[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2021
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
_________
SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
RELATED AGENCIES
ROSA L. DeLAURO, Connecticut, Chairwoman
LUCILLE ROYBAL-ALLARD, California TOM COLE, Oklahoma
BARBARA LEE, California ANDY HARRIS, Maryland
MARK POCAN, Wisconsin JAIME HERRERA BEUTLER, Washington
KATHERINE M. CLARK, Massachusetts JOHN R. MOOLENAAR, Michigan
LOIS FRANKEL, Florida TOM GRAVES, Georgia
CHERI BUSTOS, Illinois
BONNIE WATSON COLEMAN, New Jersey
NOTE: Under committee rules, Mrs. Lowey, as chairwoman of the full
committee, and Ms. Granger, as ranking minority member of the full
committee, are authorized to sit as members of all subcommittees.
Robin Juliano, Stephen Steigleder, Jared Bass, Jennifer Cama,
Jaclyn Kilroy, Laurie Mignone, Philip Tizzani, and Brad Allen
Subcommittee Staff
_________
PART 5
Page
Department of Health and Human Services ........................... 1
Department of Education/Budget Request for Fiscal Year 2021 ........ 123
Reducing Child Poverty.............................................. 185
National Institutes of Health/Budget Request for Fiscal Year 2021... 225
Centers for Disease Control and Prevention.......................... 331
National Labor Relations Board...................................... 379
COVID-19 Response, May 6, 2020...................................... 405
COVID-19 Response, June 4, 2020..................................... 449
The Impact on Women Seeking an Abortion but are Denied Because of
an Inability to Pay................................................. 527
_________
Printed for the use of the Committee on Appropriations
U.S. GOVERNMENT PUBLISHING OFFICE
43-462 WASHINGTON : 2021
COMMITTEE ON APPROPRIATIONS
----------
NITA M. LOWEY, New York, Chairwoman
MARCY KAPTUR, Ohio KAY GRANGER, Texas
PETER J. VISCLOSKY, Indiana HAROLD ROGERS, Kentucky
JOSE E. SERRANO, New York ROBERT B. ADERHOLT, Alabama
ROSA L. DeLAURO, Connecticut MICHAEL K. SIMPSON, Idaho
DAVID E. PRICE, North Carolina JOHN R. CARTER, Texas
LUCILLE ROYBAL-ALLARD, California KEN CALVERT, California
SANFORD D. BISHOP, Jr., Georgia TOM COLE, Oklahoma
BARBARA LEE, California MARIO DIAZ-BALART, Florida
BETTY McCOLLUM, Minnesota TOM GRAVES, Georgia
TIM RYAN, Ohio STEVE WOMACK, Arkansas
C. A. DUTCH RUPPERSBERGER, Maryland JEFF FORTENBERRY, Nebraska
DEBBIE WASSERMAN SCHULTZ, Florida CHUCK FLEISCHMANN, Tennessee
HENRY CUELLAR, Texas JAIME HERRERA BEUTLER, Washington
CHELLIE PINGREE, Maine DAVID P. JOYCE, Ohio
MIKE QUIGLEY, Illinois ANDY HARRIS, Maryland
DEREK KILMER, Washington MARTHA ROBY, Alabama
MATT CARTWRIGHT, Pennsylvania MARK E. AMODEI, Nevada
GRACE MENG, New York CHRIS STEWART, Utah
MARK POCAN, Wisconsin STEVEN M. PALAZZO, Mississippi
KATHERINE M. CLARK, Massachusetts DAN NEWHOUSE, Washington
PETE AGUILAR, California JOHN R. MOOLENAAR, Michigan
LOIS FRANKEL, Florida JOHN H. RUTHERFORD, Florida
CHERI BUSTOS, Illinois WILL HURD, Texas
BONNIE WATSON COLEMAN, New Jersey
BRENDA L. LAWRENCE, Michigan
NORMA J. TORRES, California
CHARLIE CRIST, Florida
ANN KIRKPATRICK, Arizona
ED CASE, Hawaii
Shalanda Young, Clerk and Staff Director
(ii)
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2021
----------
Wednesday, February 26, 2020.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
WITNESS
HON. ALEX M. AZAR, SECRETARY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Ms. DeLauro. The subcommittee will come to order.
Good morning, Mr. Secretary. Welcome to the Labor, HHS, and
Education Subcommittee, I suppose I should say and related
agencies as well. This is our first hearing on the President's
fiscal year 2021 budget request.
However, I want to start with a matter of urgency, the
novel coronavirus, COVID-19. Cases are growing, as is alarm.
This is both domestically and internationally. The U.S.
Government has responded to the COVID-19 outbreak with
aggressive measures, significant travel restrictions, a
mandatory 14-day quarantine for individuals returning to the
U.S. from Hubei province.
Mr. Secretary, I support your declaration of a public
health emergency. We are dealing with the likelihood of a
global pandemic. It is interesting to note yesterday from the
CDC that commented that with regard to the United States it is
not a question of if but a question of when we will face this
issue seriously here.
That said, I have serious concerns about the
administration's responsiveness with respect to funding. I
understand Senators of both parties expressed a similar concern
to you at their hearing yesterday. I have repeatedly asked for
information about expenditures thus far and about the balances
remaining in the Infectious Diseases Rapid Response Reserve
Fund. And yet, we have not received an adequate answer.
In addition, you submitted a letter late Monday night
notifying the committee that you would begin transferring up to
$136 million from other HHS programs, including NIH and the
Low-Income Energy Assistance Program. And on Monday, the
administration finally submitted a request for an emergency
supplemental funding, but there is no supporting documentation.
You must share that information immediately. In that
request, the administration also asked permission to shift more
than $500 million from Ebola preparedness. That is a mistake,
and we are not robbing funding for other emergency activities
to pay for this emergency.
There is another $536 million-$550 million of reprioritized
funding and funding that was provided for fiscal year 2020, and
that funding is coming from other HHS programs. We know of
the--and we need to know specifically where that money is being
cut from.
What the American people need is an emergency supplemental
bill that answers these questions, supports development of
therapies and a vaccine, funds State and local agencies and
healthcare providers, and strengthens our public health
infrastructure. And the American people, Mr. Secretary, need to
know that now. As you know, there is great alarm and
consternation in the country about this.
Another important issue, an issue that I, like many
Americans, find deeply disturbing, is the administration's
ongoing and cruel treatment of asylum seekers and children
entering the United States. In recent weeks, we learned that
agents with ICE, Immigration and Customs Enforcement, are
showing up at HHS-funded shelters to fingerprint 14-year-olds
in the unaccompanied children program. That is outrageous.
They are allowing ICE agents to intimidate kids. I
recognize that there is a statute, but it remains the
responsibility of HHS to ensure the safest environment for the
children. So I want HHS to make clear to its grantees that
children are to have a representative present to allay their
fears and ensure their understanding of the process, and I
would, and I expect my colleagues on the subcommittee, would
want to see a copy of that guidance.
We also learned that ORR took confidential notes from
children's therapy sessions and shared them with ICE for
multiple years. I appreciate your comments on stopping this. It
should not have happened. You and I know this, that it cannot
happen again. There needs to be a firewall with DHS. ORR is not
an immigration enforcement agency. Its mission is to provide
for the care and the welfare of children.
Turning to your budget, Mr. Secretary, despite what you may
try to say, this document would hurt millions of Americans, and
you have to ask who is paying the price. It is not the wealthy
or well off; no, it is the vulnerable who are the victims. It
is the working people, middle-class families of this country,
who would be forced to do less with less.
This is a time they need more help, but you are proposing
to cut $10 billion from the Department of Health and Human
Services, an 11 percent cut. You are leaving people at risk of
a potential pandemic by cutting $700 million from the Centers
for Disease Control and Prevention, and especially the
Infectious Diseases Rapid Response Reserve Fund.
You are telling suffering families that we will not do all
we can to help their ill loved ones by cutting $3 billion from
the National Institutes of Health. It is the world's leading
biomedical research institution, and you would want to hit the
brakes on that research. It is unacceptable. You would leave
people without enough trained doctors and nurses by cutting
hundreds of millions of dollars for training for healthcare
careers like nursing.
The health issues of this Nation require a trained
healthcare workforce. You would force 6 million seniors to have
to choose between eating, buying prescription drugs, heating or
cooling their homes by eliminating LIHEAP, the Low-Income Home
Energy Assistance Program.
And you would reject the bipartisan intention of this
Congress to save lives and address the public health crisis by
ending the $25 million for gun violence prevention research.
One hundred Americans are killed every day by guns, 36,000 per
year, two-thirds of which are suicides, a particular concern
for our veterans.
That is not all. On the mandatory side you would take away
health insurance from 20 million Americans by cutting
healthcare by $1 trillion over 10 years and eliminating the
Affordable Care Act and its Medicaid expansion. And you are
still in Federal court to repeal the Affordable Care Act,
endangering the health coverage for 130 million Americans with
preexisting conditions.
To date, you have not come up with a comprehensive plan to
help. I could go on, and I am not, but the consequences of your
budget would leave us as individuals and as a Nation less
healthy, less safe, and less able with respect to economic
security.
And so we will not allow you to go after millions of
Americans; instead, we will continue to invest in health
workforce programs, medical research, and the public health,
because it is what American people need and what the American
people deserve.
I appreciate the administration's request for increased
funding to reduce maternal mortality as well as additional
funding to address tick-borne diseases like Lyme disease.
Although, it is one step forward and three steps backwards as
the growth in incidents of Lyme disease is related to climate
change, and yet, you propose to eliminate the CDC's climate
change program.
The administration is also requesting increased funding for
the second year of an HIV initiative to reduce transmission of
HIV by 90 percent over 10 years. We strongly share that
ambitious goal. Again, I have to note the contradiction at the
heart of this because the administration is simultaneously
proposing to cut NIH's HIV research portfolio, USAID's PEPFAR
program, eliminate the Affordable Care Act, and eviscerate
Medicaid. These are programs essential to combatting HIV. In
fact, Medicaid is the largest payer for HIV care in the United
States.
So, much to discuss today. We appreciate your being here.
And before we turn to you for your testimony, let me turn to
our ranking member, Congressman Cole, for remarks that he would
like to make.
Congressman Cole.
Mr. Cole. Thank you.
Thank you very much, Madam Chairman.
Thank you, Mr. Secretary, for being here. I have got some
prepared remarks that I am going to read in just a second, but
before I do, I want to begin by thanking you. I want to thank
you, I want to thank the professionals at the Centers for
Disease Control and the National Institutes of Health, the
folks that you have supervising our strategic stockpile.
I think you guys have--your team, in working with other
departments--I know you have worked very closely with Homeland
Security and Transportation. You have been up here briefing us
on a very regular basis--have done a really remarkable job in
responding to something that this committee has been preparing
for for years, and this committee ought to be very proud of its
work on a bipartisan basis providing the tools for you and your
colleagues to respond.
And through you, I want to thank the President. The
President has taken very strong and decisive action here in
terms of protecting our borders and, you know, I am pleased to
see this supplemental here, and, you know, I suspect we will
change it in some ways.
My good friend, the chairman, makes some points that I
agree with her on, and I wouldn't be surprised to see you back
here. But you are doing the right thing. You have used the
resources we have given you. You have come back for a
supplemental. I have no doubt you will come back again if you
feel like you need them or need additional support, and I have
no doubt, frankly, the Congress will be forthcoming.
I have to tell you, I have heard a lot of stuff not on this
committee and certainly it isn't--but particularly in the other
body that I have got to tell you is just transparently
political claptrap. And that is what it is. And when I hear
people say, well, the President's done--it is too little and
too late. I think, where have you been? We have been preparing
for this honestly before this administration was here.
We had 5 years in a row of substantial NIH funding. I know
my friend, the chairman, worked with me when I was chairman. I
have tried to work with her as her ranking member. We have
shared this goal all along the way. And we have done the same
thing at CDC.
We have done the same thing with strategic stockpile with
this subcommittee that came up with the Infectious Diseases
Rapid Response Fund that gave you the initial money to not wait
around on Congress or political theatrics but to start
responding immediately, and I think you have done that
exceptionally well.
So when I hear you criticized by people that in many cases
didn't vote for the bills that gave you the tools then I regard
that as political as opposed to substantive.
Last point I want to make on this is, I really appreciate
the briefings that we have gotten, Congress as a whole has
gotten. You have been--you know, had your representatives here
before this committee. Our chairman did a wonderful job in
bringing in folks. We had an honest and open dialogue.
So the idea that we haven't been kept well informed or
people have not said, look, we are going to do our very best
but this is an unpredictable disease, this could spread at any
time, these are not warnings that I just heard in the last 24
hours. These are things that your team has been telling us from
the very beginning. And it suggests to me that the
administration has been on top of this, and, again, I
appreciate the President in that regard from the very
beginning.
So I know you are--I was going to open by asking you how
has your last week been, but I was afraid I would get an honest
answer, so I don't want to begin that way.
But I do want to commend you, and I mean that with all
sincerity. You are one--I think one of the best cabinet
officers that the President has, and I think you and your team
serve this country very well. And I think this incident is
proof of that, not a contradiction to it.
Mr. Secretary, let me, again, wish you good morning. I look
forward to the hearing today. Department of Health and Human
Services has broad responsibility covering almost every aspect
of daily life. In the next year, you are projecting almost a
$1.4 trillion in outlay. You oversee healthcare for our seniors
and Native Americans, and ensure both the quality and safety of
the Nation's food and drug supply.
Your agency forms the backbone of the public health
infrastructure and is responsible for the development of
medical protections against infectious diseases and chemical,
biological, radiological, and nuclear agents. Discretionary
spending provided by this subcommittee amounts--you know,
accounts for only a small fraction of your overall total,
really, just 8 percent of your outlays.
In just the last 2 years--I was reflecting about your
tenure as Secretary--you have responded to unprecedented storms
leaving thousands of limited access to healthcare in Puerto
Rico, humanitarian crisis at our southern border, and opioid
addiction epidemic, and most recently, the spread of a new
infectious disease from China. And I want to commend you and
your leadership of this agency.
First, I want to address the aggressive budget you have put
before us. We know the cuts proposed are deep and, quite
frankly, unlikely to be sustained. And I also know who writes
the budget. They are called the OMB, the, you know, Office of
Management and Budget, and you get to submit things but you
have to come out and defend the decisions that are made there.
And I appreciate that, and you work for the President, and you
have to do that.
But I want to stress, continued cuts to discretionary
spending will not solve the Nation's fiscal problems, period.
It is not possible to balance our national budget by chipping
away at discretionary spending. We must look to broader
entitlement reform to achieve the valued goal of a balanced
budget. Nearly 90 percent of your agency is entitlement
spending on autopilot. The authorizing committees of
jurisdiction need to tackle the mounting problem of entitlement
spending.
I know, Mr. Secretary, you know these figures, but I hope
those listening will take heed and recognize the challenges
with Federal spending are not within the discretionary spending
controlled by the Appropriations Committee.
Second, I want to stress again that, while small compared
to your total outlays, the discretionary component of your
budget that we are going to talk about today plays a critical
role for our country. Moreover, several programs we will
discuss here today touch the life of every American. I usually
start with the National Institutes of Health, but today I think
it is fitting to highlight how important the Centers for
Disease Control and Prevention is to protect the health of the
American people.
In the span of just a few weeks, we have witnessed a
massive interagency undertaking to respond to the novel
coronavirus from China. The CDC is built on lessons learned
from past outbreaks and was positioned to respond, inform,
deploy, and protect. Hundreds of staff were marshalled quickly
to work on different elements of the response efforts.
While not everything has gone perfectly, the Agency has
shown the value of preparing for the unexpected and having a
transparent, proactive communication strategy. I urge this
committee to increase its support for the Infectious Diseases
Rapid Reserve Fund at the CDC. As I have said here before, the
threat of a pandemic is far greater than a terrorist event.
Having resources uncommitted and immediately available is
vital.
I know many are disappointed to once again see proposed
reductions for the National Institutes of Health. You and I
have had have candid conversations about this. I too agree with
my chairman here that a reduction there is unwise. However, I
do want to point out this budget actually is $12 billion more
for the NIH than the level proposed just 4 years ago. So it is
not as if you haven't recognized the value there, and, frankly,
I think you are going to catch up to us someday and you are
going to be with us in continuing this bipartisan effort to
increase this spending.
I ardently urge Congress to continue to maintain its
commitment to sustained increases for biomedical research, and
I am pleased to see that with each budget the total request for
NIH continues to increase. I hope decades from now future
legislators commend the work of this committee for showing its
commitment to biomedical research and maintaining American
dominance in basic science.
Recent news reports highlighting efforts by the Chinese
Government to steal intellectual property and use financial
incentives to manipulate researchers stresses the importance of
our advantage. We should be proud the knowledge gained from
hard work of our scientists is the envy of the world, but we
must also understand protecting and safeguarding that
information is necessary to ensuring the Nation's security.
I also want to highlight your commitment to emergency
preparedness. However, I was disappointed to see the reduction
in Project BioShield and the Infectious Diseases Rapid Response
Reserve Fund and only flat funding of the Strategic National
Stockpile and the Biomedical Advanced Research and Development
Agency, or BART as it is known.
And, again, I will just be candid with you. I attribute
that to OMB more than I do to people at HHS. And we can have
that discussion later, because this whole Congress and
administration needs a serious discussion on spending, but that
has been true for a long time and under previous
administrations as well.
Our country needs to be ready to respond to any event to
protect the health of the Nation. These programs are the
Nation's frontline of defense against a domestic chemical,
biological, or nuclear attack or infectious disease outbreak.
We know current funding levels are not enough to have the
Nation prepared for a large-scale event; therefore, reductions
there, in my view, are misguided.
I do want to recognize the $50 million increase for
pandemic flu. While the current flu season has been milder than
in years past, it has still resulted in thousands of
hospitalizations and hundreds of deaths, including children.
And I am encouraged by the commitment expressed in your budget
to increase vaccination rates and efforts to develop more
effective vaccines. We will save lives with those investments.
Your budget also proposes to provide an additional $680
million for the unaccompanied children program. This program
has been a difficult and--has had a difficult and unpredictable
history resulting in a deficiency in highly contentious
supplemental appropriation last year. Your agency's efforts to
move the program to a more stable position to respond to
increases in arrivals at the southern border is long overdue.
Building a system that can accommodate unpredictable arrivals
at the southern borders is both necessary and responsible
management of Federal resources.
Finally, again, I want to personally thank you for your--
the efforts that you have undertaken in your agency to protect
the life of innocent children and respect a person's right to
follow their religious beliefs. I support your efforts to align
the Title 10 Family Planning Program with current law and
ensure a separation between family planning services and
abortion.
I also support your efforts to allow for the free exercise
of conscience and health insurance coverage and enforce current
law provisions, which prohibit discrimination based off of
decision not to support an abortion.
Again, I appreciate the job you have done for the American
people. I look forward to your testimony here today.
Ms. DeLauro. Let me now yield to the chair of the full
Appropriations Committee, Congresswoman Nita Lowey from New
York.
Mrs. Lowey. Welcome. And I thank Chair DeLauro, Ranking
Member Cole for holding this hearing.
Secretary Azar, thank you for joining us today. As you
know, Chair DeLauro and I sent you a letter on February 4
requesting information on additional resources for the
coronavirus. Despite urgent warnings from Congress and the
public health community, it has taken weeks for the Trump
administration to request these emergency funds while tens of
thousands have become ill around the world. And I understand
well, as my colleague Mr. Cole has said, this may not be
attributed to you, but here you are today, and I thank you.
Where still the overall request is inadequate to
effectively combat this threat, it is alarming that the
administration is proposing to take money from one emergency to
pay for another, which would leave us more at risk for emerging
diseases and is an irresponsible approach to combatting what
the WHO has said is a potential pandemic. House Democrats will
move quickly to enact a robust package that will fully address
this threat without jeopardizing other necessary programs.
Now to the budget. Mr. Secretary, you and I have been able
to work together on important public health issues, and I value
our relationship. That is why it is so disappointing when you
come before us with a budget that is really devoid from reality
and would seriously harm the American people.
President Trump's disastrous budget is filled with program
cuts opposed by the public and bipartisan majorities in both
chambers. It is unfortunate that instead of using the budget to
build on the historic investments secured in last year's
appropriation bills, the President doubled down on partisan
talking points.
To propose investing $2 billion for the wall or steal it
outright from our veterans and servicemembers while proposing
to cut initiatives that improve the well-being of Americans
exposes the Trump administration priorities to what they are,
campaign promises over public health.
Among many reckless proposals your budget would cut CDC by
nearly $700 million, just as CDC is combatting epidemics on
opioids, surging rates of youth vaping--we could use a whole
hearing, again, on just the youth vaping issue. I have never
seen anything expand in all our public schools, even down to
fourth, fifth, sixth grade.
One of the worst flu seasons in decades and the
coronavirus, cut NIH by $3.3 billion jeopardizing lifesaving
medical research, and eliminate preschool development grants
which would stall the important progress dates made to build
strong early education systems.
In addition, the irresponsible proposal to eliminate teen
pregnancy prevention while assaulting Medicaid and attacking
the foundation of Title 10 Family Planning with a domestic gag
rule is a dangerous combination that will leave many women
without access to quality care, result in more unplanned
pregnancies. This is an assault on women's health and the
rights of women and their doctors.
And I was dismayed--actually shocked--with the elimination
of the Federal funding we included in the fiscal year 2020
spending bill for the first time in two decades for gun
violence prevention research. While you have supported this
research in the past--I want to say that again. I am aware that
you have supported this research in the past--the budget makes
clear that the President does not intend to do anything to
combat the gun violence epidemic in this country.
In addition, rather than invest in the ability of State and
local governments to combat the vaping epidemic, which has led
to at least 64 deaths, nearly 3,000 hospitalizations, this
budget would consolidate CDC's office on smoking and health,
cut its funding at the very moment we need the CDC's expertise
and resources.
So if a budget is a statement of values, that it is clear
that President Trump has no intention of protecting our young
people or improving the health of Americans.
So thank you so much for being here. I look forward to
continuing the discussion.
Ms. DeLauro. Thank you.
I now want to yield to the ranking member of the full
Appropriations Committee, Congresswoman Kay Granger from Texas.
Ms. Granger. Thank you so much.
Before I begin my prepared remarks on the crisis that we
are dealing with right now, I want to associate myself with
Ranking Member Cole's remarks having to do with your good job
and the planning that has gone on in this committee for such a
long time.
I would like to thank Chairwoman DeLauro and Ranking Member
Cole, who also serves as the vice ranking member for the full
committee, for holding this hearing.
I also want to thank you, Secretary Azar, for your efforts
to protect our Nation from this new coronavirus. Your immediate
actions have enabled us to get ahead of the virus and begin
protecting our citizens.
At the beginning of the outbreak you told Members of
Congress that you would let us know as soon as possible when
more funding was needed, and you have done just that. I am
confident that Congress will work with you to make sure you
have the resources in hand to continue to respond rapidly to
this dynamic situation.
All Americans should be reassured this morning that we have
a robust public health system that is able to respond in every
State to an infectious disease outbreak such as this. Congress
has strengthened our State and local efforts with recent
investments, including $85 million in the most recent fiscal
year 2020 appropriation for a rapid response to an infectious
disease.
This is the very situation that led the subcommittee under
the leadership of my friend Mr. Cole and Chair DeLauro to
create such a fund, and I am pleased to see that it is enabling
your agency to mount a quick and proactive effort to keep our
Nation safe.
I look forward to working with you and my colleagues in
Congress as we continue to prevent the spread of this and other
diseases within our country. I thank you for being here to
testify today, and I yield back my time.
Ms. DeLauro. Thank you very much.
Mr. Secretary, your testimony--and as you know, your full
testimony will be entered into the record, and now you are
recognized for 5 minutes. Thank you.
Secretary Azar. Great. Thank you very much.
Chairwoman Lowey, DeLauro, and Ranking Members Granger and
Cole, thank you very much for inviting me to discuss the
President's budget for fiscal year 2021. I am honored to appear
before this committee for budget testimony as HHS Secretary for
the third time, especially after the remarkable year of results
that HHS has produced in the last year.
With support from this committee this past year we saw drug
overdose deaths decline for the first time in decades, another
record year of generic drug approvals at FDA, and historic
drops in Medicare Advantage, Medicare Part D, and Affordable
Care Act exchange premiums.
The President's budget aims to move toward a future where
HHS programs work better for the people we serve, where our
human services programs put people at the center, and where
America's healthcare system is affordable, personalized, puts
patients in control, and treats them like a human being not
like a number.
HHS has the largest discretionary budget of non-defense
department agencies, which means that difficult decisions must
be made to put discretionary spending on a sustainable path.
This committee has made important investments over the years,
and some of HHS's large discretionary programs, including the
National Institutes of Health and we are grateful for that
work.
The President's budget proposes to protect what works in
our healthcare system and make it better. I will mention two
ways we do that: First, facilitating patient-centered markets,
and second, tackling key impactable health challenges.
The budget's healthcare reforms aim to put the patient at
the center. It would, for instance, eliminate cost sharing for
colonoscopies, a lifesaving preventive service. The budget
would reduce patients' costs and promote competition by paying
the same for certain services regardless of setting. And it
endorses bipartisan, bicameral drug pricing legislation. The
budget's reforms will improve Medicare and extend the life of
the hospital insurance fund for at least 25 years.
We propose investing $116 million in HHS's initiative to
reduce maternal mortality and morbidity, and we propose reforms
to tackle America's rural healthcare crisis, including
telehealth expansions, and new flexibility for rural hospitals.
The budget increases investments to combat the opioid
epidemic including SAMHSA's State opioid response program where
we appreciate this committee's work with us to give States
flexibility to address stimulants like methamphetamines. We
request $716 million for the President's initiative to end the
HIV epidemic in America by using effective evidence-based
tools, and this committee's support has enabled us to begin
implementation already.
Today, I am pleased to announce that the Health Resources
and Services Administration is dispersing $117 million in
grants to expand access to HIV treatment and prevention by
leveraging successful programs and community partnerships, such
as the Ryan White HIV/AIDS Program and community health centers
to reach more Americans who need treatment or prevention
services.
The budget reflects how seriously we take the threat of
other infectious diseases such as the novel coronavirus by
prioritizing funding for CDC's infectious disease programs and
maintaining investments in hospital preparedness. We still have
only 14 cases of the novel coronavirus detected in the United
States involving travel to or close contacts with travelers.
We have three cases among Americans repatriated from Wuhan
and 42 cases among American passengers repatriated from the
Diamond Princess. The immediate risk to the American public
remains low, but there is now community transmission in a
number of countries, including outside of Asia, which is deeply
concerning. We are working closely with State, local, and
private sector partners to prepare for mitigating the virus'
potential spread in the United States, as we expect to see more
cases here.
On Monday, OMB Center requests to make at least $2.5
billion in funding available for preparedness and response,
including for therapeutics, vaccines, personal protective
equipment, State and local public health support, and
surveillance. I look forward to working closely with Congress
on that request.
Lastly, when it comes to human services, the budget cuts
back on programs that lack proven results while reforming
programs like TANF to drive State investments in supporting
work in the benefits it brings for well-being. We continue the
fiscal year 2020 investments Congress made in Head Start and
child care programs, which promote children's well-being and
adults' independence.
This year's budget aims to protect and enhance Americans'
well-being and deliver Americans a more affordable,
personalized healthcare system that works better rather than
just spends more, and I look forward to working with this
committee to make that commonsense goal a reality.
Thank you very much.
[The statement of Secretary Azar follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeLauro. Thank you very much, Mr. Secretary.
And we are going to step out of regular order for a moment.
Chairwoman Roybal-Allard is chairing a hearing at 10:30 with
the Department of Homeland Security, so I want to say thank
you, you know, for--to my colleagues for your graciousness and
allowing Congresswoman Roybal-Allard to ask her question before
she has to excuse herself.
We recognize Congresswoman Roybal-Allard.
Ms. Roybal-Allard. Thank you, Madam Chair. And also thank
you to the committee for the courtesy of being able to speak
out of order.
Secretary Azar, since the initial passage in 2008 of my
Newborn Screening Saves Lives Act, it has helped ensure high-
quality diagnostics and lifesaving followup interventions for
the over 12,000 newborn babies diagnosed each year with genetic
and endocrine conditions.
As you know, the Newborn Screening Act codified the
Advisory Committee on Heritable Disorders in Newborns and
Children to help address the vast discrepancy between the
number and quality of State screening tests. Because of this
committee's work, today 49 States and the District of Columbia
screened for at least 31 of the 35 currently recommended core
conditions.
Last September, the reauthorization of the newborn
screening law expired, and we have passed a new reauthorization
bill in the House, and we continue to push our Senate
colleagues to pass the bill out of their Chamber.
However, since October, your office has suspended the
activities of the Advisory Committee, which is preventing it
from completing its current work at commencing new business
including a critical update to the recommended uniform
screening panel nomination process. Meanwhile, you have the
authority reinforced in the 2014 newborn screening
reauthorization to deem the advisory council a secretarial
Advisory Committee so it could continue its charter.
Given the essential role that the advisory council plays in
our Nation's newborn screening system, why haven't you used
this authority, and when will you extend the term of the
committee until reauthorization occurs?
Secretary Azar. Well, first, Congresswoman, I would like to
thank you for your leadership with respect to maternal health
and as co-chair of the congressional caucus on maternity care.
As you know, maternal health is a very serious public
health challenge in the United States, and our budget is
actually investing in--thanks to your leadership and both
chairwomen of this committee--by increasing funding by $74
million at CDC, HRSA, ARQH, and IHS to reduce maternal
mortality and morbidity.
We are going to continue funding for maternal and child
health block grants to States, which provide States with
additional flexibility for programs such as heritable
disorders. We also have $126 million for Healthy Start for
community-based strategies to reduce disparities in infant
mortality and improve perinatal outcomes for women and children
in high-risk communities.
With regard to the Advisory Committee on Heritable
Disorders, due to that lapse in the authorization, that
committee has halted activities. I am happy to look into the
question of its work as we work with Congress around
reauthorization, of course, of the Neonatal Screening Act.
Ms. Roybal-Allard. Okay. Because you do have that authority
to continue that committee.
And you mentioned another issue that I am concerned about,
that in your 2021 budget that you propose to eliminate the
HRSA, heritable disorder program, that provides grants to
educate providers and parents to help States expand their
newborn screening programs.
Without this funding, how will the States fulfill these
newborn screening activities and improve followup care for
infants diagnosed with heritable disorders, and who will
operate, update, disseminate information from the Federal
Clearinghouse of newborn screening information? Those are
questions that I would like some answers to. But you did
mention that you also rolled the newborn screening into the
maternal health, child health block grant. Is that what you
just stated?
Secretary Azar. So, no, I was emphasizing that we have
within the maternal mortality block grant that those provide
addition that has flexibility to States for programs such as
heritable disorders. So they could use that block grant
funding, is my understanding, to continue while we are waiting
for congressional reauthorization work on heritable disorders.
Ms. Roybal-Allard. Well, the concern is that, number one,
you put less money into the block grant than was in the
programs that you eliminated and then States are free to use
their block grant money as they desire. So increasing funding
for the MCH block grant, I think, is an important investment,
but it does not guarantee the money will be spent on improving
State newborn screening programs. So maybe we can work a little
bit on that and talk a little bit more about the possibility of
reinstating the committee, Advisory Committee.
Secretary Azar. Happy to work with you on that.
Ms. Roybal-Allard. Thank you.
Secretary Azar. Thank you.
Ms. Roybal-Allard. Thank you.
Ms. DeLauro. Thank you. We are going to return to regular
order, and I have a question for you, Mr. Secretary. Just
before you testified yesterday morning before Senate
Appropriations, OMB finally submitted a supplemental funding
request. And Chairwoman Lowey mentioned and that we both asked
you to submit such a request 3 weeks ago, and while we are glad
the administration has finally done so, what has been provided
to date is unacceptable. It lacks the fundamental components of
a supplemental request, including proposed bill language,
supplemental documentation, and OMB did not transmit a budget
table with programmatic details until last night.
To be clear, we want to be supportive. We realize this
situation is evolving, and you are adjusting to shifting
circumstances, but it is important for the committee to better
understand the needs going forward.
One, can you tell us how much of the Infectious Diseases
Rapid Response Reserve Fund has been used for this emergency
response? Has----
Secretary Azar. So as I think you--oh, sorry.
Ms. DeLauro. Has the $105 million that was available from
that fund been exhausted?
Secretary Azar. We are at the point now where we have used
or where we have either committed or obligated the moneys in
that $105 million rapid response fund, and that is why I sent
you the notice last night about the reprogramming and transfer
on the 136 so that future obligations we can continue our work
pending----
Ms. DeLauro. So that the $105 is gone?
Secretary Azar. It is in budgets being committed or
obligated, exactly. Right.
Ms. DeLauro. Yeah. Right. Well, it's not there, okay.
Secretary Azar. Right.
Ms. DeLauro. And are you going to--how quickly are you
expending the funds?
Secretary Azar. The actual run rate of the money going out
the door I don't know. I believe we were at about $20 million
the last update we had given to the subcommittee, but I would
want to defer to staff if we could check with you on that.
Ms. DeLauro. Okay.
Secretary Azar. I do want to make sure you are getting
information on spend rate as quickly as OMB will, you know,
authorize the release of that. But we are--basically we are out
of the $105, for which we are very grateful that you all
funded. It has proven to be vitally, vitally important, so
thank you.
Ms. DeLauro. Let me ask you to provide additional details
of the supplemental request for the subcommittee. I have only
seen the two-page letter from OMB and a one-page budget table.
You know, I was around when the Obama administration submitted
a supplemental request for Ebola. They sent a 28-page document
outlining the intended purpose of each component of the
request, and that was demanded by this committee. I was there.
Every time they came with much more information.
So let me ask you these several questions. How do you
intend to reimburse State and local agencies for their
expenditures on the ground?
Secretary Azar. So we have got--I appreciate your
frustration with the two-page letter being the documentation.
We have been working with your staff to provide detail----
Ms. DeLauro. By the way, this is the Obama submission.
Secretary Azar. Yes. Right. So we have been working with
your staff. We actually do--we do have plans that we are going
to work with your teams to make sure we educate on and work
together to flesh out. It is a very fast-moving process, as I
am sure you understand.
So within the $2.5 billion, at least $2.5 billion request
we would have the CDC have a major fund, which would be through
the public health emergency fund, to allow them to work with
State and local governments to reimburse for expenses around
contact tracing, laboratory work, lab testing, et cetera.
Ms. DeLauro. So we are going to reimburse State and local
agencies?
Secretary Azar. Yes. So that would be--that is the goal to
have a fund that would enable the feedback we have gotten from
State and locals, whether through grants or actual
reimbursement, and we would work with the committee on the
appropriate structure of how you think that should be done.
Ms. DeLauro. Okay. And I would just like to know what we
think that is going to be, how much money is involved, et
cetera, so that we can also respond.
Secretary Azar. Absolutely. Yeah.
Ms. DeLauro. We are all getting those questions.
Secretary Azar. Yes. So that is in the table. So if--there
are five key areas that didn't--weren't quite transparent in
the letter, if I could mention the key strategic announcements
we want to make.
Ms. DeLauro. Quickly. My time is going to run out.
Secretary Azar. Okay.
Ms. DeLauro. I will get the five areas.
How much of the funding is designated for international
activities versus domestic preparedness?
Secretary Azar. So I believe in the most recent document
that I saw, the table that I believe you have access to, there
is $200 million in there of USAID funding that may be from
existing sources. I don't know if that is new money or not.
That may be existing moneys that would be dedicated on that.
We have focused our $2.5 billion request at HHS frankly on
U.S. preparedness and response. And I would say, compared to
the Ebola response where getting that stopped in West Africa or
now in East DRC is the critical element, here our activities
are really mitigation--containment and mitigation preparation
in the homeland because we are not going to help the Chinese
stop this in China. China is going to do that or not be able to
do that.
Ms. DeLauro. Does the supplemental request include funding
to replenish the Infectious Diseases Rapid Response Reserve
Fund? Yes or no.
Secretary Azar. I don't believe we use the Rapid Response
Fund, but what we would do is work with you on the 2021
appropriation to ensure that that is appropriately funded in
light of this. The funding request, of course, was locked in
December before any of this happened, so we want to be flexible
on 2021 funding to respond to this.
Ms. DeLauro. Did OMB reject any of your requests for
emergency supplemental funding to respond to the coronavirus?
Secretary Azar. Well, I am not going to get into back and
forth with the White House or OMB discussions, but I want to
let you know, this $2.5 billion request, it has my complete and
full support. It attacks the five critical success factors that
I made clear I needed to invest in, and it supports that. It is
at levels I think are appropriate. And if not, if it doesn't
fund it enough, we will come back to you and work with you.
And, again, we are trying to be flexible. We said at least
$2.5. We want to work with you on both funding sources as well
as top-line amounts.
Ms. DeLauro. Well, as the chair pointed out, we will put
together a supplemental that will address this issue.
Congresswoman--Congressman Cole.
Mr. Cole. You gave me a promotion there for a minute. I am
sorry? Oh, yeah. I know she has got to get to the next meeting.
Ms. DeLauro. Yes. I apologize.
Ms. Granger. No problem.
Ms. DeLauro. Congresswoman Granger.
Ms. Granger. Thank you for allowing me to go. I have to go
to another one.
Mr. Secretary, I was alarmed to learn recently that almost
90 percent of active ingredients used for pharmaceutical
manufacturing originate in China. What should we be doing in
the United States to ensure the safety of the American drug
supply?
Secretary Azar. Well, Chairwoman, as you know, this is
really--this has brought to light the issue of the complete
internationalization of the supply chain not just for medical
products but really across all of the economy. And so what we
are doing now is the FDA is reaching out to all pharmaceutical
manufacturers, device manufacturers, et cetera, to make sure we
have got visibility.
The latest fruits of that work show that there are 20
pharmaceutical products we are aware of to date at FDA where
either the entire product is made in China or there is a
critical active ingredient that is solely sourced within China.
So those would be obviously the most targeted to be concerned
about.
To date we are not aware of any expected shortages, and we
have aggressively proactively reached out to manufacturers for
that information. I am told there are two manufacturers in
Hubei province of pharmaceuticals, but fortunately the
manufacturer has a large, large stockpile supply of advanced
production there.
But we have to be very alert to this, and we have to be
candid that there could be disruptions in supplies. We already
experience that, of course, with medical shortages, generic
shortages, due to sole-source producers, manufacturing defects,
inspection problems. And we have got an aggressive agenda for
shortages that we have worked with this committee and
authorizing committees onto help alleviate shortages.
Ms. Granger. Good. Thank you. And would you keep us
informed on those?
Secretary Azar. Of course, yes.
Ms. Granger. Thank you, Madam Chair, for letting me do
that.
Ms. DeLauro. Thank you.
I now would like to recognize the chair of the committee
who has a hearing to get to as well, Congresswoman Lowey.
Mr. Cole. You are a very busy woman.
Mrs. Lowey. We will all talk fast. Thank you.
First of all, I echo the concerns raised by Chair DeLauro
on the coronavirus, and we really do need these answers right
away, but I would like to turn to another matter on--which is
impacting public health.
As you know, I have worked to restore funding for gun
violence prevention since former Representative Dickey first
attached his amendments to the spending bill more than 20 years
ago. Some of us were there. The fiscal year 2020 spending bill
enacted with bipartisan support in December included $25
million for Federal gun violence prevention research split
between the CDC and the NIH.
And when you and I have discussed this issue, including at
the budget hearing 2 years ago, you expressed support for this
research and responded that we are in the science-gathering
business. Well, clearly, that sentiment isn't shared by the
White House as the President's budget would eliminate this
groundbreaking funding.
Nearly 40,000 Americans lose their lives due to a firearm
each year, hundreds of thousands more are injured. Why does the
Trump administration not believe this is a public health
priority worthy of funding?
Secretary Azar. So thank you for having funded that in the
2020 appropriation in December, and we are actually executing
on the funding both at NIH and at CDC. In fact, just on the
21st, the CDC put out a new research funding opportunity,
research grants to prevent firearm related violence and
injuries to solicit investigator initiated projects with a
deadline of May 5 for submissions of those.
In terms of the budget submission and the continuation of
that, as you know, with CDC's budget we prioritized infectious
disease preparedness and global health security, and so that
did mean cuts and prioritization away from chronic and
preventive activities which included the firearm research
there.
We, of course, continue at NIH to always be open for
business as we have always been for firearm research within the
peer review process of submissions, and so that would continue
regardless of whether Congress accepts the budget submission or
not.
Mrs. Lowey. Well, with all due respect, the administration
chose to make these cuts. This wasn't a tough choice; it was
the wrong choice.
With limited time, I am going to go to another key issue.
And I thank you, Madam Chair.
As I mentioned, at least 64 people died last year and
nearly 3,000 were hospitalized with vaping-related respiratory
illnesses. While many but not all of these cases were
attributed to vitamin E acetate, the crisis raises serious
question about how little is known about vaping, particularly
as concern grows that there could be long-term health
consequences such as heart disease, stroke, cancer, and more.
This is particularly alarming as the youth vaping rates have
skyrocketed.
So I was optimistic when President Trump said he would
clear the market of flavored e-cigarettes. But after speaking
to his political advisers, he turned his back on public health
for political gain and instead proceeded with an announcement
that has left thousands of kid-friendly flavors on the market
and allowed disposable e-cigarettes to flourish. How many more
people will have to be sickened or die for the administration
to take this seriously and ban all flavors?
Secretary Azar. Chairwoman, thank you for your passion
around the e-cigarette and vaping issue and access for kids. I
share that and want to keep working with you on this challenge.
When the President made the initial announcement with me on
September 11, we included all flavors other than tobacco in
that statement because at the time we had the National Youth
Tobacco Survey data, which had mint and menthol together as
single category of use.
We were actually at that time concerned about including
menthol in the immediate removal from the market given the fact
that menthol combustible is a discrete legal category used
especially in the African American community, and we want to
make sure that off-ramp would not be immediately pulled away
from folks.
After making our announcement we got the Monitoring the
Future data out of NIH that broke apart for the first time and
showed that menthol was really not being used by kids. It was
much more like tobacco flavoring of the e-cigarettes, and it
was the mint that was driving it. And that was what led to the
modification of the flavoring question there as we move forward
to the submission deadline.
We just--also, with regard to disposables, we don't have
data on disposables. NJOY, the largest manufacturer, did pull
their flavors off the market, is what they announced, the
comparable kid-friendly flavors off of the market. But we are
going to keep working and enforcing. If anybody is marketing to
kids, we are going to enforce against them. We are going to
watch the data in terms of enforcement priorities. And, of
course, they all have to submit by May of 2020 per court order
for the PMTA at FDA.
Mrs. Lowey. Well, just a quick, final question. Frankly, we
need more resources to combat this epidemic not less. So maybe
you can think about why the administration recommended yet
again to consolidate and then gut funding for the Office on
Smoking and Health.
I guess I--oh, I guess I don't have any time.
Ms. DeLauro. No. You are out of time.
Mrs. Lowey. Why don't you think about that and perhaps
answer--just let me say, in conclusion, Madam Chair, this is an
epidemic. You know, I speak to my grandkids, sixth grade, fifth
grade, it is unbelievable what is going on out there. So we
have to take it seriously, be tough and strong and respond to
this epidemic that is growing. Thank you very much.
Ms. DeLauro. Thank you.
Mrs. Lowey. Thank you, Madam Chair.
Ms. DeLauro. Ranking Member Cole, thank you, again, for
your----
Mr. Cole. Absolutely. Thank you.
And, Madam Chairman of the full committee, you have all the
time you want whenever you need it. I am sure our chairman will
make sure----
Mrs. Lowey. Oh, really?
Mr. Cole. Yes, you do. This is your committee.
Mrs. Lowey. Thank you. But I am going to go over to
Homeland Security.
Mr. Cole. Okay. Well, we will miss you because we know we
are really your favorite, and we always have been.
Let me start--a couple things. I want to first associate
myself very much with our chairman's request for the additional
detail on the supplemental, and that is meant to try and help
you----
Secretary Azar. Of course.
Mr. Cole [continuing]. Quite frankly, because our job will
be to sell this supplemental to our colleagues on both sides of
the aisle. I know we will work together to do that. So the more
you can arm us with information, the better off we will be.
I do have a couple of quick questions on the coronavirus.
And I want to--again, my chairman made this point and I want to
associate myself with her on this too. I agree with her about
Ebola. You know, I don't think you should sacrifice short term
here what--this is bad dealing with coronavirus.
If we ever had an Ebola outbreak inside the United States,
it would be devastating. So I just don't think we should be,
you know, penny wise and pound foolish on that. I would hope
working together we protect that funding going forward, and I
just I say that just to advise you of that. And, again, I don't
have any problem with people being prudent, trying to stretch
the dollars as far as they can. That is a good thing. This is
just one that I think we are going to have to do something
different.
Now, I want to ask one question, and I know the answer to
it but I want to get it clearly on the record. If you do not
have enough money in the $2.5 billion you asked for, you will
come back and ask for it, additional funds. Is that correct?
Secretary Azar. Absolutely.
Mr. Cole. I can tell you, I have talked to our leadership
and they are fully supportive of that. They understand that
this is difficult to estimate and that it could grow
exponentially. And so, I mean, I have got the green light from
our side of the aisle to say, look, if we have to go beyond
this, please feel free to alert your colleagues on the other
side that we are going to work with you on that.
Second question, and, again, a compliment, I want to thank
you. We don't have the jurisdiction over funding on the Indian
Healthcare Service, but you do, and you had a modest increase
in that this year and a tight budget. I appreciate that. And
thank you, and I will do my very best to give you more money
than you asked for this that area.
But I do want to also alert you, the budget does propose
for the elimination of the good health and wellness in Indian
Country program at the CDC. That ain't going to happen. You
know, that is a program that we work with tribal governments
on. They are vastly underfunded in this particular area. And
so, again, I sympathize with you dealing with OMB, but I just
alert you that I certainly would be very opposed to that.
If you want to comment on some of the things you are doing
in tribal health, I would be very interested in listening to
what you have to say.
Secretary Azar. Yeah, absolutely, Mr. Cole. Thank you very
much. And I think you know our passion, my passion around
tribal health. And we have--even in tight budget environments
we have really tried to ensure appropriate investment in Indian
Country.
While our budget does, as everyone has noted, propose an
overall decrease of almost 10 percent in discretionary
spending, IHS is funded in our budget request actually at $6.2
billion, which is a 3 percent increase. So just by scale, I
think that reflects the prioritization of Indian health that we
are trying to make here.
Discretionary funding for IHS has actually gone up by 24
percent between fiscal year 2017 and 2020. We are working to
improve quality, safety in our facilities. In fact, my deputy
secretary is out there in South Dakota this week inspecting our
facilities that we are trying to get brought up to
certification.
We are working to--as part of this appropriation we want to
really build up a whole quality, safety culture and mindset
throughout IHS beyond just compliance with CMS certification
requirements. So that is part of all that we are trying to do
for Indian health, so thank you.
Mr. Cole. Well, again, I am very appreciative, and we are
going to work with you where we can and then occasionally stop
you where we must.
But let me move to another area. And you and I have talked
about this recently, and I think it is important for the
committee to know. We have had some very legitimate questions,
in my view, about reimbursement particularly during coronavirus
for State and local people.
But the reality is CDC provides, I think, 50 percent of all
the funding for State and local health programs in the United
States. I know in my own State it is 60 percent. So it is not
as if you haven't put a lot of effort out there already, and,
you know, this is something that maybe State and local
governments need to be looking at, not that I am calling for
any decrease in what we do, but maybe they need to be doing a
little bit more themselves.
But I want to ask you how ready you think these State and
local departments are to deal with this as we go forward and
what additional steps you think we ought to take to strengthen
those things without making them totally dependent on the
Federal Government.
Secretary Azar. Well, as you mentioned, thanks to this
committee we, through the CDC fund, approximately 50 percent of
the public health infrastructure at the State and local level
in the United States. In addition there is--or connected to
that is the Public Health Emergency Program, the PHEP, which
funds over the last many years $675 million a year to States to
then give to locals to--precisely for this kind of situation,
to be ready for public health emergencies.
I have been impressed by most States and local governments'
degrees of cooperation and preparedness, but it has also
highlighted to me, I believe there is a need for greater
accountability and oversight with that money that is going out
to ensure that it is, in fact, leading to readiness for a
public health emergency.
Mr. Cole. Last quick question because I only have about 30
seconds, but I probably get more concerns about mental health
in my district than almost anything else, and I think that is
pretty common for all of us. Could you address quickly some of
the things in your budget that would help us deal with the
mental health problems that I know all of us face?
Secretary Azar. Well, one of the most exciting things in
our budget, from my perspective, is the proposal that would
allow a State option on what is called the IMD exclusion, not
just to have inpatient--expanded inpatient facility capacity
for substance use disorder but also for serious mental illness,
to really--we have seen where we have had IMD exclusions
approved for--the waivers approved for States on substance use
disorder and expansion in capacity, and by bringing this as a
State option, which means it is not, I think, subject to the
budget neutrality issues of a waiver, that is a major
investment that could allow that for serious mental illness.
Just one example there.
Mr. Cole. Thank you very much.
Thank you, Madam Chairman.
Ms. DeLauro. Congressman Pocan.
Mr. Pocan. Thank you very much, Madam Chairman.
And thank you Mr. Secretary for being here.
First off, let me say your department is in the final
stages of a regulation regarding the interoperability of
healthcare data. More than 10,000 of my constituents work in
the health IT industry.
I just wanted to let you know that the outcome of this rule
is very important to my district. I appreciate you listening to
the concerns of comments. I look forward to the improvements
that will happen in the regulation, and I want to thank you for
your leadership.
Secretary Azar. I have worked directly with Epic leadership
in hearing their concerns. I think often they--we put a
proposal out, precisely because we want to get that feedback
about operationalizing and everything. So I hope that we are
trying to be reflective of----
Mr. Pocan. I look forward to----
Secretary Azar [continuing]. As much as we can.
Mr. Pocan. So let me try to get the meat which may not be
as pleasant. I would love to get to talks about the cuts to
Medicare and Medicaid, the cuts to NIH, but I really want to
talk about the coronavirus. And I need you to help provide some
comfort to the American people that this administration and
Federal officials actually have a grasp on this. So let me just
go down a little bit of litany of what I found on the news just
in the last few days. We had the Secretary of Homeland Security
Chad Wolf yesterday say a vaccine was several months away, the
President said we are very close to a vaccine, and yet I think
you and the CDC and others have said it is more like 18 months.
We have heard from Commerce Secretary Wilbur Ross say that
the coronavirus could be good for U.S. business because it
hurts China. We have heard Larry Kudlow say it is contained. We
have heard Rush Limbaugh, Medal of Freedom winner and White
House surrogate, say it is no worse than the common cold. And,
yet, we have also heard from CDC officials not a question of if
this will happen anymore, but rather a question of exactly
when. And Dr. Fauci, who many of us really respect, said it is
inevitable this will come to the United States. So we have got
those kind of comments.
Second, we know that this first started information coming
around January 7, and the budget that was produced by the
President on February 10 provided a number of cuts that would
have actually worked to directly affect this from the almost
$700,000,000 cuts to CDC, $167,000,000 from the Office of the
Assistant Secretary for Preparedness and Response, $18,000,000
from the House Preparedness Response Account, and $200,000,000
cut to Project Bioshield.
We have seen recent reporting that 150 prescription drugs--
and this is from the FDA--are at risk of shortage if this
outbreak worsens, and yet the FDA Commissioner Stephen Hahn, is
reportedly not part of the task force as planning the U.S.
response to the coronavirus virus.
In 2018, the CDC cut 80 percent of its efforts as part of
the global health security initiative to prevent global disease
outbreaks because it was running out of money, and it was
reported that the Department could go from working in 49
countries to just 10 countries. Also, in 2018, the White House
official that was responsible for leading the U.S. response of
the deadly pandemic left the administration, and the global
health security team he oversaw was disbanded.
And, finally, the tweet from this morning from the
President talking about low ratings fake news, doing everything
possible to make the coronavirus--spelled incorrectly, but I am
a journalism major--look as bad as possible, including
panicking markets if possible. Markets being the concern.
So help me, if this contained the common cold, inevitable,
2 months, 18 months, provide me some security that someone
knows what is going on in this administration about the
coronavirus virus.
Secretary Azar. Well, thank you. Where shall I begin?
Mr. Pocan. It is a long list of----
Secretary Azar. What we are trying to do, and we have tried
to do this with Members of Congress, Senate, and the public and
the media is really flood you with information about this to
make sure that we are being transparent about what we are
facing, what we know and what we do not know, as well as what
our plans are.
So the risk right now is very low to Americans. We have--as
Kudlow--as Larry Kudlow said, from a public health perspective,
we technically are in a state of containment in the United
States. We have had 14 domestically identified cases here from
nonrepatriation. That has remained the case now for 15 days,
but we have always been clear that, number one, that could
change rapidly. And from the outset, I and the public health
experts have said we fully expect we will seek more cases here
in the United States. We have to be mentally prepared and,
also, as a government prepared.
Mr. Pocan. If I can, just to reclaim my time. It still
didn't provide me the comfort I was looking for. Because the
variety of statements I said are from 2 months ``it is
nothing,'' ``it is a common cold'' to ``inevitable.'' And I
still do not think this administration seems to have grasp on
it.
Let me ask you this, you are looking for the funds--I also
agree with the bipartisan concern around stealing it from
Ebola. I talked to a senior White House official last year--not
White House, but administration official. One of his two main
concerns he was dealing with was Ebola. So taking money from
that would be ridiculous.
Let me ask you this. We have redirected $3,800,000,000 from
Defense for the wall. The wall is not going to stop any real or
imaginary migration, and it is certainly not going to stop the
coronavirus. Would you supportive of taking some of that
$3,800,000,000 or any money for the wall and transferring it to
take care of the coronavirus.
Secretary Azar. So the Ebola funding and all of the
transfers proposed in the supplemental, I do want to be very
clear: That is simply a concept of how you could fund half of
the supplemental. We are not wed to that. We wanted to give you
ideas.
On the Ebola money, that in particular with Ebola, it is--
thanks to the Ebola supplemental funding we had before, it is
important to note, we have now an approved vaccine from Merck,
and we now have two therapeutic candidates. I have been almost
daily involved with the eastern DRC Ebola outbreak that, God
willing, is coming close to being under control. It is
certainly, on the epidemiological curve, is looking more like
that if the security situation stays. But I want to thank this
committee for the support on Ebola that we have had. And we
have now major weapons to use against Ebola, which is really a
revolution.
Mr. Pocan. And if I could may interject, just the specific
last part of the question, would you be okay with taking funds
that have been redirected for the wall and redirecting to stop
coronavirus?
Secretary Azar. I don't believe the administration would be
supportive of that, but Congress would make the decisions about
how to fund supplemental.
Mr. Pocan. Thank you very much, Mr. Secretary.
Ms. DeLauro. Congresswoman Herrera Beutler.
Ms. Herrera Beutler. Thank you, Madam Chair.
I want to commend you for your initiative on advancing
kidney health. Most people don't know that 750,000 Americans
have irreversible kidney failure. And 90 percent of CKD
patients are undiagnosed. So 9 in 10 people do not know that
they are on this track. It represents--so, then, it is too late
to slow the disease progression. So that is--Medicare spends
more 120,000,000,000, 34 percent of total spending. And end-
stage disease accounts for 7 percent of Medicare spending,
despite representing 1 percent of Medicare patients. And this
is only going to get worse.
So my hat is off. I have been super excited about the
initiative that the White House, that you have launched to go
after several of the problems within our current system to both
educate and inform and help people more healthy, also to make
sure that we are getting more solid organ procurements, that
people are getting the transplants needed. And they are also
going after--the big fear for most people that have
transplants, which is when is the immunosuppressive coverage
going to end, because I cannot afford that.
So I just want to say thank you. It is a breath of fresh
air to have someone really taking on this issue. It represents
a lot of hope for a number of us who have been laboring in this
field.
I wanted to ask. There are two things--you know I have a
lot of questions about the coronavirus, and I do appreciate it.
I have seen multiple options for Members that come for
briefings from your staff, from your team. So thank you for
keeping us abreast. I think do think it is going to change and
iterate, like you said.
I wanted to see if someone from your office would be
willing to come in and just sit down with me about some real
specific questions. How does it jump? What test kits are being
made available locally? I saw something about commercial test
kits becoming available. I think if it does iterate and becomes
communicable--in each of our communities, we do not know how
really our public health agencies and even our hospitals need
to be able to test. That is what we are going to need. I know
they keep saying it is only 2 percent of people die with this
as compared with SARS, but those 2 percent represent the
elderly. I mean, almost every article I have read, it is
someone 70 years or older, or it is someone with a chronic
illness. And I think we should be defending those folks to the
best of our ability. So I know we probably don't have the time
to go into that now, but I would just love somebody to come in
and spend a little bit of time with me on that.
Secretary Azar. We would be happy to try to do that, or if
we could address those--because those are questions everybody
has. And so that might be one of our----
Ms. Herrera Beutler. So if you want to take a quick swing
at it.
Secretary Azar. So in terms of----
Ms. Herrera Beutler. So let me give you the three----
Secretary Azar. Right.
Ms. Herrera Beutler [continuing]. How does it spread?
Secretary Azar. Right----
Ms. Herrera Beutler. Is it on table tops? How long does it
sit there? How does it jump? And the test kits and their
availability?
Secretary Azar. Right. So, in terms of transmissibility,
obviously as a respiratory illness, it usually would transmit
versus aerosolization. But there might be fomite--it is called
fomite transmission when it would sit on a hard surface, for
instance. Dr. Fauci has spoken publicly about this. But, of
course, we don't have hard data with regard to the novel
coronavirus. But usually one would expect fomite transmission
in the several-hour range as opposed to multiple-day range.
But, again----
Ms. Herrera Beutler. You do not know.
Secretary Azar. But, again, we do not have studies on this
or the data on this that would be the usual with the
coronavirus. But I rely on Dr. Fauci on that.
In terms of fatality rates, we are seeing various
estimates. The WHO team that was just in China saw higher rates
of fatality; I think over 2.5 percent in Wuhan. But outside of
Hubei province, I believe they were seeing numbers closer to
0.7 percent. So there again is a range. And we are going to
have--one of the numbers--the top projects for us is to get a
set of public health statements of our beliefs and what is the
fatality rate we believe would be applicable in a modern
healthcare system like the United States with very aggression
active containment at the outset, as well as community
mitigation efforts in the event of community spread here. So it
might be quite different than that in terms of assumptions.
On testing, we currently have the CDC test, which they
invented in 1 week. That is at CDC and is now validated at 11
other sites. We had an issue on the third stage of the--there
is a third stage of the test. One of the 92 reagent aspects of
it, if it is not done just right, was having issues on quality
control on the control element, not leaving the false positives
or negatives, just an inconclusive result on 1 of the 92. We
are working on both fixing up, but also perhaps we have over-
engineered that test in the first two stages of it. It may
actually be enough to enable a faster test. So we are working
on getting that as soon as possible to the remaining public
health labs. The commercial sector is looking at, we hope, the
bedside diagnostics, as you have said. And we have heard from
dozens and dozens of them. And the FDA will obviously expedite
work with them on that.
Ms. Herrera Beutler [continuing]. Good. I know I cannot ask
you more questions. Could someone--I would also like to talk
about the pharmaceutical slowdowns. I realize the
immunosuppressive--there are some other things that are
happening both in India and China, kind of impacting India with
regard to shortages that have started that we are seeing that
is leading to some of the major pharmacies and retail
pharmacies and mail order pharmacies--I do not want to use
the--they are being judicious in how they are filling scripts.
I only see that getting worse.
Secretary Azar. I would say, just to clarify for the
public, those would be our general shortage issues that are not
connected to the novel coronavirus.
Ms. Herrera Beutler. I would like----
Secretary Azar. Because we have not seen any shortages
connected to this.
Ms. Herrera Beutler. I do not want incite any fear here,
but I would like someone to come in here and talk with me
about--I just want to know what the contingencies are and some
forward planning.
Thank you so much, Madam Chair.
Ms. DeLauro. Thank you.
Congresswoman Frankel.
Ms. Frankel. Thank you, Madam Chair. I want to talk to you
about something that I think is actually one of the greatest
health issues here in this country. But I want to say for the
record--and then I think my colleagues will follow this up--the
public should know that Mr. Trump fired the government's entire
pandemic response chain of command while in the White House.
But I am not going to get into that. I want to ask you a
question, a couple of questions. Would you agree that doctors
should not lie to their patients?
Secretary Azar. Doctors should provide truthful information
to their patients.
Ms. Frankel. All right. There is one. And doctors should
give full information to their patients. All right.
Secretary Azar. I know you said doctors should not lie to
their patients, and I agree with that.
Ms. Frankel. Okay. They should give full information.
Secretary Azar. If they are in a statutory system that
precludes certain information or certain communications, then
they have to comply with statutory requirements.
Ms. Frankel. Okay. Let's get that. So let's talk about the
contradiction of really of those two statements. Because I am
going to talk about Title IX. I am sure you anticipated that.
And, listen, I just wanted to say thank you for being here.
Okay.
Title X, that is right, I cannot even read my own paper.
All right. So the Trump budget, Title X, you keep it stable
funding, $286,000,000. And I want to say something about Title
X. It has in the past been a bipartisan and very incredibly
effective program. It is meant to ensure people who are
struggling to make ends meet, who do not have health insurance.
They can still have access to birth control, cancer screenings,
STD testing and treatment, as well as annual exams.
Unfortunately, in March of 2019, HHS published a rule which
prohibits providers from providing referrals for abortion, even
upon a patient's request, and impose onerous physical and
financial separation requirements, which under a rule, all
abortion activities must be physically and financially
separated.
So let me just say this: I call this the Trump abortion
obsession. So, for example, even if a patient who came into a
Title X provider found out they were pregnant and asked, ``Do I
have an alternative whether I keep this pregnancy or not,'' the
provider is not allowed to tell them--not allowed to say. They
are gagged, g-a-g-g-e-d. They are gagged. Because of this,
Planned Parenthood announced it would leave the program. And,
unfortunately, the courts have upheld the administration's
rule. Planned Parenthood served 1,500,000 of the 4,000,000 of
the Title X patients. And I have just to go--not going through
all of the statistics, but half the patients who rely on Title
X funding do not have the provider they had been turning to.
I want to ask you this, do you have a list--could you
provide us with a list of the new providers that have come into
the program?
Secretary Azar. I believe we could, I think.
Ms. Frankel. Okay. I would like--do you happen to know how
many new providers there are?
Secretary Azar. The number of new--I am just looking to see
if I happen to have that here. I do not believe I have just the
exact number of new providers, but we could get that for you.
Ms. Frankel. Okay. Would it have surprised you that, as of
1 year after the rule was published, there had only been one
new provider and/or maybe--and the provider did not provide
contraceptive services.
Secretary Azar. Well, actually, the provider has--I know
the entity you are speaking of, but that provider has to,
through their subgrantees have subgrantees that would provide
the full range of contraceptive services required under Title
X.
Ms. Frankel. And there are several States that have no
Title X funding right now. Well, you know, I could go on and on
about this. But let me ask you another question. Who should
decide whether or not someone brings a child into this world?
Who is in the best--should someone have to call the Governor or
call you or call me?
Secretary Azar. So, with regard to Title X, we are
enforcing the Title X law, which by Congress prohibits referral
for abortion as a method of family planning, and our final rule
actually was upheld even by the----
Ms. Frankel. Well, abortion is a medical service that is
legal. It is legal. Is that correct?
Secretary Azar. The Congress decides where Federal money
may be used in connection with abortion, and so the Federal,
the statute in Title X prohibits referral to programs in
which----
Ms. Frankel. I do understand that. And as a result, because
what is called as a gag rule, which means providers cannot give
their patients all the information they need to make important
decisions, you have lost the biggest provider in the country,
which is called Planned Parenthood? Are you aware that Planned
Parenthood does a lot more than refer to abortions or provide
abortions, STD exams, mammograms?
Secretary Azar. So I am actually aware that between 2020
and--2010 and 2015, 141 Planned Parenthood clinics have closed;
that, over the past 9 years, cancer screening and prevention
services at Planned Parenthood decline by over 60 percent;
contraceptive services declined by 30 percent; and there are
important preventive activities, like HPV vaccinations and well
women exams, that account for less than 10 percent of their
activities as they focus on their abortion work.
Ms. Frankel. Hundreds and hundreds of thousands of patients
are taken care of--were taken care of by Planned Parenthood.
Mammograms, STDs, contraception. You need to check--all right.
Sorry about that.
I would say you should go back to school.
Ms. DeLauro. Congressman Moolenaar.
Mr. Moolenaar. Thank you, Madam Chair.
Mr. Secretary, thank you for being with us here today and
for the update on the coronavirus and the regular briefings
that you and the administration, the team, have been doing.
Also, I want to thank you for all that you and your team are
doing kind of around the clock on this. So I appreciate that.
I wondered if we could talk a little bit about some of the
initiatives you are doing in the rural health space. I know you
have a 4-point strategy. A few specific areas I wanted to talk
about. One is the opioid situation. You know and overdoses of
opioids. That is a huge concern in my district. And I know
Naloxone is used in kind of the front lines on this to help
people. And I wondered what HHS is doing to help create an
awareness with the general public, as well as work with
pharmacists to make sure it is accessible and available, and
then anything you can do to help us understand the insurance
aspects as well to keep costs down for people.
Secretary Azar. Sure. So, Congressman, with regard to rural
health and the opioid crisis, I did want to mention that we
have got consistent funding of $23,000,000 for the First
Responders Training Program, which actually trains first
responders in opioid overdose in rural communities. We have the
Project AWARE rural set-aside. We have the Rural Health
Outreach Grants Program, which maintains $80,000,000,
consistent funding there to support grants for primary care and
opioid use disorder treatment and prevention and behavioral
services there.
In terms of Naloxone, with Naloxone, we have actually seen
the genericization of that product. As a result, we have seen
405 percent increase in Naloxone prescribing. We have got, in
2019, FDA approved the first-ever generic Naloxone. We have
granted priority review to every other Naloxone product that
would be used for emergency treatment. And we also are
encouraging over-the-counter by laying out what would be needed
to do an OTC of Naloxone also. So we have seen pricing--I
think, at this point, with CMS with part D, we have encouraged
placement on the select care tier for Naloxone, which would be
zero-dollar copay. I think we are seeing similar types of
support in commercial insurance also.
Mr. Moolenaar. Thank you. And I also want to talk a little
bit about telehealth, if we could. That is very important in
these rural communities. And I just wondered if you could
discuss how your proposed changes to Medicare fee-for-service
advanced payments will broaden access to Medicare at telehealth
services.
Secretary Azar. Absolutely. So we have got in the budget
several proposals. One of those would be to modernize Medicare
telehealth so that it would promote value-based payments. So we
are moving barriers to telehealth in rural and underserved
areas by expanding the availability and fee-for-service where
we have advanced payment models. So those APMs, making sure
telehealth is available in fee-for-service. So that is one.
The next is to enhance our services in federally qualified
health centers and rural health clinics. So that would allow
these centers to actually be distant site providers in rural
America, which would make them eligible for payment under
Medicare fee-for-service as part of that proposal.
We would also extend Medicare telehealth for his and Tribal
facilities. As we know, his is of course one of the most
important rural healthcare providers that we have in America.
Mr. Moolenaar. Wonderful. If I could take you to the CDC
for a minute. I know the CDC surveillance data platform, can
you talk or give us an update on the status of that and the
plans going forward?
Secretary Azar. So we have got one of the finest
surveillance platforms in the world in terms of CDC support of
this. In fact, one of the critical elements of the emergency
supplemental is to enhance that surveillance system for novel
coronavirus. What I want to get to is where we are getting data
on suspected flu cases nationwide and getting those tested for
novel coronavirus nationwide. We have expanded that immediately
to six cities. So Seattle, San Francisco, Los Angeles,
Honolulu, Chicago, and New York currently have this enhanced
surveillance. We want an early detection system because this
will be the backbone of our effective mitigation program.
We are also--something I am quite interested in, we are
talking with Google and others about, how can we leverage novel
IT social media interactions as part of a modern
epidemiological surveillance system? They may know things
faster than we can get public health reports in from local
health agencies.
Mr. Moolenaar. Are we on track of these things? I know
there are reports that are due to you and to Congress.
Secretary Azar. I don't know about any particular reporting
issues on that. But if we get the supplemental, obviously, we
are going to use transfer money immediately to try to enhance
that surveillance system and then working on the rest of these
initiatives. If there are particular questions, we would be
happy to get back to you on any timing or deadlines.
Mr. Moolenaar. Thank you very much.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you, Madam Chairwoman, Mr.
Ranking Member.
And thank you. Mr. Secretary.
Real quick thing. I think we have a 6-degree-of-separation
relationship. You clerked for Scalia. His aunt, who was very,
very proud of him, was my both French and Spanish teacher, and
he comes from Trenton.
I want to ask you a couple of quick questions, and I have
some questions regarding New Jersey specific. Number one is
that you were quoted as saying we have a 30,000 stockpile of
masks, and if there is a real pandemic, we need 300,000. And
since we generally see products of that nature come out of
China, where will we get ours and be prepared?
Secretary Azar. Thank you, and, first, I would like to
actually clarify something that I said yesterday in the Senate
Appropriations Committee. I had been informed of some
information that is a bit different than what I had at the
time. To clarify first, we have more masks than the 30,000,000
that I related yesterday. But we have a different mix of those
masks than what we have been informed of. So we have 30,000,000
surgical masks. Those would be the gauze-type tied-behind-the-
ear-type mask. It is meant to really protect people from the
healthcare worker spreading. We have 12,000,000 N95 NIOSH-
certified masks in the stockpile. And then we have about
5,000,000 N95 masks that I believe may have expired. They are
no longer NIOSH certified.
Mrs. Watson Coleman. So where do we get the rest?
Secretary Azar. And then we would need--so what we have
talked about is we would need approximately 300,000,000 N95
masks from the emergency supplemental. We have already from the
reprogramming----
Mrs. Watson Coleman. But where will we get them?
Secretary Azar. Well, so from the reprogramming, we are
going to initiate immediately procurements to do domestic
manufacturing around N95 as quickly as we can scale it up. And
then, if we get the emergency supplemental money on the
Strategic National Stockpile, that would add on to those
contracts. It will be--I do want caution: It will take time
because China, as you rightly mentioned, China does control a
lot of the raw materials, as well as manufacturing.
Mrs. Watson Coleman. Thank you. Thank you. I need to ask
you some New Jersey specific questions because New Jersey has
been designated a funnel airport, which means that individuals
who are contagious or could possibly be contagious could
possibly be contained or quarantined in New Jersey. So I am
interested in sort of the costs associated with our
responsibility to do that. And I know New Jersey is gearing up
for that purpose. What do you think is an appropriate and fair
model to reimburse the State for costs that might be incurred
over incidences like that, including quarantine facilities,
test kits, overtime, service, that kind of thing.
Secretary Azar. So, first, with regard to the emergency
supplemental, that is exactly why we are asking for a large
amount of money to help State and local governments with larger
scale containment activities. With regard to the particular
issue of Newark Airport as one of the funneling airports, that
means individuals who have been in China within the previous 14
days would be directed by DHS into Newark and others. We have
worked very collaboratively with New York, which if we have any
cases that required actual quarantine, New York has taken those
on out of the Newark airport, New York. And then the others
really are not--should not be an impact on New Jersey because
at this point, because we are screening them with CDC and DHS
people for health screening. And then the rest of the people
are going on. We have screened I believe total about 46,000
travelers and have yielded only, I believe, 17 nationwide who
have actually needed to go into quarantine because they were in
Hubei province.
Mrs. Watson Coleman. Okay. Then let me clarify something
for my own self. That they are being--that they are being
brought in and looked at in Newark, there is no provision or no
discussion about those individuals who need quarantining being
like on the Joint McGuire Air Force Base, which is more
southern New Jersey.
Secretary Azar. I do not believe so, but I am happy and
certainly can be corrected on that, and we would get you
updated information. My understanding what we worked out was
Newark would funnel--that any patients with Newark would go
into New Jersey.
Mrs. Watson Coleman. So New York I said--
Secretary Azar. I want to make sure I am right about that.
Mrs. Watson Coleman. Would you please because I understand
that that is going to--allowing that is going to expire on
March the 5th. But if there is going to be this need, we need
to know what the emergency response is going to be to do that.
Secretary Azar. Sure. I want to make sure I get you
accurate information. If I could, we will call your office
after the hearing to get you information.
Mrs. Watson Coleman. I think that Ms. Frankel asked--made a
comment about sort of the organization of the administration's
response to pandemic diseases and things of that nature. And I
was wondering why we do not have a, quote/unquote, czar and why
this administration is not organized in a way that there is a
person at the top who represents sort of the policies and has
some authority? Because I know we had a pushback between the
CDC and the State Department in terms of flying individuals who
are contagious on an airline. So why don't we have that
structure? What is a plan to have such a structure, and is
there a plan to have such a czar?
Secretary Azar. Under the national--if I might. Under the
National Response Plan, Emergency Support Function 8 for public
health emergencies, I am the lead--mine is the lead agency. I
actually helped build these plans decades ago for pandemic
preparedness after 911. So I serve as the lead on this while it
is a public health emergency. I work on a daily basis with the
chief of staff and the President. So if there is any
deconflicting of agencies needed, that can happen there. So we
effectively get that same function. And it is just the
longstanding doctrine that this should be led by HHS with the
public health emergency. There is not actually a change. The
oddity was actually what President Obama did with the Ebola
response. I do not know why they felt things were not working
and needed to do that. This has been the smoothest interagency
process I have experienced in my 20 years of dealing with
public health emergencies.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you very much.
And thank you, Mr. Secretary. And I have to tell you, after
hearing your testimony, you know, the inference that no one in
the administration knows about coronavirus is pretty stunning.
Your knowledge is actually as up-to-date as you can get about
it.
I will tell you the other fake news is the budget as
referred to as cuts to Medicare and Medicaid. The first time I
heard that, I went back and looked at that budget document.
Medicare and Medicaid spending go up every single year in the
President's budget, don't they? That is a rhetorical questions.
I know what the answer is. So only in Washington is an increase
called a cut. I am not sure I understand it, but we will leave
it at that. Let's talk about the emergency funds. I have not
been aware of anything that could be done here in the United
States that has not been done. Let me bring a couple of
examples. For instance, we know that Moderna think just
yesterday shipped their novel vaccine. 6 weeks after the idea
of making a vaccine, it shipped for Phase 1 trial to NIH.
Moderna, by the way, is an American company, right? It is.
Right outside of Boston, isn't it?
Secretary Azar. Right.
Mr. Harris. Absolutely. This is stunning. And this lays on
the framework that the ranking member had mentioned over the
years of us dealing and preparing for exactly this kind, this
kind of potential crisis. I mean, that is stunning. But 6 weeks
from conceptualization to shipping, a phase 1 vaccine is
stunning. And I would urge that you and the Department to speed
that through the Phase 3 trial hopefully to get it here before
the next winter season.
Another American company, Gilead, Remdesivir, is developing
a novel approach to an antiviral that could be effective in
coronavirus. That is pretty good, I think. So we have
incentivized--it is amazing that the two companies that have
taken the lead in a pharmacological approach to dealing with
this are American companies. Now, I will tell you what is
disappointing is the President warned us China is a bad actor.
Do we yet why the genotypes from China of the first cases of
this virus?
Secretary Azar. I do not believe we have the first
generation isolates or genetic sequence.
Mr. Harris. That is a real problem, because we can talk
about what this country can do, but when you are talking about
DNA sequence or MRNA sequences of a vaccine, it depends on an
accurate genotype that China is unwilling to share with the
United States. Now I do not know why they are unwilling to
share. You can use your imagination why they might be unwilling
to share. But to hold the President of the United States
responsible for the behavior of China in response to this is
unconscionable. It is unconscionable. I pick the newspaper, and
that is all I hear. You have heard some of it today in the
subcommittee. No one is talking about China's role withholding
the genetic sequencing of those initial isolates, exceedingly
important to figure out how this disease is going to affect
Americans ultimately. All right. But there are other things and
I just want to congratulate you for your support of BARDA. As
you know, Sanofi and J&J are making two other novel vaccines
under the BARDA program. Again, we have thought about this in
advance. We have done what we needed to do. And I believe that
we are on the track to dealing with this. There are other
issues that are important to me, and I do not have the time to
ask more indepth questions.
Maternal mortality is very important. I was an obstetric
anesthesiologist. I have seen patients get very, very ill.
Fortunately, knock on wood, I have not seen a mother die. But
it happens in the United States, it happens more often than it
should, and I applaud you for doing things about it.
Antimicrobial resistance is incredibly important. And by
the way as we begin strategies to fight coronavirus, we have to
realize that the antivirals--I was unaware of this actually
until very recently that viruses develop resistance to
antivirals too. It is not just bacteria. So increasing or
keeping the drug pipeline for antivirals open and working is
very, very important.
One thing that I would ask you to look into--I have asked
this for a year and a half--is that Medicare still does not pay
for oxygen therapy for cluster headaches. And as I have told
the CMS Administrator, I had cluster headaches; oxygen worked
for me when I was younger. We should not deny it to Medicare
patients. It is a serious disease. You should not deny it.
DIR fees, I am a little disappointed that the
administration has not taken action on them. The rebating
mechanisms and what happens helps I think drive up the cost of
pharmaceuticals. I would ask you to take action on it. I think
we have to come up--and this is one of the most frequent
questions that I get asked in the townhall meetings, is, what
are we going to do about prescription drug prices? I would
suggest, instead of separating into our opposing camps as we
always do, let's get together and agree on some common things
that we can do.
Finally, on Naloxone, incredibly important to make sure--as
we know and is true in my district, the number of overdoses
continues to rise or plateaus. The number of deaths,
fortunately, has gone down mostly to the availability of
Naloxone. So I want to thank the Department for what it has
done with that.
With that, I yield back, Madam Chair.
Ms. DeLauro. Thank you.
Congresswoman Bustos.
Mrs. Bustos. Thank you, Mr. Secretary for being here. We
appreciate it.
So I come from the State of Illinois where we have actually
had some cases of coronavirus. And I actually want to shift my
line of questioning not so much just around appropriations,
even though we are here at our Labor-H Subcommittee of
Appropriations, but more about preparing communities. About 85
percent of the towns I represent are 5,000 people or fewer; 60
percent are a thousand people or fewer. So a lot of small and
rural areas. And with the expected increase in cases that we
have learned about, what will you and your Department do to
help prepare our local health providers to be ready for this?
Secretary Azar. Yeah, and Congresswoman, first. Thank you
for your leadership on rural health. I really appreciate you
coming over and meeting with me.
Mrs. Bustos. I appreciated you having me. It was very nice
of you. Thank you.
Secretary Azar. In terms of rural communities and rural
hospitals and providers in the coronavirus situation, first, we
don't know how broad any spread would be. We prepare for
community outbreaks. Those could be really localized, and then
taking mitigation efforts. Dr. Anne Schuchat, who is the top
career official at CDC, yesterday at our press conference, she
tried to clarify one of the impressions--misimpressions that
people have had from our current active containment efforts.
Because, right now, we are bringing people back from China or
from Japan, repatriating them. And they may be positive or in
active containment. We are using high-end health facilities,
like Ebola treatment centers, as really isolation units, even
though they don't require that level of medical care; because
we are in active containment, we don't have another place for
them to be. So the impression I think is getting created that
anybody who gets novel coronavirus not only goes to the
hospital but also goes to very intensive type negative airflow
facility, which our rural communities do not have. In fact,
what she said is most people who would get novel coronavirus
are going to stay at home. They are going to treat it the way
they would treat a severe flu or a cold, managing symptoms. And
we will publish clear information when you should seek medical
attention. When you might, you go to the hospital for the rarer
instances where that would be required. So part of it is really
managing that patient flow so we do not collapse our rural
hospitals unnecessarily. So it is really important that we all
work together to educate the public and providers about that.
Mrs. Bustos. So really no different in rural America than
urban America; it is just educating the public on how best to
treat this, rather than head to the biggest hospital.
Secretary Azar. It is not going to be race into the
emergency room, right? But, also, the State and local support
in the supp will, of course, be really important for our
hospitals and local public health agencies.
Mrs. Bustos. Thank you. Let me shift to the discussion that
we had when I was in your office back in November. That was
about healthcare provider shortage. So I will give you an
example in the congressional district that I serve. We have a
county--it is called Henderson County--where the patient to
physician ratio is 6,995 patients to 1 physician. That
contrast, like if you look at Cook County, our largest county
in Illinois where, you know, Chicago area, the ratio there is
1,200 to 1. So and then you have also have these example--we
have a hospital that literally took 7 years to recruit a
physician. So we talked a little bit about this before. So we
work together--my colleagues and I, in last year's funding bill
to direct the health resources services administration to
provide a report to our committee within 120 days of how, how
recruitment could be better handled to address these provider
shortages. And so I did note that, in the President's budget,
his proposal is to cut the Healthcare Workforce Program by
$824,000,000, or about 50 percent. So I was just wondering how
your Department will square that massive cut with ending
provider shortages or at least addressing provider shortages
especially in rural America.
Secretary Azar. Yes, so I understand your concern and your
question. The program that we fund there is the National Health
Service Corp, which really lets us through tuition
reimbursement get people who are nurses, doctors, dentists,
through a reimbursement system to serve in rural communities
and underserved areas. The other program, the one you mentioned
that we proposed cutting, it doesn't have demonstrable results
in terms of producing that kind of service in rural and
underserved areas. It more goes to institutions as subsidies
around teaching.
The other thing that we want to do is reform our graduate
medical education program. That is why we advocate in combining
the Medicare Medicaid in children's graduate medical education
programs and getting rid of the caps that we had from the 1990s
that freeze in place specialties so that we can enhance our
primary care doctors that we produce and psychs other
underserved specialty areas to get them into rural areas. That
is part of the plan also.
Mrs. Bustos. I have several followup questions. I can get
those to you later because I am out of time right now. But
thank you being here, and thanks for your answers.
Ms. DeLauro. Congresswoman Lee.
Ms. Lee. Thank you very much.
Thank you, Madam Chair, and also ranking member.
And thank you, Mr. Secretary. A couple of questions. First
of all, let me just follow up on the N95 masks. Last week, I
came through the international terminal from the bay area in
San Francisco, and I noticed quite a few people had masks on,
but they were not N95. The reason I knew this is because of the
fires in the bay area, and I have an aunt who is 99 years old
and also some senior centers where they were wearing masks. But
come to find out, they were useless in many respects. And that
is how I learned about N95. And there was only one place where
I could purchase them. I wanted to ask you how you are rolling
out the public education just with regard to which masks are
the appropriate ones to use and which ones are not. Because
when I entered the terminal last week, no one had an N95 mask
on. So how are we reaching out and letting the public know the
difference between the masks and which ones to use?
Secretary Azar. Thank you. I am so glad you asked about
that. We just need to use avenues like this and when we have
press conferences and all, because I do fear, especially given
that this coming out of Asia where there is much more of a
culture of mask wearing when one is sick or at risk of being
sick, that people do have the sense of the mask as like the be-
all end-all of either preparedness or response activity. It is
an element in our armamentarium mostly for healthcare workers.
And that is that N95 mask that is actually fitted; it has be to
carefully fitted, and it can protect the worker.
The other mask, just you and me wearing these masks--what
Dr. Fauci and what Dr. Schuchat have said is that actually
sometimes be more harmful to you than not wearing a mask.
Because if it is not fitted right, you are going to be fumbling
with it, you are going to be touching your face, which is the
number one way you are going to get disease is unclean hands
touching your face. And so we are really--and every press
conference I have been asked about masks, I have tried to
settle these expectations that it is--that is not the be-all
end-all. Basic public health hygiene, washing hands at extended
time with soap and water, not touching your face, coughing into
your elbow. These are best things for flu season for common
cold, for novel coronavirus that any of us can do.
Ms. Lee. So you are not suggesting that the public access
the N95 mask.
Secretary Azar. No, we do not recommend that. We do not
recommend that, no.
Ms. Lee. Let me ask you now about some of these cuts in
your budget. First of all, HIV and AIDS, while we know that we
can achieve an AIDS-free generation by 2030, you have a funding
cut of $170,000,000 to PEPFAR, which, of course, reduces the
transmission of HIV and AIDS throughout the world. Also, you
have a cut in Medicaid, which is the largest source of coverage
for people with HIV. So now it is estimated to cover 42 percent
of people. So, while you are proposing an increase or new money
for Ryan White and CDC, you are cutting 42 percent--you are
cutting Medicaid which affects 42 percent of people.
Secondly, and I will do this very quickly, you propose to
eliminate the teen pregnancy program. And I want to follow up
with Congresswoman Frankel's comment about this obsession with
abortion that this administration has, yet you have moved
forward to eliminate programs that prevent abortion, such as
the teen pregnancy prevention program. You just zeroed that
out. You zero out the racial and ethnic approaches to community
health, which is the only Federal program that funds community-
based organizations to address racial health disparities. And
you for the most part cut I think it is $30,000,000 for the
National Institute on Minority Health and Health Disparity. And
so the impact of these cuts on minority communities, on young
people, on people living with HIV and AIDS, they are
horrendous. And I want to know how you justify cutting these
programs which really do good and help people and provide for
good quality public health strategies.
Secretary Azar. So we clearly agree with you on the
importance of solving minority health disparity, as well as
supporting minority health. We may just approach it in
different programs and different ways of doing it. We are
providing $5,700,000,000 for our health centers which serve 1
in 12 Americans. And 62 percent of patients in our health
centers are actually racial and ethnic minorities. They are
really one of the gems of our primary and preventative health
system.
Our HIV program that you mentioned my--the one that I
really am very passionate about to end the HIV epidemic--the
investment of Ryan White HIV AIDS there is critical. And that
serves--75 percent of Ryan White clients are actually racial
and ethnic minorities.
Ms. Lee. But actually you are cutting Medicaid, which
serves 42 percent of people.
Secretary Azar. As Congressman Harris mentioned, we are
actually not even proposing a cut to Medicaid. We would slow
the rate of growth on Medicaid from 5.1 percent per year to 3
percent per year, increasing in every single year of the budget
outlook in terms of Medicaid. So it actually grows Medicaid
just by not quite as of much, as its unsustainable pathway for
States.
Ms. Lee. If we have a second go around, you can answer teen
pregnancy prevention. That is totally crazy.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. Thank you, Madam Chair. Thank you, Secretary for
being here.
So, when I was preparing for the hearing today, I really
wanted to focus on the Low-Income Housing Energy Assistance
Program, LIHEAP. There has been a lot of unpredictability
because we simply cannot understand the formula that is being
used. And this impacts over 7 million families who rely on
LIHEAP for their cooling and heating in the season. So I was
planning on asking you to follow up on the request of this
committee that you provide an explanation of the formula. And I
was given this particular--this is the formula for LIHEAP that
I was given yesterday by some advocates. So I can understand
why it is difficult for you to understand, but I am wondering
if you can--I was planning on asking if you can tell us if you
are going to have the formula explanation ready for us in time
with the 120-day deadline that we gave you?
Secretary Azar. We will work on getting that to you. I am
not familiar with the request that you had for the LIHEAP
formula in terms of information, but we will certainly work to
get that to you.
Ms. Clark. Well, it was in our fiscal year 2020 funding
bill, and you have 67 days left to comply with it. So I would
get cracking if I were you.
Secretary Azar. I will put coronavirus on hold.
Ms. Clark. But then maybe it does not really matter because
you completed eliminated LIHEAP in this budget. Is that right?
Secretary Azar. As we have before, the budget environment
with budget caps we had a----
Ms. Clark. That is right. You decided to eliminate the
entire program.
Secretary Azar. We did recommend that it is not as
effective as a program, and it is duplicative of other State
and local programs.
Ms. Clark. You just zero out the budget item.
Secretary Azar [continuing]. You make the choices on
whether to accept that.
Ms. Clark. But that is your recommendation.
Secretary Azar. It is our recommendation, yes.
Ms. Clark. Basically you said that is because you think
that utilities now cover this because many more States have--
that you cannot have your utilities cut off. Is that right?
Secretary Azar. That is correct as well as GAO funding
findings about the risk of fraud and abuse in the program. It
is a tight budget environment, and making choices, it is a
large discretionary program----
Ms. Clark. Okay. So you decided that seniors, families with
children, that is going to be where we are going to make our
decisions in the tight budget environment. I do want to note
that many of the rural electric co-ops, municipal utilities,
and many of the larger utility companies, the rural and
municipal have none of these protections in most States. And in
many States, it is not based on income. It is based on whether
and trying to figure out the Federal formula that nobody
understands. But we will look forward to your report. But then
it got a lot worse for LIHEAP because you not only eliminated
it, you decided to transfer $37,000,000 to fighting the
coronavirus. So that is another 750,000 families that you
decided, okay, they can go cold, but we are going to put this
money towards the coronavirus. And you also did that with
$535,000,000 in Ebola funding, which I know you talked about a
little. Do you agree with those Ebola cuts?
Secretary Azar. So, as I mentioned earlier on the emergency
supplemental, we proposed funding half of it through various
transfers and reallocations. Congress can of course decide
other funding sources or no funding sources for the money. The
Ebola money is, while it is useful to us, right now the most
pressing need is the novel coronavirus and I----
Ms. Clark. I agree with you.
Secretary Azar. And we can restore in the coming years
also. As we think about it.
Ms. Clark. That is a pressing need, but I certainly think
that you understand as Secretary that public health crises keep
coming, and that is why you prepare. So I am mystified why the
White House totally took apart the pandemic chain of command.
And you have said today that you do not think you need it; this
is one of the smoothest operations. But breaking news while we
sit here and maybe the White House did not inform you, is that
there is a press conference at 6 o'clock, and the White House
is in fact now saying, we might need to appoint a czar to
overlook this pandemic.
Secretary Azar. No, not at all. The President and I spoke
this morning as he returned from India, and he said: I want to
keep being radically transparent. When you come over to brief
me this evening, let's sit and invite the press in.
It is quite that simple.
Ms. Clark. Quite that simple. Okay. So you have taken that
apart. You have recommended $700,000,000 in cuts to CDC. You
have underfunded our emergency response. $6,100,000,000 was
what the President asked for in response to Ebola. This
President is asking for $1,250,000,000 to address this
pandemic. But how if you consistently underfund the CDC, you
have taken up the heart of chain of command, you are using
other critical public health and security measures to fund this
coronavirus even at those very low levels, are we possibly able
to be transparent, as you just said and look at Americans and
saying: Your country is doing everything we can, not only to
prepare for this crisis, but for those that we know are coming
in the future. I am sorry. My time has expired.
Ms. DeLauro. We are going to move to the second round and
asking people to do 3 minutes so everybody has a chance to say
or do what they need to do, and then we will wrap up. I will
just mention, it just says here: White House is waiting whether
to appoint a coronavirus czar to coordinate response to the
spreading epidemic.
Secretary Azar. I do not put much stock in anonymous
sources in Politico.
Ms. DeLauro. Well, we will see what happens. But let me
move to a different area. I am told that DHS can still be given
significant incident reports which might include child's past
accounts of trauma or witnessed activity. You know the vast
majority of children that end up in ORR's care are there are a
result of fleeing, unimaginable violence, gang activity,
poverty, desperate situation. What is ORR's policy with regard
to sharing information, sharing significant incidence reports
collected by case managers or clinicians with ICE? It is my
understanding that you have said, Secretary Azar, that you have
talked about consent. How are children capable of giving
consent to sharing notes from their confidential therapy
sessions with ICE?
Secretary Azar. So, as we have discussed, the transmission
of the clinical notes should not have happened. That was under
the Obama guidance in 2016 that led to misunderstanding where
providers were putting their clinical notes either completely
into the serious incident reports, or they were being
transmitted by ORR correctly over to DHS. That should not have
happened. When we learned of it in August of 2019, that
practice has stopped. We corrected the understanding of
providers. It is important, a serious incident report must be
completed if a child evidences harm to self or harm to others.
And that goes into the SIR which does get transmitted to DHS as
important information about the child. But that should be
minimal information, not include--we believe in respecting that
psychiatrist or mental health professional relationship.
In terms of consent, our children who are not tender age of
course, they are in our care, and they have to consent for
medical treatment for any other things all the time. This is
part of how ORR has to operate. Remember these are kids who do
not have--who left their parents, whose parents abandoned them,
whose parents sent them here. And they consent, that is what
they do for whether they are getting vaccines or whether they
are getting medical treatment.
Ms. DeLauro. But their ability to----
Secretary Azar. We try to keep in touch with parents as
best we can, as you know.
Ms. DeLauro. Again, that requires probably to have legal
counsel in order to be able to provide the child with
recommendations depending upon obviously the age. I do not know
whether or not you require legal counsel if a child has asked
to consent to sending their clinical notes or significant
incident reports to DHS.
Secretary Azar. Well, as you know, we do provide legal
counsel. You fund it. So kids are offered, do have legal
counsel. But we serve as the guardian for these individuals.
They do not----
Ms. DeLauro. I understand that, but the guardianship has
been--and there has been some changes made, but guardianship
hasn't been a really, that substantial, as we have found out
over the last 2 years about how we guard these children.
Private rights, et cetera. It has not been the case. I would
hope we would get to direct representation, legal
representation of children. What guidance have you given case
managers or clinicians to distinguish in a child's file or in
the report that a child has witnessed gang activity or violence
without forever associating that child as a gang member? There
is an important distinction if that's what justifies sharing a
child's information with law enforcement.
Secretary Azar. We would be happy to work with you. The
guidance that went out in August of 2019, I do not know about
the divide between witnessing versus participation, and we
would be happy to share that with you.
Ms. DeLauro. I would like to see that guidance and would
like to sit down and figure out what your oversight is of DHS
with regard to this transmittal of this information.
Congressman Harris.
Mr. Harris. Thank you very much.
And thanks again, Mr. Secretary, for staying over 2 hours
to talk with us about the importance subjects. You know, with
regards to the budget request, the emergency request, look, I
applaud the Department for doing what every department should
do when they come to Congress for an emergency request, which
of course exceeds our budget caps--so this just directly
contributes without the constraints of a budget cap to our debt
and deficit--of actually only asking for only half of it coming
from really new funding and the rest finding places where we
perhaps over budgeted or we gained efficiencies and transferred
it.
So, for instance, you know the $535,000,000 from Ebola,
well, the fact of the matter, as you mentioned, we do have a
vaccine. We actually are participating with the international
community in controlling Ebola. And it seems perfectly
reasonable, instead of asking for new money above budget caps,
I just read something that I think over in the Senate side,
someone is requesting $8,000,000,000 or something. I mean, you
could not spend the money fast enough. I am going to ask you a
question. Is there anything that could have been done up till
now that has not been done that you haven't had money for?
Secretary Azar. No, no. We have had that money. We have
used the--thanks to this committee, the Infectious Disease
Rapid Response Fund, we have been spending that. And then, with
our transfer authority, we will continue to spend as a bridge
to whenever we get the emergency supplemental. And we are using
that money to seed contracts to be able to execute works on the
expansions once we receive the supp.
Mr. Harris. Sure. In fact, we have a novel vaccine having
been developed. We have a novel antiviral having been
developed. You know, we used to say--I used to be in Maryland
legislation, and we only met 3 months out of every year. We
would say, well, we would meet every year. So if the problem is
a--that you could bring it back, but Congress meets all year.
Don't we? I am going to ask you, do you take an August recess
and an October recess?
Secretary Azar. No, we do not.
Mr. Harris. So we could. I mean, God forbid, this becomes
more serious than it is--and it is anticipated it could be
serious, more serious--we could actually come back any time and
pass more emergency funding above our budget caps, couldn't we?
Secretary Azar. We could. And in addition, it is important
to remember, this request is only for 2020 funding, so through
September of this year. And then we have said we would work
with appropriators on modifying 2021 requests based on the
progress of the disease over the next weeks and months.
Mr. Harris. Right. And the plan transfers that have
occurred, as I read this chart, right, is $135 million out of
$81 billion. So that is----
Secretary Azar. I believe 0.2 percent.
Mr. Harris. I think it is a little less than 0.2 percent
actually. You are being a little generous about that. I think
it is actually less than that.
And, finally, just to clear up one question, because a
question came about LIHEAP, but do I recall in the Obama
budgets that LIHEAP was zeroed out?
Secretary Azar. I do not remember if that is the case or
not.
[Response from audience]
Mr. Harris. It was cut? Oh, so it was cut? It was cut in
previous administration budgets, so you are just doing what
previous--you are just following the lead of previous
administrations. Well, on that I applaud you for following the
lead; on other things, I don't.
Finally, look, on title 10 funding, the fact of the matter
is that you and I both understand exactly what title 10 was
intended for. It was never meant to promote or fund abortions.
There are a vast number of Americans who believe the taxpayer
dollars should not be used to promote or fund abortions.
And I congratulate the administration on finally restoring
title 10 to its initial purpose and, again, allowing us to go
home to many of my constituents who strongly believe--who
oppose abortion and who believe the Federal Government has no
role in promoting or funding abortions.
So I thank you, and I yield back.
Ms. DeLauro. Mr. Pocan.
Mr. Pocan. Thank you, Madam Chair and Ranking Member.
Okay. So I just want to make sure I understand on this czar
part, okay. We just got an alert coming out. You said, ``I
don't put much stock in anonymous sources in Politico,'' but
that is neither a yes or no. So you had a conversation this
morning with the President. Have you ever discussed having a
czar?
Secretary Azar. Well, first, I am not going to discuss the
content of my interactions and advise to the President, but the
President is the one who said, consistent with the National
Response Framework, as well as Emergency Support Function
Eight, which I actually played a role in designing, that HHS is
the lead agency on a public health emergency.
Mr. Pocan. So you don't anticipate a czar?
Secretary Azar. I don't anticipate one. This is working
extremely well. If it doesn't work or if there is a need for a
change as there is, for instance, implication of other
emergency support functions under the NRP, then that would be
for the President to decide perhaps there is a multi-ESF
leadership, which is part of the NRP is contained in there
also.
Mr. Pocan. Okay. So you are saying from your conversations
you don't expect a czar to be appointed today----
Secretary Azar. I do not.
Mr. Pocan [continuing]. Or anytime in the near future. All
right. That is good. Jared Kushner will have more free time
then because I am sure, otherwise, he takes on a lot of those
responsibilities. So that is good to know.
Let me go back to the question that Ms. Granger asked
because I just over vacation read ``China Rx,'' and pretty
scary, you know, when you look at the amount of stuff that is
being done. This is your wheelhouse, right, where you came
from.
I am really concerned--and I saw the President had a
directive for military personnel especially about buying
American. Are you concerned that so many of our drugs or
essential ingredients in drugs are made in places like China,
and I think they said 90 percent of generics probably or 80
percent of production, but 90 percent of the essential
ingredients are made in China, that at some point that could
cause some problems, especially given some of the last--some of
the recent various commerce activities we had had with China,
how they could hold things up, or in this case what could
happen in the Wuhan province where people may have to stop
working for a while and you could have some problems? Are we
able to do anything? Are we able to try to get production back
in the United States?
Secretary Azar. So I am concerned about that. Having our
supply chain, especially on medical products, which can be
strategic, so intertwined with China or any other--dependent on
any other country is a challenge.
Here is the issue, and I know you have, as do I, a deep
passion around getting drug prices down. If there is a reason
they are being made in China or India, and that is low-cost
manufacturing so----
Mr. Pocan. Yeah. Let me--if I can----
Secretary Azar [continuing]. If we force them to make them
here, we could see an increase in price.
Mr. Pocan. To that very point though, how much does it
actually cost to produce a pill? So like the Hep C pill is
$1,000 a pill, right? What is the actual production cost on
average for a pill?
Secretary Azar. Well, it depends on the product, but the
difference is a special and generic manufacturing between the
U.S. and other countries----
Mr. Pocan. But what is the average cost of production for a
pill?
Secretary Azar. I couldn't tell you that. It depends on the
product and how it is----
Mr. Pocan. 10 cents? $1? $100?
Secretary Azar. It would depend on the product.
Mr. Pocan. Yeah.
Secretary Azar. But manufacturing generics, just we see
this, is materially different in lower cost countries than in
the U.S. That is why we don't see generic production----
Mr. Pocan. So how about on generic drugs, because we know
they are generic, the cost difference. I am just trying to
decide why a company--like, are they saving a nickel or are
they saving 50 cents by doing that and risking our flow
potentially of those essential drugs?
Secretary Azar. Well, I think it is important to remember
the generic business is an extremely low-margin, high-volume
business. And so even what you and I may think of as a penny
difference could be bankruptcy versus success for a generic
company on that, difference in manufacturing with competitors.
So I absolutely understand it is a critical issue. I don't know
the solution. I want to work with you on that because I don't
want to do something that causes our generic prices to soar, of
course.
Mr. Pocan. Thank you.
Ms. DeLauro. Congresswoman Herrera Beutler.
Ms. Herrera Beutler. Thank you.
I want to shift gears a little bit to the announcement for
the healthy adult opportunity proposal. And I noted that CMS
specifically stated that children in very low-income households
will, quote, not--will not be, quote, directly affected.
You know, one of the things that I have found that goes
unnoticed is that kids are about 20 percent of the Medicaid
population--or I should say it this way: They are about 40
percent of the population; they are about 20 or less percent of
the actual dollars spent.
So any kind of shifts within Medicaid I believe need to be
done with a specific eye towards safeguarding really the
intended recipients of the program. It is a safety net program
mostly for a certain population. I think children are kind of
front and center in that.
I wanted to know how the Department is going to keep--so--
and I know--the answer I have heard before is the States are
going to do--the States can do that. I don't trust that my
State is going to do that to the best--I should say it this
way: I am a trust but verify with regard to how my State is
going to make sure that the adults aren't just protected and we
are going to push the kids to the edge, because I have children
with disabilities who are on Medicaid who come to me and say
they get put at the back of the wait lists with regard to
Medicaid.
So how is the Department going to be able to step in? I
know this is a little different from some of the Republican
State's rights questions, you know, give it all to the States.
Well, what if we haven't necessarily seen the best instances of
children being protected at the State level? How is your
department going to be able to do that in the midst of this new
proposal?
Secretary Azar. Well, I would just note first that the
actual proposal or the actual opportunity is literally called
the healthy adult opportunity. It is an optional demonstration
program for States to restructure benefits for adult
populations. It is important to remember this is not a
mandatory change. This would only be if the State wanted to do
it. It would require CMS approval. There is no entitlement on
approval. It just states a pathway that we are open to look at
these.
It doesn't allow stripping of benefits, limits on
eligibility. They can't cap or limit adult enrollment even. So
that is even with regard to adults. It requires coverage of
essential health benefits. So, even with regard to adults whose
name is in the title, all of those protections are in place.
And so that is why for low-income individuals, for pregnant
women, the elderly adults, people disabled, the traditional
Medicaid populations aren't in any way impacted by that. This
is that--the able-bodied adult expansion populations under the
Affordable Care Act that would be at issue.
Ms. Herrera Beutler. Perfect. That is what I wanted to
know. And I am glad you mentioned the pregnant women receiving
Medicare. That is the other piece there.
In my view, the goal should be to keep Medicaid as a safety
net, a strong, robust safety net for those who it was intended
to serve. And for those who are not--shouldn't be part--who
weren't part of the original outlay, I think we need to get
them into different programs and different options to get them
care so that we are not breaking the safety net for, you know,
a single mom with three children, one of whom has multiple, you
know, different abilities. So I appreciate that.
Continuing with the discussion on child health and disease,
particularly with regard to research, they generally receive
significantly less attention and funding compared to other age
groups. In 2021--in the 2021 proposal, what is the
administration doing to focus on child health and research and
on childhood diseases?
Secretary Azar. So, as you know, the President's pediatric
care initiative, which you all funded through NIH, is really
important because children and cancer really have been
neglected for too long. Different disease profiles, so we have
been building up the databases to share information so that we
can actually help discover cures targeted for kids. So that has
been part of the work of NIH. But really the budget continues
that funding with $50 million in 2021 on top of what you
already funded.
Ms. Herrera Beutler. Thank you.
Thanks, Madam Chair.
Ms. DeLauro. Congresswoman Lee. I am sorry, Frankel,
Congresswoman Frankel.
Ms. Frankel. Okay. That is okay. My turn?
Ms. DeLauro. Your turn. Go for it.
Ms. Frankel. Thank you. All right. We are going to get back
to our last subject. So, I guess, I want to correct what I
think was some misinformation that you put out or maybe a spin.
I am going tell you about Planned Parenthood, its last report:
2.4 million patients; 9.7 million services provided; over 4.7
million STI testing and treatment; 2.6 million birth control
information services; they estimated that approximately 400,000
unintended pregnancies were averted; over 500,000 breast exams
and Pap smears; and 1.2 million people reached through
education and outlet.
So I would say, and I think most people in the public would
say that Planned Parenthood has done a really good service,
especially to poor women, women of color in this country. And
your administration has basically, with what we call--with a
very, very cruel gag rule, so putting the gag rule on steroids.
And what does that mean, gagging? It is like they put a
piece of cloth across the doctor's mouth because I think we
need to all understand that Federal money is never used for
abortions, and Planned Parenthood has never used Federal money
for abortions.
Oh, you are going to get the little red sticker from
somebody there. But the fact of the matter is, now with the new
gag rule on steroids, a provider who does not use Federal money
for abortions cannot even tell somebody, when they go in
office, if a patient says, ``What are my options,'' they are
now gagged, the provider is gagged.
And what Planned Parenthood has done, which I think is very
courageous, but unfortunately I think it is going to maybe hurt
a lot of women, is they have said: We are not going to be
untruthful with our patients. We are an organization that, if a
patient comes in for care, we are going to tell them the truth.
And I wanted to give you another example of your--the
alternatives that are being provided in this country and now
that Planned Parenthood has had to withdraw. In Louisiana, the
State list of alternative providers include dentists and
nursing homes; and in Florida, it includes school nurses; in
Ohio, it includes food banks.
So I would just--I am running out of time, but I am going
to end it by saying this: The women and the girls in this
country, we need to be in charge of our own bodies in order to
have full, productive lives, not Donald Trump being in charge
of our bodies.
And, with that, I yield back.
Ms. DeLauro. Congressman Cole.
Mr. Cole. Thank you very much, Madam Chairman.
Mr. Secretary, just a couple of quick questions. I know you
are working hard on the President's request for targeted HIV
testing and working toward the hopefully elimination in the
next 10 years of this dreaded disease. But, unfortunately, the
Interior Subcommittee did not provide additional resources to
the Indian Health Service as part of this initiative.
You and I have had a little discussion about this. You
know, what can be done as we move forward? And, again, let me
just make clear, that is no criticism for our colleagues on the
Interior Health because they have a very low budget. Actually,
the chairman and I were talking about it, very difficult for
them to provide the resources that they would like to do given
the range of responsibilities they have. So I sympathize with
them, but this is an important initiative. We have got to find
a way to get it funded in Indian Country.
Secretary Azar. It is quite important. We used money
Congress had given us in 2019 to do four jump start projects.
So we funded planning in all of the 57 jurisdictions so that,
as soon as you funded the President's request, we would be able
to get off to the races as we did with the funding from HRSA,
this morning, the $117 million that I announced on executing.
We had four jurisdictions, one of which was the Cherokee
Nation that we advance funded so they could actually get moving
right away on it in anticipation of funding for Tribal
territory. We do have in this budget request a request of $27
million for his that would support the critical needs of the
disproportionately affected on the HIV spread in Indian
Country.
That would be expanding HIV testing in Indian country;
connecting American Indians and Alaska natives to care; getting
previously undiagnosed HIV infections in treatment so that they
can be--if they are undetectable, they can be un-transmissible;
getting prep out among people who are at risk to ensure that
they cannot transmit to others; and also supporting disease
surveillance in Tribal epidemiology centers.
Mr. Cole. Well, again, we appreciate your efforts. I have
very little time left, and this is a big question, but all of
us know suicide rates have been rising literally in every State
in the country. So I am interested in what you have in your
budget that might help us to do more in that particular area.
Secretary Azar. So we have been very active, especially in
supporting on suicide with regard to our veterans. So we--
with--the suicide hotline now has a very important function.
The very first question you are asked if you call the suicide
hotline is, are you a veteran? If you are a veteran, we now
have an immediate hot transfer over to a live person who will
give immediate counseling tailored to veterans and the risk of
suicide.
We have collaborated very closely between NIH and DOD and
VA and have come up with artificial intelligence algorithms
that help us actually predict, based on a veteran's history,
certain categories, certain individuals who are at much higher
risk of suicidality. Those individuals actually receive--I
think it is monthly coaching and proactive intervention. So we
really hope that this collaboration between us and DOD and VA
can help with the just devastating issue of our veteran suicide
issues.
We are also investing, of course, suicide prevention
programs, 93 million community mental health services block
grants with an increase of 35 million there. So and many other
programs that are in the budget. Suicidality is a very
important priority for us.
Ms. Cole. Thank you.
Thank you, Madam Chair.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you, Chairman.
Mr. Secretary, I need you to check back with your
Department because my understanding is that New Jersey was
specifically told to get ready to be able to house or deal with
those individuals that would come through the funnel airport,
and that is why they were looking to use the Joint Air Force
Base, and that is why it is important because the ability to
use that is being eliminated as of next week.
Two other things really quickly. I am really pleased that
you find maternal morbidity a really important issue. And I
know we recognize that nearly half of pregnancies are
unplanned. Women need to be able to have the kind of healthcare
that they need when they find out that they are pregnant.
I have been working on Healthy Moms Act, which would open
up a special enrollment period for women who are finding
themselves pregnant, but I know you can do that by executive
order by just--you know, by your authority, and I would like to
work with you on that. Would you be willing to work with me?
Secretary Azar. Yeah. I haven't been familiar with that as
a special enrollment period option, but I am happy to look at
that and work with you on that.
Mrs. Watson Coleman. Oh, great. Okay.
Secretary Azar. I did not know that that wasn't--that for
new--so for new pregnant women, there is not currently a
special enrollment period?
Mrs. Watson Coleman. No. It is not----
Secretary Azar. I didn't know that.
Mrs. Watson Coleman. It is not eligible right now. Okay. We
can talk about that.
Last thing is I did a lot of work with the special task
force on mental health issues and Black youth suicide. As a
result of that, we did--we had a report done by a series of
professionals, working groups, identified a lot of issues that
your department can address. So I am concerned about the $200
million cut to the NIH.
I would like to, with unanimous consent, enter this report,
which is called ``Ring the Alarm: The Crisis of Black Youth
Suicide in America'' into the record. And I would very much
like to have the opportunity to work with you on making sure
that some of these very important issues, particularly as
access to culturally competent services, enough services, and
research and things of that nature are addressed.
Secretary Azar. Absolutely. That could be very valuable for
us and our work on suicide. So, no, I look forward to that.
Thank you.
Mrs. Watson Coleman. Thank you. I yield back.
Ms. DeLauro. We will--unanimous consent to enter your
document.
Mrs. Watson Coleman. Thank you.
Ms. DeLauro. Congresswoman Lee.
Ms. Lee. Thank you very much.
Okay. I want to go back to a couple of my remarks and
questions earlier, Mr. Secretary. First of all, you know that
PEPFAR has been a bipartisan initiative since we really began
this when President Bush was President. And so, every year, we
are trying to make sure that we are on target in terms of
reaching the 2030 goals of really eliminating HIV and AIDS.
So this budget though calls for $170 million cut in PEPFAR,
which does not make any sense if, in fact, we are going to keep
working together to try to get to our goals. So I am not sure
what the rationale was for putting forth a cut. That is a
significant cut to the PEPFAR program. We need to increase it.
Secondly, again, with regard to teen pregnancy prevention,
for the life of me, I can't understand why you would eliminate
this when we know for a fact that a wide range of evidence-
based and innovative interventions to support the sexual health
of young people is extremely important. It helps develop
healthy--it really develops the education that is needed to
help our young people prevent abortions, and so I can't
understand why you would eliminate that program.
Also, it harms young people who are already marginalized,
like LGBTQ youth and young people who have been victims of
sexual violence. And so eliminating this program, what is the
rationale, and what is the basis for that?
And then, finally, you mentioned community health centers,
which are wonderful and provide health services where there are
many gaps in both rural and urban communities, but they don't
address the basic racial health disparities, and you know what
they are.
And so the REACH program provides strategies to address the
basic racial disparities in chronic health and the National
Institute of Minority Health. It impacts millions of Americans
by providing in the health delivery system specific
perspectives and strategies to reduce health disparities as it
relates to minority communities. So why would you cut that
also? I mean, minority communities are really under attack
through this budget.
Secretary Azar. So, with regard to PEPFAR, I would have to
defer to the Department of State on that. It is their program.
I am not consulted on the funding levels for PEPFAR in terms
of--but I would say PEPFAR is obviously an important program. I
have gotten to see the fruits of the work of PEPFAR in building
up public health capacity. PEPFAR plus the global health
security agenda. As I traveled the DRC, Rwanda, Uganda on the
Ebola crisis, I have gotten to see the fruits of that important
work there.
The teen pregnancy prevention program, we just--we
fundamentally disagree in terms of whether those are evidence-
based interventions that actually from an evidence perspective
deliver. The rate of teen pregnancy was declining long before
the TPP was put in place. It serves less than 1 percent of the
teen population.
And a longitudinal study of the program actually during the
Obama administration looked at 37 of those programs, and it
found that 73 percent of them either had no impact or actually
a detrimental impact in terms of STDs and teen pregnancy, teen
initiation of sex.
Ms. Lee. Well, I beg to differ with you, Mr. Secretary.
Years of research have shown that the abstinence-only approach
not only fails in getting young people to delay sex but also
can harm young people.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. Thank you, Madam Chair.
I first want to correct myself. I told you that there were
67 days to get the congressionally mandated report. It is
actually 53----
Secretary Azar. Okay.
Ms. Clark [continuing]. So an even bigger challenge than I
first reported.
And I just want to add that President Obama never proposed
eliminating LIHEAP, but he did propose dramatic cuts to it, to
the tune of $3 billion. And it was strong bipartisan opposition
that rescued this program. I certainly hope we will see that
again this year from your proposal to completely eliminate it.
But switching gears, Madam Chair, I would ask unanimous
consent to enter this letter from the American Psychological
Association chief into the record.
Ms. DeLauro. Without objection.
Ms. Clark. This letter is addressed to you as of February
21 and is concerning the very dangerous and disturbing practice
that we are seeing emerging at ORR, where, as you know, we are
required--you are obligated to act in the best interest of
immigrant children in their care.
But reports are that the notes from the psychotherapy
sessions of children who have experienced trauma are being
shared by ORR with ICE, and this information is being used
against the children in deportation proceedings even though
these conversations are supposed to be confidential. What are
you doing to halt the sharing of this confidential information
with ICE?
Secretary Azar. So I am glad you raised that because I have
been able to have a discussion with the chairwoman in private
before the hearing about this issue. We agree that those notes
and that interaction between the mental health provider and the
child should be normally confidential. There are exceptions, as
the APA would make clear also, where there is a risk of harm to
the child or to others.
Ms. Clark. But that is not----
Secretary Azar. But there was guidance put out in 2016 in
the Obama administration that was not clear, and it led to two
mistakes happening: One was clinician notes were provided and
that was not correct to DHS; and sometimes clinicians just cut
and pasted their notes into the serious incident report in the
management system where they should have just noted there was a
threat of harm to self or other, which they have to do by law,
and they cut and pasted it, and that was provided.
When we learned about this in August of 2019 before any
media reports, we stopped it. We issued corrective guidance and
said that is not proper; minimal information should go in the
serious incident report and go over, but it should not have
happened.
Ms. Clark. Okay.
Secretary Azar. We agree with you.
Ms. Clark. Speaking of children in custody, as I think
about places that you can get money to address this
coronavirus, and I still don't know why we are building a
public health response once the pandemic threat is already
here, but has the contract for Homestead where we were paying
$720,000 a day to not house children, has that actually ended
as of November 30?
Secretary Azar. I don't know--I don't think it has ended as
of November 30 or what the current contours are. I can explain
to you why we have that contract, which is, in response, in
fact, to the chairwoman and this committee's concerns around
the care for kids, we are increasing fixed capacity, but we do
need influx capacity in the event that, if Mexico changes
border policy and we see kids, the number one priority is not
letting them be backed up at ICE or at the border and coming to
us, so----
Ms. Clark. So that $80 million we have spent not to house
children you feel that is better spent than putting that money
into coronavirus. That is really an incredible set of
priorities. Thank you.
Ms. DeLauro. Thank you.
Let me just recognize the ranking member for some closing
remarks, and then I have two or three, and I am mindful of your
hard stop.
Mr. Cole. Thank you very much, Madam Chairman. I will be
brief. First, I want to thank you for the hearing, excellent
hearing, a lot of good questions, a lot of excellent points
made I think by every member on the committee. And I want to
commit to you, again, I look forward to working with you on the
supplemental. I thought the points you made were good points.
We want additional detail, but we intend to work together on
this and certainly work with you, Mr. Secretary.
And let me finish by thanking you again and your team.
Look, this committee has worked hard for 5 years on a
bipartisan basis to create the institutions that I think are
serving us very well now, obviously, your entire department but
specifically the NIH, the CDC, the strategic stockpile, the
creation of the rapid response--Infectious Diseases Rapid
Response Fund.
All those things I think have put us in a position to do
well, and I think you have done a good job. I think you guys
have been very transparent with us from day one. I think the
congressional briefs have been excellent. Appearance of a
number of members of your department before this committee and
a special briefing session that my good friend, the chairman,
convened for us, extremely helpful.
The contrast between what I saw yesterday in the Senate and
what I saw here today on both sides of the aisle makes me very
proud of our chamber and this subcommittee. I think we have a
lot of people saying a lot of things that either haven't been
participating in the process or have not been transparent about
it.
And, again, I want to also thank you because you did commit
here and I know it is sincere commitment that if we need to go
beyond your initial recommendation to protect the American
people, we are all prepared to do that. So I don't look at
the--I want to be prudent in the use of funds. I know my
colleagues up here do as well, but we are like you.
And I remember in one of our briefings--I think it was
actually one that the chairman and I coordinated--you made the
statement that, you know, you would rather be accused of doing
too much in retrospect than accused of doing too little. And I
think you have been true to that commitment every step of the
way. I think the people that work with you have as well, and I
am very confident you will continue to do that.
So thanks for your hard work on behalf of the American
people. Thanks too for your honesty and transparency here. We
will try to help you in a lot of the places you need help, and
then we are going to help you in some places you probably
officially don't need help but we officially think you do. And
so I look forward to that working relationship and, again, just
thank you for your service to the American people.
Thank you, Madam Chair.
Ms. DeLauro. Thank you. If I can just wrap up being mindful
of your timeframe, I would just tell you that the issue of
suicide makes me--and the commentary on that makes me view that
you need to review whether or not you want to cut $25 million
from gun violence prevention research where the basic focus is
on suicides. It is mostly suicides with veterans. And I don't
care how good the hotline is; we need to find out what is going
on in the minds of veterans and others in order to be able to
plumb why they are taking their lives.
But the issue of--we are not going to talk influx
facilities today, my colleague mentioned this, but we are, very
flat out. And I will just tell you, it is my goal with an empty
facility and millions of dollars being spent and the numbers
declining as they are and we are nowhere near capacity at the
State-licensed shelters, we are going to shut them down because
we can deal with the issues in other ways.
I might also add the issue came up with regard to cuts,
determining whether a Federal budget proposal counts as a
budget cut is simple. If the proposal would reduce funding for
a program's benefit or services or reduce the number of people
who qualify for benefits relative to levels that would occur
under current law, it is a cut. We are cutting $920 billion
over 10 years to Medicaid, $756 billion over 10 years for
Medicare.
I want to get--let me just do this, because you mentioned
this, Mr. Secretary, and I thought it was very clear. You
stated that infectious disease, global health, and preparedness
were prioritized in the CDC budget request following essential
programs we--were proposed for cuts, which makes the
commentary, quite frankly, inconsistent, cutting CDC $693
million or 9 percent. We are cutting Infectious Diseases Rapid
Response Fund by $35 million, 41 percent, and you don't--not
replenishing it in your supplemental.
The public health data initiative $20 million, a 40 percent
cut, specifically asked by the Director Redfield in order for
us to modernize our efforts to transform public health data
into analysis so that we can move more quickly; the public
health workforce, which we talked about today, $6 million or 12
percent; and the epidemiology and laboratory capacity program
by $40 million as a cut, 18 percent. This flies in the face of
what you have talked about in terms of what your goals are.
Lastly, about information sharing with DHS. Is ORR sharing
information about rejected sponsor applicants with ICE at DHS?
Secretary Azar. So we have shared the names and addresses
of 141 individuals who were denied sponsorship due to criminal
histories or due to fraudulent representations to ORR that they
have a bona fide relationship with a child. No parents were
included in that group. And then whenever we have----
Ms. DeLauro. You are----
Secretary Azar. I am sorry?
Ms. DeLauro. You are prohibited by law from detaining
sponsors based on information that HHS collects on potential
sponsors during the vetting process.
Secretary Azar. Well, again, I don't detain sponsors. But
also the Department of Homeland Security is complying with the
legal restraints in the act, but this is not parents. This is
individuals denied sponsorship due to criminal histories or due
to fraudulent representations to ORR that they would--that they
have a bona fide relationship with the child, no parents being
included in that group is what I am informed.
Ms. DeLauro. Can you tell me also, is ORR sharing
information with DHS on any adult who does not fall into the
categories included in the DHS rider, the prohibition on use of
funds to detain a sponsor unless they have a certain specific
criminal criteria?
Secretary Azar. I would want to get back to you on the
details there. We certainly are complying with the rider, but
if there is any beyond the rider, I don't have that detail.
Ms. DeLauro. And I would like the information.
Secretary Azar. Yep.
Ms. DeLauro. What kind of firewall exists between ORR's
information about potential sponsors and ICE given that
information sharing for enforcement actions is prohibited?
Secretary Azar. The use of it for enforcement maybe be
prohibited, but there is no firewall that is required. And so
information is shared, and it has been shared frankly for--I
think for quite some time. For instance, we share information
on sponsors within 24 hours of discharge, and that is part of
also double--there are a couple things.
One, the sponsor actually has to certify to us and to DHS
that if they move the child, that that will be reported.
Remember, this is a child who is not legally in the country and
subject to proceedings; and, second, that the sponsor isn't,
for instance, illegally in the country and subject to a removal
order and about to be deported. That wouldn't be a safe
environment for us to then place the child. So there is that
last minute check and information sharing. I think that has
gone on, my goodness, for at least over a decade, I believe.
Ms. DeLauro. Well, we need to get a very, very detailed
view of the current information that is being shared and
whether or not it is in contravention of the rider in the bill.
And further to that is that we need--because ICE walks into
State-licensed facilities and fingerprints. And you may or may
not know about it. ICE is transmitting--ORR is transmitting
clinical notes. There are all kinds of avenues here which are
being breached in terms of the privacy and the care of these
children and the intimidation of these children.
We need to get to a point where that is no longer the case
and that ORR and DHS have only their concern about the welfare
of these children. And, yes, I understand criminal activity. I
understand human trafficking. But we have seen over the last
year and a half or more that we are moving into what is really
unbelievable mental health issues arising out of intimidation
of children that are in our care. They are in your care, but
they are in our care while they are here, and we are not going
to continue to put up with that.
Thank you for being here this morning. Thank you for being
upfront with us on issues. And as my colleague said, we want to
be ahead of this crisis on the coronavirus. We do not want to
be behind the curve. So thank you very much, Mr. Secretary.
[The following questions and answers were submitted for the
record:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, February 27, 2020.
DEPARTMENT OF EDUCATION BUDGET REQUEST FOR FISCAL YEAR 2021
WITNESS
HON. BETSY DEVOS, SECRETARY, DEPARTMENT OF EDUCATION
Introduction of Witness
Ms. DeLauro. The subcommittee will come to order.
Good morning, Secretary DeVos. Good to see you this
morning, and welcome to the subcommittee.
Chairman's Opening Statement
This is our second budget hearing of the year, and it is
your fourth hearing with us. And today, as you know, we are
going to examine the President's Department of Education budget
request for fiscal year 2021.
As I was reviewing the budget materials, Madam Secretary,
this much was clear to me, that you are seeking to privatize
public education. I believe--and I have had this conversation
before with you. I believe that is the wrong direction for our
students and for our country.
IMPORTANCE OF PUBLIC EDUCATION
Instead, we need to be moving toward expanding public
policies like early childhood education that we know help
students succeed. We see this in other countries around the
globe. They are not shrinking public support but, in fact, are
expanding it. I will get more into the consequences of the cuts
that you are proposing, but I want to start by examining your
privatization philosophy, the false premise on which it is
built, and the research that it ignores.
Contrary to your claims, the Nation's public education
system, which 90 percent of our children attend, has witnessed
significant progress for all groups of students over the last
30 years. Average mathematics scores on the National Assessment
of Educational Progress, NAEP, have improved for fourth graders
by 13 percent, eighth graders by 7 percent. While overall,
reading improvements have been more modest--Black fourth
graders' scores improved by 6 percent and eighth graders' by 3
percent; Hispanic fourth graders' scores improved by 6 percent
and eighth graders' by 5 percent--these are significantly
higher than 40 years ago for all racial and ethnic groups.
And I reflect on that and ask myself the question, where
would we be without Federal investment? There is no question
that there is more to do to address the disparities in
achievement. We know we face significant challenges in
assisting the kids that come into our system in education
districts where they experience poverty and exposure to
violence, often resulting in trauma. But the solution is not
less resources, nor is it more privatization.
Let me, if I can, just quote for you from a report by Dr.
Pamela Cantor, who is a psychiatrist, and she co-founded an
educational organization called Turnaround for Children, which
translates the science of learning and development into
problem-solving in our schools. She led a team commissioned in
New York City by the Board of Education to assess the impact of
the terrorist attacks on the city's public school children.
What did she find? Surprisingly, while 68 percent of the
children they observed had experienced trauma sufficient to
impair their functioning in school, it is from their ongoing
experience of growing up in poverty, not from what they
witnessed that terrifying September day.
In fact, the Administration's own data has shown how
privatization has let students down. The Trump administration
evaluated the D.C. Opportunity Scholarship Program and found
that vouchers had a statistically significant negative impact
on the mathematics achievement of impacted students. In other
words, more vouchers, lower math achievement.
That is not a lone data point either. Previous multisector
studies using NAEP data have found that no student achievement
scores for children in private schools were higher than those
of children in public schools by any statistically significant
degree. And I think they found this to be the case, I believe,
in Indiana and in Louisiana, and there are other examples,
which I can make available to you and to your staff.
So your push to privatize public education is based, in my
view, on a false premise that is not supported by data. But its
consequences would be to undermine the education of our
students in nearly every State, particularly for vulnerable
students in high-need regions, including the rural parts of our
country.
CUTS IN PRESIDENT'S EDUCATION BUDGET
You would end career and college readiness for 560,000 low-
income middle school students across 45 States by eliminating
the highly competitive grant program known as GEAR UP, a minus
$365 million.
You would endanger academic tutoring, personal counseling,
and other programs for 800,000 students in sixth grade by
slashing TRIO programs by $140 million. TRIO serves low-income,
first-generation students and students with disabilities,
helping them to graduate from college.
You would endanger education access for children
experiencing homelessness by eliminating the Education for
Homeless Children and Youth Program, minus $102 million. This
funding is desperately needed. In the 2016-2017 school year,
more than 1.3 million enrolled children had experienced
homelessness at some point in the past 3 years, an increase of
7 percent from 2014-2015.
You would endanger youth literacy, as well as potentially
increase class size and undermine efforts to support diverse
teachers by eliminating the main program, Supporting Effective
Instruction State Grants, which we increased for the first time
in many years. And you have taken $2.1 billion away from this
program.
You would potentially put higher education out of the
financial grasp of students by flat-funding the Pell Grant.
Forty percent of undergraduate students, 7 million students,
rely on Pell Grants to afford higher education. But while Pell
covered 79 percent of the average costs of tuition, fees, room
and board at a 4-year public institution in 1975, it covers
only 29 percent today. Our students cannot afford for us to
stand pat for this.
And finally, your budget would risk exacerbating the
financial challenges of under resourced rural districts by
converting rural formula grants into a block grant. These
districts already struggle with lower student populations,
higher transportation cost, and your move to undermine their
funding in this way is unacceptable.
With all of this, and I just say this to you, Madam
Secretary with all sincerity, this is not going to happen. It
is not going to happen.
OTHER REQUESTS IN THE BUDGET
I am supportive of the recognition of the IDEA State
grants, $100 million proposed increase; career and technical
education, $680 million proposed increase for the CTE State
grants. I am disappointed that adult education State grants are
left with level funding, which I plan to ask you about later.
You have also once again requested an increase for student
loan servicing. We included new reforms, as you know, in the
fiscal year 2020 bill to help us conduct more oversight and
ensure that borrowers are getting the help they need. Many of
these ideas stem from an oversight hearing that this
subcommittee held last year. And to be direct, I will need to
see how the Department implements the new requirements as I
review your request for next year.
With regard to charter schools, there is a place for them.
They have a role in our education system. However, we have
moved in the direction of creating a parallel education system.
Concerns remain around issues of accountability and
transparency, which, to this point, they have not been
forthcoming. As I have said time and time again, I believe
charter schools ought to be held to the same rigor, and where
they fail, we need to know about it.
And to close, Madam Secretary, you are clearly, again in my
view, seeking to privatize public education. I hope that I have
been clear that we are not going to do that. Because doing so
ignores the research indicating the gains we have made, ignores
the many areas private education shortchanges students, ignores
the very reason the Federal Government has needed to be
involved in education, as so powerfully indicated with Brown v.
the Board of Education, and ignores the spirit and the values
of this country.
No, instead, we need the expanding public policies that
boost education attainment, not restricting or reducing them.
So I look forward to our discussion today, and now it is my
pleasure to turn to my colleague, the ranking member of the
subcommittee, Congressman Tom Cole from Oklahoma.
Ranking Member's Opening Statement
Mr. Cole. Thank you very much, Madam Chairman.
I want to tell you this is my favorite time of year because
I get to spend so much time with you in this committee hearing.
We are going to have dinner tonight, and it is always a
delight. It honestly is a vigorous exchange of ideas and more
cooperation than we tend to get credit for.
And Madam Secretary, it is a particular pleasure for me to
have you here today. I have known you for a long time, long
before either of us were in our respective capacities. And I
will leave it to you to describe your public philosophy, but
there are two things that I know about you--your public
education philosophy.
But one is that you have always been for individualizing
education. You have always been for what is the right job,
role, or place for this particular student to be, and I see a
lot of that in your proposals. And two, you have never been
afraid to put a bold idea on the table and advance it, and I
see a lot of that in this budget as well. There is a lot of
boldness here. Some of which I agree with, some of which, quite
frankly, I don't. But that doesn't bother me. I like the idea
that you are willing to break the mold and think about this
because we have got a lot of challenges.
And also, you know, you are our chief officer overseeing
probably the most diverse educational system in the world. And
I just think about my own district. I have got five colleges
and universities, everything from great comprehensive State
institutions to elite liberal arts institutions, to regional
facilities, to private Christian colleges.
I have got, like everybody else, most of the young people
that I am privileged to represent and their families go to
public schools, but I have got charter schools. I have got
private religious schools. I have got home schools. And they
all do a good job. They all wrestle with the same problems.
And I have got one of the most robust career/tech systems
anyplace in the country throughout Oklahoma, and certainly in
my district. And I was particularly pleased with a number of
proposals that you made in that regard. So I think we will have
a great discussion today.
I am looking forward to your testimony. As a former
educator, I understand how important it is for our entire
population to have access to quality education. Without
question, education is one of our most important building
blocks for success, and access to quality learning directly
impacts lifelong development and unlocks each individual's
potential.
PROPOSALS IN THE PRESIDENT'S EDUCATION BUDGET
I was pleased to see that your budget request continues to
prioritize resources to certain populations of children who
need additional support, including children with special needs
and disabilities, and Indian education and school districts
whose revenues are impacted by a Federal presence within their
boundaries.
As you know, I am a strong supporter of career and
technical education, and I am proud that my home State of
Oklahoma is leading the way in innovative models for delivering
cutting-edge skills that can lead to good-paying, rewarding
careers for students who do not wish to pursue a 4-year liberal
arts degree. And I thank you for your support of these
programs, and I am looking forward to asking you more questions
about the substantial increases in your budget, that your
budget proposes for these programs this year.
I also want to recognize your proposal to expand Pell
Grants to students enrolled in short-term programs that offer a
credential in a high-demand field. These opportunities offer
high-payment employment in a variety of fields needed
throughout my district, as well as many others.
Interesting to me how many times we have had, when we do
Member testimony, Members come here and specifically push the
need for career and technical education, both in terms of job
opportunities and talking to their employers in terms of needed
skills. So I think you have really focused on a key area here.
I have spoken, again, to small business owners, other
Members of Congress who believe it is time to make Pell Grants
available to individuals for enrollment in certificate-based
programs, and I applaud you for putting that on the table for
us to consider.
CONCERNS OVER PROPOSED CUTS
Madam Secretary, your budget once again proposes to
eliminate, consolidate, or change over two dozen programs. Some
of these proposals may make sense in the context of a
reauthorization or consolidation. I believe others are
shortsighted.
I actually agree with my friend the chairman, I am
particularly concerned about the proposal to move the
successful TRIO program from a competitive grant model to the
formula grant to our States. That is no surprise to you. That
has been a position I have held throughout my career.
I am also concerned about the proposal to consolidate
several Minority Serving Institutions' funding into a single
stream. As you know, these institutions serve distinct
populations with different needs, and I am not certain that
such a change makes sense. Moreover, I feel that these often-
disadvantaged minority populations may be overlooked or
marginalized if they are not singled out for special attention.
So I am interested in hearing your perspective on that.
I also would like to acknowledge your proposal to address
limitations in the student aid program. Establishing Federal
Student Aid as a separate organization is an issue I think is
worth thinking about. I am not sure we are the right people to
consider it here. It really is much more of an authorizing
function than we are probably equipped to handle on this
committee.
But I do support your efforts to streamline and create a
more user-focused system for student borrowers. The Next
Generation project promises to modernize and improve the
student loan infrastructure, benefitting over 40 million
customers.
Finally, while I tend to support block grants to States and
freeing school districts from the bureaucracy involved with
administering dozens of small, separate Federal programs, I do
have some concerns that consolidating some programs, such as
the Charter School Program, could have a negative consequence
for the very students we hope to benefit by these proposals.
And I will have a few questions about that.
Again, there is a risk here that some States are welcoming
the charter schools. Others, quite frankly, are not. And so I
worry a little bit about the public sector taking money that we
want to try and seed these innovative things.
And I know you probably know more about this than anybody
on this panel. You have got a lot of experience here. So I am
interested in your perspective on that.
EDUCATION BUDGET IN BROADER CONTEXT
I know you faced a very difficult challenge in making all
the pieces fit into a tight budget. I made this point with
Secretary Azar yesterday. This isn't necessarily your budget.
This is the OMB's budget that you are tasked to defend. And
that is what you are supposed to do. You work for the President
of the United States. That is the budget process here.
But obviously, you had to wrestle with a much smaller
budget than you might have otherwise chosen. I am not going to
ask you about that. I would expect you to be, of course,
supportive of the President's position on this and overall
budget priorities. But I think that does put you, just as it
did Secretary Azar, in a difficult position. Sometimes you may
well have been forced to make cuts that you did not advocate.
SPECIAL OLYMPICS
We had a rather famous incident of that last year on
Special Olympics, as I recall. So I know you sometimes
privately make an argument that we might agree with up here,
but publicly, you have got to go, you know, make the case. So,
again, I respect that. That is one of the obligations you
undertake when you accept a position, as you have, at--by the
way--great personal sacrifice. It is not exactly a job you
need, and I admire you, quite frankly, for your commitment to
public service.
I know that under the leadership of our chairman, the
gentlelady from Connecticut, a strong quality education for
students across the country will remain a fundamental priority
in the creation of this year's Labor-HHS bill, just as it was
last year. Frankly, just as it was when I was privileged to be
chairman.
And my friend has always been a good partner in that
endeavor, whichever role she has--chairman, chair of the
committee, or ranking member. So I look forward to working with
my friend once again to craft a budget that balances our many
priorities and invests in our country's people and its future.
I look forward to your testimony today, Madam Chairman, and
I yield back the balance of my time. Or Madam Secretary, and I
yield back to you, the chairman.
Ms. DeLauro. I thank my friend the ranking member and,
again, look forward to working with you on this, and we will
put it together, as we have in the past.
And now I would like to turn to the distinguished chair of
the full committee for any comments that she may have,
Congresswoman Nita Lowey.
Full Committee Chairman's Opening Statement
Mrs. Lowey. Good morning, and thank you, Madam Secretary,
for appearing before the committee. I look forward to the
exchange of ideas.
And I want to thank Chairwoman DeLauro and Ranking Member
Cole for holding this hearing. This is the fourth budget
request Congress has received for the Department of Education
under your leadership that has been filled with program cuts
and outright eliminations. Without fail, your vision hurts our
students and their families.
PROPOSED CUTS AND ELIMINATIONS
Like every previous year, we are going to reject this
proposal. You would like us to believe this proposal empowers
States and districts with flexibility, but the numbers don't
lie. You propose eliminating 41 programs, cutting education
funding overall by $6.2 billion.
The Department of Education's mission is to promote student
achievement in preparation for global competitiveness by
fostering educational excellence and ensuring equal access.
Secretary DeVos, your budget is clearly on a different mission,
one that shirks accountability to our students and taxpayers.
It would take more than my allotted time to read the
complete list of eliminations and funding cuts. So I will only
highlight a few, all of which demonstrate a lack of commitment
to educational equity across elementary, secondary, and
postsecondary education.
Where we should be protecting and building on a $16.3
billion investment in Title I schools, your budget proposal has
eliminated this crucial support for students in high-poverty
schools.
You propose eliminating Full-Service Community Schools in
my district. The Thomas Edison Elementary School in Port
Chester was among the first in the country to implement the
Full-Service Community School model, and their success has
shown that integrating academics, social services, community
engagement improves student learning, strengthens families, and
empowers communities.
I must admit I was an author at that time. I have visited
this school, and it is so exciting to see these youngsters get
all that they need within the school itself because many of
these parents are working two jobs. And to have it all there,
to have the parents come in and be a part of it, is very, very
exciting. So I must admit it was disappointing to me to see
this program eliminated.
Now we will put it back, but it is still disappointing
because I know of your interest in educating all the kids.
The budget request eliminates the English Language
Acquisition Grant Program, which is vital for combating
inequality by improving outcomes for English language learners.
Working families count on after school programs so that they
can go to work knowing their child is safe and learning, but
your budget request eliminates this funding.
More than half of Americans live in a childcare desert, and
that includes the one in five college students who are parents.
On-campus childcare programs, like the Virginia Marx Children's
Center at Westchester Community College, help student parents
successfully pursue degrees. But you would cut funding for the
Child Care Access Means Parents in Schools, the CCAMPIS
program, by nearly 72 percent.
I am trying not to elaborate in getting to the point, but
72 percent is a lot of parents and children who won't be able
to access this opportunity.
It would be absurd to champion this budget request for its
so-called fiscal responsibility. More than $2 billion in
student financial aid and grants to institutions would be cut
and instead squandered on a border wall.
By eliminating programs and reducing funds, this budget
request would exacerbate the opportunity gap. Our students
deserve better, and I sincerely hope your response to our
questions will address these concerns.
And I thank you again for appearing before us.
Ms. DeLauro. Thank you.
Introduction of Secretary DeVos
Madam Secretary, we will now turn to you for your
testimony, and your full testimony, as you know, will be made
into the record. And I would ask that you take 5 minutes to
summarize so that we can get to everyone's questions, and after
that, we will proceed to 5-minute rounds for questions. And in
that effort, I would recognize members in order of seniority
and appearance at the time that we put the gavel down.
And so, Madam Secretary, please begin when you are ready.
Opening Statement
Secretary DeVos. Thank you. Chairwoman DeLauro, Ranking
Member Cole, and members of the subcommittee, thank you for the
opportunity to testify on the President's fiscal year 2021
Budget.
While we are discussing a budget, it is important to
remember that Federal Government spending does not determine
everything that is important to us, nor is it the only solution
when we encounter challenges and opportunities. Instead, we the
people overcome challenges and seize opportunities.
That is why this Department's budget is focused on
returning power to the people, to those closest to students and
to students themselves. Our budget begins by recognizing that
education is a local issue.
Congress recognized that truth when it created the U.S.
Department of Education 40 years ago. It promised the move
would, and I quote, ``not increase the authority of the Federal
Government over education, nor diminish the responsibility for
education, which is reserved to the States.''
This administration proposes Congress align the budget with
that 40-year-old promise. Our budget would take a big step
toward right-sizing the Federal role in education so that
families, teachers, and State and local leaders are free to do
what is right for students.
The budget would expand education freedom for students so
that they can prepare for successful careers. And it would
refocus our approach to higher education so that students are
at the center of everything we do.
First, let us consider recent history. Over 40 years,
Federal taxpayers have spent more than $1 trillion trying to
fix K-12 education. Each year, Congress grew the budget from
nearly $7 billion in 1980 to more than $41 billion in 2020 for
K-12 education alone.
But what have we bought with all that spending? Just open
up the latest ``Nation's Report Card'' to see the sad results.
No real improvement in student achievement in decades. So
instead of holding fast to what we know does not work, let me
suggest we find the courage to do something bold and begin a
new era of student growth and achievement.
The Every Student Succeeds Act gives us good insights into
where we should go. ESSA became law because many of you on both
sides of the aisle realized Federal overreach in education had
failed. So you moved to restore the proper roles in education.
The bipartisan K-12 law affords States and communities more
flexibility to address local challenges.
This administration proposes Congress complement its work
on ESSA and make the budget match the law. States must work
with local communities and families to develop comprehensive
plans that best meet the needs of their students, and so States
should be able to target their Federal taxpayer dollars
accordingly. To that end, we propose putting an end to
education earmarks by consolidating nearly all Federal K-12
programs into one single block grant.
ESED BLOCK GRANT
Overall, Americans spend about $860 billion on K-12
education every year. Last year, Congress appropriated about
$24 billion of that through the programs in our proposed block
grant, or roughly 2.5 percent of total education spending. And
yet, each year, teachers and school leaders spend more than 2
million hours complying with Federal reporting and
recordkeeping requirements for that small slice of the pie--2
million hours, more than 83,000 days, more than 225 years. That
is time that could have been focused on helping students learn
and grow.
Teachers, administrators, and State leaders need to be free
to focus on people, not paperwork. Results, not regulations.
Different States will invest their share of the block grant
differently, and that is okay. In fact, that is what we hope
they do.
EDUCATION FREEDOM SCHOLARSHIPS
They can better figure out what their students need because
they know their students. Every student is unique, and each one
of them learns differently. Every child needs the freedom to
learn in places and in ways that work for them. That is why the
President's 2021 Budget also renews its call for a historic
investment in America's students, Education Freedom
Scholarships.
Our proposal is a dollar-for-dollar Federal income tax
credit for voluntary contributions to State-based, nonprofit
organizations that provide scholarships directly to students. I
like to picture kids with backpacks representing funding for
their education following them wherever they go to learn.
The budget also requests a $100 million increase in
supporting children with disabilities, amounting to a total of
$14 billion for IDEA programs.
There is also a request for a dramatic expansion of career
and technical education programs. At an overall increase of
nearly $900 million, it is the largest investment in CTE ever.
It includes a total of $2 billion for Perkins State grants,
which is an increase of nearly $800 million.
Additionally, we are requesting $150 million, an increase
of more than $135 million, to fund STEM activities led by HBCUs
and other Minority Serving Institutions located in Opportunity
Zones. This administration wants every student in America to
have more education options that focus on preparing them for
successful careers.
FEDERAL STUDENT AID
That goes hand in hand with our ground-breaking initiatives
at Federal Student Aid. Consider that FSA is essentially a $1.5
trillion bank that has dramatically outgrown its governance
structure. We propose evaluating a new governance structure and
whether FSA should be a standalone entity.
In the meantime, we are continuing to build on our
important reforms that establish one platform, one operating
system, one website. And importantly, on providing customers--
students and their families--with a seamless student loan
experience.
PRIORITIZING STUDENTS
In the end, our budget is about one thing--putting students
and their needs above all else. It is a budget that recognizes
that no student and no State, no teacher and no town are the
same. States need to be free to address the particular problems
and possibilities of their people, and students of all ages
need the freedom to find their fit.
This budget proposes that Congress give it to them.
Thank you for the opportunity to testify. I am happy to
respond to your questions.
[The information follows:]
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SPENDING INCREASES AND EDUCATIONAL OUTCOMES
Ms. DeLauro. Thank you very much, Madam Secretary.
And I am sorry I was remiss in recognizing Larry Kean, who
is the Budget Service Director at Department of Ed. So welcome
to you as well, Mr. Kean.
Madam Secretary, to justify your cuts, you repeatedly claim
additional funding for our public schools does not improve
student outcomes. A claim that has no basis in reality. A 2018
review of recent research on education spending, student
outcomes by Northwestern economist Kirabo Jackson found
statistically significant positive results for students in 12
out of 13 studies, which is why, Dr. Jackson concludes, by and
large, the question of whether money matters is essentially
settled.
I don't understand, Madam Secretary, why do you continue to
claim that additional resources to public schools do not
improve student outcomes when the empirical evidence tells us
the exact opposite?
I am just going to--I admittedly have not read through all
of them. I have read some of them, but this is by education
experts, people who understand the science of learning and
development and how it improves. The data is overwhelming.
So I ask you again, how can you continue to make these
claims that student outcomes do not improve when empirical
evidence tells us the opposite?
Secretary DeVos. Chairwoman, let me just refer back to the
NAEP results. But before I do that, I just--there are a couple
of things that you said in your opening comments that I need to
comment to.
First of all, I am not out to privatize anything about
education. I am out to make sure every student's education is
personalized, individualized for them, that they find the right
fit to unlock their potential. So let us talk about
personalization, not about privatization. That is not the
issue. That is not the goal.
And we have spent over $1 trillion at the Federal level to
close the achievement gap in the last 40 years. That
achievement gap has not closed one little bit.
Ms. DeLauro. Well, that is not true.
Secretary DeVos. In fact, for many poor students, it has
only grown wider.
Ms. DeLauro. That is absolutely not true.
Secretary DeVos. You look at the State-by-State results,
you look at the overall results, and they are dismal.
NATIONAL ASSESSMENT OF EDUCATIONAL PROGRESS SCORES
Ms. DeLauro. I am going to----
Secretary DeVos. Two out of three eighth graders cannot--
cannot read or do math at their grade level.
Ms. DeLauro. And I would want to know where those schools
are, what the environmental circumstances are, what kind of
resources are going into those schools to the training of
teachers and improving the lives of the families who live
there, and making sure that the youngsters have that experience
and have trained people that they need. If you deny the
resources to the most--to the schools that need the help most,
yes, you will fail.
I am going to tell you NAEP scores----
Secretary DeVos. No, if you free--actually, if you free up
the resources for people at the most local level, you see
results. You can see it in Florida. You can see it in
Mississippi, where they focused solely on improving reading
outcomes.
Ms. DeLauro. And you can see in the District of Columbia,
where the data from this administration has demonstrated that
that is not the case.
And you know, we have got scores higher in 2019 for most
racial and ethnic groups in both subjects and in both grades,
compared to the early 1990s. This is the--the NAEP data, scores
in math and reading are significantly higher than they were 40
years ago for all racial and ethnic groups. So the fundamental
principle and the underlying philosophy on which you move
forward and cutting all these programs and move to $5 billion
for vouchers flies in the face of the progress that is made.
Let us work together to understand the statistics, realize
that where are, know that there is a difference, and we have
got somewhere to go on an achievement gap. But let us not
denigrate a public school system that serves 90 percent of our
kids and that is making gains. Let us continue to make those
gains. And quite frankly, the cuts that you have proposed is
doublespeak. It is doublespeak.
So I am just going back to your words that are the NAEP
study. And as I said, you have got more studies released in
2019 reached the same conclusion, including a study showing how
extra money for Texas schools had a particularly strong impact
on low-income and Hispanic students.
I am going to share the studies with yourself and with your
staff and with the members of this subcommittee to take a look
to see if, in fact, the data belies the direction that you are
taking public education in this country.
And my time has run out. Let me yield to my colleague from
Oklahoma.
PELL GRANT PROPOSAL
Mr. Cole. Thank you very much, Madam Chairman.
As I have said in my comments, Madam Secretary, I am really
excited about your Pell Grant proposal and your additional
investment in career and technical education. So I have got a
couple of questions along those lines.
You actually say that we would give these grants to provide
credentials in ``in-demand fields.'' So I guess I am sort of
interested to know how would you define ``in demand''? What
would actually be covered? How would that work? Would all the
programs--let us say a duly recognized State career and
technical, would that be covered, or are you going to--do you
have sort of selectivity in mind?
Secretary DeVos. Well, our proposal really seeks to work
with Congress to determine what--the definition around those
programs and the extent to which they would be a part of a
short-term Pell program.
I know it varies by region, and I think it would behoove
all of us to work closely with regions and States and to look
at what those opportunities are. But we would look forward to
working with Congress to determine that and to really address
these opportunities for students.
Mr. Cole. Well, I actually find, certainly in my State,
honestly, quite often young people or not so young--because
obviously you can be any age coming for additional technical
training--they literally end up with a job faster usually than
somebody coming out of a 4-year education, and it is quite
often a very high-paying job. Believe me, when you need a
plumber, you really need a plumber. You know, you can't wait
around.
Secretary DeVos. That is right.
Mr. Cole. And so, again, I applaud that. We get a lot of
questions about this because a lot of the students that go to
these facilities are comparatively low income, and frankly,
just the cost of college or the idea of assuming the debt that
is often associated with that, to them, doesn't make sense.
This really does. So I am glad you put it on the table.
TRIO AND GEAR UP
I want to go to an area where, frankly, we don't agree, and
that is on the TRIO and GEAR UP proposals that you have. I have
got a lot of TRIO students in my State. We have historically
been one of those States that has really benefited from that.
We have really benefited from GEAR UP.
And frankly, I have never met a single student or
instructor in these programs that didn't think they were
worthwhile. I look at TRIO, for instance, and since its
inception, it has produced over 5 million college graduates.
And I think a lot of those young people, quite honestly, would
not have had the opportunity or the support structure to
succeed in college without TRIO or the preparation that is
necessary. That is one of the great things about GEAR UP. A lot
of families where nobody has gone to college before really are
not in a very good position sometimes to counsel their own kids
or prepare them.
And you want to--I don't want to send them to college and
not have them successful. I want them to get that degree, not
walk out of there with a few hours and thousands of dollars'
worth of debt. So these programs, to me, seem to do that.
And I used to have this problem, quite frankly, with the
last administration, which I thought underinvested in these
programs, even though historically we were always doing Race to
the Top or some, you know, New Deal, when we had a couple of
programs here I think have demonstrated their utility over time
again and again. So explain to me again the advantages you
would see in the consolidation and the movement to formula
grants as opposed to competitive grants in this area.
Secretary DeVos. Well, thank you, and I totally agree that
these programs are beneficial and effective for many students.
And our proposal does seek to essentially move GEAR UP into the
TRIO program and block grant it to the States. The reality is
that most of the awardees for the TRIO program are consistent
year after year after year, and it is very difficult for any
new program to break into it.
We think that by allowing more flexibility----
Mr. Cole. So that would tell me we should put more money in
TRIO.
Secretary DeVos. Well, and that is certainly your
prerogative. But I think coupled with our proposal to block
grant the elementary and secondary education funding of the 29
different programs and, again, provide a lot more flexibility
at the State and local level, the answer for one district might
look quite different than an answer for the other district.
Mr. Cole. A fair point.
Secretary DeVos. And I think, coupled, it could be a really
powerful----
ESED BLOCK GRANT IMPACT ON CHARTER SCHOOLS
Mr. Cole. Fair point. I have only got about 30 seconds
left, so let me just quickly ask one other area because I know
you have historically been a great champion of charter schools.
And I do worry. Not everybody shares that point of view.
I think if you block grant these to States, a lot of the
money that has been set aside specifically for charters
honestly is apt to be diverted into the public system, even
though--well, to the normal K through 12 system. Particularly
when the overall amount of money is coming down, well, let us
concentrate within the K through 12 system. These are more
experimental, or these are little bit more outside the
``mainstream.''
So I have gone over my time, but just briefly, do you have
that concern?
Secretary DeVos. Well, let me be very clear. I totally
support charter schools and think we need not fewer of them. We
need many more of them. There are a hundred--I mean, sorry, a
million families on the waitlist for charter schools across the
country, and they--I actually view our consolidation and block
grant proposal as one that is additive and positive for
charters.
I have talked with a number of Governors about the block
grant concept, and they are very excited about it. In States
where they embrace this, there is going to be dramatic
expansion and for----
Mr. Cole. I have gone over my time. So I want to--I don't
want the chairwoman to have to interrupt me. I will interrupt
myself.
But thank you, and I would like to continue this
discussion. I appreciate it.
Secretary DeVos. Thanks.
Mr. Cole. Thank you, Madam Chair, for the indulgence.
Ms. DeLauro. Thank you. Sure.
Congresswoman Lee.
Ms. Lee. Thank you very much.
PRESCHOOL DISCIPLINE AND RACIAL BIAS
Thank you, Madam Secretary.
Let me go right to this because there is still--and this is
increasing--in terms of systemic injustices toward our Black
and Latino students. First of all, you eliminated the 2014
school discipline guidance to help ensure that students of
color are not subject to harsher discipline practices than
their White peers.
Now let me ask you about your Office for Civil Rights
proposal. Now this is a double whammy. To combine the counts of
preschool children who received out-of-school suspension with
those who received more than one out-of-school suspension and
your proposal to eliminate preschool enrollment data by race
and ethnicity.
Now without this distinction, it is going to be very
difficult to understand whether and to what extent this trend
persists. The ability to track this data is critical because
while Black students--now you have got to hear this and
understand this and why this is so important. Black students
make up 20 percent of preschool children.
Now these are babies, right? They represent 50 percent of
suspended, again, babies, preschoolers. Don't forget also that
the Education Department's, your own data, in 2013 and 2014
found that Black preschoolers--again, babies--are three times
more likely to receive one or more out-of-school suspension
than their White counterparts.
So I requested in the last 2 years that this subcommittee
receive language detailing school discipline in all preschool
and K through 12 classrooms and to also include it in your 2020
budget justification. Here you are again without having
submitted this data--we went through this last year--although
your budget request says that you will brief us on your plan
with a horrendous plan to significantly alter this data
collection.
So why do you plan to change the data collection so that it
really--and that is what it is going to do, it is going to mask
the trends for out-of-school suspensions of preschoolers. And
we should have solved this, and we shouldn't have to ask you
once again for this data.
So that is my first question. What in the world is going
on, it would take us so long for us to get this report that we
required you to submit for the last few years?
And also do you believe that Black students are punished
and suspended at greater rates than their White peers? Yes or
no? I mean, do you believe that? The data shows this, and these
are children. These are babies.
Secretary DeVos. Ma'am, I agree and love children, as you
do, and want to ensure that all children have the opportunity
to get a great education.
We have been focused on answering and responding to all of
your requests.
Ms. Lee. But you haven't done that.
Secretary DeVos. I will check on that specifically----
Ms. Lee. But you said that last year, Madam Secretary.
Secretary DeVos. And what I know and what I am committed to
is ensuring that all kids have an opportunity and equal access
to----
Ms. Lee. I understand that. Madam Secretary, you tell us
that every year. But what about Black and Latino kids? You
don't even submit to us----
Secretary DeVos. That is exactly my point with opportunity
for personalizing their education.
Ms. Lee. No, Madam Secretary, no. You are trying to mask
this by saying you are now not going to collect the data by
race. So how in the world are you going to be able to say that
you care about Black and Latino kids?
RESPONSIVENESS OF THE DEPARTMENT
The other report we asked you, we asked you detailing the
recommendations with regard to how to address adverse impacts
of resegregation, including designating Title VI school
monitors to ensure that every student has the opportunity for
an equal education. Again, you said you were aware of this
report. You would get it back to us as soon as possible. We
still don't have this report.
We have tried and tried over and over again, Madam
Secretary, to get these reports from your office. They are
written into the bills. They are required. And you are just
thumbing your finger at us.
Secretary DeVos. That is not the case.
Ms. Lee. Well, it is the case.
Secretary DeVos. We are--we are responsive. We have
continued to be responsive to the many requests from Congress--
--
Ms. Lee. Well, where----
Secretary DeVos [continuing]. And we are committed to
doing----
Ms. Lee. Madam Secretary, on Black and Latino kids, these
babies, these preschoolers, you have not been responsive. These
are children who don't even get Head Start because they are
kicked out of school before they are even in kindergarten.
Don't you think that is important?
Secretary DeVos. I think each one of them is important, and
I care about each one of their futures. That is why I am
suggesting we do things very differently than what we have been
doing.
Ms. Lee. Now, Madam Secretary, this committee has asked you
for this data, and instead of providing the data and the
reports, you are now trying to mask it by saying you are not
going to use race and ethnicity to even present the facts. So
how can you sit there and say that? We ask you over and over
and over again every year.
Secretary DeVos. I am committed to each of those children,
as you are.
Ms. Lee. But you are not showing that. Could you submit----
Secretary DeVos. A report--a report does not solve----
Ms. Lee. Well, wait a minute. Let me ask you about----
Secretary DeVos. A report does not solve a child's problem.
Ms. Lee. But we are asking--wait a minute. We are asking--
--
Secretary DeVos. A report is not a child's future.
Ms. Lee. Madam Secretary, we are asking you for the report.
We need the data to understand this. I would think you would
want the data to understand it also. That is all we are asking
for. This is basic.
So why wouldn't we get the information that this committee
has asked you for for 2 years about preschoolers being
disproportionately suspended from preschool? These babies,
these Black babies.
Secretary DeVos. Let us talk about the lack of
achievement----
Ms. Lee. When are we going to get the report?
Secretary DeVos. Let us talk about the lack of achievement
and the lack of opportunity by being forced to go----
Ms. Lee. So we can't ask you for these reports, Madam
Secretary?
Secretary DeVos. By being forced to go to schools that
don't work for them.
Ms. Lee. I want to know when we are going to get the--Madam
Secretary, are you just saying forget the reports? Just tell us
that, if you are not going to give them to us.
Secretary DeVos. No, ma'am, I am not.
Ms. Lee. Well, then when do we get it?
Secretary DeVos. I will check on when that report will be
available.
Ms. Lee. Both reports, on school resegregation and the
suspension and expulsion of Black and Latino kids. You told us
this last year. A year has gone by, and it is outrageous.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you very much.
Thank you, Madam Secretary.
What is outrageous is the 25 percent of our children, of
our eighth graders can't read a grade-level passage. That is
what is outrageous. And you are right. Money doesn't solve this
problem.
DC OPPORTUNITY SCHOLARSHIP PROGRAM
You know, I had the privilege of being invited to the 15th
anniversary of the OSP program at Department of Education,
where we met the parents. All they wanted was a better life, a
better schooling for their children.
Madam Secretary, you know that 90 percent of those students
who took advantage of that program are Black students. The vast
majority of the rest are Latino students. So to somehow suggest
that you, as an advocate for programs like that, don't care
about Black and Latino students just doesn't jive with the
data.
Secretary DeVos. That is right.
Mr. Harris. Let us talk about the data. Significant
progress on NAEP. Really? U.S. News and World Report headline
about the last scores say ``Across the Board, Scores Drop in
Math and Reading for U.S. Students.''
They dropped. They didn't go up. There is no significant
improvement.
And with regards to the disparity, it is pretty clear the
disparities existed between the highest and lowest performers
for 30 years consistently. Now there are some people who would
suggest that repeating the same thing you are doing that
doesn't work is insanity. This is exactly what we are doing in
the United States.
EDUCATION FREEDOM SCHOLARSHIPS
So I want to congratulate you on the suggestion for the
Education Freedom Scholarships. Now I know it is a bold idea to
somehow believe that you should put parents in charge of their
children's education or maybe making the choice where to send
their children to school because, of course, God knows, we know
better. That somehow some bureaucrat somewhere knows better.
Some academic sitting in some ivory tower knows better than the
mother.
Some of those mothers I saw at that Department of Education
celebration, who really knew what was better for their
children, and it was not to be sent to the same poorly
performing public schools because there was no competition.
Now let me tell you what is interesting from the NAEP
scores. There was one jurisdiction in the country where
actually students performed better on three out of four of the
measurements, Washington, D.C. Because for 13 years before that
test was taken, Washington, D.C., instituted competition for a
failing public school system.
And the academics go, oh, no, it doesn't--oh, no, we are
going to compare the scores of the people who went to the
voucher schools and people that didn't go to the voucher
schools. Competition works, and the Education Freedom
Scholarships will induce competition.
Now let me ask you, does a dollar for those scholarships
come from the Department of Education budget? I think I saw it
was the Department of Treasury budget, wasn't it, where those
dollars----
Secretary DeVos. For Education Freedom Scholarships?
Mr. Harris. Yeah, for Education--right.
Secretary DeVos. Yes, that is part of the Department of
Treasury budget.
Mr. Harris. Right. So this wouldn't really take a dollar
from our public schools, would it?
Secretary DeVos. No. No, it would be voluntary
contributions.
Mr. Harris. So let me see. So what could the possible
opposition to voluntary contributions to a program, and I think
I have the facts right, about three-quarters of parents favor
that idea? The idea of actually giving choice.
In fact, the statistics I see, 68 percent of African-
American parents, 82 percent of Latino parents. Specifically
about the EFS program, 83 percent of African-American parents,
83 percent of Latino parents actually want that choice.
Secretary DeVos. That is right.
Mr. Harris. Why in world would we deny it? Can you come up
with any reason why? Other than teacher union opposition, could
you come up with any other reason why we would deny that?
Secretary DeVos. I see no reason to deny these kids that
opportunity.
Mr. Harris. Madam Secretary, thank you for putting up with
what you do, what you put up with to stand up for the idea that
every child--and as an educator for the 30 years before I came
to Congress, for the idea that every child in America and every
parent in America deserve a choice where to get sent to school.
And if they are unfortunate enough to live in a geographic
area or school district where their school is just plain lousy,
that they should have the opportunity to go to a charter
school. And it could be a public charter school. It could be
nonpublic charter school, a charter school, or get a voucher,
especially under the Education Freedom Scholarships. So these
are voluntary contributions to get a voucher to help those
children go to a better school.
I just don't understand the argument against it. I never
will understand the argument against it. It is about time we
get raw politics out of education because it is standing in the
way. Because you know, if you look at the statistics, yes,
there was improvement in the NAEP. We went from 31st to 30th in
the world in the last NAEP, 31st to 30th in the world, and it
wasn't math or reading. I guess it was science. That is
pathetic.
In the 21st century, we can't afford to be anything but
first in the world, and I just want to congratulate you on what
you do to see to it that that could happen.
I yield back.
Secretary DeVos. Thank you, Congressman.
Ms. DeLauro. Congressman Pocan.
PUBLIC SCHOOLS WEEK
Mr. Pocan. Thank you very much, Madam Chair.
Thank you, Madam Secretary.
Easiest question you will get today. We have something in
common, five-letter last name that gets mispronounced a lot. Is
it DeVos or DeVos?
Secretary DeVos. It is generally DeVos, but I have heard it
lots of different ways.
Mr. Pocan. Just my name, too. So I appreciate it. So,
Secretary DeVos, thank you for being here, and I want to thank
you, first, for not having cuts this year to special education
and not cutting the Special Olympics. The fourth time is the
charm, and I just want to say thank you.
And also happy Public Schools Week. I am sure you are
around the country advocating for public schools this week.
Thank you. We had a strong bipartisan resolution with 90
people, including our ranking member, on that, and very proud
of the public schools we have in this country.
CHARTER SCHOOL PERFORMANCE
I do want to pick up on where our ranking member started
talking about charter schools, though, because this is where I
think we don't have as good information. First of all, on
academic performance, we know on charter schools, about one out
of six does better than public schools. About half are about
the same. But two out of six perform worse than public schools
on academic performance.
But I think there is something even worse. You mentioned
what we bought with the spending. When you look at charter
schools, there was a report last year that said 1,000 charter
school program grants were given out by the Department of
Education were given to schools that never opened or later
closed because of mismanagement, poor performance, or fraud.
And another report just last December said it is actually
worse than that. It was 2,127 schools out of 5,286 that
actually never opened or failed. That is 40.5 percent failure
rate on charter schools. I looked it up. That is an F grade
when you are below 60 percent, and yet you are advocating for
doing more Fs rather than more As, like we get with public
schools. Or Bs in some cases and maybe a few Cs. But Fs
certainly don't seem to be the grade we want to advocate for.
Also there was a School of Idea charter chain that have
been awarded about $200 million in Federal funds. Over the
years, they got a $67 million grant, another $116,000,000. Yet
this is some of what they have spent their money on.
WASTE, FRAUD AND ABUSE BY CHARTER SCHOOLS
They had $400,000 going to a luxury box and tickets for
Spurs tickets. I don't think you would see public schools
getting a luxury box. They purchased a property from one of
their board members for $1.7 million. I don't think a school
board member would sell their property to a public school.
Another board member got the commission on that sale on
over millions of dollars of property, and only after a lot of
scrutiny did the CEO back off of a plan to lease a private jet
for $2 million a year over 6 years.
So I guess my question on this terrible failure rate we
have with charter schools that you are still advocating for,
just a yes or no, do you think charter schools who receive
Federal funding should be allowed to use those funds to
purchase private jets?
Secretary DeVos. Well, Congressman, I am not----
Mr. Pocan. It is a yes or no question.
Secretary DeVos. No, it is not a yes or no question.
Mr. Pocan. Well, actually, it is. Actually, it really is.
It is the definition of a yes or no question.
Secretary DeVos. Actually, I have a few things to say about
the things that you said about charter schools.
Mr. Pocan. Okay, but can you answer my question, please,
Secretary.
Secretary DeVos. I have a few things to say----
Mr. Pocan. Do you think Federal funds----
Secretary DeVos [continuing]. About what you have said
about charter schools.
Mr. Pocan. Okay. Reclaiming my time, Madam Secretary.
Reclaiming my time----
Secretary DeVos. The report--and I am sorry.
Mr. Pocan. It is a yes or no question I am giving you.
Secretary DeVos. The report that you referenced has been
totally debunked as propaganda.
Mr. Pocan. I didn't ask you about the report.
Secretary DeVos. Fewer than 2 percent of the schools didn't
open.
Mr. Pocan. Madam Secretary, reclaiming my time. I gave you
the courtesy of making sure I could even say your name correct.
Give me the courtesy of answering my question.
Secretary DeVos. I appreciate that, but if you are asking
me a question, I need to have a chance to answer.
Mr. Pocan. A yes or no question. Yes, but I am asking you a
question with a yes or no answer. It is really that simple. If
the Secretary of Education can't answer a yes or no question, I
don't know why you can be the Secretary.
Do you think Federal funding should go to a school that
uses it to buy a private jet? That is a yes or no question.
Secretary DeVos. It is a very hypothetical question----
Mr. Pocan. Oh, my God.
Secretary DeVos [continuing]. That is obviously a no--no
answer.
Mr. Pocan. No, it is an actual question. It is an actual
question.
Secretary DeVos. There is no funding going to charter
schools that would even address something like that.
Mr. Pocan. You think--another yes or no--that they should
be able to put money to a box at a professional sport----
Secretary DeVos. Let me just say charter schools are public
schools----
Mr. Pocan. Madam Secretary, reclaiming my time.
PERFORMANCE OF CHARTER SCHOOLS
Secretary DeVos. Charter schools are doing a great job----
Mr. Pocan. Reclaiming my time.
Secretary DeVos--for the families that are choosing them,
and there are a million families on the waitlist to go to
charter schools.
Mr. Pocan. Madam Secretary? Madam Secretary, just talking
over someone isn't an answer, just so you know. And yes or no
often is when it is asked in a yes or no format.
We also know that the same group gave such incomplete
information over 3 years, didn't report accurate information,
reported no information on performance data. Would you think--
would you give your staff a paycheck if they didn't perform 84
percent of their tasks? Yes or no?
Secretary DeVos. Of course not. But everything you are
citing----
Mr. Pocan. Thank you for answering it in a yes or no. That
is progress.
Secretary DeVos. Everything you are citing is debunked,
ridiculous. So I don't accept the premise of your--of your
question.
DEVOS FAMILY INVOLVEMENT IN CHARTER SCHOOLS
Mr. Pocan. It is actually--It is actually not. Let me ask
you this. Do you think it is odd when people think--your family
runs a charter. Correct? That is a yes or no.
Secretary DeVos. No.
Mr. Pocan. Your husband doesn't have a charter program?
Secretary DeVos. He founded a charter school.
Mr. Pocan. He founded a charter. So when people think that
you may have a conflict of interest because of that, what do
you----
Secretary DeVos. Absolutely not.
Mr. Pocan. I will let you not do a yes or no. You can
respond however on that one.
Secretary DeVos. I will respond in that my husband founded
a charter school which is meeting needs of students all over
West Michigan. And he is on the board, but he does not run the
school. It is organized as a not-for-profit charter school, and
it is a public school serving all comers.
CHARTER SCHOOL PERFORMANCE
Mr. Pocan. Well, Madam Secretary, I think just the fact
that you couldn't answer yes or no, and you look at this
terrible rating of charter schools, this is why people have a
worry that there could be a conflict or something else----
Secretary DeVos. And you are wrong about charter schools.
Mr. Pocan [continuing]. Because if they are not performing
academically. Yeah, but 40 percent are closing down that you
are giving grants to.
Secretary DeVos. That is not true.
Mr. Pocan. That is a waste of public taxpayers'----
Secretary DeVos. That has been a totally debunked report.
It was nothing but propaganda by an individual who has it in
for charter schools.
Mr. Pocan. So what percent of charter schools are failing?
Do you have an idea, a number, any number?
Secretary DeVos. I don't have a State--any national----
Mr. Pocan. You are the Secretary of Education, and you
don't have this. You know this report is wrong, but you don't
have the numbers?
Secretary DeVos. Charter schools are chartered by States.
They are not chartered by the Federal Government.
Mr. Pocan. You know that that number is not right, but you
don't have the correct number? Is that what you are telling us?
Secretary DeVos. What I know is parents and families are
choosing----
Mr. Pocan. So you don't know. So you don't know the answer.
Secretary DeVos [continuing]. To send their children to
charter schools.
Mr. Pocan. That is a yes or no. So you don't know the
answer?
Secretary DeVos. Parents and children are going to charter
schools by choice.
Mr. Pocan. A yes or no. So you don't know the answer?
Secretary DeVos. And there are a million more families on
charter school waitlists.
Mr. Pocan. I think I have the answer. I think I have the
answer. Thank you.
[Gavel sounding.]
Ms. DeLauro. Congressman Moolenaar.
CONCERN OVER TONE OF QUESTIONS
Mr. Moolenaar. Thank you, Madam Chair.
I do want to say that I am very troubled by the tone of
this hearing, and I feel like our Secretary is being badgered,
and I would ask the chair to consider that as we move forward.
Because I feel it is very unfortunate that we have come here to
help meet the needs of our children, the Nation's children, and
I think the tone of this hearing is very disappointing in that
regard.
And I also want to say, as a person who is familiar with
the Secretary's record, I don't know of a single person who has
been more engaged in policies to help minority students across
the country than this Secretary from all of her work throughout
her career. So I am very disappointed right now, but I do want
to talk about some of the priorities.
And also, as someone who has been a former school
administrator, a charter school administrator, and someone who
has chaired a State education budget, I will say that the focus
that you have on helping people closest to the student and who
care most for the student, making decisions to me is the right
direction. So I want to compliment you on that. I know there
are a lot of issues we could discuss, but I just want to say
that at the outset.
SECOND CHANCE PELL
There is a few specific things I wanted to ask you to talk
about. First, the Second Chance Pell. I think one of the high
points of Congress working with the administration has been to
look at prison reform and to help those who have been in prison
come back into the community and contribute.
And I wondered if you could talk a little bit about your
plans going forward. I know there is interest in community
colleges in my area in participating in this, but if you could
talk briefly about the Second Chance Pell program.
Secretary DeVos. Well, thank you, Congressman. And I think
this is an area where there is actually broad-spread support
and a lot of great evidence. I have had opportunity to visit
three different prisons and see students that have--I visited
Tulsa Community College and prison in Oklahoma last summer and
was just thrilled to see all of these mostly young men
graduating with associate degrees, with certificate program
recognition. Some of them completing their high school
requirements. But it was a thrill to be there, and I think
there is so much promise with making a Second Chance Pell
program a permanent one that is going to provide hope and
opportunity for returning incarcerated individuals and give
them a really hopeful future.
FEDERAL WORK-STUDY
Mr. Moolenaar. Wonderful. Thank you.
And then I also wanted to talk with you. You mentioned
preparing students for successful careers, and I know the
Federal Work-Study proposals that you have really are aimed at
inviting the private sector to participate more. And I
understand there are 190 institutions that would be invited to
participate in a pilot program.
I know in one of my areas, Mid Michigan College is
interested in participating in that. Could you comment on that
briefly?
Secretary DeVos. Well, we think that there is a real
opportunity to help students get much more relevant work
experience while they are attending college and in a Federal
Work-Study program. Instead of working in the college
cafeteria, if they are doing student teaching perhaps or
clinicals in a health profession or perhaps it is in a business
that has a relevance with the program they are taking in their
college, we think extending this opportunity and helping
students get really relevant, almost apprenticeship-like
experience while they are in school studying is an important
step in the direction of helping students succeed.
STUDENT LOAN DEBT
Mr. Moolenaar. Thank you.
Also I think, as parents, everyone is concerned about the
higher cost of college education when you see the debt that
students are taking out and then just the burden that places on
them in the future. Can you comment about just what the
administration can do to help alleviate the high cost of
education, but also the student loan debt?
Secretary DeVos. Well, this is a huge issue, and I am not
sure I have got enough time to answer it fully. But I will
start with a couple of things.
We have taken important steps administratively to add a lot
of light to what students can access through the College
Scorecard, and now students can go and look up an institution
and then go down to the field of study or program, find out
what it is going to cost to attend that program and complete,
and then, importantly, what their first year earning potential
is after that.
They can compare between schools. They can compare programs
within schools. And this is going to, I think, help them be
more discerning prospectively. I also think it is going to help
schools look more critically at what they are offering and what
the realities are of what they are offering. Perhaps it is
going to make some changes--prompt some changes at higher ed
institutions, and that is one way, bringing light to what has
been a very murky kind of reality. And so that is one way we
have taken a step.
Another way, we have put the FAFSA form on the myStudentAid
mobile app. We are continuing to add more and more information
for students to model what their debt and what their student
loan debt would mean and how they could pay off and have real-
time information for that right on their app. And we are going
to be continuing to add more and more to give them more tools
for financial literacy.
Mr. Moolenaar. Thank you. And thank you, Madam Chair.
Ms. DeLauro. Let me just say--I beg the indulgence of the
subcommittee because I would like to address, Congressman
Moolenaar, your comments, if I can. And I have a great deal of
respect for you and your work on this subcommittee.
REPORTING FROM THE DEPARTMENT
I think what you are hearing is a level of frustration
about very, very important issues and the two issues that have
been addressed in a strong way when we cannot get reports. We
are an appropriations committee. We put in a bill that required
the Department of Education to get us reports on the data with
regard to babies being expelled from preschool. We don't have
that report, nor was there an answer as to when we would get
that report. That is a level of frustration. You would
experience that as well.
CHARTER SCHOOL MANAGEMENT
Further, with regard to charter schools, may I add that we
held a hearing last year on charter schools. The OIG raised
issues that we need to examine, including findings that States
mismanaged charter school closures and that the Department
failed to provide adequate guidance or oversight on the issue.
We are the Appropriations Committee. We have appropriated
serious money, more than $400 million last year alone. We need
to conduct oversight.
And so there is a level of frustration. And I might add,
when you can say about charter schools that God is in his
heaven, all is right with the world, and you cannot do a
serious evaluation of which ones work and which ones don't
work, that means that the Department is not doing the
evaluation that we need to hear about. So therein lies the
frustration, Congressman Moolenaar.
Sure, please.
Mr. Moolenaar. Okay. No, and I completely respect that. And
what I heard the Secretary say is that she will find out the
information on the report and get back to the committee, and I
think any Secretary deserves that courtesy to get.
CHARTER SCHOOLS
And on the charter school, I just would ask the chair to
consider that charter schools, many have different missions.
Some charter schools have the mission of educating adjudicated
youth. And so the idea that we are going to start comparing a
high-standard education with educating adjudicated youth and
somehow evaluate them the same, that is a very different
mission.
And so I think this committee would be well served to kind
of look at the unique missions of charter schools. And where
there are inappropriate----
Ms. DeLauro. I would also say to you that not our
information, but the Office of the Inspector General at a
public hearing that we had in this room last year claimed that
there were serious difficulties. We have to look at that. We
have to ask the Department about that.
So, again, there is----
Mr. Cole. May I, Madam Chairman?
Ms. DeLauro. Yes, sure.
Mr. Cole. Because we are obviously a little off topic here.
And thank you for the indulgence.
Look, I have to speak up in defense of my member. I think
Mr. Moolenaar was right to say what he said.
Ms. DeLauro. I don't have a problem with that.
TONE IN ADDRESSING WITNESS
Mr. Cole. And I have zero problem because I agree with my
friend Ms. Lee. We asked for a report, and we ought to get it.
Nothing wrong with that. And we have some tough questions about
charter schools. Nothing wrong with that.
But anybody thinks the tone was appropriate toward the
Secretary, it was not. And that, you know, we had a lot of
people in 4 years that came before this when I was the chairman
of this committee that I didn't agree with from the other
administration. I don't think I ever addressed anybody the way
I heard the Secretary addressed here, ever.
Ms. DeLauro. Well----
Mr. Cole. And I don't think any of my members ever did. So
that, I think, is a legitimate point, and that is what I think
there is concern about. Not the points----
Ms. DeLauro. Well, there--as I say, that is a result of the
frustration that people are feeling here. And quite frankly, to
my friend, there have been members of your side of the aisle
who have addressed folks who have come before this committee
with a very big lack of respect. That doesn't say that it is
right, but what we want to do is to get through the
frustration. We need to get answers.
We are an appropriations committee. This is a serious
amount of money that we are looking at. And there are deep
concerns as to the direction of public education in this
country, and you know----
Mr. Cole. I will say that I agree. There are deep concerns.
I respect the frustrations. They are real. That is part of
legislating. But it is a little bit different in terms of how
we treat our witnesses.
Ms. DeLauro. Well----
Mr. Cole. So thank you very much, Madam Chairman. I
appreciate it.
Ms. DeLauro. And it applies to both sides of the aisle, as
you know, as well.
Mr. Cole. It certainly does on occasion.
Ms. DeLauro. Congresswoman Bustos.
Mrs. Bustos. Thank you, Madam Chair.
And thank you, Madam Secretary, for being here. I promise
to apply a combination of Midwest nice----
[Laughter.]
Mrs. Bustos [continuing]. And a little bit of my former
investigative journalism background. But anyway, so interesting
conversation.
YOUTH VAPING EPIDEMIC
Thank you, again, for being here.
So we are in the middle of a public health crisis, not just
the coronavirus, but youth vaping. And my folks in education
back home asked that I call it e-cigarettes because they think
``vaping'' makes it sound nicer than it is. So I will say e-
cigarettes.
But the numbers that we have from the Centers for Disease
Control and Prevention show that back in 2011, we had 1.5, 1
and \1/2\ percent of our high schoolers were doing e-
cigarettes. Now just last year, 2019, we are at 27.5 percent.
So about a third of our high school students are now doing
this. Just alarming. That is why I call it an epidemic.
At junior high, in middle school, we are now at about 10.5
percent of our middle schoolers. So I just couldn't believe
these numbers when I learned these.
We did a series of roundtable discussions in my
congressional district in downstate Illinois. And the one that
just really alarmed me was that we had a school resource
officer said that there was third graders that were doing this.
Third graders.
And you know, this is easy to hide. They can put it in
watches. They can put it in clothing. They can do it on these
fake jump drives. So they are doing this.
And that is why we wrote a piece of legislation out of my
office called the Resources to Prevent Youth Vaping. It is part
of a bill that we--a package of bills that we will be voting on
on the floor tomorrow.
And so what I wanted to ask you, I promise I am bringing
this totally into your Department. I am wondering if the
Department of Education is coordinating with the Centers for
Disease Control and Prevention to make sure that we have
information that we can get out to our parents. Make sure that
we have resources that the teachers know about, that the school
nurses know about, and just wondering if there is any kind of
coordination going on with your Department and the Centers for
Disease Control and Prevention?
Secretary DeVos. Thanks, Congresswoman, for that question.
I know that there have been participation in task forces. I
would be happy to check on the extent to which those are
happening and get back with you on that.
Mrs. Bustos. Okay. Yes, if you could work with our office
and make sure that we are aware of this. I think it is really
just a commitment on your part. We were just with Secretary
Azar yesterday, but I think working together will just be
absolutely critical to help address this.
Again, this is a public health epidemic that is impacting
our students, our children. So I think that would be great.
[The information follows:]
E-Cigarettes--Coordination With the CDC on Prevention
The Department has teamed up with the Centers for Disease Control
and Prevention (CDC) in working groups, in coordination with the
Office, of National Drug Control Policy (ONDCP), that have addressed
drug prevention as a whole, including vaping as part of the discussion.
For example last year ONDCP's Prevention Interagency Working Group
(IWG) developed a Substance Use Prevention Resource Guide for School
Staff (available at https://www. white house. gov/ondcp/additional-
links-resources/resource-guide-for-school-staff/). The website has
links to Federal resources and information that include tobacco and
vaping. The Federal agencies that participated in the IWG included, in
addition to the Department of Education (Office of Elementary and
Secondary Education), the CDC (Division of Adolescent and School
Health) and the ONDCP, the Department of Health and Human Services'
(HHS) Office of Adolescent Health; HHS' Substance Abuse Mental Health
Services Administration's (SAMHSA), Center for Substance Abuse and
Prevention; and the Drug Enforcement of Administration.
TEACHER SHORTAGE
Switching gears, the other issue. I liked that Lois Frankel
was saying I am guessing you are going to ask something about
Illinois because I like to--I stay pretty focused on my own
congressional district. Really, really severe teacher shortage
that is happening all over the country.
In the congressional district that I represent, we are 14
counties, and we have seen the teacher shortage problem
actually increase over the last year, actually increase by
about 20 percent that we are seeing now. So in 2019, there were
195 teacher vacancies in these 14 counties that I represent.
Now there are 235. That is just over the last year. So this
problem is getting worse, not better.
PROPOSED CUTS TO ELEMENTARY AND SECONDARY EDUCATION
So I know in the President's budget, just a few things I
want to point out for the record that are concerning to me. The
Public Service Loan Forgiveness Fund has a proposed cut of $50
million. Teacher Quality Partnership Grant Program has a cut,
proposed cut of $50 million.
The funding of the Supporting Effective Educator
Development Grant, proposed cut of $80,000,000. Supporting
Effective Instruction State Grants cut of $2.1 billion.
Secretary DeVos. Can I just interject?
Mrs. Bustos. Please.
Secretary DeVos. Because a number of the programs that you
have cited are actually the ones that we have proposed to
include in the block grant and would actually be very
appropriate in your case and in your district. If there is a
drastic shortage, the district could--the districts could
target more of those resources and have the flexibility to use
more of them for programs that would address the teacher
shortage issue, teacher retention, teacher development and, in
fact, give them a lot more flexibility than the current
scenario.
Mrs. Bustos. So talk me through then, if you could in the
17 seconds we have left, talk me through about how
specifically. So you got the block grant proposal. This is a
mostly rural district I represent, 7,000 square miles, again a
lot of smaller schools. How will these block grants help
specifically recruit, retain, and fill all of these vacancies
in a very, very rural congressional district?
Secretary DeVos. Well, what it would do is allow for the
districts to prioritize what portions of these 29 different
programs would be most effective and most important for the
needs in their district to meet the needs of the most
disadvantaged students. And it would allow them, again, to
personalize and prioritize where those needs lie more
specifically than the approach of having 29 different programs,
all with their own rules, all with their own regulations. These
would be block granted to the State, and then 90 percent of
them would go out directly to the districts under the Title I
accountability and formula so all of the accountability
provision is there, but much more flexibility for every
district to be able to target the resources where they need the
most.
Mrs. Bustos. I will yield back the time that I don't have
left.
Thank you. [Laughter.]
Ms. DeLauro. I thank the gentlelady. Congresswoman Herrera
Beutler.
SECLUSION AND RESTRAINT IN SPECIAL EDUCATION
Ms. Herrera Beutler. Thank you, Madam Chair.
Thank you, Madam Secretary, for being here.
The first thing I wanted to mention, and we talked about
this a little bit. I have a few questions. So I am going to try
and bang on through them. The practice of seclusion and
restraint, we have talked about this before, of special ed
students I think is extremely detrimental to these young
people, and the stories I have heard are--they are horrific.
What is the administration doing to stop the practice and
ensure that all students are treated with respect?
Secretary DeVos. Thanks, Congresswoman.
As we have talked about, we have an initiative going
proactively through all 12 of our regional Office for Civil
Rights offices to bring light to this subject, to ensure that
schools and districts and States know what their
responsibilities are, what the law is, and to really make sure
that they are doing right on behalf of kids.
And so this was a prospective initiative, conducting audits
and also conducting a lot of proactive informational sessions
to ensure that schools know what they should be doing or not
doing.
Ms. Herrera Beutler. One of the--and some of it, as I hear,
it is a lack of reporting. Is there any enforcement mechanism
to say so you have been doing the education and they should, a
lot of them should know by now what the rules are around this.
What type of enforcement mechanisms do you have, or do you not
have any? What should we be doing to make sure that schools are
adhering?
Secretary DeVos. Well, where there are infringements on
students' rights and requests for investigation, we are doing--
we are investigating. And I think that is where the important
piece comes, on the follow-up.
But we think and we hope that, again, proactively taking
this initiative and bringing more light to this subject is
going to bring about laudable results in terms of reporting and
in terms of actual activity and action.
MENTAL HEALTH RESOURCES
Ms. Herrera Beutler. Thank you.
One of the things I hear a lot about from educators at home
in Southwest Washington is lack of resources to address mental
health needs. This is probably the top issue I hear about. It
is actually more I hear about the mental and emotional health
of the students more than I hear about math achievement and
reading achievement. I mean, it is ground zero. These educators
are doing everything they can, but these kids are coming in
with a whole set of challenges that generations before them
seem to have navigated or navigated differently.
Who knows, right? I don't know why they are at where they
are now. We are trying to figure that out. But these kids are,
a lot of them are in real distress. What is or can the
Department do to help? I mean, this is not in anybody's scope,
right? This is not in our scope of practice, but this is the
reality of where the kids are at right now.
Secretary DeVos. A couple of things I would say. First of
all, I think our proposal to block grant to the States and
then, ultimately, the local districts all of these different
programmatic funds would allow each district to address this
issue in the way that they prioritize. And if this is, indeed,
the most important issue for their most vulnerable students,
that would allow them the flexibility to tap into more of
those--a higher percentage of those resources than otherwise
through the formula or through the programmatic approach.
Ms. Herrera Beutler. So they would be able to maybe hire
like an in-school mental health counselor, for example?
Secretary DeVos. If that is what they thought would be----
Ms. Herrera Beutler. I have heard--I have asked--I have
heard requests for that, or SROs, and some of our funds are
flexible, and some of them just aren't. Or if they are using
money for this, they can't then use it for this is what is the
feedback.
Secretary DeVos. And that is why I think the block grant
proposal is really sort of transformative in that way because
it would allow for all of the uses of those programs, but for
them to prioritize the dollars in a way that is going to really
meet the needs of the most disadvantaged kids in their
district.
Ms. Herrera Beutler. And I got to believe there would be
an--is there an administrative savings? I think one of the
problems we have is we send everybody's tax dollars back to
D.C. and headquarters, and headquarters skims it off--and this
is in every department. Skims off the top and then sends back a
lesser amount.
Secretary DeVos. Well, there are--yes, I think, ultimately,
there would be. And I think, importantly, that flexibility at
the State and local level would really allow those closest to
the students to target those resources in the ways that are
going to be most meaningful for the kids that they seek to
serve.
CAREER AND TECHNICAL EDUCATION
Ms. Herrera Beutler. Okay. With my last 20 seconds, I am a
big supporter of the Running Start programs, would like to see
the Department support them. In addition, I just wanted to say
thank you for the increase in the focus on career and technical
education. We should not sell students down the river that you
have to go to a 4-year liberal arts school, and that is what
success is.
Because we all know if you live at all in life, that is not
the only definition of success. In fact, I know a lot of people
who are happy and fulfilled have good, living-wage jobs with
full benefits and are able to provide for their families on a
career and technical type of education tracks. So thank you for
the emphasis on that.
Secretary DeVos. Well, the President and myself and this
administration are really committed to advancing that and
supporting multiple pathways for adult success.
Ms. Herrera Beutler. Thank you. Yield back.
Ms. DeLauro. Congresswoman Clark.
PRESCHOOL DISCIPLINE AND RACIAL BIAS
Ms. Clark. Thank you, Madam Chair, and thank you, Secretary
DeVos, for being with us today.
I want to go back to a topic explored by my colleague
Congresswoman Lee. Do you think that the disparity in
discipline for preschoolers of color could indicate a racial
bias?
Secretary DeVos. I suppose it certainly could, and again, I
think the bigger issue here is that we make sure that every
child has the opportunity to pursue an education that is going
to unlock and unleash their personal and fullest potential.
Ms. Clark. Okay. Isn't it, however, the official policy now
of the Department of Education that the cause of these
disparate rates of discipline that we see with students of
color is explained by the fact that these children are just
inherently predisposed to misbehave and disrupt the classroom
more than White children? Isn't that your policy?
Secretary DeVos. No. No, it is not.
Ms. Clark. That is the conclusion of the research you cited
in your school safety report of 2019. Congress specifically
asked you to strike all references to this report, which
interestingly appeared in the Journal of Criminal Justice.
Your official response within this budget is that you stand
by this report and its conclusions. Isn't that right?
Secretary DeVos. Congresswoman, do you have a question
about the budget?
Ms. Clark. Yes.
Secretary DeVos. Because we are here--we are here to talk
about the budget.
Ms. Clark. That you did say in your fiscal year 2021
budget, you responded that ``Department of Education stands by
this report'' that says children of color are just more
inherently inclined to misbehave, and that explains the
disparate rates of discipline.
Secretary DeVos. I don't know where that would have fallen
in our budget narrative. I would----
Ms. Clark. We will get you the exact section because it
is----
Secretary DeVos. I would be interested in that.
Ms. Clark [continuing]. Right in your budget. And in fact,
I don't see any other way to interpret this as your new policy
because then you went on and eliminated the data collection
that could help us solve this problem because you don't see a
problem because you have adopted as the policy that this is
just a race-based problem. That these kids are inherently----
Secretary DeVos. In fact, Congresswoman, the CRDC
question--the data collection questions are open for public
comment now. They have not been concluded, and if you do have--
--
Ms. Clark. But this is what you proposed, to no longer
collect----
Secretary DeVos. If you do have input, we would be very
happy to take that.
Ms. Clark. We certainly would like you to go ahead, undo
what you put in your budget, strike this racist research, make
sure it is crystal clear that you do not buy into this theory
that children of color are disciplined because of who they are
and that they come to school with disruptive tendencies. That
is what you put in your official report. In your budget, you
say you stand by it.
Let us move on. I want to give you a chance to correct the
record. Because I think we have had some testy exchanges in the
past. And in 2018, you agreed that private and religious
schools receiving Federal funding would have to have
nondiscrimination policies.
But I think I browbeat you into that answer. Is there any
requirement that private and religious schools must have
nondiscrimination policies under your EFS voucher program?
EDUCATION FREEDOM SCHOLARSHIPS
Secretary DeVos. The Education Freedom Scholarship program,
first of all, is a tax credit. They are not Federal funds----
Ms. Clark. Is there any nondiscrimination? I did not see it
in your budget proposal.
Secretary DeVos. And--and the reality is that every student
that would take advantage of an Education Freedom Scholarship
would be protected. Their civil rights are protected, and that
is true of students no matter where they are, in whatever
school.
Ms. Clark. But I am correct that you do not have that
nondiscrimination requirement in your budget proposal?
Secretary DeVos. The budget proposal is part of Treasury's
budget, and it is only mentioned in our budget.
Ms. Clark. But you agreed that it would, but it is not
there.
In September, you visited a religious school in Harrisburg
that as a private religious institution, it is certainly
allowed to do what they do. They have policies that transgender
children can be expelled or denied admission based on that
status. They also have different tuition rates depending on the
religion of the children.
My question to you is if Pennsylvania adopted your
scholarship program, your voucher program, would this school be
eligible for Federal funding with these policies in place? If
approved----
Secretary DeVos. Ma'am, I need to correct you on the nature
of the Education Freedom Scholarship proposal. It is a Federal
tax credit that would be the recipient of voluntary----
Ms. Clark. Are you saying that Federal taxes----
Secretary DeVos. Can I finish? Can I finish?
Ms. Clark. I just want to--we are out of time. So I just
want to be clear that----
Secretary DeVos. Well, and I want to make sure that you
have full understanding of what the proposal is. A Federal tax
credit----
Ms. Clark. I understand tax credits are Federal funding.
Secretary DeVos. No, they are not.
Ms. Clark. Yes, they are.
Secretary DeVos. Because they are voluntary contributions
in advance of paying your taxes to the Federal Government.
Ms. Clark. That would be a----
Secretary DeVos. They are direct contributions to 501(c)(3)
charitable organizations, as designated by States that choose
to participate.
Ms. Clark. We are out of time, and I am going to leave you
with this. You said in your testimony you wanted to expand
educational freedom for students. I certainly hope that making
these inherently discriminatory policies part of the Department
of Education is not what you meant by that statement.
Secretary DeVos. We don't discriminate against anyone at
any time.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. I am going to follow up. Thank you for being
here. Appreciate it.
TAX CREDITS AND EDUCATION FREEDOM
I want to follow up on these voucher questions. So I was
trying to just calculate in my head because, for me, I think
this is a program for wealthy people to get free private
school. Because my understanding of a tax credit is you
actually--if you owe $10,000 in taxes and under your scenario,
and you pay, let us say, $10,000 for private school, then you
owe no taxes. Is that right?
Secretary DeVos. No, Congresswoman, can I just interject?
Ms. Frankel. Yes, please.
Secretary DeVos. Because that is----
Ms. Frankel. Okay, explain it to me.
Secretary DeVos. That is absolutely a misunderstanding of
the proposal.
Ms. Frankel. Okay. Well, just explain so we know.
Secretary DeVos. The proposal is voluntary contributions
from individuals or businesses to 501(c)(3) scholarship-
granting organizations that would then give scholarships to
families, as defined by the State that decides to participate.
And in most States where there are education freedom school
choice programs, they are geared and targeted to primarily low-
income families, many times also students with disabilities,
and they are programs for students who are most vulnerable and
most disadvantaged.
And so it would be individuals who choose to help other
students and other families who would voluntarily make those
contributions. It is not a program for people of wealth.
Ms. Frankel. Okay.
Secretary DeVos. People of wealth already have choices.
Ms. Frankel. Correct.
Secretary DeVos. People of wealth already--people of power
already have choices. All of these policies are designated for
and are targeted toward individuals and families who don't have
that power, who are assigned to schools that are not working
for them.
Ms. Frankel. Okay. I want to reclaim my time to follow up
on Representative Clark's question.
Is there anything in your proposal that requires
nondiscrimination? So, for example, can they--can somebody keep
a gay student out, or can they discriminate on the basis of
religion? Or--or----
Secretary DeVos. The key with school choice and education
freedom is families and students voluntarily choose the place
that works and fits for them.
Ms. Frankel. So, okay. All right. I just want to understand
this. So they can choose to go to a school that only allows a
certain religion or a certain gender or a certain race? Is that
correct?
Secretary DeVos. Many schools have unique missions.
Ms. Frankel. Is that the answer?
Secretary DeVos. Different missions.
Ms. Frankel. The answer is yes. Thank you. I answered it
for you.
TITLE IX
Okay. So I have another question. I think coming out soon
is a new rule in reference to Title IX on sexual harassment and
violence in colleges. Is that rule going to be published soon?
Secretary DeVos. I expect it will be soon, yes.
Ms. Frankel. So I think you probably know that there is a
lot of concern from folks about what this is going to mean.
Because all the statistics so forth show that there is still a
lot of sexual violence on campuses, and there is a lot of
concern that your new rule is going to actually discourage
victims from coming forward.
There is one particular point that I do want to ask you
about, and maybe you can just clarify it because I cannot--I
don't understand it. I read that rule. It is so long.
Under the proposed rule, alleged harassment must occur
within the school's own program or activity. So my question is
whether or not that would cover off-campus, for example, frat
houses. Would it pertain to online sexual harassment?
Secretary DeVos. Well, ma'am, because the rule is not yet
finalized nor published, I can't comment on it. It would not be
appropriate to comment, and it would not be appropriate to--
yes, you are going to ask a first question, and then you are
going to ask another. It is not appropriate to comment. The
rule is not yet final.
Ms. Frankel. So is the rule, as you understand proposed, as
it is proposed, is it going to cover, for example, a sexual
assault at a frat house that is off campus or online harassment
and bullying?
Secretary DeVos. Again, I cannot comment on the specifics
of the rule.
CORONAVIRUS AND SCHOOL CLOSURES
Ms. Frankel. All right. Well, that is really sad.
Okay. My final question is we just read that Japan is
closing all its schools because of the coronavirus. So I would
like to know what plans you are making in regards to
coronavirus?
Secretary DeVos. Good question. I have convened a task
force within the Department and have asked my Deputy Secretary
Mick Zais to head that task force to ensure we have our
continuance policies and every plan in place for work in and
through the Department. And we continue to work with the other
agencies across Government to ensure that we are prepared to
respond and react and do as we should, depending on----
Ms. Frankel. Okay, and thank you. I am happy to hear that
you are doing that. I just hope that you will keep us informed.
And I yield back.
Ms. DeLauro. Congresswoman Watson Coleman. I can have
Congresswoman Lowey go first for this first round if that
would--is that what you want to do?
Mrs. Watson Coleman. Actually, I would. If you--yes, I just
need a moment.
Ms. DeLauro. Congresswoman Lowey.
FULL-SERVICE COMMUNITY SCHOOLS
Mrs. Lowey. Thank you.
I mentioned the Full-Service Community Schools before. I
think that they are so critical to bringing together health,
social support, family-community engagement, early childhood
development opportunities to really help students and their
families thrive.
Yet you propose eliminating dozens of K through 12
programs, including community schools. We came together on a
bipartisan basis in this Congress to authorize the Full-Service
Community School program in 2015 because we know its value in
the districts.
First of all, I would like to know have you ever visited a
full-service community school.
BLOCK GRANT PROPOSAL
Secretary DeVos. I visited many schools. Maybe one of them
has been termed that. But Congresswoman--or Chairwoman, if I
could just say it is inaccurate to say that we have proposed
eliminating these programs. We have proposed rolling them all
up into a block grant.
And I think your example of the school that you have cited
and admire is exactly why we should consider the block grant
proposal. Because it would allow schools and districts in your
State to actually expand on those and target those resources in
that direction if that is the right answer for the students in
that district or in that region.
It would give a lot more flexibility to States and
communities not eliminating anything, but putting it in one big
pool----
Mrs. Lowey. With less money.
Secretary DeVos. Well, the request--the request is at the
level that it is. You are the appropriators. You will decide at
what level to fund.
Mrs. Lowey. Not that level.
Secretary DeVos. I think the important--I think the
important thing is the policy here, and the proposal--the
policy proposal is to put all of those programs together in one
block grant that would then allow the most local level, those
closest to the students, to target the resources to meet the
needs of the kids that are most vulnerable in that school
district in a way that is going to uniquely meet their needs.
Mrs. Lowey. However, you are decreasing the amount of money
in the pot so that you are making schools really compete
against each other for these dollars. So I am hoping as we go
through the budget we will increase those dollars so we can
sustain programs like this.
And I think you would be interested in visiting one of
those schools. I would be happy to give you a tour if you come
up to Westchester.
Secretary DeVos. Thank you.
AFTER SCHOOL PROGRAMS
Mrs. Lowey. Now after school program. Your budget
eliminates funding for after school programs?
Secretary DeVos. No, it includes it in the block grant.
Mrs. Lowey. So, oh, you are decreasing the pot of money and
putting everything----
Secretary DeVos. Putting it all into a block grant to allow
for flexibility at the local school district level.
Mrs. Lowey. But if you are cutting the budget, you are
cutting the budget.
Secretary DeVos. Well, again, you are the appropriators. So
you decide at what level to fund it. But I think the important
thing is the proposal to put all of them together in a block
grant and allow for States and local districts to make
decisions on which----
Mrs. Lowey. Okay----
Secretary DeVos [continuing]. What programs are most
effective and what is going to work best to meet the needs of
the most vulnerable students in that district.
Mrs. Lowey. With less money. I get it.
But let me just say this because I think it is important,
and you probably know it. The amount of Federal funds going to
districts is usually about 10 percent. I don't know if it is--
--
Secretary DeVos. It is actually--it is actually less than 5
percent.
Mrs. Lowey. Less. Probably about 9 percent of the budget.
Secretary DeVos. It is less than 5.
Mrs. Lowey. And you are saying putting all these programs
in a pot, decreasing the funds, everything is going to be fine.
But I think that is where we have a real disagreement. And you
are saying we are the appropriators, but if you are the
Secretary of Education, your opinion is valued. And it
disappoints me that you would take all these good programs, say
put them in a pot, and then, okay, decrease the dollars.
But we will move on because it is almost completed. Did
anyone ask this one? Okay. [Laughter.]
I am sorry. There are a couple of hearings going on.
Secretary DeVos. I understand. I think I was in the hold
room in the other one.
CHILD CARE ON CAMPUS
Mrs. Lowey. Yes, okay. Now another favorite program of
mine, maybe this is in the pot, too, but I think it is really
worth your seeing, is the CCAMPIS program. More than one in
five college students is a parent.
For those with a young child, accessing childcare on campus
can really make all the difference, and the struggle to get
good childcare is reality, frankly, for a growing number of
college students. Not every college campus--I have to get to
the question. Oh, yes. Sorry about that.
What do you think? Are you aware of the value of----
Secretary DeVos. I am aware of it, and I know what our
budget proposal has advanced. But I also know that the Health
and Human Services budget really contains the increased funding
around childcare. This is certainly a priority of the
administration, and we believe that those programs through HHS
would definitely be able to meet the needs of the program that
you have cited as well.
Mrs. Lowey. Well, I am out of time. But let me just say if
the $3 million cut you have proposed were to take place,
programs like this would disappear because the locals have the
major responsibility, and our work is invaluable and our money
is invaluable in supporting their efforts.
Oh, that is 30--did I say that? A $38 million cut.
But thank you so much.
Secretary DeVos. Like I said, HHS has the bulk of the
childcare budget proposal funds, and that is where--that is
where the administration has put the priority around childcare.
And let me just say, if you are going back to the
Transportation, I like the color to look at in Transportation
better than here, just a little aside. It is a really pretty
green on the wall.
Ms. DeLauro. We will take it into consideration and put
some pictures up.
Mrs. Lowey. I was so busy focusing on the issues that I
didn't notice the color.
Ms. DeLauro. Congresswoman Watson Coleman.
DISCIPLINE AND RACIAL BIAS
Mrs. Watson Coleman. Thank you very much, Madam Chairman.
And thank you, Secretary DeVos.
I am going to ask you a couple of questions regarding the
reduction in the investment in our children under your proposed
budget. I am really concerned about the achievement gap, as
well as you are, and I just maybe don't agree with our approach
to it.
The achievement gap that you talk about exists, I think, in
part because schools lack equitable discipline guidance in
addition to other resources. And students of color are
disproportionately targeted for discipline and kept out of
school, which prevents their learning.
Further, there is a gross lack of accountability from your
Department in ensuring that the school districts across the
country live up to their missions.
Let us talk first about the discipline piece. Just this
week, a 6-year-old girl in Florida was arrested and taken from
her school, even though school officials maintain they did not
want the girl arrested. This is an all too common issue for our
Black children.
According to the Civil Rights Data Collection, Black K
through 12 students are nearly four times as White kids to
receive out-of-school suspensions. Black students are nearly
twice as likely to be expelled from school without education
services, compared to their White counterparts.
This data is disconcerting because students who were
suspended or expelled for a disciplinary violation were almost
three times as likely to be in contact with the juvenile
justice system in the next year.
How do we reconcile this disparity with the percentage of
population black students represent get the percentage of
discipline? And given that you have rescinded the guidance that
was intended to give to schools to break the school-to-prison
pipeline--I hope that is what it was intended for--what are
your plans to ensure that schools are a safe and welcoming
environment that don't necessarily punish or discriminate
children?
Bottom line is what kind of resources do you envision
providing through your request to schools to address this
issue?
Secretary DeVos. So, Congresswoman, thank you for that
question, and you have cited up at the top your concern about
the achievement gap, and I share that concern and have shared
that concern for the three-plus decades that I have been
working to change policy to free up children who haven't been
able to achieve because of being stuck in a school that doesn't
work for them.
And I think you may have misstated when you said you don't
agree. You don't agree with our approach, meaning your
approach. I, too, don't agree with your approach with
continuing to do the same thing with more and more resources
and expect a different result.
That is why our proposal has suggested taking all of--
virtually all of the elementary and secondary education funding
from the Federal level and block granting it to the States. And
then they, in formula to the local districts, to allow for the
greatest amount of flexibility to directly address the needs of
the students in that district and in that school. And I think
this is an important----
Mrs. Watson Coleman. Excuse me. Excuse me. Did that include
alternatives to public options?
Secretary DeVos. No. This would be the funding from the
Federal Government for all of the elementary and secondary
education programs, and it would be granted to the States and
formulaed out under the Title I formulation. So 90-plus percent
of it going to local districts.
But it would allow the local districts the kind of
flexibility they don't have today. It would free up tons of
hours, literally 225 years of time, in complying with and
writing reports and would allow them to target those resources
directly to the kids who need it most.
ESED BLOCK GRANT
Mrs. Watson Coleman. Well, I certainly agree that teachers
are required to do a lot of paperwork that just takes time away
from their teaching.
I want to talk to you about something else that concerns me
in the budget, which I think is a reflection of our values or
your values or the President's values. The budget eliminates 41
programs and cuts a number of other----
Secretary DeVos. No. No, no, it doesn't. It takes them all
and puts them into the block grant and allows flexibility at
the State and local level. So it is not eliminating them.
Mrs. Watson Coleman. So it is----
Secretary DeVos. Twenty-nine of them.
Mrs. Watson Coleman. It is putting more programs in one box
with a limited amount of money, asking them to already compete
with one another for----
Secretary DeVos. No. So they wouldn't be----
Mrs. Watson Coleman. Are you putting more money in the
block grant?
Secretary DeVos. They wouldn't be competing. They wouldn't
be competing. They are formula granted out, 90 percent of the
funds.
TRIO AND GEAR UP
Mrs. Watson Coleman. Let us talk about the TRIO program.
Talk to me about the TRIO program. Oh, all right. I am sorry. I
can't hear you.
Ms. DeLauro. No, no. I was going to say the question was
TRIO and getting a quick answer.
Secretary DeVos. Sure. We have proposed--we have proposed
combining the TRIO and GEAR UP functions in the TRIO program.
And again, coupled with the flexibility that the block grant
for the other 29 programs would afford State and local
districts, if there is more desired to be spent in the area of
what the TRIO programs are doing, it would allow, again, more
personalization for the students that are closest, for those
closest to the students in each school district.
Mrs. Watson Coleman. All right. I seek unanimous consent to
enter some testimony from our students in the TRIO program,
which has been so vitally important, which I think is not
getting the appropriate attention that it should.
Thank you, Madam Secretary.
Ms. DeLauro. I think in a bipartisan way, there is
agreement on your comment, and we will, so ordered, put the
information into the record.
Ms. DeLauro. We are going to do another round, but it is 2
minutes so that we can move quickly.
I just might add if you have not seen the video of the 6-
year-old child being put in handcuffs, pleading, pleading for
not to have handcuffs. That is just a visual of what my
colleagues are talking about, which is what is happening to
particularly African-American kids and kids of color in
preschool. Sobbing not to be put in handcuffs at 6 years old.
Anyway.
ACCREDITING COUNCIL FOR INDEPENDENT COLLEGES AND SCHOOLS
A quick question. The Accrediting Council for Independent
Colleges and Schools, ACICS, lost its accreditation 2016,
demonstrated extraordinary lack of compliance, weak record in
monitoring enforcement, standards below the Department's
requirements.
2018, you reinstated it. It is in financial peril, lost its
former accredited institutions, not recognized by the Council
for Higher Education, uncovered by USA Today that ACICS
accredited Reagan National University, an institution, no
campus, no staff, students, or alumni.
What is the Department doing to ensure that students are
not being duped by deceitful, for-profit colleges accredited by
an agency that you reinstated? Will you consider reversing your
decision to reinstate?
Secretary DeVos. Well, Chairwoman, I was troubled by
reading that piece as well and have directed that an
investigation ensue to see what is going on there. I was--I was
not happy to read that.
Ms. DeLauro. So you would be willing to----
Secretary DeVos. We have an investigation launched, and we
are on it.
Ms. DeLauro. Okay. And decision to reinstate, I thank you
for you that.
I tell you what I am going to do. I will yield back. Mr.
Cole, go ahead.
Mr. Cole. Thank you very much. I know we have got just a
little time here.
So just quickly, Madam Secretary, information--I had some
questions on charter schools. I would like to submit them for
the record. You made your position very clear, and I appreciate
that very much, and your record is well known. But I do have
some concerns on just what would happen to the money that we
have drawn so far.
STUDENT LOAN CRISIS
Second area that--and I have enormous sympathy with you in
terms of this whole student loan problem and commend you,
honestly, for trying to think through different ways to deal
with that. In full disclosure, I was not very happy when we
moved away from the loan guarantee approach. It sort of kept
this out of your bailiwick, and we have really saddled you with
an enormous problem, an under resourced problem, frankly, for a
number of years.
Again, as I said in my earlier comments, I am not sure we
really have the power to do much here. I mean, it is really an
authorizing function, I think, for the most part. But I am very
curious about what you are doing now to try and combat this. I
know you are doing some technology things. So I would like to
know what those are.
And again, if you would like to expound longer term as to
what you think the ideal solution would be. Because we sort of
put the Federal Government on the hook in a way that I don't
think we ever should have in terms of this, and we have turned
this into an extraordinary political issue that presidential
candidates kick around. And I would like to get the Department
out of the middle of this crossfire if there is some way to do
it going forward.
So your thoughts would be most welcome.
Secretary DeVos. Sure. Well, as I mentioned earlier, I
mean, it is a very large and complex issue. And I think we
spend a lot of time talking about the loans and the debt that
students are taking on, not quite as much time challenging why
the cost of higher education continues to skyrocket.
And you know, there is a lot of theory around that, but our
budget proposal does suggest capping off the amount that
graduate students can take out in student loans through the
Federal Government and capping out the amount, importantly,
that parents can take. We know that there have been all too
many parents that have taken out loans greater than they are
able to really afford, and Social Security being garnished as a
result.
But graduate students, we have over--yes.
Mr. Cole. Thank you. I am again out of time.
Thank you, Madam Chairman.
Ms. DeLauro. We can continue the conversation.
Congresswoman Lee.
Ms. Lee. Thank you very much.
First, to my colleagues on the other side, let me just say
this to you, and I appreciate your comment. But when many of us
started public schools, schools were segregated. We could not
go to public schools. Got it?
In 2017, we asked the Secretary to submit a report about
the resegregation of our public schools. To date, that report
has not been submitted. So I cannot be nice when I ask about
this because this is serious for our Black and brown students,
and many of us understand the role of the Federal Government in
desegregation of public schools.
SECOND CHANCE PELL GRANTS
Now, Madam Secretary, let me ask you about the budget as it
relates to expanding Pell Grants for incarcerated students. You
said you supported that, but I can't find in your budget
request any line-item for that. Have you estimated how much it
would cost, and do you plan to request funding for this?
Secretary DeVos. Well, we have made the request to have
Congress consider a permanent expansion. Because it is not a
program other than a pilot through the Department currently,
there isn't a specific piece of budgetary guidance to suggest
with it.
Ms. Lee. So what do we need to do to get you to do that, to
submit a line-item for us?
Secretary DeVos. Well, I think Congress needs to act and
make Second Chance Pell a program. It is currently----
Ms. Lee. So we have to authorize it? Okay.
Secretary DeVos. It is currently just an experimental
program through our authorities in the Department.
HISTORICALLY BLACK COLLEGES AND UNIVERSITIES
Ms. Lee. Okay. So we will work on that. Let me ask you
about HBCUs because this budget doesn't increase funding for
HBCUs except those that are in the opportunity zones, which
leaves out about 50 percent of the HBCUs.
So let me ask you about that because we know that the
President has touted his support for HBCUs, yet we see a budget
that level funds our Historically Black Colleges.
Secretary DeVos. Well, I would just say that that is
definitely indication of continued support for the important
role HBCUs play. And that we also----
Ms. Lee. But 50 percent won't be included in this.
Secretary DeVos. But the level funding for the remainder of
the HBCU-related programs is also an indication of the priority
that we have placed on that. And then a $150 million plus-up
for HBCUs and other Minority Serving Institutions for STEM-
related programs in opportunity zones, which Opportunity Zones
are all across the country in rural and urban areas.
Ms. Lee. I know, and leaves out 50 percent of HBCUs.
Thank you, Madam Secretary.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you again, Madam Secretary.
And Madam Chair, without objection, I would move to include
the May 2019 Harvard Kennedy School poll, EdNext poll, into the
record.
Ms. DeLauro. So ordered.
EDUCATION FREEDOM SCHOLARSHIPS
Mr. Harris. Good. Madam Secretary, let us just clear up
something about these Education Freedom Scholarships. Just like
when I write a check to my church every week, it is tax
deductible. I am assuming my church is using it, you know,
there is something religious associated with it. So the idea of
having some tax preference for someone who actually has a
religious bent is not a new concept. Is that right?
Secretary DeVos. That is correct.
Mr. Harris. Thank you.
Okay. Now let us talk about the May 2019 Harvard Kennedy
School poll that looked at school choice and looked at tax
credits and, most importantly, vouchers for low-income
students. Fact of the matter is that by 49 to 41 percent, all
the people they sampled approve it.
But the most interesting thing, and I am ashamed that
Republicans only have 44 percent, Democrats 52 percent. But the
reason why the Democrats actually prefer it more is because
African-American Democrats have 70 percent approval for low-
income vouchers, and Hispanic Democrats 67 percent.
Secretary DeVos. That is right.
Mr. Harris. Now the fact of the matter is, is that these
parents, the people who actually are most concerned with their
students--with their children's education outcome actually want
low-income vouchers, and I would suggest it is a soft bigotry
of low expectations that somehow we are not going to provide it
to them because we know better.
You know, to quote a candidate who is now the President, I
have a suspicion that a lot of those parents are asking
themselves the question, ``What do I have to lose?''
I yield back.
Ms. DeLauro. Congressman Pocan.
Mr. Pocan. Thank you very much, Madam Chairman, and thank
you again.
APPRECIATION FOR PUBLIC EDUCATION
I am going to try to channel my inner John Moolenaar, who
always has grace in his demeanor. So I will try to do that. I
think the difficulty is I am a product of public schools. I
grew up in a lower middle class neighborhood.
Recently, we sold my mom's--my aging mom's house for about
$115,000. People like me got our opportunity to get where we
got because of public education.
So I am very passionate about public education, and many of
these schools, because they discriminate, as a gay kid, I
wouldn't have been able to go to, or I would have been beat up.
So, honestly, I take that very personal, and I think I am going
to enter my----
Secretary DeVos. May I just comment to that as well?
Mr. Pocan. Sure, please.
Secretary DeVos. I also am very passionate about public
schools. I am passionate about all schools, all schools that
serve kids and that are good fits for kids. I am agnostic to
what comes before schools.
RECOVERING FUNDING FROM CLOSED CHARTER SCHOOLS
Mr. Pocan. Sure. I got you. If I can just ask my question
because I have the 2 minutes, less than 2 minutes, 1 minute
left. What are we doing, though, to go after those tax dollars
that we have lost that have gone to these failed charter
schools, the ones that haven't opened or have failed? Are we
doing anything to get that money back?
Secretary DeVos. Well, again, that report has been totally
debunked. There is----
Mr. Pocan. But there are failed schools. Correct?
Secretary DeVos. It is riddled, riddled with inaccuracy.
Mr. Pocan. Sure, that is not my--this is the frustration,
right? When I ask a question, don't answer a different, please,
Madam Secretary.
Secretary DeVos. It was like 1.5 percent of the total
number of schools that didn't open, and I will be happy to get
back with you.
Mr. Pocan. Do we go after those dollars?
Secretary DeVos. I will be happy to look into that further
and get back with you on the disposition of those.
Mr. Pocan. I accept that as an answer. Thank you very much.
[The information follows:]
Charter Schools Funded Under the Charter Schools Program That Have
Closed or Did Not Open
As noted in a June 28, 2019 letter to Congress on the Department's
administration of the Charter Schools Program (CSP), of the 5,265
charter schools that since 2001 have received CSP funding through a
State entity or directly from the Department, 634 did not open and are
unlikely to open in the future. In addition, the Department's date
indicate that only 1.7 percent of CSP-funded schools close before their
second year of operation. More information on how the CSP supports the
successful opening and expansion of charter schools can be found in the
June 28 letter.
FOR-PROFIT COLLEGES
A follow-up on the for-profit colleges. I know that you got
rid of a program that was in the Obama administration that
protected students who had these failed colleges on their
loans. Eighteen States have had to sue the Department of
Education about this loan forgiveness.
A Federal judge recently said we were--the Department of
Education was not following that order and was fined $100,000.
I guess my question is what are we doing to collect those
payments? Are we still collecting payments from defrauded
students, and are we going to try to take care of those
students under----
Secretary DeVos. So every student that has filed what is
called the Borrower Defense claim was put in forbearance at
that time. Like when I got to my job, there was no process, and
I said it is going to take a while to figure out the process.
Let us make sure these students aren't incurring any more
interest, aren't having to pay any more on their student loans
as long as their claims are in process. And so that has been
the case on all of those claims that are not yet closed.
Now we have been stymied at a couple of steps along the way
by procedural rulings in court. We are still waiting for the
Ninth District to rule on a methodology. But nothing pains me
more than to not be able to resolve those completely.
Mr. Pocan. Great. I will follow up. Thank you.
Ms. DeLauro. Congressman Moolenaar.
ESED BLOCK GRANT
Mr. Moolenaar. Thank you, Madam Chair.
And again, thank you, Madam Secretary, for being here.
I want to talk with you a little bit about the block grants
because I think that is an important concept that it is kind of
hard to get our hands around. So if I understand what you are
saying is you are taking some of the federally mandated
spending programs. You are consolidating it together into a
flexible spending program that States and local school
districts are going to have the ability to determine.
So, for instance, if one local community said they wanted
to focus on school safety, they could use those funds for that?
Secretary DeVos. Correct.
Mr. Moolenaar. And if one said, hey, we think career and
college counseling should be part of it, they could use it for
that?
Secretary DeVos. Correct.
Mr. Moolenaar. Mental health counselors, as my colleague
had mentioned, you could use it for these needs that are
identified kind of on the ground where people are saying this
is really what our school district needs?
Secretary DeVos. Well, and recalling that most of these
programs, and including and especially Title I, were created to
really help the most disadvantaged students. And I go back to
my opening statement, where I said $1 trillion spent over the
last 40 years to close the achievement gap, hasn't closed one
bit. Has opened in many cases for lots of kids, particularly at
the low end of the spectrum.
And so let us do something different. Let us allow for that
flexibility to translate down to the local level so they can
target those dollars where the students need it most.
Mr. Moolenaar. Thank you. And then in terms of the dollar
amount, because I know whenever we are talking budgets, people
are upset about different spending levels. Ultimately, your
point is Congress is going to determine what spending level is
in that?
Secretary DeVos. Correct. From--yes, the administration has
advanced this budget proposal. The important part, the policy
part here about the block grant I think is the really important
piece to consider.
Mr. Moolenaar. Okay. Thank you very much.
Thank you, Madam Chair.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. Thank you, Madam Chair.
NON-DISCRIMINATION AND EDUCATION FREEDOM SCHOLARSHIPS
To follow up, your last statement to me is we do not
discriminate against children. Is that correct?
Secretary DeVos. We uphold all of the laws of this land,
and yes.
Ms. Clark. Okay. So if we are operating on a
nondiscrimination basis, which I think is the absolutely
appropriate role for you to take, I hope that you will rescind
on page E-8 of the Safe Schools and Citizenship Education
Fiscal Year 2021 budget request where you said you stand by
that racist research. I will look forward to you reversing
course from that position in your budget.
And we can have a long discussion about tax credits and
Treasury, and I understand tax credits. And you and I disagree,
apparently, that tax credits are Federal funding. But will you,
as Secretary of Education, who has just said you will not allow
children to be discriminated by race, religion, transgender
status, sexual orientation, will you guarantee to me, to the
children of this country that however funded this program that
is in your budget that is $5 billion of taxpayer money, when it
is rolled out in States, will you guarantee that every single
school will have a nondiscrimination policy in order to qualify
for that?
Secretary DeVos. Well, Congresswoman, this is not proposed
to be a Federal program. This is proposed to be a Federal tax
credit. That doesn't----
Ms. Clark. Will you guarantee----
Secretary DeVos. Let me finish. The legislation is
specifically for States to create programs that are going to
meet the needs of the most vulnerable and needy students in
their State.
Ms. Clark. So we are right back to where we were.
Secretary DeVos. We are right back to the reality of the
fact that this program is to be implemented and designed at the
State level, voluntarily contributed to by Federal taxpayers.
Ms. Clark. So I am going to be clear that you have
corrected the record. When you said to me that you, as
Secretary of Education, would ensure that this program would
only go to schools with nondiscrimination policies, that is no
longer your stance. This is a State's choice that you--you will
not do that as Secretary of Education.
Secretary DeVos. Ma'am, may I just suggest that you are
mixing up and you are not staying clear on the purpose of this
program, which is----
Ms. Clark. I am. I am perfectly clear----
Secretary DeVos [continuing]. To help students get a great
education in a place that fits for them.
[Gavel sounding.]
Ms. Clark. And your inability to say that you would stand
up for kids is appalling, and you really should resign.
Ms. DeLauro. Congresswoman Herrera Beutler.
Ms. Herrera Beutler. Thank you, Madam Chair.
EDUCATION FREEDOM SCHOLARSHIPS
I would love to have a little bit more clarification on the
Opportunity Scholarship, or the Federal Freedom Opportunity
Choice Program. Because I do want to make sure it is on the
record very clearly whether it is a new program or whether it
is Federal funding and whether there are strings attached. And
actually, too, whether by somehow, you know--and I recognize it
is Treasury's program--but is there some way that this is not
under the laws of the land, our civil rights, our
constitutional rights somehow abridged with starting this
program?
Secretary DeVos. Let me respond to that directly first. No,
civil rights are not abridged in any way, period.
What this does is it is not a new program to be
administered at the Federal level. It is merely a vehicle to
effectively and efficiently get voluntary contributions
directly to scholarship-granting organizations as decided by
States that choose to participate. With the idea that they are
going to turn around and create one or more programs that are
going to specifically address the needs of K-12 students in
their State.
Ms. Herrera Beutler. So no more then giving money to
Planned Parenthood, which is a 501(c)(3), or your church, which
is tax exempt. I mean, this is no more Federal funding than it
is any money that----
Secretary DeVos. Correct.
Ms. Herrera Beutler. Right? Because churches aren't
federally funded, right?
Secretary DeVos. Correct.
Ms. Herrera Beutler. I think there is a pretty big divide
there. The other--oh, it has gone down. Is it going up or down?
DUAL ENROLLMENT AND CAREER AND TECHNICAL EDUCATION
The other thing I wanted to ask about is, are there
opportunities in the Department with regard to encouraging
students to participate in dual credit programs like Running
Start? That is one way I think we are going to help them with
their college costs.
Secretary DeVos. Well, I think our proposal is to
dramatically increase funding for career and technical
education. And I think, importantly, this comes at a time when
States have been writing their Perkins V plans and are about
getting ready to implement it.
I have visited a lot of schools that have fledgling dual
enrollment programs, many that want to have many more and
expand them dramatically. I expect that that is going to
continue to be a growing reality, and certainly those places
that are being forward leaning and recognizing the
opportunities for their students are going to get that right.
Ms. Herrera Beutler. Thank you.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Thank you.
EDUCATION FREEDOM SCHOLARSHIPS
I am going to follow up on Ms. Clark's question. First of
all, I just want to say one of my colleagues compared the tax
credit to a tax deduction. I think it is a big difference. I
mean, you would agree with that. A tax credit is you take your
certain percentage of what you owe and instead of paying it to
the Federal Government, you are giving it to a private school?
Secretary DeVos. No, you get to give it directly,
effectively and efficiently----
Ms. Frankel. To a private school.
Secretary DeVos. Not to a private school, to a scholarship-
granting organization.
Ms. Frankel. Okay. Okay.
Secretary DeVos. It is a 501(c)3().
Ms. Frankel. Got it.
Secretary DeVos. A nonprofit scholarship-granting
organization. And a State that chooses to participate----
Ms. Frankel. Exactly.
Secretary DeVos [continuing.] Could decide to expand the
career and technical education.
Ms. Frankel. Let me tell you something. The State of
Florida, where I am from, they have been having this program
and----
Secretary DeVos. Very successfully, I might add.
Ms. Frankel. No, not very successfully. In fact,--in fact,
I just read an article where three banks that had been
contributing have now pulled out because they found that there
were 156 schools in Florida that are discriminating against
people who are LGBTQ.
So just here is what I am saying. We have a different
philosophy. I just want to say this. It is a mistake, I
believe, for you to come in here to cut $6 billion, to ask for
a cut of $6 billion out of public education, and then at the
same time, ask us or ask this Congress to set up a program so
that whether it is a corporation or a person, a total of $5
billion can now go, instead of to the Federal Government to pay
taxes, to some scholarship program that they could put money
into a private institution that discriminates against people.
So I think that is a mistake.
Secretary DeVos. Ma'am, isn't education about kids?
Ms. Frankel. No--yes, education is about----
Secretary DeVos. Okay.
Ms. Frankel. I want to tell you something. The great
equalizer in life is a good public education. I want to say----
Secretary DeVos. It is a good education, yes.
ON-CAMPUS VIOLENCE
Ms. Frankel. One other thing I want to say, which is this.
I am very disappointed that--I want to try to say this nicely.
Okay. I am very disappointed that you feigned ignorance today
about a dangerous new policy about on-campus violence. I am
very, very worried about that, and I really--I don't understand
why you couldn't----
Secretary DeVos. Well, ma'am, I am not ignorant about it. I
told you we have not released the final rule, and it would not
be appropriate for me to comment.
Ms. Frankel. Okay. Thank you. I yield back.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Public education is a great equalizer,
and the reason the Federal Government has a role in public
education was to guarantee that children were protected, that
opportunities were available, that there was equality and
equity of the educational delivery system. And it is not about
alternatives to that system.
DISPROPORTIONATE DISCIPLINE
We have a responsibility to make that system work for all
the children, and it concerns me, I asked you a question. How
do you reconcile the disproportionate discipline of minority
students in schools, the suspensions, et cetera? And even the
arresting of a 6-year-old in schools without your questioning
why that is happening.
And one other thing, Madam Secretary, any time the Federal
Government puts money into one of these school districts, you
can require that there be a nondiscrimination program. You have
got a responsibility to require that there is not
discrimination against children, whether or not they are Black,
Latino, or part of the LGBTQ communities. That is your
responsibility.
But you don't seem to give one good hoot about public
education. Every time we talk about public education, you talk
about education. And when you talk about education, you talk
about the alternatives that you think work.
Well, let me tell you, one of the reasons that our children
are not achieving to the extent that they are intellectually
capable of doing so is because we are not putting the resources
where they need to be, in the public school system. And until
we can reconcile that, you all don't have any right to talk
about improving the system.
I yield back.
Secretary DeVos. Madam Chairman, could I just comment on
that?
Mrs. Watson Coleman. I don't need a comment because I
didn't ask a question.
Ms. DeLauro. Congressman Cole. If you want to just try to
wrap up your comments, and I will wrap up, and then we will
bring this hearing to a close.
Mr. Cole. Well, it has been another eventful day at Labor-
H, Madam Chair.
I want to begin, Madam Secretary, by thanking you. I want
to thank you for the service that you render this country each
and every day.
Secretary DeVos. Thank you.
Mr. Cole. I have known you for a long time. I agree with my
friend Mr. Moolenaar. I don't know anybody that cares more
about young people getting a good education than you, and you
have a lifetime of commitment, service, and generosity, as does
your family, to demonstrate that.
And so while we may have disagreements on particular
programs, many of us up here--you and I have a couple--that
doesn't diminish one whit from the enormous sacrifice and
service that you and your family have given people of all
races, all colors, every ethnicity, every background for many,
many, many years. And I consider your service as Secretary to
be an extension of that, quite frankly.
CAREER AND TECHNICAL EDUCATION
Second, I really want to applaud you on this career and
technical education initiative, both the additional money for
the institutions in question that you propose. I think it is a
very wise investment, and I particularly appreciate you taking
the lead and putting on front that we have got a lot of
students that would benefit form this kind of education that
can't afford what are even very modest fees, as a rule.
HIGHER EDUCATION
So your willingness to look at the Pell Grant as an
extension, we all want kids that want to get college educations
to have that opportunity. It is one of the reasons why I am
fierce about TRIO and GEAR UP and some of these other programs.
But I also recognize the vast majority of young people aren't
going to go for a 4-year college. They either don't want to, or
that is just not the right approach for them.
And I think sometimes we forget about them a lot, and in
this proposal, I think you are actually putting the focus on
folks that are too often forgotten. And you and the President
are to be commended for that. Because he has been a leader, he
actually took things like the apprentice program, which was a
good Obama proposal, and put more money into that. This has
been a very consistent theme in his tenure and in your tenure,
and I appreciate that.
Finally, again, I want to continue to dialogue on a variety
of programs and would love to invite you--sometime I would love
for you to--I was particularly pleased with your proposal on
Second Chance Pell. I have been to Tulsa Community College and
seen that program. They do outstanding work. Thank you very
much for mentioning them. It will surprise, delight, and thrill
them no end.
But I think, more importantly, it is part of our
population, again, that gets neglected and left behind. And you
putting a search light on it and say let us help people that
have had misfortune and made mistakes get back on the right
track in life and give them an opportunity to make a decent
living. It is really a good thing.
STUDENT DEBT CRISIS
Last thing I will commit to you. I am going to wrestle with
this student loan problem because I see it as real issue, and I
am glad you mentioned the telling point about the cost of
college as well. This isn't just a matter of the Federal
Government, we have a lot of private institutions that need to
think very carefully about how they counsel students and what
they encourage them to do. And frankly, the advice sometimes
they don't give them as to what the appropriate level of debt,
if any, should be for them.
And then, finally, the administration of this. And you
rightly point out, it frustrated me when I was chairman. I am
sure it frustrates our chairman the amount of resources that
are getting put into looking after this.
Again, my personal view is we made a big mistake when we
got out of the loan guarantee business and dumped this over to
the Department of Education and asked you to take on a mission
that really, in my view, probably should not be your mission.
So your thoughts as you grapple with this are very valuable.
Finally, Madam Chairman, I want to thank you. You are
always a great working partner, and I appreciate the way that
you manage our committee. And we occasionally have differences,
but we very seldom have deep disagreements about the tasks in
front of us.
So I look forward to working with you as we craft this
budget and the other budgets that are under our jurisdiction,
and I know, as always, we will find a lot more common ground
than we do differences. Can't commit to vote for your first
bill, if but we can come to an agreement in conference, I think
we can do it again.
Thank you. Yield back.
NON-DISCRIMINATION AND EDUCATION FREEDOM SCHOLARSHIPS
Ms. DeLauro. I want to thank the gentleman. It really has
been an extraordinary positive--it is a working experience, but
it is a friendship. For that, I am deeply, deeply grateful
because it is that friendship that allows us to get the
business of the country done, and that is why we are all here.
And we believe in that.
I just want to say one thing, Madam Secretary. I got a
couple of items. But the couple of comments that my colleagues
have made with regard to this notion that States can take--they
are taking public money in whatever form, and they
discriminate, that that will be up to the States.
You may not want to take on that issue, though we all
believe you have that authority. But we are not going to stand
by and watch States discriminate against our children in terms
of proceeding to get an education.
PUERTO RICO RECOVERY
Let me mention on Puerto Rico, if I can. I want to take
time to acknowledge the continued struggles of children in
Puerto Rico. They have been really dealing with trying to
recover from earthquakes, from all kinds of disasters, still
from Hurricane Maria.
I have been told, and we will look into this, that kids are
going to school in tents. I don't know if you have been or your
staff has been to the island. But I would ask you to do that
and to see these conditions and really to urge the
administration to support the House supplemental bill. It is
really imperative.
When I was there for Maria, children were afraid to go to
school because if they went to school, they were fearful that
when they went home, their parents would not be there. We are
dealing with both education and we are dealing with mental
health issues regarding these children, and I think we all
believe we have a moral responsibility in this area.
BLOCK GRANT CONSOLIDATION PROPOSAL
And finally, let me just say there has been a lot of
discussion about the K through 12 education program. My view, I
think the view of my colleagues, is that you propose to
eliminate these programs, replace them with one block grant, in
your words, eliminate Federal burdens that have been and ``have
inhibited innovation.'' I am concerned, Madam Secretary, that
you confused essential protections for children across all the
formula programs as burden.
One of this Nation's most urgent charges is to address the
achievement gap between English learners and their Native
English-speaking peers. As a condition of receiving Title III,
States' districts need to provide effective language
instruction programs, professional development for teachers,
English learners, parents, family, community engagement.
From the testimony, it appears that you look at the
Elementary and Secondary Education Act, and you see a law for a
formula grant that placed burden on States. However, I look at
the Elementary and Secondary Education Act, I see a law full of
vital protections for the most vulnerable students in our
Nation's care. English learners, homeless children and youth,
migrant children, children in the juvenile justice system, and
the list goes on.
We need to be absolutely clear, and the Department--and you
are the Department--should be straight with the Nation's
parents and educators. Let them know which one of the vital
protections and safeguards are going to be rolled back.
My final comment is, and the ranking member mentioned this,
that maybe not your budget, but an OMB budget. But it is your
job, you defend the budget. And year after year, you defend
cuts and question the effectiveness of Federal investment in
public education.
And this year, defending the proposal to eliminate, we can
have all the words possible, but we eliminate 41 programs. Last
year, we talked about the 2020 request. I asked whether, you
know, your request to OMB in September included cuts to Special
Olympics, and we didn't get a straight answer then.
The long and the short of it, Special Olympics is not cut
this time around. But examine the cuts. What the Department and
what the administration are doing with regard to them. And it
is not so much, and this is where I come down. I am, quite
frankly, tired of just saying $40 million in a cut here, $26
million in a cut there.
It is about the consequences. It is about what the effect
of those cuts are on our children. And I think we both, from
your perspective and from ours, have to be understanding of
that opportunity to achieve your dreams and your aspirations
through education are being curtailed. And in particular for
the most vulnerable of our kids and kids who are in rural
districts, kids who are in high-poverty areas that won't get
the kind of attention that they need.
And I do believe it is a moral responsibility that we
utilize all the power of the Federal Government to engage with
these communities and these students. So my hope is, is that we
will come forward with a bill in the education area that will
meet their needs, and we can do that on a bipartisan basis.
Thank you for being here, and thank you for the work that
you do on behalf of this country's children.
Secretary DeVos. Thank you, Chairwoman.
Ms. DeLauro. Thank you. The hearing is concluded.
Tuesday, March 3, 2020.
REDUCING CHILD POVERTY
WITNESSES
KATHRYN EDIN, PROFESSOR OF SOCIOLOGY AND PUBLIC AFFAIRS, PRINCETON
UNIVERSITY
DOLORES ACEVEDO-GARCIA, PROFESSOR OF HUMAN DEVELOPMENT AND SOCIAL
POLICY, BRANDEIS UNIVERSITY
DOUGLAS BESHAROV, PROFESSOR, UNIVERSITY OF MARYLAND'S SCHOOL OF PUBLIC
POLICY
AUTUMN BURKE, ASSEMBLYWOMAN, 62ND ASSEMBLY DISTRICT, CALIFORNIA STATE
ASSEMBLY
MATT WEIDINGER, ROWE FELLOW, AMERICAN ENTERPRISE INSTITUTE
IRWIN GARFINKEL, PROFESSOR OF CONTEMPORARY URBAN PROBLEMS, COLUMBIA
UNIVERSITY
CHERYL BRUNSON, BROOKLAND MANOR TENANTS' ASSOCIATION, D.C. POOR
PEOPLE'S CAMPAIGN
Ms. DeLauro. The subcommittee will come to order.
Good morning, and let me welcome all of our guests. Today,
we are examining child poverty in America and the immense
physical toll and financial strain it puts on our young people,
our families, and our Nation.
Our ranking member, Congressman Tom Cole of Oklahoma, would
love to be here, but we are all doing double duty on our
various committees. He is held up at the Rules Committee. So I
am going to ask unanimous consent to enter his remarks into the
record.
Ms. DeLauro. To frame the impact of poverty on our
children, I want to mention the work of Dr. Pamela Cantor, a
psychiatrist who specializes in childhood trauma. After 9/11,
New York City Department of Education asked her organization,
the Children's Mental Health Alliance, to assess the impact of
the attack on the city's public school children. She found
children were traumatized, but much more so by growing up in
poverty.
Poverty was a daily attack on their well-being. So it is
for millions of children across our country who go to bed
hungry, wake up cold, grow up with less, and struggle in
communities that provide few chances to succeed, to grow, and
to make mistakes without destroying lives.
Let us remember that poverty has a pernicious impact on the
development of children. It is a lifelong scar, and I know that
our panelists will elaborate on this.
The subcommittee provides some of the largest sums of
discretionary funds in the Congress for the well-being of
children, especially those in poverty. Early childhood
programs, from the Childcare Development Block Grant to Early
Head Start, Head Start, and Preschool Development Grants;
education programs like Title I, Title II, GEAR UP, TRIO, and
the Education for Homeless Children and Youth Program; and
Labor programs that help connecting people to the training
skills they need to make ends meet, such as WIOA training
grants, Job Corps, and apprenticeship.
In fact, the budget for the Administration for Children and
Families in the Department of Health and Human Services is
larger than the entire budget for either the Department of
Justice, the Department of Interior, or the Treasury
Department. So measures to address child poverty are an apt and
fitting topic for us to review.
In fact, this hearing is a next step in the process started
by the Appropriations Committee years ago. It was in 2015 that
the full committee accepted by voice vote an amendment that was
introduced by our colleagues, both of whom serve on this
subcommittee, Congresswoman Barbara Lee of California and
Congresswoman Lucille Roybal-Allard of California.
What they wanted to have, to fund--and which is what we did
on a bipartisan basis--a comprehensive, nonpartisan, National
Academies of Sciences study of child poverty in the United
States. The evidence-based report was to ``provide its
assessment of the most effective means for reducing child
poverty by half in the next 10 years.''
I want to commend again. You won't find two more committed
individuals than Congresswoman Barbara Lee and Congresswoman
Lucille Roybal-Allard. And I can tell you they are
indefatigable. They do not give up for one second, and they
have demonstrated their leadership in this regard.
The results of their leadership and this subcommittee's
investment bore fruit last year when the National Academies of
Sciences, Engineering, and Medicine released their report, ``A
Roadmap to Reducing Child Poverty.'' Because we invested in
this report from HHS's Administration for Children and Families
social services and income maintenance research, it is only
fitting that we see it through to actually discuss the findings
and let us put the dollars to work.
The National Academies report is exhaustive and
demonstrates the immense national cost of childhood poverty and
outlines how we can half child poverty in 10 years. Let me
quickly run through some of the take-aways on the scale and the
demographics of child poverty in America.
2015, 9.6 million children lived in poverty. That is about
the size of the population of the State of Michigan, living in
households with inadequate economic resources. Two-point-one
million were living in deep poverty, households with grossly
inadequate resources. That is about the population of New
Mexico.
With regard to race, and I quote, ``The poverty rates for
black, 17.8 percent, and Hispanic, 21.7 percent, children were
more than double those of non-Hispanic white, at 7.9 percent,
children.''
The report also notes that child poverty is not an
individual problem. NAS estimates that childhood poverty costs
the United States between $800,000,000,000 to
$1,100,000,000,000 annually from increased crime, worsened
health, lower earnings when poor kids become adults. That is
the scale and the scope of the problem, then the solution.
As the NAS report states, and I quote, ``Poverty
alleviation can promote children's development, both because of
the goods and services that parents can buy for their children
and because it may promote a more responsive, less stressful
environment in which more positive parent-child interactions
can take place.''
Study after study has shown that the first few years are
essential to long-term outcomes for kids. But for our children
to thrive, we have to support them at this vulnerable time of
crucial development. The report does not identify a silver
bullet. Instead, it measures the effectiveness of four
different packages of policies.
I will note that the NAS task force, which represents the
consensus in the scientific community, found that ``Work
requirements are at least as likely to increase as to decrease
poverty.'' Instead, to actually reach the goal of cutting deep
poverty in half, we need to employ one of three policies--a
universal child tax credit, increases in the SNAP food stamp
program, or housing vouchers.
Other policies matter, like SSI, Social Security Insurance,
but do not get you there. While these are not in our specific
jurisdiction, they are worthy of our attention as
appropriators. In particular, the task force said the single
policy that would do more than any other to reduce child
poverty is a universal $2,700 child tax credit, which would
single-handedly cut child poverty by a third.
To expand and strengthen the child tax credit, I am proud--
and I hope this doesn't sound self-serving, but I am proud to
have introduced the American Family Act in the House of
Representatives with Congresswoman Suzan DelBene of Washington.
The Family Act makes fully refundable the child tax credit
and the new young child tax credit. And according to Columbia
University's Center on Poverty and Social Policy, doing so
would cut child poverty nearly by 38 percent and deep child
poverty in half.
Let me close so that we can turn to our witnesses. I
believe today's hearing is so important because it is vital
that we delve into the problems that so many of our programs
aim to solve. As we have said, the Labor-H bills makes
opportunity real for families so that everyone has a better
chance at a better life.
This report, our report that we secured on a bipartisan
basis, identifies how much is left to do. Millions of children
remain prisoners of their parents' poverty. Not all of the
policies may be in our jurisdiction, but what is in our
jurisdiction, as the Congress and as the Appropriations
Committee, is to be advancing policies that can help, that can
help immensely, and then can help immediately.
I am reminded of the words of Bobby Kennedy, and he said,
and I quote, ``I believe that as long as there is plenty,
poverty is evil. Government belongs wherever evil needs an
adversary and there are people in distress.''
There are people in distress. There are children in
distress. There is no time to delay.
I thank you very much, and now what we will do is we will
proceed to the opening statements from our panelists. And let
me briefly introduce our panelists.
First is Kathryn Edin, professor of sociology and public
affairs at Princeton University. Next will be Cheryl Brunson of
the Brookland Manor Tenants' Association, a representative with
the D.C. Poor People's Campaign. Next is Dolores Acevedo-
Garcia, professor of human development and social policy at
Brandeis University.
Next is Douglas Besharov, professor with the University of
Maryland's School of Public Policy. Then we have Autumn Burke,
assemblywoman for the 62nd Assembly District in the California
State Assembly. If you don't mind, I just have to say the
daughter of a Member of Congress Yvonne Brathwaite Burke, who
we all remember as someone with a strong and determined effort
to help people all over this country. Proud to have you here
with us today.
Next is Matt Weidinger. Did I--okay. A Rowe Fellow with the
American Enterprise Institute. And last, but not least, is
Irwin Garfinkel, professor of contemporary urban problems at
Columbia University.
I say this to all of you. Your full written testimony will
be entered into the hearing record, and so you will be
recognized now for 5 minutes. Kathryn.
Ms. Edin. In the early 1990s, I traveled the country
interviewing hundreds of single mothers about their survival
strategies, culminating in the book ``Making Ends Meet,'' which
was published on the eve of welfare reform. But I then went on
to study other topics.
However, in 2010, my work took me full circle when I came
to knock on the door of the home of Ashley. She was a 19-year-
old mother with a newborn. Now on that day, her hair was
unkempt. She wasn't making eye contact. As she moved her baby
from one shoulder to the other, she wasn't properly supporting
her baby's head. And I was stunned to learn that there was no
cash income coming into this household, not from work, not from
welfare, or from any other source. I had encountered this
situation once in my interviews in the early 1990s.
A thought occurred to me. Could it have been that in the
aftermath of welfare reform, a new kind of poverty had arisen,
one so deep we hadn't even thought to look for it?
At the end of that interview, we gave Ashley $50, as we
usually do. But I was worried about her and the baby, so I
asked if we could come by the next day. Imagine our surprise
when we found Ashley on her way out the door to search for a
job. She had purchased a home perm and a used pantsuit. There
was quite literally a spring in her step as she made her way
down the sidewalk.
Another thought occurred to me. Could it be in that in the
world's most advanced capitalist society, a mere $50 cash could
be the difference between the dispirited woman we had met the
first day and the motivated job seeker we met the second?
To answer these questions, I teamed up with Luke Shaefer,
an expert on the survey that best captures the income of the
poor, and we documented a dramatic rise in the number of
households with children living on virtually no cash income
since the mid 1990s. We then replicated these results with data
from the SNAP program, finding that about 1.2 million families
on SNAP reported zero income in 2017, up from just a few
hundred thousand in the mid 1990s.
Now for us, these numbers posed as many questions as
answers. We knew we had to find other families like Ashley's
and learn more about their lives. So we followed 18 such
families in 4 locations for many months and sometimes years.
And from this work, we developed three hypotheses about what
was behind the rise of this new form of poverty, extreme
poverty.
The first was the virtual death of cash welfare. Only a
small number of States, as you know, have anything resembling
their pre-reform system. This program is now called TANF, and
nationwide, only 20 percent of poor--sorry, 23 percent of poor
families receive TANF. This is down from two-thirds in the mid
1990s. Most remarkably, when the families we followed had hit
hard times, it hadn't even occurred to most of them to even
knock on welfare's door.
Second, housing instability is a hallmark of life for the
extreme poor. Our families' stories revealed that doubling up
was what most often exposed their children to emotional,
physical, and sexual harm. The number of homeless school
children has doubled since the mid 2000s. We document a direct
link between the decline of cash welfare and the rise of child
homelessness. For every hundred fewer TANF cases within a State
over a year, there are 14 more homeless students.
Third, low-wage employment has become increasingly
perilous. Initially, we thought families in extreme poverty
might be cut off from the world of work, but their stories were
full of jobs held, lost, and searched for. Perilous work
combined with unstable living situations created a toxic
alchemy, which spiraled many of our families into a spell of
extreme poverty.
How do families survive? Food pantry utilization has risen
dramatically since the mid 1990s, but these and other private
charities can't begin to cope with the scope of the need. Most
families in our sample had to trade SNAP for cash, often at a
steep discount, just to buy basics like socks and underwear for
their kids and to keep the lights on.
Many bore a scar on the inside of their elbow from selling
their blood plasma frequently. In the U.S., plasma donations
have increased fourfold since the mid 1990s.
Some claim the U.S. poor are not poor. We constructed an
index of deep disadvantage that combines measure of poverty,
health, and intergenerational mobility. We find that average
life expectancy in America's most disadvantaged places is
roughly comparable to what is seen in places such as
Bangladesh, North Korea, and Mongolia. And infant birth rate
outcomes are similar to those in Congo, Uganda, and Botswana.
We can argue about the causes and consequences of poverty
and what to do about it, but can anyone really argue that we
have solved it?
Thank you.
Ms. DeLauro. Professor Acevedo-Garcia.
Ms. Acevedo-Garcia. Good morning. Thank you, Madam
Chairwoman DeLauro and members of the committee. Thank you for
the opportunity to testify today.
I am a professor at Brandeis University, and I also have
the honor of being a member of the committee of the National
Academies that put together the report, ``A Roadmap to Reducing
Child Poverty.'' I want to thank Representative Lee and
Representative Roybal-Allard for their critical role in
creating the National Academies committee.
My role today is to summarize our main findings. First of
all, we found that poverty is a very serious problem for the
United States. It is very serious, of course, for the children
that experience poverty. It compromises their health, their
learning, their development, and also their outcomes as adults,
including their employment prospects and well-being.
It also costs the Nation between $800,000,000,000 and
$1,100,000,000,000 per year. So it affects all of us.
Thirteen percent of children today live in poverty. That is
9.6 million. And 2.9 percent of children live in deep poverty.
That is 2.1 million children. Just to have a sense of what
families are experiencing, the threshold for poverty in 2017
was $25,000 per year for a family of 4.
Poverty, of course, has very harmful consequences
throughout the life course for any child that experiences
poverty, but it has a stronger effect for some children because
they are more likely to experience poverty. Particularly
Hispanic children have the highest poverty rate today, about 22
percent. Black children have second-highest poverty rate, 18
percent. White children have a poverty rate of 8 percent.
Our statement of task directed us first to examine the
research evidence that child poverty compromises child well-
being. Our main conclusion is that the weight of the evidence
is that income poverty causes negative effects on children,
especially when poverty starts early in childhood or occurs
during a large proportion of childhood.
The second aspect of our statement of task was to identify
the major assistance programs that today help reduce child
poverty. The committee concluded that poverty will be much
higher without our major programs. Specifically, the EITCs, the
child tax credit, and SNAP have major effects on reducing
poverty, and SNAP and Social Security have major effects on
reducing deep poverty.
Despite the very important poverty-reducing effects of
these programs, still 13 percent of our children live in
poverty today, and 2.9 live in deep poverty. So our statement
of task, the core ask of it, directed us to examine programs
and policies with the potential to reduce child poverty by half
in 10 years. That is, we were asked to try to reduce poverty to
about 6.5 percent and deep poverty to about 1.5 percent.
We examined 20 different individual policies and programs
and found that none of them on its own would achieve the goal
of reducing poverty by half. However, we found some promising
possibilities.
One of them was to increase the EITC by 40 percent, which
would reduce child poverty from 13 to 10.9 percent, but it will
have modest effects on reducing deep poverty. Another very
promising approach is a child allowance that my colleague Irwin
Garfinkel, who was also a member of the committee, will explain
during his presentation.
Because none of these individual policies achieve the goal
of reducing child poverty by half, we also considered policy
packages, which are combinations of policies and programs that
together can achieve the goals. We specifically identified two
packages that can achieve these goals.
Package 3, which we named means-test and work package,
includes expansion to the EITC, the child and dependent care
tax credit, the Section 8 voucher program, and SNAP. We also
identify a package, Package 4, whose core element is a cash
allowance for children of $2,700 per year per child. It has
some other elements that we can discuss later, but that is the
main component. These two packages not only reduce child
poverty by half, but also increase employment substantially.
In sum, our main finding overall is that child poverty
today is not an intractable problem. We can reduce child
poverty today by 50 percent, and we know how to do it. We have
two specific packages that will allow us to do that today.
Thank you.
Ms. DeLauro. Thank you. Mr. Besharov.
Mr. Besharov. Thank you. Chairman DeLauro, nice to see you
again. Members of the committee, I am delighted to be here.
This is an important topic, and I was delighted to be
invited to speak. I know many of the members of the committee.
They have produced an impressive report, but here comes the
``but.'' And the ``but'' is I think it takes too narrow a view
of the causes of poverty and too narrow a view of what we
should do about it.
I think it adopted that view because of the charge given to
it, a combination of the legislation and HHS instructions,
which said you need absolute support for the proposal before
you make it. And let me explain the two examples of why the
report is too narrow.
It addresses the problems of single mothers but makes no
recommendations that I saw--and I am happy to be corrected--
about dealing with single parenthood by itself. I was raised by
a single mother. I think I sort of came out okay. But there is
no doubt that being raised in a family with a single mother
adds extra stresses and makes it much more difficult to be--for
a child to grow and prosper.
Childcare, income support, they are only part of the
answer, and I would have loved to see the report talk about
more. And the report didn't because the evidence we have about
single-parent programs is not as strong as giving money to
people. You give money to people, and you can measure that they
have more money every day. You give someone a better education,
and it is extremely difficult to measure that. So my advocacy
to you is when you consider implementing this report, please
think about problems like single parenthood.
The other thing the report talks about, but I think had no
specific recommendations is about race and discrimination.
Congressman John Lewis says it is a different America today
from 1960 and before. And of course, that is correct, but
racial differences are still great.
This morning, I saw in the paper that the racial
differences in schools, in the Boston public schools are so
great that the advocates are pressing for the State to take
over the entire school system of the City of Boston. I think
that is a sign of the problems that go beyond putting more
money into the system alone, alone here.
But we have to address these other things. I used to say
this to Senator Moynihan, and he would say, ``But I am in the
Senate Finance Committee. I don't have jurisdiction.'' You have
jurisdiction over some of these programs. So please, whatever
you do on the rest, think about programs for single mothers.
Think about programs that address the racial and ethnic
differences that we have in our society because those are the
things that are going to make a long-term difference for the
families that we are talking about.
So let me kind of be fancy about it. This is what I wrote
in my testimony. I said, ``The result of the committee's
approach, because of the mandate attached--'' so this is
nothing personal--``was to exclude recommendations of new or
promising ideas that either had not been tested or, at least in
their initial iteration, had not been found successful.''
That was one heck of a limitation for the proposals that
should be made and adopted by this committee and this Congress.
And it is the equivalent of saying to Silicon Valley, come up
with a plan for 10 years from now, but assume no additional
scientific breakthroughs. Just use what you have on the table.
Don't think about anything new. Don't think about anything
fresh.
The members of the committee didn't write that, but that is
what these--where these recommendations take us. And I think
that will dry up energy in other areas. So in these
conversations, I hope we talk about the broad range of causes
of poverty.
The last thing I will say in 56 seconds is that in their
proposals about expanding cash benefits, I think they minimize
the problem of benefit reduction rates, which is the phase-out
rate on many of these programs. Many of us on the left as well
as the right think they discourage work, discourage marriage.
The penalty for cohabiting parents to marry in most States is
between 10 and 40 percent of their income between $30,000 and
$50,000 of income.
We don't need that. We could fix it. We fixed it in the
income tax code. We could fix it in means-tested benefits, and
it would make it easier for people to marry, and they wouldn't
face the same kind of penalties if they worked.
Thank you very much.
Ms. DeLauro. Thank you. Assemblywoman Burke.
Ms. Burke. Thank you, Chairwoman DeLauro, the committee
members, and their staff for giving me this opportunity to
testify before the committee.
My name is Autumn Burke, and I am the California State
Assemblywoman representing the 62nd District, an ethnically and
economically diverse area of Southern California.
California is the fifth-largest economy in the world, and
it has the highest rate of child poverty in the Nation. One in
five children, or 1.9 million children, live in poverty,
equating to almost one-third of African-American and one-third
of Latino children.
Child poverty alone is estimated to cost the U.S. economy
more than $600,000,000,000 annually in lost productivity,
increased healthcare costs, and higher criminal justice
expenditures. High cost of living, income equality, and the
ongoing impacts of institutional and economic racism all
contribute to the high poverty rates not just in our State, but
across the country.
Historically, efforts to invest in measures to reduce child
poverty have been hampered by a lack of sustained focus and
defined holistic plan for addressing the problem. In 2017, I
partnered with the Grace Institute, and with the introduction
of my bill, Assembly Bill 1520, we launched an ``End Child
Poverty in California'' campaign. And I would like to thank
Congresswoman Lee for her support of that measure.
AB 1520 did away with the traditional budgetary
formulations and instead embraced a whole person approach when
considering the needs of those living in poverty. This, in
turn, produced an innovative comprehensive framework of
recommendations for the Governor and the legislature to
consider with the objective to lift an estimated 1 million
children out of poverty in California. AB 1520 received
overwhelming support from both sides of the aisle and was
signed into law by former Governor Jerry Brown.
The 2018 State report served as the foundation for
additional legislative efforts that were undertaken this past
year. Chief among those was the expansion of the California
earned income tax credit and the creation of a young child tax
credit.
Specifically, my bill, Assembly Bill 91, expanded eligible
for the CalEITC by raising the maximum allowable income to
$30,000 a year. This provision dramatically broadened the
number of families eligible to receive the CalEITC. The act
also created a brand-new $1,000 refundable young child tax
credit for families with children under the age of 6.
The work of this task force served as a policy guidance
specific to California and was the first of its kind. Since
then, more work has been done, both nationally and in other
States, the most significant being the 2019 report ``A Roadmap
to Reduce Child Poverty'' by the National Academies of
Sciences, Engineering, and Medicine.
The ground-breaking Federal study analyzed several poverty
reduction policies and in general recommended the following
programmatic changes--expanding EITC, make the child and
dependent care tax credit fully refundable and concentrate
those benefits on families with children under the age of 5,
increase SNAP benefits, and increase housing vouchers.
While we did not make the California child and dependent
care tax credit refundable, as recommended by the Federal
report, our $1,000 refundable young child tax credit largely
accomplishes the same goal. These changes are expected to
deliver about $1,000,000,000 to working families or about
$600,000,000 more than it did the previous year.
As chair of the Revenue and Tax Committee for the State
Assembly, I am acutely aware of the direct impact tax policy
has on the lives of Californians. However, many of the existing
tax benefits that the State and Federal Government provide are
only available to those who file itemized tax returns.
Additionally, credits are often not refundable, which means
low-income families will receive little or no benefits. It is
important that any attempts to address childhood poverty be a
combination of Federal and State tax policy changes and direct
expenditures like increasing SNAP and housing benefits.
It must be noted, however, that the fight to end child
poverty would fall short in California if it does not affect
homelessness. California's homeless population has reached over
151,000 people. The vast majority on the streets are not
residing in shelters. African Americans are disproportionately
affected, making up 6.5 percent of our total population, but
accounting for 30 percent of our homeless.
We can enact new tax policies and make additional
expenditures, but we cannot stop the momentum of poverty until
we make sure that every child and family has a home. That is
why I have introduced Assembly Bill 2405, which would establish
a right to housing for children and families in California,
beginning 2026.
Housing should be a fundamental right, like education and
having access to clean drinking water. If the only place you
are guaranteed a roof over your head in America is a prison, we
are failing as a society.
In short, I agree with the recommendations made by the
National Academies of Sciences. However, there is only so much
we can do at the State. If we are going to reach the goals
outlined in the study, we are going to need the Federal and
State governments to take much needed, coordinated action.
California has expanded the EITC, and it has created the young
child tax credit, and we are working to establish a right to
housing.
The closer we get to eradicating child poverty, the closer
we come as a nation to achieving the prosperity and equity
promised to every American. An endeavor such as this requires a
partnership between both Federal and State government, a
partnership that transcends elections, partisanship, and term
limits, and it is only this way that we can truly end child
poverty.
Thank you.
Ms. DeLauro. Mr. Weidinger.
Mr. Weidinger. Thank you, Chairwoman.
Chairwoman DeLauro, members of the subcommittee, thanks for
inviting me to testify.
My name is Matt Weidinger. I am the Rowe Fellow in poverty
studies at the American Enterprise Institute. Previously, I
spent over two decades working for the House Ways and Means
Committee, with jurisdiction over a number of the policies and
programs that are the subject of today's hearing and the NAS
report.
So let me start by recognizing Representative Lee and
Representative Roybal-Allard for their work leading up to the
report and today's hearing. The report is a valuable resource
that includes, as we have heard, a number of possible packages,
but it also includes tremendous background information about
these important issues and how to take a look at them and
evaluate them going forward.
What I will do is try to review some important lessons from
past efforts to reduce child poverty, which offer important
context for the Roadmap's recommendations.
First, reducing child poverty is a goal that taxpayers have
contributed significant resources towards addressing. Figure
4.5 in the Roadmap displays how annual Federal spending on
children grew eight-fold in real terms between 1960 and 2010,
which the report notes is many times larger than the 15 percent
increase in the child population during that time.
So taxpayers contribute significant help. It may not always
be as well targeted as we would like, but there is significant
assistance that is being provided.
Second, as the Roadmap notes, recent efforts to reduce
child poverty have focused on promoting parental work and
earnings and have resulted in sharp reductions in child
poverty. The shift from welfare toward work supports generally
has been bipartisan and has included a number of policies
designed to make work pay. Those policies include an expanded
EITC, welfare reforms premised on promoting work, and increased
childcare and extended eligibility for Medicaid for families
making the transition to work.
Those resulted in the parents who were least likely to be
working before welfare reform, having the most significant
gains in work and earnings in the years immediately after the
welfare reform law, which have generally been maintained. As
the Roadmap notes, rising earnings and work support benefits
like those, like the EITC and others, contributed to reductions
in child poverty.
Here is what the report says, ``Between 1993 and 2016, the
supplemental poverty measure,'' the measure used by the report,
``fell by 12.3 percentage points, dropping from 27.9 to 15.6
percent.'' That is a substantial 44 percent decline in child
poverty, as the report measures.
A third lesson is how we measure poverty matters a lot. The
official poverty measure, as the report notes, ignores a
growing share of anti-poverty assistance, including EITC, other
tax credits, and various other anti-poverty assistance like
SNAP, in its count of who is officially poor. Since 1999,
spending on benefits that are not counted, the spending that is
not counted has grown 16 times as fast as the spending on
benefits that are counted under the official poverty measure.
So to its credit, the report uses the supplemental poverty
measure that actually takes account of all those benefits and
the increased support that has been provided. Using the
supplemental measure reduces the child poverty rate from 19.7
percent under the official measure to 13.0 percent in 2015.
Again, a substantial drop just from using a more accurate
measure of what is being provided to help low-income families.
That is about 5 million children different between the official
poverty measure and the supplemental poverty measure.
Fourth, the Roadmap includes, as we have heard, several
different policy packages, including universal supports, means-
tested supports, work-oriented benefits, and so forth. The
work-oriented proposals, such as expanding the EITC and
adjusting the child and dependent care tax credit, are more
consistent with recent efforts to promote work and make work
pay. The work-oriented package is also the only package
expected to increase earnings more than it increases spending
on benefits, which I would say is an important factor.
In contrast, means-tested support and universal support
proposals, such as expanding SNAP and housing benefits,
creating a new child allowance payable regardless of parental
work, are significantly more expensive, and they also are
projected to reduce somewhat employment and earnings.
The final lesson is the relative cost of all these packages
matter, including for the prospects for enactment. The most
expensive package would cost an estimated $109,000,000,000 per
year, and similar proposals have been made in the past decade
and failed to have been enacted. The Roadmap doesn't identify
potential offsets, and the current fiscal environment, as you
all know, is very, very challenging, especially because senior
entitlements are going to claim a rising share of the Federal
budget going forward.
So this may cause policymakers looking to pursue some
progress using the Roadmap's recommendations to seek the more
incremental changes whose lower costs and greater consistency
with recent successful work support policies could improve
their chances of enactment.
Outside of the policy packages, the Roadmap also proposes
more testing of efforts to promote work and strengthen
families, like Dr. Besharov suggested, which would be
beneficial and also would likely earn bipartisan support.
Thank you for the opportunity to testify. Happy to answer
questions.
Ms. DeLauro. Thank you very much. Professor Garfinkel.
Mr. Garfinkel. Good morning.
Ms. DeLauro. Good morning.
Mr. Garfinkel. Chairwoman DeLauro, Ranking Member Cole--
thank you--and esteemed members of this subcommittee, I was
privileged to serve as a member of the National Academies of
Sciences, Engineering, and Medicine's committee on building an
agenda to reduce the number of children in poverty by half in
10 years.
Thank you, Representative Lee and Representative Roybal-
Allard, for your critical role in creating the committee.
Professor Acevedo-Garcia has summarized the major findings
of the report. I am happy to answer questions about the report,
but my testimony focuses on policy and does not represent the
committee. I draw on my own research on the benefits and costs
of alternative income-transfer programs.
The committee found two program packages that could cut
poverty in half. One relies primarily on increases in means-
tested benefits, food stamps and housing subsidies, while the
other relies primarily on universal and nonmeans-tested
benefits, primarily child allowances or refundable tax credits.
Either package would achieve a great deal of good. The child
poverty reduction and fiscal cost of each package are virtually
equivalent.
The universal approach is, in my judgment, vastly superior
in general and specifically for child allowances. What are the
benefits of universality? First, human dignity. Means-tested
programs benefits stigmatize beneficiaries. If everyone, rich
and poor alike, get the benefit, there can be no shame.
Universality eliminates stigma.
Second, universality promotes social cohesion. Benefits
limited to the poor or near poor create a sharp division
between beneficiaries and taxpayers. Lower middle class
families, who are just barely better off than the near poor,
are resentful of poor beneficiaries. Universal programs
reinforce the notion that we are all in this together.
Third, universal programs promote social cohesion by
including the poor and the rich in the same programs. And
fourth, and most important, universal benefits promote equal
opportunity and mobility. Benefits targeted at the poor reduce
benefits as income increases. Benefit reductions are equivalent
to a tax on income. Means-tested benefits place higher tax
rates on the poor and near poor than tax rates faced by the
more affluent.
This creates what the late Tony Atkinson labeled a
``poverty trap.'' You can't earn your way out of poverty or
near poverty because benefits are reduced steeply as earnings
increase. Universal benefits, by not eliminating benefits as
earnings increase, avoid the poverty trap and promote
opportunity and mobility.
In short, the benefits or virtues of universal benefits are
great. What are the costs? The fiscal costs of universal
benefits are generally much higher than the fiscal costs of
targeted benefits.
Indeed, this is the only cost or vice of universal
benefits. But as the Roadmap report clearly explains, in the
case of child allowances in the U.S. today, the extra costs are
small. Both the means-tested and universal packages cut poverty
in half at about the same cost. Why are child allowances so
cheap? Because the U.S. today nearly has a $2,000 per child
allowance.
Most families in the country get $2,000 per year via the
Federal income tax. The exception are a small group of the very
richest families and a much larger group of the poorest
families, those with very low or no earnings. Excluding the
poorest third of families is both inequitable and unwise. The
children in these families will become more productive citizens
as adults earning more, paying more in taxes, less likely to
commit crime, and less likely to be unhealthy.
In short, a child allowance of $2,000 per year is a clear
policy winner because it has all the virtues of universality
and none of the extra cost. But increasing the child allowance
beyond $2,000 does entail all the extra costs of universality.
The lower middle class, the middle class, and even the upper
middle class all receive greater benefits from a larger child
allowance than they will pay in taxes to finance those
benefits. Only those in the top fifth experience higher net
cost, with the highest cost experienced by the top 1 percent.
So are the extra costs really a vice? Or in the current
context, where inequality is as great as during the Gilded Age
and the Roaring Twenties, is this vice actually a virtue?
This concludes my testimony. Thank you for the opportunity
to testify, and I look forward to your questions.
Ms. DeLauro. I now would like to introduce Cheryl Brunson
of the Brookland Manor Tenants' Association, representative of
the D.C. Poor People's Campaign. I want to just welcome you,
Ms. Brunson. Lived in the Washington, D.C., area her entire
life. First time into any building on Capitol Hill.
Ms. Brunson. Yes.
Ms. DeLauro. So we are delighted that you are here, and
please know that you are always, always welcome.
Ms. Brunson. Thank you.
As you said, my name is Cheryl Brunson, and I am with the
tenant association at Brookland Manor, and there are some
things I would like to touch on. But I would first like to say
that I was born and raised here in Washington, D.C., and
Washington, D.C., has been my home forever.
And you know, I just want to say that, you know, Brookland
Manor is a very family-oriented neighborhood. That is what I
pretty much--you know, when you are looking for places to live,
you look for certain features. And the features that I saw was
that it was very family-oriented. They have adequate place and
space for the children to play without being in harm's way.
They had a lot of programs that were funded through the
police department, and so the police department was running the
Girls and the Boys Club, which was awesome because it gave the
kids a sense of what they want to be when they grow up and what
they could bring to the community when they grow up.
And you know, now I am parenting, raising my grandkids. My
kids are older. My oldest daughter is 45, and my youngest
daughter is 34. My baby is 33. And now I am currently raising
my grandkids because my daughter, she suffers with psychosis.
And she is schizophrenic, and she suffers from depression. And
she wanders off for days at a time, sometimes weeks at a time,
and I have to put out reports and fliers, you know, to see if
anybody knows where she is at or she is out of harm's way, or
what have you.
And a couple of times, we found her on Second and D Street
at the shelter. She was lost. She couldn't find her way. So
that is what we are dealing with, and I have to like keep my
grandkids pretty much active so that they don't really feel the
hardship that they are going through.
But it is kind of hard to do that because the school system
is failing us as well as these developers. You know, they are
putting all of these charter schools in low-class
neighborhoods, I would say, you know? And the teachers are not
as on-hand as it was when I was growing up. They jot some stuff
down on the board, da-da, da-da-da, and then the next thing you
know the kids are looking like, ``Well, what do I do?''
And they are leaving this to other kids in the classroom to
put the other kids on point with what is going on in their
activities. They don't always get what they need that way
because that child may have missed something along the way, you
know? So I am really fighting because, you know, in our
neighborhood, our neighborhood, they are jailing us. They are
setting our kids up to lock them up.
Like if you all are running for the bus, you are not going
to have a problem. But if our African-American kids or young
adults run for the bus, the police is running after them
because they think that he is up to something or they are up to
something. They are tackling them down to the ground, macing
them. This is true. This is so true.
And then we have in our neighborhood, they brought in our
neighborhood, they brought security in our neighborhood as if
the police wasn't enough. When they first brought the security
in there, they said it was for our safety, and we are looking
around, ``Safety from who?'' Because we are all family here.
And what I found out was they brought the security in to
harass us, to move us around, to run up on us when we can't sit
on our front. We can't lean on the fence. You can't smoke a
cigarette out in front of the building. We have to stand in
between--they say stand in between the tree box.
You know what the tree box is? It is the street and the
sidewalk, between the street and the sidewalk, that is where we
have to stand at in our community. We have to stand there when
we are waiting on our Uber. We have to stand in there when we
are waiting on our cabs. We have to stand on there when we are
waiting on the bus to get our kids from school. It is
disturbing.
Take, for instance, this is what MidCity and these
developers are doing to these communities that they are
rebuilding, redeveloping, they say, okay? One of the neighbors
passed away. He had a heart attack. He had three daughters. One
of his daughters was living with him to take care of him
because they knew his heart was bad.
He passed away. Before they could bury him, Brookland Manor
was giving them an eviction notice. They wanted them out in 3
days. They couldn't even bury their father in 3 days.
Mind you, Douglas Smith worked for Brookland Manor. He
worked for Brookland Manor for almost 12 years in the Boys and
Girls Club. I never seen my grandson break down like this and
cry a day in my life. Douglas Smith was a martial arts teacher,
and he taught the kids in the neighborhood martial arts out of
his own money, out of his own time. He did that for the
community.
They put that man's stuff out on the sidewalk like it was
trash. They didn't even give the family enough time to grieve.
And I see this constantly. I see this all the time, you know?
People have been put out of the community for owing $1. They
will return your money back to you if you are $1 short and
charge you $25 for being late.
Okay, these people in this community, we have a lot of
single parents. We have single fathers. We have single mothers.
We have grandparents, such as myself, raising our kids, and our
kids can't even play. They can't even run through the community
without being harassed by the security.
And our community is sitting on our front, that is an
infraction. Leaning on the fence, that is an infraction.
Ms. DeLauro. Ms. Brunson, I hate to interrupt you, but you
will get a chance to maybe continue in the questions. Everyone
is given about 5 minutes to speak so that we can get to the
questions, but thank you for the poignant testimony, and I
promise you, you will get a chance to complete your thoughts
and ideas as we move through the questions.
Thank you so much.
Ms. Brunson. Thank you.
Ms. DeLauro. With that, we will start the questioning. And
as I mentioned in my opening, my bill, the American Family Act,
would give the same full child tax credit to families earning
the minimum wage, military families, rural families, families
with young kids, all those left behind by the tax bill. It has
been endorsed by scholars across the country. It is consistent
with the NAS, what they showed us would be the most effective
policy to reduce child poverty.
Dr. Garfinkel, is the National Academies of Sciences saying
that if we had simply extended the child tax credit to the kids
who were left behind, we would have drastically reduced child
poverty? And in addition to including the left behind children,
we also increased the credit to $3,600 for young kids and
$3,000 for older kids. What would that additional income do for
children and families?
Mr. Garfinkel. So the committee talked about the costs of
child poverty, and it is roughly $1,000,000,000,000 a year. And
those costs come from less--the children who grow up in poverty
get less education. They are less healthy. So they incur more
healthcare costs. They are less productive as adults. So they
earn less, and they pay less in taxes. More likely to commit
crime. So just the fiscal costs of poverty are quite high.
So reducing poverty by, in this case, if you were to have a
child allowance of $3,000 and $3,500 for young children, we
don't know. It is hard to say that that would exactly cut the
costs in half or close to a half, but roughly speaking,
whatever the reduction in poverty, we should expect that that
would translate into a reduction in those costs.
Ms. DeLauro. Let me just ask you this. Rates of single
parenthood in the European Union are about the same as the
United States. However, child poverty in the United States is
much higher because of policy.
Also I believe that single parents get smaller tax credits
than married couples because their earnings are lower, and
families headed by women get lower tax credits likely because
of pay inequity or other reasons. I was concerned about the
issue of single parenthood and that effect overall on----
Mr. Garfinkel. So one of the packages includes a child
support assurance, a guarantee of a minimum amount of child
support for all those who are legally entitled to private child
support. So for low--for low-income families, the men who are
nonresident parents--and I am speaking in gendered terms here
because 85 percent of children where the parents are separated
live with the moms. So the fathers, their pay is low and
irregular. And when pay is low and irregular, child support is
going to be low and irregular.
So the needs of single-parent families are greater than the
needs of two-parent families, and one way to address that is to
guarantee a minimum amount of child support. Sweden does that.
Several other rich industrial nations do that. I have worked on
that in my own research. I think that would be a very effective
policy for addressing single-parent poverty.
But you can't make the benefit too big, and that is where a
child allowance comes in. A child allowance is general. It
doesn't favor single-parent families. But if you have a program
that increases the total guarantee, the total security that is
available to single-parent families, that would be an effective
way of addressing that problem.
Ms. DeLauro. Thank you very much.
With that, let me yield to my colleague, Mr. Moolenaar.
Mr. Moolenaar. Thank you, Madam Chair. And thank you for
holding this hearing today. And also for all of the
participants, appreciate that very much.
I want to begin with Mr. Weidinger. You had talked about
the work-oriented proposals, and you talked about a historical
kind of examination of what has worked in the past and kind of
guiding us to what might work better in the future. And I came
from a fairly rural district. When you look at farms, small
businesses, people are interested in hiring people. There is
actually low unemployment and people looking for employees.
So I am kind of intrigued by the work-oriented proposals
that you have identified that have been helpful. And I just
wondered if you had any thoughts on maybe what we are doing
now, but what we might want to do in the future to help people
on the income side, as opposed to just focusing on the one
aspect?
Mr. Weidinger. Sure. Well, as I recounted in my testimony,
recent anti-poverty policy history has focused significantly on
what are known as ``work supports,'' the idea of making work
pay, providing individuals with additional money if they are
working. And as the NAS report shows, if you count those
benefits, if you use the supplemental poverty measure, there
has been significant progress in reducing child poverty as a
result of that.
The report also devised different packages of benefits, and
one of them focuses more heavily on basically promoting more of
that work orientation. That includes things like growing the
EITC, sort of compressing the current child and dependent care
tax credit, and making it more generous and more available to
lower income folks to help them with childcare costs.
If you do those sorts of things, if you do more basically
of what we have been doing, you will make further progress
against poverty. It is not as simple as saying where we
encounter children, and especially low-income children, we will
give them a check. It is basically more in line with what most
American families experience, which is go to work, have
earnings, keep your family out of poverty, and make progress.
And fortunately, we also have an economy that is supporting
those sorts of things.
I would note the Conference Board recently reported that we
are actually in a labor shortage across the country in blue
collar and manual service jobs. And that is where wages are
rising fastest. So many of the types of folks that we are
concerned about have increased opportunity now, and we should
be taking advantage of that and helping them move into those
opportunities.
Mr. Moolenaar. Thank you.
And I also wonder--you know, one of the other challenges in
my district, the opioid situation that I think it is across the
country, but I wondered if in your studies, kind of how we are
addressing that challenge, and how that affects child poverty?
Any of you want to comment on that?
Mr. Besharov. Many more years ago than I like to think, I
was the Director of the U.S. National Center on Child Abuse and
Neglect in HHS. And in those days, we worried about heroin
addiction and its problems that occurred.
The opioids are more of an equal opportunity scourge, which
is to say middle class, lower middle class, white, black, not
so much Hispanic, are caught up in this. And the consensus is
that it is partly because of the stresses and the changes
taking place in the American labor force and also because of
something in the air that is just depressed. And it is
reflected in our politics, and I won't get too philosophical
with the amount of time you have, but it is a giant problem.
And in the context of today, to not talk about the drug
treatment side, but I was really so moved by Ms. Brunson's
testimony. And if you listened to what she was describing, it
is not as if an extra $1,000 a year or $2,000 a year or,
colleagues, more than that is going to change the conditions
she described. And the same is true with the opioids.
There is something deeper going on, and we have to broaden
the discussion to get to that, and it is affecting middle class
kids. And just the last point I wanted to make, as a
grandmother, she knows one of the big effects of the opioid
crisis is, again, the renewal of grandparents coming to the
rescue. I was raised by my grandmother. So I am allowed to say
that.
It is a terrific resource, but it is not enough for what we
have to do. And tax credits aren't going to do it. Sorry.
Mr. moolenaar. Thank you.
And thank you, Madam Chair. I yield back.
Ms. DeLauro. Congresswoman Lee
Ms. Lee. Well, thank you, first of all, Madam Chair, for
this really, quite frankly, historic hearing. Really appreciate
your leadership and really I know your commitment over the
years has been to end poverty, end child poverty. And so I am
so delighted this comes under your jurisdiction, and I want to
thank you very much for this.
And I want to thank all of you for being here, and it is
very seldom we get to see really the results of our work on
this committee. And it was a bipartisan effort, and so here we
are. And I really thank all of you for being here today.
Let me say to Assemblywoman Burke, you mentioned being the
daughter of Congresswoman Yvonne Brathwaite Burke. She was the
first woman who was pregnant here on Capitol Hill with Autumn.
[Laughter.]
So you made history, Autumn, before you even arrived. Tell
your mother and your dad hello for us, and I am so proud of the
work that you are doing. And you have a quite a legacy in your
family, but you have stepped up and moved forward in your own
right.
So thank you again for being here.
I wanted to ask, first of all, Assemblywoman Burke a
question with regard to national policymakers. Because, yes,
you took the lead in California, and let me just mention the
Golden State of California, which we represent, my district--of
course, Oakland-Berkeley, right next to Silicon Valley--
African-American child poverty rates 32 percent, Latino child
poverty rates 25 percent, Asian and Pacific American child
poverty rate 16 percent.
Outrageous. It is disgusting. It should not happen anywhere
in the country, but especially in California. So what would you
suggest that we hear from the work--that we learn from your
work in California?
And then my second question is--thank you, Ms. Brunson, for
being here. This is your Capitol. Welcome. Glad you are here
for the first time, but many residents of the District of
Columbia don't really feel connected to their Capitol. So maybe
you can go back and remind people to come up here as much as
they can come.
And you laid out the case and painted the picture of what
we all understand and know in terms of systemic and
institutional racism and what black people live with each and
every day. And so there is a relationship between poverty,
childhood poverty and racism. And so, Professor, I would like
for you to kind of comment on that because we have, of course,
the Fugitive Slave Act; the National Housing Act, which refused
loans to black people; sharecropping, which tied millions of
black people to their former masters. So there is damage that
still has to be repaired before we could even complete this
work of what the commission has done.
So I would like for any of you, especially, Professor, to
comment on that. But first, Assemblywoman Burke, what should we
know as we follow up from your great work in California?
Ms. Burke. You know, a few things. Obviously, making sure
that any tax credit is refundable. But I would also like to
speak to--and earned income tax credits are important. They are
an important part of creating the safety net and making sure
there are no holes.
However, I would like to address the fact that even in
rural communities--I don't come from a rural community. I come
from a very urban community. But a lot of my colleagues, the
reason they are so supportive of so much of the poverty
packages, in rural communities there isn't that consistent
work. And so there are times so many people not just in
California, but across the country are a week or two away from
becoming homeless or falling into poverty.
And so it is not always possible to have an earned income
tax credit. Those are the holes. Those are the people that fall
through the cracks. And so it is important, and especially in a
rural community, where we have some of these other mechanisms
where we can make sure that people are taken care of. If you
focus solely on an earned income tax credit, refundable or not,
you do not create the net that you need to really lift children
out of poverty and to stop that constant cycle. So that is the
number-one thing for us.
Obviously, in California, we are having a tremendous
homeless issue. We have women in Oakland who recently--who have
three jobs who are homeless and ended up having to take over a
house and because--so that they could keep a roof over their
children's heads. And people ask how could they do that? But
what would you do?
What would you do if you were 2 weeks away from losing your
home or becoming homeless and having your children on the
street? You would fight and do whatever you needed to do to put
a roof over your head.
And so although work is important, it is a very vital and
important part of this, we really support career and technical
education and making sure that those who have not had a chance
to get a college education or community college education have
an opportunity to do that. And that is all part of looking at a
whole human.
But we cannot only look at earned income tax credits. But
when we do, they need to be refundable.
Ms. Lee. Professor, can you talk a little bit about
repairing this damage that underlies all of this?
Mr. Besharov. Real fast.
Ms. Lee. Okay, real fast.
Ms. DeLauro. Go on.
Mr. Besharov. So I think the debate in this country between
left and right has gotten a little confused on part of this.
People on the right tend to think, well, it is a different
country. I quoted John Lewis. It is a different country from 50
years ago, but it is not a whole country. And that is what he
was careful to say. That was what President Obama was careful
to say, which is we have made progress. There is more to make.
Some of the proposals that you describe, Congresswoman Lee,
I think are very needed. I was in Mississippi in 1968 doing
civil rights work, and what we found was the U.S. Department of
Agriculture basically didn't give farm aid to African-American
farmers. Now that was our government, and there are loads of
other programs like that.
But the average person on the right doesn't know that
history and thinks this is 2020. Hey, you guys have the vote.
Excuse me for being a little, you know, flippant about it. All
is fine.
So there is a history, and my advice, for whatever it is
worth, besides all this other stuff, is to systematically study
the effects of this very recent discrimination, some of it that
continues.
Now I don't think it is all just racial discrimination. I
think there is good, old economics going on for some of the
stuff, and I don't want to sound as if I am only on one side of
this argument. But it is truly the case that if people
understood all the obstacles created by Government for African
Americans in every State of the Union, they would be much more
amenable to some kind of corrective action, and I think public
education is the first step.
Ms. Lee. Thank you. Thank you, Madam Chairwoman.
Ms. DeLauro. Thank you. I just might add, Professor
Besharov, that not only did they discriminate against African
Americans, they discriminated against Hispanic farmers, and
they discriminated against women farmers who never did get any
recompense for their work.
Well, now we are out of time here, but we will get back to
you, okay?
Let me now yield to Congressman Harris.
Mr. Harris. Thank you very much, Madam Chair.
Mr. Weidinger, I read the submitted testimony with
interest. I read the report with interest. My understanding is
that if you look at the discrepancies between two-parent
families and single-parent families, that the poverty rate is
22 percent with--child poverty rate, 22 percent in two-parent
family, 9 percent in single-parent families.
If you look at nonwork--nonworking households, 62 percent
nonworking households' poverty rate, 7 percent full-time work
poverty rate. It seems that if you are looking for a strategy
to half the number of people in poverty that it is glaring that
you should address these, and yet I think I am struck by how
the Roadmap pays only little attention to that. It pays some,
but little.
So I am going to ask you. I mean, do you believe that
instituting family support policies--and other countries have
done it. Institute policies that encourage families, encourage
two-parent families, and the encouragement of--and I mean,
being serious about a goal of every able-bodied American being
trained for a job, have a job, where do those fit into what
your Roadmap would be?
Mr. Weidinger. Sure. So you are right. Those statistics are
from the Roadmap, and they reflect on sort of the reality that
Dr. Besharov was saying, that the Roadmap was given a charge of
saying within 10 years, how are we going to lift half of
children out of poverty, right?
The simplest way to do that and, as Dr. Garfinkel
reflected, the most powerful way to do that is simply to
provide a cash transfer to those households. It is sort of on
the order of math, right? Somebody is low income. If you want
to give them food today or cash or whatever that is, they are
going to be less low income, less likely to fall below some
threshold of deep poverty or poverty in general.
What the Roadmap doesn't do as much of, and I would argue
that some of our Government programs currently don't do enough
of, is focus on the bigger picture, which is why is the person
low income? What can we do to help them go to work? What can we
do to raise their income from work, their earnings?
We don't tend to hold programs accountable for success in
that. What little we know about the actual outcomes of programs
is most are unsuccessful when they try to do that. So in some
sense, what the Roadmap provides is a challenge to current
programs to do a better job in those things that we know are
successful in most of our households in keeping people out of
poverty.
The Roadmap has a very specific and narrow charge. It is
different from that, but I don't think that should distract us
from the broader, sort of more whole view that you are
reflecting on.
Mr. Harris. Well, what do you--you know, look, this is a
problem that has been around a while. And look, in my opinion,
the Great Society failed. We have spent trillions of dollars,
and we still have significant number of people who are in
poverty.
So I understand that the charge was, look, how do we do
this within 10 years? But this is a generational problem, and
it is probably going to look for a generational solution. So
two specific questions.
One is what policies do we have right now that actually
discourage two-parent families? And what policies should we
look for if we are going to do generational change, and we are
going to create an expectation and make available policies that
would provide for training and employment, what would they look
like?
Mr. Weidinger. So policies that discourage two-parent
families are things like the earned income tax credit. So if
you are a single low-income person and you marry another low-
income person, you may be bumped out of the range where you
collect the EITC. That is a payment that is available today
that can be up to $6,000 per person. If you are not collecting,
that is pretty significant change.
That may also knock out things like childcare, food stamps,
housing benefits, you know, you name it, depending on the
nature of the family. So we have programs that by their design
include work disincentives, but the most pervasive of that and
most powerful of all that is the disincentives to work, when
you are basically adding a whole other earner to your
household.
In terms of functional things to change, I think we should
hold programs more accountable for actually being successful in
their outcomes, and that goes for things like the TANF program,
right? The TANF program was supposed to be about moving people
from welfare to work. It gave States tremendous flexibility. It
also said States need to make a contribution on their own to
support the costs and the effort of all that.
And what we found is in many States, States have basically
defunded their State side, and they have absolved themselves
through sort of rhetorical--or sort of mathematical gymnastics
of the expectation of engaging people in work. We need to
reinvigorate those sorts of efforts. So we are actually
encountering the types of folks that Dr. Edin suggested want to
work and, with a little bit of help, could go to work.
Mr. Harris. Thank you very much.
Madam Chair, I yield back.
Ms. DeLauro. Thank you. Congressman Pocan.
Mr. Pocan. Yes, thank you very much, Madam Chair.
Thanks to the panel. This was very interesting, and there
is so much that you could cover, but I am going to try to cover
one subject area, if I can, just because it is related directly
to appropriations.
And I understood the tax credits were not going to do it
all. I understand that line. But let me talk specifically about
the SNAP program because that came up by so many folks. And I
have done the home visits of people, the new mothers, and seen
the despair and the conditions, you know, empty--I can't even
call it apartments, but very small living quarters.
But on SNAP, when I first came here--I got elected in '12--
that first session, a number of us lived on SNAP for a week.
The benefits at that time were about $31.50 a week. And I
remember going to the grocery store, and I bought a bag of
oranges, and that took up the biggest chunk of my SNAP benefit.
Then I bought my ramen noodle soup, bought my peanut butter, my
bread, and a few other things. And at the end of the week, my
office told me I was pretty cranky because I wasn't getting
that much food and certainly not that much healthy food at all,
even at that $31.50.
Since then, the benefit now, only because we gave it a
boost in the last appropriations process, is around a little
over $29 a week. So we are actually down in real dollars, not
even inflation dollars. Inflation since then--when I did that,
it was 10.7 percent. So it should be, if it was at that $31.50,
it should go up $34.80. We are about 15 percent down in real
dollars from when I came in 2013 in that program.
Can you just talk about that a little bit? Because I find
it pretty amazing. I was always told that is the number-one
program to keep a kid out of poverty, and yet, you know, here
we are fighting, struggling to keep it in. And I have a lot of
ag areas in my district. I want to see all these ag bills get
done.
And yet over and over, SNAP becomes this philosophical
fight that I don't get because--maybe because I did it for a
week, and I saw how little you could actually buy with that
amount. But could you just address that one program in
particular? And Professor Edin, I think you brought it up
first. So thank you.
Ms. Edin. So I have studied SNAP with the USDA and talked
to hundreds of households using SNAP about what they use it
for, when they run out. I could summarize my research by saying
in the last 2 or--last week and a half, families run on ramen.
In fact, in one study I did, I was amazed at the number of
ramen recipes--of course, ramen is not great for your health--
that I collected.
But we often think about SNAP as sort of, you know, well,
at least they have SNAP, as if cash doesn't matter. I mean, one
of the reason that I have been so enthusiastic about the
American Family Act is it actually provides this critical
resource of cash. SNAP is actually intended to run out. It is
not intended to cover your entire month.
Mr. Pocan. No.
Ms. Edin. Families don't recognize this. They tend to, at
the first of the month, spend all of their money on their other
bills, leaving nothing for food. So it is a big problem. It
leaves children hungry.
And of course, we have documented this rise in $2 a day
poverty where families really have no cash and only SNAP. And
in those cases, it is the only semi-fungible resource they
have. And so if you are spending $600 in SNAP, as Alva May
Hicks did in South Carolina--sorry, in Mississippi, just to pay
your light bill, you know, getting $300 in return, your kids
are going to be very, very hungry.
It is a great issue. It is one that has I think really
fallen--kind of is under the radar. But it is probably why or
one of the reasons why we see an increase over time, even in
this economy, in very low food security. So families are
feeling it, and they are especially feeling in the last week
and a half of the month.
Mr. Pocan. Yes, and actually, Ms. Brunson, you are nodding
your head. So can you share your experience?
Ms. Brunson. Oh, yes. Yes, I would say like with SNAP, as
Ms. Kathryn said, you know, it is definitely not enough for the
kids to be able to eat. And I will tell you, a lot of these
kids are looking forward to school. They are going to school so
that they can get those meals.
And my granddaughter personally, you know, every Friday,
she brings home a bag from school, and it helps. It really does
help. They call it a ``welcoming bag.'' It is a bag of food
that she brings home every Friday.
And you know, it actually has like the little snacks in it,
like Little Debbies and stuff like that, little juices and that
kind of thing. And they give her about two or three so she can
share it with her brothers, you know, other people in the
household.
But if it wasn't for that, I am telling you, I wouldn't be
able to make it. I would not be. And thank God for ramen
noodles because I am telling you the stamps go so quick, you
know? To me, it is like where those $50 would cover, would make
at least 3 to 4 meals a week, it is only making 2 now because
everything is going up. And just the other day, I was in the
store shopping, and I am looking around like, ``Oh, my gosh,
everything in here is so----''
They are going up. Everything--it just seemed like
everything is just sky high. And so I make a lot of soups. You
know, I make a lot of stews, and I have this one particular one
that kids say, ``What is it?'' I say, ``Oh, this is my penny
soup.'' That means that I used every penny I had to make that
soup. And they enjoy it. You have to come up with names and
stuff like that so that the kids will eat it.
But most of the time, the kids--and I know in my
neighborhood, they are barely eating. So I try to buy enough
snacks so that I can share with them as well, you know? I mean,
it is really hard.
Mr. Pocan. Thank you. Yes, thank you very much.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. Thank you very much. I truly appreciate this
hearing today and thank all of you for joining us. It is so
hard to capture all your stories and expertise in 5-minute
segments, but here we go.
I really want to focus on trauma and how that plays into
kids in poverty and has lifelong effects. And Assemblywoman
Burke, we know that childhood trauma, adverse childhood
experiences can have immense impact on adulthood, including
one's ability to hold a job, physical health, higher rates of
diabetes, and other physical conditions.
I have been very impressed with California's effort to
begin screening. I am also very impressed with your State
surgeon general, Dr. Burke, and her focus on this with the ACE
scores for children. Can you comment on the importance of that
screening and how California intends to support students and
children who have those high scores?
Ms. Burke. So we found, obviously, in California that--and
I am sure everyone here is aware that African-American women
are struggling the most from things like miscarriages,
fertility issues, and a lot of that studies have shown is a
result of stress. And that starts at the most beginning level
of implicit bias and not being--and that stress that that
creates in a woman as she is having a baby in poverty and
creating that stress as well.
And so I think that as a legislature, I think we have
become extremely aware of not just how that affects a woman as
she is giving birth, but as the children are born. Malnutrition
obviously--as we have heard Cheryl talk about today,
malnutrition makes it very difficult for children to learn,
almost impossible.
And as a legislature, I think we are starting to take that
and Dr. Burke's studies and research very seriously and her
work very seriously. We have not legislated on it as of yet,
but I think that you will definitely see especially the black
caucus is taking infant mortality as one of our number-one
priorities for the year.
And that is really based on after some of our research and
some of our work, with her coming to the caucus saying that a
lot of that is the effect of implicit bias and the things that
we have--the women have taken on that we have not acknowledged
as a State or a country.
Ms. Clark. Thank you.
And Professor Acevedo-Garcia, I know that you have done in
this. Can you tell me about how you see anti-poverty measures
actually being able to help and the connection between reducing
trauma in children?
Ms. Acevedo-Garcia. Sure. Thank you for that question.
So, of course, child poverty in itself is a very
significant adverse childhood experience. So by implementing
any of the measures that the committee concluded would be
effective in reducing child poverty, we would reduce the
prevalence of ACES because poverty, child poverty is a major
ACE.
In addition to that, and I want to acknowledge Professor
Besharov for his comments about the importance of race and
racism and discrimination, we also know that there are many
other stressors that affect families in addition to poverty.
And one way in which the committee considered this is by
examining the contextual factors that influence poverty. And by
that, we mean factors that exacerbate the experience of poverty
or the negative effects of poverty and also may influence the
impact of anti-poverty policies.
We considered things like discrimination in housing and
employment and the criminal justice system. We also considered
the effect of adverse neighborhood conditions.
Although we were not able to incorporate this in the
simulations, we reviewed very carefully the evidence that these
factors tend to worsen this experience of poverty among
children and also can limit effectiveness of anti-poverty
programs. I think it is very important to recognize that we can
make anti-poverty programs better if we acknowledge that we
also have to deal with these contextual factors--again, your
comment--and that we can do both at the same time.
So I am going to give one example of that that is very
close to my interests and my research. We know that minority
children, specifically black and Latino children, are more
likely to live in poverty than other children. Also among poor
children, black and Latino children are much more likely to
live in neighborhoods of very low opportunity.
Just to give you a sense of the extent of the problem,
about two-thirds and half of poor black and Latino children,
respectively, live in very low-opportunity neighborhoods.
Twenty percent of white children who are poor live in very low-
opportunity neighborhoods. So although, of course, the
experience of poverty is very bad for all children, Latino and
black children are also dealing with a lot of problems in their
neighborhoods, and I really resonated with your comments in
that sense.
So we have a program, the Section 8 voucher program, that
is an income subsidy to buy housing. But we can make it more
effective by helping families, and we have programs that are
doing this around the country, housing mobility programs that
will help a family that has a Section 8 voucher to achieve a
better neighborhood. And that way, that is a very concrete
example of how we can tackle both poverty and ACES or multiple
hardships at the same time if we are smart about how we use our
programs.
Ms. Clark. Thank you.
Ms. DeLauro. Thank you. Let me also, Dr. Acevedo-Garcia, I
want to just get a look at what the study showed, that work
requirements are at least as likely to increase than decrease
poverty. I just would mention that in Arkansas, 18,000
individuals were kicked off the State's Medicaid program
because of work requirement, and the employment rate dropped
among Medicaid-eligible Arkansans.
Kentucky's work requirement was forecasted to force at
least 95,000 Kentuckians to lose coverage. Their new Governor,
Andy Beshear, has withdrawn the State's work requirement
waiver.
I would like to give you the opportunity to respond to that
assertion that work requirements are at least as likely to
increase as decrease poverty, if you can.
Dr. Acevedo-Garcia. Yes, it is very important to understand
how a committee like our committee of National Academies works.
For us, everything is driven by research evidence and the
strength of the evidence.
Ms. DeLauro. Right.
Ms. Acevedo-Garcia. So the criteria that we use to identify
programs included the strength of the evidence on how they
improved child outcomes, their likelihood to reduce child
poverty, and other factors such as cost, as well as the
importance of values that we held as a nation like social
inclusion or work.
In regard to work requirements, we did examine the evidence
extremely carefully, and we concluded that there is no evidence
at this point to support that work requirements as part of
social programs that aim at reducing poverty would help reduce
poverty. So we did not include this approach in our policy
simulations of either individual policies or packages because
the evidence is not saying including them.
Ms. DeLauro. We can have access to what that evidence is
because, as you know, we are in an environment where there is a
very big focus on work requirement as it pertains to the SNAP
program and other programs and where people are in real danger
unless we can answer that, this question, which is why I just
wanted to bring it up again.
Did you want to say something, Dr. Garfinkel?
Mr. Garfinkel. Yes. So the evidence that is usually
advanced for the efficacy of work requirements is the welfare
reform, the 1996 welfare reform.
Ms. DeLauro. Right.
Mr. Garfinkel. And most scholars would say perhaps about
one-third of the increase in earnings was due to the welfare
reform, but you have to understand that welfare reform was not
just work requirements, and probably even more important was
the lifetime limits on eligibility for assistance. And there
were lots of other elements as well.
So the citing that evidence is very weak for saying the
efficacy of work requirements. We do have experimental evidence
on the efficacy, or lack thereof, in terms of reducing poverty
for work requirements. So there were two different
experiments--one in Canada, one I think in Minnesota--that we
cite in the report. And the evidence from both is that work
requirements increased work but had no effect on poverty. None,
zero, zip.
Ms. DeLauro. Mm-hmm, yes.
Mr. Garfinkel. And that is because people that were kicked
off welfare lost the welfare benefit, and their earnings just
made up for the loss in benefits. That is experimental
evidence.
The last point, we were well aware or at the very end of
our deliberations of what happened in Arkansas. I think it was
Arkansas that you cite.
Ms. DeLauro. Arkansas, yes.
Mr. Garfinkel. Yes. And the evidence there is pretty clear.
So, and we have lots of other evidence that work requirements
have been instituted in a way that simply kicks people off
welfare. I say this as being an advocate 25 years ago of not a
work requirement, a broader requirement that all recipients of
welfare should have a social responsibility to either work or
do something to improve their own situation.
That--I am an optimist, a great optimist. My wife likes to
say I am the greatest optimist she has ever met. So I thought
that that could work, that we could implement such a
requirement in a decent way, and when someone was having
trouble getting to work, that would be a sign to us that person
needs help. That is not what happened.
Ms. DeLauro. I will just add to that, and my colleagues
bear with me, I can recall that debate very, very well. On the
floor of the House, there was an amendment that passed which
cut I think $25,000,000 from the food stamp program, and in
fact, there were no wraparound services that were provided at
all with the welfare bill about getting to work, about what you
do about childcare, what you do about any of these other areas
that would facilitate a person's ability to be able to get to
work and so forth.
And so we started behind the curve there. And I am proud to
have voted against it. So I just use that.
Mr. Garfinkel. Madam Chair, could I just add one--the idea
that we would work-test Medicaid is just I don't get it. I just
don't get it. It seems to me like such a bad idea that we--
Medicare, Medicaid, medical care increases people's health. The
idea that we would try and kick people off that program because
they are not working. They may be on the program because they
can't work.
And the administrative complications of enforcing the work
test in Medicaid----
Ms. DeLauro. Thank you. Congressman Moolenaar.
Mr. Moolenaar. Thank you, Madam Chair.
I want to follow up on this discussion we are having on
work because I fundamentally believe that there is dignity in
work and that it is good for people. And when you think about
generation after generation, I think there is real value in
children seeing a parent or parents working and realizing that
is sort of to your point of social responsibility.
I wondered, Mr. Weidinger, you had commented in your
testimony that some of the impressive gains made against
poverty after the 1996 reform continue to support promoting
more work and earnings by parents as the better and more
enduring solution to poverty. And that intuitively makes sense
to me, although I also am sympathetic with the idea that if you
get a certain point in your income and then you lose all the
other supports, that may be a disadvantage.
And so I wondered if I am sure you looked at that sort of I
don't know what you would call it, but that ratio. And maybe
there are ways we could improve that so that people wouldn't be
penalized for working but would also have the incentive to
work.
Mr. Weidinger. Right. So just to follow up on the previous
conversation, the work requirements in TANF or in other
programs--but I know TANF best, so I will speak to those--there
are actually 12 definitions of work. So it is not we are going
to kick you off if you don't have a job. It is a progressive
State, a smart State would say how can we help Dr. Edin's
person go to work by providing the supports that she needs to
go to work, right?
And in effect, the TANF law permitted that to be the case.
How States actually implemented that is a different thing,
right? So I would tend to agree with Dr. Garfinkel that some of
this trans--sort of in its translation to policy at the State
level has devolved in a direction that the original law didn't
really intend. It let the States somewhat off the hook for
doing the type of engagement that we know is helpful to people
to lifting their income and helping them escape poverty.
On the question of sort of the backside transition, Dr.
Besharov sort of made reference to this on the phase-outs and
some of the penalties, there is--I would refer you to a chart
by Gene Steuerle at the Urban Institute. It is a crazy quilt of
the marginal tax rate effect of the phase-out of welfare, the
welfare package that many people receive.
SNAP phases out one way. Housing phases out another way.
Childcare may have a cliff. The earned income tax credit phases
up, is level, and then starts to phase out.
All those things can create marginal tax rate effects that
in the $20,000 to $30,000 income range for households create a
marginal tax rate that is much like that that applies to
taxpayers in the $200,000 and $300,000 range. Because one day,
they are receiving a package of benefits, but the next day, if
they get a raise, and you know, heaven forbid that you marry
and bring a second earner into the household, all of a sudden,
that benefit package goes away.
So there are ways to try to address that and fix that.
Typically, what they tend to do is sort of do the taper more.
So have the phase-out be lower. That tends to raise the income
eligibility for those benefits. It increases costs.
There are other things that you can contemplate doing. You
could sort of hold people harmless for those phase-outs for a
period of time, give them a couple of years, something like
that to help them transition to work. Maybe get a raise,
develop more skills, and things like that. So there are policy
options for addressing those sorts of things.
Ms. DeLauro. Congressman Moolenaar, I know that Professor
Edin wanted to respond, but I will give you extra time if you
have different, other questions.
Mr. Moolenaar. Oh, no. Please go ahead.
Ms. DeLauro. Thank you.
Ms. Edin. So I wanted to respond to both your comments
about work and about family structure. In terms of work, if we
look at the Survey of Income and Program Participation, we find
that among children in--virtually in the spell of living in a
virtually cashless household, during that year, 70 percent will
have an adult that works. And the figure is 90 percent for
other low-income children.
So there is a high degree now of engagement even among low-
income mothers with very young children in work. I think that
is good news. What we showed in our book ``$2.00 a Day'' is it
is much more the challenge of keeping people in very low-wage
jobs in work because of all the challenges of an increasingly
perilous low-wage labor market.
So Matt has talked about factors that discourage marriage.
I have done a literature review with Sarah McLanahan, my
colleague at Princeton, about what we know about what enhances
marriage rates, especially among low-income parents.
The work of Christina Gibson-Davis has shown that if you
give an unmarried couple a small additional increase in
resources, this is through earnings, if their economic
situation improves, they are much more likely to marry. So
maybe a child tax credit won't do it all, but an additional
$5,000 to $6,000 in a household could easily increase family
stability a lot.
We also know that investments in excellent pre-K, 40 years
later, show families with much greater family stability and
fathers much more likely to live with their children and have
raised them in their own household. We also see evidence from
career academies. This program not only raises wages, 8 years
later, but it dramatically increases family stability,
especially for men.
So I think what we know about these days, right, about how
to get young people to marry, especially low-income young
people, is to support them from pre-K all the way through to
college graduation. And even small increases in their economic
stability have been shown to quite dramatically increase their
family stability.
Mr. Moolenaar. Thank you.
Ms. DeLauro. Thank you. That really gets to the issue of
dealing with the child tax credit and which I said at the
outset, it is not the jurisdiction of this committee, though we
are very supportive of this effort. And as well as what are the
programs that are within this jurisdiction, which is pre-K and
worker training and all of these other areas would come
directly under our jurisdiction that we need to meld those
together.
Congresswoman Lee.
Ms. Lee. Thank you very much.
Let me first to Dr. Edin. In your book ``$2.00 a Day:
Living on Almost Nothing in America,'' you lay out the personal
testimonies and survival strategies that Americans live in
extreme poverty. Let me ask you with regard to the pre-existing
Aid to Families with Dependent Children program and its
relationship to lifting children out of poverty and the new
welfare reform program under TANF.
Now personally, okay, I was on AFDC for years. But I could
go to college also, and I was able to take care of my kids and
finish college, get my master's degree.
Now when I was in the legislature, the welfare reform
program came through the States, and I chaired the subcommittee
that crafted a lot of the supportive services as it relates to
welfare reform. But we couldn't get rid of these work
requirements that were put into place, and a person like myself
couldn't have continued to go to school because of the work
requirements.
So I voted against it. I think that was the worst thing
Bill Clinton ever did, quite frankly. So let me just ask you
how you see that right now. In the Academies' report, I don't
know if you address this specifically, but these work
requirements now for young women especially who want to go to
college and who want to take care of their families and earn a
better income, what is the deal with that in terms of lifting
children out of poverty?
And then to Assembly Member Burke, where is California now
on our welfare on TANF and any of the terrible provisions that
were put in early on? First, Dr. Edin and then Assembly Member
Burke.
Ms. Edin. So TANF has a couple of problems. One is that
benefit levels have--the value of the benefits, even though in
many States you just can't get on the rolls. Even if you did,
in Mississippi, you would still live in $2 a day poverty. I
believe it is in 17 States you are below 20 percent of the
poverty level if you get the full benefit. I believe it is in
the majority of the States where you are under 30 percent of
the poverty level.
Some States this last year raised their benefits for the
first time, but it is still a dramatically reduced benefit.
This means that people have to work under the table to survive.
And so even if they were able to go to college, it would be
much harder to do so because they are doing hair. They are
selling their plasma. They are babysitting for neighbor's kids.
Some of them are picking up tin cans on the sidewalk for about
$1--the return of about $1 an hour.
I mean, people are really--if you pay people 20 percent of
the poverty line, and you believe the poverty line is too low,
how do we think people get by? And so I think there is that
story of when people fall so low, when benefits decrease on
average in value by a third since the late 1990s, it is mid to
early 1990s, that is an additional point to the work
requirements actually pushing people off and into low wage
work, the short-term training, which earns them poverty-level
wages.
But I would love to hear what is happening in California.
Ms. Burke. Yes, so we are still--I have been working on
this for a few years. We are trying to extend the time clock
eligibility requirement for college from 48 to 60 months, and
we are also trying to make sure that noncore activities like
job training can maintain--you can maintain your participation.
It has been a struggle. I will be honest with you. We have
been working on it, I think I have done this bill three times
now, or a version thereof three times. It is one of the great
challenges. You know, there are noncore activities that you
need to do, and there are noncore things you need to do to be
employed.
You know, whether that is--I am a single mother. So we keep
talking about single mothers, and I am a black single mother
sitting here. And I know that--and I have a good job, and I
have a good career, but I struggle with childcare. And I have
had to try to find time and space to continue my education.
It is not easy, and as a State, we are still--we are still
working on it. We still have further to go in that and
understanding that getting a job is not as easy as some of the
folks seem to think it is here, especially as an African
American or an African-American woman.
It is just there are a lot of hurdles, and there are a lot
of hurdles for people in my district. Most people don't realize
70 percent of students in California enter a high school never
see a community college or a 4-year university.
What happens to those 70 percent of young people? And they
live in my district. And yet it is $25,000 or $26,000 to make
sure a two-bedroom apartment. It is $70,000 for a child--for
the L.A. County, $70,000 to pay for a child in foster care.
This is basic math.
Ms. Lee. Basic, yes.
Ms. Burke. It really is. It is $90,000 to incarcerate one
man for a year.
This is not--this is basic math, but it is not a basic
issue. It really does require that we look at a whole human
being, and that is from the implicit bias of an African
American, a Latino trying to enter the workforce, or trying to
enter an educational facility. It is about making sure that
CalWORKS is extended so that people can get the training and
education they need while they still can do their nonconforming
activities.
This is a complex issue, and to minimize it to just the
basic ability of going to work, people want to work. I believe
it is socially equitable, and I think it does give people
pride. But it is not that simple.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. Thank you. To pick up on that theme, I often
think of the Boston Globe report that came out a few years ago
on the median net worth of families in Boston. Black families,
it is $8. White families, it was $247,000. They had to reprint
those numbers because everyone thought that $8 had to be a
mistake.
And when we talk about the dignity of work, and I would ask
you, Professor Edin, if you could repeat the statistics of how
many people are working on TANF and others. Did you say it was
upwards of 70 percent?
Ms. Edin. So for--what we did is we followed children in
the SIPP over a year, and it turns out it is easier to follow
children because family structures are so unstable. And we
found that even among children experiencing at least a 3-month
spell of extreme poverty, having no income in the house, 70
percent of those children had an adult who had worked.
Ms. Clark. Yes.
Ms. Edin. So we see that at 90 percent among other low-
income children. Since the early '90s, the penetration of work
in the lives of poor households, poor single moms, is just
astonishing. You know, back--back when I first started doing
this in the early 1990s, I am getting older, you know, mothers
really thought there was a ``Should I work? I am not sure that
is good for me as a mother. I am not sure that is good for my
kids.'' And now mothers will say, ``Of course, I should work.
How else do I model the value of education to my children?''
So people work. One of the things that was so striking in
our research for ``$2.00 a Day'' was the level of
identification with work. ``I am a worker. This is who I am.''
So work needs to live up to those aspirations that are held by
low-income families.
Ms. Clark. That is an incredibly powerful statement, and I
think part of the problem with these work requirements is that
it sets up a false paradigm that people are not working out of
choice because they are getting a handout from the Government,
when actually, I think we need to be focusing on exactly what
all of you are advocating.
And Mr. Weidinger, when we talk about accountability in
this programs, and we all want that, I think we also need to be
looking at accountability of our systems. Are we paying women
equally for equal work? Are we insisting on a minimum wage that
actually allows families to survive?
Are we addressing in a realistic way systematic racism,
systemic racism, and the toxic vestiges we have of slavery? Are
we looking at voter suppression? All of these issues come
together, and they have really been drawn into focus for me
this week with the coronavirus.
How are we going to make sure that we are able to keep
Americans safe when there are people who do not have paid sick
leave, who cannot afford to stay home from the job or multiple
jobs they have that are allowing them to hold on? How are we
going to be able to mitigate and have therapies for people who
are sick if they are immigrant communities and afraid to come
forward and get healthcare, or they have no insurance or are
under insured, as we see tests for this coming in in the range
of thousands of dollars in billing for patients who have needed
to access testing.
So all of these policies are not just a theory and a feel-
good, and we have to wrestle with this in a comprehensive way.
And when we talk about the dignity of work, we have to make
sure that those workplaces, those salaries are really giving
people a chance.
And I could go on forever, but I won't. But I just want to
thank you for your work, Mrs. Brunson, for being here today and
sharing your personal experience. It is always people, and we
all know how we feel about our grandmothers. And I miss mine
every day.
But it is we have got to look at kids and say we can do
better in this country.
Ms. Brunson. Absolutely.
Ms. Clark. And it is the connection for all of us is so
very important, and so thank you for your work. Thank you all
for being here, and thank you for having this hearing.
Ms. DeLauro. I think the one thing that struck me,
Professor Edin, when you were speaking is, you know, we all
identify ourselves by our jobs. And I think so many of us, and
I will just say this widespread, that oftentimes we just hear
folks denigrate people who have fallen on hard times, do not
have a job. But looking for a job, if you go to any of the
Workforce Alliance Boards, and you see people at those
computers looking, looking for a job, people identify who they
are by their job. I don't care who you are.
And so when you don't have a job, the stigma of that for
your own personal self-confidence and you are role model as a
parent, where how do you explain to your children that you
don't have a job? So the notion that somehow that people are
dogging it, that they don't want to work is--it really is
humiliating and denigrating to individuals and what their lives
are about and what their set of values are about.
I want to--by the way, nobody is on the clock here. I just
thought we would just have a conversation. But I do want to
bring up because this is important. We are dealing with a
budget that this administration has put forward. And I am
asking everyone here. It requests to eliminate a block grant,
more than 50 programs that benefit children and their families.
That includes Preschool Development Grants; the Low-Income
Home Energy Assistance Program, LIHEAP; the community service
block grant program; foster youth programs, among others. It
makes egregious cuts to Medicaid, to the CHIP program, and to
TANF.
Now we can sit here and say all those things are not going
to happen, but some of them are going to happen. And so what I
really do--let me just open this up. What is the impact that
these kind of cuts will make on whether it is California or
other places? What happens when there are no longer the
investments in preschool slots, childcare slots, workforce,
homelessness programs, apprenticeship programs, internship
programs that deal with 70 percent of the people in this
country who do not have a 4-year liberal arts degree?
Let me just--you know, let me just throw it open here. What
happens when we are faced with a budget like that? Go ahead.
Ms. Edin. I think Matt could also--I think this is a point
of agreement between us. What we know from the TANF block grant
is that if you give block grants and you don't really supervise
them, so to speak, you create really a race to the bottom. And
Governors have been using the TANF block grant as a fungible
stream of income for pet projects.
So we see in Michigan, we are giving away college
scholarships to middle class students. In Louisiana, we are
supporting crisis pregnancy centers. It is true that many
States fund their State-level EITCs through TANF, but that
again goes to the working poor and not the categorically needy,
as you were saying. It misses a large chunk of families who are
the most needy.
So, and also in reflection to Matt's remarks, only 8
percent of current TANF dollars are going to job training. How
could a proposal that was supposed to support job training and
job placement be spending so little on the program.
So I would say what is going to--and by the way, only of
the $16,500,000,000, only a tiny fraction now is going to cash
benefits. So most States are figuring out ways to basically
siphon off most of the money, and I think that is what we could
expect in the future. That is our most current model.
Mr. Weidinger. So since you raised the budget, I would
advise you think about this even more broadly. I included in my
testimony a summation of the coming investments in the next--
expected in the next decade, prepared by the Pete Peterson
Foundation, and found that for every dollar of spending that we
will do above our current levels, we will spend 67 cents of
that on senior entitlements. We will spend 3 cents of that on
children.
So I don't need to tell you, as appropriators, you are
feeling the squeeze of the broader budget issues that we are
facing as a country with some of this is demographics. It is
understandable. It is the way it is.
But I think everybody on this panel can agree that
children's programs are under increasing pressure because of
the broader budget dynamics that we are facing as a country.
And until we actually deal with those, these programs will
continue to be under pressure.
Ms. DeLauro. Well, I just would say this, too, Mr.
Weidinger, and I appreciate, and you know, in your testimony,
you talk about using the supplemental poverty measure, et
cetera, and where do we go and what we do. But we literally do
not focus on--and I just have to say this in response is that
we provided the biggest tax cut, the richest one-tenth of 1
percent of the people of this country. We did that in 2017
without--you know, in an immediacy.
We are not thinking about a deficit. We are not thinking
about anything else. And where we go all the time when we think
of what economic pressure we have, we focus on seniors, as we
contrast them with kids. Let us look at the top of the list
here and find out who the beneficiaries, the real beneficiaries
are of our current policy.
And when we can get to leveling that playing field, then we
will have the kind of money that we need and the resources that
we need to make sure that our kids are taken care of and that
our seniors can retire and have healthcare and a decent way of
life.
It is not you. I am not shooting the messenger here. I just
get so frustrated with the notion that we never take up what
happens at that level.
Dr. Garfinkel.
Mr. Garfinkel. So if it is okay, I want to come back to the
importance of cash for a moment.
Ms. DeLauro. Fine.
Mr. Garfinkel. Because----
[Laughter.]
Ms. DeLauro. I always think that is important as well.
Mr. Garfinkel. So, so as a long-run matter, capitalism is
the best system we know for reducing poverty. But capitalism
creates economic insecurity by its nature, and that has gotten
worse recently as the labor market has changed and gotten more
insecure. And several people have said, gosh, just what would
$2,000 or $3,000 or $5,000 or $6,000 do to--how would that
improve the lives of families with low income with children?
And the answer is it creates a base, a secure base. And it
reduces economic insecurity. Most especially at the bottom, but
I could tell you it extends well above the bottom. The most
important finding that come out of the Poverty Tracker study in
New York City, which is a random sample of the whole city, is
only about 20 percent of the population is poor in any given
year.
If you look over 4 years, it is close to half. And for
those people who aren't--some of them who aren't poor, some who
are poor, measures that we call hardship, but I like to think
of them as economic insecurity, things like not going to a
doctor because you couldn't afford it. Running out of money to
buy food. Not being able to pay your housing, so you are
possibly, in the worst case, thrown out of your housing. Not
being able to pay bills, electric bills. Getting your heat
turned off.
Those kinds of insecurities in any given year in New York
City, it is like 30 percent. And over the period of 4 years, it
is closer to 60. It is above 50 percent.
If we can find a way to stabilize the incomes, which child
allowances would do, that is a huge contribution not just to
the poor, but to the lower middle income, to the near poor, et
cetera. Capitalism will do the work in the long run so long as
we share the fruits of the capitalist system.
Ms. DeLauro. I know my colleagues want to get into this,
but you had a comment you wanted to make, Dr. Besharov, and
then we will get both of you.
Mr. Besharov. So I just want to point out--so I think many
of us would agree with the kinds of things that you said,
Chairwoman. But let me point out the following with this big,
long report about ideas to reduce poverty, and most of the
programs you described that you were feeling so angry about
being proposed to be defunded didn't make it into the report.
Now, right? Wait, no. So, so, to me, I will just close in a
minute or two.
Ms. DeLauro. Oh, no.
Mr. Besharov. So the challenge is both to make those
programs that you listed work better and to get the American
people to believe they work better. And I can tell you the
consensus about job training programs is don't do them, right,
among the technical people who look at this.
Yes, and the committees here aren't very excited about
putting money in job training either. So, and I didn't see a
big recommendation to increase job training in the report
either because their requirement was to look at the research
and say what works.
Now I was against that requirement. I think you should try
all these things, but the necessary product, and I know
politics I can't help here. But the necessary and part answer
to what you said I would say is we have to improve those
programs so that the American people believe more in them.
Sorry.
Ms. DeLauro. Everybody believes in the LIHEAP program, I am
sorry, Mr. Besharov. And boom, it has been eliminated. Go
ahead, Dolores, and then Barbara.
Ms. Acevedo-Garcia. Yes, just very quickly because I am
obviously here to represent the committee. So we did--we did
examine work training, and we did include one promising
program, WorkAdvance, in one of the packages. You are right
that we did not look into other programs. Part of the reason,
as everyone knows, is that the task was to look at programs
that could reduce poverty within 10 years. So I just wanted to
clarify that.
In regard to block grants, very important, we did examine
whether they may be able to reduce--first, we look at the
evidence carefully, and the evidence is not there to support
that block grants could reduce poverty. And actually, the
discretion that they give to States could very well work in the
opposite direction.
We have been holding different sessions around the country
to disseminate the report. In Boston, we had one that was
focusing specifically on the intersection between child poverty
and racial and ethnic equity. One of our centers has conducted
very powerful research that shows that block granting the TANF
program, one of the things that it has done, many people here
know, is that it has increased the percent of funds that go to
the other categories. That is not childcare and other things
that are legitimate uses for the other categories.
And one of the things that we found is that States in which
the caseload have a higher proportion of African-American
clients are more likely to be using the other categories, again
reinforcing this idea that we have to be looking at these
issues simultaneously. It is not only child poverty, but it is
issues of racism that are very much present in our society.
Ms. DeLauro. Barbara.
Ms. Lee. Yes. And thank you all again for being here.
I wanted to just say a couple of things. First of all,
child poverty rates right now constitute for me a state of
emergency. It has so many different layers. You talk about
systemic racism. You talk about early childhood development.
You talk about homeless children. I mean, you know, in terms of
just the ability for them to have a stable address and how do
they go to school and going to five and six schools a year and
moving around.
I mean, the next generation of children who are living now
below the poverty line are going to have a very difficult time
just negotiating living in America. And so I am at the point
now where I am saying, and I am glad Andrew Yang mentioned this
several times during his campaign, about going back to a
guaranteed annual income, something that will help stabilize
this state of emergency until we figure this whole policy thing
out.
Because I am so worried at this point that this country is
becoming a country again of it is two countries. One that is
below--that is unequal, and the other that is just off the
scale in terms of the 1 percent, in terms of the money and the
greed in many respects that now we see at each and every level.
And so we have got to somehow--and I don't want to see
another 20 years go by and more kids falling into poverty
without something dramatic and it is something that is outside
of the box. And so just can you comment on a guaranteed annual
income or some level that we will not allow people to fall
beneath, given the state of emergency with our kids?
Ms. Edin. So the reason I am advocating for something like
the American Family Act rather than guaranteed family income is
I actually believe the insight of David Ellwood when he came to
the realization that good social policy has to be attuned to
American values. So what the American Family Act does, and I
want to quote from my quote when I reviewed the proposal, is
that it sends a clear message that society values and supports
the essential tasks of parenting and recognizes the special
burden that all parents of children, especially young children,
face.
Low-income--the reason to give low-income parents with
children essentially a guaranteed income is because they are
doing something for society that is essential. Now my
democratic self might like something bolder, but it seems to me
that this is something all Americans can agree on. We value
parents.
Right now, fertility is going down in the United States,
and it could be bad. It is tough raising kids on a low-wage
job. So to the extent that this act sends a powerful social
message, ``We value you.'' It brings dignity, right, just in
the way that Professor Garfinkel described, and it reinforces
the critical task of parenting.
So that was a little off topic, but I will turn it over.
Ms. Burke. So we do in California have a bill introduced,
and we will introduce a bill that will come to our committee.
And so we will actually have the universal basic income
conversation in California this year. And it is an important
conversation to have. That stability is incredibly important.
And you asked, Chairwoman, what would be the consequences
to the State if, in fact, there was this kind of pull-away from
these programs, and I am lucky to live in a State where our
Governor values a lot of these programs, and so we would
probably try to backfill a lot of that. However, we do have our
own other crises. We have a housing crisis that we are trying
to figure out, and we also have wildfire and other incidents.
And so how long we would have the capacity to do that, I
don't know. But for others in other States, I think it would be
more of a challenge. It would be devastating.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. So much to discuss, so little time. But you
touched on housing, and the affordable housing crisis is such a
part of this and how we make sure that families have stable
housing so they can build strong, healthy families that are
employed. It is not easy when you don't have that fundamental
housing component and are forced to move away from our job
centers as we see gentrification, rising cost of housing,
certainly something we are struggling with.
But I also wanted to ask you about the role of childcare
programs like Head Start, programs making childcare affordable.
In Massachusetts, one year of infant and toddler care can be
more expensive than college tuition for families. And often the
transportation voucher, if you are lucky enough to get a
voucher, is so underfunded. And to say to parents and
students--parents who are students that you have to have these
requirements, but your voucher is only good for 8 hours is just
an impossible balance.
So if anyone could just talk about the importance of making
sure that we are having early, rich early education
environments open to every child would be great.
Yes?
Mr. Garfinkel. So the committee did not consider programs
that would--of the kind you are talking about. Not because we
didn't think they were important, but because the charge to
reduce poverty in 10 years, just consider, for example,
universal pre-K. I would say there was a lot of sympathy in the
committee for that kind of proposal.
But if you start if someone is 3 years old now, 10 years
from now they are only 13. So you don't see the reduction in
poverty. We recommended that there be another committee that
look at long-term investments in children. We think that is
very--I would say everyone on the committee believed that was
equally important, but focusing on cash programs also had a
great virtue.
And I want to come back to your question about trauma
because so I think insecurity potentially leads to trauma. And
I must say one of my very favorite experiments, people love
experiments. In general, I don't think social science
experiments are the gold standard. But there are other kind of
experiments, like with animals, that we would never do with
human beings.
But, and now we are even pulling back with respect to
monkeys. But I will tell you about an experiment that showed
that insecurity was actually possibly more damaging than just
simply poverty. And there were three conditions, and this was
with Rhesus monkeys.
One was the monkeys had to work really hard. The mothers
had to work really hard to find food. Second condition, it was
relatively easy for them to find food. And the third condition
was random alternation of those two conditions.
And the monkey mothers that had a poor environment, their
mothering and their child outcomes, their offspring outcomes
were worse than the monkeys growing up in the rich environment.
But the ones in the insecure environment, where they didn't
know what was coming because it was random, they were far
worse, far worse.
And talk about trauma, and here I am going to
anthropomorphize--or whatever the word is--the offspring would
curl up, as if they are depressed, in the fetal position,
leaning into their mothers for 15, 20 minutes at a time. That
was not uncommon outcome.
So that is how I think insecurity potentially relates to
trauma.
Ms. Clark. And we have seen that with work that we have
been doing around trauma, addressing it in early education in
our school systems. And then we come back to so many of our
teachers and early ed professionals have so much unresolved
trauma, it is a very difficult position for them to become that
person of trust.
So it is a generational problem, but I think we are
beginning, and California is leading the way in putting this
together as one of the markers that we have to look at. And we
know that being in poverty is an inherently traumatic event and
that like you said, that insecurity, that not knowing. Maybe
one week, there is good meals, and the next week there isn't.
Moving, whatever the change is, to adjust to a rapidly changing
economic condition in the family, it has profound effects that
are real and have--you know, if we really want to bend the
healthcare cost curve, we better start looking at this.
Thank you all again.
Ms. DeLauro. Ms. Brunson.
Ms. Brunson. Yes, I want to speak on what he was saying
about poverty as far as with the school system and the
teachers. You know, the teachers, like I said, they are not
teachers like we grew up with. And the teachers are being
bullied--I mean they are bullying the children, you know? And
that is where I think that the poverty comes in at with the
kids that their mentality and everything, they don't really get
everything that they really need from the school system.
Because one of the teachers told my granddaughter that he
was going to make it his business for her to stay back. Now
what kind of stuff is that to tell a child? The school system
is failing our kids.
Ms. DeLauro. I just want you to know on that note, where I
went to high school, the principal said to me--because I was a
cut-up--she said to me, ``You will never amount to anything.''
[Laughter.]
Ms. DeLauro. So, but I had an unbelievably strong support
system.
Ms. Brunson. Absolutely.
Ms. DeLauro. That I could fall back on and a support system
that said, ``You go, girl.'' That is what it was all about. And
that is what is critical.
I want to give you, what we want to do is just like very,
very briefly, if you wanted to tell us something, what we
should do, and I just want to go quickly down the line so we
are going wrap this--we are going to wrap up the hearing.
Why don't we start with you, Professor Edin?
Ms. Edin. So I would say, whatever you do, think about
whether it incorporates the poor and brings dignity. I think
the American Family Act, which is a little bit more generous
version of what was in the report, does that.
Ms. DeLauro. Cheryl.
Ms. Brunson. I would like for you to think about the
children and child poverty because in the middle class area and
especially in Ward 5, the children are suffering.
Ms. DeLauro. Yes?
Ms. Acevedo-Garcia. We have a responsibility to reduce
child poverty by half today because we know how to do it.
Mr. Besharov. I am embarrassed to be so small bore. Ask the
CRF to give you a report on marginal tax rates and work in
marginal tax rates and marriage because you can do something
with that.
Ms. DeLauro. Okay. Thank you.
Ms. Burke. I would say prevention is key. Prevention
includes universal preschool, and I would say that there is a
new class of people. They are working poor, and the notion that
they are stupid or lazy is outdated and ridiculous.
Ms. DeLauro. And demeaning.
Mr. Weidinger. The report provides a range of options. We
tend to think in this town of all or nothing. We shouldn't.
There are important incremental possibilities within the report
that are flagged. So I would point your attention to those.
Ms. DeLauro. Thanks. Dr. Garfinkel.
Mr. Garfinkel. So I understand that as an academic from
Columbia University and heading of a poverty center, I can't
endorse the American Family Act. But what I can say is that if
something like the provisions that are in the act were
enacted----
[Laughter.]
Mr. Garfinkel [continuing]. It would be a good thing.
Ms. DeLauro. Okay. Thank you. Thank you.
And just to wrap up, by the way, also--and the personal
stories that people tell--yes, do you want to make a statement?
Ms. Lee [continuing]. Oh, yes, let me just----
Ms. DeLauro. Yes, let us go.
Ms. Lee [continuing]. Thank you all for your presence, but
also for your suggestions. And Mr. Garfinkel, Professor
Garfinkel, you mentioned the report had recommended us look at
what some long-term investments in alleviating child poverty
would be. I think we have enough here to talk about some
follow-up next steps from the report, but also I would add,
Madam Chair, I think we need to take on looking at this issue
and put into our report language, looking at the issue of
systemic racism in child poverty.
Because everyone here has mentioned some of these
underlying issues, and until we really bring that forward,
sweep this out from under the rug, we are going to hold the
line on some of the programs. We are going to maybe be able to
do better with some. But we will never be able to address the
disparities with children of color as it relates to poverty.
So I think we need to have something in our report this
year that addresses long-term investments as well as the issues
of poverty and racism. And hopefully, the academy can be part
of this.
So thank you again very much.
Ms. DeLauro. Those are great suggestions, and I also would
like to ask all of you if you would bear with us as we try to
look at some of the recommendations and also try to figure out
how we craft the kinds of policy initiatives that we can moving
forward. You all will be just an excellent resource.
What I was going to say is I don't remember all the
details, but my folks were evicted many years ago, and our
furniture was out on the street at 79 Pearl Street in New
Haven, Connecticut. And I can only recall what the stories are
about what that did and what that meant to my folks in trying
to make sure that they could be gainfully employed and take
care of their only child.
I would like to say this, that you know there are people in
this country years ago who fashioned a social safety net. They
were Democrats, and they were Republicans. They were not naive
people. They were people who realized that as we moved down the
road of industrialization and of moving forward, that they had
the potential of people being left behind. And so what they
tried to do was to put in place the social safety net that
would keep people from falling behind.
And for those who would say that nothing has happened as a
result of those social safety net programs really, quite
frankly, don't look at the data. Let us just look at the data,
and you have--this is in 2018--4.7 million children lifted out
of poverty because of the EITC and the CTC, 1.47 million from
Social Security, 1.38 million from SNAP, 936,000 housing
subsidies, 800,000 school meals, 497 from SSI, 429 from child
support, 216 from TANF, 160 from WIC, 103 from the UI program,
unemployment insurance, 72 from LIHEAP, 27 for workers
compensation. These programs work. They work.
And what we need to be doing is to strengthen these
programs and adding on to them as we go forward and not fall
into our own trap that says that people are not working as hard
as they can and doing what they need to be able to have
economic security.
And that is why what you have done here today, all of you,
I thank you so very, very much for your contribution to this
effort. It means a lot to all of us. And again, I want to thank
Congresswoman Barbara Lee, Congresswoman Lucille Roybal-Allard
for in 2015 having the vision that this would be a direction
that we needed to go in to study what is going on with
childhood poverty.
With that, the hearing is closed. Thank you.
Wednesday, March 4, 2020.
NATIONAL INSTITUTES OF HEALTH BUDGET REQUEST FOR FISCAL YEAR 2021
WITNESSES
FRANCIS COLLINS, M.D., PH.D., DIRECTOR, NATIONAL INSTITUTES OF HEALTH,
ACCOMPANIED BY DIANA BIANCHI, M.D., DIRECTOR, EUNICE KENNEDY
SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
ANTHONY FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND
INFECTIOUS DISEASES
GARY GIBBONS, M.D., DIRECTOR, NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
NED SHARPLESS, M.D., DIRECTOR, NATIONAL CANCER INSTITUTE
NORA VOLKOW, M.D., DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE
Ms. DeLauro [presiding]. The subcommittee will come to
order.
Good morning, all. Dr. Collins, welcome back to the Labor,
HHS, Education Appropriations Subcommittee. Let me also welcome
all of you. We have five institute and center directors who are
joining in this morning. Dr. Bianchi, director of the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development. It is almost as long as the Subcommittee on
Health, Education, Human Services, and Related Agencies here.
So anyway. Dr. Anthony Fauci, director of the National
Institute of Allergy and Infectious Diseases; Dr. Gary Gibbons,
director of the National Heart, Lung, and Blood Institute; Dr.
Ned Sharpless, Director of the National Cancer Institute; and
Dr. Nora Volkow, director of the National Institute on Drug
Abuse.
Again, welcome, welcome, welcome to all of you. Actually,
Leader Hoyer asked me this morning, he said, do you have the
NIH coming? I said, yes, indeed. He says, and are you
ultimately going to be able to get all the institute directors
to come up, and I said, we will. And he said it is one of the
most remarkable hearings that we have, and we thank you for the
great work that you do. And what a difference you make in
savings the lives of the people of this great country.
At the start, let me just touch on the matter of the
coronavirus. I want to just say thank you to the director, to
all of the institutes. I want to just say a particular thank
you to you, Dr. Fauci, and I want to say that our public health
experts deserve our praise for what is the excellent work that
you are doing on what is clearly a matter of national
importance and national urgency, as you know, in so many ways.
Today we will be discussing the 2021 budget request for
NIH, and I want to note that I intend to invite an additional
panel of institute and center directors to testify in front of
the subcommittee later this year because I believe that we all
learn a lot from all of you. That happened with us last
September as well.
Before we get into the NIH's 2021 budget, let me just, if I
can, bring you up to date. I think you know that the committee
has been working hard to develop an emergency supplemental, you
know, to be able to fund the response of this outbreak, and
there are still one or two issues that remain, you know, open.
But with all speed and deliberation, the intent is that, and
the chairwoman can speak to that if she cares to. But we are
looking at trying to move as quickly as we can between today
and hopefully tomorrow, but before the end of this week, to get
this finalized and voted on.
So the funding, you know, includes funding for the NIH. The
funding will support research on diagnostics, therapeutics, and
vaccines. For COVID-19, that will be critical to managing the
outbreak and, again, to save lives. I also might want to note
that NIAID is not starting at square one; rather, years of
building research on coronaviruses and vaccine development. And
I just want to say to the whole subcommittee, to my colleagues
on both sides of the aisle, have invested sustained investments
in biomedical research that the committee has made in recent
years. And I am very, very proud that the Congress has
increased the NIH funding by $11,600,000,000, 39 percent over
the past 5 years.
Last year alone, the Congress provided an additional
$2,600,000,000 increase over the Fiscal Year 2019 level for the
NIH, and this was in a bipartisan, bicameral way that this was
done, and we are very, very proud of that. I know certainly the
ranking member is, and we worked closely together on this
issue. I would just say to you that, you know, I think the
President's budget would reverse this project. The budget
proposes to cut NIH funding by $3,300,000,000, 7.9 percent
below the 2020 level. This would result in NIH making nearly
1,800 fewer new grants to research, a reduction of 16 percent.
This subcommittee will not be pursuing these cuts. We
intend to move forward with a continued increase investment in
NIH to build off that progress that we have made in recent
years, and, again, that will be on a bipartisan basis. I know
that, you know, as I know anything about where we are going and
what we are doing. I am especially proud that the Congress
provided $25,000,000 for research on firearm violence
prevention, including $12,500,000 to the NIH. I was glad to see
that the NIH budget request maintains funding for research on
flu, including on the development on a universal flu vaccine.
However, I believe we need to continue to grow this research as
we did in Fiscal Year 2020, and I look forward to hearing more
about what NIAID will accomplish with these additional funds.
I was disappointed to see a $559,000,000 cut to the
National Cancer Institute at a time of unprecedented promise in
cancer research that has led to more and more promising
researchers seeking NCI research grants. I think cutting the
funding for NCI sends the wrong message. In fact, with only a
few exceptions, the proposed cuts to NIH would touch every
institute, almost every field of research.
Last year, in addition to new funding for several
initiatives, we were able to provide a 3.3 percent increase to
each NIH institute and center. We need to keep up that momentum
and not reverse it. I believe my friend and my colleague,
Ranking Member Tom Cole, will concur. Biomedical research is
one of the most important investments that a country can make
because it gives the gift of life, which we need to support,
and I promise you that we will.
Thank you again for everything that you do, and I look
forward to our conversation today. And let me turn this over to
my good friend from Oklahoma, the ranking member of the
subcommittee, Congressman Tom Cole.
Mr. Cole. I want to thank you, Madam Chair, and thank all
you for being here. Before I get to my prepared remarks, I just
want you guys to know how you span the bipartisan divide that
we have here. I actually made a statement, and it was tweeted
out by Howard Dean last night, so I thought that was worthy of
note. I very seldom get tweeted out by Governor Dean, so I was
pretty proud of that. [Laughter.]
And the statement was, if I am buying real estate in New
York, I will listen to the President of the United States. If I
am asking about infectious diseases, I am going to listen to
Tony Fauci. [Laughter.]
So I think that kind of sums up where we are as a
committee. And I want to commend all of you and thank all of
you for what you have been doing in the middle of a difficult
national crisis, but, more importantly, what you just do day
in, day out, every single day, and the amount of hope you give
people around the world, certainly to our fellow Americans. And
I think you have been extraordinary custodians of the
investment that this committee has made on a bipartisan basis
for multiple years, and I know intends to make again. If we can
find any way to do it, we will do it, and I think we will find
a way to do it.
The current challenge that we have, frankly, is a reminder
that you need to do these things, and you need to do them on a
regular basis. You can't just show up game day and think you
are going to be able to deal with something. You have to have
made the commitments, the investments over a long period of
time to have the infrastructure to do it. I am very proud of
this committee and our counterparts in the United States
because we have done that. I am proud of Congress for this,
quite frankly.
And this is no disrespect to anybody, but this committee
has consistently in the last 5 years gone beyond what any
President of either party asks it to do. And it did that
because Congress, you know, we actually doubled the NIH budget
many years ago. That was actually also a congressional
initiative, if you will recall. I think Congress actually,
because it is very close to the people, has a very keen sense
of awareness of how much your fellow Americans value the
endeavors that go on at the NIH.
So I will go to my formal remarks. After 5 years of
sustained increases for the National Institutes of Health, I am
pleased to welcome once again to this hearing Director Francis
Collins. You must get tired of hearing this, but once again, I
want to commend you, Dr. Collins, on your long and
distinguished career in Federal service. You have left a legacy
of excellence, and it is really an honor to work with you. And
I have said this often, too. You have got to be the best
politician in a town of politicians to get appointed by Donald
Trump and Barack Obama. I mean, that doesn't happen very often,
but, again, I think it says something about the bipartisan
nature of what you do and the national commitment there.
I have made no secret of the fact that increasing funding
for the NIH is one of the proudest bipartisan accomplishments
of this subcommittee. A sustained, steady commitment to
increase NIH funding is critical to ensuring our Nation's
future as a leader in biomedical research and unlocking cures
to so many of the diseases burdening our strained healthcare
system. The hard work and innovation this funding fosters is
part of the sustaining force of the United States' economic
growth.
Leaders in the House and Senate, Democrats and Republicans,
have unified behind these increases over the past 5 years, and
I ardently hope this trend continues for years to come. While I
appreciate and sympathize with the fiscal restraint expressed
in the President's budget, I do not think the reduction
proposed for NIH is in the best interest of the American
people. To reduce the NIH funding at this juncture would erode
the progress we have made, as the chairwoman mentioned, over
the past 5 years, signal to the research community instability,
and, quite possibly, delay by years or perhaps decades advances
in modern medicine, including curing diseases, finding better
treatments for cancer, and unlocking the power of precision
medicine.
I also want to caution against the budget request's
proposed changes to the negotiation for indirect costs, are
funds included as part of the grant to cover facilities and
administration. This critical funding serves as a foundational
element for research, and I support the enacted bill language.
I hope, Madam Chair, we continue that restraint. This is a
false economy that our friends in some quarters have pointed
out, and it is one that will hurt research, not provide
additional dollars. We simply, you know, need to protect the
institutions that we have been investing in.
This past year, we had the opportunity to sit down with
Nobel Prize winner, Dr. Jim Allison. His work on immunotherapy
for cancer treatment promises to chart a course for a new
direction for treatment for our deadliest cancers. The
noninvasive nature and rapid time between treatment and
resuming normal daily life is nothing short of remarkable.
Moreover, these treatments are coming to market faster than
therapies of the past and could take a decade before standard
health insurance reimbursement. New applications for research
in this area are overwhelming available Federal funding, and it
is something I hope we look at very carefully going forward.
Companies have noticed the promise of such methods and are
beginning to invest their own resources as well. Ten years from
now, we may have thousands of cancer survivors that under
today's treatment protocols would not have been helped. It is
stories like this that remind me that support for the NIH has a
real-life impact on life, and that every dollar investment is a
direct downpayment to a better future for millions of Americans
and tens of millions of others around the world.
I also want to highlight the progress we have made on
Alzheimer's disease research. This deadly disease is creating
an enormous strain on the healthcare system, families, and the
Federal budget. It is a rising cause of death and impacting
more and more Americans each year. Total spending on
Alzheimer's will exceed $1,000,000,000,000 by 2050 if it
remains on its current trajectory. We must make progress.
Frankly, fiscally, there is no other option.
I am pleased to learn an international team of researchers,
partly funded by the NIH, has made more progress in explaining
the genetic component of Alzheimer's disease. Their analysis
involving data from more than 35,000 individuals with the late
onset of Alzheimer's disease has identified variants in five
new genes that put people at greater risk of their disease. In
order to tackle the fiscal, emotional, and financial toll that
this disease is having on families, we must have a better
understanding of the underlying genetics.
I do not want to take up additional time recognizing all
the distinguished institute directors before us today, Madam
Chairwoman, because, quite frankly, like you, I would rather
hear from them about the exciting research that they are all
involved in. However, I do want to thank each of you and your
colleagues, and those institute and center leaders who are not
with us for your passion, dedication, and hard work. I believe
the work at the NIH has and will change the course of disease
direction and treatment for many generations to come. I hope
Congress continues to be a supportive partner in these efforts.
Thank you, Madam Chairman, for holding this important hearing.
Ms. DeLauro. Thank you very much. It is now my pleasure to
yield to the chairwoman of the full Appropriations Committee,
and someone who has had just a major role in making sure that
we respond in kind and with alacrity, Congresswoman Nita Lowey.
The Chairwoman. And I thank you, Chair DeLauro and Ranking
Member Cole, for holding this hearing, and welcome once again
our very distinguished guests. I don't know how you are awake,
Dr. Fauci, but----
[Laughter.]
The Chairwoman. It is all those exercise routines.
[Laughter.]
Thank you. Thank everyone because I know it is a team
effort. Let me say at the outset, President Trump's disastrous
budget is filled with deep cuts that tear at the fabric of our
Nation. Instead of building on the historic investments in last
year's appropriations bills, the President doubled down on
partisan talking points. To propose investing $2,000,000,000
for the wall and cutting $3,300,000,000 from the National
Institutes of Health really does expose the Trump
Administration priorities for what they are: political rhetoric
over public health. But as you know, this committee is on your
team, and at a time with surging cases and costs associated
with heart disease, cancer, Alzheimer's and related dementias,
a vaping epidemic, and now the novel coronavirus, this panel's
commitment to NIH will remain as strong as ever.
I would be remiss not to mention that with my retirement,
this will likely be my last NIH budget hearing. I will have to
come and be in the audience. [Laughter.]
And when I think about it, we have come so far since I
joined this subcommittee in 1993. I was a kid then when NIH was
funded at about $10,300,000,000. We committed to doubling the
NIH budget, then more than tripled it. Together, with the great
leadership of this subcommittee, in the past 5 years, we have
had increases at $11,600,000,000, for a total funding level of
$41,700,000,000. And, frankly, every penny was worth it, and we
are so appreciative for all of you, for your talents, for your
hard work, for your commitment. It has really been an honor for
me to serve on this committee.
I do remember touring a lab with a young Dr. Francis
Collins, who had a plan to map the human genome, and I remember
that first map. There was nothing in it. [Laughter.]
And the advances in combatting breast cancer have
revolutionized survivor rates as immunotherapy has given life
to people who would have had a death sentence a decade ago. We
know more about childhood development and the human brain, and
we are witnessing amazing strides in precision medicine. And if
you recall, we now even have some female lab rats. For those
who weren't part of that humor at the time, we were convinced
all the lab rats were male, so I am delighted to know that you
have female lab rats.
Your work has filled me and millions of Americans with
hope. Never in all of human history has medicine had more to
offer, and yet with all these great achievements, we have so
much more to do. I recently came across my questions from an
NIH hearing in 1999 when I asked why women are more likely than
men to have Alzheimer's. We still don't have the answer. In
fact, we don't have many answers to Alzheimer's. I was on a
panel. Lord knows why they asked me to be on a panel. And it
was about 35 of us sitting around a table with one person who
knew what he was talking about, a scientist from Columbia, and
everyone was kind of quiet. And I said, Dr. Gibson, from
Columbia, I said, so what are you recommending? You know, for
many people around that table, there were experts, people who
had been working on this for years and years. And he sat up and
he said, diet and exercise. Dr. Fauci knows that, right? We
have had conversations about that. Actually, so many of you.
But after all the investments, that is really all we are
offering most people when it comes to Alzheimer's. We still
don't know the answer, and we still don't have a method for
early detection of certain cancers. We still don't know why
treatments work for some patients but not others, and we still
don't know why rates of autism are rising, and why there are
higher rates among boys than girls. By the way, if you have
answers to any of these questions today, feel free to share
them with us. This may be up to date, I thought, as of this
morning, but if you have some answers to these questions, we
would love to hear them.
So there is so much we need to achieve, and I can think of
no better people to do it than the people sitting in front of
us today. You have saved lives. You have eased suffering. You
are our superheroes. And with the polarization in our politics,
if the American people could see how we could come together to
fund such important work, I was going to say they would be
proud. They would probably be shocked. But maybe we should
invite more to really understand how bipartisan the NIH is and
how bipartisan this committee is. And that is why we cannot let
a partisan budget request stand in the way of saving lives.
So I thank you all. It is a pleasure for us to welcome you
once again. Madam Chair.
Ms. DeLauro. Thank you. Dr. Collins, I am going to turn to
you for testimony, and as you know, your full testimony will be
entered into the record. And I would yield 5 minutes of time
for your testimony. Thank you.
Dr. Collins. Well, thank you, and good morning, Madam Chair
DeLauro, Ranking Member Cole, and especially Chairwoman Lowey.
I did not realize you were going to make this announcement
about 1993 to today. I think 1994 was the first time I appeared
in front of this committee to defend the Genome Project, so
thank you for that reflection.
On behalf of the National Institutes of Health----
[Disturbance in hearing room.]
Ms. DeLauro. Please.
[Disturbance in hearing room.]
Ms. DeLauro. Dr. Collins, please continue.
Dr. Collins. I do want you to know that the condition, ME/
CFS, chronic fatigue syndrome, is of great concern to NIH, and
these are obviously----
Ms. DeLauro. And if you need time to mention that, please
go ahead and do it, okay, in the course of, you know, the
proceedings this morning. Please, go ahead with your testimony.
Dr. Collins. I would like very much to talk about it at a
later point.
Ms. DeLauro. Yes.
Dr. Collins. Okay. Let me continue. On behalf of the NIH, I
want to thank you, this subcommittee, for that $2,600,000,000
increase in last year's omnibus. The steady increases you have
provided have brought new life to biomedical research and built
a foundation for us to take on new and unexpected challenges,
challenges like the one that is on everyone's mind right now,
the global coronavirus outbreak. Your investments have enabled
NIH to be at the forefront of action against this serious
health threat, and I am quite sure you will hear more about
what we are doing from Dr. Fauci a bit later.
In the meantime, I would like to highlight a few of NIH's
other recent achievements, and maybe I could turn your
attention to the screen. Science magazine announced its short
list of breakthroughs of 2019, three of them supported by NIH.
The first is the lifesaving progress we have made against Ebola
virus disease, including the first effective therapies. Our
second breakthrough, according to Science, was the development
of kids getting specially-formulated foods to combat
malnutrition, taking advantage of what we have learned about
the microbiome. The third is development of a highly-effective
triple drug therapy for cystic fibrosis, or CF.
I am among the legion of researchers who have been part of
a long journey to develop targeted therapies for CF. Yeah, that
is me on the left. [Laughter.]
Ms. DeLauro. Where is the guitar? [Laughter.]
Dr. Collins. It is off in the corner, on the left. Thirty
years ago, when I led the NIH-funded team that co-discovered
the gene for this devastating disease while I was at University
of Michigan. Mutations in that gene lead to dysfunction of a
protein that normally helps maintain the body's balance of salt
and water, and without that, mucus builds up in the lungs,
setting the stage for potentially respiratory infections. The
new triple drug therapy kicks that protein back into shape.
And does it work? Well, take the case of Robin Petras, an
Ohio woman with CF, who recently wrote to me. As these
snapshots show, Robin slept in a mist tent as a child, and her
parents spent hours each day loosening the mucus that clogged
her respiratory tract. Later she became so sick, she had to
give up her beloved teaching career. But just 5 weeks after
starting triple therapy, Robin's lung function improved
dramatically, and she now lives the active life she had always
imagined. She has even set a new personal best: swimming a full
mile in 60 minutes. I could not do that.
She told me this medicine has revolutionized her entire
physical and mental life. What a transformation. Thirty years
of research to get to this point, and a wonderful example of
basic science, collaborations between public and private
leading to his kind of breakthrough. So stories like Robin's
inspire researchers to keep searching for innovative ways to
help folks with all kinds of diseases.
Among the many exciting possibilities is a new generation
of gene-based therapies. At past hearings, I have introduced
you to just a few of those who have been helped by these
therapies, people like Mateo with spinal muscular atrophy;
Janelle, with sickle cell disease. And many of you have met
cancer patients, like Emily, whose lives are saved by CAR-T
cell immunotherapy for cancer.
But we need more breakthroughs. There are about 6,500
diseases for which we know the molecular basis. The pace of
discovery has increased rapidly, yet we still have effective
therapies for only about 500 of those. The latest development
in gene-based treatments, the CRISPR gene editing system,
promises to boost that number. CRISPR provides a precise find
and replace function for DNA, allowing cells to be reprogrammed
to correct disease-causing misspellings.
Five years ago, I never would have predicted this explosion
of opportunities in gene therapy, but actualizing the potential
poses real challenges. Today it can take 2 years to produce the
materials needed for clinical trials of gene-based therapies, a
new one just announced this morning. We can rely on the private
sector to support trials for more common diseases, but for
ultra-rare diseases, which involve tens of millions of people,
NIH must do more to de-risk projects if we hope to enter as
potential partners from the private sector. So to that end, the
President's budget for Fiscal Year 2021 includes a $30 million
initiative for an NIH-led consortium to shepherd development of
gene therapy targets for rare diseases from concept to clinic,
customizing processes for gene delivery, manufacture of
regulatory review, and testing.
To conclude, these are dramatic times for NIH research.
Today I have focused on gene-based therapies, but many other
remarkable advances are on the horizon, advances like
developing vaccines for coronavirus and other infectious
diseases, using science to address our Nation's opioid crisis,
and applying the power of immunotherapy to even more types of
cancer. None of this would be possible without your support.
Because of you, we at NIH are working hard to turn dreams of
healing and health into reality for all. So thank you, and my
colleagues and I look forward to your questions.
Ms. DeLauro. Thank you very much, Dr. Collins, and thank
you for the slides and the stories because that makes it real
in terms of how people's lives have been changed. I lost,
growing up, two wonderful friends with cystic fibrosis, and it
was extraordinary, you know, how we can now save lives in
thinking about what you can do.
Dr. Fauci, I recognize that you have been very, very
generous with your time in providing the subcommittee with
information about NIH's current and proposed activities related
to COVID-19, including basic research, development of
diagnostics, therapeutics, and vaccine. Just kind of a two-part
question. Would you give us a brief update on the latest
developments in NIAID's work in this area? And because, as I
mentioned, NIH isn't starting from scratch with regard to the
research on coronavirus or on emerging infectious diseases, if
you can tell us about how prior investments in NIAID, that
research, have laid the groundwork for what we are able to do
now with the coronavirus.
Dr. Fauci. Thank you very much for that question, Madam
Chair. Yes, in fact, if you look at the fundamental basic
research on molecular virology and the ability, which really
comes from NIH itself and NIH-funded investigators, to be able
to identify a pathogen and sequence it extraordinarily rapidly
allows us to do the things that I will mention in a moment.
This goes back to fundamental basic research on molecular
biology, virology, genetics, et cetera.
Remember, a major first coronavirus that caused the problem
globally was the SARS virus in 2002, 8,000 people and 775
deaths, for a death rate of about 9 or 10 percent. Several
years later, we had the MERS coronavirus, again, causing a
problem in the Middle East. Now we have the third coronavirus.
One of the things that we have been able to do, and the NIH, as
you know, does many things, and we are studying very
intensively the fundamental virology and pathogenesis of the
disease. The things that we are doing right now in the form of
interventions are in the arena of vaccines and in therapeutics.
It is really extraordinary that from the first time the
sequence was made public by the Chinese when they discovered
which virus it was, literally within days, we took that
sequence off the database and inserted it into one of our
vaccine platforms the messenger-RNA in the Vaccine Research
Center at the NIH. And then what we did was a step-wise
approach, to first determine is it immunogenic. Can you stick
it in an animal, and would it make an immune response? The
answer is yes. I predicted that it would be about 2 to 3 months
to go into Phase 1 trials, and I think we are going to beat
that. I think it will be in in probably about 6 weeks, which,
as a matter of fact, will be the fastest that anyone ever has
gone from the identification of a sequence into a Phase 1 trial
of any vaccine that has ever been done. That is the good news.
The sobering news is that since vaccines are given to
normal individuals, what is paramount is safety and whether or
not it works. So we will do a Phase 1 trial. We will do it in a
number of our research centers, including our center at the
NIH. That will take about 3 to 4 months. And then if
successful, which I believe it will be--there is no reason to
believe it won't be safe--we will go into what is called a
Phase 2 trial. The Phase 1 trial is 45 individuals. Phase 2
trials are hundreds if not a couple of thousand individuals. It
would take about a year to a year-and-a-half to be fully
confident that we would have a vaccine that would be able to
protect the American people. And so although the good news is
we did it fast, the bad news is that the reality of vaccinology
means this is not going to be something we are going to have
tomorrow.
In contrast with therapy, if I might say, we have a number
of therapies that were effective in an animal model and in
vitro. We don't know if they work in people, but we have
already started a trial in the United States on a Gilead drug
called Remdesivir in both Washington State, which is having a
problem as you know right now, as well as at the University of
Nebraska, where we have put the people who were repatriated and
brought back. A clinical trial will be done, and if, in fact,
it is shown to be effective, maybe not perfectly effective, but
at least somewhat effective in bringing down viral load, we
would imagine in the next several months, and it will take that
long to do the trial, that we might have an intervention.
So going back from what you said, all the way to the
molecular virology decades ago to where we are right now, I
think that is what we call the proof of the pudding of
investment in biomedical research.
Ms. DeLauro. Thank you. Thank you very, very much. As your
grandmother and my grandmother would have said, lemon and honey
is going to help your voice a lot, you know. [Laughter.]
So maybe a shot of bourbon, I don't know. But in any case,
I have just about 13 seconds left, so I am just going to yield
back my time and get around to my other questions second round.
Mr. Cole. In the spirit of bipartisanship, I want to assure
you that a shot of bourbon can help you, Madam Chair. I have
tested it routinely, and it works very well. [Laughter.]
Dr. Collins, you know, we all are always interested in
stretching these dollars as far as we can and putting money
behind research. But I think one of the smart things we did
last year in a bipartisan and bicameral way was to set aside
$225,000,000 for infrastructure, frankly, and for facilities
maintenance, and we know that does meet your needs. The idea, I
think, the hope would be, we can see where our allocation is,
what we could do. But that would be something we could sustain
on annual basis for a number of years to let you catch up to
where you need to go.
So, one, could you tell us sort of how that $225,000,000
has been used? Two, what would you do if you had additional
funds in the next year of comparable size?
Dr. Collins. Congressman Cole, I really appreciate you
raising this issue because it is critical to the effective
functioning of this remarkable engine of discovery, the
National Institutes of Health and its intramural program. We
have over the course of quite a few years been successively
falling behind in terms of maintenance just because of the way
the funding comes through. We are not allowed to spend money on
buildings and facilities unless it is approximately designated
as such.
And we now add up where we are. We are about $2,100,000,000
in the hole in terms of the kinds of funds that would really
ideally be necessary to keep the place in the kind of
circumstances that you would like to see. And we have had a
number of really major problems in our clinical center, which
have caused quite a lot of difficulties in terms of being able
to take care of patients. I can, if you would like, if it comes
up here, show you a particular example of just some of the
things that you can see have happened in the course of just the
last few months in terms of floods. We have had to close down
big parts of our clinic at times. So we have a big backlog of
need.
The National Academy of Sciences was asked by the Congress
to look at this issue and agreed that we need urgent attention
to this matter. We also believe we need, in order for the
clinical center to be fully effective, to replace our current
operating rooms, which are at risk of having leaking in the
ceiling in the middle of an operation, and that is obviously
something you would never want to see happen. And so we have on
the books already to go a surgery-radiology wing, the cost of
which, though, is about $500,000,000.
What you have done in terms of increasing the support for
this has helped us hugely, and it will help us both with the
backlog of maintenance that we need to pay attention to, but
also to try to build up a sufficient amount of funds to start
that new wing. And it will be greatly much appreciated if that
can be also sustained in Fiscal Year 2021. You saw the
President's budget actually did call this out as a special need
by increasing that number for B&F to $300,000,000. So I know
this is not sexy in the same way as we are going to cure cancer
or are we going to find a new answer for autism. But without
the infrastructure, we can't take care of patients in the way
that they are counting on us to do.
Mr. Cole. The fact that you showed up with slides might
suggest that people coordinated this in some way. [Laughter.]
That would never happen.
Dr. Collins. I never want to miss the chance----
Mr. Cole. Never happen. Dr. Gibbons, heart disease and
stroke are 7 times higher in American Indians/Alaska Natives
than among their white counterparts, certainly in my State,
which has a high concentration. Native Americans actually have
the highest death rate from heart disease in the country. So
could you tell us what the NIH is doing to address these health
disparities and describe some of the progress you have made in
recent years?
Dr. Gibbons. Yes. Thank you for that question that
addresses an important concern and an important health
disparity. As you pointed out, we particularly have concerns
about rural populations, and we recognize that and started a
new cohort study. Our institute started the Framingham Heart
Study over 70 years ago looking at communities to understand
the driving factors in heart disease now taking us to a we now
have a similar new program that is actually called RURAL that
focuses on Kentucky, Alabama, and other areas with large rural
populations. That is where we are seeing actually
cardiovascular disease going in the wrong direction, as it is
with certain populations, American Indians and rural Americans.
Similarly, we are engaged in a group of studies called
DECIPHER, that are taking community-based efforts to address
how to engage communities in the process of creating healthier
communities, recognizing that often there are social and
behavioral and cultural factors. And so that involves a
community engagement strategy. In fact, Dr. Amanda Fretts is
Native American and is now a principal investigator of our
Strong Heart Study, which is based in Oklahoma, the Dakotas,
and Arizona. She is engaged in a project to promote healthier
lifestyles, particularly in American Indian communities, in
fact, taking them into a more traditional diet of fruits and
vegetables, whole grains that we know can help prevent heart
disease. So this is very top of mind and a high priority.
Dr. Collins. Thank you very much. Thank you, Madam
Chairwoman.
Ms. DeLauro. Congresswoman Lowey.
The Chairwoman. Thank you. I think I ask this question
every time, Dr. Collins. Are we learning anything about the
development of Alzheimer's? How far are we from even a
temporary, I won't say a cure, but let me ask you. How far are
we away from a cure or real prevention?
Ms. Frankel. Of what?
The Chairwoman. Alzheimer's.
Dr. Collins. I wish I had a crisp answer to that, but I
would say progress in the last few years has been really
impressively moving forward. We have identified pathways that
are involved in Alzheimer's disease going well beyond the
amyloid and the tau hypothesis, which has been so dominant.
Genetic studies have revealed now about 100 different places in
the DNA that provide a risk for this. And it tells you that
there are things we didn't appreciate, such as that the immune
system is involved here in some way, and lipids are involved in
a way that goes beyond what we knew about before. And the cells
in the brain that are sort of the support cells, the so-called
microglia, are at least as important as the neurons, which have
always gotten all the attention.
All of that has led to in a partnership with industry, the
Accelerating Medicine Partnership, the identification in just
the last year of 52 new drug targets, which are of great
interest to academics and drug companies, and which will lead
us down a whole bunch of new directions in terms of
therapeutics.
But I have to say the amyloid hypothesis is still very much
on many people's minds, even though we have had all of these
failed trials and we don't understand why they have failed.
Please keep in mind, Biogen is still taking the position that
their most recent trial, when they reanalyzed the data, did
look as if it provided benefit to people who got the highest
dose of this antibody against amyloid for the longest period of
time. And they have gone back to FDA, and FDA has been willing
to look at the data again. And watch this space closely. If FDA
decides there is something there, we might actually finally be
in a place where we have a signal of some benefit, and then, of
course, the whole game changes. There is a huge difference
between having everything fail and have something work a little
bit because then you can build on that, and we are all watching
that closely. So it is really all hands on deck.
NIH is running now over 200 clinical trials, not just about
drugs, but also about preventive interventions. The SPRINT MIND
study, which Gary Gibbons could tell you more about, has
definitely shown that reducing blood pressure seems to be a
good way to prevent the onset of dementia in susceptible
individuals. Vascular contributions are really important here.
We are pretty sure that physical exercise helps. We are pretty
sure that cognitive exercises are also of benefit. I wish I was
able to say that with absolute certainty. So we are making
progress, but let's make no mistake, this is a really hard
problem.
The Chairwoman. Okay. I will ask you next year. I will
write you a letter next year. [Laughter.]
Can I come as a guest? Okay. Dr. Sharpless, another one of
my favorite issues because it has been so disappointing. Are
there any advances that have been made in early detection and
treatment for kidney cancer?
Dr. Sharpless. Yes. We think the incidence, in fact, of
kidney cancer has gone up modestly related to improved
detection, so finding smaller lesions earlier. This provides
some challenges because when you start detecting very small
cancers, we already worry about this issue overdiagnosis and
overtreatment in detecting really, you know, dangerous cancers
as opposed to the more indolent type.
But I think that kidney cancer is an important human cancer
where we have made some progress, but there is more to be made.
It is not one of our most outstanding successes in the cancer
world. Immunotherapy has some role for these patients. In terms
of early detection, we are still considering a number of
approaches, including, I think perhaps the most promising right
now in addition to imaging is, you know, the ability to detect
nucleic acid in the blood, so blood tests for something like
kidney cancer and other related cancers. So we have a number of
approaches, but stay tuned. It is still early.
The Chairwoman. Well, my time is running out, so I am sure
Dr. Gibbons and Dr. Volkow, you all know about the rising rates
of e-cigarettes, particularly among young people, which is just
startling. Okay. If you want to make a quick statement, and
then we can go back and get into it because I am really
concerned about the incredible rates.
Dr. Volkow. And I think we should be concerned. In 2018, we
saw a doubling in 1 year of the number of kids that were vaping
nicotine, and in 2019, we saw a doubling of the number of kids
that were vaping THC. So the concern is, of course, that these
kids are becoming addicted both to THC and nicotine, and we may
lose the big battle that we have won over combustible tobacco
with all of the adverse consequences. So, yes, we should be
very concerned.
The Chairwoman. So we will save it for the next round. I
don't want to overstay my welcome. Thank you.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you very much, Madam Chair. And, Dr.
Fauci, I am surprised you have a voice left at all. [Laughter.]
You appear to have been everywhere. You must have, like,
twins or something. You are everywhere. Let me ask you a
question about, because you used the word ``the sequence'' for
the coronavirus-19. And that is the one, I take it, that the
Chinese have shared, that sequence. My understanding is that
they have also been unwilling to share other samples of the
virus, that that sequence is just one place in time.
Dr. Fauci. Right.
Mr. Harris. And that it would be useful to know to see
other samples. Is that true? I mean, from a scientific point of
view, is that something that would be useful?
Dr. Fauci. It would be useful, but we are mitigating that
problem, Dr. Harris, because we now have unfortunately enough
cases of our own.
Mr. Harris. Correct, and that is of concern to me, you
know, that the Chinese did not share that because, I don't
know. Look, in this instance, days or weeks might be very
important, and I am afraid that we might have lost days or
weeks because of China's unwillingness to share those early
case samples. Now, the fatality rate is, of course,
controversial because who just announced that they think it is
3.4 percent. You have been, I think, quoted in the New England
Journal of Medicine a few days ago that, well, it is probably
less than 1 percent.
Dr. Fauci. No.
Mr. Harris. Where do you think it is going to end up
because we don't know the denominator.
Dr. Fauci. You said it, sir. If you look at the cases that
have come to the attention of the medical authorities in China
and you just do the math, the math is about 2 percent. If you
look at certain age groups, certain risk groups, the fatality
is much higher. As a group, it is going to depend completely on
what the figure of asymptomatic cases is. So if you have
asymptomatic cases, it is going to come down.
What we are hearing right now on a recent call from the WHO
this morning is that there aren't as many asymptomatic cases as
we think, which may then elevate, I think, what their mortality
is. You know as well anybody that the mortality for a seasonal
flu is 0 percent. So even if it goes down to 1 percent, it is
still 10 times more fatal.
Mr. Harris. When we will know with our own data, do you
think?
Dr. Fauci. We will know, I hope. I am torn, Dr. Harris,
because if we get enough data to have a big ``N,'' it is going
to be bad news for us, but we are learning more and more. The
thing that is encouraging is that as part of the WHO umbrella
team that went to China finally after a long period of time,
there were two U.S. individuals on there, one from the CDC and
one from the National Institutes of Health. He has come back.
He is now in self-isolation in his home, but he is going to be
giving us a report pretty soon about that. You know him. Cliff
Lane. He is the individual who is my deputy. And I think we are
going to get the information you need.
Mr. Harris. Good. Well, thank you. Dr. Collins, a couple of
questions about data and information sharing. In your budget
justification, it said the NIH is in the process of updating
its data sharing policy. I am curious if you have any
information on the amount of data that is indeed shared by NIH
grantees, and whether you believe mandatory sharing of data
should be a requirement of all those receiving granting. And a
related question. The Administration has suggested that, you
know, if someone receives Federal funding, the published
research should be available free upon publication, not a 1-
year waiting period, but free upon publication. So could you
comment on those two, what I would call, you know, just kind of
transparency issues regarding Federal funding?
Dr. Collins. Those are very much on our mind, Dr. Harris.
And certainly in terms of having our grantees share the data
that they have generated with public funds, we feel very
strongly that is part of their responsibility. And certainly
the data sharing policies that we have been putting together
make that increasingly clear. There are some legal limitations
on our actually making that a mandate, but we can certainly
put, in terms of a term and condition of the award, that that
is the expectation, and we can monitor that to see if, in fact,
it is happening.
With regard to publications, we also believe that if the
public is paid for science, that science ought to be accessible
to people who are interested in looking at it. As you know,
this is a controversial topic because some of the journals
would find this to be an existential moment for them if
everything was free immediately. We are working in that
direction. We have for a few projects, like the Cancer
Moonshot, like the HEAL Initiative, required that everything
that comes out of those projects has to be accessible at the
very moment that is published without any charge or any
firewall, and that is a signal of where we want to go
eventually. But this is a complicated negotiation.
Mr. Harris. That is right, but is it your feeling that it
would be an existential threat, or that the journals could
probably find a way around it?
Dr. Collins. I think all the journals are looking at
options that they might try to adopt as alternatives to those
that require complicated and expensive journal subscriptions.
Mr. Harris. Thank you very much. I yield back.
Ms. DeLauro. Congresswoman Lee.
Ms. Lee. Thank you, Madam Chair, thank you, Ranking Member,
for this hearing. Thank you, Dr. Collins. Thank you for your
team. It is always good to see you. And I associate myself with
the remarks of everyone who has talked about the importance of
continuing with our bipartisan work because, really, you are in
the business of life saving and life affirming, and just thank
you for everything that you are doing.
Of course, you know I have focused a lot on the National
Institute of Minority Health and Health Disparities, and
unfortunately I see this $30,000,000 cut. The request,
$305,000,000, and the enacted level was $336,000,000, it is a
$30,000,000 cut. Now, we know there are many disparities as it
relates to communities of color when you look at the
disproportionate rates of lupus, and thank you very much for
following up with our request on lupus in terms of an action
plan, higher rates of Alzheimer's among older African
Americans, sickle cell disease.
In many ways, I feel like I have received a medical
education from all of you because so many of my family members,
friends, and community suffer from multiple sclerosis, COPD,
lupus, sickle cell, HIV and AIDS, the A1c test, diabetes and
sickle-cell trait relationship. So I personally, like most
members, have gotten into the weeds on a lot of these diseases,
and we have put in budget requests and language. And I want to
thank you for being responsive and for bringing forth the plans
that we have asked for.
So in terms of these cuts, I am curious with regard to what
the $326,000,000 cut to the National Heart, Lung, and Blood
Institute would do in terms of our COPD action plan. Also the
cut, again, in the National Institute for Minority Health and
Disparities, the $30,000,000 cut, and over and over. I could
talk about these cuts as it relates to, you know, some of these
diseases. Multiple sclerosis. The BRAIN Initiative, I believe
there is a cut of about $40,000,000. So can you just kind of
tell me how you are going to deal with this if these cuts, in
fact, go through?
And then my second is, and I want to thank you for the
report as it relates to the ``Growing Absence of Black Men in
Medicine and Science.'' And we are working very closely now
with partners in this. And I wanted to ask you with regard to
the Common Fund, how can we support more comprehensive work
because this is outrageous in terms of what is happening to
black men in medicine and in the sciences. And how we can help
fund the National Academy of Sciences based on their roundtable
work that they want to continue, and can we look to the Common
Fund? Unfortunately, I see a cut of under $96,000,000 less. No,
I am sorry, $42,600,000 than 2020. So we can kind of talk about
how we are going to address these issues within this budget?
Dr. Collins. There are so many important questions there.
Let me just try, because I know time is short. With regard to
what NIH does when we encounter a circumstance of really
significant resource constraints, I think all of the people at
the table would agree with me that we try to still identify
what our priorities are and try to protect those as much as we
can. We look around to see if there are things that could be
slowed down without quite as much of a serious impact, but it
is painful to try to do that. And every one of the areas you
talked about, we would have to struggle with exactly that kind
of priority setting.
I am really glad you raised the issue about our workforce
and the need for more representation from underrepresented
groups. Our workforce does not look like our country, and it
should. I want to mention, and this is something that you
brought up in terms of the Common Fund, the program called the
BUILD Initiative, which is a way in which we are making it
possible for people from traditionally underrepresented groups
to have a real scientific experience as undergraduates, which
is how you actually capture the attention and the imagination
and the passion of young people.
And that program, which has now been going on for 4 or 5
years, is actually looking very promising. None of these
programs we do would be done without really evidence-based
analysis. We are not going to support things that don't work.
We also have supported a National Mentoring Network for people
who may not be, like me, a white male who would naturally have
a network that they could depend on. That has also turned out
to be quite positive.
You are right that maybe an area we are particularly
worried about is African-American men. We have a recent
initiative we are discussing with the NCAA about how to
interest athletes in science and provide them with scientific
opportunities, like summer internships in a research lab, so
that that will be seen as a more attractive possible career
path with mentors and role models that they can learn from. So
we are all over this.
Ms. Lee. Dr. Collins, would it be possible to work with
your team to present new strategies, new ideas, and see if we
can develop some broader partnerships that would actually
enhance what you are doing?
Dr. Collins. Absolutely. We are closely aligned with the
National Academy on this topic, and they have been very much
partners, and we would like to build on that and do even more.
Ms. Lee. Okay. Thank you very much. We will follow up.
Ms. DeLauro. Congressman Moolenaar.
Mr. Moolenaar. Thank you, Madam Chair, and thank you all
for being here. Good to see you all again, and, Dr. Collins, I
appreciate your many years of service. I wondered if you and
also Dr. Sharpless could talk briefly about the President's
Childhood Cancer Initiative. That is something that I know we
funded, and I just wondered if you could give us an update on
that.
Dr. Collins. Dr. Sharpless is ideally suited for that.
Dr. Sharpless. I would be happy to take that. You know,
childhood cancer is an area where we have seen significant
progress over the last few decades, but we still have a ways to
go. There are still clearly too many kids dying of cancer in
the United States, and even the kids we are able to cure are
often left with lifelong survivorship challenges because of
significant surgery, and radiation therapy, and chemotherapy.
So it is an area where we need clear progress. And the
Administration announced this is a top priority of theirs to
make progress in childhood cancer, and the President announced
this initiative at the State of the Union more than a year ago.
And now Congress has appropriated the funds, and we are
tremendously grateful for that important devotion of effort and
resources to this topic.
So it is under way. We have sort of convened a lot of the
thought leaders in the community about how to make progress
most expeditiously in childhood cancer. We have charged the
working group to come up with ideas, and we are well under way.
The focus here is on sort of how to use data better for
childhood cancer and sort of radical data aggregation. I
suspect, for example, we would be able to create a registry
that has data on every child with cancer in the United States,
and in terms of outcome and follow up, that will be a
significant improvement over what we have now. So it is a very
exciting initiative that is really getting started.
Mr. Moolenaar. Okay. Thank you. And Dr. Volkow, I wonder,
in the past, you have discussed efforts to develop non-opioid
alternatives to help manage both acute and chronic pain. I
wonder if you could give us an update on the status of that
research and some of the innovative approaches that might be
coming down the pipeline.
Dr. Volkow. Yeah, thanks for that question. And indeed the
general support from Congress that gave us $500,000,000 to our
base to actually study and address interventions in science
that can solve the opioid crisis has enabled us to advance
enormously our investments in understanding pain, transition
from acute and chronic, but also to develop new therapeutics,
and to determine what implementation we can currently do to
help patients that are suffering from chronic pain.
As a result of that, there are several projects that have
emerged, including the creation of two networks. One of them
will enable the development of new molecules and testing, and
the other one will enable the testing in patients with pain of
the interventions. And this is done with industry, with
partnerships with industry so that we can help accelerate, but
also with academic centers.
And this has been an incredibly challenging area to develop
treatments that are as effective for pain, but safe, and that
is why it is so incredibly relevant that we create the
partnerships with the pharmaceutical industry. I mean, Francis
has taken a lead on this, and I don't know if there is anything
else, Francis, that you think is worth mentioning.
Dr. Collins. No, I think you have said it well. I would
like to emphasize, this is another all-hands-on-deck
circumstance where 20 of the NIH institutes are getting
together to work on this initiative we call HEAL, which stands
for Helping End Addiction Long Term, and for that, we need to
have non-addictive, but effective, pain medicines. And we are
working quite quickly in that space, recognizing it is a really
hard problem.
Mr. Moolenaar. Thank you. Dr. Fauci, we have been talking a
little bit about the coronavirus, and I wondered if you could
comment some of the partnering that NIAID has been doing with
BARDA on the development of medical countermeasures for these
threats in general, biological and pandemic threats.
Dr. Fauci. Yes. Thank you very much for that question. It
transcends the coronavirus certainly because, you know, the
NIH's fundamental mandate and work is in fundamental basic
research and its translation into translational research, which
is then translated into a product for intervention. And if you
look at the things that are now out from a number of diseases,
from HIV, to Zika, and now to coronavirus, it is essentially a
process where we do the initial fundamental research, bring it
to its early stage of development, usually in a Phase 1, and
hand it over to BARDA.
What BARDA does, they get their resources and partner
predominantly with either biotech companies or larger
pharmaceutical companies to make a product based almost
invariably, in fact, if you look at some of the things that
have now come out with products, almost every single one of
them, with few exceptions, has NIH fingerprints on them from
the very beginning. So I think it is really a nice marriage and
part of the continuum from the fundamental research for the
product, and it has worked very well.
Mr. Moolenaar. Thank you very much. Thank you, Madam Chair.
I yield back.
Ms. DeLauro. Congressman Pocan.
Mr. Pocan. Thank you very much, Madam Chair, and thank you
all for being here. Dr. Collins, thanks for having all your
colleagues here. I think the single easiest thing to say is it,
and it is totally a tribute to all your work when you see the
bipartisanship when this comes forward. When our ranking member
was the chair of the committee or Ms. DeLauro, we as Congress
increased funding to NIH, and I think it just shows how much we
all value everything you do. So thank you.
And I just want to say thank you so much for updating the
statistic, and I will mention it because I think it is good for
every to know. We used to have, how many drugs were approved, I
think, in a 6-year period that had NIH support, and it was
every single drug. You just did a 10-year period. We look back
going through 19 of the 356 drugs approved by the FDA, each and
every single one had support from the NIH, and that is our tax
dollars. So thank you for updating that number, and I think it
is something, as we talk about drug pricing and other issues,
it is very, very helpful.
I feel like I would be doing legislative malpractice,
however, if I didn't talk about the coronavirus, especially
with Dr. Fauci here. I want you to know I follow you very
closely. I have enormous respect for what you say. I have been
following Scott Gottlieb and have enormous respect for him. I
have been following the World Health Organization trying to get
some various sources on this. And I have to be critical in one
area, and I would love you to help maybe talk me off the ledge
on this, but I don't know if you can, is the lack of how we are
handling testing right now, the fact that all of a sudden, CDC
has dropped keeping track of how many people we test.
We had someone this morning talk to us who was part of the
Ebola response. Their comment, and I will paraphrase, is, you
know, when you don't even know what you don't know, that is not
a great place to be, and trying to figure out how to deal with
things, and the fact that if we start not keeping track of
this, the amount of tests and who we are testing. We should be
much more aggressive, I believe, in my opinion. We should be in
the hospitals. Anyone who has got a pneumonia that we can't
necessarily identify, we should be testing, because otherwise
medical professionals need to know. I just feel like this is
one area. You gave me great response on where we are on finding
something to help, whether it be treatments or otherwise, a
vaccine. I feel like this is one where we are dropping the
ball, and I do want to get to another question, but let me ask
you on this particular one, talk me off the ledge. I am nervous
that we are not keeping track of who we are actually testing
and the fact that we are not more aggressively testing.
Dr. Fauci. Well, I am not going to try and talk you off the
ledge because you are making a good point.
Mr. Pocan. Okay.
Dr. Fauci. Push him off. [Laughter.]
No, it is less the keeping the track of the test, sir, than
it is making the tests available and withdrawing the
restrictions on who can be tested. So let me explain because
this is really an important issue.
Mr. Pocan. I just want to leave a minute for the other
question.
Dr. Fauci. Okay. So the issue is the tests from the CDC
were for public health components, State and public health
groups. They would have to give it to them. The test result
comes back from the CDC. That started off with some technical
problems which delayed the test going out. The major issue that
I find, and many of my colleagues find, problematic is that if
you are looking for people in the community who don't have a
recognized link to a case, we call it community transmission,
then you have got to withdraw the restrictions that in order to
get a test, you have to have a link to something. It is almost
inherently contradictory. Those have been lifted. The FDA has
taken the constraints off, and now we finally have companies
that are going to be making many, many more tests.
Mr. Pocan. But should we be proactive in testing,
especially in hospitals and places like that, rather than
waiting for people to come and be tested?
Dr. Fauci. Yes.
Mr. Pocan. Okay, because I just feel like that is one of
the components----
Dr. Fauci. The answer is yes.
Mr. Pocan. Okay.
Dr. Fauci. And I feel strongly about that.
Mr. Pocan. Thank you. I love when I get a one-word answer.
Maybe you could meet with Secretary DeVos and explain to her
yes or no questions. The second area, I am worried about supply
chain. You know, I just read China Rx because Rosa told me, and
now I have got Mike Gallagher, one of my colleagues on the
Republican side from Wisconsin, you know, I think is going to
read the book next. I am concerned about, you know, the fact
that, as we have had the conversation previously about this,
the number of either drugs that are made, active ingredients
that are made, I would add medical devices that are made in
places like China, and I don't know. Do we really know what
that supply chain is with the various companies?
We did a letter this morning, Pramila Jayapal and I, to, I
think, the top 20 or so prescription drug companies and are
asking this very question. But do we keep track of this
anywhere to know how many of the drugs are made in places like
China, and where we could be for potential shortages in a case
like this?
Dr. Fauci. I believe that the FDA does, and, in fact, your
concern is one that we have been talking about as part of
pandemic preparedness for years. When we put together the plan
back in 2005, we said one of the real problems is supply chain.
I was somewhat, I would say, impressed/shocked that something
like 90 percent of the fundamental ingredients that go into
many of the drugs, not the actual drug itself, comes from
China. So that is a real problem, and I don't have any answer
for you. It is not anything that we do at NIH, but it is
something that impacts us.
Mr. Pocan. Can I ask one really, really quick follow-up?
Should we be tracking active ingredients in medical devices as
well, supply chains?
Dr. Fauci. I would imagine yes, but, again, that is out of
our purview.
Mr. Pocan. Thank you.
Dr. Fauci. Thank you.
Ms. DeLauro. We will do a hearing or a briefing with
Rosemary Gibson, China Rx, so that we can talk about that.
Congresswoman Herrera Beutler.
Ms. Herrera Beutler. Thank you, Madam Chair, and I am glad
Mr. Pocan asked about this. This is one yesterday when I was at
the White House I asked Vice President Pence about, the supply
chain issue. And I know in the last number of months we have
heard ``we're fine,'' ``we're fine,'' ``we're fine,'' ``we're
fine,'' or weeks, and then this last week, we started to hear,
well, there are some concerns. I think February 27th was the
first time that a prescription manufacturer noted that there is
a supply chain issue with regard to the coronavirus, and we
have already seen shortages for unknown reasons, of things like
immunosuppressive drugs.
And this is an area that I am very focused on seeing what
the solutions can be in the short term, because people say go
get 3 weeks of your prescription. Well, if your prescription is
being rationed, you can't do that. So there is now in the, you
know, year that we are going to be dealing with maintenance and
treatment of this virus. What should we be doing? What can you
see? And then obviously there is the big picture. You talked
about needing to fix the supply chain overall for preparedness.
Could you speak to that?
Dr. Fauci. Well, the supply chain problem is, as you know
very well, a long-term problem that has been brought to our
attention multiple times. And then when you have something like
this, you realize you have a supply chain problem which you
cannot fix immediately, and there is no real easy fix for it. I
don't have an answer for you, but maybe this would be a lesson
as we go forward that, as I have said to this committee many
times, this isn't the first nor the last emerging microbe that
we are going to be confronted with. And one of the issues that
is vulnerable when you have an emerging infection is getting
cut off from things that we depend on from other nations. I'm
sorry, I can't tell you what to do tomorrow or next month, but
maybe we could talk about the future and how we might turn the
knob a little bit.
Ms. Herrera Beutler. I am interested in that. I want to
hear about the future and how we can change the big picture. I
do think there are some immediate solutions that I am going to
be asking the Administration to be considering and the
different task forces to make it easier for people to access
their prescriptions. Maybe it is even accessing a brand that is
available over a generic that is not available, and how can we
help make that cost effective for patients and hold them
harmless. That is an area that I am looking at for in the
immediate short term because people need to have access,
period.
You know, the other thing I wanted to ask about is, and I
don't know if you can speak to this. So being from Washington
State, in my districts on the coast, I am in between Seattle
and Lake Oswego. Obviously people at home are very attuned to
what is happening. The State has requested, and, you know,
there has been a lot of coordination. I have been on the phone.
The governor is talking to the Vice President, is talking to
the task force, talking to our senator. Like, everybody is
mobilizing, and I am very proud of our public health response.
I am grateful for the CDC, and even FDA folks were on the plane
immediately, so we are moving forward.
One of the things that was asked, and it is kind of around
the strategic national stockpile, which is not necessarily
under your jurisdiction, but perhaps you could speak to. We
have made a request for personal protective equipment. I think
only about half of that has been let to us as a State. And then
also what is your opinion about expanding CDC testing criteria,
because I agree. I actually think, so the State can only test
certain amount of folks. We needed it in the commercial labs
available for people to go in and test. Would you support
expanding that criteria so we could get more people access?
Your thoughts.
Dr. Fauci. Yes, I would support it. Expanding criteria
means withdrawing restrictions. That is the point----
Ms. Herrera Beutler. I just want to hear it another way.
[Laughter.]
Dr. Fauci. Okay.
Ms. Herrera Beutler. I think we can't say it enough.
Dr. Fauci. Yeah, right, and I feel very strongly about
that. Washington has a very good public health group.
Ms. Herrera Beutler. Mm-hmm, we do.
Dr. Fauci. They have put together a test that they have
done. They have been able to do it. They need help. They need
support. I was on the phone late into the night last night with
my colleagues from Washington, and we really do need to act
aggressively there.
Ms. Herrera Beutler. When you say ``help'' and ``support,''
give me specifics.
Dr. Fauci. For example, they are doing contact tracing on
in the nursing home outbreak. Now if they find out that it is a
community out there, they are going to have to do contact
tracing on that. They are stretching their resources, and that
is an issue.
Ms. Herrera Beutler. So backfill support obviously----
Dr. Fauci. They need some help.
Ms. Herrera Beutler. And they need----
Dr. Fauci. I think, in fact, I am certain. Not that I
think, I am certain the CDC is right now as we speak helping
them.
Ms. Herrera Beutler. That is my understanding, but it is an
evolving situation.
Dr. Fauci. I was on the phone with them last night, so that
is the reason why.
Ms. Herrera Beutler. We appreciate that. Thank you, Madam
Chair.
Ms. DeLauro. Thank you. On the supply chain issue, I would
hope on a bipartisan basis that we could take a look, which is
not the subject of this committee, but advanced manufacturing
and what we can do in the long term on manufacturing those
ingredients here rather than in China. And I think that is well
worth our time and effort to take a look at. Congresswoman
Frankel.
Ms. Frankel. Thank you very much for being here. All right.
So I just have to ask you some supermarket questions. So people
think, like, when I go to the supermarket, people think that
members of Congress should know everything, all right? So these
are very simple. So one of the questions I get is if the
coronavirus is just cold symptoms, well, that is what we hear
on the news.
Voice. No, flu.
Ms. Frankel. Okay. More like the flu. Okay. I guess the
question I have is how long does it last, and what makes it so
serious?
Dr. Fauci. It isn't a common cold. The confusion is that
about 10 to 30 percent of the common colds that you and I and
everyone else get during a season happen to be a coronavirus,
but a certain subset of coronaviruses can cause extremely
serious disease. They did it with SARS, they did it with MERS,
and now they are doing it here with the novel coronavirus. The
reason it is serious is that, a question that was asked by Dr.
Harris, is that the mortality of this is multiple times what
seasonal flu is. So seasonal flu spreads widely. The mortality
is 0.1 percent. Right now in China, the mortality for this
particular infection, the latest report, was 3 to 4 percent. It
might be a little bit less.
It isn't a cold. It is very interesting that most of the
common colds are upper respiratory infections. This virus, not
to get too technical, the component of the virus that binds to
a receptor in the body to allow it to infect, those receptors
are rich in the lung. That is the problem. It binds to it, so a
person can present no sneezing, no sinusitis. Fever, shortness
of breath, you do a chest X-ray, and you have pulmonary
infiltrates. That is not the common cold.
Ms. Frankel. Okay. Well, thank you for that. Now I will
have a better answer for people. Next question, if you are able
to comment on this. In terms of your research, is there
anything that you think the FDA can do to speed up your
research? I see a shaking of the head by Dr. Collins.
Dr. Collins. You are referring to coronavirus specifically?
Ms. Frankel. Or any drug that you have been researching.
Dr. Collins. So we work very closely with the FDA. We
actually have a Joint Leadership Council.
Ms. Frankel. Maybe this a better question. Is there
anything that we can do to speed up the FDA? Yeah.
Dr. Collins. Well, Tony, maybe you should say specifically
with coronavirus because FDA has been all-hands-on-deck in that
space and has been very recently pretty actively enhancing the
ability to do laboratory tests.
Dr. Fauci. I don't think there is anything that you could
do to speed up the FDA. Quite, frankly, they may need more
resources to do the kinds of things they are doing. That is
right, Madam Chair. But we have very good relationships with
them. They have been very, very cooperative and collaborative
with us in trying to get these countermeasures out as quickly
as possible without cutting corners that would impact safety
and our ability to evaluate efficacy.
Dr. Collins. Maybe the former acting commissioner of the
FDA might want to answer this question as well since he is now
the head of the Cancer Institute. So, yeah, what could the
Congress do to help the FDA there, Ned?
Dr. Sharpless. Yes. To answer your question, I am here as
NCI today. I don't really want to speak on behalf of the FDA, a
different Federal agency. But I think, you know, a challenge
like this is really trying for the Food Drug Administration
because it is so sudden, and this sort of machinery is built to
be deliberative. I think probably, you know, the device
centers, decision-making about making these LDTs, the lab-
developed test, more widely available and releasing those
restrictions is a really important development that I think the
academic labs will be able to bring these tests up to speed
very quickly. I think they are definitely going to need more
funding.
I think they have some significant hiring challenges in the
FDA that I worked on a lot. 21st Century Cures gave them a new
hiring authority that was much appreciated, and I suspect they
will be using robustly. But they are really great people, and I
am sure they are up to the task.
Ms. Frankel. I think I am running out of time. So one more
question on Alzheimer's. Is private industry doing any research
because I have always heard that because it is so expensive,
that they really are cutting back on that.
Dr. Collins. They are, but it is not all companies. Again,
I have the privilege of serving as the co-chair of the
executive committee of what is called the Accelerating
Medicines Partnership, which is focused on Alzheimer's as well
as rheumatoid arthritis, lupus, and diabetes. And there are
five companies there that are invested in this in a big way,
and they have been willing to put their funds as well as ours
together into a partnership where all the results are open
access. But it has been concerning that a number of other
companies have ceased working on Alzheimer's disease because of
so many clinical trial failures. We need them to come back. I
mentioned earlier we have more than 50 new drug targets. We are
trying to encourage them to get interested again.
Ms. Frankel. Okay. Thank you. I yield back.
Ms. DeLauro. Congresswoman Bustos.
Mrs. Bustos. Thank you, Madam Chair. Well, first of all,
thank you for answering so many of the questions that we have
around coronavirus, but I am going to actually switch topics.
Is that okay? [Laughter.]
So I am from Illinois. The congressional district I serve
is 14 counties, goes up to the Wisconsin State Line. The
Mississippi River is on the western part of my district and
then goes into central Illinois. Eleven of the 14 counties are
rural, and then we have the population centers of what we call
the Quad Cities, Peoria and Rockford. So each of these counties
and communities face the unfortunate circumstances that can
lead to negative health outcomes, probably like almost every
congressional district in the in the country. And, as you know,
these are called social determinants of health, and I am just
going to give you a few examples.
In Peoria, Illinois, we have got a problem with food
deserts. And I heard a story from a person in my district, it
takes them 16 bus stops to be able to access fresh fruit and
vegetables. Sixteen bus stops. And then in Rockford, Illinois,
Congresswoman Lauren Underwood just came to my district. She is
the co-chair of the Black Maternal Health task force, and we
brought her in so we could bring health professionals together
and find out why in the State of Illinois black women are 6
times more likely to die as a result of pregnancy-related
conditions than white women. So it is something that, again
social determinants of health. How do we get to this?
We have a hospital in my district that took them 7 years to
hire a primary care physician. Seven years. And then we have
just closed within the last year the obstetric services out of
Pekin, Illinois and Galesburg, Illinois. So those are some of
the examples that were facing. So along with Congressman Cole,
we introduced the Social Determinants Accelerator act. I am
very proud that we have gotten that out there.
But here is what I had like to ask you, and maybe, Dr.
Collins, you can start, but I would love to hear from the rest
of you on this. The National Institute on Minority Health and
Health Disparities has a strong focus on social determinants of
health, but each of your institutes obviously has skin in the
game on this. So I am wondering if you can talk about how you
are together addressing this, what I can take away from this. I
love the powerhouse that we have sitting in front of us, and
that is what I would like you to focus on for the couple
minutes that we have here.
Dr. Collins. And it is a wonderful topic, and, in fact,
every one of the NIH institutes, as you say, has skin in the
game in various ways, and I could give you many examples.
Because of the time, maybe I will first ask Dr. Bianchi to say
what we are doing in terms of this very thorny and difficult
and important issue of maternal mortality, which is
particularly a problem of health disparities.
Mrs. Bustos. Thank you, Doctor.
Dr. Bianchi. Thank you. NIH really shares your concern. The
problem that we have is, although maternal mortality is rising,
it is still a relatively rare event, so it is very difficult to
study it. There are only about 700 women. That is too many, but
it is hard to study 700 hundred a year. We are focusing on the
so-called near misses. In addition, there are 50,000 more women
who are near misses, and these women can help us to identify
differences in survival. Why do these women survive whereas
there are others who do not?
We also really need to understand why is there a difference
in African-American women, as you mentioned, but also American
Indian women as well as Alaska Native women, who all have
higher risks of mortality, as well as all women over age 40. It
is also important to recognize that maternal death doesn't just
encompass pregnancy, labor, and delivery, but it encompasses
the full year after delivery.
Mrs. Bustos. Right.
Dr. Bianchi. And so we have to connect obstetrics with
internal medicine. Pregnancy puts a stress on a woman's body,
as you know. It unmasks comorbid conditions, such as diabetes,
depression, and heart disease, so it is really an opportunity
to intervene. Dr. Collins has put up the slide because we are
now developing a trans-NIH initiative that is going to be known
as IMPROVE. This is the first time you have heard about this.
It is implementing a maternal health and pregnancy outcomes
vision for everyone.
It has two components. One side on the right is the
foundational biology part, which is really aimed at determining
predictive biomarkers as well as novel technology, and on the
left, there is a social and biobehavioral aim. It is very
important to connect the communities not only to hear from them
what they need, but then to be able to implement some of these
changes.
Dr. Collins. Everybody could tell you more about it, and I
am sorry because of the time I can't call on the other folks at
the table, but we would love to talk to you more about this.
This is a very high priority for us.
Mrs. Bustos. Okay. We will set aside some time where we can
talk outside of this hearing, but thank you very much. I
appreciate your perspective on that. I yield back.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. I yield to Congresswoman----
Ms. DeLauro. She wants to yield to you. Go for it.
Mrs. Watson Coleman. Can you take that 33 seconds off my
time?
Ms. DeLauro. Go for it.
Mrs. Watson Coleman. Good morning, everyone. Thank you for
being here, and I am so sorry that I missed a lot of the
testimony. I think that you do important work, and I thank you
for the service that you provide. Dr. Fauci, you said that do
support proactive testing.
Dr. Fauci. Mm-hmm.
Mrs. Watson Coleman. True? Right.
Dr. Fauci. Yes.
Mrs. Watson Coleman. So what does that mean? Why are we not
doing it, and what does it mean, and who would be tested, and
under what circumstances?
Dr. Fauci. We are beginning to do it now. It was not
implemented earlier, and----
Mrs. Watson Coleman. What does that mean, though?
Dr. Fauci. Proactive testing means when you have community
spread where you do not have a known index case. So let me give
you an example of what non-proactive is, and then it will be
easy to show what proactive is. So you bring in someone, as we
did when we flew many of our diplomats and others from Wuhan,
we brought them back to the United States. And the thing you
needed to do was to test their obvious contact, like their
wives or their husbands or what have you, and you wind up
seeing that they are infected or not. Proactive means I don't
know what is in the community, so I am going to go to a bunch
of emergency rooms, and when people present with symptoms that
look like they might be coronavirus, even though they have no
connection with anybody who has coronavirus, they didn't travel
anywhere, and test them to see if they are infected.
Mrs. Watson Coleman. That is even in communities that have
absolutely no knowledge of having being there.
Dr. Fauci. Absolutely. Absolutely.
Mrs. Watson Coleman. If I go to the emergency room in New
Jersey where there are no confirmed cases or anything, but I
have got some symptoms----
Dr. Fauci. Right.
Mrs. Watson Coleman [continuing]. Flu-like symptoms, right?
Dr. Fauci. Right. Right.
Mrs. Watson Coleman [continuing]. They would test and make
sure that it is not the corona.
Dr. Fauci. There aren't enough resources to do it in every
single emergency room and every single center. So what the CDC
has done, they started by taking six sentinel cities, and now
they are expanding that to many more cities, essentially doing
sentinel surveillance in different places. And that will give
us a good idea, or at least a partially good idea, of what is
under the radar screen that we are missing.
Mrs. Watson Coleman. So are these cities clustered only
near like the State of Washington?
Dr. Fauci. No. No. The cities are Seattle, Los Angeles, San
Francisco, Honolulu, New York, and Chicago, and there will be
more.
Mrs. Watson Coleman. My understanding is that the CDC is
managing diagnostic tests sent to State public health labs,
while FDA is managing tests at private labs. How does it get
determined who does what?
Dr. Fauci. It is not a question of managing. It is a
question of the CDC's fundamental mandate is to develop the
test and provide it for public health purposes to individual
State and local public health authorities. The issue with the
FDA came in when the FDA can give permission for a medical
center--you pick it, University of Washington in Seattle,
Cornell in New York City--to develop their own test or to
partner with a biotech or diagnostic production line, and do
their own tests on their own without needing the very intensive
quality control that the FDA generally gives to a test. So that
gives much more flexibility to have many, many, many more
centers do their own tests.
Mrs. Watson Coleman. Okay. My husband had pneumonia in
December, and he is still coughing. I am like, I want to send
him. I want to send him to have him checked out. I am very
interested in research into health disparities among minorities
and non-minorities and minority children, and what is happening
with the suicide rates, how it seems to be growing
exponentially or just disparately in the African-American
community. And I am wondering, the budget as proposed, what is
the impact on the Institute that would do that kind of research
and be able to support those kinds of services?
Dr. Collins. So as we mentioned earlier, when NIH is faced
with resource constraints, we try to identify what are the most
high-priority issues and try to protect those, even if it means
that we have to cut back in other places. I totally agree with
you. The question of health disparities, and especially
something as heartbreaking as suicide, has to be a very high
priority. And the National Institute of Mental Health, who is
not represented at this table, has a big investment in that
space, and particularly trying to understand are there ways of
identifying who is at risk and making an intervention before it
is too late.
And we are getting closer to that and even using things
like machine learning, taking advantage of what happens because
everybody is carrying around a cell phone. There are indicators
in terms of people's reduced social interactions that they are
perhaps in a depressed state that you would not have otherwise
known. A lot of that research is now going on, and it is very
appropriate to focus particularly on the health disparity part
of it.
Mrs. Watson Coleman. I am sorry. Is that my 33 seconds?
Ms. DeLauro. Fifty-two and now a minute.
Mrs. Watson Coleman. I yield back. I have other questions
regarding this issue. Thank you.
Ms. DeLauro. We are hoping for a third round. Congresswoman
Clark.
Ms. Clark. Thank you so much, Madam Chairwoman, and thank
you all, this incredibly esteemed panel. Dr. Fauci, I am
hearing a lot from hospitals in my State of Massachusetts who
are feeling under resourced and unprepared for the coronavirus.
Can you tell us a little bit about, as we are anticipating
moving from containment to mitigation, how we are going to help
with the hospitals around the country? Uh-oh. [Laughter.]
Dr. Collins. Was that a response?
Dr. Fauci. Yeah, that was a response. [Laughter.]
So when you say ``we,'' are you talking about the United
States government? So, I mean, I can't----
Ms. Clark. NIH and CDC.
Dr. Fauci. Well, the NIH is not going to be able to do
anything there except make, as quickly as possible, the results
of the research we do to be able to be deployable in places
like Massachusetts.
Ms. Clark. Right.
Dr. Fauci. The CDC works very closely with State and local
health authorities, and that is one of the reasons why I think
you are going to see, and I don't know what it is going to be,
is that there are going to be resources that are going to have
to be forthcoming to go. And I understand there is a
supplemental package being run through. I don't want to address
that, but that is one of the ways to answer the question, is
that the States, Massachusetts included, are going to need some
help to be able to implement the kinds of things that I think
are going to be needed.
Ms. Clark. Looking at Massachusetts and this entire health
crisis, one of the things I am glad about is that Massachusetts
has a very high number of insured people.
Dr. Fauci. Right.
Ms. Clark. That does not hold true across the country, and
I am concerned about how our health insurance policy plays out
in something like this. Can you tell me where you see the gaps,
and what is most immediately obvious to you about what we can
do to redress it?
Dr. Fauci. That is a very good question. And because of
that, most recently, it must have been in the last couple days,
they all seem to mesh these days. But it has been a couple of
days, that the director of the CMS has now been made a member
of the President's task force, so that person is there. Those
questions came up. Exactly the question you are asking came up
at the task force meeting last evening, and that is going to be
addressed.
I don't know what the answer to it is because that is not
my area, but it clearly came up, just like you said, that some
States, some territories, some regions have good insurance,
good care, and others don't. So how are we going to get the
tests equitably distributed, not based on whether somebody can
pay for them or not.
Ms. Clark. Yeah, you know, it pulls in our paid family
leave policies, all these different things, and we don't expect
the CDC to take on that whole policy agenda, but they are so
intertwined. And I hope that the task force will also look at
immigrant communities. If we cannot get immigrants to fill out
a Census because of fear, how are we going to get them to
access healthcare for their children and themselves?
Dr. Fauci. Again, a very good question because that also
came up at the task force, and from what I am hearing, that is
not going to be an impediment. Right.
Ms. Clark. Excellent. We will wait and see. Dr. Volkov,
good to see you. I was also very concerned that the Trump
Administration had proposed transferring $5,000,000 from
substance use and mental health services, nearly $63,000,000
from NIH to fight the coronavirus. I don't think we make
tradeoffs between public health emergencies. But I wonder if
you can tell me what progress has been made and what steps are
NIDA taking to work on the youth-focused interventions and
recovery support services.
Dr. Volkow. Well, again, one of the things that has helped
us enormously has been the $500,000,000 that came to address
the opioid crisis, because one of the projects that has been
prioritized is prevention interventions. And when you address
prevention interventions to help to avoid kids start taking
drugs, you don't do it specifically for opioids. You do it in a
general sense. And this is also important because we are seeing
now that the opioid crisis is shifting not just from opioids,
to getting into psychostimulants, so it is not like we are
going to have to address prevention for one drug. We need to
address the question what is making us vulnerable as a country,
and youth are the most vulnerable of all of them.
So we have several initiatives that are on that are going
to be expanded, for example, prevention to rural communities
that are at very, very high risk for drugs, to the criminal
justice setting. How do we intervene in schools? And another
project that we have been able to hopefully launch, as you
know, we have done a 10-year follow-up for children from 9 to
10 upward to understand what are the factors in the brain that
makes you vulnerable to drugs, but how does the environment
influence them? We want to start in infancy to look forward. So
these are just some of the examples that we are targeting to
try to develop knowledge and implementation methods to prevent
youth from taking drugs.
Ms. Clark. Great. I am out of time. I would love to follow
up with you in another way on medically-assisted therapies
treatment for younger people as well. Thank you.
Ms. DeLauro. Thank you. What I am going to try to do is to
ask three or four questions and get quick answers to them, so,
and let me just start with this. Dr. Bianchi, endometriosis, a
disease that impacts 1 in 10 women, leading cause of
hysterectomy. Can you describe NICHD's research related to
endometriosis? Tell us what your top priorities for the
research would be if provided with additional resources. And I
am asking this question, and where is my colleague,
Congresswoman Finkenauer, who has a very serious interest in
this area, and thank you for being here, Congresswoman
Finkenauer. So hold on to that.
Dr. Collins, we gave you $12,500,000 for gun violence
prevention research. I want to have you tell us what do you
expect to do with that. Also with the Office of Research on
Women's Health, the NIH budget has grown by 39 percent. Office
of Research on Women's Health has increased only 8 percent.
Anyway, they have a critical role in doing what we need to do
across all of the institutes. How would additional resources
for the Office of Research on Women's Health enable the office
to better advance and coordinate women's health research?
And, Dr. Gibbons, cardiovascular disease and women. You
know, stroke, heart disease leading cause of death for women in
the United States. What research is NHLBI supporting to improve
diagnosis and treatment of women with heart disease? Dr.
Bianchi.
Dr. Bianchi. Thank you, Madam Chair. As you said, 1 in 10
women have endometriosis. These are women of reproductive age.
It is associated with chronic pain, has enormous economic
impacts because women do not go to work. It is a leading cause
of infertility, and it is also associated with an increased
incidence of cancer. NICHD has a Gynecologic and Health Disease
Branch where we are funding research on the diagnosis,
prevention, and treatment of endometriosis. We have made it one
of our 10 aspirational goals in our strategic plan, and I am
very proud of the fact that NICHD's research, we are talking
about drugs that were developed as a result of NIH support, the
drug Orilissa, which is the newest drug to treat pain in women
with endometriosis, came out of an NICHD SBIR grant. Thank you.
Ms. DeLauro. And I will just say this to Congresswoman
Finkenauer, that you ought to be in touch with Dr. Bianchi to
get all the information that you need to move forward. Dr.
Collins, prevention research.
Dr. Collins. Very quickly to preserve time for Dr. Gibbon.
Firearms. We have invested in firearms research all along, and
having these additional funds from the Congress in the current
fiscal year is something that we welcome. We are invested in a
full set of threat research to Americans' well-being, and we
will continue to do so, and are certainly committed to
executing any funding directives from the Congress.
We have already written up various funding opportunity
announcements, are waiting momentarily for them to be cleared.
We will look at such things as the role of videogames, the role
of trying to keep firearms out of the hands of adolescents,
such things as the violence interrupter schemes that are
carried out in some cities, do they actually work. We need data
here, and we are the data people.
Ms. DeLauro. That is right.
Dr. Collins. So you can count on us. You asked about ORWH,
the Office of Research on Women's Health. A very important part
of what we do, Janine Clayton, who is the director of that, is
a wonderful catalyst. But let me emphasize that while the
funding of ORWH is modest, it is about $43,000,000----
Ms. DeLauro. Right.
Dr. Collins [continuing]. The overall funding for women's
health research is about $4,400,000,000, so it is reflective of
the way in which this, in fact, involves all of the institutes.
Ms. DeLauro. I am very, very concerned about the amount of
funding to the Office of Women's Health Research. I understand
it is being done. It is cross cutting, but this is something
that many, many years ago we identified as something critically
important, and I want to make sure they are getting the
resources that they need. Go ahead, Dr. Gibbons on NHLBI.
Dr. Gibbons. Well, maybe I will take off on that point. A
key part of the initiative for the NHLBI to address women's
health and cardiovascular disease is actually to take more of a
focus in their reproductive years. And to do that, we recognize
that a leading cause of maternal morbidity and mortality
actually relates to cardiovascular disease, typically women
over the age of 30 in their reproductive and child-bearing
years.
So we have a number of initiatives that are targeting that.
So, for example, pregnancy is often a stress test for the
cardiovascular system. Peri-cardiomyopathy is a major cause of
maternal morbidity and mortality. So we are really striking up
an initiative to better understand what are the drivers and
biomarkers and actually genetic factors that may be
predisposing to that. Similarly, we recognize that women who
have adverse pregnancy outcomes often have a long-term
trajectory of increased cardiovascular risk. So we have the
nuMoM2b Healthy Heart Study that is following up over time and
recognizing that there may be interventions we can do to change
the whole trajectory of those women.
Ms. DeLauro. Mm-hmm. [Audio malfunction in the hearing
room], and really these things playing together. They are not
in isolation. They are not in silos.
Dr. Gibbons. That is correct.
Ms. DeLauro. And they work together on this. Let me yield
to my colleague, Ranking Member Cole.
Mr. Cole. Thank you very much, Madam Chair. When I think
about the appropriations, you know, it is too easy sometimes
get caught up in a what are we doing this year kind of
mentality. Really the way this process works is everything is
cumulative and incremental in appropriations. And so under that
philosophy, we have adopted over the last 5 years a cumulative
and incremental increase for NIH funding. And so, Dr. Collins,
I want to ask you two of my favorite questions because you
always take me in interesting directions.
First is, one of the things we have been able to do that we
would not have been able to do had we not made these kind of
consistent investments and looking forward, what are the things
that you think we might be able to do if we were to continue
down the path that we have been on; that is, sustained
inflation plus increases for the NIH over the next 5 years?
Dr. Collins. I love being asked these questions. Thank you,
Mr. Cole. The way in which these 5 years of steady increases
influence things is perhaps most dramatically visible in what
we have been able to do for early-stage investigators. Back in
2015, we funded 600 of those grants in 1 year, and that was not
nearly enough, and people were getting pretty concerned whether
they had a career path. This past year, we funded over 1,300 of
those, more than doubled this investment in the next generation
of talent. And morale has just dramatically changed. I will be
in Alabama tomorrow and Friday meeting with investigators, and
I can tell you they are going to be really excited about
science because now the environment makes it possible for them
to take risks. Similarly, we have been able to increase the
number of just overall grants and the number of principal
investigators. We have enriched the breadth and depth of the
entire workforce that we depend on.
In terms of specific things, we have been able to put
forward projects that are truly bold improving our
understanding of life to single cells, the single cell biology
effort, being able to go after things, like the influenza
vaccine, at an even higher rate, the universal flu vaccine,
than we would have otherwise, and develop platforms like what
we are now using for coronavirus. We couldn't have done that if
we hadn't had the support.
Initiating this dramatically bold program called All of Us
that aims to enroll 1 million Americans in a long-term
prospective study of health, and that is going to be a platform
for so many other things that we will want to learn about, and
that takes resources. The BRAIN Initiative, really trying to
figure out how what is between your ears does what it does.
Again, now spending $500,000,000 on that. And it is remarkable
what kind of technologies have been invented and what impact
that will have on brain diseases. Cancer immunotherapy, making
great advances we would not have been able to do as quickly
without your help. And the whole focus on opioids and finding
alternatives to opioids through the HEAL Initiative. Those are
just a few of the things that we would not have been able to do
had it not been for your strong support and seeing this
predictable upward trajectory.
What we could do going forward? Well, gosh, the sky is kind
of the limit here. I mentioned in my opening statement about
gene therapy, that we are at this cusp where we can begin to
take what has now been done curing sickle cell disease with
gene therapy. Let's start curing a lot of other of these
conditions as well. You can see the path forward to do that.
New opportunities in terms of artificial intelligence machine
learning applied. We are going to have a big investment there
coming in the next year or two because we can see ways this
could play out in multiple different applications.
A new focus maybe on nutrition. We are talking seriously
about that. It is an area that we know is critical for health,
and yet the science hasn't necessarily quite gelled around the
new opportunities. It is time to do that, and, again, that is
going to take resources. And all the things we talked about in
terms of health disparities, ending HIV in the U.S., dealing
with the new difficulties with methamphetamine and cocaine, not
just about opioids. Those are all in our minds as visionary
things that we can accomplish with this kind of path being
continued. So I really love the question, and everybody at the
table would have their own answers, but I guess I kind of gave
you a bunch of mine.
Mr. Cole. Well, Mr. Sharpless, on cancer, what would your
answer be?
Dr. Sharpless. Yeah, you know, I think you mentioned Jim
Allison earlier, the Nobel Laureate who won the Nobel Prize for
figuring out kind of using the immune system to cure cancer,
right? I think what is maybe not known about Jim's story is
that he started out in a small institution in Texas. That is
where the first paradigm change in research was done. It was
not a glamorous institution. It was before he went to Berkeley.
It was before MD Anderson. It was before he went to Sloan
Kettering.
And I think that I am obsessed with the fear that there are
these great scientists with terrific ideas who are working out
there sending us their grants. We have had an explosion of
grant submissions, a 50 percent increase over since 2013, and
that we are not able to get to their great idea because our
paylines just aren't high enough. So with the generous
appropriation that Congress has been giving us, we have been
trying to get those numbers up so that we can get to the really
innovative cutting-edge science that make a difference for
patients, like Dr. Allison's work.
Mr. Cole. I just would say, Madam Chairman, I hope we look
at this this way. We ought to be thinking about this because,
as Dr. Collins said, every person here could give us a
different answer if we could tell them some certainty. We are
going to stay on the track that we have been on, and we want
you to think that way and present those kind of possibilities.
I think this committee has done that, and, you know, frankly
done a good job at it.
Ms. DeLauro. Congresswoman Lowey.
The Chairwoman. Thank you very much, and I want to take
this opportunity again to thank you all for your extraordinary
work. I came back because I wanted to get back to the whole
issue of e-cigarettes with Dr. Gibbons and Dr. Volker. With all
the information out there, it is not penetrating the kids, and
the rising rate of e-cigarettes among young people, as you
know, is startling. When I look at the numbers, 64 people died.
Nearly 3,000 were hospitalized last year with vaping
respiratory-related illnesses.
Now, as I understand it, many, but not all, of these cases
were attributed to vitamin E acetate, long-term impacts of
vaping, but concern is growing that there could be long-term
health consequences: heart disease, stroke, cancer. In the
couple of minutes we have, I would like to hear from both of
you. What can we do about it? And if you have any ideas, it
would be welcomed. I just see these numbers increasing on
college campuses exponentially.
Dr. Volkow. Yeah, one of the things that we don't
necessarily recognize is that these vaping devices are very
high technology for delivering drugs in ways that make them
very, very rewarding and addictive. So you can actually deliver
huge quantities of nicotine in much higher concentration than
what you normally do with combustible tobacco. As a result of
that, what we are observing is in the past where a kid will
take several months to escalate, now we are seeing this
escalate in a couple of weeks, and that is also associated with
toxicity with higher risk of addiction, and that is what we are
now facing.
And the numbers speak for themselves. One of the main
reasons, which was not even recorded in the past, why teenagers
are saying that they are vaping nicotine is because they say
they are hooked to it. So they have done that transition very,
very rapidly, and I think the message is that it is urgent that
we do interventions to prevent that. We need to stop it
because, otherwise, we will go into tobacco smoking again. But
also all of the points that you are saying that I will let my
colleague, Dr. Gibbons, address, we don't really know what are
the consequences of delivering this vaping into your lungs as
well as other organs.
Dr. Gibbons. So you clearly raised an important area of
concern. Just last summer, obviously you are describing the
cases of e-cigarette and vaping associated lung injury that
really started to explode as sort of a new epidemic and
mysterious illness. We didn't know why people were presenting
with shortness of breath, and other symptoms requiring
hospitalization, until we got this history of vaping. This was
an area where close collaboration, between NIH, FDA, and CDC in
response to this public health threat was pretty immediate and
collaborative. Within weeks, we were convening subject matter
experts from around the country, and, again, leveraging prior
investments this committee has made because we were able to
leverage centers of excellence in tobacco regulatory science,
bring and convene people who have already been studying e-
cigarettes together, and say what can we do, what is going on
about this new vaping epidemic related to lung injury.
That mobilized a research agenda. And so, again, within
weeks we put out a notice to engage our research community to
start studying what is driving this EVALI. And the CDC, with
its case definition and surveillance apparatus, was able to
start to make these links to THC and substances that might be
combined with THC that might be driving it. By December, we
clearly had a sense that vitamin E acetate from samples from
the lung may be a key associated element of this phenomenon.
And, again, related to the researcher community we
established, investigators were already beginning to study and
get the causal link between vitamin E acetate and study it in
animal models. And, in fact, in just the past few days, it was
published in the New England Journal of Medicine, by NHLBI-
funded investigators in Roswell Park, that indeed just giving
vitamin E acetate through a vaping device, at least in this
mouse model was, was they could recapitulate a lot of the
lesions seen in patients with EVALI.
So literally, within 8 months, we been able to close the
loop from a mysterious disease involving a collaborative effort
between NIH, CDC, and FDA, to address that public health
threat, and with that awareness, we are starting to see the
cases come down. But, as Dr. Volkow mentioned, we still don't
know the long-term effects. In fact, we have now funded a
cohort to follow and trace all those patients with EVALI, and
we recognize that EVALI is probably just the tip of the
iceberg. What is happening to subclinical injury to the lung in
the long term of these young people? That is still an unknown.
The Chairwoman. Well, my time is up, but I would just hope
that we could work together. I think it is pretty conclusive
this just isn't good for kids, adults, or anybody.
Dr. Gibbons. Absolutely.
The Chairwoman. What are we doing about it? The kids don't
believe it, and working with CDC, perhaps----
Ms. DeLauro. Ban it.
The Chairwoman. I am with you. I would ban it completely.
But I would like to follow up with you because it seems to me
the science is conclusive, and what are we going to do to get
these kids to understand, cut it out. Thank you very much.
Ms. DeLauro. Congressman Harris.
Mr. Harris. Thank you very much, and thank you all for
being here. It makes me nostalgic for the days I used to do
research. [Laughter.]
How exciting it is, especially when we have discoveries.
Dr. Collins, just briefly, you know, a group of us are going to
send a letter to the President asking him to look again at
human embryonic stem cell research, which we understand still
continues at the pace of about a $25,000,000 a year at the NIH.
As you know, I mean, the future really is pluripotency, you
know, inducing pluripotency of regular cells into stem cells
states. And the idea that we are continuing to destroy human
embryos and funding it or funding the destruction basically
through the NIH, I think is a mistake because, you know, human
embryos are, in fact, the youngest humans. And I think many
believe correctly that human life should never be used as a
mere means for achieving the benefit of another human being.
That is not the purpose of human life.
So I would hope that if the President responds positively
to our letter, that you could come up with a way to phase out
that, you know, to just phase out the use of a $25,000,000 on
something that really has yielded no direct clinical benefit
yet. And I understand there are basic science reasons to pursue
it, but these are humans. These are the youngest humans. We
should move away from that as soon as practical.
Dr. Volkow, it is good to see you again. You probably know
what I am going to ask about. It has been a year, and I want
you to update us on, you know, the marijuana research that is
done, looking at its effect on the brain because, you know, as
more States attempt to move to recreational use of marijuana.
Fortunately in the last omnibus bill, you know, an attempt was
turned back to make the recreational marijuana industry much
more profitable and widespread through, you know, removing
banking restrictions. I mean those restrictions are still in
place, so it buys us some time to actually educate the American
public, I think, about how dangerous it can be. So if you could
just talk about that.
And just as an aside, I do believe our colleagues in Energy
and Commerce are going to move finally a medical marijuana
research bill that makes it easier to do research and to truly
discover what is merely a pie-in-the-sky promise with regards
to what marijuana can do and those diseases where it really
will be of help. But if you could just update us about some of
the research that indicates just about the dangerous expansion
of marijuana, especially with the bleed down to younger
individuals that we see. I mean, whether it is e-cigarettes or
marijuana, you can make it illegal, but young people are going
to use it. So if you could just briefly in the last 2 minutes
discuss what is----
Dr. Volkow. You know, and thanks for asking that question
because it is an area where there has been major changes in the
perception of the American public that we have a drug that is
benign. And as a result of that, we are seeing a very dramatic
increase in the number of people that are consuming marijuana,
44,500,000 million in 2018.
Of greatest concern, of course, relates to children because
the brain is developing until we are in the mid-20s, and the
endogenous cannabinoids system, which is the one that is
basically stimulated by marijuana, is crucial in enabling that
development, including migrations of cells, how cells
communicate with one another. So what the research has shown
that kids, adolescents, consuming marijuana, and there is a
dose effect, are much more likely to show disruptions in terms
of structure and function of the brain. That appears to be
associated with cognitive impairments. The criticism that has
been done of those studies is that they have to look at it
retrospectively, which is the reason why we are currently doing
the ABCD Study that is looking prospectively to address
specifically that question objectively in ways that cannot be
challenged.
What also has merit very clearly, and this is from stories
that have come across all over the world by independent
nations, is that the use of marijuana with high-content THC is
associated with a greater risk of having psychosis. Now, the
big question is, is this acute or chronic psychosis, and there
is now data to show unequivocally that high doses of THC can
make psychotic any one of us. Chronically, now, the data
indicates that it does increase the risk, that you could
develop a chronic psychosis, whether you have the genetic
vulnerabilities as we would recognize it now or not. So and
this, again, highlights why we need to provide information to
the public so that they go in with their eyes wide open when
they make decisions of taking drugs, but, importantly, when we
make policy decisions.
Mr. Harris. Thank you very much. I yield back.
Ms. DeLauro. Congresswoman Lee.
Ms. Lee. Thank you very much. Dr. Fauci, of course have
worked together for many years on HIV and AIDS, on the
epidemic. I co-chair the bipartisan Congressional HIV/AIDS
Caucus, and we are still working together in a bipartisan way
to make sure that we have the resources to address this
epidemic. We are at the tipping point now in the field of HIV
research, including vaccine development. So I would just like
to ask you if you have kind of an update on the future progress
in these areas in terms of vaccine for HIV and AIDS.
Secondly, I would like to ask you, just in terms of the
coronavirus, has it hit a pandemic level or not, and how do we
explain to our constituents the difference between an epidemic
and a pandemic? And I want to find out, as serious as this is,
well, I think we are doing a good job in explaining how to
prevent the transmission of the virus. But given that there is
a 2 percent fatality rate for this virus and it is impacting
people who are elderly, I wanted to find out, do you think,
from your perspective, that that 2 percent is accurate right
now in terms of fatality rates?
And then to Dr. Collins if we have time, just on sickle
cell, how close are we now? I mean you have done some
remarkable work on sickle cell disease, and we are waiting, and
I know we are close. Of course, you know, 1 in 10 African
Americans in the U.S. have sickle cell, well, at least the
trait, and so I wanted to just see how close we are, and how we
are doing as it relates to identifying the trait early enough
where those who have diabetes recognize that the A1c test is
not accurate or could provide false results.
Dr. Fauci. Okay. I will be really quick because you had a
lot of questions. So the vaccine, as you know, we had a
disappointing situation with the vaccine trial that was finally
looked at by the Data and Monitoring Safety Board in South
Africa, which was called HVTN 702, which was using the model
that we used in the Thai trial, and that showed, safety, no
deleterious effect, but no efficacy. There are two other major
trials that are going on, one in southern Africa, one in the
Americas and Europe. Those trials, we won't have the data on
them probably for at least another couple of years. They are
using a different concept. They are using a different vector.
They are using a different protein, and they are using a
different adjuvant. So I can't give any prediction of what the
result is going to be.
Simultaneous with that, there is another whole effort on
HIV vaccines using a structural biological approach to get the
right confirmation of an immunogen to induce broadly-
neutralizing antibodies, which are the gold standard of
protection against viral infections. So there is still a lot of
good work going on, but we did have a disappointment.
Number two, the word ``pandemic,'' there are many, many
people who have different descriptions and definitions of
``pandemic.'' ``Pan'' being all, means widely distributed. The
WHO has not declared this a pandemic yet because they haven't
had very sustained transmission throughout the world, so,
technically, it is not a pandemic. It will be up to them to
make that declaration.
Next, the 2 percent mortality. A report just came out today
that when they looked at the totality of the data, in China
mostly because 90-plus percent of the infections are in China,
it was somewhere around 3 percent, up from the 2. The percent
mortality will depend on the denominator of number of cases. So
if you are not counting every case, then the mortality would
look high. If you are counting a lot of cases that are
subclinical, the mortality will become lower. But no matter how
you slice, it is many, many, many more times lethal than the
influenza that we get in the season, particularly for the
elderly and those who have underlying conditions, because most
of the deaths and the hospitalization, the mean age is about
70.
Ms. Lee. Dr. Collins, quickly.
Dr. Collins. Very quickly, and my colleague, Gary Gibbons,
is very much in the lead of this effort. We have a whole Cure
Sickle Cell Initiative that NHLBI is leading. And the good news
is here, we now have at least three clinical trials that are
using gene therapy for sickle cell disease that appear to be
working and working dramatically. They are very high tech. They
require very specialized technology and hospital services. So
it is not quite ready for broad extrapolation, but we are going
to see, I think, in the next few years sickle cell disease
becoming one of those conditions that we can actually cure.
In fact, we have started a new initiative with the Gates
Foundation to figure out how we might extrapolate that to Sub-
Saharan Africa, which is where most people with sickle cell
disease live. And it would be unethical, I think, at this point
to say we are fine because we figured out how to do this in a
high-tech environment. We have to figure out how to do it in a
low-resource setting as well. The interaction with A1c and
sickle trait is now well recognized, I think, by many
physicians. It was a very significant JAMA publication that
laid out exactly the data about this about a year ago, so I
think there has been a recognition that this has to be paid
attention to in managing diabetes with somebody who has sickle
cell trait.
Ms. Lee. Thank you very much.
Ms. DeLauro. Congresswoman Clark.
Ms. Clark. Thank you so much. I was delighted to hear this
morning the story on NPR about the incredible advances, and you
did a very good job, Dr. Collins, on, you know, injecting a
virus into the retina and potentially restoring vision. It is
unbelievable. But I know that there are many concerns also with
CRISPR and these technologies after the Chinese scientists
edited genes of babies last year. So I know there is great work
going on about putting up the sort of ethical guardrails that
we need. I wonder if you can tell me what steps NIH is taking
to protect patients and mitigate wrongdoing as we continue to
push the boundaries of science and medicine for amazing cures.
Dr. Collins. Well, this is an area of intense interest of
for all of us, and it is this remarkable circumstance of the
application of CRISPR-Cas, so-called gene editing, for many
different genetic diseases. And you mentioned the one that was
just reported about this morning, which is a cause of
blindness, is one of the most exciting things that is happening
right now in terms of research. Let me make it clear. Those
approaches basically approach a way to fix the spelling of a
misspelled gene somewhere in the body, but it doesn't get
passed on to the next generation. It is non-hereditary.
What happened in China was an intent to actually make this
kind of change in an embryo, which would be what you call the
germline, the hereditary changes, and we all agree that that is
utterly inappropriate at the present time. There is so much we
don't know about that, so many risks, so many theological and
philosophical consequences to beginning to change our own
instruction book. We at the NIH would not support that. In
fact, that would be illegal in the United States, that kind of
embryo manipulation. The World Health Organization has a high-
level panel that is looking at this, and we wait for their
recommendations. And so far, they have also come down quite
strong on this. Our National Academy----
Ms. Clark. Do you know when you expect that recommendation?
Dr. Collins. The WHO recommendation? I think probably in
the next few months, sometime during this calendar year, from
what I hear. They are beginning to close in on some sort of
conclusions. Again, WHO has a challenge because they have got
to get all those countries to sign on to it, so there will be a
draft and then we will sort of see what happens. Certainly in
this country, that would not be something we would do, but at
the same time, there is all this promise if you don't deal with
the hereditary applications. But what we call the somatic cell
part, you are dealing with the eye, or amygdala, liver, or
maybe the brain for a child who has otherwise an untreatable
genetic disorder. This is potentially enormously exciting. We
have a whole program at NIH and our Common Fund trying to
develop the ways to deliver that gene editing apparatus safely
to the tissue where you want it to go, because it is one thing
to know how to do it in the cell culture, but in a person, how
do you actually send it to the right zip code and have that
result happen safely and effectively. There is a lot going on
in that space, and we have made a pretty big investment.
For me, who is a geneticist, you know, these 7,000 genetic
diseases waiting for some kind of solution, this is a scalable
approach that might actually work, not in the next 100 years,
but maybe in the next decade. But we have to work really hard
to knock down all the barriers.
Ms. Clark. Thank you. Dr. Sharpless, it came to my
attention recently through crackerjack staff that 20 percent of
cancer trials failed due to insufficient patient enrollments
because there are barriers, restrictions on eligibility, access
to transportation, et cetera, ability to take time off work.
What efforts are NCI undertaking to enhance clinical trial
recruitment and operations at smaller community sites that may
not traditionally be engaged in clinical research?
Dr. Sharpless. Yeah, I think it is a really important
topic. Clinical trials accrual, the whole foundation rests on
being able to recruit patients. And we have so many trials and
so many great ideas in cancer, but if we can't test them, then
we really can't make progress. So fixing this problem is an
intense focus for the National Cancer Institute.
I think one big issue is, you know, basket trials in the
prior era are were designed poorly. They were designed to be
done in, you know, tertiary care centers only and not to be
done in sort of the other sorts of environments, and required,
you know, just a process that was bad. And so one of the things
that has happened in the last few years is a real focus on
these sort of basket trials that can be done in the community.
So the NCI match trial accrued 6,000 patients at 11,000 sites,
for example. We have this in-core network that has these sites
that allow people to get to accrued trials in the community. We
know that being on a trial provides better care, and it also
provides a more diverse population on the trial, so it is
really important.
And lastly, I should mention, we have made it a crusade to
get rid of these arbitrary and somewhat silly eligibility
enrollment criteria that keep people off trials, like HIV
positive or treated brain metastases, or things like that. So
we, working with others in the oncology community, have tried
to make trials simpler and more doable in the community, but it
is still an area where we need some improvement.
Ms. Clark. Great. Thank you so much.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Thank you again for being here. This has been
terrific. And so I have three questions. Okay. Number one is, I
had read a report or a study that women are feeling like
doctors are dismissing their complaints, so, number one, I am
curious whether or not there is any research on sex
discrimination in medicine. Number two is, where I live in West
Palm Beach, it seems like in the entertainment district, every
other storefront is selling CBD. Florida has also legalized
marijuana. So I am just curious whether or not there is any
research to show that either CBD or the marijuana is medically
effective. And then my third is back to my grocery store
questions on coronavirus, is I know you are not supposed to
touch your face, but is it any part of your face? Where are the
germs going? And if someone is gets quarantined, how long do
they have to be quarantined for, and can there be repeated
quarantines? I mean, I guess the better question is, do you
think this is going to be a widespread issue in our country?
Sex discrimination first, yeah.
Dr. Collins. Sex discrimination first. Dr. Bianchi.
Dr. Bianchi. Certainly with regard to maternal mortality,
there is definitely discrimination and that women's voices are
not being heard, and that is one of the aspects of the IMPROVE
Initiative that we want to address. That is the community-based
initiative. We know that there is not only a dismissal of
women's voices, but also there is infrastructural racism, and
we are definitely including that as part of this overall
initiative.
Ms. Frankel. The CBD and marijuana.
Dr. Collins. Nora.
Dr. Volkow. We know there is evidence from CBD to be
effective for helping to treat seizure disorders in children,
Dravet syndrome, and that has led to a medication. Otherwise,
there are no other FDA products approved for CBD, but there is
interest with respect to its analgesic effects. There is
interest with respect to its anti-inflammatory effects. And we
also definitely are interested and are evaluating its potential
therapeutic value to help treat different types of addiction,
including opioid addiction. With--respect
Ms. Frankel. When you say ``interest,'' does that mean
there is research being done or----
Dr. Volkow. Research is being done.
Ms. Frankel. Okay.
Dr. Volkow. We are funding researchers to do this both in
animals and in humans. And with respect to the THC, the
information is more limited. There is some evidence that it
could be beneficial for multiple sclerosis, for spasticity from
multiple sclerosis, also for pain indications, and otherwise,
the evidence is not very good in terms of its potential
benefits. But researchers are doing studies, and we are funding
researchers to do studies on PTSD, for example, could it have a
value.
Ms. Frankel. All right. Back to the coronavirus.
Dr. Collins. Yeah, touching your face.
Dr. Fauci. So----
Ms. Frankel. First of all, to have the germs get in you.
Dr. Fauci. Okay. So, first of all, you asked a question
about touching your face.
Ms. Frankel. Yeah.
Dr. Fauci. So the public health ways to avoid getting
coronavirus are very similar to those to avoid influenza, and
that is particularly as simplistic as it sounds: washing your
hands as frequently as you can. One of the problems with
respiratory-borne diseases is that they are spread either by
droplets, gross droplets--someone coughs or sneezes on you--or
even a bit of aerosolized where you can be sitting next to
someone very closely, and you don't cough and sneeze, but the
virus can aerosolize----
Ms. Frankel. So, I mean, does it go into you through your
nose, your mouth?
Dr. Fauci. That is what I will get to.
Ms. Frankel. Okay.
Dr. Fauci. All right. So what it is, it will get in through
a mucosal surface. That could either be your nose, your mouth,
or even your eye. The reason for washing your hands is that
people often do the wrong thing. That is why you hear us say
cough into the crook of your elbow because people sometimes go
like this, to blow their nose. They will shake hands with you,
touch a doorknob. Fifteen minutes later, you come by and do
that, then you touch your face, and that is how you get it. So
that is the way. That is the first thing.
Secondly, incubation period quarantine. The incubation
period, the median time from when you get exposed to when you
get clinical symptoms, is about 5.2 days. That is the median.
The range is somewhere between 2 and 14. Fourteen is much, much
more the outer limit. So when someone is suspected of being
exposed, they either self-isolate or they get actual
institutional quarantine for 14 days.
Ms. Frankel. But you could have----
Dr. Fauci. Fourteen days. Fourteen.
Ms. Frankel. You could have multiple self-quarantines. I
mean, what if you get exposed and then you stay home, and then
you get exposed again and you stay home? Do you have to stay
home every time you get exposed?
Dr. Fauci. Well, it depends on what you mean by
``exposed.'' I mean, if you are exposed to someone who has
documented infection, and then you are tested and you go into
voluntary isolation, not necessarily quarantine. The only time
you get quarantined is if it is very, very clear that you have
direct contact with someone.
Ms. Frankel. But it could be multiple times.
Dr. Fauci. Well, it could be if you are in a situation
where you are in an outbreak. Well, that is very interesting
because when you go from containment, which means to prevent
the spread, to mitigation, which means in the community,
distancing yourself socially. If, I don't want to say ``when''
because every time I say ``when,'' it is a headline. If.
[Laughter.]
Dr. Fauci. Okay. If it gets to the point where there is
really widespread infection, if that ever happens or----
Ms. Frankel. Do you expect that to happen in our country?
Dr. Fauci. I can't predict that. I cannot----
Ms. Frankel. Are you worried about it?
Dr. Fauci. I don't worry. I try and just do things that can
prevent it.
Ms. Frankel. Thank you very much. I yield back.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. When there is a vaccine available, who
gets it first besides my colleague to my left? [Laughter.]
Dr. Fauci, who gets it first, and how do we go about
distributing it?
Dr. Fauci. Well, the standard approach when you have a
vaccine, for example, for influenza, when you have limited
vaccines, you give it to the most vulnerable. And the most
vulnerable clearly are the elderly and those with underlying
conditions, and those generally are heart disease, chronic lung
disease, kidney, diabetes, and obesity, or those who are using
immunosuppressive drugs who might have an underlying cancer.
Mrs. Watson Coleman. And so we are 18 months or so away
from that. Probably?
Dr. Fauci. At least. The other thing that is important is
the healthcare workers and those who are the frontline
responders because those are the ones in every disease we know
that are the most vulnerable. In fact, if you look in China,
the people who were most vulnerable before they had good PPEs
were the healthcare providers.
Mrs. Watson Coleman. Mm-hmm. Thank you. Dr. Collins,
following up on my interest in the whole issue of health issues
and the disparate impact on minorities, one of the things that
I learned from the emergency task force that we had on mental
health and black youth suicide was that researchers, black
researchers in particular, have not been having their research
requests considered, and they have been denied these requests
for reasons having to do with not communicating clearly what it
is that you are looking at. The implications of community
outcomes or collaborations not necessarily recognizing the
significance in our space, with regard to issues of that
nature.
One of the things that one of the Institute directors
talked about was having more workshops, having more input from
black researchers into what would be considered and whose
grants and stuff will be considered. What are the things that
we can do to ensure that researchers of this nature are getting
an equal opportunity to do the research that is important for
the disparities that exist in the minority communities?
Dr. Collins. This is an issue that we are looking at with
great seriousness since it was documented a few years ago that,
in fact, an African-American investigator, who comes to NIH
with their best and brightest ideas, has a lower chance of
getting funded than other groups. And that is very disturbing
to look at, and there were many hypotheses about what might be
involved. I think we have not completely sorted out all the
reasons, but we have discovered a number of them, and certainly
part of this issue does relate to, I think, the fact that
oftentimes investigators may not have been in as strong a
position to be able to put forward a grant application because
of the lack of mentoring, the lack of opportunities to sort of
be involved in networks, which may be a natural thing for
others, but for minorities not so much. And we are working very
hard on ways to do a better job of mentoring with something
like the National Mentoring Research Network.
We also identified the fact that there are different areas
of research where minorities tend to migrate, and health
disparities research is one of those, and you can see why that
is. That is some oftentimes a passion for somebody who gets
into research who comes from an underrepresented group. They
want to work on understanding why their communities are not
being as well served. And yet it is clear that some of the
research that goes on in that space doesn't fare as well in our
peer review system, regardless of whether the applicant happens
to be a minority or not. So there is some action there that we
need to take.
We are still trying to sort this out. There was a paper we
published a few months ago about this which got a fair amount
of attention. We are continuing to do the analysis to see what
else we are missing here. We are determined to sort this one
out.
Mrs. Watson Coleman. Well, I am glad. I am both a co-
founder of the Congressional Caucus on Black Women and Girls,
and we are interested in those things that impact individuals,
particularly because of the intersection of their gender and
their race, and as well as the interest in what is happening
with our children and mental health disparities, things of that
nature, big issues in my community. So I thank you for the work
that you are doing, and I look forward to the work that you
will be doing in the future. Thank you. I yield back.
Ms. DeLauro. Thank you. We are going to do a kind of a
third round here with 3 minutes each. But I wanted to let you
know I have just been informed, I do not know what the dollar
amounts are, but it would appear that the House and the Senate,
Congressman Cole, have come to an agreement on the
supplemental. [Laughter.]
God is in His Heaven. All is right with the world.
Dr. Collins. Yes.
Ms. DeLauro. And so actually we just got that that notice,
and so that word will be getting out about dollar amounts, et
cetera, et cetera, et cetera. So, again, yes, wonderful. This
is where we need to go.
I am going to do my rapid fire piece here again. Dr.
Gibbon, status update on NIH's efforts on a commission on
lymphatic diseases. Okay. NCI. You talked about lots of
activity in the area, Dr. Sharpless. Tell us a little bit about
what is driving the interest in cancer research because you
have so many more. I would love to know at some point, and
maybe I will just sit and talk with you about where we stand
with ovarian cancer and finding a marker for ovarian cancer.
Universal flu vaccine update, Dr. Fauci. If we could
provide additional resources in 2021, how quickly might we move
to some success there? And, Dr. Collins, the NIEHS. In past
emergencies, they supported training for workers, for
healthcare workers, airports, correctional institutions, et
cetera. Just a quick overview of their work or training
activities in recent public health emergencies, H1N1 flu
pandemic, Ebola, and could they support what we need to do for
this current COVID-19 outbreak. So status of the commission on
lymphatic disease.
Dr. Collins. Sure.
Dr. Collins. A lightening round.
Ms. DeLauro. A lightening round.
Dr. Gibbons. Exactly. So you hit on the important issue
that of lymphedema is often debilitating and disproportionately
affecting women. We have established a task force that is
trans-NIH that is focused on lymphatic research, this issue.
The NHLBI alone spends $20,000,000 a year on this issue along
with many other ICs contributing even more to that collective
effort.
One of the key activities of interest is part of the human
cell atlas that Dr. Francis Collins described in which we were
able to get single cell resolution characterization of many
cells in the body. One of the key organs, if you will, is the
lymphatic system, and so understanding that system both in
normal human health and development, as well as in response to
injury and disease is fundamental to really getting to better
treatments for the disease.
Ms. DeLauro. We will have further conversations on this,
but we did encourage in the omnibus a national commission on
lymphatic disease, so we are going to pursue that with you.
NCI. What is driving this interest?
Dr. Sharpless. First of all, I would say it is a really
good problem.
Ms. DeLauro. Yes. Amen.
Dr. Sharpless. I mean, you think of all these people coming
with good ideas. That is that is what drives science.
Ms. DeLauro. We got to be able to fund them, too.
Dr. Sharpless. It is probably a lot of things. I think the
National Cancer Center Program plays some role. I think our low
paylines, frankly, people just write more grants. But the main
one, I think the really inherent one is the exciting time in
cancer research, the scientific progress. I saw this at the FDA
when, like, 30 percent of the business in terms of new
approvals and devices and drugs were cancer-related products. I
see this in Big Pharma. I see this in basic science. There are
just a lot of people who think they have good ideas for cancer,
so I think that is the main one. And I would be happy to follow
up with you on ovarian cancer.
Ms. DeLauro. Yes, on ovarian cancer. Still after all these
years, we don't seem to have a marker.
Dr. Sharpless. Agreed.
Ms. DeLauro. And we know how many thousands of women die
every year from ovarian cancer. Dr. Fauci, universal flu
vaccine.
Dr. Fauci. Thank you very much to the committee for the
plus-up on the universal flu vaccine. We are making significant
progress. As I mentioned last time, the first in human Phase 1
trial for a universal flu vaccine for the Group 1 influenzas,
which is a whole cluster of influenzas went into clinical
trial. It was successful. It showed to be safe, and it showed
to be immunogenic. We will start very soon a Phase 1 trial for
the Group 2, which is the other whole group of influenzas.
So we are really moving along very, very quickly. By the
end of the summer, we will be able to go into a Phase 2 trial.
That is going to be important because that is going to involve
hundreds, if not a couple of thousand, of people, and we will
need the resources that you gave us to be able to do that Phase
2 trial. Thank you.
Ms. DeLauro. And I would assume additional resources.
Dr. Fauci. Yes, indeed. No, I mean, well, that you are
going to give us. [Laughter.]
Ms. DeLauro. Amen. Amen.
Dr. Collins. Very quickly, NIEHS has played a critical role
in training people who can deal with outbreaks. They previously
worked on Ebola. They are totally prepared to step in on this
Phase 2, need some support for that. And basically, it is
airports, as you said. It is correctional facilities. It is
hospitals. They both do train the trainer efforts, they do
face-to-face, they run courses.
Ms. DeLauro. You mentioned that you need some help with
that. Can we be instrumental in pushing for NIEHS to be engaged
and involved in the training, which is----
Dr. Collins. I am curious in looking in the supplemental
and see whether there is a way that this can be factored into
that----
Ms. DeLauro. Okay.
Dr. Collins [continuing]. Because we are going to need a
lot of training for people who aren't quite prepared for this
yet.
Ms. DeLauro. Okay. Thank you. Congressman Cole.
Mr. Cole. Thank you very much, Madam Chair. I want to
follow up quickly actually on the point you raised with Dr.
Sharpless because I want to have a little more information. We
have got obviously explosion, as you pointed out, going on for
a variety of reasons. Are there some things we should do so
that we don't leave good science on the table just because
right now cancer seems to be a lane where there is a lot more
happening than maybe some other areas?
Dr. Sharpless. Yeah, I think there are. You know, probably
the main thing to realize about this problem is that it is not
a 1-year problem. You know, it is like a mortgage. We pay these
grants. They have 4- and 5 and, in some cases, even 6-year
budget tails. And so when we invest in the RPG pool and this
pool of grants today, which, you know, goes up 3, 5, 8 percent
every year at the NCI over the last, you know, 5 to 10 years,
then that has outyear costs for us that are quite significant.
And so, you know that provides some hesitation on the part of
the NCI to be good stewards.
You know, if we over invest today, we could have a real
problem 3 years from now if we are not smart about it. So, you
know, there is a realization that this problem is not going to
be fixed this year or next year, that we expect that we are
going to get these increased number of grants for a while
because there are people which have a lot of really great
ideas. So I think this, you know, sustained commitment that you
have provided for so many years is really what the doctor
ordered for the NCI RPG problem.
Mr. Cole. Yeah, I think that is important. I couldn't agree
more. Dr. Collins, the Attorney General has raised some
awareness of threats posed by foreign governments that
obviously, particularly the people Republic of China, you know,
frankly raiding our science or interfering with our research.
Can you tell us what your level of concern is on that, some of
the measures you might be taking to respond?
Dr. Collins. We are quite concerned. Dr. Mike Lauer, who is
the head of our Extramural Research Division, has spent
probably two-thirds of his time now on this over the course of
the past many months. First, let me say that we greatly depend
upon and value foreign investigators, foreign-born
investigators, who are part of our workforce, the vast majority
of whom are honorable, hardworking, incredible contributors.
And one thing we have to be careful of is that even as we have
identified this as a serious issue, that we don't extrapolate
into anything that would look like sort of racial profiling,
which would be a really unfortunate, unmerited, and
unforgivable kind of approach.
At the same time, we have identified numerous examples, I
am sorry to say, of individuals who have been receiving
substantial financial benefits from relationships with foreign
countries--yes, often China--without disclosing that, and it is
a requirement that they do so. Likewise, we have instances
where individuals have shared grant applications that were not
even yet reviewed with colleagues in other countries to give
them some kind of an edge on developing some new invention.
Obviously that has consequences for intellectual property.
We are very serious about identifying those circumstances.
You have probably seen in the press some dramatic examples of
individuals who have been found to be egregiously against the
way that scientists should behave, and have, as a consequence,
lost jobs and, in some instances, been brought forward for
various kinds of criminal prosecution. Again, I think most of
the people that you might see in our workforce or honorable,
but we are determined. We are stewards of the public trust. If
there are instances that are not going the way they should, we
will be following up on them.
At the moment, we have dozens of these investigations that
are currently under way. We are working with the FBI on this,
and they have been good partners with us, and we will keep our
eye on this and continue to see where the trouble is and then
act upon it.
Mr. Cole. I just want to commend you for your vigilance
here, and, frankly, also for the even-handed attitude. There is
a danger here that this could degenerate into a place where
none of us would ever want it to go. And so thanks for having
the focus on the problem, but also thanks for remembering, as
you say, most of the folks that are involved in these endeavors
are honorable, able, and are serving humanity. So it is a tough
problem, and I think you have struck the right balance. Thank
you, Madam Chair.
Ms. DeLauro. Congresswoman Frankel.
Ms. Frankel. Well, first I just want to say, I want to
thank our chair, and our ranking member, and all our panelists.
It is so refreshing, and I think we are blessed to be able to
have a bipartisan discussion on health research, and very
fortunate to have people of your caliber leading the way. I am
not going to ask you more supermarket questions. I would just
note that I have touched my face so many times today----
[Laughter.]
Ms. Frankel. Seriously, I am very worried about the social
and economic impacts of the potential of this virus. That is
really very frightening, and I am not going to get into it with
you guys. So I am going to ask you some different questions.
Specifically, in Florida, and I also know in the Nation, that
suicides are a big issue, and also I saw something that that it
is a leading cause of maternal death. Is that right? That is
suicide.
Dr. Collins. [Nonverbal response.]
Dr. Bianchi. [Nonverbal response.]
Ms. Frankel. No? Okay. I am glad you are saying no. But I
want to just combine these questions because I am curious not
only about suicide research, but also postpartum depression
research.
Dr. Collins. I will quickly start with suicide and then ask
Dr. Bianchi about postpartum because that fits in with our
maternal mortality topic. Certainly suicides increasing in many
different communities and demographic areas are of deep
concern, and there are many diagnostics about why that might be
going on that relate to people's sense of isolation, which is
clearly a growing problem in this Nation. We at NIH are aiming
to do everything we can to identify the factors and,
particularly, the predictors of who is at risk and what the
interventions might be. And there are certainly some of those,
such as trying to make sure that people don't have access to
lethal force for that moment where somebody makes a sudden
decision to end their life. And it is often a rather sudden
decision.
I will say also in terms of treating the clinical
depression that often undergirds this, there is a major
development that has happened, which is the development of this
drug called ketamine, which has this remarkable phenomenon in
many people who have had chronic clinical depression and not
responded to anything else, of after an intravenous infusion,
having an almost, within an hour, lifting of the clouds. That
is now being tried in people who are acutely suicidal and
starting to look pretty promising in that space if you can
catch somebody before they take the drastic action, and lift
them out of what seems to be a hopeless circumstance. So that
is one bright spot in what is clearly a very tough problem.
Dr. Bianchi. Yeah. So NICHD is funding research that
currently is looking at postpartum women who potentially are at
risk for suicide. So the difficulty with the postpartum
situation is some of these women have no prior history of
mental health problems. So, again, it is this rare issue where
how do you know if someone is going to be at risk. So we are
funding an investigator who is actually looking and taking a
machine learning approach through the electronic health record
to begin to identify certain clues in the record.
But the other issue is a lot of pregnant women are
depressed, and they are taking antidepressants during
pregnancy. So we need to know are these drugs safe to take
during pregnancy and lactation. And there is an area where I am
concerned because women who are at risk are not taking their
medicines because they think it is better for the baby, and so
we are doing research to show what is safe and what isn't safe.
And we have a study called the CUDDLE Study where women taking
these medicines are donating their breast milk so that we can
see what is actually in the breast milk.
Ms. Frankel. Thank you very much.
Ms. DeLauro. Congresswoman Watson Coleman.
Mrs. Watson Coleman. Thank you, Chairman. Dr. Sharpless, I
would like to talk to you about endometrial cancer. I know that
their cancers have shown a lot of improvements in the number of
deaths over the time. The National Cancer Institute
surveillance epidemiology and End Results Program shows a
worsening survival rate from endometrial cancer from 1996 to
2016, and the incidence rate for black women surpassed that of
white women in 2007 and continues to increase to this day. The
incidence of the more aggressive Type 2 cancers is dramatically
higher for black women than for white women.
I am wondering what your plan is. What is happening in that
field, and what are you planning in terms of funding clinical
trials and trying to come up with specific therapies that
address these disparities?
Dr. Sharpless. Sure. Thank you for the question. I think we
are equally concerned by the statistics you mentioned. This is
a cancer which is increasing in mortality in the United States.
As I mentioned, most cancers are actually declining in
mortality. The few that are actually showing an increased
mortality are particularly of concern, and why is that
happening? We think endometrial cancer and a few other cancers,
it may be partially related to obesity, you know, the obesity
epidemic. Obesity is associated with endometrial cancer. We
don't think that is the entire explanation.
The basis for the disparity is an area of active research
between African-American women and other populations. You know,
this is a problem across many cancers, including endometrial
cancer. Generally, our findings have been that they are, in
part, these, you know, social determinants of health, access to
care, these sorts of things, and partly often driven by biology
and some combination thereof. And so we have funded efforts in
endometrial cancer and other gynecological cancers to see
specifically address that question.
We have SPOREs in endometrial cancer of gynecologic
malignancies, which the Center of Research Excellence is
funding, but, you know, an area where we are devoting a lot of
focus because of the worrisome statistics you mentioned.
Mrs. Watson Coleman. Thank you. I yield back.
Ms. DeLauro. Thank you. I will just yield to the ranking
member for any final comments before we conclude.
Mr. Cole. Thank you very much, Madam Chairman. I think like
many members, this is always my favorite hearing of the year,
and I think because we all marvel at your abilities and the
work that you are doing and you are about, and what your
colleagues are doing. And we all see the good in these
investments, and we all feel as if you have been really good
stewards of money that the Congress has chosen to put at your
disposal. And we all think the American people and, frankly,
all of humanity have benefited enormously as a result of those
investments.
I am proud of this subcommittee. I am proud of my chairman
who has been my partner in this for years, and I am proud of
our colleagues on the other side of the Rotunda who have worked
with this for years, and I think it is absolutely critical,
Madam Chairwoman, that that continue. Now, I would be the first
to say, and I know my chairman knows this better than I do,
this is going to be a very tough year. We have a 2-year budget
agreement. It is essentially flat funding if you look at some
of the requirements in a couple of the other departments that
are going to take money, we know. Veterans I am thinking of in
particular. My friend, the chairman, and her counterpart, my
friend Chairman Blunt, are going to be confronted with really
tough decisions. I have had this discussion over many years
with Dr. Collins. I usually use the phrase, you know, we are in
another one of those years where we are robbing Peter to pay
Paul. Fortunately, you are Paul, and somebody else is going to
have to be the Peter, and that it is not your job to make those
decisions. It is the job of this committee.
And my friend, the chairman, and I have commiserated with
this over this many years because there are lots of wonderful
things in this bill, lots of things we agree on, lots of things
that are national priorities. But I think this committee has
made the right decision over the last 5 years in a bipartisan
sense by probably making you the top priority in the bill every
single year. And I don't think that is ever been more
dramatically demonstrated than right now.
You know, how many questions did we have on coronavirus,
and yet there will be another coronavirus out there. And I
thought one of the most telling answers of the hearing, you
know, when Dr. Collins made the point that these past
investments have put us in a stronger position to deal with
these current challenges. And I thought Mr. Sharpless made an
excellent point, Dr. Sharpless, as well when he talked about
the extraordinary opportunities we have in a particular area
right now. And those opportunities come and you have to use the
resources you have to take advantage of those openings, and you
also have to make commitments that sustain themselves over
years. I mean, the committee has to think in terms, again,
always of cumulative and incremental, whether it is investment
in your physical infrastructure, or it is just thoughts about
projects that clearly take multi years to come to fruition, and
we have got to make sure the revenue stream is there and
available.
So, again, I thank all of you for the work. I thank this
committee, you know, on a bipartisan basis for its sustained
commitment here. And I think, Madam Chairwoman, the wisdom of
that has been borne out, and I hope we can continue that. I
know if it was up to you and me, I know it would be continued,
and, you know, we are pretty persuasive with our colleagues
sometimes, too. [Laughter.]
We really make a pretty good team here and in dealing with
our friends across the Rotunda, who fortunately have approached
this with the same mindset that we have for many, many years to
come. So hopefully we can continue this because I think it
will, frankly, render enormous benefits to the American people,
and that is what all of us came here to do. With that, I yield
back, Madam Chair.
Ms. DeLauro. Thank you, very, very much to my dear friend
and colleague, and, if I might add, co-conspirator in what we
do in this subcommittee. And indeed, this is always an
extraordinary hearing, and it is a revelation. You know, we
have a doctor on our committee in Dr. Harris, but as far as I
know, the rest of us are not scientists. We are not doctors.
Mr. Cole. Wait a minute. I am a doctor. [Laughter.]
Ms. DeLauro. Well, yes, right. You are a political science
doctor here. But what we are about is trying to grapple with
issues about which we spend time studying and learning so that
we can try to do the right thing. You do every day in your life
focus on a mission of which there is no nobler cause or highest
commitment, which is to save lives. And we get to work in
cooperation with you to make sure that we push the edge of that
envelope. You do. We need to do that with the resources that we
provide you to do your work.
I will just say this to my colleague that, yes, you are
Paul, but I always have, and you have heard me say this before,
I have to worry about Peter as well----
[Laughter.]
Ms. DeLauro [continuing]. And looking at that, but I think
you know where our hearts and our commitments are to make sure
we go down the road. I would just say one other thing. You
know, this is a committee in working together, which does not
deal with ``gotcha.'' We are not sitting here to try to stump
you to make a political comment. We are here to try to get the
best information and the best advice so that we can respond.
And when some of the questions are hard and they are tough, it
is not for political purposes, but it is to look at our
stewardship of public dollars and where those public dollars
are going. And we are so trustful of you with being good
stewards of the public dollar, and we can sell that, both my
colleague and I, to other members of this subcommittee as well
as the committees across the aisle with our Senate colleagues.
I am going to end on a humorous note that I am going to
have to stop hugging people, Tom. [Laughter.]
And I just want to make sure, Dr. Collins, that people can
afford ketamine, okay? That is another issue that we could----
[Laughter.]
Ms. DeLauro. Thank you. The hearing is concluded. Thank you
all very much.
[The following questions and answers were submitted for the
record:]
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