[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]


                   HEALTHCARE INEQUALITY: CONFRONTING RACIAL 
                    AND ETHNIC DISPARITIES IN COVID-19 AND 
                    THE HEALTHCARE SYSTEM

=======================================================================

                            VIRTUAL HEARING

                               BEFORE THE

                         SUBCOMMITTEE ON HEALTH

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                               __________

                             JUNE 17, 2020

                               __________

                           Serial No. 116-114


      Printed for the use of the Committee on Energy and Commerce
      
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]      

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                        energycommerce.house.gov
                        
                              __________

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
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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
                                 ------                                

                           Professional Staff

                   JEFFREY C. CARROLL, Staff Director
                TIFFANY GUARASCIO, Deputy Staff Director
                MIKE BLOOMQUIST, Minority Staff Director
                         Subcommittee on Health

                       ANNA G. ESHOO, California
                                Chairwoman
ELIOT L. ENGEL, New York             MICHAEL C. BURGESS, Texas
G. K. BUTTERFIELD, North Carolina,     Ranking Member
    Vice Chair                       FRED UPTON, Michigan
DORIS O. MATSUI, California          JOHN SHIMKUS, Illinois
KATHY CASTOR, Florida                BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland           H. MORGAN GRIFFITH, Virginia
BEN RAY LUJAN, New Mexico            GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon                BILLY LONG, Missouri
JOSEPH P. KENNEDY III,               LARRY BUCSHON, Indiana
    Massachusetts                    SUSAN W. BROOKS, Indiana
TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
PETER WELCH, Vermont                 RICHARD HUDSON, North Carolina
RAUL RUIZ, California                EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan             GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire         GREG WALDEN, Oregon (ex officio)
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
LISA BLUNT ROCHESTER, Delaware
BOBBY L. RUSH, Illinois
FRANK PALLONE, Jr., New Jersey (ex 
    officio)
                             
                             C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Anna G. Eshoo, a Representative in Congress from the State 
  of California, opening statement...............................     2
    Prepared statement...........................................     3
Hon. Michael C. Burgess, a Representative in Congress from the 
  State of Texas, opening statement..............................     4
    Prepared statement...........................................     6
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     7
    Prepared statement...........................................     9
Hon. Greg Walden, a Representative in Congress from the State of 
  Oregon, opening statement......................................    10
    Prepared statement...........................................    12
Hon. Eliot L. Engel, a Representative in Congress from the State 
  of New York, prepared statement................................   110

                               Witnesses

Rhea Boyd, M.D., M.P.H., Pediatrician and Child Health Advocate,.    14
    Prepared statement...........................................    16
    Answers to submitted questions...............................   261
Oliver T. Brooks, M.D., President, National Medical Association..    34
    Prepared statement...........................................    37
    Answers to submitted questions...............................   275
Avik S. A. Roy, President, Foundation for Research on Equal 
  Opportunity....................................................    42
    Prepared statement...........................................    44
Answers to submitted questions\1\

                           Submitted Material

Statement of June 17, 2020, by Asian & Pacific Islander American 
  Health Forum, submitted by Ms. Eshoo...........................   112
Statement of June 17, 2020, by Association of American Medical 
  Colleges, submitted by Ms. Eshoo...............................   123
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, by LaVarne 
  A. Burton, President and Chief Executive Officer, American 
  Kidney Fund, submitted by Ms. Eshoo............................   133
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, by Monica 
  M. Bertagnolli, M.D., Chair of the Board, Association for 
  Clinical Oncology, submitted by Ms. Eshoo......................   136
Report of June 16, 2020, ``Race gaps in COVID-19 deaths are even 
  bigger than they appear'', by Tiffany Ford, et al., submitted 
  by Ms. Eshoo...................................................   138
Statement from the Center for Reproductive Rights, submitted by 
  Ms. Eshoo......................................................   145
Letter of June 10, 2020, to Mr. Hahn, from Alliance of 
  Multicultural Physicians, submitted by Ms. Eshoo...............   152
Article of April 7, 2020, ``Communities of Color at Higher Risk 
  for Health and Economic Challenges Due to COVID-19'', from 
  Kaiser Family Foundation, submitted by Ms. Eshoo...............   157
Report on June 16, 2020, from the Robert Wood Johnson Foundation, 
  submitted by Ms. Eshoo.........................................   167

----------
\1\ Mr. Roy did not answer submitted questions for the record by 
  the time of publication.
Report on May 2020, ``The Fierce Urgency of Now: Federal and 
  State Policy Recommendations to Address Health Inequities in 
  the Era of COVID-19'', from Families USA, submitted by Ms. 
  Eshoo \2\
Report ``Disparities in Outcomes Among COVID-19 Patients in a 
  Large Health Care System in California'', by Kristen M. J. 
  Azar, et al., Health Affairs Journal, submitted by Ms. Eshoo...   171
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, Jane M. 
  Adams, Vice President, Federal Affairs, Johnson & Johnson 
  Services, Inc., submitted by Ms. Eshoo.........................   179
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, from the 
  National Council of Asian Pacific Americans, submitted by Ms. 
  Eshoo..........................................................   184
Article of April 8, 2020, ``Virus is Twice as Deadly for Black 
  and Latino People Than Whites in N.Y.C.'', from New York Times, 
  submitted by Ms. Eshoo.........................................   193
Article of June 9, 2020, ```The direct result of racism': Covid-
  19 lays bare how discrimination drives health disparities among 
  Black people'', STAT News, submitted by Ms. Eshoo..............   198
Article of June 15, 2020, ``To understand who's dying of Covid-
  19, look to social factors like race more than preexisting 
  diseases'', STAT, submitted by Ms. Eshoo.......................   204
Statement of June 17, 2020, from American Cancer Society Cancer 
  Action Network, submitted by Ms. Eshoo.........................   211
Statement of May 13, 2020, ``President Donald J. Trump is 
  Committed to Providing Support to Undeserved Communities 
  Impacted by the Coronavirus Pandemic'', White House Press, 
  submitted by Ms. Eshoo.........................................   214
Statement of June 11, 2020, ``President Trump unveils vision to 
  rebuild our cities'', White House Press, submitted by Ms. Eshoo   217
Document title ``HHS Initiatives to Address the Disparate Impact 
  of COVID-19 on African Americans and Other Racial and Ethnic 
  Minorities'', from HHS, submitted by Ms. Eshoo.................   219
Statement of June 16, 2020, from Infectious Diseases Society of 
  America's HIV Medicine Association, submitted by Ms. Eshoo.....   223
Report of November 2019, ``Quantifying the Distribution and 
  Completeness of Select Demographic Variables in 2016'', from 
  Center for Medicare and Medicaid Services, submitted by Ms. 
  Eshoo..........................................................   228
Statement of June 17, 2020, from Alzheimer's Association and 
  Alzheimer's Impact Movement, submitted by Ms. Eshoo............   242
Letter of June 17, 2020, to Mr. Pallone, et al., by Scott P. 
  Serota, President and Chief Executive Officer, from the Blue 
  Cross Blue Shield Association, submitted by Ms. Eshoo..........   245
Statement of June 17, 2020, from the Biotechnology Innovation 
  Organization, submitted by Ms. Eshoo...........................   248
Article of June 10, 2020, ``To eliminate health disparities, 
  Parkland must address the root issues in black communities'', 
  Dallas Morning News, submitted by Ms. Eshoo....................   249
Letter of June 15, 2020, to Ms. Eshoo and Mr. Burgess, by Robert 
  W. Carlson, M.D., Chief Executive Office, National 
  Comprehensive Cancer Network, submitted by Ms. Eshoo...........   252
Article of June 17, 2020, ``Frosh: Virus' Unequal Devastation in 
  Communities of Color Must Guide the Response'', Maryland 
  Matters, submitted by Ms. Eshoo................................   254
Statement of June 17, 2020, from American Diabetes Association, 
  submitted by Ms. Eshoo.........................................   257

----------
\2\ The information has been retained in committee files and also 
  is available at https://docs.house.gov/meetings/IF/IF14/
  20200617/110812/HHRG-116-IF14-20200617-SD012.pdf.

 
 HEALTH CARE INEQUALITY: CONFRONTING RACIAL AND ETHNIC DISPARITIES IN 
                  COVID-19 AND THE HEALTH CARE SYSTEM

                              ----------                              


                        WEDNESDAY, JUNE 17, 2020

                  House of Representatives,
                            Subcommittee on Health,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 11:57 a.m., via 
Cisco Webex online video conferencing, Hon. Anna G. Eshoo 
(chairwoman of the subcommittee) presiding.
    Present: Representatives Eshoo, Butterfield, Matsui, 
Castor, Sarbanes, Lujan, Schrader, Kennedy, Cardenas, Welch, 
Ruiz, Dingell, Kuster, Kelly, Barragan, Blunt Rochester, Rush, 
Pallone (ex officio), Burgess (subcommittee ranking member), 
Upton, Shimkus, Guthrie, Griffith, Bilirakis, Bucshon, Brooks, 
Mullin, Hudson, Carter, Gianforte, and Walden (ex officio).
    Also present: Representatives DeGette, Schakowsky, Clarke, 
and O'Halleran.
    Staff present: Jeffrey C. Carroll, Staff Director; Tiffany 
Guarascio, Deputy Staff Director; Timothy Robinson, Chief 
Counsel; Waverly Gordon, Deputy Chief Counsel; Kaitlyn Peel, 
Digital Director; Joe Orlando, Executive Assistant; Kimberlee 
Trzeciak, Chief Health Advisor; Meghan Mullon, Policy Analyst; 
Nolan Ahern, Minority Professional Staff, Health; Jennifer 
Barblan, Minority Chief Counsel, Oversight and Investigations; 
Mike Bloomquist, Minority Staff Director; S. K. Bowen, Minority 
Press Secretary; William Clutterbuck, Minority Staff Assistant; 
Jordan Davis, Minority Senior Advisor; Theresa Gambo, Minority 
Human Resources/Office Administrator; Caleb Graff, Minority 
Professional Staff Member, Health; Tyler Greenberg, Minority 
Staff Assistant; Tiffany Haverly, Minority Communications 
Director; Peter Kielty, Minority General Counsel; Bijan 
Koohmaraie, Minority Deputy Chief Counsel, Consumer Protection 
and Commerce; Ryan Long, Minority Deputy Staff Director; James 
Paluskiewicz, Minority Chief Counsel, Health; Brannon Rains, 
Minority Policy Analyst; Kristin Seum, Minority Counsel, 
Health; Kristen Shatynski, Minority Professional Staff Member, 
Health; and Everett Winnick, Minority Director of Information 
Technology.
    Ms. Eshoo. The Subcommittee on Health will now come to 
order.
    Due to COVID-19, today's hearing is being held remotely. 
All Members and witnesses will be participating via video 
conferencing.
    For the witnesses and all the Members, you will need to 
unmute--remember that--you will need to unmute your microphone 
when you wish to speak and when you are recognized. So please 
remember that. I will kindly remind everyone. But know that you 
are muted now and when you speak, you will have to unmute.
    Documents for the record can be sent to Meghan Mullon at 
the email address that we provided to your staff. And all 
documents will be entered into the record at the conclusion of 
this hearing.
    The Chair now recognizes herself for 5 minutes for an 
opening statement.

 OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    My colleagues and witnesses and those that are listening in 
to our hearing, our country is in pain, our country is 
grieving, and our country is angry. Over 2.1 million Americans 
are sick, 44 million Americans are jobless, and most 
tragically, we have lost over 116,000 of our fellow Americans.
    The United States of America has more reported cases of 
COVID-19 and more deaths than any other country in the world. 
And this pain falls most heavily on communities of color, and 
that is why we are having this hearing today.
    The COVID mortality rate for Black Americans is 2.3 times 
higher than the rate for White Americans. Other groups are 
disproportionately impacted as well. For example, in my region 
in Silicon Valley, Santa Clara County, 24 percent of the 
county's population is Latino, but Latinos represent nearly 32 
percent of all COVID deaths.
    While this virus is new to our it country and the world, 
the plague of racism is not. According to the CDC, Black 
Americans are more likely to die at early ages from all causes. 
Black Americans are more likely to die from heart disease or 
stroke at a young age. As we know from our subcommittee's work, 
Black mothers are three and a half times more likely to die 
during childbirth even when they have--even when they have 
higher incomes and more education than their White 
counterparts.
    In the wake of the murder of George Floyd, we must 
acknowledge the public health impact of police brutality. 
According to the National Academy of Sciences, one in every 
thousand Black men can expect to be killed by police. Black men 
are about 2.5 times more likely to be killed by police over the 
course of their life than White men.
    Our expert witnesses, Dr. Boyd and Dr. Brooks, describe the 
interaction of racism in COVID-19 as a pandemic within a 
pandemic.
    Sadly, the administration has failed to anticipate, track, 
and respond to the pandemic's effect on communities of color. 
The latest example of this failure is a final rule issued last 
week by the Department of Health and Human Services that 
repeals nondiscrimination protections for individuals with 
limited English proficiency, LGBTQ people, people with 
disabilities, and women.
    Another example is that two months after Congress passed a 
law requiring the administration to provide COVID racial 
analysis, the CDC finally announced that it will require COVID 
testing labs to report demographic data. However, that 
demographic data will not be required until August 1, 8 months 
after we first learned of this disease.
    So my colleagues on the subcommittee, led by Congresswoman 
Robin Kelly, chair of the Congressional Black Caucus Health 
Brain Trust, have introduced the Equitable Data Collection and 
Disclosure on COVID-19 Act in response to the administration's 
failure to act.
    I have about a minute and a half left, so I am just going 
to say that there is so much more work that Congress needs to 
do to deliver on the belief that ``Black Lives Matter'' in 
healthcare and our society, and I look forward to hearing the 
witnesses and what they suggest to us.
    A vital part of the work will be the newly formed Energy 
and Commerce Racial Disparities Working Group, and I am pleased 
to yield the remainder of my time to its co-leader, our 
colleague, Representative Yvette Clarke, to announce their 
work.
    [The prepared statement of Ms. Eshoo follows:]

                Prepared Statement of Hon. Anna G. Eshoo

    Our country is in pain. Our country is grieving. And our 
country is angry.
    Over 2 million Americans are sick. 44 million workers are 
jobless. Most tragically, we have lost over 115,000 of our 
fellow Americans.
    And this pain falls most heavily on communities of color.
    The COVID mortality rate for Black Americans is 2.3 times 
higher than the rate for White Americans. Other groups are 
disproportionally impacted as well. For example, near my 
district in Santa Clara County, 24 percent of the county's 
population is Latino, but Latinos represent nearly 32 percent 
of all COVID deaths.
    While this virus is new to our country, the plague of 
racism is not.
    According to the CDC, Black Americans are more likely to 
die at early ages from all causes. Black Americans are more 
likely to die from heart disease or stroke at a young age. As 
we know from our Subcommittee's work, Black mothers are 3.5 
times more likely to die during childbirth, even when they have 
higher incomes and more education than their white 
counterparts.
    In the wake of the murder of George Floyd we must 
acknowledge the public health impact of police brutality. 
According to the National Academy of Sciences, 1 in every 1,000 
Black men can expect to be killed by police. Black men are 
about 2.5 times more likely to be killed by police over the 
course of their life than are white men.
    Our expert witnesses, Dr. Boyd and Dr. Brooks describe the 
interaction of racism with COVID-19 as a ``pandemic within a 
pandemic.''
    Sadly, the Administration has failed to anticipate, track, 
and respond to the pandemic's effect on communities of color.
    The latest example of this failure is a final rule issued 
last week by the Department of Health and Human Services that 
repealed nondiscrimination protections for individuals with 
limited English proficiency, LGBT people, people with 
disabilities, and women.
    Another example is that two months after Congress passed a 
law requiring the Administration to provide COVID racial 
analysis, the CDC finally announced that it will require COVID 
testing labs to report demographic data. However, that 
demographic data will not be required until August 1st, eight 
months after we first learned of this disease.
    My colleagues on the Subcommittee, led by Congresswoman 
Robin Kelly, Chair of the Congressional Black Caucus Health 
Braintrust, have introduced the Equitable Data Collection and 
Disclosure on COVID-19 Act in response to the Administration's 
failure to act.
    Until a vaccine or therapy is available, intensive testing 
will be necessary to safely reopen. However, systemic barriers, 
such as lack of insurance and paid leave, keep Americans from 
seeking COVID-19 testing and treatment. The HEROES Act breaks 
down those barriers by creating a national testing strategy, 
extending eligibility for paid sick leave, covering the 
uninsured for COVID treatment, and strengthening the Medicaid 
program.
    There's so much more Congress needs to do to deliver on the 
belief that ``Black Lives Matter'' in healthcare and our 
society and I look forward to hearing suggestions from our 
witnesses.
    A vital part of this work will be the newly-formed Energy 
and Commerce Racial Disparities Working Group, and I'm please 
to yield the remainder of my time to its Co-leader, 
Representative Yvette Clarke, to announce that work.

    Ms. Clarke. Let me thank Chairwoman Eshoo for convening 
this timely hearing today and to discuss the racial disparities 
that have been evidenced by the COVID-19 pandemic and thank all 
of my colleagues and our witnesses for being with us here 
today.
    All across the Nation, we are currently in the midst of a 
time of reckoning. For years now, issues of health disparities 
in the United States have been simmering beneath the surface of 
public discourse. But in these past few months alone, we have 
seen, in no uncertain terms, the ways in which Black, Hispanic, 
and Native Americans have faced the brunt of this pandemic.
    We must work together to find a solution to these 
disparities, and that is why I am proud to co-lead the Racial 
Disparities Working Group, along with my colleague, the 
chairwoman of the Health Brain Trust of the Congressional Black 
Caucus, Representative Robin Kelly of Illinois.
    The working group will raise awareness, find solutions, and 
address racial inequity within the jurisdiction of our 
committee. It is my hope that the Racial Disparities Working 
Group will be a major step along the road to racial justice as 
we embark, once again, on a mission to achieve equality and 
equity.
    I look forward to working with all of my colleagues on 
these important issues and to hear from our witnesses today.
    With that, Madam Chairwoman, I yield back, and I thank you 
for the opportunity to address the committee today.
    Ms. Eshoo. Thank you. The gentlewoman yields back.
    The Chair now recognizes Dr. Burgess, the ranking member of 
the Subcommittee on Health, for 5 minutes for his opening 
statement.

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A REPRESENTATIVE 
              IN CONGRESS FROM THE STATE OF TEXAS

    Mr. Burgess. And I thank the Chair. And as the Chair will 
recall, I sent a letter last month requesting a hearing to 
address the issue of racial and ethnic disparities in this 
novel coronavirus environment. I want to thank you for honoring 
that request by calling this hearing.
    This novel coronavirus, along with the deaths of George 
Floyd, Ahmaud Arbery, Breonna Taylor, Patrick Underwood, and 
David Dorn, have reminded us of the importance of addressing 
the realities of race within our healthcare system.
    I began my medical career at Parkland Hospital. I saw 
firsthand the challenges of caring for a primarily Medicaid and 
underserved population.
    Last week, Michael Horne, the chief executive of the 
Parkland Foundation, and Dr. Fred Cerise, the chief executive 
of Parkland Hospital in Dallas, wrote an opinion piece that hit 
home for me. Let me share some of their words with you. I am 
quoting here.
    ``This work, our work of healing deep-seated wounds 
necessitates that we deliver our healthcare service upon the 
foundations of care, compassion, and community. To provide 
excellent clinical care. To approach that care with compassion, 
literally translated, 'to suffer with.' We have to make it 
personal. And to be connected to our communities.
    ``Removing real and perceived barriers, we must actively 
seek to build relationships across lines of difference. It is 
only through proximity that we can understand the challenges we 
must confront.'' Close quote.
    And then on Sunday, I was surprised to read another opinion 
piece, from Dallas County Commissioner John Wiley Price. 
Typically I don't agree with Commissioner Price, but I found 
myself in agreement with most of what he had written. And he 
said: ``The discrimination that existed in the 1960s was often 
very overt and extreme, and as a result it appeared to be far 
easier to determine who was racist and who was not,'' close 
quote.
    And then, actually, he went on to observe at the end of his 
article that we all ought to bear in mind what we learned from 
our mothers: Do unto others as you would have them do unto you 
and try to put yourself in the shoes of the other person.
    So we are here today to listen. We have a chance to make a 
difference and to change things for the better. I hope this 
discussion today moves us in that direction. We should use this 
information to draft commonsense, bipartisan legislation that 
can actually become law.
    I do want to remind everyone of the work that this 
subcommittee, this subcommittee, has done this Congress and the 
last Congress. We passed an authorization to increase research 
for sickle cell disease, which President Trump signed into law 
in December of 2018. This is the first stand-alone sickle cell 
authorization that I can remember in my congressional career 
and the first authorization since one was tacked on to a tax 
bill in 2004.
    So this subcommittee did that work and got it across the 
finish line, and then eventually got it in for a signature. 
Since then, I have spoken with patients in the National 
Institute of Health trials and heard of the promising 
treatments that are in our pipeline.
    And let's not forget the Preventing the Maternal Deaths 
Act, the first law to address maternal mortality that was 
signed into law and is enabling States to establish and 
strengthen robust maternal mortality review committees.
    And then this Congress, the Energy and Commerce Committee 
has approved two bills, H.R. 4995 and H.R. 4996, that would 
further address maternal mortality and racial disparities in 
pregnancy outcomes.
    This is not the time to take our foot off the gas. I have 
read articles about the disproportionate impact of coronavirus 
on racial and ethnic minorities near my district in the Dallas-
Ft. Worth area. It is possible that we do not even know the 
full effects because some of the data is either missing or not 
collected. I do worry about the convergence of the novel 
coronavirus in individuals who are suffering from other chronic 
conditions, such as diabetes.
    There is so much we do not know about the biological 
behavior of this virus. We are learning new details every day. 
This is a critical hearing because there is a lot to unpack and 
about the disproportionate impact of the novel coronavirus on 
racial and ethnic minorities.
    Again, to the chair, once again my appreciation for your 
working with me to call this hearing and committing to a 
productive hearing and all the agenda of this subcommittee. And 
I would ask unanimous consent that the articles that I 
referenced, the opinion piece by Dr. Cerise and the opinion 
piece by Dallas County Commissioner John Wiley Price, be 
included as part of our record.
    And I yield back my time.
    [The prepared statement of Mr. Burgess follows:]

             Prepared Statement of Hon. Michael C. Burgess

    Thank you, Madam Chair. As you recall, I sent a letter to 
you last month requesting a hearing to address the issue of 
racial and ethnic disparities in COVID-19. Thank you for 
honoring that request by calling this hearing. This virus along 
with the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, 
Patrick Underwood, and David Dorn have reminded us of the 
importance of addressing the realities of race within our 
healthcare system.
    My medical career began at Parkland. I saw firsthand the 
challenges of caring for primarily a Medicaid and underserved 
population.
    Last week, Michael Horne, Chief Executive of Parkland 
Foundation, and Dr. Fred Cerise, Chief Executive of Parkland 
Hospital in Dallas, wrote an op-ed that hit home for me. Let me 
share some of their words with you.
    ``This work, our work of healing deep-seated wounds, 
necessitates that we deliver our healthcare service upon the 
foundations of care, compassion and community. To provide 
excellent clinical care. To approach that care with compassion, 
literally translated, `to suffer with.' We have to make it 
personal. And to be connected to our communities. Removing real 
and perceived barriers, we must actively seek to build 
relationships across lines of difference. It is only through 
proximity that we can understand the challenges we must 
confront.''
    Coming into this hearing I hope we will heed the words of 
Dallas County Commissioner John Wiley Price. ``The 
discrimination that existed in the 1960s was often very overt 
and extreme. As a result, it appeared to be far easier than to 
determine who was ``racist'' and who was not.''
    What we are here to do today to listen. We have a chance to 
make a difference and change things for the better. I hope that 
this discussion today moves us in that direction. We should use 
this information to draft commonsense, bipartisan legislation 
that can become law.
    I do want to remind everyone of the work that this 
subcommittee has done in this space over the past four years. 
We passed an authorization to increase research for sickle cell 
disease, which President Trump signed into law in 2018. Since 
then, I have spoken with patients in NIH trials and heard of 
the promising treatments in our pipeline.
    Let's not forget the Preventing Maternal Deaths Act, the 
FIRST law to address maternal mortality, was signed into law 
and is enabling states to establish and strengthen robust 
maternal mortality review committees. This Congress, the Energy 
and Commerce Committee has approved two bills, H.R. 4995 and 
H.R. 4996, that would further address maternal mortality and 
racial disparities in pregnancy outcomes. This is not the time 
to take our foot off the gas.
    I have read numerous articles about the disproportionate 
impact of COVID-19 on racial and ethnic minorities near my 
district in the Dallas Fort Worth area. It is possible we do 
not even know the full effect because some of this demographic 
data is not being collected.
    I particularly worry about the convergence of COVID-19 and 
individuals who are suffering from other chronic conditions, 
such as diabetes. Before the COVID-19 pandemic, African 
Americans and American Indians/Alaska Natives have historically 
been more prone to chronic conditions like asthma, diabetes, 
obesity, and hypertension -underlying conditions that, no 
matter race or ethnicity, increase the risk of contracting and 
dying from the virus. Additional factors, such as condensed 
living situations and multigenerational households, may 
exacerbate some of the issues in these minority communities.
    There is a lot we still do not know about this virus. We 
are learning new details every day. This is a critical hearing 
because there is a lot to unpack about the disproportionate 
impact of COVID-19 on racial and ethnic minorities. Madam 
Chair, once I again express my appreciation for you working 
with me to call this hearing and committing to a productive 
COVID-19 agenda at this subcommittee.

    Ms. Eshoo. I thank the gentleman. And all documents where 
there is a request to be placed record will be taken up at the 
end of the hearing.
    It is now a pleasure to recognize the chairman of the full 
committee, Mr. Pallone, for his 5 minutes of questions, and 
please remember to unmute.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you, Chairwoman Eshoo, for convening 
this really important hearing that confronts the alarming 
racial and ethnic disparities in the COVID-19 pandemic as well 
as the inequities within our larger healthcare system.
    Today's hearing comes at a time of reckoning for racial 
justice in America. As the Black Lives Matter movement works to 
bring about structural change, including addressing police 
violence in America, we are also faced with a public health 
crisis that is disproportionately afflicting communities of 
color.
    And we have long known that people of color experience 
disparities in healthcare in the United States. While we have 
made progress to close these gaps in recent years, including 
with the passage of the Affordable Care Act, people of color in 
America continue to experience disparities in care and worse 
health outcomes compared to White Americans.
    And these long-term trends are rooted in several social 
determinants that are often driven by structural discrimination 
and institutionalized racism, which has created systematic 
health inequity.
    The tragic result of these long-term trends is that people 
of color are more likely to suffer from underlying health 
conditions, and have a much harder time gaining access to care, 
and when they do, they are far more likely to experience bias, 
discrimination, and poor health outcomes.
    And predictably, these factors left minority communities 
especially vulnerable to the COVID-19 pandemic. In my home 
State of New Jersey, Black residents account for nearly 20 
percent of all coronavirus deaths despite representing just 13 
percent of our overall population. And for our neighbors in New 
York City, Black and Latino residents are twice as likely to 
die from the virus than their White counterparts. Obviously 
that is heartbreaking and demands urgent action from Congress 
and the administration.
    Now, over the past few months, this committee has taken 
steps to better understand and begin to address these health 
inequities, but that requires data, and, unfortunately, we are 
not getting a lot of crucial data from the Trump 
administration.
    In April, I wrote to the Centers for Medicare and Medicaid 
Services, CMS, Administrator Verma requesting that she make 
public Medicare data related to COVID-19 health outcomes based 
on race, ethnicity, and gender. It should have been an easy 
request for her to fulfill, considering she had publicly 
committed to releasing that data a week before my request. CMS' 
claims data is uniquely insightful because of the agency's use 
of specific coding, which gives CMS access to information that 
could inform our efforts to improve health outcomes for 
communities of color.
    But, unfortunately, we are nine weeks after my request and 
ten weeks after she committed to releasing this data, and CMS 
has yet to release any of it. So yesterday I wrote to 
Administrator Verma reasserting this request.
    And data is so important to our understanding of 
disparities, and that is why the committee also worked to 
include provisions in the Paycheck Protection Program and 
Healthcare Enhancement Act requiring the Trump administration 
submit to Congress a comprehensive report on COVID-19 health 
disparities. But, unfortunately, instead of taking this 
congressional mandate seriously, the Trump administration 
submitted a four-page document with a list of links to already 
publicly available web pages, and, again, this is a wholly 
inadequate response.
    The House has taken several additional actions in passing 
the HEROES Act last month, which requires a comprehensive 
update of the four-page demographics report and the development 
of an evidence-based response strategy to reduce disparities 
related to COVID-19. And the HEROES Act would also require the 
administration to develop a national testing strategy with 
specific requirements to help reduce disparities in testing. 
But, unfortunately, as you know, the Senate so far refuses to 
take action on the HEROES Act. We hope that they will.
    And, finally, while I was glad to see that the Trump 
administration announced plans for more extensive demographic 
reporting on COVID-19 testing, I am concerned that this is too 
little, too late. These new reporting requirements will only go 
into full effect in August, which leaves me concerned that we 
may never have a complete understanding of the harm this virus 
has inflicted on communities of color during the first six 
months of this pandemic.
    So I am hopeful that this hearing will help basically 
another step forward in better understanding and addressing 
these heartbreaking inequities with both COVID-19 and our 
overall healthcare system.
    And, you know, I really--I know several members have 
mentioned it to me earlier that the data is really important. 
So I hope that we see the administration step up on these data 
problems that we have seen and their inadequate response.
    But I do thank our witnesses for joining us to share their 
expertise. I know you have a good panel. I look forward to the 
testimony. And, again, thank you, Madam Chairwoman, and also 
thank you, Mike Burgess, as well, for putting this together.
    I yield back.
    [The prepared statement of Hon. Frank Pallone follows:]

                   Prepared Statement of Mr. Pallone

    Thank you, Chairwoman Eshoo for convening this really 
important hearing to confront the alarming racial and ethnic 
disparities in the COVID-19 pandemic as well as the inequities 
within our larger healthcare system.
    Today's hearing comes at a time of reckoning for racial 
justice in America. As the Black Lives Matter movement works to 
bring about structural change, including addressing police 
violence in America, we are also faced with a public health 
crisis that is disproportionately afflicting communities of 
color. We have long known that people of color experience 
disparities in healthcare in the United States. While we have 
made progress to close these gaps in recent years, including 
with the passage of the Affordable Care Act, people of color in 
America continue to experience disparities in care and worse 
health outcomes compared to White Americans.
    These long-term trends are rooted in several social 
determinants that are often driven by structural discrimination 
and institutionalized racism, which has created systemic health 
inequity. The tragic result of these long-term trends is that 
people of color are more likely to suffer from underlying 
health conditions, have a much harder time gaining access to 
care, and when they do, they're far more likely to experience 
bias, discrimination and poor health outcomes.
    Predictably, these factors left minority communities 
especially vulnerable to the COVID-19 pandemic. In my home 
state of New Jersey, Black residents account for nearly 20 
percent of all coronavirus deaths despite representing just 13 
percent of our overall population. And for our neighbors in New 
York City, Black and Latino residents are twice as likely to 
die fromthe virus than their White counterparts. That's 
heartbreaking and demands urgent action from both Congress and 
the Administration.
    Over the past few months, this Committee has taken steps to 
better understand and begin to address these health inequities, 
but that requires data and, unfortunately, we're not getting a 
lot of critical data from the Trump Administration. In April, I 
wrote to Centers for Medicare & Medicaid Services (CMS) 
Administrator Verma requesting that she make public Medicare 
data related to COVID-19 health outcomes based on race, 
ethnicity and gender. It should have been an easy request for 
her to fulfill, considering she had publicly committed to 
releasing this data a week before my request. CMS's claims data 
is uniquely insightful because of the agency's use of specific 
coding, which gives CMS access to information that could inform 
our efforts to improve health outcomes for communities of 
color.
    Unfortunately, here we are, nine weeks after my request and 
ten weeks after she committed to releasing this data, and CMS 
has yet to release any of it. Yesterday, I wrote to 
Administrator Verma reasserting this request .
    Data is so important to our understanding of disparities 
and that's why the Committee also worked to include provisions 
in the Paycheck Protection Program and Health Care Enhancement 
Act requiring the Trump Administration submit to Congress a 
comprehensive report on COVID-19 health disparities. 
Unfortunately, instead of taking this Congressional mandate 
seriously, the Trump Administration submitted a four-page 
document with a list of links to already publicly available web 
pages. This is a wholly inadequate response.
    The House then took additional action in passing the Heroes 
Act last month, which requires a comprehensive update of the 
four-page demographics report and the development of an 
evidence-based response strategy to reduce disparities related 
to COVID-19. The Heroes Act would also require the 
Administration to develop a national testing strategy with 
specific requirements to help reduce disparities in testing. 
Unfortunately, the Senate refuses to take action on the Heroes 
Act.
    Finally, while I was glad to see the Administration 
announce plans for more extensive demographic reporting on 
COVID-19 testing, I'm concerned that this is too little too 
late. These new reporting requirements will only go into full 
effect in August, which leaves me concerned that we may never 
have a complete understanding of the harm this virus has 
inflicted on communities of color during the first six months 
of this pandemic.
    I am hopeful this hearing will be a step forward in better 
understanding and addressing these heartbreaking inequities 
with both COVID-19 and our overall healthcare system. I thank 
our witnesses for joining us to share their expertise and I 
look forward to hearing your testimony.
    And with that, Madam Chairwoman, I yield back.

    Ms. Eshoo. The gentleman yields back.
    It is now a pleasure to recognize the ranking member of the 
full committee, Mr. Walden, for his 5 minutes for an opening 
statement. And remember to unmute.

   OPENING STATEMENT OF HON. GREG WALDEN A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF OREGON

    Mr. Walden. Thank you, Madam Chair, and thanks for holding 
this hearing.
    Before I start, I have a question for the chairman of the 
full committee. As far as I can tell, this is the first we have 
heard of this new working group on the Republican side, and I 
wondered if it will be open to Republican participation or if 
it is a partisan working group?
    I believe you are muted, Mr. Chairman.
    Mr. Pallone. My understanding was that it was open to and 
bipartisan. If you are not aware of it, then we will just have 
to, you know, find out. I don't want to really interrupt the 
meeting. I will talk to you afterward about it. But my 
understanding is that it is meant to be bipartisan.
    Mr. Walden. I would hope so because I think the spirit of 
this whole hearing is bipartisan, but this is the first--
[inaudible] That we would like to participate in that----
    Mr. Pallone. So let me get back to you later in that day, 
Greg, on that.
    Madam Chair.
    Mr. Walden. Thanks, Chairman.
    The last few months have seen an unprecedented and 
challenging time. Americans all over the country are raising 
their voices to raise long overdue awareness to the systematic 
challenges facing the Black community in America.
    Meanwhile, COVID-19 has shaken the very fabric of our 
country, with more than 2 million positive cases and over 
115,000 deaths. There is no question the pandemic has had a 
disproportionate impact on communities of color, seen primarily 
in terms of poorer health outcomes, but it is also manifested 
both socially and economically.
    According to the data from the Centers For Disease Control 
and Prevention, American Indian, and Alaska Native persons have 
a COVID-19 hospitalization rate about five times that of White 
people, followed by Black people, who have a hospitalization 
rate four and a half times that of White people. Hispanics and 
Latinos have a hospitalization rate three and a half times that 
of Whites.
    We know this isn't just an American problem as well. All 
over the globe, minority and underserved communities have 
suffered disproportionately from the pandemic.
    For example, in the United Kingdom the Office of National 
Statistics found that COVID-19-related deaths for this ethnic 
group in England and Wales exceeded those of White ethnicity. 
In the U.K., Black males and females are over four times more 
likely to die from a COVID-19-related death than their White 
counterparts. The same was found to be true for people of 
Bangladeshi, Pakistani, Indian, and mixed ethnicities.
    After seeing these alarming trends last month, Dr. Burgess, 
the Republican leader on the Health Subcommittee, sent a letter 
to the majority requesting a hearing on this very issue, 
including how Congress can help reduce these disparities. And I 
would like to express my appreciation to Dr. Burgess and to the 
majority for having the hearing we are having today.
    We know that chronic health conditions, and older age, 
congregate living increase the risk of complications and death 
from COVID-19. However, these facts do not explain the full 
story as to why certain racial and ethnic groups have come to 
bear an undue burden of the public health crisis. We need to 
better understand these differences in healthcare outcomes and 
how best to improve them.
    At a hearing earlier this month with some of our Nation's 
governors, the committee heard the disastrous and devastating 
consequences of some States actually forcing COVID-positive 
patients back into nursing homes. And we now know that upwards 
of 40 percent of the fatalities in America are coming out of 
our nursing homes.
    This misguided policy, unfortunately, exacerbated the 
suffering and mortality left in the wake of the virus and its 
tragic effects were felt disproportionately across many 
minority communities.
    The Trump administration has already taken steps to ensure 
vulnerable populations have access to testing, care, and other 
critical resources during this pandemic. It is my hope that 
every member of this committee will be willing to work 
alongside the administration to address disparities in all 
vulnerable populations.
    As we know, for data collection, this has always been a 
province of the States, and we find that the reporting from the 
States was lacking. So I applaud the administration for 
demanding States step forward with unified reporting 
requirements.
    The economic downturn caused by the stay-at-home orders and 
lockdowns has exacerbated the impact of COVID-19 on vulnerable 
communities. While these policies were needed to flatten the 
curve and slow the spread of infections, they have had an 
undeniable impact on minority communities.
    In fact, a recent study by the National Bureau of Economic 
Research found that the number of opened Black-owned businesses 
fell 41 percent. That is an astounding and very, very troubling 
number. Opened Hispanic-owned businesses fell by 32 percent, 
Asian-owned businesses fell 26 percent, and immigrant-owned 
businesses dropped by 36 percent.
    Many hourly workers have lost their jobs and are without 
work. Unemployment claims have skyrocketed despite thebetter-
than-expected jobs report for the month of May.
    We know that unemployment and financial strains are 
associated with higher stress, increased risk of mental 
illness, and increased risk for substance abuse, all of which 
lead to poorer health outcomes.
    So I believe that safely reopening the economy--safely--
maintaining targeted social distancing, and focusing resources 
where they are most needed will help minority communities the 
most. As I stated in the last hearing, listen, learn, act.
    As a country, we should be listening to others with 
different viewpoints and backgrounds, learning about their 
experiences and feelings, and taking actions to ensure justice 
and equality are available to all Americans regardless of skin 
color.
    I look forward to [inaudible] And I, again, thank Chair 
Eshoo and Chairman Pallone for having this hearing.
    And I yield back whatever balance of time I have.
    [The prepared statement of Mr. Walden follows:]

                 Prepared Statement of Hon. Greg Walden

    The last few months have been an unprecedented and 
challenging time. Americans all over the country are raising 
their voices to raise long overdue awareness to the systematic 
challenges facing the black community in America.
    Meanwhile, COVID-19 has shaken the very fabric of the 
nation, with over 2 million positive cases and over 115,000 
deaths. There's no question the pandemic has had a 
disproportionate impact on communities of color--seen primarily 
in terms of poorer health outcomes, but it has also manifested 
both socially and economically.
    According to the data from the Centers for Disease Control 
and Prevention, American Indian/Alaska Native persons have a 
COVID-19 hospitalization rate about five times that of white 
people, followed by black people, who have a hospitalization 
rate four and a half times that of white people. Hispanics and 
Latinos have a hospitalization rate three and a half times that 
of whites.
    We know this isn't just an American problem. All over the 
globe, minority and underserved communities have suffered 
disproportionally from the pandemic. In the United Kingdom, the 
Office for National Statistics found that COVID-19-related 
deaths for ethnic groups in England and Wales exceeded those of 
white ethnicity. In the UK, Black males and females are over 
four times more likely to die from a COVID-19-related death 
than their white counterparts. The same was found to be true 
for people of Bangladeshi, Pakistani, Indian, and mixed 
ethnicities.
    After seeing these alarming trends, last month, Dr. 
Burgess, the Republican Leader on the Health Subcommittee, sent 
a letter to the majority requesting a hearing on this very 
issue, including how Congress can help reduce these 
disparities. I'd like to express my thanks to the majority for 
fulfilling Dr. Burgess's request today.
    We know that chronic health conditions, older age, and 
congregate living increase the risk of complications and death 
from COVID-19. However, these facts do not explain the full 
story as to why certain racial and ethnic groups have borne an 
undue share of the burden of this public health crisis. We need 
to better understand these differences in health outcomes and 
how best to improve them. At a hearing earlier this month with 
some of our nation's governors, the Committee heard the 
disastrous and devastating consequences of some states forcing 
COVID positive patients back into nursing homes. This misguided 
policy unfortunately exacerbated the suffering and mortality 
left in the wake of the virus, and its tragic effects were felt 
disproportionately across many minority communities.
    The administration has already taken steps to ensure 
vulnerable populations have access to testing, care, and other 
critical resources during this pandemic. It is my hope that 
every member of this committee will be willing to work 
alongside the administration to address disparities in all 
vulnerable populations.
    The economic downturn caused by the stay at home orders and 
lockdowns has exacerbated the impact of COVID-19 on vulnerable 
communities. While these policies were needed to flatten the 
curve and slow the spread of infections, they have had an 
undeniable impact on minority communities. A recent study by 
the National Bureau of Economic Research found that the number 
of open black-owned businesses fell 41 percent--that's an 
astounding and extremely troubling number. Open Hispanic-owned 
businesses fell by 32 percent, Asian-owned businesses fell 26 
percent, and immigrant-owned businesses dropped by 36 percent.
    Many hourly workers have lost their jobs and are without 
work. Unemployment claims have skyrocketed, despite the better-
than-expected jobs numbers for the month of May. We know that 
unemployment and financial strains are associated with higher 
stress, increased risk of mental illness, and increased risk 
for substance abuse -all of which lead to poorer health 
outcomes.
    I believe that safely reopening the economy, maintaining 
targeted social distancing, and focusing resources where they 
are most needed will help minority communities the most.
    As I stated in the last hearing--Listen, learn, act. As a 
country, we should be listening to others with different 
viewpoints and backgrounds, learning about their experiences 
and feelings, and taking action to ensure justice and equality 
are available to all Americans, regardless of skin color.
    I look forward to hearing from our witnesses today on this 
important topic, and I again thank the Majority for having this 
hearing.
    With that, I yield back.

    The Chair would like to remind members that pursuant to 
committee rules, all Members' written opening statements shall 
be made part of the record.
    I now would like to introduce our witnesses and thank them 
for being with us today and also for your patience as we had to 
deal with some of the technological problems at the beginning 
of the hearing.
    Dr. Rhea Boyd is a pediatrician and a child health 
advocate. She serves my constituents at the Palo Alto Medical 
Foundation. She has taught on structural inequality and health 
at Stanford University's Pediatric Residency Program and she 
serves on the board of California Chapter 1 of the American 
Academy of Pediatrics.
    Thank you, Doctor, for your service as a frontline 
healthcare worker, as well as the work that you do to ensure 
that the children in my congressional district and our Nation 
grow up healthy and equitably.
    I now will yield to Representative Barragan to introduce 
Dr. Oliver T. Brooks, since he serves her constituents as a 
physician in her district.
    Ms. Barragan. Thank you, Chairwoman Eshoo.
    What an honor it is for me to introduce Dr. Oliver Brooks, 
the president of the National Medical Association. The NMA is 
the largest and oldest national organization representing 
African American physicians and their patients in the United 
States.
    Dr. Brooks is an esteemed physician in my district. He is 
the medical director and past chief of pediatric and adolescent 
medicine at the Watts Healthcare Corporation in Los Angeles. He 
also serves as the medical director of the Jordan and Locke 
High School Wellness Centers.
    His resume is very lengthy. He served as the medical 
director for L.A. Care Health Plan, whose mission is to provide 
access to quality healthcare for Los Angeles County's 
vulnerable and low-income communities and residents.
    He has various appointments to hospitals, including MLK 
Hospital in my district, and he is the chairman of the 
Community Clinic Association of Los Angeles County, a group of 
30 community health centers in southern California.
    Most importantly, Dr. Brooks has been working on the issues 
of racial health disparities and looking at the racial 
injustices to our healthcare system for many, many decades. I 
can't think of anybody more qualified and more important for us 
to hear from in this crisis that we are going through today.
    And lastly, he is a graduate of Morehouse College and 
Howard Medical School, so he brings a wealth of information to 
our committee.
    Thank you, Doctor, for your service, for your years of 
service, and for testifying here today.
    And with that, Chairwoman, I yield back.
    Ms. Eshoo. We thank the gentlewoman.
    We also want to welcome back to the subcommittee Mr. Avik 
Roy. He is the president of the Foundation for Research on 
Equal Opportunity. And as I just said, he has testified before 
our subcommittee on multiple occasions.
    So thank you to you, Mr. Roy, and welcome back.
    Dr. Boyd, you are now recognized for 5 minutes. Please 
unmute so that everyone can hear you.

 STATEMENTS OF RHEA BOYD, M.D., M.P.H., PEDIATRICIAN AND CHILD 
   HEALTH ADVOCATE, PALO ALTO MEDICAL FOUNDATION; OLIVER T. 
BROOKS, M.D., PRESIDENT, NATIONAL MEDICAL ASSOCIATION; AND AVIK 
  S. A. ROY, PRESIDENT, THE FOUNDATION FOR RESEARCH ON EQUAL 
                          OPPORTUNITY

                  STATEMENT OF RHEA BOYD, M.D.

    Dr. Boyd. Good afternoon, Chairwoman Eshoo, Ranking Member 
Dr. Burgess, and members of the committee and subcommittee. I 
sincerely appreciate this opportunity to place the health and 
well-being of those most affected by COVID-19 at the forefront 
of our Nation's public health response.
    I am testifying today as a pediatrician who works 
clinically, a public health advocate who partners with 
community-based organizations, and a scholar who writes and 
teaches nationally on the relationship between structural 
racism, inequity, and health.
    Racial health inequities in the population level 
distribution of infections and deaths related to COVID-19 are 
alarming. The scourge of COVID-19 is that this virus could have 
harmed anyone. Indeed it has stretched across the globe. And 
yet, because of racism and it is pervasive hold on every 
institution in America, this novel virus has disproportionately 
harmed indigenous Americans, particularly those in Navajo 
Nation; Latinx Americans, particularly those in Tennessee, 
Illinois, Wisconsin, and New York; Native Hawaiian/Pacific 
Islander Americans, particularly those in California, Oregon, 
and Washington; and Asian Americans, particularly those in Iowa 
and Nevada.
    This is a national tragedy, but all together COVID-19 has 
been the most devastating and deadly for Black Americans. To 
date, Black Americans have the highest overall mortality rate 
and the broadest distribution of death. In total, one out of 
every 1,625 Black Americans have died from COVID-19.
    And compared to White Americans, Black American mortality 
rates from COVID-19 are the highest right in our Nation's 
Capital, Washington, D.C., where they are six times as high.
    But similar racial mortality gaps exist for Black Americans 
in States like Kansas, Wisconsin, Michigan, Missouri, New York, 
and South Carolina.
    As a result, national county-level-data reveals that the 
COVID-19 death rate is six times higher for Americans who live 
in areas that are predominantly non-White as compared to those 
who live in areas that are predominantly White.
    This inequity is not simply a function of the chronic 
underlying illness that also unjustly plagues Black 
communities. And it is not simply a function of poverty. Racial 
health inequities in COVID-19 are the result of racism. And by 
racism, I mean the legacies and current practices of racial 
exclusion, discrimination, disinvestment, and violence that 
concentrate disadvantage, create adversity, and provide 
conditions for disease within communities of color, 
particularly Black communities.
    These intercepting forms of oppression, all linked by 
structural racism, are why Black people are fighting for our 
lives right now. Today, Black Americans are more likely to be 
the essential workers forced to navigate the workplace hazards 
of this new infectious disease. At the same time, they are more 
likely to be killed by the State-sanctioned police violence 
that renders our communities less safe.
    Black Americans account for an outsized proportion of the 
newly unemployed and a disproportionate amount of the 
chronically underpaid. Black Americans have long held one of 
the highest all-cause mortality rates of any racial and ethnic 
group in the Nation, and they have nearly become the most at 
risk for COVID-related death.
    But before COVID-19 was a pandemic, Black Americans were 
already weathering an epidemic of premature death. Before we 
were devastated by the public murder of George Floyd, we 
watched in terror while Ahmaud Arbery was lynched for running. 
Before Tony McDade was gunned down by police in Tallahassee, 
Breonna Taylor was slain by police in her own home.
    Before COVID-19 killed Black Americans at two to six times 
the rate of other populations, our tiered healthcare system 
left Black folks to disproportionately die from all manners of 
disease. Before gentrification disrupted Black neighborhoods, 
redlining undervalued our homes. Before Jim Crow terrorized 
Black people across the U.S., slavery tortured our bodies and 
fractured our families.
    Ms. Eshoo. Dr. Boyd, can you just sum up? You are past your 
5 minutes.
    Dr. Boyd. Yes, racism is making America sick and it is 
killing a disproportionate number of our mothers, fathers, 
aunts, uncles, neighbors, coworkers, and friends. These are 
members of our beloved community, and the injustice of 
inequitable disease is that it is wholly preventable.
    To address these harrowing inequities, our Nation's 
lawmakers must be bold. We need universal healthcare, universal 
workplace protections, expanded Federal and State relief 
programs, expanded access to housing and nutritional programs, 
equitable access to COVID testing and treatment, and a dramatic 
reduction of our Nation's homeless, incarcerated, and detained 
populations.
    We must move to abolish racism from every institution, 
every practice, every policy, and every social norm in which it 
operates and too often hides. The future health and well-being 
of our children and their children will be measured in how well 
we succeed in this.
    Thank you.
    [The prepared statement of Dr. Boyd follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. Eshoo. Thank you, Dr. Boyd.
    I now would like to recognize Dr. Brooks for your 5 
minutes, and thank you for joining us. And please remember to 
unmute yourself.
    Dr. Brooks.

              STATEMENT OF OLIVER T. BROOKS, M.D.

    Dr. Brooks. Good day, Chairwoman Eshoo, Ranking Member 
Burgess, members of the Committee on Energy and Commerce, and 
Representative Pallone for being on this meeting.
    Thank you for the opportunity to appear before the 
committee to discuss confronting racial and ethnic disparities 
in COVID-19 and the healthcare systems. I am testifying as the 
chief medical officer at Watts Healthcare Corporation, an FQHC 
in south Los Angeles, and as president of the National Medical 
Association, the NMA, which is the largest and oldest national 
organization representing the interests of more than 50,000 
African American physicians and the patients that we serve.
    As the Nation's only healthcare organization devoted to the 
needs of the African American physicians and their patients, we 
are disturbed by the vast health inequities of vulnerable 
populations. We have been and are on the front lines advocating 
for patients who face numerous and often insurmountable 
obstacles to receiving quality healthcare.
    Black patients experience differences in access to 
healthcare, the affordability of these services, implicit 
biases by some providers, and limited participation in clinical 
research, which has consequences around viable medical 
treatments. We have been studying and reporting on this for 
decades.
    As a result of the coronavirus pandemic, a bright light has 
recently been shown on health disparities that have always 
existed in America. What the world is witnessing is that Black 
patients are severely overrepresented among those who have 
suffered the morbidity and mortality of COVID-19.
    This pandemic is a painfully fresh reminder of these 
disparities in our healthcare system that leave minorities 
behind. COVID-19 has killed more than 115,000 Americans, with 
the Black community accounting for a disproportionate number.
    An example of this phenomenon is starkly chronicled in a 
Washington Post article published on June 12th. Blacks and 
Whites each account for about 46 percent of D.C.'s population, 
according to Census Bureau data, yet Blacks account for 74 
percent of COVID-19 deaths. And the wards of the city with the 
largest Black populations have suffered the heaviest losses.
    The disparity shows up not only in terms of who gets 
diagnosed and infected with the virus, but who is dying from 
the disease.
    Data from 40 States that collect race and ethnicity data 
show that White Americans are dying from COVID-19 at a rate of 
22.7 per 100,000, whereas African Americans die at a rate of 
54.6 deaths per 100,000.
    For Native Hawaiians and Pacific Islanders, the available 
data in ten States show percentages of COVID-19 cases and 
deaths that are two to three times greater than their 
percentage of the population.
    The question is, why are we seeing such glaring differences 
in who is dying from COVID-19?
    The CDC has noted that those with hypertension, diabetes, 
and obesity are more likely to have an adverse outcome. Blacks 
are 2.2 times more likely to have diabetes, 20 percent more 
likely to have hypertension, and 30 percent more likely to be 
obese. Right there, we see a problem.
    However, underlying health conditions alone cannot be 
viewed as the predominant factor in COVID-19 mortality. Social 
determinants of health, defined by the CDC as conditions in the 
places where people are born, live, work, and play, are as 
important a role in a person's health as genetics or medical 
treatment. They include intangible factors such as 
socioeconomic, political, and cultural structures, as well as 
place-based conditions including educational systems and 
accessible and affordable healthcare, healthy food 
availability, environmentally safe living surroundings, and 
well-designed communities.
    Social determinants of health are an underlying cause of 
today's major societal health dilemmas, including obesity, 
heart disease, diabetes, and depression. Moreover, complex 
interactions and feedback loops exist among the social 
determinants of health. For example, poor health or lack of 
education can impact employment opportunities, which in turn 
can constrain income. Low income reduces access to 
environmentally safe communities, healthcare, nutritious food, 
and increases hardships. Hardships cause stress, which in turn 
promotes unhealthy coping mechanisms.
    Poor reporting of data, which initially masked the fact 
that the disease was disproportionately affecting Black 
communities, remains a problem even as States move to reopen 
their economies. Today, Americans living in counties with 
above-average Black populations are three times more likely to 
die from coronavirus as those living in above-average White 
counties.
    The AAP, American Academy of Pediatrics, last year 
published a policy statement on how racism is a core cause of 
health problems in adolescents and children. What wasn't it? It 
wasn't race. The paper drove home a crucial point. Racism, not 
race, affects health, and race should not be used to explain 
away disparities caused by racism.
    Simultaneously, we are facing another deadly pandemic of 
police brutality, which is also caused by the common thread of 
systemic racism found in COVID-19.
    Mr. Eshoo. Dr. Brooks?
    Dr. Brooks. We have witnessed the killings of Ahmaud 
Arbery, Breonna Taylor, George Floyd, and most recently the 
shooting this past Friday of Rayshard Brooks in Atlanta. These 
deaths, that have taken place in just the past six months, are 
added to the countless other Blacks who have become victims of 
police brutality. Blacks are three times more likely than 
Whites to die from----
    Ms. Eshoo. Dr. Brooks, you are a minute over so you need to 
sum up, please.
    Dr. Brooks. Wrap it up. Yes, I am.
    Ms. Eshoo. Excuse me.
    Dr. Brooks. So, where do we go from here? We advocate for a 
health system that protects all people. We advocate for 
equitable housing, healthy food, healthcare services, 
employment opportunities, and justice. We call on you for 
universal healthcare, call on the Federal Government to endorse 
policies that address food insecurity, call on policies that 
bring more African American physicians and decrease the digital 
divide, and more data on COVID-19.
    Our fight for a better public health system in the United 
States must center on fighting for a public health system in 
which Black lives truly matter. I have a vision of transcending 
COVID-19 to a healthier Black America and, therefore, a 
healthier America, because in the end we are all Americans.
    [The prepared statement of Dr. Brooks follows:]
   [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. Eshoo. Thank you, Dr. Brooks.
    We will now recognize Mr. Roy. You are recognized for your 
5 minutes of testimony. Thank you, again, for joining us. And 
please unmute.

                  STATEMENT OF AVIK S. A. ROY

    Mr. Roy. Chairwoman Eshoo, Chairman Pallone, Mr. Burgess, 
Mr. Walden, and members of the Health Subcommittee, thanks for 
inviting me here today.
    The Foundation for Research on Equal Opportunity, or FREOPP 
for short, is a nonpartisan think tank that focuses exclusively 
on ideas that can improve the lives of Americans on the bottom 
half of the economic ladder. I welcome the opportunity to 
discuss our work on COVID-19 racial and ethnic disparities.
    My written statement contains a more detailed discussion of 
our findings. In my oral remarks, I am going to focus on three 
topics. First, I will discuss the mortality impact of COVID-19 
on major U.S. racial and ethnic groups. Second, I will discuss 
our research on the critical subpopulation, vulnerable seniors 
who live in nursing homes and assisted living facilities. 
Third, I will discuss how economic restrictions put in place by 
States and localities have disproportionately harmed 
minorities.
    We have good reason to believe that minorities are at 
higher risk from COVID-19. Severe illness and death from COVID-
19 are associated with patients with preexisting cardiovascular 
or metabolic conditions, like high blood pressure, heart 
disease, and diabetes. These conditions are disproportionately 
prevalent in African Americans, as we know.
    As we have been discussing, the latest data from the CDC 
indicates that indeed Blacks represent a greater share of COVID 
deaths than they do of the general population, even when 
adjusted for the fact that COVID is more prevalent in cities. 
Mortality rates are also higher in Native American communities, 
especially in Arizona and New Mexico.
    What may be surprising is that Whites are also dying of 
COVID at higher than predicted rates. On the other hand, 
Hispanics and Asians represent a lower share of COVID deaths 
than would be implied by their geographically adjusted share of 
the U.S. population.
    The likely reason for these differences is that morbidity 
or mortality from COVID-19 is most common among the elderly. 
Eighty-one percent of all COVID deaths in the U.S. have 
occurred in people aged 65 or older and Whites are the oldest 
racial group in the U.S. with a median age of 44. Asians have a 
median age of 37, Blacks 34, Hispanics 30. Hence we should 
expect to see higher fatality rates in Whites relative to 
Asians and Hispanics due to their age and, indeed, we do. On 
the other hand, African Americans are relatively young, but we 
are still seeing higher mortality among Blacks.
    Here is another way to think about it. Overall, 81 percent 
of all COVID deaths have taken place among those 65 or older. 
But 89 percent of White deaths are among the elderly, 78 
percent of Asian deaths, 73 percent of Black deaths, and 59 
percent of Hispanic deaths.
    On the other hand, overall people aged 45 to 64 represent 
17 percent of COVID deaths overall, but only 9 percent of White 
deaths, 20 percent of Asian, 24 percent of Black, and 30 
percent of Hispanic.
    Many of you are familiar with our research on the tragedy 
taking place in our nursing homes and assisted living 
facilities; 0.6 percent of Americans live in long-term care 
facilities, and yet, within this 0.6 percent of the population 
lies 42 percent of all deaths from the novel coronavirus--42 
percent.
    As you know, nursing homes are residential facilities for 
medically vulnerable seniors who have challenges with 
activities of daily living such as taking a shower or getting 
dressed. Nursing home residents are disproportionately poor, 
non-White, and enrolled in Medicaid. We wanted to see if States 
with high death rates in long-term care facilities were also 
associated with higher proportions of Black residents or 
residents enrolled in Medicaid.
    As my written statement details, we found no such 
correlation at the State level. We are working on a county and 
facility level analysis that may yield greater insight and we 
will be happy to share it with you when it is completed.
    When it comes to the economic lockdowns of States and 
localities imposed on people and businesses in response to the 
pandemic, there is no ambiguity regarding racial disparities. 
In late 2019, Black unemployment reached its lowest rate in 
history, 5.4 percent. Today the Black unemployment rate is 16.8 
percent. Hispanic unemployment reached 3.9 percent in late 
2019, also a record. Today it is 17.6 percent.
    In my written testimony, I detail how disparities between 
White and non-White unemployment rates also reached their 
lowest levels in history just before the pandemic. But the 
economic lockdowns have brought those disparities back to 
levels seen a decade ago.
    Compared to Whites and Asians, Blacks and Latinos are less 
likely to work in white-collar occupations where working from 
home is feasible. Instead, they are seeing their jobs and hours 
slashed; hourly wage work is down 50 percent on average, and 
even more in places with the most stringent lockdowns.
    But Black-owned businesses have been also hit far harder 
than White-owned businesses. As Mr. Walden noted, it is 
estimated that Black-owned businesses have experienced losses 
of 41 percent between February and April versus 32 percent for 
Hispanic-owned businesses and 17 percent for White-owned 
companies.
    Put simply, racial and ethnic disparities are worse when 
the economy is worse and especially during the government-
mandated shutdowns of the economy we are experiencing today. 
There is much more to say, but let me stop there, and I look 
forward to our discussions today.
    Thank you.
    [The prepared statement of Mr. Roy follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. Eshoo. [inaudible] Your testimony and thank you for it 
being within the 5-minute timeframe.
    We are now going to move to member questions, and the Chair 
recognizes herself for 5 minutes.
    Dr. Brooks, when it became clear that COVID-19 was going to 
be a public health emergency, what, in your view, should have 
been done to prepare for and prevent the health disparities by 
race?
    Dr. Brooks. First of all, it would have been very helpful 
to have aggressive testing in the African American community. 
With the knowledge that there would be disparate outcomes based 
on the higher incidence of diabetes, obesity, and hypertension, 
we should have known early on that we needed to test that 
population.
    Number two, we needed to really focus on the access to 
healthcare and the access for PPE of those that are practicing 
on the front lines where these patients would be showing up in 
the hospital and the urgent cares, such that those treating 
would be comfortable coming into contact with those that could 
possibly have COVID-19.
    And then lastly, a focus on telehealth, telemedicine, and 
getting access to these patients who have hypertension or 
diabetes. The studies show that if you have hypertension and 
have it controlled, you are less likely to have an adverse 
outcome. Same with diabetes.
    So those would have been some actions that would have been 
helpful at the time.
    Ms. Eshoo. Thank you very much.
    Dr. Boyd, Mr. Roy, do you want to add anything to that 
response?
    Dr. Roy. Well, Madam Chairwoman, I would talk about nursing 
homes. If we had been aggressive in testing both workers and 
residents of nursing homes early on and restricting 
visitations--some States did it, but many States went the other 
direction--that would have had a big impact because nursing 
homes, as you know, ma'am, are disproportionately non-White, 
disproportionate Medicaid enrollees, and that is a population 
that has really gotten hammered.
    Ms. Eshoo. Thank you.
    Dr. Boyd.
    Dr. Boyd. Yes. I would add that data that actually came out 
of your district showed us that, as Dr. Brooks said, African 
Americans are less likely to be tested and particularly less 
likely to be tested in the outpatient setting.
    So African Americans had higher rates of hospitalizations 
and ICU visits likely is because, as they presented to care, 
they were not adequately tested and identified and then able to 
quarantine themselves and not continue to spread in their 
communities.
    I will also say that because we know African Americans make 
up a disproportionate amount of essential workers, we also 
needed to distribute and we still need to widely distribute 
universal access to protective equipment, particularly for 
people who need to work indoors.
    Ms. Eshoo. To Dr. Boyd and Dr. Brooks, you both make the 
point that racism, not race, affects health outcomes. How has 
racism affected our Nation's response to the current pandemic?
    And, Dr. Boyd, you can go first.
    Dr. Boyd. Thank you for that question.
    I think one of the--what I was trying to say in my earlier 
testimony is that racism is really pervasive throughout 
society. And so the answer is, it partly affected it because 
African Americans were already at higher risk of having, as 
other folks have said, chronic illness, which is not a function 
of their race, but is a function of their access to resources 
that racism shapes; and also had higher rates of poverty, 
which, again, is a function of how racism distributes resources 
by racial group in this country.
    Ms. Eshoo. Thank you.
    Dr. Brooks, would you like to add something to that?
    Dr. Brooks. I would only that in the early days and even 
now the data was not clear. The CDC was not collecting racial 
and ethnic data on COVID-19 cases and even now is getting it 
piecemeal. So there is a feeling that there was just a neglect 
on getting information about the racial aspect of COVID-19.
    Ms. Eshoo. Thank you.
    Well, let's see, I just have a minute. So let's see what 
else I can get in.
    These questions are for all the witnesses. You can answer 
yes or no.
    Dr. Boyd, would having free COVID-19 treatment available 
help address racial disparities?
    Dr. Boyd. Absolutely.
    Ms. Eshoo. Dr. Brooks.
    Dr. Brooks. Somewhat, but then there is still going to be 
the access issues with transportation and getting off from your 
work, et cetera.
    Ms. Eshoo. Mr. Roy.
    Dr. Roy. Yes, but I worry if you just mandate coverage of 
everything, the providers are off the hook in terms of what 
they charge. So you have to make sure if you mandate coverage, 
you also keep an eye on the prices that providers are charging 
for those services.
    Ms. Eshoo. I think the issue of Federal data collection is 
really very important. So I am not going to ask what you think 
about that. It has been spoken to not only by the witnesses, 
but by the chairman of the full committee.
    I think that my time is up, and so I will recognize Dr. 
Burgess, the subcommittee ranking member, for his 5 minutes of 
questions.
    And please remember to unmute.
    Mr. Burgess. Great. Thank you.
    And thanks to our witnesses for being here with us this 
morning. Thanks for your time in helping us in these 
evaluations.
    Dr. Roy, I just need to ask you a question because so much 
of your testimony is data driven, and then the concern that our 
information is only as good as the inputs that it receives.
    So what is your opinion right now of what, both from the 
administration standpoint and what the States are doing, to 
improve reporting for coronavirus and other health data to 
ensure the inclusion of racial information?
    Dr. Roy. Well, what I would say, Dr. Burgess, is that the 
data collection is improving. We are now starting to see more 
granular data from the CDC on race, particularly race by age. I 
testified before another committee, the House Coronavirus 
Select Subcommittee, a few weeks ago and we talked about this 
issue of not seeing age-based breakdowns by race, which is 
really important because, as we know, 81 percent of all deaths 
are among people over 65.
    So seeing how that breaks down by age given, that the 
median age of each ethnic group or race is different is really 
important. So we are now starting to see that data.
    The other thing I would say is the nursing home data. 
States had very different reporting policies of nursing home 
data. Now the CDC is requiring nursing homes to directly report 
their fatality data directly to the CDC, going around the State 
governments. And I think that is helping a lot because that is 
giving us consistent reporting from States like Michigan.
    Michigan has yet to report on a State basis their data. 
They are only now starting to because the CDC is requiring it.
    Mr. Burgess. And thank you.
    And this committee, the subcommittee and the full 
committee, has a history of passing landmark legislation. One 
piece of landmark legislation that we are all proud of is Cures 
for the 21st Century. But having diverse participation in 
clinical trials, and I know from talking to some of our 
acquaintances in the pharmaceutical research and manufacturing 
side and certainly, the language in 21st Century Cures did 
attempt to improve diversity in medical research.
    So I guess, Dr. Brooks, if I could ask you, to the extent 
that you understand what we did in 21st Century Cures, 
recognizing we will be doing a follow-up on to that bill at 
some point, Cures 2.0, have we made substantial improvements in 
including all ethnicities in collection of the data? And do you 
have thoughts about what Congress, the NIH, and private sector 
partners could do to significantly increase diversity amongst 
clinical trial participants?
    Dr. Brooks. So, yes, I do believe there has been some 
movement forward with a group called the Alliance and we 
submitted a letter to the FDA asking for more representation. I 
think it will be very important to have representation in 
clinical trials as relates to a vaccine that may become 
available.
    So I think that some has been done, but there is room for 
more. And I appreciate where we are at this point, but where we 
need to be, we are not there yet.
    Mr. Burgess. Well, thank you.
    And let me just say thank you for your service to the 
National Medical Association. I know how important that is. And 
I am grateful that you are doing that.
    You raised the issue about disparate testing at the 
beginning of the outbreak of this illness. This is a novel 
coronavirus, nobody had ever seen or heard of it before, so no 
surprise every aspect of it wasn't gotten right at the 
beginning.
    But to the extent that we have learned along the way and 
you do reference vaccines and vaccine development, from the 
standpoint of the National Medical Association, what are you 
doing currently to ensure that when a vaccine does become 
available, since we have identified the high-risk nature that 
we are discussing today, what is the National Medical 
Association doing to ensure the availability of those vaccines 
when they do finally become available?
    Dr. Brooks. So I am actually on the ACIP COVID-19 Work 
Group, which is developing the potential for rollout of the 
vaccine. And I, in that capacity, am advocating for ensuring 
that those at high risk are one of the earliest recipients of 
the vaccine.
    I also am crafting messaging, because there is concern in 
the African American community regarding vaccine hesitancy. So 
I am ensuring that I study the data and can ensure my 
constituents, my doctors, and my community that the vaccine is, 
in fact, safe and effective.
    Mr. Burgess. Yes. Of course, we need to ensure that it is 
safe and effective and that is the first step. I thank you for 
that. I have got a community, in my main county, and vaccine 
hesitancy really across all races is a feature. And I do know 
that is something that as physicians we are going to have to do 
our parts in helping people understand the importance of not 
just of a coronavirus vaccine when it becomes available, but 
even the flu vaccine next fall. It is going to be critically 
important.
    So thank you all for your testimony, and your participation 
today.
    I will yield back to the chair.
    Ms. Eshoo. The gentleman yields back.
    A pleasure to recognize the chairman of the full committee, 
Mr. Pallone, for your 5 minutes of questions.
    And please unmute.
    Mr. Pallone. Thank you, Madam Chair.
    And I want to follow up on the data. I know that Dr. 
Burgess mentioned it. But I just think that data is so 
important in trying to achieve a clear picture of the problem 
that we face with inequities.
    And I mentioned before that we did include a number of 
requirements in the HEROES Act that would require the Federal 
Government to better track and more regularly make public 
racial, ethnic, age, sex, and gender data as it relates to 
COVID, as well as to require the various Federal agencies in 
charge of data collection to modernize their data collection. 
But, unfortunately, we are still waiting for the Senate to act 
on HEROES.
    So my questions of Dr. Boyd and Dr. Brooks, I am going to 
kind of put it all together and then if you could just use half 
the time to respond.
    In your view, has data on COVID-19 cases, hospitalization, 
and deaths stratified by race and ethnicity been sufficiently 
collected and shared to get a comprehensive view of the 
disparities issued? Is any key data still missing? What, in 
your view, needs to change in the process of data collection 
and sharing to achieve better information so we can address the 
problem of disparities?
    And I guess we will start with Dr. Boyd with about 2 
minutes each here to respond.
    Dr. Boyd. Thank you for that question.
    I think one of the challenges at the Federal level is that 
at the local level and at the State level there are lags in 
reporting and there is a different specificity to which various 
departments reported upwards.
    So I think one thing that we need is comprehensive data. So 
you don't just map the racial and ethnic group, as others have 
said. It needs to be coupled with age, sex, or gender, and also 
location, the county that you are in, so that youcan have an 
idea of areas that are underserved by our current medical 
infrastructure.
    I think when you put those things together you are able to 
answer questions like Avik presented, which is like is age 
actually a driving risk factor for having COVID-19.
    And data that recently came out of Harvard's Medical School 
indicated that actually at every age cohort, African Americans 
and Latinx populations, in particular, and for some age 
cohorts, indigenous populations also, have exceedingly high 
mortality rates. I think the most devastating data was that at 
age 35 to 44 in the United States, African Americans have a 
mortality rate that is nine times White Americans.
    This is even for young folks. And you only get that level 
of specificity that allows us to say something different to the 
public about who is most at risk when you combine data values 
like race and ethnicity with values like age.
    Mr. Pallone. Well, thank you.
    And, Dr. Brooks, again, you know, particularly, what key 
data is missing, and you know, and what do we need to change 
particularly at the Federal level, to get more accurate data or 
statistics that would be useful in trying to deal with these 
inequities?
    Dr. Brooks. So I think one piece that is key that we don't 
have is the rate of testing. We don't have clear data on the 
racial and ethnic findings of the number of people tested. We 
have the hospitalizations and deaths, but just tested, for 
example, what percent of African Americans are testing negative 
versus positive, and how does that correlate with the other 
populations.
    That in and of itself would be very helpful because that 
indirectly reflects on access. It indirectly affects on 
insurance coverage and the messaging in the African American 
community in terms of getting tested. So I think that that 
information would be very helpful.
    It was data coming out of Connecticut that African 
Americans had a harder time getting tested. So if we had more 
data on testing, we would have more information on access.
    Mr. Pallone. Well, can I ask you, is this just in order to 
modernize and get better data--I mean, we talk about Federal, 
but a lot of this has to be on a State and local level as well, 
or is it mainly the Federal Government that has to act?
    Dr. Brooks. So there was, in one of the recently passed 
bills, demand that the administration get better data, and they 
released a 4-page document that really didn't dig into getting 
the data well.
    So I think that there should be leadership at the Federal 
level to set particular standards of what data needs to be 
collected and reported to the national administration like the 
CDC.
    Mr. Pallone. Well, I think you heard me say in my opening 
statement, I was very unhappy with that report, and one of the 
reasons that we need the HEROES Act is because the HEROES Act 
has language that I think does more towards getting to, you 
know, national standards and requiring the Federal Government 
to do a lot of this or even get the data from the States and 
the localities.
    So again, I think the HEROES Act is really important in 
this regard.
    But thank you so much, thank you both for your input and 
for being part of this hearing. It is very important.
    I yield back, Madam Chair.
    Ms. Eshoo. The gentleman yields back. It is a pleasure to 
recognize the ranking member of the full committee, Mr. Walden, 
for his 5 minutes of questions, and please unmute.
    Mr. Walden. Thank you very much, Madam Chair, and thanks to 
our witnesses. This is really insightful, really helpful 
information, as we are all trying to figure out what we got 
right, what we got wrong, and more importantly, what do we need 
to do going forward when a second wave hits as we should 
anticipate it will in the fall.
    And Dr. Brooks, I appreciated your comments about 
telehealth. My districts would stretch from the Atlantic to 
Ohio so we really need to ramp up our access to broadband, our 
access to telehealth. We did a lot of that in the CARES Act in 
a bipartisan way for Medicare--it is up to the States on 
Medicaid--but I think it made a lot of sense.
    I wanted to ask about the data, because this is something 
we have all struggled with, and in the CARES Act and other 
legislation we passed that President Trump signed into law, the 
first time we put some requirements, maybe not as much as we 
should and need to going forward, but there are data reporting 
requirements.
    As we dealt with this onset of the pandemic, I think we 
were all looking to our local healthcare providers to 
[Inaudible.] first. So let me ask, from your perspective, in 
the facility where you are, were you reporting all of these 
data points, and if so to whom? Was this to the State of 
California? Was it on up to the CDC?
    Dr. Brooks. So what happened is, for all the testing that 
we did, it would be reported by the lab to the county. So the 
county, therefore, collect the data. Then what the county did 
with it, they would report it to CD--California Department of 
Public Health.
    Mr. Walden. And in that reporting, were you reporting 
everything to the lab, and then the lab, in theory, to the 
county, that you now, knowing what we know now, was that 
fulsome enough? Did you have enough data there? Did it have 
ethnicity and age and all of that?
    Dr. Brooks. It had age but I believe not ethnicity.
    Mr. Walden. So even the data out of your own lab, your own 
testing, then, wasn't comprehensive, as we need it to be now?
    Dr. Brooks. Well, because in general, lab data isn't 
necessarily reported by----
    Mr. Walden. Right.
    Dr. Brooks [continue]. And we were relatively small in 
number at that point in time as it began. And so----
    Mr. Walden. Yes, that----
    Dr. Brooks [continue]. We needed guidance.
    Mr. Walden. Yes, I appreciate that, and I think we all 
learned along the way, but it was that area we found, I know, 
that these labs generally didn't collect or report those data, 
and now we learn that is really important to do and we need to 
do it going forward.
    Mr. Roy, thanks again for testifying. As we address the 
issues within the United States and minority communities here, 
and certainly the nursing home issue, I am so glad you raised 
that. We saw what happened as a result of the governor of New 
York putting COVID-positive patients back into those settings, 
and obviously he has learned that was a bad idea.
    But when I looked at the information coming from overseas--
and again, just one example in the United Kingdom, Black males 
and females are four times more likely to die from COVID-19 
than their White counterparts in the U.K. So this is more than 
just a U.S. issue. And it also found the same thing true for 
Bangladeshi, Pakistani, Indian, and mixed ethnicities.
    What is it you are finding in the data about this disease, 
if anything, that goes beyond some of the topics that have been 
discussed so far? Is there something else here that we are not 
seeing, if it is happening elsewhere?
    Dr. Roy. So Mr. Walden, we haven't looked at the racial 
disparities in other countries besides the United States, but 
what the CDC has done that is very useful that I don't know if 
those other countries' data that you are citing do, is, the CDC 
data is adjusted for geography.
    So for example, we know that about half the deaths from 
COVID-19 in the U.S. have occurred in the tristate area around 
New York City. The tristate area around New York City is 
inherently more diverse than the rest of the country. So when 
you adjust for the ethnic distribution of minorities, mostly 
who live in cities--that is true in the U.K. as well--you see 
that because cities are where the outbreaks are and there is 
higher mortality in cities, minorities are disproportionately 
affected.
    So you have to adjust your analyses for that factor. And 
when you do that, as the CDC has done, you still see a 
disproportionate amount of mortality for Blacks, but not for 
Hispanics and Asians.
    Mr. Walden. Interesting. And have they gone further to look 
at why that is? Is it the higher rates of diabetes and 
hypertension and some of the things we now know this horrible 
disease, virus, attacks?
    Dr. Roy. The CDC has not, but, you know, one thing I want 
to point out--and I mentioned this in my oral statement, as 
well as in the written testimony--Whites are actually, if you 
adjust for geography, White mortality is also overrepresented 
in the U.S., and that is probably because Whites, on average, 
are older. So I would say that the main thing is, it is a 
combination of things we already know, which is age, 
cardiovascular comorbidities, diabetes, things like that, and 
then if you live in a nursing home. Those are the three big 
correlations that we are seeing, and obviously in certain 
minority populations, especially African Americans, you see the 
perfect storm there--or the imperfect, worst storm.
    Mr. Walden. I appreciate that. And Madam Chair, I have no 
idea what time I have left, but I will yield it back, and thank 
you again for doing this hearing. It has really been helpful.
    Ms. Eshoo. Well, thank you, the gentleman does yield back.
    It is a pleasure to recognize the gentleman from North 
Carolina, Mr. Butterfield, for your 5 minutes of questions, and 
please unmute.
    Mr. Butterfield. Thank you very much, Madam Chair, and 
thank you to the ranking member for yielding back a minus-10 
seconds. But it is good to see all of you today, and thank you 
to our three witnesses for your testimony.
    You know, Dr. Brooks, I watched your interview with the BNC 
news channel. It was very very enlightening on how COVID is 
affecting physicians, not only patients, but it is affecting 
physicians. You know, my dad was a dentist many years ago. And 
the National Medical Association and the National Dental 
Association were sister organizations. In fact, they often met 
for their summer conventions at the same time and in the same 
hotel, and our families looked forward to those conventions 
every year. And sir, you are continuing that great legacy, and 
thank all of you for your testimony.
    The killing of George Floyd has finally forced our Nation 
to address racism in policing. COVID is forcing us to confront 
the impact that racism has on the health of African Americans 
and other racial minority groups. These dual crises have 
illustrated what so many of us have been saying for years. The 
systemic racism and entrenched bias in all facets of our 
society have not surprisingly resulted in inequities and 
inequalities from top to bottom.
    Black Americans face higher rates of poverty, and economic 
insecurity, illness, and chronic conditions like diabetes and 
heart disease and kidney disease. African Americans also face 
higher rates of arrest and incarceration. These are 
indisputable facts. The data show this, and the experiences of 
our friends and family members prove it.
    In my State of North Carolina, 34 percent of those who have 
died from COVID were African American, despite the fact that we 
are only 22 percent of the population. And of the total cases, 
44 percent are Latinx, despite the fact that less than 10 
percent of North Carolina's population is Latinx. We have seen 
the reports linking kidney disease and its two leading causes--
high blood pressure, and diabetes--to an elevated risk of death 
from COVID.
    We also know that kidney disease had a disproportionate 
impact on minorities long before the current crisis, but this 
alone cannot account for these figures. And so Dr. Boyd, thank 
you for your testimony. You note that blaming the 
disproportionate impact of COVID on communities of color, on 
higher rates of poverty and chronic illness, ignores--it 
ignores the underlying issue of racism throughout our country's 
history.
    Dr. Brooks, you also noted in your testimony that in order 
for us to effectively eliminate the health inequality gap, we 
must address America's perpetual pandemic of racism and the 
legacy that hundreds of years of discrimination has left on the 
health and well-being of communities of color.
    Dr. Boyd and Dr. Brooks--let me take a look at my time. I 
am OK.
    Dr. Boyd and Dr. Brooks, could you elaborate on this point 
and explain to us, 1 minute each, why conflating the effects of 
racism with poverty is not a good idea?
    Dr. Boyd. OK, I will go first. Thank you so much for that 
question.
    First, not all patients that have COVID-19 are poor, and 
not all African American patients that have COVID-19 are poor. 
So first it is inaccurate.
    The other problem is that racism shapes how resources are 
distributed in this country, and so we have to think about what 
that means in terms of healthcare service delivery. One example 
we can use right now is how crisis allocation of healthcare 
resources during COVID-19 use criteria like life expectancy to 
determine whether individuals who presented to hospitals who 
were overwhelmed, particularly in New York, who are overwhelmed 
with the amount of sick patients, whether or not they got life 
support.
    If you use a metric like life expectancy--and we know who 
in this country, African Americans, have a lower life 
expectancy than other populations, a life expectancy gap as 
high as ten years between White females and Black males--then 
you automatically discount African Americans when you are 
talking about who deserves life support in the hospital 
setting. So----
    Mr. Butterfield. Let me try Dr. Brooks in the 1-minute that 
I have remaining. Dr. Brooks, why is it not a good idea to 
combine racism and poverty in the same conversation?
    Dr. Brooks. Because studies show that when you factor out 
income, education, healthcare coverages, and other social 
determinants of health, African Americans still have worse 
outcomes. So in other words, the variable there is race.
    Two people with the same income, healthcare coverage, and 
education, you will have African Americans with worse outcomes. 
This comes into implicit bias as one of the primary causes. 
African Americans are just treated differently because of how 
they are seen by the majority community. It is related.
    Mr. Butterfield. Thank you. As both of you can see, 5 
minutes goes very quickly.
    Thank you, Madam Chair. I yield back.
    Ms. Eshoo. The gentleman yields back. It is a pleasure to 
recognize the gentleman from Michigan, the former chairman of 
the full committee, Mr. Upton, for your 5 minutes of questions. 
Unmute, please. You need to unmute, Fred.
    Mr. Burgess. He states he is trying.
    Ms. Eshoo. There you go.
    Oh, no, that was someone else.
    We can't hear you, Fred.
    Mr. Upton. I am sorry. There we go.
    Ms. Eshoo. There you go.
    Mr. Upton. Well, thanks very much for doing this hearing. 
You know, it is so critical that diverse populations, 
especially those with vulnerable populations, be adequately 
represented in the clinical studies. And the 2020 COVID 
pandemic has amplified the existing inequalities that place 
individuals and groups in markedly unequal positions. We know 
that. We really appreciate the statistics today, particularly 
even some of the worldwide numbers that you have shared with 
us.
    And early reports, of course, of deaths from COVID have 
found a startlingly high rate of mortality among the African 
American community. So Diana DeGette, my colleague, member of 
this committee, and I released some initial policy ideas as we 
have been beginning to consider and update what we did with 
21st Century Cures. And Dr. Burgess mentioned a little bit 
about that as part of our CURES 2.0 process.
    In the release that we released--the concept report back in 
March, included some ideas on ways to improve healthcare access 
for diverse populations. We also included some reforms to 
support the further use of real-world evidence to support the 
approval in coverage of drugs.
    And of course, one of the big things that 21st Century 
Cures did was, we expedited the approval of drugs and devices, 
but we allowed the clinical trials which were before siloed. 
They didn't share information with others, to really change, 
which is why when we get a vaccine for this, and better 
therapeutics, we will be able to get them months, if not years, 
faster because of the work that this committee did in pushing 
that legislation onward, where President Obama signed it into 
law back in 2016.
    So I would like to ask each of you, as we do consider 
opportunities to provide and improve healthcare access for 
diverse populations, what are your thoughts on the importance 
of ensuring that diverse populations are fully represented and 
not excluded in the healthcare operations, such things as 
clinical trials? And I guess just knowing that you all control 
the button, maybe we will start with Dr. Roy, then Brooks, and 
then Boyd. Take just a brief time here.
    Dr. Roy. Sure, Mr. Upton. You know, the disparity in how 
clinical trials have been conducted has been a problem since, I 
was in med school 25 years ago. So I am glad to see some work 
on that particular topic in Congress.
    The one thing I would mention on top of that is that it is 
great that your committee has been working hard to reduce the 
cost and accelerate the pace of innovation in pharmaceutical 
development, and vaccine development, but we also have to make 
sure that innovative companies are socially responsible in the 
way they price these drugs, particularly if they are going to 
be guaranteed decades' long monopolies.
    So I hope that your legislation will consider ways to think 
about that problem as well, because that also harms access to 
drugs for low-income or disadvantaged populations.
    Mr. Upton. Exactly right. And Diana and I are working on 
that aspect of it as well. It is no good to have a new drug and 
have no one be able to afford it.
    Dr. Brooks. This is Dr. Brooks. I concur with that 
statement. The National Medical Association has had for years a 
Project IMPACT, Improved Minority Participation and Access in 
Clinical Trials, because we have understood that we needed 
minority participation. I think that the actions that are being 
taken are very helpful.
    I think it critically important when there are more studies 
that go forward with treatments for COVID-19, such as 
hydroxychloroquine, which is somewhat of a nonstarter, but 
Remdesivir and other treatments. We had a patient that just had 
convalescent plasma got better overnight. So I just want to 
make sure that there is more access to those treatments.
    Mr. Upton. Great. Dr. Boyd?
    Dr. Boyd. Yes. I will also say expanding Medicaid is really 
critical. So most African Americans predominantly live in this 
country in the 14 States that have yet to expand Medicaid. To 
participate in a clinical trial, many need insurance coverage 
to actually cover some of the services that they are receiving 
as a part of the clinical trial.
    And so the lack of Medicaid expansion disables some African 
American populations from participating just on the basis of 
affordability. So expansion of Medicaid would be a big boost.
    Mr. Upton. Well, I thank you all. I have got 30 seconds 
left, so let me just make a comment here at the end.
    You know, when we get through this thing, it is because we 
have got, in essence, really a three-legged stool. We got to 
have the therapeutics, we got to have the testing, and we have 
to have a vaccine.
    And I know that as one of the provisions in the last bill 
the President signed into law, there was $1.8 billion go to the 
Shark Tank for home testing, and credit to Dr. Collins for 
really putting together an organization literally within 48 
hours. They have taken 80 to 100 different entities' 
applications to see which private sector group may work.
    In my district--excuse me--in my State, we have an entity 
that has actually got a device about this size. It has been 
patented already to go for two different universities. It has a 
little receptacle for both saliva and blood, and it can test 
within minutes the antibodies if one has been exposed to that.
    And so far it survived the Shark Tank. We are hoping that 
it may be the big winner, but it is so important because you 
are going to be able to link that to an iPhone. And so wherever 
you go, a restaurant, a U.S. capital, your school class, your 
line at work, you will be able to show that you are green, and 
therefore, you have not been exposed to this.
    And it is so important that we get this into the field, we 
get it into our homes, because this will be a major--a major 
step forward in trying to stop this spread.
    So with that, Madam Chair, I yield back my time, and thank 
you again for the hearing----
    Ms. Eshoo. The gentleman yields back. A pleasure to 
recognize the gentlewoman from California, Ms. Matsui, for her 
5 minutes. Unmute, please, so we can all hear you.
    Ms. Matsui. Absolutely. Thank you, Madam Chair, for having 
this hearing today. I want to thank the witnesses for their 
mind-blowing testimony.
    You know, police violence and racial inequities have long 
contributed to levels of stress, toxic stress in the Black 
community. In recent months, the police killing of George Floyd 
and the unjust disproportionate impact of COVID-19 on Black 
communities, have undoubtedly taken an extra toll on the mental 
health of Black Americans.
    In response to the pandemic, we have seen behavioral health 
resource providers across the country make rapid shifts to 
telehealth. In Sacramento, data emerging from our community 
health centers, providing telesite services shows that no-show 
rates for behavior health appointments dropping dramatically.
    Dr. Boyd, from your perspective, what opportunities exist 
to leverage technology in minority communities to address 
mental health challenges? And how do we use telehealth in a way 
that creates more access and reduces barriers to care without 
exacerbating inequalities?
    Dr. Boyd?
    Dr. Boyd. Thank you. Telehealth is a great opportunity to 
reach populations that might have had other barriers to 
physically receiving their care within clinical settings. But 
we know in this country that there are wide gaps in 
availability to broadband internet, Wi-Fi access, and devices 
that support the type of connection you need to have quality 
video, to make your telehealth visit effective for your care.
    And so to expand telehealth in a way that doesn't further 
inequities, we need to ensure that people have access to 
quality devices and to internet that makes it possible for them 
to participate in this new form of care.
    Ms. Matsui. Certainly. And that is really appropriate for 
our committee moving forward also.
    Community health workers have proven to be an effective and 
versatile workforce capable of improving health outcomes for 
diverse groups. These workers are able to foster the 
relationship between communities and the healthcare system by 
promoting trust between patients and providers and ensuring the 
health system's ability to provide culturally censured care.
    Dr. Brooks, what value do community health workers provide 
in the fight against COVID-19, particularly in communities of 
color?
    Dr. Brooks. So what you will find is community health 
workers are generally very similar to the communities in which 
they work, so they relate directly to the patients in which 
they are treating.
    They also understand, therefore, the misperceptions that 
may occur, and the issues with getting access. So they are 
crucial. And so FQHCs, for example, are funded for 1 to 3 
years. What would be helpful is if FQHCs could get funded for 
up to five years without having to reapply for finances, 
because that would give us more--long--more strategic planning 
abilities.
    Ms. Matsui. Well, certainly that was something that most of 
us do support here.
    You know, a recent study by Center Health provided stark 
differences, differentials in access to testing for COVID-19, 
which also delayed diagnosis and treatment, and led to higher 
rates of hospitalization for Black Americans in Northern 
California. The study found that Black Americans were less 
likely to be tested in an outpatient setting before going to 
emergency--before going to an emergency room.
    Dr. Boyd, what do you believe can be helpful in a situation 
like this? Most people, unfortunately, go to emergency rooms, 
even though that is not the most appropriate way. What 
consequences does utilizing the system in this way have on 
health outcomes, households, and communities, and what 
recommendations do you have for changing when and where people 
seek care?
    Dr. Boyd. Emergency rooms are the most costly setting in 
which to seek medical care. In the setting of COVID when 
patients may have the acute onset of severe symptoms, that is 
an appropriate setting to seek care, but what that study found 
is that most African Americans did not receive a test in the 
clinic, in the outpatient setting, before they were severe 
enough to have to go to the emergency room and be hospitalized.
    So broader access to testing, even for patients whose 
symptoms might be subclinical, those who are not yet severe, I 
think early on we need to know if you have COVID early to be 
able to treat you effectively.
    Ms. Matsui. Absolutely. And that is why I really believe 
that the setting has to be something that is culturally 
sensitive, too. In many cases the community health centers 
would be the appropriate place to do this too.
    I see my time has gone, and I yield back. Thank you.
    Ms. Eshoo. The gentlewoman yields back. The Chair now 
recognizes the gentleman from Illinois, Mr. Shimkus, for his 5 
minutes, and unmute, please.
    You need to unmute, Mr. Shimkus. We can't hear you. We 
can't hear you. Mr. Shimkus, are you still with us? We can't 
hear you. Why don't we get your situation straightened out, and 
the chair will recognize the gentleman from Kentucky, Mr. 
Guthrie, for 5 minutes.
    Mr. Shimkus. I think I got it.
    Mr. Guthrie. OK. I will yield back to John and go to my 
spot.
    Ms. Eshoo. OK, thank you.
    Mr. Shimkus. Yes, my apologies.
    Ms. Eshoo. That is all right. You are recognized for 5 
minutes.
    Mr. Shimkus. Thank you very much, and I will try to be 
brief.
    Dr. Roy, I was really interested in the 0.6 percent of the 
population having 42 percent of the deaths. And we all come and 
bring our own personal stories. March 23rd, I started a 2-week 
vigil on my mom's passing, and we were in the long-term care 
facility with her. April 6, she passed. April 18, I took my dad 
to emergency room. April 23, he got out of the hospital and 
went to a rehab facility and a long-term care. And then he went 
to another long-term care facility. Of course, he had to be 
isolated in both those cases and in the hospital.
    Now he is out of isolation but at a long-term care facility 
that is really locked down. And they are doing, knock on wood, 
everything right. You hate to tell these stories, because you 
don't--you know, you fear that the bad news will come and--so 
in my district, we have had 2,256 cases, 125 deaths. Fifty-five 
have been in long-term care facilities. We have conducted 
58,000 tests. So information is important.
    Talk about this long-term care issue, and I know some 
States have done other things, maybe not well, but in my 
father's case, he has been fortunate to be handled 
appropriately through the medical care folks in three different 
locations--actually four and--can you talk about this issue on 
long-term care?
    Dr. Roy. Well, first of all, let me say, Mr. Shimkus, my 
condolences for your loss and best of luck with your father.
    One thing I should mention is that, you know, I mentioned 
the point about how 42 percent of all deaths nationwide have 
occurred in nursing homes even though they are 0.6 percent of 
the population. Outside of New York State, it is actually over 
50 percent. So in places like your district, in places like 
Illinois, it is over 50 percent. And there are some States--
Minnesota, I think, is at 80 percent. We--I think in my written 
testimony, I have some of those maps in there that go State by 
State.
    So the problem is especially severe in certain parts of the 
country, and policy has had an impact on that. We have talked 
about, and I know you all are aware, of how some States, like 
New York, New Jersey, and Michigan, forced nursing homes to 
accept patients who had active COVID infections even though 
those nursing homes did not have the wherewithal to quarantine 
those patients effectively.
    Other States went the other direction. Florida did a good 
job of locking down nursing homes, and you know, what they will 
tell you, it was very hard to tell loved ones, family members, 
that they couldn't visit their relatives in nursing homes. That 
was not something that was a politically or morally easy 
decision to take, but they did it because they took the threat 
seriously.
    And I think now that we have learned more and more about 
this problem, when I started talking about this two months 
ago----
    Mr. Shimkus. Dr. Roy, let me go to Dr. Brooks real quick 
because----
    Dr. Roy. Sure.
    Mr. Shimkus [continue]. My time is running out. So Dr. 
Brooks, we are all big fans of FQHCs and community health 
centers, and I have stats from my local one and how they meet 
the needs of the Medicaid, the minority, Hispanic. They also 
create--have Spanish-speaking attendants, so for those who need 
English as a second language.
    And I didn't want to go through all the stats, but the FQHC 
survived based upon benefits--and I think you raise a good 
issue--3- to 5-year extension would be a helpful thing. That is 
the things that we need to hear, as far as other opportunities.
    I know my community health clinics, I had a conference call 
with them a week or two ago, and they were addressing their 
response. They were very thankful for the $2 billion to help 
the FQHCs. Were you able to take advantage of that additional 
money for your community health center?
    Dr. Brooks. Yes, we were. We got $454,000 for testing, 
$67,000 just given, and then 927 in the CARES Act. So we did 
get some support, and we are actually appreciative of it.
    Mr. Shimkus. And I thank you for that, and there is always 
more to do. We appreciate your testimonies. This has been a 
great hearing.
    Madam Chairman, I appreciate the time. Sorry about my--
because it took me 25 seconds to get on, I will yield back my 
time.
    Ms. Eshoo. All right, the gentleman yields back. A pleasure 
to recognize the gentlewoman from Florida, Ms. Castor, for your 
5 minutes, and please unmute.
    Ms. Castor. Yes. Thank you, Chairwoman Eshoo, for holding 
this important hearing on health disparities. The COVID 
pandemic certainly has highlighted the unfortunate health 
disparities across America.
    A recent press announcement, here in Florida of, Florida 
Department of Health data showed that coronavirus is twice as 
high among our Black and Latino neighbors here in this State, 
and now we are seeing an uptick in positive cases in Florida. 
So we are very concerned about this and the fact that we really 
do not have modern data reporting systems.
    So Dr. Brooks, thank you very much for encouraging us to 
provide greater leadership on the standardization of data. I am 
especially sensitive to this because there has been a troubling 
pattern in my State about data reporting and transparency.
    For example, the State previously withheld important data 
regarding nursing home infections and deaths. They had withheld 
certain data reported by our medical examiners. That is public 
record in Florida. And they also fired a data scientist. They 
said they did that largely because she was asked to censor 
certain data.
    And, you know, we need this, public health experts need 
this information so that we know that it is safe to go back to 
work, to go to school, to go out in public, and where to target 
resources.
    Chairman Pallone, I want to thank you very much for 
pressing the CMS administrator, Seema Verma. She had said she 
would report the Medicare coding data in March, and here we are 
in the middle of June and we still don't have it. And I bet Dr. 
Brooks and Dr. Boyd can share with us why the Medicare coding 
data is so important and how that kind of data can improve the 
analysis on COVID-19 by race and ethnicity. So I want to turn 
it over to them and ask them to weigh in on that.
    Dr. Brooks. So I will speak first. So, yes, that would be 
extremely helpful. We are in the 21st century in the United 
States, and technology and data is what drives our decisions. 
So if you don't have that, you cannot make wise decisions.
    Those 65 years and older, those are the ones that are dying 
the most, getting hospitalized the most, and those who are on 
Medicare. So if we have the data coming in, we can make 
calculated decisions on how to employ testing, how to employ 
healthcare services, how to employ public health messaging. So 
without that data, we are somewhat flying blind.
    Ms. Castor. Dr. Boyd?
    Dr. Boyd. I will add that--oh, yes. Thank you.
    Ms. Castor. Go ahead.
    Dr. Boyd. Thank you. I will add that in addition to the 
Medicare population, as a pediatrician, it is also incredibly 
important that we are capturing the emergence of COVID among 
our younger civilians, and I think all insurers should be 
collecting this data so that we can have it in real-time 
because the data lags affect how well we can respond to it.
    Ms. Castor. So Dr. Brooks, I have heard from a lot of my 
local public health experts and practicing physicians. They say 
reporting to CDC is completely antiquated. Sometimes they are 
still accepting fax information from various sources. I mean, 
if these come from multiple sources, from counties and health 
departments and States and hospitals, but this seems to be 
really outdated.
    What kind of advice do you have--and I know Mr. Walden 
asked you about reporting from your lab, or from your office, 
and you may want to talk about or clarify what you are 
reporting and what your local health departments are reporting.
    Dr. Brooks. So now all our data is captured, including 
race, and ethnic data on testing. Also, on our ICD10, or our 
coding that we submit, we call it encounter reporting. But the 
broader question is what you are raising. There needs to be 
national standards for data collection and reporting and a 
national clearing house that manages this. And it is--like, you 
spend money on administration, but that is where there needs to 
be some money spent.
    And there needs to be a laser focus on this. It is really 
not that difficult in the computer age. The data is in there. 
So it is a matter of demanding it, collecting it, analyzing it, 
and acting upon it.
    Ms. Castor. Great. Thank you very much. I yield back.
    Ms. Eshoo. The gentlewoman yields back. I now recognize 
again, the gentleman from Kentucky, Mr. Guthrie.
    Mr. Guthrie. Thank you, Madam Chair. I appreciate you 
holding this hearing and how much we are all coming together to 
try to address this issue. And I am glad we are here today to 
better understand these issues.
    But I want to specifically talk briefly about the Medicaid 
population. They are some of the most vulnerable, and the data 
on this population is less than optimal. The lack of data is 
evident in a CMS report published in November, titled, 
Quantifying the Distribution and Completeness of Select 
Demographic Variables in 2016. And I know we are going to do 
this at the end, take action at the end, but I would like to 
submit this for the record.
    And the report finds that most States don't have race or 
ethnicity data for more than ten percent of their population, 
and this is vital information for fighting the coronavirus and 
other diseases.
    And before I get to my question, I will just mention about 
our colleague, if I can get through this. Dear friend of mine 
and a fellow Kentuckian, yesterday, you know, Andy Barr lost 
his wife, Carol. And it just reminds me, as we talk about all 
these statistics and numbers--and they are important as Dr. 
Brooks said. You have to understand them or you are going to 
make the wrong policy decisions.
    But everybody that we are talking about is a life. It is a 
tragedy, it is a family, it is just people affected, and that 
is why it is so important that we address this and get this 
right.
    I was talking with Andy or communicating with him mid-
afternoon yesterday, had no idea anything was wrong at all, and 
we still don't know exactly what happened, but she seemed to be 
healthy this time yesterday. And it is just tragic, but--so we 
need to understand the numbers but also understand the faces 
behind the numbers is just what I want to share.
    But with Dr. Roy, I want to ask you, and the others could 
comment as well--I guess I have used up a couple of my minutes 
already, but--you mentioned in your testimony that more data is 
needed, and I think everybody has talked about more data is 
needed.
    And I guess getting back to the personal side of it and 
addressing the issues, once we have data, how quickly or how 
fast do you think, Dr. Roy and the others, we can pivot to 
address these disparities?
    Dr. Roy. Well, Mr. Guthrie, I would say that there are 
certain aspects of it that we can address very quickly in the 
sense--for example, the nursing home piece. There is a lot that 
States and localities and the Federal Government, Congress, can 
do today to address the nursing home disparities.
    Then I would talk about Medicaid. You mentioned Medicaid. 
There are a lot of challenges with Medicaid, both in terms of 
the way Medicaid steer first people into nursing homes, instead 
of facilitating them getting the care they need in their own 
homes.
    And also just the fact that Medicaid, because it pays so 
little to providers, particularly primary care physicians, that 
people enrolled in Medicaid don't get access to primary care, 
therefore, have poor management of chronic diseases, which, as 
we have seen in COVID, is lethal.
    Those are two things I would talk about in terms of things 
that, you know, short-term, midterm. And then obviously the 
issues related to the legacy of slavery and segregation, 
structural racism, because they are big challenges that we 
obviously need to put a lot of attention into, and I welcome 
all Members of Congress doing so.
    Mr. Guthrie. And Dr. Brooks and then Dr. Boyd, if you would 
like to comment, I have a couple of minutes left.
    Dr. Brooks. Sorry had to unmute myself.
    I think that one thing is to focus on right now is implicit 
bias training. We are all talking about race [Inaudible.] There 
are studies that show that when police officers, healthcare 
providers, have implicit bias training, they make better 
decisions, better informed decisions.
    And we did talk about this once, but the digital divide. 
[Inaudible.] More access to broadband. We know right now, that 
that would have a positive effect, just in terms of access to 
information, beyond telehealth. So those are two acts that I 
would say I would look at immediately beyond any other data 
that may come subsequent.
    Mr. Guthrie. Thank you. And Dr. Boyd?
    Dr. Boyd. I would also say, we have an enormous amount of 
data already that we can start acting on. Part of that data is 
that 8 out of 10 of the COVID clusters have actually been in 
correctional facilities. In addition to thinking about nursing 
homes, we have to think about all congregate living sites--
homeless shelters, correctional facilities, detention 
facilities--and what we are doing to focus on those 
populations.
    So I would call us to act on the data we already have that 
is alarming that multiple people have noted.
    Mr. Guthrie. OK, thank you. And then I am also on the 
Education and Labor Committee, and we had a hearing on the 
length of the summer and summer learning loss, and a lot of it 
came up. So particularly there was the superintendent of the 
Cleveland schools, and just--even though that is a big city and 
has broadband, is access to the devices and just the disparity 
of families that have higher incomes and lower incomes and just 
in terms of access to broadband and that doesn't just affect 
health, it affects education.
    So I appreciate you all being here, and this is important. 
And I thank you, Chair, for bringing this hearing together, and 
I yield back.
    Ms. Eshoo. The gentleman yields back. The Chair now 
recognizes the gentleman from Maryland, Mr. Sarbanes, for 5 
minutes of questions, and please unmute.
    Mr. Sarbanes. Thank you, Madam Chair. Can you hear me?
    Ms. Eshoo. I can, very well. Thank you.
    Mr. Sarbanes. Appreciate this hearing. I want to thank the 
witnesses who joined us today. This is an extremely important 
topic.
    Maryland, like the rest of the country, is suffering, and 
communities of color in Maryland have been particularly hard 
hit by the coronavirus pandemic. There are lots of different 
reasons for this, and our witnesses today have discussed those, 
but among them certainly are the longstanding issues of 
inequality and racism that we experience in our country.
    In my State, African Americans are now accounting for 29 
percent of the population but 41 percent of the coronavirus 
deaths. Hispanic or Latinx individuals are ten percent of the 
population but represent 33 percent of the diagnosed 
coronavirus cases. So these numbers obviously are unacceptable.
    We are working hard, in this committee and in Congress, to 
address the root causes. I would like to have submitted--I know 
at the end of the hearing, you will be accepting a unanimous 
consent request from Members to submit things for the record, 
but our attorney general, Brian Frosh, authored an article 
today which discusses the health disparities, and the 
disproportionate impact. It is an excellent overview of what 
the experience in Maryland has been, and so we have submitted 
that for the record.
    Dr. Boyd and Dr. Brooks, thank you for your testimony. I 
would like to merge together two topics that have already been 
alluded to in earlier discussion today.
    One has to do with distribution of vaccines, if we can 
ultimately get the vaccine into communities that have been 
disproportionately impacted, and the other has to do with the 
sort of culturally sensitive and competent workforce and how we 
deliver treatments, vaccines, and other things in various 
communities.
    If you could speak again to how critical it is, and maybe 
let's use the availability of a vaccine as the way of doing 
this, how critical it is to make sure that the delivery of a 
vaccine is done in an equitable fashion, and how important in 
accomplishing that is, that we have a healthcare workforce that 
has a sense of understanding and connection to the communities 
that we are trying to reach.
    Because I know those are issues that both of you put front 
and center in the work that you do. So why don't we start with 
Dr. Brooks and then go to Dr. Boyd.
    Dr. Brooks. So the equitable distribution of the vaccine is 
critical, and it may not be as easy as it sounds. Should you 
give it to those in long-term care facilities? Should you give 
it to first responders? Should you give it to doctors on the 
front line? Should you give it to an 80-year-old Black man with 
diabetes and hypertension?
    So it will also be the amount of vaccine that we can 
produce per month. That being said, I do know that that work is 
ongoing, and I am very happy with the way that the decisions 
are being made thus far.
    As it relates to in the communities, yes, the issue with 
police and police brutality, there are issues with race, and it 
would be better if we had more representation by community 
advisory boards, and other actions that address implicit bias 
and racism in police and that flows over to the vaccines.
    Mr. Sarbanes. Dr. Boyd, could you speak to what it means to 
do outreach in certain communities and what it means to have 
that cultural sensitivity, particularly when it comes to 
delivering healthcare opportunities?
    Dr. Boyd. Yes. I think we have already seen, as a 
pediatrician, that we have had lower rates of vaccination 
because of how COVID-19 disrupted preventative care, primary 
care access for patients. And so as we, as a healthcare system, 
flex to go to telehealth and outdoor clinic settings, I think 
we also have to think about accessible platforms for patients 
to get the vaccine, even for kids to get their regularly 
scheduled vaccines, and definitely for families and communities 
to get the COVID-19 vaccine.
    Having platforms that are available in folks' communities, 
that they can walk up to and not have to have a car to drive 
into, I think, would go a long way in making sure that access 
is more equitable.
    Mr. Sarbanes. Thank you very much. I yield back.
    Ms. Eshoo. The gentleman yields back. A pleasure to 
recognize the gentleman from Virginia, Mr. Griffith, for his 5 
minutes. Are you unmuted?
    Mr. Griffith. I believe I am. Can you hear me?
    Ms. Eshoo. Yes, you are.
    Mr. Griffith. Thank you, Madam Chairman, I appreciate that.
    Dr. Brooks, you brought up, in your testimony and some of 
your comments, that hypertension and diabetes are a concern. I 
thought that was interesting because I was reading an article 
over the weekend that talked about how food deserts, 
particularly in poorer communities, African American 
communities, et cetera, lead the folks in those communities to 
be overweight, thus, more hypertension and diabetes.
    Do you think that that is something that we should look at 
as a part of all of this that we are looking at?
    Dr. Brooks. Absolutely. That is one of the primary social 
determinants of health that is leading to adverse outcomes. 
African Americans are more likely to be food insecure, 22 
percent versus 12 percent. And you all know that it is hard to 
get to the marker. We are doing this now.
    So if it--even under COVID, if you don't have that access, 
it is going to even be worse. So, actions that reduce food 
insecurity will directly lead to better health outcomes.
    Mr. Griffith. Well--and correct me if I am wrong on this--
part of what I interpreted from that article was that there may 
be some--like a corner store or something that they are 
carrying potato chips, frozen pizzas, you know, Vienna 
sausages, et cetera, all things that are high in sodium and 
which are not particularly healthy, and because there is not a 
full-service grocery store, even though they might be able to 
get some food, they are not getting the healthy foods that 
would help them with their weight issues, hypertension, or 
diabetes. Is that also fair?
    Dr. Brooks. That is true. And that is part of what directly 
informs the statistics of food insecurity. So access to healthy 
foods and the ability to purchase it are what define food 
insecurity.
    Mr. Griffith. Appreciate that. I also appreciate you 
bringing up telehealth. I represent a very rural community 
where telehealth is also important. It is one of those things I 
am now curious that there be a study because the most rural 
parts of my district also have higher levels of hypertension 
and diabetes as well. Even though it is not a minority 
population, it is a poor population that is separated from easy 
access to full-service grocery stores.
    So that is an interesting point. I mean, telehealth is 
going to be huge. We have got to get the broadband out there, 
whether it be through wide spaces, whether it be through lower 
satellite, or whether it be through laying of [Inaudible.] but 
I appreciate that.
    Dr. Roy, I am going to switch gears completely and go with 
you about something that you were talking about nursing homes, 
and you noted the older population in nursing homes had been 
particularly, because of the congregate care, subject to both 
getting the disease and then obviously causing the morbidity 
and fatalities.
    I had a concept that was brought to me a number of years 
ago when I was in the State legislature. We actually got a law 
passed in Virginia to allow a zoning variance for this--and 
then North Carolina followed suit--and you would basically 
create a medical cottage which then could be placed into 
somebody's backyard so that if I wanted to put my mother-in-law 
out there in the backyard because she had some issues, and if 
there were requirements that you have to needs for daily 
medical help. But if I want to do that, I could then have her 
in the backyard instead of putting her in a nursing home.
    The concept has never taken off because Medicare and 
Medicaid don't reimburse that at all, and obviously, unless you 
are extremely wealthy, you can't afford to rent a medical 
cottage and stick it in the backyard.
    But the data that we looked at when we were developing 
this, the data indicated it would actually be cheaper than 
nursing homes, and you would still be closer to family. Do you 
think that is something that this might--the time might have 
come for us to push Medicaid and Medicare to reimburse 
something like this, so that not only would people be closer to 
their family, but they also wouldn't be in congregate care 
settings where people are susceptible to getting a virus like 
this?
    Dr. Roy. Well, Mr. Griffith, what I would say is that in 
the nonpublic programs, among people who can afford to do it, 
home-based care is exploding. So overall, it is a trend that we 
are seeing. It is just that Medicare and Medicaid were designed 
at a time when none of these things were a part of the thought 
process or equation.
    So, absolutely we need to update and upgrade Medicaid and 
give States the flexibility to do more, to pay for care in a 
home-based setting.
    Right now, Medicaid, basically, as you said, because of the 
way it reimburses Medicare to a--you know, also, but it is 
particularly a Medicaid problem. It really steers people to 
these congregate facilities. So that is very, very important. 
More people should be taken care of at home. It is less 
expensive, and it is also safer.
    And then we are going to have to really do a much better 
job of overseeing the way--you know, oversight of nursing 
homes. There is, in theory, all sorts of oversight in place, 
and for whatever reason, it just doesn't seem to ever work.
    And so nursing homes don't have the ability to do adequate 
infection control. There are lots of GAO reports and others 
about this problem.
    Mr. Griffith. Well, I appreciate that, and we will be 
looking into that more, and I may contact you. And I don't know 
how much time I have, if any, but I am happy to hear from 
either of the other witnesses on that concept of----
    Ms. Eshoo. I think time has expired, Mr. Griffith.
    Mr. Griffith. Then I yield back. Thank you, Madam Chair.
    Ms. Eshoo. OK, thank you. The gentleman yields back.
    A pleasure to recognize the gentleman from New Mexico, Mr. 
Lujan, for your 5 minutes of questions, and unmute, please.
    Mr. Lujan. Thank you, Madam Chair. Great to be with you, 
and thank you to each of our witnesses for joining us today.
    The coronavirus pandemic has exacerbated many of the 
longstanding health disparities in our country. In my home 
State of New Mexico, some rural and Tribal communities don't 
even have access to running water to wash their hands, to 
bathe, to cook, to drink, which we know is essential to 
preventing the spread of the virus, let alone broadband for a 
telehealth visit for their Doctor.
    Dr. Boyd, these are exactly the types of COVID-19 
protections and COVID-19 supports that you describe in your 
testimony as being inequitably distributed, correct?
    Dr. Boyd. Yes. In our country, instead of income, racial 
group is the strongest predictor of access to clean water. And 
Native Americans are 19 times more likely to lack access to 
clean water in their homes than White households, so, yes, 
absolutely.
    Mr. Lujan. So Dr. Boyd, how has the inequitable 
distribution of COVID-19 protections and supports impacted the 
spread of the virus?
    Dr. Boyd. So, just speaking of clean water, if you don't 
have access to clean water--and hand-washing is one of the 
primary ways that we limit the spread of infectious disease in 
this country--it then affects your ability to keep yourself 
safe, your kids safe, your family safe.
    So if we know that clean water access is determined by a 
racial and ethnic group in this country, that means that we are 
limiting the protections we provide communities by their racial 
and ethnic group, and that is what is unjust.
    Mr. Lujan. You said it best, Doctor. The results have been 
devastating. And, for example, 9,845 COVID-19 cases in New 
Mexico, nearly 58 percent have been Native American. The Navajo 
Nation has more cases per capita than any other State in the 
Nation. This wasn't inevitable, though. It was caused by 
systemic inequities in our healthcare system and in our 
society, and--well, I know this may be hard for some of my 
colleagues to say today--the Trump administration's failed 
response to this crisis.
    The Indian Health Service, which has been chronically 
underfunded long before this pandemic, faced long delays in 
receiving requested testing supplies for the Navajo area and 
the Albuquerque his hospitals.
    When I called the White House to push for the delivery of 
these supplies, the administration could not give me a straight 
answer as to whether it was going to deliver these supplies or 
how it was going to meet the needs of the Navajo Nation and the 
Pueblos.
    The Trump administration also awarded a $3 million for his 
contract to an 11-day-old company run by a former White House 
staffer, which delivered thousands of substandard masks that 
were unfit for use.
    Then we learned the CDC is not sharing critical data with 
Tribal epidemiology centers the way they share it with State 
health departments. Tribes need this data to protect their 
communities, and they are entitled to access it as sovereign 
entities.
    And just this last week, the State of New Mexico is 
investigating allegations that a private hospital racially 
profiled Native American mothers and separated them from their 
newborn infants during the first crucial days while awaiting 
COVID-19 test results. If it is true, it is horrific and 
completely unacceptable.
    So, Dr. Brooks, can you speak to how instances like those I 
just described, contribute to mistrust of the healthcare system 
in many minority communities and some of the history behind 
that?
    Dr. Brooks. So what you described does not sound too 
different from what happens in the African American community. 
As a pediatrician, I do understand the critical nature of that 
bonding of the first four hours after the baby is born, so that 
separation was untenable and is not being done anywhere else. 
So I almost want to say Native American lives matter, and to 
add that to the list.
    It just speaks to systemic inequities, and what concerns me 
is that, you know, the inequities have been going on in Native 
Americans' populous, say, 200 years, African American 
population, 400 years. Though it is the same. We are asked, 
what do we do now? So it is hard to reverse 2- to 400 years of 
inequity. I think the main thing is what you did, call-- I 
would call the White--I mean, I am not you, but I would call 
the White House again, and you probably did.
    I have been telling my patients and my people to stomp 
their feet. In other words, just get active and stay active; 
don't take no for an answer. It may be easy for me to say 
because you are talking to the White House and not getting 
responses. But that is the best I can say now. I feel for you 
and those that you represent.
    Mr. Lujan. And then Dr. Brooks, as my time concludes here, 
can you just elaborate on why diversity in clinical trials is 
so important, both in ensuring equitable access to the latest 
treatments but also in ensuring that researchers have all the 
data they need to demonstrate that new treatments are effective 
for all patients?
    Dr. Brooks. So, yes, what you just said, make sure the 
treatments are effective, but also I think it is the general 
concept of these people matter. We need to include African 
Americans, Native Americans, Pacific Islanders, because we are 
thinking about them. They are on our radar. We are just not 
made to do it.
    Mr. Lujan. Thank you, Madam Chair, and I yield back. And I 
will also be submitting some information into the record at the 
end of the hearing. Thank you.
    Ms. Eshoo. The gentleman yields back. Is Mr. Bilirakis 
prepared to question? I don't see him or hear him. I did 
before. Let's move to----
    Mr. Bilirakis. I am here, I am here.
    Ms. Eshoo. Oh, there you are. And you are unmuted, so you 
can begin your questioning. It is a pleasure to recognize you.
    Mr. Bilirakis. Yes. I was concerned about my hair, but then 
when I saw Fred's hair, I----
    Ms. Eshoo. Well, you look great.
    Mr. Bilirakis. I am OK, yes.
    Ms. Eshoo. Not to worry.
    Mr. Bilirakis. All right. Dr. Brooks, approximately 36 
percent of African American Floridians experience obesity, the 
highest percentage of any racial or ethnic group in the State, 
and 31 percent of the Hispanics experience obesity, compared 
with 27 percent of Caucasians. As of June 8, 2020, 27 percent 
of COVID-19 hospitalizations and 21 percent of deaths statewide 
were among African Americans, and only 17 percent of the 
population in Florida is African American.
    According to a June 3, 2020 analysis, conducted by the CDC, 
Hispanic Floridians make up 46.5 percent of the COVID-19 deaths 
when weighted population distributions are considered, 
reflecting a disproportionate burden of COVID-19 mortality.
    While Congress and the administration have taken actions to 
increase access to telehealth, enhance State flexibility under 
Medicaid, and appropriate hundreds of billions of dollars to 
combat the COVID-19 pandemic, what can be done to ensure that 
seniors have prompt access to treatments for obesity once they 
are approved by the FDA?
    Dr. Brooks. So obesity does directly lead to diabetes. 
Diabetes is diet, exercise, and healthcare. So diet, if you are 
food insecure, you are not going to eat well. If you live in 
crowded housing, you are not going to exercise as much. And if 
you don't have insurance, you won't get the medical care.
    So we really need to look at those underlying conditions. 
The treatment for diabetes is actually lifestyle more so than 
anything else.
    As relates to medications, like, for example, Metformin, 
glimepiride insulins, you are more likely to get medical 
treatment if you have health insurance. I would say Medicaid 
expansion and universal healthcare. These are the actions that 
would drive a decrease in diabetes and, therefore, decrease in 
adverse outcomes.
    Mr. Bilirakis. OK. Now, there are medications also in the 
market that treat obesity specifically.
    Dr. Brooks. OK.
    Mr. Bilirakis. I know about Metformin as well.
    But what are the effects of those medications? Have they 
been successful? I am also concerned about any adverse effects 
of those medications. Can you elaborate quickly on that, 
please?
    Dr. Brooks. Yes. There are some medications that treat 
obesity, you know, diet suppressants. But in general those 
haven't been that successful. The main treatment for obesity, 
at this point, other than managing it with diet, is the 
surgery, fundoplication or gastric bypass surgery. So better 
access to that surgery by Medicaid would actually help quite a 
bit.
    Mr. Bilirakis. Does that include--are those surgeries 
included, reimbursement under Medicaid or Medicare? I know 
private insurance takes them.
    Dr. Brooks. At least in California, yes, if you meet 
specific criteria, yes.
    Mr. Bilirakis. OK. Thank you.
    The next question is for Mr. Roy.
    Do stay-at-home orders disproportionately impact racial and 
ethnic minority communities, and, if so, how?
    Dr. Roy. Well, thank you for the question because we have 
been talking a lot about health outcomes and they are very 
important, but we have not been talking enough about the 
economic disparities that have been created by the lockdowns, 
which is an incredibly important problem. It affects tens of 
millions of Americans.
    Yes. So as I mentioned in my oral testimony, it is also in 
my written testimony, because non-Whites are more likely to be 
hourly wage earners or in other jobs or occupations that 
require physical presence, they can't work from home, they 
can't Zoom all day to do their jobs, they are both more at risk 
if they are in a high-risk occupation from COVID and they are 
also more at risk of facing unemployment.
    So this has been a huge problem, particularly in the 
lockdowns. We have talked a lot about nursing homes today. The 
flip side of the fact that half the deaths are happening in 
nursing homes outside of New York State is that younger 
Americans, in general, are at lower risk. That both affects 
schools--we have had these schools closures which have huge 
economic consequences not only for the children, but for the 
parents, particularly single parents, who can't go to work 
because going to work means leaving their children unattended 
at home--and also the people who have lost their jobs due to 
the economic lockdown.
    So there are a lot of problems when it comes to disparities 
on the lockdowns, and I think we need to do a lot more to 
refine and target our economic restrictions to the populations 
who are most at risk.
    Mr. Bilirakis. Thank you. Thank you. I appreciate that.
    Dr. Brooks----
    Ms. Eshoo. I think that the gentleman's time has expired.
    Mr. Bilirakis. Oh, OK. All right. I will submit it for the 
record.
    Thank you very much, Madam Chair.
    Ms. Eshoo. All right. Thank you, Mr. Bilirakis.
    Next up is the gentleman from Oregon, Mr. Schrader.
    Are you there?
    If not, then we will go to Mr. Kennedy of Massachusetts.
    Voice. Let's go to Ms. Kelly. She is on camera.
    Ms. Eshoo. All right. Then, we will go to the gentlewoman 
from Illinois, Ms. Kelly.
    Ms. Kelly. Oh, I didn't think I was going to come up that 
quick.
    Thank you so much, Madam Chair, for having this.
    You know, this is something near and dear to my heart as 
chair of the Congressional Black Caucus Health Brain Trust. We 
have been working so hard around this issue, but not just 
around COVID, around maternal mortality and other issues also.
    So I just want to thank the witnesses for their comments, 
because if we don't do anything about the social determinants 
of health, we are going to revisit this with other illnesses 
over and over and over.
    And also the statement that it is racism, not race, is so 
true. I lost my uncle to COVID. So I appreciate my colleague 
saying that it is not just statistics. We know it is real live 
people. And he worked all his life. He lived a good life. He 
wasn't poor. But he lost his life also.
    The church he went to had 60 steady people that went to the 
church. Sixteen of the 60 people are now dead because of COVID 
in New Jersey.
    So we have been in Chicago, not now, but 72 percent of the 
people that died were African American, and I think we are 29 
percent of the population. So, I mean, we have just seen it all 
around. Things have improved.
    But if you could--all of you can just answer if there is--
because we can have hearings and we can do all this, but if we 
don't implement anything, if we don't do anything, then the 
hearing is in vain.
    So if each of you can mention just one thing that we have 
to do in leaving this hearing, what would it be?
    Dr. Brooks. This is Dr. Brooks now. I will speak first.
    First, I want to just pause and thank Representative Robin 
Kelly for all she has done for the NMA and supporting us, 
including gun violence, which is not a discussion today. But 
she has been there and we thank you, thank you, thank you.
    If I would say one thing, I would go to implicit bias 
training, because I do believe that the racism that occurs, a 
lot of it is subconscious. Some are conscious. We have two 
people that were hung in California. That scares me right now, 
quite frankly.
    But when you have implicit bias training, it makes you, 
first of all, this is a White person's think about it, and 
then, second of all, makes you do something about it.
    And so that, racism that is inherent in our society needs 
to be addressed. So that would be my method of addressing it.
    Ms. Kelly. And just real quickly. We spoke to a Black 
doctor who gave an example that he had tennis elbow and he went 
to a doctor and the doctor was White, but he didn't tell the 
doctor he was a doctor. And all the things the doctor said that 
he should do, and then he would say, well, shouldn't you be 
doing this or shouldn't you be doing that? And the doctor 
eventually said, oh, you must know something about healthcare. 
After he told him he was a doctor, that is when he said, oh, 
OK, let's do this or let's run this test.
    So, Dr. Boyd.
    Dr. Boyd. Yes. I would also like to begin by just saying, I 
am so sorry for you and your family's loss. It is so 
devastating.
    I think if there was anything we were really going to push 
other than universal healthcare it is to end segregation. 
Studies have shown that if you end residential segregation, you 
will close the Black-White gap in income and unemployment and 
education. And those are powerful social determinants of health 
that are shaping our COVID inequities that we have seen. So 
ending residential segregation has to be a priority.
    Ms. Kelly. We see that in Chicago, a nine-mile difference 
between the South Side and I believe the West Side. My 
colleague, Bobby Rush, can correct me. And the people that live 
north, nine miles difference, a 30-year difference in life 
span.
    So, Mr. Roy.
    Dr. Roy. Yes. Well, building on what Dr. Boyd said, 
educational attainment is the most important social determinant 
of health in terms of its correlation to health outcomes and 
that is obviously driven a lot by residential segregation.
    The other thing I would mention is, we have talked a lot 
about Medicaid. Medicaid reform, particularly Medicaid reforms 
that increase access to primary care for management of chronic 
diseases, and also getting people out of congregate facilities 
and into more home-based care, those are extremely important 
things that Congress could address today if it wanted to.
    Ms. Kelly. Thank you all for that you do, and thank you for 
being witnesses today. I really appreciate you.
    And I yield back early.
    Ms. Eshoo. The gentlewoman yields back.
    The Chair will now recognize the gentleman from Indiana, 
Dr. Bucshon.
    Mr. Bucshon. Thank you, Madam Chairwoman. I am just 
restarting my own clock here.
    As you may or may not know, I was a cardiothoracic surgeon 
before coming to Congress. And as I look at the available 
medical data being reported on COVID-19, it is clear this virus 
has disproportionately affected racial and ethnic minority 
communities, in particular our Nation's Black communities, 
although, as we have heard, more accurate data is needed.
    There are still many questions as to why this is the case 
and what all factors contribute to it, but I am deeply troubled 
by reports that show it is not necessarily infection rate that 
is disproportionate, but rather the mortality rate for minority 
patients who have become infected with the virus, which is so 
strikingly disproportionate. This is happening to communities 
all over America in urban settings and in rural settings alike.
    Through my medical practice, I understand that there are 
real racial healthcare access disparities that exist, and in 
certain underlying health conditions, such as diabetes, 
hypertension, and heart disease, the prevalence is greater in 
some of our minority populations.
    This committee has recently dedicated work to addressing 
racial and ethnic health disparities and maternal mortality. It 
has been eye opening yet informative to hear from hospitals 
across the country on steps they are taking to improve in this 
area. It helps showcase how no one urban or rural setting is 
the same.
    In fact, we heard from Parkland Hospital in urban Dallas, 
who shared impressive stories on how they are improving 
maternal mortality in their community. Their data is 
impressive. This can be done.
    As for COVID-19, I think there are similarities, and I have 
tried to focus my efforts on providing access to quality care, 
a suggestion each of you had in your testimonies. This is why I 
recently teamed up with Representative Diana DeGette to 
introduce two bills which would increase diagnostic testing 
capabilities of public health laboratories and expand testing 
access to hospitals, physicians, and other health service 
providers.
    H.R. 7025 and 7026 both prioritize underserved populations 
to help provide better access to those disproportionately 
affected by public health emergencies such as COVID-19.
    Dr. Roy, as my colleagues and I work to build up our 
Nation's testing capability so that Americans can better access 
these tests, what can be done simultaneously to help ensure 
individuals actually receive these services once access is 
there? This is particularly important because a concern of mine 
relates to future vaccines for COVID-19 once it is developed.
    Dr. Roy. Well, Dr. Bucshon, I would mention the geographic 
location of the test is really important. My family, my wife, 
and I had to get tested for COVID-19 recently due to a possible 
exposure. We had to drive 35 minutes from our house to get to a 
place and sit there for several hours to get the test.
    Now, some people don't have the luxury of doing that 
because of their jobs or other situations. So making sure that 
the test availability is close to your house and very rapidly 
accessible is really important. Obviously that has been a 
challenge.
    Mr. Bucshon. That has been a challenge, and transportation 
issues are obviously a challenge in different communities. But 
we want to, obviously, we want to get out ahead of this as we 
look forward to having a vaccine.
    In that vein, Dr. Brooks, is there a disparity in 
vaccination rates in general between ethnic groups?
    Dr. Brooks. Yes, there is. African Americans are less 
likely to be vaccinated, both at the NIS national kindergarten 
survey that is done on a yearly basis and then in vaccines for 
influenza.
    Some of this is directly related to access. If you are less 
likely to be insured, you are not going to get vaccinated.
    So when we come forward with a vaccine against COVID-19, 
that has to be kept in mind, and I think imperative will be the 
messaging. The message has to be culturally sensitive, come 
from messengers that the African American community can 
identify with, and, again, have African Americans involved in 
the clinical trials so we can speak to the safety and efficacy 
for African Americans.
    Mr. Bucshon. Well, you answered my second question, which 
was going to be, how do we avoid disparities? Because cost 
probably will not be the issue, because I think the Congress 
will make sure that people will have access to free vaccines 
for something as critical as COVID-19. But I appreciate you 
answering that question.
    And since we know this may be an issue, I think we all need 
to work towards making sure that when we actually have a 
vaccine, the historical problems that we have getting access to 
vaccinations for minority communities don't apply to COVID.
    Thank you very much. And, Madam Chairwoman, I yield back.
    Ms. Eshoo. The gentleman yields back.
    The Chair now recognizes the gentleman from Massachusetts, 
Mr. Kennedy, for 5 minutes.
    Are you unmuted?
    Mr. Kennedy. I believe so. Can you hear me?
    Ms. Eshoo. Good.
    Mr. Kennedy. Great.
    Madam Chair, thank you for calling this extremely important 
hearing.
    Thank you to our witnesses for being here and for your work 
and your dedication to this.
    Massachusetts has been hit extremely hard by this virus. We 
have had over 100,000 people infected and over 7,500 deaths.
    One of the most memorable moments for me will be spending 
some time in Chelsea, a community just east and slightly north 
of Boston that has a rate of infection about six times higher 
than the State average. It is largely immigrant, largely 
working class, largely Hispanic, disproportionate percentage of 
essential workers.
    I was a Peace Corps volunteer. I served in the Dominican 
Republic for about two and a half years. I have visited or done 
work in development in many countries around the world. I have 
never seen lines so long for food in my entire life than I did 
in Chelsea, Massachusetts.
    I spoke to the head of one of the community health centers 
that operates in the neighborhood and I asked him how they were 
doing and he said that they had received new mapping software--
this is about a month ago--and that they were looking for cool 
spots with infection.
    And I asked him, I said, why cool spots? Why don't you try 
to mitigate against hot spots?
    And he said, no, no. We know everybody is infected, 
everybody has been exposed. We need to see where we haven't 
tested.
    And the biggest cool spot on that map was the affordable 
housing development where out of the 900 residents there, only 
4 had been tested.
    So when you talk about these infection rates, they are also 
a reflection of access to testing that are in and of itself 
subject to these disparities and structural inequities that we 
have been talking about today.
    And so let me be clear about this. We have not only failed 
lower income and Black and Brown communities with regards to 
this virus, we failed them long before anybody uttered the word 
coronavirus or COVID-19 or knew what social distancing was.
    We failed them in a million ways that extend far beyond 
whether the President took this pandemic seriously or whether 
he thought it was going to impact his political survival. We 
failed because our government had dismissed workers' rights and 
living wages for people across our entire country. We have 
failed members of our community over and over again. We have 
underfunded education and healthcare and food insecurity in 
communities of color. We have failed by letting our public 
transit options crumble and our public housing deteriorate. And 
right now we cannot fail them again.
    So I think back to those lines for food in Chelsea and I 
can't help but think of what might happen when we do have an 
eventual vaccine. If we are going to be sure that history does 
not repeat itself, which it will if we do not act, wealthier 
and White communities won't see those shortages or long waits, 
but others certainly will.
    And so with that, Dr. Boyd, what policies should we be 
enacting now to ensure that those communities that have been 
hardest hit and least prepared are going to be able to receive 
access to that vaccine?
    Dr. Boyd. Thank you, Congressman Kennedy.
    I think we should prioritize those communities alongside 
other groups we determine are high-risk. For example, if 
healthcare workers are the first to receive the vaccine because 
they are most high-risk for exposure, only 5 percent of 
physicians in this country are African American.
    So we have to ensure that the communities that are affected 
are also prioritized alongside healthcare workers and other 
highly prioritized groups.
    Mr. Kennedy. Dr. Brooks.
    Dr. Brooks. I believe that messaging, again, getting the 
word out there that there is a vaccine, that it is safe and 
effective.
    I do also believe that healthcare workers should be 
prioritized but also understand that African Americans that are 
elderly and with underlying conditions are at the highest risk 
for death. So it should be clear messaging to that population.
    Mr. Kennedy. And at the beginning of this pandemic, we 
focused our attention on elderly and those with pre-existing 
conditions as parts of a high-risk population.
    Dr. Boyd, starting with you, I understand there has been 
some recent research that has also come out about age being a 
driver in these disparities. Can you talk to me a little bit 
about that?
    Dr. Boyd. Absolutely.
    So a study was just released from Harvard School of Public 
Health that looked at age-specific mortality rates, and 
actually among African Americans those aged 35 to 44 have the 
largest gap. They are nine times more likely to die of COVID-19 
than White Americans.
    They also calculated the years of life lost, and more than 
45,000 years of life had been lost per 100,000 African 
Americans. That is more than the 33,000 years of life lost for 
White Americans, despite White Americans having a larger 
population.
    So how we talk about age actually has to change. Younger 
communities of color are more affected.
    Mr. Kennedy. Do you know--walk me through the reasons that 
account for that. I mean, what we have heard over and over and 
over again is obviously that the virus--the statistics seem to 
show that it is far more deadly for older people, the impact 
that you just articulated.
    I am out of time, so forgive me, but maybe I will ask you 
about that to flesh that out when you can. And I apologize, but 
I do have to yield back.
    Ms. Eshoo. Dr. Boyd, can you answer that in 30 seconds?
    Dr. Boyd. Yes. One mechanism that we have to consider is 
allostatic load and weathering, that experiences of 
discrimination and racism actually age cells faster. And so 
although your chronological age will be younger, your cells may 
actually be sicker and older if you have experienced cumulative 
exposures to racism and discrimination.
    Mr. Kennedy. Thank you.
    Ms. Eshoo. The gentleman yields back.
    It is a pleasure to recognize the gentlewoman from Indiana, 
the wonderful Congresswoman Brooks.
    Are you unmuted?
    Mrs. Brooks of Indiana. Yes. Can you hear me?
    Ms. Eshoo. Yes, we can.
    Mrs. Brooks of Indiana. Good to see you and good to see 
everyone. Thank you to all of the doctors for your really 
important testimony.
    Something that we haven't talked about yet are the 
importance of using electronic health information exchanges and 
all of the data. And all of you are so involved in the data 
collection and understanding it.
    We have in Indiana called the Regenstrief Institute 
celebrating its 50th year, and it is all about modeling and 
information sharing and data collection. And they have 
partnered with IU Health here in Indiana and they just did a 
study that talked about the quality of healthcare data varies 
greatly based on how, oddly, how user friendly the collection 
system is. And that seems like something just so very basic, 
but I am--they found that still many people on all of this data 
submit it by fax.
    And I am curious, in this modern age where we are all 
communicating through Webex and so forth, can each of you 
comment on what you know on current data collection standards 
for COVID-19 and what may be suggestions you might have for 
Congress for standardizing data collection because--and not 
that I am necessarily questioning this data, but I don't think 
we are getting all of the data in the most accurate way we can 
and should be getting it.
    So maybe Dr. Roy--I would love to hear from each of you 
about this whole issue about the manner in which data is 
collected.
    Maybe start with you, Dr. Roy.
    Dr. Roy. Yes. So, Mrs. Brooks, the first thing to talk 
about is the HITECH Act, which was passed as part of the 
stimulus legislation in 2009, that transformed a lot of the 
mandates around the way electronic health records must be taken 
and transmitted. So that is the governing statute right now, is 
the HITECH Act, which has been, I think, tweaked and modified 
here and there.
    The one thing I would say on top of whatever you want to do 
in terms of thinking about how the HITECH Act governs these 
processes is that there is actually a lot of technological 
innovation going on in electronic health records.
    To give one example, you are starting to see people use 
voice recognition software in a physician's office to use 
artificial intelligence to record a patient encounter and 
thereby streamline some of the generation of patient notes. 
That, plus lab data, can be more seamlessly integrated.
    Part of the problem is anti-kickback statutes and HIPAA and 
other privacy laws that basically restrict data liquidity, so 
it is very hard for your primary care physician and a hospital 
and your endocrinologist and your cardiologist to communicate 
with each other about your situation as a patient because of 
all these privacy restrictions.
    And obviously, privacy restrictions are important to a 
degree, but we need to modernize those laws. The Trump 
administration has put out some proposals, recommendation rules 
and changes, and final rules to modernize the regulations at 
least, but I think you need statutory modifications as well to 
streamline and modernize these old, outdated statutes so that 
patient data can bounce back and forth between providers and 
patients.
    Mrs. Brooks of Indiana. Thank you.
    Dr. Brooks, does your association talk about the whole data 
collection challenges and your concern about the data?
    Dr. Brooks. Yes, we do. I would focus first on what you 
said on health information exchanges. We are almost there, but 
there is the devil in the details. Dr. Roy mentioned the HIPAA 
concerns.
    There are no, to my knowledge, clear standards of COVID-19 
data collection and there needs to be. And I would even look 
back to health information exchange in African Americans.
    African Americans are more likely to get fragmented care, 
get care in the ER, get care at a health center, than to go to 
a county facility for a referral. So that data ends up getting 
lost. And so not having that data sharing does adversely affect 
African Americans. So it kind of all goes full circle.
    Mrs. Brooks of Indiana. Thank you very much.
    Dr. Boyd, do you have anything to add in my 30 seconds 
remaining?
    Dr. Boyd. I will also say biased data in leads to biased 
learning out. So if we also only collect this data for 
populations that already receive government-sponsored health 
insurance, for example, or Medicaid populations, and not for 
all Americans regardless of your health insurance status, we 
also aren't learning about the full population level burden of 
infections and deaths.
    Mrs. Brooks of Indiana. Thank you.
    Thank you, Madam Chairwoman.
    Thank you all.
    I yield back.
    Ms. Eshoo. The gentlewoman yields back.
    A pleasure to recognize the gentleman from California, Mr. 
Cardenas, for his 5 minutes of questions.
    Mr. Cardenas. Thank you very much, Madam Chair, for giving 
me the floor. And thank you so much for having this important 
hearing. I don't know if you can see me, but I hope you can 
hear me.
    Ms. Eshoo. Both. You look great.
    Mr. Cardenas. OK. Thank you. My screen just went blank.
    As Dr. Brooks said in his testimony and others have 
discussed, as a result of the coronavirus pandemic a bright 
light has recently been shown on the health disparities and 
inequities that have always existed in the United States.
    There are several factors that experts have pointed out to 
explain these trends. For example, regardless of their 
profession, Black American, Latino, and indigenous populations 
also have disproportionately less access to paid sick leave, 
garner the lowest median wages, and predominantly live in 
States that fail to mandate critical worker protections like 
paid sick leave and living wages.
    Black American, Latino, and indigenous populations are also 
overrepresented among the homeless, the incarcerated, and 
detained populations in the U.S., which confines people in 
crowded facilities that also dramatically increase risk for 
COVID-19 exposure.
    Accordingly, eight of the ten largest clusters of COVID-19 
infection have occurred in correctional facilities--which, by 
the way, affects the people who work there, not just the 
incarcerated.
    While the number of insured individuals across all 
demographics increased following the Affordable Care Act's 
passage, Blacks, Latinos, American Indians, Alaskan Natives, 
Native Hawaiians, Americans in our territories or other Pacific 
Islands are also more likely to be uninsured compared to Whites 
and more likely to report going without needed care due to 
cost.
    Studies also show that racial and ethnic minorities receive 
lower quality healthcare even when insurance status or severity 
of conditions are comparable.
    As we are the country with the most and best research and 
the largest economy in the world, what I report today and what 
we are hearing is shameful. We can and must do better.
    One area that needs more attention is mental and behavioral 
health. Before the pandemic and the worldwide protests 
condemning the recent police murders of Black Americans, our 
mental health system was in bad shape. And now these events 
have made our collective stress levels skyrocket and our mental 
and behavioral health continues to be disjointed and 
disconnected from any other type of healthcare.
    Experts are warning that a historic wave of mental health 
problems is approaching--depression, substance use disorders, 
anxiety, Post-Traumatic Stress Disorder, and suicide. Over the 
weekend, new reportings show that the rates of clinical 
depression have more than tripled since the coronavirus first 
emerged and Black Americans have experienced a particularly 
high evidence of major depression disorder.
    We also know that racial and ethnic minority groups in the 
U.S. are less likely to have access to mental health services, 
less likely to use community mental health services, and more 
likely to receive lower-quality healthcare.
    In 2017, 42 percent of youth aged 12 to 17 received care 
for a major depressive episode, but only 35 percent of Blacks--
Black youth--received services and 33 percent of Hispanic youth 
received treatment for their condition. Black individuals with 
mental health and substance use disorders are more likely to be 
incarcerated rather than placed in community-based divergent 
programs.
    What are some of the things we could do at the Federal 
level and to advance health equity within the mental and 
behavioral health space? Also, what will be the consequences if 
we don't act to address racial and ethnic health disparities 
within the mental health space?
    Dr. Boyd, can you elaborate perhaps on what we could do?
    Dr. Boyd. Yes. Particularly for youth, we know that mental 
health impairments are the number one cause of school dropout 
rates, and kids who don't finish school have higher rates of 
entering the criminal justice system, as you mentioned.
    And so we have a healthcare-to-prison pipeline that we have 
to address. One way to address it is to broaden access to 
mental health supports. Many health insurances don't cover 
counseling, in-school supports, and other community-based 
programs that help kids address their mental health needs. We 
can do it for all ages, but I would advocate starting with 
kids.
    Mr. Cardenas. Thank you.
    And, Dr. Brooks, if people are unable to get information on 
treatment in their language and the CDC has only translated 
into four languages when there are 200 languages spoken in 
America, is that going to adversely affect our ability to end 
this pandemic in America?
    Dr. Brooks. Yes, it will. You need information in your own 
language. And America is a multicultural society, and that is 
what makes us great. So more translation services, and that 
would lead to more access, especially as it relates to mental 
health.
    So with better mental health, you get better physical 
health. So I think that is crucial also in terms of your point 
about being disjointed. You need integrated behavioral health 
services which will lead to better physical health.
    Mr. Cardenas. Thank you, Madam Chair.
    I yield back the balance of my time.
    Ms. Eshoo. The gentleman yields back.
    It is now a pleasure to recognize the gentleman from 
Oklahoma, Mr. Mullin, for his 5 minutes of questions.
    Mr. Mullin. Madam Chair, can you hear me, OK, or is my 
connection messed up again?
    Ms. Eshoo. Yes. Yes.
    Mr. Mullin. OK. Well, thank you. And if my connection gets 
bad, please interrupt me so I am not just talking to myself.
    Ms. Eshoo. OK.
    Mr. Mullin. While I am very happy we are having these 
important discussions on health disparities, as you guys know, 
I am Cherokee, Native American, and it is very disappointing to 
me that we don't have a tribal witness here today.
    I know when Chairman Burgess had brought this up to you, 
Madam Chair, that you had said we are going to possibly do a 
field hearing, is that correct, on Native American issues?
    Ms. Eshoo. I would very much like to do that, and I think 
that there should be interest on the part of enough members in 
order to do that. And I also believe that we need to--this 
should not be the only hearing we have on racial disparities of 
our subcommittee.
    Mr. Mullin. Chairwoman Eshoo, my concern is that with COVID 
going on, that a field hearing probably isn't going to be 
possible. And Native Americans are disproportionately left out 
on these studies, on things moving forward. And we see pockets 
breaking out in our reservations and parts of the Indian 
Country.
    And so I just hope that you will commit that the next one 
we have will have a tribal witness there, hopefully someone 
that maybe you would even allow me to bring in as a witness, 
because I do have close ties with them.
    And it is a nonpartisan issue, this should be a bipartisan 
approach, because Native Americans, as you know, Madam Chair, 
greatly underfunded already, and then they are extremely 
stressed with the COVID crisis going on.
    Ms. Eshoo. We will work with you, Mr. Mullin. Thank you.
    Mr. Mullin. Thank you.
    Dr. Brooks, I would like to talk to you for a little bit. 
As I was stating, American Indians experience a 
disproportionate rate of individuals with diabetes. In fact, it 
is three times more likely if you are an American Indian to 
have diabetes than any other race. And when you start talking 
about inside the United States, autism is also the highest in 
Indian Country.
    Can you discuss how social determinants over health can 
play roles in chronic conditions not just with COVID, but other 
diseases out there, too?
    Dr. Brooks. Yes. So thank you.
    So interesting you mentioned autism. There is some early 
data showing that environmental exposure to toxins can lead to 
autism. And you obviously get that when you have underserved 
communities, and I would certainly consider the Native 
Americans.
    As relates to diabetes, diabetes is a condition of diet and 
exercise, and 90 percent of diabetes is Type 2. Diet, exercise, 
and medication. So food deserts, lack of access to high-quality 
foods, you are going to get diabetes.
    If you live in an area where you don't feel comfortable 
exercising or where exercising isn't promoted, where you are 
too busy doing other things to have time to exercise, it is 
going to lead to higher incidents of diabetes.
    And then medication, if you don't have access. Diabetes, if 
it is controlled, can be much less harmful to the body. You 
don't have the medication without the healthcare access.
    Mr. Mullin. If you certainly look at some of the reports 
coming in, there is over half the States, they label Native 
American patients as ``others,'' not as a unique ethnic group, 
but as ``others,'' which is disappointing for me because we are 
not others. We are Native Americans.
    And when you don't have the right data, Dr. Brooks, does 
that play a role in how we treat the pandemics going on either 
with the COVID or even the diabetes or autism that is happening 
in Indian Country?
    Dr. Brooks. So from the discussions today, data informs. 
Data directs. Data provides crucial information. And I also 
would say that it implies that somebody cares about you.
    Mr. Mullin. I agree.
    Dr. Brooks. In fact, if you are ``other,'' there is an 
implication in that. I am just going to leave it to that. So I 
think that that leads to being neglected.
    So I concur with the need for data on the Native American 
population.
    Mr. Mullin. And, in fact, I had to fill out a bill the 
other day for my son and it didn't have Native American as a 
race and it had ``others,'' and it said ``explain.'' And I put 
``first Americans.'' So it was frustrating to me because it 
shouldn't happen.
    Dr. Brooks, I appreciate it.
    As I said, Madam Chair, I appreciate you holding this 
hearing. I appreciate you working with Congressman Burgess on 
it or Dr. Burgess on it. I hope, when we have another one, as I 
said, work with me please and let's get a witness from Indian 
Country in.
    And with that, I yield back.
    Ms. Eshoo. The gentleman yields back. I will certainly work 
with you. And I think you working with Mr. Lujan together will 
really strengthen the case as well. So thank you very much. And 
we are all praying for your son. And I think our prayers are 
being heard. So thank you very much.
    Mr. Mullin. Thank you. Thank you.
    Ms. Eshoo. Yes.
    The Chair is happy to recognize the gentleman from Vermont, 
Mr. Welch, for his 5 minutes of questions.
    You need to unmute. Are you unmuted?
    Mr. Welch. I am unmuted.
    Ms. Eshoo. There you are. OK. Wonderful.
    Mr. Welch. Thank you very much.
    First of all, Markwayne, I certainly support your effort, 
and I know our chair and I am sure ranking member will as well. 
It is a great idea.
    Second, I want to thank you, Madam Chair, and also Dr. 
Burgess, for your very eloquent opening statements that I think 
put this whole hearing, this very important hearing, in 
perspective.
    And number three, the witnesses have been really 
tremendous, and I thank them.
    I want to go back to something that G.K. Butterfield asked 
and it was about poverty versus racism. I think it is very 
apparent with COVID and the extraordinary impact, the 
disproportionate impact it has had on Black and Brown people, 
it is raising the question about why, and we have been 
discussing that.
    But it is also in a context where we have had the horror of 
Minneapolis and the murder that occurred there, where we had a 
man who was bird watching in Central Park accused because he 
was an African American, of a violent attack. And then we also 
had that young man jogging in Georgia who was shotgunned to 
death.
    And what is clear is that this question of poverty and 
racism is now a very active question in our country or should 
be. That behavior that was not just an incident of a rogue 
police person, but it was other White individuals against very 
innocent African Americans, has ripped off the cover of racism.
    And we don't have in this country a social insurance 
program that helps Black, Brown, White, or Native Americans who 
don't have the income when, through no fault of their own, 
something happens like COVID, the social insurance of the 
healthcare that is universal, the childcare, the family leave, 
and so on, and that is an ongoing debate in Congress.
    But, Dr. Brooks, I am going to go to you first. You said 
something that really captured my attention. There is also an 
element called racism. And it is time, in my view, that we talk 
about that. And I would ask you to elaborate on your statement, 
because as I heard what you said, it was that because of the 
color of the skin, people were just treated differently.
    And I turn to you and then would like to hear from Dr. Boyd 
about that as well. Thank you.
    Dr. Brooks. Four hundred years of institutionalized racism, 
starting with slavery, which was encoded in the Constitution. 
You had to pass an amendment to remove it. We had to have civil 
rights legislation in 1964. We had to have the Voting Rights 
Act in 1965. Right now my primary concern with the upcoming 
November election will be voter suppression.
    All of this is directly linked to racism. And it is 
interesting because the worry is now, if African Americans have 
their chance to speak, what may happen.
    It was against the law to teach a Black person to read. It 
is ingrained in the fabric of America. To me the first step in 
removing this stain in the fabric is to talk about it.
    As the loss of life of George Floyd occurred, maybe there 
is some good to come out of it. My personal belief is watching 
someone get suffocated for 8 minutes and 46 seconds is just 
unprecedented. I mean, if you get shot then you die in, what, 
less than a second.
    Mr. Welch. Well, thank you so much.
    I want to hear from Dr. Boyd and I only have a little bit 
of time, but I really appreciate your testimony.
    Dr. Boyd.
    Dr. Boyd. Yes. We also have to think about racism and how 
it functions structurally beyond just how it functions as 
individual prejudice.
    Structural racism is what drives systematic changes in how 
populations are treated. These are things like the distribution 
of insurance access in this country or the distribution of 
clean water access like we talked about.
    Those are major things that determine how racial and ethnic 
populations access services and vital supports and resources 
that are distributed by race. That is not just a prejudice that 
is baked into our laws, and that is something that we have to 
confront.
    Mr. Welch. Mr. Roy, do you have anything to add on this in 
your view on what our other two witnesses have said?
    Ms. Eshoo. Mr. Roy, do you hear us? You need to unmute.
    I don't think he hears us.
    Mr. Welch. All right. My time is up. Again, I want to thank 
our witnesses. This is tremendous. We have got a lot of work to 
do.
    Ms. Eshoo. I agree with the gentleman. We have a great deal 
of work to do.
    The gentleman yields back.
    Mr. Griffith. Madam Chair? Madam Chair?
    Ms. Eshoo. Yes?
    Mr. Griffith. Can we see if Mr. Roy can hear us for future 
questions? He can. OK. Thank you, Madam Chair.
    Ms. Eshoo. I don't know what he is motioning to us.
    Can you hear us, Mr. Roy? You can. We can't hear you.
    It is a pleasure to recognize the gentleman from North 
Carolina, Mr. Hudson, for his 5 minutes of questioning.
    Mr. Hudson. Thank you very much, Madam Chair, for holding 
this very important hearing.
    Thank you to our expert witnesses for the time you have 
given us today. I think it has been an excellent discussion.
    As you may recall, a month ago, at our last hearing, I 
asked for this hearing and noted that in my experience, 
particularly in my district, minority communities are 
experiencing gaps in outcome. So I am very appreciative of this 
opportunity to talk about this today.
    Across the Nation, there is alarming data that people of 
color are more likely to be affected by coronavirus than White 
individuals. Native Americans are five times as likely, African 
Americans are four and a half times as likely, and Hispanics 
are three and a half times as likely, according to the CDC.
    In Fayetteville, North Carolina, a city in my district, the 
leadership at Cape Fear Valley Hospital told me that African 
American patients make up 57 percent of their COVID-19 
patients. However, in Cumberland County, where the hospital is 
located, the population is only 34.9 percent African American.
    This is not just a local or national issue, it is also 
global. As Dr. Roy said in his testimony, minorities have been 
negatively affected in Canada, the U.K., France, and Norway, 
among other countries.
    This is both alarming and concerning. So I am happy to see 
this committee exploring this issue.
    On another note, I am very concerned about how the economic 
shutdown in response to the coronavirus has disproportionately 
affected minority communities. I saw this firsthand with 
problems with access to the banking system among minority-owned 
business owners in my district.
    To draw upon, again, the testimony of Dr. Roy, the effects 
of unemployment and business ownership have been staggering. 
African American unemployment has dropped from a record low in 
late 2019 of 5.4 percent to 16.8 percent, Hispanic employment 
dropped from a record low of 3.9 percent to 17.6 percent, and 
Asian employment dropped from a record low of 2.1 percent to 15 
percent. Further, African American-owned businesses fell 41 
percent, Hispanic-owned businesses 32 percent.
    I agree with Dr. Brooks and many of my colleagues who have 
said today that we need more data so that we can dive deeper 
into these issues.
    The other thing I have heard from the leadership at the 
hospitals in my district is the impact of the lack of education 
and access to resources on disproportionate outcomes with 
coronavirus.
    Patients at the hospitals I have talked to have noted that, 
while they may know about coronavirus and are generally afraid 
of the danger it represents, they do not have access to 
critical information about stopping the spread of the disease 
and best practices to avoid contracting it.
    This isn't for want of trying, though. The hospitals across 
my district are making concerted efforts to educate their 
communities about coronavirus, including taking out ads in 
newspapers that are focused on underserved communities, hosting 
weekly townhalls on radio, and posting weekly videos on their 
websites with updates from CDC. But even with these efforts, it 
is apparent these educational efforts are not enough.
    I don't know if, Dr. Roy, if we can hear from you, but I 
would love to hear from you on whether you agree with me----
    Dr. Roy. Can you hear me now?
    Mr. Hudson. I can.
    Dr. Roy. OK. Great. I just re-logged in. Apologies.
    Mr. Hudson. Great. Well, Dr. Roy, would you agree with me 
that the gap in education on coronavirus on how to make 
preventative measures is hurting our communities, especially 
communities of color?
    Dr. Roy. Well, it is hard to know. I mean, I haven't done 
enough work to understand exactly how attitudes in terms of, 
you know, or understanding, education, information is 
transmitting to various communities.
    I would say the biggest problem remains--we have talked a 
lot about nursing homes. I am glad that Dr. Boyd mentioned 
incarceration. That is another problem area. We have talked a 
little bit about Native American communities, particularly in 
Navajo Country.
    These concentrated areas where we are seeing the 
combination of geography, vulnerability in terms of age, and 
preexisting conditions, that is the nexus where the 
information, in particular, needs to go.
    One thing I would mention since we are talking about 
information here is that a lot of people are telling me, and I 
think telling members of your committee as well, that if they 
have a relative, a loved one in a nursing home, they are not 
able to access information about that individual and how they 
are doing, whether they are being adequately quarantined, et 
cetera, or protected from people who are infected.
    So that information is tough to find. Information about 
testing is hard to find. If and when vaccines happen, that is 
going to be a challenge, too.
    But one thing I want to mention. We have talked a bit about 
vaccines today. We have no assurance that there will be a 
vaccine for SARS-CoV-2 in the next 12 to 18 months, as a lot of 
people have been talking about. It could be 5 years, it could 
be 20 years before we have a vaccine for SARS-CoV-2.
    We have been working on a vaccine for HIV for 40 years, and 
we still don't have one. We have been working for a vaccine for 
hepatitis C for even longer than that, and we still don't have 
one.
    So we have to make sure that we can operate and environment 
in which vaccines do not happen in the event that they don't 
and we have to operate in an environment where treatments, 
effective treatments, cures, are longer away than we hope they 
are. And that is where the information in terms of prevention, 
physical distancing, et cetera, is so important.
    Mr. Hudson. Thank you.
    Madam Chair, I see my time is expired, so with that, I will 
yield back.
    Ms. Eshoo. The gentleman yields back.
    The Chair now recognizes Dr. Ruiz from California for his 5 
minutes of questions.
    Please unmute.
    Mr. Ruiz. Thank you. Thank you for this hearing on health 
disparities. And I, too, look forward to the tribal policy 
hearing, specifically on the Indian Health Service, that we 
have talked about, Chairwoman.
    COVID-19 has shined a spotlight on the inequity that we 
already knew existed in our healthcare system. You see, I grew 
up in a trailer park in Coachella, a farm worker community in 
southern California, where my family and neighbors did not have 
adequate access to healthcare.
    It is what motivated me to become a doctor in the first 
place and what eventually motivated me to run for Congress, and 
most recently motivated me to fight to sit on this very 
subcommittee, because I want to make our healthcare system 
better, more affordable, more equitable for everyone.
    And before I came to Congress, I served as an emergency 
physician in the Coachella Valley right here in my district. I 
conducted an intensive study on barriers to care and I found 
that in our region there was only one doctor per 9,000 
residents. For context, the medically appropriate number is 
about one doctor for every 2,000 residents.
    So it is easy to see why we have egregious health 
disparities in historically underserved and minority 
communities, which, of course, are brought to the forefront 
during a public health crisis like COVID-19 pandemic.
    The fact is that we don't have enough providers in 
marginalized communities. We don't have enough residency 
programs there.
    We know that the two biggest predictors of where a doctor 
practices is where they are from and where they last trained. 
So recruiting students from underserved communities and 
training doctors in those communities is critical.
    And I worked on creating pipelines to address the provider 
shortage crisis in a meaningful way right here in the district. 
Back in 2009, I started the Future Physician Leaders program, 
which is a mentorship program for high school and college 
students who are aspiring doctors from underserved areas where 
I grew up. I subsequently became a founding senior associate 
dean of the UC Riverside Medical School and helped pave the way 
to create residency training programs in our underserved 
communities.
    I am the first generation in my family to graduate from 
high school. So I know the importance of having that type of 
pipeline support through what can be a difficult process for a 
kid from Coachella.
    The Future Leaders program started with seven kids after a 
discussion with me at Starbucks and is now housed at the UCR 
School of Medicine with over 200 students. And since coming to 
Congress, I have introduced legislation to help increase 
providers in these historically underserved communities of 
color, such as accessing the Higher Education Act, which allows 
grants to Hispanic-serving institutions to be utilized for pre-
med mentoring.
    The Building a Health Care Workforce for the Future Act 
would establish a matching State scholarship program to 
financially support students from resource-poor communities. 
The Physician Shortage GME Cap Flex Act, which I introduced 
with my friend Dr. Bucshon, would help extend the time 
hospitals could have in underserved areas to create these 
residencies. And the Training the Next Generation of Primary 
Care Doctors Act, which I introduced with Congresswoman 
McMorris Rodgers, would expand the time that teaching health 
centers have for training in these underserved areas.
    My question to Dr. Brooks, understanding that you have not 
seen the details of these bills, would you agree that 
establishing more residency programs and slots in historically 
underserved areas is one key step to addressing some of the 
health inequities that currently plague our system?
    Dr. Brooks. Yes. Without seeing the legislation and the 
details, I would support that. The NMA strongly supports 
directing the young into STEM and developing ultimately into 
physicians and other healthcare providers, especially if it 
incorporates African American children.
    Mr. Ruiz. Dr. Brooks, the teaching health center program 
that I mentioned was created in the Affordable Care Act as a 
way to train doctors in underserved areas with the hopes that 
those physicians would stay there to practice after completing 
their residencies and we are seeing that that is happening.
    Would you agree that because of the population the health 
centers serve in our communities that expanding that program 
and ensuring that they have long-term funding stability is 
important?
    Dr. Brooks. I am an example of a National Health Service 
Corps scholar who went to work in Watts and has been there for 
31 years. So I do support that activity.
    Mr. Ruiz. It has to be longer than three years. It has to 
be a longer term to provide that stability as well.
    So my final question is, Dr. Brooks, according to the 
California Health Care Foundation, while Latinos represent 
nearly 40 percent of the total population in California, they 
only make up approximately 5 percent of California doctors.
    From your perspective, what are the reasons that racial and 
ethnic minority communities are underrepresented in the 
healthcare workforce?
    Dr. Brooks. I think it is exactly what we discussed, not 
being channeled into STEM, not having the proper education, 
maybe being intimidated to apply to medical school. So the 
focus of your program that you have I think would be very 
helpful.
    Mr. Ruiz. Thank you very much.
    I yield back.
    Ms. Eshoo. The gentleman yields back.
    I would like to recognize the gentleman from Montana, Mr. 
Gianforte, but I don't see him. Going once, going twice. OK.
    Then we will turn to recognize the gentlewoman from 
Michigan, Mrs. Dingell, for her 5 minutes.
    Mrs. Dingell. Thank you, Madam Chair and Ranking Member 
Burgess. I want to thank you for convening this hearing today. 
We really need to have this discussion about racial and ethnic 
disparities in our healthcare system.
    And we all keep saying that the African American community 
is being disproportionately impacted, but Michigan, my home 
State, is one of the most significant examples in the country.
    African Americans are 14 percent of our population; 32 
percent of the COVID cases in the State have been African 
Americans and 41 percent of the deaths have been African 
Americans. And, unfortunately, I have known more of them than I 
want to admit.
    We have got to do better. Our Governor has created the 
Michigan Coronavirus Task Force on Racial Disparities to seek 
what the issues are and how we can start to address them.
    But State-level action has to be complemented by strong, 
forward-thinking action at the Federal level. And in Congress, 
we have got to recognize the magnitude of the problem that we 
face.
    I also want to follow-up on Mr. Roy's concerns about 
Medicaid. I agree we need to invest more in getting people home 
in community-based services, and that is why I fought to 
increase dedicated funding for HCBS and we put it in the HEROES 
Act in the House. It included a 10-point FMAP increase 
specifically for HCBS. And it is my hope that the Senate will 
do the same when they take up the HEROES Act, which I hope will 
be sooner than later because it is something we have to do.
    But my questions right now are for Dr. Boyd.
    Dr. Boyd, in your testimony you discuss the need to expand 
programs like Medicare and Medicaid to address the health 
inequities that have been so apparent in this COVID pandemic. 
It is backed up by evidence, as I just talked about. And also, 
in my State of Michigan, 37 percent of the uninsured are people 
of color in Michigan.
    States don't have the resources to meet the healthcare 
needs that they have during this pandemic in spite of--my State 
has probably the record rainy day fund, including $1.2 billion 
in Michigan. States are having to make hard choices about how 
to address their budget shortfalls, especially with States like 
mine that have a balanced budget requirement.
    If we don't act, we are going to be facing scary, 
significant, and I don't know what the impact will be on these 
budget shortfalls.
    Dr. Boyd, how would significantly increased emergency 
Federal funding for Medicaid, like the provisions included in 
the House-passed HEROES Act, address the need of minority 
communities hardest hit by the virus?
    Dr. Boyd. Two primary things it would do.
    One, in terms of the COVID pandemic, it would increase 
access to testing, hospitalization, and any needed treatments.
    And two, it would increase access to primary care services 
that would help treat the chronic, undertreated, and 
underserved medical conditions that communities of color are 
disproportionately plagued with.
    Mrs. Dingell. I should have asked this question first, but 
what are the risks to communities of color as all of the States 
are facing these budget shortfalls? We are not passing the 
HEROES Act and they are really making tough decisions that they 
shouldn't have to make.
    Dr. Boyd.
    Dr. Boyd. The risk of the budget shortfalls is that we will 
also lack enough supports to support all of the other public 
and social service functions that our tax dollars pay for. So 
we have been talking today about social determinants of health, 
but many social determinants of health are supported, 
nutritional programs, workforce placement programs, and 
childcare programs are supported by our tax dollars. And 
without those dollars, those social determinants of health are 
at risk, too.RPTR MOLNAREDTR HUMKE[2:56 p.m.]
    Mrs. Dingell. Thank you.
    Dr. Boyd, you have discussed the need for universal 
workplace protections, including personal protective equipment. 
Without these, we know we are going to see another surge in 
cases as Americans begin to go back to work. We have seen the 
impact on workers of color in places like meat-packing plants 
when they are forced to work without PPE or basic protections. 
How will this lack of workplace protection further compound the 
racial health inequities if not addressed?
    Dr. Boyd. To make it safe to reopen our economy, we have to 
make sure that workers, particularly essential workers, have 
mandated paid sick leave, they have hazard pay when they go in, 
they have access to protective equipment. These are things that 
will keep the supply chains open that keep our economy running.
    We have to make sure that it is safe for folks to go into 
an indoor workplace before we ask them to take that risk, 
because asking them to take that risk is why we have higher 
rates in our communities of color.
    Mrs. Dingell. Thank you, Dr. Boyd.
    I just want to make one observation, Madam Chair, that 
three months ago, we didn't think a whole lot of people were 
worth even paying $15 an hour, and now our country is dependent 
upon these very people that we are talking about, who are only 
being paid $15 an hour and not given PPE equipment, and we need 
to think about the value of our frontline workers to all of us. 
Thank you. I yield back.
    Ms. Eshoo. The gentlewoman yields back. It is a pleasure to 
recognize the gentleman from Georgia, Mr. Carter, for 5 
minutes.
    Mr. Carter. Thank you, Madam Chair. Can you hear me, OK?
    Ms. Eshoo. Very well. Very well.
    Mr. Carter. Oh, good. Thank you, thank you.
    Thank you all for participating. This has truly been a good 
hearing, and I appreciate it very much.
    Dr. Roy, I wanted to start with you. During the discussion 
today, in your testimony you have said that the economic 
shutdown has exasperated health disparities. I know that in 
April you released a plan of how we could safely reopen the 
economy. How do you anticipate that those ideas would be 
helpful and beneficial to minority communities?
    Dr. Roy. Well, thanks, Mr. Carter, for bringing it up, and 
just for reference, it is in the written testimony, but the 
plan is at FREOPP.org, F-R-E-O-P-P.o-r-g. And I believe that 
the title is something like, a new strategy for reopening the 
economy even during COVID-19 pandemic, and the reason why it is 
titled that way is because we are very concerned that we are 
all waiting for a best-case scenario, that there is a vaccine 
or a treatment, and boom, everything can go back to normal.
    But what if we don't? What if we can't get a vaccine in the 
next 18 months? What if a treatment doesn't arrive that is 
really effective in the near term? Then these disparities will 
persist over time and become even costlier. Imagine if the 
entire next school year becomes difficult to execute on.
    So for all those reasons, our plan really focuses on two 
areas--three areas, in particular, I would say. First, let's 
make sure we are focused on nursing homes and the at-risk 
populations--the elderly and people with preexisting 
conditions, cardiovascular, endocrinological conditions.
    Secondly, let's safely reopen schools, and let's safely 
reopen workplaces where it is feasible for--you know, where it 
is going to particularly help those low-income, hourly-wage 
workers who right now have lost their jobs because their jobs 
have been defined by the government as nonessential, and their 
livelihoods have been defined by the government as 
nonessential. And that has been a huge problem right now in 
terms of widening disparities.
    So the plan talks about that in terms of how you can 
strategically increase testing and use--and reopen businesses 
where they are able to safely reopen and take into account the 
latest data on cleanliness, safe practices, et cetera.
    Mr. Carter. Let me ask you something. It has been said 
that, you know, if there is a silver lining in this pandemic, 
it may be telehealth. It has been said that we have had ten 
years of progress in one week in telehealth. How can telehealth 
and the expansion of telehealth in the minority communities, 
how can that help to resolve some of these racial disparities?
    Dr. Roy. Well, listen, telehealth absolutely can make a 
difference in terms of getting timely access to care for the 
kinds of care that can be administered in a remote setting, but 
there is a lot of care that can't be administered in a remote 
setting, and so it is very important to be aware of that.
    And this brings us back again to Medicaid. You know, I have 
talked a lot today about how access to primary care, management 
of chronic diseases, access to testing, all that is challenging 
in the Medicaid program because of the way Medicaid pays 
doctors and providers.
    I want to mention something else, Mr. Carter, if I may, 
which is, let's talk about the dual-eligible population, right, 
the elderlylow-income population that right now is in this 
completely dysfunctional system where they have two different 
Federal programs, one a Federal State program, one a Federal 
program, that don't really interact with each other that well.
    One thing we talk about in a different FREOPP policy paper, 
called Medicare Advantage for All, is giving States more 
flexibility to integrate their dual-eligible populations into 
Medicare Advantage-like plans that are available to some today, 
but could be much more widely adopted so that low-income, 
vulnerable seniors can get integrated coverage and better 
access to that primary care that they need. That is something 
that is really important that Congress could do something 
about.
    Mr. Carter. Right. Thank you.
    Dr. Brooks, I wanted to ask you in the minute I have got 
left, in your testimony, you talked about the importance of 
considering social determinants if you want to address health 
disparities. And one issue that I have been working on is 
ensuring that Medicaid beneficiaries have access to nonmedical 
transport.
    In fact, Representative Cardenas and I have introduced 
Protecting Patients Transportation to Care Act, and that 
codifies the NMET--the EENEMT benefit in the Social Security 
Act. We have seen some progress on this bill, and I hope that 
we are going to be able to get it passed, it needs to be 
passed. Can you talk about the importance of addressing things 
like transportation and other social determinants in order to 
tackle health disparities?
    Dr. Brooks. Yes. So transportation is a major barrier to 
achieving access. We have transportation service at my health 
center, but now they are shut down because of COVID. So 
nonemergency medical transportation would be very helpful.
    And just very briefly, the telehealth. So telehealth is 
very important. I mean, that reduces the need for 
transportation. It issub-optimal to a physical evaluation, but 
it is much better than no evaluation. So addressing 
transportation, I think, is very important. It will lead to 
better outcomes.
    Mr. Carter. Good. Again, thank all of you for your 
participation today. Thank you, Madam Chair, and I yield back.
    Ms. Eshoo. I thank the gentleman. He yields back. I now 
would like to--I don't see--oh, there you are. I recognize the 
gentlewoman from New Hampshire, the patient gentlewoman from 
New Hampshire, Ms. Kuster, for your 5 minutes.
    Ms. Kuster. Thank you so much, Chairwoman Eshoo, for 
holding this important hearing today. It is not possible to 
overstate how important it is that we address systemic racial 
disparities in our healthcare system, and COVID-19, as well as 
the pain and violence inflicted upon our Black neighbors, 
friends, colleagues, and fellow human beings, has brought to 
the forefront of our conversation the impact of racism on 
health and well-being in our communities of color.
    We know and we have heard a great deal today that the 
COVID-19 pandemic has disproportionately impacted communities 
of color, and we have widespread evidence of institutional 
discrimination leading to poor health outcomes.
    As a member of this committee and the Black Maternal Health 
Caucus, we have explored and legislated on the racial 
disparities in maternal health. But it goes beyond maternal 
health, and I am very hopeful that today's conversation will 
lead to more work by this committee on addressing racial health 
inequities and social justice.
    Here in New Hampshire, White people account for 90 percent 
of the population, but they are a shrinking proportion of our 
COVID-19 cases. Just weeks ago, White people made up 81 percent 
of the COVID population in New Hampshire. Now that number has 
dropped closer to 75 percent.
    But meanwhile, the proportion of cases among Black and 
Latinx granite staters has grown. Among Latinx, who make up 3.9 
percent of our population, they now account for 10 percent of 
COVID cases. Among our Black community, that make up only 1.4 
percent of our population, they now represent 6.3 percent of 
the total infections from COVID-19. So these numbers do not 
lie.
    Manchester, New Hampshire Health Department Director Anna 
Thomas recently said, the health of our community is only as 
strong as the health of our most vulnerable residents, and by 
any measurement, we must do better. She also recently requested 
city-wide data. And without this data, it is difficult to 
understand where to target resources that are needed.
    Dr. Brooks, can you provide some examples of initiatives 
that could help turn city-level data into actionable insight 
and connect with community organizations to provide resources?
    Dr. Brooks. Yes. So there is modeling, there is modeling 
software that if you provide data, and accurate data and up to 
date, it can tell you where to direct healthcare services, 
where to direct testing, where to have food supply giveaways, 
so--that is one way.
    And the other way would be to have, again, standardized 
data reporting. If we have standardized data reporting, 
everyone would be reporting the exact information, and then it 
will be apples to apples.
    Ms. Kuster. Thank you. And I wanted to just address the 
vaccination inequities that has come up. Can you speak to the 
root causes of racial disparities--I think you have mentioned 
this in vaccinations--but as we look ahead, what are some 
suggestions that you would have for making sure that we have 
equitable distribution of vaccinations?
    And I just quickly would mention the bill that I am leading 
with Congressman Hakeem Jeffries, H.R. 7104, Coronavirus 
Vaccine Development Act, requiring the administration to plan 
ahead for the coronavirus, COVID-19 vaccine distribution. What 
suggestions would you have, in the limited time that we have 
left?
    Dr. Brooks. Yes, I note that. I would say, first of all, it 
helps if States or the Federal Government mandate that if you 
do not get vaccinated, you don't get, let's say, WIC or SNAP. 
That is helpful.
    Number two, is, again, access. So Medicaid expansion is 
crucially important in terms of children, and adults for that 
matter, getting vaccinated.
    And lastly, I would say messaging. I mean, we know how to 
sell soap or fabric softener, but we really need to message 
into the communities the importance of vaccination, and as a 
vaccinator, as a pediatrician, the safety and efficacy of the 
vaccines that we have.
    Ms. Kuster. Great. Thank you. I do have one more question 
on incarcerated workers, but I can submit that for the record. 
Thank you--our incarcerated population that has been hit so 
hard.
    Ms. Eshoo. I thank the gentlewoman, and she yields back. I 
now would like to, let's see, is--do we have any Republicans 
that have not been--haven't been--I don't think so. Mr. 
Griffith was the last----
    Mr. Griffith. I don't see any, Madam Chair.
    Ms. Eshoo. I don't either. Then I will recognize the 
gentlewoman from California, Ms. Barragan, and thank you again 
for inviting Dr. Brooks. You are recognized for 5 minutes, and 
make sure you unmute.
    Ms. Barragan. Great. Thank you, Madam Chairwoman, and thank 
you to all our panelists today. I represent the communities of 
Compton and Watts. It is a very working-class community, almost 
90 percent Latino and African American community combined. I 
have seen firsthand what COVID-19 has done in our community and 
the systematic racism that is happening across a lot of 
different areas including healthcare.
    Dr. Brooks, in your testimony, which I thought was very 
powerful, you asked the prominent question, why is it we are 
seeing the glaring differences in dying from COVID-19. And in 
that, you respond and talk about social determinants of health, 
which I couldn't agree with you more about, which is why I 
introduced a bill, called The Improving Social Determinants of 
Health Act, which would provide funds to the CDC, to establish 
program focus specifically on social determinants. It would 
also establish a grant program for local, public health 
departments to tackle this issue.
    Dr. Brooks, can you, again, highlight for us, the 
importance of addressing social determinants of health and why 
Congress needs to do more and act in this area? Specifically, 
can you maybe explain what social determinants of health have 
impacted your patients in Watts, and what it means for long-
term health consequences of people in our community and how 
these conditions are impacting our community's fight against 
COVID-19?
    Dr. Brooks. Yes, thanks, and I would like to pause just a 
second to thank you very much for the warm introduction, and 
for the work you are doing in your district. You represent my 
employer in your district and you do great work on the Federal 
and local level.
    Ms. Barragan. Thank you.
    Dr. Brooks. Social determinants of health tend to determine 
about 40 percent of health outcomes, which is more than 
genetics or access to care, slash, medicine, slash, surgeries 
or treatments. So it is the most important determinant of how 
you will be, in terms of your life, as it relates to health.
    So your focus with legislation on the social determinants 
of health gets directly at the issue. And I might add, if 
passed, or if that focus occurs, it will help all Americans. I 
think that is really very important. It will help African 
Americans, but it will help Latin Americans, Latinx, Native 
Americans, et cetera. So social determinants--main one that I 
see really in our area is food insecurity. I am really focused 
on diet. If you eat well, you will likely be more healthy.
    And I also say mental health, it was mentioned, allostatic 
load. When you are stressed, you release excess cortisol, which 
is a marker for inflammation, and you have worse outcomes.
    And then education, the focus was there. If you have good 
schools, if you have a focus on education, then you will have 
better health outcomes. Education is directly linked to health 
outcomes.
    Ms. Barragan. Great. Thank you, Dr. Brooks.
    Next I want to talk in discussing points of research 
endowment program at the National Institutes of Health on 
minority health and health disparities. This is a program that 
funds to the endowment of academic institutions across the 
country, institutions such as Morehouse School of Medicine 
Atlanta, SUNY Downstate Medical Center in Brooklyn, Florida 
International University in Miami, and Charles Drew University 
in my very own district.
    The goals of the program include promoting minority health 
and health disparity research capacity and infrastructure, 
things like increasing the diversity and strength of the 
scientific workforce, and enhancing the recruitment and 
retention of individuals from health-disparity populations that 
are underserved in the scientific workforce.
    Dr. Brooks, in your testimony, you state that poor 
reporting of data, which initially masked the fact that the 
disease was disproportionately affecting Black communities, 
remains a problem even as States move to reopen their 
economies.
    Do you agree that providing funding to academic 
institutions, to encourage research in minority health, plays a 
crucial role in reducing the minority health disparities, 
including during this current crisis?
    Dr. Brooks. Clearly. Very interestingly, all of those 
institutions reside in African American communities. So they 
have a focus on the community that surrounds them. And they 
have an academic bend, they do clinical research, they publish 
articles. So that type of research, that type of funding, and 
directed into funding, would reap great benefits in terms of 
the data that would come from it and the actions that would 
come from that data. So I highly endorse that.
    Ms. Barragan. Well, thank you, Dr. Brooks. I recently 
introduced a bill called the NIMHD Research Endowment 
Revitalization Act with Congressman Carter. It is a bipartisan 
bill. I am happy to say that the Senate--the Senate--has passed 
this bill. It is on to the House. And so it is upon us to move 
this in the House and get it through to the finish line, so it 
will be one part of helping address this crisis.
    And with that, Madam Chairwoman, I yield back.
    Ms. Eshoo. The gentlewoman yields back. I now would like to 
recognize the gentlewoman from Delaware, Ms. Blunt Rochester, 
for your 5 minutes of questions. And are you unmuted? I don't 
think so. You need to unmute.
    Ms. Blunt Rochester. I am unmuted.
    Ms. Eshoo. There you are.
    Ms. Blunt Rochester. There you go. Thank you, Madam 
Chairwoman, and thank you to the panelists. This has probably 
been one of the most important panels that we have had. And 
around the country and in my home State of Delaware, and as 
others have mentioned, we have seen the disproportionate impact 
of COVID-19 on communities of color.
    As one of my favorite writers and activists, James Baldwin, 
said, not everything that is faced can be changed, but nothing 
can be changed until it is faced.
    This pandemic brought to light the health disparities that 
have long existed in our country, and we have this very moment 
to really act and address them.
    The root of health disparities are complex as all of you 
have shared. There have been a lot of conversations about the 
social determinants of health on this call--or on this zoom.
    Some State Medicaid and children's health insurance 
programs are exploring opportunities to address the social 
determinants of health, like access to safe, affordable 
housing, availability of healthy food and drinking water, and 
healthcare services. But there is not clear guidance on how 
States can leverage existing or waiver authorities to do so.
    That is why my colleague, Congressman Bilirakis, and I, 
introduced a bipartisan bill, H.R. 4621, the CARING for Social 
Determinants Act, to let States know what works and how to 
deploy the strategies, particularly for the pediatric 
population.
    Dr. Brooks, if more State Medicaid programs knew how to 
build strategies to address the social determinants into their 
demonstration projects and contracts, could we reduce health 
disparities, and more specifically, can you give us some 
examples?
    Dr. Brooks. So the answer to your question is yes, it would 
reduce disparities. An example I would give would be one of 
those that was mentioned earlier--transportation. If there were 
more Medicaid coverage of transportation, you would see better 
outcomes.
    I would also say integrating mental health. In L.A. County, 
mental health and physical health are separated. So an 
integration into the physical health side, the medical side, of 
behavior health services, as a demonstration project, funding 
it however you see, I believe, would show directly improved 
health outcomes, which I want us to remember, that is the 
goal--healthy outcomes.
    Ms. Blunt Rochester. Exactly. Exactly. And you actually 
shifted into what I wanted to talk about next, which is really 
the toll that chronic stress from exposure to law enforcement 
violence has on the Black community. Chronic stress can lead to 
diseases like hypertension and heart disease as we know, and 
both are linked to the COVID-19 mortality.
    Because of existing mental health disparities, we know that 
if we don't get the treatment, or if there is stigma attached, 
there will be challenges. And I am working on legislation to 
look at health consequences of law enforcement violence on 
communities of color, and reduce barriers these communities 
face in accessing mental health services.
    Dr. Boyd, are there additional research gaps in our 
understanding of chronic stress on Black Americans that 
Congress should be focused on or should be filling? And what 
still do we need to do to learn about the intergenerational 
nature of stress and trauma?
    Dr. Boyd. Thank you for that question. One of the gaps you 
outlined there. We have yet to fully acknowledge and address 
police violence as a public health crisis in this country. We 
need to both study it that way, and we need to equip our public 
health departments to address it in that way.
    So one of the gaps that we have is better understanding 
some of the health impacts of police violence. We know that 
police violence increases risk, as you said, to illnesses 
associated with chronic stress, like hypertension, diabetes, 
heart disease, cancer.
    We also know it has a disproportionate impact on mental 
health for all African Americans who are witnesses. So I think 
it is really paramount that we focus on police violence, 
particularly at this time.
    Ms. Blunt Rochester. Thank you for that answer. You know, I 
was going to talk about cultural competency as not just a 
program but an underlying pillar to advance health equity. It 
is something I would really like to follow up with you on, with 
both of you on, because I feel this issue of mental health and 
healing, particularly when you marry COVID on top of the issues 
that we are dealing with right now, and what we are witnessing, 
for many of us, this is not--these are not new issues.
    So much so that even as Deputy Secretary of Health and 
Social Services, when I was working in Delaware years ago, I 
got high blood pressure, just trying to create an office of 
minority health. So we need to deal with these underlying 
issues, and I thank you all so much for your work, Mr. Roy as 
well.
    Thank you.
    Ms. Eshoo. Thank you. The gentlewoman yields back.
    And now it is a pleasure to recognize the gentleman from 
Illinois, Mr. Rush, for your 5 minutes, and make sure you 
unmute yourself.
    The gentleman is recognized. Can you hear me?
    You need to unmute, Bobby.
    He has been waiting for so long, too.
    The gentleman needs to unmute. We can't hear you.
    Voice. I don't think he can hear us.
    Ms. Eshoo. He can't--I know. I am trying to motion to him. 
Why don't we see if the staff can assist Mr. Rush. And we have 
four Members that are with us that are part of the full 
committee, and according to our rules, they can waive on to the 
subcommittee, and the first one that I wish to recognize is the 
gentlewoman from Colorado, Ms. DeGette, for 5 minutes. Welcome.
    Ms. DeGette. Thank you so much, Madam Chair. Thank you so 
much. I really appreciate you allowing me to waive on to the 
subcommittee, and I want to thank the witnesses for their 
testimony. Your insights are really, really helpful to us as we 
confront the coronavirus challenge, and particularly the issues 
of racial disparities.
    I just want to say, my district is a highly urban district. 
It is the City of Denver and some other areas around it. 
According to Denver Health, the Latino population accounts for 
58 percent of COVID-19 cases in Denver, while only making up 30 
percent of Denver's population.
    And, of course, when you look at the health risks, they are 
even greater now during the pandemic. And so I want to ask a 
couple questions, and I know some of the Members have touched 
on this, but I would like to ask a couple of follow-up 
questions.
    As the number of underinsured or uninsured Americans has 
increased, because of the economic impact of COVID-19, with 
people losing their jobs, people of color are going to face a 
greater risk of morbidity and mortality associated with the 
disease due to delayed or foregone treatment.
    Dr. Boyd, can you talk about the importance of ongoing 
healthcare coverage for Americans, and especially coverage for 
minority populations, when it comes to facing, then, a great 
health challenge like this?
    Dr. Boyd. Yes. Because we linked healthcare to employer-
based health insurance, when populations lose their job--and we 
know nearly half of African Americans have lost their job as a 
result of COVID-19--they lose their health insurance. So 
ensuring that insurance is not a barrier to healthcare is 
really critical, particularly for African Americans, Latinx, 
and indigenous populations who have the highest rate of 
uninsurance and under insurance, less insurance than they need 
to meet their health needs.
    Ms. DeGette. Right. And Dr. Boyd, I also wanted to ask 
then, if somebody loses their job and their health insurance, 
then they start to get sick, it would seem to me, as a 
layperson--but you are a doctor--that it would make it even 
less likely that that individual would try to go for medical 
treatment if they had symptoms of COVID-19, causing potential 
even greater illness.
    Dr. Boyd. Absolutely. The evidence indicates that your 
economic status--your economic status informs how you utilize 
healthcare. And so if you don't have sufficient financial 
resources at home, you stay home from healthcare as well, which 
makes you more likely to present later in your case, which in 
the case of COVID means you may be more severe and more likely 
to suffer a bad outcome.
    Ms. DeGette. Yes. Now, you know another issue I have been 
working on a lot is--and actually several of our witnesses--
several of our witnesses--I think Sir Roy and also maybe Dr. 
Brooks--talked about this--is, COVID is going to be around us 
for a long time, and we need to be able to learn how to deal 
with these issues. And part of it is going to be testing and 
contact tracing.
    Congresswoman Shalala and I are working on legislation to 
make coronavirus tests free for anybody with employer-based 
insurance or a plan under the ACA.
    And I know this has been included in several of the relief 
packages, but I am worried what is going to happen with 
uninsured individuals. If they don't want to pay for testing or 
treatment, then how are we going to do the testing and then the 
subsequent contact tracing? And will this cause just a greater 
magnified effect?
    Dr. Brooks, I am wondering if you can talk about what is 
known about access to testing and tracing among minority 
populations?
    Dr. Brooks. So first of all, your presumption is correct, 
those that are uninsured will be less likely to get tested. And 
we also need aggressive testing and contact tracing. So right 
here in California right now, we do have something called 
presumptive eligibility, where some people that are uninsured 
can get tested. But I would say that that helps, but we--that 
is a bandaid. OK? We need Federal legislation that would cover 
testing for everyone and aggressive contact trace.
    We have all these unemployed, 16 percent unemployment rate. 
Employ them, give them a living wage, and have them do the 
contact tracing.
    Ms. DeGette. Right. Because even if you can give someone a 
free test, if they do the contact tracing, those people may not 
want to go get tests then. So it just--it just magnifies.
    Thank you very much, Madam Chair, and thanks for letting me 
sit on. Appreciate it.
    Ms. Eshoo. You are always welcome. So the gentlewoman 
yields back. I am going to go back to the gentleman from 
Illinois, Mr. Rush. Thank you for being here.
    Mr. Rush. Ms. Chairwoman can you hear me now?
    Ms. Eshoo. Yes, I can hear you very well. Thank you.
    Mr. Rush. Well, I have been diligently listening and on 
since the beginning----
    Ms. Eshoo. We thank----
    Mr. Rush [continue]. And I want to thank you for having 
this hearing.
    As a Black man in America, because of episodic racism and 
systemic racism, I find myself an unapologetic, angry Black 
man, even after all these decades of fighting on the frontline 
for freedom, justice, and equality. And if not for my faith, I 
really don't know where I would be.
    Dr. Boyd, I fully agree that we, as a Nation, and certainly 
we, as in Congress, are at risk of becoming data addicts, 
addicted to more and more data when we already have sufficient 
data to act courageously and willfully to solve this endemic 
problem.
    I also absolutely agree with you, Dr. Boyd, when you stated 
that according to one study, eliminating segregation brought--
erased Black/White differences in income, education, and 
unemployment. A recent public investigative piece found that in 
Chicago, lenders have invested more in a single White 
neighborhood than all the Black neighborhoods combined.
    And as you eloquently stated, this disparity snowballs to 
disparities and explodes into air pollution, access to clean 
water, employment, educational opportunities, and many other 
impacts that are clearly the bedrock of systemic racism.
    Dr. Boyd, can you expand on how Congress and the Federal 
Government can best take action to address the underlying and 
ongoing residential segregation that is all too widespread in 
our society?
    Dr. Boyd. Thank you for those powerful words. Yes. I think 
one thing that I will underscore that you mentioned is that we 
know communities of color are disproportionately exposed to 
toxins and pollutants in the air. That is because they are 
concentrated in communities that have been shaped by redlining, 
segregation, White flight, suburbanization, and zoning laws 
that allow industry to live right next to where kids play and 
where schools are.
    We can't allow that anymore. So I would love it if our 
Nation's lawmakers would respond to the disproportionate 
environmental racism suffered upon communities of color.
    One study even showed increases--that exposures to 
particulate matter in the air, like air pollution, can increase 
the COVID-19 mortality rate 15 percent more. So it is not just 
overall, you know, environmental racism, it directly affects 
your risk for COVID-19 mortality.
    Mr. Rush. Thank you.
    Dr. Brooks, I have a bill, the Communities Act, which will 
increase loan forgiveness for doctors who practice in 
underserved communities. What impact would a program like this 
have on increasing the number of physicians, and particularly 
physicians of color, who serve in medically underserved 
communities?
    Dr. Brooks. Loan repayment would be a great support 
mechanism to allow primary care physicians to come into 
medically underserved areas. As you know, the debt of--average 
debt is somewhere around $250,000, coming out of medical 
school. So that would drive the younger ones to give care in an 
underserved area. And the younger ones have new energy, new 
ideas.
    And number two, where you start working, you are more 
inclined to stay. There is a shortage of primary care providers 
in the underserved communities. Federally qualified health 
centers, one of which I am the chief medical officer, we are 
constantly looking for physicians, and specifically physicians 
of color, because again as I stated earlier, physicians of 
color provide better care to African Americans. And there is 
also a study that show they are less likely to have implicit 
biases related to race.
    Mr. Rush. Dr. Boyd, you talked a few minutes ago about the 
impact of police misconduct, police violence, as a permanent 
health issue. Can you expound upon that, police violence as a 
public health issue?
    Dr. Boyd. Yes. Particularly during this COVID-19 pandemic, 
we have to acknowledge the intercepting forms of violence that 
are facing communities of color. We have talked about the 
violence of segregation, the violence of disinvestment in their 
communities, but we also have to talk directly about State-
sanctioned violence by police that we know drives up increased 
rates of mental health conditions, for kids, of headaches, 
sleeping trouble, trouble with school performance, and for 
adults, for risks of chronic disease.
    If we don't address that, then we are leaving unaddressed 
some of the drivers that are contributing to higher rates of 
COVID-19 mortality right now.
    Mr. Rush. Thank you, Madam Chair. I yield back.
    Ms. Eshoo. The gentleman yields back, and I thank him.
    I know that Congresswoman Schakowsky and Congresswoman 
Clarke were both waiving on. I saw them earlier, but because I 
don't see them now, I am going to recognize the gentleman from 
Arizona, Mr. O'Halleran. Welcome. Wonderful to see you. Are you 
unmuted?
    You have to unmute.
    Mr. O'Halleran. Thank you, Madam Chair.
    Ms. Eshoo. There you are. OK. Wonderful.
    Mr. O'Halleran. Thank you for allowing me to waive on. This 
has been an outstanding committee meeting. I am very pleased 
that we were discussing such an essential topic at this point. 
Quite frankly, the response to the COVID-19 pandemic has not 
been adequate for our Tribal Nations, our communities of color, 
and basically across America.
    For our Tribal Nations, which I represent the Navajo and 
the White Mountain Apache out in Arizona's First Congressional 
District, up until very recently, Navajo Nation had their 
highest per capita COVID-19 infection rate in the Nation. This 
was just surpassed by the White Mountain Apache, also in my 
district.
    White Mountain Apache currently have over 1,300 cases of 
COVID-19 out of an enrollment of just 12,000 people. This is a 
small tribe that is--I just talked to the chairwoman this 
morning. It was just sad to have that discussion.
    But the common thread amongst many of these communities, 
communities of color, Tribal Nations, it is the deserts. It is 
the healthcare that is in those communities. It is the food, 
the health, the infrastructure, the housing, all of those 
deserts that are out there.
    I am looking out at a desert right now, but I am close to a 
store. I am close to healthcare. I have banks around the area. 
These areas don't have that.
    I grew up on the west side of Chicago, and Representative 
Kelly and Representative Rush know that well. And I have to 
tell you, I am just in shock. And we have bills to make sure we 
get some epidemiology information for Tribes, but it has to go 
so much further to address the critical issues of racial 
segregation, racial impacts, and the lack of this Congress and 
this country to acknowledge that we have trust and Tribal 
obligations and treaty obligations.
    This pandemic has exposed those of us who live in rural and 
underserved America already know. We lack access to healthcare 
providers. It is estimated that over 100,000 homes on Tribal 
lands lack access to running water and adequate sanitation 
infrastructure.
    On Navajo, roughly 30 percent of the population lacks 
access to running water at all. I introduced a bipartisan bill 
to address this very issue here, and I hope to see it move in a 
future House package.
    Now, before the COVID, the unemployment rates across the 
district, Navajo was at 40 to 50 percent unemployment before 
COVID, and the White Mountain Apache was close to 80 percent 
unemployment. Dr. Boyd, thank you for noting in your testimony 
that Native Americans are 19 times more likely to have access 
to clean drinking water than White Americans.
    And I also want to ask you a question. Do you believe that 
better reporting and information sharing of illness in minority 
communities can inform better the treatments to improve health 
outcomes and create better policy? Specifically, how can we do 
this to ensure that we can identify issues and allow them to be 
addressed in a culturally appropriate manner, with Federal 
support when and where it is needed? Thank you.
    Dr. Boyd. Yes. Just to bring up the clean-water example 
that you brought up, which is so devastating for indigenous 
communities, that is not a function of what we don't know. We 
already know that residential segregation onto reservations and 
that public divestment in the Indian Health Service has left so 
many indigenous communities without the resources they need, 
including basic resources like clean water.
    We don't need further data to say we need to further invest 
in indigenous communities and their healthcare infrastructure 
to further address what their needs are.
    Obviously, though, data is really important, and I will 
only underscore one more point, which is that indigenous 
communities are often left out. If they aren't counted as 
``other,'' they aren't counted at all because their populations 
are often very small, which is, again, a function of genocide 
in this country.
    So we also have to be committed to counting at smaller 
rates who is affected and how, so that we make sure we always 
encompass what is happening with indigenous communities.
    Mr. O'Halleran. Thank you, Doctor.
    Dr. Brooks, in your testimony you mentioned that implicit 
bias training is necessary for physicians and all healthcare 
professionals. I believe it is also implicit for the Congress 
of the United States.
    When patients are subjected to biased treatment from their 
healthcare provider, how does that impact their decisions to 
seek care in the future, and does it also contribute to poor 
racial and Tribal healthcare outcomes?
    Dr. Brooks. Yes. If a person feels that they have suffered 
from implicit bias and, therefore, poor care, they may be less 
likely to go seek care the next time. So--and it can happen 
with the Native American population certainly. So that is why 
it is critically important to have implicit bias training, 
because then we can--that is just one hurdle that we can get 
past and now get to the more mundane--treating illness.
    Mr. O'Halleran. Thank you, Madam Chair, and I yield.
    Ms. Eshoo. The gentleman yields back. It is always a 
pleasure to have you join us. I am just going to do one more 
call-out for Representative Schakowsky and Representative 
Clarke. I don't see them on the screen.
    I would like to bring the hearing to a close. Thank you, 
Mr. Griffith, for being with the committee from before the 
gavel went down to the rest of the gavel--you know, the gavel 
going back down again, as well as Ms. Kelly. You have spent 
hours with the committee, and I want to acknowledge that and 
thank both of you. And as I said, Mr. O'Halleran, you are 
always welcome.
    To our witnesses, I think you have been so highly 
instructive to us today. We have an enormous amount of work to 
do. But with this enormous challenge that we have--and they are 
enormous challenges--I think come enormous opportunities. And I 
think that that is the set of bookends.
    I would like to recommend for those Members that represent 
Native Americans, that I would really like to see you come 
together and hopefully put a package of bills together. We have 
Members from both sides of the aisle that are so eager to 
address the meagerness, and shamefulness, in the Native 
American community in the Tribal Nations.
    To both of the doctors, you have been outstanding 
witnesses. We have learned a great deal from you, and I know 
that you will continue to make yourselves available to Members 
as we seek to put together legislation that will be highly 
effective and help turn the page of shamefulness in our country 
around.
    This is our responsibility. I believe that there is the 
political will in our subcommittee. It is an outstanding 
subcommittee on both sides of the aisle. And to Mr. Roy, thank 
you once again for being a witness at our subcommittee. You are 
always welcome, and you gave excellent testimony to us as well.
    So what I would like to do, to submit the following 
statements for the record, and I also want to remind Members 
that pursuant to committee rules, they have ten business days 
to submit additional questions for the record, to be answered 
by the witnesses who have appeared.
    So I ask the witnesses to respond promptly. I know you have 
your hands full, but we ask that you respond promptly to any 
questions that you may receive from Members.
    So with that, I am requesting unanimous consent to enter 
the following documents into the record--a statement from the 
Asian and Pacific Islander American Health Forum; a statement 
from the Association of American Medical Colleges; comments 
from the American Kidney Fund; a statement from the Association 
for Clinical Oncology.
    A Brookings report entitled, Race Gaps and COVID-19 Deaths 
Are Even Bigger Than They Appear; testimony from the Center for 
Reproductive Rights; a June 10, 2020 letter from the Alliance 
of Multicultural Physicians to the FDA Commissioner, Stephen 
Hahn; an April 2020 Kaiser Family Foundation issue brief, 
entitled, Communities of Color at Higher Risk for Health and 
Economic Challenges Due to COVID-19.
    A June 16th, 2020 report from the Robert Wood Johnson 
Foundation; a May 2020 report from Families USA, entitled, The 
Fierce Urgency of Now, Dr. King's Words; Federal and State 
policy recommendations to address health inequities in the era 
of COVID-19.
    A Health Affairs Journal report, entitled, Disparities in 
Outcomes Among COVID-19 Patients in a Large Healthcare System 
in California; a statement from Johnson & Johnson Services----
    Mr. Griffith. Madam Chair? Madam Chair?
    Ms. Eshoo. Yes.
    Mr. Griffith. Madam Chair, how much longer is your list? I 
am happy----
    Ms. Eshoo. Well, they are not numbered. I am going
    Mr. Griffith. I am happy to waive the remainder of the 
list, assuming that all of those have also been seen by the 
minority staff.
    Ms. Eshoo. And with that, the entirety of this list--maybe 
the staff can tell me if they actually have to be verbally read 
into the record or if we can just, by unanimous consent, place 
the rest in the record.
    Well, the Republicans agree, according to Mr. Griffith.
    Mr. Griffith. That is correct.
    [The information appears at the conclusion of the hearing.]
    Ms. Eshoo. So I thank you, Mr. Griffith, for that.
    And once again, let me thank the witnesses for your superb 
testimony. I began the hearing by saying that America is in 
pain, America is in anger, America is doing something that I 
think is very healthy, and that is questioning. And that there 
is really, I think, a coalition of conscience across the 
country, responding to the wrongs that need to be made right.
    So with your good help, your testimony, and the political 
will of the members of this subcommittee, that I am so 
privileged to chair, I thank you. I know that there will be 
outreach to you, and I know that you will respond.
    And with that, I will now adjourn the subcommittee, the 
Health Subcommittee of Energy and Commerce now. Thank you, 
everyone. Good afternoon.
    [Whereupon, at 3:46 p.m., the subcommittee was adjourned.]

               Prepared Statement of Hon. Eliot L. Engel

    ``From the protests in Minneapolis to the marches in New 
York City, our nation has heard and loud clear-centuries of 
systemic racial injustices must come to an end. Most of these 
public demonstrations have focused on cases of police brutality 
towards minority communities such as the murder of George 
Floyd. In the backdrop of these demonstrations, however, the 
coronavirus pandemic continues to claim American lives, 
particularly those from communities of color.
    My district, which includes Bronx and the Westchester, has 
been at the epicenter of the nation's coronavirus outbreak. It 
is unconscionable to me that my constituents who are African 
American and Hispanic are twice as likely to die from this 
virus than their White counterparts. This pandemic has brought 
to the forefront the health inequities that the Energy and 
Commerce Committee has been trying to close for years with 
historic legislation such as the Affordable Care Act, which I 
helped author, and has enabled nearly 100,000 of my 
constituents gain health coverage.
    Like many of my colleagues on this panel, I believe that 
access to high-quality affordable healthcare is a basic human 
right, regardless of one's race or ethnic background. This 
pandemic's disproportionate impact on African American and 
Hispanic communities highlights the pressing need for a 
universal healthcare system that guarantees every American 
access to health care. To that end, I have been a supporter of 
Medicare for All since it was first introduced in 2004 and I am 
a Founding Member of the Medicare for All Caucus. This caucus 
was successful in securing the first-ever Medicare for All 
hearing in the Energy and Commerce Committee as well as the 
Ways and Means Committee this Congressional session.
    We have a unique moment in our nation's history to move 
forward truly transformational legislation, which will help 
communities of color access their basic human right to 
affordable, high-quality healthcare.''
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