[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
SOFTWARE UPDATE REQUIRED: COVID-19
EXPOSES NEED FOR FEDERAL
INVESTMENTS IN TECHNOLOGY
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON THE BUDGET
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
HEARING HELD IN WASHINGTON, D.C., JULY 15, 2020
__________
Serial No. 116-29
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Printed for the use of the Committee on the Budget
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available on the Internet:
www.govinfo.gov
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U.S. GOVERNMENT PUBLISHING OFFICE
42-321 WASHINGTON : 2020
COMMITTEE ON THE BUDGET
JOHN A. YARMUTH, Kentucky, Chairman
SETH MOULTON, Massachusetts, STEVE WOMACK, Arkansas,
Vice Chairman Ranking Member
HAKEEM S. JEFFRIES, New York ROB WOODALL, Georgia
BRIAN HIGGINS, New York BILL JOHNSON, Ohio,
BRENDAN F. BOYLE, Pennsylvania Vice Ranking Member
ROSA L. DELAURO, Connecticut JASON SMITH, Missouri
LLOYD DOGGETT, Texas BILL FLORES, Texas
DAVID E. PRICE, North Carolina GEORGE HOLDING, North Carolina
JANICE D. SCHAKOWSKY, Illinois CHRIS STEWART, Utah
DANIEL T. KILDEE, Michigan RALPH NORMAN, South Carolina
JIMMY PANETTA, California KEVIN HERN, Oklahoma
JOSEPH D. MORELLE, New York CHIP ROY, Texas
STEVEN HORSFORD, Nevada DANIEL MEUSER, Pennsylvania
ROBERT C. ``BOBBY'' SCOTT, Virginia DAN CRENSHAW, Texas
SHEILA JACKSON LEE, Texas TIM BURCHETT, Tennessee
BARBARA LEE, California
PRAMILA JAYAPAL, Washington
ILHAN OMAR, Minnesota
ALBIO SIRES, New Jersey
SCOTT H. PETERS, California
JIM COOPER, Tennessee
RO KHANNA, California
Professional Staff
Ellen Balis, Staff Director
Becky Relic, Minority Staff Director
CONTENTS
Page
Hearing held in Washington, D.C., July 15, 2020.................. 1
Hon. John A. Yarmuth, Chairman, Committee on the Budget...... 1
Prepared statement of.................................... 4
Hon. Bill Johnson, Vice Ranking Member, Committee on the
Budget..................................................... 6
Prepared statement of.................................... 8
Teresa Gerton, President and Ceo, National Academy of Public
Administration............................................. 11
Prepared statement of.................................... 14
Jennifer Pahlka, Founder, Code for America, and Co-Founder,
U.S. Digital Response...................................... 26
Prepared statement of.................................... 28
Rebecca Dixon, Executive Director, National Employment Law
Project.................................................... 36
Prepared statement of.................................... 38
Robert Wah, MD, Physician Leader in Healthcare and Technology 49
Prepared statement of.................................... 52
Hon. Steve Womack, Ranking Member, Committee on the Budget,
statement submitted for the record......................... 84
Hon. Sheila Jackson Lee, Member, Committee on the Budget,
statement submitted for the record......................... 87
Hon. Bill Flores, Member, Committee on the Budget, questions
submitted for the record................................... 92
Hon. George Holding, Member, Committee on the Budget,
questions submitted for the record......................... 93
Answers to questions submitted for the record................ 94
SOFTWARE UPDATE REQUIRED: COVID-19
EXPOSES NEED FOR FEDERAL
INVESTMENTS IN TECHNOLOGY
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WEDNESDAY, JULY 15, 2020
House of Representatives,
Committee on the Budget,
Washington, D.C.
The Committee met, pursuant to notice, at 2:07 p.m., via
Webex, Hon. John A. Yarmuth [Chairman of the Committee]
presiding.
Present: Representatives Yarmuth, Moulton, Higgins,
Schakowsky, Kildee, Panetta, Morelle, Horsford, Scott, Jackson
Lee; Woodall, Johnson, Flores, Meuser, Crenshaw, and Burchett.
Chairman Yarmuth. This hearing will come to order.
Good afternoon, and welcome to the Budget Committee's
hearing entitled Software Update Required: COVID-19 Exposes
Need for Federal Investments in Technology.
I want to welcome our witnesses who are here with us today.
At the outset,--I ask unanimous consent that the Chair be
authorized to declare a recess at any time to address technical
difficulties that may arise with such remote proceedings.
Without objection, so ordered.
As a reminder, we are holding this hearing virtually in
compliance with the regulations for committee proceedings
pursuant to House Resolution 965. First, consistent with
regulations, the Chair or staff designated by the Chair may
mute participants' microphones when they are not under
recognition for the purposes of eliminating inadvertent
background noise.
Members are responsible for unmuting themselves when they
seek recognition or when they are recognized for their five
minutes. We are not permitted to unmute Members unless they
explicitly request assistance. If I notice if you have not
unmuted yourself, I will ask if you would like the staff to
unmute you. If you indicate approval by nodding, staff will
unmute your microphone. They will not unmute you under any
other conditions.
Second, Members must have their cameras on throughout this
proceeding and must be visible on screen in order to be
recognized. As a reminder, Members may not participate in more
than one committee proceeding simultaneously.
Finally, to maintain safety in light of the Attending
Physician's new guidance, any Members present in the hearing
room--must wear a mask at all times when they are not speaking.
Those Members not wanting to wear a mask, the House rules
provide a way to participate remotely from your office without
being physically present in the hearing room.
Now I will introduce our witnesses.
This afternoon, we will be hearing from Ms. Teresa Gerton,
president and CEO of the National Academy of Public
Administration; Ms. Jennifer Pahlka, founder of Code for
America and co-founder of U.S. Digital Response; Ms. Rebecca
Dixon, executive director of the National Employment Law
Project; and Dr. Robert Wah, a physician leader in healthcare
and technology.
I will now yield myself five minutes for an opening
statement.
It is appropriate that today, on our postponed tax day, we
are discussing how our nation's outdated information technology
systems have failed to meet the needs of the American people.
Rash funding cuts over the past decade have prevented the IRS
from modernizing its IT systems, deteriorating the agency's
ability not only to carry out its core function of tax
collection and enforcement, but also needlessly prolonging the
delivery of stimulus payments to workers and families during
the coronavirus pandemic and recession.
The pandemic has proved that the quicker the response, the
better the outcome, and that the steps taken by Congress to
help American workers and families are only as effective as the
agencies delivering that relief. Unfortunately, the IRS is not
alone in its inability to meet the needs of the American people
in these perilous times.
Instead of helping to generate much needed solutions,
outdated IT systems are worsening an already difficult
situation as Americans grapple with unreliable or insufficient
internet access, useless automated systems, and overwhelmed and
underprepared agencies. Emergency assistance programs across
the board have been hampered by our antiquated IT systems,
leaving families with delayed relief or no relief at all.
The most glaring example is unemployment assistance. We are
four months into the worst economic downturn since the Great
Depression, and there are still tens of thousands of workers
who have filed for jobless claims but have not yet received a
single payment. Many are going into debt or default, skipping
meals, or losing their homes.
State unemployment offices, already underfunded and
understaffed, were left completely unprepared for the massive
influx of need, and the big reason for that is the fact that
the national--administrative funding essentially is the same as
it was in 2001, and that is before accounting for inflation.
This lack of federal investment, combined with old
hardware, crashing web services, and the need for new hires
proficient in COBOL, their systems' 60-year-old coding
language, have left states scrambling. The antiquated IT
systems failed and continue to fail repeatedly. American
workers, those who lost their jobs through no fault of their
own, are paying the price.
This aspect of our ongoing crisis is not new. The federal
government has long sought to prioritize modern, secure, and
shared IT solutions, but funding uncertainties stemming from
constrained discretionary funding under budget caps, shutdown
threats, and continuing resolutions have made agencies more
likely to update instead of modernize. And I might add, after
reading today's testimony, that it may be--another factor may
be a flawed philosophy of how to handle the whole data
management system.
GAO reports that while the total share of federal IT
spending is increasing, it isn't because we are investing in
better and new technology; it is because the price of updating
our existing systems is snowballing as our ancient software
becomes increasingly outdated and hardware parts nearly
impossible to find. We are passing these acute problems on to
state and local partners that distribute unemployment
insurance, nutrition assistance, and other support to workers
and families on behalf of the federal government.
Federal and state governments are in dire need of solutions
and investments now. We cannot foster a successful recovery
while relying on IT systems from the 1950's. We cannot meet the
demands of today when we are depending on software that is
older than some Members of this Committee.
To date, Congress has passed legislation that includes $1
billion in grants to state unemployment offices to help process
claims faster, and more is needed.
By refusing to bring the Heroes Act to the floor, Leader
McConnell is holding up an additional $1 billion for the
Federal Technology Modernization Fund and a combined $5.5
billion to help schools, libraries, and impacted families
access high-speed connectivity and devices to facilitate
distance learning, something we must prioritize in order to
protect our children and educators.
Earlier this month, House Democrats passed the Moving
Forward Act, a comprehensive infrastructure package that
includes $100 billion in broadband funding to extend high-speed
internet to underserved and hard to reach communities.
We have to invest in modernization now so that the federal
government can help provide workers, families, and state and
local governments with the necessary tools and resources to
support our nation's recovery act efforts. I look forward to
discussing this urgent need with our witnesses.
I now yield five minutes to the Ranking Vice Chair, Mr.
Johnson of Ohio.
[The prepared statement of Chairman Yarmuth follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Johnson. Well, thank you, Mr. Chairman, and thank you
for holding this important hearing. And a special thanks to our
witnesses for joining us today.
You know, as an information technology professional with
over 30 years in the industry, I understand just how important
IT is in today's digitally connected world, and there is no
doubt that the coronavirus pandemic has demonstrated the need
for workers, businesses, and students all across America to
have reliable access to the internet. And these networks must
be secure. Instances of Zoom bombing cannot become commonplace
in our children's online classrooms, nor can businesses operate
on hacked systems.
In areas such as eastern and southeastern Ohio, other rural
parts of the country, the coronavirus has emphasized the need
for broadband internet access, period. Our students in rural
Appalachia are not, for example, able to take advantage of e-
learning because they simply don't have access to the internet.
I have even heard horror stories from local teachers having
to teach their classes remotely from their cars parked in a
McDonald's parking lot because they don't have access to
internet at home. While I applaud their dedication to their
students, I am simultaneously frustrated by the lack of
progress we have made on solving the digital divide.
It is also imperative that federal information technology
systems are safe, secure, and reliable. Federal workers, many
of whom have been working remotely the last several months,
often handle sensitive or classified data. It is vitally
important that we have procedures in place to ensure that only
authorized personnel have access to such data so that we can
prevent exposure of personally identifiable data and avoid
greater national security risks.
And we have seen how the coronavirus has heightened our
awareness of just how fragile our supply chains are, including
our reliance on other countries for critical items, including
the dangers of companies controlled by our adversaries that are
equipping our networks. We must ensure that companies like
Huawei and ZTE no longer have access to our networks.
While these concerns call for federal assistance for
efforts such as rip-and-replace programs, the federal
government should also leverage American ingenuity. I have
often said technology industries have, in part, been so
successful because the federal government can never find a way
to regulate them.
Public-private partnerships and investments in tech
startups here at home can be more cost effective and, in the
long run, more advantageous in terms of providing methodologies
for advancing needed IT solutions. America has always been and
must continue to be the frontrunner in technological
innovation.
Information technology crosses every sector of our economy,
and investments in IT can drastically improve our way of life
by creating efficiency, providing access to an ever increasing
digital global economy, lifesaving medical treatments, motor
vehicle safety, advanced weapons systems to provide our
national security, and countless other solutions to problems
that we haven't even begun to realize yet.
However, we must ensure that federal funds are used
efficiently and transparently, particularly when it comes to
IT. We have seen far too many instances of the federal
government throwing money at a problem instead of investing in
carefully detailed and proven solutions. One example of this
occurred at the VA back in 2012. Then VA Secretary Shinseki's
main objective was creating an electronic health record, yet
his top IT adviser could not show me a graphic of the
Department's IT architecture.
If a federal agency can't show Congress exactly where the
IT funding would be going, how the systems connect, how the IT
investments would enable the agency to further its main
missions, then we shouldn't be supporting and increasing in an
IT's--in an agency's IT budget.
There is no question that federal funding for IT
modernization is important, but many challenges of IT
modernization efforts have included missed deadlines, cost
overruns, and the abandonment of failed programs, not to
mention a lack of transparency.
Federal IT programs are important, but Congress must focus
on reining in auto-pilot spending, while prioritizing limited
discretionary resources on federal IT investments that demand
agency accountability, efficiency, and ultimately successful
execution.
I look forward to hearing from our witnesses on this
important topic.
Mr. Chairman, thanks again for this hearing, and I yield
back.
Mr. Chairman, you are muted.
[The prepared statement of Bill Johnson follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you. See, they mute me too,
automatically.
Anyway, thank you, Mr. Johnson, for your opening statement.
In the interest of time, if any other Members have opening
statements, you may submit those statements electronically to
the clerk for the record.
Once again, I want to thank our witnesses for being here
this afternoon. The Committee has received your written
testimony, and they will be made part of the formal hearing
record. Each of you will have five minutes to give your oral
remarks. As a reminder, please unmute your microphone before
speaking.
Ms. Gerton, you will be recognized first for five minutes.
Please unmute your microphone. You may begin when you are
ready.
STATEMENTS OF TERESA GERTON, PRESIDENT AND CEO, NATIONAL
ACADEMY OF PUBLIC ADMINISTRATION; JENNIFER PAHLKA, FOUNDER,
CODE FOR AMERICA, AND CO-FOUNDER, U.S. DIGITAL RESPONSE;
REBECCA DIXON, EXECUTIVE DIRECTOR, NATIONAL EMPLOYMENT LAW
PROJECT; AND ROBERT WAH, MD, PHYSICIAN LEADER IN HEALTHCARE AND
TECHNOLOGY
STATEMENT OF TERESA GERTON
Ms. Gerton. Thank you, Chairman Yarmuth, Ranking Member--
Vice Chair Johnson, and Members of the Committee. I appreciate
the opportunity to testify today.
I am a fellow of the National Academy of Public
Administration and have served as its president and chief
executive officer since January 2017. Established in 1967 and
chartered by Congress in 1984, the Academy is an independent,
nonprofit, and nonpartisan organization with a proven record of
improving the quality, performance, and accountability of
government at all levels.
As the title of this hearing plainly states, the
coronavirus pandemic has laid bare the challenging state of
government IT systems at every level, but this is not a new
problem.
In 2016, the Government Accountability Office identified
the 10 oldest IT systems in the federal government. At that
time, they included the IRS Individual Master File that
receives taxpayer data and dispenses refund, the Department of
Veteran Affairs Benefit Delivery Network that tracks benefit
claims filed by veterans, and the Transportation Department's
Hazardous Material Information System.
IT modernization has been on GAO's High Risk List for
decades, and critical IT-related topics on the most recent list
include the 2020 Census, DoD's business systems modernization,
and the nation's cybersecurity.
This situation, though, does not surprise those in
government who have been keeping these outdated systems
operational through both extraordinary ingenuity and the
electronic equivalent of baling wire and duct tape. But it does
beg another question: If government officials know how close
these critical systems are to failure, why haven't they fixed
them before now?
As our government IT systems rely on programming language
and hardware developed in the mid-20th century, our federal
budgeting and acquisition systems are equally archaic. In the
simplest example, it is far easier to get budget authority to
maintain those old COBOL systems than it is to procure an agile
software development and sustainment contract that would
deliver modern functionality, improve cybersecurity, and better
citizen service.
Regarding acquisition practices, the federal acquisition
regulation unrealistically categorizes all purchases as either
supplies or services. This distinction, established decades
ago, is too rigid to effectively procure modern technology
solutions with evolving delivery models. It often leads to
contracts that are neither optimized, nor appropriate for the
solution being acquired.
Ironically, government bears an extra cost burden for such
strategies because they must allocate expensive resources to
maintain obsolete and inefficient solutions, which by any
reasonable standard should have been rationalized and replaced
long ago.
Institutionally, we approach IT as an overhead cost, always
seeking to minimize it instead of seeing it as a fundamental
tool in the 21st century that would deliver increased
accountability, better outcomes, and improved citizen
satisfaction.
In a recent attempt to address this situation, Congress
authorized the Technology Modernization Fund in the Modernizing
Government Technology Act of 2017. The TMF received $100
million in 2018 to fund modernization projects, $25 million in
2019, and an additional $25 million in Fiscal Year 2020, and
yet Members of Congress remainskeptical of a revolving fund
approach to IT investment.
The Academy recognized these challenges when we released
last November our list of 12 grand challenges in public
administration. Our list of grand challenges includes ensure
data security and privacy rights of individuals and make
government AI ready. We also established the Agile Government
Center to assist government agencies with applying to their
business practices the agile development processes that have
made software development so rapid and responsive. We are
currently developing proposed agendas in these and all 12 of
the grand challenges, the drive change beginning in January
2021.
In our ongoing mission to promote best practices, the
Academy has partnered with sponsors to cohost a monthly forum
on shared services and quarterly forums on grants management
and working capital fund management. Taken together, these
three venues are helping managers across the federal government
modernize their business practices and IT investment strategies
to improve operations and reduce costs. They are making the
improvements they can within the rules they currently operate
under. But to really change the future, we must change the
rules.
Today, the government has challenges with cloud
procurement, but the market is constantly evolving. More things
will be sold as a service in the future. And with enablers like
quantum computing and machine learning, technology innovation
will inevitably continue at an increased rate. We must be ready
to effectively acquire the resultant solutions or risk failures
in our support to our citizens and potentially catastrophic
failures in our ability to govern.
The National Academy of Public Administration stands ready
to assist in all of these efforts.
Mr. Chairman, that concludes my statement, and I would be
pleased to answer any questions you or the Committee Members
may have.
[The prepared statement of Teresa Gerton follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you, Ms. Gerton, for your
testimony.
I now recognize Ms. Pahlka for five minutes. Please unmute
your mic and proceed.
STATEMENT OF JENNIFER PAHLKA
Ms. Pahlka. Thank you.
Chair Yarmuth, Ranking Member Womack, and Members of the
Committee, I very much appreciate your inviting me here today
to add my voice to this critical topic.
A common proverb tells us that the best time to plant a
tree was 20 years ago, and the second best time is now. Now
that COVID has thrown millions of Americans' lives into chaos
and created unprecedented need for support, it is clear that
the best time to modernize government services was 20 years
ago.
We have largely failed to update our policies, processes,
and technology to enable scalable, agile, human-centered
services, and now we find that while Congress has the will to
support the American people through this crisis, in too many
areas the machinery of government just can't deliver.
Up to 15 million people have not received their stimulus
checks. People who may have been exposed to the virus are not
alerted quickly because too many counties still share data by
fax machine. It is clear that the next best time to modernize
our government is now.
We must invest in modernizing the technology that runs our
services, but I am deeply concerned that the urgency of the
moment will cause us to forget that we must also change how we
make these investments. Now, more than ever we cannot afford to
pour time, attention, and enormous sums of money into a process
for building and buying software that hasn't worked for
decades.
Let's take unemployment benefits. The state systems that
deliver this service rely on a hodgepodge of legacy systems,
and as has been already called out in this hearing, at their
core, many of them still use mainframe systems running a
programming language designed in 1959. We are asking this
technology to be agile, handling now the demands of three
programs with dependencies between each instead of one; we are
asking it to scale, in some places to nine to 20 times the
previous volume; and we are asking it to work for people, for
the questions and processes to be clear so that applicants know
how to answer them accurately without assistance, for the
people who administer the program to be empowered to make
decisions that get the benefit to those in need as fast as
possible.
Neither the technology nor the policies were designed to be
agile, scalable, or get to yes, and we have known this for
decades.
Ten years ago, the National Association of State Workforce
Agencies stated that most state IT systems cannot efficiently
handle today's demands. Many states joined consortia to
contract for new systems together. Some of these systems have
been implemented in the states for which they were procured.
Others are somewhere along in the 10-, 12-, even 15-year
procurement and development cycles. Collectively, they have
spent billions of taxpayer dollars, and, yet even the states
that had supposedly modernized are struggling to respond to
this crisis.
Modernization has largely failed in these cases and will
continue to fail as long as these projects and others that
support other very needed benefits follow the basic recipe of
large, slow government procurement and development done in the
conventional model. By definition, you cannot modernize if the
project takes over a decade. By definition--excuse me,-and you
cannot modernize by simply moving legacy policies and practices
that have accumulated over decades to slightly less outdated
technology platforms.
True modernization breaks down the silos between policy,
technology, and other disciplines so that the service itself
can be codesigned to work for its users and the people who
administer in it. True modernization means that services
provide real-time data about their usage, and that program
administrators analyze that data to understand what is working,
what is not working, and what can be done about it so that it
can get constantly better.
These agile, human-centered models for developing
government software systems work. When public servants are
allowed to use them, these models reduce risk, and the projects
that use them cost less and deliver results faster. These
models are currently in use at all levels of government, at
places like the United States Digital Service, GSA's 18F,
Kessel Run at the Air Force, Defense Digital Service, the
Centers for Medicare and Medicaid Services. Several states also
have stood up their own digital service teams.
But the vast majority of government technology projects
still do things the old way. Why? A common belief, or perhaps
an excuse, is that Congress dictates the old model and will
punish any deviation from how it has always been done. To fix
this, Congress will need to be more than a checkbook. This body
will have to become a staunch and visible ally of hybrid tech
policy teams who practice agile development and user-centered
design wherever they exist.
To use a metaphor beloved by my former boss, Todd Park, we
need to stop arming the empire and start arming the rebels.
Stop pouring millions of dollars into projects everyone knows
will fail. Fund the USDS and the state digital services who can
help others across government successfully implement these
practices. This is not just the next best time to truly
modernize government services; it is our last chance.
Thank you.
[The prepared statement of Jennifer Pahlka follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you, Ms. Pahlka, for your
testimony.
I now recognize Ms. Dixon for five minutes. Please unmute
your mic and proceed.
Looks like you haven't, Ms. Dixon.
STATEMENT OF REBECCA DIXON
Ms. Dixon. Thank you, Chairman Yarmuth and Ranking Member
Womack and Members of the Committee, for the opportunity to
testify today. I am Rebecca Dixon, executive director of the
National Employment Law Project, NELP.
The challenges facing workers seeking access to
unemployment insurance payments is an issue that NELP has been
working on for many years. I appreciate the Committee's work to
ensure robust UI access for millions of workers and job
seekers, especially underpaid Black, indigenous, Latinx people,
and workers of color.
The current employment surge poses--unemployment surge
poses an unprecedented challenge. Although new claims peaked at
6.6 million this week, this spring, states are still processing
upwards of two million claims a week, which is twice the
highest week in history. Workers are understandably frustrated.
During the course of this pandemic, it has been impossible
to ignore the human suffering from workers unsuccessfully
attempting to access UI. Entire online systems crashed in
several states. Workers trying to contact the agency with
questions about online applications have been unable to get
through. Some report calling dozens of times a day. Claimants
were confused about how to check the status of their claim and
were left in limbo for weeks.
States had difficulty reprogramming their systems to
provide expanded benefits. In some states, that took up to a
month and a half to establish the online application process
for the new pandemic unemployment assistance.
For underpaid workers, two months' delay can be the
difference between surviving and losing everything. For
example, Rheana from California was furloughed from a small
event production company, that the industry won't return for a
long time. She has already had to move to a cheaper apartment,
gone through her entire life savings waiting for unemployment,
and now is worried that she is going to lose her health
insurance, home, car, and even ability to eat.
Meanwhile, the program has been especially important for
workers of color. According to the CBO, 47 percent of workers
receiving UI in July are workers of color. This includes 16
percent of Black workers, 14 percent of Latinx workers, 10
percent of White workers, and 14 percent of workers of other
backgrounds.
Seven years ago, I wrote a report called Federal Neglect
Leaves State Unemployment Insurance Systems in Disrepair, and,
unfortunately, much of what I wrote remains true today.
Only 16 states have fully modernized their systems with the
rest operating on, as others have mentioned, a COBOL mainframe.
In addition, when states do not move to update these--do move
to update these outdated systems, we have seen significant
delays and service disruptions, breakdowns, backlogs, and
delays.
It is also important to recognize that modernization is not
a panacea and does not always mean progress. After all, Florida
has, quote, ``modernized their system,'' but it was built on a
foundation of public policy choices that were designed to limit
access to UI.
Few people realize that Florida's catastrophically failed
system was modernized with a consortium with Massachusetts and
New Mexico. When the other states in the consortium ran into
problems with user access, they went back to work with their
vendor to improve their systems, and as a result, did not have
the same results as Florida.
Michigan's IT system was also designed to fail. Its MiDAS
system flagged more than 40,000 workers for fraud, and its
accuracy was--it was 93 percent inaccurate. This is a really
big penalty. In Michigan, four times the amount paid, plus 12
percent interest, and as a result, some claimants lost
everything.
The new administration in Michigan has committed to
improving these systems and now has shifted course and become
one of the fastest states in terms of payment processing. We
know that faster payment processing is possible for all states.
Congress must ensure that UI IT systems are functional and
accessible. Specifically, NELP recommends funding
modernization, requiring input from workers and advocates from
beginning to end, and comprehensive user testing to ensure
participation from Black people who face the most barriers and
all communities of color.
We also want to include those who are on the other side of
the digital divide, people with limited English proficiency,
people with disabilities. DOL should also create a unit devoted
to IT that can give states hands-on assistance in
modernization, review contractor agreements, audit contractors
where necessary, and require states to document contractor
performance.
Creating a federal task force to evaluate program
performance and recommend reforms, including compliance with
civil rights laws. This task force would function to determine
whether some parts of this system need to be federalized, would
also have the authority to negotiate favorable terms with
vendors, and take advantage of the government's ability to
leverage cost savings and produce high-quality systems.
More broadly centered, customer-centered design and user
experience testing is also a recommendation. There are widely
accepted practices in the private sector that can be
implemented here. Unemployed workers need 24/7 online access,
mobile services, and they need their password reset protocols
improved.
In closing, the crisis has highlighted gaping holes in
accessing unemployment, but it has also created an opportunity.
We can build a 21st century system that is nimble enough to
handle disasters and designed to meet the needs of customers
who are depending on access to UI.
Thank you.
[The prepared statement of Rebecca Dixon follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you, Ms. Dixon, for your statement.
And I now recognize Dr. Wah for five minutes. Please unmute
and proceed when you are ready.
STATEMENT OF ROBERT WAH, MD
Dr. Wah. Chairman Yarmuth, Vice Ranking Member Johnson, and
Committee Members, thank you for inviting me to testify today.
My name is Robert Wah. I am a physician with over 23 years
of Active Duty Naval service and have worked in health IT for
over 25 years. I was the associate chief information officer
for Military Health at DoD, and then the first deputy national
coordinator at HHS, setting up the Office of the National
Coordinator for Health IT that we now call ONC. I also worked
in the private sector IT.
Health IT has advanced in three major waves. First, we
moved from paper records to digital information. Next, the
digital information was networked together. The third wave uses
this virtual pool of networked digital information for
analytics, machine learning, research, and population health.
Picture everyone in healthcare--patients, doctors and
providers, hospitals, pharmacies, payers, government, and
researchers--all around this virtual pool of interoperable
health information, putting in and taking data out.
The ONC has nearly completed Wave 1, and they are advancing
Wave 2 and 3. This work must be continued, supported, and
funded.
As has been noted, COVID-19 has exposed many needs and
opportunities for federal health IT funding beyond the
continued work on Waves 2 and 3. COVID-19 has highlighted the
value of virtual remote healthcare as effective, efficient, and
well accepted. Investment is needed to connect telemedicine
with this virtual pool of interoperable health information,
just like in-person care.
Health information exchanges formed in Wave 2 need to
support public health and research. Traditional public health
asks that certain diseases be reported when they are found,
like tuberculosis or sexually transmitted diseases.
The virtual pool of information will allow public health
officials to see patterns of new diseases and epidemics before
they are even named or reports are formulated. Clusters of
patients with fever, cough, and sudden loss of taste and smell
could be identified before we even knew to call it COVID.
Funding to connect public health agencies to this Wave 2
virtual pool is critical.
In parallel, investment is needed to connect research
innovation to the pool to expand clinical trials and use real-
world evidence about new COVID treatments and vaccines. The
pool has information about millions of people, not just the few
hundred or thousand in clinical trials.
Sam, if you could show my graphic, I would appreciate it.
[Graph.]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
COVID-19 tests normally just have the patient's name and
the result. Here is an example of the virtual pool across six
states combining information on 1.5 million COVID patients
tested, where they displayed the results, but also the
distribution of patients by age, gender, race, and ethnicity.
This is all because there is enrichment due to the virtual pool
of information that has added the patient's name and result.
Sam, you can take that picture down now.
For patients with chronic diseases like diabetes, high
blood pressure, heart and lung disease, COVID has made them
sicker and die more frequently. Patients with chronic diseases
also use the largest part of our healthcare expenditures.
We can connect with these patients in places they visit
frequently. There are self-service smart health stations with
free blood pressure, weight, BMI, and health assessments in
pharmacies, grocery stores, and for hard-to-reach population,
food banks and unemployment offices. Funding investment can
connect them to the virtual information pool so public health
tools can be employed.
One network has 10,000 stations nationwide and has taken
over 350 million measurements in the last eight years. These
could identify hotspots of prediabetes, high blood pressure,
obesity, and cardiovascular disease, targeted for prevention
and precautions during pandemic exposure and connect the
patients to virtual and in-person care.
COVID-19 has also highlighted the need to increase funding
for supply chain technology and management in conjunction with
our Strategic National Stockpile. As we send doctors and
healthcare workers into battle every day, we must arm them with
medications, equipment, eventual vaccines, and personal
protection equipment, PPE, to effectively fight the war against
the pandemic.
I hope we will have time later to talk about using clinical
data outside healthcare, like back to work and travel, as well
as cybersecurity.
These are complex issues. Health is vital and personal to
all of our citizens, and costs make up a large part of the GDP.
Government must use all available levers--policy, regulations,
legislation, as well as financial--to improve the health of the
nation. Investment in health IT has a high impact on the health
of our citizens and a higher return on investment. We must
continue investments in Wave 2 and 3 in coordination with the
ONC. Funding for the issues above will improve the health of
our citizens during this fight against the COVID-19 pandemic
and future health threats.
Thank you for the opportunity to be here today. I look
forward to your questions. Thank you very much.
[The prepared statement of Robert Wah follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you, Dr. Wah, for your testimony.
And, once again, thanks to all the witnesses for their
testimony.
We will now begin our question and answer session. As a
reminder, Members may submit additional questions to be
answered later in writing. Those questions and answers to the
witnesses will be made part of the formal hearing record. Any
Members who wish to submit questions for the record may do so
by sending them to the clerk electronically within seven days.
As I usually do, I will defer my questions until the end,
so I now recognize the Vice Chairman of the Committee, the
gentleman from Massachusetts, Mr. Moulton, for five minutes.
Mr. Moulton. Good afternoon. Thank you, Mr. Chairman. And I
want to thank all the witnesses for making the time to testify.
And I would like to offer a special thanks to Ms. Pahlka.
My team worked closely with Code for America's Boston Brigade
to develop an app to educate current and retired public
servants about the Social Security windfall elimination
provision and allow them to accurately calculate their likely
web production. This app is now hosted by Mass Retirees, an
organization of retired public employees in The Bay State, and
I am extremely grateful for your leadership and vision that
helped make this project possible.
Sir Winston Churchill is credited with first saying,
``Never let a good crisis go to waste.'' He said that in the
mid-1940's as we were approaching the end of World War II. We
must take the opportunity to learn from our crisis today to
prepare better for the future and to create a more capable
government and a stronger, better country for our children and
grandchildren.
Per a recent GAO report, the federal government invested
over $90 billion in IT in Fiscal Year 2019, but 80 percent of
this, a staggering $72 billion, went toward operating and
maintaining existing aging IT investments.
I mean, can you imagine if you spent 80 percent of your
household budget in the next five years not on buying new
devices--upgrading your TV or phone or buying a new computer
when yours becomes obsolete--but simply maintaining the devices
that you have? Think about that; investing almost the entirety
of your family IT budget in repairing your 1950's TV set to
keep it working every year, which only becomes more expensive
over time as the technology becomes more obsolete, rather than
ever buying a flat screen.
Now, speaking of 80 percent, I agree with 80 percent or
more of the Vice Ranking Member's opening statement. We need to
modernize our IT, we need to ensure that our systems are
secure, and we need to win the competition with China that,
frankly, we are starting to lose.
But I also want to point out two important places where I
disagree. Mr. Johnson spoke about investing in proven
solutions, and I completely agree with him when it comes to the
willingness of government to take commercially available off-
the-shelf solutions and put them to work for all of us.
In fact, my very first piece of legislation I passed as a
Member of Congress was a bill to get the VA to use commercially
available scheduling apps to enable veterans to schedule their
own appointments electronically when the VA wanted to instead
spend tens of millions and much more time developing a
proprietary solution on their own.
But speaking more broadly about government investment in
tech, if we only invest in proven solutions, we are guaranteed
to lose the race to China, because China is investing their
federal dollars in next-generation technology, from biotech to
quantum computing and pushing the frontier forward, not in
buying tech that exists, but in developing technology that does
not.
In fact, the Republican witness at our previous hearing
specifically pointed out that federal investment should be
focused on technology that is unproven, specifically because
taking these investment risks is necessary for progress, but
often unbearable by the private sector.
The other point is no regulation of tech. I hate excessive
regulation as much as any American. The complete and total lack
of any regulation in tech is why we have foreign influence in
our elections, unbridled monopolistic power in big tech, and we
rely not on elected representatives of the people to establish
laws for weighty issues like which Facebook or Twitter post to
delete, but, rather, rely on 20-something kids in black boxes
to make those decisions on their own, with no accountability
whatsoever to elected officials or the American people. There
is a place for regulation in tech, and there is much more that
we need to do.
My last engagement before this hearing was a visit to North
Shore Medical Center, our local hospital, to thank the heroes
on the front lines who have been fighting this pandemic, and
doing so quite successfully here in Massachusetts, I might add,
where we take our science seriously and our case numbers
continue to go down. Of course, we are preparing for that to
change given what is happening in the rest of the country.
There, I heard from doctors and nurses who want to make
sure we heed Churchill's advice and ensure that we don't just
keep doing the things the same way after this crisis.
One great example was how the psychiatry department has had
greater success with telehealth appointments than in-person
visits, enabling people to keep appointments despite other
medical conditions or family conflicts.
Of course, modernization should happen in Congress as well.
One of my team members, Ananda Bhatia, founded the
Modernization Staff Association, a bipartisan group that
focuses on internal reform issues that primarily affect junior
Hill staffers. We have a lot of work to do in that department
as well, looking ourselves in the mirror.
With that, Mr. Chairman, I yield back.
Chairman Yarmuth. Your time has expired.
I now recognize the gentleman from Ohio, Mr. Johnson, for
five minutes.
Mr. Johnson is not responding.
Can you unmute, Mr. Johnson? Are you there?
Well, in that case, I will yield five minutes to the
gentleman from Texas, Mr. Crenshaw. We will come back to Mr.
Johnson.
Mr. Crenshaw on? Mr. Crenshaw? No.
How about Mr. Burchett?
Oh, Mr. Flores? How about Mr. Flores from Texas? I know he
is here. I yield five minutes to Mr. Flores from Texas.
Mr. Flores. And so I am here, and thank you, Mr. Chairman.
Anyway, I appreciate the witnesses for joining us today.
Dr. Wah, I have a few questions for you. Let me give you
the preamble to the first set. In 2011, the VA and DoD began an
electronic health record modernization initiative to replace
two separate electronic health record systems that were used by
the two departments to combine them into a single shared
system. And in 2013, after spending more than a billion dollars
on the program, the secretaries of VA and DoD announced that
they would not continue their joint development of a single
EHR. Instead, the VA would buy and convert to the DoD her
system.
I remember being on the VA Committee at the time and was
pretty frustrated about that, because Congress had ordered the
DoD and the VA over a decade earlier to combine their systems.
So the first question is: What were the problems that were
encountered that led to the abandonment of this project? Dr.
Wah?
Dr. Wah. Yes. I had to unmute real quick.
Mr. Flores. OK.
Dr. Wah. Thank you, Congressman. First and foremost, I
would say that I left the DoD in 2006, so these events that you
are describing happened after my departure, so I certainly
don't have firsthand knowledge or inside view on circumstances
that you discussed.
It is a complex problem in dealing with two health systems
that take care of nearly 20 million patients around the world.
From my point of view, part of it is I think that the important
thing to remember is that there are different requirements for
the two organizations. The VA, while they are both healthcare
systems taking care of patients, the location and the manner in
which they take care of those patients are vastly different.
So I basically came from the Department of Defense, where
we have brick-and-mortar hospitals in the continental U.S., but
also hospitals in Landstuhl, Germany; Japan; and things like
that. But on top of that, we have a readiness and a battlefield
commitment to caring for our beneficiaries as well, and so we
have got to have a system that can meet those requirements that
are very unique in the battlefield, in the deployed
environment; that the VA is more about brick-and-mortar systems
that we are accustomed to here in the continental U.S.
So I just point that out that, you know, the requirements
are quite different between the two organizations, and so
finding a solution that meets all of those requirements is an
extensive challenge.
The other thing I would say is that the DoD and the VA also
had really pursued slightly different strategies about
government-built software versus commercially off-the-shelf
software, and so, again, merging those two issues is another
big challenge.
And so, again, I wasn't there when these decisions were
made, so I can't give you direct insight into your question,
but these are some of the issues that I have seen that have
come up in trying to deploy these vast systems for
organizations that have different requirements.
Mr. Flores. Thank you. I appreciate that. By the way, I
wasn't totally trying to hold you culpable for those issues,
so--let me--I have a couple of other questions for the record
on that, which we will submit and ask you to submit in writing,
but you brought up something. You did a lot of work in the past
on modernizing the DoD IT system. Can you describe for us the
lessons learned from your experience with the DoD IT system?
What were your biggest successes, biggest challenges? And how
can we take the lessons learned from both the successes and
challenges and apply them to future IT implementation?
Dr. Wah. Thank you for that. I think one of the things I
would say that I found particularly useful that I have reused
in all my other IT work is that it is very important to have,
in particular in healthcare IT, clinical input at the outset,
at the design and development of the system, as well as in the
deployment of the system.
And I am biased obviously because I am a physician, but I
believe that having that clinical perspective early on makes
sure that the technology works in the business process and
workflow and environment in which it is going to be used.
Left without that, the technical architects and programmers
may build something that is technically correct but doesn't fit
the workflow and business process of healthcare. So there is
just something important to that that I think that adds to the
mix.
The second thing I would say, some of the biggest successes
I always cite is that--one example I give is that in the last
30 years, I haven't written a prescription on a piece of paper
in a military facility. That is a remarkable data point, I
think. We are all used to electronic prescribing today, but it
hasn't been around for 30 years in very many environments. And
what that did was not only the legibility issue about doctors'
handwriting, but it also allowed us to build a real-time data
set of 10 million beneficiaries' pharmacy history.
So now, when I write a prescription at Bethesda Walter Reed
and hit enter, it goes against this data base and immediately
comes back to me and tells me that the prescription I just
wrote is going to conflict with an allergy the patient has, a
medication they are already on, or that duplicates one they
have already picked up. And this real-time data base covers
whether they picked up their medication at the Bethesda
pharmacy, 66,000 civilian pharmacies, or got it through the
mail order system. And we have prevented hundreds of thousands,
millions of medication errors just because of that simple
change, going from paper prescriptions to digital.
So I think there are some major advantages that we can cite
throughout the time of military health system. There are
challenges, as you have already cited, and I won't go into all
those, but, you know, it is very challenging for a large
organization with that diverse set of responsibilities in
patient care to not have problems----
Mr. Flores. Well, thank you for your service. Thank you for
being here today.
I yield back.
Chairman Yarmuth. The gentleman's time has expired.
I now recognize the gentleman from New York, Mr. Higgins,
for five minutes.
Mr. Higgins. Thank you, Mr. Chairman. I find it ironic that
we are experiencing technical difficulty on a hearing regarding
federal investment in technology.
A lot of this, you know, has to do with the current
pandemic, but I think all of us have experienced, in the past
5-1/2 months, that COVID-19 has exposed the fragility of the
American economy and American society. There is no treatment
for this. There is no vaccine, despite the fact that the
coronavirus has been with us for 20 years.
Unemployment, you know, designed to give people $600 a week
was an unmitigated disaster due to the old and broken
technology unable to efficiently administer those checks to get
people what they needed, money, and to get them what we needed
them to do, and that is spend money, creating demand in the
economy.
The good doctor had mentioned the issue of telemedicine. It
certainly was accelerated, the use of it, and a new
appreciation for it during this pandemic. But it was limited
because of the lack of infrastructure technology; very, very
important.
You know, the U.S.-China relationship is critical as it
relates to technology and who is going to win this race. The
U.S.-China trade relationship is no longer about T-shirts,
toys, and sneakers. It is about technology.
China, in the last two years, has invested a trillion
dollars connecting China physically, but also through
technology to Europe and the Middle East. The United states
spent $350 billion, the last major infrastructure investment,
15 years ago; 15 years ago. Not good enough.
5G, fifth generation, the super fast cellular networks that
are used as a foundation for both today and tomorrow's
technologies, China is beating us. China has outpaced the
United States in patent production, artificial intelligence,
quantum computing, patents in semiconductors.
So, Dr. Wah, I just wanted to ask you, sir: On the
healthcare piece of this, if we had better technology in the
United States, if we were more advanced in fifth generation,
super fast cellular networks, would that speed up development
of a vaccine and/or an effective treatment for COVID-19?
Dr. Wah. I thank the Congressman for that question. I think
what I am hearing you ask is, if we had--you mentioned things
like 5G, which to me is infrastructure.
Mr. Higgins. Right.
Dr. Wah. And so I think infrastructure is always important
in the digital world, because we need to move information
faster. But, for me, healthcare IT is all about better
information for better decisions, and it is the role of the
technology to deliver that better information so everybody
makes a better decision. The speed in which that information is
delivered and the ability to scale is important. So to that
degree, I think infrastructure would help.
But there are many other components that are needed to be
successful, particularly in developing a vaccine, and that is
why I cite the virtual pool of information that we are talking
about. The richer that pool is, the more people contributing to
and taking out of that pool, I think is what is really going to
accelerate our ability to make major breakthroughs, not just in
COVID, but in other diseases. And, as I said before, imagine
that we could use that pool to recognize patterns of disease
that we don't even know what the disease is yet; we just know
there is a cluster of problems somewhere, and then we can
employ machine learning and augmented intelligence to sort that
out.
So I think, yes, I would support better infrastructure, but
it is really what that infrastructure supports, which is this
grander pool of information.
Mr. Higgins. Final question, Doctor. Vaccine development
traditionally is a process that takes about 10 to 15 years. The
fastest vaccine that was developed was developed for Ebola, and
that took five years and manufactured later by Merck. I am
concerned that the hope for a vaccine in the first quarter of
next year and the reality, I am concerned they cannot be
reconciled. Do you have any thoughts on that?
Dr. Wah. Yes. Vaccines are not my area of expertise. I am
an OB/GYN and infertility specialist with microsurgery, so I
just want to put that as a caveat. But, yes, I think we are all
very optimistic about the ability of our scientists to develop
a vaccine that is effective and safe in a very short period of
time.
The things that encourage us are there are new technologies
that were not present previously in terms of understanding
genetic structure and protein structure, and so that, I
believe, will, in fact, accelerate our ability to develop an
effective vaccine. And also----
Mr. Higgins. Thank you, sir.
Dr. Wah.----going back to what I said about real-world
evidence, we have a way of monitoring that that we don't
previously use. Clinical trials usually enroll patients. Now we
can look at the real-world behavior of many millions of
patients either using the treatment or a vaccine. So I am
encouraged by that as well.
Mr. Higgins. Thank you, sir. I yield back.
Chairman Yarmuth. The gentleman's time has expired.
I now recognize the gentleman from Tennessee, Mr. Burchett,
for five minutes.
Mr. Burchett. Can you hear me now? Good deal. I have got to
get on another call real quick, but, quickly, I have got one
question to just ask the entire committee--the group.
What are the federal barriers to you all's progress? And
are there any federal regulations that serve as barriers to the
successful IT implementation?
Ms. Gerton. Congressman, perhaps I can take a first cut at
that. From the federal level, there are a number of procurement
flexibilities that could potentially allow organizations to
make intentional investments in IT modernization, including
working capital funds, EMF, and revolving funds.
But one of the critical issues, or maybe two of the
critical issues are, while Congress has passed flexibilities in
procurement, we remained constrained by a couple of key
features. One is the CBO scoring rules, which require the full
cost of an IT investment to be recognized in the first year and
don't allow the consideration of offsets of future savings to
be applied as a discount. So IT investment looks
extraordinarily large and must be fully accommodated in the
very first year for which it is planned.
The second is the audit rules, the GAO audit rules, which
mitigate against flexibility, I would say probably rightly so,
but their strong perception that the old ways of buying either
supplies or services are what remain acceptable even in the
face of congressional flexibility and procurement authorities.
So as Congress is thinking about alternative tools and
flexibilities, I think one of the key features would be
engaging with CBO and GAO to encourage their flexibility in
terms of how they score and how they audit those procurement
decisions.
Mr. Burchett. Thank you.
Ms. Pahlka, do you want to take a shot at that?
Ms. Pahlka. I would love to. Thank you. I would agree with
everything Ms. Gerton said. Would add, I think some of what
needs to change, as I mentioned and as outlined in the written
testimony, is practice overregulation. But practices don't
change because people are worried about being called in front
of Congress, and I think if this body can demonstrate that they
will support those who take innovative approaches, that will
change over time.
As one example, most procurement officers, you know, will
insist on putting something in a procurement that says only a
company who has done a project of this size in the past--and
there is a lot of restrictions around this and many caveats--
you know, can successfully bid on this. Well, that is very
anticompetitive, and it really means that that project will
only then be able to go to probably two companies.
We know exactly how that project will end up, and that is
one of the hallmarks of this sort of death march toward a mega
project that will fail that we see. And I think--I don't know--
and maybe Ms. Gerton can help me understand--if that is a
regulation that needs to be removed, but I think it is a
decision that contractors make--contracting officers will make
that, if they can be supported, to feel that that is not
unnecessary--many contracting officers are happy not to include
it, but that they won't be punished for not including a
requirement like that that is, one, environmental--it is sort
of the environment that can change.
I think, particular to unemployment insurance, because it
is the topic--you know, one of the major topics here and
obviously such a crisis in our country right now, there is no
safe harbor for departments of labor at the state level and
workers there to be able to say, I have done my best to make an
eligibility determination about this individual who is applying
for this benefit, and I am now going to award that benefit
without any fear of being told later that my decision was
wrong.
We need to meet much clearer guidance and probably much
more specific and useful tools that every state can use where,
much like E-Verify, which, you know, you can use to say, I have
checked this person. They are eligible for employment, and now
I have safe harbor to make this decision. We need sort of a set
of tools that we can give every state--this would be a federal
investment--that could say, I have run this person through this
particular tool. I know that they are eligible, that we have
checked their income, that they have not applied in another
state, and there is no fraud happening here, and that will
significantly increase the speed of determination and the
delivery of unemployment benefits, and that is an important
thing that I think we should consider at a federal level.
Mr. Burchett. Thank you so much.
Mr. Chairman, I yield none of my time to Jimmy Panetta and
Dan Kildee. Thank you, sir.
Chairman Yarmuth. I thank the gentleman.
The gentleman's time has expired.
I now recognize the gentlewoman from Illinois, Ms.
Schakowsky, for five minutes.
Ms. Schakowsky. Thank you, Mr. Chairman.
Ms. Dixon, I want to see if you can help me with this.
At the end of April, we saw that the Department of Labor
reauthorized its IT modernization checklist in the face of the
skyrocketing unemployment numbers, the service disruptions,
massive processing backlog.
The checklist is originally from 2017 for states to ensure
that all necessary systems functions are available before the
launch of new unemployment benefit programs. But it is my
understanding that DOL does not keep track or monitor the
progress of states' UI modernization initiatives and it does
not have any enforcement mechanism that specifically targets
current systems failures, and is that correct?
Ms. Dixon. Yes, that is correct. We know that this
checklist is there, but it is really just a list of tasks, and
it doesn't really tell the states how to accomplish what they
need to accomplish. You could actually write a manual about
each business process that is on the checklist, so it is
insufficient. And it is true that DOL----
Ms. Schakowsky. So that was really my next question, then.
You would say--my question was, is this checklist enough to
ensure that states make sufficient progress, and your answer is
clearly ``no'' to that.
So what else does the Department of Labor and the
administration have to do to ensure the unemployment system is
up and running before new benefits are rolled out?
Ms. Dixon. The DOL really needs to create a specialized
unit for IT and phone inside the agency. So they need to have
infrastructure in the agency to provide states with more
guidance, to help states find economies of scale as they do
these modernization projects.
So it needs to take a much more active role and to create
standards. There are actually very few standards around
customer service for UI. There is not a standard that says,
``All calls must be answered in 90 minutes,'' or anything. So
we manage what we measure, so having more measurement is really
important.
Ms. Schakowsky. So the CARES Act provided a temporary
expansion of unemployment compensation to help the millions of
workers who are furloughed, laid off, without work due to no
fault of their own because of the COVID-19 pandemic. This
expansion is set to expire on July 31, coming right up. I have
seen reports that it will take weeks to restart this program if
it lapses, even in states with modernized technology.
Will it be a technological problem if the $600 pandemic
unemployment compensation runs out and is not extended before
the deadline?
Ms. Dixon. You are absolutely correct. What we are hearing
is that it would take states two to three weeks to get back up
and reprogram. So that would lead to a delay, an unnecessary
delay, for folks who are depending on these benefits as a
lifeline.
Ms. Schakowsky. So is this really a technological problem
that we are facing, or is it just a decision about extending
the benefit?
Ms. Dixon. I think that the two are intertwined. We
definitely do need to make a decision and make a people-
centered decision about supporting workers who have lost their
jobs in this pandemic. And it is not just technology but also
the decisions that are behind the choices we make in
technology.
And so putting people first, developing customer-centered
systems, instead of more efficient systems, is important.
Ms. Schakowsky. Yes. Thank you.
My time is almost up, and I will yield back at this point--
oh, did someone want to answer?
OK. Thank you very much. I yield back.
Chairman Yarmuth. The gentlewoman yields back.
I now recognize Mr. Kildee from Michigan for five minutes.
Mr. Kildee. Thank you, Mr. Chairman.
And I will pick right up where Ms. Schakowsky left off,
because I think this really is fundamentally a question that we
are all facing right now.
What we are seeing right now in the unemployment issue is
both a policy question and a technology question. We have
control of the policy choices, ``we'' meaning Congress. We
could make the decision before these unemployment benefits
lapse, and I hope we do.
But there is a lot of, sort of, hang-wringing around the
issue. There is a lot of discussion about whether the $600
supplemental benefit was correct. It was done for its
simplicity, in part. That added with state benefits was
intended to equate somewhat roughly to replacement-rate wages
for the broad spectrum of people who lost their jobs.
But I would really be concerned, given the technological
problems that we have seen just in implementing the $600
uniform benefit, I would really be concerned with challenging
states to somehow implement a replacement-wage system when we
are talking about tens and tens of millions of people who are
struggling with this problem.
And I reject out of hand the idea that the $600 is what is
keeping people from going back to work. What is, for the most
part, keeping people from going back to work is either there is
no work to go back to or they are afraid, naturally, to go back
into the workplace when they are at risk of contracting this
really dangerous and deadly disease.
So I guess I would be interested in what you all see, maybe
starting with you, Ms. Dixon, because you did rightfully point
out that, in Michigan, while we made improvements, we made
improvements from a horrible system that, at one point in time,
under the previous administration, essentially charged 20,000
people with unemployment fraud because they had a lousy system.
And we have had to make up for that, and the current Governor
has been attempting to do that.
But can you talk about the challenges that the states would
have to go through in order to calculate and come up with a
replacement-rate basis for this federal supplement as opposed
to using a more simple formula that we adopted in the CARES
Act?
And starting with Ms. Dixon, but then I would open it up to
others to comment.
Ms. Dixon. Absolutely.
So each state has its own specific UI program and its own
specific UI formula for how they calculate benefits. And so,
that being the case, it is horribly complex for each state to
then have to rework their benefit formula to reach that target
replacement rate.
So it is actually a lot of work to get that done,
particularly, I think, in the case where the $600 is obviously
bolstering the economy in a very, you know, tragic crisis
situation.
Mr. Kildee. Other members of the panel?
Yes?
Ms. Pahlka. I think you should be very concerned. I think
any changes now are going to cause some chaos.
We, through the United States Digital Response, have had
volunteer teams working with six states on their unemployment
delivery. And the public servants that they are partnered with
are not incompetent. They are very dedicated. They are working
as hard as they can, given the constraints that they are under.
But the system itself is pushed to its limits. And I think you
should take them at their word when they say that there will be
a disruption.
I think the one thing we have really learned in this
technology transformation world over the past 10 years is that
policy and technology have to go together, they do go together,
and we need to make policy with the implementation in mind.
Understanding how it will be implemented is the only way to get
the results that your policy intends.
Mr. Kildee. I think that is a really important point. In
order to create public value, we have to have operational
capacity. And I think sometimes we just assume, well, we just
pass a law, and, you know, by magic, it all just sort of gets
implemented. The case here is to get help to Americans.
And I think, finally, I will say this. It is a technical
question, but it is a technical question that we ought to
consider when we adopt these policies. And if we don't believe
that we have invested in the technology sufficient to allow a
more detailed solution, then we ought to just keep it simple.
And what I say is, before the end of this month, let's give
states ample time to continue to administer this process and
then make sure that we are making the investments in far better
technology and get ahead of this, the way we want to plant a
tree 20 years ago. We ought to get ahead of it. We ought not
let the perfect be the enemy of the good. We ought to get it
done before the end of this month. It stimulates the economy,
and it helps Americans survive this.
I thank the panel.
And thank you, Mr. Chairman, for holding this very
important hearing.
Chairman Yarmuth. Absolutely.
The gentleman's time has expired.
I now recognize the gentleman from California, Mr. Panetta,
for five minutes.
Mr. Panetta. Thank you, Mr. Chairman. I appreciate that
opportunity.
I think, you know, Mr. Kildee, it goes down to what that
person on that portrait says in our Budget hearing room. It is
about governing through leadership rather than governing
through crisis. And, unfortunately, when we don't make these
types of investments, we are left with governing by crisis, as
we have seen through this pandemic.
Now, look, I think this pandemic obviously required a very,
very bold response from Congress, and I think we gave them
that. We gave the people that, with how we rose to the occasion
with the number of the relief bills that we have passed,
obviously the CARES Act being a great example of that.
But this pandemic has also, as we have seen and is being
highlighted by this hearing, Mr. Chairman, which I appreciate
you putting on--it demonstrates that ignoring these types of
delivery systems for these benefits can come with real costs.
And the attempts to save federal dollars in the short term
obviously have big costs in the long term.
And, yes, we have been warned by the GAO and the inspectors
general, but in choosing not to make these necessary upgrades
to our federal IT systems, we have really undermined a
significant aspect of our response in this pandemic and in this
crisis.
So it is important to have this hearing. It is important to
learn from our mistakes. But it is also necessary that we do
make the investments, the proper investments, going forward so
that the next crisis we can be better prepared.
Now, the coronavirus pandemic is, as we are seeing, not
just a health crisis. It is not just an unemployment crisis. As
I heard today on my local news, it is a hunger crisis. Since
the onset of the pandemic, 34 percent of households with
children have reported food insecurity in their household. The
demand at U.S. food banks, as I have seen as I go out there and
volunteer every week at food banks, has gone up by an average
of 70 percent compared to the same time last year. And nearly--
this is what is interesting--40 percent of those waiting in
line at the food banks are new customers, have never, ever been
to a food bank before. Forty percent.
Now, obviously, the Supplemental Nutrition Assistance
Program has helped address this crisis, but the technology to
deliver this program does need to be better, and it needs to be
more efficient. And I think the obvious way do that is most
likely with mobile phones, considering how many people have
them.
So, Ms. Dixon, I am going to pick on you for a little bit,
and I want to see if you can tell us about the benefits and
potential challenges that come with updating our technology
delivery systems so beneficiaries can use smartphone technology
that is so prevalent to access the federal nutrition assistance
programs.
Ms. Dixon. We know that, in particular, workers of color,
so Black and Latinx families, are the least likely to have
broadband or a computer in the home. Most of us have or have
access to a smartphone. And so it just makes good sense to
optimize all of these sites so that they will work with a
smartphone.
Mr. Panetta. Right.
Now, in California, through our CalFresh Program but also
with help from a USDA pilot program, we have been able to take
steps so beneficiaries can use their SNAP dollars to purchase
food online--if they can't go through a phone, at least they
can do it online--for delivery through certain retailers.
Ms. Dixon, can you speak to the value of that pilot
program, if you are familiar with it, and the challenges we
should be prepared for in expanding that program nationwide?
Ms. Dixon. So I can't speak specifically to that program,
but I can speak to the fact that, if we don't actually target
the program, if we don't actually look at what the needs are
for the most vulnerable, we create a program that is not
accessible to them.
So we have to actually start in the center with the most
vulnerable and their needs, and then it is a concentric circle
to help everyone else. But if we don't actually figure out what
they need, they are not going to be served.
Mr. Panetta. Are there any particular federal investments
that we should be prioritizing to support that type of
expansion on that program?
Ms. Dixon. I think that making sure that we review the
evidence from the pilot to find out what are the bright spots
and how do we replicate what is working.
Mr. Panetta. Great. Great. Ms. Dixon, thank you very much.
Mr. Chairman, I yield back my time, unless, Ms. Pahlka, did
you have your hand up?
Ms. Pahlka. I would love to share that----
Chairman Yarmuth. Ms. Pahlka wanted to add something.
Mr. Panetta. Yes. Thank you, Mr. Chairman.
Chairman Yarmuth. Go ahead, Ms. Pahlka.
Ms. Pahlka. I worked significantly in SNAP over the past 10
years through my role at Code for America, which I stepped down
from in January.
We, in fact, did create a mobile-first application for SNAP
in California, starting with a couple of counties, and the
state actually adopted it and required all counties to use. And
prior to this application, you would need to be on a landline--
you know, on a computer with broadband, since you could not do
it on mobile.
But not only was it an issue of mobile access, the legacy
application had over 212 questions, you couldn't save your
work, and it took up to an hour. And so we made something that
you could apply for SNAP in California on the mobile phone in
about seven minutes, including using the camera on your mobile
phone to take a photo of your driver's license, your paycheck,
et cetera.
And you asked about the benefits. Well, there have been
many benefits. The cost of administration goes down. But,
really importantly, we started to close the significant
participation gap that existed in SNAP in California. The
numbers were quite low, and it is going up as the state has
adopted that.
I just also wanted--and I think this is seen everywhere you
put in a simple, beautiful, easy-to-use application. I also
just really wanted to lift up what Ms. Dixon said. Design for
the most marginalized will work for everyone else.
A last brief comment about SNAP payments. There is a
desperate need, I think, to modernize the marketplace for
payments in the SNAP program. Those regulations were written, I
believe, before the internet existed, and it means that you are
not able to take advantage of the wonderful, robust, diverse
marketplace of payment vendors.
And while I am proud that we were able to get the ability
for end users to use their benefits online, there remain
significant problems with that program, including that it is
limited in most states to just a few vendors, Amazon and
Walmart, which hurts local businesses; the fact that you can
use it for the groceries, but you can't use your SNAP payment
for the delivery fees, which is a significant barrier; and a
whole host of other problems which would be solved by simply
modernizing the federal regulations that govern SNAP payments
and creating a much more robust and modern marketplace.
Chairman Yarmuth. Thank you very much.
The gentleman's time has expired.
I now recognize the gentleman from New York, Mr. Morelle,
for five minutes.
Mr. Morelle. Thank you so much, Mr. Chairman, and to the
witnesses. This is really, really, I think, an important topic.
I appreciate all the testimony. And I had written comments
which I am going to, for the most part, pass on, because so
many things have been said here.
Clearly, you know, in a typical year, we would struggle
with technology, I think, if you look at the investments we
have not made at the state and federal government. This is
hardly a typical year. So what we are facing is enormous
dislocation in public health and economic--in our economy. And
to have the systems we have, which are, I think, still largely
legacy systems, is almost criminal, considering the challenge
we are going to face.
A couple things that people said, though, I did want to
just maybe get some additional feedback.
I was interested, Dr. Wah talked about telehealth and
telemedicine. I see a day--and I think about just the
technology I have on my wrist which keeps track of steps and
heartbeat, et cetera. I envision a world, if we can get there,
where you could almost do predictive analytics, that you have
real-time data on an ongoing basis going to primary-care
providers, or if you have chronic illness. The kinds of things
you could do would enormously enhance the ability for people to
even detect illnesses or things in their body chemistry before
you even feel symptoms. But we are just not in a position, I
think, at the healthcare side and given the challenges they
face.
So I am going to ask you to comment on that in just a
second, Dr. Wah.
I was also--Ms. Pahlka talked about useful tools, benefit
eligibility. For three years, I have led a project in
Rochester, New York, where I serve, where we are trying to
break down the barriers between health, education, and social
services and have a truly integrated delivery model literally
be run by people in poverty and crisis. So they have single
eligibility, that they log onto their smartphones, that they
keep track of their data privacy and they control it.
And people do want to focus entirely on the IT, and I think
that is what we are working on a lot, how to bridge these
things, how to have data sources talk to one another, how to
create a data, you know, environment where the transfer of data
is important, but it is also: How does it help workflows? I
mean, the technology is interesting, but if people aren't
working together and if we are not getting better outcomes and
lower costs--the challenge is that there is so little
investment. So I appreciate that.
And, finally, Ms. Dixon, you said something about human-
centered design. This project that we are doing with people in
crisis, people in poverty is all using human-centered design.
Because you could have the best technology in the world; if
people aren't comfortable with it, if they don't trust it, if
it is not an environment that they feel they can use easily, it
ends up being for naught. So human-centered design is a big
part of what we are doing.
And I would like to, offline, actually talk to each of you,
because all the things you have said today and what we are
doing Rochester--we want to be the first city in America that
has completely integrated health, education, and social
services. And we have been, as I said, working for three years
on it. The state of New York has given us $15 million to invest
in the technology and in the people who will work, so nurse
practitioners, pediatricians, social-service people, people in
housing, food insecurity.
I also sponsored a bill called the HOPE Act, which would
create innovation grants for people in the space around hunger
and giving nutrition to people.
So maybe you could each, sort of, comment on the
challenges, I guess, first and foremost, about: What would be
the plan? How would the federal government start? What are the
first things we ought to be doing as a Congress, policy-wise,
to try to address some of these things?
And I did like what you said, Ms. Pahlka, that, you know, a
10-year technology--you know, 10 years is a long timeframe. You
are not going to have the newest technology if you wait 10
years to get it done.
So I am not sure who I am asking this of. If any of you
could just comment on what we should be doing in the immediate
steps, and then maybe just make some observations about the
jumble of things I just said, which probably make virtually no
sense.
Dr. Wah. Congressman, I will jump out only because you
started with my area of interest in healthcare. But I would
say, what government needs to do is continue this investment
that they have already made in what I call waves 2 and 3 in
this virtual pool of information. As you stated, devices are
coming up every day that are contributing to that pool. And
that richer pool allows us the power of analytics to be applied
to that and make many new discoveries.
The other thing I would point out is what I talked about
before, is the nonclinical use of healthcare information. As we
talk about COVID and trying to go back to work and back to
school, there is going to come a time when we are going to need
to show status, whether you have already had the antibody or
you have already had the vaccine, that is going to allow us to
enter stadiums, movie theaters, transfer to another country, or
an airplane.
We need to figure out what is the technology that is going
to allow that to happen, because we have never before put that
kind of importance on your vaccine status. Your vaccine status
used to just let your kids go to camp. But now we are going to
have to figure out a verifiable way to say that you got the
vaccine, you are immune, and you are safe to travel or go into
a stadium or go into another country.
Mr. Morelle. Yes.
Well, look, if I could maybe take the prerogative of
reaching out to each of you individually offline in my offices,
because I think each of you had a great deal to contribute
here.
And, Mr. Chairman, this is a great--this is one of the few
times I wish my five minutes were 10 minutes. But I do
appreciate very much you hosting the hearing. I think this is
really important for us to all consider.
I yield back.
Chairman Yarmuth. Thank you.
The gentleman's time has expired.
I now recognize the gentlewoman from Texas, Ms. Jackson
Lee, for five minutes.
Ms. Jackson Lee. Mr. Chairman, thank you so very much--I am
unmuted, I believe--and thank you to the Ranking Member.
I am going to be a living witness of how important this
particular hearing is. Why I am so delighted to serve on the
Budget Committee, because it digs deep into some of our most
difficult issues.
But let me, before I start my questioning to very quickly
for the witnesses, remind everyone that COVID-19 in this arena
of needs, because people are not in their normal places of work
and interaction, technology has become--I hate to say the
terminology--king in terms of working to save lives.
Confirmed cases in the United States, 3.48 million, a
61,000 increase in the last 24 hours; 138,000 deaths, a 787
increase. In the state where I am, the epicenter, one of them,
281,000 cases confirmed, a 10,745 increase; 3,378 deaths, an 87
increase overnight. In my own community, 70,000 cases in
Houston, 2,000 cases in the last 24 hours; 653; 676 deaths and
18 deaths over the last 24 hours.
We are in the most desperate moments of our tenure, or our
time, as a city and as a region. And we feel, to a certain
extent, lost because of the inadequacies of some of the
policies that we are facing.
Let me particularly focus on the backlog-of-veterans'-
benefits-claims spike during the last few months. According to
the data released in May, the backlog of claims for veterans'
benefits, those that have yet to be addressed for 125 days or
longer, has crept up to over 100,000, which is unacceptable.
So I would ask my first question--and I listened, and I do
agree that these are hardworking public servants in our state
and our federal government, but the system just doesn't help
us. They are a federal agency, besides veterans, where citizens
cannot even access to help them do simple things like file my
taxes, get tax transcripts, because the individuals cannot
access their system.
So my question is to Teresa Gerton, because, what do we do
when it comes to public services? What is your answer as it
relates to the veterans crisis that we are having?
Jennifer, if you would add to that as well.
And then to Ms. Dixon and Mr. Wah: People are feeling the
pain of unemployment. I know that our state has said, Texas has
said, if we don't extend unemployment, there will be a
disruption. And so I am interested in your response, again, on
how devastating that impact would be, inasmuch as people are so
desperate for the unemployment, the $600.
And, Dr. Wah, you made a very important point about
vaccines technology. There is a company that is U.S.-and Texas-
based, Greffen. What is the importance of technology in moving
the vaccine research along, Dr. Wah, and doing it where we can
focus on companies that are, in fact, U.S.-based? Not to the
exclusion, but these companies are struggling to be a part of
this. They are small companies. I think technology would be
very helpful.
Veterans question, employment question, and COVID-19
question on vaccines.
Could you start out, Ms. Gerton, very quickly?
Ms. Gerton. Congresswoman, I am happy to do that. As a
veteran myself, I appreciate your question about how well the
VA is addressing veterans' benefits claims.
I would circle back to one of the earlier questions about
the electronic health record. The VA has made tremendous
progress through VA.gov in addressing and being a more
customer-centered delivery mechanism. But they are still
governed by extraordinarily arcane regulations about
eligibility, about processing. And, in many cases, we still
require a human in the loop.
The Academy did a study with the Veterans Benefits
Administration about three years ago on the backlog of
veterans' claims and how they could reduce them, suggesting,
amongst other things, that they create, for example, a robotic
process automation tool that would categorize those claims into
ones that are very straightforward and could be dealt with
quickly and in a totally automated way and ones that are more
complicated that require more in-depth human interaction.
We certainly want to make sure that every veteran receives
the benefits to which they are entitled and that we do it in a
way that is responsive. And so, as the VA considers these
alternatives, I think there is a tremendous opportunity to
automate some of those----
Ms. Jackson Lee. Can I get the others to answer, Ms.
Gerton? Thank you so very much.
Ms. Gerton. Sure. Thank you.
Ms. Jackson Lee. Jennifer, can you very quickly--because I
noted that they are backlogged. They are not being helpful at
this point, I think, because of technology.
Then Ms. Dixon and Dr. Wah.
Can you do that very quickly?
Thank you.
Ms. Pahlka. Sorry. Did you want me to go now or Dr. Wah?
Ms. Jackson Lee. No. Very quickly, if you can. I am trying
to get you and Dixon in, while they have two separate
questions.
Ms. Pahlka. On the VA, I am not current on that.
But I would point to the fact that the progress with
VA.gov, which Ms. Gerton spoke to, is the result of this new
model that I keep speaking about that does work. It was done
originally by the USDS that sort of became part of the VA under
CTO Charles Worthington, who is excellent at this. And I think
the VA should continue to leverage that group in particular to
make the progress that they need to make to clear that benefits
backlog.
Ms. Jackson Lee. OK.
They are having problems, but I will continue on. Ms.
Dixon? Dr. Wah?
Ms. Dixon. So, in terms of the $600, if it goes away, we
are talking about getting rid of 50 to two-thirds of the income
of folks at the end of month, so right before rent is due, and
that is crashing into the fact that we are having upticks, as
you mentioned, in the states in COVID cases. So some folks who
were off might need to go back on.
And then add to that the expiration of rent moratoriums and
mortgage assistance in certain states. It is just a really
horrible time to add on top of that two to three weeks' delay
to change the program because we want to reduce the amount.
Dr. Wah. And if there is time, I will just very quickly
talk about vaccines and----
Ms. Jackson Lee. Dr. Wah, quickly, thank you. Dr. Wah,
quickly, as it relates to vaccines and companies.
Dr. Wah. Yes. So, just as it relates to vaccines, I will go
back to my original comment about waves 2 and 3. These virtual
pools of information that we have on our patients are going to
be very helpful in accelerating our development and finalizing
vaccines. And the U.S. companies will have access to this
primarily.
So, once it is out there, we will be able to monitor those
patients through this virtual pool of information, in a way we
previously could not through classic clinical trials.
Ms. Jackson Lee. Great.
Mr. Chairman, I thank you for your indulgence.
I just want to put on the record my question about the
Veterans Administration because I don't think I was--they are
backlogged, and I will write a letter about that.
Thank you, Mr. Chairman.
Chairman Yarmuth. Absolutely. Absolutely.
The gentlewoman's time has expired.
I now recognize the gentleman from Nevada, Mr. Horsford,
for five minutes.
Mr. Horsford. Thank you, Mr. Chairman.
Since February of this year, more than one in four Nevada
workers have lost their jobs statewide, pushing the state's
unemployment rate to 30.1 percent. That is the highest level
ever reported by any state in modern history and generating an
unemployment insurance caseload orders of magnitude higher than
anything the state has witnessed previously.
I have heard directly from my constituents during regular
telephone townhalls during this pandemic, in which so many of
them have expressed their frustrations about how difficult it
has been to navigate the unemployment system, from website
crashes, to waiting several hours on the phone before getting a
response, to having trouble resetting their passwords.
Now, the Families First Coronavirus Response Act, which we
passed in law back in March, included a provision from my bill,
H.R. 6199, the Emergency Unemployment Insurance Stabilization
and Access Act, which provided a billion dollars in grants to
state unemployment offices.
Nevada received a little over $10 million. Those grants
have been used to increase staffing, update information
technology systems, and process the onslaught of unemployment
insurance claims that have been coming in.
We have provided a billion dollars to states. I do not
think we realized how difficult it would be for state UI
offices to produce on such an outdated technology system. And I
have had many calls with Nevada's State unemployment office
about the issues, and I know that Nevada is not alone.
So, Ms. Gerton, Ms. Pahlka, and Ms. Dixon, can any of you
explain why states have struggled to update their unemployment
forms and payment systems under the Federal Pandemic
Unemployment Compensation Program?
I am particularly interested to know the various steps
unemployment offices had to take in order to even upgrade their
systems with the Department of Labor.
Ms. Pahlka?
Ms. Pahlka. I think I spoke over my colleague Ms. Dixon
earlier, so let me let her take the lead this time.
Ms. Dixon. One of the important things is making sure
that--I am sorry. I lost my train of thought when you were
speaking.
Mr. Horsford. Well, your testimony pointed out that the
national administrative funding for UI systems is essentially
unchanged from almost 20 years ago.
Ms. Dixon. Right.
Mr. Horsford. And so my question is, what could the states
have been able to do without the support from the Department of
Labor to set those standards and even to recommend the type of
systems that should have been put in place?
Ms. Dixon. We have the system that we have invested in. So
we haven't invested in it. And we know, as the Chairman
mentioned at the top, that the same funding from 2001, in terms
of administrative funding--there is no dedicated funding for IT
in particular, so states are having to try to squeeze that out
of what they do get.
So we do need to actually take this seriously and have
dedicated funding and a plan to get all the systems modernized,
including those standards. So doing it in a way where we are
putting people first and we want to know: How are they
interacting with the system? Do we need to simplify the
questions? There are lots of things that we can do to marry the
policy with the funding.
Mr. Horsford. Ms. Pahlka?
Ms. Pahlka. To your specific question of what does it take
to update these systems, I think I would just provide a little
bit of detail.
You have these systems that have really accrued over
decades. We think of them as archeological layers, where people
have made tweaks to an original system from many, many years
ago over and over and over again. And so, when you are asking
them to update, it is not simple.
In fact, in many cases, you have either just one employee
left who remembers how this script was written or that script
was written and how to actually do something and make this
change. And, in some places, you have, sort of, nobody left who
knows how to do it, or they are relying on a vendor that--
again, that speaks to the cost of maintenance of these systems
that has come up earlier in these hearings.
But the complexity of these changes really cannot be
overstated.
Mr. Horsford. Yes. It is extremely frustrating, especially
for the gig workers, the independent contractors. The employers
or the companies that they work for can't even submit
verification.
And I loved your idea about establishing a nationwide
verification system, something like E-Verify for companies that
are national or multinational, in order to verify the wages
that were paid to those employees.
That is the biggest issue that we are facing here in
Nevada. There has been no guidance provided by the Department
of Labor, or little guidance. There is no recommendation for
the types of systems that would actually work. And so we have a
piecemeal approach in 50 different states. And it is all
outdated, it is all antiquated. And yet Congress appropriated a
billion dollars.
So we need to move this forward and create solutions now
while we address the longer-term, kind of, systemic issues.
So I know my time is up. I did want to just raise one
point, Mr. Chairman, and I will submit it for the record. But,
under Department of Agriculture, children and families that are
eligible for SNAP or free and reduced meals based on their
income eligibility, that information is not shared with the
Department of Education in order for them to get free internet
service. And that is contributing to the digital divide.
And, again, it is something that Congress can fix. It is
something that, through guidance from our federal agencies, we
can address. And I hope that my colleagues would work with us
to improve that for our children and families in this country
right now during this pandemic.
Thank you, and I yield back.
Chairman Yarmuth. OK.
The gentleman's time has expired.
I now recognize the--I guess he is the Acting Ranking
Member now, the gentleman from Georgia, Mr. Woodall, for 10
minutes.
Mr. Woodall, we are not getting your audio. If you want the
staff to unmute you, just nod.
Mr. Woodall. Can you hear me, Mr. Chairman?
Chairman Yarmuth. There we go. Yes, we hear you, Mr.
Woodall.
Mr. Woodall, we hear you. We did.
Mr. Woodall. Thank you very much----
Chairman Yarmuth. There you go.
Mr. Woodall [continuing]. Mr. Chairman. I appreciate the
indulgence. It is easier to do this from my living room than it
is from your committee room, and I don't blame you for that. I
credit the living-room environment that we have all gotten used
to.
Dr. Wah, I wanted to start with you. I think about all the
crises and the responses that have been talked about today, and
then I think about what HHS did in response to that crisis. We
are going to promote telemedicine. We are going to allow
telemedicine to be used in ways we didn't allow before. But we
are only going to do that through the end of the crisis.
Tell me about some of the problems that we have seen in the
expansion of telehealth within the Medicare system over the
past three months that would lead us to want to pull that
system back instead of make that expansion permanent.
Dr. Wah. Thank you, Congressman.
I think first and foremost is what I said before, is that
we need to make sure that the telemedicine visits are the same
as in-person visits and that they are connected to our virtual
pool of information that I talked about.
So one thing is, we don't want them to be isolated so that
they are not getting information out of the pool to help the
telemedicine appointment be richer and better. And when the
appointment is finished, they need to put information back into
the pool. So that would be consistent with my waves 2 and 3.
But the other thing that people have been concerned about
with telemedicine, and I think it is imminently solvable, is
this issue of whether or not it is going to open the door to
fraud and abuse. I think overuse of telemedicine is very
unlikely. It is no more likely that we are going to overuse
telemedicine than we are going to overuse in-patient, in-person
use of healthcare. Very rarely do people wake up and say, ``I
feel like calling my doctor six times this week.'' So I don't
think it is going to be overused. But that is a concern, and I
think there are ways to put constraints on that and put
guardrails on it so it doesn't become a problem.
But I think it is recognized that it is safe, it is
effective. And it is very well-accepted to use telemedicine. It
has been around for over 20 years, but it is really come to be
highly useful in this environment when face-to-face interaction
is so much more challenging.
Mr. Woodall. I have concerns about our desire to make sure
things are qualitatively the same. We have opportunities to
expand access. And I don't expect my telemedicine visit to be
qualitatively the same. I used to have to get in the car, drive
four and a half hours, sit in the waiting room for an hour, and
get back in the car and drive four and a half hours back home.
I would be willing to accept something that is slightly
different as long as my family decides that it is a superior
value, my constituents' families decide it is a superior value.
As Ms. Dixon said earlier, we have the systems in place
that we have paid for. We have created a set of expectations
around the in-person healthcare visits that we are trying to
replicate.
As we think about what we are doing this year, next year,
10 years from now, how important is it that we stay tethered to
that ``I want it to be qualitatively the same'' as opposed to
``I want to utilize it for what it is, and then I want to
utilize something else for what it isn't''?
Dr. Wah. Yes, I would love to use this as a comment. One of
the things that I think would solve a number of things is, we
have talked a lot about the historic fee-for-service system of
medicine where we pay for everything we use and as we use it.
But if we move, as we are trying to, to value-based care,
where it is--as you said, the outcome for you and your family
is the prize. It is not how many times you have visited or how
many issues you have had. It is, are you and your family
getting healthy and staying healthy? That is what we pay for,
and that is what we incentivize. Then the private sector will
find ways to achieve that goal. And it will be a mix of in-
person care and virtual care, but it will get to the end goal
of you and your family being healthier and better.
And, if we do that, all of these things that we are talking
about will be driven by competition, to make sure that the
marketplace meets that need to deliver the best product to you
and your family so you are healthier and better because of it.
Mr. Woodall. Well, Ms. Pahlka was right when she described
the archeological dig that is our computer systems today. I am
going to use that again.
We can't change things without being intentional. The Bush
Administration tried. The Obama Administration tried. If you
would have asked me a decade ago if our EHR mandate was going
to have me in 2020 without the ability to walk into any
physician's office anywhere in the nation and have my records
transferred in in real-time, I would have said, no, of course,
we are going to have that kind of functionality. We were
intentional. We provided incentives. We provided penalties. We
gave a five-year lead time. And here we are without the
functionality that we desired.
Now, tell me where the failure was. You just lauded the
private sector and its ability to solve problems. We have all
talked about the government's need to be intentional in this
space. I thought that we combined those two in the EHR mandate,
but we have not met my expectations. Tell me a little bit about
where we went wrong and what we should be doing differently
going forward.
Dr. Wah. I am sorry. Were you addressing that to Ms. Pahlka
or myself?
Mr. Woodall. Dr. Wah, I was directing it to you. But, Ms.
Pahlka has identified the flaw----
Dr. Wah. Oh, OK.
Mr. Woodall [continuing]. but, in the case of EHR, we
started from scratch. We didn't have the archeological-dig
problem. We said, we are going to walk in on day one, we want
everybody to go out and buy a brand-new system, and we are
going to create a real, tangible benefit in terms of quality
and cost for the American healthcare public.
Dr. Wah. Yes, so I think we did accomplish what I call wave
1, which was to get off of the paper-records system, which we
sometimes forget how bad that was. When you want to talk about
archeological digs, we used to have patients come in with
shopping bags of paper. That has passed away, fortunately. So
going to digital has helped, and that was a significant
achievement of that effort that you talked about.
The interoperability is still a challenge, and creating
that virtual pool of interoperable information is an ongoing
process that we are still doing. And I would submit, some of
those reasons are not technology but business reasons. So
sometimes there were business reasons why people didn't want to
share information. We just passed, in the 21st Century Cures
law, information-blocking rules to prevent those business
things that are preventing interoperability.
So it is not solely a technology problem; it is a
regulatory, legislative, and statutory problem that we have to
continue to address.
Mr. Woodall. Well, it is not lost on me that, in order to
provide the kind of care that we all know our senior citizens
need in this time of the pandemic, that HHS had to waive some
HIPAA privacy rules and direct the Office of Civil Rights not
to enforce some of those rules so that we could use those
modern technologies that we are all accustomed to using to
achieve those goals.
Ms. Pahlka, tell me about this from a practitioner's
standpoint. We did say ``start from scratch'' with your
electronic health records systems. Physicians did go out and
buy these for the very first time. And here we are a decade
later, and we don't have the interoperability.
I couldn't have possibly predicted the state of technology
in 2020 back when the American Recovery and Reinvestment Act
was passed a decade ago. So what would you advise us to do as
legislators to mandate enough on the front end to achieve our
goals but not mandate so much that we miss the opportunity for
innovation?
Ms. Pahlka. It is an excellent question. I am not going to
be as expert or useful on the EHR issue as Dr. Wah will be. It
is a specific, sort of, mega-project in government that has,
you know, plagued many, many administrations. It has gone back
a long time. And I don't pretend to know what to do about it
now.
The pattern I see is that, when we are successful with
implementations like this, it is because we start small and
learn as we go. And it was very hard to do that in the EHR
context. But we can do that in other contexts. And we have
successfully done it in other contexts. But I think that is not
how EHRj started. It started as a very heavy requirements-
driven, extremely well-funded effort that had all the hallmarks
of a failed mega-project.
I am sorry I can't be more helpful.
Mr. Woodall. I hear that, ``start small and go big.'' And I
want to cast that against the concerns I have heard so many
folks express about the different unemployment systems we have,
of course, where we have 50 different systems in 50 different
states. That is going to be a constant tug.
And, Mr. Chairman, I know that you have called this hearing
because you want us to be intentional in this way.
I hope that our efforts to solve 50 separate problems that
we have heard so often and that we are all committed to solving
don't trample that good advice that Ms. Pahlka has given, that
some of our most successful efforts in this area have started
small, proven the concept, and then we grew them out to the 50
states, as opposed to that single mandate from on high.
So thank you, all the witnesses, for being here.
And thank you, Mr. Chairman.
Chairman Yarmuth. I thank the gentleman.
His time has expired.
I now yield myself 10 minutes.
And let me begin by thanking all the witnesses, not just
for your testimony in this live portion but for your written
testimony as well. I was actually kind of stunned in reading
testimony about what is a fairly wonky subject, how accessible
and how logical it was. I was very impressed with all of you.
As somebody who is not as attuned to IT as many, many others, I
really got it.
And there was a revelation there, particularly with Ms.
Pahlka and Ms. Gerton's testimony, that one of the issues that
we seem to have is an issue of perspective.
And when we are talking about medical health records, I
remember, I was here when we drafted the ACA and we were
working on those provisions, and the idea was, how do we gather
all this information? It was not, what is the purpose of
gathering the information? It was, how do we gather it, and how
do we incentivize the doctors to do it, as opposed to actually
thinking about the end product and the people we were going to
engage and what it was going to mean to them.
And I think for the first time I have actually started to
think, reading the testimony--and I think, Ms. Pahlka, you
specifically said this, I thought of the government as a ``-
customer service organization.'' And I don't think we do that
nearly as much. And so that was kind of a revelation I thank
you for.
The other thing why a lot of the testimony resonated very
deeply with me is, one of my standard lines when I am out
talking and talking about Congress is I say, you know, ``We
have a dilemma, and that is that Congress, at its optimum
efficiency, moves at 10 miles an hour,--right now, we are at
two or three miles an hour--meanwhile, the world is moving at
100 miles an hour.'' And how--can we possibly make policy that
anticipates where the world is going?''----
You know, we generally legislate, it has been my
experience, as if we are target shooting instead of skeet
shooting. We need to be shooting where the target is going to
be, not where it is now. And that is certainly part of the
issue here.
And when we think differently, when we stop thinking about
equipment and investment in equipment, and thinking about
functionality and purpose, it seems like that is absolutely the
right way to approach this issue, but I am not sure that
Congress is equipped to do it.
So I would start by asking Ms. Pahlka if--I am not aware of
any concerted congressional effort to deal with this problem.
And certainly in different areas of jurisdiction it has come
up, and we have discussed it, kind of, on an ad-hoc basis. One
of the things that I always think about is, we don't spend
nearly enough time in Congress thinking about and discussing
how to make the government work better. And that should be a
primary function of ours.
And I know, Mr. Woodall, we have had conversations like
this, that I am one of these Democrats who does not believe
that every regulation is a meaningful, helpful, beneficial
regulation. And we ought to be spending a lot more time
thinking about what we are doing that makes a difference in the
way government functions and in people's lives, and not about a
lot of the things we think about.
So, I mean, if you were in our position--and I will start
with Ms. Pahlka--and you want to create a congressional effort,
what would be the first place you would go?
Ms. Pahlka. What an excellent question, and a difficult
one.
I think that all efforts work when they have concrete
successes behind them that start to actually show the American
public that things can be different. So I would actually
champion a couple of very specific projects that I think
Congress could move along more quickly.
And Congress, obviously, wouldn't be implementing them. You
would need USDS----
Chairman Yarmuth. Right.
Ms. Pahlka [continuing]. or one of these places to do
something, like speed the delivery of UI benefits. And,
frankly, the thing that I have spoken about here where you
could potentially speed eligibility determinations and reduce
the wait times is relevant.
My thing is, always start small. You would start with one
state; you would expand it. But you could also start with one
benefit, like UI, and then expand it to other benefits.
Eligibility rules are different across different benefits.
One of the members spoke about SNAP, which is critical at
this time and also facing challenges, as it has had the same,
sort of, expansion of both benefits and programs. But
eventually you could create centralized service that sped the
determination of eligibility across a number of benefits.
And I think what is really important is not just that we
speed government for its own sake but that the people who are
waiting on those benefits start to see a difference.
So I would just do something very concrete, get behind it,
and figure out along the way all of the attacks that come on
it, all of the barriers to it, and just start, one by one, use
your power to remove those barriers and get the job done.
Chairman Yarmuth. Thank you.
And, Ms. Gerton, I want you to answer that as well, but I
also want to throw in that both of you mentioned the notion of
agility. And I understand the word; I am not sure I understand
how it applies here. So, if you could kind of elaborate on
that, Ms. Gerton, as well as where you would go if you were
directing Congress right now.
Ms. Gerton. Thanks, Congressman. I think I would offer two
suggestions.
We talked already today about the importance of SNAP and
the importance of UI benefits to deliver crisis services. One
of the things that we have been working on is the idea of
providing more flexibility to the grant-writers at the federal
level to allow the recipients of those grants to integrate
their systems.
And if I can give you a quick example. When I was at the
Department of Labor, I was responsible for overseeing the
Homeless Veterans Reintegration Program. It was a fairly small
grant that provided training opportunities for homeless
veterans to return into the work force.
Interestingly, the grantees who received our grants also
received grants from the VA, received grants from HUD, and they
received a variety of grants. Because of the way the grants
were structured, they had separate IT systems to report on the
compliance for every one of those grants, which placed an
extraordinary administrative cost on them, which kept them from
integrating those funds in a way that could better deliver
outcomes for homeless veterans.
So one of the things, as Ms. Pahlka just mentioned, if you
focused on UI, for example, or SNAP, thinking about all of the
grants that those grantees are receiving and making it easier
for them to combine them, in a way that still provides the
accountability that Congress needs, but that helps them
optimize the delivery of services for their constituents, would
be a huge first step. It is not removing regulations, but it is
providing flexibility.
The second place I would suggest is sort of a back-office
approach, right? At the federal level, we understand that hot
systems, for example, could deliver better finance and
accounting than our customized systems, could deliver better
H.R. services. But those are sold, sort of, as software-as-a-
service. We don't need a big requirements process to tell us
how to do best HR.
So allowing the flexibility for shared services, allowing
people to buy them as a service, where that service is
maintained in the cloud, where it is kept constantly updated,
where the cybersecurity is much tighter than, for example, any
agency who hasn't had the time invest and is running on
vulnerable software.
You could add flexibility in the shared services space and
simplify back office, which would free up additional
administrative costs. And you could allow flexibility on the
front-office side in service delivery so that grantees could
better mix their funds to deliver outcomes for their clients.
Chairman Yarmuth. OK. Well, thank you very much.
My time is running down, and even though I have the gavel,
I am not going to abuse that, even though Rob wouldn't mind.
I am so glad that you mentioned artificial intelligence in
your testimony, Ms. Gerton. And one of the things,--when I am
out speaking, I say, there are three things that we absolutely
have to focus on now if we are going to have a viable future,
and one of them is climate change, and one of them is early
childhood education, and the third one is how we are going to
deal with artificial intelligence. I think it is that critical.
And we, at some point, are going to have a hearing on
artificial intelligence and what it might mean for the budget
going forward, because, clearly, there are dangers with
artificial intelligence and enormous opportunities.
So I am glad that you mentioned that, because that is going
to have to be a part of our technological future, and we need
to start thinking and talking about that right now as to how we
are going to integrate it in a way that does serve our
customers. And so you have given me a new mantra that I am
going to talk about a lot, ``sometimes citizens, sometimes
taxpayers, but always customers of the government.''----
But, anyway, with that, I will, once again, thank all of
the witnesses. It has been an extremely valuable discussion.
And, again, I think the record of our live hearing and also the
written testimony is going to be a substantial record that we
can rely on and Members of Congress can rely on as we start
thinking about how we deal with some of these issues.
So, with that, thanks again for your participation. Thanks
to Mr. Woodall for staying with us till the end.
And if there is no further business before the Committee,
this hearing is adjourned.
Thank you.
[Whereupon, at 4:07 p.m., the Committee was adjourned.]
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