank you.
[The information follows:]
Workers and employers ask for assistance from the Department of
Labor's Wage and Hour Division (WHD) in different ways. While employers
often seek clarity about their obligations under the law through
compliance assistance efforts--including the use of opinion letters--
the vast majority of WHD's assistance to workers is through enforcement
actions. WHD receives approximately 80 percent of its opinion letter
requests from employer-side stakeholders and approximately 20 percent
from workers. Since January 2017, WHD has issued 40 opinion letters in
response to requests by an employer, an employer advocacy organization,
or a law firm representing employers. Since January 2017, WHD has also
issued one opinion letter in response to a request by a labor union,
and one opinion letter in response to a request by an individual
employee. Most of the requests WHD has received from employees actually
involved complaints or could be responded to with technical assistance
based on information that is readily available. In those cases, the
requester is referred to the nearest WHD district office that can
respond to the requester directly by registering a complaint, or
providing compliance assistance, allowing the employee to address the
information with their employer.
PAYROLL AUDIT INDEPENDENT DETERMINATION (PAID) PROGRAM
Ms. DeLauro. Let me just move to another area quickly here.
You announced in October your plans to expand the Payroll Audit
Independent Determination, the PAID Program at the Wage and
Hour Division. I believe this is a program that offers
violating employers amnesty. It is a pat on the back with no
deterrence impacts on the employer or others who are violating
the law. The Agency trumpets the $304,000,000 in wages DOL
recovered for workers in 2018. Serious questions remain around
whether the PAID Program is effective and worth the investment.
How much of the $304,000,000 recovered in 2018 is through the
PAID Program?
Secretary Acosta. I can provide that information to the
committee.
Ms. DeLauro. Okay.
[The information follows:]
At the conclusion of the pilot of the new Payroll Audit Independent
Determination (PAID) program in September 2018, the Wage and Hour
Division (WHD) reviewed quantitative enforcement data such as back
wages owed and hours spent by enforcement personnel, as well as
qualitative feedback from employers, employees, and WHD field staff,
including testimonials from employers and employees. At that time, most
PAID cases remained open, but early indications were overwhelmingly
positive. Cases with back wages due appeared to require fewer
investigator hours than full investigations. Since then, WHD has worked
to implement PAID consistent with existing protocols and procedures for
compliance actions, which has enabled district offices to incorporate
the program into existing enforcement and compliance assistance tools.
WHD has continued collecting and assessing administrative
enforcement data throughout the program's implementation. This data
will be addressed in a report in response to S. Rept. 115-289--language
which accompanied the Senate Appropriations Committee-passed version of
Labor, Health and Human Services, Education, and Related Agencies,
2019. The language directed WHD to submit a report to the Committee no
later than 12 months after the date of the Act detailing the outcomes
of the PAID pilot program.
Many cases remain open. Although the report is not yet available,
early testimonials from employees and employers continue to indicate
that the results are overwhelmingly positive. The program has been
achieving its goal of getting back wages into the hands of employees
more quickly. Providing this platform for well-intentioned employers to
resolve violations frees WHD to commit more resources to investigating
the more egregious, willful violators affecting even more employees,
and bringing those violators into compliance. Under this program, the
Department expects more employers to proactively conduct audits than
otherwise would occur. As a result, more employees will be paid the
back wages they have rightfully earned.
EFFECTIVENESS OF PAID PROGRAM
Ms. DeLauro. Now, again, you pledged when you announced the
program in March of 2018 that the Department would do an
evaluation of it after 6 months before expanding it. Why are
you extending the program without any knowledge of its
effectiveness?
Secretary Acosta. We are extending the program because it
took more time to get the word out and for businesses to
approach the Department, in large part because attorneys
general in particular States came out and said that if
businesses were to work with the Department under this program,
that they--I am sorry?
Ms. DeLauro. No, go ahead.
Secretary Acosta. That they would look and investigate
those businesses. Let me also say, with respect, because you
pointed out----
Ms. DeLauro. You are extending the program without any
knowledge of its effectiveness. You have concluded on what
basis that scarce resources, key labor standards agencies, are
better spent on a program that potentially has no impact rather
than a robust enforcement program. And that is not really what
you pledged in terms of the evaluation of this program.
And just where I started, we have seen at the Labor
Department, again, on the TIP rule that was proposed, child
labor and healthcare, other regulations are failing to do the
analysis that the Congress requires, or, in the case of PAID,
that even you pledged to do. And yet for the employers, for the
business community, we just say go for it. You know, it is
okay, and, you know, do the best you can. Not on our watch, Mr.
Secretary.
Dr. Harris.
H-2B VISA PROGRAM
Mr. Harris. Thank you very much. And let me just follow up
a little bit about what my colleague from Michigan, you know,
with the H-2B. Again, I want to thank you for the additional
visas. And I just want to confirm, I think we have had
conversations that indicate that if we were going to a
proportionality system where if Congress didn't set the quota
high enough, then everybody would get some, you know, you
wouldn't have the lottery system. But my understanding is that
you would need a slight change in statute to give you the
authority to do that? Is that right? That you cannot do it
internally without a change in statute?
Secretary Acosta. If your question is if someone applied
for, let's say, 100, could we determine we are only giving you
50?
Mr. Harris. Yes, because----
Secretary Acosta. I would have to confirm whether or not
that is something that required a statute.
[The information follows:]
The Department of Labor (Department) respectfully refers you to the
Department of Homeland Security (DHS) on this question. Under current
law, DHS has authority to administer the H-2B visa cap. The Department
of Labor's role is to provide consultative advice to DHS regarding
whether a qualified U.S. worker is available to fill the petitioning H-
2B employer's job opportunity and whether a foreign worker's employment
in the job opportunity will adversely affect the wages or working
conditions of similarly employed U.S. workers.
Mr. Harris. Okay. And if it would, I would appreciate it if
you would get back to me because I think that is one thing that
my employers have said that, you know, the lottery, they love
it when they win, they hate it when they lose. So maybe
everybody could win just a little.
AFRICAN-AMERICAN UNEMPLOYMENT RATE
The President talks about the African-American unemployment
rate, Hispanic unemployment rate being historically low. Is
that true when the President says?
Secretary Acosta. It was a historically low amount, yes.
Mr. Harris. So he is telling the truth.
Secretary Acosta. Yes.
Mr. Harris. I mean, the economy actually has improved----
Secretary Acosta. The economy has improved for everyone.
The African-American unemployment rate hit a record low. The
Hispanic unemployment rate hit a record low.
BUDGET PROPOSAL
Mr. Harris. That is what I thought. With regards to the
budget levels that you have, and I would love to compare it to,
you know, a congressional budget, issued budget, but I haven't
seen one yet. We are almost 100 days into this Congress, and I
haven't seen a budget proposal that would perhaps indicate
Congress' priorities. So it is easy to pick on, I guess, on the
priorities that you have set, but you are operating within the
original 2011 BCA caps, is that right, because there is no
updated cap this next Fiscal Year. Congress has not increased
the cap.
Secretary Acosta. To my knowledge, that is correct.
Mr. Harris. Right. So actually, and, Gallup actually asked
Americans what are the two top issues they worried about, and
the two top issues were the healthcare, and I talked to you
about that, about the cost of that. The second one with
actually an equal number of Americans, 80 percent saying what
they worry a great deal or a fair amount about is Federal
spending and the budget deficit. So I am going to applaud the
Administration for, first of all, staying within the caps that
are actually congressionally imposed. I mean, look, you are
living within the law. I know that is an unusual thing in this
town, but you are living within the law, and I appreciate that.
And, again, I anxiously await, you know, the results of a
budget that comes out of our Budget Committee here.
CURRENT OVERTIME RULE
Finally, the overtime rule. So let me get the overtime rule
straight, is that the last Administration proposed a rule which
a Texas court basically didn't allow to go into effect.
Secretary Acosta. That is correct.
Mr. Harris. So we are currently operating under the old
overtime rule provision, right? The original one.
Secretary Acosta. That is correct.
Mr. Harris. So every day we go by without an update,
actually there are a lot of workers, potentially 1,000,000
workers, who actually who might come under an increased salary,
you know, cap amount. So actually, your proposal is better than
the current we have. How many million workers would come under
your proposal?
Secretary Acosta. Well over 1,000,000.
Mr. Harris. So well over 1,000,000 workers.
Secretary Acosta. A million additional workers.
Mr. Harris. And those 1,000,000 workers, additional
workers, I take it are in the lower quintiles of income.
Secretary Acosta. That is correct.
Mr. Harris. Are they in the lowest? Are they in the two
lowest quintiles, you can imagine, most of them?
Secretary Acosta. You know, I hesitate to provide that
data, but I can certainly provide it to the committee.
[The information follows:]
As part of the rulemaking process, the Administrative Procedure Act
generally requires that agencies publish a notice of proposed
rulemaking (NPRM) in the Federal Register. The agency then provides a
public comment period and, after considering the comments received,
develops a final rule. The comment period for the overtime NPRM ended
on May 21, 2019, and the Department received 59,348 comment submissions
representing 116,298 comments, some of which may be duplicates. The
Department is currently reviewing the comments received as part of
developing the final rule.
The proposed salary level is approximately the 20th percentile of
earnings for full-time salaried employees in the South, which is the
lowest-wage Census region. Accordingly, the approximately 1,000,000
workers who would gain overtime protection if the rule is finalized as
proposed would be in the lowest quintile nationally of earnings for
full-time salaried employees. Please note that this differs from income
(which includes non-wage earnings). For purposes of this question,
earnings appear to be more appropriate in this context.
The Department estimates that the proposed changes to the standard
salary level would result in transfers (i.e., additional earnings) of
$252,500,000 in Year 1.
Secretary Acosta. But in the lower----
Mr. Harris. Yeah. So here is a circumstance where the last
Administration actually did nothing about it, right? And your
shuttered Department actually is providing relief to over
1,000,000 people. How much money would those 1,000,000 stand to
gain? What is your estimate? What do those 1,000,000 get from
this action from your shuttered Department?
Secretary Acosta. Millions, and I will certainly provide
that information.
Mr. Harris. It could be hundreds of millions, couldn't it?
Secretary Acosta. That is correct.
Mr. Harris. And that goes to the lower quintiles of income.
It sounds like the Department of Labor actually in this case
might actually be helping the people who it was established to
help. I yield back.
Secretary Acosta. Thank you. If----
Ms. DeLauro. Congresswoman Frankel.
HUMAN TRAFFICKING
Ms. Frankel. Hello again. Thank you for being here. You
know, I listened to your testimony. Listen, I sincerely believe
you want to help to do something about trafficking. I am going
to take you up on that. I want to give you an opportunity
because I know you have been under this spotlight with this
Epstein thing, and I don't want to come at you with facts, but
I want to give you an opportunity, if you want, to just explain
some things.
I think sex trafficking is one of the scourges of humanity
right now, and I think my colleague here laid out some of the
basic facts. But it sounds liked this Jeffrey Epstein,
according to, there was a Miami Herald article, and then I know
there were some comments made by the Palm Beach police that
anywhere from 50 to 80 young women that they actually knew
about were victims of Jeffrey Epstein. Does that sound about
right?
Secretary Acosta. I can't comment as to the specific
number, but he had multiple victims, yes.
Ms. Frankel. And he ends up getting a deal, I guess, a
couple of prostitution felony charges, State charges. Were
there ever Federal charges, because the Miami Herald article
said that he was facing 53 Federal indictments.
Secretary Acosta. If I could just provide a brief overview,
Congresswoman.
Ms. Frankel. Yes, please, I would appreciate it.
Secretary Acosta. This was a State matter, and it was
presented by the then State attorney to a grand jury in Palm
Beach County. The grand jury reviewed the evidence, looked at
what was available, and the grand jury recommended a single
charge that would have required no jail time.
Ms. Frankel. Not to be rude to interrupt you, but before it
went to the State, it was my understanding that he was facing
53----
Secretary Acosta. That is incorrect.
Ms. Frankel. Was he facing any Federal charges?
Secretary Acosta. That is incorrect, Congresswoman. This
started as a State matter----
Ms. Frankel. But what happened? I mean, there was an
article that said, I mean, you could tell me. Maybe this didn't
happen, but there was an article that said that Epstein's
attorneys negotiated a deal with you at the Marriott Hotel in
West Palm Beach.
Secretary Acosta. If I could walk you through the facts.
Ms. Frankel. Yeah.
Secretary Acosta. And this is supported by the public
record. So this was a State matter. It was investigated by
local police, and it was taken to the State attorney's office.
The State attorney took this matter to a grand jury, presented
all the evidence----
Ms. Frankel. How did you get involved?
Secretary Acosta. I am leading up to that.
Ms. Frankel. All right.
Secretary Acosta. Presented all the evidence to the grand
jury, and the grand jury considered it and recommended one
charge that would have required no jail time, no registration
at all, and no restitution to any of the victims. He would
have, in essence, gotten away. And that is why the local police
went to Federal authorities.
And those that have been involved, you are an attorney,
Congresswoman, those have been involved in the legal system
know that once someone is arraigned, because he had been
arraigned on that one State charge. Once someone is arraigned,
it is exceedingly rare--it is rare--for a Federal prosecution
to also take place. But our attorneys looked at that, and they
said Epstein should not be able to walk away with no jail time,
no registration, and no restitution.
And so they informed his attorneys that if something else
wasn't done, that a second Federal prosecution could take place
because, and this is something that is important for the public
to understand. You can be prosecuted, and if that is
insufficient, you can also be prosecuted by the Federal
government.
Ms. Frankel. I have limited time, and I am sorry, I am not
trying to be rude with you. But there was a report in the Miami
Herald that you actually had a meeting with Epstein's attorney
at the Marriott Hotel in West Palm Beach where he convinced you
to either drop the charges or not look into the charges. And
then there was some mention that perhaps Mr. Epstein gave you
information about other people. Is any of that correct?
Secretary Acosta. There is a lot of information in the
public record that is not correct. I saw that report in the
Herald, and it referenced October 2007, I believe. And I looked
at the date on which the agreement was signed where Federal
authorities said they would defer to the State attorney if he
actually went to jail, if he actually registered as a sex
offender and paid restitution. And the date for that meeting
postdated the agreement.
Ms. Frankel. Did that meeting take place?
Secretary Acosta. Congresswoman, this was 12 years ago. I
don't remember, but I do know because I looked it up--I am like
what is going on here--that the agreement was actually signed
in September and the meeting took place in October after the
agreement was signed. And so the answer is that that could not
have been part of that agreement.
Ms. Frankel. Okay. So I am going to yield back. Just to say
this. My community is still very upset about this, and I hope
there will be another opportunity to really flush this out and
give you an opportunity to answer all these allegations because
I think we can all agree that a very vile, disgusting man who
molested underage girls, lots and lots of them, really got off
the hook. And with that, again, I am going to take you up on
helping me on this bipartisan trafficking bill. And I yield
back.
Ms. DeLauro. Congressman Cole.
Mr. Cole. I hadn't intended to ask you anything about the
matter just discussed, but I do feel compelled just to, if you
need to add something, to extend the time to you if you wanted
to put something on the record or respond in any way. If we cut
you off, it is certainly not anybody's intention. We are on
limited time. But I want to give you the opportunity to respond
to anything you would like, Mr. Secretary.
Secretary Acosta. Congressman, I appreciate that. And let
me just say, I understand the frustration. I think it is
important to understand he was going to get off entirely. Other
than something that would have required no jail time, no
registration, and no restitution, he was going to get off, and
it was the work of our office that resulted in him going to
jail. It was the work of our office that resulted in his having
to register and put the world on notice that he is a sex
offender, and put all these other victims potentially in the
future on notice that he is a sex offender.
And, you know, there is a lot of reference made to how he
was in prison by Palm Beach County after the fact. That was a
State plea, and that was determined under Florida law. And I
have been on record as condemning the terms of his
incarceration because the work release, I understand why folks
are upset. That was Florida law. That was not a Federal
decision. So I think it is important to separate what is
Florida and what is Federal.
Mr. Cole. Thank you very much, and just for the record,
have had the opportunity to work with you for a couple years,
and I find you a person of great integrity, great ability, and
great skill. And I think the President made a wise choice when
he chose you for this position, and I think you have more than
made him proud and more than done your job. And I just thought
that ought to be in the record as well, so thank you for your
service.
H-1B VISA FEES
Now, I really do have some other questions in the limited
time I have. Throughout your testimony and in the budget
documents, you have spoken about ways you support American
workers through the H-1B visa fees used for training and
through several job programs. So how will you enforce the labor
laws and trade agreements so that American workers are on a
level field in competing for jobs on the international stage?
Secretary Acosta. Well, you know, the references were made
earlier to that same issue, and that is an issue of very high
priority, particularly as we are looking at USMCA and the
adoption of USMCA. That is something that is critical. And so I
have spoken with Ambassador Lighthizer about that, and
certainly if after this budget process proceeds, if additional
resources are needed, that is something that can be part of the
enabling legislation, because we want to ensure that the
provisions of USMCA are fully complied with, that they are
fully enforced. We need to put American workers on a level
playing field.
JOB CORPS FUNDING
Mr. Cole. Well, that is a good thing to be trying to do.
One last question, and we all know, as Mr. Harris said, you
live within the budget that Congress and the Census dealt you
and the Budget Control Act. But I am concerned on the Job Corps
front. I mean, those are drastic cuts. If you had to do
something like that, if we did, what would be the criterion
that you would go through and use to make a decision of that
magnitude because clearly you would have to close down quite a
few centers around the country.
Secretary Acosta. If we were to close them down, we would
go through and look at the metrics, and we would try to do this
in a reasonably neutral way to see which Job Corps centers were
performing less than others. Let me also say one of the things
that we have been doing with Job Corps because some are not
performing particularly well and some have issues, is we have
tried to think a little bit outside the box. And I have briefed
your colleagues both on the Republican and the Democratic side.
There is a caucus that has been organized around this because
we have been working with some governors that have ideas as to
how to make these more effective.
And so in one State, the governor is interested in
partnering the Job Corps with the community college. In another
State, the governor is interested in partnering the Job Corps
with the National Guard Program. I was just going to
Congresswoman Lee's point a little bit earlier talking to a
governor that said wouldn't it be great to set up a Job Corps
to focus on individual that are reentering society. So as they
reenter society, they have the ability to get the skills that
they need to get jobs.
Mr. Cole. You know, I am essentially out of time, but I
would really encourage you, no matter what the budget line is,
to continue along those lines. There is no question there are
reforms to be made. I think there is a lot of good things that
can be done. You have just ticked of several of them that I
think this committee would have, on a bipartisan basis, strong
interest in being helpful in. So just as you develop that
thinking, I would encourage you to keep us informed so that we
can incorporate it into the work that we do here in this
committee. Thank you very much.
Secretary Acosta. Thank you.
Mr. Cole. Yield back, Madam Chair.
Ms. DeLauro. Congresswoman Roybal-Allard.
DETERMINING JOB CORPS CENTER CLOSURES
Ms. Roybal-Allard. Secretary Acosta, my question has to do
with the selection of Job Corps centers. And WIOA requires that
centers are chosen based on past achievement and outcomes, and
that is a significant part of that evaluation when making those
decisions. And this aligns with your own priorities for Job
Corps----
Secretary Acosta. Yes, it does.
Ms. Roybal-Allard [continuing]. In the form of increased
performance standards. Yet one of the things that I have heard
from operators and from constituents is that contract award
decisions are no longer tied to performance and student
outcomes. That, in fact, the vast majority of the contracts are
being given to new operators regardless of the successful
performance of the current contract holder. So are you
purposely moving away from focusing on student outcomes when
selecting Job Corps centers?
Secretary Acosta. In fact, Congresswoman, we are focusing
much more on student outcomes in judging Job Corps performance
and in Job Corps centers. So to the extent that is what
contractors are saying, that is inaccurate.
Ms. Roybal-Allard. Well, I can give you an example in my
own district with the Los Angeles Job Corps which has an
outstanding record, has been there for years, is something that
the community at large just raves about because of the outcomes
with the young people that it deals with. Yet you chose a
company that runs a private prison in addition to Job Corps
centers that absolutely has no connection whatsoever with Los
Angeles and doesn't understand it. So it is hard to believe
that standards, performance, outcome, relationship in the
community really is a priority when somebody like this could be
chosen.
Secretary Acosta. Congresswoman, I noticed that you had
sent a letter regarding this, and I inquired about this just
this morning. And I was told that the selection happened
actually before I was confirmed as Labor Secretary.
Ms. Roybal-Allard. That is true.
Secretary Acosta. And that there had been a job--I am
sorry--a selection protest, a contract protest, and it went to
GAO, and GAO upheld the contract selection. And so I can't
speak to what happened before I was Labor Secretary, but it is
certainly not my view that Job Corps centers should be selected
over anything other than outcomes.
But let me also say, let me actually be a little bit more
broad. One of the issues in Job Corps centers has also been a
lack of safety. And so when I say the focus should be on
outcomes, let me amend, if I could, and also say that safety is
incredibly important. This has nothing to do with this
particular Job Corps center, just for the record. Where there
is a safety issue, I think the safety issue has to be
considered right alongside performance outcomes.
Ms. Roybal-Allard. Maybe we can talk a little bit more
about that so I would understand that decision better.
Secretary Acosta. Gladly.
HEALTHCARE
Ms. Roybal-Allard. And I just want to make, I guess it is
more of a statement than a question, with regard to what
Congressman Harris was saying in the beginning. And you
mentioned the fact that you were hoping that the Supreme Court
would rule in the Administration's favor when it came to ACA.
And I just want to point out that if they were to rule in favor
of the Administration, that the decision would be immediate.
The impact would be that over the first year people would be
losing their health insurance. Medicaid expansion would go
away. States could not afford to cover those individuals that
were newly enrolled, and they would not be able to offer
coverage in the following years. What is the President's
proposal to replace ACA?
Secretary Acosta. Congresswoman, thank you. I think
Congressman Harris' question went to association health plans.
But going to your question regarding the ACA, clearly if the
Supreme Court was to strike it down, the President would have
to work and should be working with Congress because we need----
Ms. Roybal-Allard. Let me just interrupt you because what
the President has said is that he will work on the replacement
after the election, which would be in 2021, which means all
these people, including those that have preexisting conditions
and are being treated now, would lose their healthcare, and
their lives would be in danger. I yield back.
Ms. DeLauro. I now recognize Congressman Cole for any final
comments.
Mr. Cole. I want to thank you, Mr. Secretary. I, again,
apologize to you and apologize to my friends on the committee
for arriving late. And I would have preferred to be here early
because I, frankly, always find your testimony enlightening and
helpful to this committee. But, again, I want to thank my chair
for allowing me to come in at a later time.
DOL ACCOMPLISHMENTS
We have put some incredibly important responsibilities in
your hand, an extraordinarily wide range of authority. And I am
very satisfied, honestly, with the manner in which you have
handled it ever since you have been at the Department of Labor.
I think you have got a great staff. I think some of the work
you have done, and I know it is sometimes controversial, but
things like the associate health plans is just really cutting
edge.
And I feel like you and the President have put the
appropriate emphasis on apprenticeship programs, trying to get
us the kind of workforce that is employable so folks can go on
and have successful lives and careers. And it worth noting, as
my friend, Mr. Harris, pointed out, you must be doing something
right when we have got an unemployment rate that is the lowest
we have had in nearly a half century, and when we have
historically disadvantaged groups that are doing better in
terms of their employment rates and wage growth than we have
seen in quite some time.
So I think that doesn't mean there is not a lot to do.
There is always a lot to do. It doesn't mean we can't do better
and shouldn't try to do better. It does, and we will. But, you
know, I think every now and then, while it is our appropriate
job here to be rigorous in our oversight and to ask tough
questions, you know, I think we do that pretty well on a
bipartisan basis, and I have no problem.
Every now and then we need to pull back and look at the
results, and at least in terms of what is happening to American
workers in terms of their employment rates, in terms of their
compensation, and in terms of trying to close a really stubborn
skills gap and provide, and, frankly, for the benefit of the
country as well as the workers, that we use the people that we
have in ways that are fulfilling to them and allow them to
prosper. Your record is pretty good, and it is something that
you and your colleagues at the Department can be exceptionally
proud of.
So thank you for the manner in which you lead, the manner
in which you conduct yourself, and I look forward to working
with you for the balance of the Administration. Thank you very
much, Madam Chair. I yield back.
JOB CORPS SAFETY AND BUDGET CUTS
Ms. DeLauro. Thank you very much. Let me just make a couple
of comments and then closing remarks as well. I just want to
set the record straight in some of these areas. We spoke about
Job Corps and about safety. I think it is important to note
that while the safety of students should always be the most
important concern for these centers, a $700,000,000 cut to the
program does not ensure their safety.
ILAB CUTS
I quite honestly, Mr. Secretary, do not know what you were
speaking about when you had the conversation with Ambassador
Lighthizer with regard to ILAB and enabling legislation. I
think that the severe cuts to ILAB really does put us in a
place where we are not really taking the opportunity to oversee
trade agreements. I might add that forced labor, child labor,
the ILAB labor attaches and other expert ILAB staff, they
completed an important 4-year project that tackled the fire and
building safety for Bangladesh's garment workers. So I don't
know what enabling legislation you are making reference to, and
at the moment we are not even sure where the renegotiated
treaty is going.
OVERTIME RULE CHANGES
With regard to the overtime rule, I just might note for the
record that under the Obama Administration's overtime rule,
workers with new protections would be 4,550,000 workers. Under
the Trump Administration's overtime rule, workers with new
protections would be 1,400,000 workers.
I, too, like my colleague, Tom Cole, and what I said at the
outset, it was not my intention to make any reference to what I
established at the outset of the kind of a cloud that exists
with regard to the Epstein case. But I would also say to you
that I think it is important that the district judge did find
that the Secretary violated the Crime Victims' Rights Act by
secretly arranging a plea deal. The issue here is for the sake
of the victims, justice needs to be served, and I am sure there
are lots of legalities around this. But I would just make that
point because I think we have to understand all of the pieces
of the case as well.
DOL MISSION AND BUDGET CUTS
As I said in my opening remarks, the mission of the
Department, and I will quote it again, is ``to foster, promote,
develop the welfare of wage earners, job seekers, the retirees
of the United States, improve working conditions, advance
opportunities for profitable employment, assure work-related
benefits and rights.'' And I think you can see from most of the
questions here today from the subcommittee, there is really
deep concern about the proposed cuts and eliminations. And,
quite honestly, your answers do not bear out the fact of what
you say right up front on the first page of your testimony that
we can do more with less.
On OSHA, I have to note that your own Department's data
contradict your claims. You talked about work development and
employment and training. That has been cut $1,200,000,000.
Again, with OSHA, the Agency has the lowest number of
inspectors in years. Your decision to not hire any inspectors
from January 2017 to October 2017 did not help. And meanwhile,
the number of work fatalities investigated by OSHA is at a 10-
year high.
Finally, there have been comments made today that the
Administration is simply living within the caps. That is simply
false. The President actually proposed massive increases for
defense spending through a budget gimmick. If the
Administration was actually adhering to the caps, the defense
budget would be cut by $71,000,000,000. What he is doing is
promoting outside of the cap through OSHA, a self-described
budget gimmick. The request is $105,000,000,000 more than was
enacted in Fiscal Year 2019. So it is not true that the
Administration is living within the caps.
Closing Remarks by Chairwoman DeLauro
Your mission is the heart and soul of what this country is
about is in terms of fostering work and giving people the
opportunity for job training, for the opportunity to have a
life with economic security. And we know that 70 percent of the
people in this country do not have a 4-year college degree,
and, quite frankly, they may not need one. But we do have the
obligation to look at employment and training, and look at the
best way to provide them with the potential for their success.
And that is through a very substantially good-run program of
registered apprenticeships. It is working.
The Europeans have standards, strict standards. To open the
door to what has happened to the for-profit colleges and what
has happened with the loan servicers, and putting students at
risk, that is not the road that we need to go down. That is not
what this Agency is about. You are the Secretary of Labor, and
I would think that what you would want on your watch is a way
to build a workforce for the 21st century and not cut the
corners and cut the programs, the heart out of the programs,
that would help to make that difference.
I am going to call this hearing to a close.
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W I T N E S S E S
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Acosta, Hon. Alexander........................................... 333
Azar, Hon. Alex.................................................. 1
Bianchi, D. W.................................................... 233
Collins, F. S.................................................... 233
Devos, Hon. Betsy................................................ 101
Fauci, A. S...................................................... 233
Gibbons, G. H.................................................... 233
Lowy, Doug....................................................... 233
Volkow, Nora..................................................... 233