[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
MEMBER DAY HEARING
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
JULY 25, 2019
__________
Serial No. 116-57
Printed for the use of the Committee on Energy and Commerce
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
govinfo.gov/committee/house-energy
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
45-261 PDF WASHINGTON : 2022
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COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois GREG WALDEN, Oregon
ANNA G. ESHOO, California Ranking Member
ELIOT L. ENGEL, New York FRED UPTON, Michigan
DIANA DeGETTE, Colorado JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland PETE OLSON, Texas
JERRY McNERNEY, California DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont ADAM KINZINGER, Illinois
BEN RAY LUJAN, New Mexico H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice BILL JOHNSON, Ohio
Chair BILLY LONG, Missouri
DAVID LOEBSACK, Iowa LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon BILL FLORES, Texas
JOSEPH P. KENNEDY III, SUSAN W. BROOKS, Indiana
Massachusetts MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California RICHARD HUDSON, North Carolina
RAUL RUIZ, California TIM WALBERG, Michigan
SCOTT H. PETERS, California EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
C O N T E N T S
----------
Page
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 2
Prepared statement........................................... 3
Hon. Greg Walden, a Representative in Congress from the State of
Oregon, opening statement...................................... 4
Hon. Eliot L. Engel, a Representative in Congress from the State
of New York, prepared statement................................ 175
Witnesses
Hon. Anthony Brindisi, a Representative in Congress from the
State of New York, opening statement........................... 4
Prepared statement........................................... 6
Hon. Mark Takano, a Representative in Congress from the State of
California, opening statement.................................. 7
Prepared statement........................................... 9
Hon. Ed Case, a Representative in Congress from the State of
Hawaii, opening statement...................................... 10
Prepared statement........................................... 12
Hon. Bill Pascrell, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 14
Prepared statement........................................... 15
Hon. Sanford D. Bishop, Jr., a Representative in Congress from
the State of Georgia, opening statement........................ 17
Prepared statement........................................... 19
Hon. Bruce Westerman, a Representative in Congress from the State
of Arkansas, opening statement................................. 20
Prepared statement........................................... 22
Hon. Ted W. Lieu, a Representative in Congress from the State of
California, opening statement.................................. 24
Prepared statement........................................... 25
Hon. Glenn Grothman, a Representative in Congress from the State
of Wisconsin, opening statement................................ 26
Prepared statement........................................... 27
Hon. Xochitl Torres Small, a Representative in Congress from the
State of New Mexico, opening statement......................... 28
Prepared statement........................................... 30
Hon. Dean Phillips, a Representative in Congress from the State
of Minnesota, opening statement................................ 32
Prepared statement........................................... 33
Hon. Marcy Kaptur, a Representative in Congress from the State of
Ohio, opening statement........................................ 35
Prepared statement........................................... 37
Hon. Sean Casten, a Representative in Congress from the State of
Illinois, opening statement.................................... 43
Prepared statement........................................... 45
Hon. Mike Levin, a Representative in Congress from the State of
California, opening statement.................................. 47
Prepared statement........................................... 48
Hon. Elissa Slotkin, a Representative in Congress from the State
of Michigan, opening statement................................. 50
Prepared statement........................................... 51
Hon. Scott Perry, a Representative in Congress from the
Commonwealth of Pennsylvania, opening statement................ 52
Prepared statement........................................... 54
Hon. Debra Haaland, a Representative in Congress from the State
of New Mexico, opening statement............................... 55
Prepared statement........................................... 57
Hon. Donna E. Shalala, a Representative in Congress from the
State of Florida, opening statement............................ 58
Prepared statement........................................... 60
Hon. Grace Meng, a Representative in Congress from the State of
New York, opening statement.................................... 62
Prepared statement........................................... 63
Hon. Gregorio Sablan, a Representative in Congress from the
Territory of the Mariana Islands, opening statement............ 65
Prepared statement........................................... 67
Hon. Lucille Roybal-Allard, a Representative in Congress from the
State of California, and Hon. Jaime Herrera Beutler, a
Representative in Congress from the State of Washington,
opening statements............................................. 68
Prepared statements.......................................... 70
Hon. Grace F. Napolitano, a Representative in Congress from the
State of California, opening statement......................... 74
Prepared statement........................................... 75
Hon. Lucy McBath, a Representative in Congress from the State of
Georgia, opening statement..................................... 76
Prepared statement........................................... 77
Hon. Bonnie Watson Coleman, a Representative in Congress from the
State of New Jersey, opening statement......................... 78
Prepared statement........................................... 79
Hon. Andy Levin, a Representative in Congress from the State of
Michigan, opening statement.................................... 81
Prepared statement........................................... 82
Hon. David Schweikert, a Representative in Congress from the
State of Arizona, opening statement............................ 83
Prepared statement........................................... 85
Hon. David Trone, a Representative in Congress from the State of
Maryland, opening statement.................................... 86
Prepared statement........................................... 88
Hon. James P. McGovern, a Representative in Congress from the
State of Texas, opening statement.............................. 90
Prepared statement........................................... 92
Hon. Dan Lipinski, a Representative in Congress from the State of
Illinois, opening statement.................................... 93
Prepared statement........................................... 94
Hon. Jared Golden, a Representative in Congress from the State of
Maine, opening statement....................................... 95
Prepared statement........................................... 96
Hon. Robert J. Wittman, a Representative in Congress from the
Commonwealth of Virginia, opening statement.................... 97
Prepared statement........................................... 99
Hon. Tom Malinowski, a Representative in Congress from the State
of New Jersey, opening statement............................... 100
Prepared statement........................................... 101
Hon. Jenniffer Gonzalez-Colon, a Representative in Congress from
the Territory of Puerto Rico................................... 103
Prepared statement........................................... 106
Hon. Abby Finkenauer, a Representative in Congress from the State
of Iowa, opening statement..................................... 115
Prepared statement........................................... 116
Hon. Rosa L. DeLauro, a Representative in Congress from the State
of Connecticut, opening statement.............................. 117
Prepared statement........................................... 119
Hon. Steve Cohen, a Representative in Congress from the State of
Tennessee, opening statement................................... 122
Prepared statement........................................... 123
Hon. Troy Balderson, a Representative in Congress from the State
of Ohio, opening statement..................................... 125
Prepared statement........................................... 126
Hon. Kevin Hern, a Representative in Congress from the State of
Oklahoma, opening statement.................................... 128
Prepared statement........................................... 129
Hon. Derek Kilmer, a Representative in Congress from the State of
Washington, opening statement.................................. 131
Prepared statement........................................... 134
Hon. Antonio Delgado, a Representative in Congress from the State
of New York, opening statement................................. 136
Prepared statement........................................... 137
Hon. Fred Keller, a Representative in Congress from the
Commonwealth of Pennsylvania, opening statement................ 139
Prepared statement........................................... 140
Hon. Vicente Gonzalez, a Representative in Congress from the
State of Texas, opening statement.............................. 142
Prepared statement........................................... 143
Hon. Stacey Plaskett, a Representative in Congress from the
Territory of the Virgin Islands, opening statement............. 145
Prepared statement........................................... 147
Submitted Material
Letter of February 15, 2019, from Mr. Bishop, et al., to Ms.
DeLauro and Mr. Cole, submitted by Mr. Pallone................. 150
List of Supporters, NEMT Medicaid, from Mr. Bishop, submitted by
Mr. Pallone.................................................... 156
Letter of June 18, 2019, from Mr. Welch, et al, to President,
submitted by Mr. Pallone....................................... 158
Prepared statements of Hon. Elijah Cummings and Hon. C. A. Dutch
Ruppersberger, Representatives in Congress from the State of
Maryland....................................................... 166
Prepared statements of Hon. Mike Kelly, a Representative in
Congress from the State of Pennsylvania, and Hon. Marcy Kaptur,
a Representative in Congress from the State of Ohio............ 167
Prepared statement of Hon. Jamie Raskin, a Representative in
Congress from the State of Maryland............................ 174
Prepared statement of Hon. Jimmy Gomez, a Representative in
Congress from the State of California.......................... 177
Prepared statement of Hon. Gwen Moore, a Representative in
Congress from the State of Wisconsin........................... 179
Prepared statement of Hon. Donald M. Payne, a Representative in
Congress from the State of New Jersey.......................... 182
Prepared statement of Hon. Andy Biggs, a Representative in
Congress from the State of Arizona............................. 184
Prepared statement of Hon. Eric Swalwell, a Representative in
Congress from the State of California.......................... 185
Prepared statement of Hon. Chris Smith, a Representative in
Congress from the State of New Jersey.......................... 187
Prepared statement of Hon. Gil Cisneros, a Representative in
Congress from the State of California.......................... 194
Prepared statement of Hon. Harley Rouda, a Representative in
Congress from the State of California.......................... 196
Prepared statement of Hon. Doug Collins, a Representative in
Congress from the State of Georgia............................. 198
Letter from Mr. Biggs, to Mr. Pallone and Mr. Walden, submitted
by Mr. Pallone................................................. 200
Letter of December 20, 2018, from Mr. Biggs, et al., to Hon. Ajit
Pai, submitted by Mr. Pallone.................................. 201
MEMBER DAY HEARING
----------
THURSDAY, JULY 25, 2019
House of Representatives,
Committee on Energy and Commerce,
Washington, DC.
The committee met, pursuant to call, at 10:00 a.m., in the
John D. Dingell Room 2123 Rayburn House Office Building, Hon.
Frank Pallone, Jr., (chairman of the committee) presiding.
Members present: Representatives, Pallone, Rush, Eshoo,
Engel, DeGette, Doyle, Schakowsky, Butterfield, Matsui, Castor,
Sarbanes, McNerney, Welch, Lujan, Tonko, Clarke, Loebsack,
Schrader, Kennedy, Cardenas, Ruiz, Peters, Dingell, Veasey,
Kuster, Kelly, Barragan, McEachin, Blunt Rochester, Soto,
O'Halleran, Walden (ranking member), Upton, Shimkus, Burgess,
Scalise, Latta, Rodgers, Guthrie, Olson, McKinley, Kinzinger,
Griffith, Bilirakis, Johnson, Long, Bucshon, Flores, Brooks,
Mullin, Hudson, Walberg, Carter, Duncan, and Gianforte.
Staff present: Mohammad Aslami, Counsel; Kevin Barstow,
Chief Oversight Counsel; Billy Benjamin, Systems Administrator;
Jacquelyn Bolen, Professional Staff; Jesseca Boyer,
Professional Staff Member; A. J. Brown, Counsel; Jeffrey C.
Carroll, Staff Director; Jacqueline Cohen, Chief Environment
Counsel; Sharon Davis, Chief Clerk; Luis Domingues, Health
Fellow; Jennifer Epperson, FCC Detailee; Elizabeth Ertel,
Office Manager; Adam Fischer, Policy Analyst; Jean Fruci,
Energy and Environment Policy Advisor; Evan Gilbert, Press
Assistant; Lisa Goldman, Counsel; Waverly Gordon, Deputy Chief
Counsel; Tiffany Guarascio, Deputy Staff Director; Caitlin
Haberman, Professional Staff Member; Alex Hoehn-Saric, Chief
Counsel, Communications and Technology; Megan Howard, FDA
Detailee; Zach Kahan, Outreach and Member Service Coordinator;
Rick Kessler, Senior Advisor and Staff Director, Energy and
Environment; Saha Khaterzai, Professional Staff Member; Chris
Knauer, Oversight Staff Director; Brendan Larkin, Policy
Coordinator; Una Lee, Senior Health Counsel; Jerry Leverich,
Counsel; Jourdan Lewis, Policy Analyst; Perry Lusk, GAO
Detailee; Dustin Maghamfar, Air and Climate Counsel; John
Marshall, Policy Coordinator; Kevin McAloon, Professional Staff
Member; Dan Miller, Policy Analyst; Jon Monger, Counsel; Elysa
Montfort, Press Secretary; Phil Murphy, Policy Coordinator;
Lisa Olson, FERC Detailee; Joe Orlando, Staff Assistant;
Kaitlyn Peel, Digital Director; Mel Peffers, Environment
Fellow; Alivia Roberts, Press Assistant; Tim Robinson, Chief
Counsel; Chloe Rodriguez, Policy Analyst; Nikki Roy, Policy
Coordinator; Samantha Satchell, Professional Staff Member;
Andrew Souvall, Director of Communications, Outreach and Member
Services; Sydney Terry, Policy Coordinator; Kimberlee Trzeciak,
Senior Health Policy Advisor; Rick Van Buren, Health Counsel;
Eddie Walker, Technology Director; Teresa Williams, Energy
Fellow; Tuley Wright, Energy and Environment Policy Advisor; C.
J. Young, Press Secretary; Jennifer Barblan, Minority Chief
Counsel, Oversight and Investigations; Mike Bloomquist,
Minority Staff Director; Adam Buckalew, Minority Director of
Coalitions and Deputy Chief Counsel, Health; Robin Colwell,
Minority Chief Counsel, Communications and Technology; Jerry
Couri, Minority Deputy Chief Counsel, Environment and Climate
Change; Jordan Davis, Minority Senior Advisor; Kristine
Fargotstein, Minority Detailee, Communications and Technology;
Margaret Tucker Fogarty, Minority Staff Assistant; Melissa
Froelich, Minority Chief Counsel, Consumer Protection and
Commerce; Theresa Gambo, Minority Human Resources/Office
Administrator; Caleb Graff, Minority Professional Staff Member,
Health; Brittany Havens, Minority Professional Staff, Oversight
and Investigations; Peter Kielty, Minority General Counsel;
Bijan Koohmaraie, Minority Counsel, Consumer Protection and
Commerce; Tim Kurth, Minority Deputy Chief Counsel,
Communications and Technology; Ryan Long, Minority Deputy Staff
Director; Mary Martin, Minority Chief Counsel, Energy and
Environment and Climate Change; Sarah Matthews, Minority Press
Secretary; Brandon Mooney, Minority Deputy Chief Counsel,
Energy; James Paluskiewicz, Minority Chief Counsel, Health;
Brannon Rains, Minority Staff Assistant; Zach Roday, Minority
Communications Director; Kristen Shatynski, Minority
Professional Staff Member, Health; Alan Slobodin, Minority
Chief Investigative Counsel, Oversight and Investigations;
Peter Spencer, Minority Senior Professional Staff Member,
Environment and Climate Change; Natalie Sohn, Minority Counsel,
Oversight and Investigations; Danielle Steele, Minority
Counsel, Health; Everett Winnick, Minority Director of
Information Technology; and Greg Zerzan, Minority Counsel,
Consumer Protection and Commerce.
Mr. Pallone. I call the committee to order.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Today, we are going to hear from our colleagues about the
issues of importance to them within our committee's
jurisdiction.
This hearing fulfils a new requirement that was approved as
part of the House rules package for the 116th Congress and I
think it's a good idea.
The Energy and Commerce Committee is working hard to build
a stronger economy, create more good-paying jobs, combat
climate change, and protect consumers from skyrocketing costs
that make it increasingly difficult to make ends meet.
We are putting consumers first and I am proud that a lot of
our work in this area has been done in a strong bipartisan
fashion.
Just yesterday, the House overwhelmingly approved a
bipartisan bill that will put consumers back in control of
their phones by targeting annoying and illegal robocalls, and
just last week the Energy and Commerce Committee advanced a
bill that will protect patients and families from surprise
medical bills.
This bipartisan cooperation is nothing new. This committee
has a proud tradition of working together to meet the needs of
the American people. We also have a proud tradition of
listening to the ideas of members not on this committee and
incorporating their ideas or advancing their proposals as we
work to develop the best legislation possible.
So we look forward to continuing to listen to the ideas of
all Members and this hearing today will help with that in the
coming months.
So today we are going to break up the testimony. Well, let
me say, we have asked members to tell us if they are coming and
so we have kind of--we have created time slots, essentially,
and we are going to try to stick to that.
But if somebody does show up who is not--doesn't have a
time slot we are still going to hear from them. But we are
trying to do it that way. And we also broke it up by the
jurisdiction of our five legislative subcommittees.
The subcommittee chair--I have asked the subcommittee chair
of that particular jurisdiction to be here when we concentrate
on that issue. So, for example, right now, Mr. Doyle is here.
He is the chairman of the Communications and Technology
Subcommittee. And so the people that we scheduled for this time
spot in the next hour or so will primarily focus on that.
But you don't have to. You know, if you want to talk about
other things, that is fine. But we try to do it that way. So we
begin with the issues within the jurisdiction of our
Communications and Technology Subcommittee, followed by
Consumer Protection and Commerce, then Energy, then Environment
and Climate Change, and then we are going to end with our
Health Subcommittee.
We have about 50 members who said they are going to testify
before us. I don't know if they will all show up, but we will
see.
[The prepared statement of Mr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone, Jr.
Today, we are going to hear from our colleagues about the
issues of importance to them within our committee's
jurisdiction.
This hearing fulfills a new requirement that was approved
as part of the House Rules Package for the 116th Congress, and
I think it's a good idea.
The Energy and Commerce Committee is working hard to build
a stronger economy, create more good-paying jobs, combat
climate change and protect consumers from skyrocketing costs
that make it increasingly difficult to make ends meet. We are
putting consumers first--and I'm proud that a lot of our work
in this area has been done in strong, bipartisan fashion.
Just yesterday, the House overwhelmingly approved a
bipartisan bill that will put consumers back in control of
their phones by targeting annoying and illegal robocalls. And
just last week, the Energy and Commerce Committee advanced a
bill that will protect patients and families from surprise
medical bills.
This bipartisan cooperation is nothing new--this committee
has a proud tradition of working together to meet the needs of
the American people. We also have a proud tradition of
listening to the ideas of members not on this committee and
incorporating their ideas or advancing their proposals as we
work to develop the best legislation possible. We look forward
to continuing to listen to the ideas of all Members and this
hearing today will help with that in the coming months.
Today we will break up the testimony by the jurisdictions
of our five legislative subcommittees. We will begin with
testimony on issues within the jurisdiction of our
Communications and Technology Subcommittee, followed by
Consumer Protection and Commerce, Energy, Environment and
Climate Change, and then we will end with our Health
Subcommittee.
We have about 50 members who plan to testify before us
today, and I look forward to hearing their ideas.
Mr. Pallone. And everybody is asked to speak for 5 minutes.
So now I will turn it over to our ranking member from Oregon,
and, you know, again, he and I have been very--tried as much as
possible to work in a bipartisan fashion and I appreciate that,
Greg.
OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OREGON
Mr. Walden. It is mutual. Thank you, Mr. Chairman, and
welcome to our members who are here today. I think this is
really an important improvement in how the committee operates.
We have had Member Day before. They haven't been as wide
ranging as this. But I think this is a good addition.
As you may recall, Mr. Chairman, we did this for the
opioid's legislation package last time and we ended up with 60
individual pieces of legislation, all of which were bipartisan,
that moved across the House floor and eventually became one
bill called the SUPPORT Act--H.R. 6.
But members come here to make a difference and offer up
their ideas, not just here in this committee but also across
the entire scope of the House, and for those that aren't
members of the Energy and Commerce Committee we welcome you.
We look forward to your ideas and concepts. My only regret
is we didn't do this in January or February but at least we are
doing it before the August break and so I think that is
important, as I say, a good addition and we have got a lot of
work to do in this committee and we wanted to hear from you.
So with that, Mr. Chairman, I will yield back and we can
get on about our business.
Mr. Pallone. I thank our ranking member, and I should also
mention that the--Mr. Latta from Ohio, who is the ranking
member of the Telecommunications--I mean, the Communications
and Technology Subcommittee is here as well.
So what is our order?
All right. So just so you know, Mr. Brindisi is first. I
think, Mr. Takano, they have you a little later. But since you
showed up early, we are going to put you second--recording you
second. And we are not doing this, you know, D versus R. We are
just, you know, based on the list that we put together.
So we will start with the gentleman from New York. Thanks
for being here.
OPENING STATEMENT OF HON. ANTHONY BRINDISI, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. Brindisi. Good morning, Chairman Pallone, Ranking
Member Walden, Subcommittee Chairman Doyle, and Ranking Member
Latta.
Thank you for the opportunity to testify at today's Energy
and Commerce Committee Member Day. I appreciate your strong
leadership on several of these issues.
So my largely rural district in upstate New York stretches
from Lake Ontario in the north all the way down to the
Pennsylvania border in the south.
So when I hear cable executives talk about 5G access and
10-gigabit connections, I am left shaking my head. For many
families in my area, basic internet access remains out of
reach.
Worst of all, I have heard from countless constituents who
have seen their cable bills go up every month as the service
just gets worse and worse. I have heard stories from families
who see their connections grind to a halt at home when they try
to get online, and when they contact their cable company, they
get no help, only excuses.
As I see it, there are three areas where Congress can do
the most good when it comes to delivering high-speed internet
access to rural America.
First, we need better data. Even the FCC agrees that the
data they use to map homes with high-speed internet is woefully
inadequate. We need better information from companies so we
know exactly where federal investments are needed most.
I want to thank the committee for making this issue a top
priority.
Second, we need to continue to expand programs which build
out broadband access in rural areas. This includes maintaining
the FCC Universal Service Fund programs and ensuring that each
unique program receives the funding it requires.
And as we continue to invest in these vital programs, we
need strong oversight at the FCC to make sure internet service
providers are fulfilling their obligations.
And that brings me to my third point--accountability. These
cable behemoths often operate as monopolies, leaving customers
no choice but to overpay for subpar service.
In New York, one cable company in particular failed to live
up to the terms of their corporate merger agreement and had to
be fined and threatened with expulsion from the state by our
Public Service Commission.
The first bill I introduced in Congress--the Transparency
for Cable Consumers Act--would force companies like this to
disclose information about their business practices to bring
transparency and accountability to the market.
By doing so, we can curb the worst monopoly practices and
perhaps help introduce real competition into the market. I have
been fortunate to work with many members of this committee,
Republicans and Democrats, on these priorities this year.
Expanding access to high-speed internet remains a task as
large as rural electrification 100 years ago, and I look
forward to continuing to work with this committee to ensure
every home in rural America is connected.
I want to thank you for your time and I am happy to answer
any questions and yield back my time.
Thank you.
[The prepared statement of Mr. Brindisi follows:]
Prepared Statement of Hon. Anthony Brindisi
Chairman Pallone, Ranking Member Walden, Subcommittee
Chairman Doyle and Ranking Member Latta, thank you for the
opportunity to testify at today's Energy and Commerce Committee
Member Day. I appreciate your strong leadership on these
issues.
My largely rural district in Upstate New York stretches
from Lake Ontario in the north all the way down to the
Pennsylvania border in the south. So when I hear cable
executives talk about ``5G access'' and ``10-gigabit
connections,'' I am left shaking my head. For many families in
my area, basic internet access remains out of reach. Worst of
all, I have heard from countless constituents who have seen
their cable bills go up month after month as the service just
gets worse and worse. I have heard stories from families who
see their connections grind to a halt at home when they try to
get online. And when they contact their cable company, they get
no help--only excuses.
As I see it, there are three areas where Congress can do
the most good when it comes to delivering high-speed internet
access to rural America.
First, we need better data. Even the FCC agrees that the
data they use to map homes with high-speed internet is woefully
inadequate. We need better information from companies so we
know exactly where federal investments are needed most. I want
to thank the committee for making this issue a top priority.
Second, we need to continue to expand programs which build
out broadband access in rural areas. This includes maintaining
the FCC Universal Service Fund programs and ensuring that each
unique program receives the funding it requires. And as we
continue to invest in these vital programs, we need strong
oversight at the FCC to make sure internet service providers
are fulfilling their obligations.
And that brings me to my third point: Accountability. These
cable companies often operate as monopolies, leaving customers
no choice but to overpay for subpar service. In New York, one
cable company in particular failed to live up to the terms of
its corporate merger agreement and had to be fined and
threatened with expulsion from the state by our Public Service
Commission. The first bill I introduced in Congress, the
Transparency for Cable Consumers Act, would force companies
like this to disclose information about their businesses to
bring transparency and accountability to the market. By doing
so, we can curb the worst monopoly practices and perhaps even
help introduce real competition into the market.
I have been fortunate to work with many members of this
committee--Republicans and Democrats--on these priorities this
year. Expanding access to high-speed internet remains a task as
large as rural electrification 100 years ago, and I look
forward to continuing to work with this committee to ensure
every home in rural America is connected.
Thank you for your time, and I am happy to answer any
questions you may have.
Mr. Pallone. I thank the gentleman.
Now, again, I mean, nobody has to ask questions but I think
you should feel free to do so, or comments, and we would do--
oh, there's no questions at all? Oh, we are just listening?
All right. Well, I didn't know that.
Mr. Doyle. Mr. Pallone?
Mr. Pallone. Yes.
Mr. Doyle. Are we allowed to make a comment? I am not going
to ask a question but----
Mr. Pallone.I am shocked that you didn't like the idea of
not asking questions.
[Laughter.]
Mr. Pallone. But yes, feel free to make a comment.
Mr. Doyle. Actually, I do like that idea.
Mr. Pallone. OK.
Mr. Doyle. No, I was--just a couple comments. Anthony,
there isn't anyone on this committee that doesn't agree that
the mapping issue is a complete disaster and needs to be
improved. That is something we have talked about on the
committee for a long time.
I just want to say with regards to getting broadband
deployed into rural America, there is not a valid business case
for that so we need money to do that, and every time we talk
about expanding broadband to rural America, it is, like, how do
we pay for it.
Well, we have an opportunity to pay for it with C-band.
There is going to be an auction. That hasn't been determined
how that auction is going to take place.
But I think it would be almost unimaginable that we would
allow a private auction and for foreign satellite companies to
keep the money. I am hopeful that is not going to happen.
But we have an opportunity here on the committee to work on
the C-band plan that will allow us to start deploying that mid-
range band, which is important for 5G and get it paid for--and
to get some money into the Treasury which could help us deploy
broadband in rural America.
It is a way to close the digital divide and there is money
to pay for it. So I am hoping that members on this committee on
both our side and our friends on the Republican side can come
together and do something legislatively to see that made a
reality.
Thanks, Mr. Chairman.
Mr. Pallone. Look, I understand we weren't supposed to ask
questions or comments. But, you know, you are here for a few
hours, members of the committee.
So if you want to briefly make a comment or ask a question
I am not going to forbid it and I am going to be bad myself and
say that I did want you to know--you may already know--that we
had a bill called the LIFT America Act, which every member--
well, every Democratic member, at least, on the subcommittee--I
mean, on the committee has signed, which has about $40 billion
for broadband in underserved areas. So we are very not--we are
very conscious of that.
Thank you so much.
I am going to go to Mark Takano next, the chairman of the
Veterans Committee.
OPENING STATEMENT OF HON. MARK TAKANO, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. Takano. Thank you, Chairman Pallone and Ranking Member
Walden, and members of the committee. I appreciate the
opportunity to testify today.
I want to start off with a brief quotation from a
constituent. My office obtained a consumer complaint to the FTC
from a constituent, and this complaint--this excerpt--clearly
demonstrates why many--what so many customers experience as
online shoppers.
I quote: ``When you place an order, you are automatically
enrolled in a monthly membership which incurs an automatic
charge each month to your account and credit card of $40
without permission. This is not clear at all when ordering. I
never agreed to it,'' end quote.
Amazingly, the reason why my constituent and so many other
online shoppers are getting swindled is really not in dispute.
It is obvious. These deals rely on a murky sales tactic known
as negative option billing, which reverses the structure of a
typical consumer purchase.
Many of us have been there. You are shopping online. You
sign up for an enticing so-called risk-free trial offer, only
to get hammered later with hidden fees and unexpected costs.
I see nodding heads from the chairman and ranking member.
Often, you know, we could feel foolish for having fallen for
something, but actually it is very deceptive marketing and the
specific tools of online sellers that I think are bilking
consumers unfairly.
Now, these transactions--these online deals have duped
consumers out of more than a billion dollars during the last
decade. Related complaints to the Federal Trade Commission more
than doubled between the years 2015 and 2017.
These transactions allow a business to interpret a
customer's lack of action to reject an offer as an approval to
be charged for goods and services. Expensive obligations can go
misunderstood or unnoticed for months while the costs pile up.
Making matters worse, customers seeking to terminate their
purchase or enrollment are often met with cumbersome and
confusing cancellation and return policies. These outcomes I
think we would regard as unacceptable.
That is why I encourage the committee to consider
legislation that I have introduced which addresses this
important topic.
My bill, which is titled the Unsubscribe Act, will give
shoppers the protections needed in today's online marketplace
and ensure negative option deals cannot be used unfairly to
deceive consumers.
And this bill--my bill--would achieve this in three ways.
First, require a straightforward cancellation process.
Businesses are required on my bill to provide a cancellation
mechanism that mirrors the enrollment process, ensuring
consumers can escape an unwanted deal as easily as they were
lured into it.
It is common sense. If you sign up online you should be
able to cancel online, not have to go and wait on a telephone
line for 20 minutes before you talk to somebody who can say,
OK, and explain to them. There should be an easy way for you to
opt out again.
Secondly, consumers--we need to protect consumers from
getting stuck in an expensive unwanted deal. We will require
sellers to obtain additional affirmative consent to bind
consumers at the end of free-trial periods.
This way consumers are protected from accidently enrolling
in a pricey membership plan if they only intended on making a
single purchase.
Thirdly, we would ensure that consumers remain fully and
fairly informed. Online shoppers are required to receive
periodic notification of any and all obligations or changes to
their contracts, proactively reminding buyers of recurring
charges, reenrollment details, and agreement changes that will
help decrypt the complex nature of negative option agreements.
Now, members of this committee, I am sure, understand how
critically important it is for consumers to receive protections
that keep pace with today's gigantic online marketplace.
In the first quarter of 2019 alone, U.S. online retailers
raked in over $135 billion, and during the last--in the past
decade, the proportion of online sales to our entire retail
market jumped from about four percent to over ten percent.
At a time when more and more Americans use their phone or
computer to shop, Congress must step up to ensure no consumer
is left unfairly vulnerable to misleading and abusive online
deals.
Thank you, I yield back my time.
[The prepared statement of Mr. Takano follows:]
Prepared Statement of Hon. Mark Takano
Chairman Pallone, Ranking Member Walden, and members of the
committee, thank you for the opportunity to testify today.
We've all been there. You are shopping online and sign-up
for an enticing ``risk-free trial offer'' only to get hammered
later with hidden fees and unexpected costs. You're not alone.
Online deals like these have duped consumers out of more than a
billion dollars during the last decade. Related complaints to
the Federal Trade Commission more than doubled between 2015 and
2017. My office obtained a consumer complaint to the FTC from a
constituent in my district demonstrating what so many customers
experience:
``When you place an order, you are automatically enrolled
in a monthly ``membership'' which incurs an automatic charge
each month to your account and credit card of $40 without
permission! This is not clear at all when ordering. I never
agreed to it!''
Amazingly, the reason why my constituent and so many online
shoppers are getting swindled isn't in dispute--its obvious.
These deals rely on a murky sales tactic known as ``negative
option billing'' which reverses the structure of a typical
consumer purchase. These transactions allow a business to
interpret a customer's lack of action to reject an offer as
approval to be charged for goods or services. Expensive
obligations can go misunderstood or unnoticed for months while
costs pile up. Making matters worse, customers seeking to
terminate their purchase or enrollment are often met with
cumbersome and confusing cancellation and return policies.
These outcomes are unacceptable.
That's why I encourage the committee to consider
legislation that I have introduced which addresses this
important topic. My bill, the Unsubscribe Act, will hold
companies accountable for deceptive marketing and ensure that
buyers are less vulnerable to the confusing nature of online
negative option agreements. The bill achieves this in three
ways:
One--require a straightforward cancellation process.
Businesses are required to provide a cancellation
mechanism that mirrors customers' method of enrollment. A
simple ``click-to-cancel'' option allows buyers to escape an
unwanted deal as easily as they were lured into it.
Two--protect consumers from getting stuck in an expensive,
unwanted deal.
Sellers are required to obtain additional
affirmative consent to bind consumers at the end of free-trial
periods. This way consumers are protected from accidently
enrolling in a pricey ``membership'' plan if they only intended
on making a single purchase.
And lastly, three--ensure consumers remain fully and fairly
informed.
The bill also ensures shoppers receive periodic
notification of any and all obligations or changes to their
contracts. Proactively reminding buyers of recurring charges,
reenrollment details, and agreement changes will help decrypt
the complex nature of negative option agreements.
Members of this committee understand how critically
important it is for consumers to receive protections that keep
pace with today's gigantic online marketplace. During the first
quarter of 2019 alone, U.S. online retailers raked in over $135
billion dollars, and the proportion of online sales in the
retail market jumped from under four percent to over ten
percent during the past decade. At a time when more and more
Americas use their phone or computer to shop, Congress must
step up to ensure no consumer is left unfairly vulnerable to
misleading and abusive online deals.
Thank you, I yield back.
Mr. Pallone. Thanks so much.
Mr. Doyle?
Mr. Doyle. It sounds like an issue for the Federal Trade
Commission, probably Congresswoman Schakowsky's subcommittee.
Mr. Pallone. Absolutely.
Mr. Doyle. This would be more germane there. But, Mark, I
think it is a great piece of legislation.
Mr. Takano. Thank you.
Mr. Pallone. And, Mark, we really have been trying to put a
lot of focus on consumerism, if you will, and Jan Schakowsky,
who chairs the Consumer Protection Subcommittee I am sure would
be very interested in this.
So thanks a lot. Thanks for coming.
Mr. Walden. Mr. Chairman, could I say something as well?
I appreciate it as well. I remember when we were in
business, we would find these little charges on our phone bill.
When we'd go to chase them out, they were things we had never
agreed to. It was only a buck or two a month----
Mr. Takano. Yes.
Mr. Walden [continuing]. And then you fought with the phone
company and they said, oh, we are just the biller--it is a
third party. You will have to take it up with them. Things you
never agreed to, and you would be months fighting this.
And I just always wondered with bazillions of phone lines
out there how much of this was going on where people didn't
know they were getting an extra dollar or two a month.
Just a little different than your shopping deal but it's
the same thing.
Mr. Takano. Yes, and sometimes----
Mr. Walden. Consumers getting ripped off.
Mr. Takano. Sometimes you have to take a couple of steps to
figure out because the description----
Mr. Walden. Yes.
Mr. Takano [continuing]. On the bill is not all that clear
and then it is not straightforward about how to find out. As
you say, who do you go to?
Mr. Walden. Yes, and somebody is making--the people doing
the billing are making money and putting it on your bill.
Mr. Takano. That is right. A little--everyone is taking a
piece of it.
Mr. Walden. Everybody is getting their piece out of our
hide, and so I am interested in this as well.
Mr. Takano. Thank you. Thank you, ranking member. I
appreciate it. Thanks.
Mr. Pallone. Thank you, Mr. Takano.
Mr. Takano. Am I excused?
Mr. Pallone. You're excused, yes.
[Laughter.]
Mr. Pallone. All right. So next we are going to go to the
gentleman from Hawaii.
Mr. Case, good to see you.
OPENING STATEMENT OF HON. ED CASE, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF HAWAII
Mr. Case. Moving right across the country, Chair Pallone,
Ranking Member Walden and members, thank you so much for
allowing me to share my thoughts on some issues of concern to
Hawaii and to our country, I believe.
I would like to focus today on what I believe are needed
changes to the 1996 Communications Decency Act that are
unintentionally preventing my state and its counties as well as
many others throughout our country from enforcing our planning
and zoning laws and implementing overall public policy in
affordable housing, community safety, and other critical areas.
The Internet has brought much progress to our world and
Section 230 of the Communications Decency Act, which provides
internet platforms with some broad immunity from liability for
third-party content posted on their sites, has been a part of
that.
But today's massive internet platforms that offer services
cannot be allowed to knowingly facilitate lawbreaking in our
states and localities by hiding behind CDA 230 immunity.
Congress first saw and addressed the modern misuse of CDA
230 last year when we passed the Allow States and Victims to
Fight Online Sex Trafficking Act--FOSTA--legislation which
imposed accountability for internet platforms that were
profiting from human trafficking.
In a parallel situation, though, this issue is also
especially acute with respect to platforms that advertise and
sell illegal short-term vacation rentals, like Airbnb,
TripAdvisor, Homeaway, VRBO, or Flipkey.
In this area, the online host platforms claim that CDA 230
prohibits states and counties from prohibiting and regulating
such rentals and from penalizing platforms that knowingly sell
them illegally.
By one account, my own State of Hawaii alone hosts
approximately 23,000 short-term vacation rental units, and that
was 2017, meaning one out of every 24 of our housing units was
a short-term rental.
That was widely considered to be low then and has only
grown since, driven largely by the ease of advertising and
reserving these units online.
The vast majority of these units are illegal since we know
that legal permitted short-term vacation rentals are in the low
thousands. The negative consequences of this unregulated
disruption of our housing market impact all segments of our
society.
First, anytime we knowingly and practice widespread
lawbreaking that has its own broader consequences. Second,
these units operate as the functional equivalent of hotels and
yet do not pay hotel-required taxes and fees and do not comply
with labor, workplace safety, or consumer laws.
Third, these units turn residential neighborhoods into the
functional equivalent of hotel zones with the loss of those
neighborhoods and the community sense.
And fourth, and possibly most important, from my
perspective, they completely distort our already sky-high
housing market, which in Hawaii is one of the highest in the
country, but his happens in any jurisdiction where this issue
is prevalent.
And because these residential dwellings are effectively
converted to hotel rooms, the available owner and renter
markets are compressed, leading to substantially higher rents
and home prices that crowd out still more local residents in
what is already one of the highest rent and lowest home
ownership areas of our country.
There should be a way to compel short-term rental platforms
to remove these illegal units from their inventory, and yet CDA
230 serves as a roadblock to that effort.
In particular, the platforms have frequently asserted that
CDA 230 does not allow full implementation and enforcement of
these initiatives. They have sued cities such as San Francisco,
Boston, Santa Monica, New York, and Miami Beach, and possibly
others, claiming that CDA 230 preempts local regulatory efforts
to take down illegal listings.
Although the U.S. Court of Appeals for the Ninth Circuit
upheld a lower court ruling in the Santa Monica case recently
that found that the short-term rental companies did not have a
valid claim under 230, the assertion still chills the remedy.
This pattern has repeated itself throughout our country, as
states and counties have continued to pursue a number of
initiatives to prevent illegal rentals while attempting to
withstand legal challenges from the online platforms.
The state of Hawaii, for example, passed legislation in
2016 which would require operators posting on rental platforms
to list their legal tax identification number and platforms not
to host advertising which does not contain such numbers.
The city and county have followed suit in trying to
regulate these illegal rentals recently and in that new
ordinance, which was just enacted about two weeks ago, was a
prohibition on the platforms facilitating short-term rentals
for units that are not properly registered, permitted, or
otherwise allowed.
I strongly disagree that CDA 230, either in language or in
intent, can be used as a legal shield against these types of
common-sense regulations and I cannot accept that in any event
that federal law does not allow states and cities to adopt and
implement reasonable planning and zoning laws and instead to
accept the broad negative social consequences of nonenforcement
of the illegal rentals, especially when those platforms know
full well that their business model relies largely on knowing
breaches of the law by their operators and advertisers.
My request to this committee is to formally examine this
and other abuses of CDA 230. We can follow the FOSTA
legislation which gives us a roadmap and I hope to work closely
with you on this undertaking.
Thank you very much.
[The prepared statement of Mr. Case follows:]
Prepared Statement of Hon. Ed Case
Thank you for allowing me to share my thoughts with the
committee on issues of importance to my constituents and the
state and county governments in Hawai`i. Today I would like to
focus on needed changes to the Communications Decency Act that
are unintentionally preventing my state and its counties as
well as many others throughout our country from enforcing our
planning and zoning laws and implementing overall public policy
in affordable housing, community safety and other critical
areas.
The Internet has brought the world much progress and
section 230 of the CDA, which provides internet platforms with
broad immunity from liability for third-party content posted on
their sites, has been a part of that. When the statute was
passed in 1996 it had an important role to play in fostering
the internet's growth. But today's massive internet platforms
that offer services cannot be allowed to knowingly facilitate
law breaking in our states and localities by hiding behind CDA
230 immunity.
Congress first saw and addressed the modern misuse of CDA
230 last year when it passed the Allow States and Victims to
Fight Online Sex Trafficking Act (``FOSTA'') legislation and
imposed accountability for internet platforms that were
profiting from human trafficking. In a parallel situation, this
issue is also especially acute with respect to platforms that
advertise and sell illegal short-term vacation rentals, like
Airbnb, TripAdvisor, Homeaway, VRBO or Flipkey. In this area
the online host platforms claim that CDA 230 prohibits states
and counties from prohibiting and regulating such rentals and
from penalizing platforms that knowingly sell them illegally.
By one account my State of Hawaii alone hosted
approximately 23,000 short-term vacation rental units in 2017,
meaning one out of every 24 of our housing units was a short-
term rental. This number is widely considered to have been low
then, and has only grown since, driven largely by the ease of
advertising and reserving these units online.
The vast majority of these rental units are illegal since
legal, permitted short-term vacation rentals are known and
number in the low thousands. The negative consequences of this
unregulated disruption of our housing market impact all
segments of our society.
First, commonly known and practiced widespread derogation
of any law has its own broader consequences. Second, these
units operate as the functional equivalent of hotels and yet do
not pay hotel-required taxes and fees and do not comply with
labor, workplace safety or consumer laws. Third, these units
turn residential neighborhoods into the functional equivalent
of hotel zones with loss of neighborhoods and communities.
Fourth, they completely distort our already sky-high
housing market. Because residential dwellings are effectively
converted to hotel rooms, the available owner and renter
markets are compressed, leading to substantially higher rents
and home prices that crowd out still more local residents in
what is already one of the highest rent, lowest home ownership
areas of our country.
There should be a way to compel short-term rental platforms
to remove these illegal units from their inventory, and yet CDA
230 serves as a roadblock in that effort. The platforms have
frequently asserted that CDA 230 does not allow full
implementation and enforcement of these initiatives. They have
sued the cities of San Francisco, Boston, Santa Monica, New
York, and Miami Beach--and possibly others--claiming CDA 230
preempts local regulatory efforts to take down illegal
listings. Notably, the U.S. Court of Appeals for the Ninth
Circuit upheld a lower court ruling in the Santa Monica case
that found the short-term rental companies didn't have a valid
claim under Section 230 or the First Amendment.
This pattern has repeated itself throughout our country,
and states and counties have continued to pursue a number of
initiatives to prevent illegal rentals while attempting to
withstand legal challenges from the online platforms. The State
of Hawaii, for example, passed legislation in 2016 which would
require operators posting on rental platforms to list their
legal tax identification number and platforms not to host
advertising which does not contain such numbers. The City and
County of Honolulu just passed an ordinance for stricter
enforcement of our local laws that limit short-term rental
units on the island of O`ahu. Included in the new ordinance was
a prohibition on platforms facilitating short term rentals for
units that are not properly registered, permitted or otherwise
allowed.
I strongly disagree that CDA 230--either in language or in
intent--can be used as a legal shield against these types of
common-sense regulations. I cannot accept in any event that
federal law does not allow states and cities to adopt and
implement reasonable planning and zoning laws and instead to
accept the broad negative social consequences of non-
enforcement, especially given that the platforms know full well
that their business model relies largely on knowing breaches of
the law by their operators and advertisers.
I respectfully ask that the committee formally examine this
and other abuses of CDA 230. We have a valuable template in the
FOSTA legislation that passed the House by a vote of 388-25 and
was signed into law last year, which could be replicated to
cover other illegal online sales. I hope to work closely with
you on moving such legislation forward and supporting our
communities.
Last, I would like to call to the Committee's attention the
fact that a version of CDA 230 appears in the digital goods
chapter (Article 19) of the draft United States-Mexico-Canada
Agreement currently under consideration. While I understand
that trade is not in this Committee's jurisdiction, to the
extent you agree that CDA 230 needs Congressional review, we
should carefully consider whether embedding a version of the
statute in our international trade agreements is wise.
Thank you very much for your consideration.
Mr. Pallone. Thank you, and we will certainly look into it.
You know, I represent the Jersey Shore, so, you know, when you
talk about rentals and tourism and economy.
And I guess it is an opportunity for me to say right now
that I know the members are here today for this Member Hearing.
But, you know, don't hesitate personally with me or the rest of
us or with your staff to contact us as a follow up today. It's
not like, you know, you're just here and we disappear. All
right. We want you to understand that.
Mr. Case. Appreciate that very much. We will be taking you
up on that kind offer.
Mr. Pallone. All right. Thanks a lot. Thanks, Ed.
And next I think is my colleague from New Jersey. Have
you--have you recovered from Prom Night or dare I ask that
question?
You have not? OK. Well, if you'll proceed, I appreciate it,
my friend.
OPENING STATEMENT OF HON. BILL PASCRELL, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pascrell. Mr. Chairman Pallone and Ranking Member
Walden, it is good to see you both this morning. I thank you
for the opportunity to highlight the need for transparency and
regulation in the badly corrupted primary and secondary live-
events ticket marketplace.
Been in the press a lot lately. We tried nine years ago
unsuccessfully and I think it's time again that we look here.
So one of my favorite groups is Metallica where a lot of the
young people today like to go to their concerts and spend--I
think they have to give a point of blood, too, in order to get
in there because the tickets are so expensive.
I followed this marketplace for over a decade. ``Wherever I
May Roam'' is one of Metallica's songs. Wherever I go across
the country, Canada, I hear complaints from my constituents on
their frantic Ticketmaster--frantic experience with ticket
sales, and you can't believe the mail that we get on this
subject. It is the furthest thing on all of our minds when we
come to work in the morning but I am telling you a fact of life
here.
The combined behemoth dominates a $9 billion per year
industry and holds over 80 percent of market share. They have
sway over everything, including the peanuts you buy there.
The record sales, licensing, the talent--the talent
management, venue ownership, ticket sales, the concessions,
down to selling hot dogs and pretzels--you name it, it is
there. If there ever was a monopoly, this is it. Sorry, Mr.
Holden, you blew it. You know what I am talking about. He
permitted the merger of it.
The GAO study of the live tickets industry that Chairman
Pallone and I requested notes questionable industry practices,
a surprise to no one who has tried to buy tickets.
It is important to emphasize the marketplace has been
governed by zero federal regulation. Live Nation operates with
impunity. Another Metallica song, ``Nothing Else Matter'' to
them but profits.
It is time for Congress to turn the page, pass legislation
to add regulation, impose some order, and stop bad actors who
make a living by ripping off regular folks daily.
The Better Oversight of Secondary Sales and Accountability
of Concert Tickets, better known as the BOSS Act--I wonder why
we named it that--is endorsed by all the consumer groups and
attacks problems of both the primary and secondary ticket
marketplace.
The BOSS Act makes on easy fix, bans the last second fees,
requires every seller advertising all fees up front, which
most--none of them do.
GAO estimated that primary and secondary ticketing
companies charge fees averaging 27 and 31 percent of the ticket
price. In my neighborhood in Paterson, New Jersey, that is
called thievery.
At the FTC's Ticket Forum last month, nearly every
stakeholder agreed that they could accept such a law, and for
fans all-in pricing would allow for easier comparison, stopping
to find the best deal.
The BOSS Act lets ticket buyers know how many tickets are
going on sale, how many are going to be held back, and where
those tickets are coming from. It will also prevent those with
connections to venues and artists from knowingly reselling
tickets at a jacked-up price. For the secondary marketplace,
the BOSS Act addresses speculative ticket sales and so-called
white label sites that trick consumers.
I first introduced the bill 12 years ago when there was a
major issue with Bruce Springsteen tour, and these problems are
not going away. Just last week, Billboard Magazine uncovered
the latest scam.
Unbeknownst to fans, apparently Ticketmaster and Live
Nation was working with the bands' management to hold back
88,000 tickets and posted them directly on resale sites. That
is sad but it is true. Ticketmaster has denied past
participation in such schemes.
In the case of Whiplash, Live Nation admitted to the scheme
last week in about a dozen artists between 2016 and 2017. They
could still be doing the same. This is wrong.
I think we need a commitment to toll the bell for an end of
the unregulated ticket marketplace by passing the BOSS Act, and
I am open for any questions and I duly appreciate your time and
your efforts on all the issues that you deal with.
[The prepared statement of Mr. Pascrell follows:]
Prepared Statement of Hon. Bill Pascrell., Jr.
Chairman Pallone/Chairwoman Schakowsky, thank you for this
opportunity highlight the need for transparency and regulation
in the badly corrupted primary and second live events ticket
marketplace. I have followed this marketplace for over a
decade. Wherever I may roam across our country, and Canada too,
I hear complaints from my constituents on their frantic
experiences with ticket sales.
And much of this can be traced to the Live Nation-
Ticketmaster merger. The combined behemoth dominates a $9
billion per year industry and holds over 80% market share. They
have sway over everything. The record sales, licensing, talent
management, venue ownership, ticket sales, and concessions down
to selling hot dogs and pretzels. The GAO study of the live
tickets industry that Chairman Pallone and I requested notes
questionable industry practices that surprise no one who has
tried to buy tickets.
It's important to emphasize the marketplace has been
governed by zero federal regulation. Live Nation operates with
impunity. Nothing else matters to them than profits.
It's time for Congress to turn the page and pass
legislation to add regulation, impose some order, and stop bad
actors who make a living by ripping regular people off. The
Better Oversight of Secondary Sales and Accountability in
Concert Ticketing or BOSS ACT (H.R. 3248) is endorsed by all
the consumers groups and attacks problems in both the primary
and secondary ticket marketplace. The BOSS ACT makes one easy
fix makes: bans last second fees and requires every seller
advertise all fees up front. GAO estimated that primary and
secondary ticketing companies charge fees averaging 27 and 31
percent of ticket prices.
At the FTC's ticket forum last month, nearly every
stakeholder agreed that they could accept such a law. And, for
fans, all-in pricing would allow for easier comparison shopping
to find the best deals. The BOSS ACT lets ticket buyers know
how many tickets are going on sale, how many are being held
back, and where those tickets are coming from. It also prevents
those with connections to venues and artists from knowingly
reselling tickets at a jacked-up price.
For the secondary marketplace, the BOSS Act addresses
speculative ticket sales and so-called white label sites that
can trick consumers.
I first introduced this bill 12 years ago when there was a
major issue with a Bruce Springsteen tour on sale. And these
problems are not going away. Just last week, Billboard Magazine
uncovered the latest scam perpetrated upon consumers.
Unbeknownst to fans, apparently Live Nation was working with
the band's management to hold back 88,000 tickets and post them
directly on resale sites. Sad but true!
Ticketmaster has denied past participation in such schemes.
But, in a case of whiplash, Live Nation admitted to the scheme
last week and ``about a dozen artists'' between 2016 and 2017.
And could still be doing this today. This is wrong. And we
should investigate these deceptive practices.
Be the hero of the day help me support consumer
transparency and give fans have a fairer chance to purchase
live event tickets. John Donne, Earnest Hemingway, and James
Hetfield have each asked for whom the bell tolls?
I ask this committee to toll the bell for the end of an
unregulated ticket marketplace by passing the BOSS ACT.
Also, I wish to highlight the bipartisan Laboratory Access
for Beneficiaries (LAB) Act (H.R. 3584) I helped Representative
Scott Peters introduce. The ongoing cuts to clinical labs hurt
patient access and erect further barriers to care. I encourage
the committee to consider H.R. 3584 to ensure payment rates
under the Clinical Lab Fee Schedule will reflect market prices
and that data collection will be representative of the whole
laboratory community. Clinical laboratory services account for
less than two percent of Medicare fee-for-service spending, but
the results of laboratory tests help guide critical decisions
for diagnosis, treatment, and prevention for millions of
patients. We must tear down any barriers to this critical
resource so that we are improving healthcare for patients every
day.
Mr. Pallone. Well, I want to thank you. I know that you
have been out front on this in trying to tackle this problem
and we do consider it a priority and, you know, we will take it
up in the fall, hopefully. You and I can talk more about it.
And, of course, I appreciate you reminding me about the
Boss and Bruce Springsteen because I am looking forward to
being back to the Jersey Shore and the Asbury Park and all the
venues, you know, that he hangs out in.
Mr. Pascrell. The Stone Pony.
Mr. Pallone. Yes, Stone Pony as well.
The gentleman----
Mr. Walden. Just a quick question.
Mr. Pascrell, thank you for bringing this to our attention,
and on a side note can you tell us how many Metallica song
titles were in your testimony?
Twelve.
[Laughter.]
Mr. Walden. I got 11 of them. All right.
Turn on your mic. We want to hear this.
Mr. Pascrell. They are advertising for--you know, they are
coming out to New York City area. But that is the only reason
why that I--and I happen to like the group myself.
Mr. Walden. There is just--you know, you learn a lot at
Member Day and knowing that Mr. Pascrell is a fan of Metallic
is something I learned today. So this is----
Mr. Pascrell. Yes.
Mr. Pallone. Well----
Mr. Walden. Thank you.
Mr. Pascrell. I have to search for my talents. I don't
have--I have so few.
[Laughter.]
Mr. Pascrell. But that interesting, and I close out my
statement, Mr. Walden, on ``For Whom the Bells Toll.'' It is
one of my favorite old movies and books.
They have a song--Metallica--``For Whom the Bells Toll,''
and I hope it tolls for Ticket Master. It was the worst thing
that happened, allowing them to join--they own the market. They
own 85 percent of the entire--I mean, we go after airlines
sometimes and this and that.
Monopolies have become, you know, part of us now. That's
not good. You know why? Our kids--well, my kids are grown--want
to go to a concern. You know, you need a wheelbarrow full of
money, literally, or else they can't go. Baseball games--you
are getting--and, you know, nobody watches over this. It is
entertainment. They say, well, if you don't want to spend the
money don't go. Well, that is very true.
Mr. Pallone. We promise to look into it, and although I
have to say that I think I would have preferred the band that
you had last night to Metallica myself. But, you know, all
right. Thanks a lot, Bill. Appreciate it.
Mr. Pascrell. My honor. Thank you.
Mr. Pallone. Next, we are going to go to the gentleman from
Georgia, Mr. Bishop.
OPENING STATEMENT OF HON. SANFORD D. BISHOP, Jr., A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA
Mr. Bishop. Thank you very much, Mr. Chairman.
I would like to thank you, Chairman Pallone, and Ranking
Member Walden, and the members of the House Energy and Commerce
Subcommittee on Health for giving me the opportunity to testify
this morning on an issue of great importance to the delivery of
healthcare, especially in rural communities across the nation.
The issue is non-emergency medical transportation, or NEMT,
which currently provides Medicaid beneficiaries with rides to
medical appointments every year.
This benefit, which has been in place since Medicaid's
inception in 1966, has come under attack recently by the
Centers for Medicare and Medicaid Services, which has sought to
roll it back by making it optional at the state level.
Such a change would have wreaked havoc on millions of
Americans' ability to get to and from their medical
appointments quickly and, most importantly, safely.
Individuals who bear the highest burden of chronic
conditions, including cancer, HIV, substance abuse disorder,
and end-stage renal disease, would not have been able to access
vital medical services like chemotherapy, physical therapy, and
dialysis.
They also would not have been able to travel to pharmacies
to obtain their drug prescriptions or their medical supplies.
In Georgia alone, non-emergency medical transportation
provided patients transportation nearly 60,000 times last year
to pharmacies to pick up prescriptions that are important for
their adherence to a plan of care.
Ending Medicaid coverage for non-emergency medical
transportation would literally have been a matter of life and
death for many of these individuals.
Earlier this year, I sent a letter to Representative Rosa
DeLauro, who chairs the House Appropriations Subcommittee on
Labor, Health and Human Services, Education, and Related
Agencies, as well as to Ranking Member Tom Cole opposing this
change.
Our letter requested legislative language in the
appropriations bill blocking funding for the implementation of
that rule change. It was signed by the entire Congressional
Black Caucus in the House and received important bipartisan
support from a number of my Republican colleagues in the House.
I would like to ask unanimous consent that the letter be
included in the record with my testimony.
Mr. Pallone. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Bishop. Fifty-six non-emergency medical transportation
stakeholders including groups representing Medicaid
beneficiaries with substance user disorder, behavioral
disorders, and end-stage renal disease also sent a letter
opposing the rule change.
I would like to ask unanimous consent that the list of
those people be included in the record also.
[The information appears at the conclusion of the hearing.]
Mr. Bishop. I am pleased to report that the language was
successfully added to the fiscal year 2020 Labor-HHS
Appropriations bill in an amendment that was offered as a
manger's amendment by Chairwoman DeLauro.
Following its inclusion in the bill, we heard word from CMS
that they won't try to promulgate the rule until after the 2020
elections.
Although this is welcome news, we still have to be
vigilant and ensure that this important benefit remains
available to our most vulnerable citizens.
Yesterday, I joined my colleagues Tony Cardenas, Tom
Graves, and Buddy Carter in introducing bipartisan legislation
that would codify the Title XIX of the Social Security Act, the
Medicaid transportation benefit.
The bill, H.R. 3935, would simply preserve the status quo.
It would add non-emergency medical transportation services for
individuals without other means of transportation to the list
of mandatory benefits that every state Medicaid program is
required to provide by law.
According to CBO, the bill would have no cost provided
that we act before CMS publishes the proposed rule. I am
hopeful that the legislation will be considered quickly by this
subcommittee for inclusion in the extenders package by the end
of the year.
In the coming weeks, we plan on introducing legislation on
the Medicare front as well. The legislation will provide
coverage for non-emergency medical transportation for patients
who qualify for Medicare based on their end-stage renal
disease.
The measure is being finalized as we speak and the details
are still being worked out. I was inspired to work on this
issue by a staff member in my Albany, Georgia office whose
daughter had end-stage renal disease and subsequently had a
successful kidney transplant in 2015.
I look forward to working with all of you in the days,
weeks, and months ahead to ensure that these important
transportation services are protected now and into the future.
So I thank you for allowing me to appear before you this
morning.
[The prepared statement of Mr. Bishop follows:]
Prepared Statement of Hon. Sanford D. Bishop
I would like to thank Chairman Pallone, Ranking Member
Walden, and members of the House Energy and Commerce
Subcommittee on Health for giving me the opportunity to testify
this morning on an issue of great importance to the delivery of
healthcare, especially in rural communities across the nation.
The issue is Non-Emergency Medical Transportation, or NEMT,
which currently provides Medicaid beneficiaries with rides to
medical appointments each year. This benefit, which has been in
place since Medicaid's inception in 1966, has come under attack
recently by the Centers for Medicare and Medicaid Services,
which has sought to roll it back by making it optional at the
state level.
Such a change would have wreaked havoc on millions of
Americans' ability to get to and from their doctor quickly and,
most importantly, safely.
Individuals who bear the highest burden of chronic
conditions including cancer, HIV, substance abuse disorder, and
end stage renal disease would not have been able to access
vital medical services like chemotherapy, physical therapy, and
dialysis.
They also would not have been able to travel to pharmacists
to obtain drug prescriptions or medical supplies. In Georgia
alone, non-emergency medical transportation transported
patients nearly 60,000 times last year to the pharmacy to pick
up prescriptions that are important to their adherence to a
plan of care.
Ending Medicaid coverage for non-emergency medical
transportation would literally have been a matter of life and
death for many of these individuals.
Earlier this year, I sent a letter to Representative Rosa
DeLauro, the Chair of the House Appropriations Subcommittee on
Labor, Health and Human Services, Education, and Related
Agencies, and Ranking Member Tom Cole opposing this change. The
letter requested legislative language in the appropriations
bill blocking funding for the implementation of the rule
change. It was signed by the entire House Congressional Black
Caucus and received important bipartisan support from a number
of my Republican colleagues in the United States House of
Representatives. I ask unanimous consent that the letter be
included in the record.
Sixty NEMT stakeholders including groups representing
Medicaid beneficiaries with substance user disorder, behavioral
disorders and end stage renal disease also sent a letter
opposing the rule change.
I am pleased to report that the language was successfully
added to the Fiscal Year 2020 Labor-HHS Appropriations bill in
an amendment offered by Chairwoman DeLauro.
Following its inclusion in the bill, we heard word from CMS
that they will not try to promulgate the rule until after the
2020 elections. Although this news is welcome, we still have to
be vigilant and ensure that this important benefit remains
available to our most vulnerable citizens.
Yesterday, I joined my colleagues Tony Cardenas, Tom
Graves, and Buddy Carter in introducing bipartisan legislation
that would codify, in Title XIX of the Social Security Act, the
Medicaid transportation benefit.
The bill would simply preserve the status quo. It would add
Non-Emergency Medical Transportation services for individuals
without other means of transportation to the list of mandatory
benefits that every state Medicaid program is required to
provide by law.
According to CBO, the bill would have no cost provided we
act before CMS publishes the proposed rule. I am hopeful that
the legislation will be considered quickly by this subcommittee
for inclusion in an extenders package by the end of this year.
In the coming weeks, I also plan on introducing legislation
on the Medicare front as well. The legislation provide coverage
for non-emergency medical transportation for patients who
qualify for Medicare based on their end-stage renal disease.
The measure is being finalized as we speak and the details are
still being worked out.
I was inspired to work on this issue by a staff member in
my Albany office whose daughter had end stage renal disease and
subsequently had a successful kidney transplant in 2015.
I look forward to working with all of you in the days,
weeks, and months ahead to ensure that these important
transportation services are protected now and into the future.
Mr. Pallone. I thank the gentleman.
So you want us to look into a permanent fix, basically?
Mr. Bishop. Yes.
Mr. Pallone. All right. We will certainly look into it.
Thanks a lot. Thanks.
And now we go to Mr. Westerman.
OPENING STATEMENT OF HON. BRUCE WESTERMAN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ARKANSAS
Mr. Westerman. Chairman Pallone, Ranking Member Walden,
thank you for hosting today's Member Hearing. I appreciate the
time that you are giving to members like me who are not on this
committee, but who share your concerns and wish to be involved
in reforming issues related to the Energy and Commerce
Committee.
As a bit of background, I represent a very large and rural
district in the Fourth District of Arkansas. My constituents
are hard-working men and women who love our country and are
busy raising families and trying to make ends meet.
Our current system of healthcare is failing them. As
Members of Congress with the ability to address this broken
system, we are failing them every day we do not take action.
Health insurance premiums are spiraling out of control,
patients can barely afford essential medications that keep them
alive, and costs to obtain care are outrageously unaffordable.
Furthermore, access is limited. Individuals in my district
must often drive hours just to get basic medical care because
local providers are out of network or because telemedicine is
not an option.
Our healthcare policy and delivery system affects everyone.
Most people don't give a lot of thought to healthcare when they
don't need it. But when they do, it is all they think about.
In the United States of America, we can do much better in
healthcare. We can cover more people. We can cover preexisting
conditions. We can lower cost and we can provide Americans with
more options, transparency, and the best care on the planet.
We are all quick to point out the problems. But I am here
today, hopefully, to provide solutions. I am not a doctor. I am
not a pharmacist or insurance actuary, though friends of mine
who are experts in those fields do serve in Congress and bring
much to the table.
I am an engineer. I was educated to approach problems
logically, methodically, and with common sense and reason. When
the American Health Care Act and its Senate counterparts proved
unsuccessful to address our nation's healthcare crisis, I
thought, why leave the heavy lifting to the traditional
healthcare policymakers? Might a fresh set of eyes make a
difference? Might a different approach be something that we
need?
With that mind set, I set out to develop a bipartisan
healthcare bill that would provide the people of this nation
with some relief and I spent a year and a half doing a deep
dive into the policy.
The Fair Care Act, which I introduced earlier this year,
can be the bipartisan framework to our nation's healthcare
crisis.
In it, I address public and private payers, drug prices,
provider competition, and healthcare innovation. My legislation
would increase access to insurance provided on the ACA
exchanges, create competition between providers and drug
makers, and ensure long-term solvency of the Medicaid program
without abandoning those who are currently covered.
It would continue to cover patients with pre-existing
conditions and states would have increased opportunities to
design healthcare programs that meet the unique needs of their
population.
And please, before you assume that a Republican from the
South couldn't possibly introduce legislation with provisions
from both parties, familiarize yourself with its content.
For example, the bill limits the exclusivity period for
certain drugs and biologic products. I see that Representative
Schakowsky is here today. She and I have already introduced a
bipartisan bill to address that particular issue.
It reforms payment structures for Medicare Parts B and D
for wealthy individuals. It creates fair access and reduces
income cliffs so more individuals can afford to enroll in
insurance plans. It reestablishes anti-trust laws that apply to
health and dental insurers.
It holds Pharmacy Benefit Managers accountable for their
actions, discourages hospital consolidation, and increases
transparency throughout the system, plus it does a whole lot
more.
I have developed this legislation from my personal
convictions as well as evidence-based research about what is
best for the greatest number of Americans, without the
influence of interest groups, lobbyists, or enterprises.
We have a choice as lawmakers, as representatives sworn to
serve our constituents. I have found that the healthcare
problems are not unsolvable.
We can either fight and bicker about trivial political
matters or we can work together to make progress and actually
address the healthcare crisis. Waiting until the next election
cycle doesn't help the American people.
Waiting for the system to collapse doesn't help the
American people. Working together on real solutions does.
I bring this legislation to you today in the hopes that it
will serve as a starting point for objective discussions and
legitimate negotiations on these issues.
I am willing to meet with any of you to discuss working
together, and I sincerely hope that we do. Healthcare cannot
and should not be a political issue if we truly hope to help
all Americans.
Again, I thank you again for this opportunity today and I
would welcome any questions you may have.
[The prepared statement of Mr. Westerman follows:]
Prepared Statement of Hon. Bruce Westerman
Chairman Pallone, Ranking Member Walden--Thank you for
hosting today's Member Hearing.
I appreciate the time you are giving to members like me who
are not on this committee, but who share your concerns and wish
to be involved in reforming issues related to Energy and
Commerce.
As a bit of background, I represent a very large and rural
district, the Fourth District of Arkansas.
My constituents are hard-working men and woman often just
trying to make ends meet.
Our current system of healthcare is failing them. And as
Members of Congress with the ability to address this broken
system, we are failing them every day we do not take action.
Health insurance premiums are spiraling out of control,
patients can barely afford essential medications that keep them
alive, and costs to obtain care are outrageously unaffordable.
Furthermore, access is limited.
Individuals in my district must often drive hours just to
get basic medical care because local providers are out of
network or because telemedicine is not an option.
It's simple--no one gives a lot of thought to healthcare
when they don't need it, but when they do, it's all they think
about.
There is no reason for this to be the case in the United
States of America.
But I'm not here to simply to discuss the problems. I'm
here to promote solutions.
I am not a doctor, pharmacist, or insurance actuary--though
friends of mine who are experts in those fields do serve in
Congress.
I am an engineer, trained to approach problems logically
and methodically.
When the American Health Care Act and its Senate
counterparts proved unsuccessful in attempts to address our
nation's healthcare crisis, I thought, why leave the heavy
lifting to the traditional healthcare policymakers?
Might fresh eyes be useful?
With that mindset, I set out to develop a bipartisan
healthcare bill that would provide the people of this nation
with some relief.
The Fair Care Act, which I introduced earlier this year, is
my answer to our nation's healthcare crisis.
In it, I address public and private payers, drug prices,
provider competition, and healthcare innovation.
My legislation would increase access to insurance provided
on the ACA exchanges, create competition between providers and
drug makers, and ensure long-term solvency of the Medicaid
program without abandoning those who are currently covered.
It would continue to cover patients with pre-existing
conditions.
And states would have increased opportunities to design
healthcare programs that meet the unique needs of their
population.
And please, before you assume that a Republican from the
South couldn't possibly introduce legislation with provisions
from both parties, familiarize yourself with its content.
For example, the bill limits the exclusivity period for
certain drugs and biologic products, eliminates Medicare Parts
B and D for wealthy individuals, funds subsidies for more
individuals to enroll in insurance plans, reestablishes anti-
trust laws that apply to health and dental insurers, holds
Pharmacy Benefit Managers accountable for their actions,
discourages hospital consolidation, and increases transparency
throughout the system.
I've developed this legislation from my personal
convictions as well as evidence-based research about what is
best for the greatest number of Americans, without the
influence of interest groups, lobbyists, or enterprises.
We have a choice as lawmakers, as Representatives sworn to
serve our constituents.
We can either fight and bicker about trivial political
matters for the next sixteen months, or we can work together to
make progress and actually address this healthcare crisis.
Waiting until the next election cycle doesn't help the
American people.
Waiting for the system to collapse doesn't help the
American people.
Working together on real solutions does.
I bring this legislation to you today in the hopes that it
will serve as a starting point for objective discussions and
legitimate negotiations on these issues.
I'm willing to meet with any of you to discuss working
together, and I sincerely hope that we do.
Healthcare cannot, and should not, be a political issue if
we truly hope to help all Americans.
I thank you again for welcoming me today, and I look
forward to working with you, my colleagues, to solve this
problem once and for all.
Mr. Pallone. All right. I want to thank you and I assure
you that we will look into your bill. And I do want to say it
really drives me crazy, and members have heard me say it many
times in this committee, that we have these disparities between
rural America and the rest of the country.
I mean, it just should not be that, you know, if you are in
a rural area that you can't get--and I understand it is not
always true but that you often can't get access or quality
healthcare or resources, and I have had a chance over the last
couple years because my son was in Japan in a rural area
teaching English.
And I was amazed how it didn't really matter whether you
went there in this small town a thousand miles from Tokyo or
you were in Tokyo. You basically had access to the same level
of care. And it is just not true here and we have got to do
something about it.
Did you want to----
Mr. Walden. No, I just want to thank the gentleman from
Arkansas and also concur with you, Mr. Chairman, on the
disparity in access to care.
I got three countries with no hospitals and no doctors
because they are so remote. One person for every nine miles of
power lines. I mean, these are wide open spaces and yet if a
heart attack or a stroke occurs, that golden hour is the same
length of time as it is in an urban setting.
So expansion of telehealth is essential in these basic
services. But I know Mr. Westerman has worked really hard and
put a lot of thought into this plan and I hope if there is an
opportunity we can dig into it a little further because has
really worked on this for a couple of years now. So I
appreciate it.
Mr. Westerman. I appreciate that, and I believe it's a
policy that works for rural America and urban America.
Mr. Pallone. Ms. Schakowsky?
Ms. Schakowsky. Yes, I just wanted to thank the gentleman.
I am so happy that we are co-sponsoring a bill to lower the
price of prescription drugs and it is an honor to be working
with you on that.
Thank you.
Mr. Westerman. Thank you.
Mr. Pallone. Thanks again. Appreciate it.
Mr. Westerman. Thank you.
Mr. Pallone. The gentleman from California, Mr. Lieu. Thank
you for being here.
OPENING STATEMENT OF HON. TED W. LIEU, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. Lieu. Thank you, Chairman Pallone, Ranking Member
Walden, Chairwoman Schakowsky, and Ranking Member McMorris
Rodgers, for allowing me to testify.
Today, I am here to urge you to consider my legislation
H.R. 3570, the Therapeutic Fraud Prevention Act, which aims to
prevent for-profit conversion therapy.
This legislation has been co-sponsored by 89 of our
colleagues including 14 members of the Energy and Commerce
Committee, and six members of the Consumer Protection and
Commerce Subcommittee.
It is supported by a wide range of organizations including
the American Academy of Pediatrics, the American Psychoanalytic
Association, and the Human Rights Campaign.
When I was in the California State Senate, I authored the
first law in the nation to ban gay conversion therapy. Since
then, 18 states have banned this practice and this is a
bipartisan issue. In seven of those states Republican governors
signed the legislation and in a number of those states the
state bill had bipartisan support.
Now, conversion therapy has three main problems.
Number one, it doesn't work. It is fraudulent. Number two,
not only does it not work and in some cases, it could severely
harm the patients who undergo it, and number three, it could be
very costly.
According to the Williams Institute, nearly 700,000 folks
in the United States have been subjected to conversion therapy,
and one group known as JONAH, was charging about $100 for
weekly individual sessions. A lawsuit filed by former victims
of JONAH represented by the Southern Poverty Law Center,
revealed that individuals could spend more than $10,000 per
year on conversion therapy.
JONAH was ordered to shut down in 2015 for violating New
Jersey's Consumer Fraud Act. So in addition to being costly and
being fraudulent, we know that the entire medical community is
arrayed against this.
The American Psychiatric Association has said that no
credible evidence exists that any mental health intervention
can reliably and safety change sexual orientation nor from a
mental health perspective does sexual orientation need to be
changed.
There is simply no disease known as being gay. It's simply
being human. That was removed out of the DSM-IV manual decades
ago. So when a for-profit mental health professional comes and
says, I am going to charge you money to get rid of a disease
that does not exist, that is called fraud.
In addition, studies have shown that patients can undergo
severe harm from this. Patients have committed suicide or
thought about committing suicide.
When I did this legislation in the California State Senate,
we had witnesses come up to talk about going through this
practice and then wanting to commit suicide later.
So this can also greatly harm people.
I also want to note that this legislation that I introduce
here only applies to for-profit conversion therapists. So if
you are a priest and you want to talk about this with members
of your church, that is fine. It doesn't apply to you. It
applies to these groups that are scamming consumers with this
fraudulent practice.
I note that this bill will protect individuals from being
defrauded by conversion therapists and falls clearly within the
subcommittee's mission to protect consumers.
So I respectfully request that either the subcommittee or
the entire committee consider this bill, and thank you for the
opportunity to testify and happy to answer any questions that
you may have.
[The prepared statement of Mr. Lieu follows:]
Prepared Statement of Hon. Ted W. Lieu
Chairman Pallone, Ranking Member Walden, Chairwoman
Schakowsky, and Ranking Member McMorris Rodgers, thank you for
allowing me to testify.
Today, I am here to urge you to consider my legislation
H.R. 3570, the Therapeutic Fraud Prevention Act, which aims to
prevent for-profit conversion therapy. This legislation has
been cosponsored by 89 of our colleagues in the House of
Representatives, including 14 members of the Energy and
Commerce Committee, and six members of the Consumer Protection
and Commerce Subcommittee. It is supported by a wide range of
organizations including the American Academy of Pediatrics, the
American Psychoanalytic Association, the Southern Poverty Law
Center, and the Human Rights Campaign.
About Conversion Therapy
Conversion therapy, also known as reparative therapy or
sexual orientation change efforts, refers to the practice of
attempting to change an individual's sexual orientation or
gender identity. According to the Williams Institute at the
University of California Los Angeles, nearly 700,000 adults in
the United States have been subjected to conversion therapy.
Not only is conversion therapy common, but it also costly. One
conversion therapy organization, People Can Change, charges
$650 to $850 for weekend conversion therapy retreats in the
woods. Another, Jews Offering New Alternatives to Healing
(JONAH), charged about $100 for weekly individual sessions and
$60 for group therapy sessions. A lawsuit filed by former
victims of JONAH revealed that individuals could spend more
than $10,000 per year on conversion therapy. JONAH was ordered
to shut down in 2015 for violating New Jersey's Consumer Fraud
Act.
Inefficacy, Harms of Conversion Therapy
The national community of professionals in education,
social work, health, mental health, and counseling has
recognized universally that conversion therapy is a wholly
useless and risky pseudoscience. In reality, it is not possible
to change an individual's sexual orientation or gender
identity, nor should we seek such change. Moreover,
administering conversion therapy causes serious harms to its
victims including depression, self-harm, and suicide. In 2013,
the American Psychiatric Association released the following
statement:
``The American Psychiatric Association does not believe
that same-sex orientation should or needs to be changed, and
efforts to do so represent a significant risk of harm by
subjecting individuals to forms of treatment which have not
been scientifically validated and by undermining self-esteem
when sexual orientation fails to change. No credible evidence
exists that any mental health intervention can reliably and
safely change sexual orientation; nor, from a mental health
perspective does sexual orientation need to be changed.'' \1\
---------------------------------------------------------------------------
\1\ APA Reiterates Strong Opposition to Conversion Therapy.
November 15, 2018. Accessed July 22, 2019. https://www.psychiatry.org/
newsroom/news-releases/apa-reiterates-strong-opposition-to-conversion-
therapy.
---------------------------------------------------------------------------
So-called conversion therapists should not be able to sell
their services by claiming that they are effective and
harmless, especially when forced upon minors. As legislators, I
believe that we have a responsibility to protect our
constituents from being swindled by these individuals and
organizations.
About the Therapeutic Fraud Prevention Act
In June, I re-introduced H.R. 3570, the Therapeutic Fraud
Prevention Act. This legislation makes it unlawful for any
person to provide for-profit conversion therapy or to advertise
for the provision of conversion therapy. It allows the Federal
Trade Commission to enforce the prohibition under the Federal
Trade Commission Act and provides additional enforcement
authority to the Department of Justice and state attorneys
general.
Because this legislation targets only those who charge for
conversion therapy, it does not infringe on First Amendment
rights. At the same time it is an incredibly effective way to
ensure that for-profit practitioners are not allowed to engage
in this fraudulent behavior.
State Progress
Across the nation, we are seeing growing support for laws
preventing conversion therapy. In 2012, California enacted the
first law in the nation to protect minors from conversion
therapy. Since that time, seventeen states-including Illinois
and Washington-the District of Columbia, and several more
municipalities have passed similar laws. Seven of these state
laws were signed by Republican governors and several received
bipartisan support in their respective state legislatures.
These bans are working. The aforementioned Williams
Institute study found that 10,000 LGBT youth living in states
that ban conversion therapy have been protected from the harm.
Still, the report also showed that 16,000 LGBT youth living in
states without such bans will receive conversion therapy from a
licensed professional before they turn 18. Clearly, we need
federal action.
Conclusion
The Therapeutic Fraud Prevention Act will protect
individuals from being defrauded by conversion therapists and
falls clearly within the subcommittee's mission to protect
consumers. I respectfully request that the subcommittee
consider this important piece of legislation and thank you for
the opportunity to testify before you.
Mr. Pallone. I thank the gentleman. Again, we will take a
look and we certainly are always concerned about anything that
relates to consumer fraud and trying to prevent consumer fraud.
So unless anyone else, I thank you again for being here and
we will follow up.
Mr. Lieu. Thank you.
Mr. Pallone. Thanks.
And next we go to the gentleman from Wisconsin is next.
Thank you.
Mr. Grothman. I voted for one of your nice amendments
yesterday.
OPENING STATEMENT OF HON. GLENN GROTHMAN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF WISCONSIN
I am here to talk about H.R. 380. It deals with requiring--
well, right now when it comes to dams, environmental agencies
frequently feel that we need fish passageways so the fish can
swim upstream.
We have a major dam in the state of Wisconsin, which is
actually in Congressman Pocan's district but it's kind of very
close to my district, and right now that dam is the only thing
that prevents Asian carp, a huge invasive species, from
swimming upstream in the Wisconsin River.
It is a very important thing to the state of Wisconsin.
Asian carp have gone all the way from the Gulf of Mexico into
Wisconsin River, which is the most important river in the state
of Wisconsin.
Wisconsin River is not only important in its own right but
as you work your way up the river you wind up in many, many
lakes in northern Wisconsin.
The only thing that has prevented these massive Asian carp
from doing so much to destroy the upper Wisconsin River and
lakes in northern Wisconsin is a dam on the southern Wisconsin
River.
Right now, the secretary of interior is doing a study to
see whether they can put a fish passageway up there. I can
understand why in most circumstances you want a fish
passageway. I can think of other examples in other parts of my
district where they work well.
However, in this era of invasive species, some of these
dams are so valuable in protecting our rivers and lakes and for
that reason, myself, with the assistance of Mr. Pocan, we
drafted a bill requiring the Department of Interior to look at
it, and I think if we do we can rest easy in knowing that not
only the upper Wisconsin River but all the lakes in northern
Wisconsin could be protected from the Asian carp. I am sure
there are other places around the country where this must be a
problem as well.
Do you have any questions for me?
[The prepared statement of Mr. Grothman follows:]
Prepared Statement of Hon. Glenn Grothman
Mr. Chairman Rush, Ranking Member Upton, and members of
the committee, thank you for giving me the chance to speak in
favor of amending the Federal Power Act to require the
Secretary of Commerce or the Secretary of Interior to consider
the threats posed by invasive species before mandating a new
fish passageway be built through a dam.
My bill is bipartisan and enjoys the support of
Congressman Mark Pocan also of Wisconsin.
Our home state currently faces an invasive species
threat that may affect the entire Great Lakes Region.
Invasive species are not just a problem in
Wisconsin but are causing serious large-scale environmental and
economic problems across the country. According to the
Department of the Interior, the prevalence of invasive species
is estimated to cost the U.S. economy over $100 billion
annually, including impacts to business and industry,
recreation, and public health.
A hydroelectric dam in Prairie du Sac, Wisconsin,
offers a case in point.
The United States Fish and Wildlife Service has
ordered the installation of a fish passageway located at the
hydroelectric plant in Prairie du Sac dam. Asian Carp, which is
an invasive species that can grow nearly three feet in length,
have been found at the base of this dam.
Fish passageways can serve an important role of
preserving and enhancing the populations of desirable, native
fish by allowing them a way to travel safely, timely, and
effectively around dams.
However, invasive species use these same fish
passageways to invade rivers and lakes and devastate native
species and their habitats.
Installing a fish passageway at the Prairie du Sac
dam could allow the Asian Carp to migrate upstream to the
Wisconsin River, Lake Wisconsin and eventually the Great Lakes.
Currently, the dam acts as a physical barrier to
upstream movement of Asian Carp and other invasive species.
None of the invasive species established in the Mississippi
River Basin are currently known to exist upstream of the dam.
In fact, Asian Carp have been captured by
Wisconsin Officials below the dam as recently as 2014.
The presence of these invasive species in the
lower Wisconsin River raises concerns that these fish could
penetrate past the protective wall of the dam and travel
upstream if a fish passage is installed.
If they do indeed move upstream through the
Wisconsin waterways, and eventually into the Great Lakes, there
would be significant adverse effects to the environment, native
fish populations, and the recreation industry of Wisconsin.
This bill would simply ensure that federal
officials have to consider this threat before prescribing and
finalizing fishway conditions like the one in Prairie du Sac.
We believe that there are viable non-fishway
alternative approaches which can both support the maintenance
of native fish populations, while also eliminating the risk of
spreading invasive species into protected waterways.
Allowing for greater flexibility and discretion
from Department of Interior, with respect to considering non-
fishway alternatives will protect watersheds and local
economies in the Great Lakes region from the detrimental
effects of invasive species.
I would like to thank the Committee again for
holding this hearing and am happy to answer any questions you
may have.
Mr. Pallone. Well, I just want--you know that we worked
with you and Mr. Pocan on this in the last Congress and we will
continue to work on it. I just want you to know that.
Yes, Mr. Upton?
Mr. Upton. Well, thank you for being here today, and I know
that as a member of the Great Lakes Caucus--I think you are
too--that fighting the Asian carp from getting further north is
a tremendous priority for all of us.
And we had a bipartisan group from Michigan go down to
Illinois during the 4th of July break to look at one of the
locks down there just literally about an hour south of Midway
Airport.
The Corps of Engineers, as you know, has come up with a
study that I think we need to implement that would block that
carp then from going north and infiltrating, causing
irreversible damage to the Great Lakes Region, and it appears
as though it is going to be a bipartisan effort.
The Corps assured us that they were on board to try and do
this, but I appreciate your commitment and your work and your
interest, and there is a lot of people that are on your side.
Mr. Grothman. Yes. I should point out that not only is this
important for the Wisconsin River but it is important for all
the Great Lakes because near where this dam is the tributaries
that flow into Lake Michigan go there as well. I mean, it is
right on the Continental Divide and a lot of people feel that
if the carp got north it wouldn't only affect the lakes in
Wisconsin but it would work its way to Lake Michigan.
Mr. Upton. Thank you.
Mr. Pallone. I thank the gentleman and we will work on it
again. Thanks.
Mr. Grothman. Thanks much.
Mr. Pallone. And now the gentlewoman from New Mexico.
Thanks for being here.
OPENING STATEMENT OF HON. XOCHITI TORRES SMALL, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW MEXICO
Ms. Torres Small. Thank you, Chairman Pallone, thank you,
Congressman Upton, and members of the Energy and Commerce
Committee.
It is an honor to get to speak with you today about the
issues relevant to New Mexico's 2nd Congressional District.
I first want to applaud the Energy and Commerce Committee's
work to lift up rural and underserved communities. Our rural
communities are important threads to the fabric of our nation.
They provide the food we put on our tables and the energy that
powers our day-to-day lives.More importantly, they represent
the American values and traditions that are at the heart of who
we are.
I love our values and way of life, but our rural
communities are facing increased hardships like never before.
Since I was sworn in, I have visited all 19 counties in New
Mexico's 2nd Congressional District and in each place, I
visited, residents voiced the same message. They want the same
economic opportunities and healthcare access that cities and
suburbs have.
These are the issues I came to Congress to tackle, and it
is why I am here today speaking before the committee with broad
and far-reaching jurisdiction to address these problems.
When meeting with my constituents, access to basic
healthcare leads nearly every conversation, because in southern
New Mexico it's not just about healthcare affordability; it is
also about healthcare accessibility.
I have met expecting mothers who have to drive for hours
for every single prenatal appointment. I have met veterans who
have to get on a bus in the middle of the night to get to a
doctor's appointment in Albuquerque the next day.
I have met with teenagers in the midst of a crisis who face
a long waiting list for a much-needed mental health
appointment, and I have visited rural and community hospitals
on the verge of closing.
These are daily challenges for the six million Americans
living in rural communities. I am by no means an expert, but I
think it is clear that one way to increase healthcare access in
rural areas is increasing the number of doctors serving in
them.
In March, along with a bipartisan group of colleagues, I
helped introduce the Resident Physician Shortage Reduction Act
of 2019, H.R. 1763.
This bipartisan legislation takes critical steps towards
reducing nationwide physician shortages, with an emphasis in
rural areas, by increasing the number of Medicare-supported
residency positions by 15,000 positions.
H.R. 1763 already has 139 co-sponsors, including 16 members
of this committee. I strongly encourage the committee to
support this bill.
Similar in mission, I also helped introduce the Training
the Next Generation of Primary Care Doctors Act alongside
Representative Ruiz in May.
H.R. 2815 reauthorizes and expands the Teaching Health
Center Graduate Medical Education Program.
The program has helped address physician shortages in low-
income regions of the country such as the district I serve,
because many medical students go on to serve the communities
where their residency program was located.
In the 2018-19 academic year, the THCGME Program supported
the training of 728 residents in 56 primary care residency
programs across 23 states.
These graduates are almost three times more likely to
remain in primary care practice than traditional GME graduates,
almost two times more likely to practice in underserved
communities, which is most of New Mexico, and more than two
times more likely to serve in rural America.
The THCGME program's success thus far helps meet this
mission and I will continue to advocate for its expansion.
Other issues that impact New Mexico include transportation. We
have transportation programs that help rural residents get to
their medical appointments and we have seen that that helps
everyone's health.
We have also seen the devastating impact that high drug
prices have and we have an obligation to address them. Let us
keep building on the momentum of the legislation passed in June
and continue putting forth measures to protect our constituents
suffering from inflated and unregulated drug prices.
Members of this committee, even with the hardships rural
communities face, we are often the first to be forgotten when
legislators and healthcare experts discuss healthcare quality,
access, and affordability.
Thank you again, Chairman Pallone and Ranking Member
Walden, for holding this hearing and for your work delivering
better healthcare to all our constituents.
[The prepared statement of Ms. Torres Small follows:]
Prepared Statement of Hon. Xochiti Torres Small
Chairman Pallone, Ranking Member Walden, and members of the
committee, thank you for the opportunity to speak about the
pressing issues facing New Mexico's Second Congressional
district.
I first want to applaud the Energy and Commerce Committee's
work to lift up rural and underserved communities.
Our rural communities are important threads in the fabric
of our nation. They provide the food we put on our tables and
the energy that powers our day-to-day lives.
More importantly, they represent the American values and
traditions that are at the heart of who we are.
I love our values and way of life, but our rural
communities are facing increased hardships like never before.
Since I was sworn-in, I've visited all 19 counties in New
Mexico's Second Congressional District.
And in each place I visited, residents voiced the same
message. They want the same economic opportunities and
healthcare access that the bustling cities and growing suburbs
have.
These are the issues I came to Congress to tackle, and it
is also why I am here today speaking before the committee with
broad and far-reaching jurisdiction to address these problems.
When meeting with my constituents, access to basic
healthcare leads nearly every conversation, because in southern
New Mexico, it's not just about healthcare affordability, it's
also about healthcare accessibility.
I have met expecting mothers who have to drive for hours,
often across state lines, for prenatal appointments.
I have met veterans who have to get on a bus in the middle
of the night to get to a doctor's appointment in Albuquerque
the next day.
I have met teenagers in crisis who face a long waiting list
for a much-needed mental health appointment.
And I have visited rural and community hospitals on the
verge of closing.
These are daily challenges for the 60 million Americans
living in rural communities.
I'm by no means an expert, but I think it is clear that one
way to increase healthcare access in rural areas is increasing
the number of doctors serving them.
In March, along with a bipartisan group of colleagues, I
helped introduced The Resident Physician Shortage Reduction Act
of 2019, H.R. 1763.
This bipartisan legislation takes critical steps toward
reducing nationwide physician shortages, with an emphasis in
rural areas, by increasing the number of Medicare-supported
residency positions by 15,000 positions.
If passed, H.R. 1763 will significantly increase training
programs for rural physicians and take the first steps towards
expanding rural healthcare access and incentivizing medical
students to serve our rural communities.
H.R. 1763 already has 139 cosponsors, including 16 members
of this committee. I strongly encourage the committee to
support this bill.
Similar in mission, I also helped introduce the Training
the Next Generation of Primary Care Doctors Act alongside
Representative Ruiz in May.
H.R. 2815 reauthorizes and expands the Teaching Health
Center Graduate Medical Education (THCGME) Program.
The program has helped address physician shortages in low-
income regions of the country such as the district I serve,
because many medical students go on to serve the communities
where their residency program was located.
In the 2018-19 academic year, the THCGME Program supported
the training of 728 residents in 56 primary care residency
programs across 23 states. Of these graduates,
1A82 percent remain in primary care practice,
compared to 23 percent of traditional GME graduates;
1A55 percent of practice in underserved
communities, compared to 26 percent of traditional GME
graduates; and
1A20 percent practice in rural America, compared
to eight percent of traditional GME graduates.
Training the next generation of rural healthcare providers
means investing in the programs that have proven to keep them
in areas with the highest need.
The THCGME program's success thus far helps meet this
mission and I will continue to advocate for its expansion.
In the coming weeks, I plan to introduce legislation to
address the maternal morbidity crisis faced in rural
communities.
The bill will likely be directed to this committee and I
look forward to working with each of you to move this critical
legislation for a full floor vote.
Additionally, it is essential that we help those in rural
communities get to their healthcare providers, even if they
live several towns or counties away. When lack of
transportation prevents people from attending routine or
preventative care appointments, it increases healthcare costs
and leads to worse health outcomes.
Currently, there are several federal programs that help
patients in rural communities reach their medical providers
with non-emergency medical transportation. Studies have proven
that programs like these not only increase access to healthcare
but also pay for themselves through healthcare savings.
However, these programs can't meet the immense need. We
need to do more to expand federal patient transportation
programs to ensure that no American is prevented from seeing
their doctor due to issues with transportation.
Last, I can attest that across my diverse district,
Republicans, Democrats, and independents all agree drug prices
are too high and that Congress has an obligation to lower them.
Let's keep building on the momentum of the legislation
passed in June and continue putting forth measures to protect
our constituents suffering from inflated and unregulated drug
prices.
Members of this committee, even with the hardships rural
communities face, we are often the first to be forgotten when
legislators and healthcare experts discuss healthcare quality,
access, and affordability.
By working to solve these issues, this committee can be on
the forefront of advancing healthcare, no matter where a person
lives.
Thank you again, Chairman Pallone and Ranking Member Walden
for holding this hearing, and for your work delivering better
healthcare to all our constituents.
Mr. Pallone. I want to thank the gentlewoman.
You know, what you said about training people and then they
are staying in the community is so true and, you know, I have
seen that. You know, one of the things that we did when we did
the--I think it was in the ACA--that we said that you could get
additional slots for--you know, for residency programs if you
did it--if you set it up at a community health center, and
because they were outside of the regular system.
And I saw that--I can't remember what tribe it was but we
were--we were on the Puget Sound, I guess, in Washington
State--one of the tribes, and they had actually done that with
their Indian Health Service where they had set up a residency
program and they just got the additional slots without having
to transfer or buy them anywhere.
And they said in every--in almost every case the doctors
that were trained there stayed, you know, with the community
health center or with the tribe in that area, and that is--it
is true.
I mean, if you have those training programs in those
underserved areas, people tend to stay there. It's just a
reality.
So the other thing that the gentleman from Arkansas
mentioned is trying to be innovative with technology too in
telemedicine, which is important.
So we will definitely look into it. Thanks again.
Thanks.
And next is the gentleman from Minnesota, Mr. Phillips.
OPENING STATEMENT OF HON. DEAN PHILLIPS, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MINNESOTA
Mr. Phillips. Thank you, Chairman Pallone, Mr. Upton, and
members of the committee for the invitation to speak today
about some important issues facing my community.
Minnesota is fortunate to be home to many pristine waters
and natural treasures, including the Mississippi River, our
infamous 10,000 lakes--and those are just ones with names--and
the Boundary Waters.
The Boundary Waters is the most visited wilderness in our
country and a special place for Minnesotans and many throughout
our nation. People from across the world also visit to canoe,
hike and to fish.
In May, the Department of the Interior decided to renew two
mining leases for a proposed copper sulfide mine right on the
edge of the Boundary Waters, despite scientific evidence,
economic data, ongoing litigation, and a public record of
opposition dating back over 50 years.
This unilateral action from the Trump administration to
move forward on the copper sulfide Twin Metals mine is
irresponsible and unacceptable. We must continue to protect our
public lands and waters and ensure that Minnesota's and the
nation's wilderness areas can be enjoyed by future generations.
Minnesota's 3rd District is home to one of the most visited
lakes in our state, Lake Minnetonka, made famous by Prince's
movie, ``Purple Rain.'' I am sure that is the first time that
has been uttered in this room.
Right now, Lake Minnetonka and the rest of our state's
waters face the grave threat of aquatic invasive species,
something to which my colleague from Wisconsin referred to just
moments ago.
Aquatic invasive species including Asian carp, spiny water
fleas, and zebra mussels--none of them native to Minnesota and
all of which cause major harm to our waters' ecosystems.
These species have been moving throughout Minnesota,
clogging our lakes and rivers, and killing off native animals
and plants. Life in our district revolves around these lakes,
so this problem is of grave concern to our community.
In June, I convened a roundtable of local experts to
discuss the threat posed by these invasive species and the
consensus was very clear. Congress must invest resources and
support state and local governments to prevent the further
spread of invasive species in our lakes and our rivers.
And unfortunately, the problem of aquatic invasive species
is exacerbated by our changing climate. Invasive species can
now live in waterways that were uninhabitable just a few
decades ago, while native species are struggling to adapt fast
enough to compete with them.
Climate change is right in our backyards and it is time to
act. I hear it from my constituents every day. Middle and high
school students in particular who contact my office to express
their distress that our federal government has refused to take
bold steps or any meaningful action to solve this issue.
These young people are motivated to organize and contact
their representatives because they feel it is their only
option; their life and future depends on it.
And I also hear from their parents and their grandparents,
worried about the world they will leave behind for their
families. Climate change is complex and requires a multi-
pronged approach. We need to consider solutions and policies
like federal support for research and development of renewable
energy, extending and supporting new tax credits for
renewables, supporting consumer purchase of electric vehicles,
and other thoughtful proposals.
Another policy we need to explore is placing a price on
carbon, like the Energy Innovation and Carbon Dividend Act.
This legislation places a fee on fossil fuels at the
source, beginning at $15 per metric ton of CO2 equivalent
emissions, and steadily increases annually by $10 per metric
ton.
The fees would be deposited into a carbon dividend trust
fund and allocated as dividend payments to all U.S. citizens
and lawful residents. Thus, the bill would use market forces to
provide incentives for the reduction of carbon emissions.
This is an achievable solution that both parties can
support and should, and I urge all who are present to consider
doing so.
The American people have sent a clear message to Congress:
please take action on climate change, and I hope you'll join me
in doing all we can to keep our planet safe and prosperous for
generations to come.
Thank you, Mr. Chair.
[The prepared statement of Mr. Phillips follows:]
Prepared Statement of Hon. Dean Phillips
Thank you, Chairman Tonko, Ranking Member Shimkus, and
members of the committee for the invitation to speak today
about these important issues facing my community.
Minnesota is fortunate to be home to many pristine waters
and natural treasures, including the Mississippi River, our
infamous 10,000 lakes, and the Boundary Waters.
The Boundary Waters is the most visited wilderness in our
country and a special place for Minnesotans. People from across
the world visit to canoe, hike and fish.
In May, the Department of the Interior decided to renew two
mining leases for a possible copper sulfide mine on the edge of
the Boundary Waters in Minnesota, despite scientific evidence,
economic data, ongoing litigation and a public record of
opposition dating back 50 years.
This unilateral action from the Trump Administration to
move forward on the copper sulfide Twin Metals mine is
irresponsible and unacceptable. We must continue to protect our
public lands and waters and ensure that Minnesota's wilderness
can be enjoyed by future generations.
Minnesota's third district is home to one of the most
visited lakes in our state, Lake Minnetonka--made famous by
Prince's film Purple Rain.
Right now, Lake Minnetonka and the rest of our state's
waters face the grave threat of Aquatic Invasive Species.
Aquatic Invasive Species including Asian carp, spiny
waterfleas and zebra mussels, are not native to Minnesota and
cause major harm to our waters' ecosystems. These species have
been moving throughout Minnesota, clogging our lakes and
rivers, and killing off native animals and plants. Life in our
district revolves around lakes, so this problem is of high
concern to our community.
In June I convened a roundtable of local experts to discuss
the threat posed by these invasive species and the consensus
was clear. Congress must invest resources and support state and
local governments to prevent the further spread of invasive
species in our lakes and rivers.
And unfortunately, the problem of Aquatic Invasive Species
is exacerbated by our changing climate. Invasive species can
now live in waterways that were uninhabitable a few decades
ago, while native species are struggling to adapt fast enough
to compete with them.
Climate change is right in our backyard and we must act.
I hear it from my constituents every day. Middle and High
School students contact my office regularly to express their
distress that our federal government has not taken bold steps
to solve this issue. These young people are motivated to
organize and contact their representative because they feel it
is their only option--their life and future depends on it. I
also hear from parents and grandparents worried about the world
they will leave behind for their families.
Climate change is complex and will require a multi-pronged
approach. We need to consider solutions and policies like
federal support for research and development into renewable
energy, extending and supporting new tax credits for
renewables, supporting consumer purchase of electric vehicles,
and other proposals. Another policy we need to explore is
placing a price on carbon--like in the Energy Innovation and
Carbon Dividend Act.
This legislation places a fee on fossil fuels at the
source, beginning at $15/metric ton of CO2 equivalent
emissions. It will steadily increase annually by $10/metric
ton.
The fees would be deposited into a Carbon Dividend Trust
Fund and allocated as dividend payments to U.S. citizens and
lawful residents.
Thus, the bill would use market forces to provide
incentives for the reduction of carbon emissions. This is an
achievable solution that both parties could support, and I urge
all who are present to do just that.
The American people have sent a message to Congress: take
action on climate change. I hope you'll join me in doing all we
can to keep our planet safe for generations to come.
Thank you.
Mr. Pallone. Thank you, and I did want to mention that just
this week myself, Mr. Tonko, and Mr. Rush, we had--we made an
announcement earlier this week that we were going to try to
achieve a goal of 100 percent, I guess I will say carbon
neutral by 2050 and that we were going to begin a series of
hearings, which actually started yesterday, and Mr. Tonko of
the Environment and Climate Change Subcommittee, to see what
legislative proposals that we have before the committee or
others with the idea that by the end of the year, if not
sooner, we would come up with legislation--you know, sort of a
climate action plan, if you will, that we will then try to sell
to the rest of not only Democrats but Republicans as well.
So we certainly want to look at your proposal in the
context of that, and we will.
Mr. Phillips. Thank you. And Mr. Chair, if I might say, you
know, we are in this together and to the extent that we can
identify best practices as practiced by other countries in many
cases ahead of us on this issue I would encourage----
Mr. Pallone. Right. And it is true. We mentioned that, you
know, the scientific community basically says that by 2050 if
we don't--you know, if we don't take action now to get to
carbon neutral by 2050 we are going to have a catastrophe, and
several countries have used that date--you know, France,
Germany, Japan, and others.
Did you want to say----
Mr. Upton. I just want to say thank you, Mr. Phillips, for
being here. I know that Minnesota is known as the land of
10,000 lakes. Michigan has more.
Mr. Phillips. I knew that was coming.
[Laughter.]
Mr. Upton. Yes. Yes.
But last year I went down the Paw Paw River which is--
merges into Lake Michigan, and when you take the jigs and jogs
you go about 35 miles inland from Lake Michigan and you
actually get 100 miles upriver, because it goes like this.
And we were working on identifying lamprey eel larva and
eggs, and that is how far we went up to look at the lampricide
that then forced the younglings of the lamprey eels to surface
and then we were able to collect and, of course, that has been
an issue that we have had at the Great Lakes for many decades,
and that is why it is so important as we look at Asian carp and
other invasive species that came in maybe with ballast water, I
think, with those eels--lamprey eels. But it is a tremendous
impact on the fisheries and tourism and everything else, and
when you look at zebra mussels as well a huge issue for all of
us.
Mr. Phillips. Thank you.
Mr. Pallone. Thank you. Thanks again. Appreciate your being
here.
And we now go to the gentlewoman from Ohio, the chairwoman
of the Energy and Water Appropriation Subcommittee who we have
worked with on quite a few issues because of the overlap
between your Appropriations Subcommittee and this committee.
Thank you for being here.
OPENING STATEMENT OF HON. MARCY KAPTUR, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OHIO
Ms. Kaptur. Thank you, Mr. Chairman and members of the
committee, and I want to thank you for your openness to working
across committees to even do greater things for our country,
Chairman Pallone.
It is a real honor to be before you today, and I want to
thank Ranking Member Walden and all members of the committee
for the opportunity to address you this afternoon. I see my
great friend, Fred Upton, from our sister Wolverine state up
there and it is wonderful to have you there as well.
As chair of the Energy and Water Appropriations
Subcommittee, I deeply value the collaborative relationship and
consultation between our two subcommittees and I believe we can
accomplish so much more working together.
In addition to my verbal testimony, I also have highlighted
several priorities that relate to the Health Subcommittee in my
longer written testimony that I will submit. But I want to
concentrate on three areas this morning. I know you were really
busy last week in several areas of overlapping jurisdiction.
But the three I want to talk about this morning are
workforce development, weatherization, and energy efficiency at
our drinking water and wastewater treatment plants across this
country.
The Energy and Commerce Committee was extremely active last
week in several areas of overlapping jurisdiction.
I want to applaud first on workforce development Chairman
Rush and the full committee for your attention to the workforce
development and pipeline issues at the Department of Energy.
Last week, you approved H.R. 1315, the Blue Collar to Green
Collar Jobs Development Act of 2019, and in March of this year,
our Appropriations Subcommittee on Energy and Water also held a
workforce development hearing.
We have a lot of work to do together on this one. As you
know, our nation has a serious pipeline and workforce
development crisis in the energy and nuclear security
industries, both at the Department of Energy as well as in the
private sector.
According to the Energy and Employment Report for 2018,
roughly, 12 percent of today's energy workforce is eligible to
retire--we are talking about hundreds of thousands of people--
and 70 percent--70 percent--of industry employers in energy
report hiring difficulty.
I hear this over and over and over again, whether it is
electrical engineers, whether it is nuclear, staff for our
nuclear power plants. In STEM fields, our nation is not meeting
demand.
The Department of Energy must be more proactive about
recruiting and training a new generation of innovators because
our country needs to compete in a new world economic order in
which our nation is skills short.
I believe that we need to be as aggressive as Members of
Congress in exploring how to create this more aggressive
recruitment opportunity in the same way as we do when we select
individuals from our district working with our service
academies to move young Americans into fields and into places
that perhaps they hadn't imagined when they were much younger.
But I don't think we are going to meet the demand based on
current trends and I would be more than willing to work with
this excellent committee on the workforce development issue,
engaging--fully engaging the Department of Energy in that
effort.
Number two, I want to focus on weatherization and I can't
thank your committee and subcommittees enough for recently
approving H.R. 2041, Representative Tonko's Weatherization
Enhancement and Local Energy Efficiency Investment and
Accountability Act.
The Department of Energy's Weatherization program has a
direct positive impact on the lives of everyday Americans, and
it is a great training ground for people going into the various
specialty sectors in the building trades as well, particularly
drawing in low-income Americans, spanning all 50 states, our
territories and our Native American tribes.
H.R. 2041 expands flexibility for the program and creates
new opportunities to innovate, and I hope to work with your
committee to ensure we can get a floor vote on the
weatherization reauthorization.
In addition, I hope that we can work together to add
language to encourage initiatives that encompass neighborhood
scale weatherization. I think we have to tiptoe our way into
that one, but the innovation fund encourages innovative
roofing, energy efficiency, and new outreach and assistance
programs, and I would like to provide slightly more clarity to
the Department of Energy on this front.
This is an older program that operates well. The states are
fully engaged and I think we can give them a hand up by
augmenting that particular language in the bill. Specifically,
the legislation I believe should include within innovative
outreach, a neighborhood scale weatherization.
At the ground level, the community action agencies work
seamlessly between various federal programs and I am on a
mission to ensure that other federal agencies, including HUD,
the Department of Health and Human Services, and the Veterans
Department collaborate with the Department of Energy to ensure
that these programs work together more seamlessly for maximum
impact at the neighborhood level.
And finally, on energy efficiency at drinking water and
waste water treatment plants, the largest segment of most
cities' and large regions' electric bills--power bills come
from their having to provide their drinking water and
wastewater treatment facilities with the--with the regular
power.
We have important work to do in making our wastewater and
drinking water facilities more energy efficient. In many cities
as much as 30 to 40 percent of their entire power bill attends
to operating those facilities.
On behalf of ratepayers, consumers, and the general public,
we have an opportunity to help our country immensely by
reducing energy usage at these facilities.
Both EPA Green Project Reserve and DOE's Office of Energy
Efficiency and Renewable Energy have a major role to play. We
need to focus that a bit.
I am glad to see the Energy and Commerce Committee is
continuing to take decisive action to improve the lives of the
American people across our nation and I want to thank you for
the opportunity to highlight some of these issues of concern to
our committee and want to thank again the chairman and ranking
member for the opportunity to testify.
[The prepared statement of Ms. Kaptur follows:]
Prepared Statement of Hon. Marcy Kaptur
Colleagues, thank you for the opportunity to address you
this afternoon. As chair of the Energy and Water Appropriations
Subcommittee, I deeply value the collaborative relationship
between our two subcommittees. We can accomplish so much
together. In addition, I will highlight several priorities that
relate to the Health Subcommittee.
The Energy and Commerce Committee was extremely active last
week in several areas of overlapping jurisdiction.
A. Workforce Development
I applaud Chairman Rush and the committee for your
attention to the workforce development and pipeline issues at
DOE. Last week, you approved H.R. 1315, the Blue Collar to
Green Collar Jobs Development Act of 2019. In March, my
committee also held a workforce development hearing.
As you know, we have a pipeline and workforce development
crisis in the energy and nuclear security industries, both at
the Department of Energy and in the private sector. According
to the Energy and Employment Report for 2018, roughly 12
percent of today's energy workforce is eligible to retire and
70 percent of energy industry employers reported hiring
difficulty.
DOE must be more proactive about recruiting and training a
new generation of innovators because our country needs to
compete in a new world economic order.
B. Weatherization
This committee recently approved H.R. 2041, Rep. Tonko's
Weatherization Enhancement and Local Energy Efficiency
Investment and Accountability Act.
DOE's Weatherization program has a direct, positive impact
on the lives of every day Americans, particularly low-income
Americans, spanning all 50 states, U.S. territories, and Native
American Tribes.
H.R. 2041 expands flexibility for the program and creates
new opportunities to innovate. I hope to work with you to
ensure we can get a floor vote on the weatherization
reauthorization. In addition, I hope that we can work together
to add a tweak to add what I call ``neighborhood scale''
weatherization. The innovation fund encourages innovative
roofing, energy efficiency, and new outreach and assistance
programs and I would like to provide slightly more clarity to
DOE on this front.
Specifically, the legislation should include within
innovative outreach, ``neighborhood scale'' weatherization. At
the ground, the community action agencies work seamlessly
between federal programs. I am on a mission to ensure that
other federal agencies, including HUD, HHS, and the VA
collaborate to ensure that these programs work together.
But, DOE can also be a focal point for innovation. We must
think about weatherization eligible individuals as part of a
larger pool of people, and take a neighborhood scale approach
to ensure mobile homes, multi-family units, or neighborhoods
participate in the weatherization program. These communities
are yearning to participate in the weatherization program but
just need a small lift from DOE and the community partners.
The needs of our nation are evolving, and with neighborhood
scale weatherization, we can connect multiple units with
integrated solar, geothermal, community scale wind, and achieve
efficiency of scale by ensuring groups of individuals are
enrolled in the weatherization program together.
C. Energy Efficiency at Drinking and Wastewater Treatment
Facilities
We also have important work to do in making our waste and
drinking water facilities more energy efficient. Drinking and
Wastewater facilities are one of the largest industrial users
of electricity. On behalf of ratepayers, consumers, and the
general public, we have an opportunity to help our country by
reducing energy usage at these facilities. Both EPA and DOE
have role to play.
The State Revolving Loan Fund can and must do better. The
Green Project Reserve (GPR) sets aside 10% of the SRF to energy
efficiency and green infrastructure. But the states have not
been given adequate direction about how to utilize the set
aside. The Green Project Reserve is misunderstood,
undersubscribed and does not serve its purpose. I am working on
a legislative solution and hope to work together with the
environment subcommittee with jurisdiction over the Safe
Drinking Water Act.
DOE provides technical assistance to drinking and
wastewater facility operators to help them determine what types
of energy efficiency measures would work best in specific
plants and provides them a path to realize those savings. DOE's
research and development programs, such as those within the
Office of Energy Efficiency and Renewable Energy, help develop
the next generation of efficiency technologies.
Congress must examine the SRF and chart out a path to
ensure that federal dollars put aside for green projects are
being used for their intended purpose.
D. Drug Pricing
I've discussed some of my energy priorities, and it is also
important to recognize the value of energy and its role in
keeping the American public healthy--especially after the
blazing summer heat last weekend. I would like to address a
couple of my priorities within the Health Subcommittee's
jurisdiction as well.
The current state of play in drug pricing involves the
corporate consolidation of Big Pharma and company monopolies
which have created a closed market--where not even capitalism
can breathe. Fundamental to capitalism is competition in the
marketplace. From patent thicketing to the stalling and
prevention of generics from entering the market for consumers,
the unfair business practices of Big Pharma have allowed greed
to overtake innovation.
I appreciate the Energy and Commerce Committee's work on
pay for delay, which takes an important first step-but there's
more work to be done. The legislative framework Big Pharma has
enjoyed for too long must be reformed. Finding cures for
diseases should not involve various entities being rewarded by
inflated prices at the expense of patients inability to afford
lifesaving medicine.
I come before you today as an advocate for thousands of my
constituents in Ohio's 9th congressional district who are
struggling to afford their prescription medicine. In recent
months I have been hearing alarming concerns from seniors,
patients and families in my district who are rationing their
prescription drugs and making life-altering decisions because
the cost of their medicine continues to rise. I am glad the
committee has held public hearings on the matter and is taking
steps to address this crisis.
Recent data has shown that the price of pharmaceuticals
continues to rise. Politico reported in the first six months of
2019, prescription drug prices for over 3,400 drugs rose by an
average of 10.5 percent--outpacing the rate of inflation four
times. Congressional rhetoric alone will not force companies to
engage in moral business standards, which is why we must enact
stronger backstops into law to protect patients from industry's
predatory practices. The American public is relying on us to
bring down the costs of pharmaceuticals, and the time to act is
now. I appreciate many of the ideas Reps. Doggett and
Schakowsky have proposed, and encourage action on H.R. 1046 the
Medicare Negotiation and Competitive Licensing Act of 2019. We
must continue to urge fair market competition to lower
healthcare costs, and allow Medicare to negotiate prescription
drug prices in a similar manner as the Veterans Administration.
E. Opioids
Not only are we witnessing pharmaceutical companies price
gouge consumers, Big Pharma has fueled and exacerbated our
nation's deadly opioid epidemic. According to the Ohio Health
Department, from 2000 to 2017, Ohio's death rate due to
unintentional drug poisonings increased by over 1,000 percent.
This is absolutely devastating, and just last week, federal
prosecutors in our state filed criminal charges against an
opioid distributor and two of their former executives. These
bad actors must be held accountable.
Additional data released by the Washington Post last week
has shed more light into the destruction unleashed on our
communities. Between 2006 and 2012, the nation's top
pharmaceutical companies distributed 76 billion oxycodone and
hydrocodone pills, according to evidence from the largest civil
action in U.S. history--and with six distributors dispersed 75
percent of the opioids, we know pharmacies also share some
blame in worsening the crisis.
The opioid epidemic has ravaged too many families and
neighborhoods, and the Energy and Commerce Committee has
crucial judication in reigning this in. In addition to the
Health Subcommittee, the Oversight and Investigations
Subcommittee also has a key role in ensuring drug companies are
held accountable.
May our federal courts too, in Cleveland, bring justice for
the victims and cities who have been devastated by opioids, and
may we work to find ways to break up corporate consolidation in
healthcare.
I can see the Energy and Commerce Committee is continuing
its tradition as a legislative powerhouse. I do not pretend to
have all the answers but I hope to work with you to help find
solutions together. I want to again thank the committee for the
opportunity to testify and I hope my colleagues will consider
the issues I have discussed with you today before both the
Energy and Health Subcommittees. Thank you for your time.
Mr. Pallone. I want to thank the gentlewoman, you know, for
continuing to work with us on common issues between your
subcommittee and our committee.
The energy weatherization package that we did pass out of
committee, we expect to bring that up fairly quickly on the
floor, you know, when we come back in September.
I know we are running out of time, but you had mentioned to
me about an initiative that was similar to the service
academies but you didn't get into it.
What was that idea again?
Ms. Kaptur. Well, I'll tell you, I am getting frustrated in
going around to our national labs and----
Mr. Pallone. Oh, it was on the labs. Right.
Ms. Kaptur [continuing]. And looking at the--also the
private sector that comes into the labs, and listening to what
they are saying to me about the lack of talent from our country
that is available to hire.
You know that in many--in most of our labs we must hire
American citizens to do work and----
Mr. Pallone. So you wanted to do something like the service
academies with the labs, right?
Ms. Kaptur. I have been thinking about a model, and, again,
I don't have it all thought out. But I know how much our office
is involved as I am sure yours are.
Every year we select a certain number of individuals and we
nominate them for West Point, Annapolis, the Air Force, the
Coast Guard, the Merchant Marines, and we work with the
Department of Defense on that.
And we have--I am on the Defense Subcommittee--we every
year have the heads of these academies come before us and we
have a very aggressive recruitment, and I believe we need to do
the same in terms of the STEM fields for these jobs.
We simply do not have enough people coming in to the
nuclear power industry, for example, and I was with--I went to
one of the lab showcases here on the Hill yesterday. We are
talking about thousands of jobs that are unfilled that must be
filled by American citizens. And I don't have the magic answer.
I am not the authorizing----
Mr. Pallone. Well, get back to us. Yes.
Ms. Kaptur. I am not the authorizing committee. But I would
love to explore with you a better model----
Mr. Pallone. Please.
Ms. Kaptur [continuing]. To the Department of Energy into
more aggressive recruitment. Maybe we work with the labs. Maybe
my subcommittee has to provide money that would provide for the
education of these individuals.
Many who go into electrical engineering by the time they
get to the junior year they go, yes, I can make more money in
business; why should I be going into debt, you know, to go into
electrical engineering. I represent----
Mr. Pallone. Well, get to back to us and we will work on an
initiative, all right?
Mrs. Kaptur. Thank you, Mr. Chairman. Thank you very much
for your openness to that.
Mr. Pallone. Mr. Upton?
Mr. Upton. I just want to say thanks for being here. As you
know, these bills that you reference--workforce development,
particularly, on weatherization--they were strongly bipartisan.
I will tell you in advance that we did raise the
authorization levels higher than they have been before. So you
are now in a perfect position to fit that within your
subcommittee along with nuclear waste.
So I look forward to working with you on that as you come
back to us in September on the floor.
I yield back.
Ms. Kaptur. Thank you, Ranking Member Upton. Thank you so
much.
Mr. Pallone. All right. Thanks a lot.
Ms. Kaptur. Just for the record, this year we were able in
the House with bipartisan support to move the appropriated
level for the weatherization program from about $254 million to
$290 million, and I don't know what the Senate is going to do,
obviously, but we are serious about aggressively modernizing
this program.
It has a terrific track record in the states and we can do
so much more, and if I could just move on a side road just a
second here.
Yesterday, again, in going to a weatherization display here
yesterday from many, many communities, it became clear that the
workforce development pathway from these various weatherization
programs so people can get training and go into the various
trades is not so streamlined, and I am very interested in how
to use these weatherization programs to identify talented
people around the country who can be skilled up to do jobs that
are needed in every single trade, craft, around this country,
and I think this can be one of the feeder programs if we are
more focused on it.
Mr. Pallone. All right. Thanks a lot.
You should know that she--Mr. Rush, she started out by
praising you, just so you know.
Mr. Rush. Well, thank you so very much for praise. I have
to give someone the credit for all that she said to her and she
is my neighbor in terms of where our offices are located. She
has been my co-collaborator for a number of years on many
policy issues.
She has been my co-conspirator. We have been conspiring in
the interests of leadership on many occasions. She has really
been a spiritual ally of mine on so many, many occasions and
she has come into my--seeing my district on many occasions
because, you know, in Chicago the largest community of Polish
American citizens are located in Chicago. So she has been such
an eminent friend of mine and been such a wonderful, wonderful,
and true friend.
So I really want to welcome her here before us. I want to
also say that in regard to weatherization, one of the
amendments that we passed in the bills that we just marked up
and passed out of the full committee amends weatherization
programs to allow for training of community residents that--in
the local areas that weatherization dollars are being spent and
they are mandated to hire--to train and hire community-based
residents for those programs. So it is line with the spirit of
what you have been discussing.
And you mentioned the workforce development area, and we,
thanks to--in a bipartisan way, thanks to our eminent ranking
member on the Energy Committee, Mr. Upton, we have and under
the leadership of Chairman Pallone and the ranking member, we
have been able to come up with some significant legislation as
it relates to workforce development.
We call it the green jobs and--blue and green jobs, and
this would impact those out-of-work coal miners, minorities,
women and veterans. It is a real, real world comprehensive bill
that would try to amp up our workforce in the energy sector.
And so I am just excited to work with you and with the
others as we embark on this space of using National Labs and
others, the Department of Energy and other programs to really
create opportunities for Americans who need work, quality work,
fulfilling work, and need to have a living wage while they are
working and be able to take care of their families.
So but your spirit permeates a lot of what we do, and so I
am just so pleased to have you with us. I am pleased to be your
friend. I recall some years ago when you and I created a
conference--Jobs Now conference--you know, the Jobs Now
conference, which was way out in front of all of these things
that we are discussing.
So, again, thank you for your stellar work and for your
involvement.
Mr. Pallone. Thank you. Thanks, Bobby.
I saw that you got--I knew when you mention anything about
nuclear that Mr. Shimkus was going to get all energized here.
So I will recognize the gentleman from Indiana.
Mr. Shimkus. Thank you, Mr. Chairman. I will be brief. I
appreciate all my colleagues being here and as the Chairman
Kaptur knows, I attended her Member Day and she knows, as I
know, that there are 39 states, 121 locations.
We have a law--an authorization law on the book that the
appropriators failed to fund. Bipartisan failure to fund. As we
talk about the Green New Deal or the chairman's zero in 2050,
nuclear has to be part of that portfolio.
It is only going to be around here longer and we have to
address the waste. So I would just respectfully plead with the
chairman to help us do this because we need to comply with the
law and we need to finalize this so for the 39 states and the
121 locations at--in places.
Like I know John from Chicago Land. I know Levin's in the
back row. We have got these places on major waterways, lakes,
streams and in environmental sensitive areas--that I am just
pleading with the appropriators to help us do the right thing
and follow the law.
With that, Mr. Chairman, I will yield back.
Mr. Pallone. Thank you.
As you can see, Marcy, you created a lot of interest here,
needless to say. So----
[Laughter.]
Ms. Kaptur. Well, Mr. Chairman, if I could just say to,
first, Mr. Shimkus, believe me, we have heard you. We have
heard you. I represent a state that has several power plants
that have waste on site.
So I--and Ohio just passed special legislation to allow
those plants to continue in operation. Other states have chosen
other options. We have a serious challenge in the nuclear
industry in this country.
I honestly believe it should not have been bucked to the
states. I think there should have been a federal financing
solution. It was not done by this administration and shame on
them, and so the states have had to struggle.
So I share your concern about nuclear. I understand what
you are saying about the waste. I hope to be someone that
contributes to a real solution here that is both practically--
practical from an engineering stand but also politically
realizable, and I think we have to keep pushing. No one has
been a stronger advocate than you have and we welcome you any
time before our subcommittee as we struggle with this very,
very important issue.
So you have been heard and I admire your work. I want to
say to Congressman Rush also you are my Great Lakes buddy. You
are my great, great friend and advisor from the city of
Chicago, which needs our attention, but also across the country
where the needs of those whose voices here are limited, and I
reciprocate the admiration.
Mr. Pallone. Thank you.
Ms. Kaptur. Thank you, and Congressman Tonko I also
complimented before your arrival today and mentioned the bill
that you worked so very hard on along with Congressman Rush,
and I thank you for your leadership in moving this forward.
And thank you, Mr. Chairman----
Mr. Pallone. Thank you. Thank you, Chairwoman. Appreciate
your being here and all that you said.
Now I have to say we are half an hour late and I don't want
to keep holding everybody up. So what we may do is go back to
what we were supposed to do and not even ask questions or make
any comments at all.
So I may just go through the next five or six and ask
everybody not to even comment on what you say, which I hate to
do, but otherwise we are never going to get through it.
So next is the gentleman from Illinois, Mr. Casten.
Although I do have to say he is a Middlebury graduate.
[Laughter.]
OPENING STATEMENT OF HON. SEAN CASTEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ILLINOIS
Mr. Casten. Thank you, Chairman. I will do my best to be
very boring.
Chairman Pallone, Chairman Tonko, the members of the
committee, I want to, you know, first really thank you for
giving us an opportunity today to share the thoughts on--as you
think about your priorities this Congress.
Chairman Tonko, your subcommittee, I would submit to you,
is the most important subcommittee in Congress right now. The
work that we do in this Congress is going to be pivotal to
determining whether or not we survive as a species. I do not
say that lightly.
The climate crisis is existential. I greatly appreciate
your leadership, Chairman Pallone's leadership, in addressing
this crisis head on. I have been encouraged by your work to
hold this administration and the EPA accountable for upholding
existing climate policies, including CAFE standards.
I thank Chairman Tonko for his work developing the climate
principles this past week, which is an integral first step
towards finding consensus within our own caucus and across the
chamber, and I believe the document lays out many important
ideas currently missing from our conversations regarding
climate policy.
If we are going to address the climate crisis, we have to
acknowledge a couple facts that may be politically difficult,
but that doesn't mean we can duck them.
First is that the climate crisis is urgent. We do not have
time to debate settled science any more than we have time to
debate gravity. It is real. It is now.
Every day that we fail to act the consequences of our
inaction become more costly and more dire. History is going to
judge us not by how we message to our political base but how we
rose to this challenge.
However, that does not mean that the necessary changes in
our energy and environmental policy are going to be simple. Our
standard of living, our economy, our social safety nets, and
our government itself depends on energy access.
It is the height of naivete to assume that the changes we
have to make are going to have simple little fixes. We can't
allow ourselves to be deluded into thinking that just because
the problem is urgent any problem will--any solution will
suffice.
If we ignore the urgency it is suicide. If we ignore the
complexity it is irresponsible. So we have to account for both.
We can't just issue edicts from on high. We also can't shy away
from expertise.
We cannot act with the purpose of scoring easy political
points. That may feel good, but we do at our own peril. The
urgency of the crisis demands we act with serious determination
and in a measured and deliberative manner that is not
inconsistent with urgency.
So if I can only persuade you to do one thing today, please
unleash the nerds. Those nerd-driven solutions may not be
exciting. They may not be sexy. They may not have a great
little sound bit around them.
They may not make prime time news headlines and many of the
solutions are in fact already known. A lot of them are low-
hanging fruit we could enact tomorrow.
That is a good thing. It is a great opportunity. Some of
the solutions would build on policies that are already working.
CAFE standards have helped increase the average fuel economy of
our light-duty vehicle fleet.
I hope this committee could encourage policies like a
feebates program that could build on this success by rewarding
consumers who buy more efficient, cleaner vehicles.
The committee should also consider complementary policies
to help get less efficient vehicles off the road. Many, many
years ago when I did some work for California, we found that
the single most cost effective they could do was just pay
everybody with an old Dodge Dart $10,000.
[Laughter.]
Mr. Casten. We can get those clunkers off the road and make
a big difference.
Other climate policies have broad bipartisan support. I
think members of both parties have agreed that we should
prioritize the deployment and development of grid-scale energy
storage technologies. Those technologies will not only lower
electricity costs for consumers but make our grid more
resilient and efficient while lowering greenhouse gas
emissions.
That is why I was proud to sponsor H.R. 2909, the
bipartisan and bicameral Promoting Grid Storage Act, alongside
many members of the Energy and Commerce Committee, and I'd urge
this committee to take up and pass the measure.
There are other solutions that require that we look back at
existing laws with renewed scrutiny for how they worked in
practice. The Federal Power Act, for instance, makes it clear
that FERC should ensure that electricity rates are just and
reasonable, and yet rates across the country fail to account
for the cost of carbon pollution.
FERC has been hesitant to address that massive externality
because some there believe they do not have the authority. I
disagree. I don't think it's what Congress intended.
I think the deregulation of energy markets did not mean
that we still don't have social obligations to set prices that
account for externalities and we need to say so and we need to
say so loudly.
Now, to be clear, economy wide measures need to be taken to
address the full scope of the issue and these policies should
be technology neutral.
They need to put the goal of reducing CO2 above the path of
how we get there and they need to embrace climate action as a
once in a generation investment opportunity.
I have spent 20 years in the clean energy space. I have
built over 80 projects in 30 different states. Every single
project that I built lowered CO2 emissions and saved money.
With one exception, none of my clients ever did those projects
because they were as passionate about climate change as I was.
They were greedy.
In Washington, to invest--I have invested about $300
million. If we view that from the lens of Washington that is a
cost we have to score and figure out how to pay for.
Outside of Washington, that is an investment opportunity.
Let us embrace it as that investment opportunity.
Let us use this to goad the economy, and to be sure, not
all these solutions are within the jurisdiction of your
subcommittee or even the broader committee.
But each illustrates the kind of task we need to be willing
to take on if we are going to address the climate crisis. The
task is urgent. The task is complicated and I hope the
committee will consider some of the proposals I have mentioned
here today along with about 3,000 others that I am working on.
And I look forward to working with any and all of you in
any way I can to help combat this crisis. Thank you again for
having me today and thank you so much for your leadership.
[The prepared statement of Mr. Casten follows:]
Prepared Statement of Hon. Sean Casten
Chairman Tonko, Chairman Pallone, members of the committee,
thank you for providing members the opportunity to share our
thoughts on the work of this subcommittee as you consider your
priorities this Congress. This subcommittee has perhaps a more
important role than almost any other. The work this
Subcommittee does this Congress will be pivotal in addressing
the greatest existential threat to life on Earth, the climate
crisis.
I appreciate your leadership and dedication in addressing
this crisis head-on. I have been encouraged by the Committee's
work to hold this administration and the EPA accountable for
upholding existing climate policies, including the CAFE
Standards. I also thank Chairman Tonko for his work developing
his climate principles--an integral first step toward finding
consensus within our caucus and across this chamber and I
believe the document lays out many important ideas currently
missing from conversations regarding climate policy.
If we are going to address the climate crisis, we must
acknowledge certain facts that are politically difficult, but
that must guide the course of action we take.
The first is that the climate crisis is an urgent one.
Regardless of what many of my colleagues may think, we do not
have time to debate settled science, and we cannot avoid this
issue. The climate crisis is here. The climate crisis is now.
And every day we fail to act, the consequences of our inaction
become more costly and more dire. Future generations of
Americans, and those from across the globe, will remember how
each of us responded now. It is up to us to put aside partisan
disagreements and act as quickly as this body can possibly act.
But that does not mean that the problem at hand is not a
complex one. It is. And it requires a complex solution. Any
actions we take to address the climate crisis that is not
predicated on this fact, will not be successful in the long
run. We cannot allow ourselves to become deluded into thinking
that because the problem is urgent, any action will solve the
problem.
We cannot simply issue edicts from on high. We cannot shy
away from expertise. And we cannot act with the purpose of
scoring easy political points. These things may make us feel
good but do so at our own peril. The urgency of this crisis
demands we act with seriousness, determination, and in a
measured and deliberative manner. In essence, to best address
the climate crisis, I'd urge this committee to unleash the
nerds.
This also means that the solutions to the climate crisis
may not be exciting, sexy, or ready-made for primetime news
headlines. Many of the solutions are already known. And many
solutions are low-hanging fruit that we could enact tomorrow.
But that's a good thing and a great opportunity.
Some of these solutions build upon policies that are
already working. For example, while CAFE Standards have helped
increase the average fuel economy of our light-duty vehicle
fleet, this committee should consider other policies like a
feebates program that could build upon this success by
rewarding consumers who buy more efficient, cleaner vehicles.
The committee should also consider complementary policies to
help get less efficient vehicles off the road--such as a cash
for clunkers program.
Other climate policies have broad bipartisan support. For
instance, members of both parties have agreed that we should
prioritize the deployment and development of grid-scale energy
storage technologies. These technologies will not only lower
electricity costs for consumers but will make our grid more
resilient and efficient, all while lowering greenhouse gas
emissions. That is why I was proud to introduce H.R. 2909, the
bipartisan and bicameral Promoting Grid Storage Act, alongside
many members of the Energy and Commerce Committee. I'd urge the
committee to take up and pass this measure.
Other solutions require we look back at existing laws with
renewed scrutiny for how they have worked in practice. The
Federal Power Act, for instance, makes clear that FERC should
ensure that electricity rates are just and reasonable--and yet
rates across the country fail to account for the devastating
impacts and high costs of carbon pollution. While FERC has been
hesitant to act to address this massive externality because
some there believe they do not have the authority. This cannot
be what Congress intended. And we should say so. Loudly.
Of course, economy-wide measures should be undertaken to
address the full scope of this issue. Preferably, these
policies will embrace the principle of technology-neutrality
and will resist the well-intentioned but misplaced dual urges
to either craft a plan that pleases all but does little or the
urge to reject any good plan in search of perfection. We cannot
wait for perfect. We cannot please everyone. We need climate
action. We need it now.
Not all of the solutions I have mentioned today fall solely
within the jurisdiction of this subcommittee or even the Energy
and Commerce Committee as a whole. Yet, each illustrates the
kinds of tasks we must be willing to take on if we are going to
address the climate crisis. This task is urgent. This task is
complex.
I hope the committee will consider some of the proposals I
have mentioned here today. And I look forward to working with
any of you in any way I can to combat this crisis. Chairman
Tonko, thank you again for having me here today and thank you
all for your leadership.
Mr. Pallone. Thank you, Mr. Casten.
It's hard for me not to ask you questions because you
raised a lot of points but I've got to move on. So thanks
again. Appreciate it.
Now, the way that--the way this is set up Ms. Slotkin
should be next. But I am told, Mr. Levin, you have a markup
that is occurring right now?
Mr. Levin of California. Yes, sir.
Mr. Pallone. Would you mind, Ms. Slotkin, if we let him go
back to his markup and then we will go to you? It's OK? All
right.
Go ahead, Mr. Levin.
OPENING STATEMENT OF HON. MIKE LEVIN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. Mike Levin. Thank you, Mr. Chairman. I very much
appreciate the opportunity to be here. Thank you to all my
colleagues and friends who are on this committee. Some of the
top priorities that I hear about from my constituents in
southern California are issues that come before this committee
so I am grateful for the opportunity to raise their voices here
today.
One of those priorities that I hear about from my
constituents is the need to move the spent nuclear fuel in our
district at the San Onofre Nuclear Generating Station to a site
that is not surrounded by millions of people, threatened by sea
level rise, and located near active earthquake faults.
It's critical that the Federal Government establish a
consolidated interim storage, or CIS, facility for this waste
and other spent nuclear fuel across the country.
I strongly endorse Congresswoman Matsui's Store Nuclear
Fuel Act, which would authorize the Department of Energy to
take title to spent nuclear fuel in order to store it at a CIS
facility.
I have also introduced common sense legislation that would
prioritize sites like San Onofre that are in locations with
high population density and high seismic risk.
My constituents are concerned for their safety and it is
long past time that we start moving this waste to a safer
location. I urge the committee to prioritize this pressing
issue and I thank my colleagues who are equally concerned.
Another issue that I hear about from my constituents is the
climate crisis and we need to take aggressive action that is
commensurate with the scale of the challenge we face.
The science is clear. Climate change will have increasingly
devastating effects on our plant if we do not make significant
changes to the way we live.
I am grateful to Chairman Pallone and my friend, Chairman
Tonko, for your continued leadership on this issue and I look
forward to working with you for a long time to come.
I am also proud to have introduced legislation that
presents an ambitious plan for transitioning auto sales in the
United States to zero emissions.
We have got to position the United States to lead the world
in clean energy and that includes clean vehicles. I encourage
all of my colleagues to support the Zero Emission Vehicles Act
of 2019.
I stand ready to work with anyone on either side of the
aisle who is serious about combating the climate crisis and I
look forward to supporting climate legislation that comes from
this committee and I am very grateful for all the work that you
are doing.
Lastly, I hear from constituents often about the need to
lower healthcare costs and expand access to affordable care
that covers people with preexisting conditions.
Nobody I talk to supports this administration's efforts in
the courts to destroy the Affordable Care Act and rip insurance
from millions of families.
Thank you to Chairs Pallone and Eshoo for working to defend
the Affordable Care Act and lower drug prices. I believe that
as we defend the ACA we must also work together to improve our
healthcare system to achieve universal coverage.
We must also do more to address the substance abuse crisis
plaguing our country and that must include measures to address
problems with the addiction, treatment, and recovery system.
Many facilities do amazing work but there are outliers that
do not. It's abhorrent that some treatment centers and recovery
housing operators engage in bad practices at the expense of
vulnerable patients and residents.
This includes deceptive marketing techniques, depriving
individuals of needed medication, failing to monitor those who
are suicidal or in withdrawal, and evicting vulnerable
residents out on the street.
I hope this committee will join me in closely monitoring
the development of recovery housing guidelines at the Substance
Abuse and Mental Health Administration to ensure a robust
framework.
Additionally, as the committee considers legislation
regarding substance abuse disorder, I hope that you will
consider ways that we can assist states in their enforcement
efforts with an eye towards stronger oversight and
accountability so that those in need actually receive the help
they deserve and are not taken advantage of.
I appreciate the amazing work of this committee in tackling
a wide range of issues--the widest range of any committee--and
I thank all of my colleagues for their dedication to address
the challenges that I've highlighted today.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Mike Levin of California
follows:]
Prepared Statement of Hon. Mike Levin
Thank you, Chairman Pallone, for the opportunity to testify
today. Some of the top priorities that I hear about from my
constituents in Southern California are issues that come before
this committee, so I am grateful for the opportunity to raise
their voices here today.
One of those priorities that I hear about from my
constituents is the need to move the spent nuclear fuel at the
San Onofre Nuclear Generating Station to a site that is not
surrounded by millions of people, threatened by sea level rise,
and located near active earthquake faults. It is critical that
the Federal Government establish consolidated interim storage,
or CIS, facilities for this waste and other spent nuclear fuel
across the country. I strongly endorse Congresswoman Matsui's
STORE Nuclear Fuel Act, which would authorize the Department of
Energy to take title to spent nuclear fuel in order to store it
at a CIS facility. I have also introduced common sense
legislation that would prioritize sites like San Onofre that
are in locations with high population density and high seismic
risk. My constituents are concerned for their safety, and it is
long past time that we start moving this waste to a safer
location. I urge the committee to prioritize this pressing
issue.
Another issue that I hear about from my constituents is the
climate crisis, and our need to take aggressive action that is
commensurate with the scale of the challenge we face. The
science is clear: climate change will have increasingly
devastating effects on our planet if we do not make significant
changes to the way we live. I am grateful to Chairman Pallone
and Congressman Tonko for your leadership on this crisis, and I
look forward to working with you on this issue. I am proud to
have introduced legislation that presents an ambitious plan for
transitioning auto sales in the United States to zero-emission
vehicles. We must position the United States to lead the world
in clean vehicle innovation. I urge all of my colleagues to
support the Zero-Emission Vehicles Act of 2019. I stand ready
to work with anyone who is serious about combating the climate
crisis on either side of the aisle, and I look forward to
supporting climate legislation that this committee considers.
Lastly, I hear from constituents often about the need to
lower healthcare costs and expand access to affordable care
that covers people with pre-existing conditions. Nobody I talk
to supports this Administration's efforts in the courts to
destroy the Affordable Care Act and rip insurance from millions
of families. Thank you to Chairs Pallone and Eshoo for working
to defend the Affordable Care Act and lower drug prices. I
believe that as we defend the ACA, we must also work together
to improve our healthcare system to achieve universal coverage.
We must also do more to address the substance abuse crisis
plaguing our country, and that must include measures to address
problems with the addiction treatment and recovery system. Many
facilities do amazing work, but there are outliers that do not.
It is abhorrent that some treatment centers and recovery
housing operators engage in bad practices at the expense of
vulnerable patients and residents. This includes deceptive
marketing techniques, depriving individuals of needed
medication, failing to monitor those who are suicidal or in
withdrawal, and evicting vulnerable residents out on the
street. I hope this committee will join me in closely
monitoring the development of recovery housing guidelines at
the Substance Abuse and Mental Health Administration to ensure
a robust framework. Additionally, as the committee considers
legislation regarding substance abuse disorder, I hope that it
will consider ways we can assist states in their enforcement
efforts with an eye towards stronger oversight and
accountability so that those in need actually receive the help
they deserve and are not taken advantage of.
I appreciate the amazing work of this committee in tackling
a wide range of issues, and I thank all of my colleagues for
their dedication to addressing the challenges I've highlighted
today.
Mr. Pallone. Thank you. And, again, I would like to ask you
some questions but we are running out of time. So thanks for
coming.
Thank you, Ms. Slotkin, for bearing with us.
Mr. Burgess. Mr. Chairman?
Mr. Chairman, may I just say something on the--on the
recovery centers? Because it is important and we spent some
time on that, as you know, in the last Congress in developing
the SUPPORT Act.
And I do think that is important and, of course, we had
really an oversight but it was a hearing on the implementation
of CURES because we had a large mental health title in the
CURES initiative and we had SAMHSA here. Unfortunately, that
hearing kind of got sidetracked on some other issues.
But I would just agree that that is an important topic and
we should be in the lead on that and asking SAMHSA what is
the--what is the current state of--in the Oversight and
Investigations Subcommittee we heard some really tough stories
about some of the things that were happening in the recovery
centers.
We need to be on top of that. We are pumping a lot of money
into that. A lot of grants are being made available. We need to
make sure we are not hurting people in the process.
Mr. Pallone. Thank you. Thank you, Dr. Burgess, and thank
you, Mike.
Ms. Slotkin?
OPENING STATEMENT OF HON. ELISSA SLOTKIN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MICHIGAN
Ms. Slotkin. Thank you, Chairman Pallone and Ranking
Member, for the opportunity to testify today on something that
is a scourge. I know we are all dealing with it--robocalls.
If you are like me and like most Michiganders, you hate
these calls and whether you're a Democrat, a Republican, and
Independent, I think they drive everybody equally crazy.
Everyone has a story about robocalls. I have two. They both
relate to the same time period right after I got elected. I
went in to meet one of the mayors of our towns, Rochester,
Michigan--a wonderful guy named Rob Ray--and it was our first
in call and I thought--I wasn't even sworn in--I thought he was
going to tell me about all the grants he needs and all the
information he wanted and I was ready for a bunch of asks.
And I said, you know, if I could do one thing when I go to
Congress what would it be, and he said stop the dang robocalls.
And then I came to Congress and I was given a cell phone,
right. We are all given phones when we become Members of
Congress.
I cannot answer that phone because I am constantly getting
robocalls. So I'll see a number. I am sure, like most people
here, you'll see a number. It's pretty similar to your number.
You think is that someone calling with something important--
congressional business. I cannot answer my phone. Let it all go
to Voicemail because of the robocalls.
So I am particularly energized on this issue. Let me just
give you some specifics. Michigan last year alone we had 1.2
billion robocalls made to us. Maybe because we are a swing
state it's even worse. We are estimating that already this year
784 million robocalls have been made. It is getting worse.
A year ago we were--we were at a certain terrible number.
We are now up 143 percent in one year, and it's important to
note that it isn't just an annoyance that we all share.
Most of these calls are calling with some sort of scam,
right. They are looking for your money. They are looking to
lure you into something. Americans lost about $10.5 billion due
to robocall scams last year. They prey on the most vulnerable,
particularly the elderly.
We know that they use the number spoofing so it looks
really close to your number. You think it's someone calling
from your neighborhood, someone calling who knows you. But it
does cause serious problems in our communities and many people
are like me. They don't--actually don't answer the calls
anymore.
So if something came in--a hospital, some emergency
happened--how many of us would let that call go to voicemail?
And I just--I think it's--it is pesky but it also is important.
So the good news is I co-sponsored the Stopping Bad
Robocalls Act. It was a bill that was introduced in this
committee and I co-sponsored it. It passed the House yesterday.
I am thrilled about that.
It is a really important first step to stemming the scourge
of robocalls. I am really hoping the Senate takes it up but I
would urge your help in making sure that in this day and age
some of these things that are very bipartisan actually get
through.
Please keep your foot on the gas on this. And I know there
is a number of pending pieces of legislation you're also
looking at around these issues. I urge you to take them up.
This is something that affects all of our constituents in
their daily lives. In an era when sometimes people feel like
government can't get anything done, I think this would be a
huge positive step that we are actually still working up here.
So thank you very much, Mr. Chairman.
[The prepared statement of Ms. Slotkin follows:]
Prepared Statement of Hon. Elissa Slotkin
Thank you Mr. Pallone for the opportunity to testify before
you today.
Mr. Pallone, if you're like me, and if you're like most
Michiganders, you hate getting robocalls.
Certainly in Michigan, whether you're a Democrat or
Republican, this is an issue that unites us all in shared
frustration.
In fact, shortly after I was elected, I had a meeting with
a local, Republican mayor in our district, and asked him what
was one thing I should be sure to work on in Congress.
I expected him to talk about a particular grant, or maybe
roads or water--but he said, ``robocalls,'' and we spent a long
time that day talking about just how pervasive this issue is in
our community, and what Congress can do it about.
Let me tell you a bit about how this issue is affecting us
in Michigan specifically: Last year alone, an estimated 1.2
billion robocalls were made to people who live in Michigan.
Experts are estimating that, already in 2019 Michiganders have
already received over 784 million robocalls.
It feels like they're getting worse--and they are: the
number of robocalls in Michigan has already gone up 143% since
this time last year.
It's important to note that this problem is more than just
a daily annoyance--these calls are scamming consumers out of
their moneyand stealing personal information.
Americans lost an estimated $10.5 billion dollars this year
due to robocall scams. These scammers prey on the most
vulnerable among us, particularly seniors.
We also know that scammers use ``number spoofing'' to make
it look like they're calling from a local number.
This causes serious problems in our communities as people
have begun ignoring calls they don't recognize from their same
area code.
This can have serious ramifications when you think about
healthcare professionals, business-owners, parents,
Clearly, this problem is pervasive and serious. Everywhere
I go in Michigan's 8th district, I get the question, ``by the
way, is there anything you can do about those pesky
robocalls?''
The good news is that we can.
I was proud to see the Stopping Bad Robocalls Act, a bill
that was introduced in this committee and which I co-sponsored,
pass in the House yesterday.
This bill is a really important first step to stemming the
scourge of robocalls, and I sincerely hope the Senate takes it
up.
And I am here today to say: let's keep our foot on the gas.
I want to encourage this committee to take up the pending
legislation you are considering on this topic, so that we can
put an end to these bothersome and threatening robocalls.
This is an issue that has broad bipartisan support, and
directly responds to a pervasive issue that affects our
constituents' daily lives.
That is our duty as Members of Congress, and I'm glad that
we get to do it on an issue where there is such strong demand
from our constituents.
Thank you.
Mr. Pallone. And I appreciate your emphasis on the
robocalls bill that passed yesterday. We will keep our foot on
the gas. There is a Senate equivalent. It's not exactly the
same.
But we are working with the Senate and we think we can get
this done. So thanks so much. Appreciate it.
Ms. Slotkin. Great. Thank you, Mr. Chairman.
And now we go to Mr. Perry.
OPENING STATEMENT OF HON. SCOTT PERRY, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA
Mr. Perry. Thank you, Chairman Pallone and Ranking Member
Shimkus, members of the committee and staff. I appreciate the
opportunity to testify this morning regarding some of my
priorities within the committee's jurisdiction.
As the focus of the nation's energy policy has shifted in
recent years towards reducing greenhouse gas emissions, the
policies pursued have increasingly been to the benefit of the
wealthy and politically connected at the expense of the
American people.
The Solyndra scandal, the various environmental tax credits
that go to most--that go almost exclusively to wealthy
individuals, the regulatory effort, and the last administration
at the behest of the environmental organizations intent to
eliminate the coal industry, et cetera.
Not only do these regressive policies have an outsized
impact on the most vulnerable among us, they have significantly
degraded the American people's trust in their government.
Yesterday's Environment and Climate Change Subcommittee
hearing entitled ``Building America's Clean Future: Pathways to
Decarbonizing the Economy'' was the next step in this
disturbing trend.
Giving legitimacy to the fringe ``keep it in the ground''
movement--that is what that did. The proposed ideas would have
crippling effects on the bottom line of each and every one of
our constituents while having little to no impact on global
greenhouse gas emissions.
Despite the usual platitudes about just transitions for
affected workers or environmental justice and the like, there
was no real answer to how destroying the economic driver of my
home state of Pennsylvania as well as numerous others could be
done in a just manner.
Little explanation of how these climate actions would be
and could be tailored in a way to create economic opportunity
for low-income communities and even less evidence was presented
showing that this would work.
Similar environmental policies are currently being pursued
in the state of California and these same promises were made to
low-income Californians.
The result? According to a study by the Center for
Demographics and Policy at Chapman University, and I'll read,
``In summary, the imposition by the state's Democratic Party
leaders of highly regressive climate schemes have engendered
disparate financial hardships on middle- and lower- income
workers and minority communities while providing direct
economic subsidies to wealthier Californians in
environmentalist strongholds,'' end quote.
In light of these findings, I think it's imperative that
the conversation shifts from an all-out attempt to destroy
entire industries to a more productive conversation about the
impact of such actions on the financial wellbeing of our
constituents as well as the massive restrictions on personal
freedoms required by this type of policy.
If the majority is dead set on imposing onerous
restrictions on reliable sources of energy, the least it can do
is try to blunt the negative impacts to the American people.
Yet, in many cases, mitigating efforts are being stalled either
through overt action by this committee or a failure to act.
Continuing to prioritize the development of intermittent
renewable sources through subsidies and incentives comes at the
expense of baseload power operators, many of whom have closed
their doors.
This government intrusion into the market is unhelpful and
actually increases emissions where nuclear plants close. The
issues of intermittence, frequency, cost effectiveness, supply
chain security and integrity, and land use requirements' impact
on endangered species and environmental degradation is
conveniently left out of the conversation about wind, solar,
and battery storage.
However, these are very real issues and need to be
addressed before any attempts to decarbonize the economy are
pursued.
In the meantime, if the committee wants to take actions
that will result in increased renewable generation, not just
capacity, it should move forward with the efforts to remove the
regulatory burdens inhibiting the further development of the
only baseload renewable power source, hydropower.
Federally imposed regulatory burdens leave hydropower
projects with the longest and most complex development time
lines of any renewable technology, often in excess of 10 years,
while wind and solar can easily go from concept to development
in two to three years.
This disparate treatment of the only baseload renewable
source is nonsensical and significantly undermines any
regulatory framework aimed at lowering greenhouse gases as it
drives private capital away from hydropower projects. These
burdens are a major limiting factor on the ability of the
industry to expand its footprint.
Currently, only three percent--only three percent of the
80,000 dams in the United States generate electricity so there
is a significant potential growth in the industry if these
burdens are lessened or removed.
Despite the significant regulatory burden on hydropower and
the preferential tax treatment received by wind and solar
projects, hydropower still accounted for 52 percent of all
domestic renewable generation in 2018.
This is both a testament to hydropower's reliability and a
damning indictment of wind and solar power. The playing field
could not be more favorable for wind and solar and yet,
combined, they don't make up a majority of generation.
And I'll close with this. Rather than pursuing a policy to
replace working power generation with one that can continues to
fail in the most favorable of market environments, we should be
leveling the playing field and allowing the free market to
drive down prices and clean up the environment has it has for
the past century.
And with that, I thank the committee and I yield.
[The prepared statement of Mr. Perry follows:]
Prepared Statement of Hon. Scott Perry
Chairman Pallone and Ranking Member Walden, I'd like to
thank the Energy and Commerce Committee for the opportunity to
testify this morning regarding my priorities within the
committee's jurisdiction. As the focus of the nation's energy
policy has shifted in recent years toward reducing greenhouse
gas emissions; the policies pursued have increasingly been to
the benefit of the wealthy and politically connected at the
expense of the American people--the Solyndra scandal, the
various ``environmental'' tax credits that go almost
exclusively to wealthy individuals, the regulatory effort under
the last administration at the behest of environmental
organizations intended to eliminate the coal industry, etc. Not
only do these regressive policies have an outsized impact on
the most vulnerable among us, but they have significantly
degraded the American people's trust in their government.
Yesterday's Environment and Climate Change Subcommittee
hearing entitled, ``Building America's Clean Future: Pathways
to Decarbonize the Economy'' was the next step in this
disturbing trend; giving legitimacy to the fringe ``keep it in
the ground'' movement. The proposed ideas would have crippling
effects on the bottom line of each and every one of our
constituents while having little to no impact on global
greenhouse gas emissions. Despite the usual platitudes about
``just transitions for affected workers, environmental
justice'', and the like, there was no real answer to how
destroying the economic driver of my home state of Pennsylvania
as well as numerous others could be done in a ``just'' manner.
Little explanation of how these climate actions could be
tailored in a way to create economic opportunity for low-income
communities and even less evidence was presented showing that
this would work.
Similar environmental policies are currently being pursued
in the state of California and these same promises were made to
low-income Californians. The result, according to a study by
the Center for Demographics and Policy at Chapman University:
``In summary, the imposition by the state's Democratic
party leaders of highly regressive climate schemes have
engendered disparate financial hardships on middle and lower
income workers and minority communities, while providing direct
economic subsidies to wealthier Californians in
environmentalist strongholds.''
In light of these findings, I think it is imperative that
the conversation shifts from an all-out attempt to destroy
entire industries to a more productive conversation about the
impact of such actions on the financial well-being of our
constituents as well as the massive restrictions on personal
freedoms required by this type of policy.
If the Majority is dead-set on imposing onerous
restrictions on reliable sources of energy, the least it can do
is try to blunt the negative impacts to the American people.
Yet, in many cases, mitigating efforts are being stalled either
through overt action by this committee or a failure to act.
Continuing to prioritize the development of intermittent
renewable sources through subsidies and incentives comes at the
expense of baseload power operators; many of whom have closed
their doors. This government intrusion into the market is
unhelpful and actually increases emissions where nuclear plants
close. The issues of intermittency, frequency, cost-
effectiveness, supply-chain security and integrity, land use
requirements, impact on endangered species and environmental
degradation is conveniently left out of the conversation about
wind, solar, and battery storage. However, these are very real
issues and need to be addressed before any attempts to
``decarbonize'' the economy are pursued.
In the meantime, if the committee wants to take actions
that will result in increased renewable generation, not just
capacity, it should move forward with efforts to remove the
regulatory burdens inhibiting the further development of the
only baseload renewable power source; hydropower. Federally
imposed regulatory burdens leave hydropower projects with the
longest and most complex development timeline of any renewable
technology, often in excess of 10 years while wind and solar
can easily go from concept to development in two to three
years.
This disparate treatment of the only baseload renewable
source is nonsensical and significantly undermines any
regulatory framework aimed at lowering greenhouse gases as it
drives private capital away from hydropower projects. These
burdens are a major limiting factor on the ability of the
industry to expand its footprint. Currently, only three percent
of the 80,000 dams in the U.S. generate electricity so there is
significant potential growth in the industry if these burdens
are lessened or removed. Despite this significant regulatory
burden on hydropower and the preferential tax treatment
received by wind and solar projects, hydropower accounted for
52 percent of all domestic renewable generation in 2018. This
is both a testament to hydropower's reliability and a damning
indictment of wind and solar power. The playing field could not
be more favorable for wind and solar and yet, combined they
don't make up the majority of generation.
Rather than pursuing a policy to replace working power
generation with one that continues to fail in the most
favorable of market environments, we should be leveling the
playing field and allowing the free market to drive down prices
and clean up the environment; as it has for the past century.
Mr. Pallone. I thank the gentleman.
Dr. Burgess, did you want to make a point?
Mr. Burgess. Yes. It was this committee, after all, that
did pass the Energy Policy Act of 2005 when Joe Barton was
chairman and part of that was loans for the development of
nuclear electricity or nuclear power.
And, unfortunately, since then we haven't done much with
that. In fact, the loans have been changed through subsequent
administrations and gone to projects that actually haven't
really delivered very much in the way of energy as they were
diverted to renewable energy.
I really don't think you can seriously talk about a zero
carbon future regardless of the time frame if you do not
include nuclear energy as part of your baseload, and this
committee should remember that.
So I thank you for bringing it back to our attention.
Mr. Pallone. And I don't want to belabor the point because
I know we have got to move on. But we really stressed yesterday
at the hearing that, you know, we were technology neutral.
We are not, you know, saying that this is all--this goal is
reached just with renewables. Hydropower is important. We
certainly want to include nuclear, carbon capture. You know, so
I don't want you to think that we are just saying that this
goal has to be reached just with renewables.
But I know we have got to move on. So thanks again.
Next is--oh, yes, the gentlewoman from New Mexico. And I
did want to mention, because I know you're--you and your
colleague from Kansas, right, are the first American Indian or
Native American women--Congresswomen.
You may not even mention it but we are determined that in
the fall we will have a hearing on the Native--on the Indian
Health Care Improvement Act because I know that that's a
commitment that I made and I just wanted to mention it to you.
Ms. Haaland. Thank you. Thank you, Chairman.
Mr. Pallone. So thank you.
Ms. Haaland. Thank you.
OPENING STATEMENT OF HON. DEBRA HAALAND, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW MEXICO
Chairman, ranking member, members of the committee, thank
you for the opportunity to testify.
My district has over 300 days of sunshine each year and
abundant wind resources. That's why I am working with several
of my colleagues on legislation to set a nationwide goal of 100
percent clean energy economy by 2050.
Thank you, Chairman Tonko, for being part of this effort.
This will protect public health and our environment, create
millions of jobs, and mitigate the impacts of climate change
for all communities and all generations, especially those
disproportionately impacted.
I urge the committee to support this effort broadly and
through intermediate steps that will enable the transition to
clean energy.
The transition to clean energy requires a modernized smart
electric grid to increase integration of renewable energy and
support adoption of zero emission vehicles.
I urge you to encourage deployment of smart meters and
other technologies which make our electric grid more responsive
and capable of supporting distributed energy resources.
I recommend improving the performance, affordability, and
deployment of energy storage systems to enhance grid
flexibility and reliability, and expanding advanced
transmission technologies to get power to demand centers more
efficiently.
Improving energy efficiency and transitioning from fossil
fuels to electricity are keys to a clean energy future. I urge
you to increase energy efficiency in new and existing public
and private housing, and provide incentives to implement energy
efficiency retrofits in public buildings.
I also recommend that you help homeowners shift from gas-
powered appliances to electric, expand consumer choices for
power consumption and production, and support the development
and integration of new technologies such as advanced insulation
windows, HVAC systems, and lighting.
It's essential to make these measures affordable for low-
income families by providing grants to utilities to make energy
efficient upgrades accessible to these communities while also
providing direct assistance to individual families and Indian
tribes.
The Federal Government can also reduce our impact on the
climate and environment by providing grants to communities to
build recycling and composting facilities and promote waste
prevention.
Composting reduces greenhouse gas emissions from landfills
and incinerators, returns carbon to the ground, and reduces the
need for chemical fertilizers. These investments can help us
move toward a national goal of zero waste.
As chair of the Native American Caucus, I am working to
address the federal neglect and under investment in Indian
Country.
One of the most pressing needs is broadband service in
tribal and rural areas and, of course, that is a necessary
addition for family farms across the country.
The FCC reports that 92 percent of Americans have access to
high-speed internet compared to 65 percent of Indian Country,
more comparable to a developing country than the world's most
prosperous nation.
The federal government is creating new digital reservations
for Native Americans, leaving Indian Country to fall farther
and farther behind.
As you work on broadband policy, I urge the committee to
pay particular attention to the needs and challenges in Indian
County and rural America, which not only include education and
healthcare but also public safety and which includes remedies
to the crisis of missing and murdered indigenous women.
American Indian and Alaska Native communities also face a
maternal mortality crisis. According to the U.S. Commission on
Civil Rights' ``Broken Promises'' report, Native American women
are 4.5 times more likely than non-Hispanic white women to die
while pregnant or within 42 days post-partum.
To address this crisis, I joined Congresswomen Gwen Moore
and Debbie Dingell to introduce the Mamas First Act. I urge the
committee to support this bill that would allow Medicaid
reimbursements for doulas and midwives to combat maternal
mortality among the nearly two million on Medicaid giving birth
each year.
I thank you so much for the opportunity to address you this
morning.
Thank you, Chairman.
[The prepared statement of Ms. Haaland follows:]
Prepared Statement of Hon. Debra Haaland
Chairman Rush, Ranking Member Upton, members of the
committee, thank you for the opportunity to testify.
My district is blessed with over 300 days of sunshine each
year and abundant wind resources. That is why I am working with
several of my colleagues on legislation to set a nationwide
goal of a 100 percent clean energy economy by 2050. This will
protect public health and our environment; create millions of
well-paying green jobs; and mitigate the impacts of climate
change for all communities and all generations, especially
those disproportionately impacted by its effects. I urge the
committee to support this effort broadly and through
intermediate steps that will enable the transition to clean
energy.
The transition to clean energy will require a modernized,
smart electric grid to increase integration of renewable energy
and support adoption of zero-emissions vehicles. I urge you to
encourage deployment of ``smart'' meters and other
technologies, which make our electric grid more responsive and
capable of supporting distributed energy resources. I recommend
improving the performance, affordability, and deployment of
energy storage systems to enhance grid flexibility and
reliability; and expanding advanced transmission technologies
to get renewable power to demand centers more efficiently.
Improving energy efficiency and transitioning from fossil
fuels to electricity are keys to a clean energy future. I urge
you to increase energy efficiency in new and existing public
and private housing and provide incentives to implement energy
efficiency retrofits in municipal buildings, hospitals, and
schools. I also recommend that you help homeowners shift from
gas-powered appliances to electric; expand consumer choices for
power consumption and production; and support the development
and integration of new technologies such as advanced
insulation, windows, appliances, HVAC systems, and lighting. It
is essential to make these measures affordable for low-income
families by providing grants to utilities to make energy
efficient upgrades accessible to low-income communities while
also providing direct assistance to individual families and
tribes.
The Federal Government can also reduce our impact on the
climate and environment by providing grants to communities to
build recycling and composting facilities and promote waste
prevention. Composting reduces greenhouse gas emissions from
landfills and incinerators, returns carbon to the ground, and
reduces the need for chemical fertilizers for crops. These
investments can help us move toward a national goal of zero
waste.
As co-chair of the Native American Caucus, I am working to
address the federal neglect and underinvestment in Indian
Country. One of the most pressing needs is broadband service in
tribal and other rural areas.
The FCC reports that 92 percent of Americans are able to
access high-speed internet compared to just 65 percent of
Indian Country, more comparable to a developing country than
the world's most prosperous nation. The Federal Government is
creating new digital reservations for Native Americans, leaving
Indian Country to fall further behind in the twenty-first
century. As you work on broadband policy, I urge the committee
to pay particular attention to the needs and challenges in
Indian Country and rural America.
American Indian and Alaska Native communities also face a
maternal mortality crisis. According to the U.S. Commission on
Civil Rights ``Broken Promises'' report, Native American women
are 4.5 times more likely than non-Hispanic white women to die
while pregnant or within 42 days post-partum. To address this
crisis, I joined with Congresswomen Gwen Moore and Debbie
Dingell to introduce the Mamas First Act. I urge the committee
to support this bill that would allow Medicaid reimbursements
for doulas and midwives to combat maternal mortality among the
nearly two million on Medicaid giving birth each year.
Thank you again for the opportunity to testify.
Mr. Pallone. Thank you, and let me just say quickly, you
know, part--last week when we did a full committee sort of
marathon markup we had this energy efficiency package that has
provisions for grants to communities and a lot of the things
that you mentioned, and that is part of this LIFT America Act,
which is sort of our infrastructure--our piece of an
infrastructure bill if we ever get to one, you know, with the
president and with the Senate, and that has $40 billion for
expansion of broadband in underserved areas, and part of that
was in reaction to mine and others visiting some of the
reservations.
I remember we went to the Gila River in Arizona and this is
all they talked about was how, you know, so many of the tribes
don't have access to the internet. So a lot of the ideas that
you are including, you know, we want to move on. So thanks
again. Appreciate it.
Ms. Haaland. Thank you, Chairman. Thank you.
Mr. Pallone. Thank you.
And now we go to Congresswoman Shalala, who needs no
introduction. So proud of the things that we did when you were
the secretary and so progressive on so many things and working
with this committee. Thanks for being here.
OPENING STATEMENT OF HON. DONNA E. SHALALA, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF FLORIDA
Ms. Shalala. Thank you, Chairman Pallone. Thank you very
much.
I, as you can imagine, had 25 things I wanted to talk to
you about but I picked out three.
This week we will celebrate the 29th anniversary of the
signing of the Americans with Disabilities Act--the ADA. So I
have come today to talk to those who often don't have a voice.
This crucial landmark civil rights legislation prohibits
discrimination against people with disabilities in all areas of
public life, including at work, at school, and public
accommodations.
Last month was the 20th anniversary of the landmark
Olmstead case. This case affirmed the rights of Americans with
disabilities under the ADA to live independently and in their
communities.
Despite this recognition that the ADA prohibits the
segregation of people with disabilities into institutions,
integration has not yet been achieved. We have a lot more work
to do.
States have long wait lists for community services and many
people with disabilities are not able to receive them. Many
people with disabilities live in fear that their fundamental
right to live in their communities, the communities that they
love will be taken away from them and they will be forced into
an institution.
This must change and I am hopeful that this committee will
consider in the coming months legislation to ensure that all
people have the fundamental right to remain in their
communities and in their homes.
Earlier this year, Congressman Sensenbrenner introduced
legislation called the Disability Integration Act, which would
create a right to home and community-based services as an
alternative to institutionalization.
This bill is bipartisan, bicameral. I am the lead Democrat.
It now has 234 co-sponsors in the House. I hope this committee
will consider this critical legislation in this Congress.
In a similar vein, it is my hope that the committee will
consider H.R. 3215, the Disaster Relief Medicaid Act, which I
introduced earlier this year with Congressman Langevin and
Congresswomen Gonzalez-Colon and Holmes Norton.
Natural disasters are occurring at increased rates across
this country and in the aftermath of such disasters thousands
of people are often forced to abandon their homes and relocate,
often to a different state.
After Hurricane Katrina over one million evacuees relocated
to another state. More recently, after Hurricane Maria, between
140,000 and 180,000 people left Puerto Rico. Many of them moved
to Florida.
The stress of moving after a natural disaster is immense,
but it is even greater for individuals and families that are
eligible for Medicaid healthcare and long-term services and
supports.
These are the most severely disabled people that we knew.
The move from one's home state to a host state as a result of
disaster can mean the loss of access to critical long-term
services and supports.
In this bill we fill a very important niche. You'll
remember that after these disasters we often allocate money but
it often takes months or even years for the money to reimburse
the states.
In this Act, the Disaster Relief Medicaid Act would ensure
that individuals eligible for Medicaid who need these long-term
services that are forced to relocate during a disaster that
they are able to continue their Medicaid supported services.
In other words, we would reimburse the states--the host
states--at 100 percent for some period of time. So as Dr.
Burgess will confirm, their services are seamless so they can
go to the host state and get those long-term care services
without the state having to absorb the costs.
Between wildfires and floods and tornadoes and hurricanes,
all of our constituents are threatened by natural disasters. No
one should have to choose between evacuating and losing access
to lifesaving services and staying and possibly losing their
life to a natural disaster.
Finally, I want to implore this committee to consider the
critical issue of youth tobacco and e-cigarette usage. Many of
us in this room have been working on this for decades.
We have achieved one of the great public health
achievements of both the last and this century. We have driven
down the number of kids that are smoking, and I joined you, Mr.
Chairman, in introducing the Reversing the Youth Tobacco
Epidemic Act of 2019.
We have made extraordinary progress in this area, and the
FDA and CDC have now reported an alarming 78 percent increase
in e-cigarette use by high school students.
Something has to be done to combat youth use of e-cigarette
products and our legislation would raise the age to buy tobacco
products to 21, which now has bipartisan and bicameral support.
It would also create a universal ban on flavors on all
tobacco products and prohibit the marketing of e-cigarette
products to people under the age of 21.
This will be our second big public health accomplishment
certainly of this century and it's very important to do, and I
hope you'll be able to markup the bill in this session.
Thank you very much.
[The prepared statement of Ms. Shalala follows:]
Prepared Statement of Hon. Donna E. Shalala
Chairwoman Eshoo and Ranking Member Burgess, thank you for
having me today. I would like to touch on a few things that are
important to me and my district which I hope the committee will
consider this Congress.
Disability Integration Act
This week we will celebrate the 29th anniversary of the
signing of the Americans with Disabilities Act -the ADA. This
landmark civil rights legislation prohibits discrimination
against people with disabilities in all areas of public life,
including at work, in school, and in public accommodations.
And last month was the 20th anniversary of the Olmstead
case. This case affirmed the rights of Americans with
disabilities under the ADA to live independently and in their
community-as most people want to do.
Despite the Supreme Court recognizing that the ADA
prohibits the segregation of people with disabilities into
institutions-in practice this has not come to pass. More work
needs to be done.
States have long wait lists for community services and many
people with disabilities are not able to receive them. Many
people with disabilities live in fear that their fundamental
right to live in the community that they love will be taken
away from them and they will be forced into an institution.
This must change. I am hopeful that this committee will
consider in the coming months legislation to ensure a right to
remain in your community.
Congressman Sensenbrenner introduced legislation called the
Disability Integration Act which would provide home and
community-based services as an alternative to
institutionalization. This bill is bipartisan and bicameral-I
am the lead Democrat-and it now has 234 cosponsors.
I hope this committee will consider this critical issue and
legislation this Congress.
Medicaid and Disasters
In a similar vein, it is my hope that the committee will
consider H.R. 3215, The Disaster Relief Medicaid Act which I
introduced earlier this year with Congressman Langevin,
Congresswomen Gonz lez-Colon and Holmes Norton.
Natural disasters are occurring at increased rates across
this country and in the aftermath of such disasters thousands
of people are often forced to abandon their homes and relocate.
It happened after Hurricane Katrina when over on million
evacuees relocated to another state. More recently, after
Hurricane Maria an estimated 140,000 to nearly 185,000 left the
island-many of whom moved to Florida.
The stress of moving after a natural disaster is immense,
but it is even greater for individuals and families that are
eligible for Medicaid healthcare and long-term services and
supports. The move from one's home state to a host state as a
result of a disaster can mean the loss of access to long-time
services and supports.
The Disaster Relief Medicaid Act would ensure that
individuals eligible for Medicaid who are forced to relocate
due to a disaster are able to continue to access their Medicaid
supported services. It would also provide states with resources
to support the Medicaid needs of individuals forced to relocate
following a disaster.
This legislation would designate an individual who resides
in an area covered under a presidential disaster declaration as
a Relief-Eligible Survivor and allow them to continue to access
their Medicaid services if they are forced to relocate to
another state as a result of the disaster.
All of our constituents are threatened by natural
disasters-whether it is a wildfire, a flood, a tornado or a
hurricane. No one should have to choose between evacuating and
losing access to lifesaving services and staying and possibly
losing their life to a natural disaster.
Tobacco
I would also implore this committee to consider the
critical issue of youth tobacco and e-cigarette usage.
Recently, I joined Chairman Pallone in introducing the
Reversing the Youth Tobacco Epidemic Act of 2019.
The FDA and CDC have reported an alarming 78 percent
increase in e-cigarette use by high school students and a 48
percent increase among middle school students from 2017 to
2018.
Something must be done to combat the youth use of e-
cigarette products and to continue our longstanding public
health battle against smoking and tobacco use.
Our legislation would raise the age to buy tobacco products
to 21-which now has bipartisan and bicameral support. It would
also create a universal ban on flavors in all tobacco products
and prohibit the marketing of e-cigarette products to people
under the age of 21.
Thank you for having me today and I look forward to working
with the committee on these issues as well as a number of other
issues that you have within in your jurisdiction.
Mr. Pallone. Thank you. And again, as you know, I really
value your expertise, you know, not only because you were the
secretary but spent so much time over the years on so many of
these health issues.
With regard to the disabilities, it's really important that
we do whatever we can to keep people in their homes and the
community, not have them institutionalized. We will work--we
will continue to work on that, and all your work on tobacco we
appreciate.
And I really appreciate too that you didn't just say, you
know, we need to raise the age to 21. I know Senator Collins
has been, you know, stressing that. But we need to address
vaping and, you know, the flavored cigarettes and these other
things.
Ms. Shalala. Exactly. Clearly, the tobacco companies
pivoted to find--to target youth again. So now we need to do
another piece of legislation to prevent that, and the American
people are right there with us.
Mr. Pallone. Thank you.
Dr. Burgess?
Mr. Burgess. Well, Mr. Chairman, as you know, we took a
bipartisan field hearing to Puerto Rico. It's been almost two
years ago. I think it's appropriate to consider a follow-on to
the island.
Basically, we were concerned about electricity grid
problems at the time but healthcare is, obviously, a big issue
for the island and we ought to include that in a field hearing
in the near future.
Ms. Shalala. Thank you.
Mr. Pallone. Thank you, Dr. Burgess, and thank you,
Secretary Shalala. Appreciate it.
Now, I just so I am told that, you know, we are trying to
follow the order that we said when we asked people to come. So
that's going to mean, what, that we have Congresswoman Meng
next, Congressman Sablan, and then we are going to go to
Chairman Roybal-Allard--the two together, I guess.
So is that accurate? All right. We will go to Congresswoman
Meng. Thank you.
OPENING STATEMENT OF HON. GRACE MENG, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Ms. Meng. Chairman Pallone, Ranking Member Walden,
Chairwoman Eshoo and Ranking Member Burgess, and distinguished
members of this committee, thank you for this opportunity to
discuss several of my priorities as it pertains to the
Subcommittee on Health but also more broadly across the full
house committee.
I sincerely ask this committee to move forward with the
following bills and priorities.
Protecting women and children from harmful chemicals is one
of my top priorities. That is why I introduced a package of
bills to ensure safeguards are in place to bolster consumer
confidence that the products they purchase are safe for their
loved ones.
First, H.R. 2267, the Infant Formula Act, would prohibit
the sale of expired baby formula. Although regulations require
expiration dates to be placed on formula, federal law does not
prohibit the sale of infant formula after its expiration has
passed.
I was shocked to learn that parents who unknowingly bought
these expired formulas reported their infants being violently
sick. Busy parents need to be able to rely on the safety of
products, like formula, that they buy in grocery stores to make
sure their newborns are well-fed and healthy.
Second, H.R. 2268, the Menstrual Products Right To Know,
would require companies to list ingredients in feminine hygiene
products, such as scented and unscented pads, cups, scented and
unscented tampons, and therapeutic douche apparatuses.
We can easily see the ingredients used in the shampoo we
put in our hair or in the foods that we eat. The same
transparency requirements must apply to products that touch, or
are inserted to, our most sensitive and absorbent parts of the
body.
Third, H.R. 2269, the Get Additives Out Act, would require
a GAO report on the physical and behavioral health risks of
food additives on children.
The food additives and its effects are dramatically
understudied, particularly on the impact on children as they
enter critical stages of development.
I am committed to ensuring more transparency in the foods
that we eat and the foods that my boys eat.
In the coming months, I will also be introducing
legislation to address the Consumer Product Safety Commission's
inability to effectively oversee recalls, particularly with
products that threaten the safety of infants and children.
The Britax jogging stroller recall rollout was a shameful
fiasco with failed missteps and a clear abuse of consumers'
trust. Sadly, this incident is not the exception, which is why
I will tackle this issue head on.
As the co-chair of the Congressional Hepatitis Caucus, I
also recently introduced H. Res. 505, which recognized July
28th as ``World Hepatitis Day.''
This legislation also encourages people from across the
world to take preventative action and urges greater
partnerships between federal, state, and local health
departments to eliminate new infections in the U.S.
Another one of my priorities is to ensure access to
affordable menstrual hygiene products. One might think these
products are ubiquitous and cheap, but many women face
difficulty when it comes to affording and accessing them.
I know this because I have heard the heartbreaking
testimonies from girls and women across our nation. That is why
I introduced H.R. 1882, the Menstrual Equity for All Act, which
is a comprehensive solution to ensuring this basic healthcare
need for over 51 percent of the U.S. population.
No girl should have to choose between their dignity or
their education, no one should have to lose their dignity just
because they are incarcerated, and no family should have to
choose between buying these products or groceries.
Additionally, I am deeply committed to the issue of our
environment and its impact on the health of our constituents
and their families. That is why, yesterday, I introduced the
Safe Drinking Water in Playgrounds and Parks Act, which would
ensure that states, schools, and municipalities have the
necessary resources to replace drinking water fountains in
those places.
As you know, no amount of lead is safe for consumption, and
if consumed, its effects are dangerous to children.
Furthermore, aviation noise is a critical issue that impacts my
district in Queens. That is why, as the founding member and
former co-chair of the Quiet Skies Caucus, I introduced H.R.
3001, the Quiet Communities Act.
This bill would reestablish the Office of Noise Abatement
and Control in the U.S. Environmental Protection Act. Chronic
exposure to excessive noise can have short and long-term
negative health impacts, including hearing loss, stress, high
blood pressure, and diminished cognitive performance.
Noise pollution is not just a minor inconvenience; it is a
health issue that needs to be addressed.
Thank you again to the subcommittee and the committee for
allowing me to testify. I ardently hope that we can work
together on the priorities I have set forth today.
[The prepared statement of Ms. Meng follows:]
Prepared Statement of Hon. Grace Meng
Chairman Pallone, Ranking Member Walden, Chairwoman Eshoo
and Ranking Member Burgess, and distinguished members of this
committee, thank you for this opportunity to discuss several of
my priorities as it pertains to the Subcommittee on Health--but
also more broadly across the Full House Committee on Energy and
Commerce. I sincerely ask this committee move forward with the
following bills and priorities.
Protecting women and children from harmful chemicals is one
of my top priorities. That is why, I introduced a package of
bills to ensure safeguards are in place to bolster consumer
confidence that the products they purchase are safe for their
loved ones.
First, H.R. 2267--the Infant Formula Act would prohibit the
sale of expired baby formula. Although regulations require
expiration dates to be placed on formula, federal law does not
prohibit the sale of infant formula after its expiration has
passed. I was shocked to learn that parents who unknowingly
bought these expired formula reported their infants being so
violently sick. Busy parents need to be able to rely on the
safety of products, like formula, that they buy in grocery
stores to make sure their newborns are well-fed and healthy.
Second, H.R. 2268--the Menstrual Products Right To Know
would require companies to list ingredients in feminine hygiene
products, such as scented and unscented pads, cups, scented and
unscented tampons, and therapeutic douche apparatuses. We can
easily see the ingredients used in the shampoo we put in our
hair, or in the foods that we eat; the same transparency
requirements must apply to products that touch, or are inserted
to, our most sensitive and absorbent parts of the body.
Third, H.R. 2269--the Get Additives Out Act would require a
GAO report on the physical and behavioral health risks of food
additives on children. The food additives and its effects are
dramatically under-studied, particularly on the impact on
children as they enter critical stages of development. I am
committed to ensuring more transparency in the foods that we
eat--and the foods that my two boys eat.
In the coming months, I will also be introducing
legislation to address the Consumer Product Safety Commission's
inability to effectively oversee recalls, particularly with
products that threaten the safety of infants and children. The
Britax jogging stroller recall rollout was a shameful fiasco
with failed missteps and a clear abuse of consumers' trust.
Sadly, this incident is not the exception, which is why I will
tackle this issue head-on.
As the co-chair of the Congressional Hepatitis Caucus, I
also recently introduced H.Res.505--which recognizes July 28th
as ``World Hepatitis Day.'' This legislation also encourages
people from across the world to take preventative action, and
urges greater partnerships between federal, state, and local
health departments to eliminate new infections in the United
States.
Another one of my priorities is to ensure access to
affordable menstrual hygiene products. One might think these
products are ubiquitous and cheap, but many women face
difficulty when it comes to affording and accessing them. I
know this, because I have heard the heartbreaking testimonies
from girls and women across our nation. That is why I
introduced H.R. 1882--the Menstrual Equity for All Act, which
is a comprehensive solution to ensuring this basic healthcare
need for the 51 percent of the U.S. population. No girl should
have to choose between their dignity or their education; no one
should have to lose their dignity just because they are
incarcerated; and no family should have to choose between
buying these products or groceries.
Additionally, I am deeply committed to the issue of our
environment and its impact on the health of our constituents
and their families. That is why, yesterday, I introduced the
Safe Drinking Water in Playgrounds and Parks Act which would
ensure that states, schools, and municipalities have the
necessary resources to replace drinking water fountains in
those places. As you know, no amount of lead is safe for
consumption, and if consumed, its effects are dangerous to
children.
Furthermore, aviation noise is a critical issue that
impacts my district of Queens. That is why, as the founding
member and former co-chair of the Quiet Skies Caucus, I
introduced H.R. 3001--the Quiet Communities Act. This bill
would reestablish the Office of Noise Abatement and Control in
the U.S. Environmental Protection Act. Chronic exposure to
excessive noise can have short and long-term negative health
impacts, including hearing loss, stress, high blood pressure,
and diminished cognitive performance. Noise pollution is not
just a minor inconvenience; it is a health issue that needs to
be addressed.
Thank you again to the subcommittee and the committee for
allowing me to testify. I ardently hope that we can work
together on the priorities I have set forth today.
Mr. Pallone. Thank you, and we will certainly follow up on
those bills. I am not surprised there is so much emphasis on
kids when I see you, you know, taking those two boys around all
the time. So thanks again.
Did you--Mr. Griffith, go ahead.
Mr. Griffith. Mr. Chairman, I do think we should probably
take a look at the food additives and the impact they have on
folks. I have a number of food additives that I avoid. So it's
not just children, but children may not know what's going on.
Usually I can, through elimination, figure out what's causing
the reaction. But it's something we should probably take a look
at.
Mr. Pallone. Absolutely. All right.
Thanks again, unless you wanted to say something else.
Ms. Eshoo. I do.
Mr. Pallone. Oh, I am sorry.
Ms. Eshoo. That's all right.
Mr. Pallone. The chairwoman of our Health Subcommittee, Ms.
Eshoo.
Ms. Eshoo. Thank you.
I want to thank our colleagues that are at the witness
table. I have to say it's refreshing to have other members
that--members that are not on the committee come in and be with
us.
You have important ideas and what--in terms of the
jurisdiction of my subcommittee, I am going to take your bills
seriously. So this is not a waste of your time here.
Grace, thank you for your work on Quiet Skies. My
congressional district is practically turned inside out upside
down by that new FAA program NextGen, and I don't know if other
members realize this but the FAA there is no responsibility
today for noise--no responsibility--and other health impacts.
So I want to work with you on that.
So thank you to each one of you. It's wonderful to see you.
You're wonderful legislators. You're great friends and you're
always welcome here.
Mr. Pallone. Thank you, and as Chairwoman Eshoo said, you
know, this Members Day is not just you come here and that's the
end of it. Do not hesitate to contact us or have your staff
contact our staff to follow up on these things that you
mentioned, please.
Thank you.
Mr. Sablan, good to see you.
Mr. Sablan. Good morning.
Mr. Pallone. Good morning.
Mr. Sablan. Good morning, Mr. Chairman.
Mr. Pallone. Well, I guess it's the afternoon actually, but
go ahead.
[Laughter.]
OPENING STATEMENT OF HON. GREGORIO SABLAN, A REPRESENTATIVE IN
CONGRESS FROM THE TERRITORY OF THE MARIANA ISLANDS
Mr. Sablan. OK. Well, I'd like to thank Chairs Pallone and
Eshoo and to Ranking Members Walden and Burgess for the
opportunity to provide testimony to the Health Subcommittee
today and to the full committee actually, and thanks to all the
members for reporting favorably the REACH Act last week.
This health extenders package is good news for the Marianas
and all the insular areas. It reauthorizes critically important
Community Health Centers, of which the Marianas has one.
Most importantly, it includes the Territories Health Care
Improvement Act and addressing the Medicaid cliff the insular
areas face when special Obamacare funding ends this year.
Thanks also to Mr. Soto and Mr. Bilirakis of the committee
for understanding the urgency of this insular Medicaid crisis.
They put together the Territories Health Care Improvement Act
with myself and seven other original bipartisan co-sponsors to
give Puerto Rico the help it needs, and the bill also becomes
the means to help the four insular areas.
It provides just what the Marianas Medicaid director told
this committee she needed--$60 million per year. No local match
is required for the first two years, of which will allow the
Marianas government to direct more money to help recover from
last year's typhoons. And after six years, we will get the best
FMAP that any state is currently offered.
This legislation will make the insular Medicaid programs
more state-like in other important ways. New program integrity
requirements, which I support, assure that every federal dollar
is used as intended.
Having a better record of utilization, enrollment, and
expenditures will allow for a greater understanding of the
unique healthcare challenges the insular areas face and, I
hope, provide a basis for the policy that comes after.
Because, as grateful as we are that the Medicaid cliff is
being addressed, and in a way that matches need, we know three
things from experiences with the ACA's Medicaid fix.
Time will pass quickly. The ACA fix lasted eight years.
Then we had the present crisis. The current legislation will
last for six years.
Perhaps with the better understanding we expect to gain
over that time we will be able to fix the problem once and for
all and treat Americans living in the insular areas like all
other Americans when it comes to Medicaid.
The second lesson--humility. We may think that the funding
we are providing to each insular area meets their needs and
their capacity to use the money. But we learned over the course
of the ACA that our predictions are not always accurate.
Some of the insular areas used their ACA money. Some did
not. Some ran out of funding because their needs were greater
than Congress foresaw and Congress had to intervene with
stopgap measures. Some areas are leaving money unspent after
eight years.
We should learn from that experience. Emergencies arise
that cannot be predicted. The recently-enacted disaster
supplemental included my amendment to provide an additional $36
million in Medicaid funds for the Marianas because with last
year's typhoons our program was down to its last dollars.
In the seven weeks since enactment 60 percent of those
funds are already expended and the balance is scheduled for
expenditure by September 30. Emergencies arise.
So I would humbly suggest that some mechanism be built into
the REACH Act to make sure its funds can be reallocated, if
necessary.
I know our staffs have discussed this problem but without
resolution, and I would suggest that all of us ask our staffs
to work a little harder so we do not repeat that mistake of the
Affordable Care Act.
I thank the Health Subcommittee for favorably reporting the
Territories Health Care Improvement Act and I thank the full
committee for bundling it into the REACH Act.
You have made a great step forward to ensure that
healthcare in the insular areas can be as good as healthcare
anywhere in America.
And finally, and always, gratitude. I am ever so grateful
to the American people for the assistance they provide to my
constituents in the Northern Mariana Islands.
Medicaid provides the means to keep our only hospital open
and to allow specialized services to patients who need to
travel off island for their services.
I say this will full sincerity. I am always truly grateful
for America's help for so many of the needs of Americans in the
insular areas, especially the Northern Mariana Islands.
So for the many Americans in the Northern Marianas and from
a grateful nonvoting delegate, Mr. Chairman and other members
of the committee, thank you.
Thank you very much.
[The prepared statement of Mr. Sablan follows:]
Prepared Statement of Hon. Gregorio Sablan
Thanks to Chairs Pallone and Eshoo and to Ranking Members
Walden and Burgess for the opportunity to provide testimony to
the Health Subcommittee today. And thanks to all the members of
the committee for reporting favorably the Reauthorizing and
Extending America's Community Health ``REACH'' Act last week.
This health extenders package is good news for the Marianas
and all the insular areas. It reauthorizes critically important
Community Health Centers, of which the Marianas has one. Most
importantly, it includes the Territories Health Care
Improvement Act, addressing the Medicaid cliff the insular
areas face, when special Obamacare funding ends this year.
Thanks, also, to Mr. Soto and Mr. Bilirakis of the
committee for understanding the urgency of this insular
Medicaid crisis. They put together the Territories Health Care
Improvement Act with myself and seven other original,
bipartisan cosponsors to give Puerto Rico the help it needs.
And the bill also becomes the means to help the four smaller
insular areas.
It provides just what the Marianas Medicaid director told
this committee she needed - $60 million per year. No local
match is required for the first two years, which will allow the
Marianas government to direct more money to help recover from
last year's typhoons. And, after six years, we will get the
best FMAP that any state is offered.
This legislation will make the insular Medicaid programs
more ``state-like'' in other important ways. New program
integrity requirements, which I support, assure that every
federal dollar is used as intended. Having a better record of
utilization, enrollment, and expenditures will allow for a
greater understanding of the unique healthcare challenges the
insular areas face and, I hope, provide a basis for the policy
that comes after.
Because, as grateful as we are that the Medicaid cliff is
being addressed--and in a way that matches need--we know two
things from experience with the ACA's Medicaid fix:
1) Time will pass quickly. The ACA fix lasted eight years.
Then we had the present crisis. The current legislation will
last for six years. Perhaps, with the better understanding we
expect to gain over that time we will be able to fix the
problem once and for all, and treat Americans living in the
U.S. insular areas like all other Americans when it comes to
Medicaid.
2) The second lesson: Humility. We may think that the
funding we are providing to each insular area meets their needs
and their capacity to use the money. But we learned over the
course of the ACA that our predictions are not always accurate.
Some of the insular areas used their ACA money. Some did not.
Some ran out of funding because their needs were greater than
Congress foresaw--and Congress had to intervene with stopgap
measures. Some areas are leaving money unspent after eight
years.
We should learn from that experience. Emergencies arise
that cannot be predicted. The recently enacted disaster
supplemental included my amendment to provide an additional $36
Million in Medicaid funds for the Marianas, because with last
year's typhoons our program was down to its last dollars. In
the seven weeks since enactment 60% of those funds are already
expended and the balance is scheduled for expenditure by
September 30.
Emergencies arise. So, I would humbly suggest that some
mechanism be built into the REACH Act to make sure its funds
can be reallocated, if necessary. I know our staff have
discussed this problem, but without resolution. And I would
suggest that all of us ask our staff to work a little harder,
so we do not repeat that mistake of the Affordable Care Act.
Again, I thank the Health Subcommittee for favorably
reporting the Territories Health Care Improvement Act. And I
thank the full committee for bundling it into the REACH Act.
You have made a great step forward to ensure that healthcare in
the insular areas can be as good as healthcare anywhere in
America.
Mr. Pallone. Thank you, Mr. Sablan. You know, I really
appreciate your input and that of the representatives from the
other territories not only on the Medicaid issue which, as you
mentioned, from Ms. Eshoo's subcommittee--we addressed that
pretty long-term considering where we have been before with
these stopgap measures, and we are hoping that, you know, in
the fall that we can take this issue up very quickly.
But I know we have to address so many of these concerns in
the territories and make sure that whether it's healthcare or
energy or whatever else that it's equal to, you know,
continental U.S. or whatever.
And you have been very helpful in pointing things out and,
you know, giving us ideas about what we need to do. So I want
to thank you for that in particular.
Thanks for being here.
Now we are going to go to--I understand that we have two
Congresswomen who kind of wanted to testify together here on--I
think it was on maternal health issues. But I am not surprised
because I several times saw Ms. Beutler on the--with her--what
was the--Azzana, was that it?
Ms. Herrera Beutler. Isana.
Mr. Pallone. Isana was--you're carrying her around, and I
asked you what it meant and you said strong willed or something
like that.
Ms. Herrera Beutler. Strong willed woman.
Mr. Pallone. All right. Well, do you want to start or
Lucille? Lucille will start. OK. Chairwoman of the
Appropriations and Homeland Security Subcommittee.
OPENING STATEMENTS OF HON. LUCILLE ROYBAL-ALLARD A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA AND
HON. JAIME HERRERA BEUTLER, A REPRESENTATIVE IN CONGRESS FROM
THE STATE OF WASHINGTON
And thanks for--I am glad we were able to work things out
last night. I know we were here late but we finally got the
bill done. So that was good.
Ms. Roybal-Allard. Before this meeting.
Ms. Herrera Beutler. Yes.
Ms. Roybal-Allard. Thank you.
Mr. Chairman, thank you for this opportunity to submit our
testimony in support of maternity caucus priorities in
Congress.
Ms. Herrera Beutler. We co-founded the bipartisan
congressional caucus on maternity care to raise awareness about
the status of childbirth in this country and the challenges
facing America's maternity care system.
It often takes a visible catalyst to get the attention of
policy makers and for maternity care that catalyst has been the
worsening maternal mortality crisis, which this committee, I
know, has delved into.
The CDC estimates 700 women die every year because of
pregnancy or delivery complications and, tragically, 60 percent
of those losses are preventable.
Ms. Roybal-Allard. We must do everything that we can to
ensure the safety of women. It is also critical to recognize
that maternal mortality is just the tip of the iceberg.
More than 50,000 women experience severe complications of
pregnancy that adversely impact their health. Our infant
mortality rates are higher than 33 other similar wealth
countries and we have made some of the slowest progress in the
world in reducing stillbirth rates.
Adding to these concerns is the extraordinary cost of U.S.
maternity care, estimated at over $50 billion. With Medicaid
financing 43 percent of all births, the Federal Government must
ensure cost effective maternal newborn care.
Ms. Herrera Beutler. Our communities also face growing
shortages of maternity care providers. The March of Dimes
estimates that more than five million women in the U.S. live in
a maternity care desert, including areas in our district--
southwest Washington--or greater Los Angeles.
We believe it's time to make these issues a national
priority. We encourage this committee to schedule more hearings
to address the maternal and infant health issues and explore
solutions to advance safe and cost-effective maternity care for
mothers and babies.
Ms. Roybal-Allard. We have several policy recommendations
for your consideration.
One, midwives are a critical part of the solution to
addressing these problems in our maternity care system. But
compared to many other countries, they are vastly underused as
providers.
Increasing access to midwives will help address maternity
care shortages while lowering costs and providing high-quality
care.
Last week as co-chairs of the maternity care caucus we
introduced H.R. 3849, the Midwives for Moms Act, to expand
midwifery education and address the lack of provider diversity
by prioritizing students from minority and disadvantaged
communities. We hope that you will consider this legislation.
Ms. Herrera Beutler. The bipartisan Preventing Maternal
Deaths Act was signed into law in December and was the first
legislation of this kind. This will improve data collection on
maternal--excuse me, number two. I switched. You probably
figured that out.
It's the first of its kind and it's going to improve that
data collection on maternal mortality so we can begin
understanding why mothers are dying.
This was a critical first step but this is just a first
step. More work needs to be done and we believe there are
bipartisan opportunities to ensure that vulnerable populations
of women have access to care during pregnancy and the post-
partum period.
We would also like to work with you on implementing best
practices through initiatives like the Alliance for Innovation
on Maternal Health.
Ms. Roybal-Allard. Number three, despite World Health
Organization recommendations to eliminate unnecessary
childbirth interventions, the U.S. continues to have some of
the highest Cesarean birth and induction rates, and yet
continues to under use proven models of care such as group
model prenatal care and birth centers.
After the August recess we will be introducing the Moms and
Babes Act to prioritize evidence-based care across all federal
maternity care programs and promote research about
physiological birth and best practices to achieve optimal birth
outcomes. We would like to work with you on this effort.
Ms. Herrera Beutler. As members of the House Appropriations
Subcommittee on Labor, Health, and Human Services and
Education, we have worked in a bipartisan fashion to support
critical programs and initiatives to improve the lives of both
mom and baby, including robust funding for the maternal
mortality review committees, the maternal and child health
block grant, Healthy Starts, and many others.
We look forward to working collaboratively with this
committee to build on this work.
Ms. Roybal-Allard. Mr. Chairman, Chairwoman Eshoo, and
Ranking Member Burgess, we thank you for your leadership and we
look forward to partnering with you to advance solutions to
improve maternity care outcomes for all our nation's mothers
and their children.
Together, we can make maternal and infant health a national
priority. We believe this is long overdue.
Thank you.
Ms. Herrera Beutler. Thank you.
[The prepared statements of Ms. Roybal-Allard and Ms.
Herrera Beutler follows:]
Prepared Statements of Hon. Roybal-Allard and Hon. Herrera Beutler
We thank Chairwoman Eshoo, Ranking Member Burgess, and
distinguished members of the subcommittee for today's
opportunity to submit our testimony in support of the
Congressional Caucus on Maternity Care priorities for the 116th
Congress. We ask unanimous consent to submit extended testimony
for the hearing record.
First, please allow us to express our appreciation for your
many years of public service and dedication to protecting and
improving the health of this nation. Your bipartisan leadership
is an example for the rest of the House, and we are honored to
appear before you today.
We started the Maternity Care Caucus in the 114th Congress
to raise awareness among our Congressional colleagues about the
status of childbirth in this country and the challenges facing
America's maternity care system. At that time there was a
widespread perception in Congress that childbirth was safe and
that the U.S. had the best maternity healthcare system in the
world.
Childbirth advocacy groups had been trying to raise the
alarm for years that this was not the case. The U.S. spends
significantly more per capita on childbirth than any other
industrialized nation. However, despite this investment,
America continues to rank far behind almost all other developed
countries in birth outcomes for both mothers and babies.
But as so often happens, it takes a visible catalyst to get
the attention of policy makers. That catalyst was the worsening
maternal mortality crisis in this country. According to the
CDC, each year about 700 women die because of pregnancy or
delivery complications, or about two women every day. Despite
many other countries around the world having successfully
reduced their maternal mortality rates since the 1990s, the
U.S. rate remains higher than most other high-income countries,
and the U.S. maternal mortality rate has increased over the
last few decades.
The racial and geographic disparities in these maternal
mortality numbers are staggering: African-American women have
nearly a four-time greater risk of dying from pregnancy-related
complications than their White counterparts, and Native
American women are dying at two to three times the rate of
White women. And these disparities in maternal deaths for
African-American women have not improved in more than 20 years.
Maternal mortality is also significantly higher in rural areas.
Scientific American analyzed public mortality data from the CDC
and found that in 2015 the maternal mortality rate in large
central metropolitan areas was 18.2 per 100,000 live births -
but in most rural areas it was 29.4 per 100,000 live births.
The Maternal Mortality crisis in our minority and rural
communities is alarming, and we absolutely must do everything
we can to address it and ensure the safety of all childbearing
women. But it is also critical that this subcommittee keeps
sight of the fact that maternal mortality is just the tip of
the iceberg when it comes to problems in our maternity care
system.
According to the CDC, Severe maternal morbidity (SMM)
includes unexpected outcomes of labor and delivery that result
in significant short- or long-term consequences to a woman's
health. SMM has been steadily increasing in recent years and is
currently estimated to affect more than 50,000 women in the
United States. That means that more than 135 expectant and new
mothers each day endure dangerous and even life-threatening
complications that have an adverse effect on their health.
And mothers are not the only victims of our maternity care
system.
Infant mortality, the death of an infant before his or her
first birthday, is an important marker of the overall health of
a society. According to the United Health Foundation, the
infant mortality rate in the United States in 2018 was 5.9
deaths per 1,000 live births. While this rate has been slowly
decreasing it has not kept up with other wealthy countries, and
in 2018 the U.S. ranked 33 out of 36 other developed nations.
The CDC reports that Black and Native American infants are two
to three times more likely to die than their white
counterparts.
Additionally, each year about 24,000 babies are stillborn
in the United States, and we have made some of the slowest
progress in the world in reducing our stillbirth rates, behind
154 out of 159 other countries. We also have unacceptably high
rates of preterm births and cesarean sections in this nation.
We are not adequately diagnosing and treating postpartum
depression, and preventive care is underused and poorly
integrated in our maternity care system.
All these poor outcomes are even more concerning because we
face a growing shortage of trained maternity care providers.
According to the March of Dimes, there are currently more than
five million women in the United States who live in a maternity
care desert. This includes women in both of our districts in
Southwest Washington and greater Los Angeles areas who live in
a maternity care desert area. An estimated 1,085 counties in
the United States have hospitals without services for pregnant
women, nearly half the counties in the United States do not
have a single ob-gyn and 56 percent are without a certified
nurse-midwife or certified midwife. And the American Congress
of Obstetricians and Gynecologists estimates these shortages
will grow significantly: there will be a shortage of up to
8,800 OB-GYNs by 2020, with the shortfall approaching 22,000 by
2050.
Adding to all these concerns is the extraordinary economic
burden of U.S. maternity care, with cumulative costs estimated
to be well over $50 billion. According to AHRQ, Maternity and
newborn care constitutes the single biggest category of
hospital payouts for most commercial insurers and state
Medicaid programs. And the Kaiser Family Foundation reports
Medicaid is the largest single payer of pregnancy-related
services, financing 43% of all U.S. births in 2016. In five
states and DC, Medicaid covers more than 60% of all births.
With this significant investment, the federal government has a
major responsibility for ensuring the quality and value of
maternal-newborn care.
As Co-Chairs of the Maternity Care Caucus, we believe it is
time for policymakers to prioritize optimal birth outcomes for
all families in the United States. Towards that end we
encourage the Energy and Commerce Health Subcommittee to
schedule hearings to address the inequities in birth outcomes
and the looming maternity care shortage, and to explore the
most promising solutions to advance safe and cost-effective
maternity care for all mothers and babies in all communities.
We have several policy recommendations we would like this
subcommittee to consider:
1. Increase Access to Midwives
Midwives are widely cited as being an important part of the
solution to addressing these problems in our maternity care
system. However, Midwives currently attend less than 10 percent
of all births in the United States, compared to countries like
Great Britain where midwives deliver half of all babies, and
Sweden, Norway and France where midwives oversee the majority
of expectant and new mothers. All these countries have much
lower rates of maternal and infant mortality than we do in the
US.
Last week we introduced H.R. 3849, the Midwives for
Maximizing Optimal Maternity Services, or Midwives for MOMS Act
to address the growing maternity care provider shortage, to
improve maternity care outcomes for mothers and babies, and to
reduce maternity care costs for families and state and federal
governments, by expanding educational opportunities for
Midwives.
This bill will establish two new funding streams
for midwifery education, one in the Title VII Health
Professions Training Programs, and one in the Title VIII
Nursing Workforce Development Programs.
Additionally, the bill will address the
significant lack of diversity in the maternity care workforce
by prioritizing students from minority or disadvantaged
backgrounds.
2. Take the next steps towards Reducing Maternal Mortality
The Preventing Maternal Deaths Act that was passed in the
115th Congress and signed into law in December 2018 will vastly
improve data collection on the maternal mortality crisis so we
can begin to understand why mothers are dying from preventable
causes. It will also help states to sustain the health of
mothers during the entire pregnancy cycle. This was a critical
first step to addressing maternal mortality, but there are more
work to be done.
We believe there are bipartisan opportunities to ensure
that vulnerable populations of women have access to care during
pregnancy and throughout the postpartum period. Additionally,
supporting the implementation of best practices throughout
hospital systems is something we would like to work with the
Committee to address.
3. Prioritize Evidence Based Maternity Care and Optimal
Physiologic Birth Outcomes
In 1996, the World Health Organization called for the
elimination of unnecessary intervention in childbirth. However,
two decades later the United States still has some of the
highest primary and repeat Cesarean birth rates, labor
induction and augmentation practices, and regional anesthesia
usage. At the same time, we are underusing proven models of
care such as group model prenatal care and birth centers, and
practices such as smoking cessation intervention and continuous
labor support. In 2018 a multidisciplinary group of maternity
care experts found that ``Current maternal-newborn practice
involves evidence-practice gaps and unwarranted practice
variation, reflecting overuse of unneeded practices, underuse
of beneficial practices and limited use of implementation
science and quality improvement methods.''
After the August recess we will be introducing the
Maximizing Optimal Maternity Services and Building a Best
Evidence System, or MOMS and BABES Act that is based on the
recommendations in the 2018 Blueprint for Advancing High-Value
Maternity Care Through Physiologic Childbearing. In that
blueprint these experts recommended that ``mobilizing innate
capacities for healthy childbearing processes and limiting use
of consequential interventions that can be safely avoided . . .
can contribute to health equity across the childbearing
population.''
We look forward to working with the Subcommittee to
prioritize evidence-based care in all federal maternity care
efforts, to ensure consumers have access to the best evidence
in maternity care practices and outcomes, and to promote
research that will further our knowledge base about physiologic
birth and the best practices to achieve optimal birth outcomes
for all women.
As members of the House Appropriations Committee,
Subcommittee on Labor, Health and Human Services, Education,
and Related Agencies, we have worked in a bipartisan fashion to
support critical programs and initiatives to improve the lives
and health of both mom and baby. We are proud to have helped
secure robust funding for programs such as Safe Motherhood
Maternal Mortality Review Committees, the Title V Maternal and
Child Health Block Grant, Healthy Start, the Alliance for
Innovation on Maternal Health, Breastfeeding Promotion, the
Task Force for Research in Pregnant and Lactating Women, and so
many others. Additionally, we were able to commission a
National Academies of Science Study on Research Issues in Birth
Settings that is currently underway and will be concluding with
consensus policy recommendations in early 2020. We will
continue our work to support maternal health in the federal
appropriations process and we look forward to working
collaboratively with the Committee to build on this work.
Chairwoman Eshoo and Ranking Member Burgess, we thank you
for your leadership and for extending us this opportunity to
share our major priorities with the Subcommittee. We look
forward to working with you to advance awareness, education and
solutions to improve maternity care outcomes for all our
nation's mothers and their children. Together we can make
maternal and infant health a national priority. We believe this
is long overdue.
Mr. Pallone. Well, thank you both for being here and being
here on a bipartisan basis. You both are appropriators so, you
know, obviously, you can--we can work with you on a lot of
these things and we certainly will take them up.
You know, I do think it's a disgrace when we talk about
maternal mortality and, you know, how we compare with other
countries, and just one thing and I am supposed to move on
here.
But, you know, when you mention C-sections--and it's a
while ago now, but I remember with my wife, you know, we have
three kids and the first two were born--were C-section, right.
But she always wanted to have--to not do the C-section if she
could.
And so when the third one came along, you know, she said,
well, if it's at all possible I'd rather not have the C-
section, and all the doctors, oh, you already had two--you
just--it's not a good idea. You should have a C-section again.
Let's just schedule in advance. And she absolutely refused and
our daughter was born without the C-section. Sort of proved
them wrong.
But that's always been the case and it's still the case
that they always try to push a C-section when it's not
necessarily--not necessary sometimes. So I appreciate you
bringing that up. But there are so many of these issues that
you raise that are just so important.
Chairwoman Eshoo and the Dr.----
Ms. Eshoo. Thank you, Mr. Chairman.
I want to thank both of you for being here today and all of
the work that you're doing with your caucus, the legislation
that you highlighted today, and I love the way you double
teamed it.
At the Health Subcommittee, we have been trying to find out
from CRS if the Health Committee has ever had a hearing on the
state of women's health in the United States of America and we
can't find one, and I think it's about time that we do one.
You know that as we--when we are part of a congressional
delegation to a foreign country on one of the first pages of
the handbook from the State Department is how that country is
measured.
One of the yardsticks is infant mortality and maternal
mortality, and now our numbers keep going up. So your work is
critically essential and I look forward to post-August where we
actually do something that will represent and, hopefully, touch
the lives of the largest percentage of our country and that is
women. So bravo to you. Bravo to you for your beautiful work.
Thank you.
Mr. Pallone. Thank you.
Dr. Burgess?
Mr. Burgess. Well, I just--I don't know if people recognize
what an extraordinary accomplishment it was for Jaime Herrera
Butler to get that stand-alone maternal mortality bill through
and signed in the last Congress. It really was a milestone.
There were days I didn't think it was actually going to happen.
Certainly, the representatives put a lot of effort into it.
Our subcommittee staffs on both sides of the dais did and did
get it across the finish line. Another milestone that we were
able to accomplish in the last Congress was on the health
professions shortage areas including maternal care providers.
Without actually changing the appropriation we changed the
authorizations that we could include maternity care providers
in health profession shortage areas.
So we can build on those accomplishments. I know the past
is just a prelude and we can continue to do that. I've got some
ideas and we will continue to work on those things.
So I appreciate you both being here. It is an important
topic and one that we need to maintain our focus.
Thank you.
Mr. Pallone. Thank you, and thank you both, really, for
what you're doing. We appreciate it. Continue to work with us.
And now we will go to my friend, Congresswoman Napolitano.
Thanks for being here.
OPENING STATEMENT OF HON. GRACE F. NAPOLITANO A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF CALIFORNIA
Mrs. Napolitano. Thank you for having me, Mr. Chairman, and
thank the ranking member.
My bill is H.R. 1109, which I feel we must pass--the Mental
Health Services for Students Act. This is my sixth Congress and
I am hoping this time we will be able to get it off the ground.
I have a Senate co-sponsor. Senator Tina Smith of Minnesota
has the companion bill, Senate bill 1122. Sixteen members of
the House Energy and Commerce Committee--this committee--
support my bill: Cardenas, Barragan, Tonko, Clarke, Rush,
Matsui, Castor, McNerney, Welch, Lujan, Kennedy, Dingell,
Veasey, Kuster, Kelly, and Soto, and we hope to add more.
My bill would provide $200 million per year for five years
for 100 school-based pilot programs on mental health
nationwide. It expands the scope of the Project Advancing
Wellness and Resilience Education called AWARE--the program--by
providing on-site licensed mental health professionals in
schools in the community.
The funding for the program would do the following: provide
for comprehensive staff development for school personnel and
personnel working in the schools. It includes administrators
and teachers assistance to recognize mental health issues.
It would support and implement comprehensive culturally and
linguistically appropriate services. It would deliver
assistance to local communities in the development of policies
to address their own child and adolescent childhood trauma and
mental health issues, and violence when and if it occurs.
Establish mechanisms for children and adolescents to report
incidents of violence or plans by other children, adolescents,
or adults to commit violence.
It would also promote positive mental health education and
support for parents and siblings and other family members of
children with mental health disorders, as well as concerned
members of the community.
H.R. 1109 is supported by the Mental Health Liaison Group,
which consists of 51 mental health organizations. It's
supported by the Los Angeles County Board of Supervisors, also
by the National Education Association, the American Federation
of Teachers, and others.
The bill is modeled off of a school-based mental health
program developed in 2001. The Pacific Clinics and I started
with half a million dollars for SAMHSA with seed money, which
ended in 2009.
SAMHSA no longer funds it. It is taken over by the county
of Los Angeles and been instrumental and have grown the project
to 35 schools instead of four.
The program began in three middle schools and one high
school and as I said, it has already grown and we are hoping to
add more schools pretty soon.
But I thank you very much for the opportunity and I hope
that you will consider this in the future.
Thank you.
[The prepared statement of Mrs. Napolitano follows:]
Prepared Statement of Hon. Grace F. Napolitano
Chairwoman Eshoo and Ranking Member Burgess, thank you for
the opportunity to testify today.
It is vital that we pass my bill, HR 1109, the Mental
Health Services for Students Act. In the Senate, Senator Tina
Smith of Minnesota has a companion bill, S. 1122. Sixteen
members of the House Energy and Commerce Committee are
currently co-sponsors of my bill: Cardenas, Barragan, Tonko,
Clarke, Rush, Matsui, Castor, McNerney, Welch, Lujan, Kennedy,
Dingell, Veasey, Kuster, Kelly, and Soto.
My bill would provide $200 million per year for five years
for 100 school-based mental health programs nationwide. It
expands the scope of the Project Advancing Wellness and
Resilience Education (AWARE) program by providing on-site
licensed mental health professionals in schools across the
country, and funding will be distributed by the Substance Abuse
and Mental Health Services Administration (SAMHSA), which will
set guidelines and measure the outcomes of the funded programs.
Funding for this program would:
Provide for comprehensive staff development for
school and personnel working in schools
Support and implements comprehensive culturally
and linguistically appropriate services
Deliver assistance to local communities in the
development of policies to address child and adolescent trauma
and mental health issues, and violence when and if it occurs
Establish mechanisms for children and adolescents
to report incidents of violence or plans by other children,
adolescents, or adults to commit violence
Promote positive mental health education and
support for parents, siblings, and other family members of
children with mental health disorders, as well as concerned
members of the community
HR 1109 is supported by the Mental Health Liaison
Group (which consists of 51 Mental Health Organizations), Los
Angeles County Board of Supervisors, National Education
Association, and the American Federation of Teachers.
The bill is modeled off of a school-based mental health
program Pacific Clinics and I started in 2001 with a half a
million dollars in SAMSHA seed money. The program began in
three middle schools and one high school and has since grown to
thirty-five schools. The Los Angeles County Board of
Supervisors and the County Department of Mental Health have
also been instrumental in the success of this program, taking
over funding the program in 2009.
Thank you again for the opportunity to testify.
Mr. Pallone. We certainly will consider it and we know that
a lot more needs to be done with regard to mental health
issues. So thanks again. I appreciate it.
Next is the gentlewoman from Georgia, Ms. McBath.
OPENING STATEMENT OF HON. LUCY McBATH A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF GEORGIA
Mrs. McBath. Thank you very much, Mr. Chairman, and the
esteemed committee. Thank you so much for allowing me to
discuss a very important topic to me once again as we have
heard a little bit earlier today--maternal mortality.
I'd like to thank my colleague and member of this
committee, Representative Robin Kelly, for being a champion on
this issue. The importance of her legislation, the Mothers and
Offspring Mortality and Morbidity Awareness Act, or MOMMA's
Act, cannot be overstated, and that is House Bill H.R. 1897.
The United States has an atrocious record when it comes to
maternal mortality. As many on this committee already know, our
rates of maternal mortality are the highest among other
developed nations in the world.
What's more concerning is that there has been a significant
increase in the maternal death rate. From 1991 to 2004, the
rate has more than doubled.
This is absolutely unacceptable. We need a comprehensive
solution to this crisis. Progress on this important issue has
stalled and represents an incredible failure.
It is a failure to women throughout this country,
especially women of color, who experience maternal mortality at
rates three times that of their white counterparts.
We have a responsibility to mothers and to their families
to make sure that safety and health is our number-one priority.
The research is absolutely clear. Comprehensive care for
pregnant women saves lives. According to the Centers for
Disease Control and Prevention, 60 percent of maternal deaths
are completely preventable.
Extending coverage for a full year will simply save the
lives of many of those mothers, and while maternal mortality is
certainly the worst outcome, it's not the only outcome.
Many women suffer from complex illnesses that complicate
their pregnancy and endanger their health. I shared the story
of a constituent of mine recently on the House floor. Her name
is Phiffer. She struggles with a mental health disorder.
During her pregnancy in 2014, she had to have an immediate
surgical correction for an irregularity in her cervix. The
surgery failed, and at 20 weeks she was confined to bed rest
for the duration of her pregnancy.
Her mental health was not addressed. At 30 weeks, she gave
birth to a beautiful baby boy but then her mental health was
yet again not addressed.
Almost immediately she began to suffer from post-partum
anxiety. She abandoned many things that once gave her joy and
it took 12 months for her diagnosis to actually come to
fruition.
This story is just like millions of other mothers
throughout our country. We must do more to improve the range of
services available to these young mothers.
We must do more to care for the coordination for these
young mothers. We must do everything that we can to give these
young mothers the best possible care they deserve.
And so we are faced with a challenge. Make no mistake that
maternal health in this country is in crisis. The MOMMA Act
will help save the lives of mothers across the country.
The Congress has this opportunity to act in the interest of
these mothers and their families. And as you know, the MOMMA
Act would provide access to life-saving healthcare for a year
after conception for women who use Medicaid.
It would also allow for Medicaid coverage of doulas and
midwives, expanding access for people who lack access to an OB/
GYN doctor.
Not only does this legislation extend coverage for low-
income women, but it improves maternal health for all women by
increasing care coordination by health systems and ensuring
that every mother has access to the best possible care.
This legislation would help America keep the promise of
safety and happiness to these new mothers and their infants.
Thank you for the opportunity to testify. Thank you so much
for hearing my heart.
[The prepared statement of Mrs. McBath follows:]
Prepared Statement of Hon. Lucy McBath
Thank you for allowing me to appear before this committee
to discuss an important topic to me, maternal mortality. I'd
like to thank my colleague, and member of this committee, Rep.
Robin Kelly, for being a champion on this issue. The importance
of her legislation, the Mothers and Offspring Mortality and
Morbidity Awareness Act, or Momma's Act, cannot be overstated.
The United States has an atrocious record when it comes to
maternal mortality. As many on this committee know, our rates
of maternal mortality are the highest among other developed
nations. What's more concerning is there has been a significant
increase in the maternal death rate. From 1991 to 2004, the
rate has more than doubled.
That is unacceptable. We need a comprehensive solution to
this crisis.
Progress on this important issue has stalled and represents
an incredible failure. It is a failure to women throughout this
country--especially women of color--who experience maternal
mortality at rates three times that that of their white
counterparts.
We have a responsibility to mothers, and their families, to
make sure that safety and health is our number one priority.
The research is clear. Comprehensive care for pregnant
women saves lives. According to the Centers for Disease Control
and Prevention, sixty percent of maternal deaths are completely
preventable. Extending coverage for a full year will save the
lives of many of those mothers. And while maternal mortality is
certainly the worst outcome, it's not the only outcome. Many
women suffer from complex illnesses that complicate their
pregnancy and endanger their health.
I shared the story of a constituent of mine recently on the
House floor. Her name if Phiffer. She struggles with a mental
health disorder. During her pregnancy in 2014, she had to have
an immediate surgical correction for an irregularity in her
cervix. The surgery failed, and at 20 weeks she was confined to
bedrest for the duration of her pregnancy. Her mental health
was not addressed. At thirty weeks, she gave birth to a
beautiful baby boy. Her mental health was not addressed. Almost
immediately, she began to suffer from postpartum anxiety. She
abandoned many things that once gave her joy. It took 12 months
for her to finally be diagnosed.
This story is just like millions of others throughout this
country. We must do more to improve the range of services
available to these young mothers. We must do more to improve
care coordination for these young mothers. We must do
everything we can to give these young mothers the best possible
care.
And so, we are faced with a challenge. Make no mistake that
maternal health in this country is in crisis.
The Momma Act will help save the lives of mothers across
the country. This Congress has the opportunity to act in the
interest of these mothers and families. As you know, the MOMMA
Act would provide access to life-saving healthcare for a year
after conception for women who use Medicaid. It would also
allow for Medicaid coverage of doulas and midwives, expanding
access for people who lack access to an OB-GYN doctor.
Not only does this legislation extend coverage for low
income women, but it improves maternal health for all women by
increasing care coordination by health systems and ensuring
that every mother has access to the best possible care. This
legislation would help America keep the promise of safety and
happiness to these new mothers and infants.
Thank you for the opportunity to testify and I yield back
the balance of my time.
Mr. Pallone. I agree when you said maternal health is in
crisis and we need to address it, as you heard the testimony of
your colleagues. So we will--we will follow through. Thanks so
much.
My colleague from New Jersey is next.
OPENING STATEMENT OF HON. BONNIE WATSON COLEMAN A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY
Ms. Watson Coleman. Thank you very much, Mr. Chairman, and
to the ranking member and to members who are here today. Thank
you very much for holding this Member Day Hearing.
I want to begin by stressing that the Affordable Care Act
has been a literal lifeline for many in my district, New
Jersey's 12th Congressional district, as well as in communities
of colors across the nation.
Since 2010, the rates of uninsured African Americans have
nearly been cut in half, going down from 20 percent to 11
percent.
In my district, if the ACA were to be struck down by the
courts in Texas v. Azar, nearly 50,000 people would lose their
healthcare insurance.
So while the law isn't perfect, I know you, Mr. Chairman,
and your subcommittee are committed to protecting the ACA and
expanding access to healthcare for all Americans.
And in the spirit of that, I come before you today to ask
for your commitment to addressing the inequities that our
healthcare institutions and structures create, which put women
and patients of color at elevated risks for certain morbidities
and even mortality.
For black mothers, who are often provided lower quality
maternal care when they can access care at all, the ACA's
requirement to cover pregnancy, labor, delivery, and newborn
care as essential benefits in health plans was absolutely
critical.
However, since nearly half of pregnancies are unplanned,
many women don't have a plan when they find that they are
pregnant. Or if they have a short-term plan, it doesn't cover
pregnancy care.
Surprisingly, while our system currently considers getting
married or giving birth to a child a ``qualifying life event''
allowing one to sign up for health insurance, pregnancy does
not currently trigger one of these special enrollment periods.
This is particularly alarming when black maternal mortality
rates in the United States are similar to rates in developing
countries at 40 deaths per 100,000.
This is why, as a founding member of the Congressional
Caucus on Black Women and Girls, I made it a priority to
address the gaps in our healthcare system which result in black
mothers dying at two to six times the rate of their white
peers.
In addition to organizing stakeholder convenings to talk
about this disparity, we are pushing legislation that is
important to addressing health disparities among black women
and girls.
One of the first bills that I introduced when I was elected
to Congress was the Healthy Maternal and Obstetric Medicine
Act, or commonly referred to as Healthy MOM Act.
The Healthy MOM Act would create a special enrollment
period in the insurance market for women when they become
pregnant so that they and their child are able to receive the
healthcare that they need.
This Congress, the Healthy MOM Act is H.R. 2278 and
currently has more than 75 cosponsors.
Chairman Pallone, as you and your committee explore ways to
protect and expand access to healthcare for American families,
I implore you to also work to address racial and ethnic
disparities in our system. The Healthy MOM Act has the
potential to be part of that solution.
Before I yield back, I would be remiss to not mention that
this year is the 20th anniversary of the REACH program, which
stands for Racial and Ethnic Approaches to Community Health.
REACH remains one of the CDC's only programs specifically
dedicated to addressing racial and ethnic health disparities.
Started during the Clinton administration, REACH is unique
because it follows a community-led model which includes robust
engagement of the population impacted by health disparities,
and multi-sector representation in all aspects of program
planning, development, and implementation to successfully
tailor programing for communities of color with the greatest
chronic disease burdens.
As this subcommittee looks to address racial and ethnic
disparities, I do hope you will look to REACH grantees for
lessons learned in how to address racial health disparities and
to incorporate them into your own policy proposals.
And with that I yield back and I want to thank you for this
opportunity to address these issues today.
[The prepared statement of Ms. Watson Coleman follows:]
Prepared Statement of Bonnie Watson Coleman
I. Introduction--Affordable Care Act (ACA)
Thank you, Chairwoman Eshoo, Ranking Member
Burgess, and other members of the Subcommittee for holding this
Member Day hearing.
I want to begin by stressing that the Affordable
Care Act (ACA) has been a literal lifeline for many in my
district, New Jersey's 12th Congressional district, as well as
in communities of color across the nation.
Since 2010 the rates of uninsured African
Americans have nearly been cut in half, going down from 20
percent to 11 percent.
In my district, if the ACA were to be struck down
by the courts in Texas v. Azar, nearly 50,000 people would lose
their health insurance.
So while the law isn't perfect, I know that you,
Madame Chair, and this subcommittee are committed to protecting
the ACA and expanding access to healthcare for all Americans.
And in that spirit, I come before you today to ask
for your commitment to addressing the inequities that our
healthcare institutions and structures create, which put women
and patients of color at elevated risks for certain
morbidities, and even mortality.
For black mothers, who are often provided lower
quality maternal care when they can access care at all, the
ACA's requirement to cover pregnancy, labor, delivery and
newborn care as essential benefits in health plans was
absolutely critical.
However, since nearly half of pregnancies are
unplanned, many women don't have a plan, when they find out
they are pregnant. Or if they have a short-term plan, it
doesn't cover pregnancy care.
Surprisingly, while our system currently considers
getting married or giving birth to a child a ``qualifying life
event'' allowing one to sign up for health insurance, pregnancy
does not currently trigger one of these ``special enrollment
periods.''
This is particularly alarming when Black maternal
mortality rates in the United States are similar to rates in
developing countries at 40 deaths per 100,000.
II. Healthy Mom Act
This is why, as a founding member of the
Congressional Caucus for Black Women and Girls, I made it a
priority to address the gaps in our healthcare system which
result in black mothers dying at 2-6 times the rate of their
white peers.
In addition to organizing stakeholder convenings
to talk about this disparity, we are pushing legislation
important to addressing health disparities among black women
and girls.
One of the first bills I introduced when I was
elected to Congress was the Healthy Maternal and Obstetric
Medicine Act, or Healthy MOM Act.
The Healthy MOM Act would create a special
enrollment period in the insurance marketplace for women when
they become pregnant so that they and their child are able to
receive the healthcare they need.
This Congress, the Healthy MOM Act is HR 2278, and
currently has [more than] 75 cosponsors.
Madam Chair, as you and your Subcommittee explore
ways to protect and expand access to healthcare for American
families, I implore you to also work to address racial and
ethnic disparities in our system. The Healthy MOM Act has the
potential to be part of that solution.
III. Reach--Racial And Ethnic Approaches To Community
Health
Before I yield back, I would be remiss to not
mention that this year is the 20th anniversary of the REACH
program--which stands for Racial and Ethnic Approaches to
Community Health.
REACH remains one of the CDC's only programs
specifically dedicated to addressing racial and ethnic health
disparities.
Started during the Clinton administration, REACH
is unique because it follows a community-led model includes
robust engagement of the populations impacted by health
disparities, and multisector representation in all aspects of
program planning, development, implementation to successfully
tailor programing for communities of color with the greatest
chronic disease burdens.
As this subcommittee looks to address racial and
ethnic disparities, I hope you will look to REACH grantees for
lessons learned in how to address racial health disparities and
incorporate them into your own policy proposals.
And with that I yield back. Thank you for the
opportunity to address these issues today.
Mr. Pallone. Well, let me thank you. I know you have a long
history of working on a lot of these healthcare issues both
here and in the state legislature.
And, you know, I will certainly follow on the Healthy MOM's
Act, and you know that the CDC for years has had this, you
know, healthcare disparities issue that they highlight. I guess
they have their brain trust--is that what it's called? Robin
Kelly for a long time--I don't know if she still is--but was
the head of that and she's on our committee now.
So, you know, we'll--we have incorporated some of those
things but I know a lot more needs to be done so we will work
with you. Thank you, Bonnie. Thank you.
Oh, and Chairwoman Eshoo wants to make----
Ms. Eshoo. I just wanted to say, Bonnie, thank you for the
courage that you've exhibited to all of us and you----
Ms. Watson Coleman. Thank you, Madam Chairman. Thank you.
Ms. Eshoo. Yes, and I think our prayers are answered and
now we have got to get your legislation done.
Ms. Watson Coleman. Thank you.
Mr. Pallone. Thank you, Chairwoman Eshoo. Thanks, Bonnie.
Next, we have Mr. Levin of Michigan. Thanks for being here.
OPENING STATEMENT OF HON. ANDY LEVIN A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MICHIGAN
Mr. Andy Levin. Thanks so much, Chairman Pallone. I am
learning while I am here. Of our four kids, the first three
were all delivered by midwives. So I've got to get on board
with the MOMMA Act, if I am not already.
So but I want to thank you and Ranking Member Walden,
Chairwoman Eshoo, Ranking Member Burgess, members of the
subcommittee or allowing me to testify today and I am here
today to talk about drug pricing, a topic that I know has been
a tremendous priority for this subcommittee and for our
constituents.
And I want to applaud the hard work that Energy and
Commerce has already done this year to tackle this issue. But,
as you know and all of us know, we have more work to do.
Personally, my family knows this all too well because two
of my sons live with Crohn's disease, and actually in the
anteroom I got a call from someone trying to get to one of my
sons to give him an infusion that he needs, you know, to be
healthy and survive.
My wife, Mary, and I would do anything to keep our kids
healthy, and I know parents across this country feel the exact
same way, even if it means waiting to pay another bill or
neglecting necessities for themselves.
Families in every community are making incredibly hard
choices for the sake of their kids. They should not have to.I
came to Congress to raise the standard of living for working
people in Michigan's 9th District and across our country and to
ensure that the deck isn't stacked against American families.
That is why I've introduced the Stop The Overuse of
Petitions and Get Affordable Medicines to Enter Soon, or the
STOP GAMES Act. This common-sense bipartisan bill that I
authored with Congressman Francis Rooney of Florida will help
to stop pharmaceutical companies from gaming the system to
block competition.
There have been multiple reports of drug makers attempting
to use the Food and Drug Administration's ``citizen petition''
tool to keep generic competition from coming to market.
While the citizen petition is meant to ensure that
stakeholders can flag legitimate issues with drugs awaiting FDA
approval, reports indicate that drug makers have filed baseless
petitions to protect their monopolies.
In fact, in October, then FDA Commissioner Scott Gottlieb
listed the misuse of citizen petitions among anti-competitive
techniques of concern.
Even if FDA doesn't ultimately agree with a petition's
argument, the agency must investigate and respond to what are
sometimes unsubstantiated claims. This prevents more affordable
drugs from reaching consumers quickly, forcing American
families to pay more.
For example, in 2017, the Federal Trade Commission filed a
complaint arguing that ViroPharma's use of the citizen petition
process constituted an anti-trust violation.
According to the FTC, ViroPharma's ``repetitive, serial,
and meritless filings lacked any supporting clinical data'' and
``succeeded in delaying generic entry at a cost of hundreds of
millions of dollars.''
The STOP GAMES Act would, as the title suggests, stop these
kinds of games. Our bill outlines circumstances under which the
FDA can promptly reject a petition meant to delay the approval
of a generic competitor and directs the secretary of Health and
Human Services to report any such incidents to the FTC.
The bill also requires drug makers to file a petition
within 60 days of learning the information it's based on, not
right before a patent or exclusivity period expires and rival
drugs are ready to come to market.
Finally, the bill requires enhanced reporting to keep
Congress informed of efforts to game the FDA approval process.
As your subcommittee continues its important work to bring
down drug prices, I urge you to consider the STOP GAMES Act and
ensure the FDA's citizen petition tool cannot be misused to
keep prices high.
I thank the members of this committee who have already co-
sponsored the bill--Congressman Tonko and Congresswoman
Schakowsky--and I would welcome the chance to talk with more of
you about this important fix.
Again, I want to thank you all for the privilege of
testifying before your subcommittee and truly look forward to
working with you on this bill and others on behalf of working
families.
[The prepared statement of Mr. Andy Levin follows:]
Prepared Statement of Hon. Andy Levin
Chairman Pallone, Ranking Member Walden, Chairwoman Eshoo,
Ranking Member Burgess, members of the subcommittee: thank you
for allowing me to testify before you today.
I am here today to talk about drug pricing--a topic that, I
know, has been a tremendous priority for this subcommittee and
for our constituents. And I want to applaud the hard work
Energy and Commerce has already done this year to tackle this
issue.
But, as you all know, we have more work to do.
My family knows this all too well. Two of my sons live with
Crohn's disease. My wife, Mary, and I would do anything to keep
our kids healthy, and I know parents across this country feel
the exact same way--even if it means waiting to pay another
bill, or neglecting necessities for themselves, families in
every community are making incredibly hard choices for the sake
of their kids. They should not have to.
I came to Congress to raise the standard of living for
working people and ensure the deck isn't stacked against
American families. That is why I've introduced the Stop The
Overuse of Petitions and Get Affordable Medicines to Enter
Soon--or ``STOP GAMES''--Act. This commonsense, bipartisan bill
that I authored with Congressman Francis Rooney will help stop
pharmaceutical companies from gaming the system to block
competition.
There have been multiple reports of drugmakers attempting
to use the Food and Drug Administration's ``citizen petition''
tool to keep generic competition from coming to market. While
the citizen petition is meant to ensure stakeholders can flag
legitimate issues with drugs awaiting FDA approval, reports
indicate that drugmakers have filed baseless petitions to
protect their monopolies. In fact, in October, then-FDA
Commissioner Scott Gottlieb listed the misuse of citizen
petitions among ``anticompetitive techniques of concern.''
Even if FDA doesn't ultimately agree with a petition's
argument, the agency must investigate and respond to what are
sometimes unsubstantiated claims. This prevents more affordable
drugs from reaching consumers quickly, forcing American
families to pay more.
For example, in 2017, the Federal Trade Commission filed a
complaint arguing that ViroPharma's use of the citizen petition
process constituted an antitrust violation. According to the
FTC, ViroPharma's ``repetitive, serial, and meritless filings
lacked any supporting clinical data'' and ``succeeded in
delaying generic entry at a cost of hundreds of millions of
dollars.''
The STOP GAMES Act would, as the title suggests, stop these
kinds of games. Our bill outlines circumstances under which the
FDA can promptly reject a petition meant to delay the approval
of a generic competitor and directs the Secretary of Health and
Human Services to report any such incidents to the FTC.
The bill also requires drugmakers to file a petition within
60 days of learning the information it's based on-not right
before a patent or exclusivity period expires and rival drugs
can come to market. Finally, the bill requires enhanced
reporting to keep Congress informed of efforts to game the FDA
approval process.
As your subcommittee continues its important work to bring
down drug prices, I urge you to consider the STOP GAMES Act and
ensure the FDA's citizen petition tool can't be misused to keep
prices high. I thank the members of this committee who have
already cosponsored the bill--Congressman Tonko and
Congresswoman Schakowsky--and I would welcome the chance to
talk with more of you about this important fix.
Again, I want to thank you all for the privilege of
testifying before your subcommittee, and truly look forward to
working with you on this bill and others on behalf of working
families.
Mr. Pallone. Let me thank the gentleman and, you know, you
certainly raise issues that we care a lot about, you know, in
terms of trying to reduce drug prices. You know, this is
bipartisan.
Mr. Levin. Right.
Mr. Pallone. It includes the president as well. You know,
we did the generic competition bills--passed the House. We did
transparency bills last week.
They are going to come to the floor probably in September.
And I know that, you know, the citizen petitions, you know, has
been abused. So we will certainly follow up.
Mr. Levin. Thank you so much. I really appreciate your
help. Thank you, and I yield back.
Mr. Pallone. Thanks. I am going to ask Mr. Schweikert to
replace Mr. Levin because he has come back and forth several
times and we have passed him over so why don't you go next
because we have passed you over several times, and then we will
go to another three? Thanks.
OPENING STATEMENT OF HON. DAVID SCHWEIKERT A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ARIZONA
Mr. Schweikert. Thank you, Mr. Chairman, Mr. Griffin.
So this is where all the cool kids hang out, right?
Mr. Pallone. Yes, right.
[Laughter.]
Mr. Schweikert. And I appreciate doing this and having sat
up there through the Ways and Means Member Hour, I know
sometimes it's interesting seeing the inbound of different
concepts and thoughts coming from fellow members.
I have two. One I just want to share with you. It's a
little conceptual though we are working on the legislation. And
the other it's a bill that's sat in the Energy and Commerce for
a couple years now.
One, I want to argue just conceptually, and this is for
every Republican and Democrat. We are having the wrong argument
about healthcare over and over and over. So if you and I were
to strip away some of the noise, the ACA--who got subsidized,
who had to pay. Our Republican alternative--who got subsidized,
who got to pay.
I want to argue we are living in a world right now that if
we could legalize technology--there are wearables coming,
something coming very soon where you can blow into it and it
would diagnose whether you have a viral infection or a
bacterial infection. The algorithm can write a prescription.
There is technology coming and it's on the cusp right now
if we can remove the barriers to it that can crash the price of
healthcare.
Wouldn't it be a much more--if we really care about our
comments about, we need to reduce the price of this or the
price of that--it's time for that sort of Blockbuster video
moment where one day you stop going and picking up this little
silver disc because you're hitting a button at home. That
technology exists, and yes, it is going to be disruptive.
We are going to have hallways full of incumbents who are
saying, you're putting us out of business--why are you letting
an algorithm write a prescription--why are you allowing data to
actually be. We know that data is actually the Holy Grail in
healthcare.
So please, we are working on it. We are actually working on
it with a couple members of your committee, both Republican and
Democrat, who sort of see the vision that we are at that
inflection point where we can use technology to crash the price
of healthcare.
And as a simple request also, I had Congressman Andy Briggs
grab me, sitting here, and he just asked me to put his
testimony and a letter into the record if----
Mr. Pallone. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Schweikert. So I will put that--hand that to staff.
So here's the piece of legislation we have had in the
committee now for a couple years. Let me also make sure I have
the right number for this year. It is H.R. 1284.
Think about how many members will come in front of you
today and actually express real concern about the environment.
Are we tracking what's happening out there? Do we know what's
happening?
Back to that same sort of techno utopia that's rolling out
right now, there is now sensors you can wear on yourself that
talk to your supercomputer we call your smart phone.
How about the concept of crowd sourcing environmental data?
And why this is so important--it's not Republican or Democrat--
it's just data. But the elegance of it if you have some clowns
painting cars in the back yard behind your house, how do you
catch them?
In today's environmental regulatory system, it's a
paperwork system. So we have our fixed towers that cost about a
million dollars a year to maintain and then we have
manufacturers, companies, those, fill out lots and lots and
lots and lots of paperwork.
Does paperwork shoved into file cabinets make our
environment cleaner? I want to argue how about a system that's
less about the paperwork and actually more about keeping the
air cleaner?
And now that there's this revolution of these new sensors
that we could have a few thousand in a community that tell you,
hey, we have a bad act happening over here--hey, a business
over here may be having a problem with its scrubbers.
Instead of spending two years putting paperwork in a file
cabinet so one day you can sue them, how about knocking on the
door and saying, hey, we have a hot spot here--let's fix it?
Now, it's a revolutionary concept because you have to
understand the current environmental regulatory model in many
ways is lots of people sitting in office chairs processing
paperwork.
How about the concept just like you may use Waze when
you're driving through a crowded area, it's the collection of
the data that gets you there faster?
Why wouldn't we do that same technology, that citizen
science technology, to say maybe file cabinets full of
paperwork isn't the best way to protect our environment but
living data of--is there something of difficulty here.
For those of us that live in the desert Southwest we
actually have real concerns because we don't know some of our
baseline numbers. What's baseline ozone? How much stuff comes
in from the L. A. basin and blows in?
And if you have enough data points--if you have enough data
points that the crowd sourcing--it's much more elegant in being
able to protect the environment.
And I would argue that whether it be air or in Flint,
Michigan, the simple little thing they could have put under a
faucet that's under $100 that would have told you there's a
problem. It's time we embrace the fact there's a technology
disruption that can fix so many of these goals and it--yes,
it's a threat to the bureaucracy. But the benefit is we live in
a cleaner world.
With that, I yield back, Mr. Chairman.
[The prepared statement of Mr. Schweikert follows:]
Prepared Statement of Hon. David Schweikert
Chairman Pallone, Ranking Member Walden, Subcommittee
Chairman Tonko and Ranking Member Shimkus, and members of the
committee, thank you for allowing me this opportunity to speak
with you today.
I'd like to talk with you today about one of my priorities
in this Congress, which is ensuring technology can play a key
role in our environment, including measuring our air quality.
We all have the same common goals when it comes to the
environment: accurate data that is publicly available,
achievable compliance standards, and ultimately a cleaner
environment.
The current system of monitoring environmental quality,
assessing the quality of the data, and enforcement around that
information, is entirely dependent on EPA's stationary monitors
throughout the country. The current system by which a state
must prove compliance, known as `attainment', could be vastly
improved and benefit our environmental process.
We can and should practice better science by leveraging
publicly available, crowdsourced data.
Currently, stationary monitoring stations, at times in
precarious locations, create a rigid algorithm of measurements
that fail tell a complete story. But what if we incorporated
mobile monitoring devices to increase the size, scope, and
density of data collected?
Imagine if affordable air monitors, some that can be
seamlessly purchased on places like Amazon, are deployed on
city or private commuting vehicles. Or if your child has asthma
and wants to go play at the neighborhood park. I challenge you
to consider the magnitude of data these mobile monitors could
provide a city or better inform parents or schools. This form
of robust data collection is being used by Google Maps and WAZE
produces, but its potential value for being deployed to improve
the environment is, by comparison, untapped.
I have introduced legislation, H.R. 1284, the Crowd
Sourcing of Environmental Data Act of 2019, that would amend
the Clean Air Act to give States the option of monitoring
covered criteria air pollutants in designated areas by greatly
increasing the number of air quality sensors in exchange for
greater regulatory flexibility in the methods of monitoring.
My bill enjoys bipartisan support, including from
Congressman Cardenas, a member of this committee, as well as
Congressman Aguilar. I thank them both for their support.
This legislation would provide a city, county or state with
optionality, not a mandate. Under this legislation, states
would annually produce the information gathered from their own
crowdsourced environmental data for submission to the state's
EPA for technical review. Upon review, and if the data is found
to be as good or better than the current data collected by the
EPA's stationary monitors, it is then submitted to the federal
EPA Administrator for final verification.
Upon successful review, the state is granted a year of
authority to monitor and act upon its own data faster and more
effectively. All the while, the current EPA monitoring stations
are running in the background to ensure that a failure in the
state's monitoring would not result in a lack of environmental
data collection.
Imagine being able to identify bad actors to the
specificity of city blocks rather than an entire county.
Through this technology we could tackle the problems in non-
attainment areas and factually see where the bad actors
operate.
I very respectfully urge this Committee consider my
legislation, H.R. 1284, and please join me in harnessing 21st
century technology.
Thank you again Mr. Chairman and ranking member for holding
this hearing.
Mr. Pallone. Well, thank you. I am sorry you had to keep
coming back. But I love all these innovative ideas and use of
technology because that's kind of what we pride ourselves on on
this committee. So----
Mr. Schweikert. Well, you--Mr. Chairman, you have the
legislation. If your Environment Subcommittee would ever--and I
have Republican and Democrat sponsors.
Mr. Pallone. Take a look.
Mr. Schweikert. I know you've been incredibly busy but it
has sat here now for a couple years.
Mr. Pallone. Yes, we will take a look at it and thank you
for coming. Appreciate it.
OK. Congressman Trone, you're next. Thank you.
OPENING STATEMENT OF HON. DAVID TRONE A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MARYLAND
Mr. Trone. Thank you, Mr. Chairman, and members of the
committee for this opportunity to testify.
As many of you know, addressing the addiction crisis in
America is my number-one priority in Congress. My constituents
sent me here in large part because we firmly agree that more
must be done to stop the 192 drug overdose deaths happening
every day, two-thirds of which involve opioids.
Every death from addiction connects another family and
community to the crisis. My own connection is devastating but
will sound all too familiar.
On New Year's Eve in 2016, my nephew, Ian Trone, died from
a fentanyl overdose. He was 24. He died alone in a hotel room.
One of my first actions as a representative was creating
the Freshmen Working Group on Addiction. I know our historic
freshman class could make real progress if we worked together
across party, geographic, and demographic lines.
It's bipartisan with 64 members from 31 states across the
country. Despite our diverse backgrounds and viewpoints, we are
united in our understanding of the necessity to put aside our
differences and come together to save lives.
Members of our working group, 64 strong, have introduced
legislation to ease access to naloxone, to put sanctions on
producers of illegal fentanyl, increasing training for
prescribers and law enforcement, and to require better warning
labels, beef up research on addiction, and coordinate and track
federal demand reduction activities.
I was proud to work with fellow freshmen Representatives
Denver Riggleman, Kelly Armstrong, and Mikie Sherrill to
introduce H.R. 2466, the State Opioid Response Grant
Authorization Act.
This bill would authorize $1 billion in funding for State
Opioid Response Grants and Tribal Opioid Response Grants for
each of the next five years to fight the opioid epidemic in
every community across the country.
Each state receives at least $4 million through the
program, with additional funding to the ten states with the
highest mortality rates due to drug overdoses.
The bill came from conversations with real people in our
districts. In the early days of our roles, we toured our
districts. We spoke with health departments, hospitals, first
responders, elected officials, police officers, incarcerated
individuals, mental health professionals, early childhood
organizations, and, of course, those suffering from addiction.
We heard loud and clear we need additional and, most
importantly, consistent funding to end this crisis--funding
that allows local communities to provide individualized and
specific services to their community.
This legislation does just that. It gives certainty--the
certainty that states need that will provide them the funding
so they can expect that to continue for at least the next five
years.
There is no committee better positioned to make real and
impactful progress on this issue than the Energy and Commerce
Committee. You hold the power to advance legislation to
authorize additional funding for prevention and treatment
programs, require more robust training for our medical
professionals, ease restrictions on prescribing lifesaving
medication-assisted treatment, and so much more.
I urge you to use the power of that to take further
meaningful steps to combat the addiction crisis, including
passing a large package of legislation that will dramatically
increase our response to the worst public health crisis our
country has ever seen.
I recognize the committee has taken bold action in the past
by passing the Comprehensive Addiction and Recovery Act, CARA,
the 21st Century CURES Act, and the SUPPORT for Patients and
Communities Acts.
I commend you for that and thank you. But the last two
years we have lost 141,000 people from our country--141,000
people in the last two years.
This is a call to action. It's important what we have done.
But we need to continue to take bold action to save lives.
Thank you for the chance to share our thoughts with you
today and for your engagement in this important work, and we'd
like to partner with you in these efforts.
[The prepared statement of Mr. Trone follows:]
Prepared Statement of Hon. David Trone
Thank you Chairman Pallone and members of the committee for
the opportunity to testify.
As many of you know, I consider addressing the addiction
crisis in America to be my number one priority in Congress. My
constituents sent me here in large part because we firmly agree
that more must be done to stop the 192 drug overdose deaths
happening every day, two-thirds of which involve opioids.
Every death from addiction connects another family and
community to this crisis. My own connection is devastating but
will sound all too familiar. On New Year's Eve in 2016, my
nephew Ian died from a fentanyl overdose. He was 24 years old,
and he died alone in a hotel room.
One of my first actions as a Representative was creating
the Freshmen Working Group on Addiction. I knew that our
historic freshman class could make real progress if we worked
together--across party, geographic, and demographic lines. It's
bipartisan--with 64 members from 31 states across the country.
Despite our diverse backgrounds and viewpoints, we are united
in our understanding of the necessity to put aside our
differences and come together to save lives.
Members of our working group have introduced legislation to
ease access to naloxone, to put sanctions on producers of
illegal fentanyl, to increase training for prescribers and law
enforcement, to require better warning labels, to beef up
federal research on addiction, and to coordinate and track
federal demand reduction activities.
I was proud to work with fellow freshmen Reps. Denver
Riggleman, Kelly Armstrong, and Mikie Sherrill to introduce
H.R. 2466, the State Opioid Response Grant Authorization Act.
This bill would authorize $1 billion in funding for State
Opioid Response Grants and Tribal Opioid Response Grants for
each of five years to fight the opioid epidemic in every
community across the country. Each state receives at least $4
million through the program, with additional funding provided
to the ten states with the highest mortality rates due to drug
overdoses.
The bill came from conversations we had with real people in
our districts. In the early days of our roles, we toured our
districts. We spoke with health departments, hospitals, first
responders, elected officials, police officers, incarcerated
individuals, mental health professionals, early childhood
organizations, and those suffering from addiction. We heard
loud and clear that we need additional and consistent funding
to end this crisis--funding that allows local communities to
provide individualized and specific services to their
community. And this legislation does just that. It gives
certainty to states that we will provide them funding, and they
can expect that to continue for at least the next five years.
There is no committee better positioned to make real and
impactful progress on this issue than the Energy and Commerce
Committee. You hold the power to advance legislation to
authorize additional funding for prevention and treatment
programs, to require more robust training of our medical
professionals, to ease restrictions on prescribing life-saving
medication-assisted treatment, and so much more. I urge you to
use that power to take further meaningful steps to combat the
addiction crisis, including passing a large package of
legislation that will dramatically increase our response to the
worst public health crisis our country's ever seen.
I recognize the committee has taken bold action in the past
by passing the Comprehensive Addiction and Recovery Act (CARA),
the 21st Century CURES Act, and the SUPPORT for Patients and
Communities Act. I commend you for that. Over 141,000 have died
from drug overdoses in the last two years. We should see this
as a call for additional action. What this committee has done
is important, but we must continue taking action in order to
save lives.
Thank you for the chance to share these thoughts with you
today. You are engaging in important work, and I would like to
be a partner with you in these efforts.
Mr. Pallone. Well, I want to thank the gentleman. I mean,
you're right on point in terms of raising the issue of fentanyl
you mentioned with your nephew, unfortunately.
We just had a hearing on that. And we know that we have to
do more in terms of funding. The biggest concern I have is
that, you know, that $6 billion that we appropriated on a
bipartisan basis over two years--$3 billion a year--that
expires in February.
So if we want to continue with the state grants we have to,
you know, come up with a way of funding that.
And, you know, there's a lot of concern. Also Congressman
Cummings came to visit me earlier this week about getting that
money--you know, getting money or grants down to the county and
the local level as well.
So we are going to definitely follow up and I appreciate
your bringing this to our attention, and go ahead, Mr.
Griffith.
Mr. Griffith. Thank you, Mr. Chairman.
I do appreciate your comments. You know, the Washington
Post has been doing a whole series of articles on opioids, and
my district has been particularly hard hit and that's one of
the reasons I would agree with Mr. Cummings.
We need to get down to the local level as well because
while the state of Virginia has issues--I don't know whether
it's in the top ten--but the Washington Post article pointed
out that the most number of pills, number one was in my
district.
Number two was in my district--two communities that were
one and two on the rank of pills that were sent out from '06 to
'12. We have had a number of deaths. A book has been written,
``Dopesick`` by Beth Macy about the problem in the Appalachian
region of Virginia in the Shenandoah Valley.
The other parts of the state may not have as many deaths
per capita as we have. And so we may need to look at some of
the programs where we can go into the hot spots and deal with
those as opposed to look--because some of the states like Texas
are huge. Texas, California--they are huge. Some of the smaller
states may have hot spots that need help but they may not
register because they are not as large as some of the others.
But we also--in talking about treatment, the deepest part
of my district in coal country there are no treatment
facilities. No overnight treatment facilities. You can get some
day stuff but that's about it. So we need to work on that.
And I think we need Mr. Chairman to push the FDA to come up
with non-opioid-based pain relievers and to push those as hard
as we can--non-addictive pain relievers.
But I will say this has been a bipartisan effort by this
committee and, Mr. Chairman, I know that will continue and we
are going to all work together to try to see what we can do and
I am so sorry that--it hits every family but not a death hits
every family and I am so sorry for your family that a death
resulted from an addiction.
Mr. Pallone. Thank you.
Chairwoman Eshoo?
Ms. Eshoo. Thank you, Mr. Chairman.
Mr. Trone, thank you for coming and testifying today and
for your passion for running and coming to Congress with this
as your top issue.
Regarding the Washington Post article, it is a blockbuster
and I really think that post-August recess that we have a
hearing on this because there are some very important
responsibilities that federal agencies have in this issue and I
think that we have to learn from what has taken place so that
it doesn't repeat itself with another product down the road.
But for those that have--that are affected by it, we have
to do much better. I mean, what my colleague just described
that in coal country there are simply no services, we can't
have that in our country.
So you carry the weight of the loss of your family. But I
do think that as you carry that, that that story can help
change the overall story in our country.
So thank you for being here today, and I look forward to
working with you.
Mr. Trone. Thank you.
Mr. Pallone. Thank you, Chairman.
Mr. Griffith go ahead.
Mr. Griffith. Mr. Chairman, if I might add, too. I know
that Subcommittee Chairwoman Diana DeGette and you and I and
some others worked really hard on trying to make sure that our
agencies are doing what they are supposed to and particularly
the DEA--that we don't have some glitches in the law that
prevents us from doing the things we need to do to stop the
flow of these horrible drugs into our community.
So I know that we will continue to work on that and
hopefully we will have a hearing in Oversight, as the gentle
lady suggested.
Mr. Pallone. Thank you, and thank you, Mr. Trone.
Now, the bells went off. We are down to 13 minutes. I'd
like to get some of you in but I don't think we can get all
four, right?
So what's the order?
Chairman McGovern, Mr. Lipinski. We can certainly get two.
I don't know if we can get three.
Why don't the--we are never going to get to----
Mr. McGovern. I'll read fast.
Mr. Pallone. All right. We are not going to get to
Malinowski then, I don't think.
All right. Do you want to come back?
Mr. McGovern. No, I----
Mr. Pallone. No, not you. I am going to try to get the
three of you in. But Tom, can you come back after the votes?
We will see.
Mr. Malinowski. I'll try. Yes.
Mr. Pallone. All right. All right. Go ahead, Jim.
OPENING STATEMENT OF HON. JAMES P. McGOVERN A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF MASSACHUSETTS
Mr. McGovern. Well, thank you, Mr. Chairman, members of the
committee. I am here to testify on behalf of two bills, H.R.
2502, the Medical Nutrition Equity Act, and H.R. 3332, which
would provide coverage for medical wigs under Medicare.
Mr. Chairman and members of the committee, Americans
struggle every day to navigate treatments for life-threatening
health conditions and all too often this battle comes with cost
barriers that prevent people from securing treatments that fit
their health and personal needs.
A few months ago, Congresswoman Herrera Beutler and I
introduced H.R. 2501, the bipartisan Medical Nutrition Equity
Act. Each year, more than 7,000 infants are diagnosed with an
inherited metabolic disorder. These life-threatening conditions
prevent patients from digesting or metabolizing most ``normal''
foods.
Patients often manage their complex nutritional needs with
prescribed specialized formulas and, without them, risk brain
damage, repeated hospitalizations, and in some cases, even
death.
Currently, children and adults who are diagnosed with
serious digestive disorders must pay out-of-pocket for
medically necessary food, which can often cost four to five
times as much as the foods that we find at a grocery store.
And to make matters worse, most health insurance companies
do not cover medically necessary nutrition unless the
medication is administered through a surgically placed tube--a
costly and, ultimately, dangerous procedure that in some cases
can be avoided.
While 35 states have already passed laws to ensure some
level of coverage for medical necessary nutrition, that
coverage is highly variable and excludes all patients covered
under federal programs.
The Medical Nutrition Equity Act would establish treatment
parity by requiring coverage for specialized formulas,
including medically necessary foods, vitamins, and amino acids
under private insurance, Medicare, Medicaid, and the Children's
Health Insurance Program.
And by the way, this coverage--this is coverage that
Congress already approved for military families enrolled in
TRICARE.
The other important piece of legislation that I am here to
talk about is H.R. 3332, which would amend Title 8 of the
Social Security Act to provide coverage for wigs as durable
medical equipment under the Medicare program.
Many patients living with medical hair loss suffers from a
variety of diseases, including cancer, alopecia areata, and for
those undergoing chemotherapy or suffering from alopecia
areata, an incurable autoimmune skin disease that causes
unpredictable hair loss, a wig is not just medically necessary
but also essential to alleviating the emotional and social
burdens of hair loss.
I was inspired to introduce this bill after meeting with
one of my constituents, Mary Aframe, who runs the Women's Image
Center located in Worcester and Leominister, Massachusetts.
Ms. Aframe has worked tirelessly to help raise awareness
about the many women undergoing chemotherapy who have trouble
affording wigs, particularly those who use Medicare.
Wigs can cost thousands of dollars and are out of reach for
many patients without help from their insurance provider. While
many private insurance plans cover wigs for those undergoing
treatments that cause hair loss, this bill re-categorizes wigs
as durable medical equipment to allow Medicare to provide
coverage if a doctor certifies that the wig is medically
necessary.
This bill will help ensure that every cancer patient and
alopecia patient who loses their hair can afford a wig and
undergo treatment with the dignity and respect they deserve.
So, Mr. Chairman, I strongly encourage you to consider
hosting hearings and markups on H.R. 2501 and H.R. 3332, and I
look forward to the opportunity to work with you and the
members of the Energy and Commerce Subcommittee on this, and I
think we need to do right by our constituents and ensure that
consistent coverage is standard for all Americans no matter the
illness they have or the healthcare coverage they require.
Thank you.
[The prepared statement of Mr. McGovern follows:]
Prepared Statement of Hon. James P. McGovern
I want to thank Chairman Pallone and Ranking Member Walden
for allowing me the opportunity to testify in support of H.R.
2501, the Medical Nutrition Equity Act, and H.R. 3332, which
would provide coverage for medical wigs under Medicare.
Mr. Chairman, Americans struggle every day to navigate
treatments for life-threatening health conditions and all too
often, this battle comes with cost barriers that prevent people
from securing treatments that fit their health and personal
needs.
A few months ago, Congresswoman Herrera Beutler and I
introduced H.R. 2501, the bi-partisan Medical Nutrition Equity
Act. Each year, more than 7,000 infants are diagnosed with an
inherited metabolic disorder. These life-threatening conditions
prevent patients from digesting or metabolizing most ``normal''
foods. Patients often manage their complex nutritional needs
with prescribed, specialized formulas and without them, risk
brain damage, repeated hospitalizations, and in some cases,
death.
Currently, children and adults who are diagnosed with
serious digestive disorders must pay out-of-pocket for
medically necessary food, which can often cost four to five
times as much as the foods we find in grocery stores. And to
make matters worse, most health insurance companies do not
cover medically necessary nutrition unless the medication is
administered through a surgically placed tube-a costly and
ultimately dangerous procedure that in some cases can be
avoided.
While thirty-five states have already passed laws to ensure
some level of coverage for medical necessary nutrition, that
coverage is highly variable and excludes all patients covered
under federal programs. The Medical Nutrition Equity Act would
establish treatment parity by requiring coverage for
specialized formulas, including medically necessary food,
vitamins, and amino acids under private insurance, Medicare,
Medicaid and the Children's Health Insurance Program-and by the
way, this is coverage that Congress already approved for
military families enrolled in TRICARE.
The other important piece of legislation that I'm here to
talk about is H.R. 3332, which would amend title XVIII of the
Social Security Act to provide coverage for wigs as durable
medical equipment under the Medicare program.
Many patients living with medical hair loss suffer from a
variety of diseases, including cancer and Alopecia Areata. For
those undergoing chemotherapy or suffering from Alopecia
Areata-an uncurable autoimmune skin disease that causes
unpredictable hair loss-a wig is not just medically necessary,
but also essential to alleviating the emotional and social
burden of hair loss.
I was inspired to introduce this bill after meeting with
one of my constituents, Mary Aframe, who runs the Women's Image
Center located in Worcester and Leominister. Ms. Aframe has
worked tirelessly to help raise awareness about the many women
undergoing chemotherapy who have trouble affording wigs-
particularly those who use Medicare.
Wigs can cost thousands of dollars and are out of reach for
many patients without help from their insurance provider. While
many private insurance plans already cover wigs for those
undergoing treatments that cause hair loss, this bill re-
categorizes wigs as durable medical equipment to allow Medicare
to provide coverage if a doctor certifies that the wig is
medically necessary. This bill will help ensure that every
cancer patient and Alopecia patient who loses their hair can
afford a wig and undergo treatment with the dignity and respect
they deserve.
Mr. Chairman, I strongly encourage you to consider hosting
markups and hearings on H.R. 2501 and H.R. 3332 and I look
forward to the opportunity to work with you and the Energy and
Commerce Health Subcommittee on advancing this legislation. We
need to do right by our constituents and ensure that consistent
coverage is standard for all Americans-no matter the illness
they have or healthcare coverage they require.
Mr. Pallone. Thank you, Chairman McGovern. You've been very
helpful to us in the Rules Committee. I appreciate that. And
Congresswoman Herrera Beutler actually mentioned the bill that
you highlighted earlier. So we are going to--we will follow up.
Thanks again.
Mr. Lipinski?
OPENING STATEMENT OF HON. DAN LIPINSKI A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ILLINOIS
Mr. Lipinski. Mr. Pallone and Mr. Griffith--Chairman
Pallone and Mr. Griffith, Chairwoman Eshoo, I want to thank for
the opportunity to testify today.
I want to draw the committee's attention to H.R. 1165, a
bill I introduced to address the serious public health issue
from a chemical called ethylene oxide, or EtO.
Just outside my district in Willowbrook, Illinois, a
company called Sterigenics has been using EtO to sterilize
medical equipment. This sterilization method is used at many
facilities across the country.
EtO is a known carcinogen. Last summer, the EPA released a
report indicating disturbingly high cancer risk in communities
across the country that are home to commercial sterilization
facilities including Sterigenics that admit EtO.
The risk was determined after a lengthy advisory Integrated
Risk Information System, or IRIS, process, which included
extensive reviews of the scientific literature.
This review found that the probable cancer risk posed by
EtO is 30 times greater than previously estimated. Further, a
report released in April by the Illinois Department of Public
Health found that certain types of cancer linked to EtO
exposure were higher in the Willowbrook community than
elsewhere in the state.
Specifically, when looking at neighborhoods near the
Sterigenics facility, the report found higher rates of
Hodgkin's lymphoma in women, pediatric lymphoma in girls, as
well as ovarian, breast, and pancreatic cancers.
This was, obviously, frightening news for every community
and family in the vicinity of Sterigenics and a cause of great
alarm to others with similar facilities nearby.
Thankfully, the Illinois EPA stepped in last February to
issue a CO order at Sterigenics and prevent it from using EtO
in its sterilization process.
But just last week, an agreement was reached to allow the
facility to reopen pending approval by a district court.
Meanwhile, the EPA has stated for months that it is considering
new emission standards for facilities that use EtO, which would
be based on the most recent risk data available.
This would provide for direct EPA regulation of EtO
emissions and protect people living in communities around EtO-
emitting facilities.
But the EPA has still not promulgated the standard, slow-
walking an issue of profound concern to my constituents. It is
also unclear whether the EPA will continue utilizing the best
available science to inform the standard by basing its decision
on rigorously reviewed IRIS risk values.
The EPA must not be allowed to undermine the integrity of
scientific process by ignoring established research methods
that may reveal unfavorable results.
I've been very vocal about this issue because I not only
represent thousands of people who live and work downwind of the
Sterigenics facility, but I also live nearby.
In order to get the EPA to act, earlier this year I
introduced H.R. 1165, the EtO is Toxic Act. This bill requires
the EPA to take IRIS assessment data into consideration when
setting an EtO emissions standard.
I request the committee to act on this bill to ensure that
EPA decisions on this matter use the best science available.
Further, I urge the committee to use its oversight authority
over the EPA to investigate whether it's taking appropriate
action to protect public health from the dangers of EtO.
After years of breathing air with an unsafe cancer-causing
pollutant, my constituents and others across the country cannot
wait.
I thank you for your time and your attention, and I yield
back.
[The prepared statement of Mr. Lipinski follows:]
Prepared Statement of Hon. Dan Lipinski
Thank you, Chairman Pallone, Ranking Member Walden, and all
members of the committee on Energy and Commerce, for the
opportunity to testify today about important issues within the
committee's jurisdiction. The primary topic I wish to address
is the problem of skyrocketing prices for healthcare and
medicine. This committee has recently taken action to move
forward legislation to start addressing this problem, including
legislation dealing with surprise bills and drug pricing, some
of which I have cosponsored. I look forward to this legislation
moving to the floor so we can pass it and get it signed into
law. But we must do more. I urge the committee to promote
healthcare price transparency as it prepares to bring
healthcare legislation to the House floor.
Every single one of us has hundreds and thousands of
constituent families who have struggled with the high prices of
medical care - including sky-high charges for drugs and
incomprehensible bills from hospitals and other providers. But
even aside from the charges patients directly see, the economy
as a whole suffers from the runaway growth in healthcare
spending as charges covered by insurance are passed on to
patients in the form of higher insurance premiums and higher
taxpayer costs for public programs. Even with a lifesaving drug
like insulin, which was first discovered nearly 100 years ago,
prices are climbing through the roof--something I have seen
firsthand as a diabetic. I have also directly seen how inflated
hospital bills can be after being treated for a bike accident.
But my own experiences are just a drop in the ocean of the
experiences of millions of patients across the U.S.
Earlier this month, the courts derailed an attempt to fight
the high cost of prescription drugs by blocking an
Administration rule requiring drug companies to include the
price of a drug when it is advertised on TV. This is an idea
that drug companies fought against - they clearly believe they
have something to be hide. But Congress has the power to fix
this court decision. I joined on as a co-sponsor of the Drug
Price Transparency for Medicare Patients Act, which would give
the Administration the authority it needs for this rule. While
there are many of the President's policies I and many others in
this room disagree with, this should be one we can all get
behind. I urge the committee to consider this bill or similar
proposals as legislation is prepared for a vote on the floor.
Similarly, I urge the committee to support transparency
into hospital prices. The first bill I introduced after I was
first elected was the Hospital Price Reporting and Disclosure
Act in 2006. I will shortly introduce an updated version which
will build on and strengthen an ACA requirement for hospitals
to publish their list of standard charges on their websites. My
bill will create penalties for non-compliance with the ACA
rule; require an identical format for published data so that
information can be easily compared create a central website for
collecting charge information; facilitate access to this data
by the public so they can create new consumer tools from the
data; require HHS to develop a way to provide insight into
actual negotiated charges while taking steps to prevent market
collusion or price increases from this data; and require
reporting on trends in standard and negotiated charges over
time, including trends in comparison to Medicare rates.
In addition to the issue of healthcare costs and prices, I
also want to draw the Committee's attention to a public health
issue from a pollutant called ethyne oxide, or EtO. Just
outside my district in Willowbrook, IL, a company called
Sterigenics has been using EtO to sterilize medical equipment.
The EPA released an updated National Air Toxics Assessment last
summer, which indicated a significantly elevated cancer risk in
the surrounding communities because of EtO emissions. This risk
was determined after a lengthy Integrated Risk Information
System, or IRIS, process, which included extensive reviews of
the scientific literature. The EPA has stated for months that
it is considering an emissions standard for facilities that use
EtO, which would protect people living in communities around
them. However, the EPA has still not promulgated such a
standard. Furthermore, it remains unclear whether the EPA will
continue utilizing the best available science to inform any
potential standard by basing its decisions on rigorously
reviewed IRIS risk values.
I worked with my colleagues to introduce the Expanding
Transparency of Information and Safeguarding Toxics Act, or the
EtO is Toxic Act for short. That bill requires the EPA to take
IRIS assessment data into consideration when setting an
emissions standard with respect to EtO. I request the
committee's support for this bill to ensure that EPA decisions
on this matter use the best science available. Additionally, I
urge the committee to use its oversight authority over the EPA
to investigate whether it is taking appropriate action to
protect public health from the dangers of EtO.
Thank you for your time and attention.
Mr. Pallone. Thank you, Mr. Lipinski. I want to comment but
we are running out of time before the vote. So thanks again for
being here.
Mr. Golden, if you want to be quick, we could do it now.
But if not, we'd ask you to come back. What do you prefer?
Mr. Golden. I'll go ahead and be as fast as I can.
Mr. Pallone. All right. All right. Thanks.
Mr. Golden. And I am sure you're trying to keep on track
today.
Mr. Pallone. All right. Thanks.
Mr. Golden. Thank you very much. Of course, I defer to you
if you would prefer to wait.
OPENING STATEMENT OF HON. JARED GOLDEN A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MAINE
Chairman Pallone, Mr. Griffith, Ms. Eshoo, thank you very
much for the opportunity.
I am here to testify to testify about the FLAT Prices Act,
H.R. 1188. It's a bill that I am proud to lead to address the
issue of rapid increases in prescription drug prices.
I am honored to have the support of Mr. Casten, Ms.
Slotkin, Mr. Cisneros, Mr. Rose, Ms. Pingree, and Ms.
Finkenauer. I am glad to be working in partnership with Senator
Durbin, who leads a companion bill in the Senate.
Traveling around Maine's 2nd District, this is a top
issue--the rising price of prescription drugs. We are a very
old state. We, in fact, per capita we are the oldest state--my
constituents. Prescription drug prices is critically important
to them.
And we have seen, obviously, over the years a lot of
coverage about spiked prices, efforts to make a quick buck on
the backs of people who are relying upon these prescription
drugs.
Examples such as Martin Shkreli, raising the price of HIV/
AIDS drugs, you know, by about 5,000 percent. I know you're all
familiar with this. Mylan and EpiPen prices going from $50 to
over $600. Insulin prices have consistently increased in recent
years as well with the average price nearly doubling between
2012 and 2016.
This issue isn't just a few well-known bad actors.
According to AARP, retail prices for a set of more than 250
widely-used brand name prescription drugs increased by an
average of more than 10 percent each year from 2012 to 2016.
These price increases have forced some families,
particularly seniors, to make very difficult decisions between
buying lifesaving medications and putting food on the table,
paying rent. In a place like Maine--very cold in the
wintertime--often that tradeoff has to do with heating your
home or getting your medications.
I've introduced the FLAT Prices Act with this data and
these real-world impacts in mind. The bill would help put a
stop to immoral price gouging by helping generic competition
come to the market faster.
The FLAT Prices Act would reduce a drug's market
exclusivity period if its price spikes by more than 10 percent
in one year, 18 percent over two years, or 25 percent over a
three-year period.
The penalty for exceeding these thresholds would be a
reduction of 180 days for the drug's exclusive monopoly period,
and the period would shorten by an additional 30 days for each
five percent price increase above these thresholds.
With this bill in place, pharmaceutical companies would be
discouraged from steeply hiking their prices, and if they did
so anyway, consumers would have less time to wait before
generic alternatives would become available to them.
I applaud this subcommittee for its recent action to
advance a number of bills related to drug pricing, and I hope
that you will consider including the FLAT Prices Act, which has
been referred to this committee in a future set of bills to
control healthcare costs.
I particularly like the bill because I think it takes a
tiered approach that matches the issue. For those who are most
abusive, this bill would be most effective in doing something
about price gouging.
For those who perhaps, you know, are price gouging a little
bit less so than some of these worst of examples it would be
less of a penalty.
But it does recognize that these companies have an
exclusivity period because they have made big investments up
front. You know, they start with a price and costs may
increase.
We are not--we are not trying to stop companies from
recovering the investments they have made. We are just trying
to protect consumers from abusive behaviors.
[The prepared statement of Mr. Golden follows:]
Prepared Statement of Hon. Jared Golden
Chairwoman Eshoo, Ranking Member Burgess, distinguished
members of the committee: I appreciate the opportunity to
testify about the FLAT Prices Act, H.R. 1188, a bill that I am
proud to lead to address the issue of rapid increases in
prescription drug prices.
I am honored to have the support of Mr. Casten, Ms.
Slotkin, Mr. Cisneros, Mr. Rose, Ms. Pingree, and Ms.
Finkenauer on this bill, and I am glad to be working in
partnership with Senator Durbin, who leads a companion bill in
the Senate.
As I travel around Maine's Second District, one issue I
hear about constantly is the rising price of prescription
drugs. For too long, big pharma has spiked prices to make a
quick buck on the backs of those who cannot survive without
these treatments.
We all remember the ``Pharma Bro'' Martin Shkreli (Skrell-
ee), whose company Turing Pharmaceuticals raised the price of
the HIV/AIDS drug Daraprim from $13.50 per pill to $750 per
pill--a 5,000% price increase.
Similarly, Mylan, a company that has exclusive rights to
distribute the lifesaving allergy medication auto-injector
``EpiPen'', raised the price from $50 to over $600.
Additionally, insulin prices have consistently increased in
recent years, with the average price nearly doubling between
2012 and 2016.
This issue isn't just about a few well known bad actors.
According to AARP, retail prices for more than 250 widely used
brand name prescription drugs increased by an average of more
than 10% each year from 2012 to 2016.
These price increases have forced some families to make the
excruciating decision between buying life saving medications
and putting food on the table, or paying rent.
I introduced the FLAT Prices Act with this data--and these
real-world impacts--in mind. The bill would help put a stop to
immoral price gouging by helping generic competition come to
the market faster. The FLAT Prices Act would reduce a drug's
market exclusivity period if its price spikes by more than 10%
in one year, 18% over two years, or 25% over a three-year
period.
The penalty for exceeding these thresholds would be a
reduction of 180 days for the drug's exclusive monopoly period,
and the period would shorten by an additional 30 days for each
5% price increase above these thresholds.
With this bill in place, pharmaceutical companies would be
discouraged from steeply hiking their prices, and if they did
so anyway, consumers would have less time to wait before
generic alternatives would become available to them.
I applaud this subcommittee for its recent action to
advance a number of bills related to drug pricing, and I hope
that you will consider including the FLAT Prices Act, which has
been referred to this subcommittee, in a future set of bills to
control healthcare costs.
Thank you again for the opportunity to testify today.
Mr. Pallone. Well, thank you, and we have just got to wrap
up. But, obviously, this is a huge priority for us in the fall.
You know, we are going to be having--we are going to
moving--you know, be moving and looking at these various bills
on negotiated prices under Medicare and we know the problem is
particularly acute for seniors.
And Ms. Eshoo is certainly--this is a priority for her,
too. So I am just going to adjourn now if that's all right. We
are going to--not adjourn. We are going to recess until 2:00
o'clock.
But I thank the gentleman from Maine.
Mr. Golden. Thank you for the opportunity.
[Recess.]
Mr. Pallone. The committee will reconvene and I assume Mr.
Wittman is--thank you for being here.
Proceed.
OPENING STATEMENT OF HON. ROBERT J. WITTMAN A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF VIRGINIA
Mr. Wittman. Thank you, Mr. Chairman. I want to thank you
and the committee members for the opportunity to come and speak
to you today.
I represent the 1st District of Virginia, which faces a
number of unique challenges in expanding broadband. The 1st
District spans the I-95 corridor in Northern Virginia, which
includes some of the foremost tech companies and data centers
in the nation and continues southeast to the Northern Neck and
Middle Peninsula, which is home to some of the most underserved
rural populations in Virginia.
Citizens in more urban areas in the northern part of my
district benefit from the highest quality broadband the market
has to offer.
With access to speeds upwards of one gigabit, these
citizens have unfettered access to services such as
telemedicine, online education, and modern business
applications and technologies that allow businesses to compete
in the 21st century.
These services are a convenience that many folks have come
to take for granted in 2019. This is not the case in the more
rural parts of my district. As population density decreases,
the business case for providers simply is not there to extend
service to these unserved areas.
Many communities and neighborhoods throughout the Northern
Neck, Middle Peninsula, and stretches of Stafford County and
localities east of Richmond, like the localities of New Kent
and Hanover, struggle to gain access to reliable broadband.
As a resident of this area who drives back and forth to DC
every day during session, I understand firsthand the plight of
rural residents when it comes to gaining quality high-speed
access.
In rural areas, broadband is oftentimes the top issue I
hear about as mothers and fathers complain about late nights
sitting in the McDonald's parking lot as their kids use the
WiFi to finish their homework; children of elderly parents
plead for quality broadband to access telemedicine services so
their parents don't have to drive an hour plus to the nearest
health facility; or business owners that know better quality
broadband would allow them to grow their businesses.
Demand for high-speed broadband has never been greater.
Closing the digital divide is the key to lifting up
countless communities and populations in unserved areas. While
Congress has made great strides in tackling this issue, more
can and should be done.
Further emphasizing policies that promote public-private
partnerships is essential. As I mentioned earlier, as the
population densities decrease in rural areas, P3s incentivize
providers through an influx of capital funds to build in areas
where the business case would often not exist without it.
Addressing our nation's broadband mapping capabilities is
also important to closing the digital divide. It is no secret
our broadband maps can be wildly inaccurate and often lead to
overbuilding on already existing networks.
I am an original co-sponsor of H.R. 3162, The Broadband
Data Improvement Act of 2019, which would require providers to
report data on a geolocation basis to create an improved
National Broadband Map that better targets funding to the areas
that need it most.
Another important element in preventing overbuilding is
through instituting challenge processes. H.R. 3162 establishes
a periodic challenge process at the FCC by which the public and
incumbent providers may challenge data on the National
Broadband Map.
The FCC must then analyze any challenges that may suggest
the map is inaccurate and resolve any disputes to update the
map accordingly.
I strongly urge the committee to markup and pass this
legislation and any other similar legislation with such
measures so that we can advance them to the floor for a vote.
Lastly, we must continue to eliminate the labyrinth of red
tape and regulations that continue to hinder shovel-ready
projects and streamline our federal permitting process.
Mr. Chairman, I want to thank you and Ranking Member Walden
and members of the committee for the opportunity to testify
today.
Thanks so much for your leadership, and as co-chair of the
Rural--House Rural Broadband Caucus, I offer my assistance on
the subject and would certainly love to work with you on these
items to help close the digital divide not only in my district
but across our United States.
[The prepared statement of Mr. Wittman follows:]
Prepared Statement of Hon. Robert J. Wittman
Chairman Doyle and Ranking Member Latta, I represent the
First District of Virginia, which faces unique challenges to
expanding broadband. The First District spans the I-95 Corridor
in Northern Virginia, which includes some of the foremost tech
companies and data centers in the nation and continues
southeast to the Northern Neck and Middle Peninsula, which is
home to some of the most unserved rural populations in
Virginia.
Citizens in more urban areas in the northern part of my
district benefit from the highest quality broadband the market
has to offer. With access to speeds upwards of one Gigabit,
these citizens have unfettered access to services such as
telemedicine, online education, and modern business
applications and technologies that allow businesses to compete
in the 21st Century. These services are a convenience that many
folks have come to take for granted in 2019.
This is not the case in the more rural parts of my
district. As population density decreases, the business case
for providers simply is not there to extend service to these
unserved areas. Many communities and neighborhoods throughout
the Northern Neck, Middle Peninsula, stretches of Stafford
County and localities east of Richmond struggle to gain access
to reliable broadband. As a resident of this area who drives
back and forth to DC every day during session, I understand
first-hand the plight of rural residents when it comes to
gaining quality high-speed internet.
In rural areas, broadband is oftentimes the top issue I
hear about-as mothers and fathers complain about late nights
sitting in the McDonalds parking lot as their kids use the WiFi
to finish their homework; children of elderly parents plead for
quality broadband to access telemedicine services so their
parents don't have to drive an hour to the nearest health
facility; or business owners that know better quality broadband
would allow them to grow their businesses. Demand for high-
speed broadband has never been greater.
Closing the digital divide is the key to lifting up
countless communities and populations in unserved areas. While
Congress has made great strides in tackling this issue, more
can and should be done.
Further emphasizing policies that promote Public-Private
Partnerships (P3s) is essential. As I mentioned earlier, as the
population densities decrease in rural areas, P3's incentivize
providers through an influx of capital funds to build in areas
where the business case would often not exist without it.
Addressing our nation's broadband mapping capabilities is
also important to closing the digital divide. It is no secret
our broadband maps can be wildly inaccurate and often lead to
overbuilding on already existing networks. I am an original
cosponsor on H.R. 3162, The Broadband Data Improvement Act of
2019, which would require providers to report data on a
geolocation basis to create an improved National Broadband Map
that better targets funding to the areas that need it most.
Another important element in preventing overbuilding is
through instituting challenge processes. H.R. 3162 establishes
a periodic challenge process at the FCC, by which the public
and incumbent providers may challenge data on the National
Broadband Map. The FCC must then analyze any challenges that
may suggest the map is incorrect and resolve any disputes to
update the map accordingly.
I strongly urge the Committee to markup and pass this
legislation so that it can advance to the floor for a vote.
Lastly, we must continue to eliminate the labyrinth of red
tape and regulations that continue to hinder shovel ready
projects and streamline our federal permitting process.
I want to thank Chairman Doyle, Ranking Member Latta, and
members of the committee for this opportunity to testify today.
As co-chair of the House Rural Broadband Caucus, I offer my
assistance on the subject and would certainly love to work with
you on these items to help close the digital divide in my
district.
Mr. Pallone. Thank you.
We--several members have talked about the need to expand
broadband into rural and underserved areas, and that's one of
the things that we definitely are striving for.
We have a bill called the LIFT America Act that would
spend, like, $40 billion on that as part of a larger
infrastructure package.
So, you know, we are going to look at this very seriously.
Thank you.
Mr. Flores. I concur. Thanks, Rob, for joining us today.
Mr. Pallone. Thanks a lot. Appreciate it.
Mr. Wittman. Thank you, Mr. Chairman.
Mr. Pallone. Take care.
Mr. Malinowski, thank you for coming back after the votes.
Mr. Malinowski. Thank you for having me back.
OPENING STATEMENT OF HON. TOM MALINOWSKI A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW JERSEY
Thank you, Mr. Chairman, Mr. Flores, members of the
committee. I very much appreciate the chance to testify.
You have a very broad jurisdiction. Obviously, I am going
to focus on just one issue. I am here on behalf of the 168,000
people in New Jersey who have been hit with medical debt due to
surprise billing.
Each year, through no fault of their own, in my state, in
our state, these folks owe an extra $420 million. We often hear
about surprise billing happening during medical emergencies--a
person is sick or injured. An ambulance is called, and later
they are hit with a huge bill because either the ambulance or
the hospital or the doctor they saw was out of network.
I recently spoke with a constituent whose husband had a
cardiac emergency. She called local emergency services, who
then called a local hospital to send an ambulance with cardiac
equipment.
After her husband was release they received four separate
bills totaling thousands of dollars. Their insurance was
covering less than half.
While the hospital where he was taken was covered by the
family's insurance, the couple was unaware that the ambulance,
which was associated with the hospital, was out of network. How
could they know? How could they be expected to know such a
thing?
It is a true testament to how broken our healthcare system
is that during our worst moments when we are most vulnerable,
when we are sick, injured, worried about getting better,
staying alive, we are also burdened with the responsibility of
ensuring that our ambulance, our hospital, every single doctor
that examines us is covered under the insurance we pay for each
month.
Surprise billing, of course, does not just happen during
emergencies. A patient can book an appointment with a doctor in
network and only find out later that one of the medical
professionals she saw actually worked for a third party and was
not covered.
Anesthesiologists, radiologists, surgical assistants, often
entire departments within an in-network facility might be
operated by subcontractors and, therefore, be out-of-network.
Seven in ten people who have been hit with unaffordable
out-of-network medical bills were not aware that the healthcare
provider they saw was not in their plan's network at the time
of receiving care.
Now, last year New Jersey passed our own law that clearly
prohibits charging patients more than what we would normally
owe under our insurance plans for urgent and medically
necessary services or inadvertent out-of-network services.
There is no good reason why we should not do the same for
every American. Patients who are no way at fault should not be
responsible for astronomical fees they were not warned they
were incurring.
Mr. Chairman, one last broader point on this. There are
many things that Republicans and Democrats sincerely disagree
about in this body. I don't think that this is one of them. I
don't see any philosophical difference among us--amongst us
about whether people should be stuck with massive surprise
medical bills, just a challenge on agreeing on the practical
details.
It is one thing to have gridlock when we disagree. If we
cannot deliver on one of the few issues where we do stand on
common ground that would further diminish our constituents'
faith in this institution.
So I would say the stakes are pretty high.
I thank you for your work on this issue, which I know has
been bipartisan in this committee. I look forward to being part
of that and hope very much that we will come to a solution
soon.
Thank you very much.
[The prepared statement of Mr. Malinoski follows:]
Prepared Statement of Hon. Tom Malinoski
Thank you Chairman Pallone and Ranking Member Walden. I
appreciate the opportunity to testify in front of the House
Energy and Commerce Health Subcommittee.
I am here today to advocate for the 168,000 New Jersians
who have been hit with crippling medical debt due to surprise
billing, including my constituents in the 7th district.
Surprise billing arises when an insured individual
unknowingly receives care from an out of network provider, and
is later hit with an unexpected medical bill.
Throughout New Jersey it is estimated that approximately
$420 million is owed by these patients each year due to
surprise billing.
In many instances those out-of-network bills are shifted to
health insurers, who then pass along their costs to an
estimated five million residents who pay up to $956 million
more per year more for their commercial insurance premiums.
We often hear about surprise billing happening during
medical emergencies. A person is sick or injured, an ambulance
is called, and later they are hit with a huge bill because
either the ambulance or the hospital or the doctor they saw was
out of network.
I recently spoke with a constituent whose husband had a
cardiac emergency. She called local Emergency Medical Services,
who then called a local hospital to send an ambulance with
cardiac equipment.
After her husband was released they received four separate
bills totaling thousands of dollars, and insurance was covering
less than half.
While the local hospital he was taken too was covered by
their insurance, the couple was unaware that the ambulance,
which was associated with the hospital, was actually out of
network.
It is a true testament to how broken our medical system is
that during a person's worst moments--when they are at their
most vulnerable--they are also burdened with the responsibility
of ensuring that their ambulance, their hospital, and every
single doctor that examines them, are covered under the
insurance they pay for each month.
Surprise billing does not just come about during
emergencies. A patient can book an appointment with a doctor in
their network, and only find out later that one of the medical
professionals they saw, actually worked for a third party and
was not covered.
Anesthesiologists, radiologists, surgical assistants, often
entire departments within an in-network facility might be
operated by subcontractors and are therefore out of network.
Seven in ten individuals who have been hit with
unaffordable out-of-network medical bills were not aware that
the healthcare provider they saw was not in their plan's
network at the time of receiving care.
According to a 2018 poll from the Kaiser Family Foundation
Two-thirds of Americans say they are either ``very worried'' or
``somewhat worried'' about their ability to afford unexpected
medical bills.
Last year New Jersey took steps to address surprise billing
and increase transparency. Providers must now inform non-
emergency patients anytime they will be responsible for any out
of network fees. Changes were also made to lower costs for out
of network care in emergency and urgent care scenarios.
There is still much to be done, and this issue needs to be
addressed at a national level. Patients, who are in no way at
fault, should not be responsible for astronomical fees they
were not warned they were incurring. Billing should remain
between the provider and the health insurance provider.
Party doesn't matter when you get hit with an unexpected
medical bill. Congress must come together to provide solutions
for Americans who are being saddled with debt they never agreed
to take on.
Thank you, and I look forward to working with the Committee
on this very important issue.
Mr. Pallone. Well, thank you.
Ms. Eshoo?
Ms. Eshoo. I want to thank you for being here today and I
agree with everything that you've said. Actually, the chairman
and the ranking member of the full committee are the chief
sponsors of what you just described.
And we have worked hard on the bill. It came through the
Health Subcommittee to the full committee on a bipartisan
basis, and I don't know if you've read the bill.
Mr. Malinowski. I have, yes. Yes.
Ms. Eshoo. You have? And do you have any--if you have any
particular views where you don't agree or you think the
legislation can be improved, let us know.
Mr. Malinowski. I will.
Ms. Eshoo. I think it's on its way and we look forward to
it going to the floor for the full House to pass it post August
recess.
Mr. Malinowski. I hope so, too.
Mr. Pallone. I appreciate what the gentlewoman has said.
The--I just want to make two remarks. First of all, I was
surprised to find out that in our state, you know, generally,
across the country the federal bill--well, I think there are
about 12 states that have their own laws including California
and New Jersey.
And so, obviously, for the states that don't this would be
even more important, right, because they don't have any state
legislation.
But even if the states that do, it generally doesn't cover,
you know, the large self-insured, you know, ERISA plans. And we
have figured that about a third of the people nationally, you
know, are in those types of plans.
But interestingly enough, I had an event with the Speaker
Coughlin, you know, who's from my district, and he said that in
New Jersey it was reverse.
In other words, the state law only covers about a third and
the federal law would cover the other two-thirds, which was, I
thought, interesting.
Mr. Malinowski. Yes. Even people covered by the state law
don't always--aren't necessarily aware that they are protected.
We have actually--my district offices have to help some of our
constituents who actually are covered.
Mr. Pallone. Yes.
Mr. Malinowski. Obviously, you know, we have referred them
to the state government, and the insurance companies and the
hospitals have not fully adjusted to the new reality in our
state.
So I think a national law, even in states where we have
taken this step, would be very, very important in ensuring that
everybody in the complicated system understands that this has
changed and must change.
Mr. Pallone. And then the other thing--not to belabor it--
as you mention ambulances, we would very much like to cover
ambulance. We do cover the air ambulance--the helicopters.
The problem in covering ambulances it was just so
complicated because a lot of them are, you know, some's
private. A lot in New Jersey, in particularly, is, you know,
the community for state squad, the local government.
So we are looking at it but it is--it is difficult for us
to cover ambulances because the way they are set up and paid
for. But we are looking at it so I wanted to mention that.
Mr. Malinowski. Good. Thank you.
Mr. Pallone. Did you want to add something, Mr. Flores?
Mr. Flores. Yes. Mr. Malinowski, thanks for joining us
today. This is an issue that cuts across all states and all
populations, and we appreciate your input.
Mr. Malinowski. Thank you, sir.
Mr. Pallone. Thank you, Tom.
Mr. Malinowski. All righty.
Mr. Pallone. Thank you.
And now the gentlewoman from Puerto Rico. Good to see you
here.
[Laughter.]
OPENING STATEMENT OF HON. JENNIFFER GONZALEZ-COLON A
REPRESENTATIVE IN CONGRESS FROM THE TERRITORY OF PUERTO RICO
Miss. Gonzalez-Colon. Thank you, Chairman Pallone, for your
visit to Puerto Rico and the commitment you have shown many
years for the island. Ranking Member Flores, again, and
Chairwoman Eshoo for all the help during the legislation of the
past week, and same thing to Peters here today.
I want to thank all for giving me the opportunity to
discuss legislation I have introduced that could be brought
before the committee.
I also want to thank this committee for taking a critical
action last week by passing the Territories Health Care
Improvement Act, which provides critically needed resources to
the territory's Medicaid programs to ensure sustainability
while a more permanent legislative solution is developed.
According to analysis undertaken by the Department of
Health and Human Services, Americans living in poverty have
significantly constrained budgets that limits their ability to
pay out-of-pocket healthcare costs.
Those in poverty have literally no available income after
they pay for their most basic necessities each month,
necessities which do not include healthcare, childcare, or
transportation.
People in poverty tend to be less healthy than those in
higher--with higher incomes and therefore need more medical
care. However, people in poverty are often unable to afford
even nominal premiums and co-payments.
Research shows that they may forgot necessary medical
treatment as a result of required cost sharing. Having said
that, Puerto Rico's population is a prime example of all these
findings.
With a median annual income of $19,000, close to half of
Puerto Rico's residents live below poverty level and depend
upon the public health system for their medical care.
Additionally, residents of Puerto Rico are ineligible for
supplemental security income solely because they live on the
island because of our zip code.
They are also ineligible to receive assistance in payments
other than Medicare Part B and Part D premiums. Residents of
Puerto Rico bear the heavier burden of healthcare costs than
residents of the states and the District of Columbia.
In order to triage this situation while Congress develops a
permanent solution, I filed the following bills that await
action before this committee, all of them in a bipartisan way.
H.R. 813, the Puerto Rico Integrity in Medicare Advantage
Act, gives Puerto Rico almost--more than 80 percent of our
people are using the Advantage program. This bill revises the
Medicare Advantage payments for three years by establishing a
.7 percent adjusted general average floor to any county in the
nation that exceeds this benchmark.
Two, it requires that at least half of the regional funding
above and beyond the 85 percent rule be used to increase
provider payments, and the reason for that is we are losing a
lot of our physicians and service providers.
And it will support Medicare Advantage Coordinated Care
Platform, which with performance base and equality standards in
care, which serves as the backbone of the healthcare system in
Puerto Rico as well.
I also introduce H.R. 2172, which removes the matching
requirement for Medicare Part D drugs in Puerto Rico. While
assistance is available for Medicare beneficiaries in the
states and in the District of Columbia, beneficiaries who
resides in the territories are not eligible for low-income
subsidy or LIS.
In lieu of the LIS, Social Security provides a block grant
to each territory for Medicaid coverage for low-income
beneficiaries prescription drugs. In the case of the island,
FMAP has been set to 55 percent.
Between fiscal years 2010 and 2016, Puerto Rico has been
able to draw down only 51 percent of its available federal
funding for prescription drugs and for low-income Medicare
beneficiaries.
Lastly, I introduced H.R. 2310, the Fairness in Medicare
Part B Enrollment Act, to address the fact that the residents
of every states and territories other than Puerto Rico who are
receiving Social Security benefits are automatically enrolled
in both Part A, Part B with coverage beginning the first day of
the month when they turn 65.
When someone who is receiving SSI in Puerto Rico turns 65,
they are enrolled in Medicare Part A but not in Part B, which
has resulted in 38,000 Medicare beneficiaries paying a lifetime
late enrollment penalty of $20 million a year.
And with that, Puerto Ricans deserve equality in healthcare
just like every other U.S. jurisdiction by enrolling in Part B
automatically.
Approximately 40 percent of the residents of Puerto Rico
who are 60 years and older live below the poverty level with an
annual income of less than $12,000.
The Part B premium, or about 15 percent of their monthly
income, can be cost prohibitive in the absence of other
Medicare savings program options available across the nation.
With that, I would like to thank you all and, again, I ask
the committee to take up these bills in a favorable way.
Mr. Pallone. I thank the gentlewoman.
I mean, you know, I feel personally--I know a lot on this
committee that we really need to do a lot more with Puerto Rico
and the territories.
And when we went on that two-day mission or whatever CODEL
with you and Stacey Plaskett we learned a lot and not only
about what we had to do with Medicaid but also the electricity
grid and so many other things that we will still follow up
with.
And thanks for all your input in putting together the
Medicaid plan, which we expect will move, you know, hopefully
the first week or soon after we get back, and we are working
with the Senate on it, too. So thanks again.
Did you want to add anything, Ms. Eshoo, or----
Ms. Eshoo. Well, I think that--I am very glad that we got
the legislation done when we did, and it is--I think it's going
to go a long way.
It's not going to close the loop on everything because the
territories are still not going to be treated the way they
should. There is not equity there in American citizens. But
thank you for the work that you've done on it and I look
forward to it passing when we come back, right?
Mr. Pallone. Right. Thank you.
Ms. Eshoo. So we will have some good full floor days just
from what comes out of our committee, Mr. Chairman.
Thank you.
[The prepared statement of Miss. Gonzalez-Colon follows:]
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Mr. Pallone. And we will still look to, you know, beyond
the four years, too. You know, we know we have to do a
permanent replacement. So thanks again, Jenniffer. Thanks.
All right. Next we have the gentlewoman from Iowa, Ms.
Finkenauer.
OPENING STATEMENT OF HON. ABBY FINKENAUER A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF IOWA
Ms. Finkenauer. Well, thank you, Chairwoman Eshoo, and also
Chairman Pallone for the opportunity to speak here today.
While I don't serve on this committee, I am proud to be a
voice for Iowa's working families and am committed to making
sure that they have a seat at the table on the issues affecting
their lives.
And one of the most significant burdens Iowa families are
facing is the skyrocketing cost of prescription drugs. It's
something that I've heard from folks all around my district at
town halls but then also things that I call ``Conversations
with your Congresswoman,'' which are modeled after kitchen
table conversations I'd have with my grandfather and my uncle.
My grandfather was a Democrat. My uncle was a Republican.
And we'd sit around the table talking about issues that
mattered and I remember, you know, we could leave and, you
know, disagree on some issues but still have respect for each
other.
And when it comes to prescription drugs, that's something
where Democrats and Republicans especially in my district are
concerned about and can find common ground.
You know, in the first half of this year alone, we have
seen over 3,400 drugs boost their prices. The average price
hike? Ten percent--five times the rate of inflation.
The cost of insulin, for instance, has risen over 500
percent in recent years. It's left a lot of Iowans with
diabetes who have been managing their condition for years
wondering what's changed.
Seniors on fixed incomes are especially burdened by the
rising costs. No one should have to choose between retiring in
dignity, keeping their home, or affording the medicine that
allows them to live their lives.
Yet, three in ten Americans report not taking their
medicines as prescribed because of cost.
Stevie is a mom in Iowa. She has said she has her son's
doctor write her son a prescription for a less effective
medicine because that is all she could afford.
She couldn't afford to pay for the drug that the doctor
originally prescribed for her son. She told the doctor that
giving her son a less effective medicine was better than none.
No mother, no American, should be put in this situation. We
live in the most innovative country in the world. There is no
reason we cannot come together and find the best policy
solutions to reduce costs, putting money back in the pockets of
Iowa families and families across the country, and getting
folks the care that they need.
I have proudly supported bills like the CREATES Act and the
Protecting Consumer Access to Generic Drugs Act. I appreciate
this committee's work to bring legislation to the House floor
that would require more transparency from drug manufacturers
and will make it faster and easier for more affordable generics
to come to market.
I encourage this committee to just continue its important
work to hold drug companies accountable and bring down the
costs for patients through common sense bipartisan legislation.
I'll continue to work with anybody who is serious about
helping Iowans and helping Americans get better, more
affordable healthcare, and I am ready to work with you and I
support you in your efforts to tackle the skyrocketing costs of
prescription drugs.
I am truly grateful again, Chairwoman Eshoo, for inviting
us today to have these voices heard and thank you for your
efforts, and I am continuing ready to keep the work going with
you guys.
Thank you.
[The prepared statement of Ms. Finkenauer follows:]
Prepared Statement of Hon. Abby Finkenauer
Thank you, Chairwoman Eshoo and Ranking Member Burgess, for
the opportunity to speak today.
While I do not serve on this committee, I am proud to be a
voice for Iowa's working families and am committed to making
sure that they have a seat at the table on the issues affecting
their lives.
And one of the most significant burdens Iowa families face
is the skyrocketing cost of prescription drugs.
It's something that I'm hearing from folks at townhalls and
Conversations with Your Congresswoman events across my
district.
In the first half of this year alone, we've seen over 3,400
drugs boost their prices.
The average price hike? Ten percent--five times the rate of
inflation.
The cost of insulin, for instance, has risen 500 percent in
recent years. It's left a lot of Iowans with diabetes--who have
been managing their condition for years wondering, what
changed? Seniors on fixed incomes are especially burdened by
these rising costs.
No one should have to choose between retiring in dignity--
or keeping their home--and affording the medicine that allows
them to live a full life.
Yet, three in ten Americans report not raking their
medicines as prescribed because of cost.
We live in the most innovative country in the world. There
is no reason we cannot come together and find the best policy
solutions to reduce costs, putting money back in the pockets of
Iowa families and getting Iowans the care they need.
I have proudly supported bills like the CREATES Act and the
Protecting Consumer Access to Generic Drugs Act. I appreciate
this Committee's work to bring legislation to the House floor
that would require more transparency from drug manufacturers
and will make it faster and easier for more affordable generics
to come to market.
I encourage this Committee to continue its important work
to hold drug companies accountable and bring down costs for
patients through common-sense, bipartisan legislation.
I'll continue to work with anyone who's serious about
helping Iowans get better, more affordable healthcare. While I
do not serve as a member of this Committee, I am ready to work
with you and support your efforts to tackle the sky-rocketing
costs of prescription drugs.
I am grateful to Chairwoman Eshoo and Ranking Member
Burgess for the opportunity to speak about an issue that is
important to me and to so many other Iowans.
Mr. Pallone. Thank you, and, you know, many members today
talked about prescription drugs as their priority, and we
appreciate your mentioning that we did, as you know, move the--
and these are bipartisan--the generic competition bills, the
transparency bills, which we did last week, which should move
when we come back and we are working on a negotiated prices
bill under Medicare as well.
So, you know, you're right on point in terms of what we are
trying to accomplish. Thank you.
And now we have the chairwoman of the Appropriations Labor
HHS Education and practically everything else subcommittee,
long time champion of trying to expand access and affordability
for healthcare. Thank you for being here.
OPENING STATEMENT OF HON. ROSA L. DeLAURO A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CONNECTICUT
Ms. DeLauro. Thank you very, very much, Mr. Chairman. It's
wonderful to be here with you today. I thank the ranking
member. Please give him my best.
But also to my colleague, Congresswoman Eshoo, Dr. Burgess,
Congressman Carter, and Mr. Peters, thank you all very, very
much. This is a wonderful committee which is dealing with some
of the most important issues that we do face in our country
today and particularly those around healthcare.
I am here to advocate for Medicare for America, which is a
proposal in your jurisdiction that I have introduced with the
chair of the Consumer Protection and Commerce Subcommittee,
Congresswoman Jan Schakowsky.
It is our proposal to achieve affordable quality universal
healthcare. Right now, families are struggling with the
skyrocketing costs of prescription drugs and healthcare costs,
costs which continue to far outpace people's wages today.
They are paying more for worse coverage than they may have
had previously. In fact, according to the Kaiser Family
Foundation, premiums increased 65 percent in 10 years for a
single person who gets their health insurance.
Meanwhile, their average deductible went from $303 in 2008
to $1,350 in 2018. As a result, one-third of Americans have
delayed care due to cost, and that's according to Gallup.
All the while, the administration is making intentional
policy choices to undermine the Affordable Care Act, raise
prices for middle class families and for working people.
In the Labor, Health, and Human Services Subcommittee, we
hosted a hearing about what--I regard this as sabotage of the
Affordable Care Act.
A study out this week found that 15,600 deaths would have
been prevented if all states expanded Medicaid and the
Affordable Care Act as intended. It was those problems we aimed
to solve long term with Medicare for America.
Medicare for America achieves universal affordable high-
quality health coverage by creating a program based on Medicare
and Medicaid.
It expands the benefits and services to include items like
prescription drugs, dental, vision, hearing services, and long-
term services and supports.
Medicare for America would be accessible to all Americans
through auto-enrollment while maintaining private insurance for
those employers who provide comprehensive, high-quality, and
affordable plans.
Right now, 165 million Americans receive their coverage
through their employer, and what we--and so what we do is to--
we maintain employer-sponsored healthcare.
Many people are happy with it. Companies may continue, as I
said, to offer these plans, or they can enroll employees in
Medicare for America, contribute eight percent of annual
payroll to the Medicare Trust Fund.
Employees have a choice as well. They can choose to enroll
in Medicare for America instead of their employer-sponsored
plan and have their employer contribute to it.
Medicare for America addresses costs. Annual out-of-pocket
costs are no more than $3,500 for individuals, $5,000 for
families on a sliding scale.
There are never out-of-pocket costs for preventive and for
chronic disease services, long-term services and supports, and
prescription drugs, generic or brand name as necessary.
There are also zero deductibles. Zero. And premiums are
capped--no more than eight percent of income for enrollees. So
for those between 200 and 600 percent of the federal poverty
level--between $50,000 and $150,000 for a family of four--
premiums are subsidized.
For those under 200 percent of the federal poverty level--
$50,000 for a family of four--there are zero premiums and zero
out-of-pocket costs.
Second, we address benefits. Currently, healthcare benefits
are largely dependent on your zip code, and Medicare for
America fixes that.
Regardless of whether you live in Connecticut, Mississippi,
Utah, and California, every single American should have robust
comprehensive health coverage.
So we set a very high standard for benefits. We cannot wait
for states to do the right thing and increase benefits and
services. Doing so will only continue and compound the
inequalities that we are trying to rid from our healthcare
system.
Third, we ensure Americans have access to long-term
services and supports, and this is with regard to disabilities
as well, emphasizing home and community-based care that
recognizes the central role that family care givers play.
Fourth, we restrain system-wide costs with all-payer rate
setting and by allowing the government to negotiate for better
prescription drug prices. What we have included as well in
Medicare for America is how we will be paying for it.
Medicare for America sunsets the Republican tax bill. It
imposes a five percent surtax on adjusted gross income
including on capital gains above $500,000.
It increases the Medicare payroll tax and investment income
tax. We also increase the excise taxes on all tobacco products,
beer, wine, liquor, and sugar-sweetened drinks.
State will also need to make maintenance of effort payments
equal to the amounts that they currently spend on Medicaid and
on CHIP.
This is a quick overview of the bill. When working people
are struggling with stagnating wages, skyrocketing healthcare
costs, we need to do more to help them out.
So as the committee continues to consider how to bring down
costs for families of working people, I urge you to consider
Medicare for America.
I believe it would achieve universal coverage, which is, I
know, our shared goal, and I thank you so much for the
opportunity to be with you today.
Thank you.
[The prepared statement of Ms. DeLauro follows:]
Prepared Statement of Hon. Rosa L. DeLauro
Thank you, Chairman Frank Pallone and Ranking Member Greg
Walden for welcoming me today. I am here to advocate for
Medicare for America, a proposal in your jurisdiction that I
have introduced with the chair of the Consumer Protection and
Commerce Subcommittee, Congresswoman Jan Schakowsky. It is our
proposal, to achieve affordable, quality universal healthcare.
Right now, families are struggling with the skyrocketing
costs of prescription drugs and healthcare, costs which
continue to far outpace wages. They are paying more for worse
coverage than they may have had previously. In fact, according
to the Kaiser Family Foundation, premiums increased 65% in 10
years for a single person who gets their health insurance.
Meanwhile, their average deductible went from $303 in 2008 to
$1,350 in 2018.
As a result, one-third of Americans have delayed care due
to cost, according to Gallup.
All the while, the Trump administration is making
intentional policy choices to undermine the Affordable Care Act
and raise prices for middle class families and working people.
In the Labor-Health and Human Services subcommittee, we hosted
a hearing about this sabotage. A study out this week found that
15,600 deaths would have been prevented if all states expanded
Medicaid and the ACA as intended.
It was those problems we aimed to solve long term with
Medicare for America.
Medicare for America achieves universal, affordable,
highquality health coverage by creating a program based on
Medicare and Medicaid. It expands the benefits and services to
include items like prescription drugs, dental, vision, hearing
services, and longterm services and supports. And Medicare for
America would be accessible to all Americans through auto-
enrollment, while maintaining private insurance for those
employers who provide comprehensive, high-quality, and
affordable plans.
Right now, 165 million Americans receive their coverage
through their employer. Many are happy with it, and companies
may contain to offer these plans. Or, they can enroll employees
in Medicare for America and contribute 8% of annual payroll to
theMedicare Trust Fund. Employees have a choice, too. They can
choose to enroll in Medicare for America instead of their
employer-sponsored plan and have their employer contribute to
it.
Medicare for America address costs. Annual out of pocket
costs are no more than $3,500 for individuals and $5,000 for
families on a sliding scale.
There are never out-of-pocket costs for preventive and
chronic disease services, Long Term Services and Supports, and
prescription drugs (generic or brand name as necessary).
There are also zero deductibles. Zero. And premiums are
capped: no more than 8% of income for enrollees. So, for those
between 200% and 600% of the Federal Poverty Level-between
$50,000 and $150,000 for a family of four -premiums are
subsidized. For those under 200% of the Federal Poverty Level-
$50,000 for a family of four--there are zero premiums and zero
out of pocket costs.
Second, we address benefits. Currently, healthcare benefits
are largely dependent on your zip code, and Medicare for
America will fix that. But, regardless of whether you live in
Connecticut or Mississippi or Utah or California, every single
American should have robust, comprehensive health coverage. And
so, we set a very high standard for benefits. We cannot wait
for states to do the right thing and increase benefits and
services. Doing so will only continue and compound the
inequalities that we are trying to rid from our healthcare
system.
Third, we ensure Americans have access to long-term
services and supports, emphasizing home and community-based
care that recognizes the central role family caregivers play.
Fourth, we restrain system-wide costs: with all-payer rate
setting and by allowing the government to negotiate for better
prescription drug prices.
That is a quick overview of the bill.
When working people are struggling with stagnating wages
and skyrocketing healthcare costs, we must do more to help. So,
as the committee continues to consider how to bring down costs
for families and working people, I urge to you to consider
Medicare for America. It would achieve universal coverage,
which is our shared goal.
Thank you for the opportunity to talk with you today.
Mr. Pallone. I thank the gentlewoman--the chairwoman.
You know, you have been involved with so many of these
healthcare affordability and accessibility issues for so long I
don't even know where to begin to thank you.
But I do want to say, obviously, we will take a look at
Medicare for America. But in terms of what the committee has
done, you know, in our first six months here before the August
recess we have been trying to basically look at shoring up the
existing programs and marketplace, you know, whether it's the
Affordable Care Act or generic competition or the transparency
bills.
But, you know, we are--in the fall we will start looking
at, you know, innovative things. You know, when you talk about
long-term care, you know, you and I both wanted to include a
long-term care initiative in the Affordable Care Act and we
just ran into the costs problem with CBO. I usually blame CBO
for everything, in case you haven't noticed.
And, you know, in terms of the negotiated prices for
Medicare, that is something that we are certainly working on.
Home and community-based care--the list goes on.
So I just--you know, I just want to thank you. I want you
to know that we are going to be looking at a lot of these gaps
that exist because there are some and certainly, you know, idea
of capping or trying to reduce out of pocket cost is very
important as well.
So thank you. I don't know----
Ms. DeLauro. Appreciate that very much and long-time
supporter of, obviously, the Affordable Care Act, and I don't
see--I mean, what I do see is that, you know, our being able to
achieve universal healthcare, build on that, take a look at new
opportunities at the time when you can also be very, very
mindful of employer-sponsored insurance and those 165 million
people who take advantage of that, and you just can't put them
aside.
But to allow them to be able to either opt in or their
employer to opt in, and at the same time look at a way in which
we begin to auto enroll people from birth so that we get--begin
to get them into the system.
And above all, I know you're conscious about cost, and so
that what we do do is to provide a way and to look at how one
pays for this.
So appreciate the opportunity.
Mr. Pallone. Absolutely. Thank you.
Dr. Burgess or Ms. Eshoo, did you want to say--no?
Chairwoman Eshoo?
Ms. Eshoo. Rose, I thank you for coming here today.
Your energy is infectious. You're a force of nature, and
your ideas are always very important ones and large ones. It
represents big thinking, but underneath it the thinking
continues. It's not just the big tag line.
So I remember years and years ago in the Clinton
administration we tried to set up an early buy-in to Medicare
for people younger than 65. We weren't successful with that.
But I think that you make a very important point about the
following. It's estimated to be anywhere from 165 million to
180 million people who receive their healthcare through their
employer.
That is not something we can ignore. But those of us who
have spent our adult lifetimes working for universal coverage
for every person in this country so that every person in this
country is covered, we want to make sure that they are not
thrown on the scrap heap of humanity if they lose their jobs.
So we don't know what's going to happen to the Affordable
Care Act. But I think that you've brought forward a thoughtful
plan.
You might think of doing some workshops with members on
both sides of the aisle so that they understand what are in--
what's in your proposal, and what the estimates would be--you
know, what it would cost a family, an individual, how long,
what it would include.
I mean, you've talked about some of those things today. But
thank you.
Ms. DeLauro. Thank you very, very much. Thank you for the
suggestion. I appreciate it.
Ms. Eshoo. Good. And I'll come, too. Thank you.
Thank you. Thank you, Rosa.
Mr. Burgess. So you brought some interesting ideas, most of
which I probably don't agree with. But the concept that we
should be talking about that----
Ms. DeLauro. Agree with universal healthcare, Dr. Burgess.
Mr. Burgess [continuing]. In this committee I think is
important, and the--I suppose a competing bill with yours would
be the Jayapal bill. I know Representative Dingell on our
committee has been interested in that.
We actually had a hearing in the Rules Committee much
earlier in this Congress. I don't understand why it was the
Rules Committee and not our committee. I think we are the
committee. We are the authorizing committee of jurisdiction.
This should be--this should be open for our consideration.
I know the chairman does not like association health plans
but I think that is going to be part of the argument. Health
reimbursement accounts, which recently were allowed under
rulemaking by the administration and yes, I did complain about
executive actions under the previous administration.
I do think we ought to be doing the--if ideas are good
ideas, we ought to authorize them and bring them through the
legislative process.
A health reimbursement account where a person is--where an
employer is allowed to give a person a fixed amount of money
outside of what would be taxable so that they could walk that
into whatever exchange or insurance product that they want.
After all, that's what most members of Congress have in the
DC exchange in the Affordable Care Act. So if it's good enough
for Members of Congress it should be good enough for the
general population.
But I am willing to consider all of these ideas and I think
we should have a robust and lengthy hearing and hear--have this
same sort of perhaps Member Day structure on this because I
know many members do have their own ideas.
Interestingly enough, the--when all of the excitement was
toward the Medicare for all when we had that hearing in the
Rules Committee and, yes, as you point out it would end
employer-sponsored insurance. It would end Medicare Advantage.
It would end TRICARE.
So there were a lot of things that would--if people were
doing today that they liked that they would lose and that--I
think that is a valid consideration and one that I perhaps
brought up that morning in the Rules Committee.
And then lost in the translation--the same day the Mueller
report came out coverage numbers were released by the
Congressional Budget Office, and I guess we have all--have our
differences with the Congressional Budget Office. But 2.6
million more people had multi--I am trying to say the employer-
sponsored insurance.
Two point six million people since January of 2017 now have
this coverage. So that's a good thing and we should celebrate
that. In my opinion, we shouldn't try to take that away from
them.
So it's an interesting concept. This committee is where it
belongs. We are the only committee that hasn't really had a
hearing, and Budget Committee's had a hearing. Rules Committee
has had a hearing. Ways and Means Committee has had a hearing.
Our turn, and we are next.
Thank you.
Ms. DeLauro. Thank you very, very much. I appreciate
staying in your lane, too. So I understand the relevance of the
Energy and Commerce Committee.
Thank you.
Mr. Pallone. Thank you, Madam Chairwoman.
The gentleman from Tennessee.
Mr. Cohen. Thank you, Mr. Chair.
I appreciate you and I appreciate Rosa for that pat on the
back. That was nice of you.
Ms. DeLauro. North and South.
OPENING STATEMENT OF HON. STEVE COHEN A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TENNESSEE
Mr. Cohen. And I want to thank the Members for allowing us
to bring our suggestions to the Energy and Commerce Committee
and this Subcommittee on Health. I appreciate your time and the
leadership of Chairman Pallone and the committee in this 116th
Congress.
As we meet in a room named for the champion of healthcare,
Mr. Dingell, and as I look at Henry Waxman looking down on me,
I know that there are giants in this committee that have done
much for healthcare over the years. I am a proud sponsor of
H.R. 117, the Nationally--it is an acronym, NEWBORN, and that's
Nationally Enhancing the Wellbeing of Babies through Outreach
and Research Now. Pretty good of an acronym. Thanks, staff.
Which builds from the belief that healthcare is a basic human
right.
The NEWBORN bill was introduced way back in, like, 2010 or
2009 the first time, and it was part of the Affordable Care
Act. And it would have been included therein but for some
mistake that Chris Dodd made. And I haven't forgiven him. The
Democrats used it as a way to promote the healthcare, and it
was a highlight of what we were doing, without the members that
we were going to have this NEWBORN Act as part of the
healthcare bill.
I guess it is when we had to deal with the Senate bill that
we had the problem.
The NEWBORN Act gives a voice to children who have been
taken by our country's ongoing crisis of infant mortality.
Fifty-four developed countries have lower rates of infant
mortality than the United States. As the wealthiest country in
the world, the United States, we should not be 55th. Members of
Congress, we should be ashamed.
In fact, Jon whatever his name is of The Daily Show ought
to be here giving us hell, Jon Stewart.
The NEWBORN Act would help address this problem by creating
infant mortality-focused pilot programs in the highest risk
areas of our country. The pilot programs should focus on
addressing the top five reasons for infant mortality: birth
defects, pre-term birth, and low birth rate, Sudden Infant
Death Syndrome, maternal pregnancy complications, and injuries
to the infant.
These deaths disproportionately affect black women. My
district is proportionately, is predominantly black and
predominantly black women. It is estimated that nine out of
every 1,000 children born in the district will not see their
first birthday. By focusing studies on the highest risk areas
of our country, the NEWBORN Act directly confronts this
disparity. Pilot programs will provide insightful data and
immediate support to the areas with the highest rates of infant
mortality.
So, I would encourage the committee, ask the committee,
beseech the committee to have a hearing to consider the
immediate threats the maternal and infant mortality crisis
poses to women and children, especially African American women.
It is our duty to act, and I believe the NEWBORN Act would be
crucial, and a crucial step forward.
And I know Dr. Burgess knows these issues, too. As a
pediatrician he sees it. It is really awful in Memphis. We have
rights with Third World countries.
So that is my ask. And I appreciate the opportunity to
address you.
[The prepared statement of Mr. Cohen follows:]
Prepared Statement of Hon. Steve Cohen
Chairwoman Eshoo, Ranking Member Burgess, I want to thank
you for allowing members to testify about our legislative
priorities within the Energy and Commerce Committee's
Subcommittee on Health. I appreciate your time and Chairman
Pallone's leadership of the Committee in the 116th Congress.
As we meet in the room named for a champion of healthcare,
I am reminded of Mr. Dingell's remarkable legacy of advocacy
for access to comprehensive care.
I introduced H.R. 117, the Nationally Enhancing the
Wellbeing of Babies through Outreach and Research Now (NEWBORN)
Act, which builds from his belief that healthcare is a basic
human right.
The NEWBORN Act gives a voice to children who have been
taken by our country's ongoing crisis of infant mortality.
Fifty-four developed countries have lower rates of infant
mortality than the United States. As the wealthiest country in
the world, the United States has no excuse. We as Members of
Congress have no excuse.
The NEWBORN Act would help address this problem by creating
infant mortality-focused pilot programs in the highest-risk
areas of the country. The pilot programs would focus on
addressing the top five reasons for infant mortality: birth
defects, preterm birth and low birth weight, sudden infant
death syndrome, maternal pregnancy complications, and/or
injuries to the infant.
These deaths disproportionately affect black women. In my
district that is predominately black, it is estimated that nine
out of every 1,000 children born will not live to see their
first birthday. \1\
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\1\ https://wreg.com/2019/02/20/report-85-percent-of-tennessee-
maternal-deaths-preventable/
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By focusing studies in the highest-risk areas of the
country, the NEWBORN Act directly confronts this disparity. Its
pilot programs would provide insightful data and immediate
support to areas with the highest rates of infant mortality.
I encourage the Committee to hold a hearing to consider the
immediate threats the maternal and infant mortality crisis
poses to women and children--especially black women. It is our
duty to act, and I believe the NEWBORN Act would be crucial
step forward.
Mr. Pallone. I want to thank the gentleman. You know, I
know your interest in this NEWBORN. It is very important and we
are certainly going to take a look at it.
We did a Newborn Screening Act bill yesterday.
Mr. Cohen. Yes.
Mr. Pallone. But this is different.
Mr. Cohen. This is different. It has a pilot program for
the more difficult, highest districts with the highest risk.
Mr. Pallone. Right, right. All right, so we will take a
look at it and get back to you.
Mr. Cohen. When it was in the ACA everybody thought it was
great.
Mr. Pallone. Yes.
Mr. Cohen. Held it up, this is great. And Chris Dodd messed
up. So we need to help Chris Dodd redeem his reputation.
Mr. Pallone. All right. And let me mention to all of you,
you know, we are having this hearing today but you can follow
up with either of us on a member-to-member basis, or your
staff, on anything that you might want to mention as well. So,
thanks a lot, Steve.
Mr. Cohen. Thank you.
Mr. Pallone. Thank you.
Mr. Burgess. Mr. Chairman, just----
Ms. Eshoo. I just----
Mr. Pallone. Oh, I am sorry. Go ahead, Chairwoman.
Ms. Eshoo. Thank you for coming Steve. I think that you
have a very good bill. And as the chairman said, we will take
it under consideration.
I just, I know that, I assume that you are just casting
Chris' name around tongue in cheek; correct? Yes, OK. This is a
brother friend, so we just have to make sure. OK.
Thank you.
Mr. Pallone. Dr. Burgess.
Mr. Burgess. I thank the chairman. Just to correct the
record, I am not a pediatrician. My specialty was obstetrics
and gynecology.
Mr. Cohen. Then you were even more informed, and I just
knew it but didn't say it.
Mr. Pallone. Thank you, Mr. Cohen.
Next is the gentleman from Ohio, Mr. Balderson.
OPENING STATEMENT OF HON. TROY BALDERSON A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OHIO
Mr. Balderson. Thank you, Mr. Chairman, members of the
subcommittee. I am here today to discuss an issue that is
important not only to me personally but also to the thousands
of Ohioans I represent.
Roughly a quarter of the district I represent, Ohio's 12th
Congressional District, is comprised of rural area. I was born
and raised in one of those rural areas, the Appalachian
community of Zanesville, Ohio, where rural broadband is of
critical importance.
As you know, this subcommittee has jurisdiction over
telecommunications issue. Unfortunately, many of my
constituents, as well as millions of Americans, don't currently
have access to highspeed broadband internet, which puts them at
great disadvantage to their peers who live in more urban
connected areas. As a Congress, we are failing those Americans.
In an increasingly digital era, rural Americans in Ohio--rural
Ohioans and Americans from around the country require access to
modern broadband e-connectivity as much as those in urban and
suburban communities.
With a connection to highspeed internet, rural Americans
gain every important access to healthcare services through the
option of telemedicine, and tools to fight the opioid epidemic,
have increased capacity to grow their small businesses by
opening up the digital marketplace to small businesses so they
can compete and benefit from drastically improved educational
opportunities by providing rural students the same ability to
research, access educational materials as their urban and
suburban peers.
Without access to these high-speed internet standards,
rural Americans suffer from a disadvantage in connectivity to
the online world. According to the U.S. Census Bureau, one in
five Americans live in a rural area. Rural farmers supply food
for our country. Rural labor keeps our manufacturing base
strong. And rural energy exports keep America powered.
Yet, for all they do for our country, the Federal
Communications Commission recently found that more than 30
percent of rural America Americans do not have access to basic
broadband services. In comparison, only two percent of urban
Americans experience this same lack of connectivity.
We, as a Congress, have the opportunity to level the
playing field by helping rural Americans access critical
services by supporting rural broadband e-connectivity.
According to the USDA, rural broadband e-connectivity puts the
United States at the top of the world's productivity by
fostering economic development, job growth, rural
entrepreneurship, and innovative technologies.
The USDA also found that enhanced connectivity in rural
communities leads to important markers for success, including
an increase in productivity for farmers through use of smart
farm equipment and crop-focused innovation; expansion of
entrepreneurship in a global digital marketplace; an
improvement in business operations through small towns' ability
to respond to market conditions; support farmers' ability to
predict production inputs, increase yields, and access
potential customers worldwide; an expansion of educational
opportunities; and, finally, an enhancement of healthcare
options by enabling healthcare professionals to spread
awareness of local resources.
As you can tell, rural broadband access would do a world of
good for millions of Americans currently living without this
resource and would give our country an advantage in the global
space. This is why I will continue to be a vocal advocate of
this issue, and why I am a proud cosponsor of H.R. 3162, which
would require broadband providers to create an improved
national broadband map that is significantly more accurate and
granular, as well as subject to an ongoing and multi-facet
challenge and reinforcement process, refinement process.
I ask you all to consider the millions of Americans who are
starving of access to rural broadband e-connectivity. These
rural Americans are no less deserving of the opportunities to
succeed than their peers.
Thank you all for your time, and I welcome any questions
that you may have.
[The prepared statement of Mr. Balderson follows:]
Prepared Statement of Hon. Troy Balderson
Mr. Chairman, members of the subcommittee, I am here today
to discuss an issue that is important not only to me
personally, but also to the thousands of Ohioans I represent.
Roughly a quarter of the district I represent, Ohio's 12th
Congressional District, is comprised of rural areas. I was born
and raised in one of those more rural areas, the Appalachian
community of Zanesville, Ohio, where rural broadband is of
critical importance. As you know, this subcommittee has
jurisdiction over telecommunications issues.
Unfortunately, many of my constituents, as well as millions
of Americans, don't currently have access to high-speed
broadband internet, which puts them at a disadvantage to their
peers who live in more urban, connected areas. As a Congress,
we are failing those Americans. In an increasingly-digital era,
rural Ohioans and Americans from around the country require
access to modern broadband e-Connectivity as much as those in
urban and suburban communities.
With a connection to high-speed internet, rural Americans
gain ever important access to healthcare services through the
option of telemedicine and tools to fight the opioid epidemic,
have increased capability to grow their small businesses by
opening up the digital marketplace to small businesses so they
can compete, and benefit from drastically-improved educational
opportunities by providing rural students the same ability to
research and access educational materials as their urban and
suburban peers. Without access to these high-speed internet
standards, rural Americans suffer from a disadvantage in
connectivity to the online world.
According to U.S. Census Bureau, one in five Americans
lives in a rural area. In my home of Central Ohio, we know that
rural Americans are the backbone of our nation's economy. Rural
farmers supply food for our country, rural labor keeps our
manufacturing base strong, and rural energy exports keep
America powered. Yet for all they do for our country, the
Federal Communications Commission recently found that more than
thirty percent of rural Americans do not have access basic
broadband services. In comparison, only two percent of urban
Americans experience this same lack of connectivity. We, as a
Congress, have the opportunity to level the playing field by
helping rural Americans access critical services by supporting
rural broadband e-Connectivity.
According to the FCC, ``Rural and Tribal areas continue to
lag behind urban areas in mobile broadband deployment. Although
evaluated urban areas saw an increase of 10 Megabits per second
(Mbps) download and 3 Mbps upload mobile LTE from 81.9% in 2014
to 90.5 % in 2016, such deployment in evaluated rural and
Tribal areas remained flat at about 70% and 64%, respectively.
Approximately 14 million rural Americans and 1.2 million
Americans living on Tribal lands still lack mobile LTE
broadband at speeds of 10 Mbps download, 3 Mbps upload.''
According to USDA, rural broadband e-Connectivity puts the
United States ``at the top of the world's productivity by
fostering economic development, job growth, rural
entrepreneurship, and innovative technologies.'' The USDA also
found that enhanced connectivity in rural communities leads to
important markers for success, including:
An increase in productivity for farmers through
the use of smart farm equipment and crop- focused innovation;
An expansion of entrepreneurship in a global
digital marketplace;
An improvement in business operations through
small towns' ability to respond to market conditions as well as
the ability to manage their finances;
Support for farmers' ability to predict production
inputs, increase yields, and access potential customers
worldwide;
An expansion of educational opportunities by
reversing current trends that show rural students suffer
without access to high-speed internet because they lag behind
in school, must drive miles into town for a Wi-Fi hotspot to do
their homework, have trouble completing college applications,
and fail to access important online learning tools that help
students pursue a career in certain trades or attain a
professional certification;
And finally, an enhancement of healthcare options
by enabling healthcare professionals to spread awareness of
local resources, prevent prescribing mistakes and pharmacies
through access to controlled substance registries, and provide
addiction care in remote locations through telemedicine.
As you can tell, rural broadband access would do a world of
good for millions of Americans currently living without this
resource and would give our country an advantage in the global
space. This is why I will continue to be a vocal advocate of
this issue and why I am a proud cosponsor of H.R. 3162, which
would require broadband providers to create an improved
National Broadband Map that is significantly more accurate and
granular as well as subject to an ongoing and multi-faceted
challenge, validation, and refinement process. I ask you all to
consider the millions of Americans who are starving of access
to rural broadband e-Connectivity. These rural Americans are no
less deserving of the opportunity to succeed than their peers.
Thank you all for your time and I welcome any questions you
may have.
Mr. Pallone. I want to thank the gentleman. We stressed
earlier, you know, a number of the people, a number of our
colleagues that have been here have talked about more attention
to rural areas, particularly with broadband. And we are very
much aware of that and want to prioritize expansion of
broadband in rural and underserved areas. And that is part of
our Lift America Act, you know, which would be a larger
infrastructure bill.
So, I just want you to know that we are very cognizant and,
you know, follow up on the things you mentioned.
Did either of you want to? No?
Go ahead, Dr. Burgess.
Mr. Burgess. Mr. Chairman, I don't know if you're aware
that Mr. Balderson, of course, joined us as a result of a
special election last year. So this is not his first term
technically. But his predecessor was my counterpart on the Ways
and Means Committee, the chairman of the Health Subcommittee on
Ways and Means, Pat Tiberi.
So, welcome, Mr. Balderson, we are glad you are here. I
acknowledge, as the chairman does, that the issue that you
bring to us is important. My district is, the district that I
represent is no longer as rural as it was when I grew up. We
are half rural and half urban now. But the rural half certainly
the broadband issues are significant and an issue that I have
worked on for several years.
We have worked on things like telehealth. It is important
that that be available, reliable, and be within the range that
people can use it.
So, thank you for bringing this to our attention.
Mr. Balderson. Thank you very much.
Mr. Pallone. Thank you again.
And now we have--oh, I am sorry, Mr. Peters has a comment
or question.
Mr. Peters. I just want to quickly comment to Mr.
Balderson, I have not heard any discussion of large
infrastructure package in this building on either side of the
aisle which doesn't include rural broadband. We see it as an
access issue, as an investment issue, and as an infrastructure
issue. And so we will look forward to working with you on that.
Mr. Balderson. Yes. Thank you very much.
Thank you, Mr. Chairman.
Mr. Pallone. Thank you.
And now we go to Mr. Hern from Oklahoma.
OPENING STATEMENT OF HON. KEVIN HERN A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OKLAHOMA
Mr. Hern. Thank you, Mr. Chairman, and the members here for
allowing me to testify today. I want to thank the Energy and
Commerce Committee for passing H.R. 3375, the Stopping Bad
Robocalls Act. This is an important piece of legislation that I
proudly cosponsored and the House of Representatives passed
overwhelmingly yesterday.
We have all received spam phone calls before. They are
annoying, harassing, frustrating calls during all hours of the
day and night. I sometimes get as many as 20 fake phone calls
per day. These robocalls are frequently coming from your own
area code, a trick that makes us all extra vulnerable to this
epidemic.
Con artists are manipulating the incoming phone numbers in
order to gain the trust of the American people to steal money
and personal information from the unsuspecting victims. It is a
criminal--it is criminal and it is long overdue that we do
something about this breach of trust. It is urgent that we
shine some light on the pressing and increasingly frustrating
issues of robocalls. Currently robocalls make up about 50
percent of all phone calls.
In 2018, there were more than 47 billion robocalls in the
United States, an increase of 17 billion from the previous
year. And this is--and this year, according to AARP, we are on
track to receive a record 60 billion illegal robocalls. In my
home state of Oklahoma, robocalls are received over 55 million
times per month, about 75,000 calls per hour. That is
completely absurd.
Oklahoma state officials are working tirelessly to solve
this issue on a local level, but the scope of this abuse
requires federal intervention. Therefore, I want to thank
Oklahoma's Attorney General Mike Hunter, who has met with
Federal Communications Commission Chairman Pai, to do his part
in ending the robocall epidemic in Oklahoma.
For rural Oklahomans, their phone may very well be their
lifeline, and robocalls block the lines, putting their very
lives in danger.
Additionally, robocall epidemic is also a public health
crisis that is plaguing our hospitals and healthcare
facilities' phone lines. For people with life-threatening
illness and the elderly who rely on their phone as their
lifeline these phone calls can get in the way of lifesaving
help. When a person is trying to contact a hospital, every
second counts. A blocked phone line due to a spam call can mean
life or death to a patient.
For example, in the heart of Boston, at Tufts Medical
Center, administrators registered more than 4,500 calls within
a 2-hour window just last year. Many hospitals around the
country share this experience.
In Congress I have made it a priority to uphold consumer
protections. Unsolicited calls and text messages violate these
protections, which is why I support the Stopping Bad Robocalls
Act. This legislation requires consumer consent to receive
calls and text messages from automated dialing systems, and
requires those who are sending robocalls to maintain records of
consent they have received from consumers.
Consumers will also have the ability to withdraw consent
from automated texts and calls. This legislation requires phone
carriers to provide a call authentication technology so
consumers can trust their caller I. D. again. It is required
that this technology should not impose an additional line-item
cost to a consumer's phone bill. There will be also a process
to help rural carriers implement this call authentication
technology. Consumers should be able to block harassing spam
phone calls without being charged extra.
These harmful phone calls are defrauding our seniors and
preventing our hospitals from providing timely care. Robocalls
are a serious, pervasive, and persistent problem that are
causing serious issues, particularly for our hospitals,
seniors, and rural populations. These unwanted and unwarranted
calls are illegal, and it is our responsibility to ensure that
consumers are protected from these fraudulent calls.
Illegal robocalls put Americans at risk of scams and fraud.
It is time that we stop this abuse and do something about
robocalls.
I ask my colleagues in the Senate to join us in putting a
stop to this nuisance to prevent violation of American
consumers' right to privacy.
Once again, I want to thank you, Mr. Chairman, and the
Energy and Commerce Committee, and the full House of
Representatives for passing H.R. 3375, the Stopping Bad
Robocalls Act. And thank you for having me here today. And I
yield back.
[The prepared statement of Mr. Hern follows:]
Prepared Statement of Hon. Kevin Hern
Thank you, Mr. Chairman and Ranking Member Walden, for
allowing me to testify before your committee today. I want to
thank the Energy and Commerce Committee for passing H.R. 3375,
the Stopping Bad Robocalls Act. This is an important piece of
legislation that I proudly cosponsor and that the House of
Representatives passed overwhelmingly yesterday.
We've all received spam phone calls before. They are
annoying, harassing, frustrating calls during all hours of the
day and night. I sometimes get as many as 20 fake phone calls
per day.
These robocalls are frequently coming from your own area
code - a trick that makes us all extra vulnerable to this
epidemic. Con artists are manipulating the incoming phone
numbers in order to gain the trust of the American people to
steal money and personal information from their unsuspecting
victims. It is criminal and it is long overdue that we do
something about this breach of trust.
It is urgent that we shine some light on the pressing and
increasingly frustrating issue of Robocalls. Currently,
Robocalls make up about 50% of all phone calls. In 2018, there
were more than 47 billion robocalls in the U.S., an increase of
17 billion from the previous year. And this year, according to
AARP, we are on track to receive a record 60 billion illegal
Robocalls.
In my home state of Oklahoma, robocalls are received over
55 million times per month, about 75,000 calls per hour. That
is completely absurd.
Oklahoma's state officials are working tirelessly to solve
this issue on the local level, but the scope of this abuse
requires federal intervention. Therefore, I want to thank
Oklahoma's Attorney General Mike Hunter, who has met with
Federal Communications Commission Chairman Pai to do his part
in ending the robocall epidemic in Oklahoma. For rural
Oklahomans, their phone may very well be their life-line, and
robocalls block the lines--putting their very lives in danger.
Additionally, the Robocall epidemic is also a public health
crisis, as it is plaguing our hospitals and healthcare
facilities' phone lines. For people with life-threatening
illness and the elderly, who rely on their phone as their
lifeline, these phone calls can get in the way of life-saving
help.
When a person is trying to contact a hospital, every second
counts. A blocked phone line due to a spam call can mean life-
or-death to a patient. For example, in the heart of Boston, at
Tufts Medical Center, administrators registered more than 4,500
calls within a two-hour window, just last year. Many hospitals
around the country share this experience.
In Congress, I have made it a priority to uphold consumer
protections. Unsolicited calls and text messages violate these
protections, which is why I support the Stopping Bad Robocalls
Act.
This legislation requires consumer consent to receive calls
and text messages from automated dialing systems and requires
those who are sending robocalls to maintain records of consent
they have received from consumers. Consumers will also have the
ability to withdraw consent for automated texts and calls.
This legislation also requires phone carriers to provide
call authentication technology, so consumers can trust their
caller ID again. It is required that this technology should not
impose an additional line-item cost to a consumers' phone bill.
There will also be a process to help rural carriers implement
this call authentication technology.
Consumers should be able to block harassing spam phone
calls without being charged extra. These harmful phone calls
are defrauding our seniors and preventing our hospitals from
providing timely care.
Robocalls are a serious, pervasive, and persistent problem
that are causing serious issues--particularly for our
hospitals, seniors, and rural populations. These unwanted and
unwarranted calls are illegal, and it is our responsibility to
ensure that consumers are protected from these fraudulent
calls. Illegal robocalls put Americans at risk of scams and
fraud. It is time that we stop this abuse and do something
about robocalls.
Conclusion:
I ask my colleagues in the Senate to join us in putting a
stop to this nuisance and prevent violation of the American
consumer's right to privacy. Once again, I want to thank the
Energy and Commerce Committee and the full House of
Representatives for passing H.R. 3375, the Stopping Bad
Robocalls Act.
Thank you for having me here today. I yield back the
balance of my time.
Mr. Pallone. Dr. Burgess.
Mr. Burgess. Thank you, Mr. Hern, for coming and
reinforcing what has really work for this committee,
subcommittee, and full committee have been doing this year. As
you know, we passed the bill yesterday on the floor.
During the markup in this committee Ms. Dingell and I
actually had an amendment accepted that addressed the hospital
portion that you bring up that is critically important. People
need to know that when their hospital calls it is their
hospital and not someone spoofing their hospital's number,
particularly if they are giving out personally sensitive
information.
So, I guess the next thing to do is for us all to robocall
Senators Lankford and Inhofe so that--I mean that it passed so
overwhelmingly here in the House yesterday, that my hope is
that, you know, a big vote from the House will sometimes get
the attention of the people over on the other side of the
Capitol. But we can't let up the gas, we can't take our foot
off the gas, we have to keep going. This is what people want us
to do.
And it was important work that got done yesterday. May not
have done everything that you outlined in your remarks. To the
extent that there needs to be fine tuning, or to the extent
that there needs to be modification as it goes through the
rulemaking process at FCC, so be it. But we have to start
somewhere. This bill yesterday was a good start.
Mr. Hern. I thank the chairman for the Member Day. And this
is an opportunity. You know, we, we don't often compliment one
another across the aisle. I am a new freshman here, and I
wanted to make sure that the Commerce Committee knew that we
appreciated this on all sides of the aisle. I think America
appreciates it.
And just as my colleague mentioned, we need to maybe put
all our senators on robocalls and we could irritate them enough
that they pass it over there.
Thank you so much.
Mr. Pallone. Thank you so much. Thank you.
So, Mr. Delgado, you would normally be next, but Mr. Kilmer
has asked if he could go before you because he has to chair a
hearing or a markup of some sort. Is that OK?
All right. Mr. Kilmer, you are next.
Ms. Eshoo. Can I just thank,----
Mr. Pallone. Oh, of course.
Ms. Eshoo [continuing]. Mr. Hern for being here? I love
your idea about robocalls to the senators. So, thank you.
He is walking out, he doesn't know I am saying that.
Mr. Pallone. I don't think I want to robocall mine.
Ms. Eshoo. Thank you. Thank you for your wonderful
testimony.
Mr. Pallone. You can robocall the New Jersey guy? Is that
right.
Mr. Kilmer.
OPENING STATEMENT OF HON. DEREK KILMER A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF WASHINGTON
Mr. Kilmer. Thank you, Mr. Chair, and the ranking member,
and the members of the committee. And I want to thank my
colleague from New York for letting me jump the queue.
And thanks for holding this Member Day. It is, I think it
is really important for members who are not on the committee to
be able to share some of the challenges our constituents face
back home.
I am here to speak with you about something that keeps m up
at night. Some of you may know I was born and raised in a
timber town on the Olympic Peninsula. It is a beautiful region
in Northwest Washington that I now have the honor or
representing. And though many people think of the sprawling
metropolis of Seattle when they think of the State of
Washington, the area I represent is quite different. A majority
of the land is actually quite rural.
And, Mr. Chairman, I think a lot of folks on this committee
know this: rural hospitals are really struggling. A recent
study found that 97 rural hospitals have closed since 2010. And
earlier this year, Navigant found that 21 percent of rural
hospitals are at a high risk of imminent closure. That equates
to 430 hospitals in 43 states that employ over 150,000 people
and, most importantly, that care for millions of our friends
and neighbors.
And despite the growing problems facing rural hospitals,
last year the Trump administration put forward a policy called
Site-Neutral Payments that reduces reimbursement under Medicare
for hospitals with affiliated clinics or care facilities. Those
affected clinics and care facilities bring quality healthcare
closer to folks in rural areas. But this rule cuts
reimbursement by 30 percent in 2019, and 60 percent going
forward to those facilities.
In a time when we should be protecting rural hospitals,
this policy does exactly the opposite, it punishes hospitals
for brining medical care closer to the patients. In my
district, that means Olympic Medical Center, the hospital where
I was born, could face, could lose $47 million over the next 10
years. A reduction in reimbursement from Medicare beneficiaries
would go from $118 to just $47.
This rule is especially harmful because it impacts many
hospitals serving health professional shortage areas, as
designated by the Health Resources and Services Administration.
Cutting reimbursements actually exacerbates that shortage by
dramatically reducing the funds available to retain and hire
healthcare professionals and purchase new medical equipment.
Earlier this year I went over to visit Olympic Medical
Center and talked to them about the impacts of this rule. They
told me that this rule has played a factor in OMC postponing a
$15 million planned construction project. It may cause
elimination of some services, while also forcing the hospital
to change plans to hire eight new primary care providers.
My district is not the only one impacted. In fact, it is
not even on the list of the top 30 hospitals across the
country, including Southwestern Vermont Medical Center, Central
Vermont Medical Center in Mr. Welch's district, Dartmouth-
Hitchcock in New Hampshire in Ms. Kuster's district, Cox
Medical Center in Branson, Missouri in Mr. Long's district, all
in the top 30, impacted worse than Olympic Medical Center.
Now, in 2018, as CMS was exploring this rule, 138
bipartisan members signed a letter urging CMS not to adopt this
rule. But, unfortunately, CMS ignored this request. CMS argues
that reducing these payments will increase competition with
private providers. That argument is based entirely on flawed
logic and faulty assumptions because it assumes that there are
numerous private providers in every region, and that people who
go to hospital clinics will be able to get seen by someplace
else.
That misses the point that these hospitals tend to care for
more medically complex cases and will care for every patient,
even if they can't pay. Private providers have no such
obligations, which means that as hospitals lose money and
capacity, access to healthcare will be put in serious jeopardy,
especially in those areas already suffering from a lack of
healthcare.
Not only is this a bad--is this rule bad policy, it also
exceeds the authority of CMS. Section 603 of the bipartisan
Budget Act of 2015 affirmed that no existing off-campus
hospital clinics should have their payment rates reduced.
Additionally, in 2016, in the 21st Century Cures Act, Congress
expanded those protections to cover clinics that were in the
process of being built when that bipartisan Budget Act of 2015
was passed.
So, the arbitrary rule actually violates both of these
laws. It is essential that this Congress acts to ensure that
legislative intent is upheld in law, and to prevent further
damage. And out of concern for the damage this rule is doing to
our hospitals I have introduced bipartisan legislation called
the Protecting Local Access to Care for Everyone Act, or the
PLACE Act. The PLACE Act would freeze--it is H.R. 2552--it
would freeze the site neutral rule until December 31st, 2020,
direct CMS to reimburse hospitals at the previous Medicare
reimbursements rates for the money lost under the rule since
the policy went into effect.
The American Hospital Association and the Federation of
American Hospitals have both endorsed this bill.
I am asking for your help because Olympic Medical Center is
literally the only game in town in one of the most remote rural
regions in my district. And if these hospitals and clinics
close, the next option for care can be hours away. And that is
just dangerous. This is a really critical issue for the folks I
represent and for a massive part of the country.
And I thank you for your attention and I ask for your help.
[The prepared statement of Mr. Kilmer follows:]
Prepared Statement of Hon. Derek Kilmer
Site Neutral Testimony
Mr. Chairman, thank you for having me here today and for
holding this Member Day hearing--I think it's really important
that members not on committee have the opportunity to share
some of the challenges their constituents face back home--and
their ideas for how to address them--so I applaud you for
taking advantage of this new opportunity created by Democratic
leadership in the Rules Package earlier this year.
I'm here today to speak with you about something that keeps
me up at night. Some of you may know that I was born and raised
in a timber town on the Olympic Peninsula, it's a beautiful
region in northwest Washington that I now have the honor of
representing. And though many people think of the sprawling
metropolis of Seattle when they think of Washington State--the
area I represent is quite different--and a major portion of it
is largely rural.
Now I think many of you also represent Districts pretty
similar to mine--and people are starting to realize what many
folks across the country already know--rural hospitals are
struggling.
A recent study found that 97 rural hospitals have closed
since 2010--and earlier this year, Navigent found that 21% of
rural hospitals are at ``high risk of imminent closure.'' This
equates to 430 hospitals in 43 states that employ over 150,000
people and most importantly, care for millions of our friends
and neighbors.
Despite the growing problems facing rural hospitals, last
year, the Trump Administration put forward a policy called
``site neutral payment'' that reduces reimbursement under
Medicare for hospitals with affiliated clinics or care
facilities. (CMS-1695-FC).
These affiliated clinics and care facilities bring quality
healthcare closer to folks in rural areas.
But this rule cuts reimbursement by 30% in 2019 and 60%
going forward to those facilities. At a time when we should be
protecting our rural hospitals, this policy does exactly the
opposite--punishes hospitals for bringing medical care closer
to patients.
In my district, this means Olympic Medical Center, the
hospital where I was born, could lose $47 million over the next
ten years--and a reduction in reimbursement for Medicare
beneficiaries would go from $118.35 to just $47.34.
This rule is especially harmful because it impacts many
hospitals serving Health Professional Shortage Areas, as
designated by the Health Resources and Services Administration.
Cutting reimbursements exacerbates this shortage by
dramatically reducing the funds available to retain and hire
healthcare professionals and purchase new medical equipment.
Earlier this year I went over to visit OMC and talk to them
about the impacts of the rule. And they told me that this rule
has played a factor in OMC postponing $15 million of planned
construction projects and may cause the elimination of some
services--while also forcing the hospital to change plans to
hire eight new primary and specialty care providers.
My district is not the only one impacted. In fact, it's not
even on the list of the top 30. Hospitals across the country,
including Southwestern Vermont Medical Center (Welch), Central
Vermont Medical Center (Welch), Dartmouth Hitchcock in New
Hampshire (Kuster) and Cox Medical Center in Branson, Missouri
(Long) will all be impacted even worse than Olympic Medical
Center.
Now in 2018, as CMS was exploring this rule, 138 bipartisan
members signed a letter (Roskan/M. Thompson), urging CMS to not
adopt this rule. But unfortunately, CMS ignored this request.
CMS argues that reducing these payments will increase
competition with private providers. This argument is based
entirely on flawed logic and faulty assumptions because it
assumes that there are numerous private providers in every
region and that people who go to hospital clinics would be able
to get seen by them.
It misses the point that hospitals tend to care for more
medically complex cases and will care for every patient, even
if they cannot pay.
Private providers have no such obligation, which means that
as hospitals lose money and capacity, access to healthcare will
be put in serious jeopardy, especially in those areas already
suffering from a lack of healthcare.
Not only is this rule bad policy, it also exceeds the
authority of CMS. Section 603 of the Bipartisan Budget Act of
2015 (Public Law 114-74), affirmed that no existing off-campus
hospital clinics should have their payment rates reduced.
Additionally, in 2016, Congress passed the 21st Century
Cures Act (Public Law 114-255), which expanded these
protections to cover clinics that were in the process of being
built when the Bipartisan Budget Act of 2015 was passed.
This arbitrary rule clearly violates both laws.
It is essential that Congress act to ensure its legislative
intent is upheld in law and to prevent further damage to
healthcare access, especially in rural areas.
Out of concern for the damage this rule is doing to our
hospitals, I have introduced the bipartisan legislation called
the Protecting Local Access to Care for Everyone Act--or the
PLACE Act.
The PLACE Act (HR 2552) would freeze the Site Neutral rule
until December 31, 2020 and directs CMS to reimburse hospitals
at the previous Medicare reimbursement rate and for the money
lost under the rule since this policy went into effect.
The American Hospital Association and the Federation of
American Hospitals have both endorsed this bill.
I am asking for your help because OMC is literally the only
game in town in the rural regions of my district. If these
hospitals and clinics close, the next option for care can be
hours away--and that's just dangerous.
Folks, this is a critical issue, not just for the
constituents I represent, but for a massive part of the
country--and we must work together to fix it.
I thank you for your attention to this matter and for your
willingness to consider my testimony today.
Thank you.
Mr. Pallone. Did you want to comment, Ms. Eshoo?
Ms. Eshoo. I did. Thank you, Mr. Chairman.
Thank you, Derek, for coming here today and for your
testimony. To the ranking member of the subcommittee and Mr.
Pallone, I met with Mr. Kilmer at his request. We have to pay
attention to this. This is it is not just in his district, this
is a rural hospital issue.
I believe, am I recalling this correctly, that you have
even gone so far as to identify how this would be paid for, or
am I confusing that with something else?
Mr. Kilmer. We didn't stipulate that in the bill but, you
know.
Ms. Eshoo. But this has bipartisan cosponsorship. This
really deserves the attention of our committee.
So, I want to work with you to resolve this.
Mr. Kilmer. Thank you.
Ms. Eshoo. It is troubling to me that this was brought
about by a reversal of policy in the Administration. And but
whatever it is, we have to contend with it. And I pledge to you
that I will work with you to resolve this. Because people's
lives are--you are holding all of these people in the palm of
your hand. And we have a responsibility to them.
So, thank you for being here today.
Mr. Kilmer. Thank you.
Ms. Eshoo. We will work with you. And let's see what we can
get going post August recess.
Mr. Kilmer. Thank you.
Mr. Pallone. Dr. Burgess.
Mr. Burgess. I probably need to study the issue again. But
in the Budget Act of 2015 the concept was that hospitals were
acquiring medical practices and the reimbursement from CMS to
the hospitals was three times what the individual doctors had
been prior to the time their hospital--their practice was
acquired by the hospital. So it was really driving
consolidation.
We had a hearing on consolidation in the last Congress in
the Oversight and Investigations Subcommittee. And I will have
to say I don't remember all of the, all of the moving parts
there. But ones you bring up are important. At the same I would
just say to the committee there are multiple moving parts here.
And just like any time you move--this would be an argument for
not expanding federal footprints in healthcare delivery--but
any time you move one piece in that big puzzle, a lot of other
things change. So it needs to be done with some care.
I don't think it is fair to say it was all on this
Administration because it was passed back in 2015. I know I
heard from MD Anderson Hospital, not in my district but just
outside, because they were concerned that their cancer clinics
would be affected because they were more than 200 yards from
the front door of their hospital, which was I think the, if I
recall correctly, that was the stipulation that was in the
Budget Act.
But point made. And we do need to, we do need to take it
seriously. There are reasons that that was done back in 2015,
probably reasons the rule was delayed, reasons that you allude
to. And any time you move one piece in this, a lot of other
pieces move unintentionally. And we need to be careful with it.
Thank you for bringing it to our attention.
Mr. Kilmer. Thank you.
Mr. Pallone. Mr. Peters.
Mr. Peters. Thank you, Mr. Chairman. I would like to thank
Mr. Kilmer for bringing this issue to our attention. It is a
reminder, as you can see very clearly, as I don't represent a
rural area, that you can see very clearly how this rule is
affecting access in his district, and it is a reminder again
that one size doesn't fit all. What could be a very sensible
approach in a urban district where there's many providers just
may not fit at all in an urban area.
So, I think we should look at this, we should take a look
at your bill. And I look forward to working with you on this,
Mr. Kilmer, so we can get it right.
Mr. Kilmer. Thank you. Thank you, Mr. Peters.
Mr. Pallone. Thank you, Derek.
We, you know, we have been saying over and over all the
time here since 10:00 o'clock that we have to make sure that
rural areas have access and affordability. And we can't neglect
them, because too often that has been the case. So we are
certainly going to take another look at this rule.
Thank you.
And I wanted to thank Mr. Delgado for waiting. You are
next. But we are going to switch chairs here. I am going to ask
our chairwoman of the Health Subcommittee to replace me.
Thank you, Anna. Mr. Delgado, you are recognized.
OPENING STATEMENT OF HON. ANTONIO DELGADO A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. Delgado. All right. Thank you, Chairman Pallone,
Chairwoman as well of the subcommittee, and Ranking Member
Burgess. I appreciate the opportunity to come before the
committee today to talk about an issue that is critically
important to me, and one I have prioritized from the beginning
of my commitment to serve New York-19, and that is healthcare.
It is unacceptable that the United States, the richest
country in the world, is also the only developed one without a
universal healthcare system. This is one of the top reasons why
I came to Congress. And I am proud to be here today to share
with you a bill I introduced to finally get us to that goal.
H.R. 2000, the Medicare-X Choice Act establishes a public
option plan available for purchase on an individual and small
businesses exchange. I want to thank my colleagues
Representatives Higgins and Larson for working with me on this
important legislation.
The folks I talk to back home want more coverage options at
lower cost. Importantly, the Medicare-X Choice Act would
deliver by allowing those who are happy with their employer-
provided insurance to keep it, while giving another more
affordable coverage option to those who need it. My bill would
combine the Medicare physician networks and reimbursement rates
with ACA coverage standards to create a new public option
available to all Americans.
The effect of creating a public floor in the private
marketplace would be to drive down premiums and deductibles for
everyone.
Another critical aspect of this legislation addresses the
urgent priority for New York-19 constituents, and those all
across the country, and that is the cost of prescription drugs.
As we all know, currently Medicare is unable to negotiate drug
prices with the pharmaceutical industry--a travesty. And my
bill will change this by allowing for such negotiation through
Medicare Part D, and these prices would carry over to Medicare-
X.
Lastly, my bill would expand access to premium tax credits
to those beyond the 400 percent of the federal poverty line,
the current threshold for premium assistance under the ACA.
With this bill we are introducing more choice and more
competition to the marketplace, starting in the places that
need it most, like rural areas, without provider shortages.
Our constituents expect us to take on the big issues
impacting their lives, not shy away from the hard decisions.
Lowering the cost of healthcare should not be partisan. Taking
on the skyrocketing costs of prescription drugs should not be a
divisive issue. I am here to be a part of the solution. I
encourage my colleagues to cosponsor the Medicare-X Choice Act
and join me in urging consideration of this bill to achieve
universal coverage.
I thank my colleagues again for the opportunity to talk
about this issue that I care so deeply about; and yield back
the balance of my time.
[The prepared statement of Mr. Delgado follows:]
Prepared Statement of Hon. Antonio Delgado
First, thank you to Chairwoman Eshoo and Ranking Member
Burgess for the opportunity to speak about a priority essential
to my community.
It's unacceptable that the United States, the richest
country in the world, is the only developed one without a
universal healthcare system. This is one of the top reasons I
came to Congress, and I'm proud to be here today to share with
you all a bill I introduced to finally get us to that goal.
H.R. 2000, the Medicare-X Choice Act, establishes a public
option health plan available for purchase on the individual and
small business exchanges. I want to thank my colleagues
Representatives Higgins and Larson for working with me on this
important legislation.
The folks I talk to back home want more coverage options at
lower costs. Importantly, the Medicare-X Choice Act would
deliver by allowing those who are happy with their employer-
provided insurance to keep it, while giving another, more
affordable coverage option to those who need it.
My bill would combine Medicare physician networks and
reimbursement rates with ACA coverage standards to create a
new, public option available to all Americans. The effect of
creating a public floor in the private marketplace would be to
drive down premiums and deductibles.
Another critical aspect of this legislation addresses an
urgent priority for New York's 19th District--cost of
prescription drugs.
Currently, Medicare is unable to negotiate drug prices with
the pharmaceutical industry--a travesty. My bill will change
this by allowing for such negotiation through Medicare Part D--
and these prices would carry over to Medicare-X.
Lastly, my bill would expand access to premium tax credits
to those beyond the 400% of the federal poverty line, the
current threshold for premium assistance under the ACA.
With this bill, we're introducing more choice and more
competition to the marketplace, starting in the places that
need it most--like rural areas with provider shortages.
Our constituents expect us to take on the big issues
impacting their lives--not shy away from the hard decisions.
Lowering the cost of healthcare should not be partisan.
Taking on the skyrocketing cost of prescription drugs should
not be a divisive issue.
I'm here to be part of the solution. I encourage my
colleagues to co-sponsor the Medicare-X Choice Act and join me
in urging consideration of this bill to achieve universal
coverage.
I thank my colleagues again for the opportunity to talk
about a topic I care so deeply about and I yield back the
balance of my time.
Ms. Eshoo [presiding]. Thank you. We thank the gentleman
for making time to be here today. And congratulations on your
legislation. And today is all about welcoming the ideas that
members have. So thank you, we will do that.
Mr. Delgado. Thank you.
Ms. Eshoo. Your passion for the subject matter is more than
self-evident.
Mr. Delgado. Yes.
Ms. Eshoo. Dr. Burgess.
Mr. Burgess. May I just ask a question, Mr. Delgado?
Mr. Delgado. Absolutely.
Mr. Burgess. What is the geographic distribution of New
York-19? Where is it?
Mr. Delgado. Oh, I am happy to talk about my district. It
is nearly 8,000 square miles about two-and-a-half hours north
of New York City. It includes the Hudson Valley and the
Catskills.
It is the third most rural seat of any Democrat in Congress
in the eighth in the entire country. It is made up of the best
collection of small cities and big towns in the country. I
believe the largest population center is Kingston in Ulster
County, which is only about 25,000 people. So that is why it is
one of the more rural seats. A land of plentiful dairy farms,
fruit and vegetable farms, Delaware River, one of the best
trout fisheries in the country, along with the Hudson River and
the beautiful Catskill Mountains.
Come on by.
Mr. Burgess. Maybe we ought to do a field hearing.
Ms. Eshoo. It sounds like we need to travel to your
district.
Mr. Delgado. Hey, it is God's country.
Ms. Eshoo. It is, yes. The whole country is God's country,
yes.
Mr. Burgess. You heard Ms. DeLauro talk about her issue, as
I mentioned, the Medicare for All was just discussed in the
rules Committee, but I believe we need to have a major hearing
in this committee and would--I am not the chairman so I can't
welcome you to come back, but I will bet there would be a
favorable disposition to hear your ideas and----
Mr. Delgado. Appreciate that.
Mr. Burgess [continuing]. Perhaps to have, to have that
included in the whatever, whatever the healthcare hearing looks
like when we do get around to doing that in this committee. I
feel certain we shall, I just don't know when.
Thank you for bringing those ideas. Again, we would
probably disagree about a number of things but, nevertheless,
you deserve, it deserves to be heard. Thank you.
Mr. Delgado. Much appreciated. Thank you.
Ms. Eshoo. Thank you, colleagues, Mr. Delgado.
Now it is a pleasure to recognize and welcome Congressman
Keller from the great state of Pennsylvania. Welcome.
OPENING STATEMENT OF HON. FRED KELLER, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA
Mr. Keller. Thank you, Chairwoman. And thank you, Ranking
Member. I would also like to thank the members of the committee
for allowing me to testify about the importance of
Pennsylvania's natural gas industry.
Pennsylvania's natural gas has far-reaching economic and
geopolitical benefits, both to the Commonwealth of Pennsylvania
and the United States. The record is clear, domestic natural
gas production strengthens our communities and makes our
country safer. Pennsylvania's natural gas industry supports
more than 300,000 jobs, contributes $45 billion to the
commonwealth's economy, and saves the average household $1,100
per year in energy costs. This means more financial security
for families, making day to day life more affordable.
The success of natural gas in Pennsylvania and across the
United States has completely shifted long-term thinking about
American energy policy and our role in the global energy
marketplace. Not long ago the United States was an energy--was
energy dependent, relying on foreign adversaries to meet our
energy goals. That's no longer the case.
Thanks in large part to our nation's robust supply of
natural gas, paired with a strong economy, American energy
production has significant implications for our national
security and our relationships abroad. For the first time in
six decades, the United States is a net natural gas exporter.
We can now use our energy exports as leverage in our foreign
policy, giving our allies flexibility while diminishing the
influence of unfriendly nations.
Natural gas production is also environmentally sound.
Natural gas is the cleanest and lowest carbon-emitting fossil
fuel and has helped the United States to reduce carbon
emissions by more than any other country. Pennsylvania has
reduced carbon emissions by 30 percent in the last 10 years,
mostly because of increased use of natural gas fired electric
generation.
We have a great opportunity to create some good-paying
jobs, lower energy costs, and expand America's role as a global
economic leader. To continue with this success, we must do more
at the federal level. I am committed to supporting policies
that allow the natural gas industry to grow and expand into new
markets. Unfortunately, some states are abusing the state
environmental permitting costs to stop critical pipeline
infrastructure.
Just last year, New England imported natural gas from
Russia because infrastructure cannot pass through New York. It
is absurd that an individual state can threaten our national
security and interfere with interstate commerce. I look forward
to working to stop these abuses, allow companies to transport
gas to market, and strengthen our national security.
Again, I would like to thank the chairman, the ranking
member, and the members of this committee for allowing me to
speak about the importance of natural gas for our nation's
economy, the environment, and our national security.
Thank you. I yield back.
[The prepared statement of Mr. Keller follows:]
Prepared Statement of Hon. Fred Keller
Good afternoon and thank you for the opportunity to speak
about the importance of Pennsylvania's natural gas industry.
Pennsylvania's natural gas industry has far-reaching
economic and geo-political benefits, both to the Commonwealth
of Pennsylvania and the United States as a whole.
The record is clear: Domestic natural gas production
strengthens our communities and makes our country safer.
In Pennsylvania, the natural gas industry supports more
than 300,000 jobs, contributes $45 billion to the
commonwealth's economy, and saves the average household $1,100
every year in energy costs.
This means more financial security for families, making
day-day life more affordable.
The success of the natural gas industry in Pennsylvania and
across the United States has completely shifted long-term
thinking about American energy policy and our role in the
global energy marketplace.
Not long ago, the United States was energy dependent,
relying on foreign adversaries to meet our energy needs.
That's no longer the case, thanks in large part to our
nation's robust supply of natural gas.
Paired with a strong economy, American energy production
has significant implications for our national security and our
relationships abroad.
For the first time in six decades, the United States is a
net natural gas exporter.
We can now use our energy exports as leverage in our
foreign policy, giving our allies flexibility, while
diminishing the influence of unfriendly nations.
Natural gas production is also environmentally sound.
Natural gas is the cleanest and lowest carbon emitting
fossil fuel and has helped the United States to reduce carbon
emissions by more than any other country.
Pennsylvania has reduced carbon emissions by 30 percent in
the last 10 years, mostly because of increase use of natural
gas fired electric generation.
We have a great opportunity to create more good-paying
jobs, lower energy costs, and expand America's role as a global
economic leader.
To continue with this success, we must do more at the
federal level.
I am committed to supporting policies that allow the
natural gas industry to grow and expand into new markets.
Unfortunately, some rogue states are abusing state
environmental permitting processes to stop critical pipeline
infrastructure.
Just last year, New England imported natural gas from
Russia because infrastructure cannot pass through New York.
It is absurd that individual states can threaten our
national security and interfere with interstate commerce.
I look forward to working to stop these abuses, allow
companies to transport gas to market, and strengthen our
national security.
Again, thank you to Chairman Pallone, Ranking Member
Walden, and the members of this committee for allowing me to
speak about the importance of natural gas for our nation's
economy and national security.
Ms. Eshoo. Thank you, Mr. Keller, for your excellent
testimony.
What part of the overall energy portfolio of your state is
represented by natural gas? Do you know?
Mr. Keller. The natural gas, we actually have our energy
portfolio standards. And currently right now there is probably
up to 20 percent that is renewables. Up to that. That is by
2025.
Actually, in Pennsylvania I did do some legislation to help
solar energy production in Pennsylvania, so that, that is one
thing I worked at at the state level. Natural gas is probably I
am going to say 35 percent or between 35 and probably 45
percent, just off the top of my head, as I remember it. Nuclear
energy is big in Pennsylvania. We are one of the states that
has--largest states for nuclear production also.
Ms. Eshoo. Thank you very much.
Dr. Burgess.
Mr. Burgess. Thank you. And thanks for your testimony. When
I first started on this committee in 2005, we had hearings
about how America was running out of natural gas and the crisis
that was developing because of that. So the fertilizer people
were saying we don't have the feed stock to create the
fertilizer that we need to have the harms to grow the corn that
we need to provide the ethanol.
And then it all changed with horizontal drilling, hydraulic
fracturing, as you know well. And we have now become a net
energy exporter. And there are geopolitical implications. A
country that used to be entirely dependent upon the former
Soviet Union for their energy now have another source for that,
and that would be the more friendly United States of America.
So it really has been just in the brief time that I've been
on this committee the world literally has changed, and it has
changed because of the ability to produce and, as you point
out, move natural gas from the point of its origin to the point
where it is consumed.
It is an important part of our energy infrastructure. It is
an important part of our economy. And you are correct to be
focused on it. And we need to maintain that focus as well.
So thank you.
Mr. Keller. I appreciate that concern. You know, when you
look at, when you look at natural gas, it lowers energy costs
for families. So, families that are lower income families, it
helps them.
It has also helped the Commonwealth of Pennsylvania. They
had an $800 million surplus in the past budget cycle. So it has
helped the Commonwealth of Pennsylvania, and I think it can
help our nation just as well as it helped the commonwealth.
Thank you.
Mr. Burgess. I think Representative DeLauro spent that on
her healthcare.
Mr. Keller. Excuse me?
Mr. Burgess. I am just kidding. I am just kidding. I said I
think she spent your surplus.
Mr. Keller. OK. Well, I think we can spend it ourselves in
Pennsylvania pretty well. Thank you.
Ms. Eshoo. Thank you. It is a pleasure to welcome and
recognize our colleague from Texas, the Honorable Vicente
Gonzalez.
Mr. Gonzalez. Thank you.
Ms. Eshoo. And who just, I just want my colleagues to know,
a week ago--it was a week ago. Oh, it is almost----
Mr. Gonzalez. Right.
Mr. Gonzalez [continuing]. Two weeks ago now. Hosted a
congressional delegation in his district in Texas. And we
appreciate what you did for us.
Mr. Gonzalez. Thank you.
Ms. Eshoo. It was more than an eye-opener. And your
hospitality is so gracious, warm and welcoming. Thank you.
So, you are recognized.
Mr. Gonzalez. It was a pleasure having you.
Ms. Eshoo. You have 5 minutes----
Mr. Gonzalez Thank you.
Ms. Eshoo [continuing]. To present your ideas to us.
Mr. Gonzalez. Thank you. And I am here on a different
issue. But as a Texan and as chairman of the Oil and Gas Caucus
for the Democratic party, I agree with everything Congressman
Keller had to say.
Ms. Eshoo. I saw you nodding.
Mr. Gonzalez. It is shameful to see----
Ms. Eshoo. I noticed that you were nodding, yes.
Mr. Gonzalez. It is shameful to see a Russian vessel
plugged into a terminal in New England selling us Russian gas.
Ms. Eshoo. Oh my God.
OPENING STATEMENT OF HON. VICENTE GONZALEZ A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS
Mr. Gonzalez. But thank you, Chairwoman, and thank you,
Ranking Member, for having us and allowing me to testify before
you about the importance of including direct and indirect
remuneration, or DIR fee reform in your discussion on how to
best lower prescription drug prices. These price concessions
are imposed on community pharmacists serving Medicare Part D
patients by plan sponsors and their pharmacy benefit managers,
or PBMs.
Rather than including these concessions at the point of
sale, these retroactive fees are taken back from pharmacies
months after the sale has taken place, exploiting patients, the
government, and our community pharmacies. I can't think of any
other business in the world that, that would require, would be
required to sell a product to a consumer without knowing what
it costs themselves.
These unpredictable fees increase patient cost sharing for
drugs, pushing them into coverage gaps, better known as the
donut hole, and accelerating their approach to the catastrophic
phase, increasing Medicare spending at the expense of
taxpayers. These fees are costing taxpayers, patients and small
business money, and are, most importantly, not contributing to
improved patient outcome.
I think we can all agree that without prices that make
these lifesaving drugs accessible, innovation for the sake of
innovation is not why we were sent to Congress. I am thankful
for this committee's promises to lowering prescription drug
prices. I think the American people are reliant on you. I
commend you all for your bipartisan consideration and the
passage of H.R. 2296, the More Efficient Tools to Realize
Information for Consumers Act, or the METRIC Act, which
requires for price concessions to include DIR fees to be
reported to the Secretary of HHS, along with other pricing
documentation.
Given your consideration of H.R. 2296, I ask that the
committee consider H.R. 1034, the Fair Pricing Act of 2019,
introduced by myself and Congressman Doug Collins of Georgia.
Mr. Collins and I have worked with Mr. Welch, Mr. Carter, and
Mr. Griffith to ensure that DIR fee reform is included in
efforts to lower the costs of prescription drugs.
The Fair Pricing Act seeks to reduce prescription drug
costs by--for seniors by bringing all negotiated price
concessions at the point of sale. I can't think of anything
that makes more sense. Ensuring savings are passed on to
patients, that our community pharmacists--and that our
community pharmacists are not taken advantage of through DIR
fees or indirect remuneration.
The Fair Pricing Act also defines standard quality measures
and sets criteria by which they are developed and applied to
pharmacies. Addressing these fees would not only refocus an
important part of our drug supply chain to improve patient
health, but combat the financial uncertainty that these small
businesses face, enabling them to continue serving Medicare
beneficiaries.
I look forward to working with this committee, the Centers
for Medicare and Medicaid Services, our Senate colleagues, and
the President to address these fees that are hurting our
seniors, our small businesses, and our taxpayers. We are seeing
our community pharmacies across the country disappear.
Again, I thank you for all your leadership in lowering the
costs of prescription drugs and ensuring that these policies
address the role of PBMs that they are playing increasing costs
of medications that our seniors are taking or that the American
people are taking. I thank you for taking this issue up in such
an important fashion, and I thank you for your time.
I yield back.
[The prepared statement of Mr. Gonzalez follows:]
Prepared Statement of Hon. Vicente Gonzalez
Chairman Pallone, Ranking Member Walden, and members of the
committee
Thank you for allowing me to testify before you about the
importance of including direct and indirect remuneration, or
DIR fee reform, in your discussion on how to best lower
prescription drug prices.
These price concessions are imposed on community pharmacies
serving Medicare Part D patients by plan sponsors and their
Pharmacy Benefit Managers, or PBMs.
Rather than including these concessions at the point of
sale, these retroactive fees are taken back from pharmacies
months after the sale has taken place, exploiting patients, the
government, and community pharmacies.
These unpredictable fees increase patient cost sharing for
drugs, pushing them into the coverage gap, better known as the
donut hole, and accelerating their approach to the catastrophic
phase--increasing Medicare spending at the expense of
taxpayers.
These fees are costing taxpayer, patients, and small
businesses money and are, most importantly, not contributing to
improved patient outcomes.
I think we can all agree than without prices that make
these lifesaving drugs accessible, innovation for the sake of
innovation is not why we were sent to Congress.
I am thankful for this committee's promise to lowering
prescription drug prices.
I commend you all for your bipartisan consideration, and
passage of H.R. 2296, the``More Efficient Tools to Realize
Information for Consumers Act,'' or the ``METRIC Act,'' which
requires for price concessions, including DIR fees to be
reported to the Secretary of HHS along with other pricing
documentation.
Given your consideration of H.R. 2296, I ask that the
Committee consider H.R. 1034, the PHAIR Pricing Act of 2019,
introduced by myself and Congressman Doug Collins of Georgia.
Mr. Collins and I have worked with Mr. Welch, Mr. Carter,
and Mr. Griffith to ensure that DIR fee reform is included in
efforts to lower the cost of prescription drugs.
The Phair Pricing Act seeks to reduce prescription drug
costs for seniors by bring all negotiated price concessions to
the point of sale--ensuring savings are passed on to patients
and that our community pharmacists are not taken advantage of
through Direct and Indirect Remuneration (DIR) Fees.
The Phair Pricing Act also defines standard quality
measures and sets criteria by which they are developed applied
to pharmacies.
Addressing these fees would not only refocus an important
part of our drug supply chain to improve patient health, but
combat the financial uncertainty these small businesses face,
enabling them to continue serving Medicare beneficiaries.
I look forward to working with this committee, the Centers
for Medicare and Medicaid Services, our Senate colleagues, and
the President to address these fees that are hurting our senior
citizens, small businesses, and our taxpayers.
Again, I thank you all for your leadership in lowering the
cost of prescription drugs and ensuring that future policies
address the role PBMs play in increasing costs.
Thank you for this time.
Ms. Eshoo. I thank the gentleman. We did, we have taken up
some legislation that tracks some of the elements of your
legislation relative to manufacturers, PBMs, the discounts that
are negotiated. And they say that those discounts move on to
the providers, and that the patients win because their premiums
are lowered.
I don't think the committee really went for that, that
notion. But that is really the outcome.
Mr. Gonzalez of Texas. I am glad they didn't.
Ms. Eshoo. And so, what you have is one of the, you know,
the basic values of your legislation I think on a bipartisan
basis the committee agrees with. Yours very directly goes to
Part D, and that is where the money is.
Mr. Gonzalez of Texas. Right. Our pharmacies----
Ms. Eshoo. And so I think that----
Mr. Gonzalez of Texas [continuing]. Need to have certainty
that whatever they are selling----
Ms. Eshoo. They do.
Mr. Gonzalez of Texas [continuing]. They know what it costs
them themselves. And right now we don't have that.
Ms. Eshoo. And we are very fortunate, because the only
pharmacist in the entire House of Representatives is the
gentleman from Georgia, Mr. Carter.
Did you want to say something? Yes, you are recognized.
Mr. Carter. Mr. Gonzalez, thank you, Representative. I
appreciate this very much. And you are spot on. And I just want
to thank you for bringing this to the committee's attention.
And, Madam Chair, I wanted to ask, Congressman Doug
Collins, who is one of the primary sponsors of the FAIR Act is
unable to be here, but I wanted to ask unanimous consent to
submit his letter for to be included in the record.
Ms. Eshoo. Without objection.
[The information appears at the conclusion of the hearing.]
Mr. Carter. And also, earlier this year the CMS had
proposed a rule about DIR fees that, unfortunately, did not,
was not finalized. And we, along with Representative Gonzalez,
Peter Welch and Morgan Griffith, members of our committee and,
in fact, there were 20 members of the Energy and Commerce
Committee as well as over 100 other Members of Congress who
signed this letter to the President expressing our
disappointment.
And I wanted to add that as part of the record and ask
unanimous consent.
Ms. Eshoo. Without objection.
[The information appears at the conclusion of the hearing.]
Mr. Carter. Thank you. And thank you again, Representative.
Mr. Gonzalez of Texas. Thank you.
Ms. Eshoo. Dr. Burgess.
Mr. Burgess. I'm smart enough to not get between Buddy
Carter and DIR fees.
Mr. Gonzalez of Texas. It is some slippery stuff, which is
part of the problem; right?
Mr. Burgess. So, I just, and I agree with what Mr. Carter
said, but I also wanted to point out I have visited your
district a number of times over the years, a lovely district.
And the doctors at Renaissance Hospital is certainly one of the
gems of the medical delivery model in this country. So----
Mr. Gonzalez of Texas. They are. Thank you.
Mr. Burgess [continuing]. H.R. 3062, which would allow for
continuation and expansion of physician-held hospitals is a
cause that I now carry with the retirement of Sam Johnson from
our state.
Mr. Gonzalez of Texas. Thank you. And I support you on
that.
Mr. Burgess. It is, it is an important concept. They do a
great job down there. Always enjoy it every time I get to visit
their campus. And they do a lot of work on the border health
problem.
Mr. Gonzalez of Texas. Would love to have you back.
Mr. Burgess. Again, I am not a frequent flyer, but still I
have been, I have been through McAllen Airport enough times
that I know, I know where the best restaurants are.
Mr. Gonzalez of Texas. Yes.
Mr. Burgess. Well, there is only one. But anyway.
Mr. Gonzalez of Texas. Thank you.
Mr. Burgess. Thank you for your, for your presentation
today.
Mr. Gonzalez of Texas. A pleasure.
Ms. Eshoo. And he hosted us at one. So, it was wonderful. I
am still full.
Thank you. Thank you. We will work with you.
Now we have the pleasure of recognizing the Honorable
Stacey Plaskett, the delegate from the Virgin Islands. You have
5 minutes. And this is the second time we are meeting today,
the two of us.
OPENING STATEMENT OF HON. STACEY PLASKETT A REPRESENTATIVE IN
CONGRESS FROM THE TERRITORY OF THE VIRGIN ISLANDS
Ms. Plaskett. Yes.
Ms. Eshoo. And I think that you are going to raise some of
the issues that we spoke to. And look forward to your
testimony. Welcome and thank you.
Ms. Plaskett. Thank you, Madam Chairwoman Eshoo. And Mr.
Burgess, thank you as well, and to the committee for allowing
many of the members the opportunity to present brief statements
about our views on some of the areas that this committee deals
with.
I would like to use this time in particular to speak about
healthcare concerns on the island territories in the United
States. You know that we all need significant investment in
healthcare in this section. Even before the severe natural
disasters of the last two years the healthcare systems in the
territories were under great distress.
Specifically regarding Medicaid, the arbitrarily high local
match required of territories under Medicaid impose severe and
unsustainable financial demands on the territories. Each of us
have tried to resolve these very differently and has had little
success in doing so up until now.
Up to 30 percent of the population of my district could
lose access to healthcare unless Congress takes action to
eliminate the fiscal cliff that we know we are facing due to
Medicaid. And Congress must act to prevent this potentially
calamity before September 30th.
I am so grateful that this committee has really taken on
that task and has taken action to address that cliff by moving
legislation, H.R. 2328, the REACH Act, which includes the
language of Mr. Soto's bill, the Territories Health Care
Improvement Act, to provide an additional stream of Medicaid
funds for the Virgin Islands and other territories from fiscal
year 2020 to fiscal 2025.
Under this bill, for my district, the Virgin Islands, the
Medicaid cap would be increased by an overall $756 million over
six years. The rate of federal matching funds for Medicaid in
the Virgin Islands would also be raised temporarily at 100
percent for fiscal year 2020, 83 percent for fiscal years 2021
through 2024, and 76 percent in fiscal year 2025. Without this
additional funding stream and at least another year of waiver
for any local match required for Medicaid, the resulting
Medicaid cuts would put healthcare delivery at risk not only
for Medicaid recipients on our islands, but actually for the
population at large.
Due to the large amount of individuals on Medicaid, our
hospitals and other systems are solely dependent on Medicaid
revenue, which help us to understand how lost Medicaid revenues
would hurt healthcare providers in private practice as well.
And I have to say that I am so appreciative of this
legislation. I would respectfully request, however, that the
Virgin Islands have the ability to carry over any unspent
funding provided in any given fiscal year to a later fiscal
year in order to improve the flexibility in the way dollars are
able to flow, and to better ensure that the beneficiaries will
see the services they need in full, for the full entirety of
the bill's 6-year period.
Lastly, I would also like to highlight healthcare needs of
the territories that fall outside of the Medicaid funding
cliff.
Even before the 2017 hurricane, the Virgin Islands' two
hospitals, publicly owned, have been excluded from the Medicaid
disproportional share for hospitals, or DISH program, in spite
of disproportionate amount of care provided to low-income
patients. The exclusion of all of the territories from Medicaid
DISH, and the small territories from Medicare DISH--Puerto Rico
receives a Medicare DISH--had major health issues in the
territories for many years, resulting in significant
uncompensated care costs, burdens on providers, hospitals,
local government across the islands.
If you talk with the hospitals, this in many ways
necessitated the reason why we had the type of destruction we
did within our hospitals, where a hospital provides, the
hospital had to make a decision are we going to pay our doctors
or are we going to get a new roof put on our hospitals? We lost
both of our public hospitals in the storm in 2017, and are
awaiting modulars now while we are primarily doing triage care
and having people medevaced out for any long-term care in the
Virgin Islands.
We have two emergency rooms on each island that are
operational, which is very, very precarious situation to be in.
I have sponsored legislation, joined by my colleagues from
the territories, and others, to correct inequities we face
under all of the federal health programs. By eliminating the
Medicaid cap, providing for fair inclusion of the territories
in Medicaid and Medicare, as well as other issues. It also
tries to address Medicare Part D low-income subsidy programs,
and address exclusion from the healthcare insurance exchange
program under the Affordable Care Act.
I recognize that my time is over. That is under legislation
in this session, H.R. 1354, the Territories Health Equity Act
of 2019. We confront difficulty, difficult reality living in
the territories. U.S. citizens have been neglected and allowed
to fall behind. I trust that this committee sees the importance
of this and is willing to work with us to resolve these issues.
Thank you.
[The prepared statement of Ms. Plaskett follows:]
Prepared Statement of Hon. Stacey Paskett
Thank you to the chair and ranking member, and members of
the committee, for allowing me the opportunity to present a
brief statement of my views on the work of this committee in
the 116th Congress. I would like to use my time to speak in
particular about healthcare concerns of the island territories
in the United States.
The territories will need significant investments in
healthcare in this session. Even before the severe natural
disasters of the last two years, the healthcare systems in the
territories were under great stress.
Specifically, regarding Medicaid, the arbitrarily high
local match required of U.S. territories under Medicaid imposes
severe and unsustainable financial demands on the territories.
Each of the territories have tried to resolve this very
differently and have had little success in doing so up until
now.
In addition, while overall federal Medicaid funding to the
States and the District of Columbia is open-ended, Medicaid in
the territories is subject to annual federal funding caps. Once
the cap is reached, the territory must assume the full cost of
Medicaid services.
While the capped federal funding has been supplemented by
additional Affordable Care Act block grants since 2011, the
Virgin Islands and all other territories face the so-called
fiscal cliff on September 30th of this year when these
Affordable Care Act allotments expire.
Up to 30 percent of my district could lose access to
healthcare unless Congress takes action to eliminate the
Medicaid fiscal cliff. Congress must act to prevent to this
potential calamity before September 30th.
I am grateful that this committee has taken action to
address the Medicaid cliff by moving legislation, H.R. 2328,
the REACH Act, which includes the language of Mr. Soto's bill,
the Territories Health Care Improvement Act, to provide an
additional stream of Medicaid funds for the Virgin Islands and
the other territories from fiscal year 2020 through fiscal year
2025.
Under this bill, for my district, the Virgin Islands, the
Medicaid cap would be increased by an overall $756 million over
six years ($126 million in each of fiscal years 2020 through
2025). The rate of federal matching funds for Medicaid in the
Virgin Islands would also be raised, temporarily, to 100% for
fiscal 2020, 83% from fiscal 2021 to 2024, and 76% in fiscal
2025.
Without this additional funding stream, and at least
another year of a waiver for any local match required under
Medicaid, the resulting Medicaid cuts would put healthcare
delivery at risk; not only for Medicaid recipients on our
islands, but also for the population at large. Due to the
relatively large number of individuals on Medicaid, our
hospitals and other systems depend on Medicaid revenue.
Therefore, the loss of Medicaid revenue resulting from the
fiscal cliff would hurt healthcare providers in private
practice as well. Using 2018 data for the Virgin Islands,
Medicaid funding would go from roughly $70 million to just $18
million. The islands cannot suffer cuts like that and continue
to deliver services. Significantly more funding is needed, and
at a far more equitable matching rate.
While I am very appreciative of the committee's approval of
the Territories Health Care Improvement Act, I respectfully
request that the Virgin Islands have the ability to carry over
any unspent funds provided in any given fiscal year to a later
fiscal year in order to improve flexibility in the way dollars
are able to flow, and to better ensure that the beneficiaries
will see the services they need for the full entirety of the
bill's six-year period.
Lastly, I would like to highlight healthcare needs of the
territories that fall outside of the Medicaid funding cliff.
Even before the 2017 hurricanes, the Virgin Islands' two
hospitals, publicly owned, have been excluded from the
disproportional share hospital (or ``DSH'') program, despite
the disproportionate amount of care provided to low income
patients. The exclusion of all of the territories from Medicaid
DSH, and the small territories from Medicare DSH (Puerto Rico
receives Medicare DSH), has been a major health issue in the
territories for many years; resulting in significant
uncompensated care cost burdens on providers, hospitals, and
local government finances across all of the islands.
These uncompensated care costs, in many ways, were a major
reason why the hospitals experienced the extent of their
destruction in the event of disaster. For a very long time, the
hospitals have been forced to make choices like whether to pay
doctors and nurses or to fix a roof. The hospitals in the
Virgin Islands are still waiting for modular structures to come
online, while primarily doing triage care, and having people
evacuated out for any long-term care. The hospital on St. Croix
has only one operating room. Both hospitals remain in a very
precarious situation nearly two years after the 2017
hurricanes.
I have sponsored legislation, H.R.1354, the Territories
Health Equity Act of 2019, joined by my colleagues from the
territories, and others, to correct the inequities faced by the
territories across all of the federal health programs. The bill
eliminates the Medicaid funding caps and provides for fair
inclusion of the territories in Medicaid and Medicare DSH. It
also improves the treatment of the territories in the Medicare
Part D low income subsidy program, and addresses their
exclusion from the health insurance exchange program under the
Affordable Care Act.
Regarding the Affordable Care Act, I have long been
dismayed that it was underinclusive of U.S. territories. My
bill would allow residents of the territories (where there are
no Affordable Care Act insurance marketplaces) who lack
employer-provided healthcare to access marketplace insurance
plans offered to Members of Congress and congressional staff.
We must confront the difficult reality that Americans
living in the territories are U.S. citizens that have been
neglected and allowed to fall behind. I trust that this
committee sees the importance of this and is willing to work
with us to resolve these issues. Thank you.
Ms. Eshoo. Well, I thank you, Stacey, very much. I think on
the first issue that you raised relative to rolling over of the
funds, I already spoke to Mr. Pallone about that. And we look
to be helpful to you. And I don't see any reason why funds
can't be, unused funds from one fiscal year can't be rolled
into another.
The DISH issue, as I said to you today earlier, is a larger
one. But we appreciate what you said about the work that we
have done together. I think that there is a sense of pride here
on the committee on both sides of the aisle, and we saw an
expansion of the commitment to the territories. We will keep
working together and before the legislation goes to the full
House post August recess.
So thank you. Dr. Burgess?
Ms. Plaskett. Thank you. We love that there is an August
recess.
Ms. Eshoo. Yes. Yes.
Ms. Plaskett. We get to work on this. Thank you so much.
Ms. Eshoo. For many reasons, right. Thank you, and have a
good one. And thank you for being here today. I am glad that I
mentioned it to you, yes, and that you took us up on it.
The Chair requests unanimous consent to enter the following
into the record: Joint testimony of Mr. Cummings and Mr.
Ruppersberger of Maryland; joint testimony of Mr. Kelly of
Pennsylvania and Ms. Kaptur of Ohio on behalf of the House
Congressional Auto Caucus; testimony of Mr. Raskin of Maryland;
testimony of Mr. Engel of New York; testimony of Mr. Gomez of
California; testimony of Ms. Moore of Wisconsin; testimony of
Mr. Payne, New Jersey; testimony of Mr. Briggs of Arizona;
testimony of Mr. Swalwell of California; testimony of Mr. Smith
of New Jersey, and; testimony of Mr. Cisneros of California.
Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Ms. Eshoo. And is there anything that you would like, Dr.
Burgess?
Mr. Burgess. We will do it again real soon.
Ms. Eshoo. OK. I want to thank the Members, most especially
Dr. Burgess here for the participation in today's hearing,
Members Day--Member Day. I think that we learned a lot, have
much to appreciate in what they brought forward, and even more
work to do with the committee to help meet the needs that they
have in their congressional districts. So, we are grateful to
all.
And at this time, the committee is adjourned.
[Whereupon, at 3:51 p.m., the committee was adjourned.]
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