[House Hearing, 107 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2002
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
________
SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES,
EDUCATION, AND RELATED AGENCIES
RALPH REGULA, Ohio, Chairman
C. W. BILL YOUNG, Florida DAVID R. OBEY, Wisconsin
ERNEST J. ISTOOK, Jr., Oklahoma STENY H. HOYER, Maryland
DAN MILLER, Florida NANCY PELOSI, California
ROGER F. WICKER, Mississippi NITA M. LOWEY, New York
ANNE M. NORTHUP, Kentucky ROSA L. DeLAURO, Connecticut
RANDY ``DUKE'' CUNNINGHAM, JESSE L. JACKSON, Jr., Illinois
California PATRICK J. KENNEDY, Rhode Island
KAY GRANGER, Texas
JOHN E. PETERSON, Pennsylvania
DON SHERWOOD, Pennsylvania
NOTE: Under Committee Rules, Mr. Young, as Chairman of the Full
Committee, and Mr. Obey, as Ranking Minority Member of the Full
Committee, are authorized to sit as Members of all Subcommittees.
Craig Higgins, Carol Murphy, Susan Ross Firth, Meg Snyder,
and Francine Mack-Salvador, Subcommittee Staff
________
PART 7B
TESTIMONY OF MEMBERS OF CONGRESS AND OTHER
INTERESTED INDIVIDUALS AND ORGANIZATIONS
________
Printed for the use of the Committee on Appropriations
________
U.S. GOVERNMENT PRINTING OFFICE
77-408 WASHINGTON : 2002
COMMITTEE ON APPROPRIATIONS
C. W. BILL YOUNG, Florida, Chairman
RALPH REGULA, Ohio DAVID R. OBEY, Wisconsin
JERRY LEWIS, California JOHN P. MURTHA, Pennsylvania
HAROLD ROGERS, Kentucky NORMAN D. DICKS, Washington
JOE SKEEN, New Mexico MARTIN OLAV SABO, Minnesota
FRANK R. WOLF, Virginia STENY H. HOYER, Maryland
TOM DeLAY, Texas ALAN B. MOLLOHAN, West Virginia
JIM KOLBE, Arizona MARCY KAPTUR, Ohio
SONNY CALLAHAN, Alabama NANCY PELOSI, California
JAMES T. WALSH, New York PETER J. VISCLOSKY, Indiana
CHARLES H. TAYLOR, North Carolina NITA M. LOWEY, New York
DAVID L. HOBSON, Ohio JOSE E. SERRANO, New York
ERNEST J. ISTOOK, Jr., Oklahoma ROSA L. DeLAURO, Connecticut
HENRY BONILLA, Texas JAMES P. MORAN, Virginia
JOE KNOLLENBERG, Michigan JOHN W. OLVER, Massachusetts
DAN MILLER, Florida ED PASTOR, Arizona
JACK KINGSTON, Georgia CARRIE P. MEEK, Florida
RODNEY P. FRELINGHUYSEN, New Jersey DAVID E. PRICE, North Carolina
ROGER F. WICKER, Mississippi CHET EDWARDS, Texas
GEORGE R. NETHERCUTT, Jr., ROBERT E. ``BUD'' CRAMER, Jr.,
Washington Alabama
RANDY ``DUKE'' CUNNINGHAM, PATRICK J. KENNEDY, Rhode Island
California JAMES E. CLYBURN, South Carolina
TODD TIAHRT, Kansas MAURICE D. HINCHEY, New York
ZACH WAMP, Tennessee LUCILLE ROYBAL-ALLARD, California
TOM LATHAM, Iowa SAM FARR, California
ANNE M. NORTHUP, Kentucky JESSE L. JACKSON, Jr., Illinois
ROBERT B. ADERHOLT, Alabama CAROLYN C. KILPATRICK, Michigan
JO ANN EMERSON, Missouri ALLEN BOYD, Florida
JOHN E. SUNUNU, New Hampshire CHAKA FATTAH, Pennsylvania
KAY GRANGER, Texas STEVEN R. ROTHMAN, New Jersey
JOHN E. PETERSON, Pennsylvania
JOHN T. DOOLITTLE, California
RAY LaHOOD, Illinois
JOHN E. SWEENEY, New York
DAVID VITTER, Louisiana
DON SHERWOOD, Pennsylvania
VIRGIL H. GOODE, Jr., Virginia
James W. Dyer, Clerk and Staff Director
(ii)
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2002
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Wednesday, March 21, 2001.
TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS 2002 BUDGET
WITNESS
DR. RENEE JENKINS, PROFESSOR AND CHAIRMAN, DEPARTMENT OF PEDIATRICS AND
CHILD HEALTH, HOWARD UNIVERSITY COLLEGE OF MEDICINE
Mr. Regula. Let us get started. We have a lot of witnesses
today, so we want to move right along. We are sorry we cannot
give you more time, but that is the way it is. You won the
lottery or you wouldn't even be here because our requests for
testimony are about double what we are able to accommodate, but
it is very helpful to even have a brief statement to give us an
opportunity to understand--especially for me because I don't
have time and I hate to tell you this but I am not going to be
able to read all your statements completely. That is the
staff's job and I am not even sure they will get through the
whole thing but we will try as much as possible to evaluate all
the testimony that is presented. These topics are very
important on every subject, are of great interest and affect a
lot of people. We understand that very well.
We have the little boxes there that the green light will
go, then there will be an amber light which means you have a
minute and a half to wrap up and then the red light which means
stop. Francine has a little buzzer that goes off, she is the
enforcer. It is a challenge to get through these and we want to
give everyone a chance.
Sometimes we will have a few questions. I often have a lot
of questions but we just don't have time to get into depth with
all of them. All of these topics are very interesting and more
importantly, they affect the lives of people. We want to do the
best job we can in allocating the resources to achieve
hopefully successes and meeting some of the challenges of the
illnesses and diseases that confront us.
First we have Education. Some of you will be here on
education. I just saw a poll the other day that said among the
American people, education is the number one issue and close
behind it is health. These are subjects that are very important
to people.
With that, we will get started. Our first witness today is
Dr. Renee Jenkins, Professor and Chairman, Department of
Pediatrics and Child Health, Howard University. I would like to
welcome you.
Dr. Jenkins. Thank you.
I am Renee Jenkins from Howard University. I have been
practicing in the Washington community for 25 years. I am also
the President of the D.C. Chapter of the American Academy of
Pediatrics. On behalf of the American Academy of Pediatrics and
our pediatric and adolescent endorsing organizations, I would
like to thank the Subcommittee for the opportunity to present
this statement.
Today, children are generally healthier now than they were
only half a generation ago. According to recent reports, the
national infant mortality and child death rates and the
percentage of children living in poverty have all declined and
immunization coverage rates for infants and toddlers have
increased. However, despite these significant improvements,
there are still over ten million children and adolescents who
remain uninsured. Moreover, racial and ethnic health
disparities for many children and adolescents continue to
exist. We, you and I, both have more to do.
As a clinician, I must work hard with my colleagues to not
only diagnose and treat our patients but also to promote strong
interventive interventions, to improve the overall health and
well being of all infants, children, adolescents and young
adults. Likewise, as a policymakers, you, along with your
colleagues, have an integral part to play to improve the health
of the next generation through sustained and adequate funding
of vital Federal programs that support these efforts. I am
going to speak on three issues particularly--access, quality,
and immunizations.
Under access, as a child and adolescent health clinician,
we believe that all children and adolescents deserve and should
have full access to quality health care, from the ability to
achieve primary care for the pediatrician trained in the unique
needs of children to timely access to pediatric medical
subspecialists and pediatric surgical specialists should the
need arise. Today, federally supported initiatives such as the
Maternal Child Health Block Grant, Title X Family Planning
Services and the Health Professions Education Training Grants
are for many communities their only access to health care. We
urge you to ensure that these and other important child and
adolescent health programs receive sustained and adequate
funding in fiscal year 2002. Of equal importance to access to
care is an equitable Federal investment in the training and
education of the Nation's future pediatricians, clinical and
scientists, particularly in independent teaching hospitals. A
bipartisan Congress has recognized in the last two years, and
you have personally supported, maintaining adequate funding to
continue the education research programs and delivery of health
care in these child and adolescent-centered settings is
imperative.
Under quality, access to health care is only the first step
in protecting the health of all children and adolescents. We
must make every effort to ensure that the care provided is of
the highest quality. Robust Federal support for the wide array
of quality improvement initiatives is needed if this goal is to
be achieved. Leading the effort to develop and implement the
highestquality of care through research and better application
of science is the agency for Health Care Research and Quality and the
NIH, National Institutes of Health. Together, these agencies provide
not only scientific knowledge and basis to cure disease, improve the
quality of care, but also support emerging critical issues in health
care delivery. They also address the particular needs of priority
populations like children and adolescents.
Continued Federal sustainable funding for health research,
including pediatric research in the face of new challenges and
new technology is essential to continued improvements in the
quality of America's health care.
Over the years, NIH has made dramatic strides that directly
impact on the quality of life for infants and children. I am a
recipient of an NIH grant that has definitely shown in a
controlled study that one can effectively postpone and reduce
early sexual involvement in young girls which is important to
the issue of adolescent pregnancy prevention. We are now using
the results of this research to pilot a program to educate and
support parents in their efforts to work with children. We join
the medical research community to support the fourth
installment in the doubling of the NIH budget for fiscal year
2003.
Under immunization, pediatricians working alongside public
health professionals and other partners have brought the United
States its highest immunization coverage levels in history. As
a result, disease levels are at or near record low levels.
However, the public health infrastructure that now supports our
national immunization efforts must not be jeopardized with
insufficient funding. One of the conclusions of the June 2000
Institute of Medicine report ``Calling the Shots,'' was that
unstable funding for State immunization programs threatens
vaccine safety and coverage levels for specific populations.
For example, adolescents continue to be adversely affected by
vaccine preventable diseases such as chicken pox, Hepatitis B,
measles and Rubella. Comprehensive adolescent immunization
activities at the national, State and local level are needed to
achieve national disease elimination goals.
As a pediatrician who sees adolescents, immunizations were
generally thought to be a less critical issue in this age
group. However, the recent college outbreaks of meningococcal
meningitis which is a life threatening infection of the brain
and spinal cord have made us much more aware of the need to be
vigilant about immunization protection even in this age group.
While the ultimate goal of immunization is clearly the
eradication of disease, the immediate goal must be the
prevention of disease in individuals or groups. To this end we
strongly believe that the continued investment in the efforts
of the Centers for Disease Control and Prevention must be
sustained and increased.
In conclusion, I thank you for this opportunity to provide
our recommendations for the coming fiscal year. We look forward
to working with you as the new Chair of this important
subcommittee, and I would like to personally invite you to the
Department of Pediatrics at Howard University so that you can
see child and adolescent health care at work. As this
subcommittee is once again faced with difficult choices and
multiple priorities, we know that as in the past years, you
will not forget America's children.
Thank you very much.
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Mr. Regula. Thank you.
With a couple of small grandchildren who live down the road
from me in Ohio, I have heard a lot about pediatricians.
We are happy to have our colleague from California, Mr.
Duke Cunningham. For those of you who don't know, Duke was the
only Air Force ace in the Vietnam war, so he is not only a
skilled legislator, he was a very skilled pilot, and is a very
valued member of this committee.
Duke is going to introduce our next witness, Carolyn Nunes
from San Diego. That is your home city, isn't it, Duke. You
have quite a family of educators, don't you?
Mr. Cunningham. Dr. Nancy Cunningham. I have two built-in
lobbyists right at home.
Mr. Regula. Duke takes care of education.
Mr. Cunningham. I was a Navy pilot, not an Air Force pilot.
Mr. Regula. And I am a Navy man. I really missed up that
one.
Mr. Cunningham. Thank you, Mr. Chairman.
I see my colleague, Frank Purcell in the audience. I think
you are probably here with the nurse anesthetists, Frank.
My wife has her doctorate degree in Education. The witness
I am going to introduce is the sister of my wife, my sister-in-
law in charge of Special Education in San DiegoCity Schools.
She works for Alan Bursin, who was a Clinton appointee in the border
and now is the Superintendent. I want to tell you he has my full
support.
What Carolyn is going to talk about a little bit today is
not just special education but education reform in five
minutes, and talk about what we are trying to do.
Alan Bursin is supportive of many of the Bush initiatives
for the reform of education. I am very, very proud to support
her boss, the Superintendent, Alan Bursin.
Carolyn testified before the Oversight Committee a couple
of weeks ago on special education. She is here today to do the
same thing. I have seen her cry when she can't help students
with special needs. Now she is an administrator but she spent
23 years in the field of education and is trying to breach the
gap between schools and the parents to make sure the parents'
special needs are met with their individual children, but on
the other hand, trying to breach that the school systems are
not bankrupted by the local trial lawyers that are ripping off,
in my opinion, the school systems and the parents.
There are only two areas in which we should have caps. One
is trial lawyers and the other I will leave to you to decide
what it is.
Carolyn has been a special education teacher and an
administrator. This is the second year of implementation of the
blueprint for student success that her boss, Alan Bursin, has
presented. I want to tell you that on the D.C. Committee we
capped lawyer fees. To give you an example, we saved $12
million. Instead of going to lawyers, it went to the children
with special needs. We have done that for two terms.
We hired 23 special education specialists, speech
pathologists, hearing specialists, sighted specialists, and I
want you to listen very carefully because we need a change in
special education. Carolyn is the expert in all of San Diego
City schools to bring that to you.
It is my honor to introduce my sister-in-law, Carolyn
Nunes.
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Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
CAROLYN NUNES, SPECIAL EDUCATION PROGRAM MANAGER, SAN DIEGO UNIFIED
SCHOOL DISTRICT
Ms. Nunes. Thank you.
Today, my testimony focuses on some needed reforms to
special education law and services in San Diego Unified School
District and the Nation's school districts. Large scale reform
efforts are not unfamiliar to San Diego City Schools.
Currently, the District is in its first year of implementation
of the Blueprint for Student Success. The reform strategies
included in the blueprint are designed to improve teaching and
learning for all students, including special education students
while ending the practice of social promotion. Initial test
score data indicates student performance is improving but much
work remains to be done to successfully implement this program
districtwide.
For local reform efforts like the blueprint to continue to
succeed, the reauthorization of the Elementary and Secondary
Education Act and IDEA must make changes consistent with local
reforms and provide the necessary funding to support change.
The San Diego Unified School District currently serves over
142,000 students in over 184 schools. Of those, over 15,000
students have active IEPs and receive special education
services; 92 percent of the special education current budget
provides direct instruction and support for students with
special education services. The following addresses some of our
current issues regarding special education, IDEA, and funding
as well as our recommendations for possible solutions.
Nationally, we have witnessed an alarming increase in the
number of students with autism. Families are bombarded with the
latest and new forms of treatment for autism. All who view and
read this information in the media make assumptions that all
such services are research based and conform to best practice.
There are a variety of instructional strategies and
methodologies that are available. As educators, we realize that
using only one instructional strategy for all students is not
appropriate. More emphasis must be placed in the area of
research in the educational approaches which will promote
student achievement based on the student's ability and
independence. School districts are currently finding the need
to retrain teachers in strategies and techniques used with
students with autism. We would recommend the development of
special grants for the purpose of ongoing professional
development for the training of certificated and classified
staff in the field.
Today, multiple agencies are funded by Federal dollars for
providing services to students with special needs. Each of
these agencies are under different rules and differentsystems.
Although these agencies have a common purpose to provide services for
students, these systems become a barrier. At times, although with good
intentions, Federal laws will frequently promote a system of
disconnect. Although Congress placed limitations on the recovery of
attorneys' fees in the 1997 IDEA reauthorization, little has been done
to reduce the significant roles such fees continue to play in the
decisions that school districts and even parents make regarding
educational programs for children with disabilities.
An early independent review without all the formal
requirements of a due process proceeding may temper each side's
expectations and lead to a quicker and fairer resolution. I
suggest mandating school districts to participate in alternate
dispute resolution and all due process proceedings and reduce
reimbursement of attorneys fees proportionately for parents who
refuse to participate. Today, significant amounts of program
monies are spent on independent educational evaluations. These
evaluations are conducted at the request of parents when they
disagree with the result of the school district evaluation.
Under IDEA and its regulations, the school district must
initiate due process proceedings and its associated costs to
avoid paying for an independent evaluation. School districts
have little economic incentive to request due process in
challenging independent educational evaluations when such an
action would prove costlier than paying for the evaluation. In
my experience, special education has resulted in a system
driven more by the need to comply with numerous requirements of
both Federal and State laws and regulations than by the genuine
educational needs of children with disabilities.
The California Department of Education has developed a
process of sanctioning school districts who do not meet the
zero tolerance level of compliance with timelines for review of
annual IEPs or three year reevaluations. This system does not
provide for reporting extenuating circumstances that prevent us
from meeting timelines. While our district has made great
strides in electronic capture of information regarding the
status of students receiving special education, 100 percent
compliance is difficult to achieve. Requests for data
collection and reports by various agencies at the national,
State and local levels impose a strain on the district's
ability to provide information in a timely manner.
Our recommendations are as follows. Data collection should
be allowed to report the extenuating circumstances that prevent
timelines from being met. Definitions regarding placement
settings, disability categories, designated and related
services should be consistent across agencies. Data
repositories should be developed that can be access by any
interested agency from a central location. Thresholds of
compliance should reflect the percentage of students reported.
Special education reform cannot be done in isolation. While
increased IDEA funding may reduce encroachment from the
district's general fund, it is necessary to support local
reform through augmenting other programs in the education
budget. It is essential to support successful districtwide
reform efforts that narrow the achievement gap while focusing
on enhancing the education for all students.
On behalf of the San Diego Unified School District, we
appreciate the opportunity to comment on these issues and would
offer any assistance.
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Mr. Regula. Do you think these regulations should be
implemented by the Department of Education rather than a
statutory requirement in the law?
Ms. Nunes. Yes.
Mr. Regula. Questions?
Thank you very much. It is a very important program to a
lot of parents and to their children. Hopefully, we can meet
the challenge of funding.
Mr. Cunningham. Thanks, sis.
Mr. Regula. Next Ms. Northrup will introduce Dr. Stevan
Kukic, a Member of the Board of Directors, National Center for
Learning Disabilities. I might say Ms. Northrup is a valued
member of this committee and very involved in education matters
in the City of Louisville, Kentucky, and brings a broad range
of experience as we deal with the difficult education issues.
Ms. Northrup.
Ms. Northrup. Thank you.
It is my pleasure to introduce today Stevan Kukic of the
National Center for Learning Disabilities. Dr. Kukic is
currently the Vice President of Professional Services, Soppers
West Education Services in Longmont, Colorado, a former
Director of At Risk and Special Services for the Utah State
Office of Education for 11 years. His office provided
supervision for all special education services delivered
tostudents with disabilities.
Dr. Kukic has also provided leadership for services for
students at risk, Title I, migrant education correction, youth
in custody, homeless, drug and alcohol and vocational special
needs. In addition, he has served on many national advisory and
editorial boards and is Past President of the National
Associations of State Directors of Special Education.
Finally, he has been a member of the National Center for
Learning Disabilities' Board of Directors since 1996 and on the
NCLD's Professional Advisory Board since 1992.
Dr. Kukic will talk about the subject that is especially
important to me and to us all, how do we help young children
develop the skills they need to have to be ready to read.
Dr. Kukic.
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Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DR. STEVAN KUKIC, MEMBER, BOARD OF DIRECTORS NATIONAL CENTER FOR
LEARNING DISABILITIES
Dr. Kukic. Thank you.
It is my pleasure to be with you this morning. Thank you,
Ms. Northrup, for that great introduction. All of us are keenly
aware if we could get to problems early, we save money and we
solve problems in more profound ways. The National Center for
Learning Disabilities has dedicated itself through its mission
to make certain that we do intervene as early as we possibly
can with research based practice and that we do that so people
with learning disabilities can achieve their fullest potential.
That is our mission.
With that in mind, we are pleased to introduce to you this
possibility that you would endorse our Get Ready to Read
Initiative that we have begun. This initiative is a national
screening program to be used by parents of young children as
well as early childhood professionals who want to promote early
reading and school success. The initiative seeks to ensure that
these people have research based, easy to use tools to be able
to get a better handle on the kinds of problems young children
have that could cause them later difficulties in reading in
school. We believe at NCLD if we can accomplish the task of
this initiative, we will give people the ability to be able to
assess what children are experiencing in their young lives, to
recognize those behaviors that will link to resources that will
be able to help those children and the people who deal with
them to be able to have those kids be successful.
It is interesting that even with all the work we are doing
in this era of standards based reform, still 30 to 40 percent
of our Nation's fourth graders still do not know how to read.
There is a wide variety of testing measures that are being used
to try to deal with this. What is wonderful is that through the
good work that has been done by the National Institutes of
Health and especially the National Institute for Child Health
and Human Development, we have begun to uncover what the
precursors are to success in reading and school. That research
has told us that there is a high correlation between the
quality of early language and literacy interactions and the
acquisition of linguistic skills necessary for reading. That is
a very profound piece of research that should be affecting what
everyone does in relationship to children, and is beginning to.
It is an interesting note; parents who have children with
special needs often they wait to get services. There was a
recent study that suggests that 40 percent of parents wait a
year or longer before they get some help. If you think of what
you know about young children, waiting a year or longer is a
real dilemma.
Seventy-five percent of children who are not identified as
having problems and having intervention by the age of nine will
continue not to be able to read when they leave high school. So
there is a need for research based screening and assessment and
a number of complementary efforts have helped to produce the
prelude to this initiative.
Congress has supported a number of ongoing literacy
programs to help improve the ability of children and adults in
relationship to this issue. The national education goal of
having all preschool kids ready to enter school and ready to
learn has also been of value. It sets the stage for what we are
trying to do in this Get Ready to Read Initiative. Early last
year with leadership from Representative Ann Northrup and
Senator Thad Cochran and NICHD, we recruited a team of experts
to develop this screening tool. The tool was developed under
the leadership of Grover Whitehurst and Christopher Lonigan who
worked closely with NCLD staff and advisors and a 20 item
screening tool was developed. It was developed using a great
process of validation wherein a set of items were correlated
with a well accepted goal standard assessment tool so that
parents and early childhood professionals can have a screening
tool they can trust. In addition, we have identified a set of
resources and a set of materials these folks can use after they
have done the screening so they can link not only to those
resources andmaterials but to other professionals for
appropriate diagnosis.
The tool itself focuses on four building blocks of
literacy: linguistic awareness, letter knowledge, book
knowledge and emergent writing. These are all reliable
predictors of early reading success. It is our goal to
disseminate this tool through national partnerships. The target
audience is parents, teachers, child care providers, early
childhood providers and other professionals. It is our goal to
saturate the field in one year and to embed the tool in the
operations of early childhood service organizations. It is a
tool to be used with four year olds. We have private sector
partnerships, a major multimedia educational publisher that has
agreed to disseminate this tool to hundreds of thousands of
people. With your support, we will be able to get the
initiative going and be able to do a statewide demonstration in
nine States including Arizona, California, Kentucky, Maine,
Maryland, Mississippi, New Jersey, New York and Washington.
Mr. Regula. How do you get it to young parents that need to
know.
Dr. Kukic. This is going to be a paper tool as well as a
web-based tool. We have a partnership with the multimedia
international publisher that is helping us be able to get to
several million people on the web is what they are able to get
to, so we hope that will work out.
I will close by saying if we work together in the private
sector, in the nonprofit sector and with your support, we will
be able to achieve this great goal to be sure no child is left
behind.
I thank you for this opportunity to speak with you.
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Mr. Regula. Questions?
Ms. Northup.
Ms. Northup. I would like to thank Dr. Kukic for being here
and for the effort. There has been an amazing amount of effort
to develop a tool.
All the research has now told us that children can be
identified as early as four or five years old as being at high
risk for needing intervention to learn to read; that if they
get effective intervention, we should have single digit
percentages of children that don't read and read to their
capacity at fourth grade. Is that correct? What you have done
is actually developed the test that parents or schools could
use.
Dr. Kukic. That is exactly correct. This research is not
equivocal, it is not a possible. I would go so far as to say it
is fact, we know how to teach kids how to read, we know how to
identify kids who are at risk of failure at an early age and it
is a moral imperative that we do so.
Ms. Northup. I would like to compare that with what is
actually going on. In my district, an urban district that has a
significant population of at risk based on poverty levels and
so forth, at risk children that our public schools do not
screen children, that a child has to be estimated by a teacher
to be one year behind before they are even able to request a
test. This is usually sometime in second grade.
There is usually a full year's wait before your child is
actually tested because of the waiting list and so it is often
fourth grade before a child gets in to special education.
NIH tells us that at that level, it takes an enormous
amount of resources in order to catch up a child who has missed
those years of learning to decode and slowly become more
accurate and quick so they can get to the understanding age.
Part of that is because of the enormous cost for every child
discovered.
With this tool, you could just screen every child and get
to the remediation before they ever--they are not necessarily
learning disabled, they just need intervention.
Mr. Regula. Mr. Cunningham.
Mr. Cunningham. Thank you.
If you do that in California and San Diego, I will put it
in my newsletter for you so we can put it out there to help
disseminate it.
I helped rewrite the IDEA bill, so I am very familiar with
it, when I was on the Education Committee and authorization.
One of the problems we had was parent expectations and the
wrong person reaches out and a parent has a child with special
needs. They want the absolute best for that child like I want
for mine but many times, either a medical doctor not trained to
give that diagnosis on how muchper hour or how much per week in
training they receive, that parent's expectations are raised to a
significant level that is unrealistic and what happens is the school is
expected to poll that judgment. Then there is a conflict between the
school and the parent.
In your program, do you have anything that identifies say a
student with dyslexia that may have a higher problem of reading
than say a child without that ailment, so that parents don't
get the wrong idea or at least expectations?
Dr. Kukic. What I like about the screening tool that we
have developed is that it is to be used with four year olds. It
is a functional kind of tool rather than label-based, it is
based on those prerequisite skills that all kids need if they
are going to be effective readers. So the interventions that
work that have been uncovered so far for those children are
usually not very expensive at all. It demands a redirection of
the kind of early intervention that is done for these kids as
four to six year olds. If you do that well, then there is much
less need for very expensive interventions later.
There is a lot of a lack of knowledge among a lot of fine
professionals about this issue and there is a public relations
or public awareness that our chairman of the board really
believes in very sincerely that people need to understand what
this research is saying so we can intervene at an early age in
an economical way to be able to become a nation of readers.
That is the point.
Mr. Cunningham. I would like to read more about the
program.
Mr. Regula. Thank you.
Our next witness will be Dr. Judith Albino, President,
California School of Professional Psychology. She will be
introduced by our colleague, Mr. Cunningham.
Mr. Cunningham. I would tell Dr. Albino that I have a lot
tied to her programs. First of all, she has four campuses. One
is Los Angeles, I was born there. Another is in San Diego, I am
a member of Congress from there. Another is Fresno where I grew
up at 3212 Pine Street and the other is Alameda where I sailed
out on an aircraft carrier.
She is going to be named the President of Alliant
International University which is combining with USIU where my
wife got her doctorate degree in education.
It is my pleasure to introduce Dr. Albino, President,
California School of Professional Psychology. The school has
four different campuses, as I mentioned. She is going to be
named President of a combined school system. USIU and Alliant
have over 2,300 students supported by three campuses and a
faculty of over 200 specialists. It supports many of the
research and community service programs throughout California.
I am pleased to introduce Dr. Judith Albino. I would say
you will find another supporter of doubling medical research,
especially with San Diego with its super computers, its biotech
and its teaching universities.
Thank you for coming.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DR. JUDITH E. ALBINO, PRESIDENT, CALIFORNIA SCHOOL OF PROFESSIONAL
PSYCHOLOGY
Dr. Albino. Thank you.
I appreciate the opportunity to be here today. We are
looking forward to expanding our programs in Congressman
Cunningham's district and we are grateful for his leadership
there. I should note that CSPP currently is headquartered in
San Francisco in the district of your subcommittee colleague,
Congresswoman Nancy Pelosi.
I want to begin by thanking the subcommittee for its
recent, very generous support of CSPP's Partners for Success
Program which works with California school districts to provide
teacher education with a special emphasis on the prevention of
violence in the classroom. I appreciate the opportunity to
testify today on the importance of providing our Nation's
schools with elementary and secondary school counselors. I also
am testifying in support of programs of the Health and Human
Services Administration and the Substance Abuse and Mental
Health Services Administration.
Last year, the subcommittee provided $30 million to
continue funding for the Elementary School Counseling
Demonstration Program. Legislative constraints limited this
generous funding to elementary schools. Moreover, the $30
million provided can only begin to meet the needs for these
services. At a time when our communities are shocked and
griefstricken by incidents of violence in our schools, we have an
obligation to do all that we can to provide resources to keep our
schools and our students safe. School counselors are an integral part
of this effort, yet America's schools are in desperate need of
qualified school counselors. The current national student to counselor
ratio averages 561 students to every school counselor. The maximum
recommended ratio is 250 to 1. Yet, not one State in our Nation meets
that recommendation.
Although the increase is significant, I am recommending
that $100 million be allocated to these efforts in fiscal year
2002 and that the program be expanded to secondary schools. The
Surgeon General's National Action Agenda on Children's Mental
Health released this past January outlines goals for improving
services for the 7.5 million children under the age of 18 who
need mental health services; 1 in 10 children and adolescents
suffer from mental illness severe enough to cause impairment.
Yet, in any given year, it is estimated fewer than 1 in 5 of
these children actually receives treatment. The long term
consequences of untreated childhood disorders are costly in
human as well as dollar terms.
Many adult Americans also face challenges that could be
prevented or mitigated with behavioral and mental health
counseling. These include 18 million with depressive disorders,
14 million who abuse alcohol and 13 million who use addictive
drugs. In view of this need, I urge your favorable
consideration of $3,150,000,000 in support of the programs of
the Substance Abuse and Mental Health Services Administration
and $6,472,000,000 in support of programs of the Health
Resources and Services Administration.
In closing, I want to mention that CSPP trains more than
half of the clinical psychologists graduated in California each
year and about 15 percent of those across our country. More
than 25 percent of our students come from ethnic minority
backgrounds. As Congressman Cunningham indicated, CSPP students
and faculty provide many hours annually of mental health
services at nominal or no cost. Most recently this amounted to
nearly 2 million annually. In San Diego County where there are
812,000 people with diagnosed mental health or addictive
disorders, the planned construction and staffing of our new
community mental health counseling center will significantly
expand these services, leveraging public support with in-kind
contributions in the form of the services of our faculty and
doctoral students.
Thank you for your time and I appreciate your support.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Questions?
Mr. Cunningham. One of the issues we have before this
committee that affects directly is a hold harmless that follows
Title I for underprivileged children. California is a payer of
taxes but doesn't receive its fair share and many of the other
States while they have lost population, the growth of
California schools with minorities--you stated of these
children having problems, 75 percent of them are minorities. We
are seeking to have the hold harmless rule instated. I worked
with Senator Feinstein last year to make sure that happened.
That will help the schools to have the dollars possible.
Secondly, my adopted son was in a substance abuse program.
Dr. Samms in San Diego and they do a very good job with those
children, so you have my support on the issue. When you look at
Santana High School, Columbine, the drug problems we have in
our schools, if we can get to these children early, it will
save a lot of problems down the line. I want to thank you for
your services.
Dr. Albino. Thank you. I appreciate that statement. I think
we all know how important it is to have the resources for these
children if we are to avoid the kinds of problems we see in the
schools you have mentioned and in so many others as well. They
don't all make the headlines but these problems are much more
prevalent than they should be.
Mr. Regula. I think you are saying they are all
interrelated.
Dr. Albino. They are indeed.
Mr. Regula. Thank you.
Next, we have Mr. Pat Teberry from Ohio, a member of the
Education Committee. You are doing mark up this morning,
putting together the bill we are supposed to pay for. He is
going to introduce Dr. Thomas Courtice, President, Ohio
Wesleyan, where my daughter graduated.
Mr. Teberry. Thank you.
There is also another connection to Canton in your
district. As you may know, Wesleyan has a strong presence in
Canton. Of about 1,800 students, about 50 are from Canton and
about 800 alumni in the Canton area.
I welcome this opportunity to bring to your attention an
issue of significance, not only to Ohio Wesleyan, but to the
State of Ohio and the Nation. That is the underrepresentation
of minority groups in the sciences at the undergraduate and
professional levels.
Dr. Tom Courtice serves as the President of Ohio Wesleyan
University, an independent, undergraduate liberal arts
institution, founded 159 years ago in Delaware, Ohio north of
Columbus. Ohio Wesleyan is one of the top liberal arts colleges
in the Nation. During his seven years as President of Ohio
Wesleyan University, Dr. Courtice has served tostrengthen that
institution.
I am happy to share with you the fact that there are three
Ohio Wesleyan alumni who are members of Congress--Congressman
Hopson, Congressman Gilmore as well as Congresswoman Joanna
Emerson from Missouri. The entire Ohio Wesleyan community is
proud to call them their own and looking forward to working
with Dr. Courtice and Ohio Wesleyan and thank you and the
committee for allowing him to testify today.
Mr. Regula. Dr. Courtice.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DR. THOMAS B. COURTICE, PRESIDENT, OHIO WESLEYAN UNIVERSITY
Dr. Courtice. Thank you.
Thank you for this opportunity to provide testimony to you
and the members of the subcommittee.
Ohio Wesleyan's undergraduate students represent 40 States
and 54 countries bringing what is a rich diversity to our
campus and it is this commitment to diversity as well as to an
enduring commitment to academic excellence that has enabled us
to reach and maintain the ranking as one of the top liberal
arts colleges in the United States. I want to address briefly a
topic that relates to both the quality of education and
diversity and that is the need for increased attention to
science education for currently underrepresented or minority
groups. Ohio Wesleyan has long been acclaimed for its
particular attention to science education. We employ some of
the Nation's best science teaching faculty and we have
committed considerable resources to improving our science
facilities. In fact, we will soon begin new construction to
expand and renovate existing science buildings and to bring our
labs and classrooms up to a 21st century standard.
Our commitment to exposing our students to a strong science
curriculum has resulted in a doubling of the enrollments in
science and math over the last ten years and a similar increase
in the number of students who graduate with a Bachelor of
Science Degree. In fact, 25 percent of the class of 1999
graduated with a science major and over 60 percent of that
number entered directly graduate or professional schools
relating to their majors. Student demand for the sciences
obviously affects the resources that a particular university
dedicates to its science and math departments, yet the
increased commitment to the study of science and technology has
also been mandated by the explosive growth of science research
and its applications in our society.
As this commitment to enhancing the quality of science
studies grows, so too must the commitment to supply a well
educated, large and diverse work force in these growing fields.
Scientific, engineering and technological jobs are among the
fastest growing in the workforce to the point that current
demand for workers has outstripped supply.
Demographic trends also inspire concern about the Nation's
ability to meet its future technological work force needs.
Historically, white males have made up a large fraction of U.S.
scientists and engineers. However, this portion of the
population has a percentage of the total work force is
projected to decrease significantly in coming years as other
population groups, African Americans and Hispanics are expected
to make up to close to 50 percent of the U.S. work force quite
soon. Unfortunately, due to a lack of financial resources,
sufficient high school preparation and practicing mentors and
role models, minorities are currently severely underrepresented
in the science and technology fields.
Ohio Wesleyan understands that a more diverse science work
force means a broader science agenda bringing different
perspectives to bear and producing a deeper analysis of
alternatives. As we begin to enhance our own program to
encourage greater minority participation in the sciences, I
would ask that the Subcommittee consider funding and support
for policies and programs which also constructively address
similar issues. Such programs may incorporate strategies to
provide students with more minority role models and mentors
from both public and private sectors. According to the
information gathered a few years ago by the National Center for
Education, statistics on African Americans, Hispanics and
Native Americans teaching in the sciences make up only 1.1
percent of all full-time college faculty. Creative initiatives
could help colleges like Ohio Wesleyan broaden the base of
minority faculty members and mentors in the sciences. Such
programs may also incorporate more science research and other
intimate learning opportunities for minority students and they
may provide engaging residential sciences programs to pre-
college populations.
Our Nation's well being has long depended on our ability to
adapt and advance with scientific and technical progress. The
Federal Government should continue to spend considerable time
and effort examining what actions will ensure the Nation has an
adequately trained science work force in the future while using
liberal arts colleges like Ohio Wesleyan as partners. We
anticipate deepening our role in this effort. We look forward
to sharing our experience with peer institutions across the
country and with public policymakers as we discover what really
works when it comes to systematically enhancing and expanding
science education and career opportunities to an increasingly
diverse population.
Thank you for providing us the opportunity to testify
before the subcommittee this morning.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you find the students you are getting have
an adequate background coming out of high schools to meet your
science curriculum and I am sure you have a placement office
and do you find it easy to place these students in good jobs
once they complete their studies?
Dr. Courtice. I think we have found they have been well
prepared, particularly if they declare science as a field of
study. It is just that we can't get enough to come across that
threshold and declare.
Placement opportunities are simply overwhelming and with a
solid science background, the options for young people today
are quite wide and expansive, whether graduate professional
study or entering the work force immediately.
Mr. Regula. Thank you. There certainly is a lot of interest
in science but a precursor to that is you have to be able to
read. That puts literacy right at the front end of all this.
Dr. Courtice. That is why we think those pre-college
programs are very important.
Mr. Regula. Do you offer remedial for students coming in?
Dr. Courtice. We do have remedial work in both quantitative
and writing skills. We have also tried to introduce some of
that work prior to the time students actually enroll on campus
so they are doing that in their junior and senior years in high
school.
Mr. Regula. Thank you.
Our next witness will be Warrick Carter, President,
Columbia College, Chicago, to be introduced by our colleague,
Mr. Jackson.
Mr. Jackson. Thank you.
Since early last year, Dr. Warrick Carter has served as
President of Columbia College in my hometown of Chicago.
Columbia is a private, four-year, liberal arts college
specializing in the visual arts, performing arts and
communications. Columbia's philosophy of hands-on, minds-on
education plus their location in one of the world's most
vibrant cities adds to a depth and richness of experience for
all who enter its doors.
From 1996 to last year, Dr. Carter served as Director of
Entertainment Arts at Walt Disney Entertainment in Lake Buena
Vista, Florida and from 1984 to 1996, he served as Provost,
Vice President of Academic Affairs and Dean of Faculty at
Berkley College of Music, Boston, Massachusetts.
Dr. Carter received his Bachelors Degree in Music Education
at Tennessee State University, his Masters and Doctorate in
Music Education at Michigan State University.
I present Dr. Warrick Carter, President of Columbia
College.
Mr. Regula. A couple of questions. Do you get a lot of your
students from college?
Mr. Carter. Yes, about three-quarters of our students come
from the State of Illinois.
Mr. Regula. Yesterday, thanks to Mr. Jackson, we had the
Superintendent or CEO of the Chicago School system, very
impressive. My question to you is are you seeing this as a
result of their efforts in the public school system and the
level of achievement of the students you are getting?
Mr. Carter. Yes, we are. In fact, we work hand and glove
with Chicago Public Schools. We offer a variety of programs
that serve to train teachers specifically in science. We have
an innovative approach to teaching science through the arts and
we are training teachers to do so. We have received some rather
outstanding accolades because of it. It has changed the whole
quality of science instruction in the public schools.
Mr. Regula. Thanks to Mr. Jackson, I will be meeting with
the CEO this evening. I was impressed with what is being done
and certainly Mr. Jackson has related a lot of this to me. So
you are telling me the system is working?
Mr. Carter. The system is working, working much better than
it worked before.
Mr. Regula. Thank you.
----------
Wednesday, March 21, 2001
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
WARRICK CARTER, PRESIDENT, COLUMBIA COLLEGE
Mr. Carter. Thank you for that introduction and your time.
You have a lot of friends at Columbia College and we look
forward to seeing you soon.
I am Warrick L. Carter, President of Columbia College.
Thank you for this opportunity to speak to you. As Congressman
Jackson said, Columbia College is a private, nonprofit,
undergraduate and graduate institution in Chicago's South Loop
neighborhood that offers educational programs and arts in the
communications disciplines within a context of liberal arts.
With a fall enrollment of over 9,000 students, we are the
fifth largest private institution in the State of Illinois. I
am here to speak about the many needs of institutions of higher
education, particularly those of urban colleges and
universities like Columbia College and how Federal programs can
help address some of these needs.
Columbia College is one of the very few open arts
administration institutions in the United States and has the
largest minority enrollment of any institution of its kind in
the country. We enroll students from across the country, across
the world but it is primarily an Illinois and Chicago
institution. More than three-quarters of Columbia College
students are from the State of Illinois and the majority of
these are from Chicago and the Chicago metropolitan area.
A third of the college's students are African Americans,
Latino or Asian Americans and a large number of all of our
students are first in their family to attend college.
Delivering excellent higher education with open admission in a
very diverse urban setting is exhilarating but full of
challenges. City kids, minority kids, first generation college
kids are much more likely than their peers to drop out before
they complete college. The loss of these kids, to their
families, to Chicago and to the country is staggering. Helping
students to stay in college and complete their degree at
Columbia is our most important challenge.
The U.S. Department of Education funds a number of programs
that are of critical importance to retention at Columbia
College, Chicago and to urban colleges and universities in
general. The Pell Grant Program is first and foremost amongst
these. At Columbia, nearly one-third of our undergraduate
students receive Pell grants and are eligible to participate in
the matching grant programs supplied by the State of Illinois.
Although these grants do not cover the full cost of tuition and
fees, without them, many of these students could not attend
college at all.
Title III and the Fund for the Improvement of Post
Secondary Education are also vital to this effort. Currently at
Columbia, Title III funds a multifaceted, academic and social
support program for lower income, first generation and minority
students. These funds support a comprehensive, all college
effort to enhance and improve the first year experience of all
new students. Research shows from around the country that the
first year, even the first semester, and sometimes the first
week of a student's experience in college will determine the
likelihood that they will stay in college and ultimately
graduate.
In 1999, the college adopted a comprehensive retention
program that focused on new freshmen which holistically
addresses the interwoven factors that affect students' success.
We received a $500,000 grant from the Department to support
this initiative. In just one year, the percentage of freshmen
returning to their sophomore year climbed by five percent. This
past fall, 90 percent of all at risk students who participated
in a summer program we refer to as our summer bridge program
returned for a second semester.
Columbia is now hoping to undertake an ambitious mentoring
program for our minority students. Under the program, all new
entering minority students will be paired with a faculty member
or staff mentor to help students determine his or her own
educational goals, negotiate the new and unfamiliar college
experience, and to utilize student services, and hopefully
develop this ongoing bond that is soimportant to be connected
to an institution and to stay until completion. As mentoring has proven
to be a very effective retention tool, this program will reinforce new
students' decisions to attend college and quickly integrate these
minority students into the academic, artistic and social fiber of the
college.
A sense of community is vital to retention and to providing
a rich educational environment as well. Campuses such as
Columbia are diffused and less contained than traditional
college campuses. Fewer students live on campus and many
commute daily throughout the metropolitan area. Although our
dozen plus buildings are interspersed with residential, retail,
commercial make us a major landowner within the area, we have
only what can be defined as a loosely defined campus. The
college hopes to counteract this with a new Student and Art
Center that will create a focal point for our campus and for
diverse community groups in the South Loop that we serve,
private, nonprofit.
We have the largest program of film studies in the country
with 1,700 students, one of the largest programs in television
and radio and recording technology. Our alums have gone on to
rather well heights and others stay in the area. We have alums
in California who are Academy Award winners, one for saving
Private Ryan and Schindler's List, so we are proud of the
quality of what we do in film and television.
Mr. Regula. It is a growing industry.
Mr. Carter. We found in Chicago a lot of independent films
are moving away from Los Angeles because it is more cost
effective to do films outside, so we see the industry growing
in Chicago. There was over $150 million spent in Chicago last
year in films and television shows.
In Orlando, where I spent time recently, we did some $500
million worth of films. Compare that with what is going on in
California, slowly but surely people are looking to do films
outside of California. We think our alums are partly leading
that charge. We have two who have chosen to return to Chicago
and do their films there. The very recent film, Men of Honor,
was done there and prior to that Soul Food, also the television
program. Each case, they chose to return to their hometown and
therefore create employment for our alums as well as for others
in the city.
Mr. Regula. That is a great impact.
Do you interact with the National Endowment for the Arts?
Mr. Jackson. Yes, we do. We have been fortunate to receive
both NEA and NEH funding.
Mr. Regula. Do you think they do a good job?
Mr. Jackson. Yes. If that funding were a bit larger, I
think they would do a much better job.
Mr. Regula. I knew that was coming. [Laughter.]
Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
MARILYN HELD, DIRECTOR, LABORATORY SUPPORT SERVICES, ST. JOHN HEALTH
SYSTEM, DETROIT
Next is Ms. Kilpatrick from the great State of Michigan
where they have a better football team than Ohio State, but
times will change, is going to introduce Marilyn held, Director
of Laboratory Support Services, St. John Health System,
Detroit.
Ms. Kilpatrick. Thank you for allowing us to present our
constituents and for you to take the time to consider them. We
appreciate it.
I would like to present to you Ms. Marilyn Held, Director
of Laboratory Support Services at St. John Health Systems in
Detroit; a prominent member of the American Society of Clinical
Pathologists; and has served as a board member on that society,
has served on the Finance and Planning Committee and has been
awarded the Distinguished Service Award from the Society in
1999.
Ms. Held received her Bachelor's Degree at the University
of South Dakota, performed her medical technology internship at
the University of Iowa and completed her graduate education in
Microbiology at the University of Arizona. I am happy to
present Ms. Held.
I have three 10 o'clock assignments this morning,
Transportation being next door. I am happy to be with you this
morning and Foreign Operations in a totally other building.
Please excuse me if I am not able to stay with you.
Mr. Regula. I have some interest in a few projects in
Transportation so we will be very nice to you.
Ms. Kilpatrick. Thank you.
Ms. Hill.
Ms. Held. Thank you for your support of the laboratory
community and back home in Michigan. We appreciate it.
Ms. Kilpatrick. Thank you.
Ms. Held. Thank you for inviting me to represent the
American Society of Clinical Pathologists. The ASCP has 75,000
members and is the world's largest organization representing
pathologists and laboratory personnel. I am here to inform you
today that the United States is facing a very serious shortage
of medical laboratory personnel. Vacancy rates for 7 of 10 key
laboratory medicine positions is at an all time high. ASCP in
conjunction with an independent polling firm conducts a
biannual wage and vacancy survey of 2,500 medical laboratory
managers. The data for 2000 was published this month and I
would like to give you a glimpse of what we found.
Vacancy rates for cytotechnologists, the professionals who
perform pap smears, in the northeast, the vacancy rate was 45
percent, 16.7 percent for the east north central and 33.3
percent for the far west, rural areas average a 20 percent
vacancy rate and large cities a rather surprising 28.3 vacancy
rate. Histotechnologists, the individuals who prepare tissue
specimens, have an average vacancy rate of over 20 percent, the
west, south central region of the country has a 73.7 percent
vacancy rate; the south central Atlantic States have an average
vacancy rate of 16.7 percent. By comparison, the vacancy rate
for medical technologists will not appear to be of concern but
it is. Medical technology vacancy rates average 11.1 percent
but rural areas are at 21.1 percent.
Rather than continue to quote statistics, I would like to
put a face on these numbers. It is estimated that 70 percent of
diagnostic and treatment decisions for patients are based on
laboratory tests. In my own institution, our laboratory will
perform over 10 million diagnostic tests next year alone. Tests
such as measuring cardiac enzymes for heart attacks, performing
prostate biopsies, hemoglobin electrophoresis for the diagnosis
of sickle disease and trait and measurements for high calcium
levels in blood and urine to assess future risk for
osteoporosis are only a few examples. In my hospital, we have
as of yesterday, a 12.4 percent vacancy rate of those personnel
that assess cardiac enzymes and osteoporosis related tests and
a 19 percent vacancy rate for people who prepare prostate and
breast tissue for biopsies.
One of the logical solutions to this vacancy rate problem
is to train more students. However, the number of programs are
decreasing. In my home State, we have seen the number of
programs plummet from 27 to 8 in less than two decades.
Nationwide, the number of graduates in medical technology has
decreased 30 percent in the five years. The continued demand
for laboratory services is real and is expected to grow. Given
the country's aging population, the number and complexity of
biopsy specimens, tests and the use of molecular techniques
will increase in the next decade. Laboratory professionals who
entered the work force in the 1960s and the 1970s will be
retiring soon. Also, the threat of bioterrorism and emerging
infectious diseases calls for trained laboratory professionals
to respond.
There are solutions to these problems. There are allied
health grants available to attract laboratory professionals to
the field especially minorities and individuals in rural and
under served communities. For example, the University of
Nebraska Medical Center established medical technology
education sites in rural Nebraska under an Allied Health
Project Grant. As of 1999, of 69 graduates, 99 percent took
their first job in a rural community and 74 percent took their
first job in rural Nebraska.
The grants are also designed to create successful minority
recruiting and retention programs for medical technologists. As
a direct result of this Federal support, the University of
Maryland, Baltimore, as of the fall 2000, reached a 64 percent
minority student enrollment at a majority institution, one of
the highest in the country. Most Allied Health Grant projects
continue after Federal funding ends, making them a long lasting
worthwhile investment in the future of allied health. The
Allied Health Project Grants Program is a relatively small step
in assuring that funding is available to attract individuals to
the allied health professions. It needs to be seriously
considered.
Thank you for your time. We are requesting $21 million.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Why do you think there aren't more young
people, certainly the opportunities are enormous? Why don't
young people elect this field?
Ms. Held. We have looked at that a lot and the field
requires a good background in math and science. We are finding
that with the opportunities in computers, the .coms, the
biotech corporations that there are many opportunities now that
people just aren't going into health care as frequently.
Mr. Regula. Do you get information out to high schools so
that young people can think about this as a career?
Ms. Held. Yes. The American Society of Clinical
Pathologists has partnered with organizations like the National
Biology Teachers Association and we do work with recruitment in
those sort of forums. Independently, my organization like other
hospitals, goes to high schools, middle schools, elementary
schools whenever we are given the opportunity.
Mr. Regula. Is St. John a free-standing organization that
provides services to a number of hospitals?
Ms. Held. Yes. St. John Health System is a seven hospital,
integrated delivery network and three of our hospitals are in
Detroit and four in the neighboring suburbs and out in the
rural areas as well.
Mr. Regula. So it is a consortium that all seven can use?
Ms. Held. Right.
Mr. Regula. Thank you for coming.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DEBORAH A. CHAMBERS, PRESIDENT-ELECT & MEMBER OF THE BOARD OF
DIRECTORS, AMERICAN ASSOCIATION OF NURSE ANESTHETISTS
Next is Deborah Chambers, President-elect and Member of the
Board of Directors, American Association of Nurse Anesthetists.
Welcome.
Ms. Chambers. My name is Deborah Chambers. As President-
elect of the American Association of Nurse Anesthetists, I
represent 29,000 certified registered nurse anesthetists across
the country, also known as CRNAs. We deliver safe anesthesia
care to patients in every State, every day. I will summarize
four points: what do CRNAs do and where, the nursing shortage
and the CRNA shortage, our appropriations request and one
regulatory issue of interest to Congress.
America's 29,000 CRNAs provide two-thirds of all the
anesthetics in the United States. We are the sole anesthesia
provider in over 70 percent of rural hospitals. We are the
predominant anesthesia provider in rural and urban under served
areas of communities and to the military. For over 100 years,
nurse anesthetists have been providing anesthesia. The
Institute of Medicine reports anesthesia is 50 times safer
today than it was 20 years ago. We believe this is in part due
to our advanced training and our continuing education and
recertification requirements that are by far the most rigorous
in the field of anesthesia care.
Yet, as more Americans become eligible for Medicare, there
are fewer nurses and CRNAs to care for them. It is in America's
interest to work together so that nurses and CRNAs are
available for patients who need care. The nursing shortage is
here today. Student nurse anesthetists must have practiced as a
nurse for at least two or more years so we are deeply concerned
that the number of registered nurses under the age of 35 has
fallen by more than 50 percent over the last 20 years to a
level less than 20 percent of all registered nurses in the
country. Our 82 accredited nursing anesthesia programs are full
but they are graduating about 700 fewer nurse anesthetists per
year than what HHS says is required to meet the demand. The
demand is growing and creating a CRNA shortage in the
marketplace.
In 1999, the State of North Carolina reported 82 CRNA
position vacancies and it is projected these vacancies will
extend to beyond 133 by the year 2004. Today, the number of
classified ads advertising and recruiting for nurse
anesthetists published in our national journals is growing
month by month. What should we do? We should work together to
educate more CRNAs. With such shortage helping to support the
education of nurse anesthetists is much more cost effective for
taxpayers than subsidizing other types of anesthesia providers.
The committee has shown real leadership and we are asking for
that leadership to continue.
We commend the committee for providing significant
increases for nursing education programs in fiscal year 2001,
especially for the advanced education nursing program within HHS's
Bureau of Health Professions. For fiscal year 2002, we recommend an
increase of $11 million for advanced education nursing to at least $70
million. We note that the President's fiscal year 2002 blueprint
identifies this type of program to help alleviate the nursing shortage.
We recommend an increase of at least $10 million to the
Nursing Education Loan Repayment Program. We urge an increase
in the National Institute for Nursing Research budget up to
$125 million. We also recommend that the committee consider
funding specific initiatives to help expand existing CRNA
schools, establish new schools and to recruit and retain
faculty for the training of nurse anesthetists. While America's
existing nursing anesthesia schools are full, expanding these
schools or establishing new ones without Federal funding as a
catalyst has proven to be very difficult. We look forward to
working with the members of the committee on this project.
We recommend the committee permit Medicare's new anesthesia
care rule to take effect. Published on January 18, 2001, this
important Medicare rule lets States decide the issue of
physician supervision for nurse anesthetists. This rule gives
States and hospitals the flexibility they need to provide
superior health care to patients. It is supported by hospitals,
nursing organizations and the National Rural Health
Association, many members of the House and Senate and many
members of this panel on both sides of the aisle.
Secretary Thompson has signed an order to have the rule
take effect on May 18, 2001. This should be a matter for the
States which govern health professional scope of practice.
This concludes my remarks. I welcome your questions.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Is this group licensed by medical boards in
each of the States?
Ms. Chambers. Your licensed as a registered nurse through
the State and you are certified by the National Association.
Mr. Regula. So you get your nursing license from the State
and certification is national?
Ms. Chambers. Yes, sir.
Mr. Regula. Can you move from State to State?
Ms. Chambers. As long as you have license as a registered
nurse from that State. The certification is the national
certification so you can move.
Mr. Regula. Do some States require a doctor be present and
others not? I have heard that is an issue.
Ms. Chambers. The whole can of worms is that nurse
anesthetists practice along with physicians. Obviously in the
surgical arena, a nurse anesthetist is present to provide
anesthesia for a patient undergoing a surgical procedure.
The difference comes in that States rules and regs differ
from State to State so there are actually 29 States that do not
require supervision of a nurse anesthetist. What we are asking
is to let the States decide.
Mr. Regula. Thank you.
Mr. Jackson.
Mr. Jackson. No questions.
Mr. Regula. Thank you for coming.
Next, Mr. Jackson will introduce Miguelina Leon, Director,
Government Relations and Public Policy, National Minority AIDS
Council.
Mr. Jackson. Since 1994, Miguelina Ileana Leon has served
as the Director of Government Relations and Public Policy for
the National Minority AIDS Council. She is a certified social
worker with a Masters from Columbia University and she has
worked in HIV AIDS services in advocacy since 1985.
Established in 1987, NMAC is the leading national
membership organization addressing the HIV AIDS epidemic among
communities of color. With a membership of over 600
organizations and 3,000 affiliates, NMAC provides training,
technical assistance and policy analysis for community-based
organizations on the front lines of the HIV AIDS epidemic.
NMAC's most recent advocacy work focuses on the elimination
of ethnic and racial health disparities with a special focus on
the disproportionate HIV AIDS incidence and death rates among
ethnic minorities.
NMAC has worked with the Congressional Black Caucus to
address the state of emergency of HIV AIDS in the African
American community, helping to secure $156 million in Federal
funding for highly impacted communities of color in 1998, $250
million in 1999 and $350 million last year.
Mr. Chairman and members of the subcommittee, I present Ms.
Miguelina Ileana Leon.
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
MIGUELINA LLEANA LEON, DIRECTOR, GOVERNMENT RELATIONS AND PUBLIC POLICY
NATIONAL MINORITY AIDS COUNCIL
Ms. Leon. Thank you, Congressman Jackson, for that very
comprehensive presentation.
My name is Miguelina Ileana Leon. I am testifying today on
behalf of the National Minority AIDS Council. I would like to
thank the members of the subcommittee for your extraordinary
leadership and commitment to HIV AIDS prevention and care
programs, biomedical and behavioral research and other crucial
health programs.
NMAC commends the leadership and the foresight of the
Congressional Black Caucus and the Congressional Hispanic
Caucus in crafting and expanding the minority aids initiative
to assure a targeted response to the growing HIV AIDS health
disparities among communities of color. Our work as health
advocates and HIV service providers has been strengthened by
your combined efforts and generous support. Our Nation has made
remarkable progress in combating HIV AIDS in the last decade,
however, the dynamic nature and evolving epidemic represents
complex challenges and requires intensified efforts to respond.
The disproportionate impact of HIV on communities of color
is not a new phenomena, yet the trends over the last decade
clearly reflect a growing burden of morbidity and mortality
among ethnic and racial minorities. Consider these facts,
people of color make up 56 percent of the cumulative AIDS cases
and 68 percent of the new AIDS cases report by the Centers for
Disease Control through June 2000. Men of color accounted for
63 percent of the new AIDS cases and women of color accounted
for 82 percent of the new AIDS cases among females. Similarly,
children of color represented 84 percent of the pediatric AIDS
cases. Most recently, young men of color and women of color
have become highly vulnerable. Just a few weeks ago, the
Centers for Disease Control and Prevention released a survey of
young men which looked at over 2,000 gay and bisexual young men
in Los Angeles, Miami, New York and Seattle. This survey showed
that the highest infection rates were among African Americans,
30 percent, and Latinos, 15 percent.
The CBC Minority AIDS Initiative was developed in 1999 to
target funds to eliminate the persistent HIV AIDS related
health disparities among ethnic and racial minorities. The CBC
Initiative continues to be needed now more than ever. The
initiative is intended to expand the infrastructure and
capacity in minority community-based organizations to provide
quality HIV prevention interventions and medical and supportive
services. By building infrastructure and increasing the
capacity of these organizations, the initiative enables the
organizations to access needed funding to build their own
programs in their own communities. The CBC Initiative is not
intended to create a parallel system of programs or services.
It does put in place HIV AIDS services in communities that have
been historically underserved and also complements existing HIV
prevention and health care services. These resources are
intended to provide a bridge that will enable minority
community-based organizations to ultimately broader Federal HIV
AIDS funding.
The CBC Minority Initiative cannot stand alone and we know
it must work in conjunction with other HIV AIDS programs.
However, we believe it is necessary to expand this initiative
to a level of $540 million in fiscal year 2002 in order to
support and expand the infrastructure of minority community-
based organizations and to ensure that we address the health
disparities by enabling these organizations to provide
culturally competent services within their own communities. We
believe it is important to commit to this effort, to sustain
these efforts and we strongly recommend the Subcommittee
sustain, safeguard and expand the CBC Minority AIDS Initiative
by providing the additional funding in fiscal year 2002.
Thank you for your attention and consideration of these
issues.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you work in the area of prevention as well
as curative approaches?
Ms. Leon. Yes. Actually, we are a national organization and
we provide training and technical assistance and support to
organizations on the front line of the epidemic. They actually
are working in prevention and supportive services, and also
providing health services.
Mr. Regula. Is there some growing success in treatment?
Ms. Leon. There definitely have been great advances in
treatment over the last ten years. However, what we see in
relationship to ethnic and racial minorities is that they don't
experience the same benefits in terms of health outcomes for a
variety of reasons, including they have less access to quality
health services, greater numbers of uninsured people and there
is a large proportion of ethnic and racial minorities that have
been traditionally hard to reach populations such as the
homeless, people who have chemical dependency problems and
women.
Mr. Regula. Other questions?
I see we have a vote. I think we can take one more before
we have to vote.
We will have Mr. Phil Jacobs, President, BellSouth
Corporation.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
PHIL JACOBS, PRESIDENT, BELLSOUTH CORPORATION
Mr. Jacobs. I am Phil Jacobs, President of Georgia
Operations for BellSouth Corporation and also a graduate of
Dennison University in Granville, Ohio.
Thank you for the opportunity to be here.
I am here today on behalf of a group called Friends of CDC
to discuss infrastructure funding for the Centers of Disease
Control and Prevention construction budget in the 2002 budget.
Let me begin by offering my thanks to this subcommittee on
behalf of the Friends of CDC for securing the appropriations in
this year's budget of $175 million. This was an enormous step
forward and a great step forward to begin the construction of
new facilities at both of our campuses for the CDC in Atlanta.
It is just that, a start.
I am here today to respectfully ask this committee to
continue to support averting what I believe is a pending crisis
waiting to happen in health care. The current infrastructure of
the Centers for Disease Control and Prevention in Atlanta has
dilapidated buildings that are creating a hazardous situation
for our world class scientists. This situation must be
corrected. It is clear to me if we are going to continue to
have the world's leading health organization to be able to
address the myriad of health issues that are coming at us
today, we need to have first class facilities and need to
continue to recruit first class scientists into those
facilities.
Before I tell you more specifically about the facilities in
Atlanta, let me take a minute and talk about the organization,
Friends of CDC and how we began. The Friends of CDC is a group
of corporate citizens who joined together about two years ago
to highlight the need for infrastructure funding for the CDC in
Atlanta. This group includes not only my company, BellSouth,
but also UPS, Home Depot, Delta Airlines, Cox Communications,
the Southern Company, Healtheon Web/MD, Merck, HCA, the Health
Care Company, General Electric and Aetna Insurance Company. It
is a voluntary, civic-minded group deeply concerned with the
facilities situation at the Nation's premiere health
institution and we are concerned that this institution's
facilities have been allowed to deteriorate to the point they
have today.
I personally first visited the CDC in Atlanta in 1999 but I
never imagined what I would see in terms of the horrific
conditions in the buildings there. By the way, I would like to
extend to any member of this subcommittee an invitation to join
us in Atlanta for a tour of the facilities because I will tell
you now that words can't do justice to the lack of and horrific
conditions that we are asking our folks to work in.
Mr. Regula. The $170 million that was put in last year,
will that provide some help?
Mr. Jacobs. Some relief, absolutely. As a matter of fact,
we just had the opening of a new facility on the Emory
University Campus which gave us an additional number of level
four laboratories which is where the highest security and most
dangerous agents are dealt with. However, there are a host of
other facilities that are still housed in inadequate housing
that need to be addressed. This $250 million we are asking for
this year is part of an overall $1 billion program that will
bring us basically to the 21st century.
Mr. Regula. Your company is contributing?
Mr. Jacobs. Financially contributing?
Mr. Regula. Yes?
Mr. Jacobs. To the Friends of CDC organization, we are all
contributors to that organization.
Mr. Regula. So there is local help and support in addition
to the Federal money?
Mr. Jacobs. The money we are contributing which is a small
amount actually goes towards our efforts in creating public
awareness around this. There is no contribution to actual
construction of the buildings.
As you know, the role of the CDC over the past few years
has continued to expand, addressing a group of areas, including
infectious diseases, HIV and AIDS, tuberculosis and since 1973,
the CDC has discovered more than 35 new deadly viruses and
bacteria that create human health hazards.
In addition to infectious diseases, they also work on
preventing chronic diseases such as cardiovascular, cancer and
diabetes. Other activities include the maximization of
immunization rates for children, preventing a wide range of
environmental diseases by preventing exposure to toxic
chemicals and protecting employees from workplace injuries and
disease. I would not allow any of my employees to operate in
that kind of an environment. Quite frankly, if the same Federal
and State health and workplace requirements were applied to
this facility, it would be shut down.
Let me say that the Parasitic Disease Laboratory which is
one of the laboratories that has not yet been updated under
this plan, are in temporary wooden barracks that were built in
the 1940s, with a lifespan expectancy of 15 years. We are now
45 years beyond that life expectancy. We have regular
occurrences where, for example, refrigeration units fall
through the floor; where power is inadequate and shut down
periodically. We even had a incidence recently where we lost
samples in a refrigeration unit, because the power system could
not adequately supply the building.
Mr. Regula. Let me tell you, our committee is going down
there in about a week or shortly thereafter and visit the
facility.
Mr. Jacobs. Right.
Mr. Regula. So I am sure we will be given an opportunity to
see some of the deficiencies.
Mr. Jacobs. Thank you; we look forward to having you down
here.
Mr. Regula. Do you have much more, sir?
Mr. Jacobs. No, I will just close by simply saying that
last was an excellent start, with $175 million, and we
respectfully request that the $250 million be put in this
year's budget. Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, we thank you and all the companies that
expressed an interest in this. Hopefully, maybe they can make
some financial contributions to help get the job done, and we
appreciate that.
Mr. Jacobs. Thank you.
Mr. Regula. The committee will recess. We have a one minute
vote, which is in process now, and then three five minute
votes. So I would say roughly ten after or a quarter after, we
will reconvene, as we can get the votes over with. So if you
all will be patient, we will go and do our duty.
[Recess.]
Mr. Regula. We will reconvene the committee.
Mr. Jackson, I think you want to introduce your guest here.
Mr. Jackson. Mr. Chairman, Linda Anderson has served as
President and Chief Operating Officer for the Sickle Cell
Disease Association of America, Incorporated, since 1992.
During her eight year tenure, the Pittsburgh native and
Carnegie Mellon graduate has used her 24 years of corporate
management experience to position SCDAA as a source of services
and support for individuals and families affected by sickle
cell disease.
Ms. Anderson was instrumental in developing and
implementing a five year strategic plan, designed to strengthen
the infrastructure of the 64 member association, promote the
association's national programs, and heighten public awareness.
Ms. Anderson is also active on several national boards or
committees, including Vice Chair, Executive Committee,
Community Health Charities, and the President's Committee on
the Employment of People with Disabilities.
Mr. Chairman and members of the subcommittee, Ms. Anderson.
----------
Wednesday, March 21, 2001.
THE SICKLE CELL DISEASE ASSOCIATION OF AMERICA
WITNESSES
LYNDA K. ANDERSON, PRESIDENT/COO, SCDAA, THE SICKLE CELL DISEASE
ASSOCIATION OF AMERICA
TAHIRA YVONNE GIVHAN
Ms. Anderson. Thank you very, very much, Congressman
Jackson. On behalf of the Sickle Cell Disease Association of
America, I want to thank you, Chairman Regula and members of
the subcommittee, for giving me this opportunity to testify.
With me today, I have Tahira Yvonne Givhan, the 2000/2001
national poster child, our junior ambassador, for the Sickle
Cell Disease Association of America. She is our star. Tahira
will be speaking with you today on the challenges that she
faces in life, because of having sickle cell anemia, an
inherited genetic disease. Before Tahira delivers her remarks,
I would like to briefly summarize the SCDAA's fiscal year 2002
appropriations request. First, we ask that $4 million be
provided to support a two part community outreach
demonstration.
Specifically, $2 million is requested from the Maternal
Child Health Block Grant. Special projects of regional and
national significance account to support the strengthening and
expansion of locally-based newborn screening follow-up
activities; and $2 million is requested from the Office of
Minority Health, or another account within the Health Resources
Services Administration, to support the strengthening and
expansion of locally-based related outreach and supportive
service efforts.
Second, we support the efforts underway at the National
Heart, Lung, and Blood Institute, to strengthen data coordination
efforts of the ten comprehensive sickle centers, and seek increased
resources for the establishment of a clinical research network.
We ask that increased funding and report language in
support of this effort be included in the fiscal year 2001
Labor HHS Education Appropriation Bill. A more detailed outline
of these requests has been submitted for the record. However,
now I would like for Tahira to tell you why, in her words,
these resources are so desperately needed.
Mr. Regula. Well, Tahira, we are happy to welcome you. I
can see why you chose her. She is a very pretty young lady.
Ms. Givhan. Thank you.
Mr. Regula. So we will be pleased to hear your testimony,
Tahira. What grade are you in?
Ms. Givhan. Fourth.
Mr. Regula. Fourth grade, and where do you go to school?
Ms. Givhan. Oak Mountain Intermediate School.
Mr. Regula. What city is that?
Ms. Givhan. Shelby County.
Mr. Regula. Well, we are pleased that you could come this
morning, so we will look forward to hearing from you.
Ms. Givhan. Thank you, Mr. Chairman and other committee
members. My name is Tahira Yvonne Givhan. I come to you on
behalf of the Sickle Cell Disease Association of America. I
have sickle anemia. It is a disease of the red blood cells. I
am inherited the gene from both my parents.
First and foremost, thank you for providing the funding for
new treatment therapies, supportive services, and newborn
testing. In fact, the doctor tested me while I was still in the
hospital, as a newborn baby. That is the law in most states,
and it is a fantastic law, because babies with sickle cell
anemia often require special care. As a result of your
investment, sickle cell anemia no longer spells doom and gloom,
the way it did years ago. The mortality rate for infants with
sickle cell anemia has decreased dramatically. Again, I thank
you.
Yes, the advances made in biomedicine in recent years are
appreciated greatly. However, more funding is badly needed to
help find a cure, so that we will no longer have to manage the
pain and suffering that comes with having this unpredictable
disease. Because I have sickle cell anemia, my cells are
sickled, making it hard for oxygen to stay in them. Sometimes,
these sickle shaped cells become sticky and thick, and can clog
small blood vessels in my body.
When this happens, I hurt. This can cause a lot of pain
anywhere in my body. When my head hurts, my parents and doctors
have to monitor me closely, to make sure that I do not have a
stroke, like many people with sickle cell anemia.
It is true that I enjoy a number of activities like other
young people my age: ballet, riding my bike, and playing on the
swing set. But during most of the days of the week, I am very
tired and in pain. At school, I do not think that my teachers
understand how difficult it is for me to keep up with the other
kids, particularly in P.E. So in addition to being in great
pain, I have to suffer the embarrassment of being different.
The challenges faced by families that have children with
sickle cell anemia are pretty serious. Therefore, the services
provided SCDAA's member organization, such as outreach, are
very important; but they need more help so that they can help
more kids like me. I believe and have faith that a cure will be
found in my lifetime, so that as we move into this new
millennium, we, too, can enjoy the American dream in its
totality. When this happens, it will just be wonderful.
Mr. Regula. Well, Tahira, you are a very persuasive
witness. [Laughter.]
Mr. Jackson.
Mr. Jackson. Mr. Chairman, let me again thank Ms. Anderson
and Tahira for their testimony. I do not have sickle cell
anemia, but I, like my father, carry the trait, as well.
I introduced elevating the Office of Research on Minority
Health at NIH to a center status last year, which fortunately
passed with the help of Mr. Bilirakis, John Lewis, Benny
Thompson, Senator Frist and Senator Kennedy in the Senate.
Sickle cell anemia just happens to be one of those diseases
at the National Institute of Health that could use better
coordination amongst all of the centers. But for the elevation
of the office to center level, the office itself did not have
the ability to even sit in the room with the other centers, to
look across the entire institute, for the purposes of trying to
arrive at a cure.
If there ever was a disease, Mr. Chairman, that is
reflective of the disparities that exist amongst those groups
who have been left behind in America, it is certainly sickle
cell anemia. Of all of the options and diseases that will be
before the Center for Research on Minority Health at NIH,
sickle cell anemia should be way on top of the list for Dr.
Ruffin, Dr. Fouchey, and Ms. Kirschstein at NIH.
I will be arguing on behalf of Tahira and other children,
as well as Americans who are similarly situated, for the
appropriate amounts at the National Institute of Health, to
reflect her desire and our desire to bring an end to this
devastating illness.
Thank you, Mr. Chairman.
Mr. Regula. Thank you.
Tahira, do you have to miss much school?
Ms. Givhan. No.
Mr. Regula. You must not, because you certainly speak very
well for a fourth grader.
Ms. Givhan. Thank you.
Mr. Regula. Thank you for coming.
Ms. Anderson. Thank you for having us.
Mr. Regula. Our next witness is Dr. John Sever, Member,
International PolioPlus Committee, Rotary International.
Wednesday, March 21, 2001.
INTERNATIONAL POLIOPLUS COMMITTEE, ROTARY INTERNATIONAL
WITNESS
DR. JOHN L. SEVER, MEMBER, INTERNATIONAL POLIOPLUS COMMITTEE, ROTARY
INTERNATIONAL
Mr. Sever. Thank you very much, Chairman Regula and
Congressman Jackson. It is a pleasure and a privilege to be
here to tell you about the International PolioPlus Program to
eradicate polio worldwide. I am a professor of pediatrics at
the Children's Hospital here in Washington and George
Washington University. I am representing Rotary International,
which I am a member of. There are 1.1 million members of Rotary
International, of which there are about 380,000 members in the
United States.
Some years ago, the Rotary founded a coalition to eradicate
polio worldwide. That includes the March of Dimes Birth Defects
Foundation, the American Academy of Pediatrics Task Force for
Child Survival and Development, and the U.S. Fund for UNICEF,
along with Rotary International. We are working to help
eradicate this disease worldwide. The goal is to complete that
eradication by the year 2005, which is just a few years ahead.
It will be only the second disease in the history of man that
has been eradicated; small pox being the other disease. So the
goal is not just to control the disease, not just to immunize
children, but to eradicate the disease completely worldwide by
the year 2005, at which point we will be able to stop
immunizing for polio, because it will no longer exist in the
world, just as we did stop for smallpox.
There has been a great deal of progress made, and the
support from this subcommittee, your support, has been very
important through the U.S. Centers for Disease Control, over
the years. That, along with Rotary International's support and
other nation's support, has really made a big difference. You
have in your material the fact that in 1988, there were over
350,000 cases a year worldwide, and today, just last year,
there were only 3,500 cases. So that is down to just one
percent of what it was in 1988.
Mr. Regula. The United States is fairly clean.
Mr. Sever. The United States has had no polio for almost 18
years now. There has been no polio. Eradication has been
complete in this hemisphere since 1991. Eradication in the
Western Pacific area was achieved two years ago, so this has
been focusing down. The only places in the world that polio
still exists is in Southeast Asia, India, Pakistan, Bangladesh,
and in Africa. So that, right now in the next five years, is
the focus to complete the eradication of this disease, so that
it will no longer happen.
The efforts can be measured in many ways. First, of course,
one can estimate the number of children who have not been
paralyzed, who would have been paralyzed, if this effort had
not taken place, and it now exceeds three million. The effort
can be measured in terms of cost savings. In the United States,
for example, although as we mentioned, we do not have any cases
of polio, we still must immunize all the children in the United
States for polio, because it could be brought in from one of
these other areas. That costs us, in this country, about $230
million a year to immunize for a disease that we do not have.
That would be, of course, saved, once the disease is
eradicated.
Worldwide immunization costs about $1.5 billion a year for
polio. Again, on a worldwide level, that would be a tremendous
savings. So both in terms of the reduction, the suffering, and
the cost, just to mention two areas, there is a tremendous
benefit for completing this job in the next few years. The U.S.
Center for Disease Control has been a great assistance. This
last year, the appropriation was for $91.4 million. When you go
to Atlanta, and besides seeing the buildings, I hope that you
will learn more about how they are providing epidemiologists
worldwide to help participate in this eradication effort.
There is a large new group in India and another group in
Africa, which are vital to identifying where polio is
continuing, and where it has to be immunized in carrying
national immunization days; plus, providing vaccines. The
Rotary is also doing this. Rotary, since 1988, has been
providing money for vaccine immunizations, as well as
volunteers. By the time this job is done, Rotary will have
provided about $500 million towards this eradication program,
from its own contributions and its own funds.
We are asking this year that the appropriation be increased
by $15 million, for a total of $106.4 million. The reason for
that is, that the price of the vaccine has gone up from about
seven cents a dose, to about 9.6 cents a dose, and because of
the tremendous amount of effort that is required now in Africa
specifically to get the job done.
Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, thank you very much. I think it is great
that a service organization such as Rotary does get behind what
is obviously a very worthwhile project.
Mr. Sever. Thank you.
Mr. Jackson. Mr. Chairman, I just have one question.
Mr. Regula. Yes, Mr. Jackson?
Mr. Jackson. Let me also congratulate you, sir, for the
work that you have undertaken. To what do we owe the
substantial cost increase for the cost of the polio vaccine?
Mr. Sever. Well, basically, the costs of materials have
gone up in the last couple of years, and the large volumes that
are now being used have caused the manufacturers to have to
build additional facilities, as I understand, in order to
produce this.
For example, in India, we had an immunization date, which
is the way you would eradicate this, as we are doing in Africa.
There are 17 countries in Africa, simultaneously immunizing
their entire population of children under five years of age.
It takes enormous amounts of vaccine, and we have had to
just tremendously increase the capacities to provide this
vaccine, and to have it available. In India, for example, a few
weeks ago, they just immunized 140 million children in one day.
There is just an unbelievable effort to that, and it is an
enormous quantity of vaccine.
So unfortunately, the cost of producing the vaccine and the
cost of augmenting the facilities has come back in terms of
this increase in vaccine costs.
Mr. Jackson. Is the cost that you have requested, in terms
of the increase in the program, does it approximate the size of
the problem, in terms of our ability to curtail the disease by
administering polio vaccines, but at the same time, does it
take into account the fact that the population in many of these
areas is constantly growing and expanding?
Mr. Sever. It takes into consideration both, sir. The
population growth is important. The issues of administration
under these massive programs has to be taken into
consideration. The other countries are assisting, too. The
United States, I think, is the leadership of countries, but
Great Britain and most European countries are also helping to
try to get this job done.
The fact that we are focusing on it to get it done quickly
in the next five years is important, too, because we can then
complete the job, and it will not have to go on and on and on.
Mr. Jackson. Thank you, Mr. Chairman.
Mr. Regula. Thank you.
Our next witness is Lydia Lewis, who will be introduced by
Mr. Jackson.
Mr. Jackson. Mr. Chairman, Lydia Lewis became Executive
Director of the National Depressive and Manic-Depressive
Association in 1997.
Headquartered in my hometown of Chicago, the National DMDA
is the largest patient-directed, illness-specific organization
in the country, with nearly 400 patient-run support groups
throughout the country.
Ms. Lewis' primary responsibility has been to position
national DMDA as a leading source for information on mood
disorders, and the treatments for patients, family members,
health care professionals, the media, and others.
She holds a bachelor's degree in psychology from the State
University of New York at Buffalo. She was a charter member of
the NIH Director's Counsel of Public Representatives.
She also serves on the oversight committees of several
large NINH clinical trials, including current trials studying
the effectiveness of treatments for bi-polar disorder and the
study of treatment of adolescents with depression. One of her
proudest accomplishments has been her willingness to confront
her own life-long battle with depression.
Mr. Chairman and members of the committee, I present Ms.
Lewis.
----------
Wednesday, March 21, 2001.
NATIONAL DEPRESSIVE AND MANIC-DEPRESSIVE ASSOCIATION
WITNESS
LYDIA LEWIS, EXECUTIVE DIRECTOR, NATIONAL DEPRESSIVE AND MANIC-
DEPRESSIVE ASSOCIATION
Ms. Lewis. Thank you very much, Congressman Jackson; I
truly appreciate the introduction. Mr. Chairman Regula and
members of the subcommittee, as Congressman Jackson said, I am
Lydia Lewis. I am the Executive Director of the National
Depressive and Manic-Depressive Association. We appreciate the
opportunity to testify in support of funding for neuro-science,
behavioral science, and genetic research, through the National
Institutes of Health and the National Institute of Mental
Health. National DMDA applauds the doubling of the NIH budget,
and encourages the subcommittee to continue providing strong
leadership on this effort, which has had a significant impact
on mental health research.
While I am here today to testify on behalf of National
DMDA, I know personally what it is like to battle depression
every day, to fight the urge to end my life. It is a dreadful
way to live. I, myself, suffer from the disease, and I am not
alone. The recent global burden of disease study conducted by
the World Health Organization, the World Bank, and Harvard
University found that mental illness has long been
misunderstood. In fact, it accounts for more than 15 percent of
the burden of disease in established market economies. This is
more than the disease burden caused by all cancers combined.
More than 20 million American adults suffer from unipolar
or major depression every year, and it is the leading cause of
disability in the world today. An additional 2.3 million people
suffer from bipolar disorder. Onset is nearly always before the
age of 20, meaning more high school drop-outs, more illegal
drug and alcohol use, higher teen pregnancy rates, more teen
violence, and more adolescent suicides. An estimated 50 million
Americans experience a mental disorder in any given year, yet
only one-fourth of them actually receive mental health and
other services. Women are more than twice as likely as men to
experience depression. One out of every four American women
will experience a major depressive episode in her lifetime.
Coping with these devastating illnesses is a tragic,
exhausting, and difficult way to live. Mood disorders and other
mental illnesses kill people every day. Depression is the
leading cause of suicide. One in every five bipolar sufferers
takes his or her life; one in five. Suicide is the third
leading cause of death among fifteen to twenty-four year old
Americans. For every two homicides committed in the United
States, there are three suicides.
Despite these facts, stigmatizing mental illness is a
common occurrence. Labeling people with mental illnesscontinues
to send the message that de-valuing mental illness is acceptable.
Equally devastating is the stigma associated with the
research of mental illnesses. Research in behavioral science is
as critical as that undertaken for any other illness. Our
understanding of the brain is extremely limited, and will
remain so for decades, unless much greater financial support is
provided. Neuro-science research is also critically important
to understand the mechanisms in the brain that lead to these
illnesses. Every day, technology and science bring us further
in understanding the brain. These kinds of successes build upon
each other. Great strides are being made, but it is imperative
that the progress be maintained.
In 1999, the Surgeon General released the first-ever study
from that office on mental illness. It concluded that these
diseases are real, treatable, and affect the most vital organ
in the body, the brain. We are particularly pleased that NIMH
played a lead role in the Surgeon General's report on youth
violence. With further research into the relationship between
mental illness and violence, we are hopeful that tragedies like
the recent school shootings in California and across the
country can be prevented in the future. Research supported by
NIMH has led to a much better understanding of these illnesses.
We are learning more about their impact on other diseases, such
as Parkinson's, cardio-vascular ailments, stroke, diabetes, and
obesity. But more funding for NIMH and other research
institutions is critical to ensure that any forward momentum is
not lost.
We commend the subcommittee's past support of the National
Institutes of Health and the National Institute of Mental
Health, and your renewed commitment to full funding of mental
health research. Together, our efforts will mean real treatment
options, and an end to the stigma associated with mental
illness, lives saved, and a far more productive America.
Again, I appreciate the opportunity to testify.
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Mr. Regula. Thank you.
Mr. Jackson, do you have any questions?
Mr. Jackson. I do not have any questions, Mr. Chairman.
Mr. Regula. Thank you for coming.
Ms. Lewis. Thank you.
Mr. Regula. Our next witness will be Dr. George Hardy,
Executive Director of the Association of State and Territorial
Health Officials. Mr. Hardy, welcome.
----------
Wednesday, March 21, 2001.
ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS
WITNESS
GEORGE E. HARDY, JR., MD, MPH, EXECUTIVE DIRECTOR, ASSOCIATION OF STATE
AND TERRITORIAL HEALTH OFFICIALS
Mr. Hardy. Thank you, Mr. Chairman, Mr. Jackson, and
members of the subcommittee. I appreciate the opportunity to
appear here this morning. My name is George Hardy. I have the
privilege of serving as the Executive Director of ASTHO, the
Association of State and Territorial Health Officials.
In the last century, our nation has made tremendous strides
in improving the health of Americans. As Dr. Sever just
reminded you, we have eradicated smallpox from the globe, polio
from the Americas, and we have had substantial reduction in the
incidents of disease and death from major infectious and
chronic diseases. We also recognize that there is a lot more
that we have to do.
I would like to make the case that as a nation, we need to
continue our investment and research, but just as importantly,
we need to invest in the transfer of research findings to
public health programs. If research findings are not made
available to the public, they might just as well not have been
made.
If society is going to be the ultimate beneficiary of our
commitment to research, we need to make the same kind of
commitment to investment in programming.
CDC and HRSA provide the states with the resources to carry
out these public health programs. ASTHO urges the committee to
assure that CDC receives a total appropriation in fiscal year
2002 of $5 billion and HRSA, $6.7 billion
This morning, I will discuss only a few of the important
programs to states. You have heard about immunization, but you
are going to hear about it again. Let me tell you how important
this is.
In the last 50 years, immunization programs have produced a
95 percent decline in most childhood vaccine-preventable
diseases. Despite this, an estimated one million American two-
year-olds have not received one or more doses of vaccine that
they should have had, at that point in life.
Not only must we assure that the children are adequately
immunized, but we also need to assure that adolescents and
adults receive needed immunization services, such as influenza,
hepatitis, and pneumococcal vaccine.
We thank the members of this subcommittee for ensuring that
CDC received a down-payment last year on much-needed
immunization funding. But as the Institute of Medicine has
pointed out, additional funds are still necessary to meet the
need.
Just one example of such a need is the important challenge
of raising immunization levels among children served by WIC
programs. Specifically, we are requested $32.5 million
additional dollars for CDC's immunization infrastructure
program, and $93 million additional for domestic vaccine
purchases.
This latter figure, I know, sounds high; but it is
necessary if we are going to provide the newly-approved
pneumococcal vaccine for children. This vaccine will cost
health departments nearly $200 per child to purchase.
The preventive health and health services block grant is a
component of every state's strategy to address their own unique
health needs. ASTHO has just produced this new publication,
``Making a Difference,'' which I know you have seen, Mr.
Chairman, and it documents the impact of public health through
this program.
Every state does something different. In Ohio, for
instance, to just pick a state at random, the Health Department
has shown a marked reduction in the incidents of adverse
reactions and preventable hospital admissions, as a result of
medication errors in the elderly.
As I have said, every state has addressed its own problems.
I think that this document will convince you of the importance
of the preventative block.
Since its inception 20 years ago, funding for the
preventive block grant has been stagnant. It has not kept pace
with inflation.
It has not been adjusted for the increasing population, or
for the new public health needs that were not even known at the
time it was created, such as AIDS and West Nile Virus. We are
asking the subcommittee to provide an additional $75 million
for that block grant.
Last year, the Congress enacted the Public Health Threats
and Emergencies Act, to address bioterrorism, antimicrobial
resistance, and public health capacity. Each of these are
critically important, and we would urge the subcommittee to
fully fund the $534 million that is authorized for these
services.
Many other programs at CDC and HRSA deserve this
committee's attention. The Maternal and Child Health Block
Grant and the Ryan White Care Act, both programs at HRSA, are
critical to the states, and we support the request of $850
million for the MCH block grant.
I want to close by expressing again our appreciation to
this subcommittee for its past commitment to public health.
Your work has made a tremendous difference in the lives of
people, and we are going to need your help again this year, as
we try to advance the health of our Nation.
Thank you, Mr. Chairman.
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Mr. Regula. Well, thank you very much for your comments. I
am sure there is a great need there.
The next witness is Dr. Thomas Clemens, Professor of
Medicine and Molecular and Cell Physiology, University of
Cincinnati.
----------
Wednesday, March 21, 2001.
NATIONAL COALITION FOR OSTEOPOROSIS AND RELATED BONE DISEASES
WITNESS
DR. THOMAS L. CLEMENS, PROFESSOR OF MEDICINE AND MOLECULAR AND CELL
PHYSIOLOGY, UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE, NATIONAL
COALITION FOR OSTEOPOROSIS AND RELATED BONE DISEASES
Dr. Clemens. Thanks, Mr. Chairman and Congressman Jackson.
My name is Tom Clemens. I work at the University of
Cincinnati. I do basic research in bone biology. With me is
Charles Hall, a patient with fibrous dysplasia.
The National Coalition for Osteoporosis and Related Bone
Diseases appreciates this opportunity to present our position
on the need for continued and expanded funding for osteoporosis
and related bond disease research at the National Institutes of
Health. We also appreciate the committee's past support for the
goal of doubling the NIH budget, and last year's significant
increase.
The bone diseases represented by our coalition occur in all
populations and at all ages. They are devastating diseases,
with significant physical, psycho-social, and financial
consequences, including pain, disability, and death.
Consider, if you will, what we already know about how our
bones function. Throughout life, our bone is constantly being
remodeled through repeated cycles of bone breakdown and bone
build-up. As we age, this balance shifts in favor of bone
breakdown, rather than bone build-up. If unchecked, this
delicate balancing act goes awry, and this results in bone
disease.
Our increasing understanding of this process has led to
exciting new drug therapies, that balance out. Yet, bone
disease still has no cure, and there are many important
questions remaining unanswered.
What are the major bone diseases? One is osteoporosis, the
most prevalent bone disease in this country. It is
characterized by low bone mass and structural deterioration of
bone. Ten million Americans have osteoporosis, and 18 million
more have low bone mass, placing them at risk of the disease.
In 1995, osteoporosis was responsible for 2.5 million
physician visits; 180,000 nursing home omissions, and over
400,000 hospital admissions. The direct cost of fracture is
$13.8 billion, which should triple by the year 2040.
Paget's disease of bone is a chronic disorder that may
result in enlarged or deformed bones in one or more regions of
the skeleton. Complications may include arthritis, fractures,
bowing of the limbs, and hearing loss. Paget's affects up to
eight percent of our population over 60. That is two to three
million Americans.
Osteogenesis Imperfecta is a genetic disorder that is
typically diagnosed in infancy. Osteogenesis imperfecta causes
bones to break easily. For example, a cough or a sneeze can
break a rib; simply rolling over in bed can break a leg.
Osteogenesis Imperfecta affects an estimated 30,000 adults,
children and infants in the United States, causing as many as
several hundred broken bones in a lifetime.
I understand from Mr. Grove, Chairman Regula, that you have
actually had the opportunity to see a number of these patients
at the Institute of Child Health.
Fibrous dysplasia, which affects Mr. Hall, is a chronic
disease of the skeleton, which causes expansion of one or more
bones, due to the development of a fibrous scar within the
bone. This weakens the bone, causing pain, deformity,
disability, and fracture. At present, there are no approved
therapies for this disease.
Osteopetrosis is a disease present at birth, at which bones
are overly dense. This is due, again, to an imbalance between
bone formation and bone breakdown. Complications often begin
before the age of five, and include fractures, frequent
infections, and problems with sight and blood vessel disease.
The National Institute of Arthritis and Muscular Skeletal and
Skin Diseases, NIAMS, leads the Federal research effort on bone
disease; however, the need for trans-NIH search is vital. Bone-
related disease cuts across many research institutes at the
NIH. Given the breadth and depth of these diseases, we urge the
committee to instruct NIH to make this one of its top trans-NIH
priorities.
With the steady greying of Americans, now is the time to
find solutions to these dehabilitating diseases, in order to
alleviate the stress that will be placed on the Medicare system
in the future.
Vast opportunities still exit to expand our current
knowledge base. Initiatives that may serve as springboards to
further research include: basic research, funded by the NIH;
and clinical trials with power-thyroid hormone, or PTH, the
newest front-line treatment for osteoporosis.
One form of PTH has just been submitted to the FDA for
approval. Researchers still do not really know how it functions
at the cellular level.
While osteoporosis was once thought to be a woman's
disease, it is now an important issue among men. An estimated
one-third of hip fractures, worldwide, occur in men, including
the one recently sustained by President Ronald Reagan. A major
study on how the disease affects men is currently underway and
supported by the NIH. In the area of osteogenesis imperfecta,
researchers are exploring the effectiveness of a drug that
appears to increase bone marrow density and decrease bone loss.
Finally, a new clinical center for patients with fibrous
dysplasia was recently established at the NIH, and has proved
to be a resource for physicians and patients around the
country, while furthering research on this crippling disease.
Mr. Chairman, the research community sincerely appreciates
the committee's efforts over the years to ensure continued
strength of the NIH research program. The high value that we
continue to place on biomedical research will lead to the
prevention of disease, reduce disability, and decrease the
staggering health care costs associated with bone and other
diseases.
Just let me say one more thing before I finish, and that
concerns the timing of our request. With the completion of the
human genome project, researchers right now are poised to make
new discoveries and identify new gene targets. This is going to
be absolutely essential, so the timing of our request is
critical.
Thank you, Mr. Chairman.
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Mr. Regula. Do you deal with brittle bones?
Mr. Clemens. Yes, and the one disease that I did mention,
osteopetrosis, is called marble bone disease. Osteogenesis
imperfecta is also associated with brittle bones, and is called
actually Brittle Bone Disease.
Mr. Regula. That is a very difficult challenge.
Are there any questions, Mr. Jackson?
Mr. Jackson. Mr. Chairman, just by virtue of the fact that
NIAMS is an institute at NIH, and they are already engaged in
trans-NIH research on many of the diseases that you indicated,
is there a specific funding request for any of the diseases
that you mentioned, that should be covered, above and beyond
what the committee and the President have already made a
commitment to do? I am not so sure that I actually heard that
in your testimony.
Mr. Clemens. We would recommend a 16.5 percent increase for
NIAMS; but I wanted to stress the trans-NIH funding; because
there are institutes, for example, child health and the cancer
institutes, where these bone diseases are also funded. So we
would like to recommend the 6.5 increase, with the trans-NIH
funding for that. That is not over and above 16.5 percent.
Mr. Regula. Thank you very much.
Our next witness is Lawrence Pizzi, Volunteer, North
American Brain Tumor Coalition.
----------
Wednesday, March 21, 2001
NORTH AMERICAN BRAIN TUMOR COALITION
WITNESS
LAWRENCE PIZZI, VOLUNTEER, NORTH AMERICAN BRAIN TUMOR COALITION
Mr. Pizzi. Good afternoon, Mr. Chairman. I am going to
follow suit with many of my predecessors, and tell you that
although I was born overseas, my first and earliest memories
are Kent, Ohio. [Laughter.]
Mr. Regula. You are getting close.
Mr. Pizzi. I knew I had to come up with something.
Mr. Regula. Well, Chicago and Ohio have done well today.
Mr. Pizzi. My name is Larry Pizzi. It is my privilege to
appear today as a representative of the North American Brain
Tumor Coalition, a network of 12 charitable organizations that
raise funds for brain tumor research, and provide information
and support to individuals with brain tumors, their families,
and their friends.
We corroborate in advocacy to increase brain tumor
research. We also work to guarantee that every brain tumor
patient has access to the best possible health care.
I am also the Executive Director of one of the coalition's
founding member organizations, and the only member of the
coalition not represented by one of the states on this
committee. I am from Massachusetts.
Most importantly, though, I am the father of Timothy
Lawrence Pizzi, a child diagnosed with a brain tumor in 1989.
He lived nearly seven years, before dying at the age of 12.
Mr. Regula. This was your son?
Mr. Pizzi. Yes, my son.
Mr. Regula. He was born with the tumor?
Mr. Pizzi. He was diagnosed at age six with a tumor that he
probably had since birth. He died at age 12. He and thousands
like him, children and adults, are the reason that my testimony
today is a privilege, and I thank you.
Brain tumors are a unique disease and present special
challenges for all that they touch. Brain tumors are not a
single disease. Instead, there are at least 126 types of
central nervous system tumors. It is difficult to treat brain
tumors, not only because of their diversity, but because of the
unique biology of the brain.
I am sure that you can understand how it is possible to
remove a lung, a breast, or prostate that is affected by
cancer; but we cannot remove the brain. Treatment strategies
that are successful with other cancers cannot be used to treat
brain tumors.
Moreover, brain tumors affect the organ that make us who we
are. They are a disease not only of the body, but also of the
soul. They are a disease of the quality of life.
A recent Government study accurately defined a brain
tumor's impact as mental impairment, seizures, and paralysis
that affect the very core of a person, and have a demoralizing
effect on loved ones.
Added to these burdens is the knowledge that for most brain
tumors, adequate treatment is not available. In children, even
if they do survive the devastating impact of the treatment, it
often leaves them with permanent damage. However, these are
exciting times, and there is hope for progress.
I would simply echo those who have come before me, and ask
that we continue to fund the National Institutes of Health in
such a way that we essentially double the research budget by
the year 2003. We join the other patient organizations in
commending this committee for its role in that progress, and we
would ask that you continue it.
Brain tumor research suffers from a lack of trained
clinical investigators. Good funding is going to be very
important to continue attract them.
Mr. Regula. Is there any one institution that is focusing
on this, that you are aware of?
Mr. Pizzi. That is my next point. We have been urging for a
number of years corroboration between the two institutes at the
National Institutes of Health, that have responsibility for
brain tumors, the NINDS and NCI. That is the National Institute
of Neurological Disorders and Stroke and the National Cancer
Institute.
I am very glad to say that over the last year, we have seen
much progress in that area, resulting in this document by a
progress review group, that was carried out jointly bythe NINDS
and the NCI, and advocates in the extra-mural community.
I am here today to ask you and your committee to ensure
that this progress review group document, which represents a
true corroboration between Government, the private sector, and
the advocacy sector, not become a document on a shelf.
These organizations, the NCI and the NINDS, have worked
very well together to produce a national strategy for attacking
this disease. We have a couple of specific requests.
One is that we enhance brain tumor research through
continuing the corroboration that this document represents. The
two institutes should strengthen their mechanisms for
coordination and corroboration among extra-mural researchers.
The written version of my testimony contains the details of how
we would like this accomplished.
They should organize and fund a series of inter-
disciplinary meetings, of researchers that would focus on the
subjects of brain tumor biology. They, along with the Center
for Scientific Review, should make sure that study sections, or
the people who look at the grant requests coming up from the
field, saying yes, we should fund this or no, we should not,
have the right expertise to evaluate brain tumor grants.
Currently, they do not.
Mr. Regula. You do not think they are capable of making
judgments on the allocation of the resource money?
Mr. Pizzi. Brain tumors are highly specialized. Our
experience is that the specialists who make up the brain tumor
community are not adequately represented on those.
I will close with this point. In addition, there is the
recently established NCI-NINDS Neuro-oncology Branch. They see
this as great progress, because it represents the two
institutions. We would like to see that branch continue, to not
only work intermurally in Bethesda, but to be sort of the focal
point for the corroboration.
I would like to tell you that my son was very close to a
very prominent brain tumor researcher. His name was Dr. Mark
Israel. One day shortly before my son died, knowing that he
would die, he called Mark on the telephone, and asked him the
question that he would always love to ask him, ``Mark, are
still looking for a cure?'' Mark, of course, told him that he
was. Timothy said to him, ``Now would be a good time.''
It did not work for Tim, or thousands of others, since he
died five years ago. He became part of one statistic that I
will leave you with. Brain tumors are the leading cause of
cancer deaths in children under the age of 20, now surpassing
acute lymphoblastic leukemia, and are the third leading cause
of cancer deaths in young adults, ages 20 to 39.
We applaud the dedication of this subcommittee to advancing
biomedical research. We look forward to working with you to
support brain tumor research at a time when advances, we
believe, are truly going to be possible, and to make a time
when the Timothys of this world will have a much brighter
future.
I thank you.
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Mr. Regula. Thank you.
What are the choices, since you cannot use chemicals or
chemotherapy?
Mr. Pizzi. Brain tumors are resistent, generally, to
chemotherapy, because of the nature of the biology of the
brain. Radiation is a very common treatment; but, of course, it
does a lot of damage to normal, healthy brain tissue.
So we have a case where the treatment can leave the patient
cured or in remission, but with so many deficits. Nearly 80
percent of adults who have brain tumors or are treated for them
are unable to go back to work, even though they are still
alive.
Children who are treated for brain tumors live the rest of
their lives with cognitive deficits. So it is just the nature
of where it is, Mr. Chairman. It is truly a unique organ of the
body. There are 126 kinds of them. There is no other cancer
that has that many sub-sets of a disease.
Mr. Regula. It puts pressure on the brain.
Mr. Pizzi. Automatically, and that, of course, is a major
problem.
Mr. Regula. I had a friend that died that way.
Thank you very much.
Mr. Pizzi. Thank you very much for your time.
Our next witness is Ken Moss, Friends of Cancer Research.
Mr. Moss?
----------
Wednesday, March 21, 2001
FRIENDS OF CANCER RESEARCH
WITNESS
DR. KEN MOSS, FRIENDS OF CANCER RESEARCH
Ms. Segal. Good afternoon, Mr. Chairman, I am Ellen Segal
of Friends of Cancer Research. I am pleased to introduce to you
Dr. Ken Moss. He is from your home state of Ohio, from
Cleveland. He is an endothesiologist, and he also teaches at
Case Western.
Dr. Moss and his wife Anita are going to put a human face
on this disease, and talk about their daughter Elisa. You will
hear from Dr. Moss.
Dr. Moss.
Dr. Moss. Thank you.
Chairman Regula and members of the subcommittee, thank you
for the opportunity to testify today.
I come before you not as a physician, but as a father of a
beautiful and talented 17 year old, who passed away last
October from cancer.
I took this photo on Elisa's high school graduation, almost
four months before she died. She looked exactly the same way on
that fateful day in October. In fact, hours before she died,
she stopped in front of the mirror on the way out the door to
the doctor's office, telling her mother that she was going to
put on makeup, so that no one would be able to tell that, ``I
am a cancer patient.''
Elisa was gifted and mature beyond her years. Almost
everyone she met liked her. Over 900 people attended her
funeral. Classmates flew home from college from as far away as
California, because Elisa meant that much to them.
It is impossible in five minutes to tell you of all the
anguish, fear and frustration that we felt as we watched
helplessly as cancer slowly took her.
While returning from a New Year's cruise in January of
1998, my daughter noticed pain in her thigh. I did not think
anything of it; however, the pain persisted. Within a few
weeks, my wife arranged for a MRI. A mass was found and quickly
biopsied.
``I am sorry, but your daughter has cancer.'' No statement
will strike more terror into a parent than that. Even worse,
Elisa had a rare, highly malignant tumor. The prognosis was a
20 percent five year survival.
As a parent, I was devastated; but as a doctor, I simply
could not accept it. We took her to Memorial Sloan Kettering
for a second opinion. They recommended high dose chemotherapy,
surgical excision, and a bone marrow transplant.
Throughout the chemotherapy that caused extreme illness,
loss of her hair, and most importantly, forced her to remain at
home and stop going to school, Elisa fought back. She never
gave up and she never complained.
During each of the 12 surgical procedures that she had in
the two years that followed her diagnosis, she always remained
optimistic, and she was an inspiration to everyone who knew
her.
In August, 1998, Elisa underwent a stem cell transplant.
Yet, six months later, she relapsed, with a tumor in her lung.
After a biopsy confirmed the worst, a big debate ensured about
what to do. Traditional medicine had failed her, so we examined
experimental protocols at the National Cancer Institute.
One study in particular had promise, and Elisa, who had
always played an active role in her treatment, agreed. This
began a period of four months of commuting to Bethesda with
Elisa. But the home run that we had hoped run was not to be,
and by August 1, 1999, it was clear to investigators that Elisa
was not responding and, in fact, her tumors were doubling, both
in size and in number, each month.
I brought Elisa back home to the Cleveland Clinic, and her
doctor sat me down and told me that she had less than three
months to live, and that her only chance was more chemotherapy,
to hopefully shrink the tumors and buy her more time. To me,
this was insanity, doing the same thing again, and expecting a
different result.
I knew that her only hope was to target the cancer cells by
other means, such as attacking the tumors' blood supply. My
family and I had already read all the literature. We were
knowledgeable about the tremendous advances that were being
made with different agents.
There were so many promising treatments on the horizon; if
only we had the time to wait for the studies to be carried out;
time for new drugs to come to market. But we did not, and Elisa
had only three months to live.
Elisa's doctors at the Cleveland Clinic accepted my
suggestion that we try a radically different approach that was
only vaguely described in one person and in animal studies. The
treatment which we modified constantly over the next 13 months
significantly slowed her tumor growth. Not only did Elisa not
die, she went with us on a 10 day Christmas cruise, and had a
ball.
In March, Elisa returned to high school and completed her
senior year. She went to prom and lived as normally as she
could, despite the fact that twice a week, in our family room,
I would hook her up to an IV, and administer the experimental
treatment.
She graduated with highest honors, and was accepted to Case
Western Reserve University, where she intended to get a
combined degree in nutrition and biochemistry.
Sadly, her time ran out before the treatment protocol that
we were using could be fine-tuned. Elisa was content to live
with her cancer. She was hopeful that we could convert it to a
chronic disease.
Elisa's dream can become a reality if Congress and the
White House live up to the five year commitment to double the
NIH budget. If the Government falters on the commitment, at a
time of great excitement and optimism amongst cancer
researchers, the momentum will be lost. It is also essential to
fund NCI's bypass budget request, which is a comprehensive
national plan for cancer research.
There is hope in the near future for effective treatment
alternatives, and promising laboratory research awaits clinical
studies, such as those underway at the NCI. No single treatment
will effectively control cancer. Combinations of different
treatments will be necessary. Costly clinical studies of
treatment combinations must be started.
Elisa did not die because she had incurable cancer. My
daughter died because we did not know how to control it.
A week before she died, she said her goodbyes. She made one
request to each member of her family. She requested that my
son, Jordan, name his first-born child after her. She requested
that my wife, Anita, visit her grave every day, for the first
year.
To me, she asked that I ensure that her death would not be
in vain; that something positive would result from it. It is
for this reason that I come before you today. Please do not
allow Elisa's legacy to die.
Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. We will try. Thank you for coming.
Our next witness will be Michaelle Wormley, Executive
Director of Women Opting for More Affordable Housing Now, Inc.
----------
Wednesday, March 21, 2001.
WOMEN OPTING FOR MORE AFFORDABLE HOUSING NOW, INC.
WITNESSES
MICHAELLE WORMLEY, EXECUTIVE DIRECTOR OF WOMEN OPTING FOR MORE
AFFORDABLE HOUSING NOW, INC.
JOANNE KANE, EXECUTIVE DIRECTOR OF THE MCAULEY INSTITUTE
Ms. Wormley. Good afternoon, Mr. Chairman and members of
the subcommittee. You have my written statement. I will just
provide you with some of the highlights.
I am Michaelle Wormley, the Executive Director of Women
Opting for More Affordable Housing Now, WOMAN, Incorporated. We
are a Southeast Texas non-profit organization, that creates
affordable, livable transitional housing, and supportive
services for women living in abusive relationships. We are
asking for at least $25 million for fiscal year 2002, for a
housing assistance program authorized under the Violence
Against Women Act last year.
WOMAN, Inc. grew out of a networking group of nine battered
women's shelters and service providers in a 13 county area,
including Houston, Dallas, and Beaumont, Texas. Our long-term
goal, since we were founded in 1993, has been developing
transitional housing facilities at each of the nine locations
represented in the consortium.
Each sponsor provides comprehensive social services and
property management, while WOMAN, Inc. may finance, own,
maintain, operate and sell the properties it develops in order
to provide the most cost-effective project that is affordable
to woman earning 50 percent or less of the medium income.
I am accompanied today by JoAnne Kane, Executive Director
of the McAuley Institute. McAuley was founded by the Sisters of
Mercy in 1983, and is the only national faith-based housing
organization that focuses its resources on low income women and
families.
McAuley has worked closely with WOMAN, Inc. since 1993,
providing both technical assistance and financial services.
Many of the women who participate in housing programs and
related services provided by the community-based groups like
WOMAN, Inc. are survivors of domestic violence.
As housing providers, the dilemma that we saw was that
families, having begun to stabilize their lives in a shelter
program had only one choice when seeking affordable housing;
that of returning to their batterers.
Our vision was to provide survivors more viable options for
restoring their lives. That vision was honored by the Fannie
Mae Foundation with the maximum Awards of Excellence in May of
1999, and recognition of our Destiny Village Project in
Pasadena, Texas. Destiny Village is a 30 unit apartment
complex, which provides supported housing to families leaving
domestic violence.
Over the past several years, McAuley, along with a
coalition of 200 groups representing domestic violence and
sexual assault survivors have strived to re-authorize the
Violence Against Women Act with the Housing Assistance Program.
With the October, 2000 Enactment of VAWA 2000, our goal was
partially realized. VAWA housing assistance would provide a
bridge, up to eighteen months, to help survivors secure a
stable, secure environment for themselves and their children.
The new law requires that the housing assistance must be
needed to prevent homelessness, and may be used for rent,
utilities, security deposits, or other costs of relocation.
Support services to enable survivors to obtain permanent
housing, and to aid their integration into a community,
including transportation, counseling, child care services, case
management, and employment counseling could be supported with
grant funds.
VAWA enjoyed strong bipartisan support, and the Congress
clearly intended to create and fund a viable housing assistance
program under VAWA.
We fully expect the program to be extended this year as
part of the Child Abuse Prevention and Treatment Act, for which
the current authorization is five years, and expires this year.
The need for this program is critical. According to the
U.S. Conference of Mayors 1999 survey of 26 cities, domestic
violence was listed as the fifth leading cause of homelessness.
The Texas Department of Human Services figures indicate
that for the fiscal ending 1998, 3,796 adults were denied
shelter, due to lack of space. A conservative estimate from
HUD's homeless office is that nine percent of all clients
serviced came directly from a domestic violence situation.
An informal poll of domestic service providers nationwide,
conducted over the last two months about a national coalition
against domestic violence, the number one funding need
identified by shelter based programs was for transitional
housing for battered women.
The importance of housing assistance to families fleeing
abusive situations cannot be overstated. Short-term housing aid
and targeted supportive services can help survivors bridge the
gap between financial and emotional dependency, and productive,
healthy, and life-sustaining environments for themselves and
their children. We ask that you provide $25 million for VAWA
housing assistance for the coming year.
JoAnne, did you want to speak?
Ms. Kane. The experience of WOMAN, Inc. is duplicated
across the country, both as a direct response to the woman
fleeing violence, and an example of successful programs,
created by local women leaders to deal with some of our
nation's most intractable problems.
These women leaders project a solely pathological
assessment, which looks at violence alone as the problem. They
craft multi-faceted programs that combine human development and
community development, family health andcommunity building
strategies.
The care-givers are often finding themselves in the same
situation as the women, knowing that housing is the one
solution, and yet finding that the opportunities for women
decline daily. There are 5.4 million worse case housing needs
in this country, and 60 percent are women.
So the appropriation is needed, a system and a practical
system is ready to respond, and their are women for whom the
opportunity is not just a home of their own, but an opportunity
to leave family violence behind forever.
Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
Do the habitat programs help?
Ms. Wormley. They are a critical response to the need.
However, again, in trying to assure stability for the mothers
and the children, transitional housing is very critical.
Mr. Regula. Thank you very much.
Our next witness is Jerold Goldberg, Dean, Case Western
Reserve, School of Dentistry. Welcome to the panel.
----------
Wednesday, March 21, 2001.
HEALTH PROFESSIONS AND NURSING EDUCATION COALITION [HPNEC]
WITNESS
JEROLD GOLDBERG, D.M.D., DEAN, CASE WESTERN RESERVE UNIVERSITY SCHOOL
OF DENTISTRY, TESTIFYING ON BEHALF OF THE HEALTH PROFESSIONS AND
NURSING EDUCATION COALITION [HPNEC]
Mr. Goldberg. Mr. Chairman, I am Jerry Goldberg, Dean of
the Case Western Reserve University School of Dentistry. I am
testifying today on behalf of the Health Professions and
Nursing Education Coalition [HPNEC].
This is an informal alliance of over 40 organizations,
dedicated to ensure that Title 7 and 8 programs continue to
help educate the Nation's health care personnel.
These programs improve the accessibility, quality, and
racial and ethnic diversity of the health care work force. In
addition to providing unique and essential training and
education opportunities, these programs help meet the health
care delivery needs of under-served areas in this country. At
times, they serve as the only source of health care in many
rural and disadvantaged communities.
Additionally, the graduates of Bureau of Health Profession-
funded programs are three to ten times more likely than average
graduates to participate in medically under-served communities.
These programs graduate two to five times more minority and
disadvantaged students.
As the Nation's health care delivery system rapidly changes
and makes dramatic changes, the Bureau of Health Professions
has identified the following five priorities, to ensure that
all providers are prepared to meet the challenges of the health
care in the 21st Century. They are: geriatrics, genetics,
diversity, and informatics.
HPNEC has determined that these programs require $550
million to educate and train the health care work force that
addresses these priorities.
As part of the two year effort to reach this goal, HPNEC
recommends at least $440 million dollars for Title 7 and 8 in
fiscal year 2002. These figures do not include funding for the
Childrens Hospital's Graduate Medical Education Program, and
are now separate from Title 7 and 8 funding.
The programs are organized in the following categories:
minority and disadvantaged health professions; primary care
medicine and dentistry; interdisciplinary, community-based
linkages; health professions work force information and
analysis; public health work force development; Nurse Education
Act; and student financial assistance.
A serious defect in our health care system is the lack of
dental care for low income populations and those in under-
served areas. With funding from Title 7, institutions are able
to provide oral health to these under-served populations.
Dentists who have benefitted from advanced training in
general dentistry and pediatric dentistry consistently refer
fewer patients to specialists, which is especially important in
rural and under-served urban areas, where logistics and
financial barriers can make specialized care unobtainable.
The Bureau of Health Professions in HRSA provides threeyear
grants to start expanded programs and to expand programs, after which
time, these programs must be self-sufficient. Eighty-seven percent of
the dentists who go through these programs remain in primary care
practice.
Members of HPNEC are concerned that the Administration has
severely cut or even eliminated portions of Title 7 and 8
funding. It states in the health profession section of the
budget blueprint that ``Today a physician shortage no longer
exists. Moreover, the Federal role is questionable in this
area, given that these professions are well paid, and that
market forces are much more likely to influence and determine
supply.''
We contend that typical market forces do not eliminate work
force shortages in under-served areas, and that their effect on
skyrocketing costs of living has directly contributed to the
kind of health care professionals in these regions. HPNEC has
provided a letter to the President, outlining this position.
We appreciate the subcommittee's support in the past. We
look to you again to support these programs and their essential
role in the health care system. Thank you for accepting this
testimony.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for bringing this to our attention.
Our next witness is Dr. Frankie Roman, Medical Director,
Center for Sleep Disorders, at Doctors Hospital in Massillon,
Ohio. We are happy to welcome you, my next door neighbor,
almost.
Dr. Roman. For a second, Mr. Chairman, I thought you were
avoiding your neighbor. [Laughter.]
----------
Wednesday, March 21, 2001.
NATIONAL SLEEP FOUNDATION
WITNESS
FRANKIE ROMAN, M.D., MEDICAL DIRECTOR, CENTER FOR SLEEP DISORDERS,
NATIONAL SLEEP FOUNDATION
Dr. Roman. Good afternoon, Mr. Chairman and Congressional
staff members. Thank you for inviting me to present testimony
this morning, or this afternoon, on behalf of the National
Sleep Foundation.
We have submitted written testimony to the official record,
and I would like to use my time to address some of the major
points regarding how sleep disorders, sleep deprivation, and
fatigue impact the Nation's health and safety.
As the Chairman mentioned, I am based in Massillon, Ohio. I
drive through Navarro, Ohio, his home town every day. I just
want to make my Ohio connection clear.
The National Sleep Foundation is an independent non-profit
organization that works with thousands of sleep experts,
patients, and drowsy driving victims throughout the country, to
prevent health and safety problems, related to fatigue and
untreated sleep disorders.
The Foundation's interest today in the subcommittee's work
is based on the National Sleep Foundation's relationship with
the Center for Disease Control and Prevention, and specifically
with the National Center for Injury Prevention and Control.
The NSF today is asking the subcommittee to consider
providing an additional $1.5 million to the center's fiscal
year 2002 funding, to address sleep deprivation and fatigue-
related injuries.
Sleep represents a third of every person's life, and has a
tremendous impact on how we function, perform, and think during
the other two-thirds. Unfortunately, that is the first thing we
sacrifice. We give up sleep to attend all these Congressional
hearings and Congressional fund raisers later on in the
evening.
Too many of us forget that lack of adequate, restful
slumber has serious consequences at home, in the work place, at
school, and on the highway. Members of Congress are not immune
to this. If you recall, Mr. Chairman, I did an informal survey
a few years ago, with the help of your office. We found that
seven percent of the Congressional members fall asleep during
these Congressional hearings.
Mr. Regula. Maybe it has got something to do with the
witnesses.
Dr. Roman. Well, hopefully it does not.
The numbers were worse for the Congressional staff members,
so I am not even going to mention that, just for them.
It just shows that the ill effects of sleep deprivation are
suffered by all, including members of Congress. This is
something that touches each and every person in this country.
Tragically, drowsy driving claims more than 1,500 lives,
and accounts for at least 100,000 crashes in the UnitedStates,
every year. The sad thing is that these incidents are preventable. Just
this past week, Mr. Chairman, I saw a school bus driver from our
community, who fell asleep at the wheel, and the kids are complaining
about how the bus is wagging.
I have seen many police officers, I have actually seen some
of your Congressional members, I have seen elected officials
from the school and the Government in our community; and so I
do not put a face or a name today before you. However, I ask
you, the next time you go to your community, look around and
you will see that this is an issue that affects each and every
one of us.
Many of the groups before you, too, would benefit from my
request today, or what the National Sleep Foundation is trying
to accomplish through the CDC.
Fatigue or sleep deprivation should be considered an
impairment like alcohol and drugs. New research shows that a
person who has been awake for 24 consecutive hours demonstrates
the same impairment in judgment and reaction time, as an adult
who is legally drunk. Today, it is unacceptable to drive or
work under the influence of drugs and alcohol. Fatigue should
fall under the same category.
The National Sleep Foundation has worked with volunteers
like myself for the next decade to raise awareness and minimize
fatigue-related injuries. While public awareness is desperately
needed, a strong Federal partner with the expertise and the
ability to disseminate, test, and improve education, training
and injury prevention programs to communities like ours in
Stark County, Ohio, is crucial to attacking these problems.
We feel that the CDC is our partner, and should help the
NSF and public health officials address these problems.
We have data telling us that lack of sleep affects the
Nation on many different levels, from the airline pilot, and I
have several pilots of that nature, to the child in the
classroom, I receive many with a court order coming to see me;
and from the Amish. Surprisingly, even though they have a
simple life style, they are identifying sleep disorders as a
problem in their day-to-day lives.
This research is absolutely no good if we cannot translate
it into education and injury prevention programs for the
general public. Public education, physician and police
training, school-based programs and work place prevention
programs are all desperately needed.
We believe that the CDC can and should play a vital role,
working with the sleep community to address these problems by
developing a sleep awareness plan that would set national
priorities around sleep issues and public health and safety.
This proposed sleep awareness program would allow the CDC and
other Federal agencies to develop and distribute accurate
medically sound information in programs to local communities.
This information, coupled with training for those involved
with public health and safety at the state level, will begin to
turn the tide of injuries, health problems, and costs
associated with sleepiness and sleep disorders, which I see on
a daily basis.
I thank you, Mr. Chairman, for your time. Again, we wish
that the subcommittee would consider increasing the overall
budget for the center by $1.5 million, to allow the center to
act as a coordinating body for the development and
implementation of this five year sleep awareness plan.
Thank you for your consideration in this request. I would
be glad to answer any questions that you may have.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. It seems to me that you are talking about two
different things, disorders and deprivation. Deprivation is
lifestyle.
Dr. Roman. Yes, but we consider it a disorder, also,
because many of the sleep disorders cause sleep deprivation.
Only through education and awareness will people realize that
it is just not lifestyle, and that there are other things going
on.
Mr. Regula. Do you try to treat physical causes, or just
try to treat the habits of people; that they just do not get
enough sleep, they do not go to bed on time, and so on.
Dr. Roman. We do both, Mr. Chairman.
Mr. Regula. Are there certain physical causes that people
do not sleep well, and is that something you treat?
Dr. Roman. Yes, the most common one that we see is sleep
apnea. That is people who snore and stop breathing in their
sleep. Most of their manifestation is, I do not get enough
sleep, or I feel tried when I wake up. These are people who
fall asleep in different social situations, including driving
or at work, or even on the toilet seat.
Mr. Regula. Well, I suppose our societal lifestyle has
something to do with it, the demands are so great.
Dr. Roman. Unfortunately, the first thing that we all
sacrifice is sleep, to get in all the activities, social,
professional, and personal, that we would like. What we
aretrying to educate the public is, this is a major mistake.
Mr. Regula. Is there any magic number? I see different
numbers. You should have six hours, seven hours, eight hours.
Would that not depend a little bit on the physiology on the
individual?
Dr. Roman. Yes, the average is around eight hours. But
there are some people who require less sleep, and some that
require more. You cannot train yourself to sleep less. That is
a myth; where you can say, I can get by with only four hours.
What we do as a society, most Americans, we are chronically
sleep deprived, and on the weekends, we make up, we sleep in;
which, unfortunately, makes us start off the next week in a
bind.
For example, next week, which is National Sleep Awareness
Week, and our clock shifts forward, there is a seven percent
increase in accidents that Monday. It does not matter if you
spring forward or fall back with our clock, but there is a
seven percent increase. So I strongly recommend that no one
drive next Monday.
Mr. Regula. You should stay home from work; is that it?
[Laughter.]
Well, you apparently have got an ally in our President. He
seems to have good habits about going to bed early, and that
will be helpful.
Dr. Roman. He also takes naps, which we strongly recommend.
Unfortunately, it is very un-American to take naps.
Mr. Regula. I thinking about one, myself, if I can get
through this list. [Laughter.]
Dr. Roman. I thank you for your time, Mr. Chairman. I am
available in our community, as I am your neighbor. I will
always be available to you. Thank you very much.
Mr. Regula. Well, thank you for coming.
Next is Deborah Neale, a member of the Ohio Chapter
Executive Committee of the Ohio State Public Affairs Committee.
----------
Wednesday, March 21, 2001.
OHIO CHAPTER EXECUTIVE COMMITTEE OF THE OHIO STATE PUBLIC AFFAIRS
COMMITTEE
WITNESS
DEBORAH NEAL, MEMBER, OHIO CHAPTER EXECUTIVE COMMITTEE OF THE OHIO
STATE PUBLIC AFFAIRS COMMITTEE
Ms. Neal. Thank you, Mr. Chairman.
Good afternoon, I am Debbie Neal, a long time volunteer of
the March of Dimes. I also bring you greetings from our former
State Senator Grace Drake, who has just agreed to be on our
committee in Cleveland, Ohio.
As you know, the March of Dimes is a national voluntary
health agency, founded in 1938 by President Roosevelt, to find
a cure for polio. Today, the three million foundation
volunteers and 1,600 staff members in every state, the District
of Columbia, and Puerto Rico, work to improve the health of
infants and children, by preventing birth defects and infant
mortality.
I am here today seeking the prioritization of funds to
improve and health and well being of mothers, infants, and
children, through research, prevention of birth defects, and
developmental disabilities, and improved access to care. I am
not here to lobby for funds for the March of Dimes, as less
than one percent of the Foundation's funding comes from Federal
sources.
The Foundation supports continuing the five year effort to
double the funding. We are especially interested in three
issues within the National Institutes of Health.
First, the National Institute for Child Health and Human
Development should have the resources to expand research on
birth defects and developmental biology, allowing for testing
of new treatments for autism, and further research on Fragile
X, which is the most common inherited cause of mental
retardation.
Secondly, we recommend increased funding for the National
Human Genome Research Institute, to allow scientists to develop
the next generation of research tools, and thereby accelerate
an understanding of genomics.
Third, other activities at NIH strongly supported by the
Foundation include work being done by the National Center on
Minority Health and Disparities; advancement of treatment
options for sickle cell disease; and extra-mural research
through the Pediatric Research Initiative.
As you know, Mr. Chairman, last year, the Children's Health
Act of 2000 created a new center on birth defects and
developmental disabilities at CDC, bringing the number of
centers that make up the CEC to seven. Support in Congress for
this new center is indicative of the importance that members
place on research and prevention activities related to birth
defects.
The new center begins operations in mid-April, April 15th,
and we encourage the subcommittee to commit the resources
needed to ensure a successful launch.
Currently, three-quarters of the states monitor the
incidents of birth defects. However, the systems vary
considerably. CDC is working with states to standardize
datacollection through 26 cooperative agreements, lasting three years
each. However, funds are not adequate to support all the states seeking
assistance, including our own state of Ohio.
The March of Dimes recommends adding $2 million to CDC's
state-based birth defects surveillance program. This CDC also
supports eight regional birth defects research and prevention
centers, where groundbreaking work on spina bifida, heart
defects, Downs Syndrome, and other serious, life-threatening
conditions present at birth are underway.
Increased funding would allow additional data collection to
study genetic and environmental causes of birth defects. The
March of Dimes recommends adding $8 million to the budget for
these eight centers.
Developmental disabilities, monitoring and research are
also important, and the Foundation supports CDC's plan to
create five regional research centers to study developmental
disabilities, such as autism, cerebral palsy, mental
retardation, and hearing and vision deficits. The funding
needed is $5 million.
The new Center on Birth Defects and Developmental
Disabilities will administer the folic acid education campaign
and newborn screening program. The current folic acid education
campaign has been inadequate, and should be funded at a greater
level of $5 million for 2002, with an estimate by 2006. This
life-saving intervention is needed to reduce the number of
babies born with neural tube defects.
Newborn screening for metabolic diseases and functional
disorders such as PKU, sickle cell disease, and hearing
impairment is a great advance in preventative medicine. To
support newborn screening, the foundation recommends an
increase, so that CDC can provide states the technical
assistance needed to ensure that babies who test positive for
these conditions receive appropriate care.
Finally, we would like to focus your attention on two
programs, administered by the Health Resources and Services
Administration, that improve access to health care for mothers
and children.
The Maternal and Child Health Block Grant compliments
Medicaid and the Children's Health Insurance Program. It is no
wonder we call it CHIP. That is easier to say. This program
targets service to under-served populations. The foundation
recommends funding at the authorized level of $850 million.
Secondly, community health centers are an essential source
of obstetric and pediatric care, and the foundation supports
$175 million in new funds, to increase both the number of
centers, and improve the scope of services offered.
Thank you for allowing me to testify today.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Was it the March of Dimes started to eradicate
polio?
Ms. Neal. It was.
Mr. Regula. So you heard the success story of that?
Ms. Neal. It is. In fact, our friend, Pat Sweeney, has
always said, it should change its name from the March of Dimes
to the March of Quarters, because of inflation. [Laughter.]
Mr. Regula. Right, but it was a tremendous success story.
Ms. Neal. Well, it is fascinating to listen to the doctor
talk about eradication worldwide. I mean, it is in our
lifetimes that this has happened.
Mr. Regula. I believe he said that they vaccinated 107,000,
I believe.
Ms. Neal. Yes, at one time.
Mr. Regula. No, that was million, 170 million.
That is great progress to make those achievements. We hope
we can have the same success with birth defects.
Ms. Neal. One of the reasons that I have chosen to be a
volunteer with March of Dimes for so many years is because they
do accomplish a lot of real concrete success stories.
Mr. Regula. Well, thank you for coming.
Ms. Neal. Thank you.
Mr. Regula. Next is Dr. Amy Lee, Assistant Professor of
Community Medicine, from Northern Ohio.
----------
Wednesday, March 21, 2001.
FRIENDS OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION
WITNESS
AMY LEE, MD, MPH, MBA, FRIENDS OF THE HEALTH RESOURCES AND SERVICES
ADMINISTRATION
Dr. Lee. Actually, besides your wonderful support to my
academic institution, I have a brother who lives in Stark
County, and my real estate agent works with your son, David, at
Cutler GMA. That is my Ohio connection.
Mr. Regula. My goodness.
Dr. Lee. I am honored to be here today to testify on behalf
of the Friends of the Health Resources and Services
Administration or HRSA.
The Friends of HRSA is an advocacy coalition of 125
national organizations, and it represents millions of public
health and health care professionals, academicians such as
myself, and consumers.
HRSA programs assure that all Americans have access to
basic health care services. In Ohio, in fact, three fourths of
our public health funding comes from Federal sources, and HRSA
plays a major role in this support.
HRSA is a health safety net for nearly 43 million
Americans, who lack health insurance; 49 million Americans who
live in areas that have little access to primary health care
services; and also African American babies who are 2.4 times
more likely than their white counterparts to die before their
first birthday.
The Agency's overriding goal is to provide 100 percent
access to health care, with zero disparities. The Friends of
HRSA feel the Agency requires a funding level of at least $6.7
billion in order to achieve this goal.
HRSA funding goes where the needs exists. Although programs
are geared towards health care access, I would just like to
highlight two programs, and mention several others.
The first program is the new community access program. It
allows communities to build partnerships among health care
providers to deliver a broader range of health services to
uninsured and under-served residents. Cincinnati actually
received a CAP grant, and was one of the highest grant
applications.
This program coordinates some 50 organizations in this area
through strategies to improve care, including the
implementation of regional disease, management protocols for
asthma, depression, diabetes and hypertension.
The Friends are very concerned that the Administration's
budget blueprint recommends eliminating this program of
coordinated service delivery. This is an innovative program
that is not duplicated anywhere else.
The next program I would like to highlight is the health
professions programs, which assure adequate national work
force, despite projected nationwide shortages of nurses,
pharmacists, and other professionals. Actually, Dr. Goldberg
speak on behalf of this program, as well.
Graduates of these programs are three to ten times more
likely to practice in under-served areas. In addition, they are
two to five times more likely to be minorities. The Friends are
also concerned that cuts in these programs, which are proposed
in the Administration's budget blueprint will impact this
poorly.
These programs provide up-front incentives for dozens of
types of health professionals, not only physicians, but mental
health, dentists, and also public health professionals, as
well.
Market forces will continue to drive shortages and mal-
distribution in many of these sectors, potentially leaving
health centers under-staffed, without the support of health
professions programs.
Also, it is clear for the need for other HRSA programs, as
well. The Maternal and Child Health Block Grant provided funds
for the Cleveland Healthy Start Program, and they saw a 40
percent in infant mortality, as a result.
I really did not need to look any further than my local
newspaper, the Akron Beacon Journal, to find other sources of
need. On February 20th, the Akron Beacon Journal reported ``HIV
stalks careless men.'' It reported that HIV is increasing in
numbers in young people and heterosexuals.
HRSA, next to Medicaid, provides the largest source of
funding for AIDS programs, for low income and under-insured
Americans.
Over the weekend, actually, they ran a series of Ohioans
spreading out, and blacks flee to suburbia. This told of folks
who were going to suburban areas and rural areas to stay and to
live there. Of course, there will be more need for programs
such as the programs provided by HRSA to provide health care
services.
I would like to submit these three articles for the record,
as well.
Mr. Regula. Without objection.
[The referenced articles follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Dr. Lee. As you can see, HRSA programs are all about access
to health care for Americans. We are really, because if we have
a toothache or if we get sick, we know where to go, and we will
get taken care of. For millions of these Americans, it is not
that easy.
I would like to close with a story from a HRSA-funded
vision specialty clinic; actually from your district in Wayne
County in Wooster. On one occasion, a four year old boy was
taken in by one of the Head Start Clinic staff, because they
thought he might have problems seeing. They found, on exam,
that he was functionally blind.
Because of the actions of the crack staff, this boy had
glasses in three days. After he put the glasses on, the doctors
said, he passed the smile test, because when they put the
glasses on, the boy had a huge grin. For the next few days, the
days said that he just looked at things and people that he had
never really seen before, because he had these glasses, and due
to the services of this HRSA specialty care clinic.
I do not think it is by accident that we have heard a
number of public witnesses here that have spoken on behalf of
HRSA programs, because HRSA offers that link between the
services and the people that need it the most.
Thank you for this opportunity for me to speak on behalf of
the Friends of HRSA. I welcome any questions.
Mr. Regula. Well, do you, in your role as Professor of
Community Medicine, work with the physicians in training there?
Dr. Lee. I work with a few. Actually, I am mostly an
Administrator. I direct the master public health program, which
is a partnership program of five public institutions there.
I am also involved in public health activities through the
Ohio Public Health Association. I am President this year, as
well. I am a little involved in the medical student training.
Mr. Regula. But the public health programs would be
delivered by physicians and/or nurses, I assume?
Dr. Lee. Actually, the master public health program, it
could be physicians, but also nurses, health care
administrators, for them to better provide health care services
to communities, as opposed to individuals.
Mr. Regula. I assume the community health centers would be
something where you would have a direct involvement.
Dr. Lee. Actually, I sat on the board for the one in Akron,
and because of a lot of other responsibilities, I had to give
that up. But I was very much involved in that community health
center for awhile.
Mr. Regula. Are you using the new center up there, that you
bring in people for lectures?
Dr. Lee. Oh, that center has not been built, yet.
Mr. Regula. You have not got it built?
Dr. Lee. No, no, the ground has not been broken, yet.
Mr. Regula. Oh, my.
Dr. Lee. They are still making the plans.
Mr. Regula. Well, at least you have the money.
Dr. Lee. Yes, yes, thanks to you. [Laughter.]
Mr. Regula. Okay, thank you for coming.
Thank you for coming. Our witness is doctor James Pearsol.
----------
Wednesday, March 21, 2001.
CENTER FOR DISEASE CONTROL AND PREVENTION (CDC) COALITION
WITNESS
JAMES A. PEARSOL, BA, MED, CHIEF, OFFICE OF POLICY AND LEADERSHIP, OHIO
DEPARTMENT OF HEALTH
Mr. Pearsol. Good afternoon, Mr. Chairman and Members of
the Subcommittee. You may be a Cleveland Indians fan. If you
are, then maybe you know Jimmy Person, who has quite a baseball
player and quite a character. I am not a baseball player, but I
probably qualify as a character.
I am honored to be here today to testify on behalf of the
CDC Coalition. The CDC Coalition is a nonpartisan association
with more than 100 hundred groups committed to strengthening
the Nation's prevention programs. Coalition members groups
represent millions of public health workers, researchers,
educators, and citizens served by CDC Coalition programs.
I would like to welcome the Chairman into his new position.
In addition, overseeing the funding for Public Health Service
and to thank you for the work that you will do in the
forthcoming year on this difficult bill. The CDC Coalition is
the Nation's prevention agency that is putting health research
into practice.
Public health prevention is about two things. The what of
health prevention is preventing adverse health outcomes and the
how are the tools of the trades including programs,
surveillance, and best practices. Prevention translates into
lives saved and pain and suffering avoided, health costs
avoided, quality of life improved, use of best health
practices, and use of credible health information.
In the best professional judgement of the CDC Coalition,
CDC will require funding of a least $5 billion to adequately
fulfill its mission for fiscal year 2002.
Mr. Regula. Do you work directly with CDC?
Mr. Pearsol. Yes. We receive, again, probably $40 million
of our budget, part of the three-fourths of Federal funding at
the Ohio Department of Health, and pass that on in large
measure to local health and community departments.
Mr. Regula. The funding is channeled through CDC.
Mr. Pearsol. Correct.
Mr. Regula. The Federal portion.
Mr. Pearsol. That is correct.
Mr. Regula. You in turn work with local public health
agencies in the communities around Ohio.
Mr. Pearsol. That is correct.
Mr. Regula. The State County Board of Health would be
working directly with to you.
Mr. Pearsol. I work directly for them, Bill Franks and his
Board, the city, Bob Patteson, and Mayor Watkins.
Mr. Regula. Go ahead.
Mr. Pearsol. Thank you. Health prevention is like auto
maintenance. It is not appreciated until it fails. It is not
much fun when it fails. In any maintenance of prevention
ignored is guaranteed to lead to failure. CDC makes Public
Works in Ohio, and I will give you some examples. Chronic
diseases are Ohio's quiet killer. Five diseases account for 70
percent of Ohio's deaths. In fact, heart disease, 91 deaths
each day, cancer, 68 deaths each day, stroke, 18 deaths each
day, lung disease, 15 deaths each day, and diabetes, nine
deaths each day.
The CDC Center for Chronic Disease Prevention and Health
Promotion supports programs that combat this chronic set of
diseases. The impact on the elderly is profound and about 80
percent of seniors have at least one chronic condition and 50
percent have two or more. We know that breast and cervical
cancer, prostate, lung, and colon rectal cancers can be avoided
through early detection.
The CDC supports programs like these and other chronic
illness such as diabetes. Nearly 16 million Americans have
diabetes and the largest increases are among adults 30 to 39 in
age. CDC supports state and territorial diabetes control
programs that attack this problem.
Health disparities persist in all of these disease that I
talk about in Ohio. This CDC's REACH program that is racial and
ethnic approaches to community health address serious
disparities and infant mortality, breast and cervical cancer,
HIV and AIDS, etc. In Ohio, infant mortality rates for African
American are twice those of whites.
One of Ohio's Public Health Service success stories is
childhood immunizations. In 1994, only about half of our two
year old had been immunized by 2001 and 78 percent had been
immunized, which is a 55 percent increase. This was possible
through the availability of low cost vaccine from CDC. Injuries
and their prevention is crucial.
Each day an average of 9,000 U.S. workers sustained
disabling injuries, 17 died from work related injuries, and 137
died from work related illnesses. Finally, the preventive help
block grant is the key to flexible funding at the local level
were local program can match solutions to demand in the local
community.
The how of CDC is cease surveillance. This is a lot like an
air traffic control system. It is the disease tracking control
system. It is a basic monitoring system that detects early
warning signs. The National Electronic Disease surveillance
system created Ohio's early warning system for disease
outbreaks. The Epidemic Intelligence Service Officer Corps has
supported many outbreak investigations in Ohio and including TB
outbreak in Columbus, Typhoid outbreak in Cincinnati, Listeria
in northwest Ohio; part of a National outbreak,
Cryptosporidiosis in a Delaware county swimming pool, and E.
coli in Medina county fair grounds water system.
In terms of capacities and skills, the CDC Coalition
supports full funding for the provisions authorized in the
Pubic Health threat emergency act sponsored by representative
Burns Stewpack. This concluded my prepared remarks. I would be
happy to answer any questions.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you work any with the schools as part of an
education program for preventive medicine?
Mr. Pearsol. Yes. We work directly school program with
nursing staff and the Public Health teachers. In order to get
the message to the community.
Mr. Regula. There are a lot of gains that could be made in
preventive medicine to achieve good health, that is to develop
programs of preventive medicine to alert people.
Mr. Pearsol. Yes, that is right. We believe this is the
key. Ohioans smoke more are more obese, exercise less, and eat
fewer fruits and vegetables. Those are behaviors that can
change the kinds of chronic diseases that I am mentioned that
kill Ohioans and others in Americans in this country.
Mr. Regula. Is it an education process?
Mr. Pearsol. Yes, education is part of the process. It is
changing the behaviors and repeating the message.
Mr. Regula. Thank you.
Mr. Pearsol. Thank you, Mr. Chairman.
Mr. Regula. Our next witness is Gerald Slavet.
Ms. Hurley-Wales. It is Slavet.
Mr. Regula. I am intrigued by ``From the Top.'' Is that
Ringling Brothers?
Mr. Hurley-Wales. No, it is a radio program.
Mr. Regula. Oh, where is it?
Mr. Hurley-Wales. Actually, in your area, it is on WCLV in
Cleveland.
Mr. Regula. What kind of a program is it?
Mr. Hurley-Wales. Well, I am happy to answer that.
Mr. Regula. I guess you are going to tell us.
Mr. Hurley-Wales. Right, I will tell you all about it.
Mr. Regula. Okay.
----------
Wednesday, March 21, 2001.
GERALD SLAVET EDUCATION PERFORMANCES FOUNDATION
WITNESS
JENNIFER HURLEY-WALES, EXECUTIVE VICE PRESIDENT, GERALD SLAVET
EDUCATION PERFORMANCES FOUNDATION
Ms. Hurley-Wales. My name is Jennifer Hurley-Wales. I am
here to testify on behalf of Gerald Slavet of the Education
Performances Foundation. Gerald is out of the country today. We
were very appreciative to have this opportunity to appear
before you and the Subcommittee.
I am the Executive Vice President of our foundation and co-
founder of our flagship project ``From the Top.'' Since its
launch in 1998, ``From the Top'' radio program has brought into
the foreground the exceptional achievements of pre-collegiality
classical musicians. It helped build the self esteem of the
young participants, and provided role models for 100 to 1,000
young people across the United States.
The mission of ``From the Top'' is to celebrate and
encourage the development of youth through music. The project
is designed to demystify classical music making it more
accessible to young audiences and adults. ``From the Top''
believes that young people that can play Mozart's Clarinet
Concerto are just as cool as those who dunk basketballs.
We know those who play that kind of music are usually
strong students and that is why we celebrate young classical
musicians in the same way that their athletic schoolmates are--
as heroes.
Early involvement with classical music plays a key role in
the development of children's intellects, which is important
for the new economy that relies on math, science, and
analytical skills.
We believe that ``From the Top's'' is entertaining and
accessible and national radio program will lead to a public
conversation at the grass roots level. Perhaps this will help
influence public opinion and policy about the value of arts
education.
``From the Top's'' weekly radio series taped before a live
audience, features America's most exceptional 9- to 18-year-old
classical musicians and performance and interviews. Now
broadcast on 215 station nationwide, the show has a projected
listenership of 700,000 people each week.
A passionate listenership I should say as demonstrated by
the daily flood of positive e-mails we continue to receive.
Mr. Regula. Do you go nationwide?
Ms. Hurley-Wales. We are on 215 stations nationwide.
Mr. Regula. Produced in Cleveland?
Ms. Hurley-Wales. It was produced in Boston.
Mr. Regula. OK.
Ms. Hurley-Wales. ``From the Top'' is considered today the
most listened to classical music program on public radio.
Tapings take place before family audiences in Boston at New
England Conservatory's Jordan Hall and in halls across the
country including Carnegie Hall in New York and the Kennedy
Center in Washington. In fact, we will be here next week.
The extraordinary popularity and success of ``From the
Top'' radio series has led to the creation of three additional
components. ``From the Top'' television specials are in
development for production for PBS. They will feature host
Christopher O'Riley, performances and documentary style
profiles of five exceptional young musicians and ensembles.
``From the Top.org'' is the only site on the Internet that
provides a complete suite of services and community for young
people who are passionate about music. The site is an
interactive forum for kids, teachers, and parents to discuss,
present, and research all matters that relate to music.
``From the Top's'' newest initiative, Sound Waves education
project addresses the urgent need to bring cultural
missionaries into our communities through curricular materials
linked to the radio shows, teacher training workshops, and
cultural leadership training for young musicians.
This Sound Wave project builds on ``From the Top's''
greatest asset and the power of the young performer as a role
model for other kids. Thanks to the interest and leadership of
Congressman Joe Moakley, and the support of this Subcommittee,
our foundation has received funding from the U.S. Department of
Education in the past, including a $510,000 grant for this
fiscal year.
``From the Top'' would not be in existence without the U.S.
DOE funding. Please know that we are aware of the importance in
improving our funding and we mounted a comprehensive
development effort to that effect. We appreciate the support of
this Subcommittee and we now respectfully request that you
extend your commitment to young people and the arts by
providing a $1.25 million grant to Education Performances
Foundation to continue support for this innovative program.
This grant would allow us to further develop and implement
our cultural leadership training and expand the reach of
educational efforts through school, community, and Internet-
based programs. Your continued support would allow the
overwhelmingly positive impact of ``From the Top'' to continue
and multiply for the greater mission of our project to be
reached. Thank you.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. I thought that I left the arts when
I left Interior. The next witness is Joseph E. Pizzorno,
President Emeritus of Bastyr University in Seattle, Washington.
----------
Wednesday, March 21, 2001.
BASTYR UNIVERSITY
WITNESS
JOSEPH E. PIZZORNO, JR., PRESIDENT EMERITUS, BASTYR UNIVERSITY IN
SEATTLE, WASHINGTON
Mr. Regula. Do you know my friend Sled Gordon?
Mr. Pizzorno. Actually, I have talked to him several times.
Mr. Regula. We worked together on Interior matters.
Mr. Pizzorno. Great. You said Washington like a true
native. You must have spent some time with him.
Mr. Regula. We spent quite a bit of time together. He was
Chairman and I was Chairman of house, parks, and forests. We
also took care of the flagship in your part of the world. You
are in Seattle.
Mr. Pizzorno. Yes.
Mr. Regula. OK. We look forward from hearing from you.
Mr. Pizzorno. Thank you, Mr. Chairman. My name is Joseph
Pizzorno. I am a licensed naturopathic physician in the state
of Washington. I am also the founding President of Bastyr
University. The first fully credited institution of natural
medicine in the United States.
I am also a member of the Seattle County Board of Health.
The Chair of special interest groups on Alternative Medicine
for the American Public Health Association. I have also been
appointed to the White House Commission on Complementary and
Alternative Medicine Policy. This was created by Congress to
advise Congress on how to integrate natural medicine into the
health care system.
While I am very active in several of these organizations,
and have 25 years of leadership in natural medicine, education,
research, and health policy innovation, I am not here
representing any particular organization.
I am here because I believe that the most pervasive and
silently accepted crisis in America today is ill health of our
people. We have a health care system that is oriented towards
disease treatment and symptom relief, but does relative little
to actually restoring and promoting people's health.
Every decade, for the past 50 years, the incidence of
chronic and degenerative disease has increased in virtually
every age group in the past 50 years. The message that I am
presenting to you today is somewhat different from the message
you have heard earlier today.
Our current health care system is excellent in many ways,
such as acute conditions and emergency care, but it is not
particularly effective in restoring and promoting health.
Health promotion is the area in which natural medicine is most
effective.
My written testimony addresses several areas and defines:
What is Complementary in Alternative Medicine? How popular is
CAM? Why is it important in heath care? Who are the CAM
professionals? What state of the research in CAM? What are the
critical issues that determine if the full benefits of CAM will
be experienced by the American people. Finally, I present
specific recommendations to the Subcommittee.
What is CAM? It is something that is know by many names.
Natural medicine, alternative medicine, integrative medicine,
and complementary medicine. It seems that our government is now
calling it CAM. I will use CAM in my further address.
When many people think about CAM, they think about it as
simply substituting natural therapies for drugs and surgery.
That is not what natural medicine is about. It is about
philosophical approach to heath care fundamentally difference
from that of the conventional medicine.
It is about health promotion rather than disease treatment,
about correcting the underlying causes of ill health rather
than system relief. It is about improvement in function rather
than waiting for end stage pathology that requires heroic
intervention. It is about education, healthy lifestyles, self
care, and natural health products rather than dependence on
medical doctors.
It is about supporting the body's own healing processes
rather than turning to drugs to support or replace by systems.
It is about a powerful belief in the inherent ability of the
body to heal if just given a chance. These concepts of healing
change the way in which we think about and provide health care.
Why are these concepts important to health care? Americans
are experiencing unpresitant burden of ill health and disease
worsening disease trends, appallingly high incidence of
treatment side effects and out of control health care costs.
There are a lot of statistic in my written testimony.
Of the 191 countries that maintain health statistics, the
United States rant seventy second in health status according to
the World Heath Organization. According to Christopher Muray,
M.D., Director of WHO's Global Program on Evidence for Health
Policy.
Basically, you die earlier and spend more time disabled if
you are an American rather than a member of most advanced
countries. One of the key differences between health care in
the United States and most of the rest of the world, especially
those ranking higher in health statistics, is significantly
higher healthier life styles and in several countries such as
number two ranked Australia, and much greater use of CAM in
natural health care products.
In fact, in both European countries, ranking above the
United States in health care statistics, the lead prescription
drugs are herbal medicines and not synthetic chemicals. CAM is
most effective precisely in those area weakest in conventional
medicine.
How popular is CAM? 42 percent of Americans now seek the
services of natural medicine practitioners. There were 629
million visits in natural medicine practitioners in 1997, which
was more than primary medical doctors for primary care.
What can I recommend to this committee? Currently, the
primary mechanism for Federal funding in CAM research is
through the NIH National Center for CAM research. It receives
less than one percent of the NIH total budget and that is
inadequate to meet the need of the mission.
The state of CAM research is widely misunderstood. It is
easily dismissed as having no evidence. In fact, there is
tremendous amount of evidence supporting the natural medicine.
The textbook of natural medicine 10,000 citations of peer
review scientific literature documenting the authenticity of
these kinds of interventions.
I would like to leave you with one recommendation. We have
experience tremendous benefits in our country form having
invest a lot of resources in conventional medicine research. We
have invested less than one half of one percent in research
into natural medicine. I believe that we can experience the
same kind of benefits if we engage in more natural medicine and
reap the benefits of the centuries long traditions of healing.
Thank you.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Peterson must be delayed
arriving. I take one more and hopefully he will get here. Mr.
Akhter. I have a meeting with the Secretary of Education. If
you can cut it short, that would be helpful.
----------
Wednesday, March 21, 2001.
AMERICAN PUBLIC HEALTH ASSOCIATION
WITNESS
MOHAMMAD AKHTER, EXECUTIVE DIRECTOR, AMERICAN PUBLIC HEALTH ASSOCIATION
Mr. Akhter. Thank you, Mr. Chairman. My name is Mohammad
Akhter. I am the Executive Director of the American Public
Health Association. We have 55,000 members and they are primary
concerned with the health of the American people. I am not here
to testify and support particular agency, particular program or
special group of people, but just the American people.
Mr. Regula. You have heard the testimony. Will your
testimony be similar to what we have heard.
Mr Akhter. No. It is very specific. Let me point out to you
three or four areas we think the major emphasis should be
really help the American people be healthy and happier for the
future.
First, there are health disparities among our Americans. We
have made tremendous progress in life expectancy, immunization,
and other arenas. I have been health commissioner in
Washington, DC. I have been state health director for the state
of Missouri. We have done wonderful work. However, some of
minority do not enjoy the same health status.
The number of minorities is increasing. By 2050, there will
be 50 percent of all people of racial ethnic descent. We cannot
have a strong Nation if some of our people our suffering this
disproportionately from heart disease and cancer. For example,
the infant mortality rate is twice as high for the African
American than it is for the average American.
Similarly, the death rate from the diabetes is twice as
high for Hispanics as it is for rest of the country. Last year,
Congress passed a bill and created a center in the NIH for
minority health. Mr. Chairman, we respectfully request that the
center be fully funded so it can get its work going. In
addition, we are asking that you fund the agency for health
care research and quality so that research can be taken to the
people at large to be able to help people.
Secondly, Mr. Chairman, these were the issues that are very
near and dear to most Americans. The second most important
problem among our communities is the substance abuse problem.
Many of the social and public health problems have root cause
is the substance abuse.
President has put some additional money in the budget for
substance abuse treatment. We hope that the Subcommittee will
look at this carefully. We will push that forward.
The third area is our seniors. 80 percent of them have one
chronic condition and 50 percent have two or more. They become
utterly disabled and have to go to nursing home or need more
medical care. HCFA has started a new program were they have
combined the company assessment with health promotion disease
prevention and treatment. We can keep people healthier in their
own homes. Not only improve theirquality of life, but also save
some money.
Finally, Mr. Chairman, last year, the Congress passes a
bill to deal with the bad terrorism to repair our Nation. The
responsibility for this was placed in the Center for Disease
Control in Atlanta. It is a problem today, as it was last year.
We need to fund that completely so that we can have our
communities prepared and our people protected.
Lastly, Mr. Chairman, like the economy, disease is also
become global. Now the hoof mouth disease. A disease can come
at any time. We have the best scientist in the world. We need
to make them available to other countries so that they can
contain the disease at a local level. The Office of
International Health, CDC, NIH where they have these experts,
that those programs be funded so that the programs can be
available to other countries so we do need to fight the
diseases once its inside of our borders.
Mr. Chairman, I appreciate very much the opportunity to
testify before you. I would be glad to answer any questions.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for your testimony. You are
absolutely right. Announce prevention. It is worth a pound of
cures, they always say. Thank you for being here.
Our next witness is Marianne Comegys. I appreciate the
patients of all of you. Somebody has to be last. Francine makes
out the list so do not hold me responsible. [Laughter.]
----------
Wednesday, March 21, 2001.
MEDICAL LIBRARY ASSOCIATION AND THE ASSOCIATION OF ACADEMIC HEALTH
SCIENCES LIBRARIES
WITNESS
MARIANNE COMEGYS, CHAIR, MLA GOVERNMENT RELATIONS COMMITTEE, MEDICAL
LIBRARY ASSOCIATION AND THE ASSOCIATION OF ACADEMIC HEALTH SCIENCES
LIBRARIES
Ms. Comegys. I am Marianne Comegys, Associate Professor at
Louisiana State University Health Science Library in
Shreveport, Louisiana.
I am pleased to testify on behalf of the Medical Library
Association and the Association of Academic Health Sciences
Libraries regarding fiscal year 2002 budget for the National
Library of Medicine.
MLA is a professional organization representing 1200
institutions and 4,000 individuals involved in the management
and dissemination of biomedical information.
AAHSI is compromised of the directors of libraries of 142
accredited U.S. and Canadian medical schools. The NLM is the
world's largest medical library with 5.8 million items through
National network of regional libraries. MLM ensures that health
professionals and the public have access to health prevention
and treatment.
Mr. Regula. OK. You have sold me. Where do you get your
funding? What does it come through.
Ms. Comegys. It comes through NIH. The NLM is one of the
agencies within NIH.
Mr. Regula. Your effort would be to get more funding for
NIH.
Ms. Comegys. Right, through the NLM.
Mr. Regula. So that can give you more money.
Ms. Comegys. Specifically, to the NLM as well.
Mr. Regula. You would like that to be mentioned in the
report.
Ms. Comegys. Right.
Mr. Regula. I got the message. You will have to wrap up in
a minute or two.
Ms. Comegys. Okay, I will.
I will mention that recognizing the invaluable role that
NLM plays in our health care delivery system, NLM also joins
with ad hoc for medical research funding, and recommends a 16.5
percent increase for NLM in the NIH in fiscal year 2002.
Many of our programs today, that the other witnesses have
testified to, and one of the important issues that I will just
sort of mention and sort of just regard this today since you
are in a hurry, is that we provide, as the medical library
community, the information resources necessary for those.
Mr. Regula. Who uses your services, doctors?
Ms. Comegys. The public, the health care physicians, and
right now, there is a big push for consumer health.
Mr. Regula. Well, if I wanted to use your services as a
layman, where would I go?
Ms. Comegys. You can go now to the public libraries; you
can go to the medical libraries.
But what we are doing now and what the National Library of
Medicine has done is emphasize the consumer, and what wehave
provided for you, Mr. Chairman, is easy access to this information
through user-friendly databases.
Mr. Regula. Here comes my pinch hitters. Now you have go
lots of time. [Laughter.]
Mr. Peterson [assuming chair]. He said you had lots of
time, so take it.
Ms. Comegys. Well, okay, I will start over. Do I still have
that five minutes?
On behalf of the Medical Library Community, I thank the
subcommittee for the leadership in securing a 15 percent
increase for NLM in fiscal year 2001. With respect to the
library's budget for next year, I will address four issues:
NLM's basic services outreach and telemedicine activities,
PUBMED Central and the clinical trials database, and a need for
a new library building.
It is a tribute to NLML that the demand for its services
continues to steadily increase each year. There are more than
250 million Internet searches annually on the Medicine
database.
Mr. Chairman, NLM is a national treasure. I can tell you
that without NLM, our Nation's medical libraries would be
unable to provide the type of information services that our
Nation's health care providers, educators, researchers, and
patients have come to expect.
NLM's outreach programs are designed to educate medical
librarians, health care professionals and the public about NLM
services. The need for enhanced outreach activities has grown
in recent years, following the library's decision to provide
free access to its Medicine databases.
Mr. Chairman, we applaud the success of NLM's outreach
initiatives, and look forward to continuing our work with them
on these important programs. Telemedicine also continues to
hold great promise for dramatically increasing the delivery of
health care to under-served communities. NLM has sponsored over
50 telemedicine related projects in recent years.
Introduced in 2000, PUBMED Central is an on-line collection
of live science articles, which evolved from an electronic
publishing concept, initially proposed by former NIH director,
Dr. Harold Varmus. This new on-line resource will significantly
increase access to biomedical information, and we encourage the
subcommittee to continue to support its development.
I also want to comment on a new NLM service. It is the
clinical trials database. This service is free, and it logs
more than two million hits a month. It is an invaluable
resource, which lists 5,000 Federal and privately-funded trials
for serious or life-threatening diseases.
In order for NLM to continue its mission, a few facility is
urgently needed. Over the past two decades, the library has
assumed several new responsibilities, particularly in the areas
of biotechnology, high performance computing, and consumer
health. As a result, the library has had tremendous growth in
its basic functions.
An increase in the volume of biomedical information, as
well as library personnel, has resulted in a serious shortage
of library space. The medical library community is pleased that
Congress last year appropriated the necessary architectural and
engineering funds for facility expansion at NLM.
We encourage the subcommittee to continue to provide the
resources necessary to acquire a new facility, and to support
the library's information programs.
Thank you for the opportunity to present the view of the
medical library community.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Peterson. Who all has access to the library.
Ms. Comegys. To the databases of the libraries?
Mr. Peterson. Yes.
Ms. Comegys. Everyone, from the physician to the researcher
to the consumer; and one of the pushes that the National
Library of Medicine has had for the last few years, and it has
actually come the demand of the consumer, is that they know
more about themselves and their health, and where to find this
type of information.
So Medline, which is a database of references and articles,
now is free, on the web. It is easily accessible amd the user-
friendly version is called Medline-Plus.
Mr. Peterson. Medline-Plus.com?
Ms. Comegys. Well, Medline-Plus is actually through NIH
NLM, and then I think Medline-Plus is a database that lists 450
different health topics.
Within that database, there is also dictionaries. There are
consumer health links to other information on specific
diseases. There is drug information. There is information on
physicians within each territory. There is also, as I
mentioned, the clinical trials database, and that is also quite
accessible for anyone.
So you, as a patient, or you, as a family member of someone
who has a serious or life threatening disease, could go in,
look on the clinical trials database, which is on theweb, which
is free, and see which clinical trials are available right now, which
are those that will be available.
Then you, as an informed patient now, or informed family
member, can go to your physician and say, you know, this is
something that I think I would be interested in and want to
participate in. It gives you all of the criteria listed, as
well.
So one of the pushes for NLM is the consumer and the
consumer health, along with the human genome project which, of
course, is for the researcher, and it is that enormous DNA data
sequencing information, of course, which all the researchers in
the U.S. and worldwide are so excited about. So we are from the
researcher, as well as to the consumer.
Mr. Peterson. If I was to inform my constituents on how
they could utilize this, what should I tell them?
Ms. Comegys. You can actually tell them, in Pennsylvania,
they can go to their public libraries and have access to it.
You can actually tell them to look on the Internet, just to
search at home under National Library of Medicine. Within that
website, it gives you all of the databases that I have
described, plus others that they can have access to, free of
charge.
I can get you the website information. That is something
that more and more people utilize, the Med-line databases. As I
mentioned in my report, I think it mentioned so many million
hits. Thirty percent of that is actually from the public, and
that is probably increasing every day.
Mr. Peterson. The rest is doctors, hospitals.
Ms. Comegys. Researchers, health care professionals, and
medical students.
Mr. Peterson. If you could give us a short paper on that.
Ms. Comegys. I will do that.
Mr. Peterson. We may bog down the system.
Ms. Comegys. Well, that is great. Do you know, the National
Library of Medicine has sort of looked at those statistics, and
they have never been down. They have continued to keep the web
site.
That is good, because they were actually surprised at the
increase that has come about from that database. That is why
they have gone to more and more of the consumer-based database.
We, in the medical library community, work with the
National Library of Medicine, through regional medical
libraries. We go out, through grants from NLM, and train the
public librarians on how to search for this information. We
train the health care professionals on how to search it. We
have grants to train the public health professionals on how to
search, and how to help the patient, so that it is not just the
patient out there, trying to search it with not as much
knowledge as maybe they needed. But actually, it is quite user
friendly. You could get on there today, and find out all sorts
of information.
Mr. Peterson. I shall do that.
Ms. Comegys. The other thing is that I want to mention
that, it is an accurate up to date databases. One of the
concerns is that I think is with all the medical literature out
there on the web. How accurate, reliable or up to date is the
information. When you come to our databases, that is what you
are getting is good information.
Mr. Peterson. I wonder if real physicians use that often.
Ms. Comegys. Yes, that is one of the other projects within
the outreach projects with the NLM. Many of the grants are
given to the regional medical library groups. There are eight
regional library groups and through those groups, the grants
are distributed to the local areas. The push for the rural and
the medically undeserved areas.
Telemedicine also comes in now to also help within those
areas. Those in those areas that are medically undeserved have
no less health information than those in the large cities. This
is real important to us as well.
Mr. Peterson. How does your telemedicine project work?
Ms. Comegys. They all work quite differently. You can have
telemedicine where it is the consultation from a small town
physician who is sending visual images. We can do this now
because of the technology. The high bandwidth and the wheel
time video imaging that is available to us now.
Small town physician can actually send these visuals images
to the specialist in the larger city. The specialist in the
large city can work on diagnosis and treatment. The patient
would not have to travel to that large facility and that city.
On a personal level right now in Louisiana at the Louisiana
State University, we have a telemedicine program that we are
working with the prisoners at a correctional institution in
Louisiana.
Our physicians at LSU are looking at information at the
prison for those physicians there and then we are diagnosing
and sending treatment information back to them so that they do
not have to transport those prisoners to Shreveport or any
other major facility.
It can be used whether is it consultations with the
physician and a patient. There is a lot of home health
telemedicine projects. You can use it for continuing education
with the physician and the student, who many of our students
are in rural areas in Louisiana. Louisiana has a lot of rural
areas. The patient themselves sort through some telemedicine
projects and having access to the electronic resources.
Mr. Peterson. Thank you very much.
Ms. Comegys. Thank you.
Thursday, March 22, 2001.
MEMBER OF CONGRESS
WITNESS
HON. LOUIS STOKES, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO
Mr. Regula. We'll get started. I see we have many
interested people again. I think it's great that you're here. A
lot of you are going to a lot of trouble to be here to testify
for your cause, and that's what this country's all about. I
know that it's time and money that you have to do, but you're
not only helping your cause, you're helping a lot of others who
are going to follow along. Really, it's a very generous thing
for each of you to come and bring to our attention the
importance of something that's close to your heart.
This Committee does have a lot of challenges, obviously.
This is our sixth day of public witnesses. We have the former
chairman of this Committee with us this morning, Mr. Lou Stokes
from Cleveland. How many years did you chair this, Lou?
Mr. Stokes. About as long as the committee, Mr. Chairman,
24 years.
Mr. Regula. Twenty-four years. I need you as a consultant.
I've been on it for about 24 days.
Mr. Stokes. You'll do fine, Mr. Chairman.
Mr. Regula. Lou's out practicing law in Cleveland, Ohio. He
did a lot of good things, not only here, but the other
committees, and we're happy that you're here today.
Just a few of the rules. We have the boxes here which are
timekeepers. I hate to do it, but we have to. We have about 28
today, and we've had 28 most every--this is the sixth day. I
think it's indicative of the great interest that the public has
in this Committee, is the fact that we've had so many, and then
on top of that, we had to have a lottery to decide who would
get to be even a public witness, because the requests are far
more than we can accommodate. But it's great that you bring
these things to our attention.
The boxes will be green and then it goes to amber, which
means you've got a minute to wrap up, and then the red light
goes on and the buzzer. So we regret it has to be that way, but
we'll do the best we can to get all the evidence in.
I see Nancy has arrived. Would you like to introduce your
former Chairman?
Mrs. Pelosi. It would be an honor.
Mr. Regula. Okay. I don't know whether to call you Chairman
or former Congressman or lawyer. You have a selection of
titles, Lou, but I like to call you best of all friend. That's
the one I like.
Mr. Stokes. And that's something that means a great deal to
me, Mr. Chairman, the friendship that you and I share, and the
friendship you shared also with my late brother, Carl, with
whom you served in Ohio.
Mr. Regula. That's right. Lou's brother Carl was the first
African American mayor of a major city in the United States, he
was mayor of Cleveland. I sat beside him in the State House of
Representatives, and we became very good friends. In fact, he
endorsed me. [Laughter.]
And he's a Democrat in Canton District. So see, Steny,
there's an opportunity for you. [Laughter.]
Mr. Hoyer. You never can tell.
Mr. Regula. I think, Nancy, you came close once. You were
out there, weren't you, at that meeting?
Mrs. Pelosi. Yes, Mr. Chairman, I remember it well. And so
do you. [Laughter.]
Mr. Regula. Okay, well, Mrs. Pelosi, will you introduce our
first witness this morning?
Mrs. Pelosi. Mr. Chairman, this is a very great honor, as I
know that any one of my colleagues would attest to. As you
indicated in your opening remarks, this is almost a family
affair for all of us, for Steny, for Jesse, because when Lou
comes to the Committee, he not only comes personally, but he
brings a great tradition with him.
You talked about Carl, and I have my connection, too, my
brother, Thomas D'Alessandro was a very close friend of Carl.
They were both mayors in that very difficult time in our
country's history, both young mayors. And they had a very, very
close personal bond.
I always used to say to Lou when I came here, I one day
would love to meet your mother, she has to be the greatest mom
in the world to have produced two great sons. Now the
courthouse is--is it this Saturday?
Mr. Stokes. It was this past Sunday.
Mrs. Pelosi. This past Sunday, it was dedicated in Ohio in
honor of her in her name. So with all of that personal and
political history, I'm pleased to welcome our former colleague,
Lou Stokes, behind whom and under whose leadership it was a
pleasure to serve here and in other committees in the Congress.
Congressman served in the Congress for 30 years, my friends,
for those younger people here who don't know, 30 years, 1969 to
1999. He spent many of those years as a member of this
Subcommittee.
He's currently senior counsel of the law firm Squire,
Saunders and Dempsey, and is a member of the faculty of Case
Western Reserve University, senior visiting scholar at the
Mandel School of Applied Social Sciences. Congressman Stokes is
also a member of the board of advisors for the Trust for
America's Health, which brings him here today. He will describe
what it is, so I won't take any time to do that.
But Congressman Stokes and the Trust for America's Health
have shown great leadership in the effort to improve our
Nation's response to environmental health hazards. As Iwelcome
him, I want to say that in welcoming Lou Stokes to this Committee, I am
welcoming the best that America has to offer.
Our chairman, Mr. Stokes.
Mr. Hoyer. Mr. Chairman?
Mr. Regula. Mr. Hoyer.
Mr. Hoyer. Thank you. I want to join Nancy's remarks.
Before you got here, Nancy, I indicated to our audience that I
had the great privilege and honor of sitting next to Lou for
many years as he served on this Committee. He and his brother
and family have been giants on behalf of so many different
issues.
But clearly, every young African American child in America
can have an extraordinary role model in Lou Stokes. As I sat
next to him, as you know, Mr. Chairman, you didn't serve on
this Committee, so you didn't have the privilege of seeing him,
but whether it's the historically black colleges dealing with
higher education, or it was in TRIO, or it was in primary and
secondary education programs, or whether it was dealing with
employees at NIH who were aspiring to be treated on the basis
of their character, their talent and their contribution rather
than the color of their skin, Lou Stokes has been and continues
to be a giant on behalf of all Americans.
I want to join Nancy in welcoming him to this Committee.
His leadership was a powerful, it was a quiet leadership, a
leadership of conscience and of character, not of bluster and
power, which made it even more powerful because of that. And
Lou, all of us who know you are honored to be your friend and
honored to have served with you. I join Nancy and Ralph and
Jesse in welcoming you to the Committee.
Mr. Regula. Mr. Jackson.
Mr. Jackson. Thank you, Mr. Chairman.
Let me just say that we run the danger this morning with
all of the accolades that we could bestow upon Mr. Stokes, of
the kind things that all of us who have had the opportunity to
work with him, who have witnessed him from afar, and those of
us who for the very brief tenures that we've been in the
institution have had the great opportunity and privilege of
working with Mr. Stokes, we run the danger this morning of our
accolades being much longer than your testimony. [Laughter.]
When I first came to this Committee, I came really as the
successor to Lou Stokes. Many of the programs that I champion
and argue for on this Committee were programs that Lou Stokes
one, authored as a member of this institution, shepherded the
legislation through the process, and then, on this Committee,
fought to make sure that those programs were fully funded.
The outstanding work that his family has done, his brother
as mayor of Cleveland, the Congressman himself here in the
United States institution, there are very few people who have
earned the respect of both sides of the aisle like Congressman
Lou Stokes.
I remember when he announced his retirement, and many of us
went to the Floor essentially to say goodbye to Mr. Stokes, the
outpouring from both sides of the aisle was nothing less than
astounding. I've seen other members of Congress who served the
same amount of time in the institution, and literally within 15
or 20 minutes, whatever accolades were being bestowed upon
them, essentially the special order was essentially over. We
could have spent the entire day, maybe even the entire week,
talking about the contributions that Lou Stokes has made to
this Nation.
I'm indeed honored that you're before our Committee, and
I'm equally as honored to have the great privilege of trying my
very best to follow in my footsteps on the Committee. I'm very
grateful, Mr. Stokes.
Mr. Stokes. Thank you.
Mrs. Pelosi. This isn't about Mr. Stokes' contribution to
this Committee, but it's important to note that he was the
chair of the Ethics Committee, he was the chair of the
Intelligence Committee, and all that that implies in terms of
the changes. As the Ranking on Intelligence now, I can speak to
all that he has done to, as far as diversity is concerned in
that community as well. He has pioneered so many fronts, he's
the all American boy. We could again take all day to talk about
him.
Mr. Jackson. I believe he was also lead investigator on the
assassination of Martin Luther King, Jr., lead investigator on
the assassination of John F. Kennedy, as well. So for those of
you who are here, it's really a great privilege and a great
honor for those are here and are very unfamiliar with our
Committee to be in the presence of Mr. Stokes.
Thank you, Mr. Chairman.
Mr. Regula. Well, it's not only that, you go to Cleveland,
every other street is a Stokes Boulevard. [Laughter.]
And the Stokes VA clinic, and I don't know, is there
anything left to name up there? Between you and Carl and your
mother, I guess you skipped the Terminal Tower. But you've done
well. Lou, we're happy to welcome you.
Mr. Stokes. Mr. Chairman and Mr. Hoyer, Mrs. Pelosi and Mr.
Jackson, I'm indeed overwhelmed.
Mr. Regula. And we have a new member down here, Mr.
Sherwood.
Mr. Stokes. Mr. Sherwood.
Mr. Regula. He's the newest member of our Subcommittee.
Mr. Stokes. Greetings, Mr. Sherwood.
Obviously I'm overwhelmed, your kindness and your kind
remarks this morning have indeed overwhelmed me. It's difficult
to even say to you what it meant to walk back into this room
where I spent 24 of the 30 years that I served on the
Appropriations Committee. It is a part of my life, and I
suppose will always remain a part of my life, as will the
personal friendships I had with each one of you.
We've spoken, Mr. Chairman, of the great friendship you
had, not only with me but with my brother, Carl, with whom you
served. And Mr. Hoyer, I remember even you were out in Ohio
when my daughter was running for judgeship out there, and you
shared that experience with us. She's still on the bench, and
enjoying it, thanks to you and others.
Mrs. Pelosi, as you mentioned, your brother and my brother
were mayors at the same time, and they were great friends. You
enjoyed a special relationship also with my brother Carl.
And Mr. Jackson, in your case, your father, Rev. Jesse
Jackson, was highly instrumental when Dr. King came to
Cleveland and walked the streets of Cleveland, to register
voters in a way that they were able to elect Carl Stokes as
mayor of Cleveland and set history. Your father was one of the
young lieutenants that Dr. King brought with him. And your
father over the years was a part of everything that Carl and I
did in that city.
It was a great honor for me to counsel with you about the
fact that when I was leaving here, that this would be a great
subcommittee for you to get on. I hear such wonderful things
about what you're doing in terms of carrying on the work that I
endeavored to do over the years.
Mr. Chairman, I'm indeed honored to be here this morning.
Mr. Chairman and members of the subcommittee, I'm currently
serving on the board of a new public health organization called
the Trust for America's Health. A former chairman of this
Committee, John Porter, and Governor Lowell Weicker are also on
this board.
The Trust's mission is to put prevention back into the
fight against chronic diseases. I serve on the Pew
Environmental and Health Commission, located at Johns Hopkins
Hospital. Based on the Commission's recommendation, the Trust's
first initiative is to fight for the creation of a nationwide
health tracking network to track chronic diseases. Today,
chronic diseases such as cancer, asthma, leukemia, birth
defects and Parkinsons kill four out of five Americans. More
than a third of our population, 100 million women, children and
men suffer from chronic diseases. These diseases annually cost
our country $325 billion.
Yet there is no national system to track these killer
diseases. Our Federal and State agencies only coordinate
tracking infectious diseases: polio, typhoid and yellow fever,
diseases that a national tracking system helped to eradicate.
Chairman Regula, let me give you some examples from our
home State of Ohio. Even though asthma attacks are the number
one cause of school absenteeism, and asthma has increased 75
percent between 1980 and 1994, Ohio does not track this
disease. Ohio does not track cerebral palsy, autism and mental
retardation, even though the National Academy of Sciences
estimates that 25 percent of these diseases in children are
caused by environmental factors.
Although birth defects are the leading cause of infant
mortality, Ohio does not have a birth defects registry. Even
though multiple sclerosis has increased by about 20 percent
between 1986 and 1995, Ohio does not track this disease. And
unfortunately, Ohio is not unusual, it is the norm.
To fill this void, the Pew Commission proposed a nationwide
health tracking network. The network involves three basic
features. The first feature establishes and coordinates local,
State, and Federal health agencies to collect vital data. This
data becomes part of a national system to track and monitor
priority chronic diseases and potentially related environmental
factors.
The second is an early warning system that would identify
environmental health threats in their earliest stages and give
public health officials valuable data about health risks, such
as lead poisoning. This network would be similar to the
existing system that informs communities about infectious
disease outbreaks.
The final piece consists of enhancing and coordinating
local, State and Federal health officials into rapid response
teams to quickly investigate clusters and outbreaks. The
response system would include regional programs to investigate
local health problems and centers at our universities to assist
with research and data analysis. The network would provide our
doctors and hospitals, public health officials and communities,
with data on patterns and possible environmental factors to
enable them to form preventive strategies.
Currently, chronic diseases cost our country $325 billion
annually and are expected to reach $1 trillion in 15 years.
These medical costs could be reduced significantly if we had
data to prevent the onset of these diseases. The network has
estimated the cost at about $275 million, or less than $1 for
every man, woman and child in America. This investment is
necessary now to stem the crushing medical costs to our
country.
This subcommittee and the Administration have rightfully
doubled the investment in NIH. But we need to fund a network to
give our NIH scientists the data they need. As a Nation, we can
track birds and people with West Nile virus and the ebola virus
on another continent. But we still can't track asthma.
In the fiscal year 2001 budget, this subcommittee asked the
CDC to research developing a network and expects the CDC to
present the findings during this year. Now I am asking this
subcommittee to finish what you have already begun. Please make
the investment in this basic public health tracking tool. Only
with your help can we pull our health tracking system into the
21st century and win the war against chronic diseases that
cause so much human suffering.
I thank you for the privilege of testifying.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Lou, where would you think we should
put this kind of a record keeping, data collecting, in NIH or
CDC or HHS?
Mr. Stokes. I would think probably, Mr. Chairman, that CDC
ought to be the appropriate agency here. And as I said, in the
2001 budget, the subcommittee asked CDC to look into this
matter and report back to the subcommittee. I would think that
they would probably be the correct one, the Centers for Disease
Control.
Mr. Regula. Right. Questions? Mrs. Pelosi.
Mrs. Pelosi. Just a comment, Mr. Chairman. I thank--it's
music to our ears to hear the maestro sing this song. Because
this is such an important issue and you've worked on it so many
years, Mr. Stokes.
I just want to call the Chairman's attention, this subject
came up, whether it was yesterday or the day before, when we
were talking about the Sugar Law Guild Center, where they
talked about tracking, and especially in minority communities,
which are disproportionately affected by some of this, and the
tracking will give us the data to verify that.
But again, this was the only hearing that we had in this
Committee, was on this subject, environmental health, and the
issue of tracking was very, very important in that, the asthma,
and how it affects children especially, is really a
responsibility we have to get to the bottom of.
So there's a connection to all of this. The non-profit
community is playing a very major role, and with the prestige
of Mr. Stokes, I'm sure we're going to find an answer to this.
Thank you, Mr. Chairman. Thank you, Mr. Stokes.
Mr. Stokes. Thank you very much.
Mr. Regula. I checked with the staff, of course, as you
know, the bill didn't get finished until December, early
December or late November. Anyway, we don't have a report back
yet, but we anticipate that coming this year, the response to
the Committee's action.
Mr. Stokes. Good.
Mr. Regula. Any other questions?
If not, thank you, Lou. We're happy to welcome you back
here.
Mr. Stokes. Thank you so much.
Mr. Regula. It's a great idea.
----------
Thursday, March 22, 2001.
SAFER FOUNDATION
WITNESS
DIANE WILLIAMS, PRESIDENT AND CEO, SAFER FOUNDATION
Mr. Regula. We'll move on. Next, Mr. Jackson will introduce
Diane Williams.
Mr. Jackson. Mr. Chairman, as President of the Safer
Foundation, a position she has held for four years, Diane
Williams heads the Nation's leading non-profit provider of
social services, education and job opportunities, exclusively
targeting ex-offenders. Ms. Williams' association with Safer
began in the 1970s as a volunteer, then serving on the agency's
board of directors and as the vice president for development
and strategic initiatives.
Before she began her tenure at Safer, Ms. Williams was
marketing director for the enhanced business unit at Ameritech,
and she has held executive positions at AT&T and Rockwell
International. Ms. Williams is an accomplished speaker in the
areas of criminal justice policy, community corrections
strategy, as well as prevention and basic education programming
for adult and juvenile ex-offenders.
She has been profiled in the Chicago Tribune, Chicago Sun
Times, and her televised appearances include talk shows aired
on CBS, NBC and WGN. In 1994, Diane was named the best and
brightest among business executives by Dollars and Sense
Magazine. Ms. Williams earned an MBA from Northwestern
University and serves as an adjunct professor in marketing at
Aurora College.
Mr. Chairman and members of the Subcommittee, I present Ms.
Diane Williams.
Ms. Williams. Thank you, Congressman Jackson and Mr.
Chairman, for allowing me to present the Safer Foundation to
you today. You heard a long list of things that I've done, and
this that I do today and throughout my time at the Safer
Foundation is the most important work that I've done in my
career. So you scare me to death when I come here and present
this subject today.
The Safer Foundation is a not-for-profit organization that
works to reduce recidivism by supporting the efforts of former
offenders to become productive, law-abiding members of their
communities. We provide a full spectrum of services, including
education, employment and case management.
Established in 1972, with facilities in Chicago, Rock
Island, Illinois and Davenport, Iowa, Safer has placed clients
in over 40,000 jobs and is the largest community based provider
of employment services for ex-offenders in this country. The
Nation's prison population you know is on the rise. Over
600,000 men, women and youth are released from institutions
each year.
When ex-offenders come out of the correction system, they
often have a variety of needs, as does the community have a
variety of needs around helping them to re-integrate into
society. All too often, many ex-offenders do not secure
permanent, unsubsidized employment, because they lack
occupational skills, have little or no job hunting experience,
or find that many employers refuse to hire those with criminal
records. Without a strong support system in place, all too
often ex-offenders fall back into the criminal subculture. They
do what they know how to do best.
The re-entry partnerships initiative begun in 1999 is a
Federal demonstration that assists eight States in confronting
the challenges presented by the return of offenders from prison
to the community. Funded through the Department of Justice, the
Department of Labor and the Department of Health and Human
Services, re-entry partnerships include identification of the
appropriate re-entry offender population, surveillance and
monitoring, community based support resources, and coordination
between the criminal justice system and the employment, social
services and treatment systems.
The Safer Foundation respectfully requests that the
subcommittee continue to support and to expand this important
initiative.
Safer is also committed to bridging the gaps that preclude
the ex-offender population from successfully living in the
community. We do that by providing, as we said, employment
services geared to make successful job placements. We have
employment specialists who work with our clients to complete
job applications, to train them on how to behave inthe
interview process, but even more importantly, to train them on how to
behave in the job once achieved, so that they might not only be placed
in employment, but retain that employment for a long, successful period
of time.
We have focused lots of our efforts on what we call a
lifeguard position, which supports that client around those
issues that arise while working sometimes or often for the
first time when you're working, how you interact with your
supervisor, how to work with other people and how to keep up
your commitment as a team member in that work environment.
The one on one relationship provided by our job developers
is critical as we transition or assist to transition people
into the mainstream. In addition to offering job training and
placement, Safer also offers education programs. Current
research indicates that the more education an offender has, the
less likely they are to return to prison. Our youth empowerment
program is one of Safer's most effective education programs,
both in terms of helping clients earn their GEDs and also in
reducing recidivism.
Sixteen to 21 year olds are referred by probation and
parole officers, or word of mouth, and are placed in this
program which is designed to help students continue their
education and training after Safer. Rather than provide
traditional classroom instruction, which we know has been a
failure for the clients that we serve, we offer an approach
that's considered peer tutoring, or in today's more appropriate
terminology, cooperative education. We started it before there
was such a term as cooperative education.
In addition to learning basic skills to prepare for taking
the GED, these youthful ex-offenders learn problem solving
skills that are needed to succeed in the world of work and
community, increase their level of confidence in their ability
to learn and to make and sustain constructive life changes. Of
the over 300 students that have participated in our youth
empowerment program, 81 percent complete the program. And their
academic progress increased 12.5 percent from pre to post GED
readiness. This is the equivalent of three grade levels in an
eight week period of time.
Of the students who finish the program, 50 percent passed
the GED exam the first time they took it, a pass rate well
above the State average, and actually the norm that the country
averages. Nearly 200 of the students who completed the training
were placed in either higher education, vocational training or
jobs, and 95 percent completed at least 30 days retention in
their placements.
Perhaps most significantly, our three year recidivism rate
for the youth empowerment program is only 21.4 percent, less
than half of the Illinois juvenile rate of 51 percent for the
same period.
We are in the process of building a program on the south
side of Chicago because three out of the four students that
apply for our program today are denied access to the program.
We are asking your support in continuing that project that
Congressman Jackson was very instrumental in helping us to
start this year. Thank you.
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Mr. Regula. Thank you.
How far out do you reach? Do you go beyond Illinois?
Ms. Williams. We've gone into Illinois and Iowa, have not
gone beyond those two States today. It is interesting that you
ask that question, Mr. Chairman, because a number of other
folks are asking us about coming to States where they serve.
Mr. Regula. I think I heard you say that among juveniles,
the recidivism rate is 51 percent?
Ms. Williams. In the State of Illinois, for the 16 to 21
year old age group, that's correct.
Mr. Regula. I suspect it's even higher--I was on the Ohio
Crime Commission, and at that time it was 75 percent in the
adult population. That's tragic.
Ms. Williams. It is tragic. On the adult side, we have in
Illinois, it's almost 50 percent. Our recidivism rate for the
adult population that we serve is 17 percent. So we do help
people.
Mr. Regula. The ones you serve are at 17 percent?
Ms. Williams. That's correct.
Mr. Regula. Those that are outside the system, it's
probably much higher.
Ms. Williams. That's correct.
Mr. Regula. Any other questions? Yes, Mr. Kennedy.
Mr. Kennedy. Yes, Mr. Chairman, I want to commend the good
work that's being done, just say, we have a permanent prison
class in this country right now, 2 million people in jail.
These people are going to have to come out. And the thought
that we as a Nation have not come to grips with what that's
going to mean, I mean, these are people with a record. They're
going to be living in our society, trying to get jobs, trying
to get re-integrated. I mean, we're going to pay the price as a
Nation if we don't come up with a better solution than we have
now for helping them re-integrated into the community.
And every one of those people that you're saving is also, I
would venture to say, many families who might otherwise be
victimized by this person that you're saving, a lot of
heartache and grief. So I think you're doing more than our own
criminal justice system is doing to help keep our communities
safer. And I want to thank you for the good work you're doing.
Ms. Williams. Thank you very much.
Mr. Regula. Thank you.
----------
Thursday, March 22, 2001.
MARYLAND STATE DEPARTMENT OF EDUCATION
WITNESS
NANCY S. GRASMICK, MARYLAND STATE SUPERINTENDENT OF SCHOOLS, MARYLAND
STATE DEPARTMENT OF EDUCATION
Mr. Regula. Our next witness, Mr. Hoyer will introduce Dr.
Nancy Grasmick.
Mr. Hoyer. Thank you very much, Mr. Chairman.
While Dr. Grasmick is coming forward, I'll start to
introduce her. Dr. Grasmick has been superintendent of schools
in Maryland since 1991, for over a decade. Nancy, are you the
longest serving superintendent in the United States now?
Ms. Grasmick. There's one other that's longer.
Mr. Hoyer. Dr. Grasmick is a graduate of Johns Hopkins
University, Towson and of Gallaudet. So she has a very broad
background and a lot of ways to communicate with people, and
does so extraordinarily well on behalf of children and on
behalf of families.
I'm not objective when it comes to Dr. Grasmick, I must
say, because Judy, my wife Judy and Nancy were at Towson
together, and graduated together and worked together throughout
their professional careers and frankly, until Judy died. Dr.
Grasmick has received too many awards, Mr. Chairman, for me to
articulate. But if you read her resume, she has been cited as
one of Maryland's most outstanding leaders, one of the Nation's
most outstanding educators, has been cited, as I say, both by
National and State organizations for her work and leadership in
education.
She has been the superintendent, which is, by the way,
selected by our board, under two governors. She is the only
person that I know of that was the secretary of two departments
at the same time in the State of Maryland. She was with
Juvenile Family--what was the name of it, Nancy?
Ms. Grasmick. The Office for Children, Youth and Families.
Mr. Hoyer. The Office of Children, Youth and Families,
which we have a similar one, as well as the superintendent of
schools, an extraordinarily accomplishment. She has been
recognized by her peers throughout the Nation as somebody who
has brought a commitment to quality education and to
accountability, which is being discussed, properly so, so
widely.
So I'm pleased on behalf of all the Committee to welcome
Dr. Grasmick to our Committee, and look forward to her
testimony.
Ms. Grasmick. Thank you. Thank you, Mr. Hoyer. It's really
an honor to be here and testify before you, Mr. Chairman, and
members of the Committee.
It is also an honor to perpetuate the vision of an
extraordinary woman, Judy Hoyer, who was such a champion and
pioneer for young children in the State of Maryland. In her
honor, and because of her incredible work, we have created in
the State of Maryland a concept known as the Judy Center.
As you begin your work on the fiscal year 2002 budget, I'm
asking that you give consideration to nationally replicating
this incredible collaborative full service program for all of
America's young children. What is a Judy Center? It is a
comprehensive early childhood education program, which is
coupled with family support services for children birth through
six years of age and their families. It is either located in a
public school or located in a facility in close proximity to an
elementary school.
Currently in the State of Maryland, our Judy Centers are
serving over 4,400 of these young children. Over the years,
Government has been dedicated to generating program after
program, wonderful programs, for young children and their
families. However, these programs have been generated in a
piece-meal fashion where they are scattered across communities,
where space is sometimes the primary consideration of where
they will be located.
Often citizens do not know of the existence of these
services and they don't have the capability to access them.
Imagine needing three or four different services for your
child, but you don't have transportation to even get to one
service. It can be a daunting task, and sometimes the
conclusion is, it's easier not to participate than to try to
figure out how to access these services.
This is the wonderful part of the Judy Centers. We take the
best part of Government, all of the helpful services being
generated, and make them accessible to families. This is cost
effective, it provides services to our citizens, but in
addition to that, it provides for cost avoidance. In the State
of Maryland, we are spending more than $328 million a year of
State and Federal funding to help children catch up as they
matriculate through their school career.
We're all aware of the current brain research talking about
the potential for learning that young children have. In
Maryland, we've created a kindergarten work sampling system,
and we have concluded that 40 percent of the children entering
kindergarten in the State of Maryland are not ready to learn as
we've defined it as a national goal. These Judy Centers offer
full day, full year services, including kindergarten, pre-
kindergarten, therapeutic nurseries, special education
services, infant and toddler programs, before and after school
child care, Head Start, Family Support Centers, Healthy
Families, parent involvement programs, community health
programs. It builds a continuum of education and support
services from birth through school entry.
Thirteen of our 24 jurisdictions in the State of Maryland
currently have Judy Centers. We anticipate the expansion very
soon. Why do these centers work? In addition to the reasons
I've already cited, they are results oriented, strong
accountability for outcomes, program accreditation is a
requirement for all of the programs contained in these centers.
Family support services are required. Project coordination and
case management services are essential.
Finally, it brings together a whole community of
professionals. And I would say that all of us in this room know
that education is the bridge to opportunity. The Judy Centers
help young children and their families take those first steps
on that bridge.
Thank you.
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Mr. Regula. Thank you. That's a wonderful legacy for Judy
Hoyer.
A couple of questions. Can you use Title I or do you use
Head Start money to finance these? How do you handle that?
Ms. Grasmick. We cobble together a lot of the dollars that
we receive. Yes, we do use Head Start monies for a portion of
this, and yes, we do use some of our Title I funding for a
portion of this. Certainly we do that. But it's all of the
collateral services that make these so special that often are
not funded.
Mr. Regula. Do you use volunteers at all, medical personnel
or consultants?
Ms. Grasmick. We have medical personnel, we have the
presence of higher education in terms of doing professional
development for the individuals who work in these centers. So
there's a K-16 relationship, as well as social workers, health
professionals, etc.
Mr. Regula. Another aside. Do you do testing in the
Maryland system?
Ms. Grasmick. We certainly do, throughout the school career
of children. I'm proud to say in quality counts, which is the
national assessment of all 50 States, Maryland was rated number
one with a score of 98 for its assessment accountability and
standards.
Mr. Regula. Questions?
Mr. Hoyer. She's terrific, isn't she? [Laughter.]
Obviously I'm not very subjective on this issue, Mr.
Chairman, I admit to that. But I know those of my colleagues
who have served on this Committee for some time, Nita Lowey and
I particularly, talking about comprehensive schools, and in Dr.
Grasmick's testimony, this is not necessarily a program that
costs more money. What it seeks to do, we have at the Federal
and State levels a lot of programs that all of us have
sponsored or supported, that have a multiplicity of parents who
are all very proud of those programs.
The problem that Judy had and that others have at the local
level is looking sort of at this array of programs that are
designed to help Mary Jane or Johnny Brown. But the complexity
of getting from HHS, Department of Education, Department of
Transportation, Department of Agriculture, HUD and other
agencies who have resources available to help children learn
better and to help their families be more functional and
therefore have the family unit and the child ready to learn and
learning well, is a challenge.
I will be introducing in the next couple of weeks the Full
Service Community Schools Act of 2001. I put $500,000 in this
bill about five years ago, for the purposes of having a study
done by HHS and the Department of Education on how to better do
this. They came out with a report, we didn't implement it as
quickly as we could.
The Governor and Judy, the present Governor, who was then
county executive of Prince George's County, and Governor
Schaffer, then our Governor, very close to Dr. Grasmick, and
Judy put together a similar center in Prince George's County,
Mr. Chairman, and that has served as the model for this program
that Dr. Grasmick and Governor Glendenning put together. In
fact, it was Governor Glendenning's suggestion to name these
the Judy Centers, which he thought was much more family
friendly than the actual title of the bill, which was the
Judith B. Hoyer Early Child Care and Education Act.
But Dr. Grasmick, I want to thank you so very much for the
leadership and commitment that you have shown in making sure
not just that this program works, but that we are effectively
reaching out to every child, and that like President Bush says,
we cannot afford to leave a child behind.
Thank you for being here, and thank you for your
leadership.
Ms. Grasmick. Thank you, Congressman.
Mr. Regula. Mrs. Pelosi.
Mrs. Pelosi. Mr. Chairman, I know usually you don't want us
to have too many comments, but very briefly, I want to join
Congressman Hoyer in welcoming Dr. Grasmick. Her reputation in
Maryland is well established for a long time. As Steny pointed
out in his opening remarks, her qualifications are exquisite.
But I just want to thank you for this model, which as
anyone who knew and loved Judy would know how much this means
to her. I want to thank you and Mr. Hoyer for your leadership
on this. Your successful implementation of it serves as a model
to the rest of the country. For that we're all grateful. Thank
you.
Ms. Grasmick. Thank you.
Mr. Regula. Thank you for being here.
We have a motion to adjourn on the Floor. If everybody
could go over and get back quickly. I think Mr. Jackson--Mr.
Peterson will do one other one until you get back and introduce
your witness. I think, Mr. Hoyer, you have some, too.
Mr. Hoyer. I'll go vote.
Mr. Regula. So we will do one, then we'll go to yours, Mr.
Jackson.
----------
Thursday, March 22, 2001.
MINORITY HEALTH PROFESSIONS SCHOOLS
WITNESS
RONNY B. LANCASTER, MBA, J.D., PRESIDENT, ASSOCIATION OF MINORITY
HEALTH PROFESSIONS SCHOOLS
Mr. Regula. Okay, we'll get started. Mr. Jackson, if you'd
like to introduce your guest today, Mr. Ronny Lancaster.
Mr. Jackson. Thank you, Mr. Chairman.
Mr. Chairman, thank you for the opportunity to introduce
Ronny Lancaster. Mr. Lancaster is the Senior Vice President for
Management and Policy at the Morehouse School of Medicine, and
the President of the Association of Minority Health Professions
Schools. Mr. Chairman, the Association of Minority Health
Professions Schools is comprised of the Nation's 12
historically black medical, dental, pharmacy and veterinary
schools. Combined, these institutions have graduated 50 percent
of all African American physicians and dentists, 60 percent of
all African American pharmacists, and 75 percent of all African
American veterinarians.
Mr. Chairman, working closely with the Association in the
106th Congress, we were successful in passing legislation
establishing the National Center for Minority Health and Health
Disparities at the NIH. Following the passage of this
legislation, this subcommittee included a line item
appropriation of $130 million in fiscal year 2001. Mr.
Chairman, members of the subcommittee, I want to thank Mr.
Lancaster and the Association of Minority Health Professions
Schools for their commitment to improving the health status of
all Americans, and I look forward to working with Mr.
Lancaster.
Mr. Lancaster, welcome to the subcommittee.
Mr. Lancaster. Thank you, Mr. Jackson.
Thank you, Mr. Chairman, and good morning to you and
members of the subcommittee and to Mr. Jackson.
Mr. Chairman, it's an honor to appear before the
subcommittee this morning, and thank you for the opportunity.
It is an honor to be introduced by any member of Congress, and
a privilege to be introduced by Congressman Jackson, a member
not only of this subcommittee, but a member who has
distinguished himself in that in just a second term he has
successfully sponsored legislation which leads to the
improvement of lives for millions of Americans in our
association and the Nation. We owe Mr. Jackson and his
colleagues a debt of gratitude for their hard work, their
vision and their commitment in accomplishing this most
important objective.
Our association also welcomes you, Mr. Chairman, and we
look forward to a long association during your tenure as Chair.
We ask that the record reflect our deep appreciation to
Chairman John Porter who led this subcommittee with
distinction.
Mr. Chairman, before beginning my formal testimony, I'd
like the opportunity, very briefly, to introduce the gentleman
to my left, your right. This is Dr. John E. Maupin, President
of Meharry Medical College. It will be my privilege to hand
over the gavel as president of this association to Dr. Maupin
in about two weeks.
Mr. Chairman, you may know, and interestingly, Mrs. Pelosi
mentioned in introducing Mr. Stokes, she referred simply to
difficult days in our Nation's history. We, I think, all
recognize that our history has been punctuated by glorious
moments, and yet simultaneously, unfortunately, there have been
difficult times. Meharry Medical College stands alone with
Howard University School of Medicine as only two universities
in this Nation where for almost eight decades, these were the
only medical schools in the country where African American and
other students were allowed to go for medical education. So it
is a privilege to introduce Dr. Maupin, and again a privilege
to hand the gavel to him.
Mr. Chairman, I'm here this morning to ask the support of
the subcommittee for three areas. These include support for the
continuation of the doubling effort for the National Institutes
of Health, support for the Title III program which is
administered by the U.S. Department of Education, and finally,
support for a group of programs administered by the Health
Resources and Services Administration, HRSA, collectively
referred to as Health Professions Programs.
To go through these, just a word about each of these
quickly, Mr. Chairman. Support for the doubling of the
appropriation to support the National Institutes of Health is
nearly universal. We add our voice to that chorus. The National
Institutes of Health has done a magnificent job in leading the
world in scientific inquiry and discovery, leading in turn to
the improved health status of many Americans.
Regrettably, despite the success, NIH has not done as good
a job focusing on the important subject of minority health and
health disparities. Now, thanks to the leadership of Mr.
Jackson and Congressman Charlie Norwood, and the strong support
of Republican and Democratic leaders in both chambers, we now
have at NIH a new national center for minority health and
health disparities charged with examining these very important
issues.
So we support a 16 percent increase for NIH and request
also a funding level of $200 million for this new center, to
enable it to conduct the important work for which it has been
charged.
Secondly, Mr. Chairman, with respect to the Title III
program, this program is authorized by Title III of the Higher
Education Act, commonly referred to as Title III, and its
purpose simply is to strengthen historically black graduate
institutions by establishing and strengthening program
development offices, helping to initiate endowment campaigns at
those institutions, strengthening information technology
programs and finally, strengthening their library capacity.
And finally, Mr. Chairman, I will say also, we are very
appreciative to this subcommittee for their very strong support
of this program last year, and we request support again in this
program at the level of $60 million.
Finally, in the area of health professions, we ask your
support for the group of programs collectively referred to as
Health Professions, programs such as the Health Careers
Opportunities Program, HCOP, which encourages minority and
underprivileged youth to consider careers in health
professions, another program, Scholarships for Disadvantaged
Students, which makes it possible for these students, frankly,
to receive an education. And finally, Centers of Excellence
programs, which seeks to support a level of excellence at each
of our institutions.
These programs, Mr. Chairman, collectively, without
exaggeration, are the difference at our institutions between
the doors being open and closed.
So in closing, Mr. Chairman, once again I'd like to thank
Mr. Porter for his leadership in the past. I'd like to thank
Mr. Jackson for the privilege of introducing me this morning.
And finally, thank you, Mr. Chairman, for the privilege of
appearing this morning. Welcome, and we look forward to working
with you during your tenure.
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Mr. Regula. Thank you.
How many institutions do you represent?
Mr. Lancaster. There are nine institutions, Mr. Chairman,
with twelve graduate programs at these nine institutions. These
institutions are located throughout the country.
Mr. Regula. Are these exclusively African Americans, or do
you have a mixture of student body?
Mr. Lancaster. They all have a history in the African
American tradition, that is to say, they are HBCUs. But, it's
really important to emphasize that each of our institutions
admit a wide range of students. My institution, for example,
the Morehouse School of Medicine, 80 percent are African
American students, approximately 10 percent are Hispanic and 10
percent are white.
Mr. Regula. Okay, thank you.
Mr. Jackson, questions?
Thank you for coming.
Mr. Lancaster. Thank you, Mr. Chairman.
----------
Thursday, March 22, 2001.
SOCIETY FOR INVESTIGATIVE DERMATOLOGY
WITNESSES
LUIS A. DIAZ, M.D., PRESIDENT, THE SOCIETY FOR INVESTIGATIVE
DERMATOLOGY; CHAIRMAN, DEPARTMENT OF DERMATOLOGY, UNIVERSITY OF
NORTH CAROLINA AT CHAPEL HILL
DANIELLE CURTIS
DAVID ZARET
Mr. Regula. Next is Dr. Luis Diaz, The Society for
Investigative Dermatology and Chairman of the Department of
Dermatology, University of North Carolina, and accompanied by
Danielle Curtis and David Zaret.
Dr. Diaz. Thank you, Mr. Chairman, subcommittee members.
On behalf of the Society for Investigative Dermatology, the
thousands of patients with skin diseases and myself, I wish to
thank you, Mr. Chairman, for this opportunity to testify before
your Committee. I am Luis Diaz, President of the Society for
Investigative Dermatology, a dermatologist dedicated to patient
care, skin research and training of dermatologists and
scientists. I work at the University of North Carolina.
On my left is Danielle Curtis, a patient suffering with
vertiligo, an autoimmune disease in which the immune system
destroys the pigment of the cells. On my right is Mr. David
Zaret, a patient suffering from a disease named anthivulgaris,
an autoimmune disease in which the immune system destroys the
skin on the lining of the oral cavity. These diseases were
lethal until the decade of the 1950s.
Complications of treatment of these diseases are serious.
You can imagine the problems that Danielle and David are
suffering every day of their lives.
The mission of the Society for Investigative Dermatology is
to support research in skin diseases, and to facilitate the
training of physicians and scientists of the future. We believe
that scientific research on skin diseases is the best approach
to bring hope and assistance to millions of Americans of all
ages, gender and ethnicity that are currently suffering from
these ailments. Through research, we wish to enhance our
knowledge in prevention, diagnosis and treatment of skin
diseases.
We have four suggestions which are also advocated by the
American Academy of Dermatology, representing all U.S.
dermatologists, and the Coalition of Patient Advocates for Skin
Disease Research, which is composed of 24 organizations
concerned with skin diseases. One, our Society is deeply
grateful to the members of this Committee for our efforts to
double the funding of NIH over five years. We support the
proposal of the Ad Hoc Group for Medical Research Funding,
which calls for a 16.5 percent increase in funding for NIH in
fiscal year 2002 and specifically for the National Institute of
Arthritis, Musculoskeletal and Skin Diseases, NIAMS.
Last year, Congress passed and the President signed a bill
which included a major section regarding clinical research and
loan repayment provisions for young trainees interested in
biomedical research. The pool of physician scientists is
decreasing at an alarming rate in all fields of medicine, and
in dermatology. We request that this Committee provide the
appropriate level of funding for this new, important
legislative initiative.
You would be surprised, Mr. Chairman, the information
regarding total cost to society of a skin disease is not
updated since 1979. Information about incidence, prevalence,
mortality and disability, along with the economic cost is
unavailable. Also unavailable is information about loss of
economic productivity and activities that are foregone as a
result of disease.
A number of Federal agencies collect information about
these matters. We believe a workshop developed under the
auspices of the NIAMS and including representatives of all
various agencies to identify existing information sources on
the causes and scope of skin diseases, and to recommend
strategies to developing new information sources would be very
valuable. Such a workshop would be useful to NIAMS for its own
planning purposes, it would be useful to the field of
dermatology for its use in planning for future research,
manpower and service needs. And it would be very helpful to the
volunteer organizations in informing their constituencies on
patients, for raising funds from the public for research.
If the committee is interested, we would be pleased to work
with your staff regarding bill report language in that regard.
Thank you very much for giving me the opportunity. I am
pleased to answer any questions you may have, Mr. Chairman.
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Mr. Regula. Thank you. Any questions?
Thank you for coming. I see you're headquartered in
Cleveland, is that right? Or the Society is.
Dr. Diaz. In Cleveland, yes.
Mr. Regula. How many members do you have nationwide?
Dr. Diaz. Three thousand.
Mr. Regula. Mostly physicians that treat?
Dr. Diaz. Physicians and scientists working in research in
dermatology.
Mr. Regula. So you get help from NIH?
Dr. Diaz. We get help from NIH, yes.
Mr. Regula. Okay. Thank you for coming.
Dr. Diaz. Thank you very much, Mr. Chairman.
----------
Thursday, March 22, 2001.
RETT SYNDROME ASSOCIATION
WITNESSES
KATHY HUNTER, FOUNDER AND PRESIDENT, INTERNATIONAL RETT SYNDROME
ASSOCIATION
CHERYL DUNIGAN
Mr. Regula. Next, Mr. Hoyer will introduce Kathy Hunter.
Mr. Hoyer. Thank you very much, Mr. Chairman. I also
understand she's joined by Dr. Dunigan.
Mr. Chairman, some years ago, Kathy, when did we do this,
1985?
Ms. Hunter. In 1986.
Mr. Hoyer. In 1986, I spoke with Chairman Natcher, and we
had some testimony about a disease, an affliction that I had no
knowledge of. But I knew a wonderful, and still know, a
wonderful young woman named Christy. And she and I went to
church together.
She at that point in time, I presume, was about seven or
eight years of age. For the first 18 months of her life, she
developed normally, 16, 20 months, developed normally. And then
for some unknown reason, her neurological development not only
stopped, but it went back. And to this day, she has not
progressed much beyond the age of a 14 or 15 month old. Her
body has developed, obviously. She is still a good friend, and
I see her in church from time to time, not as often as she used
to come.
She's a wonderful young woman. She was afflicted with what
we now know is Rett Syndrome. It is a syndrome that affects
young women at that age. The tragedy of course is that it
afflicts a normally growing child that parents have related to
for the first few months of life, thinking that their child was
going to develop fully and normally.
We put $500,000, we didn't earmark it, but we put in, we
asked NIH to look at this. And both Johns Hopkins and Baylor
undertook to look at this syndrome and have now developed,
identified and we are making progress.
Kathy Hunter has a child as well with Rett Syndrome, and
founded an organization to spur research and development, and
parents getting together and talking to one another and making
it easier to cope and to understand and work on behalf of these
afflicted young children. She has done an extraordinary job, as
so many citizens who take unto themselves the personal
responsibility to make a difference. She and her husband have
made an extraordinary difference, and I am pleased to be her
friend and to welcome her to this Committee. She is one of
those advocates on behalf of health of her own child, but on
behalf of thousands and thousands of other children and
parents, and of our society.
John Kennedy once said, in talking about some children with
disabilities that although these children were the victims of
fate, they would not be the victims of our neglect. And
certainly, Kathy Hunter has not neglected these children. Thank
you, Kathy, for all you've done.
Thank you, Mr. Chairman.
Ms. Hunter. We're so appreciative for your leadership and
your advocacy and support and that of the Committee over the
years.
Julia Roberts has just become our national spokesperson,
and we made a film that's now showing on Discovery Health.
Mr. Hoyer. Kathy, if you could tell her that I would
certainly be open to working closely with her as well----
[Laughter.]
Mr. Hoyer. I love seeing you, I want you to know that, I
don't want her as an alternative. But you could bring her to
testify next time.
Ms. Hunter. It would be very helpful to have a pretty
woman, but we're also very happy to have your support.
Mr. Hoyer. Thank you.
Ms. Hunter. Thank you for this opportunity to convey the
importance of increased funding to the National Institutes of
Health to accelerate research on the cause, treatment and cure
for neurological disorders. The International Rett Syndrome
Association joins the biomedical community's efforts to double
the NIH budget by fiscal year 2003 and stands by the request
for a $3.4 billion increase for NIH in fiscal year 2002.
The impact and burden of neurological diseases cannot be
emphasized enough. As I have for the last 16 years, I come
before this Committee to talk about the Rett Syndrome story.
It's the tale of a unique and puzzling brain disorder which
doesn't show its face until the child is about a year old,
andhas achieved normal developmental milestones, and then a frightening
mental and physical deterioration follows.
Rett Syndrome robs its victims of the ability to walk,
speak, and use their hands purposefully. It renders children
incapable of performing the simplest acts of daily living
without total assistance from others. Though rarely fatal, Rett
Syndrome follows a tragic and irreversible course leaving its
victims permanently impaired for life.
Pearl Buck said, ``We learn as much from sorrow as from
joy, as much from illness as from health, as much from handicap
as from advantage and indeed, perhaps more.'' And this is true.
Parents learn many good lessons in their journey with Rett
Syndrome, but our children's suffering does not begin to
balance the knowledge or insight gained from the terrible
tragedy of Rett Syndrome.
My daughter with Rett Syndrome is 27 years old. She's as
tall as my heart.
Think of what it would be like to realize that your child
will never grow up like her brothers or sisters, and imagine
what it's like to provide the kind of care and support required
for an infant, but for a lifetime. But I'm not here to tell you
just about the bad news about Rett Syndrome. I'm here to share
some marvelous news, and that is that last year when I was
here, I told you about the dedication and triumph that led to
the miraculous discovery of the gene for Rett Syndrome. Located
on the X chromosome, this gene produces part of a switch that
shuts off the production of proteins. When these are not shut
off when they should be, the protein over-production causes
nervous system deterioration which you see in Rett Syndrome.
This finding is the first incidence of a human disease
caused by defects in a protein whose function it is to silence
other genes. So in a way, Rett Syndrome is the little disease
that could.
The gene discovery will help us better understand the
disease process in Rett Syndrome and will likely lead to
treatments. Because brain development continues long after
birth and symptoms of Rett Syndrome do not develop for several
months, there's a window of opportunity during infancy in which
we might be able to intervene to prevent further damage,
something we never thought possible before. In fact, clinical
trials based on the gene discovery are already underway.
One of the most thrilling pieces of news is the recent
development, just in the last two weeks, of two animal models
which mimic Rett Syndrome. These mouse models will allow drug
experimentation which may mitigate the damage or improve
function, and will permit post-mortem studies at all stages of
development. Even more exciting, researchers will be able to
study the effects of the mutation in animals who have not yet
developed clinical symptoms. These studies could answer many
questions about the cascading effect of the mutation in the
brain and throughout the body, both before and after birth. The
understanding of these basic molecular changes greatly improves
our understanding of finding prevention and treatment
strategies.
Studies of the mouse have already shown that the genetic
defect is in effect not only during brain development before
birth, but has a critical prolonged effect even after birth.
Since it's easier to treat newborns than to correct defects in
embryonic development, this gives us hope and promise for
future treatments.
Since the first time I came before this Committee, we have
come such a long way. I told you, now I'm wearing reading
glasses and I brought my grandchild with me. So back in 1986,
when NIH funding began, it was a study of a rare and little
understood disorder. It was a pretty risky venture. Work had to
start at the beginning, because this was a disorder that had
nothing more than a name.
Before the gene discovery diagnosing Rett Syndrome before
the age of four or five years was often difficult. Today, we
have a new genetic test to improve the speed and accuracy of
early diagnosis, and people don't have to wait like I did until
my daughter was 10 years old, and also to screen prenatally in
families who already have a child with Rett Syndrome.
Another significant result is the discovery that Rett
Syndrome is not limited to females, as previously thought. It's
now known that while rare, males can have Rett Syndrome, they
die before birth or shortly after birth. So the mutation could
play a major role in non-specific mental retardation in both
males and females. The finding of the MECP2 mutation appears
also in people who do not have Rett Syndrome and this knowledge
leads us to know that it's responsible for milder forms of
mental retardation, and may account for a large number, about
65 percent of people who have mental retardation and have no
known diagnosis for it.
So this rare, little-known disorder that came to your
attention some 16 years ago may have a profound effect that
lasts far beyond Rett Syndrome. The biggest news in this story
is not about Rett Syndrome, it's about those thousands and
thousands of people who fall into that category, the 65 percent
of unknown causes for mental retardation.
So we urge you to increase funding that will bring about a
better tomorrow and a brighter future for people with
neurological disorders. Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Hoyer. I want to again thank you. The bad news is that
this syndrome exists. The good news is, as Kathy indicated,
that we've had recently some extraordinary progress.
I would say to my friend, Don Sherwood, and Patrick
Kennedy, who are both spending their first few days on this
Committee, it is an extraordinary opportunity to assist both
individuals but more importantly, millions of people in the
United States and around the world. Dr. Rett is from
Switzerland, right?
Ms. Hunter. Austria.
Mr. Hoyer. Austria, excuse me. From Austria. He was the
first medical doctor to identify this, but NIH grants to
Hopkins and Baylor have been really the spur that has led to
the discoveries. So it is a good news story as well that we are
on the brink, hopefully, of possibly prevention and perhaps
even amelioration.
Thank you, Kathy. Doctor, thank you.
Thank you, Mr. Chairman.
Mr. Regula. Thank you. Thank you for coming.
----------
Thursday, March 22, 2001.
AMERICAN ACADEMY OF FAMILY PHYSICIANS
WITNESS
JAMES C. MARTIN, M.D., BOARD MEMBER, AMERICAN ACADEMY OF FAMILY
PHYSICIANS
Mr. Regula. Next we have our colleague from San Antonio,
Texas, Mr. Charles Gonzalez, who's going to introduce Dr. James
Martin. Welcome, Mr. Gonzalez.
Mr. Gonzalez. Thank you, Mr. Chairman.
Good morning, Mr. Chairman, members of the Committee. It is
a distinct pleasure, of course, to be introducing someone who
will be testifying here this morning who is from San Antonio.
It's Jim Martin, and as I said, he is from San Antonio, and
he's here representing the American Academy of Family
Physicians, AAFP.
After 20 years of private practice, Dr. Martin now serves
as program director for the Family Residency Program at Santa
Rosa Health Care in San Antonio. He is also a clinical
professor with the University of Texas Health Science Center in
San Antonio. Dr. Martin has been a member of the AAFP since
1976, and currently serves on the board of directors. The AAFP
represents more than 88,000, I believe it may be closer to, or
surpasses now, 90,000 family physicians, family practice
residents and medical students nationwide.
Health profession training programs are vital in the effort
to train more family doctors, especially in medically under-
served communities, much like my district, San Antonio, Texas.
What determines the effectiveness of a Congress is how well
informed are its members. So to Dr. Martin and all other
witnesses that will be testifying today, I commend them. And as
a member of Congress, and even on behalf of this Committee, the
important role that you play to inform us in making the
decisions that better serve our constituents.
And with that, it's a great pleasure to introduce Dr. Jim
Martin of San Antonio.
Dr. Martin. I would like to address three specific funding
issues with you this morning. The first is family medicine
training under Section 747 of the Public Health Safety Act. The
second is the Agency for Health Care Research and Quality, and
the third are the rural public health programs which you now
sponsor.
Before doing that, the Academy has asked me to thank this
Subcommittee for its incredible support for these programs
through the years. We especially appreciate your recognition
last year of the need to enhance the program by additional
funding in fiscal year 2001. The Academy now asks you to also
provide appropriate support for Section 47 by $158 million, $96
million of which will go to family medicine training.
That becomes very important to us, especially at a time
when the Administration budget blueprint suggests that cuts
should occur in these programs. The rationale of the cuts is
based on the presupposition that there already are enough
primary care family physicians, and that the market should be
able to regulate the supply itself. The realities of health
care in American would suggest otherwise, which I would like to
state to you.
First of all, there is a shortage of primary care and
family physicians in America. The Institute of Medicine, the
Council on Graduate Medical Education, and other entities have
long advocated that we have a balanced physician work force, 50
percent primary care physicians, 50 percent subspecialists. By
the most conservative number that I could find, America is
short 20,000 family physicians.
And the markets have not helped us here, in that the number
of students interested in primary care specialties have
decreased over the last four years, and we suspect in the
national residence and matching program that will come out
today that that trend will still continue, with a decreased
interest on the part of medical students.
There is good news. Your Title VII funds have been
effective. The Graham Policy Center has shown very clearly that
students who are in medical schools receiving Title VII funding
are more likely to go into primary care, they're more likely to
go into family medicine, they're more likely to practice in
rural areas, and as Congressman Gonzalez said, they're more
likely to practice in the primary care health profession
shortage areas, or HPSAs, which I will shorten it to at this
point.
A very intriguing study by the Graham Policy Centerlooked
at the HPSAs across the country. There are 3,000 counties in the United
States, 800 of which now are primary care HPSAs. If we take the general
internists, general pediatricians and the obstetrician gynecologists
out of this mix, there become another 176 counties that are HPSA
designated.
If we remove the family physicians, that number goes to
almost 1,500. The conclusion is that family physicians are
responsible for the health care infrastructure of half of the
counties in the United States, and we don't have enough of
them.
Very briefly, I would also ask you to continue to support
the ARHQ programs. We have worked very carefully with them. We
especially appreciate what ARHQ brings to the table in its
research at the practice level. We also appreciate their
commitment to addressing some of the quality and health safety
issues that we now are all concerned about.
For the second the Subcommittee recognized that the
research that's being done here is taking the new discoveries
of the NIH and other basic biomedical technology and
translating that into how we take better care of our patients
at the doctor patient level, and we think this is some
important.
And finally, I ask you also to continue to support the
National Health Care Service, your State offices of rural
health, for the work that they do.
That concludes my remarks. I'd be happy to respond to any
questions that you might have.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I agree with you, there's a real shortage. But
how do you overcome the fact that here comes a student with a
huge debt for education, and obviously, the specialists have
better earning power than the family practice. I don't know if
we can address that simply by saying we want more members in
family practice.
Dr. Martin. Well, they are issues that need to be
addressed. I think that there are individuals out there who
want to be what family doctors and the primary care physicians
do. I think it's important for the medical schools to go back
and look at their admitting policies and try to identify those,
what shall I say, more altruistic individuals who are willing
to take on jobs where they are not paid as well, and where
their work hours are much longer than some of their
subspecialty colleagues.
Mr. Regula. Do you think Medicare's reimbursement rates
tilts this table a little bit?
Dr. Martin. They're certainly not helpful, especially for
those in the rural or the inner city areas, like Congressman
Gonzalez has.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. On the Medicare reimbursement, though, for the
residency it tilts it, clearly. The subsidies are enormous for
specialties. We should like to get some specific
recommendations from you in terms of what we can pass on to our
colleagues, because the reimbursement for these residencies,
we're all paying for that. The Medicare program is subsidizing
these people getting a specialty.
So that's all money that's taxpayer money that's going to
help educate someone to get higher earning power, and if it's
the need of this country to have primary care physicians, we
ought to reverse that policy, especially given the fact there's
a shortage of graduate medical education dollars. We ought to
point it, if we do have a shortage, towards those primary care
professions.
Dr. Martin. May I respond to Mr. Kennedy? We agree very
much that needs to be addressed. As I stated earlier, there
needs to be a balance. Obviously, we need many subspecialists.
But we also need an appropriate number of primary care, and
specifically family physicians. I hope that the work force
policies will really look at that graduate medical education
funding, and make sure the funds go to where this country needs
it.
Mr. Hoyer. I just want to make an observation. You have an
extraordinarily effective member of Congress who has presented
you to this Committee. His dad was a giant, as you know, in
this institution. I am struck by the fact that his personality
is different from his father's, but his father was and he is
extraordinarily effective and popular and respected in this
institution. I'm sure you probably know that, but I wanted to
reiterate. He does a great job.
Mr. Gonzalez. Thank you, Steny.
Mr. Regula. Thank you. Thank you for bringing the doctor.
I think you make a good point, Mr. Kennedy, we slant the
table.
Mr. Kennedy. In terms of budget cutting, there's always a
fight for those of us who represent prime graduate medical
education programs. And we're fighting for the dollars. But if
there are going to be cuts, let's make sure that the funding
goes to support our priorities.
Mr. Hoyer. If Mr. Kennedy will yield, I am very confident
that because Mr. Regula is such an effective leader of this
Committee, that our 302(b) allocation will be sufficient to
fund all the priorities that this Nation ought to be investing
in. [Laughter.]
Mr. Regula. Take down his words. [Laughter.]
----------
Thursday, March 22, 2001.
OHIO STATE UNIVERSITY COLLEGE OF LAW
WITNESS
GREGORY H. WILLIAMS, DEAN OF THE OHIO STATE UNIVERSITY COLLEGE OF LAW
Mr. Regula. Okay, Mr. Hoyer, you're going to introduce Greg
Williams.
Mr. Hoyer. Dr. Williams, the Dean of the----
Mr. Regula. I'm trying to figure this one out. It's an Ohio
State University Law School Dean, and we go to Maryland to get
him introduced.
Mr. Hoyer. Well, it's not so surprising, because of course,
Dr. Britt Kerwin was the President of the University of
Maryland College Park for many years, until stolen away in the
dead of night by Ohio State.
But I frankly think that we're sort of a twofer here. I
don't think it was lost on the folks that put together their
spokesperson that he was from Ohio State. Not that they would
be that cynical, understand. [Laughter.]
I understand that.
Mr. Regula. Trained in Maryland, learned well.
Mr. Hoyer. Dean, we welcome you to this Committee.
Mr. Chairman, I suppose the reason that I'm doing this is
that I had been a proponent last year of a program that was
authorized in 1998. The Dean is going to talk about it. But the
effort is to, we talk about diversity, we talk about reaching
out to people, and to include the legal profession, the medical
profession, other professions, so that we do have a diversity,
not just so that we have diversity for diversity's sake, but
diversity so that we will have expertise and experience in
various different cohorts of our population. It's an
extraordinarily important effort.
And so I suppose it's for that reason that I am doing this.
But Dean, we welcome you to discuss this Thurgood Marshall
program, Thurgood Marshall, of course, a son of Maryland as
well. That may be another reason, Mr. Chairman, that I'm
involved in this. But in any event, Ohio State, as you know,
one of the great institutions of this country. And I might say,
Dr. Kerwin, I teased, you didn't steal him at all, he chose to
go there.
But in my opinion, one of the finest educational leaders in
our country. We were very, very sorry to lose him. He is an
extraordinary talent, as you know, Dean, and I know a delight
to work with as well.
Thank you, Mr. Chairman.
Mr. Williams. Thank you, Mr. Hoyer, and thank you, Mr.
Chairman, for being here. I appreciate the opportunity, and Mr.
Hoyer, you're right, Dr. Kerwin is truly outstanding and we are
very fortunate to have him at Ohio State.
As indicated, I am Dean of the Ohio State University
College of Law. It's a real pleasure to be here. I want to
thank you, Mr. Hoyer, for your support of Thurgood Marshall
Educational Opportunity Program. It's been very important, and
we appreciate that support.
Actually, it's certainly consistent with things you've done
in the past and things you've supported. You may not remember,
but our meeting goes back many years ago. Thirty years ago, you
and I served on the national membership committee of the Young
Democratic Clubs of America.
Mr. Hoyer. How could I forget?
Mr. Williams. Thank you. So it's a real pleasure to be here
today. I'm speaking as past president of the Association of
American Law Schools, as well as Dean of the Ohio State
University College of Law, and for Martha Barnett, the
President of the American Bar Association, who unfortunately is
not able to be here.
But more importantly, actually, I'm speaking as a legal
educator with 25 years experience working with the CLEO
program, which I'm sure you know administers the Thurgood
Marshall program. For almost a quarter of a century, I
personally have recruited law students to this program,
minority, disadvantaged students, and have worked with them to
develop their legal careers. In 1999, I served as the first
African American male president of the Association of American
Law Schools, and my theme as president of the association of
American Law Schools was enhancing diversity in the legal
profession. I spent a lot of time working with law schools
around the country talking about the issues that the Committee
is concerned about.
As you know, Congress has authorized the Thurgood Marshal
program in the Higher Education Act Amendments of 1998, and the
program is designed to increase the number of low income,
minority and disadvantaged persons in the legal profession. The
Marshall program is administered through the Council on Legal
Education Opportunity, which is a non-profit organization
supported by the American Bar Association, as well as the
Association of American Law Schools and a number of other
groups.
The CLEO program was established in 1968 to make it
possible for economically and culturally disadvantaged students
to enter and successfully complete law school. Since that time,
over 6,000, over 6,000 students have gone through the CLEO
program. I have personally seen many of these students, in
fact, I've taught in the CLEO programs in Iowa and Ohio and
Wisconsin and other places. And of all the students that I've
seen go through the program in the last 25 years, I can't
recall more than two that did not successfully complete the
program.
So it is a program that truly has made a difference. In
fact, I think there are three members of Congress presently
serving who went through the CLEO program. It's a program that
has truly made a difference. The CLEO training program as
funded by the Marshall program has been so successful that many
States have tried to emulate it. Chairman Regula, as you may
know, Chief Justice Moyer, of the Supreme Court of Ohio, has
developed a program to develop a CLEO type program in the State
of Ohio to complement the national efforts that are ongoing,
and Chief Justice Moyer, of course, has provided greater
leadership on this issue.
By opening the doors of opportunity to more minority and
disadvantaged students, the Marshall program will help to
ensure that the legal profession reflects the diversity of the
population that it serves. The social justice system that
represents the population that it serves is a critical
component to maintaining public trust and confidence in the
justice system.
A recent ABA report called Public Perceptions of the
Justice System found that almost half of all Americans believe
that the justice system treats minorities different than
whites. A significant contributor to this perception is a
society that's nearly 30 percent persons of color, yet minority
representation in the legal profession is less than 10 percent.
One key to remedy this crisis in confidence, in my view, in the
justice system is to increase the number of minorities serving
as lawyers, judges, prosecutors, public defenders and
legislators.
Over the past five years, minority law enrollment has
increased only four-tenths of 1 percent, the smallest increase
in the past 20 years. In 1999, the total number ofminority law
graduates in the United States dropped for the first time since 1985.
With the minority population growing in the United States and the law
school enrollment increasing only at four-tenths of 1 percent, minority
representation in the legal profession looks bleak.
Currently, minority representation in other areas actually
is much higher, including accounting and economics, engineering
and medicine. All of those are higher in representation of
minorities than the legal profession.
Increasing diversity in the legal profession has multiple
advantages even beyond the public trust and confidence. Within
an educational setting, there's been a number of studies
recently, for instance, one done at Harvard and the University
of Michigan that found that it really made a difference when
the classes were diverse in terms of the experience that the
students were going to be able to get in law school. And of
course, what we find is most of the, not most, but many of the
graduates who go through the CLEO program and minority students
are in fact going out to serve those communities that need
service the most.
It appears that my time is finished, but I would urge you
to seriously consider funding the Thurgood Marshall program. It
is a program that has truly made a difference in this country
and deserves your continued support. And I thank you very much.
[Editor's Note.--Prepared statement to be kept as part of
committee files.]
Mr. Regula. You make a very good point.
Any other questions?
Well, thank you for coming. We have a vote on the rule on
tornado shelters and two suspensions and a possible motion to
adjourn. I don't know why anyone would want to adjourn.
[Recess.]
Mr. Regula. We have a vote coming up very soon. Let us see
if we can take one more witness before we have to vote.
----------
Thursday, March 22, 2001.
COALITION OF ACADEMIC HEALTH CENTERS
WITNESS
DONALD C. HARRISON, SENIOR VICE PRESIDENT AND PROVOST FOR HEALTH
AFFAIRS, UNIVERSITY OF CINCINNATI
Dr. Harrison. Good morning, Mr. Chairman and members of the
subcommittee. Mr. Chairman, your good friend, Bill Keating, who
has visited me a number of times, sends his regards.
My name is Dr. Donald Harrison. I am the Senior Vice
President and Provost for Health Affairs at the University of
Cincinnati.
I am also a practicing cardiologist and I served as
National President of the American Heart Association and Vice
President of the American College of Cardiology. I was Chief of
Cardiology for 20 years.
I am here on behalf of a coalition of 20 academic health
centers across the nation to highlight issues of concern to all
academic health centers in the United States.
We are the institutions that conduct a significant portion
of extramural, biomedical and behavioral research funded
through the National Institutes of Health.
I would like to thank all of the members of this
subcommittee for the outstanding support to NIH over the past
several years. These additional funds have clearly had
significant impact on the cause, prevention and the treatment
of health problems, which afflict the citizens of our nation
and the world.
A few of these merit mention. First, the life expectancy of
our citizens has increased by more than 20 years since the1930s
to reach 76 years for males and 80 years for females for a child born
today.
Secondly, the adjusted death rate from heart disease and
heart attacks has been reduced by 40 percent in the past 25
years.
Thirdly, our ever-increasing elderly citizens live much
more active lives, thanks to artificial joint replacement,
pacemakers and medications which prevent osteoporosis and the
treatment of breast and prostate cancer and the control of
diabetes.
On the other hand, the advances in the future, which can be
developed from the human genome project, will dwarf our past
accomplishments.
I am here today to seek your support for further enhancing
this extraordinary partnership that has been established with
great foresight over the years between the academic
institutions and the Federal government.
For the fiscal year 2002, we urge you to provide a
$3,400,000,000 increase for the NIH, which is a little more
than 16 percent. Such an increase will bring the Agency's
budget to $23,700,000,000 and keep on track to double the NIH
budget by fiscal year 2003.
I will repeat a statistic that I am sure you all are very
aware of. The NIH currently funds fewer than four of every ten
approved research grants. For this reason, I urge you to
continue your efforts to double the NIH budget by 2003.
We are really just at the dawn of the biomedical
revolution. This increased funding will keep our world
preeminence in medical innovation. It will also fuel our
country's economic growth and development.
Universities and other research institutions bear the cost
for conducting NIH research that are not supported by the
Federal research dollars. In fact, all institutions, both
public and private, provide part of the research expense for
their institutions.
Let me raise a major concern regarding the state of
extramural research facilities and laboratories. For the past
two years the NIH has included $75,000,000 in extramural
research facilities and laboratories.
For the past two years the NIH has included $75,000,000 in
extramural construction funding through the National Center for
Research Resources. It is vitally important that institutions
have the facilities and equipment to exploit research
opportunities and utilize the increased projected grant
funding.
Exciting developments in genomics, molecular biology and
neuroscience, cancer and many other fields require these kinds
of laboratories and instrumentation. Even the best minds cannot
compensate for outdated equipment and facilities. New
technology is expensive, but it is important for the
advancement of science.
That National Science Foundation, in a study in 1998 on the
status of scientific and engineering research facilities in the
United States colleges and universities found that there was
$11,500,000,000 in deferred research construction and repairs
needed.
I urge the subcommittee to provide the funding level of
$250,000,000 for extramural research construction in the year
2002.
A second significant concern of academic medical centers is
the increased cost of research institutions for complying with
research related Federal regulations. While extramural
researchers have always been subject to Federal research
regulations, the increasing number of research administration
imposed on institutions has resulted in escalated costs.
Let me stress that researchers are not opposed to providing
these safeguards and do not question the necessity of the
measures. But we believe that the Federal government and the
Federal Research Institution should help us fund the cost of
these regulations.
Finally, I would ask the committee to consider $50,000,000
to go to the Agency for Health Care Research and Quality to
reduce medical errors. This is a major problem.
Mr. Chairman, the polls reflect the fact that the American
public strongly supports Federal investment in biomedical
research. Each of these institutions mentioned will increase
the productivity of this relationship.
Best wishes to you and good health to all Members of the
Committee.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. We accept that.
Mr. Hoyer. Mr. Chairman, I know you are trying to go vote,
but Dr. Harrison mentioned that the average life expectancy of
a child born today was 76 for males and 80 for females.
Mr. William Hazeltine, whom you may know, who was one of
the leaders in the mapping of the human genome, spoke to our
bipartisan retreat.
He indicated--and he was speaking to the younger members,
not me, because my grandchildren perhaps fall in this category.
He said he believes that the average life expectancy of the
children of the younger Members, Patrick's age, would be 100
and that the life expectancy of our grandchildren would be 120,
which obviously will be confronting us with extraordinary
challenges as well. But it is amazing.
Dr. Harrison. That is a wonderful goal.
Mr. Kennedy. Mr. Chairman, that means when I get to be
Chairman I get to be there for a while.
Mr. Regula. That is right.
Mr. Hoyer. He didn't say the rest of us were going to die
real soon, however.
Mr. Regula. The committee will be suspended for
approximately 20 minutes.
[Recess.]
Mr. Regula. We will reconvene the committee. Our next
witness is Dr. Charles Schuster, Professor of Psychiatry and
Behavioral Neuroscience, Wayne State University College of
Medicine. Welcome.
----------
Thursday, March 22, 2001.
COLLEGE ON PROBLEMS OF DRUG DEPENDENCE, INC.
WITNESS
CHARLES R. SCHUSTER, PROFESSOR OF PSYCHIATRY AND BEHAVIORAL
NEUROSCIENCE, WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Dr. Schuster. Thank you very much. First of all, let me ask
permission to change my written testimony from ``good morning''
to ``good afternoon.''
Mr. Regula. Or ``good evening.''
Dr. Schuster. I am here today representing not only myself
as a drug abuse research scientist and treatment provider, but
as well I serve as the President of the College on Problems of
Drug Dependence.
The college has been in existence since 1929 and is the
oldest and largest scientific society devoted to the study of
addictions. It has over 600 members and about 1,000 people come
to our annual scientific meeting.
The membership is comprised of a broad array of scientists,
from molecular biologists through criminologists, policy
analysts, and sociologists, et cetera, concerned with the range
of problems that drug abuse is involved with.
I would like to first of all today, on behalf of the
college, thank this committee for their support of the NIH in
general in terms of the doubling of its budget, and
specifically for its support of the National Institute on Drug
Abuse and appeal to you for continuing this support for it
obviously is one of the nation's most important problems.
On the way here today I came across a recent report from
Constant Horgan of Brandeis, which states that substance abuse,
is the nation's top health problem, causing more deaths,
illness and disabilities than any other preventable health
problem today.
I am not going to burden you with statistics about that
because we are all aware of the tragedies associated with it.
What I would like to say is that the National Institute on
Drug Abuse is a governmental organization that is very
important, not only to the members of the College, but as well
to our society in general, because it supports the overwhelming
majority of scientific research on the complex problems
associated with drug abuse and dependence.
This research has already paid off in a number of ways in
terms of the development of effective prevention and treatment
interventions, which are already being utilized. However, a
great deal more is in the pipeline.
We are at a time when advances are occurring very, very
rapidly. In my written testimony I said that we were studying
the long-term effects of methamphetamine or speed on the brain
and that definitive evidence would be soon forthcoming.
Well, in the weeks between the time I wrote this and the
time I am coming here a report has come out definitely
corroborating the fact that methamphetamine causes the same
kind of brain damage in humans that has been reported in
laboratory animals for many, many years. So, this is a very
rapidly emerging field.
My own group is now studying MDMA or Ecstasy in terms of
the effects of it on the brain. One of the things we are very
interested in and is of the utmost importance to us to
understand if we are going to be able to effectively treat the
problem of drug abuse is what happens in the brain when people
move from casual, experimental drug use to regular drug use and
finally to compulsive drug use, which is what characterizes
addiction. What is going on in the brain there?
We now have the techniques to PET scanning, functional MRI
and magnetic resin spectroscopy to study these kinds of things
in living human beings and animals. Rapid advances are being
made in this area today.
In addition, NIDA's research has been responsible for a
variety of behavioral interventions to help people cope with
the behavioral changes that they have to make when they
transition from being active drug users to a drug abstinent
state.
These are very effective procedures that are now being
utilized across the United States and I think are making a real
difference.
One of the areas that I am personally involved in that I
think is very exciting is the so-called National Drug Abuse
Treatment Clinical Trials network. This is a new program at
NIDA, which is designed to bridge the gap between
academicresearchers, which is myself, and community treatment programs.
It is true in all branches of medicine that there is a gap,
but it is particularly large in the area of the treatment of
drug abuse.
NIDA has now established a network of 14 regional training
and research centers. These are academic centers spread out
across the United States, each one of which has gone out into
their community and established a collaborative relationship
with community treatment programs where research has never gone
on.
Now, what we are doing is taking new treatment
interventions which have been shown under rigidly controlled
clinical trials to be effective or efficacious, as we call it.
We are then looking at them in community treatment programs to
find out if they are useful in the real world. If they are
useful, how can we better get other community treatment
programs that are not part of the CTN to adopt their use.
This is the goal of this project. Although there are 14 of
these centers around the United States linked up with about 100
treatment programs, I think the National Institute on Drug
Abuse is very much interested in expanding this.
Mr. Regula. Are all addictions centered in the brain?
Dr. Schuster. Yes.
Mr. Regula. What does the body do, send a message that they
want to smoke or that they want a shot, to the brain?
Dr. Schuster. The message begins in the brain. We have
studies now in which we can take individuals who are chronic
drug users, we put them into a machine called a Functional MRI
and we provoke them to crave drugs by giving them cues that
have in the past been associated with their drug use.
We can delineate the regions of the brain that are
activated when they see these cues and they report an
overwhelming urge to get the drug.
Mr. Regula. So, part of drug therapy would be to change
patterns of the things that trigger?
Dr. Schuster. Absolutely. This is can be done in a couple
of ways. First of all, we are looking for medications that may
decrease craving. We are also looking for behavioral and
psychological interventions that may alter that. Great progress
has really been made because we understand the mechanisms now.
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Mr. Regula. Very interesting.
Mr. Kennedy.
Mr. Kennedy. I wanted to get into the whole idea of this
being behavioral and biological. We, obviously, need to fund
more research in the area of how the genome and how we can
intervene earlier. Because to wait until people get to be
addicts is just a waste of time.
I think it is probably very useful for us to advance the
concept that the brain is part of the body and mental health is
overall health so that we don't have insurance companies
treating people differently for mental health issues that are
chronic like drug and substance abuse any different from asthma
or diabetes or anything like that.
We need to get this bill passed in this Congress, hopefully
the Domenici Parity Bill and the Roukema bill on this side will
pass, because that is the best thing we can do in my view right
now, to get more treatment to people out there.
Dr. Schuster. I would also like to comment on the fact that
one of the problems that we have with the treatment of drug
addiction is the fact that many of the people that we see also
have concomitant mental health problems, other psychiatric
disorders. It is very common.
Yet, because of the separation in the funding streams, it
is oftentimes very difficult for us to provide both services in
the same site. As a consequence of this, when you take
somebody, as somebody said earlier today, they don't have a
car. They have to take three buses. You refer them to a
psychiatrist or a mental health clinic on the other side of
town and they don't get there.
We really have to work on trying to mainstream these so
that we can provide these kinds of services in the same venue,
so to speak.
Mr. Kennedy. That is my point, Mr. Chairman, about the
schools for the kids because it is a non-threatening
environment. It is not some substance abuse treatment center,
some mental health place that has all kinds of stigmas laden
with it. You can treat people collocated.
As you said, a lot of this is behavioral and it is mental
health. We need to identify these kids who are predisposed,
either through sociological factors, their parents, they have
trouble at home, their parents are addicts or what have you,
and address it early on.
Mr. Regula. Thank you for coming.
Dr. Schuster. Could I have ten seconds? Research has shown
that if we could ensure the children learn to read in the first
grade, if they become positively engaged in school that is the
most effective prevention intervention we could have.
Mr. Regula. Good point. We have the whole gamut here.Thank
you.
Mr. Steve Wilhide, President of the Southern Ohio Health
Service Network.
Thursday, March 22, 2001.
NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, INC.
WITNESS
STEVE WILHIDE, PRESIDENT, SOUTHERN OHIO HEALTH SERVICE NETWORK
Mr. Wilhide. Thank you, Mr. Chairman. Mr. Chairman and
members of the subcommittee, I want to thank you for the
opportunity to be here today. I am President and CEO of the
Southern Ohio Health Services Network, which is a rural
community health center. I am speaking on behalf of the
National Association of Community Health Centers regarding
funding for the Consolidated Health Center Program within the
Department of Health and Human Services. I would like to thank
this committee for your increases that have enabled us to serve
millions more people nationwide in our community health
centers. We appreciate your commitment to this program and
appreciate your consideration of expanding the program so we
can serve millions more.
Southern Ohio Health Services Network is a Federally
supported community health center founded in 1976. I was
brought there as the first Executive Director. Our first year's
budget was $49,000. It was an Appalachian Regional Commission
grant and $200,000 from the Department of Health and Human
Services to provide direct care.
Today, approaching our 25th anniversary, we have a budget
of approximately $17,000,000 of which about 20 percent comes
from a Federal grant and we serve approximately 50,000 people
who had one or more visits for one or more services last year.
We have over 50 physicians, dentists, nurse practitioners,
social workers, and clinical psychologists.
Mr. Regula. Do you have volunteers?
Mr. Wilhide. We have volunteers. We have a volunteer
physician who is retired that I met through my church who
volunteers. We have a nurse who is retired and volunteers and
we have a volunteer board that is very, very active. I will be
getting back to my board meeting this afternoon.
Nationwide, health centers serve 11 million people, 4.6
million of whom have no health insurance.
We applaud President Bush's call to double the number of
patients served by health centers and to double the number of
sites. We would urge Congress to appropriate $175,000,000 more
in order to achieve that goal.
I think it is important to understand that community health
centers are locally controlled and operated entities. The
boards of those health centers, the majority of whom are
consumers of the care, determine what health care needs are
prioritized and then hold me accountable for reporting back to
them as to what progress we are making toward clinical outcome
goals.
So, the board, each year, sets forth a list of clinical
priorities, whether they want to decrease the risk of diabetics
who have foot problems or what have you. We report to the board
on our progress.
Back in 1977 and 1978 two of our counties had the highest
infant mortality rates in the State of Ohio, higher than many
Third World countries. The board felt this was unacceptable. We
targeted that program. We were able to receive a Maternal and
Child Health grant in addition to our Federal dollars and other
dollars. We worked with the entire community, public health
departments, and community action programs with outreach, the
Grads Program which targets pregnant teenagers to keep them in
school.
Mr. Regula. Did that include nutrition help?
Mr. Wilhide. Absolutely. We also have the WIC Program that
we operate. We were able to integrate all these services into
one comprehensive approach. Because as many people have
indicated before, it is not a medical problem, it is not a
psychological problem, it is total integration that makes up
the human being.
So, we actually were able to recruit, through the National
Service Corps, and we would not have gotten these doctors had
we not, pediatricians and obstetricians, gynecologists. The
first pediatrician ever to serve in Brown County just retired a
few months ago.
I am please to report today that our infant mortality rates
are below State average in those two counties and 82 percent of
women are getting first trimester prenatal care compared to
about 58 percent before we started the campaign. Again, it was
a combination of education, nutrition, socialwork, and
psychology, integrated together into one setting.
In addition to being responsive to local health care needs,
community health centers have proven to be effective and
efficient over the years. They provide their comprehensive
services at an average cost of about $350 per person per year.
That is obviously less than $1 per person served.
They are having many studies to show their cost
effectiveness in reducing hospitalization, reducing unnecessary
emergency room utilization, higher child immunizations. My own
program has a 93 percent immunization rate of two-year-olds.
That is considerably above the State average.
So, again, I think we are not a medical model. We are a
comprehensive model with a variety of services based upon the
needs of our own individual communities.
Last year the National Association of Community Health
Centers surveyed 100 health centers and found that those health
centers could serve 50 percent more people if funding was
available.
In order to do this we are going to have to establish new
sites in new locations and expand existing services in present
locations.
By way of example, in Adams County, which you may not be
familiar with, which fortunately now is only the second poorest
county in the State, I think Perry County is first; we opened a
23,500 square foot mall-type service facility and closed two
aging facilities that were inadequate. We have in that facility
the only psychiatrist in the county, a clinical pharmacy,
internal medicine, the WIC Program, social work. There is a
significant increase in the numbers of elderly served and
dental. We have gone from three dental operatories to nine and
the appointment books are full right now.
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Mr. Regula. I am sure they are.
Thank you for coming. I think those community health
centers do great work.
Mr. Donald Price, President of the Society for
Neuroscience.
----------
Thursday, March 22, 2001.
SOCIETY FOR NEUROSCIENCE
WITNESS
DONALD L. PRICE, PRESIDENT
Dr. Price. Good afternoon. My name is Don Price. I am a
Professor of Neurology, Pathology and Neuroscience at Johns
Hopkins and present President of the Society for Neuroscience.
The Society for Neuroscience has about 28,000 members and
its major commitment is to basic and clinical neuroscience. We
are obviously very grateful for the support that we have gotten
in the past and that biomedical research has gotten in the
possibility.
So, with that as a background, I want to depart from those
remarks and give you an example of a human disease where really
extraordinary progress has been made. That is Alzheimer's
disease, which is the most common cause of dementia in late
life.
I think we are now on the threshold of coming up with
therapeutic targets which could prevent this disease. What I
would like to do, because you heard for example, an elegant
discussion of the problem of rats. I would like to explain how
that happens.
The first thing that happened with Alzheimer's was to
define it as a disease. The second thing was to look at the
brain and find that there were very unusual deposits called
ambyloid in the brain tissue. Then, the gene that encoded the
protein that gave rise to ambyloid was identified. It turns out
that it was like this pen. It is a protein thatlooks like this
and the ambyloid component is imbedded in it.
So, somehow abnormal scissors, enzymes, leave that peptide
out and it becomes deposited in the brain of an Alzheimer's
patient and causes the disease.
Over the past few years we have identified mutations in
that gene that are linked to the human disease. I brought two
specimens, one from my grandson and the other from my
administrative assistant. It is not hard to tell which is the
Alzheimer mouse versus the other.
But basically, what you can do is you can take the mutant
human gene, put it in the mouse and the mouse will come up with
the disease. It is now possible to use these mutant mice to
test mechanisms and therapies. It represents the kind of
advance that I think we are going to see over the next decade
for Parkinson's disease, for Rett syndrome where the gene has
now been identified, and so forth.
It really represents an extraordinary step forward in terms
of trying to treat disorders which, when I was neurology
resident and a clinician, one really didn't want to diagnose
because the news was so bad for the family.
It is now possible to knock out the genes that make these
scissor-like clips. It turns out when you knock those genes out
in mice, the mice look perfectly well. What that tells you is
that you could then give this mouse an inhibitor of that
cleavage product, that enzyme, and this would not happen. The
mouse would not get Alzheimer's disease. If it works in mice,
it should work in humans.
To emphasize the point that was made before about
prevention, if one comes up with a small molecule that can get
into the brain that can inhibit these enzyme activities that
cleave this ambyloid protein, one could potentially completely
prevent a disease like Alzheimer's.
I think the same story is going to be translated to Lou
Gehrig's disease and many of the other devastating neurological
diseases. When genes are identified for psychiatric diseases,
we are going to be able to do the same kinds of things.
So, really, that is how the NIH monies are being invested.
I think they are critical if we are going to improve the health
of our population.
Thank you very much.
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Mr. Regula. Thank you.
Are there questions?
I have just one. Does Alzheimer's have a pattern of onset
that you would start this treatment once you identified it? You
would not do it in a healthy person, I assume.
Dr. Price. No. I think it would depend. I mean Alzheimer's
disease clearly starts much earlier than the first obvious
clinical sign. If you had a very safe drug, you could start it
early. The earliest case of Alzheimer's that I know of is a
young person who had a gene lesion who got it at 16 years of
age. So, it can occur from 16 to late 80s. But it usually has a
very indolent course.
So, to answer your question directly, if you had a safe
therapy, then one might treat patients prospectively.
Mr. Regula. I understand there is some genetic pattern,
that it is inherited.
Dr. Price. That is right. It is really the identification
of those genes that has allowed this kind of research to go
forward. That is what we are going to see, I think, in
psychiatry in the next decade.
Mr. Regula. Well, thank you for coming.
Dr. Price. Thanks very much.
Mr. Regula. Dr. Robert Felter, Chairman of Pediatrics and
Medical Director, Tod Children's Hospital in Youngstown.
I am happy to welcome you.
----------
Thursday, March 22, 2001.
NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS
WITNESS
ROBERT A. FELTER, CHAIRMAN OF PEDIATRICS AND MEDICAL DIRECTOR, TOD
CHILDREN'S HOSPITAL, YOUNGSTOWN, OHIO
Dr. Felter. Good afternoon. My name is Robert Felter. I am
a pediatric emergency physician and currently Chairman of
Pediatrics and Medical Director of Tod Children's Hospital in
Youngstown, Ohio.
Thank you for the opportunity to testify on behalf of the
National Association of Children's Hospitals. Mr. Chairman, I
especially want to thank you and the members of your committee
and your colleagues very much for last year's appropriation off
$235,000,000 for Graduate Medical Education or GME Programs for
the nation's nearly 60 pediatric teaching hospitals.
You enacted this funding at a time when it was critically
needed by hospitals all across the country. Your 2001
appropriation is a major step toward fulfilling the Congress's
authorization of the $285,000,000 needed to provide equitable
Federal support for our GME Programs.
In today's increasingly price competitive health care
marketplace, Medicare has become the only major reliable source
of GME support. Teaching hospitals absolutely rely on it to
remain competitive. But children's hospitals qualify for
virtually no Federal GME support from Medicare because we care
for children.
On the average, one of our hospitals receives less than one
half of one percent of the GME support which other teaching
hospitals receive through Medicare. That creates a huge gap in
Federal support for children's hospitals. According to the
Lewin Group, it amounts to about $285,000,000 annually.
It puts at risk not only our hospitals, but also the future
of our entire pediatric workforce and health care for all
children. Here is why: On the average our hospitals consist of
less than one percent of all hospitals, but we train nearly 30
percent of all pediatricians, nearly 50 percent of all
pediatric specialists and almost all pediatric emergency
specialists such as myself.
We are also the major pipeline for future pediatric
research. We also serve all children, regardless of economic
need, from the furthest rural to the nearest inner city
neighborhoods. We provide personal, compassionate care combined
with state-of-the-art medical treatment.
Mr. Chairman, as we discussed in your office last week, you
know that this affects my own hospital very much. We provide
more than 30 pediatric sub-specialists and highly specialized
programs such as our pediatric in-patient cancer unit. We serve
all children. More than 60 percent of our care at Tod
Children's goes to children who are assisted by Medicaid or
have no insurance.
We also train 27 medical residents each year. The majority
of them go into practice in the Youngstown area or in Ohio.
Mr. Regula. You got some financial support for that program
out of this committee this current year; right?
Dr. Felter. Yes, we got $200,000 for Tod and we will get a
little over $1,000,000 this year from the increased finances.
Again, it costs us about $200,000,000.
As you know, Youngstown is an economically depressed
community, which makes it difficult for us to attract and
retain strong clinical talent. The loss of our GME Program
would seriously affect Youngstown's pediatric workforce. We
face the potential for that loss right now. We spend more than
$2,000,000, our hospital does, just on the direct cost of the
program.
We face increasing pressures to eliminate either that
training program or other programs. Frankly, without strong
Federal funding through Children's Hospital GME program, the
future of our training program is in jeopardy. That in turn
puts into jeopardy the long-term future of our children's
hospital and the health of our community.
With such a major impact on small institutions such as Tod
Children's Hospital, you can image the impact of this funding
on much larger institutions in their regions such as Children's
Hospital in Boston or Los Angeles, which train hundreds of
residents.
Please take the next step to close the gap by appropriating
full funding this year. It is vital for the future of our
pediatric workforce and the healthcare of all children.
Thank you again for your past support. We appreciate very
much your consideration of our request today for fulfillment of
equitable GME support for children's hospitals.
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Mr. Peterson [assuming chair]. I didn't really hear most of
your testimony, but I didn't really need to. I am very familiar
with Pennsylvania's Pittsburgh Children's Hospital and CHOP in
Philadelphia. I call them miracle hospitals, because that is
really what you do. We send our very sickest children to you
and you do miracles.
I totally support, personally, and I am just speaking for
one person, of closing that gap. If there is any part of our
teaching system that should not have been shortchanged, it is
our kids.
Dr. Felter. Thank you very much. I appreciate the support.
Mr. Peterson. Are there any questions?
Thank you very much.
Next we will hear from Stephen Bartels, President of the
American Association for Geriatric Psychiatry. We welcome you.
Please proceed.
----------
Thursday, March 22, 2001.
AMERICAN ASSOCIATION FOR GERIATRIC PSYCHIATRY
WITNESS
STEPHEN BARTELS, PRESIDENT
Dr. Bartels. Mr. Chairman and members of the subcommittee I
am Dr. Stephen Bartels, President of the American Association
for Geriatric Psychiatry. AAGP is a professional membership
organization dedicated to promoting the mental health and well
being of older Americans and improving the care of those with
late life mental disorders.
Mr. Chairman, I join many of those other witnesses here
today in thanking the subcommittee for its continued strong
support for increased funding for the National Institutes of
Health over the last several years.
However, I am here today to convey the serious concern
shared by researchers, clinicians and consumers that there
exists a critical disparity between Federally funded research
on mental health and aging and mental health needs of older
Americans.
Mr. Chairman, as we have already heard today, the U.S.
Census projects that numbers of Americans over age 65 will
increase dramatically over the coming decades.
However, despite recent significant increases in
appropriations for research in mental health, the proportion of
new NIH funds for research on older persons has actually gone
down and is woefully inadequate to deal with the impending
crisis of mental health in older Americans.
With the Baby Boom generation nearing retirement, the
number of older Americans experiencing mental health problems
is certain to increase in the future. By the year 2010, there
will be approximately 40 million people in the United States
over the age of 65. Over 20 percent of those people will
experience mental disorders.
Current and projected economic costs of mental disorders of
aging alone are staggering. Depression is an example of a
common problem among older persons. Approximately 30 percent of
older persons in primary care settings have significant
symptoms of depression. Depression is associated with greater
health care costs, poor health care outcomes and increased
morbidity and mortality.
Older adults have the highest suicide rate of any age
group. AAGP would like to call to the subcommittee's attention
the fact that recent increases in the National Institute of
Mental Health and the Center for Mental Health Services have
not been reflected in new research funding on mental health in
aging.
For example, while total research grants awarded by NIMH
increased 59 percent in 1995 to the year 2000, NIMH grants for
aging research increased at half that rate over the same
period. In fact, between 1999 into the year 2000, the actual
amount of new funding for aging grants by NIMH declined.
I brought this diagram here to show that the proportion of
total NIMH newly funded research devoted to aging declined from
an average of eight percent in 1995 down to six percent in the
year 2000. It is juxtaposed against significant increases that
this committee has approved for NIMH over the last several
years.
I have also taken the liberty to bring this other diagram
that shows the increasing numbers of people who are elderly
that are projected to come, the associated health care
expenditures. This large increase is showing the number of
people with mental disorders as opposed to younger people and
this is the NIMH funded research at the current rate, which is
quite low.
Now, Mr. Chairman, the research that this committee has
funded shows definitely that treatment works for many mental
health problems in older persons. However, if current trends in
funding for aging and mental health continue at NIMH and CMHS,
we will dramatically fall short of the need for continued
developments and our understanding of the causes of mental
health problems in older people and the development of
effective prevention and treatment.
Improving the treatment of late life mental problems will
benefit not only the elderly, but also the current Baby Boomer
generation whose lives are often profoundly affected by those
of their parents who comprise an unprecedented challenge to the
future of mental health services in America.
In short, Mr. Chairman, this is not simply a concern for
our nation's elderly. Under-funding research on mental health
in aging is a problem for those of us with parents afflicted
with mental disorders and for the future of those of us who
will reach retirement age in the next two decades.
Based on our assessment of the current need and future
challenges of late life mental disorders, we submit the
following three recommendations for consideration:
One, the current rate of funding for aging grants at NIMH
and CMHS is inadequate. Funding of aging research grants by
these agencies should be increased by approximately three times
the current funding level, to be commensurate with the current
need. Two, infrastructures within NIMH and CMHS are needed to
support the development of initiatives in aging research,
including the creating of positions with these agencies
dedicated to promoting, maintaining and monitoring research on
mental health in aging. Three, the establishment of grant
review committees with specific expertise in reviewing research
proposals on mental health in aging. In conclusion, we are
dramatically under-investing in research on mental health in
aging at a time when the NIMH and CMHS budgets have seen
significant increases. The projected economic impact of the
aging Baby Boom generation on Medicare and Social Security
systems is well known.
But there is another challenge that has not received
attention. We can expect an unprecedented explosion in the
number of people over age 65 with potentially disabling mental
disorders.
I would like to thank you for allowing me to submit this
testimony today. We will be happy to answer any questions.
Mr. Peterson. In your research, are you tracking some of
the mental health drugs that our seniors have been on for
decades?
Dr. Bartels. Yes.
Mr. Peterson. I would like to just raise one. I have a
personal experience. My mother had depression problems all of
her life. I don't remember when she would not go into the lows
and the highs. She was never doctored until the last two or
three decades. I do not think we doctored it much when I was a
child.
But she was on a drug called Vivactil for maybe 25 or 30
years. I had a younger brother who over a period of time had to
get the doctors that prescribed that to reconsider that drug.
He had done some research. He was always unsuccessful. I guess
I kind of hold myself responsible that I didn't give him more
assistance, but I certainly didn't hamper him.
Recently, she had a health problem where she broke her hip
and was temporarily in a nursing home for rehab. The doctor
there quickly agreed with my brother that she ought to be off
that drug.
My mother could not carry on a conversation with me for
three years. My mother can carry unlimited conversation today
after six months. I just find that a tragedy that she was
deprived of the ability to communicate. She knew my name. She
always knew me. She expressed love for her children, but she
could not communicate.
She is actually gaining. We were blaming it all on
Alzheimer's. She is actually gaining the ability to have a
conversation with her children.
In discussing this with nurses, they feel there are a
number of mental health drugs over long periods of time that
have actually harmed people's ability to think and carry on a
conversation.
Do we monitor them long term?
Dr. Bartels. Well, not well enough. I think part of that
has to do with health services research in pharmacoepidemiology
and look at precisely this: co-prescriptions, old medications
that have bad side effects that do impair cognition.
The good news is that there are new medications which have
minimal side effects that enhance functioning. We know, for
example, like your mother had a hip fracture, that untreated
depression actually results in worse health care outcomes.
Those people do not get better as fast and they are more likely
to die.
So, untreated depression, untreated disorders without the
state-of-the-art medications is actually a tragedy.
Mr. Peterson. Well, I guess in Pennsylvania where they had
the PACE Program where they really know what everybody is on
and she was in the PACE Program. I have been going to talk to
them because I have worked with them for years at the State
level.
How many people are still on that drug? I personal think it
is a bad drug.
Dr. Bartels. I think there are newer and better drugs that
are out there and that is part of the research that we are
hoping to focus on, looks at those medications, treatment and
services that will make a difference for people like your
mother.
Mr. Peterson. Of course, I am one who thinks we rely too
much on drugs today. There are wonderful drugs. I am not
against new drugs.
Dr. Bartels. There are very effective non-pharmacologic
interventions also that we are doing research on.
Mr. Peterson. There are so many seniors. I tour home health
agencies. Five, six, seven, eight, nine or ten drugs, I am just
amazed how many drugs our seniors are on and the complications
of them. Are we studying that, too?
Dr. Bartels. We are. Our group at Dartmouth is doing just
those sorts of studies right now.
Mr. Peterson. Do you have any questions?
The gentleman from Rhode Island.
Mr. Kennedy. I agree, Mr. Chairman. The fact of the matter
is seniors are over-utilizing the health care system for many
reasons, because they are depressed or they are not getting
connections. So, they use the Medicare system as a way to get,
you know, some attention and whatever that makes up for lack of
proper love and so forth from their family or the losses that
they have suffered.
If you would establish a kind of program that was a
practicum of how to identify depression among seniors, I mean
if you had limited resources and I am not talking about the
research angle and increasing science, which I agree with you
on, but just out there right now, what would be your kind of
vision of what a program would look like?
Dr. Bartels. I think there are several things. First of
all, you are exactly right that we know from health services
research that there is increased health services utilization,
emergency room visits, hospitalizations, et cetera, with
untreated depression.
I think the place to go is where seniors are, which is to
say that because of the stigma of mental illness, they are less
likely to go to specialty care providers. So that primary care
physician offices, educating primary care physicians to better
identify and use state-of-the-art treatments is a place to go,
senior citizens centers as well as senior housing.
Some of the innovative programs that we have actually
looked at and a number of us have researched, I think, are the
places to look at.
Mr. Kennedy. I would love to have you share what some of
your findings have been in those areas because I would like to
get those things back in my community because I know there are
too many seniors who are suffering needlessly. People think,
oh, that is just part of being old.
Dr. Bartels. I would be delighted to talk with you in
details about some of these programs.
Mr. Kennedy. That would be great. Thanks very much.
Mr. Peterson. Thank you.
We are trying to accommodate people who have plane
reservation problems. We are next going to hear from Dr. Felix
Okojie, Vice President, Research and Strategic Initiatives,
Jackson State University.
If you have a similar problem, let us know. We will try to
accommodate you.
Please proceed.
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Thursday, March 22, 2001.
JACKSON STATE UNIVERSITY
WITNESS
FELIX OKOJIE, VICE PRESIDENT, RESEARCH AND STRATEGIC INITIATIVES
Dr. Okojie. Mr. Chairman, distinguished members of the
subcommittee, I am Felix Okojie, Vice President for Research
and Strategic Initiatives at Jackson State University. I want
to thank you members of the committee for giving me the
opportunity to appear before you today as you consider the
fiscal year 2002 funding year priorities for this subcommittee.
First of all, I would like to be on record with this
committee for the extraordinary and strategic efforts for
putting significant amounts of dollars in agencies like NIH and
the education in that has helped historically Black colleges
and universities across this country to contribute
significantly to the health and other problems of the citizens
of this country.
As a result of the efforts of this committee, I would like
to speak very briefly to how Jackson State University in
Jackson, Mississippi has benefitted and continues to benefit
from the efforts of this committee.
There are two initiatives that the university is very much
interested in that we think, because of the resources that have
already been invested at the university by Federal agencies as
a result of the appropriations from this committee, can even
further enhance the critical goal that we have.
There is a study going on right now in Jackson called The
Jackson House Study, which is an epidemiological,
cardiovascular disease study by the largest CVD study for
African-Americans in this country. Within that we also have a
major cancer study going on at the medical school.
Jackson State University recently developed an
epidemiological institute where CVD and things like prostate
cancer will be the major focus.
Jackson State University is at the forefront in trying to
help to meet some of the disparity, particularly in the area of
cities in Mississippi and this country.
One of the initiatives we would like to highlight is the
establishment of a minority Rural and Urban Health and Wellness
Center. The impetus for this center is as a result of the
critical mass of the human resource and intellectual capital
that has been harnessed over the years to do a lot of disparity
studies in collaboration with institutes like NIH and CDC.
Information out of these studies can be disseminated both
in the rural and urban areas of the State as well as across
different parts of this country. So, the Health and Wellness
Center would take advantage of this synergy and the
intellectual capital to capitalize and to disseminate
significant information on both disparities as it relates to
those common issues that afflict minority populations in
Mississippi and in other parts of this country.
I ask this committee that sufficient funding be provided in
the health facilities account of the HHS section of the
Education Appropriations bill to support projects such as this
that Jackson State is proposing.
The other major project is a project called the Mississippi
e-Center at Jackson State University. This is a center that we
would like the committee to be aware of. Again, this center is
designed to create some more outreach efforts through the use
of technology to reach urban and rural areas in Mississippi, as
well as providing some new and innovative ideas that can help
service some of the needs across this country by using
research, e-technology programming and e-service opportunities
to meet the needs of minorities in this country as well as
major aspects of people in this country.
Mr. Chairman, thank you for this opportunity. I will take
any questions.
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Mr. Peterson. Thank you very much. I guess we have no
questions.
Next, we will call on Dorothy Hill, President of the
American Psychiatric Nurses Association. Please proceed.
----------
Thursday, March 22, 2001.
AMERICAN PSYCHIATRIC NURSES ASSOCIATION
WITNESS
DOROTHY HILL, PRESIDENT
Ms. Hill. Mr. Chairman, my name is Dottie Hill and I am
Vice President of Patient Care at Arcadia Hospital in Bangor,
Maine. I am here today as President of the American Psychiatric
Nurses Association, or APNA. Thank you for providing me with
the opportunity to outline APNA's funding priorities for fiscal
year 2002.
Founded in 1987, APNA is comprised of approximately 4,000
psychiatric nurses representing every State in the nation. Our
mission is to advance psychiatric and mental health nursing
practice, improve mental health care for culturally diverse
individuals, families, groups and communities and to help shape
mental health care policy.
Before moving on, I would like to quickly review some
startling statistics to demonstrate the impact mental illness
has on our country. One out of every five children has a mental
health disorder. Two-thirds of our nation's seniors living in
nursing homes have a mental health disorder.
Although 80 percent of those with depression can be
effectively treated, only one out of three receives appropriate
treatment.
The economic burden related to mental illness is staggering
with the total estimated cost for mental health disorders in
1994 at approximately $204,000,000,000. I would like to
reiterate that mental illnesses are biological, medical
illnesses.
First APNA is seeking increased Federal support for
psychiatric nursing research. Psychiatric nurses have been and
will continue to be an integral part of our nation's research
community.
With this in mind, APNA would like to commend this
subcommittee and in particular, Congresswoman DeLauro for the
fiscal year 2001 appropriations measure that led to a joint
NINR and NIH mentorship program for psychiatric nurse
researchers. The program will support the development of expert
psychiatric mental health nurse researchers in the area of
measuring outcomes in the care of psychiatric patients.
APNA is extremely excited about this program and wishes to
acknowledge the tremendous work done by Dr. Patricia Grady,
Director of NINR, and Dr. Steven Hyman, Director of NIMH, and
the staff at both institutions.
In addition to supporting the nurse researcher mentorship
program, strong Federal support is needed in order to build our
nation's research capacity by ensuring an adequate supply of
nurse researchers.
As a result, we would ask the committee to include nurse
researchers in any research-related loan repayment program so
that we can attract the most promising students into
psychiatric nursing research.
We would also like to take a moment to note our concern
that current NIH and NINR funding does not fully reflect the
broad range of psychiatric nursing research. With the grant
funding focused on issues such as violence and substance abuse,
while these issues are very important, we would like to extend
this research portfolio.
In all, APNA is seeking $144,000,000 for NINR and at least
a 16.5 percent increase for NIMH.
APNA's second priority relates to the nursing shortage our
country now faces. I am sure you folks have heard a lot about
that. In order to address this serious problem, APNA and other
members of the health professions and nursing education
coalition recommend at least $440,000,000 in fiscal year 2002
overall funding for Title VII and Title VIII of the Public
Health Service Act.
These figures do not include funding for the children's
hospitals Graduate Medical Education Program, an amount
separate from Title VII and Title VIII funding.
Within the health professions programs, APNA is joined by
other members of the nursing community in seeking a minimum
increase of $25,000,000 within Title VIII.
Further, we are seeking an additional $10,000,000 for 2002
for the Nursing Education Loan Repayment Program. Equally
important, APNA is advocating for an improved data collection
to learn even more about our nursing workforce.
Finally, APNA would like to ask for the committee's helpto
ensure that recent reforms related to the use of seclusion and
restraint include the expertise of our nation's psychiatric nurses. We
are concerned that new policies could overlook our nation's psychiatric
nurses in a way that could negatively impact patient and staff safety.
Safety in nursing work environments is crucial with the
impending nursing shortage.
Thank you very much for providing me with the opportunity
to present our funding priorities. I would be happy to answer
any questions.
[The information follows:]
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Mr. Peterson. The last county medical society that I met
with shared with me that 40 to 50 percent of their patients
needed mental health treatment. That has not been historic; has
it?
Ms. Hill. It actually has been historic, but I don't think
we have discovered or admitted or understood that until more
recently with some of the advances that we are finding, that
people have described before this community in terms of being
able to look in people's brains and understanding that many of
what we heretofore thought were maybe disorders of aging or
just adulthood or disorders related to stress actually had a
biological and medical basis.
The more we understand that, the more we are beginning to
diagnose and hopefully treat those illnesses.
Mr. Peterson. But you don't think that is an uncommon
figure?
Ms. Hill. No, I do not.
Mr. Peterson. Do psych nurses basically work in psych
units? I have a lot of small rural hospitals. They don't all
have psych units. But if they don't have a psych unit, would
they hire a psychiatric nurse?
Ms. Hill. Eighty percent of our psychiatric nurses are
functioning in hospitals, but not in small rural hospitals. If
there is not a psychiatric unit in a hospital, it would be very
hard to find a psychiatric nurse.
Mr. Peterson. They are basically in where the units are?
Ms. Hill. Right.
Mr. Peterson. You kept using the term ``mental health
nursing research.'' I don't quite understand that term.
Ms. Hill. Well, in the past most of the nursing research
that has been done has not been funded. Psychiatric nursing,
mental health nursing research has not been funded or it has
been under-funded.
We have had some great success in the last year getting
some dollars put towards nursing research for psychiatric
nursing. That is what we are asking about. Much of the funding
has gone to much broader nursing research that does not relate
to psychiatry.
Mr. Peterson. Is that separated from psychiatric research
in general? I guess that is the question maybe I should have
asked. Why is it separate who the provider is, whether it is a
nurse or a doctor?
Ms. Hill. Again, nursing research has a specific body of
knowledge all its own which relates to how patient care
influences how patient care influences people to get better. It
is a different science.
Mr. Peterson. Do you think we need to get a little bit
drastic, maybe, in our future budgets about dealing with the
nursing shortage in general, beyond psychiatric, I mean just in
general. Are we approaching, in your view, a huge crisis?
Ms. Hill. A drastic crisis.
Mr. Peterson. I have young nurses in my district, who, now
that we are basically Bachelor's degree nurses, who found that
they can go to school one more year and be anything they want.
That is a foundation for other careers. So, what we thought was
maybe the right direction now allows them to just move on.
Several are going to be accountants, CPAs. That is not exactly
what you would think a nurse would go to.
But because of what they found on the floor in their first
two or three years in practice, they are just moving on. They
are going to night school and they are going to move on and
leave the nursing profession.
If it is like that across the country, we are really in
trouble.
Ms. Hill. That is right.
Mr. Peterson. We are always looking for projects or pilots
that we can do across this country. I think we really need to
put our thinking caps on to discover how we can get people into
nursing quickly.
Ms. Hill. I agree.
Mr. Peterson. I look forward to your advice.
Ms. Hill. Thank you.
Mr. Peterson. Dr. Robert Schwartz, Professor and Chairman,
Department of Family Medicine and Community Health, University
of Miami, School of Medicine.
Good afternoon and welcome.
----------
Thursday, March 22, 2001.
ORGANIZATIONS OF ACADEMIC FAMILY MEDICINE
WITNESS
ROBERT SCHWARTZ, PROFESSOR AND CHAIR, DEPARTMENT OF FAMILY MEDICINE AND
COMMUNITY HEALTH, UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
Dr. Schwartz. Thank you. It is an honor and a privilege to
be here. As you mentioned, I am Professor and Chair of the
Department of Family Medicine and Community Health at the
University of Miami School of Medicine. I am also a member of
the board and legislative chair of the Society of Teachers of
Family Medicine.
I have been a practicing physician and teacher for more
than 20 years. I thank you for the opportunity to be able to
talk on behalf of the organizations of academic family medicine
today.
I am here to discuss two programs under the purview of this
committee: The Family Practice Training Programs under Title
VII of the Health Services Act; and the Agency for Health Care
Research and Quality, also known as AHRQ.
Both of these programs address real and important needs in
our society. These programs are not sexy. They do not have a
natural and sympathetic constituency. What they do have is a
proven ability to make positive changes in our nation's health
care and in our patient's lives.
These are programs this committee supported well in the
last funding cycle. We are asking for that support again this
year.
We ask in addition that the funding for the Primary Care
Medicine and Dentistry Cluster of Title VII be increased
$158,000,000. This would allow for $96,000,000 for family
practice training programs.
Currently, the Federally funded educational system
reinforces the sub-specialization of the physician workforce.
The President's budget blueprint says that the nation has too
many doctors. We respectfully disagree.
What we are experiencing is a surplus of specialists. We do
have a shortage of doctors, primary care physicians and doctors
who care for families.
Title VII programs are designed to counter this market bias
and support development of the primary care physician
workforce. These are the only Federal programs that explicitly
fund the infrastructure to produce physicians who will address
Congressional stipulated goals. They will help deliver health
care to under-served populations. They will bring health care
professionals to rural areas and will improve geographic mal-
distribution of the physician workforce.
We are excited because now we have new data. Federal
funding through Title VII of Family Medicine Department's pre-
doctoral programs and faculty development has made a
difference. A current study shows that these three types of
grants really do make a difference in producing more family
physicians and more primary care doctors.
Pre-doctoral and department development grants made a
difference in producing more primary care doctors serving in
rural areas and more doctors serving in primary care health
professional areas, also known as HPSAs.
Sustained funding during the years of medical school
training had more positive impact than intermittent funding.
Another recent study data show that without family physicians
over 1,000 additional counties would qualify for this
designation as a HPSA.
This compares to an additional 176 counties that would meet
the criteria if all internists, pediatricians and obstetricians
in aggregate were withdrawn. These funds must be maintained and
increased to help our nation's service needs.
I would like to share one of the main success stories
created by Title VII funding. Dr. Joyce Lawrence is a young
African-American woman who grew up in Liberty City, one of the
poorest communities in South Florida and even in the country.
She was able to gain entrance to the University of Arizona
School of Medicine and early in her training was exposed to a
Title VII-funded pre-doctoral family medicine. This had an
enormous impact on her future.
Dr. Lawrence graduated, returned to Miami, determined that
she was going to do something for the community in which she
grew up. She gained a position in our residency program,
supported through the years again by Title VII dollars and
successfully completed her three-year post-graduate training.
Dr. Lawrence was recently hired as the medical director for
a privately-funded school health initiative to put health care
back into the Miami-Dade County school system, one of the
largest public school systems in the country, one with limited
health care access for its predominately minority and under-
served community.
This is a real success story, but only one of many made
possible by sustained Title VII funding for academic family
medicine in the country.
Mr. Chairman, the other program I am testifying on today is
funding for AHRQ. We also appreciate the increased funding
provided this past year. However, we support a budget
allocation of $400,000,000 for fiscal year 2002. This includes
funding for patient safety, translating research into practice,
outcomes research and 350 new investigator-initiated grants.
Why? Just like Title VII programs, the research conducted
through AHRQ is critical to responding to national health care
needs. While our country has dramatically increased investment
in basic medical science research through NIH programs, there
has been little support to answer questions of major concern to
many America's and their family physicians.
Nor has there been adequate effort to develop the clinical
applications in primary care from this new basic science
knowledge. We applaud the investment in NIH, but we feel
strongly that an increase in funding for AHRQ will dramatically
enhance the ability of the recent resources to maximize
research in primary care.
As a practicing family doctor, I need to know how the rapid
advances in new pharmacological products, information,
technology, gene therapy, and diagnostic techniques are
applicable to the care of my patients.
In addition, we need to know the risks of these new
treatments and techniques. AHRQ is the only Federal agency to
support this.
Thank you, Mr. Chairman.
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Mr. Peterson. Thank you, Dr. Schwartz.
Let me ask the first question. What do you consider primary
care?
Dr. Schwartz. Well, that is a good question and obviously,
it is a controversial one.
Mr. Peterson. It shouldn't be.
Dr. Schwartz. It shouldn't be. A family doctor is a
physician who has been trained to take care of the entire
family. They do pediatrics. They do adult medicine. Many of
them still do obstetrics and gynecology. They specialize in
geriatrics. Behavioral medicine is a very important component
of the family medicine programs.
It is really the broadest physician that exists in the
United States and it is the perfect physician for rural areas
and urban centers. The interesting thing is that the majority
of the care to poor and minority populations, the under-served,
takes place in academic or residency training programs
throughout the country.
Mr. Peterson. I always considered family physicians
internists. OB-GYN, I know that is one lot, too. But I don't
understand it because OB-GYNs are many women's primary doctor.
And you mentioned pediatrician. Who should I have included in
that? Anybody else?
Dr. Schwartz. Primary care is usually all of those that you
mentioned. But family physicians consider themselves the real
primary care physician because we really do the broad range of
services where many families go to one physician and then, if
they have a problem, they are referred to somebody else and a
third and a fourth.
One of the things that we hold up most importantly is
continuity of care, seeing the same physician year after year,
understanding patient's problems and understanding them within
the context of family. Those are some of the things that
unfortunately modern medicine has pushed aside.
We have really created so many sub-specialties, I hear all
the time of people being grateful for having a family physician
who really knows the entire family.
Mr. Peterson. In the rural setting, if I did not look at
their license, I would not know an internist from a family
physician because they practice almost the same. Most people
don't know the difference.
Dr. Schwartz. No. That is true.
Mr. Peterson. Where are we at today in the percentage
coming through the primary care specialty? Do you know what the
numbers are nationally? I don't.
Dr. Schwartz. Well, you are going to hear in the news very
soon that today was the match results and unfortunately family
medicine training programs did not do as well as they have done
in the past. That is a significant problem. It has improved
dramatically in the last decade, but as has been mentioned
today, there are many pressures that push students into sub-
specialty medicine. Salaries are much higher in diagnostic
radiology.
Loan repayment is an enormous issue. Students are coming
out with $90,000 or $100,000 indebtedness. Those are clearly
forces that push people away from doing family medicine.
Mr. Peterson. A decade or more ago in State government I
chaired health and welfare. I got the attention of our nine
medical schools by proposing legislation that would have made
those who go into primary care residencies less costly than
those who chose the other.
The medical schools were all in my office within a week
discussing this issue. Now, what I was able to do was-we
changed the numbers in Pennsylvania. I have not watched them
since I left five years ago. But we changed the numbers and
primary care residencies grew in Pennsylvania because of that
action and that fear that we were going to do something to
penalize them.
Of course, some of the bigger schools went back into
primary care because they needed the doctors themselves, just
to fill their own slots.
Now, I guess I would be for loading some incentives. We
have to somehow change this. Everett Koop was the one who
brought me to the issue years ago. We don't have that kind of a
voice any more. He talked about this issue a lot.
I don't think people realize where we are headed.
Dr. Schwartz. I think you are right. I think it is an
extraordinary problem in terms of people understanding that
primary care physicians are essential in health care.
Many of the problems that were discussed today in terms of
the research, et cetera, can only really be handled on the
front line. There is less hospitalization than ever before
because of the cost of hospitalization. Well, where is that
care going to take place but in the community?
You also mentioned the issue of medications. I feel very
strongly that our communities and patients are over-medicated.
One of the reasons we need money in AHRQ is because outcomes
research needs to occur in the community. A lot of the things
that we empirically know as physicians need resources to be
funded.
Mr. Peterson. Come to me privately with you are ideas about
what we talked about. We are running short of time here today.
I would love to talk to you for an hour. Sometime contact me, I
will be glad to work with you.
Dr. Schwartz. Thank you very much, sir.
Mr. Peterson. Next, we are going to hear out of order
Patricia Underwood, the First Vice President of the American
Nurses Association.
If you have a flight problem, let us know.
Welcome. Please proceed.
----------
Thursday, March 22, 2001.
AMERICAN NURSES ASSOCIATION
WITNESS
PATRICIA W. UNDERWOOD, FIRST VICE-PRESIDENT
Ms. Underwood. Good afternoon. Mr. Chairman and members of
the subcommittee, I am Patricia Underwood, the First Vice
President of the American Nurses Association, the only full
service professional organization representing the nation's 2.7
million registered nurses.
This afternoon I will address funding for nursing education
and research. The American Nurses Association believes that our
shared goal of ensuring the nation of an adequate supply of
well-educated nurses will reaffirm the need for increasing
funding for these programs.
Mr. Chairman, as you know, there is a shortage of nurses,
particularly due to a mal-distribution of nurses and their
unwillingness to work in dissatisfying and unsafe environments.
An even more critical shortage of nurses is coming due to a
lack of young people entering the nursing profession.
Due to an aging workforce, the average age of the working
nurse is 43.3 years, and also due to nurses leaving the
profession because of increasingly stressful, non-supportive
working environments.
This shortage will mean that patients in hospitals and
long-term care may not get the frequent checks that they need
to ensure quality of care, prevent complications and thereby
increase hospital stays and increase mortality.
This shortage will also mean that there will be not enough
nurses to care for our vulnerable population such as children,
the elderly or those with mental health problems. It will mean
that there will not be enough nurses to promote health in our
inner city environments and in the rural areas of our nation.
There are several things that can be done right now to
begin to increase the supply of nurses and to create the
environments that will attract and retain nurses.
ANA is encouraged by President Bush's budget blueprint that
recommends focusing on resources, on grants that address
current health care workforce challenges such as the nursing
shortage.
Now, the first thing that we can do is to support the
expansion of programs under the Nurse Education Act
reauthorized under Title VIII of the Health Professional Act of
1998. It provides for competitive grants to schools of nursing
to strengthen nurse education. Unfortunately, lack of funding
within the current NEA has kept the Health Services
Administration from funding programs such as scholarships for
disadvantaged students.
The HRSA Division of Nursing reports that it will not even
hold a competitive grant cycle for nurse stipend and pre-entry
programs for this year due to lack of funds.
The American Nurses Association supports a $25,000,000
increase to a total of $103,700,000 for NEA.
Secondly, we need to find ways to increase the number of
nursing faculty because the average age of the nursing faculty
is 55 years. If we are going to be able to increase the number
of nurses, we have to have the faculty to education them.
Preparation at the Masters level could be increased through
NEA by expanding the current loan repayment program. Fifty
percent of all applications made for loan repayment, however,
are denied due to a lack of funds.
ANA supports increasing the funding for this repayment
program to $10,000,000 for fiscal year 2002.
Preparation of faculty at the doctoral level could also be
increased to some degree through pre- and post-doctoral
training grants provided by the National Institute for Nursing
Research.
Currently, we need to look at funding to ameliorate the
shortage. We need to look at issues that address the nurses
working environment.
Research shows that health facilities catering to nursing
needs are like magnets and can draw nurses to them. It is
interesting, ANA has data that clearly indicates that when you
have appropriate nurse staffing in acute care settings, there
is a decrease in hospital-acquired infections, a decrease in
patient falls, a decrease in pressure sores, a decrease in
lengths of stay and an increase in patient satisfaction, all of
which increase recovery and decrease the cost of health care.
Appropriate staffing also increases nurse satisfaction with
the care that they provide. Further, research has shown very
clearly that the ability of nurses to have decision-making
authority at the bedside and throughout the organization is one
factor that enables hospitals to attract and retain nurses.
Increased funding for the National Institute for Nursing
Research so that research to find models to retain nurses and
identify interventions that are able to achieve the desired
health outcomes with the lowest cost is essential.
Nursing research helps attract talented people into the
profession and provides nurses with an opportunity to conduct
research that makes a difference in the lives of patients.
Mr. Chairman, we thank you for your support of nursing
education and research. You have the opportunity to act in a
way that will truly influence the health of our nation.
Thank you. I would be happy to answer questions.
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Mr. Peterson. I would just like to run an issue by you.
Last year when a group of nursing school people were visiting
me, I urged them to come back and give us some ideas on how to
deal with the nursing shortage.
Two weeks ago they came to my office and gave me a
proposal, asking for a little money. It was the following: This
major nursing school from a major university in Pennsylvania is
going to couple with a group of hospitals and also with a group
of LPN programs and it will be a two-year nursing degree
utilizing LPNs with a certain amount of floor experience.
I would be interested in your reaction to that. That is
sort of a difference in the trend. We have been phasing out of
the two- and three-year programs that have provided a lot of
our nurses to all four-year Bachelor degrees.
Are we in a position where we may have to reverse that?
Ms. Underwood. I do not personally agree with reversing
that. The problem is, when you think about the shortage, many
times people think, okay, let's get more bodies in there to
give care.
The reason this shortage that we are heading for, and it is
going to peak around 2010, is that we have an increasing
demand, because of the increasing acuity in the health care
system throughout the country, we have a demand for an increase
in nurses with more knowledge and experience.
It is those very nurses that have more knowledge and
experience would are going to be retiring and moving out of the
system. So, just increasing the number of new people coming in
is not going to help that. One of the things that I think is a
much more attractive model that a number of State have been
using, is to really encourage nurses who have their associate
degree, their two-year programs, to make the articulation
between the two-year and the four-year and the articulation
actually between the LPN and the two-year and four-year much
more smooth and to really get those people in and facilitate
their moving up in terms of the nursing education.
But just having more people educated is not enough if we
don't change the working environments to keep people.
You mentioned to another speaker about the people who are
preparing for nursing and then going into other fields. While
nursing is great, we need to keep them in nursing.
Mr. Peterson. But I think something has happened that I
didn't anticipate. I didn't realize a Bachelor degree nurse
could go to school for one more year and go to almost any
career that she wants. That is something I think we have to
look at.
I guess a lot of my hospital administrators and nursing
home administrators would argue with your theory. I personally
think we need to do what you want to do and do what this
university wants to do.
We can discuss that another day, but I think the problem is
large enough that if we did all of the above, we are still
going to be in trouble.
Ms. Underwood. One important point that I think you did
make and it came through: This is not a situation that nurses
can solve by themselves, even if we are totally united as a
profession.
We really need to work with all of you and with the public
and with the physicians and with the hospitals to address the
issue.
Mr. Peterson. Thank you.
Mr. Regula [resuming chair]. Our next witness is Dr.
William Harmon, Transplant Physician and Director of Pediatric
Nephrology, Children's Hospital, Boston.
We are happy to welcome you.
----------
Thursday, March 22, 2001.
AMERICAN SOCIETY OF TRANSPLANTATION
WITNESS
WILLIAM E. HARMON, TRANSPLANT PHYSICIAN AND DIRECTOR OF PEDIATRIC
NEPHROLOGY, CHILDRENS HOSPITAL, BOSTON, MASSACHUSETTS
Dr. Harmon. Mr. Chairman, thank you for the opportunity to
present testimony on behalf of the American Society of
Transplantation. I am William Harmon, a transplant physician
and Director of Pediatric Nephrology at Children's Hospital in
Boston and Secretary-Treasurer and Chairman of the Public
Policy Committee of the American Society of Transplantation.
The AST, which is a professional organization that has no
governmental support, was established in 1982. Our membership
which now numbers more than 1,600 is comprised of physicians,
surgeons and scientists engaged in the research and practice of
transplantation medicine, surgery and immunobiology.
The AST is the largest professional transplant organization
in the United States and represents the majority of
professionals in the field of transplantation.
Today, there are more than 75,000 Americans whose names are
on the organ transplant waiting list. During the next hour,
four new names will be added to that list. By the time I get
home to Boston this evening, at least 15 individuals will have
died because the wait for a transplant was just too long.
These patients awaiting transplantation represent a cross-
section of our society. They are mothers and fathers who
provide for their families. They are community and business
leaders. And they are children who should havetheir entire
lives ahead of them.
We have made great strides in the past four decades of
transplantation and we have developed extraordinary medical and
surgical procedures to provide transplants to people with
catastrophic organ failure. But the very success of these
procedures has expanded the pool of candidates much faster than
the supply of available donors.
We simply don't have enough organs to transplant. The organ
transplant waiting list has increased in size by approximately
380 percent in the last ten years while the number of available
donors has changed very little.
Each year the AST identifies the shortage of available
donors as the number one problem in the field of
transplantation. The Society is particularly pleased to see
that Secretary Thompson was very quick to emphasize the need
for enhancing organ donation in the United States.
Support for organ donation is only half the battle. The
other critical issue is ensuring the long-term survival and
function of the transplanted organ. Over the last 40 years,
transplantation of solid organs has moved from an experimental
to an accepted therapy with approximately 22,000 transplants
performed in the United States annually.
The short-term success of this procedure has improved
greatly over the last few years with recipients now enjoying
more than 90 percent survival at one year. Most of this success
can be attributed to research in immunosuppression that is
being funded by Federal appropriations.
Our better understanding of immunity and the body's
response to foreign proteins has led to countless breakthroughs
in many areas of medical science.
The AST believes that now at the dawn of a new millennium
we are on the threshold of many important scientific
breakthroughs in the area of transplantation research. These
include new insights into the immune mechanisms of rejection,
the induction of total tolerance transplant organs, the
immunologic response to animal organs and tissues, so-called
Xenographs, and even bold new experiments in tissue engineering
and organ development.
As one example, two years ago NIAID, NIDDK and the Juvenile
Diabetes Foundation collaborated in the formation of the Immune
Tolerance Network, which is dedicated to the rapid development
and deployment of novel clinical trials in the broad areas of
organ transplantation and autoimmune diseases.
Already new trials have begun and important scientific data
are being collected by the ITN.
AST strongly urges the subcommittee to continue its
leadership in the area of biomedical research and to provide at
least a 16 percent increase in funding for the NIH in fiscal
year 2002.
The AST supports the level of increase for NIAID and HLBI
and NIDDK.
To truly translate the promises of scientific discovery
into better health for all Americans, the President, Congress,
and the American people must continue the commitment to
significant, sustained growth in funding for the NIH.
Clinical and basic transplantation funding at the NIH must
be increased. In particular, we recommend to Congress that the
NIH give consideration to high priority initiatives of NIAID
and HLBI and NIDDK, which I have provided to you in written
testimony.
The fruits of current research have produced many important
successes in the field of transplantation. Ever more precise
and powerful transplant immunosuppressive drugs have greatly
increased both patient and graft survival. However, despite
today's success, virtually all the transplanted organs will
eventually be lost.
Many challenges lie ahead of us, including the
understanding of preexisting and concomitant illnesses such as
cardiovascular disease, hypertension, infection, hepatitis,
bone disease, diabetes and malignancies.
In addition, the therapeutic strategies to induce donor-
specific tolerance hold promise. The strategies to overcome
Xenogenetic barriers have begun. Expansion of these programs,
as well as others I have provided, will ultimately enable
transplant physicians, surgeons and scientists to provide
patients with a successful transplant for a failed organ for
their entire natural lifetime.
Therefore, I end my remarks here today by repeating AST's
request that this subcommittee and Congress stay on track to
double NIH's research budget by the year 2003 and permit these
high priorities and initiatives to move forward.
Thank you very much.
Mr. Regula. Thank you. As I understand it, there is a
nationwide compilation of the people who have need of a
transplant so that you have to take your turn.
Dr. Harmon. Yes. Every patient who is on the transplant
list is known by what is known as the Organ Procurement and
Transplant Network, which is funded through the NOTA
legislation which was enacted in 1987.
We track every patient and every donor so we know who is
coming up. There are 75,000 of them waiting right now.
Mr. Regula. I know. My secretary in the committee I
previously chaired is waiting on lungs. I think she is number
two or three at Johns Hopkins.
I explored Pittsburgh and they said, well, the order of
succession is the same no matter where you go because it is a
nationwide program.
Dr. Harmon. It is a national program.
Mr. Regula. You are doing a lot of great work, though. I
know my colleague, Floyd Spence, is a wonderful example of the
success. He had a lung replacement maybe ten years ago.
Well, thank you for coming.
Dr. Harmon. Thank you very much.
Mr. Regula. The next witness is Dorothy Mann, Board Member
AIDS Alliance for Children, Youth and Families.
----------
Thursday, March 22, 2001.
AIDS ALLIANCE FOR CHILDREN, YOUTH AND FAMILIES
WITNESS
DOROTHY MANN, BOARD MEMBER
Ms. Mann. Good afternoon, Mr. Chairman. My name is Dorothy
Mann. I am a Board member of the AIDS Alliance for Children,
Youth and Families, a national organization addressing the
needs of children, youth and families who are living with,
affected by or at risk for HIV and AIDS. It is my honor also to
serve on the CDC's HIV STD Prevention Advisory Committee.
I am also the Executive Director of the Family Planning
Council in Philadelphia, serving over 120,000 Title X funded
family planning clients. We also provide a range of community-
based HIV and STD prevention, screening and treatment services.
Mr. Chairman, I am here today because our nation is
becoming complacent about AIDS. How many new HIV infections do
you think we have in this country every year? In 2001, 40,000
people will become newly infected with HIV. Half of these
infections will occur in people under 25.
That means 100 people in this country will become infected
with HIV today and again tomorrow. Can we prevent HIV from
infecting 40,000 people in America? Yes. But it will take
bolder leadership, increased funding and smarter allocation of
resources.
The Ryan White Care Act, which was reauthorized by Congress
in the year 2000, is the most critical Federal program
dedicated to people living with HIV and AIDS.
Today I will focus on Title IV of the Care Act, which
provides funding for medical care, social services and access
to research for children, youth, women and families. Simply
put, Title IV is a success story. It has enabled communities to
respond quickly and efficiently to the HIV epidemic.
Since the science became clear about the role of AZT in
reducing mother-to-child HIV transmission, Title IV grantees,
including my own, have played a major role in the remarkable
steady decline in the number of infants born with HIV in this
country.
CDC estimates that fewer than 200 infants were born with
HIV last year. But even one baby born with this disease is too
many. As the number of HIV-infected women of childbearing age
rises, reducing perionatal transmission becomes more
challenging and expensive.
Despite the successes of Title IV, currently funded at
$65,000,000, much more needs to be done.
The President's budget calls for a four percent increase in
discretionary spending. But with 40,000 new infections each
year, we need to increase spending on Federal AIDS programs
much more than four percent or people will die.
If funding for the Federal AIDS program does not keep pace,
individuals, families and entire communities across the country
will continue to be decimated by this terrible disease.
The AIDS Alliance recommends a total funding of $83,000,000
for Title IV for fiscal year 2002. This is a 28 percent
increase over 2001, which is the same rate we received this
year.
As you know, the Congressional Black Caucus Minority AIDS
initiative has provided critical increase in Federal AIDS
programs reflecting the disproportionate impact of HIV and AIDS
on communities of color. Eighty-four percent of the clients
served by Title IV are people of color.
AIDS Alliance would be happy to provide additional
information to this committee as you consider the Congressional
Black Caucus funding for 2002.
It goes without saying that HIV is spread from an infected
person to an uninfected person. Thus far we have focused HIV
prevention efforts almost exclusively on uninfected people. We
have largely ignored those who are already infected.
Mounting evidence suggests that as people with HIV are
living longer and more active lives, they are more likely to
engage in unprotected sex. Let me be clear. I am not advocating
laws or policies that criminalize or stigmatize HIV-positive
people or their behavior.
I am talking about interventions that help HIV-positive
people reduce their risk behavior and protect their uninfected
partners.
What can be done? We must work to break down the walls
between HIV prevention and care programs. As you appropriate
funding to agencies such as HRSA, CDC, and SMSA, you must
encourage coordination to the greatest extent possible to
reduce barriers between these agencies and between prevention
and care.
It is estimated that CDC needs an additional $300 million
each year to implement their new strategic plan to reduce HIV
new infections to 20,000. Scientific evidence should be the
basis for HIV infection policies.
We know, for example, that needle exchange programs work
and do not increase drug use. Yet, we still have Federal
restrictions on their funding. We need to take politics out of
science.
Let me leave you with a final thought: Reversing the
nation's growing complacency about AIDS is a daunting task, but
we must do more, much more, than simply prevent an escalation
in the rate of new infections.
It is intolerable. If we had 40,000 American casualties in
a war, would we find that acceptable? I hardly think so. We
have to do more because if we don't, it will only get worse.
Thank you.
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Mr. Regula. Our next witness is Emily Sheketoff, Executive
Director, American Library Association.
----------
Thursday, March 22, 2001.
AMERICAN LIBRARY ASSOCIATION
WITNESS
EMILY SHEKETOFF, EXECUTIVE DIRECTOR
Ms. Sheketoff. Thank you, Chairman Regula.
We wish to thank you for your support for our libraries in
the past. We look forward to working with you on behalf of
America's libraries in your first year as Chairman of this
subcommittee.
I know that you are familiar with libraries, as a result of
your experiences as a teacher, and as the father of a librarian
at Western Reserve in Hudson, Ohio.
I would like to talk to you about the crucial benefits that
Federal support brings to the libraries.
Mr. Regula. You did not know that my wife started the
National First Ladies Library.
Ms. Sheketoff. Yes, sir, and I have a terrific magazine
article with a good picture of that for you. [Laughter.]
So I tried hard. On Federal support for libraries, we would
like to talk about two key National goals: outreach to those
for whom libraries service requires extra effort or special
materials, such as individuals with disabilities; and
mechanisms to identify, preserve, and share library and
information resources across institutional or governmental
boundaries through technology.
The library community is capable of astonishing creativity
and expertise in support of National goals such as revitalizing
the economy, having children start school ready to learn, and
developing literate, informed adults.
Oftentimes, one of the few sources of funding for
innovation available to libraries is Federal funding. It is
estimated that library programs generate from three to four
dollars for every Federal dollar invested.
Mr. Chairman, our new President has said on many occasions,
``We must leave no child behind.'' I can tell you that
America's libraries believe that we must lead no reader behind.
That is why we feel so strongly that library programs need
additional Federal funding.
We need to ensure equitable access and participation of our
Nation's readers to library activities and opportunities in
their communities. We need to support our libraries continuing
efforts to keep pace with the rapidly changing information
technology environment.
We need to recognize the important contributions that
libraries make to the social, civic, and educational health of
their communities. Like many schools, libraries often service
as the hubs of their communities, and provide important
services, training in technology, and opportunities for life
long learning, particularly in traditionally under-served
areas.
Recently, the library community corroborated on developing
a draft for the reauthorization of the Library Services and
Technology Act, which will expire in fiscal year 2002. We are
seeking to increase the authorization level to $500 million. As
you know, this represents a significant expansion in the
Federal Government's commitment to the support of our Nation's
libraries.
Today, we request your support for fiscal year 2002 of a
down-payment of $350 million for library programs authorized
under LSTA. With this increase, more libraries could expand
their services to include technology training and literacy
programs that enable students to achieve the success and
education, and programs for families, who may not have not used
libraries before.
Library programs for young children encourage pre-reading
skills and develop a love for reading.
Mr. Regula. We will have to wrap it up. I am going to have
to go vote here. You are preaching to the choir.
Ms. Sheketoff. Great, well, I just wanted to give you an
example in Ohio. In this year, Ohio received $5.5 million. If
the state distribution was increased to $350 million, Ohio
would get about $11 million. This would enable Ohio to complete
the school library connections to the statewide Ohio network.
In 1999, the libraries of Ohio requested $7.5 million in
LSTA funding, but received only $2.9 million. So you see, the
need is great and the funds available can stretch only so far.
We are also asking that this subcommittee support education
Title 6, the Block Grant that goes to libraries, at least at
the $400 million level.
As you know, school library materials are only one option
of this block grant. Unfortunately, less and less of the funds
are used for school library materials. As a result, many school
libraries have old, outdated, and inaccurate material on their
shelves.
Research shows that a good library media program in the
school is an excellent predictor of student achievement. In
summary, an increase in LSTA funding to $350 million would
allow more of the 16,000 libraries to begin to provide Internet
training and information access services to families, adult
learners, the small business sector, and the communities who
need them.
Thank you very much, Mr. Chairman.
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Mr. Regula. Thank you, and they are very important. I
understand that. We, of course, have constraints on what we
have available.
Ms. Sheketoff. With a real dedication to education, the
library component is really critical.
Mr. Regula. Well, we hope that we get enough adequate
funding from OMB.
Thank you for coming today. I regret that I have to get
over to there and vote or we will run out of time.
Ms. Sheketoff. Thank you, Mr. Chairman.
Mr. Regula. The committee will be in recess for about 10
minutes.
[Recess.]
Mr. Regula. We will reconvene.
Our next witness is Mr. Richard Kase.
----------
Thursday, March 22, 2001.
ARTHRITIS FOUNDATION NORTHEAST OHIO CHAPTER
WITNESS
RICHARD D. KASE, CHAIRMAN, CANTON OHIO ADVISORY BOARD, ARTHRITIS
FOUNDATION NORTHEAST OHIO CHAPTER
Mr. Kase. Good afternoon, Mr. Chairman and members of the
subcommittee, which are few and far between at this stage of
the game.
Mr. Regula. Yes, that is true.
Mr. Kase. It is truly an honor to speak to you, one of
Canton's favorite sons.
I want to thank you for the opportunity to speak today
about how Congress can continue to play an important role in
helping improve the quality of life for the 43 million
Americans living with arthritis, including the 300,000 children
living with the disease.
Specifically, I would like to thank the subcommittee for
its leadership in supporting funding increases to support
arthritis research at the National Institute of Arthritis, and
musculoskeletal skeletal and skin diseases and the Centers for
Disease Control and Prevention's Arthritis Program.
As I said, my name is Richard Kase. I am from Canton, Ohio.
I am a business man and a volunteer. I am here today in my role
with Arthritis Foundation of Northeast Ohio as the Volunteer
Chair of the Canton Area Advisory Board.
I am also one of the 43 million Americans living with this
painful and oftentimes debilitating disease. I was first
diagnosed with osteoarthritis in 1992, at the age of 40.
Due to osteoarthritis, I have had five knee operations and
one back surgery. While osteoarthritis limits my daily
activities, simply climbing stairs is extremely painful.
I consider myself fortunate. For today, there is new hope
for the millions of Americans with arthritis. We have new, more
effective therapies to prevent pain and disability, thanks to
the Federal investment in research.
With the CDC's arthritis program, we are reaching out and
empowering millions of Americans to help them take steps to
improve their quality of life.
Mr. Chairman, 95,000 persons living in Ohio's 16th
Congressional District have arthritis. One of those individuals
is Tiffany Kenyan.
Tiffany was diagnosed with juvenile rheumatoid arthritis at
the age of four. Every day is a challenge, as she faces the
pain, physical disabilities, and psychological trauma brought
on by the disease.
Now a teenager, Tiffany has been unable to do many of the
activities that most of her friends take for granted. However,
thanks to new therapies, early diagnosis in the treatment and
the support of family, she plans golf, dances, and swims when
possible. She may have arthritis, but it does not have her.
Like me, Tiffany has been a beneficiary of the research
investments in the National Institutes of Health by this
subcommittee. Our lives have been made better, thanks to a new
generation of treatments and therapies, for the many serious
forms of the disease.
Ongoing growth in the NIH budget will provide the National
Institute for Arthritis and Musculoskeletal and Skin Diseases
the resources to support critical research ranging from
osteoarthritis to lupus to juvenile rheumatoid arthritis.
To meet this pressing national need, the Foundation urges
the members of the subcommittee to continue the doubling of the
NIH budget, within five years, and provide $462 million, as
part of the NIH's fiscal year 2002 appropriations for NIAMs.
With this in mind, the Arthritis Foundation strongly
believes this investment must be matched with a similar
investment in public health programs, designed to ensure that
all Americans benefit from our new understandings about the
disease, effective self-management strategies, and improved
treatment options.
As a person with arthritis, I am proud that Congress has
recognized the importance of this national effort by
establishing and funding the National Arthritis Action Plan,
which is a public health strategy.
This innovative public health strategy is being implemented
by the CDC, in partnership with state health departments across
America. The Arthritis Foundation, and its 55 state-based
chapters.
Among our goals are improving the scientific information
base on arthritis; researching how we can better prevent
arthritis; and encouraging more individuals with arthritis to
seek early diagnosis and treatment, to reduce pain and
disability.
Due to this subcommittee's support and leadership, the CDC
was provided with $12 million as part of the fiscal year 2001
budget, to move forward with this vision. To date, 37 states
have been awarded funds to begin executing the plan.
Based on the enthusiasm of our state partners, the
Foundation's commitment to invest its resources, and the
pressing need to address the growing public health problems
associated with arthritis, we strongly encourage the members of
the subcommittee to provide the CDC with $24.5 million, as part
of the fiscal year 2002 budget, to help establish state-based
arthritis programs in all states in territories.
This modest investment will help us meet the challenge of
arthritis, and lead to a day when arthritis is no longer the
leading cause of disability in the U.S., for individuals 18
years of age and older.
It will help lead to a day when arthritis no longer costs
our economy $82.5 billion a year in medical care and related
expenses, including lost productivity.
Congressman Regula, for generations, we have labored under
the many myths surrounding arthritis. Arthritis was an
inevitable part of the aging process. There were no effective
treatment options, apart from taking a few aspirin.
Exercise was harmful for individuals with arthritis.
Children do not get arthritis was another myth. It cannot be
prevented.
Today, we stand ready with the necessary tools, expertise
and energy, to shatter these myths, and capitalize on the
fruits of our research to help improve the lives of Americans
living with arthritis.
On behalf of the 43 million Americans living with
arthritis, I appreciate the opportunity to speak to you today,
and urge the members of the subcommittee to help us win the war
against arthritis by supporting funding for these critical
Federal Programs.
It has been a pleasure and honor to testify to you today on
behalf of all of the arthritis victims. Thank you.
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Mr. Regula. You are saying that there have been some very
substantial progress, though?
Mr. Kase. There has been tremendous progress, relative to
new drugs that have reached the market; great progress relative
to public awareness and prevention.
Mr. Regula. Do the drugs just relieve the pain, or do they
actually affect some degree of cure or change?
Mr. Kase. It is really a supplement to other non-steroidal
drugs, just to relieve the pain. I, for one, have been on
Vioxx, which is a new medication. You take one a day, as
opposed to the 12 Advil that I was taking every day.
Mr. Regula. I see Vioxx advertised. Does it work pretty
effectively?
Mr. Kase. For me, it has worked very well. For some people,
it does not work quite as well, and it has some side effects
for other individuals. But for me, it was a very good drug, and
is a very good drug.
Mr. Regula. Thank you for coming. I know it is a
substantial trip here from Canton, Ohio.
Mr. Kase. But to come to see you, Congressman, it was well
worth it. [Laughter.]
Mr. Regula. You had better reserve judgment until we get
the bill out and see.
Mr. Kase. Well, we will talk about that back in
Canton.Thank you. [Laughter.]
Mr. Regula. Well, we are going to do what we can for all of
these things. It depends what we have available in the
allocation of funds, which is beyond our control.
Our next witness is Dr. Paul Mintz, Professor of Pathology
and Internal Medicine, University of Virginia Health System.
----------
Thursday, March 22, 2001.
AMERICAN ASSOCIATION OF BLOOD BANKS
WITNESS
PAUL MINTZ, M.D., PROFESSOR OF PATHOLOGY AND INTERNAL MEDICINE,
UNIVERSITY OF VIRGINIA HEALTH SYSTEM; AMERICAN ASSOCIATION OF BLOOD
BANKS
Dr. Mintz. Good afternoon, Mr. Chairman. I appreciate the
opportunity very much to come here today.
I am Professor of Pathology and Internal Medicine at the
University of Virginia. Today, I am speaking to you on behalf
of the American Association of Blood Banks, the professional
society for approximately 8,000 individuals involved in blood
banking and transfusion medicine; and about 2,000 institutional
members, including community blood centers, the American Red
Cross, and hospital-based services.
Mr. Regula. I understand they are having trouble getting
people to donate. Is that true?
Dr. Mintz. That is true, sir. There really has been
intermittent blood shortages. Of course, fewer and fewer people
are eligible to donate, as restrictions are put into place.
Mr. Regula. Yes, well, mad cow disease has put a six month
waiting period on anyone in England, as I understand it.
Dr. Mintz. It is anyone who actually has lived in England,
between 1980 and 1996, for six months, cannot be a blood donor,
indefinitely, in the United States.
Mr. Regula. Indefinitely?
Dr. Mintz. That is correct. That actually is also going to
apply now in France, for people who have been in France for 10
years or Portugal for 10 years, based on a new recommendation.
So there are fewer and fewer eligible blood donors in this
country; that is correct.
AABB has long recognized the critical role of the National
Institutes of Health, and especially the National Heart, Lung,
and Blood Institute, and other public health agencies that they
have played in ensuring that patients have access to the best
possible transfusion therapies.
In fact, today, the Nation's blood supply is safer than it
has ever been. Each year, over 26 million units of blood are
transfused into millions of individuals. With enhanced Federal
support for research, transfusion medicine promises new
lifesaving therapies, as well as an even safer blood supply.
We strongly encourage to support the following research
initiatives. First, ongoing Federal support for blood supply
data is needed. Blood safety and availability are inseparable
requirements for ensuring optimal patient care.
The safest possible blood component cannot benefit the
patient if it is not readily available. The number and duration
of seasonal blood shortages are increasing. An aging population
and more complex medical procedures have resulted in an
increasing demand for blood.
In order to predict and prepare for possible shortages, we
need reliable data regarding both collection and utilization of
all types of blood components.
In 1996, recognizing the significant need for blood supply
data, the AABB founded the National Blood Data Resource Center,
the NBDRC. In prior years, NHLBI had funded this data
collection. However, when this Federal funding ceased, there
was a clear vacuum in public and private support for national
blood data collection.
The AABB is very proud of the fine work that the NBDRC has
produced, including its important biennial nationwide blood
collection and utilization survey. In fiscal year 2000, the
NHLBI agreed to fund the collection of certain monthly supply
statistics. Unfortunately, ongoing support from the NHLBI for
blood supply data is not continuing in fiscal year 2001.
The AABB is very concerned that so long as no specific
Federal agency is responsible for supporting critical data
collection regarding the blood supply, we will not be able to
generate necessary long-term information.
Policymakers, including Congress, cannot make sound
decisions affecting patients lives, absent reliable data.
Therefore, the AABB strongly urges Congress to designate an
appropriate office within the Public Health Service, to be
responsible for Federal support of blood supply data
collection. In addition, Congress should appropriate sufficient
dollars to support long-term efforts, like those of the
National Blood Data Resource Center, to collect,analyze, and
distribute data about the Nation's blood supply.
In short, we need to know who is donating the blood, what
kind of components are being collected, and where it is going.
Then we can plan responsibly regarding donor selection
criteria, and patient initiatives.
Mr. Regula. I assume you work with the American Red Cross,
since they seem to take the lead.
Dr. Mintz. Yes, that is correct. The American Red Cross is
responsible for about half the blood collection in this
country, and then other community blood centers are responsible
for the other half. We, in the AABB, actually work with all of
these centers.
A second initiative that I would like to suggest is
research regarding non-infectious risks of transfusion. The
AABB urges the subcommittee to support additional Federal
efforts to enhance the safety of blood transfusion.
In recent decades, the United States invested significantly
in reducing transfusion risks associated with infectious
diseases, as you well know. This investment has paid off
dramatically.
When I first taught medical students in 1979, I told them
there was one percent risk of acquiring what is not hepatitis C
from a blood transfusion. That risk is now about one in a
million. The same kind of statistics apply to HIV. The risk of
acquiring such an infection from a blood transfusion has
actually been reduced about 10,000 fold in the last 20 years.
Mr. Regula. So you have better control.
Dr. Mintz. We have better testing, better donor screening,
and also viral inactivation of many blood components.
Mr. Regula. How do we help?
Dr. Mintz. Actually, I think that right now, Federal
funding should be directed toward non-infectious risks. There
is actually about a 100 fold increase in risk of patient who is
receiving a blood transfusion right now, getting the wrong
unit, than there is of getting an infection.
There has not been an investment in the processes to assure
appropriate safeguards in getting the right unit to the right
patient.
Mr. Regula. Where would that investment be; CDC, NIH?
Dr. Mintz. I think it would be in developing a clinical
trials network, that would emphasize research in the non-
infectious risks of transfusion, including providing processes
to get the right unit to the right patient, and other non-
infectious risks, such as immuno-modulation.
Mr. Regula. Well, thank you, and we will put your testimony
in the record.
Dr. Mintz. Thank you very much.
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Mr. Regula. We have two young ladies here, and one of them
from my district. They are in the Presidential classroom, and
this is the real world, young ladies.
What we are doing in here will touch your lives, because we
do all the research on medical, and something that is
discovered over the next many months and years may save your
life.
Likewise, we do education. Of course, I am sure that is
important to both of you. So we are happy to welcome you. As
soon as we get finished up here, we will go back and get a
picture with you in the office.
Okay, next we have Kathryn Peppe, President of the
Association of Maternal and Child Health Programs.
----------
Thursday, March 22, 2001.
ASSOCIATION OF MATERNAL AND CHILD HEALTH PROGRAMS
WITNESS
KATHRYN PEPPE, PRESIDENT, ASSOCIATION OF MATERNAL AND CHILD HEALTH
PROGRAMS
Ms. Peppe. Thank you, Mr. Chairman. I am Kathy Peppe,
President of Association of Maternal and Child and Health
Programs. I am also the Chief of the Division of Family and
Community Health Services at the Ohio Department of Health.
That is Ohio's maternal and health program.
Thank you for the opportunity to testify today. We at the
Association of Maternal Child and Health Programs really
appreciate the subcommittee's interest and support of Maternal
and Child Health Services Block Grant, and all of the programs
that are supported with that funding source in our states.
For over 65 years, programs authorized under Title 5 of the
Social Security Act, the Maternal and Child Health Programs
Block Grant, have helped fulfill our Nation's strong commitment
to improving the health of all mothers and children. Title 5 is
the foundation of our Nation's public health system.
It continues today to watch over and promote the health of
mothers, children, and youth, while serving as a safety net
program for all of our country's high risk and most vulnerable
residents.
State maternal and child health programs funded by the
Block Grant have demonstrated their ability to adapt through
decades of change.
We have had to respond to the emergence of new diseases,
the discovery of new vaccines and treatment methods, and the
changing health care financing and delivery systems across the
country. Yet Congress has remained committed to this public
health program, because we have been accountable for what we
have been doing.
We have provided proven preventive health programs with
demonstrated and measurable results. Grants to the State Health
Departments are used to help locally-determined needs that are
consistent with the national healthy people goals for fiscal
year 2010 or 2000, so on.
This includes reducing maternal and infant mortality,
helping children with disabilities function to their full
potential, and educating children and adolescents about how to
reduce risky behaviors and learn healthy lifestyles.
The Maternal and Child Health Block Grant encompasses lots
more than just moms and babies. Children with special health
care needs and teenagers are a major focus for our programs.
Maternal and Child Health Programs ultimately address the
health needs of families. The flexibility of the Block Grant
gives us the chance to develop innovative programs and services
that go beyond health care needs to address individual specific
needs and help people access needed health care services.
Last year, Congress raised the authorization level for the
Title 5 Program to $850 million. While funding for other public
health programs has been expanded over the past five years,
Title 5's funding has remained relatively flat in the past
decade. So the increased authorization was desperately needed
and comes at an ideal time for us in states.
The MCH programs have just completed a five year needs
assessment. As a result, all of the states and territories are
poised to move forward to address their unmet health needs, as
soon as additional funding is appropriated.
Each state knows precisely how it would allocate its
resources to meet the priority needs for maternal and child
health populations. In Ohio, we could use additional funds to
expand our child and family health services clinic programs.
These are clinics that provide primary health care for pregnant
women, child and infants, who otherwise would go without health
care.
We could implement a statewide system of child fatality
review. We could offer additional children with special health
care needs access to the services of specialists around the
state. We could put preventive dental sealants on the teeth of
more children to reduce cavities.
I want to share with you a couple of stories about real
people, who we have touched in Ohio. Anna is someone who is
from Stark County, your home. She is a pregnant 31 year old
woman with a history of premature delivery, closely spaced
pregnancies, and late entry into prenatal care; plus asthma,
tobacco use, drug use, homelessness, and three of her four
children are in permanent placement.
Fortunately, Ohio's Title 5 Program had what Anna needed.
The Ohio Infant Mortality Reduction Initiative paired a trained
outreach worker from the local neighborhood, where these high
risk, low income pregnant women, who are either uninsured or
under-insured.
The outreach worker helped this mom, and subsequently her
baby, get into care and stay in care, as well as meet other
basic needs. Thanks to the outreach program, Anna has her own
apartment today. She has completed parenting classes and
attends substance abuse treatment programs.
The best news is that she delivered a healthy beautiful and
drug free baby girl, she regained custody of one of her other
children.
This is a victory for Ohio. In its recent needs assessment,
Ohio Title 5 Program identified the reduction of infant
mortality, particularly for those with disabilities, as one of
our top 10 health issues.
It is an excellent example of how assessment of local needs
can translate into effective programs. Let me just close by
saying that we are urging you to remember the faces of people
who are actually touched by block grants in the states and
their stories like Anna's.
There are hundreds of thousands of other stories that we
could share with you similar to these. Please fully fund the
Title 5 Program at $850 million.
Mr. Regula. It sounds like you are having a lot of success
and that is what we like to hear on these programs.
Ms. Peppe. Yes, thank you. I would be happy to answer any
questions.
Mr. Regula. Thank you.
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Mr. Regula. Our next witness is Carl Suter, Director of
Vocational Rehabilitation Programs, Council of State
Administrators; welcome.
----------
Thursday, March 22, 2001.
COUNCIL OF STATE ADMINISTRATORS OF VOCATIONAL REHABILITATION
WITNESS
CARL SUTER, DIRECTOR, COUNCIL OF STATE ADMINISTRATORS OF VOCATIONAL
REHABILITATION
Mr. Suter. Good afternoon, Mr. Chairman, I am Carl Suter. I
am the Director of the Illinois Rehabilitation Agency of
Vocation Rehabilitation Services.
I also am a member of the Council of State Administrators
of Vocational Rehabilitation. We are a Federal and State
partnership, and have been a partnership for over 80 years in
helping individuals with disabilities become employed.
The Rehabilitation Act and the Vocational Rehabilitation
Program is the cornerstone of our Nation's commitment to
serving individuals with disabilities and helping them to
become employed.
Our program, every year, get thousands of folks into jobs.
One of the things that I am here to tell you today, is that
even though I know Congress had intended in the past to give
our program cost of living increases every year, states like
Ohio and Illinois are not receiving those cost of living
increases.
For example, in Illinois, we received less than one-half of
one percent of an increase for cost of living.
Mr. Regula. Do you think that other states are getting it,
and you are not; or is it across the board?
Mr. Suter. Well, because of the way the formula works, in
Illinois and Ohio, the formula has had an adverse impact on us
being able to get what the COLA, the overall COLA that you had
for the program. In Illinois, we got less than one-half of one
percent. I think that Ohio got less than two percent of an
increase.
This comes at a time in which, when you would look at Louis
Harris pole and other National surveys, we know that 70 percent
of people of disabilities are not employed. Yet, two thirds of
those wish to work. Individuals between the ages of 18 and 60
are not working, and yet they want to work.
Our program has many pressures on it. The special education
program, is a great program, a sister program, that helps many
youths with disabilities get great services. Now as those youth
begin to come to adulthood, and they come to vocational
rehabilitation, that adds additional pressures to our program
to serve them.
I would like to tell you about one youth in Illinois to
kind of illustrate this point. Rick is a young man with Down's
Syndrome in the Chicago area. We started working with him when
he was a junior in high school. We helped him get a job after
school and on weekends.
When Rick graduated last summer, he told us that he did not
want to sit at home, like some of his friends were going to be
doing. He wanted to work. He wanted a real job.
He did not want to have to get $550 each month from SSI. He
wanted to work. We got Rick a job working in a hospital. He is
earning over $9 an hour. He is getting full benefits.
There are thousands of Ricks in this country. They want to
work, and they turn to vocational rehabilitation services for
the kinds of training technology that they need.
There are many pressures on our program. The Olmstead
decision is another one, where folks are coming out of
institutions and now into the community. Not only do they want
to live independently; they want to work.
With TANF, we have had great success in this country in
getting folks off of TANF. But what is left now is the hard
core of that population. Many of those, in fact, have
disabilities and they are coming to us for vocational
rehabilitation services.
We have enough funds to only serve one in twenty eligible
individuals with disabilities; one in twenty. Yet, the data
shows that there are thousands and thousands, hundreds of
thousands of folks who need our services.
The Rehabilitation Services Administration tells us that in
fiscal year 1999, we spent $2.2 billion on services for this
population. We serve nationally over 1.2 million people and got
230,000 of those folks into competitive jobs.
Sir, let me leave you with one recommendation. Our Council
of State Administrators of Vocational Rehabilitation would like
for us to be able to have an increase that will allow us to
serve these hundreds of thousands of folks who come to us.
We are asking for a 10 percent increase in funding, about
6.5 percent over the regular CPI that we would normally
bereceiving. That equates to about $240 million.
Mr. Regula. Well, you really have two problems. You need to
change the formula, because I think it penalizes Illinois and
Ohio; and secondly, of course, to get more money into the
program.
Mr. Suter. Right.
Mr. Regula. Thank you for coming.
Mr. Suter. Thank you very much.
Mr. Regula. I know that it is a good program. I am familiar
with it back home.
Mr. Suter. Thank you.
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Mr. Regula. Our next witness is Steve Korn, President of
National Council of Social Security Management Associations.
----------
Thursday, March 22, 2001.
NATIONAL COUNCIL OF SOCIAL SECURITY MANAGEMENT ASSOCIATIONS, INC.
WITNESS
STEVE KORN, PRESIDENT, NATIONAL COUNCIL OF SOCIAL SECURITY MANAGEMENT
ASSOCIATIONS, INC.
Mr. Korn. Chairman Regula, my name is Steve Korn and I am
here as President of the National Council of Social Security
Management Associations, an organization of over 3,000 managers
and supervisors who work in SSA's field offices and telephone
centers.
Thank you for giving me the opportunity to come before you
today to talk about the budget needs of the Social Security
Administration, from the perspective of the front-line managers
and supervisors who are directly responsible for delivering
service to the American public.
Over the past two decades, SSA has witnessed a dramatic
reduction in staff. For example, the local Canton, Ohio field
office lost seven positions just in the past six years.
In addition, over the past five years, supervisory staff in
SSA's local field offices and telephone centers have been
reduced by more than 1,000 positions. Accommodations of
dramatic reductions in both overall and supervisory staff, has
resulted in a critical situation whereby the level and quality
of service provided to the public is in severe jeopardy.
A little over a year ago, the Bipartisan Social Security
Advisory Board warned of the need to bolster resources in the
Social Security field offices. The board found that staff
resources in offices all over the country have declined to the
point where their ability to provide quality service to the
community is threatened. The board reaffirmed these findings in
an updated report issued earlier this month.
To better quantify the findings of the Social Security
Advisory Board, our organization conducted a survey of field
office management throughout the country. The responses which
were received from managers in over 50 percent of all field
offices confirm that services were below acceptable levels in
three critical areas: telephone service, the quality of work
products, and in employee training.
They also found that customer waiting times are increasing.
A copy of these findings has been sent to this committee, as
well as to each Congressional office.
While the statistics of the results are revealing, I
thought it was interesting to share a couple of the more than
64 pages of comments that we received from these front-line
managers.
For example, regarding telephone service, a manager in the
Chicago region, which includes the State of Ohio writes the
following: ``We need more incoming lines. However, we do not
have the staff to cover the additional lines.''
Another manager offered this chilling story. A physician
contacted us in response to a representative pay issue. He
wrote the manager saying he was on hold for over an hour.
Fortunately, he had a speaker phone, which enabled him to
take care of his patients while waiting for us to answer.
Hedisconnected the call before we ever spoke to him. In his letter he
stated, ``You call me from now on, because I will never contact Social
Security again.'' I wish I could tell you that this was simply an
isolated incident, but unfortunately, it really is not.
Another Chicago region manager wrote, ``As we take the SSA
measures to the community, we have generated more work for the
staff. We say we are ambassadors of the agency, and cultivate
good relationships with neighborhood. We then make our public
wait longer to be served, and have insufficient staff to
validate what we went out preached.''
Another manager writes, ``Quality has suffered here to a
great extent as the result of the loss of front-line
supervisors. These were the people with the hands-on
experience. They reviewed the work. They addressed individual
employee shortcomings. They saw to the technical needs of the
employees. Now they are gone.''
If these current service delivery and quality problems were
not bad enough, Social Security will face additional challenges
over the coming decade, as the large baby boom generation
begins to file for disability and retirement benefits, at the
same time that the agency faces its own wave of retirements.
For example, Quinzella Hobbs, who is the manager of the
Canton Field Office, reports that right now, 29 percent of her
staff has both the age and required years of services to retire
today. It generally takes replacement hires three years to
become fully productive.
In the face of these current and future challenges, NCSSA
recommends the following. First, SSA's budget should reflect
the immediate need to increase front-line staffing in SSA's
field offices by 5,000 full-time equivalents, a 17.5 percent
increase.
Second, SSA's field offices and telephone centers should be
allowed to fill front-line supervisory positions, based on the
need to maintain adequate levels of quality training and
customer service.
Third, SSA's administrative budget should be removed from
the discretionary spending caps, along with SSA's program
budget, allowing Congress to allocate sufficient funds to SSA,
based on demonstrated service needs.
As an independent agency, in accordance with Section 104(b)
of the Social Security Act, Social Security submitted its own
fiscal year 2000 budget to this committee. Social Security
requested $8.11 billion, which is $438 million more than was
requested by the new Administration.
The additional funds will allow SSA to begin to address
many of the problems identified. For example, new employees can
be hired now, so they can be trained and up to speed before we
lose our experienced employees. Certainly, we would urge you to
support this higher level of funding.
Mr. Chairman, I thank you again for inviting my testimony.
I am certainly happy to answer any questions that you might
have.
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Mr. Regula. Well, thank you, and I am aware of some of the
problems because, of course, we look to our local Social
Security Office to help with constituent problems. I have hired
a couple of your people away. That is probably one of the
reasons that you have a shortage. [Laughter.]
They are good people, and they are well trained. It works
out well for us. But we are aware of the problem, and we, of
course, have the report that was submitted. Thank you for
coming. Where are you located?
Mr. Korn. I am located in Vallejo, California, Northern
California. Again, the problems we face are very similar to
what is faced in your state.
Mr. Regula. Is automation helping you?
Mr. Korn. Automation is essential. Quite honestly, without
automation, we would be much worse. The problem is, there is
not enough automation out there to address the problems.
Mr. Regula. Somebody has to put the material in to
automate.
Mr. Korn. And there has to be people to use what is out
there. So it is a combination. It is not one answer.
Mr. Regula. Well, thanks for coming; you have made a long
trip here.
Mr. Korn. Yes, I have.
Mr. Regula. We appreciate it.
Mr. Korn. I am happy to do it.
Mr. Regula. Do not be too distressed that we do not have
other committee members here. You have got the most important
people here, and that is the staff.
Mr. Korn. That is absolute true, and we have the Chairman.
Thank you very much.
Mr. Regula. You are welcome.
Our next witness is Mr. John Black, General Counsel,
National High School Federation.
----------
Thursday, March 22, 2001.
NATIONAL HIGH SCHOOL FEDERATION
WITNESS
JOHN BLACK, GENERAL COUNSEL, NATIONAL HIGH SCHOOL FEDERATION
Mr. Black. Thank you. Good afternoon, and I appreciate the
opportunity to give the keynote address here today.
Actually, Dr. Martin and I are both from Indiana. Given the
success, or lack thereof, of the Indiana University basketball
team, I guess we are just having one of those weeks.
Mr. Regula. Well, your former coach was from my district.
Mr. Black. Oh, really?
Mr. Regula. Yes, we keep chairs away up there. [Laughter.]
Please continue.
Mr. Black. Well, I am here on behalf of the National High
School Federation, which is an organization comprised of all 50
state associations and the District of Columbia, and one of the
members is Clara Mascara in Ohio High School Athletic
Association.
We have approximately seven million young people who play
under the rules that we write each year in 17 sports. One of
them is right here, and maybe both of them. We have got a
couple of high school athletes there.
We have a concern that is coming up. It factors into the
idea that a lot of teachers who used to be coaches are going on
to other things; either they are getting tired of coaching or
they run for Congress.
So we wind up with a situation where instead of having
experienced educators providing coaching to young people, we
wind up, particularly at the lower level, the JV and freshmen
and sophomore teams and in middle schools, with a lot parents
and a lot of volunteers from the community, who may know
something about ``Xs and Os,'' but are not necessarily
experienced in the teaching skills that help them instill what
we like to think of are some of the advantages of participation
in inter-scholastic activities.
The CDC has pointed lately very much at childhood obesity,
and Health and Human Services has talked a lot about the
benefits of extra-curricular participation, in terms of staying
in school, better grades, lower team pregnancies, lower
incidents of drug use.
So we think we are doing a good thing. It costs about three
percent of the total budget for education to take care of
athletics and extra-curricular activities. However, we are
winding up with all these coaches who really need to have a
little bit of extra help, in terms of how to take advantage of
what we call the teachable moments that come in the course of
teaching.
We have a program that has worked for about 10 years. It is
the Coaches Education Program. It is very inexpensive. It costs
about $40 per person. It is focused on people who are not
trained educators.
Our concern is that although we are giving it to about
25,000 people a year, that is only a drop in the bucket. We
have got an awful lot more coaches out there, and there is a
very high turnover.
So we are thinking that it might make some sense to try a
model program, where we make it available, and particularly
available to inner city in situations, where the $40 to come as
a volunteer coach may seem as a real impediment.
We would like to try that on an experimental basis in a
couple of states, to just see if it works and see if it helps.
Mr. Regula. Have you put your suggestion in your statement?
Mr. Black. We have.
Mr. Regula. We will get a chance to look at it.
Mr. Black. Okay.
Mr. Regula. And we appreciate your being here.
Mr. Black. Thank you very much.
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Mr. Regula. All right, our last witness today is Dr.
William Martin, President and CEO of Indiana University Health
Care, and President of the American Thoracic Society, and Board
Member of the American Lung Association. Tell us your story.
----------
Thursday, March 22, 2001.
THE AMERICAN LUNG ASSOCIATION AND THE AMERICAN THORACIC SOCIETY
WITNESS
WILLIAM J. MARTIN, II, MD, THE AMERICAN LUNG ASSOCIATION AND THE
AMERICAN THORACIC SOCIETY
Dr. Martin. Well, I realize that I am the last witness of
the last day. I would first like to thank you and your members.
This is our only chance to put forth the story for our patients
and the scientific community, and we thank you very much for
this opportunity.
I am a pulmonary and critical care physician at Indian
University and, as you noted, President of the American
Thoracic Society and a Board Member of the American Lung
Association.
In my brief time before you today, I would like to raise
three issues. The first is the rapidly disappearing physician
scientist. That is not simply physician scientists in lung
disease, but in all of health related science.
Physician scientists are essential to the research
enterprise, because they link bench research to the patient's
bedside. However, fewer and fewer physicians are devoting their
time and talents to research.
There are several mechanisms at NIH that they could use to
address these problems, but perhaps most importantly, Congress
needs to address why physicians choose not to pursue science.
Invariably, this is because of the overwhelming debt from
medical school, which you have earlier today, that can average
anywhere from $75,000 to $150,000.
Physicians with large debts often leave their research
careers behind, and pursue private practice, where debts can be
more easily paid off. The next generation of physician
scientists should not be selected on the basis of whether or
not they have debts from medical school.
Last year, Congress passed legislation that provided debt
relief for physicians who do clinical research. We would
request that Congress support expansion of this program to
include all areas of biomedical science.
If enacted, Congress would ensure that the quality of the
scientist, and not his or her financial background, would
determine the next generation of physician scientists.
Mr. Regula. Was this debt relief on student loans, Federal
supported loans?
Dr. Martin. Yes, it is for medical school. It was part of
an omnibus package last year. This was specifically the
Clinical Research Enhancement Act.
The second issue that I wish to bring to your attention is
that of chronic obstructed pulmonary disease, or COPD. COPD is
a collection of airway disorders, including emphysema, that are
progressive and fatal.
An estimated 16 million Americans have COPD, and another 16
million Americans are undiagnosed. COPD affects twice as many
Americans as diabetes, and is the Nation's fourth leading cause
of death.
In the April issue of ``Scientific American,'' which I was
just reading on my way here, it is noted that the mortality
rate for heart disease and stroke for the past 20 years has
declined by more than 50 percent. In contrast, in this same
article, the mortality for COPD has increased by 34 percent.
Surprisingly, little is known about how COPD develops.
Genetics may provide important clues. We know that of all long-
term smokers, only 15 percent develop COPD. This is something
that shows that some people are disposed to the disease.
We also do not fully understand the role of genetics in
other types of airway diseases, such as asthma. More research
into COPD will likely help us understand why certain people
with asthma also develop progressive and irreversible disease.
In approximately two weeks, April 4th, an important
document will be released by NHLBI and the World Health
Organization called GOLD, that provides for the world community
what can be done for COPD.
We need break-through research to understand why people
develop COPD and to effectively reduce the morbidity and
mortality associated with airway diseases.
The third issue is tuberculosis. Tuberculosis is an
airborne infection that primarily affects the lungs, but can
also affect other body parts, such as the brain, kidneys, and
spine.
TB is spread by coughing and sneezing. There are over
18,000 active cases of tuberculosis in the United States. The
Institute of Medicine recently published a report that
documents the cycles of attention and progress toward
tuberculosis elimination, followed by periods of insufficient
funding, and the re-emergence of TB.
The IOM report provides the U.S. with a road map of
recommendations on how to eliminate TB in the U.S. The American
Lung Association and the American Thoracic Society endorse the
IOM report and its recommendations.
Representatives Brown, Morella, and Waxman will soon
introduce legislation to give NIH and CDC the authority and
resources to implement the IOM report.
Thank you.
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Mr. Regula. Well, thank you. This shows a connection
between the lungs and the heart. I am not sure how this is
different from just an ordinary heart problem.
Dr. Martin. I am sorry, in reference to COPD?
Mr. Regula. Yes.
Dr. Martin. Well, with COPD, although people with advanced
COPD develop heart failure, and it is a complication, the vast
majority of people with COPD die a slow respiratory death.
Mr. Regula. Then it obviously would be connected with
smoking?
Dr. Martin. It is, and I think it does not always engender
public support, when you consider a disease like COPD as being
self-inflicted.
Mr. Regula. Yes.
Dr. Martin. But I would argue that every patient that I
have ever taken care of with COPD acquired the addition to
cigarettes when they were an adolescent, and typically under
the age of 15.
Mr. Regula. So that is the time to try to deal with the
problem.
Dr. Martin. Absolutely.
Mr. Regula. I think you are right. It grieves me, when I
drive past a high school, and I see these kids out there.
Dr. Martin. Yes.
Mr. Regula. You girls see that in your schools, do you not,
and you wonder, why would you want to start? I do not know.
Well, good luck to you.
Dr. Martin. Thank you very much.
Mr. Regula. Thank you, and we are sure glad to see you
today.
Dr. Martin. I bet. [Laughter.]
Mr. Regula. The hearing is adjourned.
Tuesday, March 27, 2001.
TESTIMONY OF MEMBERS OF CONGRESS
VARIOUS PROGRAMS AND PROJECTS
WITNESS
HON. JOSEPH CROWLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
YORK
Mr. Regula. Our first witness this morning is Mr. Joseph
Crowley from the State of New York, who has some interest in
various programs and projects. We try to limit you to five
minutes. Good morning.
Mr. Hoyer. Good morning, Mr. Chairman. I want to welcome
the distinguished representative from the State of New York,
Mr. Crowley. He's one of our outstanding members.
Mr. Crowley. I thank Chairman Regula and my good friend,
Mr. Hoyer, but also the Ranking Member, Mr. Obey, for granting
me this opportunity to testify before the Subcommittee on
Labor, Health and Human Services and Education Appropriations,
to discuss some of my key priorities.
To best communicate the needs of my district, I would like
to present my remarks in three specific parts. They are
educational priorities, strengthening of public health
infrastructure and improving the quality of life for the people
of Queens and the Bronx in New York.
Regarding education, I believe it is imperative that our
society continue to invest in our children and in our public
schools. I recently conducted a study of the schools in my
Congressional district that documented how almost every child
in the public school system is being taught in classrooms that
are nearly 100 percent over capacity. Unfortunately, this
situation is all too common in school districts throughout New
York City, and unfortunately more so throughout our Nation.
In these types of environments, the teacher's ability to
teach becomes seriously altered. For these reasons, old
teaching methods and techniques do not always prepare young
teachers for real life situations that occur in inner city
school classrooms every day. As a response, the City University
of New York has launched a teacher empowerment zone, which is a
major effort to improve teacher training programs.
The program would create virtual classrooms with teachers
teaching students to observe during the course of their study,
in addition to other traditional learning tools. A student
enrolled in the teaching program would have the opportunity to
monitor a real classroom with the use of digital technology and
at the end of the class period, engage in a dialogue with the
teacher of the class to discuss the events that have occurred.
One of the sites of the program would be at LaGuardia
Community College, part of the City University of New York
system. This school is centrally located at a transit hub that
links Queens, the most ethnically diverse borough in the City
of New York, with the world's center of finance, commerce and
of arts. The College provides access to higher education and
serves New Yorkers of all backgrounds, ages and means. For its
part in the teacher empowerment zone, LaGuardia Community
College has launched a major campus-wide initiative to expand
the educational use of digital technology and is prepared to
focus particular attention on the interlocking issues of
technology in instruction and assessment.
For this project, I am requesting $2.8 million. This money
would be used to improve the infrastructure and provide the
faculty development needed to advance this initiative.
Additionally, funding would be used to improve and expand
classroom connectivity, create links to local secondary
schools, upgrade available software and enhance professional
development programs. This is a worthwhile and creative program
that deserves Federal assistance.
To continue to build on our children's potential, I am also
seeking assistance for the Queensborough Public Library to
expand its Jackson Heights Queens branch. The Queensborough
Public Library has the highest circulation of any library
system in the United States, and spends more money per capita
on books than any other major urban library system in our
country.
The funding I seek will not only expand the Jackson Heights
branch, but will also provide greater access of materials to
patrons, provide resources for new children's programs, and
allow for more computers, offering free access to the
electronic information.
Furthermore, there is one more additional educational
program I would like to touch on that I did not include in my
prepared remarks. The Taft Institute at Queens College, which
is also my alma mater, the Taft Institute was founded in 1961
to honor Ohio Senator Robert Taft's exemplary record of public
service and political courage. The Taft Institute is a non-
partisan enterprise dedicated to promoting informed citizen
participation in the United States and around the world.
In 1996, the Taft Institute chose Queens College of the
City University of New York as the site of its national
headquarters. This institute strives to reverse the mounting
trend of citizen apathy and cynicism. Its programs reflect the
conviction that true democracy requires that each new
generation of citizens be committed to civic involvement. At a
time when the high water mark of political involvement, the
simple act of casting a ballot, scarcely reaches 50 percent,
the need for such a program should be self-evident. Yet the
unexamined, often unspoken premise persists that active
citizenship will somehow emerge spontaneously in adulthood
without prior learning or experience.
The Taft Institute takes the opposite view. Responsible
citizenship must be fostered from the earliest age. To thisend,
the Institute has created a program of professional development to
inspire and empower the teachers who will help to shape America's
political future.
Funding for Taft Institute programs comes from both public
and private sources. While private sector funding has
significantly increased in recent years, the Institute seeks
new sources of support to continue and expand the innovative
civic education programs essential to our country. Among its
distinguished fellows would be our Speaker, Dennis Hastert,
just to name one.
I hope that we can work together for this important
program, and I am therefore reaching out to this Congress and
this Committee for $300,000 for this important institute.
With regard to the health concerns of New Yorkers and all
Americans, I want to inform the Committee that last Thursday, I
sent a letter to President Bush requesting at least $25 million
for the Centers for Disease Control. These funds would be used
to monitor, detect and combat West Nile encephalitis, a disease
that originated in my Congressional district, but has since
spread throughout the eastern seaboard.
I was pleased to be joined by 43 other Northeastern members
of Congress in this effort to ensure that adequate attention
and resources are provided to combating this mosquito-borne
virus.
Additionally, I will be asking the Committee to provide the
needed resources to combat sexually transmitted diseases
including HIV and AIDS. Here I urge a two-pronged attack, one
globally based and one locally based. On the prevention side, I
would appreciate if the Committee would highlight the need for
funding of microbicide testing. Microbicides would fill a gap
in the range of prevention tools because they are woman
controlled and could protect against various STDs, not just
HIV. These user controlled products that kill or inactivate the
bacteria in viruses that cause STDs and HIV-AIDS are the only
hope to prevent the transmission for many women overseas and
even some here in our own country.
Locally, I seek funding for an innovative program in my
district to combat sexually transmitted disease, including HIV-
AIDS in the often overlooked minority community. While the rate
of HIV-AIDS infections is decreasing in the white population,
it has drastically increased in the African American and Latino
populations.
Finally, as the representative of the middle and working
class districts in northwestern Queens and the southeastern
Bronx, I would like to discuss some specific needs of my
constituents. Among these needs are for the young adults of
Queens and the Bronx. Therefore, I am working to secure vital
dollars for additional computers for a job training center at
the Queens Bridge Homes, America's largest public housing unit.
In these uncertain economic times, these dollars are needed now
more than ever to assure the support and strength of this job
training and skill providing site.
Oftentimes, public housing is seen as a trap of despair,
but Queens Bridge is different. It has been successful in
utilizing the full potential of residents to keep it safe and
full of promise. I hope to build on the existing job training
and educational center at Queens Bridge, so as to harness all
the abilities of the people of this community.
For my older constituents, I am working for two senior
centers in my district that are in need of assistance. First,
the Sunnyside Community Services Senior Center in Sunnyside,
Queens, which seeks capital project funding to make their
center both disability accessible and more senior friendly.
While my office is working with them and the city and the State
of New York for funding, a shortfall is expected, and I hope
this Congress will be able to provide some funding for this
important senior center.
Additionally, I will be championing the cause of the
seniors of North Flushing Senior Center, a center as familiar
to Representative Lowey as it is to myself. Last year, a
funding shortfall almost caused havoc at this important
community organization. I hope that working together, we can
ensure that meals are always provided and the good works of
that institution will continue well into the future.
There are a great many other needs in my community and
throughout our global community for assistance. I thank you,
Chairman Regula, for your time, and my good friend, Steny
Hoyer, for being here and taking the time to listen to some of
my priorities.
[The information follows:]
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Mr. Regula. Thank you. Quick question. The superintendent
of New York, I heard him speak at a seminar, sounds like an
impressive regime that he's installed. What do you think?
Mr. Crowley. In terms of?
Mr. Regula. The New York City school system. Is it Mr.
Levy?
Mr. Crowley. The chancellor. Yes, I think he's an
impressive individual, and someone who has been able to work
with not only both sides of the aisle, so to speak, but really
work within all the different communities of New York. The one
thing that he's been grappling with and we've all been
grappling with has been class size, and the problem with school
modernization and overcrowding, the lack thereof in schools.
In my district particularly, we're faced with the fact that
the average school age is 50 years of age, and one out of every
two schools is 75 years or older.
Mr. Regula. He mentioned it.
Mr. Crowley. These are real problems. In Queens County, we
expect to be between 30,000 and 50,000 seats shy by the year
2007. So forget about a school building, there's not actually a
seat for these young people to sit in. That's a real crisis
that we're facing in the New York city public school system.
But Chancellor Levy is doing all he can.
Mr. Regula. Sounds like an interesting approach. Mr. Hoyer?
Mr. Hoyer. I have no questions, I'd like to thank
Congressman Crowley for obviously a very thoughtful
presentation, dealing with a number of different areas of
critical concern to his district, and frankly, to the country.
Mr. Crowley. Thank you. Thank you both.
Mr. Regula. We'll give you the forms, if you don't have
them, to make a formal request.
Mr. Crowley. Thank you very much.
----------
Tuesday, March 27, 2001.
EDUCATIONAL AND HEALTHCARE PROGRAMS
WITNESS
HON. BILL PASCRELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
JERSEY
Mr. Regula. Our next will be Mr. Pascrell of New Jersey,
Education and Health. Summarize as much as you can. We have a
long list today.
Mr. Pascrell. Mr. Chairman, thanks for extending the
courtesy to us, and members of this great Committee. Just a
week ago, I was here with Thelma Thiel, if you remember, the
President of the Hepatitis Foundation, and you were so kind to
her, and I thank you for that.
Today I want to talk about two subjects, education and
health care, if I may. As a former teacher, I know the impact
that large classroom sizes have on student performance. The
quality of our children's education is largely dependent upon a
strong teaching work force.
According to the United States Department of Education, the
Nation will need 1 million new teachers by the year 2010.
Similar to what's happening to teachers is happening to nurses
in America, as you well know. The looming shortage is already
creating problems for school districts across the country.
Even in advance of the peak of the shortage, school
administrators are already reporting tremendous difficulties in
recruiting qualified teachers. We can't get science and math
teachers, they're moving into other areas that are obviously,
will put more money in their pocket, to be very honest with
you.
While this is certainly a national problem, New Jersey, Mr.
Chairman, particularly is plagued by the mass exodus of
qualified teachers who are retiring. We rank among the top five
States in the Nation for projected growth, however, in the
student population.
The number of high school graduates in the State is
expected to increase by 25 percent in the year 2008. That's not
a long way off. Mr. Chairman, the numbers do not tell the whole
story here. Unless the new members of the teaching force are
well educated, well prepared and unless current teachers'
knowledge and skills are updated and honed, our Nation's need
for quality educators will not be met.
A compelling and growing body of research shows that the
single greatest determinant of student achievement is teacher
quality. New and experienced teachers alike are educating an
increasingly diverse population with many different languages
and cultural backgrounds.
Mr. Regula. If I could interrupt you there. If you had a
priority choice between more pay, upgrading skills versus
reducing classroom size, assuming you can't do both, which
would you opt for?
Mr. Pascrell. Qualified teachers.
Mr. Regula. That's my inclination, too, that that's number
one, is to have qualified teachers.
Mr. Pascrell. I can recommend a book, and I don't want to
take more time, Mr. Chairman, you've been more than fair with
me, but the book, Thomas Jefferson's Children, excellent book
on education, provides reforms that are succinct and we can all
understand. I recommend it.
Mr. Regula. Thank you.
Mr. Pascrell. Schools of education must meet the needs of
this diverse student population and the needs of our
technologically advancing world. That's why we wired our
schools. The university in my district has been working on this
problem. Montclair State University, 90 years in business, has
built a nationally recognized teacher education program.
Currently, Montclair graduates approximately 300 teacher
candidates a year. It also turns away hundreds of qualified
students each year, because of an acute shortage of space at
the university.
To alleviate this problem and to help the State and the
entire Nation create more teachers, Montclair State is building
a $45 million center for teacher preparation and technology.
State of the art, authentic, not money thrown to the wind. The
new center will allow the university to increase the number of
teacher candidates it graduates each year by 60 percent. It
will also allow the university to increase the number of
masters degrees it awards to teachers already in the field, a
critical component of teacher retention.
While increasing in number of teachers, the center for
teacher preparation and technology will make certain these
teachers are competent in incorporating instructional
technology into their teaching. This center will include
interactive distance education equipment, wireless technology,
full internet access and applications and hardware to keep
track of student progress more effectively. This is supported
bipartisanly, Mr. Chairman.
Montclair State will receive $5 million from the State of
New Jersey. It is asking Congress for $5 million to complete
this critical project. And the rest of the money will be raised
by the University itself.
There are numerous pieces of legislation that call for an
increase of teachers in the coming years. I believe, Mr.
Chairman, this is a good project. I ask the Committee to take a
look at it. Ask me any questions if you will. I think it's
worthy, because it goes to the very heart of what we're talking
about in education.
The second project is a 21st Century institute for medical
rehabilitation research. During the last cycle, my colleagues,
Frelinghuysen, Payne, Rothman and Andrews and I asked this
Committee for $3.9 million. Congress provided $775,000 of that
amount. I'm here today to ask for the remaining funds, Mr.
Chairman.
This Committee has long recognized the extraordinary value
and promise of medical research. You have demonstrated that
time and time again with your support for increases in funding
to NIH. All Americans should be grateful for this action as you
are bringing all of us new hope for key breakthroughs in
medicine and treatment.
Up until now, this area has not seen the kinds of increases
that many others have enjoyed and the need remains substantial
in the area of rehabilitation medicine and research. One of the
premier institutions in the country in the rehabilitation
research field is in my district, the Kessler Medical
Rehabilitation Research and Education Corporation, and the
Kessler Rehab Hospital are widely regarded as leaders
nationally in rehab medicine, treatment and research. Much more
can and must be done to accelerate and build on the work which
is already underway.
So several years ago, the Kessler organization decided to
create a new and unique effort in the United States. This was
it, this was pro forma for the rest of what has happened since.
Last year, your Subcommittee recommended funding for this
effort. I'm deeply grateful, Kessler is deeply grateful.
One area of rehab that I am particularly involved in, and
interested in, we've done work in other areas, is the traumatic
brain injury. We now have a registration list which is very
critical. Kessler is dealing with this problem, Mr. Chairman.
Two million Americans experience a traumatic brain injury every
year. Two million. About half of these cases result in at least
short term disability.
Eighty thousand people sustain severe brain injuries,
leading to long term disability. Most people with a brain
injury must experience some type of rehab in order to function
in their daily lives. So Mr. Chairman, to make a long story
short, I ask for these two projects, and I think they're worthy
projects, and I've come to the right Committee.
[The information follows:]
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Mr. Regula. Well, we'll probably get a better estimate of
that later in the year. [Laughter.]
Thank you. Is Kessler tied with NIH in any way?
Mr. Pascrell. Yes, much of the dollars comes from NIH. It's
probably the premier institution in the country.
Mr. Regula. So it works with them?
Mr. Pascrell. A lot of breakthroughs, Mr. Chairman.
Mr. Regula. Your education institution that you mentioned,
is that a State university?
Mr. Pascrell. Yes. Montclair State University is a State
university.
Mr. Regula. Mr. Hoyer.
Mr. Hoyer. No questions. Thank you.
Mr. Regula. Thank you for coming.
Mr. Pascrell. Thank you, Mr. Chairman.
----------
Tuesday, March 27, 2001.
NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL
WITNESS
HON. MICHAEL HONDA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Honda, we're ready for you. Glad you came.
Mr. Hoyer. Mr. Chairman, as you know, Mr. Honda is one of
our newer members, but a very experienced member, a
distinguished member of the general assembly in California, and
does an outstanding job.
Mr. Honda. Does that mean I get a raise?
Mr. Regula. Do you take any responsibility for the rolling
blackouts?
Mr. Honda. No, not yet. I take the responsibility of
helping, though.
Mr. Regula. It's a tough issue out there.
Mr. Honda. Yes, it is. Not to be funny, though, there may
be light at the end of the tunnel.
Mr. Chairman, thank you very much for allowing me to
testify here. I want to thank Mr. Hoyer for acknowledging my
presence also.
Distinguished members of the Subcommittee, thank you for
this opportunity to testify today. I'm here to respectfully
request your assistance on a very important initiative that
affects millions of Americans. Specifically, I'm asking you to
consider an additional $1.5 million for the National Center for
Injury Prevention and Control at the Centers for Disease
Control and Prevention, to address a very important topic,
sleep deprivation and fatigue related injury.
I think many people smile when they hear the term sleep and
fatigue, because they probably just pooh-pooh it and say that
it's something that doesn't seem to be very important.
Mr. Regula. We had a public witness, an M.D., that spoke at
length about that, runs a couple of clinics back in Ohio.
Mr. Honda. Right.
Mr. Regula. So it is, and I think the NIH has done some
work, is doing work on the impact.
Mr. Honda. Right. We just need to do more work in the
public domain to sort of raise the issue. I appreciate this
opportunity.
Sleep represents a third of every person's life. It has a
tremendous impact on how we live, function, perform, and think
during the other two-thirds of our lives. Lack of adequate,
restful sleep has serious consequences at home, in the
workplace, at school and on the highway. Untreated sleep
disorders, of which there are more than 80, and sleep
deprivation contributes to injuries, impaired work
productivity, academic performance, reduced quality of life,
poor health and even death.
As a teacher, a school principal and school board member, I
have seen sleep deprivation as a growing problem for high
school students, the largest at-risk group for fall-asleep car
crashes, as well as being a factor in causing car accidents for
parents, transportation workers, police officers and medical
residents.
According to the National Sleep Foundation, the direct or
indirect cost to the United States economy due to sleep
disorders and sleep deprivation are estimated to exceed $100
billion each year. As someone with a sleep disorder myself, I
know these problems all too well. I am one of the approximately
40 million Americans who suffers from chronic sleep disorder. I
was diagnosed with obstructive sleep apnea, which is a very
common sleep and breathing disorder that affects at least 12
million Americans.
Each time a person with sleep apnea stops breathing,
sometimes up to 400 times a night in severe cases, and I was
one of them, the brain awakens the person just enough to get
them breathing again. What I learned is that when you stop
breathing, the chemistry of your blood changes, and it clicks
off in your brain to say, wake up, dummy, wake up.
That's when you hear folks just gasping for breath in the
middle of the night, and then they continue to sleep. This
allows them to go into deep sleep, what they call REM, where
they get that rest, but they continue to appear to be sleeping,
to get their rest, but they don't get that deep rest.
This not only affects the quality of a person's sleep and
daytime functioning, but it leads to very serious health
problems. Untreated sleep apnea has been linked to
hypertension, cardiovascular disease, diabetes, depression,
memory problems, obesity and other serious problems.
I am very lucky, because unlike most undiagnosed Americans
with sleep disorders, I have a nationally recognized physician,
Dr. William DeMent, who was able to treat my sleep disorders.
And the diagnosis and proper sleep treatment definitely has
improved the quality of my life immeasurably. I say, Mr.
Chairman, that it's a malady that can be cured overnight.
While public awareness is desperately needed, a strong
Federal partner with expertise and ability to disseminate
tested and proven education training and injury prevention
programs to communities throughout the Nation is needed even
more. The CDC can help us address the comprehensive and complex
health and safety problems related to sleep issues by
developing a sleep awareness action plan that would set
national priorities around sleep issues in public health and
safety.
This five year sleep awareness action plan would develop
the evaluative research including daily collection through the
National Center for Injury Prevention and Control and others at
the CDC. The research would include an attempt to validate or
improve existing surveys and survey methodologies regarding how
sleep deprivation problems are related to the on the job
injuries, highway crashes and other medical conditions, such as
diabetes, heart disease, cancer and obesity.
The data from this research will allow the CDC to devote
accurate educational material and model prevention and health
promotion programs to provide to States as they address these
important issues. This information will begin to turn the tide
of injuries, health programs and costs associated with
sleepiness and sleep disorders.
So as I sit here today, I'm happy to report that I am
feeling fine. But I want all of you to know that it has taken
hard work with my doctor, reprioritizing with my family and my
life. I hope that you all take the time you need to get the
quality sleep you need every night. As a new member of
Congress, I am quickly learning that our schedules are so
packed and our days are so long that you are probably not
getting all the sleep that you need, but getting sufficient
sleep should not be optional.
I just want to close by thanking you for the opportunity to
testify today, and I look forward to working with the group and
providing myself as a personal testimony to the issue of sleep
disorders and fatigue, as it relates not only to adults and
sleep disorders, but also fatigue as it relates to young people
who are coming to a point where, especially seniors that are
coming to graduation. We see too many youngsters who fall
asleep at the wheel because of fatigue. It doesn't have to be
disorders, it's just our attitude toward sleep and sleep
deprivation.
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Mr. Regula. I think you're suggesting that CDC needs to do
a major public information campaign to make people aware that
this is a problem that's curable.
Mr. Honda. That's correct. Succinctly put, Mr. Chairman.
We're looking for support of $1.5 million.
Mr. Regula. We're going to be visiting there next week, so
it will be a good question for us to raise.
Mr. Hoyer, questions?
Mr. Hoyer. No, I have no questions. Thank you, Mr. Honda.
Mr. Regula. Thank you for coming.
Mr. Honda. Thank you, Mr. Chairman.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. ROBERT FILNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Filner.
Mr. Hoyer. I pledge to Mr. Filner that I will read every
sentence of your statement.
Mr. Filner. I just want you to give me the money.
[Laughter.]
Mr. Regula. Welcome, Mr. Filner.
Mr. Filner. Thank you, Mr. Chairman. And we all appreciate
your--and the staff and as many members as possible--sitting
through and listening to all these requests. We do appreciate
it and thank you so much.
I bring forward to you two proposals that are important to
my district, my constituency, but I think also serve as models
for broader application to similar situations in other parts of
our Nation. First is a $3.9 million appropriation for Paradise
Valley Hospital to create what is called a complementary
medical center, and therefore address health needs of a
minority population that is often overlooked. Your Committee
provided about $700,000 for this center in the last
appropriation. This would allow them to actually set up and
begin services in this complementary medical center.
It would be a unique showcase of how public and private
health care enterprise can cooperate, because it would provide
needed specialty care to an under-served community which then
could be replicated throughout the country. What we have in
Paradise Hospital is the only community hospital in our county.
It serves not only the whole county, but it is located in the
fourth poorest city in California, National City, one of the
cities I represent. In fact, the thirteenth poorest city in the
Nation.
And it is truly a safety net provider, but has not been
able to provide the kind of complementary health care that
wealthier medical centers can.
Mr. Regula. Is this a non-profit or a city facility, or
State?
Mr. Filner. It's a non-profit hospital, but it's a private
hospital. It's in the Adventist medical chain of facilities.
As I said, the complementary nature or the complementary
medical techniques have been available to wealthier
communities, but have never really been given in a holistic way
or in a very comprehensive way to disadvantaged populations.
What we have in mind here is to showcase that when these
services are provided to even poorer communities, they will
have a very much enhanced medical care and in fact save us, of
course, as a Nation, money in the long run.
So again, you have provided some startup money for this in
the last appropriation cycle. The money that I would ask for
now would allow them to actually set up the center.
In my second request, I am joined by my colleague,
Congresswoman Susan Davis from San Diego. We are asking that
the senior community center of San Diego be funded for a
demonstration program, $250,000 for Title IV of the Older
Americans Act, to establish a demonstration project entitled
Health Promotion/Harm Reduction.
What this is for is seniors, a growing number of seniors,
who have emotional or mental health problems, to help them
before they get more seriously ill or in fact, thrown out on
the street into homelessness. The only organization in San
Diego to provide at-risk seniors is the senior community
centers. They have shown in an 18 month test that if they
provide intensive case management services in conjunction with
nutrition services, the self-reliance of this population is
greatly increased.
So with just $250,000, they think they can in fact decrease
emergency medical interventions, reduce medical costs to our
community, get early treatment of illness and thus allow
seniors to have an independent and healthy lifestyle.
These are two areas, again, for San Diego, mainly in poor
communities for a population that is under-served, as you well
know.
Mr. Regula. Is the senior unit a private, non-profit?
Mr. Filner. It's a non-profit also.
Mr. Regula. It's not operated by your senior groups?
Mr. Filner. It's not operated by the city government. It's
a private non-profit.
Again, these services, we believe of course not only will
help our specific population, but serve as good models for
other places in the country.
So that's what I have before you, Mr. Chairman. I thank you
for the time.
[The information follows:]
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Mr. Regula. Thank you for bringing this to our attention.
----------
Tuesday, March 27, 2001.
IMPACT AID AND CROHN'S AND LYME DISEASE
WITNESS
HON. SUE W. KELLY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
YORK
Mr. Regula. The next witness is Representative
Congresswoman Sue Kelly from New York. Sue, on Impact Aid,
Crohn's and Lyme Disease.
Ms. Kelly. That's a polyglot, isn't it?
Mr. Regula. You have quite a list.
Ms. Kelly. I brought this map, because I want to show you
this map. This map shows you the area, actually, of West Point.
And this little tiny strip, this little tiny strip outlined in
red right there, this all belongs in one township. This little
tiny strip of land, which represents about not quite 7 percent
of all of the land in this----
Mr. Regula. It's the Hudson River, I assume.
Ms. Kelly. This is the Hudson River. Right there, bounded
by the Hudson River, that's all the land that this township has
that they can use for any kind of tax purposes at all to
support the school system. This is the most highly impacted
school system in the Nation, here at West Point.
Mr. Regula. Is that all West Point?
Ms. Kelly. This is all West Point.
Mr. Regula. How many acres would be in that?
Ms. Kelly. West Point? I don't know. I should know. I'm the
Vice Chairman of the West Point Board, I should know, but I
don't. [Laughter.]
But the thing I'm trying to point out here is that these
people can't grow. This is mountain in here. So they have
mountainous areas in here, they have the river over here.
Mr. Regula. Is that a school district?
Ms. Kelly. There is a school district here, and the
students who are taught in grade school on the Point come out
into this school district for their high school.
Mr. Regula. So the Point doesn't operate a high school?
Ms. Kelly. It doesn't operate a high school, a junior high,
high school. They come out into this district for their high
school.
Mr. Regula. That would be all the personnel that operate
it.
Ms. Kelly. All the civilian and military personnel. And
remember, this is an active base as well. All those people send
their kids out here into this little area to this high school.
Years ago, this high school was properly funded. And I'm
talking about Section 8002. This is the most highly impacted
district in the Nation. We've got to have our Impact Aid.
Because years ago, we can get a copy of that for you if you
want. Years ago, this was fully funded and we had enough
funding coming in there to help the school district. When I was
elected, that school district was teaching social studies out
of a book that stopped at the Vietnam War. That was six years
ago.
These kids had very old books, they had teachers that were
leaving, their teachers hadn't had any advanced training, the
school buildings themselves were in terrible shape. And this
school district was a threatened school district. There it is,
sandwiched between the Point, the river and mountains. They
can't grow, they've got nothing to tax. They need our help.
We've got to have that money that we had, at least what we
had last year if not more. We really do need an increase. But
since we've been working----
Mr. Regula. Does that go out by formula?
Ms. Kelly. Yes, it goes out by formula. I'm just trying to
locate it and see.
Mr. Regula. Does it depend on the per capital wealth of the
district as to how much they get?
Ms. Kelly. You can imagine, if it's a military base, you
know the state of what the military gets paid.
Mr. Regula. On the portion that they tax. Do you use real
estate taxes in New York for schools?
Ms. Kelly. We use real estate taxes for schools, but
there's no place to tax. This is very, there's only so much of
that land you can use, because people live there, too. There's
housing.
Mr. Regula. What I'm getting at is, the Impact Aid is
predicated on the amount of available tax revenues within a
district. So Impact Aid would vary from place to place
depending on the wealth of the district that's involved. What
you're saying is you need more, either change the formula or
more money to this district.
Ms. Kelly. I need more money in this district. We need a
better formula for taking--now, there's 8002, which is land
based, and I'm talking about land based right now, because----
Mr. Regula. Staff tells me you went from 32 million to 40
million last year. So apparently we do control in the Committee
the macro amount that goes to each of the districts.
Ms. Kelly. You do, yes, absolutely.
Mr. Regula. That's what I was trying to determine, is it
formula, and the answer is no. It's just a judgment call.
Ms. Kelly. Well, correct me if I'm wrong, sir, but I think
perhaps there is a formula for one part of this. It's the per
capita student part that has a formula. Then the part I'm
talking about does not.
Mr. Regula. Kind of an enrichment.
Ms. Kelly. It is something to make up for the fact that the
land was taken by the Federal Government. The Point didn't used
to be that large. But for one reason or another, during the
various wars, they've added land in because they need it for
training. And as they've added land in, endingit for training,
they've eaten into the township.
Mr. Regula. Does the Point train any other than cadets? Do
they have other training facilities there? You mentioned that
it was more than just a military academy.
Ms. Kelly. It's an active Army base as well.
Mr. Regula. That's what I'm saying, do they train troops
there?
Ms. Kelly. I don't know if we train--we train specified
things. They run mountaineering courses, they do some other
things. Plus they have some, if I remember correctly, I know we
have a mint there, there's a number of Federal activities that
are going on at the Point and a lot of people working there and
living there on the Point.
The thing is, what we got last year wasn't even 50 percent
of what basically we are entitled to under what we were
promised when the Point's land was taken, when the Point took
our land. So from an Impact Aid standpoint, we really, I really
need to help these people. Because what's happened, because we
got that increase, we now have teachers who are coming back
into the district. We are training the teachers, we have bought
new books, there's a social worker to help the kids, which
we've never had before, and we really need not only that, but
the school has a new roof over part of it, so that now they can
use that part of the school. It was really raining in.
So it's not money gone to waste. It's good money, we need
to do it. And we really need to have a full funding. I'll take
50 percent, that's $62 million, but it's the second step of a
promise that we have made in the past to this school district.
And Impact Aid all across the Nation needs our help. But this
is the most highly impacted district in the Nation.
I want to go quickly to a couple of other things that I
have on the ticket here. Because we can talk further if you'd
like about the Impact Aid. I want to talk about Crohn's
disease. Crohn's disease is an inflammatory bowel disease.
Mr. Regula. We had some public witnesses on that. Not here
today, but in the past couple of weeks.
Ms. Kelly. It encompasses a whole group of diseases.
There's about a million people in the United States who have
this disease. It is economically and physically debilitating
for people. I know about that, because my daughter has Crohn's
disease.
Mr. Regula. You're asking for more money on research on
this?
Ms. Kelly. I want you to designate more money to research.
I know you can't tag it that way, but I'd like report language
that really strongly recommends NIH do something to put more
money into research for Crohn's. It's on the increase, and it
is very debilitating. People who have Crohn's disease have the
option of losing a part of their intestine or sometimes all of
their intestine. The disease can come from your mouth to your
anus.
It blocks off your ability to allow food to get through
your gut, and then what happens is you go, what happens to a
lot of people with Crohn's disease is they get sick, they have
an operation and they lose a piece of something. They are fine
for a while, they get sick, they have an operation, they lose
another piece of something. Pretty soon, there's not much left
between their mouth and their anus, and they live with a
feeding tube if they live at all.
It's a very serious disease, it's on the increase, and we
are paying very little attention to the people who have Crohn's
disease. We need to give them some hope and we need to do some
research. I hope that you will think about putting some strong
report language in about that.
Mr. Regula. We will have NIH before us, and your concern is
that we just get more money into research to try to find cures.
Ms. Kelly. There are some interesting ideas about cures.
Dr. Crohn actually lived in my district before he died. And he
is the person who identified this disease that was killing
people and no one knew what it was. But from his
identification, from that point onward, there's been very
little attention paid to it. It's one of these diseases that
people just simply don't pay a lot of attention to.
Just like Lyme disease, which is the other thing that
brought me here today. I could talk about a couple of other
things, like juvenile diabetes and so forth. But Lyme disease,
the epicenter of Lyme is in my district. So I'm here for three
causes: Impact Aid, which I care ardently about; Crohn's
disease, which is in my family; and Lyme disease, which I have
had. We are in the epicenter of it, we need to have----
Mr. Regula. Is this the deer----
Ms. Kelly. Deer ticks, yes. And we have some ideas about
what we can do to stop the transmission of Lyme. We need money
for research. We have come up with a vaccine that works, but it
doesn't work on people over 60 or under 10, as far as I know,
from what their research has shown. So we can't vaccinate our
very young. And it's a debilitating disease. Many people are
left permanently disabled because of Lyme disease.
So from a long range standpoint, it's a very expensive
disease.
Mr. Regula. It's tick-borne, and the deer is the host?
Ms. Kelly. The deer are a host for the tick. The tick is
actually the host of the spirochete that causes the disease.
There is now three identified diseases, but it's only the deer
tick I'm talking about. There's also the reketsial diseases
that are borne by dog ticks. That's the Rocky Mountain spotted
fever and so on. We have cases of Rocky Mountain spotted fever
that have been on Long Island last year. It used to be only in
the Rocky Mountains. Now that is spreading.
We need research on tick-borne diseases, both reketsial
diseases and the spirochete diseases, because we don't
understand completely how to stop them. And they are walking
right straight through our Nation.
I'm chairman of the Lyme Disease Caucus. We have a number
of people, I've had several of our colleagues come up to me on
the Floor saying, let me get on your caucus, my wife just got
Lyme disease, because it is very prevalent in the midwest, it's
prevalent on the coast and in the mountainous areas and the
Rocky Mountains and out in California and Oregon and
Washington. But it's most prevalent, and the epicenter is in
the northeast. We need your help.
Mr. Regula. I remember you telling me about it. It doesn't
seem to have impacted in Ohio yet, but it will probably get
there.
Ms. Kelly. That's perhaps because the doctors don't know
how to identify it. One of the biggest problems we have is that
doctors don't understand what they're looking at. They know
they have a disease and they can treat it with a broadspectrum,
heavy duty antibiotic, and sometimes if it's a mild case, it will knock
it out. And they think, well, didn't quite identify it, but I got it.
So the patient is better.
Part of what we need to do is use this money for educating
the doctors and the other part for doing the research needed to
stop the disease itself. We can do it.
Thank you.
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Mr. Regula. Thank you.
Mr. Sherwood.
Mr. Sherwood. What's the name of the school district?
Ms. Kelly. The name of the school district is Highland
Falls School District.
Mr. Sherwood. What's the annual budget?
Ms. Kelly. I don't know if I have it. I'll have to get back
to you, because I don't remember.
Mr. Sherwood. Do you have the cost per student per year?
Ms. Kelly. I can give you a cost per student per year. I
can also give you a per student, how much the Impact Aid means.
We're talking about over a million dollars to this school
district. And if we don't get it, that school district will
fold.
Mr. Sherwood. You mentioned $62 million.
Ms. Kelly. Because this is what we've been asking for. This
is the second step in what we had asked for originally and got
started on. And a ten year program to bring the section 8002
funding into its full funding level. And that's only 50 percent
that I'm asking for.
Mr. Sherwood. But did you use the term $62 million?
Ms. Kelly. I did, yes. We need to have the funding next
year. We need to have the funding next year at $62 million,
because this is what the school district has got to have.
Mr. Sherwood. You mean that's their total budget or what
you're asking for under Impact Aid?
Ms. Kelly. No, this is for the total Impact Aid. Our school
district gets a piece of that. But what we haven't had is 50
percent funding. We need to get it fully funded. Any one of us
who represents an impacted district knows full well that
without that funding, we're going to go down the tubes with
these school districts. Since we have a President who's
dedicated to education, we want to fund these schools. We need
to.
Mr. Sherwood. But doesn't the State of New York fund their
participation in your school district on the wealth effect? In
other words, the smaller your tax base, the higher percent you
get from the State? That's the way it works in Pennsylvania.
Ms. Kelly. We get some aid that way, but we have not gotten
the school building aid that we needed. There's just not enough
money to--we have New York City, as you know, that eats up the
majority of our funding for our education budget. So we have
not had that much. The people in this town, if you look at
their income, this is not a wealthy town. It's a very, very--I
hesitate to say low income, but it's lower middle income folks
who live there. These people are people who are living on
Government salaries because they work for West Point, they're
the people who are the teachers at West Point or they're
working on the base, and these are guys and women who are, you
know, they're taking Government salaries. They don't have a lot
of resources. And they don't have the money to put into the
school itself, and there are not a lot of wealthy people who
live in the surrounding area to put taxes in.
Mr. Sherwood. Is there a local elected school board that
makes the financial decisions?
Ms. Kelly. We do have a local elected school board that
makes those decisions, yes.
Mr. Sherwood. Thank you, Mr. Chairman.
Mr. Regula. Mr. Cunningham, any questions?
Mr. Cunningham. Mr. Chairman, thank you. I'd just make a
comment. I've worked with Ms. Kelly even when I was chairman of
the Education Subcommittee on Authorization. I went to that
area. Matter of fact, if you haven't made a trip to, West Point
itself is underfunded, the military academy, compared to the
other academies. If you look at the area around, she's not
exaggerating. Impact Aid is critical to her particular
district, more so than I think a lot of districts. Maybe not so
much as mine----
[Laughter.]
Mr. Cunningham [continuing]. But it is important. Having
visited the area, it is, Impact Aid is very important to that
area.
Ms. Kelly. I thank you. Mr. Cunningham has worked very
carefully with me, because he has been there, he's driven
through the trailer parks that these people live in, and he
knows full well that it's very important for us to get----
Mr. Regula. The trailer parks are on the West Point campus?
Ms. Kelly. Not on the campus, sir, but they're outside in
Highland Falls. That's where these folks can afford to live.
Mr. Regula. Thank you for coming.
----------
Tuesday, March 27, 2001.
IMPACT AID
WITNESS
HON. MARK STEVEN KIRK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Regula. Mr. Kirk from the State of Illinois, Impact
Aid. We've heard that subject discussed here.
Mr. Kirk. Thank you, Mr. Chairman. I'm here to basically
underscore the point. I sit here as the successor to John
Porter, so I with some trepidation testify before this
Committee.
Mr. Regula. You have Great Lakes, then, don't you?
Mr. Kirk. I do. And I used to be sitting on the seats in
the back row there very recently. So to be here is a real
honor.
For me, in our Congressional district, as far as the United
States military in the midwest, we're about it. But boy, are we
it. If you join the United States Navy, you're coming to the
Tenth----
Mr. Regula. I spent some time in Great Lakes. Very familiar
with it.
Mr. Kirk. And now that all naval training is being
concentrated there--well, we didn't steal it, we bought if fair
and square. For us, now, at Great Lakes, we expect the recruit
population will go from 50,000 to 70,000 in the coming four
years. So as a member of the military family, it is only
growing in our district.
Mr. Regula. Is that the only one giving boot camp now?
Mr. Kirk. That's it.
Mr. Regula. For the whole USA?
Mr. Kirk. For the surface fleet, right.
With me is the actual superintendent of the district, 187
school district, Dr. Patricia Pickles. Mr. Chairman, with your
permission, if I could have Dr. Pickles join me up here.
Mr. Regula. Okay.
Mr. Kirk. I actually stand in awe of Dr. Pickles and what
she went through. As the Impact Aid situation worsened about
four years ago, this Subcommittee rescued the program, and
specifically district 187. We were looking at scenarios in
which we would have to close down schools in north Chicago and
send, bus the students to schools in surrounding school
districts, which would have made no sense, because we had a
perfectly functioning good school infrastructure there.
But the structure of education funding did not allow us to
meet the needs of the students. In our 187 school district,
several others were approaching over 30 percent of the students
coming from military housing. So this program is essential for
our very survival, and will become increasingly essential. As
Great Lakes expands its impact on all of the surrounding school
districts will grow.
I have a detailed statement, which with your permission----
Mr. Regula. All the statements will be part of the record.
Mr. Kirk. I would just like to underscore a couple of key
points. The military family that we know, I just left the fleet
last year, so for me, I'm coming straight out of that
environment. My last tour was in Operation Northern Watch. For
us, we have seen, Charlie Muscow is a great academician at
Northwestern University, who studies the cultural divide
emerging between the active duty military and the civilian
world, it's really expanding. And we see that in the kids.
For us, we are expecting that about 50 percent of the
recruits coming into today's military are from military
families. So the children of the men and women who protect us
today will be the people who protect our children tomorrow.
With all of this concern about military pay, health care,
housing and benefits, I would suggest we add one key component.
And that is Impact Aid for military education.
I made this point very forcefully with Secretary Rumsfeld,
who is actually also the Congressman from our district. He
represented our district in the 1960s. And with Secretary
Paige, who made a very forceful statement in favor of Impact
Aid before the House Budget Committee. That's the key point
that I want to make, that these young leaders in these impacted
schools will most likely be the military personnel of the
future. That point needs to be made to support this program.
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Mr. Regula. Does Great Lakes impact on a number of school
districts?
Mr. Kirk. It does. For us it's North Chicago, Waukegan,
Highland Park, Glen View, Lake Forest.
Mr. Regula. And they all get a piece of the Impact Aid,
then?
Mr. Kirk. They do, but let me hand it over to Patricia. She
has one of the, probably the most heavily impacted districts in
the country.
Ms. Pickles. Most of the students do attend North Chicago
Public Schools, district 187, 35 percent of our student
population----
Mr. Regula. Thirty-five percent of your student population
is military?
Ms. Pickles. Thirty-five percent.
Mr. Regula. So Impact Aid is an important part of your
budget?
Ms. Pickles. Very important part. Over 72 percent of our
student population qualifies for free and reduced meals. With
that 35 percent, more than 200 of those students are identified
as needing special needs, so they need special education, which
is an additional burden in terms of cost. And as the
Congressman stated, almost 10 years ago, our district almost
dissolved because we didn't have the funds to support them due
to the Federal presence.
So we dearly need Impact Aid.
Mr. Regula. All right, thank you. I know it's a tough
situation, you heard Ms. Kelly.
Mr. Kirk. As you all know, Chairman Porter spent a lot of
time on this. It was no accident. And for us, I would expect
that the size of the military under this Administration will
grow. It's already growing in my district, so it's under those
concerns that we look forward to supporting your legislation
and supporting the program.
Mr. Regula. Thank you.
Mr. Kirk. Thank you.
Mr. Cunningham. Mr. Chairman, could I ask one real quick
question on it? San Diego does have a lot of military, as well
as important in Impact Aid. You alluded to, as far as the
special education, we have a hospital called Balboa there. Many
times, military families seek orders that are close to those
hospitals, because of their children and special education. Is
that one of the reasons that military families are drawn there,
because of the medical facility?
Mr. Kirk. Yes, we are not only home to the Great Lakes
Naval Hospital, we're also home to the North Chicago VA Medical
Center, which, if you look at the morbidity and mortality
statistics among DOD and military related health care
facilities, is one of the best in the country. The taxpayers
spent about $110 million there to bring that facility up to the
state of the art. And that is an enormous attractive factor.
What we've seen now, and it's just like, I just got off
Dakani so I know the attractiveness of San Diego. But
similarly, in northern Illinois, people like to, when they
leave the service, remain with us. And it's because of those
services.
Mr. Cunningham. I know my sister-in-law just testified
before the committees in charge of special education in San
Diego City. I think it would be good to do a study on the
relationship of military families, special education and Impact
Aid, how it really affects the entire community.
Mr. Kirk. Right.
Mr. Cunningham. Because the original intent is to make sure
that it didn't, with Native Americans or the military, and it
does. So it's an area in which I think all of us, Republicans
and Democrats, support. I don't see why we can't help. I don't
know if we can help as much with budget, but I think we could
do that.
I was sworn in at Glen View Naval Air Station and I coached
football at Insdale. So I'm very familiar with the area.
Mr. Kirk. Gosh. Well, Mr. Chairman, as you know, since the
military most likely will be growing, this program is one of
the pieces of glue that allowed the community to welcome the
military family and expansion in our districts. If expansion of
Great Lakes means bankrupting the local school districts, we've
got a problem on our hands.
So thank you.
Mr. Regula. Thank you. Mr. Sherwood, any questions?
Mr. Sherwood. No, thank you.
----------
Tuesday, March 27, 2001.
HEALTH PROJECTS
WITNESS
HON. LYNN WOOLSEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Next is Mrs. Woolsey from California. Any park
issues today?
Mrs. Woolsey. No park issues today, no, but there will be
in the future, I can assure you.
Mr. Regula. I'm quite sure.
Mrs. Woolsey. Speaking of Impact Aid, that affects Park
Service personnel also.
Mr. Regula. True.
Mrs. Woolsey. Thank you, Mr. Regula, for hearing me again,
and thank you, members of the Committee, for giving me the
opportunity to talk about five excellent education and health
projects in my Congressional district.
Some of you, well, you, Mr. Regula, Mr. Chairman, you heard
my constituent, Dr. Sushma Taylor testify last week about
Center Point, a non-profit comprehensive drug and alcohol
treatment center. Center Point is one of a very few full
service drug and alcohol treatment centers that provides
comprehensive social, educational, vocational, medical,
psychological, housing and rehab service.
Mr. Regula. Do they take patients from all over the country
or just in California?
Mrs. Woolsey. Mainly in California, but I'm sure that they
do tradeoffs with other areas in the country.
Mr. Regula. But is it a private non-profit?
Mrs. Woolsey. Private non-profit.
Mr. Regula. Thank you.
Mrs. Woolsey. But there's local funding, Federal funding,
State funding involved. That's why again, I'm supporting their
request for $1.8 million to purchase and equip an additional
rehab center, and $1.5 million for their successful adolescent
residential treatment program.
Next, I'm very proud that I represent the only public four
year university, Sonoma State University, serving the large six
county region north of the San Francisco Bay. On behalf of
Sonoma State University, I'm asking for $1 million for lab
equipment for their masters program in computer and engineering
sciences. I'm also requesting for them $1 million for their
lifelong learning institute, which offers programs specifically
tailored to the interests and needs of the North Bay senior
population.
The third request I have is an exciting new program in my
district for Dominican University, a private university that
serves minorities, women in great proportions and has one of
the best diversities of any private institution that I know of
in at least the North Bay, but probably in many parts of the
country.
What they have is, they're trying to develop a training and
lifelong learning center to address the current shortage of
math and science teachers, and to meet the need for health
professionals in the Bay region and around the Nation. We don't
have a number for their request at this moment, they came in with a
huge number that would have wiped out all the rest of my requests, so
we're asking them to come back with something else, and I'll provide
that when I write my requests to you.
Mr. Regula. If you have multiple requests, it would be
helpful if you sort of prioritize them, because obviously we're
not going to have enough funding to do everything everybody
would like.
Mrs. Woolsey. And Mr. Chairman----
Mr. Regula. So if we had your priorities, it would be
helpful.
Mrs. Woolsey. I appreciate that, and I am willing to do
that. I also know that what we ask for we don't always get all
of, but I sort of feel that if we get our nose under the tent
and you see how well these programs work, then the next year we
can build on that.
One of the programs that we've had experience with in that
regard is Yosemite National Institute, an institute that
conducts institutionally rigorous hands-on environmental
science programs in my district and elsewhere. One of
Yosemite's highest priorities is to make these programs
available to low income minority communities, those who
traditionally have little access to quality, science-based
education programs.
That's why I support their request, Mr. Chairman, for $1
million to develop more outreach programs for this population.
I'm also requesting, and behind me I have a whole group of
people who came and met with me this morning, and I was already
prepared to come here and they asked could they come with me,
so they're back there. I'm requesting $2 million for the Sonoma
County Health Care Information Network. It's a network that
integrates local health information in order to improve the
quality of local health care.
Mr. Chairman, the Sixth District of California is a leader
in meeting the health and education needs of the 21st century,
and that's because I've been able to work with them and to get
the support from our Federal Government and from your Committee
to give them the help they need to be successful. So I thank
you very much, and I thank the Subcommittee.
I look forward to working with you. I will prioritize these
requests.
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Mr. Regula. Thank you. I know that you did get some help
last year.
Mrs. Woolsey. I did. You've been good. And I appreciate
your work.
Mr. Regula. We'll see. Thank you.
----------
Tuesday, March 27, 2001.
NATIONAL CENTER FOR SOCIAL WORK RESEARCH WITHIN NIH
WITNESS
HON. ASA HUTCHINSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ARKANSAS
Mr. Regula. Okay, Mr. Hutchinson from the great State of
Arkansas. You're interested in the National Center for Social
Work Research with NIH.
Mr. Hutchinson. That's correct, Mr. Chairman, and thank you
for this opportunity to present the case for this. This is
legislation I'm sponsoring with Congressman Rodriquez. It would
create the national center for social work research within----
Mr. Regula. So it's a new regulation you would hope to get?
Mr. Hutchinson. That's correct, it's new authorization.
Even though the authorization has not yet passed, I wanted to
alert you to the fact that we have introduced this legislation,
we'll be asking for support for funding it. And this is within
the National Institutes of Health, but they do some social work
research, but it's not organized toward a national center.
Presently, there is limited funding available through NIH, but
this would emphasize the importance and urgency of research on
social problems from child abuse to juvenile violence. It would
give researchers more guidance, it would change the hard data
into effective policy recommendations.
Funding appropriated to a national center for social work
research would be used for grants to universities and other
non-profit organizations to support ongoing research, national
coordination and dissemination efforts and to cooperate with
legislators of Government, every level.
I think a national center is needed to address some very
important issues. As a father of four and new grandfather, I am
concerned about the next generation. And some questions that
could be asked, why does our system not work better to prevent
violence in our schools? Why has there been a increase in child
abuse today over 50 years ago? Is there a reason for the
occurrences of child abuse being on the rise? Are there
societal pressures on parents that didn't exist even 10 years
ago?
What can we do to help these families? I don't have the
answers to those questions. And I think that that is the reason
this is needed, and I daresay with great respect for this panel
that you might not have the answers to all of those questions.
So social workers are the professionals who can give us
insight into those areas. I was struck by a recent Rand health
study on youth violence, which stated that ``to devise better
programs, researchers need more information.'' Our Nation's
young people are increasingly affected by violence, both as to
its perpetrators and its victims. Many violence prevention
programs aim to reverse this trend but few of them have been
properly evaluated and even fewer have been shown to work.
We need to learn what causes young people to become
violent. Such information could provide the tools for
legislators to make better policy decisions and aid parents,
teachers and counselors in providing better care for these
young people.
Just this month, there's been two school shootings that
we're all aware of in California, which has reminded us of the
many dangers of ignoring children's needs. The alarming
sequence of school shootings from Jonesboro, Arkansas, to
Paducah, Kentucky, to Littleton, Colorado and scores of others
cry out for a response. We find ourselves searching for answers
that do not come easily, and we have to research the solutions,
analyze them for our families, our community schools and
interaction between the peers.
To do that most effectively, they've got to have an
understanding of the factors that lead to these tragedies,
information social workers are compiling right now. But today's
resources are limited. Policy makers lack the information that
is needed, information that the social workers have. And the
national center will provide this critical link.
I can think of no one better qualified or in a better
situation to evaluate this great need than the social workers
who work with these children on a daily basis. It makes sense
to put them to work on these public policy decisions. Social
workers are problem solvers. They work to solve problems
dealing with people's counseling needs, health care needs,
treatment of mental and emotional disorders. So they are
uniquely qualified to do research into this particular area.
As the Subcommittee considers the fiscal year 2002 Labor
and Education Appropriations Act, I respectfully request and
encourage you to consider funding for a national center for
social work research, ideally to be funded at our authorization
level that's requested, but whatever that you believe fits
within your budget, the highest level possible, I think it
would be well deserving.
Let me conclude with this. I'm a conservative, and
sometimes conservatives don't jump into the social work arena.
But whenever you look at the President's initiative on using
faith based organizations, when you look at the arena of child
abuse, when you look at juvenile violent crime, whenever you
look at our investment in cancer research and things that are
causing people to die, is it not incumbent upon us as
conservatives to say, we ought to invest in research in the
very societal problems that lead us this direction, and that
give us this heartache in society.
So I don't think we should neglect this area of community,
of family, of what we can do as policy makers. And this would
coordinate it, rather than just being out there all over the
globe, we need to put it in a focused fashion in the National
Institutes of Health, tell them to elevate this to a higher
priority, because we need some help in solving these problems.
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Mr. Regula. And your bill does that, I assume?
Mr. Hutchinson. That's exactly what the bill does.
Mr. Regula. Questions? Mr. Cunningham.
Mr. Cunningham. Asa, my wife drug me to an event this
weekend. Remember Peter Yarrow? Peter Yarrow is a good friend
of David Obey as well, Peter, Paul and Mary. Maybe you remember
that name.
Mr. Hutchinson. That I remember. [Laughter.]
Mr. Cunningham. He was, I thought, well, this guy is a left
wing anti-military guy and I didn't want to go. But I'll tell
you what, he's got a program called Don't Laugh at Me for
children, and it is fantastic. I think he's a fantastic
individual. I've got the tape and the things, I'll let you look
to it. It may be something that we can get a copy for you. But
it talks about the very things you're doing. I was 100 percent
sold, once I saw the program.
Mr. Hutchinson. Good. And you're a wise man to go where
your wife leads you. [Laughter.]
Mr. Regula. Thank you. As I assume, you want to pull
information that's being developed in many disparate sources
into once center, so there's a focus of it, which then would be
able to communicate this out to the public?
Mr. Hutchinson. Absolutely. To coordinate what is going on
out there, to beef it up, to analyze it a little bit more,to
get the information to the people who are making the decisions,
to give us more hard data as the Rand study indicated.
Again, cancer research would be a good example of that,
women's health issues, you know, once you coordinate it, it
gets more focused and directed. We need to do this in the
social work arena.
Mr. Regula. Have you presented your bill to the authorizers
yet?
Mr. Hutchinson. Oh, absolutely. And Congressman Fred Upton
is, I believe, going to put a package together or children's
health bill, or a public health bill.
Mr. Regula. This is the Education and Work Force Committee,
then?
Mr. Hutchinson. Correct. So this would be a component, I
believe, of what they will do----
Mr. Regula. Oh, part of the Commerce Committee, Energy and
Commerce.
Mr. Hutchinson. Yes. But we have worked with them and I'm
very hopeful that this will move forward.
Mr. Regula. Okay, well, thanks for coming this morning.
Mr. Hutchinson. Thank you.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS AND PROJECTS
WITNESS
HON. JOE BACA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Baca, various programs and projects, from
California. Welcome.
Mr. Baca. Thank you very much, Mr. Chairman, for granting
me an opportunity to discuss the importance of education and
social issues and needs of the 42nd Congressional district.
As you are aware, and my colleagues, I am deeply honored to
testify before you. I believe that this Subcommittee handles
some of the most important issues facing our Nation, and
especially my district. I have submitted a more detailed
written statement of my actual requests.
Mr. Regula. It will be made a part of the record,
obviously.
Mr. Baca. Thank you.
Education is a top priority for my district, for myself,
and has been since I served in the legislature in California
and continues to be here. I share with you in my belief that
every student should have an opportunity that he or she should
be whatever they want to be. As the President indicated, that
no child should be left behind, that means having good quality
education, encouraging students to stay in school, to go to
college, to graduate from school. Many of the appropriations
requests I am submitting for reading instruction, mentoring,
teaching training, are designed to address these goals,
including student retention, crucial issues in my district.
Health issues is one important priority in my district.
I've submitted to the Subcommittee venues in Congress seeking
for funding for drug and alcohol treatment for youth age 12 to
17. Sometimes we forget that a lot of our youth in that area
are not receiving the funding especially as it pertains to
drugs and alcohol. It's important we put our top priority into
supporting individuals. I've supported this legislation in the
State legislature. I hope that we can support that kind of
legislation to really address teenage drinking and alcohol,
especially as it pertains to a lot of us and the effects it has
in our schools, especially what's going on, too, as we look at
what's going on.
Expanding the Healthy Family programs in California to
include indigent adults, supporting health care for seniors and
children, fighting against breast cancer, license plate funding
program, supporting prostate cancer, diabetes research and
treatments are also important priorities, which require Federal
funds which I am requesting this year. Specifically, I am also
requesting funding for San Bernardino Community College
district, in my district, we're multi-campus, providing KVCR
television station owned by the district for $21 million for
digital conversion and expansion of operations, studio space,
for $35 million to $42 million for moving the KVCR facility to
a more desirable location.
Last year you granted me $1.7 million to obtain for distant
learning. This is very important, especially as we see
community colleges right now. Most of our students are going to
community colleges, they can't into four year institutions. And
KVCR, through its digital program, is doing a lot more of the
outreach and providing educational services. We need to make
sure they continue to provide an opportunity, especially as we
look at students right now that are trying to get into our four
year institutions and can't get in to our State colleges and
universities. This is an avenue that can be done through KVCR
telecommunications in providing not only classes that they can
take and outreach, but also assuring that we provide the
facilities. I think this is very important for our area as
well.
I'm also requesting $500,000 for Fontana Unified School
District for subsequently retrofitting an ADA improvement to
the civic auditorium, a facility that is utilized by hundreds
and thousands of students in the City of Fontana, purchased a
building in 1985, this is high priority funding and
retrofitting which I think is very important for us. While also
the capacity to the city, it has capacity only of 1,000 but we
need to continue to improve and provide subsequent retrofitting
for that area.
I'm also requesting $3 million for the City of Ranch
Cucamonga, which I share along with Dreier and Miller that were
surrounded in that area to design and construct a new senior
citizen center that provides 25 to 30 square feet. The city is
providing matching funds of $2 million for land and ongoing
maintenance and operation cost.
For the City of San Bernardino, I'm requesting $1.5 million
for the city to support job training for the city on one stop
career center. This request is strongly supported by the civic
and business groups in my district, along with Congressman
Lewis.
Mr. Chair, I have many other projects that I've outlined
specifically, the California University at San Bernardino, San
Bernardino County Superintendent of Instruction Schools, San
Bernardino County Unified School District, the University of
California at Riverside, with an incubator that's important to
our area, as we look at providing jobs and getting
universities. It's the only university in that area that is
supported not only by myself, Ken Calvert, Mary Bono, Miller
and also Congressman Lewis support the project for funding in
that area, even though it's not in my district, but it's the
only university within that area, and I think it's our
responsibility to provide assistance to them.
These are but a few of the many projects that I have
submitted requests for you. You have specific details on the
others, Mr. Chairman. I thank you for giving me the opportunity
to come before you. I know it is a long list and a wish list of
many areas. But I believe it's important that I represent my
district, submit those requests and whatever possible can be
funded, I would appreciate very much if the Committee would be
able to look at some of the important projects to improve the
quality of life, education and health in our area.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Questions?
Thank you for coming. You do have a substantial list.
Mr. Baca. Thank you, Mr. Chair. I look forward to your
continued support, and I'm not shy. [Laughter.]
----------
Tuesday, March 27, 2001.
CLOSE UP FOUNDATION AND PROJECTS
WITNESS
HON. DONALD M. PAYNE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW JERSEY
Mr. Regula. Mr. Payne, New Jersey.
I'm sorry, Don, I got you out of order here.
Mr. Payne. Well, I may not get an extra program, then.
[Laughter.]
Mr. Regula. Pretty high price you're asking.
Mr. Payne. Thank you. It's certainly a pleasure to be here,
Chairman Regula. Let me just start by saying that our city of
Newark, New Jersey is really on the rebound, it's coming back.
We had a civil disorder in 1967 that really is the dividing
point as we look at history in Newark. And because of support
that we've gotten from your Committee, we've been going in the
right direction over the last decade.
Mr. Regula. Are you getting a new airport there, or a lot
of pretty major----
Mr. Payne. Yes, pretty major, the road construction funding
has just made it, actually, it's the third largest airport now,
it's overtaken Kennedy and JFK, I mean, JFK and the other New
York air, LaGuardia.
Mr. Regula. Is it a hub at this point for any of the
airlines?
Mr. Payne. Yes, Continental, which has gained a lot of
strength and health now, and is doing an excellent job to
overseas, South America.
Mr. Regula. We left out of there for the----
Mr. Payne. That's right, it's a great place. So anyone
who's traveling, at least come through Newark. We have a little
city tax on it, you know.
But it's great to be here. I'll be brief. We have some
health projects, the Emergency Medical Services demonstration
project, the Children's Health Care Services and Outreach
Center, and Babyland Family Services. What the coordinated
Emergency Medical Services demonstration project is, it's a
project to bring together transportation and emergency services
in older cities. This is a very vital need. So we have, we're
asking for $5 million to help with this demonstration project.
Of course, the details are in the packets.
The second one is the Newark Children's Health Care Service
and Outreach Center. It's to positively impact on the health of
Newark's children through the development of a coordinated
health care system that will allow the city to bring health
care services to the community. Through the centralization of
services, we believe that we can increase access to an array of
health and social service needs to Newark's citizens. We ask
for $2.5 million for that.
And thirdly, the Babyland Family Services is a major non-
profit child and family service organization, providing
comprehensive child care and family development services to
1,500 at-risk children and their families annually. Babyland is
seeking additional funding to establish the technological
linkages to nurture the educational development of almost 700
children, provide computer training for 2000 parents, teachers
and entry level professionals. We're asking $2 million there.
Just quickly, at the UMDMJ, we have a series of programs
that we're asking. One is elimination of health disparity, and
they have a very well focused program. We're asking for $5
million over a five year period. There is also a cancer
institute center, the Dean and Betty Gallow Prostate Cancer
Center. Dean Gallow is a former member of this Subcommittee,
unfortunately passed away from prostate cancer. His widow,
Betty Gallow, has been carrying the work on that Dean started.
So we're asking for $10 million to assist in that project,
which has become extremely successful.
I'll conclude there, but there is one national program that
I am making a request for, Mr. Chairman, it's the Close Up
Foundation, civic education fellowship program. As you know,
the Close Up Foundation is a civic educational program that
brings students from around the country to our Nation's capital
to study about government. It's been around for quite a while.
As you know, we need all the help we can get in civic
education and responsibility. We see what's happening at our
high schools and elementary schools in our country. As a former
teacher and coach, I didn't coach in the Army, but I coached in
high school, we really see the need for these kinds of
programs, bringing youngsters to our Nation's capital,
stressing civic education, which I think is missing in a lot of
our school systems.
So with that, we'll submit our full text and I appreciate,
like I said before, the previous support and look for continued
support.
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Mr. Regula. Thank you. Questions?
Mr. Cunningham. Don, the Close Up Program, that's not the
one that recently had controversy with Reverend Jackson, is it?
Mr. Payne. No, not to my knowledge, no. It's really a
program that has a lot of support from business, but we do need
to have our Federal support. But to my knowledge, this is not
that program.
Mr. Cunningham. Okay, thank you, Don.
Mr. Payne. Thank you very much.
Mr. Regula. Thank you for coming.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. ROBERT SCOTT, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH
OF VIRGINIA
Mr. Regula. Mr. Scott, from the great State of Virginia.
Mr. Scott. Thank you, Mr. Chairman and members of the
Committee. I appreciate the opportunity to speak with you
today.
To save time, Mr. Chairman, you have the testimony and I
want to just speak very briefly on two projects, the Massey
Cancer Center at the Medical College of Virginia, and the
Achievable Dream Program in Newport News, Virginia.
The Massey Cancer Center, Mr. Chairman, is a building, a
$26 million project. We're requesting $2.8 million from
appropriations. The board of directors will be raising $10
million to $15 million.
Mr. Regula. Is this a private non-profit?
Mr. Scott. I'm sorry?
Mr. Regula. Is it a private, non-profit school?
Mr. Scott. The Medical College of Virginia is a State
college. It's part of the Virginia Commonwealth University.
Mr. Regula. Right.
Mr. Scott. It's a $26 million program. The board of
directors will be raising $10 million to $15 million, and we
have received previous requests of $1.2 million, and we hope to
receive the remaining $2.8 million to complete the project. The
center is one of 59 national cancer institute programs, and
it's an excellent program, Mr. Chairman, and I would hope that
staff will read the details on it, and it's one that we're very
much interested in. They have an outreach program going into
the rural areas where they've had a significant impact on
incidence of cancer and success in treating cancer from the
Medical College of Virginia, going out into rural areas.
The Achievable Dream Program is an education program
consisting of teaching at-risk students at an elementary and
middle school. Basically they have as kind of a hook, you come
in and play tennis in the afternoon during the summer,
education in the morning, then they go into the full year-round
session. It's basically an inner city school. They have extra
curricular and character building activities.
They have shown that the program works. Their test scores
are at or above the city average, and we have some areas where
there are very high income students, very low income students.
These low income students are at or above, in some cases way
above, the city average. They receive significant support from
the community, an average of about $1,800 per student. We're
asking for $1.5 million from funds for the improvement of
education so that we can start an early childhood center for
three to four year olds. The earlier you start, the much better
you can do.
This is a very successful program, and we hope we can have
your continued support.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Questions? Mr. Cunningham.
Mr. Cunningham. Bobby, we have a teaching hospital in San
Diego for medicine, and it's just about to fold. With the HMOs,
California is a leader in HMOs, yes, we do need HMO reform. But
are you having those similar problems with the teaching
hospitals and the training of doctors? A, the number that are
requesting medical school has gone down, secondly, that they're
having trouble funding it.
Mr. Scott. A significant portion of the patient load is
Medicaid, Medicare. So the reduced reimbursements are squeezing
all of the hospitals, particularly the teaching hospitals,
because they're open to everybody. So anybody that comes in,
they're going to deal with. It's a major strain.
Mr. Cunningham. I think across the Nation we're having
trouble, and we're going to have trouble having good doctors, I
think, in the future, unless we attend to it.
Thank you.
Mr. Scott. Thank you.
----------
Tuesday, March 27, 2001.
CLEVELAND BOTANICAL GARDEN (PROJECT)
WITNESS
HON. STEPHANIE TUBBS-JONES, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF OHIO
Mr. Regula. Next, from the great, great State of Ohio,
Stephanie Tubbs-Jones. Stephanie, you're going to speak on
behalf of the Cleveland Botanical Garden.
Ms. Tubbs-Jones. That's correct. If you'll allow me to
stray for just a moment, I want to bring you greetings from my
predecessor, the Honorable Congressman Louis Stokes.
Mr. Regula. He was here in person last week.
Ms. Tubbs-Jones. Oh, really? Did he tell you about us
naming a post office after his mom, and how great it was? Well,
doggone it, I'll have to tell him he preempted me.
Mr. Regula. About everything I see in Cleveland has been
named after him. We're running out of streets.
Ms. Tubbs-Jones. I think so. [Laughter.]
I'm just trying to hold my name out there. I can't get the
streets and the buildings, but I'm doing okay.
Mr. Chairman, thank you very, very much for the opportunity
to present this morning. I'm here on behalf of the Cleveland
Botanical Gardens. This is our fiscal year 2002 request, to
secure $1 million in Federal funds to enable the Cleveland
Botanical Garden to develop interactive ecological exhibits and
educational materials for students from kindergarten through
12th grade and their families.
You have all this information in your packet. I thinklast
year when I presented, you had the opportunity to taste right from
downtown salsa, which is a salsa that is produced by the students who
grow tomatoes at this facility and surrounding facilities. What the
botanical gardens has attempted to do is let young people in
Cleveland's school districts and surrounding school districts have an
understanding of ecology, an understanding of preserving the
environment.
So in this next step, we've already begun the funding of a
glass house, but what the next step will allow us to build, two
ecological systems, one like that exists in Costa Rica, where
you have high ground properties, where people will be able to
come through and interact with the activities, similar to
probably some of the rainforest and other areas. But the other
areas have focused on the lowlands, and we're going to focus in
on the highlands.
I could be very detailed in my presentation, but I know you
don't want me to be, so I will not. But I come here to say that
this is a project that's very important to my Congressional
district, but also important to the region and the area and the
State of Ohio. I appreciate all the support that you gave me
last year, and in my second term as now a sophomore member of
Congress, no longer a freshwoman, I'm here to say I need your
help again, and any additional information that I can supply
you, I'll be glad to do so, and I thank you for the opportunity
to be heard.
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Mr. Regula. I think I got a note that they're doing long
distance learning from there.
Ms. Tubbs-Jones. That's correct. In fact, the director of
the program would be here, but he's in Costa Rica, because
we're doing exchange programs with children from Ohio and
children from Costa Rica. It's a pretty exciting opportunity
and a collaboration between Case Western Reserve University,
the Botanical Gardens and the University of Costa Rica.
Mr. Regula. Questions?
You got some support for this last year, I believe.
Ms. Tubbs-Jones. Yes, sir, and if I didn't say it, I
thought I did, thank you for last year's support, and I'm back
again. Anything else you can give me, I'd appreciate it.
Mr. Regula. I'm not surprised. [Laughter.]
----------
Tuesday, March 27, 2001.
LUPUS RESEARCH AND CAREGIVERS AND PROJECTS
WITNESS
HON. CARRIE P. MEEK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
FLORIDA
Mr. Regula. Our next guest is Carrie Meek from Florida.
Carrie, we're glad to have you, an also a member of our Full
Committee.
Mrs. Meek. Thank you, Chairman Regula, and all my friends
on this Committee. I'm pleased to be here today.
It's regarding a program in which I'm very, very interested
and very concerned. I want to testify this morning on my
highest funding priorities for fiscal year 2002. I understand
you have a very awesome responsibility and you don't have the
resources that you really need to meet some of these
responsibilities. But we'll have to do the best we can.
There are some issues that I'm interested in, and I know
the time is limited, so I want to submit the rest of my
testimony for the record.
Mr. Regula. Without objection.
Mrs. Meek. My number one priority, Mr. Chairman, is
increased funding for lupus. Each of you is aware of this
disease, we've been before your subcommittee for many years.
And thank God, it was authorized last year, through Chairman
Bilirakis' committee. It was a very long fight. It is something
that I come before this Subcommittee to ask you, now that it's
authorized, will you please fund it to the point that we can
stop the killing and the maiming of this disease of young
women?
I'd like to request $30 million for the Centers for Disease
Control to fund a grant program authorized under Title V,
Subtitle B of Public Law 106-505. It's the Public Health
Improvement Act of 2000, for treatment and support services for
lupus patients and their families. This is a little bit
different from the rest of the things you've been doing for us.
Through the years, you have each year provided some funding for
lupus. Now we're asking you to provide funding to support the
lupus patients, in that they have a very, very hard time with
their physical bodies being naturally undermined by this
disease.
I also request $25 million in additional research funding
over and above the enacted 2001 level on the Title V, to enable
the National Institutes of Arthritis, Musculoskeletal, and Skin
Diseases, you call it NIAMS, to conduct expanded research to
understand the causes and to find a cure for lupus. First of
all, there is no cure for lupus. The treatment for lupus many
times is just as harmful to the patient as is the lupus itself.
The third thing is, if you continue the research, sooner or
later you will get to the cause and a cure for this disease.
Now, it's very important to me that we find a cure for
lupus, and find a cure for the suffering that people go
through. My sister died of lupus, a lot of young women die of
lupus in their child bearing years. I've been urging the Congress to
direct NIAMS and NIH to mount an all-out campaign against lupus.
Now, rest assured that this is not to say that they have
not been working hard on this. Except that they need more
resources to do the support service, they need more
researchers, more resources to do the research as well.
Now, this is a killer. It's an autoimmune disease and it
kills more people than HIV-AIDS and most of the other
autoimmune diseases. It's really significant for women to focus
on this disease, because about 1.4 million Americans have some
form of lupus, and most of them are women. Many of these
victims, if you've ever seen anyone or talked to anyone with
lupus, the pain is very debilitating. The women aren't even
able to hold their own children.
Suffice it to say, Mr. Chairman and members of the
Committee, I'm asking for $30 million for the Centers for
Disease Control to fund a grant program which will support
lupus patients. I'm requesting $25 million in additional
research funding. That's going to NIAMS, which is a part of the
National Institutes of Health. These groups have done an
outstanding job, and if anyone can beat this diseases, it's
those two.
The most discouraging thing is that the family members
suffer so from this particular disease.
My second priority, Mr. Chairman, is a demonstration
project to develop and test HIV-AIDS prevention, a media
campaign. We brought it before the Committee last year, they
thought it was a good idea, but they didn't fund it. What we'd
like to do is a demonstration project to develop and test on
HIV-AIDS. We know that the media program has worked with
cigarettes. It has worked with HIV. But I'm requesting this
now, and you know the drug program has worked. Every time you
see one of those very well thought out drug programs regarding
children, you will see that it's very, very effective.
I'm requesting $10 million for the Centers for Disease
Control and Prevention to develop and implement a grass roots
minority HIV-AIDS prevention media campaign. That would be
modeled after the $185 million the Congress spent on anti-drug
media programs for the National Office of Drug Control. Funding
for it would be used to develop and test the effectiveness of
the HIV-AIDS prevention media campaign in 20 United States
counties with the greatest number of minority HIV infections.
I won't prolong that. Each of you is aware of the
propensity of HIV-AIDS to kill and to maim the population.
Third, Mr. Chairman and members, $15 million to fund the
Higher Education Demonstration Projects, which will ensure
equal opportunities for individuals with learning disabilities.
Now, you all have heard of learning disabilities in youngsters
from K-12. And a lot is done for them. Very little is done for
youngsters who get out of high school and go to college and
have learning disabilities.
And to say that means that they need support as well as the
younger persons do. It's one that shows you that you'd be
surprised that a number of youngsters who go to college with
learning disabilities, they don't read very well, most of them
are very bright students. But they have these learning
disabilities, and the teachers are not really capable of being
able to understand how to teach these young people, nor do they
understand what these learning disabilities are.
So I'm urging the Committee to include $15 million to fund
the grant program currently authorized. We were able to get
this program authorized about two years ago here in the
Congress through the Labor HHS Committee, and we were able to
get it funded at $5 million for the entire country. But think
of all the students who are enrolled in institutions of higher
education who need these services and cannot get them.
So as I understand it, each year a million dollars has been
placed in that program to take care of some of the needs. I'm
sure you realize that $1 million more each year certainly would
not put that program where it should be.
What this does, it identifies college students with
learning disabilities and develops effective techniques for
teaching these students. I think it's very fair that we think
of the fact that we are really developing our students, and
just because they have a learning disability doesn't mean that
they're not bright. I think if you note, Einstein was learning
disabled. That just gives you one example of the kind of
student you're dealing with with learning disabilities. They're
very bright students.
University professors have found the research that has
developed as a result of this program has been very helpful,
helping them to teach students in higher education.
My next one, Mr. Chairman, I listed them all for the
Committee to look at, increased funding for community health
centers. I support an increase in funding for the consolidated
health centers program by at least $175 million for fiscal year
2002 in order to provide an inexpensive way to get high
quality, affordable primary health care to under-served
communities.
Now, just take my State of Florida. There are 2.5 million
people who have no regular source of primary care. Most of
these people are in urban inner city areas like my home
community in Miami, and in isolated rural areas. They do need
better health care. And of course, the community health care
centers is one that can provide that kind of help to people.
The last one has to do with please increase funding for
graduate medical education for pediatric hospitals to $285
million, the fully authorized level. You say, well, Carrie,
that's really asking for a lot. You made a good start in your
funding for pediatric graduate medical education the last time.
But this is one of the areas of health care which has been
overlooked for a very long time. We should take the next step
by moving as quickly as possible toward funding at the fully
authorized level.
And I want to thank the Chairman and the members of the
Committee for your patience in listening to the list of things
I've brought before you. I'm sure that you will look at them in
such a way as will meet the needs of the people of this
country. I think of all the things we deal with here in the
Congress, health is one of our most important ones, and I thank
the Committee for having me appear before you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
Questions? Thank you, Carrie. Did you get that building
down there that we had a couple of years ago and name it after
the President, the college?
Mrs. Meek. No, you wanted to name it after me, that's why
they didn't build it, I think.
Mr. Regula. Did they build it?
Mrs. Meek. Yes, they did.
Mr. Regula. They didn't name it after you, though?
Mrs. Meek. No, they did not.
Mr. Regula. Well, we'll have to----
Mrs. Meek. We'll have to take the money back, Mr. Regula.
[Laughter.]
Mr. Regula. Has it been named yet?
Mrs. Meek. No, not yet.
Mr. Regula. Maybe we can address that problem.
Mrs. Meek. All right, thank you so much.
----------
Tuesday, March 27, 2001.
MEDICARE AND HEALTH CARE FINANCING ADMINISTRATION
WITNESS
HON. PETE STARK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Stark from California.
Mr. Stark. Thank you, Mr. Chairman. Do you have any
leftover buildings in the 13th Congressional District in
Northern California? Maybe Duke and I could work something out.
Mr. Regula. No money.
Mr. Stark. No money, okay. [Laughter.]
Well, if I were just to build the sign that goes over the
door, could I contribute that?
Thank you for giving me the opportunity to address you this
morning, Mr. Chairman, members. I hope you'll take my complete
statement for the record, and just let me summarize it for you.
As the Chair recalls, for 10 years, I guess, I chaired the
health subcommittee of the Ways and Means Committee. It has
since been chaired both by Mr. Chairman Thomas and now Mrs.
Johnson. I believe we are all in accord on this, and we have
all had our disagreements with HCFA. Under the 10 years that I
chaired the Committee HCFA was under Republican, under a
Republican Administration, it's been under a Democratic
Administration when Mr. Thomas was there. The reports have been
late, we've had complaints from doctors and hospitals, you've
all had complaints in your Congressional districts.
But the truth is, in all of that time, we have been able to
say, as we speak to people across the country, that they're
operating the Medicare operation a couple of hundred billion
dollars a year with a 2 percent overhead. There's not an
insurance company in the world, Blue Cross and Kaiser maybe
come to 12 percent, that could operate on 2 percent. And some
of the more expensive insurance companies that are doing the
same thing, 14, 18 percent. And it's these same insurance
companies, Blue Cross, that do a preponderance of the work
under the supervision of HCFA for distributing these payments.
Think about this. Today, Medicare beneficiaries will make a
million physician visits. This is not just hospitals. This is
going to the doctor. A million visits. And Medicare will
process more than 3 million claims today and spend a billion
bucks. That's what we're doing every day. And we're doing this
on their share of the budget, about $2.2 billion for program
management.
The graph will show, Mr. Chairman, that this is in real
dollars, the dotted line down here, and it's only in the past
year that we've gotten up to 1993 expenditures.
Now, what's wrong? Their computer system doesn't work. They
haven't gotten up to the full time employee level that they
were 10 years ago. We have been starving them. And since 1996,
we gave 700 new legislative provisions for them to administer.
Now, you can say we're cockeyed for doing that. My point is
that we all do that. This is a Congressional mandate, and it's
been under both parties and under both Administrations.
The money, although you get scored for it, comes out of the
trust fund. So those of us who want to protect the trust fund
realize, but let me just tell you this. That it was in 1996
that we came out with this, or we didn't come out, we got this
14 percent of what we were spending. Again, let's say it's $2
billion a year. Twenty-eight billion of that was spent
incorrectly. Now, some of the incorrect payments were fraud and
abuse, and some were just mistakes, just filled out the form
wrong, paid the check wrong, whatever we did. We were throwing
away, if you will, in the 20s of billions of year.
They have cut that, because of legislative provisions we
mandated, to 6.8 percent. They have cut that in half. So they
have saved $12 billion in six years by addressing the fraud
provisions which we forced on them.
Now, what I'm telling you, they're doing this, and they're
still only spending $2 billion a year for administration, and
the results of what they're doing have saved us $12 billion. So
I'm just here saying, could we double their budget over a
period of years and get them up to say, 4 percent of benefit
spending. I don't know how much a new computer system is going
to cost. It's in the dark ages. But you and I know that the
phone company can find everybody, and our credit card people,
Visa and Master Charge are more efficient than HCFA, and
they're spending more to collect money from us.
So that's my plea. I'll be glad to try and answer any
questions. This is one of our better managed bureaucracies.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Has mechanization helped, the computers and
record keeping?
Mr. Stark. Of course. And they're behind the curve. There's
no question that mistakes were made, I'm trying to think of how
many years ago it was, Mr. Chairman, they decided to do eight
different computer programs around the country, because they
felt they had to give eight different people a chance to bid on
the work. How do you have eight different systems?
Mr. Regula. Do they still have more than one system?
Mr. Stark. They have more than one. Because historically,
when Medicare came into being, it was, the billing part of it
was turned over mostly to Blue Cross people around the country.
So every are has a different billing system. Because they have
a different person, we actually contract out the majority of
the work to people called intermediaries. We've got to change
that. This is the 21st century.
Mr. Regula. Are you saying change the contracting out, or
changing the coordination?
Mr. Stark. Changing the coordination, changing the method.
There's a whole lot of modernization. But they've got to have
the equipment and the personnel to do it.
And I have great faith in Governor Thompson, a good
administrator in my natal State of Wisconsin. But we've had
good administrators right along. It's one of the biggest
bureaucracies, as you know.
Mr. Regula. It's a Herculean task.
Mr. Stark. It is. And we can't starve them at the same time
we're forcing more work down on them. As I say, I don't think
we can find either a budgetary fight or a partisan fight on
this issue. I know we don't get scored for the savings out of
the fraud and abuse as opposed to directly. But it's there, and
as I say, these are----
Mr. Regula. Do the intermediaries pick up fraud?
Mr. Stark. They will trigger investigations, because
they're the ones who can understand patterns. But each
intermediary, the problem is, has a different way of judging.
In other words, certain screening tests, that would call for
surgery or certain screening tests that would call for more
clinical tests could differ. One area of the country might pay
for bone marrow and another might not. Don't ask me why. This
is just the historical way they have done this.
So there's a lot we can accomplish. But for us to begin to
proceed more rapidly, which we should do, is going to take
people and--the sheer volume, the complexity of all the
different medical procedures. And one of these days, we're
probably going to get into pharmaceuticals, and that's just
going to add another whole bunch of words and numbers and
procedures that you and I wouldn't be able to spell or
understand, but we would end up paying for.
Mr. Regula. That's an enormous challenge.
Mr. Stark. Yes. If you could find, as you push these
numbers around, some there, I think that you will find the
Republican Administration, the Democratic minority will move to
help in any way we can.
Mr. Regula. Pretty much a bipartisan issue.
Mr. Stark. I believe so, Mr. Chairman. I certainly don't--
all I can tell you is that in the past years, the current chair
and the now chair of the full Committee have supported efforts
to see that HCFA gets better funding.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. I talked with Governor Thompson about this
problem the other night. It's very real and we have to address
it. We find that all over the Government, that our computer
systems are not anywhere near up to date with the work we're
trying to accomplish. And it costs us money in unusual ways,
because of that.
Mr. Stark. If the gentleman would yield, and this is the
poster child of the type of operation that can save from
computerization, because of the huge volume of small claims and
forms that have to be filled out. As I say, we're all excited
that Governor Thompson can do a good job over there, but I
think we've got to give him the resources.
Mr. Sherwood. I agree.
Mr. Stark. I thank the gentleman for his concern.
Mr. Regula. Thank you.
Mr. Stark. I thank you for the opportunity to present the
case here today, and I hope you can find a few dollars to help
out this group.
Thank you very much, Mr. Chairman.
Mr. Regula. Thank you.
----------
Tuesday, March 27, 2001.
CONGREGATE AND HOME-DELIVERED-MEALS PROGRAM
WITNESS
HON. CHRISTOPHER SHAYS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CONNECTICUT
Mr. Regula. Mr. Boehner.
Mr. Boehner. I'll yield to my colleague who's in the middle
of a hearing.
Mr. Regula. Oh, all right, Mr. Shays, congregate and home
delivered meals program.
Mr. Shays. Thank you. He yielded on the agreement I'd be 30
seconds. I thank him very much.
Mr. Chairman, just to make you aware of the fact that our
congregate meal and our home delivered meals has been somewhat
static, and there hasn't been a sense of--
Mr. Regula. Static in reimbursement, static in numbers?
Mr. Shays. Funding, except in terms of adding a little bit
to the congregate last year. But the bottom line is, I'm asking
if you would restore $43 million to put $43 million into the
congregate meal program to bring it to a total of $421 million,
which would bring it to the funding level of 1995.
The only point I want to make to you is that there have
been unused funds in the congregate meal that have been unused
by agencies, and they have built up a level of spending now so
those unused funds from past years have been used up, and
you're going to start to see around the country some
significant deficits. Just an alert to you that you may need to
take a look at it.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Don't we get a lot of volunteers involved in
this operation?
Mr. Shays. Yes, it's great. You get a lot of volunteers,
but this pays for the meals. You get a lot of volunteers who
come to the congregate sites, a lot of volunteers who do the
home delivered meals. It's a cost effective program.
Mr. Regula. Do they get reimbursed mileage, because they
drive their automobiles?
Mr. Shays. I'm not even sure of that, sir. We just had a
challenge in our district because what we found is they had
built up to levels using past funds. They built up their
spending level above the annual appropriations that exist. So
the States made up the difference in Connecticut. But I suspect
you may be having a problem around the country that will start
to surface as people use past funds for present operations.
Mr. Regula. Well, and of course, more seniors, too.
Mr. Sherwood?
Mr. Sherwood. No questions.
Mr. Regula. Well, thanks.
Mr. Shays. Thank you, and I thank my colleague for
yielding.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS
WITNESS
HON. JOHN A. BOEHNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
OHIO
Mr. Regula. Mr. Boehner.
Mr. Boehner. Hello, Mr. Chairman. I'm glad to be here this
morning.
Mr. Regula. What will you be doing to our budget over there
in your committee?
Mr. Boehner. We'll be working very closely with you. Good
morning and thanks for the opportunity to be here. Let me say
hello to my friend and the newest member of your Committee, Mr.
Sherwood. It's nice to see that you're here.
And I appreciate the job that you all have in terms of
trying to decide how to allocate the biggest chunk of the
Appropriations Committee. It is a difficult choice. I'm here
today as chairman of the Education and Work Force Committee to
really outline our priorities. I think the President has done a
good job in his proposal on education, which is embodied in a
bill that we introduced last week, H.R. 1. And the effort there
is to close the achievement gap that exists between
disadvantaged students and their peers, and to work with States
to improve the schools to be the best in the world.
I could talk about the President's education proposal, but
you all understand it fairly clearly. More flexibility in terms
of consolidating programs, in allowing schools to have more
flexibility over how to use those resources in their schools.
Secondly, actually doing a better job of targeting the
money to the schools who need it the most. And thirdly, putting
into place a new reading program that is absolutely essential.
Because if children can't read, they're not going to learn.
We know that the early childhood reading program, and the
President's proposal, will do a lot to improve reading scores,
and we think, learning.
Now, money is not the only issue here. We've spent $130
billion since 1965 on well intentioned, well meaning education
programs. The fact is, we've gotten almost no results for the
money we've invested. And what we need is a system of
accountability and rededication of the Federal Government's
commitment to helping those students who would otherwise fall
through the cracks.
Let me point out three issues that I think are most
important on the education side. They're outlined in the
authorization levels in our bill, H.R. 1, which is in effect
the President's proposal. A $461 million increase in Title I,
$320 million for the President's State assessment initiative
for grades 3 through 8 in reading and math and thirdly, $975
million for the President's reading first and early reading
program.
When you look at what we're attempting to do over there in
terms of providing for more accountability and more
flexibility, we believe that, and targeting, targeting the
money to these children who most need it, these three programs
that we've outlined here are the core of making this work.
I'd also ask that you find the resources to increase
funding for IDEA. This Committee has done a marvelous job the
last five years in increasing IDEA funding. The President's
calling for increased funds, and I know that every member of
Congress listens to what I listen to when I go home from every
one of my school districts. And that's that IDEA needs more
money.
You should be aware that part of the President's request
for his reading program and the early childhood reading program
will in effect help with IDEA issues in local districts. That's
because there are an awful lot of students that end up in IDEA
because they can't read. To the extent we can solve this
reading problem or address this reading problem, both the early
childhood reading and the K-3 reading program, I think we'll
take a big step in helping these school districts with their
IDEA money issues.
Secondly, in this area, the President has also asked for a
billion dollar increase in Pell Grants. We all understand the
need to continue the effort to increase the Pell Grants, to
help those children, again, at the bottom of the economic
ladder, who without that effort would never be able to attend
post secondary education programs. And I think that again,
you're getting a lot of requests, but I think we all understand
the importance of the Pell Grant program.
Let me switch gears and talk about the other side of my
committee, and that would be the labor side. I support the
President's plan to level fund the Department of Labor,
especially in our enforcement areas. In the past, the DOL has
had the habit of administering the Nation's labor and
employment laws beyond what I believe the scope of what
Congress intended. And I think taxpayers savings will arise
from effectively protecting workers by properly enforcing
important labor and employment laws.
I would ask that you support the efforts of the Department
of Labor's inspector general to better protect workers benefit
funds and reduce waste, fraud and abuse that continues to exist
there.
So I thank you for the opportunity to be here and look
forward to answering any questions that you might have.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. One of the components of the President's
program is testing.
Mr. Boehner. Correct.
Mr. Regula. Do you anticipate that the Federal Government
will fund these tests, even though the States develop them?
Mr. Boehner. What the President proposed is that we, the
Federal Government, assist the States in developing their
tests. Under his proposal and under H.R. 1, the States will
determine what tests to use in their States.
Mr. Regula. I understand that.
Mr. Boehner. But the actual implementation of it is left to
the States. Now, this bill is going through committee here in
the next month or month and a half. Whether we get into funds
for the actual implementation of the test is yet to unclear.
But Mr. Chairman, I think you understand that in virtually
every school district in America, there's testing that goes on
every year.
Mr. Regula. Oh, yes.
Mr. Boehner. And under the President's proposal, some
States are already testing in every grade, reading and math.
Others may be doing other tests. But frankly, I'm not so sure
that when it's all said and done there's any additional testing
that's going to result from the President's proposal. I believe
that the requirement that we'll have in our bill, that we have
annual assessments in reading and math in grades three through
eight may in fact replace some other testing that's already
being done.
Mr. Regula. Staff just advised me, apparently the budget
resolution withholds a $1.25 billion from this Committee,
unless we appropriate a commensurate increase for special ed.
Well, obviously that's going to squeeze what we have to do some
of these other things that are embodied in your bill.
Mr. Boehner. Sounds like a big issue between the
Appropriations Committee and the Budget Committee.
Mr. Regula. I've noticed that there's some discussion of
that. You're going to be involved, too, because you're going to
bring to us through authorization programs that cost money.
Mr. Boehner. I'm confident that when the budget resolution
gets through the House and the Senate and we come to
conference, that all of these issues will be ironed out to our
satisfaction, as they always are.
Mr. Regula. That there will be adequate funding.
Mr. Boehner. I'm convinced that there will be adequate
funding. Even though the President has called for an overall
increase in discretionary funding of about 4 percent, it is
going to put pressure on all of you to make serious decisions
about what needs to be funded.
Mr. Regula. True. Very true.
Mr. Boehner. But I think it's obvious from all the national
polling that we see that education is the number one issue in
the country. The President called for it during his campaign.
He has devoted serious time to this over the last several
months.
And as we get the bill through our Committee and the Floor,
and the Senate does theirs, I do expect that we will have a
bill signed into law prior to your bill, your appropriations
bill, being on the Floor. I would expect that Mr. Miller and I,
the Ranking Democrat on the Committee, we expect to work
closely with you as we move through this process.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Mr. Chairman, I have great faith in your
ability to work those things out.
Mr. Boehner. So do I.
Mr. Sherwood. But the assessment issue I think is so
important. Because parents and students deserve to know where
they stand in relation to other schools. I think our education
establishment has tried to push that on the back burner,
because they don't want the comparison and they worry about
teaching towards the test and those sorts of things.
Well, I think our college board tests and so forth have
told us that if the test is well designed, there are tests that
work. I like the President's proposal to bring assessment
forward, testing forward.
Mr. Boehner. Well, Mr. Sherwood, as a former school board
member, you understand better than most, well, the Chairman's a
former member of the education establishment, I might add, but
the annual assessments really are important, because there's a
big secret out there. The big secret is that about half of our
kids just are not learning.
Now, we've lost a generation of students in our country. We
can keep looking the other way, and act like it doesn't exist.
We can continue to allow the disease of low expectations to
continue. But the people that get hurt the most are the people
at the low end of the economic ladder in our country, the most
disadvantaged of our children are the ones who are trapped and
who will never succeed without an education.
And although we've done all types of well intentioned
programs out of here, the fact is that we need to start asking
for results. And one of the issues that, and Mr. Miller and I
are in much more agreement than most of you would ever guess
about the direction of this bill, because the money needs to
get to those students who most need it.
Those schools in inner city neighborhoods and rural
communities, they've got bigger problems. They need the extra
funds in order to ensure that those kids get a decent
education. But without the testing, without the bright light of
truth being shone on what's happening in some of our buildings,
I don't think we'll ever get there. Because there's a certain
amount that we can do in terms of the Federal Government.
But when you put the bright light on what's happening in
these schools, it will energize communities, businesses,
parents to get out of their easy chairs, get away from their TV
and find out what in the world is happening in our schools.
That is just as important as the change in direction that we're
going to be proposing the next couple of months.
Mr. Sherwood. Expectations are the key.
Mr. Regula. Accountability.
Mr. Boehner. That's it. We'll have plenty of time to talk
about it as the year goes on.
Mr. Regula. I think we'll hear from you in the future.
Mr. Boehner. Thank you.
----------
Tuesday, March 27, 2001.
HEALTH RESEARCH PROGRAMS
WITNESS
HON. CHRIS SMITH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
JERSEY
Mr. Regula. Mr. Smith, Chris, health research programs.
Mr. Smith. Thank you very much.
Mr. Chairman and members of the Committee, thank you for
this opportunity to appear before the Committee. I would ask
that my full statement be made a part of the record, Mr.
Chairman.
Thank you. Let me just say on last Congress, I formed,
along with Congressman Ed Markey a caucus that now comprises
131 members and continues to grow in the area of Alzheimer's
research. As all of us know, and many of us have had family
members who have suffered the devastating impact of that
disease, as we all know, it's not terminal, but it devastates
not only the patient but also the family and especially the
primary caregiver, who often, it turns out to be, is the
spouse, raising serious questions about respite care.
But the bottom line is that right now, there are about 4
million people who have Alzheimer's and many more thousands,
tens of thousands, who are in the process of developing this
devastating disease. It's estimated by the year 2050, 14
million people, today's baby boomers, will have Alzheimer's
disease in those who are moving into that age category. So it's
a ballooning epidemic, that if we don't marry up the necessary
resources in research and trying to get to the cause and
hopefully to solve it, to reverse it in those who have it and
prevent it in those who do not have it, we're talking about a
major----
Mr. Regula. Chris, I'm curious. Is this prevalent in other
countries in somewhat the same degree that we have it?
Mr. Smith. It's a very good question. Increasingly, it's
recognized that Alzheimer's is a disease of aging. So where you
have an aging population, and many of our developing countries,
people simply don't make it into their 60s or 70s. It's
estimated that anyone who's 85 or older, one out of every two,
are in some part, one degree or another into Alzheimer's
disease. So it is a function, to some extent, of our aging.
Mr. Regula. It has parameters of degrees of severity, I
assume, from what you are saying.
Mr. Smith. Yes, there are. It's a progressive disease that
gets progressively worse as the dementia and the plaques and
everything else in the brain form.
Mr. Regula. Then in turn have impact on the physical well
being of the individual, is that correct?
Mr. Smith. That's correct. It may not lead to, like we see
with some diseases, a breakdown where the kidneys don't
function. It doesn't do that. But it leads to an overall
deterioration of the patient. They're not as viable. They
certainly are not interacting.
But primarily, if they exist and get worse and worse and
worse, they very often just sit in a chair and do very little.
They don't recognize family members. And the impact on the
family members, because I've known so many of them, sometimes
it's much harder for them, for a husband or wife to go spend
time with their family member and they don't even recognize
them.
So we're asking on behalf of our coalition, of our caucus,
for a $200 million increase to really declare war on this.
There have been a number of very promising studies that have
been done. They're all in one stage or another, and it seems to
me that this is something we can lick if we again have enough
resources.
The second, if I could, because I know we--it's not a vote.
The second is in the area of autism. I've been involved in the
autism issue since elected to Congress 21 years ago. On and
off, I always thought CDC-NIH were doing what they could do,
inquiries that I would make over the years, particularly in the
1980s, suggested that yes, we're doing what we can.
Three years ago, in one of my major cities, Brick Township,
we discovered that there may be a cluster of autistic children.
There seemed to be an elevated number, perhaps as much as
double what the national average was expected to be, which is
one out of every 500 children.
We asked CDC to come in, we asked other people from ATSDR
to come in and do a study. They did. They found out that indeed
there was a four per thousand, a doubling of instances of
autistic children in that area. From my contacts since and
during that process, I have been astonished as to what we don't
know about autism and how we have almost been frozen in time
over the last 20 years doing very little to mitigate this
disease.
We don't know what causes it, we don't even know what the
prevalence of this terrible disease is, the reporting that goes
on in State after State is passive. Most States don't have a
clue.
To remedy that, last year I introduced legislation that
became Title I in Mike Bilirakis' bill of the Centers of
Excellence to get at the prevalence issue, but also to begin
looking at what can we do, what triggers autism. We all know
families who have had autistic children who are into their
second and going into their third year, all of a sudden, bingo,
their child can't communicate. And this developmental disorder,
for whatever the trigger is, becomes very compulsive and again,
they start down a course of expenses and tragedy, even though
they love their children desperately, it is a heartbreak like
few heartbreaks one can experience.
We're asking for a very modest $5 million to try to, in
addition to what's already been allocated, to try to, it would
be for the Center for Birth Defects and Development
Disabilities at CDC. We've scoped it out, we think it's a good
idea. We ask you to take a look at it. More needs to be done
without a doubt. New Jersey has taken the lead. We don't know
why there seems to be an elevated number in New Jersey. If
there is one. There may be no cluster. There may be a problem
that is going on everywhere else, it's just been below the
radar screen.
And I would hope that you could take a look at this as
well.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. No questions, Mr. Chairman.
Mr. Regula. Well, I'm sure, Chris, both of these require
attention. I think NIH is working on them, and as you know,
there's been a commitment to double their budget over a five
year period. And I assume the groups contact them, because they
do allocate resources at NIH. We don't try to dictate just
where they should do their work.
Mr. Smith. I do understand that, and I think they have
realized maybe belatedly, because they have such a full plate,
just that this has been underfunded in the past and this is a
problem overseas as well. In Poland, for example, I've been
working with a group that's, they don't know how to deal with
it. Some of our people, Johnson and Johnson has been active in
this. There seems to be a gross under-reporting of these cases
as well over there. I'm sure as we get into the surveillance
and the prevalence issue, we're going to find that there's so
much more that we don't know. The numbers are higher, and I say
that as a tragedy.
Just one final point. We have formed a caucus, Mike Doyle
and I formed it this year, we have 101 members, and that's
growing as well, to deal with the issue of autism. I know
you'll be very sympathetic, and I look forward to working with
you.
Mr. Regula. Thank you for coming.
Mr. Smith. Thank you, Mr. Chairman, Mr. Sherwood.
Mr. Regula. We'll recess until 2:00 o'clock this afternoon.
[Recess.]
----------
Afternoon Session
Mr. Regula. Well, Wes, you are number one.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. WES WATKINS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
OKLAHOMA
Mr. Watkins. First, let me say congratulations, Mr.
Chairman to you, after many years of serving in the Interior.
Well, you are still in the Interior, but you are just not the
Chair over there. I appreciate the opportunity, and I
appreciate all your work over all the years on the various
committees, and especially Interior, and now as Chair of the
Subcommittee on Labor and HHS.
Mr. Chairman, you know, you have probably heard me over the
years talk about our needs in the rural and economically
depressed areas of the southeast Oklahoma quadrant. I have 21
counties in my district, and all of them are rural, and also
the Tulsa area, which is doing well economically, and the big
Oklahoma City metropolitan area. I have got a nick that goes in
between, and then all of the southeast part.
Mr. Regula. They do not have any oil, do they?
Mr. Watkins. They have very little on the far west side.
That touches very little of my overall district.
But one thing that has not touched us is the fact that we
have been left behind economically speaking, with all the
manufacturing. I do not have a Fortune 500 company in my
district. I have got some timber in one area that is
warehoused, but I do not have big, huge manufacturing.
I am a product of out-migration. When I was growing up, my
family had to leave three times to go to California and search
for jobs. That is what made the burning imprint on my life
about going into public life, in order to try to build the
economy and build jobs. As I have told people before, I am not
in politics as an end, but politics as a vehicle.
We are trying to change that. We have done some good, and
we have still got a long way to go. The per capita income in my
district is about 60 percent of the national average; not the
top, but it is about 60 percent of the out-migration.
Like I said, we have been doing some good. We have had to
do a lot of things on our economic infrastructure. One of the
things also that has happened to us is we have been passed by
the high technology, the information technology, in that rural
area of the state of Oklahoma. The big cities, again, are doing
well.
What I am trying to do, I am working with Career Tech.
Career Tech is the state vocational technical education system
all across the state of Oklahoma. I am working with them trying
to work through the hub and provide the high tech potential in
that area. We call it REVTECH.
Last year, the committee provided $921,000. I am asking
this year, Mr. Chairman, and I hope you will be able to help
us, for about $1.25 million to help work with the State
Department of Career Tech. That would allow us, in a lot of
those different areas, to be able to provide the necessary
wiring, the technology, et cetera, to be able to attract more
people.
For instance, I work with an industry that is up around
Tulsa, but not in my district. They said they could hire 500
more people if they could find trained people. Well, I have got
500 people, but they are scattered throughout my area, if I can
get them all together.
So that is the one request that we have up at the top of
the list. The other is the fact that for many years, I have
worked on international trade. The reason for my commitment and
dedication to international trade is the fact for every $1
billion of increase in trade, you actually produce about 20,000
jobs. So it makes a lot of sense.
Mr. Chairman, I know your background is in rural areas, and
some of it is in agriculture. I think, if I recall, you were
out on the farm there.
We are not going to save rural America just with
agriculture alone. I say that with two degrees in agriculture.
I love agriculture. But we have got to have off-farm jobs some
way to be able to survive or to be able to re-build our small
communities.
We are working also on the international trade aspect of it
at Oklahoma State University, our land grant university there.
This committee helped last year with $320,000. I am asking, if
you could, give us $750,000, or as close to that as you
possibly can.
The other thing that you worked with me on last year on the
committee was Fragile X, and I am just asking for language as
to the help on working with that. That is one of the things
that has come along, that has dealt with the retarded. They
have made some very scientific breakthroughs, and I have got
some language in there for that.
The other request, and I have had several others, but this
other one is the one new one. It is the Seminole Junior
College, or Seminole College. They have got dormitories, but
there is some renovation that needs to take place there, if
they are going to be able to continue to use them. I am trying
to figure out how we can get that done.
I have said to community there that I would do my best to
try to help them with some renovation some way, if we possibly
could. So that would be a big help to that community.
Mr. Regula. Is that BIA operated?
Mr. Watkins. No, it is not, but there are a large number of
Native Americans there. In fact, Mr. Chairman, and you probably
know this from your work with the Interior, Oklahoma has got
the highest percentage of Native Americans of any state in the
nation. In fact, close to 22 percent are in Oklahoma.
Mr. Regula. Okay, we will look at them.
Mr. Watkins. If you could help me, sir, I would appreciate
it very, very much. This is a committee that I felt like there
are some things there that maybe you could help us. I really
would appreciate it.
Mr. Regula. It will depend a lot on what we have available
to work with.
Mr. Watkins. Being on the Budget Committee, I am trying to
do my best to let you have as much as we possibly can.
Mr. Regula. We look forward to that, Wes.
Mr. Watkins. We will keep pushing for it.
Thank you, Mr. Chairman.
Mr. Regula. Thank you.
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Mr. Regula. Ms. Mink, I see you have various programs, too.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS
WITNESS
HON. PATSY T. MINK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
HAWAII
Mrs. Mink. I brought a very modest list. [Laughter.]
Thank you, Mr. Chairman. I do not know how long my voice is
going to last, so may I just ask unanimous consent that my
testimony be inserted in the record.
Mr. Regula. Yes, all the testimony will be included in the
record.
Mrs. Mink. I also brought with me a letter which 85 members
have signed with respect to the ovarian cancer research. I
believe you are familiar with my annual trek to this committee,
urging that more funds be committed to this research.
Mr. Regula. That would be through the NIH.
Mrs. Mink. Yes, that is correct. I remember when I started
this campaign for funding for research in this area, that the
NIH was only spending $7 million. Today, it is up around $70
million, but we need a lot more.
It is a very tragic situation where the situation of our
research has not come to a point where an early detection test
has been found. I believe they are close to it, but until we
can find a satisfactory detection for ovarian cancer, we are
going to continue to lose many, many thousands of young women.
A lot of the women who come down with this are in their mid-to-
late 30s. It is very, very tragic.
About 23,000 women are diagnosed each year. Most of them
are in their late stages, where they cannot be saved. So the
mortality every year is about 14,000, which is the highest in
the reproductive illnesses.
So I think it really takes a determined effort on the part
of this committee to recognize the enormous situation that
women are in today.
There are no symptoms for ovarian cancer, usually, that the
doctors can detect by physical examination or by pain or other
kinds of things. So unless we have a test, it is not going to
be possible to save these lives. So the research is really
very, very critical.
My bill that I have circulated in the House with about 115
co-sponsors asks for a $150 million commitment. I hope that
this committee will find the necessary funds to make that
possible.
The other institute which I feel needs to have real
attention is the National Eye Institute. We are not aware of
how many people in America suffer from eye diseases. We need to
spend more money on research, money to determine why these
illnesses occur, and what can be done to alleviate this
condition.
Some of it has to do with diabetes and other kinds of
related illnesses. But the NEI, which is a separate institute,
the National Eye Institute, is currently funded at $510
million. This year, I am hoping that you will be ableto go up
to $604 million for this institute.
Last year, we had put in a bill asking for the funding to
be doubled in at least five years, and we are marching steadily
ahead. So I hope that the progress that we have gained in the
last several years will not be stayed in any way, and that we
will continue.
The last item is one that relates to education funding. We
are really absolutely transfixed on the fact that our young
people are killing each other in our schools for almost no
understandable reason. A lot of them are from middle class
neighborhoods, coming from well stationed families, without any
clear evidences of problems in their homes.
The Speaker, Mr. Hastert, established a task force last
year on school violence. I was fortunate enough to serve on
that. Most of us had various approaches to it. But the one
thing that we agreed on was the necessity for having additional
staff put into our schools, particularly in the intermediate
years.
We do not want to call them counsellors, because they
already have categories for those people. We do not want to
call them social workers or whatever. So we came up with the
title, school-based resource staff.
The schools could then pick whatever kind of personnel they
felt suited for their particular school situation. But what we
want to do is to get a ratio of one of these resource staff
people per every 250 students.
That is still a high ratio, but we think that is a starting
point. In order to get there, Mr. Chairman, we have a target of
100,000 additional school-based personnel. I hope you will come
up with the funding necessary to support it.
Mr. Regula. Would you contemplate 100 percent of that being
Federally financed?
Mrs. Mink. Yes, 100 percent; it is like 100,000 teachers,
to phase them in. But the target is 250 to one ratio,
ultimately.
Some schools already have that. So they would not be
getting into this particular fund. But for those school
districts that do not have these extra personnel to take care
of handling the students, this is not the chore of the
curriculum-type person or the vice principal, who has to do
administrative work, or worry about discipline and those kinds
of things.
This is a school personnel individual that is there solely
and exclusively to deal with the students, so they can go to
someone with their problems; or if they hear something about
someone making some outrageous statements or threats, they can
go to this individual, without the fear of peer pressure and so
forth. They can go to this individual and tell us staff person
what they heard, and let the staff person decide to what level
that should be taken.
We think that this is a position that the Federal
Government can take very, very easily. Our task force that the
Speaker appointed unanimously agreed that this is a step that
must be taken.
So I thank you very much for your consideration.
Mr. Regula. Thank you for coming, Patsy.
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Mr. Regula. Next is Billy Tauzin from the great state of
Louisiana. Boy, you are just getting warmed up down there on
your celebrating, are you not?
Mr. Tauzin. Lent time is a time for rest.
Mr. Regula. So you are resting now, is that it? [Laughter.]
Mr. Tauzin. We are paying for our sins.
Mr. Regula. Well, you need more than 40 days.
Mr. Tauzin. Actually, 40 is a good start.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS
WITNESS
HON. BILLY TAUZIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
LOUISIANA
Mr. Tauzin. Mr. Chairman, thanks for having me. I bring to
you today a young friend of mine who has been before the
committee for three years now. His name is Keith Andrus. He is
a ninth grade student, and he happens to be the son of my
office manager, Rachel Andrus. She and her husband, Ron, are
here with me. He is also afflicted with Friedreich's Ataxia.
Now Friedreich's Ataxia and Usher Syndrome are very rare
disorders which occur in rural medically under-served Cajun
populations at a rate of 2.5 times the national average. It is
genetically, apparently, connected and, as a result, the Cajun
population in my state have severe incidents of this particular
disorder.
It is rare. It is degenerative. It severely diminishes the
physical abilities, and ends up confining patients to
wheelchairs by their late teens.
The quality of life is heavily comprised and, sadly,
because of heart problems, life expectancy is shortened to 37
years. Currently, Mr. Chairman, there is no treatment and no
cure. Keith stands as an example of courage, in the face of
that kind of a statement: no treatment, no cures.
By the way, there are many people across America who face
this disorder. There is a young family in Ohio, in Struthers,
Ohio. They are a very closely knit family with a mom and dad
and three kids. One of the twin boys has Friedreich's Ataxia.
That is in your own home state, just asan example.
But across America, families like them watch their children
grow up knowing that so far, there is no treatment and no cure.
We are trying to do something about that. I am pleased to
tell you that your subcommittee established at home in
Louisiana the Center for Acadiana Genetics and Hereditary
Health Care. It was established through a health care outreach
grant. It is administered through the Health Resources and
Services Administration.
For three years, you have helped fund this center. By the
way, it is heavily supported at home. Over 50 percent of its
support comes from state and voluntary contributions. We are
asking your support for the $1.5 million of Federal funding to
keep the center open.
Mr. Regula. It was $921,000 last year?
Mr. Tauzin. Right, and the center, Mr. Chairman, links the
School of Medicine, the Biomedical Center, the hospitals, the
rural clinics, and a strong telecommunications network to
provide urgently needed health services, information, and
education regarding these kinds of genetic diseases.
By the way, this is, of course, not the only disease that
is genetically connected. Through the work of the center, in
connection with other genetic research done around the country,
we are learning and discovering much more about Usher Syndrome
and diseases like diabetes, cancer, heart disease, Alzheimer's,
Parkinson's and other psychiatric disorders.
But here is this kid and his hope, literally, lies with
you. Will we find a cure; will we find a treatment in time?
Mr. Regula. Well, we have done a lot with genetics.
Mr. Tauzin. We are doing an awful lot.
The work that your committee has done is supported at NIH.
We, at Energy Commerce, have jurisdiction over at NIH. I want
to thank you from the bottom of my heart for the commitment
that you have made to NIH.
Mr. Regula. You did the authorizing in your committee.
Mr. Tauzin. So we are connected here, Mr. Chairman. We will
continue to be connected in this vital effort.
But the bottom line is that we can not stop this kind of an
effort. This kind of an effort may lead to a day when I can
bring Keith here and say, guess what, we have found a cure; we
have found a treatment in time for him and in time for others
like him, and families like him.
Mr. Regula. It seems to me that the potential lies in the
genetic research that they are doing today.
Mr. Tauzin. In fact, at one of the hearings, Mr. Chairman,
we heard that work being done in a completely different area
yielded some very exciting information that may, in fact, touch
upon Friedreich's Ataxia one day.
The neat thing about the work being done in all these
different areas is that with the human genome completed, we are
going to be able to tie some of that work together and discover
how one has application on the other.
My plea to you today is not for a large sum. I am not
asking for half a billion dollars or hundreds of millions of
dollars, just $1.5 million to keep literally hope alive for
this young man and others like him.
I lay it again at your feet and ask you humbly to take it
seriously, and to keep this thing alive for him.
Mr. Regula. Well, we have a lot of challenges on this
committee, as you can fully understand. A lot of what we can do
is dependent on funding. We are doing some wonderful things in
research, and we hope that this will be one of them.
Mr. Tauzin. Oh, I have no doubt that it is. Keith will tell
you that he has no doubt. With the advances we are finding, he
has no doubt that we are going to find it in time. His family
has no doubt. I just want to commend him for his personal
courage, and for his family's courage.
Mr. Regula. Does he go to school here in Washington?
Mr. Tauzin. He is here in school.
Go ahead and say hello, Keith. What school do you go to?
Mr. Andrus. Woodson High School
Mr. Regula. Is it in D.C.?
Mr. Andrus. In Virginia.
Mr. Regula. In Virginia; that is Fairfax County, probably.
Mr. Tauzin. Keith is already having great difficulty
walking. As a result, he can not carry hot liquids or liquids,
because of health reasons. Every year that Keith has come, the
committee has been able to see how the disease is wrecking his
frame and hurting his chances for a good healthy, long life.
Mr. Regula. Keith, we will make every effort to help the
NIH find a cure. Thanks for coming.
Mr. Tauzin. Thank you, Mr. Chairman.
Thank you all.
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Mr. Regula. Yes, Mr. Stupak, you are just in time.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. BART STUPAK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MICHIGAN
Mr. Stupak. Thank you, Mr. Chairman, Nancy; thanks for
giving me the call and saying, come on over in a hurry. I was
just down the hall, and I made it. [Laughter.]
We have a number of requests for the committee's
consideration, today, Mr. Chairman. First, let me start with
Operation Uplink. This involves technological assistance to the
Upper Peninsula of Michigan. What we are looking for is $2.5
million to fund an initiative to comprehensively design and
advance an information-based infrastructure in the Upper
Peninsula.
What we are really saying is this. Northern Michigan
University, Michigan Technological University, Bay de Noc
Community College, Marquette General Regional Hospital, our
regional libraries, economic development, and local government
would like to get linked up. In doing that, we want to look at
certain factors which are unique to the Upper Peninsula.
If we could get a well-designed telecommunications
infrastructure, we would have the opportunity to level the
playing field between rural areas, like my district, and the
urban areas.
Mr. Regula. Would this require fiberoptics, or what type of
link are you contemplating?
Mr. Stupak. With the technology clusters that we are
talking about, and this last mile of connections that theyare
talking about, it would be better than the fiberoptics. We have some
fiberoptics around Marquette and the rest of the Upper Peninsula. We
are talking about high speed Internet, broad band access, things like
this.
In my district, even with this great economy that had been
going for the last few years, the Upper Peninsula still had 5.8
percent unemployment. In Michigan Tech, where part of this is,
it is around 10 to 12 unemployment.
What we are saying is, in order to compete and to really
get our future going, we really would like to have this UP
uplink program going.
If you take a look at it, Mr. Chairman, it is not much
different than what we did. I have introduced legislation in
the past to bring electricity, to bring telephones, to bring
those services to rural America.
This is one region of the country that is geographically
unique. We have always had a problem with high unemployment, at
5.8 percent, while the rest of Michigan was 3.6 percent. I said
some parts, in the winter months, like on the eastern end of
the Upper Peninsula, unemployment is 30 percent.
Now when the ice leaves the lakes, as you know, come
summertime, they would have virtually no unemployment; but for
four or five months out of the year, we are at 30 percent
unemployment. What do you do on those cold winter nights? If we
had the technology, I think there are a lot of things that we
could do and can do.
That is where we would like to go with that opportunity. It
is $2.5 million. I would hope that you would take a look at
that request.
The next one is for our gerontological studies, basically
for senior citizens. Again, this is at Northern Michigan
University, the Upper Peninsula. Our population is about 12
percent senior citizens. On the western end, again, we just did
a study in Kohebic, in Ougan Counties, and it is 25 to 30
percent of older population that is 65 and older.
While we would like to use the center for research,
education, community service in rural Michigan, that is related
to older individuals and the aging process. It would be the
knowledge of the aging process and the aging network, and its
service provisions apply information as a mechanism to enhance
the lives of people who reside in rural communities like
Michigan's upper peninsula.
This would be worked out in Northern Michigan. Again, these
two programs almost go hand in hand.
Thirdly, Mr. Chairman, Northwestern Michigan College, you
helped them out last year. This is in Traverse City. Again,
they want to operate a life-long learning center on the West
Bay Campus.
The senior citizen center is there. It is a waterfront
area. The lifelong learning center would be the hub for
participatory learning for faculty, staff, and students at
Northwestern Michigan Community College in Grand Traverse
County.
As you know, Mr. Chairman, this is probably one of the
fastest growing areas of Michigan. Retirees leave the auto
plants in southern Michigan and they come up to my district to
retire.
Traverse City and Northwestern Michigan have been a leader
in trying to provide senior programs. Again, this would go with
Northwestern Michigan College in Traverse City.
Last, but not least, the Olympic Scholarship is a program
that we have been here a couple of times, advocating for in the
last two years. You have funded it, which has helped out many
athletes. Athletes train at our four Olympic Centers in
Marquette, Michigan; Lake Placid, New York; Colorado Spring,
Colorado; and outside San Diego, California.
These athletes, most of them are young people. They are in
sports such as speed skating, boxing, Greco-Roman wrestling,
many of the Nordic sports.
There are no scholarships for them. But they are willing to
train. They take money out of their own pockets. They go all
over the nation, doing training, competing. They go to Europe,
where they get some help.
At the same time, many of these people would also like a
degree. Even if you won the gold medal in Greco-Roman
wrestling, I do not know how you could make that into some kind
of an economic benefit for the rest of your life, or speed
skating.
Even though we may win the gold medal, like some of the
athletes that came out of Marquette, a couple of Olympics ago,
and we may win the speed skating, there is no career in that.
There is nothing.
So where they are putting in all the hours, we think we
should have an Olympic education training center, as Northern
Michigan and these others are, and let them go to school, give
them a scholarship, let them train.
The boxers start at 5:00 in the morning. I have been up
there talking to them many times. Many of them come from inner
cities. Many of them come from poor backgrounds. They are
there, and if it was not for the Olympic scholarships, not only
could they not probably participate and train and work for the
Olympics, but at the same time, they are getting a quality
education.
So the Olympic scholarships have been a great advantage to
the four sites throughout this country. I hope you would fund
it again.
That is a quick overview. Like I said, I literally ran down
here, and I think I ran through my report, too. But it is all
here, and it is 15 pages. I am not going to read it. But if you
have any questions on any of these three programs, that I have
outlined, I would be happy to answer any questions.
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Mr. Regula. Okay, thank you; are there any questions?
[No response.]
Mr. Regula. Thank you.
The Olympic Center is named after your son, I believe.
Mr. Stupak. Yes, that is true, and I thank the committee
for that courtesy that they have shown us. Thank you.
Mr. Regula. Thank you.
Next is Representative Danny Davis.
----------
Tuesday, March 27, 2001.
CONSOLIDATED HEALTH CENTERS
WITNESS
HON. DANNY DAVIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Davis. Thank you very much, Mr. Chairman and members of
the subcommittee. I am pleased to provide the subcommittee with
testimony in support of the urgent need to increase funding by
$250 million for the Consolidated Health Centers Program; that
is community, migrant, homeless, and public housing health
centers, to at least $1.419 billion for fiscal year 2002. I
realize that this committee has been very supportive of the
community health center program in the past. In fact, members
on both sides of the aisle of this committee have united to
advance this program. It is a true testament of the integral
role health centers play in the delivery of health care for
this nation.
I appreciate the committee's support last year of our
request for a $150 million increase. Unfortunately, the $150
million increase has only enabled health centers to serve 10
percent of the Nation's 43 million uninsured people. With the
uninsured population continuing to grow at a rate of over
100,000 individuals per month, it is estimated that the
uninsured population will reach over 53 million by 2007.
There is no question that much more needs to be done to
expand health center services to reach more uninsured people,
and to continue to provide quality care to existing health
center patients.
I applause President Bush's recent call to double the
number of patients served by community health centers, enabling
millions more to have access to the most basic health care.
In fact, the President's budget has recommended a modest
increase of $124 million for the health center program. I
believe that is a good start, but because of the demand for
health care and the rise in the number of uninsured, I believe
we will need to raise that number to $250 million.
With an additional $250 million, health centers will be
able to serve and expand facilities in rural and urban
communities, and see an additional 700 patients.
Our nation is still divided when it comes to health care;
that is, those who have and those who have not. I have had the
good fortune to work directly with and in community health
centers, prior to running for public office.
It has been my testament and my goodwill to see that there
is no other group of centers or programs in the nation that has
been able to provide the kind of access to health care that
these centers have given.
So, Mr. Chairman, I would urge that we seriously look at
increasing by $250 million, so that all of the uninsured people
in this country, who would then benefit, would come out of the
uninsured, to the serviced area.
I thank you, Mr. Chairman. It has been a pleasure to be
here.
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Mr. Regula. They use a lot of volunteers, am I correct, in
the community health centers?
Mr. Davis. Well, they used to. Volunteerism in this country
is not quite what it used to be. They use volunteers. But these
centers basically started out of the old OEO programs. They
were put in urban and rural communities where nothing hardly
was there.
Many of them have become the centerpieces for economic
development in those communities, as well, and they are the
biggest thing there. They provide not only health care, but
they have provided employment opportunities, business and
economic development opportunities, and they are pretty much
considered to be community-owned. People feel really good about
them.
Mr. Regula. I am sure that is true. We have one in our
area.
Are there any questions?
[No response.]
Mr. Davis. Thank you very much, Mr. Chairman and members of
the committee.
Mr. Regula. Thank you.
Next is my colleague from Ohio, Mr. Kucinich.
----------
Tuesday, March 27, 2001.
UNITED STATES HOUSE OF REPRESENTATIVES
WITNESS
HON. DENNIS KUCINICH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
OHIO
Mr. Kucinich. Good afternoon, Mr. Chairman.
Mr. Regula. Dennis, we are happy to welcome you.
Mr. Kucinich. It is my pleasure to be in front of your
subcommittee. I appreciate it very much. Good afternoon to my
colleagues; I appreciate the chance to be in front in your
committee. With the permission of the Chair, I will begin
whenever it is appropriate.
Mr. Regula. Go ahead.
Mr. Kucinich. Thank you very much for the opportunity to
appear before the committee. I am urging the committee to
prevent the use of Federal funds for prolonging the public
comment period of the final Medical Privacy Standards.
Last month, a new 30-day comment period was opened on the
standards mandated by the Health Insurance Portability and
Accountability Act, and several industries are lobbying to
extend the period even further.
These regulations are long overdue. When Congress passed
HIPAA in 1996 with strong bipartisan support, it required HHS
to promulgate rules by August 23rd, 1999, if Congress did not
legislate. During HHS' work on the regulations, Congress and
other interested parties articulated their views.
In September, 1997, the Secretary of HHS submitted a health
privacy report to Congress and testified before the Senate
Committee on Labor and Human Resources. Several bills were
introduced.
The proposed rule was published in November, 1999. Industry
and consumer groups asked for the comment period to be
extended, and HHS pushed the deadline back by 45 days.
The rule generated extraordinary feedback; 52,000 comments.
Clearly, the health care and insurance industries have had
ample opportunity to make their voices heard, and have done so.
Now the industry groups seeks to weaken the medical privacy
law by delaying the rule's implementation. The rule already
allows health plans two years to comply, and gives small plans
an additional year beyond that deadline. These groups do not
have a leg to stand on in lobbying for continued delay.
They have had plenty of input into the regulations, have
known for five years that the regulation was forthcoming, and
now have another two to three years to meet the deadline.
By not implementing the rule, not only are the medical
privacy of patients put at risk, but so is the privacy of their
Social Security numbers, the privacy of their financial
information, their ability to maintain health coverage, and
even keep a job. That is really the core of this.
Here are some examples of abuses that have occurred because
of the lack of medical privacy laws. Last December, Terry
Sergeant, a North Carolina resident, was fired from her job,
after being diagnosed with an expensive genetic disorder.
Three weeks before being fired, she was given a positive
review at work and a raise. She suspects her self-insured
employer found out about her condition and fired her to avoid
the medical expense.
A truck driver in Atlanta was fired from his job after his
employer learned that he had previously sought treatment for a
drinking problem.
A California woman requested that her pharmacy not disclose
her prescription information to her husband, from whom she had
separated. When he contacted the pharmacy, he received a copy
of all of her prescription records, and then gave them to the
rest of the family, her friends, the Department of Motor
Vehicles and others, claiming she was a drug addict and a
danger to her children.
A banker who served on his county's health board cross-
referenced his customer accounts with patient information, and
then called the mortgages of anyone with cancer.
The University of Michigan Medical Center inadvertently put
several thousand patient records on public Internet sites for
two months in 1999. Only when a student searching for
information about a doctor found links to private patient
records with numbers, job status, medical treatments and other
information was the problem discovered. It goes on and on and
on, Mr. Chairman. I will submit, with the Chair's permission,
all of this testimony.
But what it comes down to is that the implementation of the
Medical Privacy Rules on April 14th ought to be strongly
considered. Americans long ago asked Congress to respond to the
threat of vulnerable privacy records, and many have already
suffered from abuse of private information made public.
This committee can ensure that these protections go into
effect if you prohibit the use of funds in this bill to delay
the implementation of the medical privacy regulations any
longer.
I am here presenting this in my capacity as the Chair of
the Progressive Caucus. I thank the Chair for his indulgence
and I thank the members. Thank you.
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Mr. Regula. Are there any questions?
[No response.]
Mr. Regula. Thank you.
Mr. Kucinich. Thank you and good afternoon.
Mr. Regula. Do we have any other members here? Don Young is
the next one on the list.
Mr. Kucinich. Mr. Chairman, in concluding, I am just going
to submit all of this record, if the Chair would accept it.
Mr. Regula. Oh, yes, all statements are part of the record.
Ms. Pelosi. Would the Chair yield?
Mr. Regula. Yes, certainly.
Ms. Pelosi. Mr. Chairman, I do not know whether you saw it
last night, but on TV on PBS, they had a special presentation.
What it consisted of, largely, is something of interest to the
committee. It was about environmental health.
What it was, it was the release of documents from the
chemical industry, as to what they knew and when they knew it,
about danger to workers in the work place, and communities
surrounding these factories.
Last year, as I have mentioned a couple of times in our
hearings, under Chairman Porter's leadership, we had a hearing
on environmental health. Scientists came and talked about the
need for bio-monitoring to monitor what people are breathing
and drinking in the water, from chemicals in the environment.
It was a very important hearing. In fact, I have been on
the committee, and others who have been on it longer, do not
recall us ever having a hearing on a single subject. Usually,
we have hearings of this kind.
So that hearing, plus the funding and the generosity of
this committee to fund the CDC over the last four years to
increase the funding of the environmental health project, have
taken us a long way down the road to having an understanding of
the connection between health or disease and chemicals in the
atmosphere or in the water.
I would commend Moyer's show to the Chairman's attention,
and to all of our colleague's attention. Certainly, we want to
have a balanced approach as to how we go forward. We do not
want to do anything that is not science-based. But certainly,
on behalf of our children's health, we really do not know what
risk we are putting children at.
Of course, because they are younger and developing, they
are impacted more directly and more negatively than older
people.
Mr. Regula. Well, it seems to me, we have had an EPA for
many years, and we have all these agencies. Would they not have
a vast body of knowledge about these types of hazards?
Ms. Pelosi. You would think so. In the testing that is
done, you know, they will test the air, they will test the
water, and they will test this or that. But this is the work
that we are doing now to see what to monitor in human beings.
Because of the generosity of this committee over the past
few years, the CDC is in a much better position to do some of
the monitoring, which I think you have heard in one of the
points that Mr. Stokes made, when he was here, on the
environmental health issue that he is working and that
monitoring.
Then we see that children have higher incidences of asthma,
because of the atmosphere in which they live and that the
connection between the environment and health is a direct one.
The committee has taken the lead on this. I think it would be
interesting to see some more evidence on that.
Mr. Regula. What conclusions did Moyer reach, or what
recommendations, if any?
Ms. Pelosi. Well, the whole point was that we have to have
data. We have to have a ground truth on the basis of which we
go forward. Even the chemical industry admitted in their own
statements that we really do not know what some of the risks
are to these. Even though they have set out to make some tests,
they have not done them, yet.
Again, this is information that would be useful to the
committee. The committee has to have a scientific basis and
data on which to make judgments. This is another piece of
information that I think would be useful to the committee, as
it balances its decisions.
Mr. Regula. Where did you see this?
Ms. Pelosi. It was on PBS, and it was called ``Trade
Secrets.'' Basically, what it was, a lot of the chemical
industries, over the past 40 years, have known the danger that
their chemicals have posed to the public, but have kept that
information from the public.
Indeed, in their own documentation, they show how, when
they were going to go to NOISH, which is the science part. OSHA
is the work place safety and NOISH is the scientific research
part of it.
They said, well we cannot deny if they ask us, but we will
not volunteer the information, even though NOISH had put out a
call for all information regarding some of these chemicals in
the atmosphere. So it is interesting.
Mr. Peterson [assuming chair]. I think the situation with
liability that we have, I know ladder companies, and this is on
the whole safety side, were hesitant to improve the ladder,
because they admit then that the ladder was not as strong and
safe as it could have been with the new improvements, and they
were instantly liable, if anybody got hurt on the old ladder,
so they never put the new structure out or changed it.
I have a feeling that companies, as they improve their
processes, realize that they have come up with a new process
that is better than how they were doing it, but instantly are
liable to the trial lawyers for cases, because they have now
improved the process. They have found out how to reduce it. I
mean, I really think this thing cuts both ways.
Ms. Pelosi. I say we have to balance that. You bring up an
interesting point. When I say this was a trade secret, all of
this was largely a presentation of their own documents, of the
documents of the chemical industry that are now public.
One of the things that does not relate to workman's comp or
anything like that is, for example, hair spray, and what is
involved in aerosol hair spray. If you have it in the work
place, you have some protection in liability, because of
workman's comp and this or that.
But once that is proven to be a danger to the general
public, then it is a different dynamic, if you were to be sued
or something like that. So they have, in this case, even more
reason to keep the information secret, not because of what it
meant in terms of work place, but what it meant in terms of the
general public.
I see that one of our colleagues has arrived. Again, this
would be a good committee, because we have the CDC. We have the
NIH. We have the science at NOISH. We have the scientific
institutions, as part of our dynamics.
We do not want to proceed on a notion or emotion. We want
to proceed on the basis of science. This is a very valuable
contribution, in terms of avoiding the science.
We have a different responsibility, I think. But we do have
responsibility for balance, and I look forward to working with
you on that.
Thank you, Mr. Chairman.
Mr. Regula [resuming chair]. Thank you, Nancy.
We have a health care task force group. The first speaker
in that group will be our friend from Ohio, again, Mr.
Kucinich, and I believe Ms. Christenson is here, also.
Ms. Pelosi. Mr. Chairman, I am sorry, I did realize Mr.
Kucinich was coming forward again, or I would not have
continued.
Mr. Regula. No, that is all right. I think it is a real
problem.
Ms. Pelosi. For everything that I have said, it is more so
in minority communities and disadvantaged communities, because
that is where a lot of these chemicals are.
Thank you, Mr. Chairman.
Mr. Regula. Thank you.
Representative Kucinich.
----------
Tuesday, March 27, 2001.
HEALTH CARE INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
WITNESS
HON. DENNIS KUCINICH, CHAIR, CONGRESSIONAL PROGRESSIVE CAUCUS HEALTH
CARE TASK FORCE
Mr. Kucinich. Mr. Chairman, it is a pleasure to be a part
of your committee once again. I thank you very much for the
chance to appear, and to Ms. Pelosi. I saw that two hour
program. We will have a chance to chat about it soon; thank
you. I am here on behalf of the Congressional Progressive
Caucus, of which I am the Chair, and to address some issues
that I know this committee is very concerned about.
America is home to the most advanced medical research
facilities and scientists in the world. In part, that is
because this committee has provided funding and guidance to
achieve it.
I am pleased that so many of my colleagues have supported
doubling the budget at the National Institute of Health. I
think we all appreciate the priority of finding therapies and
cures for diseases and other ailments to improve public health;
but America is home to irony, as well.
For example, the United States ranks 25th among other
nations in infant mortality rates, which is twice the rate of
Singapore, which has the lowest rate. These statistics reflect
the gross failure of our health system to provide access to
adequate prenatal care.
Every day, 410 babies are born to mothers who receive late
or no prenatal care, according to the National Center for
Health Statistics. African American infants are more than twice
as likely as white infants to die before their first birthday.
Among others, the United States ranks 20th in maternal
mortality levels. According to the World Health Organization,
half of these could be prevented through early diagnosis and
appropriate medical care of pregnancy complications.
For a country with advanced medical technology, it is
unfortunate that mothers and infants do not have access to
basic preventive health care. This example illustrates the
broader point that this committee must also fund programs to
get cures that we pay for to the people who need them, prevent
disease, and ensure a minimum level of health care to every
American.
The AIDS crisis in our country requires a comprehensive
strategy, meaning prevention therapy and research for a cure.
Up to 900,000 Americans are now infected with HIV, and half of
this population is under the age of 25.
This committee, I hope, will be able to fund the following
programs at the Centers for Disease Control to prevent
infection and provide care for those who are infected:
prevention activities that depend on CDC funds given to local
health departments; HIV Prevention Community Planning Groups,
and the Substance Abuse Prevention and Treatment Block Grant.
The minority HIV/AIDS Initiative works on both prevention
and providing care resources in communities of color, where the
major of new AIDS cases occur.
In order to provide care for those infected with HIV, the
Ryan White CARE Act and the Housing Opportunities for People
with AIDS Program support a range of services. This coordinated
group of programs is crucial to dealing with the HIV virus, and
all should be fully funded.
The Progressive Caucus is also asking that the committee
raise its funding level of support to programs under the Health
Resources and Services Division that are critical to maintain a
skilled health work force.
They have a number of other recommendations here, which I
would ask the Chair and the committee to please give their
thoughtful consideration to. As any of the health programs we
are talking about, the solution needs to be comprehensive.
Besides research and development of therapies, we must
train doctors and nurses in new therapies, for us to have
medical professionals serve in shortage areas of the country.
This strategy must also include educating people about how
to take care of their own health, and exercise preventive
strategies. Prevention is the best medicine.
Mr. Chairman, the committee has been a leader in providing
for health advances in our country. I ask it to continue to be
a leader by funding initiatives to make health advances
accessible to all Americans.
I thank the Chair, and thanks to all the members for your
time.
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Mr. Regula. Thank you.
Representative Christensen.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL BLACK CAUCUS HEALTH CARE TASK FORCE
WITNESS
HON. DONNA M. CHRISTIAN-CHRISTENSEN, A DELEGATE FROM THE U.S. VIRGIN
ISLANDS, CHAIR, CONGRESSIONAL BLACK HEALTH CARE TASK FORCE
Ms. Christensen. Thank you. Good afternoon, Mr. Chairman
and members of the subcommittee. It is a pleasure to be here.
Mr. Chairman, I want to begin by congratulating you on your
assumption of the Chair of this new subcommittee. As Chair of
the Interior Subcommittees for several years, my constituents
have been the beneficiary of your leadership.
Of course, the territories are a part of the health dilemma
that we are going to discuss this afternoon. It is one which is
defined by grave disparities in health care status.
The subcommittee has my full testimony. I am going to
summarize and also clarify a few points in it, if I might.
First, the funding, including my request in the CBC and HIV
and AIDS minority initiative, is not intended just for African
Americans, but for all communities of color. It also extends to
people living in our rural areas.
Second, the request is additional to and not intended to
supplant or take away from any other Department of Health and
Human Services funding. Indeed, we are requesting that the
department's budget be fully funded, at least at the 2001
level.
Third, the request, which includes our HIV and AIDS
initiative, is for $1 billion for fiscal year 2002, and
hopefully for subsequent years through 2006.
Fourth, while they do not come under the jurisdiction of
this subcommittee, we have included in our overall agenda,
universal coverage in the full lifting in the cap on Medicaid
for the territories. We hope for your support, as well as the
support of other subcommittee members on this initiative.
My testimony here today, however, is on the state of
African American health in this country, and what I think it
will take to adequately address it.
In any discussion on the health of people of African
descent in the United States, it is important that it be framed
in the context of what is called the Slave Health Deficit; 400
years of health care, deferred or denied, a deficit that has
never been made up.
Even at the dawn of this new century and millennium,
African Americans have the lowest life expectancy of any other
population group in this country, and the gap has widened,
actually, since 1985.
Today, hundreds of African Americans will die from
preventable diseases. This number is increased over the last 20
years. Deaths from heart disease are 38 percent higher in black
males and 68 percent higher in black females.
In recent years, our death rate due to stroke was about 75
percent higher than in our white counterparts. The prevalence
of diabetes in African Americans is almost 70 percent higher
than in whites; and with less access to care, African Americans
suffer more amputations, blindness and kidney failure.
The infant mortality gap has widened since 1985, and ours
is twice that of our white counterparts. Over 50 percent of all
new HIV infections annually are in African Americans, and we
make up 45 percent of all AIDS cases, and we are only about 13
percent of the total population.
An African American male is almost eight times as likely to
have AIDS as his white counterpart, and for women, that is
about twenty times more likely.
Mr. Chairman, our health agenda in the request to the
subcommittee makes an attempt to address the causes of
disparities. The facts that I have just recited just barely
scratch the surface.
Twenty-three percent of African Americans are uninsured.
Many have Medicaid; but recent studies have called into
question the quality of care, and in particular, for HIV/AIDS,
that Medicaid recipients have received.
Much current research has demonstrated that even with
insurance, and when other factors are equal, African Americans
and particularly women experience clear discrimination in their
receipt of health care services.
On the other hands, when language, ethnicity, and culture
are the same or similar, research shows better rapport and,
therefore, better compliance and outcomes.
Mental health services are severely lacking for American
Americans at all ages. Put simply, according to our Surgeon
General, Dr. David Satcher, the U.S. mental health system is
not well equipped to meet the needs of racial and ethnic
minority populations.
All of these and other factors conspire to create the
disparities that exist for African Americans, as well as other
people of color. They form the basis for our request.
As discussed briefly in the full testimony, they are:
allotting full funding for the new Center for Minority and
Disparity Health Research at NIH, as well as having the other
offices of minority health in the agencies funded.
The $1 billion request would provide the following:
increase health providers of color; provide adequate staff for
our medically under-served areas; enhance the ability of our
providers to practice their art and to provide for ethnics and
diversity training in our health profession schools, and
collect important health data.
These are provisions of the Minority and Disparity
Education Act of 2000. It would increase and provide culturally
and linguistically sensitive mental health services in
communities of color; adequately fund the community health
centers, which are the nexus of health care for our
communities; provide adequate health services for inmates in
correctional facilities; provide adequate outreach and funding
for immunization programs; continue and expandthe CDC minority
AIDS initiative.
Mr. Chairman, in 1998, the Congressional Black Caucus,
joined by community organizations and health advocates from
around the country, called on Secretary Donna Shalala to
declare a state of emergency for HIV and AIDS in the African
American community and other communities of color.
What we achieved was a declaration of a severe and ongoing
crisis; and to have, first $156 million in 1999; $249 million
in 2000; and this year, $350 million targeted to communities of
color.
This initiative, which needs to be expanded, has been
effective, and it has been affected across all communities of
color. However, we made one mistake; we should have called for
a state of emergency in the overall health of African Americans
and other people of color.
It is this emergency, that for the health of African
Americans and for people of color, across all of the diseases,
which is the emergency that truly exists.
With the full funding of the request before you today,
which this country today has the resources to do, we can begin
to respond appropriately to the crisis that exists in health
care for our communities today. Under your leadership, this
country can make the moral and political commitment to
guarantee access to medical care as a fundamental right to all
of its people.
I thank you, Mr. Chairman and subcommittee members, for the
opportunity to testify. I will be happy to answer any
questions.
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Ms. Pelosi. I just have a brief question.
Mr. Regula. Yes, go ahead.
Ms. Pelosi. I was so impressed by the very important
testimony that our colleague has presented. It stands on its
own, and her credentials are well known to us.
But I would like her to put on the record her credentials
as a health professional, and all that she brings to this
testimony today, Mr. Chairman. We are so proud of her.
Ms. Christensen. I should have said that I chair the Health
Braintrust of the Congressional Black Caucus. I am a family
physician, and have been in practice for 21 years in the Virgin
Islands, also. I was a public health official in the Virgin
Islands for many of those years.
Mr. Regula. Well, that is a vanishing group, the family
physicians.
Ms. Christensen. Yes, and that is the pearl of American
health.
Mr. Regula. I agree with you. I felt strongly that we
should encourage more family physicians. You cannot just take
one area of a human being, and not be sensitive to the whole
person.
Ms. Christensen. I suspect that it will come back.
Mr. Regula. Probably economics are driving it, as much as
anything. With the high costs that students have, they feel
like the specialties pay better.
Ms. Christensen. Well, they do. That is another area that
has to be addressed, in terms of the reimbursement. I know that
HCFA is going to be under much scrutiny this year. Hopefully,
some of those issues will be addressed.
Mr. Regula. Well, it is great what you did. Were you in a
smaller community?
Ms. Christensen. I practiced in the Virgin Islands. I was
always able to make house calls, for most of practice. The
island that I practice on has between 50,000 and 60,000 people.
Mr. Regula. There are others besides you there, I hope?
Ms. Christensen. Yes. [Laughter.]
Mr. Regula. That would keep you busy.
Well, thank you for bringing this to our attention.
Ms. Christensen. You are welcome. Thank you, again, for the
opportunity to testify.
Mr. Regula. Next, we have our friend from Alaska.
----------
Tuesday, March 27, 2001.
CLOSE UP FOUNDATION
WITNESS
HON. DON YOUNG, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ALASKA
Mr. Young. I have a very short statement that I will read
in its entirety, primarily because the staffer wrote it, and
this is the first time she ever wrote anything for me.
Mr. Regula. I thought you were going to say that it was the
first time you ever asked for any.
Mr. Young. No, not really. [Laughter.]
I will say, Mr. Chairman and members of the committee, I
would suggest, as we have new members on this committee that
have not been involved in the Close Up Program, and that is
what I am here today to talk about.
The Ellender Fellowship Program is a critical component in
Close Up's educational program to educate our Nation's young
people about how our Federal system of Government works, and
their rights and responsibilities as citizens.
Congress created the Allen J. Ellender Program in 1972, out
of a belief that our Nation was at a critical juncture in
ensuring that the next generation of Americans would share in
the values and beliefs of the preceding generations, who forged
our democratic form of government.
By the way, Mr. Chairman and members of the committee, 1972
was the first year that I ran for this job.
I believe that we must ensure the present generation of
young Americans is committed to the ideals of active
citizenship, service to the community, and loyalty to country,
that are the foundation of our democratic system of government.
We must be dedicated to educating young people about civic
virtue and teaching them about their place in our democracy.
Our national heritage includes an unwavering belief in the
importance of each and every citizen to the success and health
of our democracy. The Close Up Foundation has embraced this
belief and made it an integral part of its mission to educate
young people.
Close Up is dedicated to the principle that the poorest
among our Nation's young people should have an opportunity to
come to Washington to gain first-hand experience in how our
Government works.
The Close Up Foundation utilizes the Ellender Fellowship
Program to reach out to student populations that are among the
most economically needy and under-served. The Ellender
Fellowship recipients include students from our Native
American, immigrant, rural and inner city communities.
As the State of Alaska's sole representative in the House,
I have had the privilege to meet with numerous students from
Alaska, visiting Washington as part of the Close Up's civic
education program.
Mr. Chairman and members of the committee, we have had
11,000, since the beginning of this program, from Alaska, that
have come to participate in this good program.
For students in rural Alaska, Washington, D.C. is far
removed from their everyday lives, and is a place that operates
in a way that they may not fully understand. Many of these
students do not have access to C-Span, so they have never seen
Congress in action.
Close Up recognizes that their geographic isolation does
not mean they play less of a role in the future of our country.
I believe that we should be highly supportive of programs
that successfully aid young people in becoming well-rounded,
informed, and active citizens.
The Allen J. Ellender Fellowship Program provides teachers
and economically disadvantaged students with a unique
opportunity to travel to Washington, and learn first-hand about
Government.
A health democracy depends upon the participation of its
citizens. This critical education program deserves our full
attention and our full support.
In closing, I would ask the subcommittee to recognize the
critically needed work of the Close Up Foundation through
continued and increased funding of the Allen J. Ellender
Fellowship Program.
I want to thank you, Mr. Chairman and members of the
subcommittee. As I said, this is a short statement. I wouldbe
willing to answer any questions. Again, I want to stress, there are
11,000 Alaskan students who have participated in this program.
Thank you, Mr. Chairman.
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Mr. Regula. Are there any questions?
The Ellender Fellowship or Foundation provides money for
students to participate, who otherwise would not be able to?
Mr. Young. That is the primary purpose of this program, to
have those people in from the rural areas and impoverished
area; and believe me, we still have them in Alaska, to come to
Washington, D.C.
We do have other schools that do participate in this in
here, from a more influential group of people. However, we are
a long ways away, and it has been very good for the State of
Alaska.
Mr. Regula. Is Ellender just confined to Alaska?
Mr. Young. No, it is nationwide; it is huge. Alaska has
participated in it. I have helped raise money in the private
sector for this program.
Mr. Regula. Well, you have had 11,000 over what period of
time?
Mr. Young. Since 1972.
Mr. Regula. Given your population base, that is still a
lot.
Mr. Young. Yes, that is a lot of them; and if we had the
same population, same ratio, it would be over 250,000 in
California. We really do participate in this program.
Mr. Regula. Yes, they do.
Well, thank you for coming today.
Mr. Young. I am pleased to see that my two new members did
not ask me any questions. I was not sure that I could answer
them.
But thank you, Mr. Chairman, and congratulations to you.
Mr. Porter sat in that chair for many years, and I know you
will do a wonderful job.
Mr. Regula. He did a great job when he was here.
Mr. Young. And you will do equally as well.
Thank you very much.
Next is Mr. Fattah from Pennsylvania.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL BLACK CAUCUS EDUCATIONAL BRAIN TRUST
WITNESSES
HON. CHAKA FATTAH, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH
OF PENNSYLVANIA, ON BEHALF OF REP. MAJOR OWEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK, CHAIR, CONGRESSIONAL BLACK
CAUCUS EDUCATIONAL BRAIN TRUST
HON. RUBEN E. HINOJOSA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS, CONGRESSIONAL HISPANIC CAUCUS
Mr. Fattah. Thank you, Mr. Chairman. If you do not mind, I
have asked my good friend, Congressman Hinojosa, to join me,
because we share a similar interest, and we could expedite the
committee's work.
Mr. Regula. That is fine.
Mr. Fattah. Let me thank you for allowing me to pitch hit
for Congressman Major Owens, who was scheduled to provide this
testimony, and is unable to do so. I am going to let my written
testimony stand for the record.
I would like to thank the Chairman, because of his
tremendous interest in a variety of matters, relative to
education. I am not going to belabor any of the points that
need to be made.
I would also like to welcome my two colleagues from
Pennsylvania, Congressman Peterson and Sherwood, who have
served with me before in the State Senate, and worked on
education-related matters. We have a lot of mutual interests.
Let me say on behalf of the Congressional Black Caucus, the
Caucus has laid out a number of positions, which are
articulated in the written testimony about the need for this
committee's continued support.
This committee really has been in the vanguard of pushing
for a set of programs and initiatives that have helped hundreds
of thousands of young people live up to their potential, pursue
an adequate education, and to go on to higher education.
There is an emphasis, obviously, on the Pell Grant and the
Trio Programs and, most particularly, the Gear Up Program,
which is close to my heart.
I want to thank the committee for its support over the last
three cycles for its support for Gear Up, which I authored and
moved through the House, with a lot of help from a lot of
different people. It is now helping over one million young
people in our country.
Mr. Regula. You introduced me to it, when we were down at
St. Petersburg.
Mr. Fattah. That is right, and it is a tremendous program.
It is doing very, very well.
But I know that this subcommittee will have an allocation,
and you have some very difficult decisions to make. I respect
whatever deliberations and outcomes there will be from the
result of that. There are a lot of choices from Head Start on
through in the education pipeline, to help move young people
and their families.
However, in terms of the Congressional Black Caucus and the
Hispanic Caucus, we represent constituencies that these
programs impact most acutely, and they are very important, too.
So we just want to urge you to do all that you can do.
I would also say that I am very concerned, and I will
betestifying before the House Education Committee tomorrow, about the
whole question of how to encourage states to do more themselves to give
disadvantaged and poor communities, both in urban and rural areas, an
equal educational opportunity.
Part of the problem is that the Federal Government is
trying to help make up the deficit that is the result of a lack
of full support from our state governments in the poor
communities in those states. We need to work more as a Congress
to try to encourage states to treat both our rural school
districts and urban school districts in a way in which young
people will get a fair and an equal opportunity.
I know that we cannot legislate outcomes, but I think that
we could do more to encourage states not to have poor children,
who are already disadvantaged, made more disadvantaged by the
way that they create their funding cycles and dispense
curriculums around the state.
Nancy Pelosi, in the great State of California, knows that
there is a major litigation going on there in which young
people in Compton High have little or no opportunity to take AP
courses; and young people at Berkeley High have more than 25 AP
courses to choose from.
It just creates a circumstance in which not every young
person can pursue, within their own potential, what God-given
talents they have.
So I just think, Mr. Chairman, that your committee will
make a lot of tough decisions about allocations and
programmatic thrusts.
We can also do more by encouraging these states to take
their children, and to give not just the wealthy, middle class
suburban youngsters every opportunity, but to also make sure
that those who are impoverished, who live in rural and urban
communities in their states, to have the same opportunity to
have quality teachers in the classroom, good facilities, and an
adequate curriculum to prepare them.
So thank you, Mr. Chairman.
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Mr. Regula. I think it is a universal thing. Ohio is going
through the same type of lawsuit, involving Appalachia.
Mr. Fattah. Yes.
Mr. Regula. Mr. Hinojosa.
Mr. Hinojosa. Thank you very much, Mr. Chairman.
On behalf of the Congressional Hispanic Caucus, CHC, I want
to thank you and the members of the Appropriations Committee
for allowing Chaka and me to come before you and discuss the
educational needs of the African American children, Hispanic
children, and all minority children in the United States.
I want to preface my remarks by saying that I have only
served four years in Congress. As I start my fifth year, I want
to say that it has been a real pleasure for me to collaborate
with Chaka Fattah.
Both of us serve on the Education Committee, and we are
well informed and certainly committed to work on trying to help
children graduate from high school and go on to higher
education.
It is no doubt that two caucuses, the Black Caucus and
Hispanic Caucus, working together, are beginning to really make
a difference in bringing to the forefront the importance of
educating children early: Early Start, Head Start, Gear Up, K-
12 programs that are exemplary in helping students graduate
from high school, and then of course bringing a great deal of
attention to the work that is being done by HSIs and HBCUs.
All of this is to say that some of the senior members of
committees that I serve on in Education have commented that
never before have they seen the collaborative work being done
by the Black Caucus and the Hispanic Caucuses.
So I thank you for this opportunity. As you know, the
Census Bureau projects that by the year 2030, Hispanic children
will represent 25 percent of the total student population.
Census figures already indicate that Hispanics have become the
Nation's largest minority.
In my area, the largest county that I represent, Hidalgo
County, has grown to 88 percent in population.
Mr. Regula. Where is that located in Texas?
Mr. Hinojosa. It is south of San Antonio, 250 miles.
Hidalgo County is on the Texas border region, between
Brownsville and Laredo, an area that is the third fastest MSA
in the country. It is an area that in my own district, it has
grown by 50 percent over the last 10 years.
Mr. Regula. That would be southwest then; am I correct?
Mr. Hinojosa. We are considered the Southwest. Texas is so
spread out that I am 850 miles from west Texas and El Paso. I
am 650 miles from Dallas. It is an area that is just growing by
leaps and bounds.
Mr. Regula. Where do you fly to go home?
Mr. Hinojosa. I fly Houston, and then Houston to McAllen.
It takes me seven hours.
Mr. Regula. But you are not on the Gulf of Mexico, though?
Mr. Hinojosa. No, I am approximately an hour. Solomon Ortiz
represents the coastal area from Brownsville to Corpus
Christie; and I run parallel with him, from McAllen to San
Antonio; Rodriguez is parallel with mine, from Rio Grande City
to San Antonio. Then the fourth one would be Henry Bonilla from
Laredo to San Antonio.
All that area has grown so much that we are going to get
two new Congressional Districts in that area.
Mr. Fattah. They are taking those from Pennsylvania, right?
[Laughter.]
Mr. Regula. They are both going to be Republican; is that
right?
Mr. Fattah. We will see. [Laughter.]
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Mr. Regula. Are there any questions from the members?
[No response.]
Mr. Hinojosa. I want to say that the amounts that are in my
prepared material have some very specific numbers that we are
asking, as the Congressional Hispanic Caucus, on the
Appropriation funding that we are asking.
For example, on Title 1, we are asking for a level of
funding of $24 billion. If you ask why it is that much, the
reason is that we are not serving all of the eligible children.
So what we did is, we took the number that are eligible and
multiplied it, because it is a formula-funded program, and it
would take $24 billion to serve all those that are qualified
and eligible.
The Caucus also is suggesting a funding level of $508
million for Title 7 of the ESEA. Another figure that is very
important to us is the request for $500 million for adult
continuation programs.
Mr. Regula. That is a pretty hefty increase that you are
proposing.
Mr. Hinojosa. We are, simply because this is the time that
President Bush is saying that education is the foremost
important issue. If we are going to do what he says, and not
leave any child behind, then it is going to take getting up to
the funding level that will reach all the children, and not
just a few.
If you look at some of the programs, such as Gear Up, and
you will see that we are asking for an amount that will take us
into the next funding level, so that they would be getting,
what is that number, Chaka?
Mr. Fattah. $495 million.
Mr. Hinojosa. Yes, $495 million.
Mr. Fattah. Right.
Mr. Hinojosa. Again, I am not trying to exaggerate when I
say that when you are only serving 38 percent of the children
who are eligible in head start; when we are serving only a
small number who qualify for Gear Up; when you take a look at
the under-funding that has occurred in the last 10 years for
HSIs, Hispanic Serving Institutions, where we were getting only
$10 million in help, and we took that number from $10 million
to $28 million, just think about this.
There are 203 Hispanic Serving Institutions, and over three
million Hispanic college students. So this is just to say that
we have neglected many of these exemplary programs. All we are
asking is that you take a good look at these programs, because
they are the ones who are going to help our students graduate
from high school, go on to colleges, and become professions. In
fact, some of them may become Congressmen.
Mr. Fattah. Thank you, Mr. Chairman.
Mr. Regula. I think Henry Bonilla went through the Trio
Program.
Mr. Fattah. Yes.
Mr. Regula. Is the state pulling its share?
Mr. Hinojosa. We are challenging them, I guarantee you. We
are challenging the State of Texas to do their share.
Mr. Regula. Are there any questions?
Mr. Sherwood.
Mr. Sherwood. I would just like to suggest to the gentleman
from Texas that he take good care of those two Congressional
seats, because we might want them back some day. [Laughter.]
Ms. Pelosi. Mr. Chairman, I would like to commend these two
gentlemen. They have worked so hard on the education issues on
their committee and with Mr. Fattah here on the Appropriations
Committee. Mr. Hinjosa will do a lot for the economic
development of his area on the Banking Committee, which has
some important jurisdiction, down there for economic
development.
But when they talk about Gear Up, the work on the
authorizing side is so important to us here, both for the
Hispanic servicing institutions and the Historical Black
colleges and universities, that have been such a tremendous
resource to us.
So for all of the K-12 preschool and the rest and higher
education, thank you for making it, I do not want to say
easier, but for helping our community give this such a high
priority. I am pleased to work with you in these areas.
Mr. Fattah. Thank you, Mr. Chairman, for giving us the
time, and we look forward to working with you. I am sorry that
I am off the House Education Committee. However, I am happy to
be on the Appropriations Committee.
Mr. Regula. I believe you made a worthwhile change.
Next is Mr. Underwood from Guam. I used to see you in the
Interior.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL ASIAN PACIFIC AMERICAN CAUCUS HEALTH CARE TASK FORCE
WITNESS
HON. BOB UNDERWOOD, A UNITED STATES DELEGATE FROM GUAM AND CHAIR,
CONGRESSIONAL ASIAN PACIFIC AMERICAN CAUCUS HEALTH CARE TASK FORCE
Mr. Underwood. Mr. Chairman, it is always a pleasure to
appear in front of you, begging for more money in various
capacities.
Mr. Regula. And you are pretty good at it. [Laughter.]
Mr. Underwood. Well, thank you, Mr. Chairman and members of
the committee, for the opportunity to present the concerns of
the Asian and Pacific Island Caucus on some major health issues
concerns.
You may already know, Mr. Chairman, that the Asian and
Pacific Island is the most diverse ethical and racial group in
the country, comprised of both immigrant populations and
indigenous populations of Pacific Islanders.
It also is the most heterogenous community. What you may
not know is that Asian and Pacific Islander communities are
severely hampered by a lack of accurate demographic data to
monitor and enforce civil rights, laws, and ensure equal access
to Federal programs, and in particular, health care. This lack
of meaningful data makes it difficult to track health treads,
identify problems areas and solutions, and enforce civil
rights.
This problem has been attempted to be resolved by the
Office of Management and Budget back in 1997, when it made a
significant change to the standards for maintaining, collecting
and presenting Federal data on race and ethnicity.
This chain separated Asians from Native Hawaiians and other
Pacific Islanders, and allowed respondents to designate more
than one racial ethnic category. We hope that this effort will
provide more accurate data.
In addition, to this particular issue, the 1990 Census also
reported that about 35 percent of Asian and Pacific Islanders
live in linguistically-isolated household, in which none of the
individuals ages 14 or over spoke any English very well.
In 1997, the Census reported the rate of persons with
limited English proficiency grew to 40 percent for Asian and
Pacific Islanders Americans, and over 60 percent for Southeast
Asian Americans.
The absence or severe lack of culturally and
linguistically-assessable services leads to the gross under-
utilization of health care services, misdiagnosis and treatment
of disease, chronic illness and needless suffering.
It also contributes to Asian and Pacific Islanders seeking
treatment at a much later more progressed state of illness,
which is not only costlier to treat, but is often preventable
with earlier detection.
Asian and Pacific Islanders are often mislabeled as the
model minority with few health is social problems. This label
is a myth and a gross myth representation of the community,
which is very diverse.
Within this population alone, there exits divergent social
economic achievement rates, among euthenics and racial diverse
cultures.
Recent data from various institutions and Government
agencies, including the Department of Heath and Human Services
and the Census, revealed for example the following disparities.
Compared to the total U.S. population, disproportionate
numbers of minority Americans lack health insurance; about 24
percent of Asian and Pacific Islanders Americans. Asian and
Pacific Islander Americans continue to experience the highest
rate of tuberculosis and hepatitis B in this country.
Approximately one half of all woman who give birth to
Hepatitis B carrier infants in the U.S. were foreign-born Asian
woman. Liver cancer, which is usually caused by exposure to
Hepatitis B virus, disproportionately effects the Asian
Americans. Filipinos have the second poorest five year survival
rates for colon and rectal cancers of all U.S. ethnic groups.
Cancer is reported as the leading cause of death in nearly
all Pacific Island jurisdiction. In Guam, lung cancer accounts
for one-third of all recorded deaths. Native Hawaiians have the
second highest mortality rate in the National due to lung
cancer.
Cervical cancer is a significant problem in Korean and
American women, and it affects Vietnamese American women at a
rate five times higher than white women. Breast cancer
incidents in Japanese American women is approaching that of
white women.
Moreover, some studies indicate that approximately 79
percent of Asian-born Asian American women have a greater
proportion of tumors larger than one centimeter at diagnosis.
Breast and cervical cancer rates for Marshallese Islander are
five times and 75 times higher respectably for rates for all
U.S. women.
Native Hawaiian woman have the highest incidents of
mortality rates of endometrial cancers of all U.S. woman.
Diabetes affects tomorrow's indigenous people of Guam and
Commonwealth of the northern Marianas Islands at five times the
National average. Infant mortality rates in the U.S. insular
areas of American Samoa, Guam and Siena more than double the
National average.
Finally, in my home island of Guam, there has been a recent
and significant incidence of suicide, and particularly teen
suicides, fostered by contacts through suicide packs over the
Internet.
Last week, the Guam Department of Mental Health and
Substance reported that about 95 percent of the admissions into
the children's unit of the Guam Memorial Hospital are related
to suicide intentions.
In response to all of this, we have listed five listed
budgetary priorities, including a funding increase of $12
million additional for the Office of Minority Health and the
Department of Health and Human Services for the REACH
initiative in the Center for Disease Control.
This is currently funded at $35 million. In fiscal year
2000, the CDC was able to fund only 32 grants, which works in
collaboration with OMH and other appropriate Federal agencies,
to intensify efforts to eliminate health disparities. However,
a funding increase is requested to allow communities to apply
for REACH initiative grants.
For the National Center for Minority Health and Health
Disparities in the NIH, we are asking again for additional
funding for the minority ADIS initiative, which was funded in
2001 at $350 million, which is an increase of $100 million over
fiscal year 2000. However, the 2001 funding fell short of the
original funding request of approximately $540 million.
Finally, in fiscal year 2001, SAMSA's minority fellowship
program received nearly $2 million over the fiscal year level,
for a total of $3 million.
A $2 million increase is again requested for fiscal year
2002, to help address the critical needs to enhance the quality
and effectiveness of the provision of health and mental health
services to community of colors by increasing numbers of well-
trained professionals.
It is very critically important to understand that the
context of the provision of health care services in minority
communities is affected by cultural linguistic factors and the
lack of, in many instances, trained personnel.
I believe that it should be our strong commitment as a
Nation to help bridge this gap for the provision of health
services, so that we can reduce the disparities, some of which
I have outlined here today.
Again, I want to thank you, Mr. Chairman, as always. I do
not know what other subcommittee you are going to go to next,
but I always enjoy appearing in front of you. Thank you very
much.
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Mr. Regula. I am sure you will have a request, whatever
subcommittee it is. [Laughter.]
Mr. Rodriguez.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL HISPANIC CAUCUS HEALTH CARE TASK FORCE
WITNESS
HON. CIRO RODRIGUEZ, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS AND CHAIR, CONGRESSIONAL HISPANIC CAUCUS HEALTH CARE TASK
FORCE
Mr. Rodriguez. Mr. Chairman, let me first of all apologize
for being a little bit late. As the Chairman of the Hispanic
Caucus and member of the VA committee, we had an opportunity to
provide some testimony on health, and you will have an
opportunity to vote on those bills this afternoon on the VA,
which is also very critical for a lot of Hispanic veterans that
are out there.
But I want to thank you for allowing us the opportunity, as
Chairman of the Task Force on Health with the Hispanic Caucus,
that has 18 members of the 21 Hispanic members of the Congress,
to be here before you.
Hispanics continue to experiences barriers in the areas of
health care insurance. I want to briefly just mention to you
that out of 44 million uninsured Americans in this country,
one-quarter of those, or 11 million, are Hispanics.
These are individuals that are working. In fact, out of
those 11 million that are Hispanics that are uninsured, 9
million are working individuals, that despite the fact that in
this country, if you are working for a small company, if you
are not working for a major corporation, if you are not working
for Government, you do not have access to insurance.
Yet, you are not poor enough to qualify for Medicaid; you
are not old enough to qualify for Medicare; and you find
yourself without any access to insurance. So the importance of
the CHIPS Program is critical, and so we want to be supportive
of those efforts and encourage the importance of continuing to
fund those efforts in that area.
The importance of access to health care is one of the
things that is lacking in the Hispanic community, and one of
the areas that impacts us the most.
To address the growing problems, and one which is a
negative impact on local health disparities in our local
communities, it is important that we continue to move forward
in those efforts.
Our community health centers that provide a vital safety
net for Hispanics and other minorities throughout this country
need to continue to be funded. Seventy percent of those served
by the community health centers are minority. Sixty-six percent
of them live in poverty.
The request from our efforts, from the Hispanic Caucus, is
that we fund them at $250 million above the current funding
levels for the community health centers.
President Bush has promised to provide $3.6 billion, over
five years, to build additional 1,200 community health centers.
We request a $250 million increase. It would put us on the
right track to meet the President's needs in this specific
area. So we ask for your serious consideration.
Hispanics also account for 20 percent of the new AIDS
cases. As we look at the issue of AIDS, we see the new data
that is there and it looks like we are making some inroads but
despite, it is hitting disproporionately a lot of the low
income areas.
Despite the fact that Hispanics represent 12.5 percent of
the population, we represent 20 percent of HIV cases. So we ask
for your help and your support in that specific area and
request full funding at the level of $539.4 million for year
2002 for the Minority AIDS Initiative to promote capacity
building for minority-based organizations.
The U.S. Census 2000 shows that Hispanics make up 12.5
percent as I indicated. One of the basic ways of dealing with
AIDS is to make sure we have those community-based programs.
With the Hispanic community, we have not been able to organize
those. We have been lagging behind in resources to fight the
issue of AIDS and we need those resources to make sure we
establish those community-based organizations to reach out to
those pockets that are out there.
In the area of diabetes, it strikes Hispanics--especially
Mexican Americans and Puerto Ricans--at a disproportionate
rate. In addition, growing evidence shows that Type II diabetes
and adult onset diabetes increasingly strikes Hispanic
children. We are learning more about the relationships. The
beauty of this is we have a lot of new research where we can
identify those specific areas with young people, with children.
We have been able to identify a large number, but now we have
to do something about that. We need to move forward.
We ask for increased support of $100 million for Hispanic
focus on diabetes prevention and treatment. These activities
include targeting geographic areas throughout this country that
need to be targeted.
It doesn't do any good to identify those kids--we are doing
it--and not do anything about it. Part of that is the education
that goes along with that. So we ask for your help, assistance
and your efforts.
In the area of mental health and substance abuse, one of
the areas that we have neglected as a country and where people
have fallen through the cracks, as indicated earlier by my
friend, is we are finding a lot of young people. When they
first came to tell me we were having a large number of suicides
among young ladies of Mexican-American descent, I told them I
don't believe it, show me the research. Sure enough, they came
to me and it is startling to see the rates of suicides among
young Hispanics as well as alcohol and drug abuse. So it
becomes important that we look at that area of mental health
and substance abuse, and that we provide some resources.
President Bush's budget includes an initiative to double
NIH funds for 2003. While the Hispanic caucus supports
increasing research funding levels, it is important to find
ways to encourage Hispanic focused research. The key is toalso
look at specific research that targets Hispanic populations with a
clear understanding that with what we face, we can then deliver
culturally competence.
There is example after example and one example that comes
to me, which I have been sharing, when we talk about competency
and culturally relevant, when this person was told she was
positive. When you tell them in positive, then you think
everything is okay and sure enough this person later on had a
child and contracted AIDS. So there is a need and we should not
take things for granted. We need to reach out and make sure
people understand, especially when we deal with issues of
mental health and the competency and cultural relevancy of
reaching out to those individuals.
We had another case of mental health with a person in a
State hospital in San Antonio who would go out and walk and
walk, walk and stop, walk and stop and walk and stop and people
would try to stop her. She would get angry and throw a fit. She
was actually doing her rosary. She would walk so many steps and
would stop and keep on. People didn't understand that.
It is important to recognize the importance of cultural
competency, language proficiency and what it means. We are
going to ask for some funding in that specific area of $3
million. If you want specifics on the funding, I would look
forward to meeting with you to provide some of those
statistics.
The budget also proposes reduced funding to the health
professionals which provide training grants to institutions to
increase the number of under represented health professions.
This is a serious mistake. Right now, every agency in the
Federal Government is expecting to retire one-third of our
people. We were just told in the GAO report on the military
that of 50 percent, 65,000 employees, we are going to retire
32,000 of them, almost half.
There is a need for us to invest in apprenticeships. It is
important for us to invest in those individuals and make sure
that we have good quality professionals.
In the area of access to health care, there is a nursing
shortage in this country and this is not the time to cut back
on these programs. The budget estimates of $125 million for
community access programs provides grants to communities,
hospital and community health centers that serve uninsured
youngsters and is key. Please look at that funding, especially
in terms of the apprenticeship programs and providing the
health professions the assistance that is needed.
We need to go beyond that. We need to make sure we have
those qualified professionals out there, those individuals that
can be culturally competent and have access to the training
that is important and needed.
According to the Department of Health and Human Services,
there are 3,000 medically under served communities. So we need
these grants.
Thank you for the time and the opportunity to address the
subcommittee on the Congressional Hispanic Caucus priorities
and we look forward to working with you.
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Mr. Regula. The community health centers have served a very
worthwhile role and I hope we can increase those because I
think it catches a lot of people who are uninsured and probably
not able to get medical care.
Mr. Rodriguez. Yes, sir. In fact, 67 percent are uninsured
in that category and 70 percent are minority.
Mr. Regula. Questions?
Ms. Pelosi. I want to thank the two gentlemen for their
excellent testimony and Mr. Underwood for his leadership in the
Asian Pacific Islander Caucus and Mr. Rodriguez who has been
working on this for such a long time. Last year, he was able to
get $1.7 million for minority health research and outreach. We
are hoping that money will be coming very soon to help in
getting a handle on what these needs are.
I wanted to bring Congresswoman Christensen in on this as
well. As you testified earlier, we are blessed that the former
Chair of the Interior Committee is now in the Health seat
because he understands the needs of the territories better than
anyone.
Mr. Regula. I have had a lot of assistance from Mr.
Underwood.
Thank you both for your interest.
Our next witness is Ms. Ros-Lehtinen from Florida.
----------
Tuesday, March 27, 2001.
CLOSE UP FOUNDATION
WITNESS
HON. ILEANA ROS-LEHTINEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF FLORIDA
Ms. Ros-Lehtinen. We are so thankful to have such a strong
organization nationally and in all of our districts.
Thank you, Mr. Chairman and members of the subcommittee. We
are pleased to submit my testimony in support of the Close Up
Foundation's Allen J. Ellender Fellowship Program.
During my time in Congress, I have been a strong supporter
of Close Up and its civic education programs. As a former
educator, I believe the Close Up Foundation Civic Education
Program is a valuable weapon in our arsenal to combat
disaffection with government among our young people.
The Allen J. Ellender Fellowships are vital in reaching out
to a diverse group of young people, specifically those in need
of financial assistance so that we can enable them to
participate in Close Up's unique civic education program.
Without the Ellender Fellowship Program, the Close Up
Foundation would be unable to reach students who are perhaps
more in need of having their importance to our democracy
validated.
The only criterion for a student to receive an Ellender
Fellowship is an income eligibility requirement and student
recipients of these fellowships are among the neediest students
in our educational system. Impressively, the overwhelming
majority of Ellender Fellowship recipients participate in local
fundraising activities throughout the year to cover the full
cost of the program.
The foundation also has special programs to reach students
who are recent immigrants to the United States. As a member
from Florida, one of the most culturally diverse States in our
Nation, I can personally attest to the growing positive
influence that these immigrants have had upon the cultural
fabric of our Nation and the great contributions that they make
every day to our country. They too need to be educated about
their adopted homeland and specifically about how our
government and our democratic form of government works. Close
Up also outreaches to students in our rural towns and urban
communities who are beneficiaries of Ellender Fellowship
assistance.
I understand the subcommittee faces an extremely difficult
task in trying to prioritize what programs to fund and at what
levels, but I ask you to consider the grave need for civil
education programs, and particularly for programs that reach
our disadvantaged youth.
The Close Up Foundation uses the relatively small
appropriations that it receives for the Ellender Fellowship
Program as seed money around which educators and students
expand their local Close Up programs. I ask that the
subcommittee demonstrate its support for Close Up's civic
education program by not only maintaining the current $1.5
million funding level for the Allen J. Ellender Fellowship
Program but by increasing the funding level. This would send an
important signal that we in Congress believe that citizenship
education is as important to being a well-rounded individual as
knowing math, science and literature. It would be a great
investment in the strength and well being of our democracy.
I thank the Chairman and I thank the members and the staff.
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Mr. Regula. Do you think these young people go back home
and take the message of things they learn here in the Close Up
Program back to their colleagues?
Ms. Ros-Lehtinen. I think so. At least that has been the
case in our district office. We encourage them to participate,
they come to our district office, put in their time there as
well, and go back to their areas, whether they are working in
Washington or in the district office and really make it work.
They demonstrate that this is a great country where we are
given all kinds of opportunities.
I thank you for funding it and we hope to be there with
even a little more this year.
Mr. Regula. Next we have a panel of Mr. Hayworth and Mr.
Edward on Impact Aid. We heard from some of our colleagues
earlier making a pretty powerful case. I will let Mr. Sherwood
take this one.
Mr. Sherwood [assuming chair]. Gentlemen.
----------
Tuesday, March 27, 2001.
IMPACT AID
WITNESS
HON. J.D. HAYWORTH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ARIZONA
Mr. Hayworth. Let me thank the gentleman from Pennsylvania.
It is good to see him in the Chair but my joy at seeing him
there is eclipsed by the temporary departure of the full
Chairman of the Subcommittee who is all too aware of the
challenges we confront.
I would note for the record that a number of my
constituents join me in this chamber here today for this
testimony who could offer very eloquent testimony as to just
how important this program is. On behalf of all the members of
the Impact Aid Coalition, I want to thank you and members of
the subcommittee for affording us this opportunity to address
what we consider to be a very, very important issue, an issue
of critical importance, impact aid.
Impact aid is a Federal education program that provides
funding to more than 1,500 school districts connected in some
way to the Federal Government, whether by an Indian
reservation, a military installation, or the designation of
Federal land. Traditionally, property sales and personal income
taxes account for a large portion of the average school
district's annual budget but impact aid schools educate
students whose parents may live on nontaxable Federal property,
shop at stores that do not generate taxes, work on nontaxable
Federal land, or do not pay taxes in their States of residence.
School districts could also receive impact aid if some or all
of their property was taken off the tax rolls by the Federal
Government.
As one of the Co-Chairs of the Impact Aid Coalition, I am
honored to be here to fight for this important program and I am
so pleased the gentleman from Texas, Mr. Edwards, joins me in
this endeavor. The Coalition will be sending you a letter
requesting your support for its goals of securing $1.19 billion
in funding for the Impact Aid Program for fiscal year 2002.
While this is an increase of approximately 19 percent over last
year's funding level, Mr. Chairman, it is important to note
that the amount the Federal Government actually owes impact aid
schools for basic support and Federal property payments is more
than $2 billion.
Increasing impact aid funding to $1.19 billion will be an
important step toward fully funding this program which
currently receives less than half of its authorized funding.
As you may know, the Sixth District of Arizona, which I am
honored to represent, is the most federally impacted
congressional district in the country. My district alone
receives nearly $100 million in impact aid funds. Without these
funds, thousands of my young constituents would simply not be
educated, constituents who join me today in this hearing room.
My district is unique because it has the largest Native
American population in the 48 contiguous States, nearly 1 out
of every 4 of my constituents is a Native
American.Approximately 50 percent of the land mass in my district is
tribal land. Many Native American reservations face staggering
unemployment rates and other devastating economic conditions. For many
children on these reservations, education is their only hope to escape
a life of poverty.
I am sure you are aware of the Federal Government's treaty
obligations to our sovereign Indian tribes and nations. Part of
these obligations includes educating these children. It was
part of the treaty trust obligation. Without impact aid, the
Federal Government cannot live up to those aforementioned
treaty obligations. Therefore, I wholeheartedly support the
Coalition's goal of securing $1.19 billion for this important
program.
You know that I am ever critical of wasteful and
unnecessary government bureaucracy. Therefore, I am
particularly pleased to support impact aid as funds in this
program are provided directly to the local school districts for
general operating expenses. The use of impact aid funds is
determined by locally elected school boards. As you know, the
money appropriated by Congress is sent by electronic financial
transaction directly to the financial institution of the
eligible school district. There is no administrative cost
associated with the program.
I am also a strong critic of wasteful spending and the
inappropriate use of Federal tax dollars that is seen from time
to time here in our Nation's Capitol. I am completely committed
to maintaining a balanced budget. However, because impact aid
services military families and Indian tribes, my colleagues
understand this full well. It is an unequivocal Federal
responsibility.
Through a robust impact aid program, we can demonstrate our
commitment to those children who would otherwise be shut out
from most educational opportunities. By funding impact aid, at
$1.19 billion for fiscal year 2001, we can fulfill our
responsibility of providing these educational opportunities to
each of our Nation's students.
Again, thank you, Mr. Chairman, and members of the
subcommittee for inviting members of the Impact Aid Coalition
here today to voice our opinions, to be joined by our
constituents. I would be happy to remain here to answer any
questions you might have.
Thank you very much.
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Mr. Sherwood. Thank you very much.
Now we will hear from the gentleman from Texas.
----------
Tuesday, March 27, 2001.
WITNESS
HON. CHET EDWARDS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS, ON BEHALF OF THE IMPACT AID PANEL
Mr. Edwards. It is an honor for me to join my colleague,
J.D., to speak on behalf of the bipartisan 127 House member
Impact Aid Coalition.
To most Americans, the term impact aid may not mean
anything but to 13 million American children, it means the
difference between receiving a quality education and a mediocre
or poor education.
With the Chairman's approval, I would like to submit my
written testimony and would like to do something a bit
different if I could, and then give back some of my five
minutes of time.
I would like to put a human face on the statistics behind
those 13 million Americans impacted directly by this education
program.
This comes from a Washington Post article of March 14, a
story of one military family. Let me read several excerpts. The
first is a letter from an Army Soldier, Randy Roddy who was in
Saudi Arabia at the time his son was about to have his second
birthday. This is what he wrote to that son. ``As your second
birthday rolls around and it is apparent that we will not be
able to spend it together, I find it important to write you and
tell you some things you need to know. Someday perhaps you will
be able to pull out this letter and comprehend.''
He then goes on to say, ``I must start by telling you how
proud I am to have you as my son. You never cease to amaze me
when I see you on a video cassette. Because of events in this
world of ours that are bigger than either you or me, I have not
been able to share these last five months with you.''
The article goes on to talk about Mr. Roddy's spouse. It
said, meanwhile at Ft. Bliss in the Texas desert, Lisa had her
own struggles raising their child, working a receptionist job
to supplement their pay, soothing the fragile emotions of
several dozen wives whose husbands served in Randy's command.
``They look to me,'' she said, ``as a troop commander's wife. I
helped deliver two babies, I helped when someone's car was
repossessed. One wife tried to kill herself and her three
children and called me.'' The articles goes on and says, ``You
don't just join the Army, the whole family does.''
It talks about Mr. Roddy's four-year-old child, a little
girl, who lost all of her hair because of being distraught when
her father was deployed to Korea on a company tour for a year.
The reason I mention the story of the Roddy family is it is
clear we underpay our military soldiers and their families, all
of our troops from all services. It is clear to our Military
Construction Subcommittee that 60 percent of our military
families live in housing that does not meet basic DOD
standards.
The reason I mention that is it seems to me if we can't pay
our military soldiers and their families what they deserve, if
we ask them to live in substandard housing, if we ask their
families to spend month upon month away from loved ones serving
our country, risking their lives for you, me and our families,
the very least we should do as a country for these families is
to say to them while you are serving your country and risking
your life, we are going to ensure that your children will
receive a quality education.
I think the story of the Roddy family tells the story of
the importance of impact aid. Whether it is Native American
children or children of military families, amidst the many
important competing priorities that you must set, I hope this
subcommittee would once again remember the importance of
funding adequately the Impact Aid Program. I would like to look
at Mrs. Roddy who will be before our Military Construction
Subcommittee in a few weeks and say, despite all of the
difficulties and perhaps some of the things we ask you to
sacrifice, we will see that your children receive a quality
education.
That has happened in the past, Mr. Chairman, because of the
members of this subcommittee and we respectfully ask, on behalf
of the Coalition and these 13 million children for whom we
speak, that you please continue that leadership effort and
support fully funding for impact aid.
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Mr. Sherwood. Thank you both very much for your exceptional
and compelling testimony.
Two years ago at a readiness hearing in Italy with our
distinguished late chairman of the Readiness Committee, Mr.
Bateman, I was talking with some military personnel there and
made almost the same statement you did. When our brave young
men and women are defending us around the world, the least we
can do is see there is a good education for their children.
In all these areas where the Federal Government, by treaty
or law, has denied these school districts of revenue that would
normally be there, we have to step up to the plate, so we will
take a strong look at it.
Mr. Hayworth. One note. We should point out that though my
friend from Texas concentrated on military dependents and I
talked about some of the challenges facing tribes, these
concerns are not mutually exclusive. If you take a look at
those who answer the call to military service, tribal members,
Native Americans, more than any other group, answer the call to
military service. So there is a connected interrelationship
here. I would appreciate the committee taking that into
account.
I commend my friend from Texas for very eloquent testimony
about what is faced by military dependents. You can see on the
faces of my constituents here and they could offer very
profound testimony from their real life experience.
I appreciate your hearing us and the Chair's indulgence for
this time this afternoon.
Mr. Sherwood. The gentleman from New York, Mr. Fossella.
----------
Tuesday, March 27, 2001.
JUVENILE DIABETES RESEARCH
WITNESS
HON. VITO J. FOSSELLA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW YORK
Mr. Fossella. Thank you for providing me the opportunity to
testify today.
I would like to thank you and this committee for continuing
the effort to double the budget of the National Institute of
Health by the year 2003. Since being elected to Congress, I
have been a strong supporter of meaningful funding for the
National Institute of Health, and I applaud the President's
recent announcement that he will seek increased funding for
life-saving medical research at the NIH.
I would pause to thank publicly all those dedicated
professionals employed by the NIH and all health care
professionals publicly and privately who dedicate their lives
to try to improve the human condition.
Politics is a lot of things to a lot of people but one
thing we can agree upon is that we can all work together to
improve the human condition. We have seen it time and time
again where illnesses we thought could never be solved have led
individuals to lead better lives. As far as I am concerned, our
best days are ahead.
Of special concern to me is meaningful funding for the
National Institute of Diabetes and Digestive and Kidney
Diseases for fiscal year 2002. Finding a cure for Type I
diabetes is absolutely doable and with congressional support,
it will happen. No one in my parents' generation ever imagined
a human being would travel in space, let alone land on the moon
but on May 25, 1961, President Kennedy stood before a joint
session of Congress to declare it ``time for a great new
American enterprise.'' Then in 1969, what seemed impossible
became reality.
I believe we are now in a time of a great American
enterprise, a time when we are closer than ever before to not
only helping the millions who currently suffer from the
insidious condition of diabetes but laying the foundation for
future generations to live their lives free of this disease.
It is not just a health issue, it happens to be an economic
one as well. Diabetes happens to be a very costly disease to
our Nation and accounts for approximately $105 billion in
direct and indirect health care costs. One out of ten health
care dollars overall are spent on individuals with this
disease.
I understand the World Health Organization estimates there
are 125 million people worldwide with diabetes. This number has
increased 15 percent in the last 10 years and is actually
expected to double by the year 2005. In the U.S., the CDC
refers to diabetes as ``a major public health threat of
epidemic proportions.''
Ten million people in our Nation have already been
diagnosed with diabetes while an estimated 6 million have
diabetes but are undiagnosed. To put that in prospective,
onaverage, there is an estimated 23,000 people diagnosed and another
14,000 undiagnosed in every congressional district across the country.
More important than the costs are the lives this disease
takes. Each year, 193,000 people die from complications from
this disease. That is one every three minutes. Clearly a cure
must be found and I believe it will be.
Great and promising strides have recently been made in
funding a cure for Type I diabetes. The contributions must
continue and with your assistance, I am confident a cure will
be discovered during our lifetime.
Researchers are collaborating on many new treatments and
others on the identification of the genetic components of
diabetes. One of these promising treatments is known as the
Edmonton Protocol for Eyelet Cell Transplantation. This is a
process where insulin-producing cells called eyelet cells are
removed from the pancreas and transplanted to a diabetic
patient. The success rate has been extremely encouraging.
The researchers in Edmonton, Canada have announced they
were successful in transplanting the insulin producing eyelet
cells into a number of men and women with Type I diabetes
resulting in the discontinued use of insulin injections which
is the scourge of millions who suffer from it. To date, more
than 16 men and women have received this transplant and 100
percent remain off insulin entirely.
Researchers are further studying this transplantation
without the need of the dreaded immunosuppressant drugs. The
Edmonton Protocol has given the diabetic community great hope
for a cure. Clinical trials of this extraordinary
transplantation will be taking place and are taking place here
in the United States. The procedure may not be helpful to
children because it requires the use of the immunosuppressant
drugs I mentioned before. Children's fragile bodies simply
cannot withstand these very strong drugs.
It is my hope that continued research with your support and
members of this committee and indeed all of Congress, will soon
enable more adults and even children to utilize eyelet
transplantation. Our support is crucial to capitalize on the
success of eyelet cell transplantation and to shorten the
timeline to cure that we know is within our grasp.
Mr. Chairman, you have been a leading advocate in this in
playing an important role in encouraging increased research of
diabetes and particularly Type I diabetes. Last year, Congress
and the White House approved a 60 percent increase, the largest
ever in juvenile diabetes research funding at the NIH. This
increased funding will allow researchers to explore new
opportunities to cure diabetes.
It is my hope that Congress remains committed to helping to
find a cure for diabetes. The time is now, the cure is within
our grasp. It is not just the individuals, it is the families
that are affected adversely, the 18-month-olds, the two-year-
olds that have to live and forever live until a cure is found
with the six to eight times a day of pin pricks and two, three
and four injections. All we would like to do is help them live
a normal and healthy life.
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Mr. Regula [resuming chair]. I understand. I have had some
families from my district visit with me and I know the
difficulty it creates for everyone involved. We do hope we can
get a cure. It would be a wonderful thing to get a breakthrough
on that.
I know NIH is pursuing research very aggressively,
especially using cell process as you described. That would be a
wonderful thing if we could. We will do all we can.
Mr. Fossella. Thank you, sir.
Mr. Regula. Mr. Wu, you get the honor of being the last one
today.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. DAVID WU, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OREGON
Mr. Wu. Thank you.
I thank you for the opportunity to testify before the
subcommittee today. As you prepare the fiscal year 2002
appropriations bills, I would like to bring to your attention
several projects from my congressional district that I think
are worthy of national attention.
I am seeking $2.5 million from the Fund for the improvement
of post-secondary education to support the Mark O. Hatfield
School of Government at Portland State University. It is named
in honor of Oregon's most prominent and distinguished national
leaders and has been a solid academic center for the
advancement of education and research about public service.
The money will be used to fund faculty and staff and
support students at the school and the various research
institutions such as the Institute for Tribal Government which
the larger committee helped fund last year.
Among the activities that will be funded is advanced
education for elected and appointed officials at all levels of
government, including those at non-profit organizations and
other public institutions.
In addition, funds will be used to increase the awareness
of the importance of public service and to foster among young
Americans greater recognition of the role of public service in
the development of United States and to promote public service
as a career choice.
There is an extensive history of Federal funding for the
Hatfield School of Government. Congress approved funding for
the school in fiscal year 1999 and 2000 and last year as I
noted funding was approved for the Institute of Tribal
Government, an institution unique in the 50 States to study and
support tribal governments.
The second project I would like to mention briefly is a
million dollar request from the Fund for the Improvement of
Education for the Portland Metropolitan Partnership. We talk a
lot about improving primary and secondary teaching but without
strong leadership from the top, I don't believe that progress
is possible. This program at Portland State University is aimed
at providing that kind of leadership within schools.
Third, I am seeking $2 million from the Administration on
Aging for Oregon Health Sciences University for the second
phase of the Center for Healthy Aging. The subcommittee
supported the first phase of this project with a $1 million
appropriation in fiscal year 2000. This demonstration project
promotes health and prolonged independence by coaching
participants and connecting them with resources to bring about
positive changes in health behaviors and status.
Here I would like to go off the written track a bit by
mentioning that Oregon is among that handful of States thathas
really innovated in helping older Americans achieve and maintain
independence for longer periods of time. This not only gives older
Americans their choice of lifestyles because I think many would prefer
to stay as independent as long as possible, but in addition, it helps
save the Federal Government money because if we don't have to
institutionalize people, it is a significant savings. The Center on
Health Aging's purpose is disseminate a clinical model which works both
for older Americans and for our public purse. It is a worthwhile
project this committee has seen fit to fund in the past.
About two weeks ago, this subcommittee heard from Dr.
Grover Bagby, the Director of the Oregon Cancer Center at OHSU.
Dr. Bagby addressed the growing shortage of nurses faced by
academic as well as rural health centers. The baby boom
generation has provided its share of nurses and as a result, we
will be facing large scale retirements soon. OHSU is expecting
that 45 percent of the nursing faculty will retire within four
years and because of this, we are attempting to alleviate the
nursing shortage through the Laboratory for Teaching Technology
application and innovation in nursing at OHSU. I am requesting
$1.9 million from the Health Resources and Services
Administration, Rural Health Outreach Grant Account.
Without the teaching nurses at OHSU, we do not expect to be
able to get nurses into the rural parts of the State nearly as
effectively as we otherwise could.
Finally, I hope you will be able to support a small portion
of the Columbia River Estuary Research Program through the Fund
for the Improvement of Post Secondary Education. We are seeking
funding to train scientists, students and faculty for this
program. Last year, the subcommittee supported the program
through an appropriation to establish certificate and graduate
degree programs in environmental information technology. We are
seeking to continue that programmatic development and training.
I might add I became familiar with this program several
years ago as a private citizen. It is an amazing public/private
partnership where this research institution has basically gone
to the mouth of the Columbia River, one of the major estuaries
of the U.S. west or anywhere in America, and by studying the
currents, studying temperature, salinity, water density and
flows, by being able to predict where things wind up, these
folks are better able to help ships navigate the Columbia
River, help salmon smelts navigate downstream to get out to the
ocean, help predict where pollutants will wind up.
There is an obvious hardware component of this program but
there is a very important human and training component to this
program. That is where we are seeking help from this
subcommittee. It is a well leveraged and well worthwhile
program.
I thank the committee for its attention to these programs
of importance to Oregon and am ready to answer any questions
you may have.
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Mr. Regula. Thank you. Sounds like you have some
interesting projects.
Is the School of Government at Portland something like what
they have at Harvard with the Kennedy School?
Mr. Wu. In essence, it is our northwest version of the
Kennedy School, yes, or the midwest version of the Hubert
Humphrey School or the LBJ School.
Mr. Regula. The aging project sounds interesting. You are
trying to help older people stay independent for a longer
period of time?
Mr. Wu. That is an important goal. Perhaps that is a
primary goal along with helping them to stay healthier longer.
Mr. Regula. That goes along with it. You can't be
independent if you are not healthy.
Mr. Wu. That is right. And at a fixed health status, if you
will. We want to help people stay healthier but at one fixed
health status, if you are able to coach the individual and also
bring together community resources to focus on the individual,
if the individual can reach out to the resources and bring
community resources to bear, at the same health status that
person might be tempted to go into an institution whereas if
you bring the services together in the right way and empower
the individual.
Mr. Regula. You make the community more friendly to
independence?
Mr. Wu. Yes.
Mr. Regula. Do you involve the family? A lot of times this
would take education of families for support members. Does the
program involve family members too?
Mr. Wu. Absolutely. In this program there is a very strong
educational component for the family and I should say outside
of this program in the general model, there is the availability
for some State funding of family members so that family members
can take more time away from other things and be more
appropriate and more effective caregivers to fellow family
members.
Mr. Regula. Sounds like a very worthwhile program.
Mr. Wu. It is something that had a bit of room to run in a
few other States and no where has it gone as far as it has
especially in the Klamath Valley part of the State of Oregon.
If we can make this model effective and try to replicate it
elsewhere, I have heard academicians from around the country
discuss how this would make people happier by keeping them
independent but be a major cost savings to the Federal
Government.
Mr. Regula. I think that is absolutely right on both
counts.
Do you have Klamath Valley?
Mr. Wu. No, I do not. It is Mr. Walden's good fortune to
have the Klamath Basin.
Mr. Regula. It would be further east.
Mr. Wu. A bit to the east and to the south.
Mr. Regula. Do you have the city?
Mr. Wu. Most of my congressional district is rural but I
also have the urban core of Portland, the financial district,
the most urban parts of Portland through the high tech suburbs
but two-thirds or three-quarters of my congressional district
is actually forestland or agricultural land.
Mr. Regula. What corps or cattle?
Mr. Wu. Not much in the way of cattle but we have a lot of
orchards, a lot of nursery stock as it became too costly to run
nurseries in southern California, a lot of the nursery folks
came up to my neck of the woods, and hazelnuts or filberts as
we prefer to call them in the northwest and I think some of the
best wines in America.
Mr. Regula. You must have a somewhat temperature climate
there?
Mr. Wu. Yes. It is a temperate climate more like the
Mendocino coast or the burgundy kind of climates in Europe. We
are so far north that our vinters have the challenge of highly
variable growing seasons. That creates both the best of times
and the worst of times as agriculture tends to do.
Mr. Regula. Thank you for coming.
The committee is adjourned until 10:00 a.m. tomorrow.
Tuesday, April 3, 2001.
McKINNEY EDUCATION FOR HOMELESS CHILDREN AND YOUTH
WITNESS
HON. JUDY BIGGERT, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Regula. I call the committee to order.
We have four panelists. You are not the ones that were
scheduled for Panel 1, but we have four of you, so I am just
going to go ahead and then as the others come in, we will use
them on Panel 2 or Panel 3. I would be interested to hear what
you have to say, and I know these are tough issues.
We will start out with you Mrs. Biggert. Try to stick to 5
minutes, if possible.
Mrs. Biggert. Thank you, Mr. Chairman and distinguished
members of the subcommittee, who aren't here, but I will say
hello to them anyway.
Mr. Regula. This is not unusual. That is why I get the
extra pay.
Mrs. Biggert. I am sure they will join you as time goes on.
As the Republican cochair for the Congressional Women's
Caucus, I am pleased to have the opportunity for our members to
testify today. Every year this forum has provided the caucus an
opportunity to come together as a bipartisan group to discuss
issues affecting women throughout the United States. And I
would like to thank you again for extending us the opportunity
for this year.
Today I would like to express any support for the McKinney
Education for Homeless Children and Youth, the EHCY program,
and I respectfully request the subcommittee to appropriate
$70,000,000 for this program in fiscal year 2002. Children
represent one of the fastest growing segments of the homeless
population. In fact, an estimated 1,000,000 children and youth
will experience homelessness this year, a situation that will
have devastating impact on their educational advancement.
Because of their unstable situation, these children face
significant hurdles in obtaining an education. Studies show
that homeless children have four times the rate of delayed
development, are twice as likely to repeat a grade, and are
more susceptible to homelessness as adults. EHCY removes these
obstacles to education for homeless children and has made a
real difference in the lives of many children and families.
Yet, appropriations for the McKinney Education Program, the
only Federal education program targeted to these children, have
not kept up with demand for services or inflation.
Despite the increase in homelessness, Congress did not
increase the funding for this program at all from 1995 until
2000. When Congress did finally increase the funding in 2001,
it appropriated $35,000,000 for the program an increase of just
$6,200,000. The lack of adequate funding for this program has
been a major barrier to educating homeless children and youth.
According to a recent national survey, in 1997 States were only
able to serve 37 percent of school-aged children identified to
be in this difficult situation.
Compounding the problem is the poor collection of data on
homeless children. States often do not have the resources to
conduct the necessary assessments, and the lack of a uniform
method of data collection has resulted in unreliable national
data and the possible underreporting of homeless children.
Earlier this month the subcommittee heard testimony from
Lois Ferguson on behalf of the National Coalition for the
Homeless. She gave emotional testimony about her experiences
with homelessness and how the EHCY program had benefited her
family. EHCY can make a real difference in many more lives, but
only if the funding is there.
I understand and appreciate the enormous budget constraints
under which this subcommittee is working. However, I believe
there is no better time than now to renew and strengthen
Congress' financial commitment to helping provide homeless
children with access to a quality education. I ask that you
match the $70,000,000 that the Senate Health, Education, Labor,
and Pensions Committee has recommended for the program in
fiscal year 2002. By doing so, you will be reaching out to
homeless children, helping to ensure that they don't lose out
on what is guaranteed for all our children, a free public
education. You also will be meeting President Bush's call to
leave no child behind.
Thank you very much for allowing me to testify today.
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Mr. Regula. Do you think the faith-based, if that program
does develop, would be one group that might offer some services
for these children?
Mrs. Biggert. I think that is one way to address it. But
what really concerns me is getting them back into a school
system immediately and no red tape. And I think that the amount
of money to do that, to have help financially for the
ombudsman, and then the awareness that they know they can go to
a school right away. And spreading $70,000,000 even over 50
States doesn't go very far.
Mr. Regula. I notice you are close to Chicago. They have
had some enlightened programs in their school system. Has the
Chicago system done anything innovative in providing these
services?
Mrs. Biggert. What we did in Illinois--and, in fact, I have
introduced the homeless education bill, which is in the
reauthorization of the K-through-12 program, and that is the
model that we use for that program. So Illinois has a very
great model for all the States in the education of children,
and it is working very well there. And even, in fact, just a
couple of weeks ago one of my schools, you would not think
would have homeless children in it, it really worked out a
program for a couple of kids that were homeless and didn't know
where to go were enrolled in school; and they had the ombudsman
that was provided in this program.
So it really is working there. It was brought to my
attention from other States, saying why can't we have the same
kind of program.
Mr. Regula. I guess it takes local initiative, because we
had $35,000,000 last year, which obviously is not enough.
Mrs. Biggert. Well, you know, for the homeless centers just
to be able to provide not only for education, but to be able to
provide for all the homeless and particularly the children.
Mr. Regula. I am sure it is a severe problem.
----------
Tuesday, April 3, 2001.
THE WELLNESS OF WOMEN
WITNESS
HON. JUANITA MILLENDER-McDONALD, A REPRESENTATIVE IN CONGRESS FROM THE
STATE OF CALIFORNIA
Mr. Regula. Mrs. McDonald.
Ms. Millender-McDonald. Thank you, Mr. Chairman, and good
morning to you.
Mr. Chairman, as the co-chair of the Women's Caucus, I am
proud to come this morning. And we thank you for the
opportunity to come before you this morning to again lay out
our agenda for women and women's health. I am proud to have the
women who have come this morning as a strong showing of
advocacy for women across this country, especially the women
who know of the myriad of health issues and problems that we
see.
I have testified in the past, Mr. Chairman, before you and
others, on the need for us to look at the National Bone Marrow
Program, telemedicine, breast, cervical, and lung cancers,
fibroid tumors and other critical health issues. I was very
pleased and very happy to have sat in the audience when the
President mentioned his increase in funding in his budget for
NIH.
I respectfully request then that the 16.5 percent that the
NIH is requesting for the various outlines of health issues
that I will talk to this morning really be put in the budget,
that is, $3,400,000,000 for NIH so that we can see some
improvement in women's health. We have chosen for our theme
this 107th Congress ``The Wellness of Women,'' and we certainly
want, in our efforts and others' efforts, to promote and
preserve women's health.
As you know, heart disease is the number one killer for
American women. Studies suggest that women are more likely than
men to die from a heart attack, and women who recover from a
heart attack are more likely than men to have a stroke or
another heart attack. In fact, 44 percent of women die within a
year following a heart attack compared to 27 percent of men.
CDC is asking for $50 million to expand community education
programs in 35 States for cardiovascular health programs.
Another illness, Mr. Chairman, is that of cancer. It is the
second leading killer of American women claiming 43,900 women
in 1997. So early detection coupled with improved treatments
has led to a decline in breast cancer rates, as well as
cervical cancer, if women do get Pap smear tests. However, lung
cancer has become the number one killer for women in terms of
cancer in the cancer category, so we are asking, as well as the
CDC, for the National Breast, Cervical, and Lung Cancer the
Early Detection Program in the amount of $210,000,000 so that
we can try to grapple with this whole notion of women and lung
cancer, as well as cervical and breast cancers.
Another disease that is really crippling women is that of
lupus. Lupus affects one out of every 185 Americans. Although
lupus can occur at any age and in either sex, 90percent of the
victims with lupus are women. During the child-bearing years, lupus
strikes women 10 to 15 times more frequently than men. And so we are
asking for again, the NIH appropriation for lupus at $55,200,000.
We are also--and the final thing that I would like to
address is diabetes, the fourth leading cause of death in
African American, Native Americans and Hispanic women, the
sixth leading cause in Asian women and the seventh leading
cause in white women. An estimated 16,000,000 Americans have
diabetes, but only 10,600,000 cases are diagnosed, of which
4,200,000 are women. Left untreated, diabetes can lead to
severe vision loss, heart disease, stroke, kidney disease, and
amputation of the lower limbs.
The current NIH appropriation earmarked for diabetes is
only 65 percent of the funding necessary. Therefore, I am
asking for 1,500,000,000, which is 100 percent of the funding
needed to address this single most costly disease in America.
Mr. Chairman I was really thrown aback when I went to one
of the clinics in my district to find that young African
American women, ages 25 to 35, are really being crippled with
visual impairments due to diabetes because they do not have
health insurance. And so we are asking for this increased
funding for education programs, for research, and for treatment
of women.
We know that women now are making up 52 percent of the
heads of households; there must be a wellness among women for
them to continue to be sometimes the only breadwinner for our
children.
Thank you, Mr. Chairman.
Mr. Regula. Thank you. I might mention to you, we did go to
the Centers for Disease Control yesterday, nine of the
committee members and the staff. It was a very interesting day,
and they mentioned some of the things that you just brought
out.
Ms. Millender-McDonald. Thank you.
Mr. Regula. I think one of the problems in diabetes is that
people don't know they have it until their vision and some of
the things you just mentioned becomes evident of it.
Ms. Millender-McDonald. I will be following them. And thank
you so much; the CDC and NIH I will be working with them, so I
do thank you.
Mr. Regula. They do a nice job. We will be hard-pressed to
do all the things that we need to do----
Ms. Millender-McDonald. I know that is right.
Mr. Regula [continuing]. With what is allocated to us, but
we are going to give it a try.
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Tuesday, April 3, 2001.
WOMEN IN SMALL BUSINESSES
WITNESS
HON. SHELLEY MOORE CAPITO, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF WEST VIRGINIA
Mr. Regula. Mrs. Capito.
Ms. Capito. Thank you, Mr. Chairman, for allowing me to
come here today and give you some brief and very general
testimony.
Wellness of women--I am the Vice Chair of the Women's
Caucus--I am talking more wellness of women in terms of their
economic wellness. In recent years women have made great
strides in the workplace, especially as entrepreneurs. Between
the years of 1987 and 1997 the number of women-owned businesses
has increased 89 percent, and today there are more than
8,500,000 small business owners in the United States that are
women, and many in West Virginia, my home State.
The small business has been and always will be the key to
the American dream, especially for women and other minorities.
But erecting and ignoring government barriers that hinder their
success will slow their creation of and stifle their growth. In
February of this year, six of my constituents received Small
Business Administration loans; three of those business owners
were women. Although they were very happy to receive the
financial support, they probably would have been happier if the
government would remove some of the unnecessary regulations
that prevent them from doing such things as offering expanded
health insurance policies to their employees or creating new
jobs, all things that could be done with the costs that they
expend jumping through the hoops of government bureaucracy.
Women need to have better access for financing, for they
are small businesses. As leaders entrusted with this
responsibility, we need to be vigilant and recognize these
needless barriers that burden our small businesses. So we have
to be aware that we need to not tolerate the unnecessary
obstacles that prevent women and minorities from the American
dream. I can't help but wonder how many more women or minority
entrepreneurs we could have if we made starting and running a
small business a little bit easier.
So today I would like to ask that we work together to
preserve and extend the ideas of the American dream, and let's
send this message that the true entrepreneurial spirit is
available to them.
Thank you for letting me make this general statement. I
appreciate you listening.
Mr. Regula. Thank you.
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Mr. Regula. I read a comment the other day that--I think it
was Germany's czar for production said, if his country had used
women as effectively as the United States, it could have had a
pretty substantial impact on their ability to fight World War
II. He recognized--fortunately, belatedly--that women are
very--and I think that was a unique phenomenon in the United
States, the impact of the women on the war effort. Rosie the
Riveter truly was a very great part of it.
And the point you make is well taken that the role has
expanded. When I came here there were 18 in the House, now we
have how many?
Mrs. Biggert. Sixty-one.
Mr. Regula. There was one in the Senate. Now there are
nine.
Ms. Capito. Watch out.
Mr. Regula. None on the Court and now we have two, of
course.
I was startled to sit with a lady the other day who had
three or four stars, which is kind of unique too. Times have
changed, fortunately for the better.
Stephanie, you are on the third panel, but I will just take
Louise and then we will come to you.
----------
Tuesday, April 3, 2001.
NIH OFFICE OF RESEARCH ON WOMEN'S HEALTH
WITNESS
HON. LOUISE M. SLAUGHTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF NEW YORK
Mr. Regula. Mrs. Slaughter.
Ms. Slaughter. Thank you, Mr. Chairman. Good morning to you
and Ms. DeLauro.
I guess, in view of this conversation, it is probably good
to point out this is Equal Pay Day, and women in the United
States are still only paid 78 cents to the male dollar. So we
are making some progress, but it is going pretty slow there.
And we have contributed a great deal; we do want to be
recognized.
I do appreciate the opportunity to testify before the
subcommittee on issues that are important to the Women's
Caucus. As a Vice Chair of the caucus, I speak on behalf of all
my colleagues when I say that we look forward to continuing our
excellent working relationship with this subcommittee under
your leadership.
I would like to highlight briefly two issues that are
extremely important to the health of American women. The first
is women's health research at the National Institutes of Health
and particularly the efforts of the NIH's Office of Research on
Women's Health.
This is a tiny office with a monumental mission. It has a
threefold mandate to, one, strengthen, develop, and increase
research into diseases, disorders, and conditions that affect
women, determine gaps in knowledge about such conditions and
diseases, and establish a research agenda for NIH for the
future directions in women's health research;
Second, to ensure that women are included as participants
in NIH-supported research; and
Third, to develop opportunities and support for
recruitment, retention, reentry and advancement of women in
biomedical careers.
Under the leadership of Dr. Vivian Pinn, this office has
made major inroads on all of these issues. Its progress is
hampered, however, by a lack of resources. Over the past 4
years they have received paltry budget increases, especially
given the fact that Congress is working to double the NIH
budget. For fiscal year 2000, NIH received a budget increase of
14 percent, but the ORWH budget was increased less than 4
percent. It is currently carrying out its mission with a
$22,000,000 budget and, by contrast, the new Center for
Minority Health and Health Disparities is funded at
$132,000,000 for fiscal year 2001 and the Office of AIDS
Research at $48,200,000.
Last year I organized a letter from 22 women Members to
Acting Director Ruth Kirschstein asking her to increase the
budget. It is my understanding that she has requested a
respectable budget increase for the Office of Research on
Women's Health for fiscal year 2002. I hope the subcommittee
will not only fund this request fully, but include language in
the accompanying report encouraging the future permanent
director to maintain this commitment. And that is a very
important step.
I would like to turn now to the other issue on my agenda,
which is environmental health. The interplay between an
individual's genetic predisposition to disease and the
environment is not well understood. The evidence is clear and
accumulating daily, however, that the by-products of our
technology are linked to illness and that women are especially
susceptible to these environmental health-related problems.
There are many reasons for that, the makeup of a woman's
body containing more fatty tissue, more exposure to household
chemicals, and the like. You may have seen or heard Bill
Moyers' recent report, titled ``Trade Secrets.'' Mr. Moyers
detailed the fact that the chemical industry has kept
confidential documents over the past 50 years about adverse
health effects of workplace chemical exposures on their
employees.
In addition, a recent CDC report showed that all Americans
have traces of pesticides, metals, and plasticizers in our
blood and urine. What does this mean for our health? We don't
know. However, the chemical industry has also provided great
benefits to society through industrial and technical
advancement. It is a question of benefit versus risk, but we
need to at least understand the risk to make an assessment.
I urge the subcommittee to provide increased funding for
the National Institute of Environmental Health Sciences to
enhance the research on environmental causes of disease so that
we may improve the public health of America. This investment
will save the lives and health of people who today suffer
needlessly because we lack the scientific data to understand
the effect of environment of exposures on human health.
Mr. Chairman, I would like to note that I am proud to have
recently introduced H.R. 183, the Women's Health Environmental
Research Centers Act, a bill that will enhance scientific
research in women's health and the environment and will fill a
gap in the NIEHS research agenda by targeting resources to
women's environmental health. NIEHS fully supports the
initiative, and I would very much like to work with you, Mr.
Chairman, on empowering the agency to create these research
centers.
Again, thank you very much for the opportunity to address
you on these important issues.
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Mr. Regula. Thank you.
I might mention that at CDC they have one section on
environmental health generally. An interesting footnote, they
said they could take a sample of your blood and tell you all
the various components how much arsenic is in it, how much all
the various metals. Ms. DeLauro was there.
You want to go ahead and ask some questions or comments.
Ms. Slaughter. They can tell you almost everything from a
drop of blood, including all the diseases that you have had as
a child. It is a remarkable fluid that we have here. As former
microbiologist, I am very fond of it.
Mr. Regula. I like a good supply myself.
Ms. DeLauro. I will just briefly comment to Mrs. Slaughter
it was a really fascinating what the CDC is doing--I was there
with the group yesterday--particularly in this area and what we
could do by way of tracking illnesses and so forth and dealing
with genetic predispositions. So your words are well taken.
Ms. Slaughter. Three to 4 percent of breast cancer in women
is genetically linked; the rest of it must be environmental. So
we need to study this very closely.
Mr. Regula. Staff advises me that we are probably getting a
larger allocation on the women's health issues.
Ms. Slaughter. Thank you. I am so happy to hear that. Thank
you very much.
Mr. Regula. Mrs. Lowey.
Mrs. Lowey. Thank you, Mr. Chairman. I personally want to
thank you and thank the entire Women's Caucus. This is always
the highlight of the presentations for us.
And I want to particularly associate myself with your
comments on environmental health. To date, they really haven't
done enough work in that area. And I feel there so strongly the
mapping we have done in New York, the coincidences between high
rates in particular areas--not only New York, San Francisco,
around the country. I think this is something that we have to
continue looking at. I have always been interested in the work
of Stephanie Coburn and the connections of her research with
cancer. So I want to thank you and the entire Caucus for your
presentations.
Ms. DeLauro. I can explain it to my colleagues; I have to
leave at 10:30.
Pay Equity Day it is, and there is a press conference about
the Paycheck Fairness Act, which, as my colleagues know, is a
piece of legislation most of them are on for pay equity for
women; and we are going to do that over on the Senate side this
morning.
But I just wanted to say, this is an unbelievable
committee. When I first came, it was a 15-member committee. In
terms of the representation for women, there are three
Democratic members, there were two Republican members. I can go
back and think about when it was Mrs. Pelosi, Mrs. Lowey, and
myself, and Helen Bentley on the other side--a feisty,
wonderful woman.
But I think, Mr. Chairman, in terms of focus of this
committee and where it goes and what it does not only on just
women's health and those issues, but broadly, with the
portfolio that exists in the committee, that I think women have
made a difference; and the women members who come before this
committee every single year talk about issues that face this
Nation broadly and, I think, make a remarkable contribution to
what is being done.
Just one additional thing: When I first came here, it was
only 10 years ago, I worked with women here who were courageous
in charting the waters for the NIH, doing clinical trials for
women and for minorities, and for there to be an Office of
Women's Health at HHS; and because of the tenacity of the women
who served in this body longer than 10 years ago--I look at
people like Louise, Nita was here, it is people like Pat
Schroeder and Barbara Kennelly and Nancy Johnson who charted
the way--Connie Morella.
Thank you, Mr. Chairman. I apologize to my colleagues for
interrupting your testimony.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman.
I understand from my colleagues, Nita Lowey and
RosaDeLauro, that they both have meetings at 10:30. This makes my
arrival just right, so I can carry on for them when they leave. So I
just want to thank you guys and say again, like Rosa said, this is a
great committee and I really look forward to working on it.
On the pay equity, we had a wonderful press conference and
committee hearing up in Rhode Island about 2 weeks ago. The
response was overwhelming. My local newspaper carried it front
page, the whole story. My colleagues in the State legislature
are pressing for it; they say they are not going to go for a
budget that doesn't include it within State payroll. So it is
not just equal pay, but pay equity, that there is a point
system for jobs so that, you know, given experience and the
duties of the job, that is going to be the criterion by which
people are paid, not a set, you know, number of jobs that are
set up.
So anyway, thank you, Mr. Chairman. Thank you, my
colleagues.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you, Mr. Chairman. I am looking forward
to listening to my esteemed colleagues and helping them work on
this very important program. Thank you.
Mr. Regula. Well, thank all of you on the first panel. And
I just want to tell you, if my wife and daughter were here,
they would be cheering you on.
Ms. Slaughter. I am sure you will, as well.
----------
Tuesday, April 3, 2001.
NORTHEAST OHIO NEIGHBORHOOD HEALTH CENTERS
WITNESS
HON. STEPHANIE TUBBS JONES, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF OHIO
Mr. Regula. Our next panel. We have the three--oh, here is
Connie. Don't wait. We will go ahead. Is Connie on panel 4?
That is all right. Okay. It is very informal here.
Okay, we will take them in the order I have them here. But
you were here early, so we will start with you, Stephanie.
Mrs. Jones. I appreciate you giving me the opportunity to
plead.
Mr. Chairman, the Congressional Black Caucus is holding
election reform hearings somewhere in this building. I am
trying to get over there to all my colleagues.
Good morning. Just for the record I would like to add to
the names of some people who have been working in the past on
the issue of women's health: Mary Rose Oakar, as well as my
predecessor, Louis Stokes. I got that in.
I appreciate your extending time for me to relate some of
the very urgent concerns of the 11th Congressional District
regarding the provision of health care at federally qualified
community health centers.
Northeast Ohio Neighborhood Health Centers is located in
the heart of Cleveland and serves some of the most impoverished
neighborhoods in the city. As in most large cities, large
hospital health care providers have been migrating out of the
inner city. The end result of this migration is many more
uninsured for our health care centers to serve. The majority of
constituents served by these centers live under 100 percent of
the Federal poverty line. Many of these people are now working
but remain uninsured because their jobs do not provide health
benefits.
The rollout of Ohio's SCHIP has helped. SCHIP covers
children who live at up to 200 percent of Federal poverty
level. Moreover, the State of Ohio has expanded coverage to
adults living at 100 percent of the Federal poverty level.
The Northeast Ohio Neighborhood Centers have experienced an
increase of almost 10 percent in the uninsured patient base in
the last year, partially due to hospital closings. NEON is not
the only provider that has suffered immensely from managed care
in our city.
Approximately one-half of NEON's 35,000 patients are
children. Approximately 28,000 of those 35,000 patients live
under 100 percent of the poverty level. Many of them have
mental health or drug and alcohol problems as well as diabetes,
hypertension, cancer or high-risk pregnancies, as well as other
health issues that often parallel living in poverty.
Twenty-three physicians and six dentists logged more than
115,000 encounters in the year 2000. NEON provides
transportation, translation and counseling to encourage and
empower patients.
Despite the hospital closings, managed care and numerous
other earth tremors in the health care system, NEON's
community-based system of five health care center sites is
still open and providing care.
I will skip over only to say that the neighborhood health
centers need additional support for them to continue to be able
to provide care.
In my district we lost two large hospitals in this control
of the health care delivery system; and only on Sunday, in the
Plain Dealer newspaper, it was reported that many of the
hospitals are diverting patients. They close down their EMS
center, their emergency room; and, therefore, the EMS trucks
have to go to the next hospital, the next hospital. That has a
significant impact on the delivery of health care.
Very quickly, we would like to have $600,000 to do MIS
upgrades or information management upgrades, as well as we seek
$3,800,000 in addition to the MIS for many of the facilities
that NEON operates. The facilities are old, and they are in
need of renovation to be able to continue to provide care.
I thank my colleagues and the Women's Caucus for giving me
the opportunity to be heard today. I would ask this committee
to keep in mind the desperate need of community health centers
in our Nation and the need for them to provide care. I submit
my testimony for the record.
Also, let me not forget, there--I should say that,
incidently, Mr. Chairman, you may also know that there is a
center comparable in your community in Massillon.
Mr. Regula. I am very aware of it. They reminded me several
times.
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Tuesday, April 3, 2001.
VARIOUS PROGRAMS
WITNESS
HON. CONNIE MORELLA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MARYLAND
Mr. Regula. I think what we will do is do the panel and
then questions, because we have a pretty full schedule here to
get through today. So, Connie, you are next.
Mrs. Morella. Thank you, Mr. Chairman.
I want to begin by congratulating you on the chairmanship
of what I consider one of the most important subcommittees of
the Appropriations Committee and thank you for extending to us
this opportunity to testify before you. And, Ms. DeLauro, I am
wearing my red for Equal Pay Day.
Mr. Regula. Isn't there equal pay in the Congress?
Mrs. Morella. Well, it is--actually, I would say it is one
of the few places where we are pretty close to equal pay, but
in so many other areas that is not the case.
Among my top priorities is the continuation of our
commitment to double the budget for the National Institutes of
Health, and we are on the right track. We are in year number 4
of the 5-year plan. The President has called for
$23,100,000,000, which is a 13.8 percent increase. To keep on
track, we could use $23,700,000,000.
Let me jump around to a couple of other issues that are
important to all of us and indeed to me.
Since 1990, I have been the sponsor of legislation to
address women and AIDS issues. Women are the fastest-growing
group of people with HIV, with low-income women and women of
color being hit the hardest by the epidemic. AIDS is the
leading cause of death in young African American women.
We particularly urge your support for the development of a
microbicide to prevent the transmission of HIV and sexually
transmitted diseases at a level of $75,000,000. Currently, less
than 1 percent of the budget for HIV and AIDS-related research
at the National Institutes of Health is being spent on
microbicide research. Actually, I would like to see the
important work of the Office of AIDS Research quickly converted
into a proactive, strategic plan for microbicide research and
development that has the active involvement and support of NIH
and institute leadership. Much progress has been made, but more
needs to be done.
You know, microbicides, I remember many years ago when I
first introduced legislation I couldn't pronounce microbicide,
but it is so critically important to making sure that we don't
have HIV and AIDS and sexually transmitted diseases. It is like
a vaginal solution that has nothing to do with a spermicide, so
it is not a birth control method; and, boy, what a difference
this would make in the world.
I would like to jump to breast cancer. Mr. Chairman, as you
know, women continue to face a one in eight chance of
developing breast cancer during their lifetime. More than
2,600,000 women are currently living with breast cancer. This
year alone more than 183,000 women will be diagnosed with
breast cancer, and 41,000 women will die of the disease.
This subcommittee has clearly demonstrated its commitment
to breast cancer research. We urge you to continue this
momentum in this fiscal year 2002. On behalf of all the women
who live in fear of the disease, we urge the subcommittee to
continue its strong commitment.
And, Mr. Chairman, although it is not a widely known fact,
tuberculosis is the biggest infectious killer of young women in
the world. In fact, TB kills more women worldwide than all
other causes of maternal mortality combined. Currently, an
estimated one-third of the world's population, including 15
million people in the United States, are infected with the TB
bacteria; and due to its infectious nature TB can't be stopped
at national borders. So it is important to control TB in the
United States, and it is impossible to control it until we
control it worldwide. I urge support for an annual investment
of $528,000,000 for the Centers for Disease Control in its
efforts to eliminate TB. Of course, there is that multiple-
drug-resistent strain of TB that is so dangerous.
The Violence Against Women Act is a very important
priority. We reauthorized it, added some new programs. Now I
respectfully request that the funding become a priority for
this subcommittee; and I am requesting that the shelters under
the FVPSA, which is the Family Violence Prevention Act, be
funded at their authorized level of $175,000,000 for fiscal
year 2002.
Also, transitional housing that Asa Hutchinson and Bill
McCollum helped to put into that bill, the transitional housing
program to be funded at its original and one-time authorization
level of $25,000,000.
Rape prevention and education to be funded at its full
authorization level of $80,000,000 for fiscal year 2002.
Several other programs I have mentioned in the testimony
that I am submitting but are, very briefly, the Women in
Apprenticeships and Nontraditional Employment Act, I introduced
that many years ago, it has been working well on $1,000,000, to
continue it. The Campus-Based Child Care Program, which is
working to allow low-income women to have some assistance with
child care on college campuses. What a great way to get them
off of welfare and into the work world.
That being said, you are very kind and gracious, you and
the members of this subcommittee, Mr. Sherwood, and I see Ms.
Pelosi is here. We had Ms. Lowey, Ms. DeLauro and Mr. Kennedy
listening to us and hope that you will be able to accommodate
these.
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Tuesday, April 3, 2001.
PREVENTION OF DOMESTIC VIOLENCE
WITNESS
HON. SHELLEY BERKLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEVADA
Mr. Regula. Could you all stay when you finish the panel?
Then we will take the questions. Because we are on a pretty
tight schedule to get through all the other witnesses.
Ms. Berkley.
Ms. Berkley. I am delighted to have an opportunity to
testify before this subcommittee which enjoys a wonderful
reputation for tackling issues of major importance to women and
children and families in our Nation and has been instrumental
in improving the quality of life for millions of American
families that, prior to your interest and actions, had little
hope for their futures or the futures of their children.
I want to thank you for allowing me to speak today in
support of increased funding for programs to prevent domestic
violence. Crimes of domestic violence have devastating
consequences for women personally, as well as for their
families and for society as a whole. In my district of southern
Nevada, I have visited shelters for battered women and talked
with law enforcement officers, counselors and community
leaders. I had an opportunity to do a drive-along with the
police when they were doing their domestic violence shift, and
I have seen firsthand the horrible effects domestic violence
can have on a community. That is why today I ask you to
continue efforts to prevent domestic violence by fully funding
domestic violence grant programs within the Department of
Health and Human Services.
These programs, which include grants for rape prevention
and education, community intervention and prevention
organizations, as well as the National Domestic Violence
Hotline, are vital to the fight against domestic violence.
Of particular importance, however, is funding that supports
shelters for battered women. These shelters are often the only
source of protection and relief for women who are fleeing from
a violent situation.
Women across the country need the services that domestic
violence programs provide; and, again, I urge you to fully fund
these programs.
I have had an opportunity to tour all of the domestic
crisis shelters in southern Nevada in my district, from the
ones where people are going just for a very temporary 24-hour
situation to get them out of their house, get their children
out of the house, to the more complex situations where, when I
went to visit the shelters, they blindfolded me and drove me
there because these are places that are so secret that the
perpetrator of the violence cannot find his family and continue
to perpetuate the crime against his family.
Most of these women, when I sit down and speak to them,
they tell me how desperate they are to have a place to go not
only for themselves but particularly for their children. Many
women are stuck in a violent situation because theydon't have
anyplace to go, and they endure incredible violence in their homes
because they are afraid to be without an income, without a roof over
their heads, without shelter for their children.
If we can provide this tool for them to get out of those
situations, they can break this dependency and codependency
that they have on the perpetrator of the violence and begin to
get the counseling they need and break out of the situation and
be able to take care of not only themselves but their children
as well. Many times, it is just a shelter to house them until
they can get on their feet. But if we don't provide this they
will end up back in the abusive situation.
When I was practicing law I spent a good deal of my pro
bono time trying to help these women get out of the situation,
provide them with low-cost divorces. But it wasn't--it was the
dependency, it was the emotional damage, it was the
psychological fear that they had of breaking that tie and
getting out of their home and feeling that without that home
they would be destitute and on the streets. And for many of
these women they endure incredible pain and incredible violence
just so their children aren't out in the streets.
Again, I want to thank you very much, but unless we fully
fund these domestic crisis shelters we are going to have this
problem in perpetuity; and the cost to society is far more
extensive if we don't spend the money to fully fund these
shelters and these programs than if we don't.
Mr. Regula. Thank you.
Are you familiar with Parents Anonymous? It is--at least in
Ohio they are pretty active where they--it is like single
mothers can go and talk to each other and get help. It is a
support group and somewhat goes to what you are discussing
here.
Ms. Berkley. There are many programs available, but in the
final analysis, if the women has to go back to that violent
environment, she is never going to break the cycle.
Mr. Regula. Very true.
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Mr. Kennedy. Mr. Chairman, these grants also help us
identify those children, because the National Institutes of
Mental Health have developed an absolute correlation between
children from families with domestic violence and drug abuse,
cognitive delay in learning and further violence within the
family among these children. This is absolutely a determinative
in terms of the cycle of violence. So these grants have another
effect of allowing us to try to address the needs of these
children along with their mothers in many cases.
So I look forward to working with you on making sure that
we get some training for these kids, too, when they face these
situations. A couple of States have done very well by these
grants to get the whole families involved.
Thank you, Mr. Chairman.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Well, the testimony is very compelling; and
we have all in our private lives seen examples. If there is
anything that we can do, such as these grants, to put that
behind us, we are certainly on the right track. Thank you.
Mr. Regula. Ms. Pelosi.
Ms. Pelosi. Mr. Chairman, while I was listening to the very
excellent testimony of Representative Berkley, especially
toward the end when she was talking about her own experience
doing pro bono work, I was reminded of our work together when
we were on Commerce, Justice, State together. We were able to--
I had worked with Senator Cohen, others in the Senate and
this--not Senator Cohen, others in the Senate on the Republican
side where we tried to make--for women to have legal
assistance. They were testing the income of the spouse.
So we had an amendment in our Commerce, Justice bill for
legal assistance that would say that the income of the spouse
would not be counted against the woman when she tried to get
some legal assistance, some legal aid. Which made a very--as
you well know, you graciously did pro bono work, but everyone
is not able to avail themselves of that. So that made it a
difference, too.
But this has been a fight for a while in the Congress to
get as much as possible for these grants. It is one of the
proudest moments that we have, when the Women's Caucus comes
before us with this array of issues that are so important; and
we have been able to make a substantial difference in many
areas of health, Mr. Chairman. Everybody understands that this
is a tricky issue, because everyone is uncomfortable with it
and all the more reason we have the maximum resources to do it.
So I am glad the Women's Caucus has made this a priority.
Mr. Regula. As you pointed out, you and I have been
champions of legal services in Commerce, State because that is
one way that women can get help that otherwise just wouldn't be
available.
Tuesday, April 3, 2001.
COMMUNITY HEALTH CENTERS
WITNESS
HON. LORETTA SANCHEZ, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mrs. Sanchez.
Ms. Sanchez. Thank you, Mr. Chairman, and congratulations
on your chairmanship. Thank you to the entire subcommittee for
allowing us to come before you to testify today.
I would lend my voice to many of the issues that--probably
all of the issues that these women are going to talk to today,
but in particular I want to take a couple of minutes to talk
about increasing the funding for community health centers. We
would like to see an increase in the amount of $250,000,000.
I will tell you, it is some of best money that we can
spend, because this directly affects areas that are usually low
income, as parts of my district are. It is about putting health
care readily accessible to people there, because they either
don't have transportation or they do not have an ability to get
off work or they have children they have got to take care of or
they have to bring the children with them.
What happens when you don't have community health clinics
is that people don't go and see a doctor. When they do go and
see the doctor, it is with a very chronic problem already when
they walk through the front door. Where is it that they go?
They don't go to a clinic. They go to an emergency hospital
where they know it is the highest cost of delivery in the
entire health care system.
So when we are able to put these community clinics in areas
where people can come, they can come with their kids, they can
walk, they are readily available, they are open on Saturdays
and Sundays, and they can get preventative medicine. They can
work on issues of nutrition for diabetes, for example, where
the Latino community has about five times the amount of
diabetes in our community than anybody else in the United
States, and that is simply because of nutrition. There are
problems that we have that become very expensive if we don't
get access to health in a meaningful way to people in lower
income areas.
One of the things that has happened in my district and why
I feel so strongly about this is that we are now seeing what we
call back room clinics in pharmacies. So if you go to an
independent pharmacy or you go to a drugstore that doesn't even
have a pharmacy there in my area and you need something, you
need medication for your kid, your kid is sick, what is
happening is that these people are taking them into the back
room, somebody who is not even a doctor is analyzing what is
wrong with this kid and giving them drugs that are either
coming in, brought across the border from Mexico--and we have
had, just in the last 6 months, an 18-month-old baby girl and a
15-year-old boy die because of illegal drugs, prescription
drugs coming from someplace else being given to these kids. And
these parents are--this is the kind of health care that they
think they can afford.
So the more that we can do to put in neighborhood clinics
the better it will be for all of us in the long run. We don't
need to lose these kids simply because parents are doing the
best that they think they can do in a system that is pretty
much ignoring them.
And I am talking about working people. I am talking about
people who have taxes taken out of their paychecks. I am
talking about people who pay taxes when they go and they buy
everything at the store. These are people who are low income
and need the access to health care.
So I would hope that you would really consider increasing
the amount towards the community health care centers.
Mr. Regula. Thank you.
Any questions?
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Tuesday, April 3, 2001.
TRANSITIONAL HOUSING
WITNESS
HON. JANICE D. SCHAKOWSKY, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF ILLINOIS
Mr. Regula. Our next witness is Mrs. Schakowsky, the
successor to my great friend, Sid Yates.
Ms. Schakowsky. As I was going to say, Mr. Chairman, though
you and I don't know each other very well, I feel very warmly
toward you because of the great relationship that you had and
the things Sid Yates said about you, so thank you very much.
Mr. Regula. I still miss him. He used to call me after I
was gone to tell me how to run the committee.
Ms. Schakowsky. Well, I wanted to also talk about violence
against women and the needs for transitional housing, and I am
so glad that Connie Morella spoke to you about it. Shelly
Berkeley talked about the need for shelters.
I wanted to particularly emphasize the $25,000,000 for
transitional housing that was authorized in the Victims of
Trafficking and Violence Protection Act of 2000. So I am hoping
that that money now can be appropriated.
The Department of Justice has identified 960,000 women
annually who report having been abused by their husbands and
boyfriends, but we know that number is really just the tip of
the iceberg. The first comprehensive national health survey of
American women conducted by the Commonwealth Foundation says
that 3.9 million American women actually experience abuse by an
intimate partner each year, 3.9 million.
Hundreds of these women, hopefully thousands, are able to
get out of those situations, but they have few financial
resources and often have no place to go. Lack of affordable
housing and long waiting lists for assisted housing mean that
many women and their children are forced to choose between
abuse at home or on the streets.
While we absolutely need more money for shelters because
they are filled to capacity right now, we know that, in fact,
50 percent of homeless women and children--that is, 50 percent
of the families, the women and children who are homeless right
now are fleeing abuse. So the connection between housing and
abuse is overwhelming.
Housing can prevent domestic violence and mitigate its
effects. Shelters provide immediate safety to battered women
and their children and help women gain control over their lives
and get on their feet. A stable, sustainable home base is
crucial for women who have left a situation of domestic
violence. While dealing with the trauma of abuse, they are also
learning new job skills, participating in educational programs,
working full-time jobs or searching for adequate child care in
order to gain receive sufficiency. Transitional housing
resources and services provide a continuum between those first
emergency shelters and independent living and so those
transitional housing dollars are very important.
According to estimates by the McAuley Institute,
$25,000,000 in funding for transitional housing would provide
assistance to at least 2,700 families. We must be supportive of
individuals who are escaping violence and seeking to better
their lives.
In closing, let me reiterate my appreciation to the
subcommittee and restate my strong support for providing safe
transitional housing assistance to women and children fleeing
domestic violence. Thank you.
Let me just, on a personal note, mention that my last visit
to this committee last year I was sitting next to Loretta
Sanchez. Actually, it was sort of depressing because she was
talking about being in the first Head Start class and how
important it was, and I was there to talk about being the
first--teaching the first Head Start class. I thought, oh, my
word, the difference here. But I am so happy that so many of us
are here today talking about domestic violence and the
importance of providing the support for women seeking to flee
that.
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Mr. Regula. We hope that in Head Start we can maybe improve
on it and make it a little more of an educational experience,
rather than just warehousing of kids. That tends to be the
characteristic of it, and I think you will miss a great
opportunity in Head Start to not do more on the education side
of it. I have never figured out quite why it was in the welfare
department and not in the education department.
Ms. Schakowsky. Head Start has been a wonderfully
successful program.
Mr. Kennedy. Mr. Chairman, on the Head Start, the thing
that the teachers say is most important is the social and
emotional development of the child. That is what gives them the
cognitive advantage over those kids that haven't gone through
Head Start. So it is not so much that they are learning their
ABCs, but they are in an environment that starts to make it
conducive to learning down the road. So it is kind of an
interesting thing. But it is not the cognitive development so
much at Head Start, which is what we think it is, but it is the
social and emotional development, which I might add is lacking
in our other primary education, which we need to work on.
Ms. Schakowsky. I agree. I didn't want to step on my own
message, though. I wanted to be sure that I am focusing here on
the $25,000,000 for the transitional housing.
Mr. Regula. This committee has a broad jurisdiction.
Any other questions? Thank you very much.
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Tuesday, April 3, 2001.
ENFORCEMENT OF WORK PLACE PROTECTIONS
WITNESS
HON. HILDA SOLIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mrs. Solis.
Ms. Solis. Thank you, Mr. Chairman and members. It is a
pleasure to be here for the first time to speak before your
subcommittee; and I want to add my comments also, along with
those that have been made by previous members, regarding health
care research and the whole issue of domestic violence.
Just as kind of a footnote there, in my own district I was
successful in getting one shelter established in Los Angeles
County in the area that I represented. It is a really sad
situation when you think about all the animal shelters that
exist in my district.
When you put a price at where you value human life and what
have you, we only were able to get funding for one shelter. So
much more is sorely needed.
I would hope that this committee would strongly take a good
look at how we can enhance partnerships, both public and
private, with law enforcement, so we can have both permanent
shelters for those and transitional.
Our problem in our district is that we have many women who
are faced with this issue of domestic violence, and with that
bring their children. In cases for Latinos, for example, you
are talking about 4 or 5 siblings, children that come along
with that one woman, who is looking for a place to go and
possibly a warm meal, a roof over her head, but also the
opportunity to find employment. So I would hope that this will
be a priority for this coming session.
But my remarks, I would like to focus in on the issue of
enforcement of Federal wage and overtime laws by the Department
of Labor. As you go through in crafting the Labor-HHS funding
budget for fiscal year 2002, I would like to urge the committee
to allocate sufficient funds for the enforcement of workplace
protections.
This issue is very critically important to women, not just
in my district, but in many corners of our country,
particularly in those areas where you find an enormous number
of low skilled workers, women in particular, who are working,
as an example, in the garment industry.
My district has a very high proportion of individuals who
work in the garment industry. Unfortunately, a few years ago it
was discovered there was a sweatshop in the City of El Monte,
which I happen to represent. There were 72 women, Thai women,
that were held hostage there, many for 7 years. They did not
mention though, however, in those news articles, there were
many Latino women also working there day in and day out and
were forced to work under very harsh conditions and were not
given minimum wage, were not given overtime, were actually
placed in a warehouse setting where they were pretty much
locked in and could not leave the compound as it was later
viewed by the public.
I would hope that we could do as much as we can to help to
provide information to the workforce, but particularly women
that tend to be attracted to this particular type of industry,
because it is a problem, not only in California, but along the
border and other parts of the country, where I believe we need
to do more to provide those protections for women and their
children, because we also know there are many children working
in it these factories as well.
Because of a lack of resources in the past few years and
also on the part of our local municipalities that may not have
enough funding to follow through on code enforcement to really
go through and find out if, for example, a true small business
is actually working legitimately and that they are paying for
their licenses and what have you. We are finding there has been
a cutback in these areas, and obviously that leads to more
abuse.
So I would hope that this committee would take a strong
look at protecting the rights of women in the workplace as we
work towards pay equity. We also have to work towards a place,
an environment, where they can work and be treated with
dignity, and that they are fully aware of their rights when
they are at the workplace, and that the employer also plays a
meaningful role in providing that kind of information as well.
This year we are going to be working on trying to elevate
the minimum wage. In the State of California, we happen to have
a higher minimum wage than here at the Federal level, and I
hope we can work in partnership to bring some equity. That
isn't to say where I would like to see it. I would like to see
it much more higher, but at least it is a start. I would hope
we can venture into those discussions.
I would like to thank you for the opportunity to speak to
you today.
Mr. Regula. Thank you. We will bring this issue up with
Mrs. Chao when she testifies, because it would be her
department responsibility.
Questions.
Ms. Pelosi. No questions.
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Tuesday, April 3, 2001.
SCHOOL-BASED LATINO MENTAL HEALTH SERVICES
WITNESS
HON. GRACE F. NAPOLITANO, A MEMBER OF CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Thank you very much. Our next witness is Mrs.
Napolitano. Am I saying it right?
Ms. Napolitano. You are very right on, sir.
Good morning, and thank you so much for the opportunity you
have given the Women's Caucus to come before you and bring the
issues that all of us feel are important. I associate myself
with the remarks at every turn.
One of the reasons, Mr. Chairman and members, that I am
here, is because there is an issue that has been identified in
the last 2 years dealing with youth mental health crisis in
this country. Recent incidents in school shootings only add
more urgency to that particular matter, and that is the reason
why I am here, again, to respectfully request you continue
support for the school-based Latino mental health services
program in my an area. It is a pilot we begun.
Let me provide some disturbing facts that illustrate, and I
am sure you heard them before, but I just need to get them to
you again, the depth of the crisis for young Latinos in the
country.
Today, nearly one in three Latino adolescents has seriously
considered suicide. This is the highest rate for any racial or
ethnic group in the whole country. Additionally, they also lead
their peers in the rates of alcohol and drug abuse, teen
pregnancy, and self-reported gun handling.
These statistics are all more alarming when one considers
that fewer prevention and treatment services reach young
Latinos than any other racial or ethnic group. This is a report
that came to us in 1999 with the state of Hispanic girls
through the National Alliance for Hispanic Health, a
conglomerate of groups that provide mental health services for
Latino groups. This is in spite of the fact that Hispanic girls
now represent the largest minority of girls in the country, and
are expected to remain so for the next 50 years.
Last year this subcommittee gratefully took a major and
laudable step when it directed SAMHSA to provide $680,000
through the programs of national and regional significance
activity, center for the mental health services, to begin
addressing the mental health need of Latino adolescents through
innovative school-based mental health services in our area.
What we have done is we have taken the nonprofit mental
health care provider and all other mental health advisers and
have gone to the schools, setting the program actually in three
middle schools and a high school, to give the direct services.
The funding does not go to the State, does not go to the
county, but goes directly to the providers and the schools
where the most need is.
Now I am asking, I am urging and I am begging the
subcommittee to give this fledgling pilot program an
opportunity to make a difference in the lives of these young
women and many others. School administrators, teachers,
community mental health providers, and parents, and, most
importantly, young Latinos believe this program is urgently
needed.
This subcommittee and Congress has begun to provide
national leadership in dealing with this crisis and in finding
appropriate solutions. Our aim as a society should be to help
these young girls reach their true potential and allow them to
make positive contributions to their communities, to their
State and to their Nation. Failure to do so may condemn a
generation of young girls to lives that are significantly less
hopeful and productive than they deserve.
Again, I respectfully request the subcommittee to continue
providing this program at the same level of funding as last
year, and hopefully this program will provide a way for
duplication throughout other areas where it may be so
desperately needed at this point.
Thank you again for the consideration, and look forward to
answering any questions you may have.
Mr. Regula. Thank you. Questions.
Mr. Kennedy. Yes, Mr. Chairman.
I applaud you for your work on this. I have been working
with the chairman to address this issue. Would you kind of
explain further how the schools end up being a non-stigma
environment so the kids can get the help in the schools, rather
than in some mental health counseling outside, which would
certainly be so loaded with stigma, and of course explain the
culture, the Latino culture, so that it really oppresses people
with this mental health issue. We think we have got a stigma.
Imagine what it is for the Latino culture.
Ms. Napolitano. It is a tremendously important area to be
able to provide the service in the school itself. Understanding
that my Latino friends and relatives and my peers and everybody
else, they consider it an area that you don't go. You don't
talk about it, you don't bring it up. Especially in the male
Latino, you just don't admit that you have a mental problem.
The stigma is they don't know the difference between a
mental health issue and a mental disease issue. Part of what
has happened in our society, and the Latino society
specifically, is this has carried on to the family, you are not
allowed to admit you have a mental problem or a mental health
issue that can be dealt with, that you can talk out.
So the idea is to have it in the schools where the peer
pressure is. These teachers can be a part of it. The parents
will be a part of it. This is not just a school thatis going to
be involved. It is a whole community effort by bringing all the players
in at the school to deal with the issue.
The classrooms are going to be set up so that they can go
to specific rooms to deal with it, and there will be classes
given to others that do not have the same problem of dealing
with mental health issues, but rather to understand that it is
not a stigma, but rather an idea for them to identify, in their
own mind, how they can deal with pressures and those kind of
issues.
Mr. Kennedy. Thank you very much.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Ms. Napolitano. Thank you.
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Tuesday, April 3, 2001.
ON BEHALF OF CHILDREN WITH MENTAL ILLNESS AND HIV/AIDS
WITNESS:
HON. SHEILA JACKSON-LEE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS
Mr. Regula. Okay. Ms. Jackson-Lee.
Ms. Jackson-Lee. Thank you very much, Mr. Chairman. It is
nice to see you, and thank all the members for being here on a
Tuesday morning. Might I associate myself with all of my fellow
colleagues from the Women's Caucus and their different issues.
Might I particularly associate myself with my colleague sitting
next to me on the issue of mental health.
I have offered, over the last two sessions, the Omnibus
Give a Kid a Chance Mental Health Bill, that deals with
providing more resources for children that are dealing with
mental health concerns. I would like to give you what you may
already know very quickly, and then focus in particular on the
concerns that I have.
Mr. Chairman, I think you may be aware that 13.7 million
children in this country have diagnosable mental health
disorder, yet less than 20 percent of them receive treatment.
The White House and U.S. Surgeon General have recognized mental
health needs to be a national priority in this Nation's debate
about comprehensive health care.
I have found that at least 1 in 5 children, adolescents,
have a diagnosable mental, emotional or behavorial problem that
may lead to school failure, substance abuse, violence or
suicide. However, 75 to 80 percent of these children do not
receive the services.
According to a 1999 report of the U.S. Surgeon General for
young people 15 to 24 years old, suicide is the third leading
cause of death behind intentional injury and homicide. In
particular, in the African American community, the U.S. Surgeon
General has found that the rate of suicides among African
American youth has increased 100 percent in the last decade.
Black male youth, ages 10 to 14, have shown the largest
increase in suicide rates since 1980 compared to other youth
groups by sex and ethnicity, increasing 276 percent. Almost 12
young people between the ages of 15 and 24 die every day by
suicide.
When we speak about another selective group in the study of
gay male and lesbian youth suicide, the U.S. Department of
Health and Human Services found lesbian and gay youth are two
to six times more likely to attempt suicide than other youth
and account for up to 30 percent of all completed teen
suicides.
I interact with such a group, family group, in Houston,
working with these young people in particular, trying to make
adults available to be engaged in their lives. You see it
firsthand because, as my colleague said, they are intimidated,
they don't know where to turn for information. They are
different, whether they are Latino, whether they are African
American, whether they are different by way of a lifestyle,
whether they are different by way of their particular religious
background.
Mr. Regula. Do you think they recognize that they have a
need?
Ms. Jackson-Lee. No, Mr. Chairman. I think, as my colleague
has said, sometimes it is culturally different, sometimes there
is a cultural difference. If I take my community, the African
American community, very heavily based in religious beliefs, it
is well-known that you are directed toward your Savior, and, if
you are not grounded in that, then you are not directed
anywhere. It is a stigma in the community, and I would argue,
not having firsthand experience to the gay and lesbian
teenager, but as I have been told by groups that advocate for
them, they particularly are isolated because they are
different. So I think what it is is that I don't know what I
have, I am confused, but no one will understand me.
So I think that this whole concept of having services,
whether it is in the schools, which I support, whether it is in
community-based health clinics, which I support, because I want
parents to be able to feel free who are not able to access the
private sector for psychiatric or counseling service, to have
the access to do this.
This is not a conversation about guns, Mr. Chairman. I know
it is well known, my position, but I think over the last 48
hours, we have saw some studies that were shocking aboutteenage
boys being able to have access to guns or bring guns to school. So we
know that our children suffer from gun violence. Handgun Control
reports that in 1996, more than 1,300 children, aged 10 to 19,
committed suicide with firearms.
What I would like to get at is the intervening act factor,
to be able to help these young people before they get to that
point.
With the high number of uninsured young people, Texas has
the second highest rate of uninsured children in the Nation
with over 25 percent, there are programs that you support that
I would like to ask for increased support.
The National Mental Health Association has a children's
mental health services program that provides grants to public
entities for comprehensive community-based mental health
services for children with serious emotional disturbances.
These grants go to direct services that include diagnostic,
evaluation services, outpatient services at schools, at home,
and in the clinic, and day treatment. I would like to see that
funded and provided additional funding.
In addition, I would like to see parity for alcohol and
drug addiction treatment for young people and their families. I
emphasize their families, Mr. Chairman. I think that is an
excellent combination, because many times the adults in the
home, whoever is the supervising adult, a grandmother maybe,
are as much in need of service as might be the child.
I met with these individuals through the National Mental
Health Association, and I had grandmothers raising 15-year-olds
who already had a child and already tried to attempt to commit
suicide 2 or 3 times, a little girl 15 years old. And to see
the grandmother who was not that old to have to confront the
needs of this 15-year-old, they both needed to be in
counseling.
The Children Mental Services Health Program only serves now
34,000 children, so I ask the committee to authorize $93
million for that. The Safe Schools Health Student Initiative is
another program of the Children's Mental Health Services
Program, and I would ask for $78 million involved in that
program.
Quickly, Mr. Chairman, I want to move from mental health
and focus briefly only on children as victims of HIV-AIDS. I
know this may have been previously discussed.
I support a particular community organization called the
Donald R. Watkins Memorial Fund, which has seen its dollars cut
drastically. It is estimated that 800,000 to 900,000 Americans
are living with HIV and every year another 40,000 become
infected.
I happen to come from a community in Houston that at the
time of the issuance or the establishment of the Ryan White
treatment dollars, we were 13th in the Nation of HIV infected.
That was about 1991-92. My particular community has not
decreased as much as we would like, and we find a large number
of our young people infected with HIV-AIDS. In fact, we find a
large number of African American's infected, and particularly
children.
So I would ask to receive a total additional amount, I
believe this is $4 million during FY 2000, and even more during
FY 2001. Let me get this amount into the record. I am asking
for an increase for $89 million for Title I, $45 million for
Title II, $46 for Title III, $19 million for Title IV, so
Houston will receive additional funds, as well as the Nation,
and I am particularly asking for direct grants for Donald R.
White Memorial Foundation for $500,000 for their special
services dealing with children and young people.
I will conclude, because my statistics may be a little
long, to simply say that Andy Williams in California,
Columbine, we can all talk about guns, we can talk about taking
guns away from children, but these children are disturbed. And
as I followed this, I had a hearing in my district with Senator
Wellstone. It is amazing. First of all, what we do is we put
most of them in a juvenile justice system, because we don't
have any place to put them.
The parents don't know what to do. The parents don't
intervene soon enough. If we had just known, or Andy Williams
had somewhere to go to talk about this bullying or maybe talk
to the children about character issues. And I think mental
health, if we can destigmatize it and ensure that children feel
free--it is just like coming to a counselor or going to Burger
King or McDonald's, to be able to express your feelings, we
might not have all of these painful situations that are
happening in our community.
I am with these children, I talk to the gay and lesbian
youth, it is really an emotional situation when you speak to
them. No one cares about them.
I just think we can do better. I know how we are fighting,
when I say fighting, I know the difficulty of appropriators. I
appreciate all of you very much. But this has gotten to be a
crisis in our Nation, not taking care of our children who are
disturbed and resulting in adults who are dysfunctional.
So I would appreciate very much your indulgence. I conclude
by simply saying I had an amendment on underserved populations
in the last Congress, and this is what this is all about, many
underserved populations, because they are not getting some of
the services that they need.
Mr. Regula. I think you are suggesting that there ought to
be counselors available somewhere for this disturbed youth to
go.
Ms. Jackson-Lee. Somewhere, and it can be either theschool-
based efforts, that I support enthusiastically, and then there are
these community-based mental health clinics that, because they are in
the community, they can be called any manner of names. Whether they
have to be called mental health clinics, they become familiar.
The National Mental Health Association has interfaced with
this structure, where they put them in the community and the
parent, the guardian, whoever it is, can go with the child, and
it may be down the block, or it may be just a few blocks away,
or maybe connected to the school, or it may be connected to
some community-based group. But what it does is it allows the
families to come without stigma and also not go very far away.
When you hear the word ``psychiatrist'' or do you have to go to
a doctor's office, these are community-based entities that may
be helpful. I think they are in only 34 States right now.
Mr. Regula. Could they be part of the community health
centers? We have had testimony here about the importance of
those.
Ms. Jackson-Lee. That is part of the effort of the National
Mental Health Association. We would like to see more funding so
they could be in more states.
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Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman. This is not social
science; this is not soft science. We have the Surgeon General
just come out with his report on children's mental health. This
is part of the health. The brain is like any other organ. It is
like diabetes, asthma, it is a chronic illness, it needs to be
treated regularly.
We have one in five children, according to the Surgeon
General's report and as Ms. Jackson-Lee pointed out, who have
severe emotional mental illness, and the schools are one of the
primary places to capture them, because that is obviously a
non-stigma environment.
In addition to that, as Ms. Jackson-Lee pointed out, the
community health centers are good places. But what we also need
to do is train the primary care physicians to identify
depression and mental illness. You would be surprised how many
regular primary care general physicians do not know how to
identify this, and therefore it goes undetected.
You also, being a member of Commerce-Justice-State, the
Office of Juvenile Justice and Deliquency Prevention, the
juvenile crime rate is going up. What is the surprise?
We know through sociological studies that parents are
spending one-third less time with children today than they did
just a couple of decades ago. If you don't think that comes
with a price, when you have two parents working or it is a
single-parent family, where that child doesn't see the parent
until the end of the night and the child has to be put to bed,
this is a significant cost to our society. We need to bring the
families together somehow, and hopefully these kinds of
programs will help do it. I just wanted to pass that along.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Mr. Regula. Mrs. Pelosi.
Ms. Pelosi. Mr. Chairman, I just want to associate myself
with Mr. Kennedy's remarks. We have to have parity in terms of
mental health and what other people call other health issues. I
particularly want to commend both of our witnesses for their
focus on the School-Based Mental Health Initiative, and also
Congresswoman's Jackson-Lee's testimony about HIV-AIDS, and I
want to say that thanks to both of our witnesses and many women
here this morning, we were able to send a letter to President
Bush on March 29 signed by 153 members in a bipartisan fashion
to talk about the AIDS epidemic.
I think that at some point we will have the opportunity to
meet with the President on this subject, and the subject of
young people and HIV-AIDS, which is certainly an important
component of it. We are optimistic we can meet with the
President.
Good work on these issues. Mr. Chairman, the testimony that
people bring in for a few minutes is important to us. This is
like the tippy-tippy-tip of the iceberg of the work that they
do in that regard. Thanks to both of you.
Mr. Regula. I would be curious, since the Secretary of
Education is from your town, did you have anything in the
school system there, any counseling, that would be accessible
to students in a disturbed state?
Ms. Jackson-Lee. We were beginning to make some progress on
school-based health clinics. In those health clinics we had
individuals who could stand in for counselors. When I say that,
nurses who were trained, et cetera, they could go right in the
school.
They are slowly but surely--in fact, we argued in the
present legislative session in Texas for more funding for
school-based clinics. But we, too, I would say the Secretary of
Education is very open to this, but we too need more growth in
those areas.
I will also I guess acknowledge that we have been--I will
knock on some wood here-- fairly fortunate in Houston, but
again, I don't take any special pride, because violence breaks
out anywhere and everywhere. So it is just that it is something
that we need to make great strides on.
Might I just say on the hearing that I had in Houston, the
juvenile justice officials came forward and noted
whatCongressman Pelosi noted and Congressman Kennedy noted, is that we
don't know what to do with these children. They said you are sending
them to us because we are the only physical plant they can be housed.
You would think they would say bring them on or we are
prepared to do it, but they were the ones pleading with us,
find us more mental health services because you are sending us
children who we can't treat, we can only house them.
Mr. Kennedy. Mr. Chairman, if I could, these kids who end
up in our juvenile justice system, you have 95 percent or
higher that come from abusive homes. This is, like, the
correlation is too great. We know which kids are high risk. We
ought to intervene earlier. These kids, by the time they end up
in the juvenile justice system, the parents know, the teachers
know, the schools know, for us to let them slip through its
cracks itself is criminal.
On the Elementary and Secondary Education Act with the
Education Secretary, this might be a good issue for us to try
to include somewhere in the Elementary and Secondary Education
Act, because it is so fundamental to the child's education.
Mr. Regula. We will have an opportunity when the Secretary
of Education is before us to talk about that, and probably one
of the things that teacher education should include is some
course or so that would, because the teacher would be a very
good person to identify disturbed children early.
Ms. Napolitano. They are with them a major portion of the
time, and they can tell when the student is beginning to act up
or the grades are beginning to fall.
Mr. Chairman, I have a mental health hospital in my area
and have been involved for many years at the adult level. We
have also different clinics from the Mental Health Association
that I have been involved with through the years.
They deal with really mostly the disease more than the
illness. I think it is time we began to add substance to the
local provision of services by giving some assistance to the
families, as my colleague was saying, for mental health
services.
What we are attempting to do is begin to show that the
partnership between the county and the State, adding additional
services, maybe not even in funding, but services, whether it
is personnel or whether it is a locale, so that we can expand
on the delivery of the service at the local level.
You are right. The correlation of the children, the
neglected one, the at-risk kids, all has a bearing, and we all
know those areas. So if we can target the areas and begin to
work with the community to be able to deal with the child, we
will be successful. That is what I am attempting to do, along
with my colleague.
Mr. Regula. Thank you both for coming. It is a significant
problem you have identified. We will do what we can.
Ms. Jackson-Lee. Mr. Chairman, may I ask a procedural
question on the time that members have to have requests in?
Mr. Regula. The 27th of April.
Ms. Jackson-Lee. It has not passed. Someone had given me a
date that caused migraine indigestion.
Mr. Regula. My experience in Interior is some requests may
not be timely, but they still get to the chairman.
Ms. Jackson-Lee. I am trying to meet your rules and
regulations. So you are saying April 27th?
Mr. Regula. That is correct.
Ms. Jackson-Lee. Thank you, Mr. Chairman.
----------
Tuesday, April 3, 2001.
RE: PROJECTS
WITNESSES
HON. BRAD SHERMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Sherman.
Mr. Sherman. Mr. Chairman, it is interesting to appear
before you in a new capacity. I want to thank the members of
the subcommittee for being here. I have had a number of
projects in my district that I think will interest the
subcommittee.
The first--I guess it works better when you turn the
microphone on.
The first is a request for $500,000 to help build the new
Guadalupe Community Center in the poorest part of my district.
It is a program run by Catholic Charities of Los Angeles. The
building program will cost $1.5 million. Private charities will
come through with one-third of that amount, the City of Los
Angeles roughly a third, and I am asking the Federal Government
to provide the final third.
The center serves 900,000 individuals from low income
families, 84 percent of its clients are Hispanic. It provides
emergency food, clothing, case management, senior nutrition,
welfare to work services, a youth mentoring program. Due to
immigration, there is a substantial additional need. The center
needs to expand so it can provide English as a second language
and computer and math skills. That is the first project on my
list, is a request for half a million dollars for the Guadalupe
center.
The next two projects are so important that I am
bringingthem to the subcommittee's attention, even though 80 percent of
the project is outside my district. The projects will take place
primarily in Elton Gallegly's district. He and I share Ventura County.
He can't be here today. He is counting on my eloquence to explain the
programs.
The first is a preventive health care program for the
people of Ventura County. This is an outreach program to
provide preventative health so we don't have people showing up
at emergency rooms. The county has had a drop of roughly 20,000
people in the number who are in Medicaid, but then there has
been a 20,000 increase in the number who were on Medicaid and
now have no insurance at all.
This is an innovative program to provide cost-effective
preventive medical services. Some $9 million is being provided
by the county, and we need $5 million of Federal funds,
slightly more than a third, Federal funds for this program.
The next of the two Ventura County projects that are
primarily outside my district is a Center for Mental Health
Services grant request dealing with mental health services for
those in prison, in transition to being released and rejoining
society. This program has already received $900,000 in Federal
support for start-up, and the State has granted $1.6 million.
It is an innovative program to provide a full range of
mental health services to those in prison. There has been a
significant reduction in recidivism from those who get this
kind of treatment, and this is, I think, an ideal pilot study
to show the importance of this treatment to other county prison
facilities.
The next project I am seeking $2.75 million for a child
care center in Newbury Park. This will go an along with some
local funds. The total budget is $3 million. We are also
seeking in roughly the same area funds for a senior adult
center expansion.
Finally, for a YMCA that will be focusing much of its
attention on the low income people of the region, providing
social services. Roughly half the money there is being provided
by local government and local charities, and we are seeking the
other half from the Federal Government.
Mr. Regula. Thank you. Things haven't changed too much
since Interior.
Mr. Sherman. I do have many things on the list, but I did
put them in what I think is a reasonable order. As I say, the
first one is a $500,000 project.
Mr. Regula. Questions.
Mr. Honda.
----------
Tuesday, April 3, 2001.
RE: EDUCATIONAL PROGRAMS
WITNESS
HON. MIKE HONDA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Honda. Good morning, Mr. Chairman. I think the last
time I was before you we were talking about sleep or fatigue;
is that correct?
Mr. Regula. Right.
Mr. Honda. I just want to thank the Chair and the
distinguished members for the opportunity to present my
testimony today.
I have submitted a full written testimony for the record,
but today I would like to focus on increasing school
construction, recruiting 100,000 new teachers over the next 7
years, increasing Pell grants, as well as fully funding special
education.
If we are going to judge teachers, Mr. Chairman, and
students by test scores, then Congress must fund programs that
encourage improvement, growth within education, and we must
demonstrate a commitment and respect and confidence in students
by providing safe, permanent classrooms that are not crumbling.
Nearly 80 percent of Americans support providing Federal
funding for school repair and modernization, yet the
President's budget eliminates $1.2 billion the Congress
approved last year for school renovation and cuts another $433
million in unspecified programs.
It would take nearly $112 billion to bring public and
elementary and secondary schools to adequate condition.
Thisfunding would help renovate up to 14,000 needy public schools and
serve around 14 million students. I urge the committee to spend the
$24.8 billion over the next 2 years in new tax credit bonds to renovate
up to 6,000 schools.
If we want students to learn more at a faster rate, then we
need to reduce class size to enable teachers to teach
efficiently. We also need to provide the teachers with the best
training in order for them to provide the best instruction, and
in order to attract and train teachers for both high need
schools and underserved teaching topics, such as math and
science, Congress should increase compensation for qualified
teachers.
According to the National Center for Education statistics,
elementary and secondary school enrollment will grow from 52.2
million in 1997 to 54 million in 2006, requiring new schools
and new teachers. Research has also shown that students in
smaller classes and grades K-3 learn fundamental schools better
and continue to perform well even after returning to larger
classes after third grade.
I urge the committee to continue to recruit 300,000 new
teachers over the next 7 years in order to reduce class size
averages in the early grades. I also encourage the $1 in new
funding in 2002 and $18.4 billion over the next 10 years to
provide up to $5,000 in supplemental pay to fully qualified
teachers in high poverty schools or those in need of
improvement under Title I.
I request an increase of $600 in the maximum Pell grant,
for a total of $4,350. I also ask that Congress fully fund
special education in order to free up general fund money to
allow schools to spend their money where it is most needed.
By failing to meet these needs, Mr. Chairman, in the
education system, we are failing to meet the needs of every
single American. If we truly expect our schools to meet the
challenges of greater accountability and higher achievement,
then we as Congress need to ensure that we continue to fund the
initiatives that we have put forward. Congress, as well as
schools, need to be held accountable for their actions, and
accountability is a two-way street.
I just want to close by talking about accountability, and I
guess student achievement.
We know that we have made mandates, such as PL 94-142,
which is requiring the pursuit of special education
identification of youngsters. Since we are at 13 to 15 percent
funding level, where we said we would be funding them at 40
percent, this ties up, as you well know, a lot of the local
funds that school districts are trying to use, as they try to
meet the mandates. So we have created a mandate without the
full funding.
As a school principal of two schools, identifying
youngsters, I know this is a big struggle between parents who
want youngsters to be identified and seek the special help and
school districts in their inability to fully fund it all. If we
really want to help our local schools, then we should fully
fund special education so they can free up their local money to
do the things that they could do more efficiently at the local
level.
Mr. Regula. Thank you. Questions?
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Ms. Pelosi. Mr. Chairman, since many of our witnesses today
are senior Members of Congress, and Mr. Honda is a freshman, he
alluded to his experience as a school principal, but, for the
record, I wanted him to tell you how he knows of what he speaks
as a very distinguished record as an administrator and a
teacher in the San Jose area.
Mr. Honda. Thank you, Ms. Pelosi.
Mr. Chairman, I have spent over 15 years as an
administrator in a K-8 school in South Central San Jose, and I
know that we tell our parents what their rights are, and a lot
of times, in the community I worked with, we had to be their
advocates in order to be able to identify these youngsters.
Many times school districts are so strapped that they are
hesitant to go all the way, because they have to look at their
bottom line. We put them in this situation that is untenable
for both the districts and we frustrate our parents because
they want the best for their youngsters, as do the schools.
In other sections of our valley, parents do know their
rights and they bring lawyers with them to the school
districts. That creates, again, another situation where it is
untenable for both sides. So if we solve this problem, we will
solve the problem not only for the poor neighborhoods, who
where administrators need to be the advocates of the
youngsters, and also the well-to-do neighborhoods, where
parents have the wherewithal to bring attorneys with them, and
we can solve that problem by fully funding a mandate that we
have put forward a few years ago.
Ms. Pelosi. Mr. Chairman, our witness also brings
impressive academic credentials from graduate studies at
Stanford University in education.
Mr. Honda. I get it.
Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Mr. Honda, as a 20-year school board member,
I have great respect for your credentials as a principal and
know how important that is. IDEA is something that we have to
step up to, because we have created the mandate, but not put
the funding with it. So I certainly agree with you on that, and
the Pell grants, and a lot of your presentation.
But when you talk about the Federal Government providing
100,000 new teachers or reducing the student-teacher ratio,
doesn't that go against what you said earlier, that if we
provide the IDEA funds, then the districts have the right to
run, the ability to run their own deal?
I am very pro-education then and I agree with you, but I
think there are things we can do from Washington and things we
shouldn't try to do from Washington.
Mr. Honda. I agree with you, Mr. Sherwood. I was aschool
board member for over 9 years in San Jose unified. I understand how
budgets are dealt with. You are caught in the middle really as a school
board, isn't that correct? At the Federal Government level, you know,
the 100,000 teachers was an effort by the Federal Government to help
reduce class sizes in many classrooms across the country. I think that
is a good role for the Federal Government to do, to encourage the
reduction of class size, and also to find funds to be able to
compensate teachers who are teaching in high need areas and who are
teaching in subject matters that are subject matters that we need, like
math and science.
Now, today we are talking about accountability, and if we
are talking about accountability, then we have to also be
accountable by fulfilling our obligation and fully funding that
mandate. We are also talking about student achievement.
Now, student achievement is obtained by having time on
task, and the way we attain time on task in our role can be to
help reduction of class size and encourage that, and we can
fully help the local school districts if we fund fully special
education. That frees up an incredible amount of monies that
can be reinvested in reduction of class sizes and hiring new
teachers. But when we do that, Mr. Sherwood, you know when we
reduce class sizes, we create a need for more teachers. So we
need to help support that effort and do just our part so until
they get on their feet.
The other thing is when we create more teachers, we need
the classrooms when we reduce class size. If we don't do those
two things, in addition to in our effort to reduce class size
and to increase student achievement, if we don't help in the
construction of new classrooms, providing new teachers, then we
are only going one-third of the way.
The other way we can help the local school districts is to
free up the local money so they can reinvest that in those
areas also. So we need to help school districts be able to
provide new construction or modernize by putting up the $25
billion for the tax credit, because at the local level, when we
create a bond indebtedness, we are in there for 30 years,
right? If we come up with a tax credit against the interest on
the principal, that reduces the local effort by 10, sometimes
15 or 20 years, and that is a big impact that is not really
well seen by the general public. But we do know that, because
we have been involved in that kind of dynamics of budgeting.
So the Federal Government has a very unique role, but a
very important role, to help attain accountability, student
achievement, by helping the local classroom achieve that time
on task by creating, hiring more teachers in those needed areas
and providing the funds to create more classrooms or modernize
classrooms.
Mr. Sherwood. We agree and we disagree.
Mr. Regula. Thank you, Mr. Honda.
Mr. Honda. I am trying to give a macro-picture along with
the details.
Mr. Regula. Thank you.
Mr. Honda. Thank you very much. Let me close, Mr. Chairman,
by reiterating what some of the other folks said. I do think we
need to start looking at more brain research. That is one area
we haven't paid a lot of attention to. Youngsters do come with
developing minds and brains. If we look at minds as one set, we
have to look at the brain and its development in the process of
education.
The last comment is we are getting close to senior prom,
graduation, and you know as well as I do that we see tragedy in
our newspapers about youngsters dying behind the wheels, not
because of drugs, not because of alcohol, but because of
fatigue. I would just like to reiterate if there is some way we
can admonish our schools to talk to our youngsters about taking
care of themselves and not get overly tired so that they avoid
those tragedies.
Thank you, Mr. Chairman.
Mr. Regula. Good point. Mr. Bereuter.
----------
Tuesday, April 3, 2001.
APPROPRIATION FOR THE UNIVERSITY OF NEBRASKA--LINCOLN AND FUNDING FOR
THE CLOSE UP FOUNDATION
WITNESS
HON. DOUG BEREUTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEBRASKA
Mr. Bereuter. Mr. Chairman, Ms. Pelosi, Mr. Sherwood,
members, thank you for letting me testify today. May I observe
the Chairman loose, unusually rested and tan, and I am not
quite sure how he did it, but I know how he got his tan,
because I was with him.
I am here to testify, Mr. Chairman, and members of the
subcommittee, on two items, an appropriation for the University
of Nebraska--Lincoln, and funding of the Close Up Foundation.
The first item is the Great Plains Software Technology
Initiative. A substantial amount of detail is given about this
program. It is, in some ways, a unique program, but I think it
is replicable across the whole country. It takes a look at the
importance of information technology, attempts oh to help our
students cope with it; to use it well as a building block for
their future.
The program at the University is the result of an $18
million grant from one of our alumni, a challenge grant, and
this would provide an opportunity for some internship programs
as these students in their educational experience in this
honors program implement the curriculum with industry applying
what they are learning in the process as they approach the
junior and senior year. This will provide an opportunity for
additional students, but, most importantly, it helps develop
further the curriculum which is replicablearound the country.
It is an important initiative. I took a look at the whole
range of proposals from the University of Nebraska systems,
including this campus, which is in my district, and decided
this was the one that I thought had the greatest opportunity
for replicability around the country for its application.
Secondly, I want to speak about the Close Up Foundation, as
I usually do. They have a request for $1.5 million, which is
almost below the area where you observe it. But I think it is
an important testimony to the corporate world that provides
most of the funds for the fellowships for low income students
that the Federal Government and the Congress, specifically,
thinks this is an important program.
When I first came here, Nebraska was one of only seven
States that did not participate, although I was speaking to
teachers and student groups, and today Steve Janger, the
president and founder, tells me that we have the highest
participation rate on a per-capita basis in the country. I just
spent about 45 minutes this morning speaking to students from
my district.
It is, in my judgment, the most outstanding citizen
education program that brings people to Washington of any age
group, and this happens to be a course focused than our high
school juniors and seniors. I, along with Mr. Roemer, I
believe, who also takes a lead on helping the Close Up
Foundation, interested in making sure that this program which
focuses on the Federal Government, a national program, is not
block granted, that it maintains its separate identity through
the authorization process, where Mrs. Landrieu is working in
the Senate and where various House Members are taking a lead to
make sure the Close Up Foundation's programs continue.
Mr. Chairman, thank you very much for listening to my
request. I would be happy to answer any questions you may have.
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Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Thank you.
Mr. Regula. Thank you.
Mr. Dreier. This is a switch. I am usually on the other
side of the table with you.
----------
Tuesday, April 3, 2001.
RE: DIABETES RESEARCH
WITNESS
HON. DAVID DREIER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Dreier. It is very nice to be here.
Mr. Chairman, let me begin by extending very hearty
congratulations to Mr. Sherwood on his recent appointment to
this very important committee, and obviously the great
intelligence that all of you had in placing him on your
subcommittee.
I want to congratulate you also, because I have spent the
last 30 minutes or so listening to the testimony, and you have
very important work with which you deal, and this is the first
time I have been before this subcommittee, and I appreciate it.
It is interesting, if 10 days ago someone had said to me
that I was going to be testifying on diabetes funding before
Ralph and his subcommittee, I would have said, well, that is
interesting, but I was--really would be a little skeptical
about it.
A week ago Sunday night, many people watched something that
took place in the area that I am privileged to represent, the
Academy Awards, and I happened to see an old friend of mine, a
guy called Doug Wick, accept the Oscar for the best motion
picture. He produced Gladiator.
Doug and I had been friends for 25 years, but, quite
frankly, we had lost contact, and I have been very good friends
with his parents, whom I mentioned to you the other day,
Charles Wick, who is director of the U.S. Information Agency in
the Reagan Administration, and Doug's mother, who was the
chairman of the Reagan inaugurals in the 1980s, and I
maintained contact with them, but frankly had not been in touch
with Doug.
But when Doug won this academy award, I decided to call him
and congratulate him, and we had a nice chat, and he informed
me that his daughter, Tessa, had 3 years ago--she is now 10--3
years ago had been diagnosed with juvenile diabetes, and he
asked that I come before you to strongly support the funding
that has been provided, and I am very happy that the President
has doubled the budget for NIH, and we have also had a
significant increase I know for diabetes funding, due in large
part to your efforts, and I want to encourage that.
What I would like to do is I would like to just read
highlights of a letter that Lucy and Doug Wick's daughter,
Tessa, wrote recently to a number of people, encouraging
support for diabetes funding. I have a longer version which I
would like to put in the record.
Mr. Regula. Without objection.
Mr. Dreier. As I said, she has politics in her veins with
her grandparents, so she has a much longer version, but I am
going to take the somewhat briefer version. I was rather moved
by this.
I haven't even met Tessa. I look forward to meeting her.But
Doug encouraged me to be here, so let me just share this with you.
``January 15th, 1998, was a day I will never forget. It was
the worst day of my life. I was at school in second grade when
right before lunch my parents rushed through the door and told
my teacher I would have to leave. I could tell by the look on
their faces that they were not taking me to Disneyland.
Instead, they drove me to the UCLA hospital.
``When I got to the hospital, the doctors told me I had
diabetes. They said that I would have to get 2 or 3 shots every
single day. I was used to maybe 1 shot every year. And there
was more bad news. I was going to have to prick my finger 4 or
5 times a day and put a drop of blood into a little computer. I
was going to have to do this before every meal, before bed, and
maybe even in the middle of the night. So far, according to my
sister's calculations, I have had to prick myself or inject
myself with insulin over 4,500 times, and I have had diabetes
for a year and a half.
``And then there was this creepy information about what I
could eat. For instance, everyone likes to trade food at lunch,
but unless I want to have an extra shot, which is usually
never, I have to stay away from cheesecake, slurpies and
cookies. I don't know if you are a big lunch trader, but I am,
and take it from me, what is the use of trading food if you
can't win any of the good stuff?
``Sometimes I try and remember what it was like to just eat
whatever I wanted without taking a shot of insulin. I try and
remember all the nights that I could just go to sleep without
worrying about having a seizure in the middle of the night and
making my mom wake up at 2 in the morning to check my blood
sugar just in case.
``The last 2 summers I have gone to diabetes camp. The
first day the camp director stood up and said, will anybody
here with diabetes please raise your hands? And every single
kid and all the staff members raised their hands. I couldn't
believe it. Then the director said, I guess anybody here with
diabetes will be the normal ones, and everyone clapped.
``I like feeling normal at camp. But where I really wanted
to feel normal is at home, at school, and with my friends, and
that is only going to happen one way, and that way is to find a
cure. So please support diabetes funding and help us find a
cure.
``Thank you very much, Tessa Wick.''
Obviously no one could say it any more eloquently than
Tessa did in this letter, Mr. Chairman. But I just want to
congratulate you and encourage you to proceed with funding for
this very important effort to find a cure for diabetes.
Mr. Regula. Thank you. I have a young lady in my district
whose parents brought her to visit with me in the office, an
identical situation. You really reach out to these young
people. We hope to find something. We are going to commit as
much in the way of resources as we can to this.
Mr. Dreier. Thank you very much. I will convey that word to
the Wicks for you.
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Mr. Regula. Give my best to Charles. He did a terrific job
at USIA. I worked with him. Of course, Mrs. Wick was active
with the Ford Theater.
Mr. Dreier. Right. She still is.
Mr. Regula. She still is. That is a great program there.
Mr. Sherwood.
Mr. Sherwood. It is bad enough with adult onset diabetes,
but to think a child is looking forward to their whole life
with this insidious disease, tell your young lady that her
testimony was very compelling and we will pay attention.
Mr. Dreier. Thank you very much, Don. I will try to be as
nice to you all when you come before the Rules Committee as you
have been to me today.
Mr. Regula. We will keep that promise in hand.
Mr. Dreier. I said I will try.
Mr. Regula. Okay, Mr. Roemer.
Mr. Roemer. Thank you, Mr. Chairman. Congratulations again
on your ascension to the most important, in my estimation, of
many of the important subcommittee chairmanships. As a member
of the education committee, we look to you to fund many of our
suggestions, but also to work in a bipartisan way with you on
cooperative projects.
Mr. Regula. We await your bill with interest.
Mr. Roemer. We are working in a bipartisan way to try to
report an ESEA bill to you. Congratulations to Mr. Sherwood on
his elevation to this important committee.
I ask unanimous consent to have my entire statement entered
into the record.
Mr. Regula. Without objection.
----------
Tuesday, April 3, 2001.
RE: TRANSITION TO TEACHING
WITNESS
HON. TIM ROEMER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF INDIANA
Mr. Roemer. My good friend, Mr. Dreier, talked about the
Academy Awards. One of the parts that you may have seen, if you
watched, Mr. Chairman, was that they wanted to keep the
testimony as short as possible. I am sure you are looking for
some of that in your time here. They were going to award a high
definition television to those people that kept their testimony
short. While I don't pretend to be any Julia Roberts, I might
have more success between the two gentleman here in the room if
I was for the three or four actual projects that I am going to
ask your cooperation for.
I will try to keep my testimony short, although I don't
certainly have the----
Mr. Regula. You won't get a television, but you will get
our appreciation.
Mr. Roemer. Okay. I will try to get the appreciation and
the support for my projects.
Certainly the Preventing Child Neglect and Delinquency
Program with the University of Notre Dame is important. The Ivy
Tech College Machine Tool Training Apprenticeship Program,
where we are trying to train more people in manufacturing jobs
is very important in my district as we go through some rough
layoffs.
As Mr. Bereuter testified about the importance of the Close
Up Program, that is a program that I have been involved in for
my 10 years here in Congress. Steve Janger does a great job
running that program, and they bring a host of minority
students into Washington, D.C. for civic education. I hope you
will continue to show your strong support for that.
I am testifying here for a program that we started last
year for the first time, Transition to Teaching. We provided in
the appropriation billion dollars 31 million for this
appropriation, and I would encourage your subcommittee to fund
it once again.
Imagine, Mr. Chairman, if you have a 17-year-old son or
daughter, sending them to school, and you are going to try to
encourage your son or daughter to maybe take an honors class in
physics and go to Ohio State University. And that physics
teacher is not certified in physics, but certified in physical
education.
Imagine if you have a second grader going to school and
they are having difficulty reading, and we are having a teacher
who is not certified in teaching reading in their first year
who is not comfortable with the format, the subject matter or
the inclusion of technology into the curriculum. Many of our
first year teachers are in that position.
We are going to have to hire 2 million new teachers in the
next 10 years, many of which will fall into the situations that
I have just outlined for you, in the second grade or as juniors
in high school.
We have this transition to teaching program that follows up
on the very, very successful troops to teachers program that
was instigated in 1994. We brought people from the military
into the teaching profession. Many of them were trained in
science and technology and math. Eighty three percent of them
are still teaching in high need areas, in high need schools,
and now we have followed on with the transition to teaching
program where we are rewarding universities and not-for-
positive profits to train the next generation of teachers in
math, science, technology areas, to come into our schools in
mid-career, at 45 or 50 years old, and teach in these subject
matters in high need areas. This is a program that is going to
work very well, that is hopefully going to address some of our
need for the 2 million new teachers, although it is not the
silver bullet by itself, and I hope you will continue to fund
this program.
Thank you for the testimony today.
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Mr. Regula. Thank you. I assume that there will be
hopefully a lot of military retirees that will participate.
Mr. Roemer. There will be some, Mr. Chairman. That has
actually slowed down since 1994, with some of the attrition and
some of the military people leaving now. We are doing
everything we can to try to keep some of those people and
retain them, and we are looking outside the military to follow
up on the troops to teachers with this transition to teaching
program.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you.
Mr. Roemer. Thank you. Thank you, Mr. Chairman.
----------
Tuesday, April 3, 2001
FUNDING REQUESTS FOR EDUCATION, LABOR, AND HHS PROGRAMS
WITNESS
HON. MAXINE WATERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Ms. Waters.
Ms. Waters. Good morning. Thank you very much, Mr. Chairman
and members, for sitting in those seats for the hours that you
have to sit to hear all of the testimony that comes before this
committee and a particular thanks for the time that you are
giving to all of the Members today. I am delighted to be here.
I will go into a few of my requests. Mine are not as program
specific as they are general in nature, and I have broken them
down into the three areas that you have oversight
responsibility for: Education, health and human services, and
the labor issues.
Mr. Regula. We will put your entire statement in the
record.
Ms. Waters. Thank you very much. On education I am hopeful
that this Congress will be known as the Education Congress. We
have all talked a lot about education, and there is some
confusion about how much increase we are going to have in this
education budget. I certainly hope that it is in the
neighborhood of 11 percent or more rather than the 4 or 5
percent I keep hearing alluded to.
Under education, educational technology is very important.
This includes programs such as the Technology Literacy
Challenge Fund. There is a digital divide, and if we are to
prepare young people for the future, particularly in some of
the poor communities, we must make sure that they have access
to computers and new technology. So I think that we should not
have any cuts in that area.
Teacher training is extremely important. I was at a teacher
training program this past weekend that was done by my local
school district where they have the teachers, the
administrators and the parents all together, and teacher
training, mastering English for many of the immigrant students
and students who are coming from other places, and I thought it
was very, very effective. We have got to put money into teacher
training programs.
School modernization. Without a doubt we have schools that
are falling apart. The air conditioning does not work, the
heating systems are broken, graffiti on walls, the toilets not
working. And so I think again if we are to be the Education
Congress, we have got to make sure that we modernize our
schools and buy some new schools because we have expanding
populations that cannot accommodate the growth in many of these
areas.
After school programs such as the 21st Century Learning
Centers, very important. Many of our schools could help out
with the problems of the entire community if they had after
school programs, programs that gave additional support to what
is going on in the classrooms during the day, and I think we
have talked about that a lot and we have these facilities that
are sitting there and we should put them to good use.
Let me move on to Health and Human Services. Numerous
studies have demonstrated that minorities are
disproportionately impacted by a variety of health problems.
The National Institutes of Health is collaborating on 12 5-year
projects to research how social and environmental factors
contribute to the desperate health problems of racial and
ethnic minorities.
Cardiovascular disease, the death rate in 1998 for African
Americans attributable to heart disease was 136.3 per 100,000
people compared to 95.1 per 100,000 for others. In cancer the
Centers for Disease Control are currently allocated 174,000 for
breast and cervical cancer screening. African American women
have the highest death rate from cervical cancer. African
American women have breast cancer rate similar to other women
but die at greater numbers from preventable disease. Women
should not be dying from breast cancer, but we need to have
more research in those areas.
You have heard probably a lot about AIDS. The Congressional
Black Caucus has spent a lot of time on creating additional
funding in this category of AIDS because of the alarming
increases in HIV and AIDS in the African American community. I
would ask this committee to pay special attention to that
funding and the special category that we worked so hard for to
help build capacity in minority communities, in poor
communities that don't have the capability of dealing with
outreach and prevention and all of that.
Mr. Regula. We were at the CDC yesterday, Centers for
Disease Control, and they made emphasis on that very point that
you are making.
Ms. Waters. Thank you so very much. It is extremely
important. I won't go into the death rates. I will talk about
diabetes that has been mentioned here a lot today. I want to
tell you that I am watching too many people lose limbs and die
from diabetes. They are cutting off arms and--well, feet and
legs in particular, and people are going blind from diabetes.
We need a lot of money in prevention and outreach so people can
understand the symptoms of this disease and how to care for
themselves. People are dying at a very early age.
Mr. Regula. They made a good point yesterday that a lot of
times people don't recognize it early enough and the impact on
the body is already pretty progressive before it is recognized.
Ms. Waters. That is right, Mr. Chairman. They refer to it
as the silent killer because by the time many people get there,
their bodies are already overcome by all that goes along with
it and we need health care prevention for all of America,
everywhere.
Mr. Regula. I agree with that.
Ms. Waters. So we don't learn until, you know, after we get
50 and things start falling apart. Then we get very conscious
about our health. But I sure would have liked to have known a
lot of this when I was a lot younger.
In education also I wanted to mention Head Start. I worked
in Head Start when Head Start first was originated. I was the
supervisor parent involved in voluntary services, and of course
I learned a lot about how parents and communities can be in
control of the children's educational destiny. There is not a
lot that I need to say about Head Start. I think everybody
recognizes that it is a wonderful program that needs full
funding, and to the degree we do that we have prepared children
for school and they are prepared to read, et cetera.
In labor, I want to mention Job Corps. Job Corps is very
important and they really have done a very good job. I am
concerned that we still have Job Corps programs that don't have
the residential component. That is extremely important when you
take these kids into Job Corps. If, for example, in Los
Angeles, where we have a big Job Corps program, some of them
have to go back to their communities at night, we lose them, or
the influence of the community is so great that in one program
they change clothes. For example, they wear one set of clothes
while they are in the Job Corps, but when they go back to their
communities they have to wear another set of clothes to
identify with the neighborhoods that they come from. We would
like to see more residential facilities associated so that by
the time they transition out, they are into jobs, they are
going to live on their own so they don't have to go back to
those communities.
The veterans employment and training I can't say enough
about that. I have a program in my district. This is very
important because they take the homeless veterans off the
street, and they have a program that is designed to get them
back into the main stream and they live in this facility while
they are being trained and they are doing jobs. And many of
them go on from there again to have their own homes and to live
a full life and off the street and using their talent.
And so these are just some of the things that I wanted to
quickly mention in the short period of time that we have here
today, and I appreciate your attention to these matters.
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Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Mr. Regula. I would like to visit with you on Head Start,
but I will catch you on the floor.
Ms. Waters. That is my favorite subject any time.
Mr. Regula. I would like to talk with you about it and see
how you suggest ways to making it even more effective. But I
will find you there. We have one more witness.
Ms. Waters. Thank you.
----------
Tuesday, April 3, 2001.
FUNDING REQUESTS FOR FAR ROCKAWAY PENINSULA PROGRAMS IN QUEENS, NEW
YORK
WITNESS
HON. GREGORY W. MEEKS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW YORK
Mr. Regula. Mr. Meeks.
Mr. Meeks. Thank you, Mr. Chairman. I ask unanimous consent
for my statement to be in the record in its entirety.
Mr. Regula. Without objection.
Mr. Meeks. Mr. Chairman, Mr. Sherwood, I thank you for this
opportunity to present testimony to you today. And I will be
succinct. Let me first, I come to talk about a specific program
within my district. And we are asking for a mere $2 million
earmarked to the Joseph P. Addabbo Family Health Care Center.
Mr. Regula. I knew Joe well, good man.
Mr. Meeks. He was a great man who did a lot in the
community that I now represent, and this particular health care
center we named after him because he really started it while he
was here in Congress. And it deals with the part of the
district that is probably the most isolated part of New York
City, of all of New York City. It is a peninsula that is about
24 miles outside of downtown Manhattan. And many individuals
who have to live on that peninsula, they are subject to just
the services that are there. They don't have access to what we
call the mainland, which is the other part of New York City,
and that is just how difficult it is because of the
transportation to the mainland if you happen to live on the
peninsula.
As you may know, the Joseph P. Addabbo Family Health Care
Center is a private, nonprofit, federally funded community
health center that was established in 1987 to provide
comprehensive health services to the poor and medically
indigent and or medically underserved residents of the Rockaway
peninsula. The Rockaway peninsula ranked 14th among the 58
neighborhoods in the city for severe health-related problems in
1995 and 1996, the years for which the most recent data is
available, with the rate of preventable hospital admissions
more than 50 percent above the city average in 1996. This is an
area home to the sickest and poorest segments of all of New
York City, and this project that we are talking about is a
joint project. It is a joint health and educational project
that we are looking to develop on the peninsula.
The Joseph P. Addabbo Family Health Care Center
participated in a Robert Wood Johnson-funded needs assessment
in the peninsula's low income communities. This project was
designed to identify primary health care needs. As a result of
this assessment, Far Rockaway has been designated a health
crisis area by the Health Systems Agency of New York City.
Another important aspect of the health profile of the
Rockaway peninsula is a greater portion of its residents are
children, with 38 percent of the population below 20 years of
age. The large number of children and the high level of risk
factors present in the community warrant particular attention
to the needs of the children and young adolescents. Twenty-nine
percent of the children live below the poverty level. Academic
achievement levels in schools range near the bottom, with 54
percent of the students reading below their grade level and 44
scoring below their grade level in mathematics.
There is also a high incidence of pregnancy among
teenagers. In fact, it is 14.5 percent higher than all of the
Borough of Queens, and New York City's average is only 8
percent. And most of these are young adults between the ages of
15 and 18 years old. The AIDS rate has been growing much faster
than the growth rate increase of 82 percent from 1990 to 1991.
Now this project is something that is a conglomerative. We
have several different parts of the community that are engaged
in helping this, and what we are trying to do is to get our
Federal portion of it funded. For example, the New York City
Housing Authority has invested $1.5 million into the project.
The New York City Council has put in $1.1 million for it. The
New York State Assembly has put in $500,000. The Borough
President of Queens has put $2 million. York College, a local
college within the district, is putting $500,000 into this. And
the College of Aeronautics is putting another $500,000 in this.
So this becomes for the peninsula a mass educational and health
care facility that will cover some 104,000 people that
currently live on the peninsula who are isolated from other
parts of the city. So we just come asking to bring in our
Federal share and ask for whatever consideration this committee
could give us in getting an earmark of $2 million.
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Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Mr. Regula. Mr. Addabbo was a senior member of
Appropriations.
Mr. Meeks. He was.
Mr. Regula. And he and I went to Tokyo. I had forgotten. It
was quite a while ago. He is not living anymore?
Mr. Meeks. No, he is not. He passed away. His family is
still very involved in this and through all of his good work we
have named this for him.
Mr. Regula. You have what was his district or portions of
it?
Mr. Meeks. Most of it is what he used to represent. He was
my Congressman.
Mr. Regula. Thank you for bringing this.
The subcommittee is adjourned.
Tuesday, May 22, 2001.
EDUCATION
WITNESS
LISA GRAHAM KEEGAN, CHIEF EXECUTIVE OFFICER, EDUCATION LEADERS COUNCIL
Mr. Regula. Well, we'll get started. We have a number of
witnesses this morning, and we need to keep moving, so that
everyone has an opportunity to be heard and some time for
questions. Our first witness, Bishop Conway, is not here yet,
so I think we'll go to Lisa Keegan, the Chief Executive
Officer, Education Leaders Council. Mr. Obey, would you like to
make any comments here?
Mr. Obey. Thank you, Mr. Chairman. I think we might as well
get started. We're more interested in hearing what they have to
say than what I have to say.
Mr. Regula. Okay. Well, we're happy to welcome you. As you
know, we have a five-minute rule, so if you'll summarize it
will be helpful.
Ms. Keegan. I'll do that. Thank you very much, Mr.
Chairman. As you said, my name's Lisa Keegan. I am the Chief
Executive Officer of the Education Leader's Council. We are a
group of reform minded State school chiefs, State board
members. We have governors who are members, and we have
superintendents, teachers who are members.
Our organization believes that reform is necessary in
American education, and we have been engaged in that in our
States. We believe that most of this will happen in the States.
And we appreciate the opportunity to discuss with the Congress
the direction that you're going to take in your budget and in
the education bills before you.
Our organization believes that in fact it is instruction
that makes the difference for kids. It is not externals. What
matters in a classroom is dependent on high expectation and
instruction of a child. And we see going about that in a number
of ways, many of which are very innovative in the States. But
we do think it's our responsibility to educate the kids, and
we're not looking for excuses or external situations to be
solved.
We don't believe class size is the answer, we don't believe
that wealth issues are the answer, we don't believe color of
children has anything to do with ability to learn. We feel very
strongly that instruction is the answer and the classroom is
where this has to happen.
I want to talk a little bit about the proposals that have
been made on the House budget. I realize many of them have
reform components. Oftentimes those of us who talk about
reform, it's happening here and we're listening to it, are
characterized as not being interested in children or because we
want to have a change, that's seen as very hostile.
At the Council we try to remain very disciplined in our
focus on a few things. One is that our appropriations from the
Congress and in the States needs to be focused on the needs of
kids and not on the bureaucracies that serve them. They need to
as much as possible go directly to the classroom and to the
needs of the instruction leader, who is the teacher, usually.
Secondly, that oftentimes means that those resources will
have to be changed in terms of formula. Where they are needed
is in the classroom. Where they are often lobbied for is
outside of the classroom, because organizations for education
tend to be interested in organizations outside of the
classroom. We believe that's problematic.
Thirdly, we would like to see that the Congress, in pushing
some majorly important ideas, will seek not to strangle so much
with regulation but rather to support movement in the direction
of strong instruction, strong assessments and product and
result for students. We do believe it's absolutely essential to
have assessments. You may find our opinion quite different than
a lot of the education organizations. We make no apologies for
assessments. We are about the business of assessing in our
States. We think it's critically important.
We think it's fabulous that the President has proposed $320
million in his budget to assist States with their testing
programs. However, we also hope that most States are already
about this business already. It's critically important to know
where our kids are.
We do take issue with much that's been said about the cost
of assessment. We listened to a number of statements from the
National Association of State Boards of Education saying that
the cost was $7 billion for testing. That assumes about $125
per student, which we think is nonsense. In our States, where
we are running testing programs, the State of Virginia has a
very extensive budget that costs $4 per year. They are not
testing annually. If they did that, that would double, but it
would not be anywhere near this $125 that's being bandied
about.
In Massachusetts, which exceeds the President's proposal in
terms of the frequency of testing and the depth of that
testing, their costs are $14 per child. In Arizona, they are
about $10 per child. So I would keep that in mind. The exercise
ought to be strong but narrow focus on assessment and let the
States go beyond if they want to. We feel it's very important
to let them determine sort of the extent to which they're going
to test, beyond reading and writing and mathematics that's
being asked for, which we think is necessary, particularly to
prove Title I.
We are pleased with the increases to Title I. We think that
money should follow students into programs that work for them.
That has always been our bottom line. We recognize the desire
to try to hold everybody harmless and make sure we're funding
everybody last year the way we were, or this year the way we
were last year because of political reasons. We would encourage
you to let that money follow kids. Kids and parents will find
successful programs and those programs should prosper because
of it.
We do support the money for teacher quality. We think it's
very important to keep that flexible. There are a number of
very, very innovative teacher quality programs going on,
depending on the needs of States. Our States, our member
States, have everything from Troops to Teachers to the teacher
advancement programs, all sorts of innovative programs.
We also hope you will continue support for choice. Our
organization is a strong believer in school choice. We think
all options that work for kids ought to be made available to
them. And as State school chiefs, we support that. You find
that might be unusual from time to time, coming from State
school chiefs. We believe any school that's working well for a
child is one worth investigation as to whether or not they'll
be able to go there, and we're pleased that that discussion is
ongoing in the Congress.
Thank you very much, Mr. Chairman.
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Mr. Regula. Did you have any input with the authorizing
committee on the bill that's on the Floor this week? And if so,
have you looked at it and do you agree with most of it?
Ms. Keegan. Mr. Chairman, we have had input on that bill,
which we appreciate. We like very much the President's original
No Child Left Behind idea. We feel it's had to be compromised,
we understand that. We support very much the emphasis on
assessment. We would like to see that simplified a little bit,
so that the States are looking at gain of all kids and that we
don't make it so complicated that it fails in its
implementation.
We would like to see some of the amendments on flexibility
and choice come on. It's very important for the members to
recognize that any time there's a program, we have a
requirement then to staff that program in our departments of
education with X number of people, and it makes it very
difficult to focus when you have to be maintaining dozens of
different programs. We would like to be able to focus on our
standards and assessment programs.
Mr. Regula. Mr. Obey.
Mr. Obey. As you know, the President has proposed under his
plan that NAEP be used as a second check on the annual
assessments. However, the bill before the House today allows
States to use other tests that might not be as rigorous as
NAEP. With which position do you agree, the President or the
bill as it's before the House today?
Ms. Keegan. Mr. Chairman and Representative Obey, we are
fans of the NAEP test at the Education Leaders Council. We use
it. We believe it is strong. We understand the concern that you
could slide into a situation where you are sort of mandating a
national tests that States have a discomfort with. Our concern
is that we know the NAEP well, we understand it, we think the
standards are rigorous. We would not look forward to having a
requirement for a test that was not in line with our own
standards.
So any language that allows for an alternative, which we
understand the need for, we hope will maintain the same kind of
rigor that is present in the NAEP. We are big supporters of
OERE, OERI and the research arm in the Department and of NAGBE,
which sponsors the NAEP tests. It's something all of us have a
great deal of confidence in right now.
Mr. Obey. You prefer the NAEP, rather than some substitute
as a second check?
Ms. Keegan. Mr. Chairman, Mr. Obey, we prefer the NAEP in
our organization. That does not mean that we don't understand
there could be a need for something down the road. So all I'm
saying is, to the extent there's going to be an alternative, we
would like for that to be extremely tight in its language. I
think we all have reason to be quite confident in the NAEP.
Most of us are using its statistics right now when we talk
about how the country is doing.
So if we had to decide between one or the other, the NAEP
or any series of tests that might not be of the same quality,
we would go just with the NAEP.
Mr. Regula. Mr. Jackson.
Mr. Jackson. I have no questions, Mr. Chairman.
Mr. Regula. One last question. We're going to have an
amendment on the education bill on the President's suggestion
on vouchers, or if the school is failing, the children have a
choice. How does your group feel about that? The language was
in the President's original bill.
Ms. Keegan. Correct. Mr. Chairman, we support that. We
don't believe any child should be in a school that's failing.
There are options available for these children. We believe the
first priority is to have a child in the classroom with a
teacher that's going to move that child. We realize these are
difficult decisions for lots of people, but for us, it's an
easy decision. We want that child educated and in any way we
can find to do that, we will be supportive of.
Mr. Regula. Do you like the Troops to Teachers program?
Ms. Keegan. Mr. Chairman, we do. Most of our States are
using it. We've had a great deal of success with it. When I was
the chief in Arizona, we had great success with that program
and Teach for America, and any number of alternative entryways
into teaching.
Mr. Regula. I'm curious, you take this retiree from the
military, did you require that they go back to school and go
through the hoops to get certification that you normally have
to do?
Ms. Keegan. Mr. Chairman, no, and that's what's interesting
about these alternative programs. They do go through
preparation in instruction and classroom management. There are
some tests to determine content knowledge. That's similar to
Teach for America, another project that brings in very young
graduates and puts them in inner city schools, which has been
very successful.
We believe there are several ways to prepare very strong
teachers and make them qualified. There does have to be an
instruction, but probably not the traditional route.
Mr. Regula. Well, thank you very much.
Mr. Jackson.
Mr. Jackson. I think I do have a question, just one. At
least as I understand the nature of our education system in the
country, we have, based upon the way our country has evolved,
50 separate and unequal States, 3,068 separate and unequal
counties, and at least as many separate and unequal cities.
Many States derive their revenue from agricultural economy,
others derive them from a service based economy, others derive
them from an industrial based economy, which only exacerbates
the nature of that inequality.
So for the 53 million children in public schools across the
country who find themselves in the 85,000 separate and unequal
schools in the 15,000 separate and unequal school districts,
I'm wondering how your programs overcome those limitations, and
how the vast majority of those children who find themselves in
those unequal schools are reached?
Ms. Keegan. Mr. Chairman, Representative Jackson, we think
this is a huge concern. In fact, it's a concern that a lot of
people don't like to address. That is the fact that public
education in its traditional form segregates by wealth, because
it relies on a property tax base and a boundary by which to
serve children. So it doesn't so much keep children within a
neighborhood as it keeps other children out.
We believe that the solutions to this need to be generated
by the State, but that they ought to be generated by coming up
with funding formulas wherein money follows students, into
school that work for them, that funding probably ought to be
more generated by shared taxes rather than just local property
taxes. And as you know, there is a wealth of political fallout
when you start to talk about changing district basis for
education.
So it is a local-State issue, it is very difficult. I think
there are 25 States right now, Representatives, thatare engaged
in a sort of Supreme Court argument over this very issue. It's
something that our organization has been involved in at the State level
and will continue to be, because we think there's a moral imperative.
Mr. Jackson. Does your organization believe that every
child deserves the right to an equal, high quality education?
Ms. Keegan. Mr. Chairman, Representative Jackson, yes, sir.
Mr. Jackson. Is there any way for us to guarantee that
every child gets such a right without the idea of education as
a fundamental right being part of our constitution?
Ms. Keegan. Mr. Chairman, Representative Jackson, I'm not
quite sure that it isn't at least a moral imperative as part of
what we do. Obviously that has not been part of the
constitution overall. It has been part of implementation in
every State. I don't see that changing. I think most people are
dedicated to that ideal. We have tripped ourselves up in its
implementation, we believe, and we just have to address that
without pointing fingers at why that happened.
Mr. Jackson. I thank you. Thank you, Mr. Chairman.
Mr. Regula. Mr. Obey.
Mr. Obey. Mr. Chairman, I just can't help but observe, it's
very interesting that the bill before the House today would
withhold education funding from States if children are not
tested annually. For instance, if Wisconsin decided to test on
math in odd numbered grades, and decided to test on reading in
even numbered grades, money would be withheld from the State
for exercising that judgment.
But money would not be withheld from States if they have
outrageous differences in the dollars per child in say, Maple
School District in my district versus Maple Bluff, where they
spend almost twice as much money. I find that an interesting
focus on the hole in the doughnut.
Mr. Regula. I think our witness would agree with you, but
we're going to have to move on.
----------
Tuesday, May 22, 2001.
LIHEAP
WITNESS
THE MOST REVEREND EDWIN M. CONWAY, AUXILIARY BISHOP OF THE ARCHDIOCESE
OF CHICAGO
Mr. Regula. We're pleased to call Bishop Conway, the Bishop
of the Archdiocese of Chicago. Mr. Jackson, I understand you'll
introduce our guest.
Mr. Jackson. Thank you, Mr. Chairman.
Mr. Obey. Where is Chicago? [Laughter.]
Mr. Jackson. Somewhere sandwiched between Ohio and
Wisconsin.
Mr. Regula. It's the new home of the Boeing Company.
Mr. Jackson. When our bill comes before the Committee, I
want both of you to remember that.
Mr. Regula. I said it's the new home of the Boeing Company.
Mr. Jackson. Yes, sir, it certainly is.
Mr. Chairman, I am honored today to introduce the Most
Reverend Edwin M. Conway, who was ordained a priest on May 6th,
1960, and ordained a bishop on March 20th, 1995. Currently,
Bishop Conway serves as the Episcopal Vicar for Vicariate
Number Two of the Archdiocese, which includes supervision of 63
parishes on the north and northwest side of Cook County,
Illinois.
Bishop Conway serves as the liaison for the Health Affairs
Office of the Archdiocese, which oversees 23 Catholic health
care centers and long term health care facilities of the
Archdiocese. He has served as an associate pastor and in
various roles of service and management within the Catholic
Charities system and the Archdiocese of Chicago.
Bishop Conway was the administrator of Catholic Charities
from 1980 through 1997, and served as the director for the
Archdiocese of Chicago and was a member of the Cardinal's
Cabinet from 1985 through 1997. Bishop Conway holds a masters
degree in theology and a masters degree in social work from
Loyola University in Chicago. Mr. Chairman, and members of the
Subcommittee, I present to you Bishop Conway.
Bishop Conway. Thank you.
Mr. Regula. Thank you. We're happy to welcome you, and look
forward to your comments. Your testimony will be made part of
the record.
Bishop Conway. Good morning, Chairman Regula and thank you,
Mr. Jackson, for the invitation to come and also for your
introduction this morning. And good morning also to the members
of the Committee that are here before us.
We have written testimony, I'd like to submit that and just
spend briefly, some four or five minutes here discussing some
of the high points of that testimony.
Thank you for the invitation to speak to you this morning
regarding the Low Income Home Energy Assistance Program,
LIHEAP. I am an Auxiliary Bishop from the Archdiocese of
Chicago. Cardinal George was asked, as the Archbishop of
Chicago, to come and testify this morning. Fortunately
orunfortunately, he has been called to Rome for a Consistory of the
Cardinals along with Pope John Paul II and has asked me to speak on his
behalf for the Archdiocese of Chicago.
As you will see from my resume, I've spent more than 30
years with the Catholic Charities of the Archdiocese of
Chicago. Many of those years I spent as its administrator.
Thus, I speak from my own experience as well as a bishop in
Chicago which oversees some 67 parishes, serving multi-ethnic
and multi-racial communities. The Archdiocese of Chicago has
377 parishes, with approximately three-quarters of a million
active parishioners.
This morning I wish to speak to you specifically about the
Low Income Home Energy Assistance Program. I fervently urge you
to appropriate at least $2.3 billion in core funding for the
LIHEAP program for the fiscal year 2002. The overall totals,
you recall, last year were $2.3 billion and were made available
to all the States in order to help low income families with
home energy problems. Illinois received approximately $132
million and it was supplemented by an additional $65 million in
State grants. This money came from various sources within State
supplemental low income assistance funds.
The program in Chicago was administered through the
Community Economic Development Association of Cook County,
which serves the household of elderly disabled and others who
are disconnected or meet the poverty guidelines. In Illinois,
approximately 775,00 households are eligible for low income
below this level. Currently, Peoples Gas in Chicago records
approximately 25,000 elderly and disabled with heating bills
that are significantly or substantially past due.
I point this out as it comes time when gas prices have more
than doubled. The energy bills will not return to the 2000 year
level in the foreseeable future, which gives us an example of
the Archdiocese itself, which purchases gas at approximately 60
percent less value from NICOR and Peoples Gas in Chicago. Based
upon that usage, however, of the present and past heating
seasons, an additional $8 million will be required of the
Archdiocese in payments in the year to come.
This will severely decrease the amount of discretionary
dollars that the parishes and pastors will have to distribute
to poor clients who are experiencing eminent shut-off of the
utilities. I point out that in the week prior to April 4th, the
deadline for gas shut-off in Chicago, the Archdiocese of
Chicago Catholic Charities received more than 300 requests for
energy assistance over the past several months. They have
received more than 500 requests regarding utility assistance.
The average bill for heating in Illinois in the area of
Chicago is $1,500. The State assistance LIHEAP program is $495.
This amount is less than one-third of the energy bill going to
assist elderly and the vulnerable poor.
The Bishops of Illinois have talked about the right to
housing for families and their children, and they have sought
to estimate the number of households in which families will be
experiencing no heat. I therefore strongly believe, and I have
been informed by the Catholic Charities of the United States,
that the situation nationally, especially in some of the colder
States, is also parallel to Illinois.
I stress the fact that unless the amount is restored to at
least last year's level, more than 50,000 households in the
Chicago area will be ineligible this coming year if the current
grant remains the same. The facts in this instance are very
clear, the dramatic increases in home energy costs, lack of
corresponding increases in salaries and income, results
certainly and assuredly that families will be unable to meet
their bills.
Therefore, we implore this Committee to fund LIHEAP for the
year 2002 at at least equal to the amounts in the resources
that were available to the States for the last winter, or $2.3
billion. And since even this amount may not be adequate to meet
the needs of low income families living on the edge of
homelessness, we would strongly encourage an appropriate
increase over this level in the overall funding.
We hope at the very least that if this amount remains as
introduced by the Administration, the $300 million be also
allocated in an appropriate basis to each State. We know that
our brothers and sisters in California have been publicly and
visibly shown to have utility problems. We are seeking some
sort of the same recognition in Illinois and among our Chicago
citizens, who rely on this program to continue to survive.
Thank you, Mr. Chairman. And thank you to the members of
the Committee for receiving testimony this morning.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. Bishop Conway, I don't know if you're aware of
it, but Chairman Regula is a member of what is known as the
College of Cardinals in the Congress.
Bishop Conway. Which means?
Mr. Obey. I thank you for reminding him that he doesn't
belong to the only College of Cardinals.
Mr. Regula. I didn't get summoned to Rome, though.
[Laughter.]
Mr. Obey. Let me simply ask one question. In your
statement, you referred to the need for funding LIHEAP at last
year's level of $2.3 billion. I believe what that refers to is
that $1.7 billion was made available in the regular 2000
appropriation, plus an additional $556 million was available in
carry-over funds, for a total of $2.256 billion.
I think it's important for the Committee to understand that
if we adopt the President's fiscal year 2002 request, which is
$1.7 billion, composed of $1.4 billion in core funds and
$300,000 in contingency funds, that States would see a 25
percent reduction in the actual amount of deliverable aid next
winter.
How many people did you say that would not be served in
Illinois?
Bishop Conway. In Illinois, we think there will be at least
50,000 households in the Chicago-land area that will not be.
And also we know that probably the $2.3 billion is inadequate.
It certainly is what we would like you to achieve, but even
more is needed if we're going to match the increasing energy
bills.
Mr. Obey. I certainly agree with that. Thank you, Mr.
Chairman.
Mr. Regula. Mr. Jackson.
Mr. Jackson. Mr. Chairman, I did have a question, but the
Bishop spoke to it in his remarks. My district, the Second
District of Illinois, receives $12 million of that $76 million
in the LIHEAP program. The next closest district receives some
$4 million.
So I'm very well aware of the benefit that LIHEAP provides,
and I think the Bishop's testimony and his extended remarks,
when we begin to negotiate over our bill, I certainly hope that
the Committee will take into account that there are a number of
communities, particularly those who suffer in Chicago winters,
who are in desperate need of this program, and any efforts to
under-fund the program can only create the kind of misery
amongst some Americans that none of us would want in a Chicago
winter.
So I'm certainly hoping, Mr. Chairman, that you'll be
sensitive and the Committee will be sensitive to the Bishop's
remarks. Thank you, Mr. Chairman.
Mr. Regula. I might say, I think there will be a
supplemental emergency appropriation. It will include money for
LIHEAP. I know that's in the planning stage. I'm not sure how
much yet. But there will be.
Mrs. DeLauro.
Mrs. DeLauro. I'm delighted to hear that the Chairman
thinks there will be a supplemental appropriation. We weren't
sure that that was going to be the case. Clearly, LIHEAP is a
lifeline for people in our communities where we have tough
winters, and those that have tough summers as well, as we've
seen in the past. And we need to continue the past efforts with
regard to LIHEAP, especially now given the kinds of crises that
people are facing in their lives with energy.
Thank you.
Mr. Regula. As I understand it, you just deal with Chicago?
Bishop Conway. That's correct.
Mr. Regula. How about the outlying areas? Is that part of
another----
Bishop Conway. It's a different diocese.
Mr. Regula. Configuration?
Bishop Conway. Yes, different diocese. However, we are in
communication and we have a statewide organization. The
Illinois Catholic Conference, that deals with issues. It's
fundamentally the same. In fact, some of the rural areas
outside Chicago, which are more devastated economically, are
really concerned about facing this.
Mr. Regula. Does your diocese administer this program, or
just work with individuals to apply for it?
Bishop Conway. Yes, it works with the county to distribute
the funds.
Mr. Regula. What's the policy, pretty much, of the gas
companies? Do they shut off if they don't get paid?
Bishop Conway. Well, this has been a very sensitive point.
We've gone through several public manifestations and
demonstrations about this. And currently, it's in abeyance
until it is handled in a much better way. There were two due
dates set and at both times the gas companies gave a reprieve
until some further discussion was done by the local
municipalities, county government and hopefully the Federal
Government.
Mr. Regula. Do you think most people know that this is
available and take advantage of it? Because otherwise they
could be in a real crisis situation.
Bishop Conway. I think most people become aware of it and
maybe they're not aware of it at first glance, where they
certainly begin to come to the point of having their gas turned
off or collaterally through some other arrangement with the
social service agency they become aware of this and apply for
it.
Mr. Regula. I assume the gas company would let them know.
Bishop Conway. They do.
Mr. Regula. They have an interest, too.
Bishop Conway. Right.
Mr. Regula. Well, thank you very much for coming and
testifying this morning.
Bishop Conway. Thank you.
----------
Tuesday, May 22, 2001.
WOMEN'S HEALTH
WITNESS
CAROLYN M. MAZURE, CHAIR, WOMEN'S HEALTH RESEARCH COALITION
Mr. Regula. I think Mrs. DeLauro, we'll move then to
Carolyn Mazure, the Chair of the Women's Health Research
Coalition. You'll be introduced by Mrs. DeLauro.
Mrs. DeLauro. Good morning. Mr. Chairman, let me just say
thank you to you and to my colleagues. It's such a pleasure to
welcome to the Committee a woman whose work I truly do admire
greatly, and of whom I'm tremendously proud to count as one of
my constituents. Dr. Carolyn Mazure is a professor of
psychiatry at the Yale University School of Medicine, the
principal investigator for the Donohue Women's Health
Investigator Program at Yale. I might add that that is the
largest university-wide women's health research program in the
United States.
Dr. Mazure is a national leader in the field of women's
health, conducting research on women and tobacco dependence,
post-traumatic stress disorder in determining predictors of
depression and psychosis. She serves on the board of the
Society of Women's Health Research and in addition to that, she
really has been a leader in bringing the work of research on
women's health into the community, to look at how we actually
try to improve the health and the lives of women across their
entire life span.
So it's a great honor for me to welcome Dr. Mazure and to
be able to say to the Committee, this is someone who really
does have an unbelievable grasp of what is happening out there
with regard to women's health and research and look forward to
her comments on the budget for the next fiscal year, and say
thank you to you for spending some time with us, Doctor.
Mr. Regula. Thank you. Your entire statement will be put in
the record, and we'll appreciate your summarizing.
Ms. Mazure. Thank you. First, thank you, Congresswoman
DeLauro, for your very kind words of introduction. It's very
much appreciated. Mr. Chairman and other members of the
Committee, I appreciate the opportunity to speak with you
today.
For the record, I am Dr. Carolyn Mazure, with the academic
affiliations as noted by Congresswoman DeLauro. I'm testifying
today in my capacity as the chair of the Women's Health
Research Coalition, which was created by the Society for
Women's Health Research two and a half years ago.
The Coalition has nearly 200 members committed to advancing
women's health research. Most of these members really include
national leaders in scientific and medical investigations and
in academic institutions throughout the country, and also does
include people from voluntary health organizations as well as
pharmaceutical and biotech companies, again, to the larger
issue of trying to make transfer of information possible across
these different constituencies.
To begin, let me first emphasize that we strongly support
the goal of improving the health and the health care of all
individuals through newly discovered research based information
that can be incorporated into medical practice and also
incorporated into personal practice. But there are at least
three reasons for a special focus on women's health and on
understanding what are referred to as sex-specific factors in
health and disease.
First, women historically have been under-represented as
subjects of scientific research for a variety of reasons. And
when women have been included, even to this day, sex-specific
analyses of health data have not traditionally been conducted.
A recent GAO report coming out in 2000 also confirmed that
finding.
Second, age adjusted indicators of both health status and
also of service utilization continue to show that women have
more acute medical problems and higher hospitalization rates,
even when you exclude hospitalizations due to childbirth.
Finally, there are large gaps in our scientific knowledge
about disorders and conditions that either affect women solely
or predominantly or differently. For all these reasons, we ask
the Congress to play a pivotal role in advancing research on
the health of women, research that we believe will make a
difference in women's lives and in so doing, will benefit every
person in the country.
That's what brings me to why I am testifying here today.
The Coalition is seeking the Subcommittee's support on four
major priorities. First, we join with others who have appeared
before this Committee to advocate for a $3.4 billion or 6.5
increase in the NIH budget for fiscal year 2002. However,
importantly, as the NIH grows to meet the great need for
medical research in many areas of health, we ask for your
support in ensuring that there be at least comparable increase
directed towards women's health research within that pot of
money. There is too much work to be done, as detailed in the
written statement that I'm providing, not to ensure such
funding.
Second, we ask that the various offices, advisors and
coordinators throughout the Department of Health and Human
Services, those individuals who enhance the Department's focus
on women's health research, be funded at least to the
Administration's recommended levels. In particular, we strongly
support the $50 million request in the President's budget for
the Office of Research on Women's Health, which is, as you
know, based within the NIH, and the $27 million request for the
Office of Women's Health in the Office of the Secretary.
These are significant increases that need to be maintained,
but I want to point out also that other women's health
representatives in SAMHSA and CDC and FDA andelsewhere also
need strong support to carry out their missions.
Third, within the $50 million for the Office of Research on
Women's Health, that is the office with NIH, we ask for your
strong support in creating women's health research centers, as
recommended in the Administration's proposed budget. We believe
these should be well funded interdisciplinary, peer reviewed
centers, which collectively cover a wide range of critical sex
and gender based health research issues.
Such centers would provide an effective mechanism for
operationalizing a strategy in women's health that would pursue
a research agenda that's been designed by the Office of
Research on Women's Health. This strategy is used, that is the
strategy of centers, is used in cancer research, it's used in
asthma research. Surely we can do it in a field of research
that will directly affect so many of our citizens. With this
funding, the entire field of sex and gender based research can
move into a new era.
Finally, we ask for your support in maintaining and
expanding the BIRCWH program, which is sponsored by the Office
of Research on Women's Health, again as recommended in the
President's budget. BIRCWH, which stands for Building
Interdisciplinary Careers in Women's Health, is training the
next generation of women's health researchers. It is strongly
supported by the institutes within NIH and by the community.
NIH plans to issue a request for applications to generate a new
round of these centers, but the Office of Research on Women's
Health must have the $50 million appropriation to create them.
Just last month, the Institute of Medicine issued a
landmark report called Exploring the Biological Contributions
to Health Research: Does Sex Matter? The results were
unequivocal with regard to the incredible scientific
opportunity in studying sex differences with regard to health.
This Subcommittee and the Department of Health and Human
Services routinely does turn to the IOM for advice on major
questions related to medical research and practice because the
IOM provides objective, scientific analysis.
The report makes it clear that sex is a critical variable
in understanding biology at the cellular level, and remains so
through early development, puberty, adulthood and old age. We
hope that the Committee will support the priorities I've
outlined above to begin the process of implementing the IOM's
fundamental conclusion that sex matters.
Mr. Chairman, Committee, the Women's Health Research
Coalition stands ready to work with the Subcommittee to advance
research on women's health and sex-specific factors in health
and disease and thus build a better future for all Americans.
Thank you for this opportunity to testify.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. No questions.
Mr. Regula. Mr. Jackson.
Mr. Jackson. No questions, Mr. Chairman.
Mr. Regula. Mrs. DeLauro.
Mrs. DeLauro. No questions. I think Dr. Mazure just laid
out a mission for all of us, and the kind of first-rate work
that is done that we have seen and see the results of, I think
just continues to let us know that we need to focus in this
area, because of what the results have been, and where we might
go. Thank you for your great work.
Mr. Regula. I'm curious, obviously, the life expectancy of
women is substantially higher than men. Shouldn't the focus be
perhaps on both men's and women's health issues? For some
reason it's just been women's health out at NIH. It would seem
to me that it ought to be a little broader. What would be your
observation?
Ms. Mazure. I think that's a very important point. The way
in which we really see it is, I think several points are
embedded in the answer. One is that historically, women have
not been the subjects of research. So we have a bit of
scientific catch-up to do. Secondarily, in the new science and
the way in which we're approaching women's health, we're very
interested in what's referred to as sex-specific differences.
And by looking at differences between women and men in
reference to all forms of illness and all forms of disease
prevention, we really are discovering as much about men's
health as women's health. So I think the broad field of women's
health really advances health knowledge in all areas for
everyone.
I also do think that in reference to the issue that you
raised where men tend to live on average a shorter length of
life than women, living longer doesn't always necessarily mean
living better. It often is associated with higher rates of
chronic disease, cancer, dementias, cardiovascular illness.
Nevertheless, I think we have to do better at communicating
information about health to men so that men are in a position
to take better care of their own health.
Mr. Regula. Thank you. We appreciate your being here.
----------
Tuesday, May 22, 2001.
SMALL SCHOOLS
WITNESS
TOM VANDER ARK, EXECUTIVE DIRECTOR OF EDUCATION, BILL AND MELINDA GATES
FOUNDATION
Mr. Regula. Our next witness today is Mr. Tom Vander Ark,
who's the Executive Director of Education for the Bill and
Melinda Gates Foundation, to talk about small schools. We're
pleased to welcome you, Mr. Vander Ark.
Mr. Vander Ark. Thank you, Mr. Chairman, members of the
Committee. It's a pleasure to be with you today.
I'm Tom Vander Ark, I'm the Executive Director for
Education for the Bill and Melinda Gates Foundation in Seattle.
There's been a great deal of attention paid to elementary
schools in particular in education reform in the last decade,
and very little paid to high schools, which is surprising,
because American high schools work well for relatively few
students. Unfortunately, that's most true for economically
disadvantaged students and students of color.
But today there are hundreds of schools that are bucking
that trend. They're public schools, charter schools, private
schools, urban, rural, they're suburban schools, but they all
have one thing in common: they're small. After 40 years of
consolidation, about two-thirds of American students now go to
high schools larger than 1,000 students. As former Governor Jim
Hunt said, we've made a terrible mistake in America. And we
think it's time to reverse that mistake.
There are decades of research, and especially a plethora of
research in the last five years that small schools make a
difference. It's interesting to note that there's very more
conclusive research on small schools than there is on small
class size. And yet small class size is a top of mind issue for
teachers and parents.
What we know from the research is that small schools
improve attendance, achievement, motivation, graduation rates,
it results in higher college attendance rates, school safety
and school climate are improved, there's better parent and
community involvement and better staff satisfaction.
Mr. Regula. I'm sorry to interrupt you, would you define
small school? You're talking about it as a term. If we had some
definition it would be a little easier to relate to your
testimony.
Mr. Vander Ark. The research is inconclusive on that front.
We generally say about 400 students, or less than 100 students
per grade. So if it's a 6-12 school, it might be 600 students.
But it's less than 100 students per grade.
Mr. Regula. Would that be, would you define it as a small
school in terms of a building, could it be one school district
with a lot of small units?
Mr. Vander Ark. Absolutely. I'll give you an example. The
Julia Richman High School in the East Side of Manhattan, in the
early 1990s, was one of three dozen large comprehensive high
schools in New York City that had graduation rates of less than
25 percent. Let's think about that for a minute. This is a
school that serves economically disadvantaged students,
primarily students of color. They had a graduation rate of less
than 25 percent.
Today that center, it's now called the Julia Richman
Education Complex, that complex now has four small focused high
schools, a K-8 school, a school for autistic children and a day
care center. So there's about 1,600 students on that campus.
All four of those high schools have graduation rates between 90
and 95 percent and college attendance rates of the same. All of
the students in that school share the amenities of a large
school, gymnasiums, auditorium, performing arts center, and a
library.
All of these schools, and the hundreds of great small
schools in New York, in Chicago, in the Bay Area, all operate
on the same per pupil allocation as large schools. So the
notion that they're less efficient is absolutely not true. For
the same money, we can get the benefits that I described
earlier.
Why is this important to us? It's become a focus of our
work because high schools are the largest, the least efficient
and least effective and the most intractable schools in our
system. We've developed a two-pronged approach of starting new
small high schools and trying to help transform big bad schools
into a multiplex of good small schools.
But changing an American tradition is far from easy. The
Gates Foundation and a number of other private philanthropies
have contributed considerable resources to this daunting
challenge. But it's going to take multi-sector collaboration to
effect real change at scale.
There's a growing consensus that our high schools aren't
working, especially for most economically disadvantaged
students. And there's fortunately a growing consensus about the
attributes of schools that work for all students. We feel
strongly that it's time to address this important injustice in
our schools and to promote real design, so that all of our
schools work for all of our kids.
Thank you for the opportunity to testify.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
Isn't it true that the research shows that student
performance is superior in high schools that are smaller than
800 students as opposed to larger?
Mr. Vander Ark. No question.
Mr. Obey. I find it interesting and frustrating that last
year this Committee worked to increase the appropriation to
assist school districts to explore the opportunity to create
smaller schools, especially at the high school level. We
increased funding for that program from $45 million to $125
million. But, the bill which is on the floor today eliminates
this specific authorization for small schools.
I find that distressing because I think that small schools
are absolutely critical at the high school level if we're going
to improve not just academic behavior but social behavior as
well. I congratulate the organization that you are running for
its emphasis on the problem.
Just one other point. It's my understanding, Mr. Chairman,
that in Florida, Governor Bush and the legislature have passed
legislation requiring that all new high schools that are built
be of the smaller variety. I wish that nationally we would get
the same message as we're getting from the kid brother in
Florida. [Laughter.]
I also would note that I've seen a number of comments which
suggest that small high schools are more costly per student. My
understanding is that while they may have a higher cost per
student, that they are less costly per graduate, indicating
that there is a higher level of performance that pays off
economically as well as academically.
Mr. Vander Ark. Mr. Chairman and Mr. Obey, our findings are
that the hundreds of small schools that exist today generally
operate on the same per pupil allocation. I would argue, as Ms.
Keegan did earlier, that we do need to address the inequities
in our funding system. This is true especially in our major
cities. I would agree that we need funding that's needs based
and that follows the students.
That's a different but related issue to this one. I think
the important point here is, there are hundreds of great
schools doing a great job for the same per pupil allocation.
Now, two related issues on capital costs. Some would argue that
it costs more in terms of capital construction per pupil for a
small school. That may be true if you want to adorn it with all
the amenities that we traditionally think of on a secondary
campus. But clearly, there's opportunity, as Julia Richman and
many others illustrate, for a number of schools to share a
campus facility with the traditional accoutrements of an
American high school.
The second issue is that there is a transaction cost, a
transformation or a redesign cost to transform a big,
comprehensive school into a multiplex of small schools. It's
not capital cost, it is primarily time and resources for the
staff to rethink the way their schools are designed, to be
trained to teach in small teams, to serve as advisors for
students. And that's what the bulk of our funds pay for, is
that redesign effort.
Mr. Obey. Thank you, Mr. Chairman.
Mr. Regula. Mr. Obey, you and I both went to the Aspen
seminar. As I recall, Dr. Levy from the New York City system
was pointing their system in that direction. Is my recollection
similar to yours?
Mr. Obey. He certainly indicated that he wanted to, in the
remarks that he gave to the conference.
Mr. Vander Ark. I can address that, Mr. Chairman and Mr.
Obey. The Gates Foundation, Carnegie and the Open Society
Institute have helped to support a major initiative with New
York City and New Visions for Public Schools in an effort to
both start new small schools and to attempt to transform 12 to
15 of the worst large high schools in New York into small
schools, small, a multiplex of small schools much as I've
described.
Mr. Regula. Do athletics get in the way?
Mr. Vander Ark. Absolutely. This is dangerous and
politically radioactive work, largely because high schools work
today for elite athletes and for the top 10 percent of our
students. Those are vocal and influential parents. So it is
clearly an issue.
I'll mention the Julia Richman story. The students from
those four high schools play together on interscholastic teams.
They compete, they mix teams and compete internally on
intramural teams. So again, that's a great model of how you can
have your elite sports, if that's what a community desires, but
have very small focused coherent programs where every child
gets the attention they deserve.
Mr. Obey. Mr. Chairman, I guess I would observe that it
would be interesting to compare headline size for a high school
that wins a conference football championship versus a high
school that produces an unusually large number of national
merit scholars.
Mr. Regula. I agree with you completely. I live on a farm.
At the end of my driveway is an old red brick one room school
that was closed about 50 years ago. I've said many times, I
have three children, I would have been absolutely delighted had
they gone there. Because they would have had eight grades eight
times, provided there was a good teacher. That's always a
caveat that goes all the way througheducation. We're into a
consolidated school, and I see some real problems.
I'm curious, how does your foundation practically, how do
you try to encourage this trend, probably to discourage
consolidations or big schools and at the same time encourage
some deconsolidation, if you will?
Mr. Vander Ark. Well, Mr. Chairman, I'll give you an
example of the work that we just initiated in Colorado with
Governor Owens' office. First of all, we're helping to create a
statewide foundation to create a network of technology focused
high schools in the most economically disadvantaged
neighborhoods in Colorado.
Secondly, we're working with the State accountability
system, so that every high school that's labeled as under-
performing in their State becomes eligible for the program that
we've designed, that will actually supplement the State aid to
failing schools. So they get a small amount of money from the
State and then if they can demonstrate to us some sense of
leadership and initiative, we'll supplement that with
additional money, with outside consulting help and some clear
direction on what they ought to do.
Mr. Regula. You've obviously worked with the New York
system and from what I remember of Dr. Levy's comments it's
working pretty well in terms of, as compared to what it had
been before.
Mr. Obey. I'm sorry, I didn't hear you.
Mr. Regula. I said, I think Dr. Levy indicated in his
testimony to us in that seminar that their decentralization was
working fairly effectively for students.
Mr. Obey. He thought it was. He also mentioned that there
were a considerable number of critics after him, as you
indicated. But I think he'll outlast them.
Mr. Regula. Chicago's done--I'm sorry Mr. Jackson isn't
here--Chicago's done some pretty innovative things. I met with
their superintendent, and at least I was under the impression
that they were doing what you're suggesting. Is that accurate?
Mr. Vander Ark. Mr. Chairman, that's accurate. Pat Walsley,
who is now the dean at the University of Washington, recently
authored a study called Small Schools Great Strides, which
chronicles the success of the roughly 150 small schools in
Chicago. So they've certainly recognized that size matters, and
that good teaching most frequently happens in small schools,
where teachers can work together, where they can hold each
other accountable, and where they can hold students
accountable. You can create an authoritative environment in a
small school that's virtually impossible to create in a large
school.
Mr. Regula. Did you get an opportunity to testify in the
authorizing committee? They were doing a bill that we have on
the Floor now.
Mr. Vander Ark. Mr. Chairman, as a foundation we don't
advocate for particular appropriations or bills. So no, I
didn't.
Mr. Regula. Well, from what you're saying, Mr. Obey, the
ability of this Committee to support a small school program
would be inhibited by the lack of authorization in the new
bill.
Mr. Obey. Well, what I'm saying is that the authorization
bill repeals the specific authorization. We have, in the past,
on this Committee found ways, by using general authorizations,
to accomplish purposes that are constructive, and I hope that
we can find that in this instance as well. I think it's a
strange argument that some people make--that no effort is
required on the part of the Federal Government because the
Gates Foundation is involved. That seems to say, let cousin
Johnny do it, rather than me, when we all ought to be working
on it together.
Mr. Regula. Well, thank you for coming. I'm in total
agreement with what you're saying. I've been seven years in
public education and on the State school board. I think this
trend of bigness is better is just being demonstrated as not
the right way to go. Have you developed any paper on this
subject, to support what you've presented this morning? Of
course we have your testimony. Is there anything additional to
that?
Mr. Vander Ark. Mr. Chairman, we have several articles on
this subject. My testimony includes references to a number of
the research studies that have been published in the last four
or five years. I'd also call your attention to the Dropout
Commission that made their report on January, Commission on the
Senior Year, which made their report in February, the American
Youth Policy Forum, which published their report earlier this
year, the Education Trust, all of those organizations have come
out very strongly in favor of small schools, and all of those
reports cite many of the same pieces of research that are noted
in my testimony.
Mr. Regula. What you're saying is that in the thoughtful
establishment, this is the direction that the research is
taking?
Mr. Vander Ark. There's very strong momentum among people
that are looking at data. Unfortunately, that conversation has
not reached most local school districts.
Mr. Regula. I think we'll need to be creative.
Mr. Obey. Well, I think that's allowed in the democratic
system. [Laughter.]
Mr. Regula. Thank you very much for coming. I commend you
for your work, and I hope you have ever greater success.
Mr. Vander Ark. Thank you.
Mr. Regula. Because I think it's absolutely the right way
to go.
----------
Tuesday, May 22, 2001.
NIH
WITNESS
ERIC S. LANDER, CHAIR, JOINT STEERING COMMITTEE FOR PUBLIC POLICY
Mr. Regula. I understand, Dr. Lander, you're on a tight
schedule. So we'll give you an opportunity to be heard at this
moment.
Mr. Lander. Thank you very much, Mr. Chairman.
Mr. Regula. Your testimony will be in the record and we'll
welcome a summary.
Mr. Lander. Great. Mr. Chairman, members of the
Subcommittee, thank you for inviting me here this morning to
testify. My name is Eric Lander, I'm a professor of biology at
the Massachusetts Institute of Technology and the Director of
the Whitehead Institute/MIT Center for Genome Research. I'm
here today representing the Joint Steering Committee for Public
Policy, which is a coalition of scientific research societies
that jointly represents about 25,000 research scientists
nationwide and globally.
My own scientific research is related to the Human Genome
Project. Our own center at the Whitehead Institute was the
largest of the contributors to the recent sequencing of the
human genome, and in addition, we work on trying to apply this
knowledge to dissect the basis of human diseases, the causes of
cancer and diabetes and heart disease.
The scientific community is tremendously grateful for the
support of this Committee and of the Congress in increasing the
funding for the National Institutes of Health over the past
several years. The additional funding is having a major impact
on the pace of biomedical research, and it's been responsible
for much of the remarkable scientific progress that we read
about on a daily basis.
I'm here today to ask you to continue increasing that
support toward the goal of doubling the NIH budget. Given your
own history of support for biomedical research, I take it for
granted that you consider funding the NIH to be a tremendously
important investment in our children's future. And I take it
for granted that you know that millions of Americans suffer
from Alzheimer's disease and arthritis and cancer and chronic
lung diseases and diabetes and heart disease. And I take it for
granted that you know that such diseases pose an incalculable
burden of pain and hardship on its victims and their families,
as well as a financial burden estimated approaching $1 trillion
annually.
But this alone would not be enough to justify substantial
increases now. Substantial increases now can only be justified
if two things hold. First, that there really are extraordinary
and urgent new opportunities that justify additional
investment. And two, that there's confidence that additional
investment can be used well.
And you have every right to demand answer to those
questions, and I want to provide them. Number one, what are
these new opportunities and what's so urgent them anyway? Mr.
Chairman, there is an extraordinary revolution now underway.
The revolution is most apparent in such landmarks as the Human
Genome Project, which has given us the parts list for human
medicine, the inventory of 30,000 or 40,000 human genes. This
is having a dramatic effect on medicine. It's the equivalent of
being able, for the first time, to have a look under the hood
of the car to see what's wrong.
One of the most uncomfortable facts about medicine in the
20th century is that for most diseases, including heart
disease, diabetes, hypertension, depression and schizophrenia,
we have had no clue what the actual cause is, the molecular
mechanism of the disease. So we've been shooting in the dark.
We've mostly been treating symptoms. Sometimes we get it right,
but often it's a matter of luck.
In the past decade, we've begun to see real progress on
discovering the mechanisms, the causes of disease. Let me give
you an example of what happens when we know the mechanism. Ten
days ago the FDA granted swift approval to a new cancer drug,
Gleevec, directed against a kind of leukemia called Chronic
Myelogenous Leukemia. It was a new kind of cancer drug: it is
non-toxic and taken orally. Of 53 patients who had failed
conventional therapy and were expected to die of their disease,
53 had remissions. Moreover, the drug is now turning out to be
effective against other cancers for which it wasn't even
designed, including a kind of stomach cancer.
Some people call this a miracle, and in many ways, it is.
But it's no accident. It resulted from a dogged effort to
understand the cause, the mechanism of leukemia. First, the
recognition that two chromosomes were consistently rearranged
in this cancer. Then the discovery that a novel gene caused by
this chromosome rearrangement produced an errant protein locked
in the on position.
Then the proof that this protein, this errant protein, was
absolutely essential for the cancer cells to grow. All this was
the product of NIH funded research, through the foresight of
this Congress. Once the mechanism was known, talented chemists
in the pharmaceutical industry stepped in and created a drug to
block this errant protein, and without side effects.
Mr. Chairman, it's the difference between trying to fix a
car when you have no idea what's wrong and between trying to
fix a car when you can look under the hood. And this is not an
isolated story. Ten years ago we had no idea what the mechanism
was of Alzheimer's disease. Since then, we've been able to look
under the hood and find key causative mechanisms. And it's led
to an explosion in drug development.
I believe that we will see drugs emerge that can prevent
Alzheimer's disease before symptoms occur, that is, prevention
of diseases, rather than dealing with the devastating
consequences. This could only happen by knowingthe mechanism.
Similar stories have emerged for Parkinson's disease and
other diseases. We're standing on the threshold of what I think
is the greatest revolution in the history of medicine. We're
now set to work out the mechanisms underlying most common
diseases that afflict people. And it's an audacious program to
imagine that this could happen, but I believe it will happen in
the next one to two decades.
But it's going to take major and increased investment now.
I think the investments were justified. We finally have the
tools to lay bare the secrets of disease, and I think we'd be
failing the American people in general and our children in
particular if we didn't seize the opportunity. If we delay
investment today, we delay understanding, we delay therapies
and cures. I think this is a very special moment in history and
we need to seize it.
Number two, how can this Congress be sure that the
increased investment is being used widely? That is, how can you
monitor the progress?
Some years ago, this Congress passed the Government
Performance and Results Act, GPRA. What performance and results
should you be monitoring?
Well, the development of new drugs and therapies that
stemmed from NIH is one such measure. But it's a long term
measure, because it can take a decade or more for understanding
to translate to therapy.
Instead, I would urge you to focus on the discovery of
mechanisms. Keep a scorecard of how we're doing at discovering
the mechanisms. That's the key, because you can feel confident
that if we reveal the molecular mechanisms, it will unlock the
prodigious energies of industry and academia to fashion
therapies and cures. In this way, you can be sure that the
investments are reaping dividends.
You can also look at new initiatives at NIH, such as the
newly established NIH Center for Minority Health, which is a
sign that we're working together to ensure that biomedical
research benefits all Americans.
Number three, finally, Mr. Chairman, I know it's not the
purview of this Committee, but I would like to add that for all
of this to succeed, we need increased investment in other areas
of science as well. Increased investment in biomedical research
will not reap its full potential unless we have corresponding
investment in physics, chemistry, computational science, etc.
These allied disciplines are absolutely essential. For example,
for figuring out what protein shapes and functions are about,
or for developing non-invasive imaging to speed clinical trials
through the study of early markers of disease.
The President's budget for biomedical research is very
encouraging. But I'm deeply concerned that the budget for other
sciences is neglecting key investments.
In summary, this is no ordinary time. The science of the
last century has now brought us to an extraordinary threshold
of understanding the basis of disease, and it is time for
extraordinary investment to reap those benefits.
Thank you for your consideration, and I'd be glad to answer
your questions.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. Well, I want to thank you very much for your
statement. It's not the first time that I've heard you, but I'm
very happy that you focused on our obligations beyond NIH. I've
said this before, but I'll say it again very frankly. There is
a member of the Subcommittee that was prepared to vote for at
least the President's budget on NIH. It's become the holy
picture item in the health budget. We all pose for political
holy pictures by stumbling toward the nearest microphone to say
how much we're dedicated to NIH research.
The problem is two-fold, as I see it. First of all, this
big investment in NIH, according to the budget, will stop after
2004. Because then the budget estimates don't contain the 15
percent increases any more, the increases drop to low single
digit levels, accurately reflecting what will be available in
the budget as this tax cut that's being passed continues to
drive everything else off the table.
The other problem that we have, as you have indicated, is
that if all we do is fund NIH and don't deal with NSF and some
of the other seed corn agencies, we are going to cut the plant
off at its roots. The flowers may look pretty for a few days,
but they won't last that long, at least not in the health we'd
like to see them.
This isn't really a question. It's just a statement of
philosophy. I think that we have a once in a generation
opportunity, now that we have surpluses instead of deficits. We
have a choice to make between tossing almost all of those
surpluses at the private sector in the form of individualized
realizations of happiness through tax cuts, or we can try to
reserve a major part of those surpluses, I would hope by far
the largest part, to finally enhance the quality of public
services and the strength of public investments that must by
nature be a collective enterprise rather than an individual
enterprise.
I think we're about to blow the biggest chance we've had in
a generation to really make a difference, not just for medical
research, but in a number of other areas as well. I thank you
for focusing not just on NIH, but also on the other near
orphans in the scientific community, given the squeeze that we
have on those agencies.
Mr. Lander. Thank you. We can't deliver on the promise
without a full picture of the support it will take.
Mr. Regula. Thank you for a thought provoking testimony.
Mr. Lander. Thank you, Mr. Chairman.
----------
Tuesday, May 22, 2001.
TEACHERS
WITNESS
C. EMILY FEISTRITZER, PRESIDENT, NATIONAL CENTER FOR EDUCATION
INFORMATION
Mr. Regula. Our next witness is Emily Feistritzer,
President of the National Center for Education Information.
Your testimony will be made part of the record, we welcome your
comments.
Ms. Feistritzer. Thank you, Mr. Chairman. I'm the President
of the National Center for Education Information, which is a
private, non-partisan research organization in Washington. I
started the National Center for Education Information just to
fill what I thought was a gap of a need for collecting,
analyzing and reporting objective and unbiased information. So
we really don't take a position on these matters, but we take
great pride in the kind of data that we've been able to make
available.
I thought I was going to follow the gentleman from the
Gates Foundation and I wanted so much to do that, because so
many things he said fit right into this changing market for
teaching and alternative routes for bringing people into
teaching.
But I wanted to share with you, before I get into my
statement, in a book that we do called Alternative Teacher
Certification: A State by State Analysis, which I will make
available to the entire Committee, in the introduction we have
a section on schools in the nature of how schools are organized
in this country. One of the bulleted items states that at the
high school level, only 3 percent of all secondary schools in
this country enroll 1,500 or more students, and yet they
account for 33 percent of all enrollment. It just reinforces
what Mr. Vander Ark said. Forty-one percent of schools enroll
fewer than 400 students, and yet account for only 18 percent of
all students.
So we're really talking about a relatively small number of
schools throughout this country that enroll the proportion of
all the students who are enrolled in schools. This is very much
related to the whole issue of teacher supply and demand, which
is the topic that I was asked to speak with you about. We've
all heard that we're going to need to 2.2 million additional
teachers in the next decade. You could have a whole hearing
with probably 25 witnesses to just debate what that actually
means.
But the fact of the matter is, the demand for teachers is
increasing, not decreasing. But it's actually not increasing
everywhere. The demand for teachers is really isolated in
certain regions of the country, namely large inner cities and
in outlying rural areas of the country. And in certain subject
matter areas, such as science, mathematics and special
education.
We find that actually, the Nation nationally is turning out
enough people to teach. The colleges and universities that
prepare teachers in this country are producing roughly 200,000
brand new, never taught before teachers each year, and that's
more than enough actually. The problem is most of the people
who are coming through colleges of education fully qualified to
teach don't want to teach where the demand for teachers is
greatest. Undergraduate teacher education programs historically
have turned out young white females who do not want to teach in
large inner cities and who do not want to move actually very
far away from home.
Now, what we find also is that in the National Center for
Education Statistics data from baccalaureate and beyond
studies, that about 60 percent of baccalaureate degree
recipients who are fully qualified to teach are not teaching
the following year, and only about 53 percent of them are not
teaching five years out. So we have a production of teachers in
this country that is great enough to meet the demand. The
problem is that the production of teachers is not satisfying
the demand, because the demand is, as I said earlier, isolated
and quite specific to geographic regions and to specific
subject areas.
That's why this new movement toward States developing
alternative routes for recruiting, training and licensing
teachers makes so much sense. Because not only have alternative
routes evolved since the mid-1980s and grown rapidly since the
mid-1990s, it is because not only are they meeting the demand
for additional teachers in specific areas of the country, they
are also meeting the demand created by the supply of people who
are stepping forward to want to teach who do not fit the
traditional definition of a teacher, which is a high school
student going to go college and majoring in education.
We find that there are huge numbers of what I call non-
traditional candidates for teaching, people who already have a
bachelor's degree, usually in a field other than education,
many of whom have life experience, some of whom have been in
other careers and retired, who really do want to teach. And
they really do want to teach in areas of the country where the
demand for teachers is greatest. And alternate routes are being
developed all over the country to specifically recruit these
people to teach in these ares of the country where the demand
is greatest.
And the Federal Government, in its infinite wisdom, has
been through the authorizing language and through this
appropriation moving in the direction of providing some much
needed support of the development of these types of programs.
I see that my formal time is up, so I'll stop here.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I'm curious, is the multiplicity of
requirements, and it varies from State to State for
certification, is somewhat of a barrier to the people you
characterize perhaps who have had other careers and would like
to teach, but suddenly they're faced with going back and taking
a couple of years of how-to courses, is that a problem?
Ms. Feistritzer. I think it is a problem. You can't ask
people who have finished their degrees, in some cases masters
degrees and some cases professional and even more advanced
degrees, to give up employment and go back to college and pay
tuition to take courses required for certification and may or
may not be able to find a job.
So that is a problem. That's why the alternate routes that
are designed specifically to attract this population of people
and are developed to train that population of people to teach
in the very schools that most traditionally trained teachers
don't want to teach in make an awful lot of sense, and are
being met with a tremendous amount of enthusiasm from mid-
career changers and military personnel and so on.
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
As you know, last year we were able to provide $34 million
in the budget for non-traditional teacher recruitment
activities. And $31 million of that was based on the
Transition-to-Teaching Initiative. What's your evaluation of
that program?
Ms. Feistritzer. I have testified before the authorizing
subcommittee, and I'm very much in favor of that. I think that
the States really do need financial support in developing these
programs. Most of the programs that are springing up around the
country are really on the backs of the participants in the
program. They can be very costly to the individual who's trying
to get a credential to teach. So I think the transitions to
teach program, in the current budget, is an excellent program.
My only caution, I was around during the block grant era of
Chapter II in the early 1980s. I saw a lot of really good
programs, like teacher centers and teacher corps really get
lost in the block grants. And I think that, I have a problem
with turning all of this money over to the States to do with as
they will. I would hope that there would be some guidelines
that these monies be used for such things as the design and
implementation of alternative certification routes, for
example. Because I'm not sure the States will wind up using it
for that if they can get away with using it for something else.
Mr. Obey. How about the Teach for America model?
Ms. Feistritzer. Teach for America is really a recruitment
effort for recent college graduates to make a two year
commitment to teaching. I like Teach for America a lot. I like
Troops to Teachers an awful lot. But those two programs are
specifically recruitment efforts for specific populations of
people.
The alternative teacher certification arena is much broader
and much bigger and encompasses a whole lot more people and has
more potential, I think, for bringing in wider audiences of
people in a way that fits with the current bureaucracy of
American education, which is not likely to change in our
lifetimes.
Mr. Obey. I would just have to say that in light of your
other comments about block grants, that I'm fascinated. One
thing that fascinates me is that there are a number of people
in Congress and out who will criticize the degree of
educational attainment of students in the country. And they
will say, we just aren't doing very well at all. So their
answer is to turn even more authority over to the people who
already have the lion's share over running schools, namely the
local school boards.
I don't think my district is much different than anybody
else's, local school boards make 95 percent of the decisions
about how kids get educated and where they get educated, who
they get educated by and where resources go. It's always
fascinated me that the Federal Government, which really is only
nibbling around the edges in terms of the financial support it
gives education, somehow gets the blame for the lack of
performance in schools that are largely governed by local
school districts.
I think you have to conclude that that judgment is not
based on evidence, but it's based more on ideology or
philosophy.
Thank you, Mr. Chairman.
Mr. Regula. Has there been any movement on the part of
States to remodel their requirements for certification to make
it easier for these transition type of individuals?
Ms. Feistritzer. We survey the State departments of teacher
ed and certification every year. And the results of that are
published here. There's been a lot of movement in that
direction.
I am more encouraged, I've been covering and around
education all my life, I'm a third generation educator. And I'm
actually more optimistic than I think I've been throughout my
life about the future of the teaching profession for this
single reason, that the population of people who are stepping
up to the plate sincerely wanting to teach is radically
changing, positively.
And the States and even the institutions of higher
education are being, I think, very positively responsive to
using it as an opportunity to design some really good,
sensible, not a whole lot of courses and riff-raff, but really
sensible, field based mentor companion teacher preparation
program for life experienced adults. Forty-one States now say
they are doing such a thing, but they need a lot of support.
Mr. Regula. Has the NEA and/or the AFT been a help or
hindrance, or are they neutral on this whole effort?
Ms. Feistritzer. The NEA and the AFT both, to their credit,
have been back in the early 1980s, rather silent on the issue
and increasingly open to the development of good new
alternative teacher preparation programs. They've not gone as
far as sitting here before you, calling for $1.2 billion for
them.
But they have been increasingly, I think, open to the
development of collaborative alternative teacher preparation.
Mr. Regula. That's a positive note.
Thank you for coming.
Ms. Feistritzer. Thank you.
Tuesday, May 22, 2001.
STUDENT FINANCIAL AID
WITNESS
BRIAN FITZGERALD, STAFF DIRECTOR, ADVISORY COMMITTEE ON STUDENT
FINANCIAL ASSISTANCE
Mr. Regula. Brian Fitzgerald, Director, Advisory Committee
on Student Financial Assistance. Your statement will be made
part of the record, you may summarize, please.
Mr. Fitzgerald. Thank you, Mr. Chairman, Mr. Obey, for the
opportunity to present an overview of the Advisory Committee's
most recent report entitled Access Denied: Restoring the
Nation's Commitment to Equal Educational Opportunity, a copy of
which is in your materials today.
For the record, my name is Brian Fitzgerald, I'm staff
director of the Advisory Committee. I will deliver testimony on
behalf of Dr. Juliet Garcia, who is President of the University
of Texas-Brownsville and Chairperson of the Advisory Committee.
She is ill today and apologizes for not being able to be here
herself.
Our committee was authorized by Congress in the Higher Ed
amendments of 1986, to provide expert, independent, objective
advice to Congress and the Secretary on Federal student
financial aid policy issues. The committee's most important
legislative charge is to make recommendations that maintain
access to post-secondary education for low income students.
Over two years ago, the committee began a comprehensive
examination of the condition of access, that is the opportunity
to attain a baccalaureate degree. At three public meetings
devoted exclusively to access, the committee was informed by
testimony of dozens of students, college administrators and
scholars about the financial as well as the academic, social
and cultural dimensions of access.
Emanating from those activities and a parallel two year
study, the Access Denied report marshals the most authoritative
data to pinpoint the access problem and its causes. The report
documents the wide gap between available aid, including loans,
and college costs for low income students. This gap, known as
unmet need, is $3,200 a year at two year public colleges and
$3,800 a year at four year public colleges. Significant enough
to lower the rate at which low income students enter college,
attend four year institutions and attain a bachelor's degree.
More than 30 years ago, the Federal Government entered into
a partnership with States and higher education institutions to
ensure that all Americans could have access to a college
education without regard to their economic means. As a result,
tens of millions of Americans who otherwise would not have had
access to college have attended and earned associate's and
bachelor's degrees. This highly successful effort increased the
rate at which Americans enter college to record levels, which
has fueled this Nation's economic growth.
Unfortunately, the post-secondary participation of low
income students continues to lag far behind that of their
middle and upper income peers. Large differences in college
entry rates persist, with gaps as wide as three decades ago.
In addition, a recent U.S. Department of Education study
indicated that low income students who graduate high school at
least marginally qualified, enroll in four year institutions at
half the rate of their comparably qualified high income peers.
Equally troubling, only 6 percent of low SES students earn a
bachelor's degree, as compared to 40 percent of high SES
students. These facts have major implications not only for the
lifetime earnings of low income students, but it also robs the
Nation of hundreds of billions of dollars a year in gross
domestic product.
Yet the challenges that face low income students today in
gaining access to college will worsen considerably as a result
of impending demographic forces. Rivaling the size of the baby
boom generation, the projected national growth of college age
population by 2015 exceeds 16 percent or about 5 million, with
at least 1.6 million additional students enrolling in college,
many of whom will be low income. Thus, even if college costs
continue to grow no more rapidly than family income, these
demographic changes will greatly increase the gross amount of
financial aid required to ensure access.
Unfortunately, financial barriers are higher now in
constant dollars than they were three decades ago. The unmet
need gap facing low income students has reached unprecedented
levels, once again, $3,200 and $3,800 respectively at two year
and four year public institutions. This includes all work and
loan.
Given these levels of unmet need, the failure to close the
participation and completion gaps is not surprising. Unmet need
is forcing low income students to choose levels of enrollment
and financing alternatives not conducive to academic success,
persistence and ultimately degree completion.
One often hears the argument that poor academic preparation
is the primary reason for low income students' lack of access.
That is simply not true. Inadequate financial aid, that is the
unmet need gap, often prevents the most highly qualified low
income youth from attending college at all. In fact, the lowest
achieving high income students attend college with the same
frequency as the highest achieving poor students.
If my committee members could leave you with only one
message today, it would be this. The inability of tens of
thousands of academically prepared low income students to
enroll in a four year institution, attend full time and earn a
bachelor's degree is the result of unmet need just as it was 30
years ago, and portends no narrowing of participation gaps,
even in the long run. No matter how strong the Nation's
commitment to academic preparation, no matter how quickly
academic preparation advances, no progress can be made toward
improving access without increases in need based grant
assistance starting with the Pell Grant program.
Thank you, Mr. Chairman and Mr. Obey. I would be happy to
respond to any questions you have.
[The justification follows:]
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Mr. Regula. Thank you. I have just one.
On the Pell Grants, which would you think would be more
effective, have a larger amount the first year with a
decreasing amount the second, third and fourth year, or have a
flat amount for four years as part of a Pell Grant program? And
some of the colleges have indicated they have to end up picking
up the difference where it drops off in the second, third and
fourth year. Do you have an opinion on this, which would be the
better way to do it?
Mr. Fitzgerald. Mr. Chairman, we looked not only at the
ability of students to enter college, but the most important
thing is that students must be enabled to persist and obtain a
degree of their choosing. We feel that giving higher grants in
the first year or first two years may have a slight impact on
the number of students enrolling, that is to say, it may
increase. We are very concerned that it may actually harm
persistence, and put colleges in a position, and many of them
serving the lowest income students will not be able to do this,
but put colleges in a position where they have to make up the
difference.
Mr. Regula. So you'd prefer a flat amount for four years?
Mr. Fitzgerald. That is correct, Mr. Chairman.
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
I would simply note that, the reason why low-income
students don't attend college in the numbers that we would like
them to is very easy to understand, when you recognize that in
1975 the Pell Grant maximum award, as a percentage of the cost
of going to college, was 84 percent, and today it's 39 percent.
I don't think it takes a rocket scientist in order to figure
out that that's a major reason why much smaller numbers of low-
income people attend college than would be the case if we
really, truly had equal access to education.
This country is great at myths. We always talk about equal
justice under the law, and liberty and justice for all in the
pledge of allegiance. But when you take a look at performance,
if our words were to match what we're actually doing, the
pledge of allegiance would be amended so we say that we're
providing liberty and justice for almost everybody, but not for
all.
That's all, Mr. Chairman.
Mr. Regula. There have been some allegations that college
tuition tracks with whatever we do with Pell Grants. Any
validity to that? When you look at the numbers, it would appear
that might be the case.
Mr. Fitzgerald. Mr. Chairman, although our report does not
specifically deal with college costs, I think there's been a
good deal of emphasis on college costs recently. We've examined
that very carefully. We find no relationship whatsoever to the
level of Pell Grants and college costs.
Congress created a commission on college costs to look at
that. The fact of the matter is, the number of Pell Grant
recipients is a relatively small number, it's a minority among
students enrolled in college. So if Pell were driving college
costs, you would be, for example, I believe you are on the
board of trustees at Mount Union----
Mr. Regula. Right.
Mr. Fitzgerald. I was just look at the data, I don't know
what the enrolment is, I'm sort of backing into it. But there
are three times as many loans as grants, as Pell Grants, at the
college. If Pell were driving tuition at your college, you
would be in effect taxing non-Pell Grant recipients when they
are no better off as a result of rising Pell Grants.
In fact, the majority of students attend public
institutions, about 80 percent of all students. Those tuitions
are set by a public governance process unrelated to levels of
Federal and often unfortunately, State aid. And in key States,
California, Massachusetts, Virginia, tuitions have declined, 20
percent in Virginia in 1999-2000.
So frankly, I think the concern about college costs is
actually, the jawboning, if you will, has led college leaders
to look very carefully at that and frankly make a very
concerted effort to even lower tuition. That is going to
change, though, with the decline in State subsidies.
Mr. Regula. Yes, we're having that in Ohio because of the
budget constraints.
Mr. Kennedy.
Mr. Kennedy. All the talk about Pell makes me very proud to
come from Rhode Island. And of course, Pell didn't pioneer the
Pell Grant without understanding the importance of what it
meant to my State and all the institutions of higher learning
in my State.
I know from hearing from them, having gone to a number of
graduations this past weekend and talked to the boards of
directors at the different public institutions, they're all
very concerned about what's coming down the road in terms of
funding for higher education and assistance from the Federal
Government. So I welcome your concerns and advocacy on behalf
of financial aid to students. We certainly need it now more
than ever, because as we all know, higher education is the key
to opportunities for the future.
So thank you.
Mr. Regula. Mr. Obey.
Mr. Obey. Mr. Fitzgerald, I'd just like you to repeat one
sentence that you uttered earlier. You said the lowest
achieving high-income students attend college at the same rate
as the highest achieving low-income students?
Mr. Fitzgerald. That's correct, Mr. Obey. It's 78 percent
of the highest achieving low-income students go to college, and
77 percent of the lowest-achieving high income students. The
inescapable conclusion is that money matters.
Mr. Obey. You bet. Thank you, Mr. Chairman.
Mr. Regula. You made your point very effectively.
----------
Tuesday, May 22, 2001.
EDUCATION
WITNESSES
PETER HORTON, ACTOR, THE CREATIVE COALITION AND COMMITTEE FOR EDUCATION
FUNDING
CAROLYN HENRICH, PRESIDENT, COMMITTEE FOR EDUCATION FUNDING
Mr. Regula. Mr. Peter Horton, from the Creative Coalition
and Committee for Education Funding. You're accompanied by
Carolyn Henrich, President of the Committee for Education
Funding.
We're happy to welcome you, your testimony will be made
part of the record, and we'll welcome your comments.
Mr. Horton. Thank you very much. Good morning, Mr. Chairman
and Congressman Obey, members of the panel.
On behalf of the Creative Commission and the Committee for
Education Funding, I would like to thank you for letting us
speak on such an important topic. I think all of us in this
room would agree that education of our children is a foundation
stone, if not the cornerstone, for building and maintaining a
healthy and prosperous society.
My name is Peter Horton, as you stated. I am an actor,
director, writer in the film and television business, as you
also stated. This is Carolyn Henrich, President of the
Committee for Education Funding.
Mr. Chairman, I think I'm going to take your advice and not
read my full written statement into the record. I can feel the
room slowly wilting as we go along here, and with the exception
of a couple of points, facts, I would like to share, I will
then take another tack.
One of the facts in my written statement is that the
Federal investment in education has actually declined as a
share of the Federal budget from 2.5 percent in 1980 to 2.1
percent today, which means that we are spending only two cents
of every Federal dollar on education. Now, the groups that I am
representing today are advocating a five cent expenditure,
which certainly to me seems reasonable, at least.
There's just a couple other quick facts. At the elementary
and secondary level, enrollments are projected to set new
records every year, reaching over 54 million by the year 2006.
Over the next decade, college enrollments are expected to
continue to grow another 11 percent, with one in five students
coming from families below the poverty line. And then the last
one, which truly shocked me, which is that 30 percent of our
students live in poverty in this country, in this Nation.
Mr. Regula. Thirty percent in the public schools live in
poverty, is that correct?
Mr. Horton. Yes, sir. It's shocking.
Mr. Regula. It is.
Mr. Horton. I think what I would like to do for the balance
of my time, if you don't mind, is really speak to you from my
heart. If I can, I would like to try and explain to you why I'm
so passionate about this issue, why I think it's so important
that you provide adequate funding for education in this
country. I went to public school my whole adolescence and
childhood. My sister Ann is a school teacher. One of my heroes
growing up was a woman named Jo Egger Lundquist, who is an
extraordinary educator up in the northwest, who believes that
teaching is not a profession but a calling, which I believe and
concur with completely.
But most importantly, what's affected me the most on this
issue is I recently became a father for the first time. As you
know, becoming a father for the first time changes your whole
outlook on things, your whole perspective on the world. I am
facing a situation in Los Angeles where, for me to get adequate
education for my daughter, I have to be willing and able to
spend $15,000 a year for her grammar school education, and
$10,000 for kindergarten.
Now, there's a significant portion of this country that
makes $10,000 to $15,000 a year in salary, and an even larger
group that's making more than that but still can't afford that
kind of expenditure for education. I don't know what we tell
them. I don't know how we explain that to their children.
My family and I spend a lot of time in a small community in
California called Cambria. It has 5,000 students and the public
school there is so overcrowded that a lot of the classroom work
has to be done in the halls of that school. Now, recently a
number of, or two education bond measures were up for a vote in
that community, and both failed. Now, this is a community where
neighbors know each other, they know the children that they're
voting against. I don't know how to explain to those children
why they still have to use the hallway as their classroom.
Now, you are the only body in this country that has the
ability to set a national standard of education for this
country, a bar if you will, under which no student, not my
daughter, not any student, will fall. We're spending two cents
on a dollar. It used to be two and a half cents, it's now two
cents. We need at least five cents.
And that's not just my opinion. As I'm sure you know, polls
indicate a vast majority of Americans feel like spending five
cents on education is something they can support
wholeheartedly, in fact are asking you to do something about
that. I mean, we are the wealthiest country in this planet. And
we're going through one of the most prosperous times in our
history. We can afford five cents. We can afford the nickel.
Thank you for your time.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you for your testimony. I think you're
right. I would put it another way, I don't think we can afford
not to provide that nickel.
I would just note two things. My wife started out at the
time she married me, as a speech therapist. She used to work
with kids in a hall closet, because that's all that the school
system provided, in one of the schools that she taught. I never
dreamed that 30 years later, you'd still have the same
conditions. I was silly enough to believe in the improvability
of a society on a consistent basis and in so many ways I've
been proven wrong.
The other point I would simply make is that you indicated
that we've actually seen investments in education going down as
a percentage of our national budget. I would point out that
we've seen our investments in everything go down as a
percentage of our national income. If you take a look at all of
the dollars that the Appropriations Committee can provide in
the budget this year, and if you compare that to what we were
spending in 1980, this country was spending 5.2 percent of our
total national income in 1980 on all domestic initiatives of
the Federal Government except for entitlements. That's not
counting programs like Social Security.
Today we are at 3.4 percent of our total national income.
And within five years, under the budget that Congress has just
adopted, we will be down to 2.8 percent of our total national
income. We are shortchanging education. We are shortchanging
science. We are shortchanging health care. We're shortchanging
environmental cleanup. We're shortchanging all of those
collective enterprises that represent the fundamental
responsibilities of people to each other in this society.
And that's what makes this budget this year so incredibly
frustrating.
Mr. Horton. I would say also, I think the way we treat our
children as a Nation is sort of the canary in the cave. It's
our best indicator of our integrity as a Nation. I would say,
our best focus right now, our most necessary focus right now is
to make that statement as a Nation, that our children are worth
at least five cents on the dollar, and the rest up to you.
Mr. Obey. Well, again, all I will say is that over the last
five years we've had an average annual increase in federal
education appropriations of about 13 percent.
Mr. Horton. Yes.
Mr. Obey. This year, the President's budget cuts that rate
of increase in half when you compare apples to apples, program
delivery versus program delivery by academic year. Some
progress. Thank you.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you. It seems to me that the big
challenge we have as a Nation is to get these facts that you've
just mentioned out and in the public consciousness. But not
only that, there has to be a will, because we know more today
than we ever have in our history about brain development and
the impact of violence on children long term in terms of their
learning. We know all these things, and yet we are treating our
kids worse than they've ever been treated in the history of the
Nation.
So even during times of the Depression, kids were,
according to historians and child development specialists, were
essentially treated better because of the nature of family and
attentiveness to children than they are today. It says
something about the fact that it isn't just simply knowing
more. We as a society believe that if we just had more
information that would do it. It's not enough. It's a culture
of change that has to take place for us to embrace this
increase.
So all I can say is that it takes a fundamental political
change of heart. I think those that have advocated a reduction
in Government spending insofar as the collective enterprises
that Mr. Obey was talking about have been doing so by
denigrating government and tearing down our public institutions
and saying that you can't be trusted, politicians can't be
trusted, our whole democracy is failing you, the public. And if
you say that enough, people will believe it. And what they have
come to believe is that that's true. Unfortunately, when they
believe that that's true, there isn't the confidence to support
these programs, and the public will to support these programs.
So we need to change the ethic in this country that looks
upon government and political leaders as the lowest form of
life, and start changing the civic ethic in this country in
terms of public institutions. So I can just say, I
wholeheartedly appreciate what you're saying, and I do agree
that we're becoming two separate societies as a result.
What comes to mind is John Kenneth Galbraith's book,
Private Wealth, Public Squalor. We're going to have a lot of
people that have the wealth, and then we're not going to have
any infrastructure in this country that everyone can share.
It's not going to be a pretty sight, we're going to become a
banana republic of sorts, an oligarchy, which is essentially
what we're becoming now.
So I think the disparity in income and wealth has never
been greater in our country's history. It's an absolute
travesty that we don't have public policy that reflects a newer
view of where investments need to be made in education, because
that is clearly the correlation between a good education and a
person's ability to get a good job. It'sjust so direct. So how
we can not look at that as a civil right, and if you deny that person a
good public education, essentially they should be able to sue under the
Fourteenth Amendment for denial of their civil rights.
So I'm in agreement with you and I hope that you're
successful in helping us change the public culture in terms of
this. And certainly I acknowledge the fact that Hollywood has a
great deal of influence in shaping our culture to the degree
that folks like yourself can take a leadership role. I think
that's really constructive and I appreciate it, and I really
applaud your efforts.
Mr. Horton. Thank you. I think one last brief thing. From
the beginning of civilization, there's been a balancing act
between the need of the community, the good of the community,
the good of the individual. A healthy society has a very even
balance. I think you here in Washington set that tone.
Mr. Regula. I appreciate your testimony. I have to say, I
read a disturbing article over the weekend from the Los Angeles
Times. The headline is, after spending $2 billion, Kansas City
schools get worse. A judge in Kansas City, Missouri ordered the
schools to spend a lot more money. And he ordered the State
government to come up with the money. They did spend the $2
billion, on top of everything else. And their scores are down
now. Admittedly they didn't do well. It says, 900 top of the
line computers, an Olympic size swimming pool, with six diving
boards, I don't know exactly how that makes you a better
scholar, padded wrestling room, etc., etc.
I think we have to be careful, and I support more funding,
but I think we also need to say what works. Because it's
obvious that in Kansas City, $2 billion did not improve. In
fact, they're going to take the system away, apparently, and
turn it over to the State and/or the mayor. It says the new
approach, back to the basics. I would hope this Committee has
time after we've finished our regular hearings to have some
oversight on what really works. How do we make sure the money
we do spent causes an improvement in the system and the
education of young people?
I think that's part of the challenge.
Mr. Horton. I agree with that. I clearly agree with that. I
think, though, if you go back to Jo Egger Lundquist's statement
that teaching is a calling, I think it's important.
Mr. Regula. That's true.
Mr. Horton. And I think we have to start treating teachers
with that respect. I think yes, in any endeavor, there is going
to be anecdotal evidence that says, this didn't work over here.
And maybe that anecdotal evidence is a good reason to take a
look at the system, try and make sure that we're functioning
well in that system.
Mr. Regula. Leadership, it says in Kansas City they've had
20 superintendents in 30 years. That tells you a lot right
there.
Mr. Horton. There you go. There's the problem. But I don't
think that means we should not fund it.
Mr. Regula. Oh, no. No, I'm more interested in how we can
make sure our funding gets results, and that's exactly what
you're saying, that's what all of us here want.
Just as an aside, you have many credits as an actor. I see
you were in the Into Thin Air, Death on Everest.
Mr. Horton. I was.
Mr. Regula. Did they film that there or here?
Mr. Horton. I wish we could say we braved the elements and
went all the way to Tibet, but we did it in Austria, which is
sort of like Tibet but not really. [Laughter.]
Mr. Horton. I think the food in Tibet would probably be
better, actually, than it was in Austria.
Mr. Regula. Very interesting. This was a TV series?
Mr. Horton. A TV film, yes.
Mr. Regula. That was a takeoff on the book?
Mr. Horton. Yes.
Mr. Regula. I read the book.
Mr. Horton. The book was terrific. Better than the TV show,
I have to admit. [Laughter.]
Mr. Regula. Thank you for coming and for your interest.
Tuesday, May 22, 2001.
DEPARTMENT OF LABOR BUDGET
WITNESS
RICHARD TRUMKA, SECRETARY-TREASURER, AFL-CIO
Mr. Regula. Our next witness will be Mr. Richard Trumka,
the Secretary-Treasurer of the AFL-CIO, on labor issues. Thank
you for coming. We'll put your testimony in the record, and you
can summarize for us.
Mr. Trumka. Thank you very much, Mr. Chairman. I'll do just
that.
Mr. Chairman, Congressman Obey, Congressman Kennedy, on
behalf of the 13 and a half million working women of the AFL-
CIO, I appreciate the opportunity to address some of the
concerns the President's fiscal year 2002 budget raises for
working families. Of particular interest and importance are
proposals for key worker protection, work development and
international labor programs. Those are the three that I'll
focus on.
Many of these programs, in our opinion, are already
inadequate to fully protect the rights of working people here
at home. Program cuts and flat funding will dilute these
protections even further, with the impact harshest for the very
workers who need most of the protections.
If current economic weakening persists or worsens, these
effects will be magnified. For workers in the global economy,
program cuts undermine our capacity to promote workers' rights
and fight child labor and other abuses, efforts central to
ensuring that trade improves the living standards for all,
rather than undermines the protections for America's working
families. We ask you to bear all these concerns in mind as you
consider the President's proposal for 2002.
And I'll briefly talk about three of those areas. Worker
protection. For 2002, the President proposes flat funding for
the Employment Services Administration, which enforces the
Nation's wage and hour laws, and for OSHA. These translate out
into a $6 million cut in ESA and an $11.5 million cut in OSHA.
We think this is the wrong approach.
Violations of basic wage and hour requirements remain
pervasive, especially in low wage industries. In the poultry
industry, for example, a DOL survey in 2000 found wage and hour
violations in virtually every surveyed establishment. Similar
problems exist in garment manufacturing, where one DOL survey
found violations in two-thirds of establishments in Los
Angeles, agriculture and industrial laundries and many other
traditional low wage industries.
They even exist among workers in the modern economy, such
as Silicon Valley immigrant workers who assemble circuit boards
at home on a piece rate basis. The President's ESA funding
proposals threaten the Department of Labor's oversight of
working conditions and enforcement of work protections for all
of these workers.
Proposed funding levels for OSHA also threaten that
agency's capacity to ensure workplace safety and health by
cutting 94 full time staff positions, two-thirds of which come
from enforcement, and by reducing funding for standard setting
and worker safety training. In sum, the funding proposals for
key worker protection programs concern us greatly. At a time
when a Nation can afford to do so much, we should be investing
more, not less, in protecting workers' rights.
In job training, Mr. Chairman, the fiscal year 2002 budget
would cut over $500 million in training and employment
services, including reductions in adult, youth and dislocated
worker programs, the latter having been targeted for a 13
percent reduction. Ironically, the President proposes to boost
funding for the unemployment insurance system to handle an
expected increase in claimants at the same time that he wants
to cut back on retraining and reemployment programs that would
help the unemployed return to work.
We're also deeply troubled by the proposal to eliminate
national funding for incumbent worker training. It's
unrealistic to expect State and local programs to pick this up,
this funding slack up, unless the needs of other workers,
including the unemployed and the disadvantaged, are to be
sacrificed. On the international labor program side, the
President's proposals for DOL international labor programs in
2002 is $71.6 million. That's less than half of the 2001 budget
of $148 million.
It's especially ironic that the President is calling for
such steep cuts at the same time that he is trumpeting those
programs as the preferable alternative to trade agreement
provisos as the mechanism for ensuring international labor
rights.
The cuts proposed by the President would seriously,
seriously reduce the Nation's capacity to combat child labor
around the world, to provide child laborers with basic
educational opportunities, to support workplace HIV and AIDS
programs targeted at youth, to promote the ILO declarations of
the fundamental principles and rights of work and promote
workers' rights around the world.
Mr. Chairman, we believe these cuts are misguided and will
undermine the efforts of American workers to compete in the
global economy. We ask this Subcommittee and the full Committee
to keep the needs of working families in mind during your
budget deliberations and to fund adequately the important
worker protection, job training and international labor
programs on which many families in this country so deeply
depend.
Thank you, Mr. Chairman.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Your testimony is timely, we have
the Secretary of Labor this afternoon before this Committee.
Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
Mr. Trumka, I would simply make one observation and ask one
question. In this tax bill that's working its way through the
Congress, the cost of providing tax cuts over the next 10 years
to persons making more than $200,000 a year--the cost of
refusing to limit the size of their tax cuts to about $7,500
just from the rate cut alone--is about $280 billion over 10
years. We're going to toss that kind of money at them. Yet,
we're being told that we have to cut the Dislocated Workers'
Program appropriation by 13 percent and international labor
programs by 50 percent.
Would you explain what these international labor programs
do? Would you explain how they work and would you explain why
they're needed? I find it interesting that an Administration
that is about to ask Congress for additional authority in the
trade area is making a 50 percent cut in the program that is
meant to cushion the blow of globalization on American workers
because of their increasing vulnerability to products that are
produced with either slave labor or child labor. Would you
explain why these programs are not trinkets and why they are
crucial to the average working person?
Mr. Trumka. In short, the answer to that question is, these
programs allow us to identify the most outrageous actions that
take place around the world, whether it's child labor, whether
it's forced labor, and allow us to correct them in one form or
another. To not correct them causes American employees and
American employers to compete with products in the global
market that are made and subsidized and actually reward this
type of child, prison, convict labor or forced labor.
The other things allow us to monitor work places, for
instance, to find out abroad who is complying with their labor
laws and who isn't. We have tried for a significant amount of
time to get workers' rights as part of every trade agreement,
because it's our belief that workers' rights should be elevated
to the same level as intellectual property rights. We've been
unsuccessful to date.
Each and every time we're told that we should look to
another forum. And the forum that is always pointed to is the
UNDILO. This cut actually slashes in half the program and takes
any resemblance of seriousness that that claim can make away.
No one, if this budget is passed with this type of funding, no
one can seriously say to an American worker, you should go
elsewhere to protect your rights, you should go elsewhere to
look for help for a Mexican worker or Chilean worker or
Brazilian worker, you should go elsewhere. Because this flies
in the face of that argument.
Then when you look at things like AIDS and HIV, all of
those affect us on a moral basis and on an economic basis. The
spread of AIDS-HIV has been a horrible thing that all of us
want to eliminate. And we tried that, particularly with you,
and particularly in some of the African nations, it's a very
serious problem. But it's growing elsewhere. This would hamper
our ability to do that.
The other thing this would do is, we were successful in
getting a few people, 17 I believe, around the world to work in
embassies to identify outrageous workers rights and to promote
workers rights in those areas, so that they could increase
their standard of living, so that laws were either enforced, or
if they were inadequate, we as a person in the global economy
could say they were inadequate, change the laws so those
workers have a real chance to participate in the global
economy.
All of those programs directly impact people here, whether
it's in the Trade Bill directly with TAA assistance, whether
it's competing with child labor, whether it's competing with
people at forced labor, whether it's competing with Colombians
who have workers truly assassinated. In one of the coal mines
of Colombia, the president and vice president of the local
union were being bussed from the home to the work site. The bus
was stopped, they were taken off the bus and both of them were
assassinated, shot directly in the head as a message to
everybody else that if workers stand up for their rights, this
is the fate that befalls you. We're forced to compete against a
society that uses that threat to lower their prices and to
avoid any resemblance of honest, fair treatment and dignity in
workers.
Mr. Obey. I think that's an eloquent statement. I think it
will be a cold day in hell before the average worker in this
country will be willing to support further trade agreements, so
long as he sees programs like this that are meant to provide
them barely minimal protection being shredded by their own
government.
Mr. Trumka. We would very much like to be able to support
those trade agreements. But we would like for those trade
agreements to be fair to workers on both sides of the border.
And when we're told to go to the ILO, and then first of all, we
don't adopt here at home any of the ILO standards that protect
workers and then the meager funding that there is is slashed in
half, I think it speaks forcefully to the American worker
about, is that truly an avenue, or is that just a convenient
way to deflect us.
This truly highlights and makes it irrefutable that that
avenue is a means to deflect us, not to protect our rights.
Mr. Obey. Thank you, Mr. Chairman.
Mr. Regula. Thank you. Thank you for coming.
Just off the record, you were in mining, did you work in
the mines?
Mr. Trumka. Yes, I did, seven and a half years.
Mr. Regula. Open pit or what type?
Mr. Trumka. Deep mines in southwestern Pennsylvania. And
Mr. Chairman, it's been my experience, when there's a downturn
in the economy that the first place that employers,
particularly mining employers, attempt to cut is in the health
and safety area.
Mr. Regula. Yes.
Mr. Trumka. If you look at the last time, we had a downturn
in both of our States.
Mr. Regula. Right.
Mr. Trumka. You saw that the downturn was preceded by a
rash of belt line fires, people being killed, people being
crippled and lost production facilities. At a time when our
country needs as much energy as we can get, I think that's the
wrong thing for us to be advocating.
Mr. Regula. I was curious, my dad was a farmer, but he was
also involved in a drift mine. I used to go back in there, and
the closest I ever got to a pony was that animal that pulled
the cars out to dumping tipple. So that's kind of a dangerous
business, when you get right down to it, the point that you
make. And I see, in China they've trapped a large group of
miners. There's always that threat.
Mr. Trumka. It's horrible what's happening, the lack of
mine safety in China, the lack of safety in the workplace in
China.
Mr. Regula. Do you get any opportunity to communicate to
countries like the Chinese, some decent standards and ideas on
safety?
Mr. Trumka. It's difficult, because as you well know, the
representatives that they send to all the international events
that are supposed to be worker representatives are really not
worker representatives. So we talk to them about health and
safety. We have American companies that attempted to go over
there one time and create mining, but they've never caught on
to the notion that the value of a human life was more important
than a pound of coal.
Mr. Regula. Well, thank you very much for your testimony.
----------
Tuesday, May 22, 2001.
COMMUNITY HEALTH CENTERS
WITNESS
PATRICIA DIETCH, PRESIDENT AND CEO, DELAWARE VALLEY COMMUNITY HEALTH,
INC.
Mr. Regula. Patricia Dietch, President and CEO, Delaware
Valley Community Health. Thank you for coming. Your statement
will be put in the record, we'll appreciate your observations.
Ms. Dietch. Thank you, Mr. Chairman, Mr. Obey. I'm Patty
Dietch, I'm as you said, President and CEO of Delaware Valley
Community Health in Philadelphia, Pennsylvania. I'm happy to be
here today to represent the National Association of Community
Health Centers and the millions of patients who get their
medical care in health centers across the country.
I want to start by thanking Congress and this Committee for
your past support and let you know how much it's appreciated,
that the past increases that have been awarded to community
health centers have not gone unnoticed by those of us who try
to keep them going and those of us who work in them and by our
community boards and the patients who get their care there.
I'd like to take a moment to tell you about how some of
those past increases are used, from our experience. In 1999,
Congress awarded a $94 million increase for community health
centers. My organization applied for and received an expansion
grant. And we moved into a suburban, actually an affluent
suburban county, a suburban county of Philadelphia that has,
their county seat is an old industrial town that has a lot of
poverty pockets, economically depressed, because most of the
industry had left the town. We identified a group of mostly
minority low income patients who had very poor health status
indicators and little or no access to health care.
So we received this grant, and we projected that we would
approximately serve about 1,600 patients. In the first year
alone, we had 2,200 patients, over 7,000 medical visits. These
are people who are working poor, who work in service jobs, in
restaurants and landscaping, temporary construction jobs, 7-11,
people who work but work in low paying jobs where they don't
have employer sponsored health care plans. As a matter of fact,
83 percent of the people who come to the center do not have
health insurance.
These people, because they haven't received medical care in
a long time, some of them 10 years, are very expensive to work
up and treat. They require a lot of diagnostic tests, they have
multiple problems that when you first get them, it takes a lot
to get them managed, people who would have probably waited
until they got catastrophic illnesses and went to the emergency
room. So this center, by everyone's measure, has been a
success. I think that you'll see opportunities for that all
over the country.
So far this year, there's 100 applications that have been
received to expand health center sites, and almost 500 that
have been submitted to add services to existing sites. Even the
$150 million increase that we received last year, only half of
these applications could be funded with that increase. And this
year, we're starting in a new position for us, the President
has made health centers a priority, and both President Bush and
Health and Human Services Secretary Thompson have been very
supportive of community health centers. The President has
pledged to double the number of patients served by health
centers over the next five years. And also, he has called to
increase the number of new sites by 1,200 in 2006.
Last year, health centers served over 11 million. Forty-two
percent of them have no health insurance. Although already,
health centers are the most efficient and effective providers
in the country, serving each patient for just over $1 a day.
When I learned that statistic, I did my own health center and
we're actually below that. So I was pretty proud of that.
In order to double the number of patients served over the
next five years, NACHC has calculated that next year, health
centers would have to serve an additional 1.65 million
patients. If you add that up, that's a cost of $175 million
increase. I understand that this is an ambitious goal that the
President has set, and we're ready to meet it, how and ever we
can.
We continue to see an increasing number of
uninsuredpatients in our health centers. In my organization in the last
five years, the percentage of uninsured has grown from 11 percent to 43
percent, just since 1996. And now with the spotlight placed on the
program by the President, I expect we will see more uninsured patients
finding health centers and increasing our patient loads.
Mr. Chairman and Mr. Obey, I work at health centers because
I'm really committed to serving those less fortunate and to
ensure that all people have access to high quality primary
health care, and they really receive it at health centers. I
think it's unparalleled, the kind of care that they get. We're
extremely pleased with the President's call to double the
number of patients seen in health centers in the next five
years, but it's going to be difficult to achieve if the
funding, the dollars say that even this year we're going to
need $175 million just to start to get there over the five
years.
So that's what we're here to say, is that we appreciate
your support and it's been greatly appreciated by the millions
of people and those of us who keep these centers open every
day. Thank you.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I think they are great programs.
Mr. Obey.
Mr. Obey. You say that the President has made funding of
community health centers a high priority. I'd like to examine
that statement a little bit.
Last year, as you know, we provided an $150 million
increase. Even with that, only half the applications were
funded. Now the Administration is proposing an increase, not of
$150 million as we had last year, but $124 million.
I told the story in this Committee a week ago about a woman
I met about two months ago who was not fortunate enough to live
in an area where they had centers. I went to announce the
creation of a dental clinic in this four-county low-income
area. I met a young woman who was on Medicaid. Only about half
the dentists in those four counties would even take Medicaid
patients. And those who did take Medicaid patients would take
no new ones.
She had a child who needed to have the braces removed from
his teeth. She looked for a long period to try to find a single
dentist who would take those braces off. After calling 30 of
them, she could find not a one. So she held the kid down while
the father took the braces off with a pair of pliers.
How many more health centers could be provided, and how
many more people could be provided service, if the President's
budget this year provided the same dollar increase that we had
in the budget last year, namely $150 million rather than $124
million that's in the President's budget?
Ms. Dietch. Well, I'm not sure I can do this math in my
head, but $175 million would be 1.6 million additional
patients. So a little over a million more patients for $150
million, 1.2.
Mr. Obey. We have 40 million Americans without health
insurance. At that rate, it will take about 40 years before we
can get them covered by health centers, right?
Ms. Dietch. That's true.
Mr. Obey. Probably every member of this Committee and this
Subcommittee will be pushing up daisies at that point, Mr.
Chairman.
Mr. Regula. Yes, probably.
Mr. Obey. Thank you.
Mr. Regula. Thank you for coming. I'm curious, is your pin
of significance to community health centers? I sort of thought
it might be, given the configuration?
Ms. Dietch. No, I'd like to tell you that it is, but it was
really just a gift from someone where I left a former job, and
she bought it in a department store. It didn't come from
Colombia, I probably should make up a better story. But it's
really true.
Mr. Regula. It indicates people helping people, and our
reliance on each other.
Ms. Dietch. Yes, and they're multicultural.
Mr. Regula. That's very much what a community health center
is.
Ms. Dietch. Absolutely.
Mr. Regula. A lot of volunteers, people helping people.
Ms. Dietch. Actually, and a lot of usages of other Federal
programs. My organization participates with the Senior
Reemployment, the Older Americans Act, we have seniors who are
trying to re-enter the work force come to us as volunteers,
we've hired a couple of them, AmeriCorps, I mean, we utilize a
lot of people.
Mr. Regula. I think it's a great program. I hope we can do
more.
Ms. Dietch. Thank you.
----------
Tuesday, May 22, 2001.
PUBLIC HEALTH
WITNESS
ANTHONY ROBBINS, M.D., CHAIR, DEPARTMENT OF FAMILY MEDICINE AND
COMMUNITY HEALTH, TUFTS UNIVERSITY SCHOOL OF MEDICINE
Mr. Regula. Dr. Anthony Robbins, you get the blue ribbon
for patience this morning. I'm sorry we couldn't get to you
sooner, but as you can tell, there was a lot of testimony.
You're the Chairman of the Department of Family Medicine
and Community Health--where, it doesn't tell me.
Dr. Robbins. I'm sorry. It's at Tufts University in Boston,
Massachusetts.
Mr. Regula. Okay. And you want to talk about public health.
Dr. Robbins. I'd like to talk about public health. I spent
most of my career in public health, in government, State and
Federal. Actually before I go to the core of my statement,
perhaps I could just say to you how sad it is to be in front of
this Committee without Silvio Conte here. He was a great
advocate for public health and we miss him.
The President's budget that you're considering today is
problematic for efforts to improve the health of Americans. I
want to make just two key points and then a lot of the
illustrations are in my written testimony and we can go to
those questions if you'd like.
Expansion at NIH has great merit. But to expand NIH alone
is shortsighted public policy. It's already clear that many
Americans are not in a position to benefit from scientific
advances in medicine and public health. The budget will
increase the likelihood that under-served citizens, the
elderly, the needy, and rural Americans will never benefit
fully from NIH research.
As we saw last week with the introduction of this new
leukemia drug, when we rely on commercial firms to exploit
research results borne of Government investment, lifesaving
products may be beyond the financial reach of many Americans.
Investment at NIH must be balanced with full drug coverage
under Medicare and expansion of health programs to help the
under-served.
And that point really refers particular to the programs of
HRSA and to the programs of the Substance Abuse and Mental
Health Services Administration. That's point one.
The second point refers to how public health works in our
Federal system, where protecting the health of the public is
principally in the domain of States. But we have wisely built
federal programs that now provide the critical glue that holds
State public health efforts together. Any weakening of the
Federal public health programs will be far more damaging than
the reduced Federal budget numbers might indicate. State and
city programs will not be able to provide adequate protection
for their people against tuberculosis, lead poisoning, or
asthma, for example. We in New England, where we've been
dealing with the West Nile virus problem will probably not have
the resources we need.
If you look at the history of this, since the Michael
Debakey Commission on Heart Disease, Cancer and Stroke reported
in 1965 that the benefits of biomedical research were not
reaching all Americans, the gulf between investment and
research and the application of the results has actually
widened. Since that time, there is a wide body of evidence that
early detection and intervention can reduce the burden of
illness and disability on our aging population. As a
consequence of our failure to assure the broad distribution of
health advances produced by NIH research, many Americans,
particularly the poor, those who live in rural areas, and the
elderly, become sick and disabled and die unnecessarily.
Two health agencies of the Department of Health and Human
Services, HRSA and SAMHSA, define their mission in terms of
improving health and services for under-served Americans. To
the life saving programs of these two agencies the President's
budget would inflict serious damage. Then in the written
testimony I describe what happens in the community access
program and the rural health program, the Bureau of Health
Professions, Maternal and Child Health Block Grant and Ryan
White, poison centers and the mental health grants to
communities.
I follow a witness who has spoken about the increase of
10.6 percent for the community and migrant health centers. And
the President is to be commended for that. But that represents
only a small part of the overall HRSA budget which would
decline overall, including the increase for health centers, by
10.4 percent.
At SAMHSA, the targeted capacity program to which a small
amount of money has been added isn't growing nearly rapidly
enough. The agency itself estimated that 2.9 million people are
left out in terms of getting services from this program, from
these targeted areas. Yet the budget would cover 17,000 new
people or only .06 percent of what the agency says is needed.
Now, let me go to the Centers for Disease Control and sort
out the constitutional issue that States retain the prime
responsibility for protecting and improving the health of their
people. State health departments delegate some of their
responsibility to city and local health departments. I used to,
when I was a State health officer, first in Vermont and then in
Colorado, I was always reminding the Feds, as we called them,
that we in the States have the prime responsibility.
But in truth, in modern society, threats to health have
outgrown the capacity of State and local health departments to
respond without Federal help. Pathogens and toxic chemicals
cross borders. People cross borders. And public health
responses must as well. The Federal Government has responded
very well historically, with important assistance, help in
gathering data and surveillance, laboratory supportto stay
ahead of threats to health, and would help building capacity and
purchasing power, and help developing new programs where the science
has made it possible.
The Centers for Disease Control and Prevention have grown
to become the critical Federal public health assistance
program. Yet CDC's overall programs are being cut back in a
number of areas. The chronic disease and health promotion
program would be cut back by $174 million in the proposed
budget, cutting back on cervical and breast cancer screening,
heart disease and stroke, the diabetes program and many others.
There's new technology that is finally letting us look at
environmental hazards by seeing how people are exposed. Yet the
Center for Environmental Health would see a diminution in its
budget.
Vaccine purchases, which have become a very important part
of Federal assistance to States, I guess it goes up a little
bit, but the fact is that the cost of vaccines to vaccinate one
child fully will almost double next year because of the
addition of a wonderful new vaccine that comes out of NIH
research. The pneumococcal vaccine, which is effective against
one of the major causes of meningitis, and the blood borne
pneumococcal infections in infants, costs a lot of money. And
the new budget does not incorporate enough funding to continue
to cover the same number of kids with these vaccine purchases.
I mentioned asthma, where we have a national epidemic and
where in fact we're finally getting a handle on it, and yet
that program is cut back. And finally, the Prevention and
Health Services block grant is reduced.
I urge you, and maybe this is another one of those cases
where creativity will be needed, but I urge an expansion in the
health programs in the rest of the Department of Health and
Human Services, especially CDC, HRSA and SAMHSA, comparable to
that that has been proposed by the President for the National
Institutes of Health.
Let me conclude with a story. About 25 years ago, I was a
brash young State health officer, State health commissioner in
Vermont. I joked with the head of our appropriations committee
in the State house of representatives, and I told him that the
budget that he was proposing for me, that there wasn't a heck
of a lot I was going to be able to do about a variety of
avoidable problems, and that I might just have to sit back and
name the outbreaks and epidemics after the members of the
committee.
Now, Em Hebard was really very supportive and used my joke,
I guess, to help bring the budget up to a reasonable level. I
guess I would conclude by hoping that you can do as well by my
colleagues in the Public Health Service and for the people of
the country. Thank you.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do we get to pick our disease?
Dr. Robbins. Oh, I guess so. [Laughter.]
Mr. Obey. Tony, good to see you. Just a couple of
questions.
First of all, would you expand on what this new PCV
vaccine? Would you give us a little more information about what
would happen in terms of numbers of kids who would actually be
covered by all the vaccines they need if we stuck to the
President's budget? How many kids are going to be left out?
Dr. Robbins. Well, I can only, I can guess----
Mr. Obey. Why is it important?
Dr. Robbins. Let me go back to the vaccine, because this is
a very good story. We have had in the last 20 years three major
vaccine successes. All the other vaccines are older than that.
But first there was the hepatitis B vaccine and now hepatitis A
vaccines. These were developed out of research efforts and
brought to market and included in the universal vaccine
programs.
The most magnificent success was the hemophilus influenza B
vaccine, where essentially this disease, which was the most
common form of meningitis in children, virtually disappeared in
this country. Now we're succeeding similarly in the rest of the
world.
The most common remaining cause of meningitis in young
children is streptococcal pneumoniei, the organism that causes
pneumococcal meningitis. And interestingly enough, the old
vaccine that was effective in adults has been around for a long
time. It was developed many, many years ago and the technical
advance was producing something that would make it immunogenic,
would produce an immune response in children.
When that was done, they then had to produce a vaccine that
covered seven different strains of pneumococci. And in doing
that, this became a very expensive vaccine, sufficiently
expensive so that I'm told that next year's price, this vaccine
will cost as much as all the other vaccines together have been
costing under the CDC purchase program.
That meant in effect, if you were just going to keep the
same number of children protected you were going to have to
double the allocation. I think, if I remember the numbers, it's
up by $73 million or about a third of the increase that would
be needed to keep pace with immunization.
CDC provides by bulk purchases, by making contracts with
the vaccine manufacturers, I believe it's 11 States, 6 in New
England plus 5 others that buy all of their vaccines for all of
their children, and then the other States which buy a smaller
number for the under-served, for the uninsured. This has become
critical to every immunization program in the country.
These programs are essentially surveillance, so you know
where you've got the disease and you know how good the coverage
is, organization so that you make sure that everyone is coming
into health centers and health plans to be immunized, and the
support of certain personnel and the purchase of vaccines.
They've been magnificently successful.
Mr. Obey. Thank you. I noticed in public polling, Mr.
Chairman, that there's a strange gap in the public
understanding of the Public Health Service and the public
health agencies. When you use the term public health, what
many, many Americans think you're talking about is health care
delivered to the poor--Government health care for poor people.
They don't realize that what the public health service does is
to try to protect the health of the entire American population
from serious diseases.
I think if we could just find a way to make that change in
people's heads it would be a whale of a lot easier to get
support for some of these programs.
Dr. Robbins. I'm even reminded that when you go into
building one of NIH that the plaque on the wall describing the
mission of the institutes includes public health. It is not
simply to produce products and advances for the medical care
system. That's the problem for the under-served and the poor.
As we get new advances, it makes it to us, they make it to us
middle class people. But without the HRSA program, without the
kind of emphasis on screening and advances for diabetes
treatment that CDC is pushing so effectively now, this doesn't
make it to the under-served portions of the population.
Mr. Obey. Thank you.
Mr. Regula. Thank you, and we appreciate your patience.
Very worthwhile information.
The subcommittee will be in recess until 2:00 o'clock.
Dr. Robbins. I should thank the staff, because I've been
where you are, and you stuck it out, too.
[The following statements were submitted for the record:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2002
----------
Wednesday, March 21, 2001.
TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS 2002 BUDGET
WITNESS
DR. RENEE JENKINS, PROFESSOR AND CHAIRMAN, DEPARTMENT OF PEDIATRICS AND
CHILD HEALTH, HOWARD UNIVERSITY COLLEGE OF MEDICINE
Mr. Regula. Let us get started. We have a lot of witnesses
today, so we want to move right along. We are sorry we cannot
give you more time, but that is the way it is. You won the
lottery or you wouldn't even be here because our requests for
testimony are about double what we are able to accommodate, but
it is very helpful to even have a brief statement to give us an
opportunity to understand--especially for me because I don't
have time and I hate to tell you this but I am not going to be
able to read all your statements completely. That is the
staff's job and I am not even sure they will get through the
whole thing but we will try as much as possible to evaluate all
the testimony that is presented. These topics are very
important on every subject, are of great interest and affect a
lot of people. We understand that very well.
We have the little boxes there that the green light will
go, then there will be an amber light which means you have a
minute and a half to wrap up and then the red light which means
stop. Francine has a little buzzer that goes off, she is the
enforcer. It is a challenge to get through these and we want to
give everyone a chance.
Sometimes we will have a few questions. I often have a lot
of questions but we just don't have time to get into depth with
all of them. All of these topics are very interesting and more
importantly, they affect the lives of people. We want to do the
best job we can in allocating the resources to achieve
hopefully successes and meeting some of the challenges of the
illnesses and diseases that confront us.
First we have Education. Some of you will be here on
education. I just saw a poll the other day that said among the
American people, education is the number one issue and close
behind it is health. These are subjects that are very important
to people.
With that, we will get started. Our first witness today is
Dr. Renee Jenkins, Professor and Chairman, Department of
Pediatrics and Child Health, Howard University. I would like to
welcome you.
Dr. Jenkins. Thank you.
I am Renee Jenkins from Howard University. I have been
practicing in the Washington community for 25 years. I am also
the President of the D.C. Chapter of the American Academy of
Pediatrics. On behalf of the American Academy of Pediatrics and
our pediatric and adolescent endorsing organizations, I would
like to thank the Subcommittee for the opportunity to present
this statement.
Today, children are generally healthier now than they were
only half a generation ago. According to recent reports, the
national infant mortality and child death rates and the
percentage of children living in poverty have all declined and
immunization coverage rates for infants and toddlers have
increased. However, despite these significant improvements,
there are still over ten million children and adolescents who
remain uninsured. Moreover, racial and ethnic health
disparities for many children and adolescents continue to
exist. We, you and I, both have more to do.
As a clinician, I must work hard with my colleagues to not
only diagnose and treat our patients but also to promote strong
interventive interventions, to improve the overall health and
well being of all infants, children, adolescents and young
adults. Likewise, as a policymakers, you, along with your
colleagues, have an integral part to play to improve the health
of the next generation through sustained and adequate funding
of vital Federal programs that support these efforts. I am
going to speak on three issues particularly--access, quality,
and immunizations.
Under access, as a child and adolescent health clinician,
we believe that all children and adolescents deserve and should
have full access to quality health care, from the ability to
achieve primary care for the pediatrician trained in the unique
needs of children to timely access to pediatric medical
subspecialists and pediatric surgical specialists should the
need arise. Today, federally supported initiatives such as the
Maternal Child Health Block Grant, Title X Family Planning
Services and the Health Professions Education Training Grants
are for many communities their only access to health care. We
urge you to ensure that these and other important child and
adolescent health programs receive sustained and adequate
funding in fiscal year 2002. Of equal importance to access to
care is an equitable Federal investment in the training and
education of the Nation's future pediatricians, clinical and
scientists, particularly in independent teaching hospitals. A
bipartisan Congress has recognized in the last two years, and
you have personally supported, maintaining adequate funding to
continue the education research programs and delivery of health
care in these child and adolescent-centered settings is
imperative.
Under quality, access to health care is only the first step
in protecting the health of all children and adolescents. We
must make every effort to ensure that the care provided is of
the highest quality. Robust Federal support for the wide array
of quality improvement initiatives is needed if this goal is to
be achieved. Leading the effort to develop and implement the
highestquality of care through research and better application
of science is the agency for Health Care Research and Quality and the
NIH, National Institutes of Health. Together, these agencies provide
not only scientific knowledge and basis to cure disease, improve the
quality of care, but also support emerging critical issues in health
care delivery. They also address the particular needs of priority
populations like children and adolescents.
Continued Federal sustainable funding for health research,
including pediatric research in the face of new challenges and
new technology is essential to continued improvements in the
quality of America's health care.
Over the years, NIH has made dramatic strides that directly
impact on the quality of life for infants and children. I am a
recipient of an NIH grant that has definitely shown in a
controlled study that one can effectively postpone and reduce
early sexual involvement in young girls which is important to
the issue of adolescent pregnancy prevention. We are now using
the results of this research to pilot a program to educate and
support parents in their efforts to work with children. We join
the medical research community to support the fourth
installment in the doubling of the NIH budget for fiscal year
2003.
Under immunization, pediatricians working alongside public
health professionals and other partners have brought the United
States its highest immunization coverage levels in history. As
a result, disease levels are at or near record low levels.
However, the public health infrastructure that now supports our
national immunization efforts must not be jeopardized with
insufficient funding. One of the conclusions of the June 2000
Institute of Medicine report ``Calling the Shots,'' was that
unstable funding for State immunization programs threatens
vaccine safety and coverage levels for specific populations.
For example, adolescents continue to be adversely affected by
vaccine preventable diseases such as chicken pox, Hepatitis B,
measles and Rubella. Comprehensive adolescent immunization
activities at the national, State and local level are needed to
achieve national disease elimination goals.
As a pediatrician who sees adolescents, immunizations were
generally thought to be a less critical issue in this age
group. However, the recent college outbreaks of meningococcal
meningitis which is a life threatening infection of the brain
and spinal cord have made us much more aware of the need to be
vigilant about immunization protection even in this age group.
While the ultimate goal of immunization is clearly the
eradication of disease, the immediate goal must be the
prevention of disease in individuals or groups. To this end we
strongly believe that the continued investment in the efforts
of the Centers for Disease Control and Prevention must be
sustained and increased.
In conclusion, I thank you for this opportunity to provide
our recommendations for the coming fiscal year. We look forward
to working with you as the new Chair of this important
subcommittee, and I would like to personally invite you to the
Department of Pediatrics at Howard University so that you can
see child and adolescent health care at work. As this
subcommittee is once again faced with difficult choices and
multiple priorities, we know that as in the past years, you
will not forget America's children.
Thank you very much.
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Mr. Regula. Thank you.
With a couple of small grandchildren who live down the road
from me in Ohio, I have heard a lot about pediatricians.
We are happy to have our colleague from California, Mr.
Duke Cunningham. For those of you who don't know, Duke was the
only Air Force ace in the Vietnam war, so he is not only a
skilled legislator, he was a very skilled pilot, and is a very
valued member of this committee.
Duke is going to introduce our next witness, Carolyn Nunes
from San Diego. That is your home city, isn't it, Duke. You
have quite a family of educators, don't you?
Mr. Cunningham. Dr. Nancy Cunningham. I have two built-in
lobbyists right at home.
Mr. Regula. Duke takes care of education.
Mr. Cunningham. I was a Navy pilot, not an Air Force pilot.
Mr. Regula. And I am a Navy man. I really missed up that
one.
Mr. Cunningham. Thank you, Mr. Chairman.
I see my colleague, Frank Purcell in the audience. I think
you are probably here with the nurse anesthetists, Frank.
My wife has her doctorate degree in Education. The witness
I am going to introduce is the sister of my wife, my sister-in-
law in charge of Special Education in San DiegoCity Schools.
She works for Alan Bursin, who was a Clinton appointee in the border
and now is the Superintendent. I want to tell you he has my full
support.
What Carolyn is going to talk about a little bit today is
not just special education but education reform in five
minutes, and talk about what we are trying to do.
Alan Bursin is supportive of many of the Bush initiatives
for the reform of education. I am very, very proud to support
her boss, the Superintendent, Alan Bursin.
Carolyn testified before the Oversight Committee a couple
of weeks ago on special education. She is here today to do the
same thing. I have seen her cry when she can't help students
with special needs. Now she is an administrator but she spent
23 years in the field of education and is trying to breach the
gap between schools and the parents to make sure the parents'
special needs are met with their individual children, but on
the other hand, trying to breach that the school systems are
not bankrupted by the local trial lawyers that are ripping off,
in my opinion, the school systems and the parents.
There are only two areas in which we should have caps. One
is trial lawyers and the other I will leave to you to decide
what it is.
Carolyn has been a special education teacher and an
administrator. This is the second year of implementation of the
blueprint for student success that her boss, Alan Bursin, has
presented. I want to tell you that on the D.C. Committee we
capped lawyer fees. To give you an example, we saved $12
million. Instead of going to lawyers, it went to the children
with special needs. We have done that for two terms.
We hired 23 special education specialists, speech
pathologists, hearing specialists, sighted specialists, and I
want you to listen very carefully because we need a change in
special education. Carolyn is the expert in all of San Diego
City schools to bring that to you.
It is my honor to introduce my sister-in-law, Carolyn
Nunes.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
CAROLYN NUNES, SPECIAL EDUCATION PROGRAM MANAGER, SAN DIEGO UNIFIED
SCHOOL DISTRICT
Ms. Nunes. Thank you.
Today, my testimony focuses on some needed reforms to
special education law and services in San Diego Unified School
District and the Nation's school districts. Large scale reform
efforts are not unfamiliar to San Diego City Schools.
Currently, the District is in its first year of implementation
of the Blueprint for Student Success. The reform strategies
included in the blueprint are designed to improve teaching and
learning for all students, including special education students
while ending the practice of social promotion. Initial test
score data indicates student performance is improving but much
work remains to be done to successfully implement this program
districtwide.
For local reform efforts like the blueprint to continue to
succeed, the reauthorization of the Elementary and Secondary
Education Act and IDEA must make changes consistent with local
reforms and provide the necessary funding to support change.
The San Diego Unified School District currently serves over
142,000 students in over 184 schools. Of those, over 15,000
students have active IEPs and receive special education
services; 92 percent of the special education current budget
provides direct instruction and support for students with
special education services. The following addresses some of our
current issues regarding special education, IDEA, and funding
as well as our recommendations for possible solutions.
Nationally, we have witnessed an alarming increase in the
number of students with autism. Families are bombarded with the
latest and new forms of treatment for autism. All who view and
read this information in the media make assumptions that all
such services are research based and conform to best practice.
There are a variety of instructional strategies and
methodologies that are available. As educators, we realize that
using only one instructional strategy for all students is not
appropriate. More emphasis must be placed in the area of
research in the educational approaches which will promote
student achievement based on the student's ability and
independence. School districts are currently finding the need
to retrain teachers in strategies and techniques used with
students with autism. We would recommend the development of
special grants for the purpose of ongoing professional
development for the training of certificated and classified
staff in the field.
Today, multiple agencies are funded by Federal dollars for
providing services to students with special needs. Each of
these agencies are under different rules and differentsystems.
Although these agencies have a common purpose to provide services for
students, these systems become a barrier. At times, although with good
intentions, Federal laws will frequently promote a system of
disconnect. Although Congress placed limitations on the recovery of
attorneys' fees in the 1997 IDEA reauthorization, little has been done
to reduce the significant roles such fees continue to play in the
decisions that school districts and even parents make regarding
educational programs for children with disabilities.
An early independent review without all the formal
requirements of a due process proceeding may temper each side's
expectations and lead to a quicker and fairer resolution. I
suggest mandating school districts to participate in alternate
dispute resolution and all due process proceedings and reduce
reimbursement of attorneys fees proportionately for parents who
refuse to participate. Today, significant amounts of program
monies are spent on independent educational evaluations. These
evaluations are conducted at the request of parents when they
disagree with the result of the school district evaluation.
Under IDEA and its regulations, the school district must
initiate due process proceedings and its associated costs to
avoid paying for an independent evaluation. School districts
have little economic incentive to request due process in
challenging independent educational evaluations when such an
action would prove costlier than paying for the evaluation. In
my experience, special education has resulted in a system
driven more by the need to comply with numerous requirements of
both Federal and State laws and regulations than by the genuine
educational needs of children with disabilities.
The California Department of Education has developed a
process of sanctioning school districts who do not meet the
zero tolerance level of compliance with timelines for review of
annual IEPs or three year reevaluations. This system does not
provide for reporting extenuating circumstances that prevent us
from meeting timelines. While our district has made great
strides in electronic capture of information regarding the
status of students receiving special education, 100 percent
compliance is difficult to achieve. Requests for data
collection and reports by various agencies at the national,
State and local levels impose a strain on the district's
ability to provide information in a timely manner.
Our recommendations are as follows. Data collection should
be allowed to report the extenuating circumstances that prevent
timelines from being met. Definitions regarding placement
settings, disability categories, designated and related
services should be consistent across agencies. Data
repositories should be developed that can be access by any
interested agency from a central location. Thresholds of
compliance should reflect the percentage of students reported.
Special education reform cannot be done in isolation. While
increased IDEA funding may reduce encroachment from the
district's general fund, it is necessary to support local
reform through augmenting other programs in the education
budget. It is essential to support successful districtwide
reform efforts that narrow the achievement gap while focusing
on enhancing the education for all students.
On behalf of the San Diego Unified School District, we
appreciate the opportunity to comment on these issues and would
offer any assistance.
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Mr. Regula. Do you think these regulations should be
implemented by the Department of Education rather than a
statutory requirement in the law?
Ms. Nunes. Yes.
Mr. Regula. Questions?
Thank you very much. It is a very important program to a
lot of parents and to their children. Hopefully, we can meet
the challenge of funding.
Mr. Cunningham. Thanks, sis.
Mr. Regula. Next Ms. Northrup will introduce Dr. Stevan
Kukic, a Member of the Board of Directors, National Center for
Learning Disabilities. I might say Ms. Northrup is a valued
member of this committee and very involved in education matters
in the City of Louisville, Kentucky, and brings a broad range
of experience as we deal with the difficult education issues.
Ms. Northrup.
Ms. Northrup. Thank you.
It is my pleasure to introduce today Stevan Kukic of the
National Center for Learning Disabilities. Dr. Kukic is
currently the Vice President of Professional Services, Soppers
West Education Services in Longmont, Colorado, a former
Director of At Risk and Special Services for the Utah State
Office of Education for 11 years. His office provided
supervision for all special education services delivered
tostudents with disabilities.
Dr. Kukic has also provided leadership for services for
students at risk, Title I, migrant education correction, youth
in custody, homeless, drug and alcohol and vocational special
needs. In addition, he has served on many national advisory and
editorial boards and is Past President of the National
Associations of State Directors of Special Education.
Finally, he has been a member of the National Center for
Learning Disabilities' Board of Directors since 1996 and on the
NCLD's Professional Advisory Board since 1992.
Dr. Kukic will talk about the subject that is especially
important to me and to us all, how do we help young children
develop the skills they need to have to be ready to read.
Dr. Kukic.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DR. STEVAN KUKIC, MEMBER, BOARD OF DIRECTORS NATIONAL CENTER FOR
LEARNING DISABILITIES
Dr. Kukic. Thank you.
It is my pleasure to be with you this morning. Thank you,
Ms. Northrup, for that great introduction. All of us are keenly
aware if we could get to problems early, we save money and we
solve problems in more profound ways. The National Center for
Learning Disabilities has dedicated itself through its mission
to make certain that we do intervene as early as we possibly
can with research based practice and that we do that so people
with learning disabilities can achieve their fullest potential.
That is our mission.
With that in mind, we are pleased to introduce to you this
possibility that you would endorse our Get Ready to Read
Initiative that we have begun. This initiative is a national
screening program to be used by parents of young children as
well as early childhood professionals who want to promote early
reading and school success. The initiative seeks to ensure that
these people have research based, easy to use tools to be able
to get a better handle on the kinds of problems young children
have that could cause them later difficulties in reading in
school. We believe at NCLD if we can accomplish the task of
this initiative, we will give people the ability to be able to
assess what children are experiencing in their young lives, to
recognize those behaviors that will link to resources that will
be able to help those children and the people who deal with
them to be able to have those kids be successful.
It is interesting that even with all the work we are doing
in this era of standards based reform, still 30 to 40 percent
of our Nation's fourth graders still do not know how to read.
There is a wide variety of testing measures that are being used
to try to deal with this. What is wonderful is that through the
good work that has been done by the National Institutes of
Health and especially the National Institute for Child Health
and Human Development, we have begun to uncover what the
precursors are to success in reading and school. That research
has told us that there is a high correlation between the
quality of early language and literacy interactions and the
acquisition of linguistic skills necessary for reading. That is
a very profound piece of research that should be affecting what
everyone does in relationship to children, and is beginning to.
It is an interesting note; parents who have children with
special needs often they wait to get services. There was a
recent study that suggests that 40 percent of parents wait a
year or longer before they get some help. If you think of what
you know about young children, waiting a year or longer is a
real dilemma.
Seventy-five percent of children who are not identified as
having problems and having intervention by the age of nine will
continue not to be able to read when they leave high school. So
there is a need for research based screening and assessment and
a number of complementary efforts have helped to produce the
prelude to this initiative.
Congress has supported a number of ongoing literacy
programs to help improve the ability of children and adults in
relationship to this issue. The national education goal of
having all preschool kids ready to enter school and ready to
learn has also been of value. It sets the stage for what we are
trying to do in this Get Ready to Read Initiative. Early last
year with leadership from Representative Ann Northrup and
Senator Thad Cochran and NICHD, we recruited a team of experts
to develop this screening tool. The tool was developed under
the leadership of Grover Whitehurst and Christopher Lonigan who
worked closely with NCLD staff and advisors and a 20 item
screening tool was developed. It was developed using a great
process of validation wherein a set of items were correlated
with a well accepted goal standard assessment tool so that
parents and early childhood professionals can have a screening
tool they can trust. In addition, we have identified a set of
resources and a set of materials these folks can use after they
have done the screening so they can link not only to those
resources andmaterials but to other professionals for
appropriate diagnosis.
The tool itself focuses on four building blocks of
literacy: linguistic awareness, letter knowledge, book
knowledge and emergent writing. These are all reliable
predictors of early reading success. It is our goal to
disseminate this tool through national partnerships. The target
audience is parents, teachers, child care providers, early
childhood providers and other professionals. It is our goal to
saturate the field in one year and to embed the tool in the
operations of early childhood service organizations. It is a
tool to be used with four year olds. We have private sector
partnerships, a major multimedia educational publisher that has
agreed to disseminate this tool to hundreds of thousands of
people. With your support, we will be able to get the
initiative going and be able to do a statewide demonstration in
nine States including Arizona, California, Kentucky, Maine,
Maryland, Mississippi, New Jersey, New York and Washington.
Mr. Regula. How do you get it to young parents that need to
know.
Dr. Kukic. This is going to be a paper tool as well as a
web-based tool. We have a partnership with the multimedia
international publisher that is helping us be able to get to
several million people on the web is what they are able to get
to, so we hope that will work out.
I will close by saying if we work together in the private
sector, in the nonprofit sector and with your support, we will
be able to achieve this great goal to be sure no child is left
behind.
I thank you for this opportunity to speak with you.
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Mr. Regula. Questions?
Ms. Northup.
Ms. Northup. I would like to thank Dr. Kukic for being here
and for the effort. There has been an amazing amount of effort
to develop a tool.
All the research has now told us that children can be
identified as early as four or five years old as being at high
risk for needing intervention to learn to read; that if they
get effective intervention, we should have single digit
percentages of children that don't read and read to their
capacity at fourth grade. Is that correct? What you have done
is actually developed the test that parents or schools could
use.
Dr. Kukic. That is exactly correct. This research is not
equivocal, it is not a possible. I would go so far as to say it
is fact, we know how to teach kids how to read, we know how to
identify kids who are at risk of failure at an early age and it
is a moral imperative that we do so.
Ms. Northup. I would like to compare that with what is
actually going on. In my district, an urban district that has a
significant population of at risk based on poverty levels and
so forth, at risk children that our public schools do not
screen children, that a child has to be estimated by a teacher
to be one year behind before they are even able to request a
test. This is usually sometime in second grade.
There is usually a full year's wait before your child is
actually tested because of the waiting list and so it is often
fourth grade before a child gets in to special education.
NIH tells us that at that level, it takes an enormous
amount of resources in order to catch up a child who has missed
those years of learning to decode and slowly become more
accurate and quick so they can get to the understanding age.
Part of that is because of the enormous cost for every child
discovered.
With this tool, you could just screen every child and get
to the remediation before they ever--they are not necessarily
learning disabled, they just need intervention.
Mr. Regula. Mr. Cunningham.
Mr. Cunningham. Thank you.
If you do that in California and San Diego, I will put it
in my newsletter for you so we can put it out there to help
disseminate it.
I helped rewrite the IDEA bill, so I am very familiar with
it, when I was on the Education Committee and authorization.
One of the problems we had was parent expectations and the
wrong person reaches out and a parent has a child with special
needs. They want the absolute best for that child like I want
for mine but many times, either a medical doctor not trained to
give that diagnosis on how muchper hour or how much per week in
training they receive, that parent's expectations are raised to a
significant level that is unrealistic and what happens is the school is
expected to poll that judgment. Then there is a conflict between the
school and the parent.
In your program, do you have anything that identifies say a
student with dyslexia that may have a higher problem of reading
than say a child without that ailment, so that parents don't
get the wrong idea or at least expectations?
Dr. Kukic. What I like about the screening tool that we
have developed is that it is to be used with four year olds. It
is a functional kind of tool rather than label-based, it is
based on those prerequisite skills that all kids need if they
are going to be effective readers. So the interventions that
work that have been uncovered so far for those children are
usually not very expensive at all. It demands a redirection of
the kind of early intervention that is done for these kids as
four to six year olds. If you do that well, then there is much
less need for very expensive interventions later.
There is a lot of a lack of knowledge among a lot of fine
professionals about this issue and there is a public relations
or public awareness that our chairman of the board really
believes in very sincerely that people need to understand what
this research is saying so we can intervene at an early age in
an economical way to be able to become a nation of readers.
That is the point.
Mr. Cunningham. I would like to read more about the
program.
Mr. Regula. Thank you.
Our next witness will be Dr. Judith Albino, President,
California School of Professional Psychology. She will be
introduced by our colleague, Mr. Cunningham.
Mr. Cunningham. I would tell Dr. Albino that I have a lot
tied to her programs. First of all, she has four campuses. One
is Los Angeles, I was born there. Another is in San Diego, I am
a member of Congress from there. Another is Fresno where I grew
up at 3212 Pine Street and the other is Alameda where I sailed
out on an aircraft carrier.
She is going to be named the President of Alliant
International University which is combining with USIU where my
wife got her doctorate degree in education.
It is my pleasure to introduce Dr. Albino, President,
California School of Professional Psychology. The school has
four different campuses, as I mentioned. She is going to be
named President of a combined school system. USIU and Alliant
have over 2,300 students supported by three campuses and a
faculty of over 200 specialists. It supports many of the
research and community service programs throughout California.
I am pleased to introduce Dr. Judith Albino. I would say
you will find another supporter of doubling medical research,
especially with San Diego with its super computers, its biotech
and its teaching universities.
Thank you for coming.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DR. JUDITH E. ALBINO, PRESIDENT, CALIFORNIA SCHOOL OF PROFESSIONAL
PSYCHOLOGY
Dr. Albino. Thank you.
I appreciate the opportunity to be here today. We are
looking forward to expanding our programs in Congressman
Cunningham's district and we are grateful for his leadership
there. I should note that CSPP currently is headquartered in
San Francisco in the district of your subcommittee colleague,
Congresswoman Nancy Pelosi.
I want to begin by thanking the subcommittee for its
recent, very generous support of CSPP's Partners for Success
Program which works with California school districts to provide
teacher education with a special emphasis on the prevention of
violence in the classroom. I appreciate the opportunity to
testify today on the importance of providing our Nation's
schools with elementary and secondary school counselors. I also
am testifying in support of programs of the Health and Human
Services Administration and the Substance Abuse and Mental
Health Services Administration.
Last year, the subcommittee provided $30 million to
continue funding for the Elementary School Counseling
Demonstration Program. Legislative constraints limited this
generous funding to elementary schools. Moreover, the $30
million provided can only begin to meet the needs for these
services. At a time when our communities are shocked and
griefstricken by incidents of violence in our schools, we have an
obligation to do all that we can to provide resources to keep our
schools and our students safe. School counselors are an integral part
of this effort, yet America's schools are in desperate need of
qualified school counselors. The current national student to counselor
ratio averages 561 students to every school counselor. The maximum
recommended ratio is 250 to 1. Yet, not one State in our Nation meets
that recommendation.
Although the increase is significant, I am recommending
that $100 million be allocated to these efforts in fiscal year
2002 and that the program be expanded to secondary schools. The
Surgeon General's National Action Agenda on Children's Mental
Health released this past January outlines goals for improving
services for the 7.5 million children under the age of 18 who
need mental health services; 1 in 10 children and adolescents
suffer from mental illness severe enough to cause impairment.
Yet, in any given year, it is estimated fewer than 1 in 5 of
these children actually receives treatment. The long term
consequences of untreated childhood disorders are costly in
human as well as dollar terms.
Many adult Americans also face challenges that could be
prevented or mitigated with behavioral and mental health
counseling. These include 18 million with depressive disorders,
14 million who abuse alcohol and 13 million who use addictive
drugs. In view of this need, I urge your favorable
consideration of $3,150,000,000 in support of the programs of
the Substance Abuse and Mental Health Services Administration
and $6,472,000,000 in support of programs of the Health
Resources and Services Administration.
In closing, I want to mention that CSPP trains more than
half of the clinical psychologists graduated in California each
year and about 15 percent of those across our country. More
than 25 percent of our students come from ethnic minority
backgrounds. As Congressman Cunningham indicated, CSPP students
and faculty provide many hours annually of mental health
services at nominal or no cost. Most recently this amounted to
nearly 2 million annually. In San Diego County where there are
812,000 people with diagnosed mental health or addictive
disorders, the planned construction and staffing of our new
community mental health counseling center will significantly
expand these services, leveraging public support with in-kind
contributions in the form of the services of our faculty and
doctoral students.
Thank you for your time and I appreciate your support.
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Mr. Regula. Questions?
Mr. Cunningham. One of the issues we have before this
committee that affects directly is a hold harmless that follows
Title I for underprivileged children. California is a payer of
taxes but doesn't receive its fair share and many of the other
States while they have lost population, the growth of
California schools with minorities--you stated of these
children having problems, 75 percent of them are minorities. We
are seeking to have the hold harmless rule instated. I worked
with Senator Feinstein last year to make sure that happened.
That will help the schools to have the dollars possible.
Secondly, my adopted son was in a substance abuse program.
Dr. Samms in San Diego and they do a very good job with those
children, so you have my support on the issue. When you look at
Santana High School, Columbine, the drug problems we have in
our schools, if we can get to these children early, it will
save a lot of problems down the line. I want to thank you for
your services.
Dr. Albino. Thank you. I appreciate that statement. I think
we all know how important it is to have the resources for these
children if we are to avoid the kinds of problems we see in the
schools you have mentioned and in so many others as well. They
don't all make the headlines but these problems are much more
prevalent than they should be.
Mr. Regula. I think you are saying they are all
interrelated.
Dr. Albino. They are indeed.
Mr. Regula. Thank you.
Next, we have Mr. Pat Teberry from Ohio, a member of the
Education Committee. You are doing mark up this morning,
putting together the bill we are supposed to pay for. He is
going to introduce Dr. Thomas Courtice, President, Ohio
Wesleyan, where my daughter graduated.
Mr. Teberry. Thank you.
There is also another connection to Canton in your
district. As you may know, Wesleyan has a strong presence in
Canton. Of about 1,800 students, about 50 are from Canton and
about 800 alumni in the Canton area.
I welcome this opportunity to bring to your attention an
issue of significance, not only to Ohio Wesleyan, but to the
State of Ohio and the Nation. That is the underrepresentation
of minority groups in the sciences at the undergraduate and
professional levels.
Dr. Tom Courtice serves as the President of Ohio Wesleyan
University, an independent, undergraduate liberal arts
institution, founded 159 years ago in Delaware, Ohio north of
Columbus. Ohio Wesleyan is one of the top liberal arts colleges
in the Nation. During his seven years as President of Ohio
Wesleyan University, Dr. Courtice has served tostrengthen that
institution.
I am happy to share with you the fact that there are three
Ohio Wesleyan alumni who are members of Congress--Congressman
Hopson, Congressman Gilmore as well as Congresswoman Joanna
Emerson from Missouri. The entire Ohio Wesleyan community is
proud to call them their own and looking forward to working
with Dr. Courtice and Ohio Wesleyan and thank you and the
committee for allowing him to testify today.
Mr. Regula. Dr. Courtice.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DR. THOMAS B. COURTICE, PRESIDENT, OHIO WESLEYAN UNIVERSITY
Dr. Courtice. Thank you.
Thank you for this opportunity to provide testimony to you
and the members of the subcommittee.
Ohio Wesleyan's undergraduate students represent 40 States
and 54 countries bringing what is a rich diversity to our
campus and it is this commitment to diversity as well as to an
enduring commitment to academic excellence that has enabled us
to reach and maintain the ranking as one of the top liberal
arts colleges in the United States. I want to address briefly a
topic that relates to both the quality of education and
diversity and that is the need for increased attention to
science education for currently underrepresented or minority
groups. Ohio Wesleyan has long been acclaimed for its
particular attention to science education. We employ some of
the Nation's best science teaching faculty and we have
committed considerable resources to improving our science
facilities. In fact, we will soon begin new construction to
expand and renovate existing science buildings and to bring our
labs and classrooms up to a 21st century standard.
Our commitment to exposing our students to a strong science
curriculum has resulted in a doubling of the enrollments in
science and math over the last ten years and a similar increase
in the number of students who graduate with a Bachelor of
Science Degree. In fact, 25 percent of the class of 1999
graduated with a science major and over 60 percent of that
number entered directly graduate or professional schools
relating to their majors. Student demand for the sciences
obviously affects the resources that a particular university
dedicates to its science and math departments, yet the
increased commitment to the study of science and technology has
also been mandated by the explosive growth of science research
and its applications in our society.
As this commitment to enhancing the quality of science
studies grows, so too must the commitment to supply a well
educated, large and diverse work force in these growing fields.
Scientific, engineering and technological jobs are among the
fastest growing in the workforce to the point that current
demand for workers has outstripped supply.
Demographic trends also inspire concern about the Nation's
ability to meet its future technological work force needs.
Historically, white males have made up a large fraction of U.S.
scientists and engineers. However, this portion of the
population has a percentage of the total work force is
projected to decrease significantly in coming years as other
population groups, African Americans and Hispanics are expected
to make up to close to 50 percent of the U.S. work force quite
soon. Unfortunately, due to a lack of financial resources,
sufficient high school preparation and practicing mentors and
role models, minorities are currently severely underrepresented
in the science and technology fields.
Ohio Wesleyan understands that a more diverse science work
force means a broader science agenda bringing different
perspectives to bear and producing a deeper analysis of
alternatives. As we begin to enhance our own program to
encourage greater minority participation in the sciences, I
would ask that the Subcommittee consider funding and support
for policies and programs which also constructively address
similar issues. Such programs may incorporate strategies to
provide students with more minority role models and mentors
from both public and private sectors. According to the
information gathered a few years ago by the National Center for
Education, statistics on African Americans, Hispanics and
Native Americans teaching in the sciences make up only 1.1
percent of all full-time college faculty. Creative initiatives
could help colleges like Ohio Wesleyan broaden the base of
minority faculty members and mentors in the sciences. Such
programs may also incorporate more science research and other
intimate learning opportunities for minority students and they
may provide engaging residential sciences programs to pre-
college populations.
Our Nation's well being has long depended on our ability to
adapt and advance with scientific and technical progress. The
Federal Government should continue to spend considerable time
and effort examining what actions will ensure the Nation has an
adequately trained science work force in the future while using
liberal arts colleges like Ohio Wesleyan as partners. We
anticipate deepening our role in this effort. We look forward
to sharing our experience with peer institutions across the
country and with public policymakers as we discover what really
works when it comes to systematically enhancing and expanding
science education and career opportunities to an increasingly
diverse population.
Thank you for providing us the opportunity to testify
before the subcommittee this morning.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you find the students you are getting have
an adequate background coming out of high schools to meet your
science curriculum and I am sure you have a placement office
and do you find it easy to place these students in good jobs
once they complete their studies?
Dr. Courtice. I think we have found they have been well
prepared, particularly if they declare science as a field of
study. It is just that we can't get enough to come across that
threshold and declare.
Placement opportunities are simply overwhelming and with a
solid science background, the options for young people today
are quite wide and expansive, whether graduate professional
study or entering the work force immediately.
Mr. Regula. Thank you. There certainly is a lot of interest
in science but a precursor to that is you have to be able to
read. That puts literacy right at the front end of all this.
Dr. Courtice. That is why we think those pre-college
programs are very important.
Mr. Regula. Do you offer remedial for students coming in?
Dr. Courtice. We do have remedial work in both quantitative
and writing skills. We have also tried to introduce some of
that work prior to the time students actually enroll on campus
so they are doing that in their junior and senior years in high
school.
Mr. Regula. Thank you.
Our next witness will be Warrick Carter, President,
Columbia College, Chicago, to be introduced by our colleague,
Mr. Jackson.
Mr. Jackson. Thank you.
Since early last year, Dr. Warrick Carter has served as
President of Columbia College in my hometown of Chicago.
Columbia is a private, four-year, liberal arts college
specializing in the visual arts, performing arts and
communications. Columbia's philosophy of hands-on, minds-on
education plus their location in one of the world's most
vibrant cities adds to a depth and richness of experience for
all who enter its doors.
From 1996 to last year, Dr. Carter served as Director of
Entertainment Arts at Walt Disney Entertainment in Lake Buena
Vista, Florida and from 1984 to 1996, he served as Provost,
Vice President of Academic Affairs and Dean of Faculty at
Berkley College of Music, Boston, Massachusetts.
Dr. Carter received his Bachelors Degree in Music Education
at Tennessee State University, his Masters and Doctorate in
Music Education at Michigan State University.
I present Dr. Warrick Carter, President of Columbia
College.
Mr. Regula. A couple of questions. Do you get a lot of your
students from college?
Mr. Carter. Yes, about three-quarters of our students come
from the State of Illinois.
Mr. Regula. Yesterday, thanks to Mr. Jackson, we had the
Superintendent or CEO of the Chicago School system, very
impressive. My question to you is are you seeing this as a
result of their efforts in the public school system and the
level of achievement of the students you are getting?
Mr. Carter. Yes, we are. In fact, we work hand and glove
with Chicago Public Schools. We offer a variety of programs
that serve to train teachers specifically in science. We have
an innovative approach to teaching science through the arts and
we are training teachers to do so. We have received some rather
outstanding accolades because of it. It has changed the whole
quality of science instruction in the public schools.
Mr. Regula. Thanks to Mr. Jackson, I will be meeting with
the CEO this evening. I was impressed with what is being done
and certainly Mr. Jackson has related a lot of this to me. So
you are telling me the system is working?
Mr. Carter. The system is working, working much better than
it worked before.
Mr. Regula. Thank you.
----------
Wednesday, March 21, 2001
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
WARRICK CARTER, PRESIDENT, COLUMBIA COLLEGE
Mr. Carter. Thank you for that introduction and your time.
You have a lot of friends at Columbia College and we look
forward to seeing you soon.
I am Warrick L. Carter, President of Columbia College.
Thank you for this opportunity to speak to you. As Congressman
Jackson said, Columbia College is a private, nonprofit,
undergraduate and graduate institution in Chicago's South Loop
neighborhood that offers educational programs and arts in the
communications disciplines within a context of liberal arts.
With a fall enrollment of over 9,000 students, we are the
fifth largest private institution in the State of Illinois. I
am here to speak about the many needs of institutions of higher
education, particularly those of urban colleges and
universities like Columbia College and how Federal programs can
help address some of these needs.
Columbia College is one of the very few open arts
administration institutions in the United States and has the
largest minority enrollment of any institution of its kind in
the country. We enroll students from across the country, across
the world but it is primarily an Illinois and Chicago
institution. More than three-quarters of Columbia College
students are from the State of Illinois and the majority of
these are from Chicago and the Chicago metropolitan area.
A third of the college's students are African Americans,
Latino or Asian Americans and a large number of all of our
students are first in their family to attend college.
Delivering excellent higher education with open admission in a
very diverse urban setting is exhilarating but full of
challenges. City kids, minority kids, first generation college
kids are much more likely than their peers to drop out before
they complete college. The loss of these kids, to their
families, to Chicago and to the country is staggering. Helping
students to stay in college and complete their degree at
Columbia is our most important challenge.
The U.S. Department of Education funds a number of programs
that are of critical importance to retention at Columbia
College, Chicago and to urban colleges and universities in
general. The Pell Grant Program is first and foremost amongst
these. At Columbia, nearly one-third of our undergraduate
students receive Pell grants and are eligible to participate in
the matching grant programs supplied by the State of Illinois.
Although these grants do not cover the full cost of tuition and
fees, without them, many of these students could not attend
college at all.
Title III and the Fund for the Improvement of Post
Secondary Education are also vital to this effort. Currently at
Columbia, Title III funds a multifaceted, academic and social
support program for lower income, first generation and minority
students. These funds support a comprehensive, all college
effort to enhance and improve the first year experience of all
new students. Research shows from around the country that the
first year, even the first semester, and sometimes the first
week of a student's experience in college will determine the
likelihood that they will stay in college and ultimately
graduate.
In 1999, the college adopted a comprehensive retention
program that focused on new freshmen which holistically
addresses the interwoven factors that affect students' success.
We received a $500,000 grant from the Department to support
this initiative. In just one year, the percentage of freshmen
returning to their sophomore year climbed by five percent. This
past fall, 90 percent of all at risk students who participated
in a summer program we refer to as our summer bridge program
returned for a second semester.
Columbia is now hoping to undertake an ambitious mentoring
program for our minority students. Under the program, all new
entering minority students will be paired with a faculty member
or staff mentor to help students determine his or her own
educational goals, negotiate the new and unfamiliar college
experience, and to utilize student services, and hopefully
develop this ongoing bond that is soimportant to be connected
to an institution and to stay until completion. As mentoring has proven
to be a very effective retention tool, this program will reinforce new
students' decisions to attend college and quickly integrate these
minority students into the academic, artistic and social fiber of the
college.
A sense of community is vital to retention and to providing
a rich educational environment as well. Campuses such as
Columbia are diffused and less contained than traditional
college campuses. Fewer students live on campus and many
commute daily throughout the metropolitan area. Although our
dozen plus buildings are interspersed with residential, retail,
commercial make us a major landowner within the area, we have
only what can be defined as a loosely defined campus. The
college hopes to counteract this with a new Student and Art
Center that will create a focal point for our campus and for
diverse community groups in the South Loop that we serve,
private, nonprofit.
We have the largest program of film studies in the country
with 1,700 students, one of the largest programs in television
and radio and recording technology. Our alums have gone on to
rather well heights and others stay in the area. We have alums
in California who are Academy Award winners, one for saving
Private Ryan and Schindler's List, so we are proud of the
quality of what we do in film and television.
Mr. Regula. It is a growing industry.
Mr. Carter. We found in Chicago a lot of independent films
are moving away from Los Angeles because it is more cost
effective to do films outside, so we see the industry growing
in Chicago. There was over $150 million spent in Chicago last
year in films and television shows.
In Orlando, where I spent time recently, we did some $500
million worth of films. Compare that with what is going on in
California, slowly but surely people are looking to do films
outside of California. We think our alums are partly leading
that charge. We have two who have chosen to return to Chicago
and do their films there. The very recent film, Men of Honor,
was done there and prior to that Soul Food, also the television
program. Each case, they chose to return to their hometown and
therefore create employment for our alums as well as for others
in the city.
Mr. Regula. That is a great impact.
Do you interact with the National Endowment for the Arts?
Mr. Jackson. Yes, we do. We have been fortunate to receive
both NEA and NEH funding.
Mr. Regula. Do you think they do a good job?
Mr. Jackson. Yes. If that funding were a bit larger, I
think they would do a much better job.
Mr. Regula. I knew that was coming. [Laughter.]
Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
MARILYN HELD, DIRECTOR, LABORATORY SUPPORT SERVICES, ST. JOHN HEALTH
SYSTEM, DETROIT
Next is Ms. Kilpatrick from the great State of Michigan
where they have a better football team than Ohio State, but
times will change, is going to introduce Marilyn held, Director
of Laboratory Support Services, St. John Health System,
Detroit.
Ms. Kilpatrick. Thank you for allowing us to present our
constituents and for you to take the time to consider them. We
appreciate it.
I would like to present to you Ms. Marilyn Held, Director
of Laboratory Support Services at St. John Health Systems in
Detroit; a prominent member of the American Society of Clinical
Pathologists; and has served as a board member on that society,
has served on the Finance and Planning Committee and has been
awarded the Distinguished Service Award from the Society in
1999.
Ms. Held received her Bachelor's Degree at the University
of South Dakota, performed her medical technology internship at
the University of Iowa and completed her graduate education in
Microbiology at the University of Arizona. I am happy to
present Ms. Held.
I have three 10 o'clock assignments this morning,
Transportation being next door. I am happy to be with you this
morning and Foreign Operations in a totally other building.
Please excuse me if I am not able to stay with you.
Mr. Regula. I have some interest in a few projects in
Transportation so we will be very nice to you.
Ms. Kilpatrick. Thank you.
Ms. Hill.
Ms. Held. Thank you for your support of the laboratory
community and back home in Michigan. We appreciate it.
Ms. Kilpatrick. Thank you.
Ms. Held. Thank you for inviting me to represent the
American Society of Clinical Pathologists. The ASCP has 75,000
members and is the world's largest organization representing
pathologists and laboratory personnel. I am here to inform you
today that the United States is facing a very serious shortage
of medical laboratory personnel. Vacancy rates for 7 of 10 key
laboratory medicine positions is at an all time high. ASCP in
conjunction with an independent polling firm conducts a
biannual wage and vacancy survey of 2,500 medical laboratory
managers. The data for 2000 was published this month and I
would like to give you a glimpse of what we found.
Vacancy rates for cytotechnologists, the professionals who
perform pap smears, in the northeast, the vacancy rate was 45
percent, 16.7 percent for the east north central and 33.3
percent for the far west, rural areas average a 20 percent
vacancy rate and large cities a rather surprising 28.3 vacancy
rate. Histotechnologists, the individuals who prepare tissue
specimens, have an average vacancy rate of over 20 percent, the
west, south central region of the country has a 73.7 percent
vacancy rate; the south central Atlantic States have an average
vacancy rate of 16.7 percent. By comparison, the vacancy rate
for medical technologists will not appear to be of concern but
it is. Medical technology vacancy rates average 11.1 percent
but rural areas are at 21.1 percent.
Rather than continue to quote statistics, I would like to
put a face on these numbers. It is estimated that 70 percent of
diagnostic and treatment decisions for patients are based on
laboratory tests. In my own institution, our laboratory will
perform over 10 million diagnostic tests next year alone. Tests
such as measuring cardiac enzymes for heart attacks, performing
prostate biopsies, hemoglobin electrophoresis for the diagnosis
of sickle disease and trait and measurements for high calcium
levels in blood and urine to assess future risk for
osteoporosis are only a few examples. In my hospital, we have
as of yesterday, a 12.4 percent vacancy rate of those personnel
that assess cardiac enzymes and osteoporosis related tests and
a 19 percent vacancy rate for people who prepare prostate and
breast tissue for biopsies.
One of the logical solutions to this vacancy rate problem
is to train more students. However, the number of programs are
decreasing. In my home State, we have seen the number of
programs plummet from 27 to 8 in less than two decades.
Nationwide, the number of graduates in medical technology has
decreased 30 percent in the five years. The continued demand
for laboratory services is real and is expected to grow. Given
the country's aging population, the number and complexity of
biopsy specimens, tests and the use of molecular techniques
will increase in the next decade. Laboratory professionals who
entered the work force in the 1960s and the 1970s will be
retiring soon. Also, the threat of bioterrorism and emerging
infectious diseases calls for trained laboratory professionals
to respond.
There are solutions to these problems. There are allied
health grants available to attract laboratory professionals to
the field especially minorities and individuals in rural and
under served communities. For example, the University of
Nebraska Medical Center established medical technology
education sites in rural Nebraska under an Allied Health
Project Grant. As of 1999, of 69 graduates, 99 percent took
their first job in a rural community and 74 percent took their
first job in rural Nebraska.
The grants are also designed to create successful minority
recruiting and retention programs for medical technologists. As
a direct result of this Federal support, the University of
Maryland, Baltimore, as of the fall 2000, reached a 64 percent
minority student enrollment at a majority institution, one of
the highest in the country. Most Allied Health Grant projects
continue after Federal funding ends, making them a long lasting
worthwhile investment in the future of allied health. The
Allied Health Project Grants Program is a relatively small step
in assuring that funding is available to attract individuals to
the allied health professions. It needs to be seriously
considered.
Thank you for your time. We are requesting $21 million.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Why do you think there aren't more young
people, certainly the opportunities are enormous? Why don't
young people elect this field?
Ms. Held. We have looked at that a lot and the field
requires a good background in math and science. We are finding
that with the opportunities in computers, the .coms, the
biotech corporations that there are many opportunities now that
people just aren't going into health care as frequently.
Mr. Regula. Do you get information out to high schools so
that young people can think about this as a career?
Ms. Held. Yes. The American Society of Clinical
Pathologists has partnered with organizations like the National
Biology Teachers Association and we do work with recruitment in
those sort of forums. Independently, my organization like other
hospitals, goes to high schools, middle schools, elementary
schools whenever we are given the opportunity.
Mr. Regula. Is St. John a free-standing organization that
provides services to a number of hospitals?
Ms. Held. Yes. St. John Health System is a seven hospital,
integrated delivery network and three of our hospitals are in
Detroit and four in the neighboring suburbs and out in the
rural areas as well.
Mr. Regula. So it is a consortium that all seven can use?
Ms. Held. Right.
Mr. Regula. Thank you for coming.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
DEBORAH A. CHAMBERS, PRESIDENT-ELECT & MEMBER OF THE BOARD OF
DIRECTORS, AMERICAN ASSOCIATION OF NURSE ANESTHETISTS
Next is Deborah Chambers, President-elect and Member of the
Board of Directors, American Association of Nurse Anesthetists.
Welcome.
Ms. Chambers. My name is Deborah Chambers. As President-
elect of the American Association of Nurse Anesthetists, I
represent 29,000 certified registered nurse anesthetists across
the country, also known as CRNAs. We deliver safe anesthesia
care to patients in every State, every day. I will summarize
four points: what do CRNAs do and where, the nursing shortage
and the CRNA shortage, our appropriations request and one
regulatory issue of interest to Congress.
America's 29,000 CRNAs provide two-thirds of all the
anesthetics in the United States. We are the sole anesthesia
provider in over 70 percent of rural hospitals. We are the
predominant anesthesia provider in rural and urban under served
areas of communities and to the military. For over 100 years,
nurse anesthetists have been providing anesthesia. The
Institute of Medicine reports anesthesia is 50 times safer
today than it was 20 years ago. We believe this is in part due
to our advanced training and our continuing education and
recertification requirements that are by far the most rigorous
in the field of anesthesia care.
Yet, as more Americans become eligible for Medicare, there
are fewer nurses and CRNAs to care for them. It is in America's
interest to work together so that nurses and CRNAs are
available for patients who need care. The nursing shortage is
here today. Student nurse anesthetists must have practiced as a
nurse for at least two or more years so we are deeply concerned
that the number of registered nurses under the age of 35 has
fallen by more than 50 percent over the last 20 years to a
level less than 20 percent of all registered nurses in the
country. Our 82 accredited nursing anesthesia programs are full
but they are graduating about 700 fewer nurse anesthetists per
year than what HHS says is required to meet the demand. The
demand is growing and creating a CRNA shortage in the
marketplace.
In 1999, the State of North Carolina reported 82 CRNA
position vacancies and it is projected these vacancies will
extend to beyond 133 by the year 2004. Today, the number of
classified ads advertising and recruiting for nurse
anesthetists published in our national journals is growing
month by month. What should we do? We should work together to
educate more CRNAs. With such shortage helping to support the
education of nurse anesthetists is much more cost effective for
taxpayers than subsidizing other types of anesthesia providers.
The committee has shown real leadership and we are asking for
that leadership to continue.
We commend the committee for providing significant
increases for nursing education programs in fiscal year 2001,
especially for the advanced education nursing program within HHS's
Bureau of Health Professions. For fiscal year 2002, we recommend an
increase of $11 million for advanced education nursing to at least $70
million. We note that the President's fiscal year 2002 blueprint
identifies this type of program to help alleviate the nursing shortage.
We recommend an increase of at least $10 million to the
Nursing Education Loan Repayment Program. We urge an increase
in the National Institute for Nursing Research budget up to
$125 million. We also recommend that the committee consider
funding specific initiatives to help expand existing CRNA
schools, establish new schools and to recruit and retain
faculty for the training of nurse anesthetists. While America's
existing nursing anesthesia schools are full, expanding these
schools or establishing new ones without Federal funding as a
catalyst has proven to be very difficult. We look forward to
working with the members of the committee on this project.
We recommend the committee permit Medicare's new anesthesia
care rule to take effect. Published on January 18, 2001, this
important Medicare rule lets States decide the issue of
physician supervision for nurse anesthetists. This rule gives
States and hospitals the flexibility they need to provide
superior health care to patients. It is supported by hospitals,
nursing organizations and the National Rural Health
Association, many members of the House and Senate and many
members of this panel on both sides of the aisle.
Secretary Thompson has signed an order to have the rule
take effect on May 18, 2001. This should be a matter for the
States which govern health professional scope of practice.
This concludes my remarks. I welcome your questions.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Is this group licensed by medical boards in
each of the States?
Ms. Chambers. Your licensed as a registered nurse through
the State and you are certified by the National Association.
Mr. Regula. So you get your nursing license from the State
and certification is national?
Ms. Chambers. Yes, sir.
Mr. Regula. Can you move from State to State?
Ms. Chambers. As long as you have license as a registered
nurse from that State. The certification is the national
certification so you can move.
Mr. Regula. Do some States require a doctor be present and
others not? I have heard that is an issue.
Ms. Chambers. The whole can of worms is that nurse
anesthetists practice along with physicians. Obviously in the
surgical arena, a nurse anesthetist is present to provide
anesthesia for a patient undergoing a surgical procedure.
The difference comes in that States rules and regs differ
from State to State so there are actually 29 States that do not
require supervision of a nurse anesthetist. What we are asking
is to let the States decide.
Mr. Regula. Thank you.
Mr. Jackson.
Mr. Jackson. No questions.
Mr. Regula. Thank you for coming.
Next, Mr. Jackson will introduce Miguelina Leon, Director,
Government Relations and Public Policy, National Minority AIDS
Council.
Mr. Jackson. Since 1994, Miguelina Ileana Leon has served
as the Director of Government Relations and Public Policy for
the National Minority AIDS Council. She is a certified social
worker with a Masters from Columbia University and she has
worked in HIV AIDS services in advocacy since 1985.
Established in 1987, NMAC is the leading national
membership organization addressing the HIV AIDS epidemic among
communities of color. With a membership of over 600
organizations and 3,000 affiliates, NMAC provides training,
technical assistance and policy analysis for community-based
organizations on the front lines of the HIV AIDS epidemic.
NMAC's most recent advocacy work focuses on the elimination
of ethnic and racial health disparities with a special focus on
the disproportionate HIV AIDS incidence and death rates among
ethnic minorities.
NMAC has worked with the Congressional Black Caucus to
address the state of emergency of HIV AIDS in the African
American community, helping to secure $156 million in Federal
funding for highly impacted communities of color in 1998, $250
million in 1999 and $350 million last year.
Mr. Chairman and members of the subcommittee, I present Ms.
Miguelina Ileana Leon.
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
MIGUELINA LLEANA LEON, DIRECTOR, GOVERNMENT RELATIONS AND PUBLIC POLICY
NATIONAL MINORITY AIDS COUNCIL
Ms. Leon. Thank you, Congressman Jackson, for that very
comprehensive presentation.
My name is Miguelina Ileana Leon. I am testifying today on
behalf of the National Minority AIDS Council. I would like to
thank the members of the subcommittee for your extraordinary
leadership and commitment to HIV AIDS prevention and care
programs, biomedical and behavioral research and other crucial
health programs.
NMAC commends the leadership and the foresight of the
Congressional Black Caucus and the Congressional Hispanic
Caucus in crafting and expanding the minority aids initiative
to assure a targeted response to the growing HIV AIDS health
disparities among communities of color. Our work as health
advocates and HIV service providers has been strengthened by
your combined efforts and generous support. Our Nation has made
remarkable progress in combating HIV AIDS in the last decade,
however, the dynamic nature and evolving epidemic represents
complex challenges and requires intensified efforts to respond.
The disproportionate impact of HIV on communities of color
is not a new phenomena, yet the trends over the last decade
clearly reflect a growing burden of morbidity and mortality
among ethnic and racial minorities. Consider these facts,
people of color make up 56 percent of the cumulative AIDS cases
and 68 percent of the new AIDS cases report by the Centers for
Disease Control through June 2000. Men of color accounted for
63 percent of the new AIDS cases and women of color accounted
for 82 percent of the new AIDS cases among females. Similarly,
children of color represented 84 percent of the pediatric AIDS
cases. Most recently, young men of color and women of color
have become highly vulnerable. Just a few weeks ago, the
Centers for Disease Control and Prevention released a survey of
young men which looked at over 2,000 gay and bisexual young men
in Los Angeles, Miami, New York and Seattle. This survey showed
that the highest infection rates were among African Americans,
30 percent, and Latinos, 15 percent.
The CBC Minority AIDS Initiative was developed in 1999 to
target funds to eliminate the persistent HIV AIDS related
health disparities among ethnic and racial minorities. The CBC
Initiative continues to be needed now more than ever. The
initiative is intended to expand the infrastructure and
capacity in minority community-based organizations to provide
quality HIV prevention interventions and medical and supportive
services. By building infrastructure and increasing the
capacity of these organizations, the initiative enables the
organizations to access needed funding to build their own
programs in their own communities. The CBC Initiative is not
intended to create a parallel system of programs or services.
It does put in place HIV AIDS services in communities that have
been historically underserved and also complements existing HIV
prevention and health care services. These resources are
intended to provide a bridge that will enable minority
community-based organizations to ultimately broader Federal HIV
AIDS funding.
The CBC Minority Initiative cannot stand alone and we know
it must work in conjunction with other HIV AIDS programs.
However, we believe it is necessary to expand this initiative
to a level of $540 million in fiscal year 2002 in order to
support and expand the infrastructure of minority community-
based organizations and to ensure that we address the health
disparities by enabling these organizations to provide
culturally competent services within their own communities. We
believe it is important to commit to this effort, to sustain
these efforts and we strongly recommend the Subcommittee
sustain, safeguard and expand the CBC Minority AIDS Initiative
by providing the additional funding in fiscal year 2002.
Thank you for your attention and consideration of these
issues.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you work in the area of prevention as well
as curative approaches?
Ms. Leon. Yes. Actually, we are a national organization and
we provide training and technical assistance and support to
organizations on the front line of the epidemic. They actually
are working in prevention and supportive services, and also
providing health services.
Mr. Regula. Is there some growing success in treatment?
Ms. Leon. There definitely have been great advances in
treatment over the last ten years. However, what we see in
relationship to ethnic and racial minorities is that they don't
experience the same benefits in terms of health outcomes for a
variety of reasons, including they have less access to quality
health services, greater numbers of uninsured people and there
is a large proportion of ethnic and racial minorities that have
been traditionally hard to reach populations such as the
homeless, people who have chemical dependency problems and
women.
Mr. Regula. Other questions?
I see we have a vote. I think we can take one more before
we have to vote.
We will have Mr. Phil Jacobs, President, BellSouth
Corporation.
----------
Wednesday, March 21, 2001.
TESTIMONY OF PUBLIC WITNESSES 2002 BUDGET
WITNESS
PHIL JACOBS, PRESIDENT, BELLSOUTH CORPORATION
Mr. Jacobs. I am Phil Jacobs, President of Georgia
Operations for BellSouth Corporation and also a graduate of
Dennison University in Granville, Ohio.
Thank you for the opportunity to be here.
I am here today on behalf of a group called Friends of CDC
to discuss infrastructure funding for the Centers of Disease
Control and Prevention construction budget in the 2002 budget.
Let me begin by offering my thanks to this subcommittee on
behalf of the Friends of CDC for securing the appropriations in
this year's budget of $175 million. This was an enormous step
forward and a great step forward to begin the construction of
new facilities at both of our campuses for the CDC in Atlanta.
It is just that, a start.
I am here today to respectfully ask this committee to
continue to support averting what I believe is a pending crisis
waiting to happen in health care. The current infrastructure of
the Centers for Disease Control and Prevention in Atlanta has
dilapidated buildings that are creating a hazardous situation
for our world class scientists. This situation must be
corrected. It is clear to me if we are going to continue to
have the world's leading health organization to be able to
address the myriad of health issues that are coming at us
today, we need to have first class facilities and need to
continue to recruit first class scientists into those
facilities.
Before I tell you more specifically about the facilities in
Atlanta, let me take a minute and talk about the organization,
Friends of CDC and how we began. The Friends of CDC is a group
of corporate citizens who joined together about two years ago
to highlight the need for infrastructure funding for the CDC in
Atlanta. This group includes not only my company, BellSouth,
but also UPS, Home Depot, Delta Airlines, Cox Communications,
the Southern Company, Healtheon Web/MD, Merck, HCA, the Health
Care Company, General Electric and Aetna Insurance Company. It
is a voluntary, civic-minded group deeply concerned with the
facilities situation at the Nation's premiere health
institution and we are concerned that this institution's
facilities have been allowed to deteriorate to the point they
have today.
I personally first visited the CDC in Atlanta in 1999 but I
never imagined what I would see in terms of the horrific
conditions in the buildings there. By the way, I would like to
extend to any member of this subcommittee an invitation to join
us in Atlanta for a tour of the facilities because I will tell
you now that words can't do justice to the lack of and horrific
conditions that we are asking our folks to work in.
Mr. Regula. The $170 million that was put in last year,
will that provide some help?
Mr. Jacobs. Some relief, absolutely. As a matter of fact,
we just had the opening of a new facility on the Emory
University Campus which gave us an additional number of level
four laboratories which is where the highest security and most
dangerous agents are dealt with. However, there are a host of
other facilities that are still housed in inadequate housing
that need to be addressed. This $250 million we are asking for
this year is part of an overall $1 billion program that will
bring us basically to the 21st century.
Mr. Regula. Your company is contributing?
Mr. Jacobs. Financially contributing?
Mr. Regula. Yes?
Mr. Jacobs. To the Friends of CDC organization, we are all
contributors to that organization.
Mr. Regula. So there is local help and support in addition
to the Federal money?
Mr. Jacobs. The money we are contributing which is a small
amount actually goes towards our efforts in creating public
awareness around this. There is no contribution to actual
construction of the buildings.
As you know, the role of the CDC over the past few years
has continued to expand, addressing a group of areas, including
infectious diseases, HIV and AIDS, tuberculosis and since 1973,
the CDC has discovered more than 35 new deadly viruses and
bacteria that create human health hazards.
In addition to infectious diseases, they also work on
preventing chronic diseases such as cardiovascular, cancer and
diabetes. Other activities include the maximization of
immunization rates for children, preventing a wide range of
environmental diseases by preventing exposure to toxic
chemicals and protecting employees from workplace injuries and
disease. I would not allow any of my employees to operate in
that kind of an environment. Quite frankly, if the same Federal
and State health and workplace requirements were applied to
this facility, it would be shut down.
Let me say that the Parasitic Disease Laboratory which is
one of the laboratories that has not yet been updated under
this plan, are in temporary wooden barracks that were built in
the 1940s, with a lifespan expectancy of 15 years. We are now
45 years beyond that life expectancy. We have regular
occurrences where, for example, refrigeration units fall
through the floor; where power is inadequate and shut down
periodically. We even had a incidence recently where we lost
samples in a refrigeration unit, because the power system could
not adequately supply the building.
Mr. Regula. Let me tell you, our committee is going down
there in about a week or shortly thereafter and visit the
facility.
Mr. Jacobs. Right.
Mr. Regula. So I am sure we will be given an opportunity to
see some of the deficiencies.
Mr. Jacobs. Thank you; we look forward to having you down
here.
Mr. Regula. Do you have much more, sir?
Mr. Jacobs. No, I will just close by simply saying that
last was an excellent start, with $175 million, and we
respectfully request that the $250 million be put in this
year's budget. Thank you.
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Mr. Regula. Well, we thank you and all the companies that
expressed an interest in this. Hopefully, maybe they can make
some financial contributions to help get the job done, and we
appreciate that.
Mr. Jacobs. Thank you.
Mr. Regula. The committee will recess. We have a one minute
vote, which is in process now, and then three five minute
votes. So I would say roughly ten after or a quarter after, we
will reconvene, as we can get the votes over with. So if you
all will be patient, we will go and do our duty.
[Recess.]
Mr. Regula. We will reconvene the committee.
Mr. Jackson, I think you want to introduce your guest here.
Mr. Jackson. Mr. Chairman, Linda Anderson has served as
President and Chief Operating Officer for the Sickle Cell
Disease Association of America, Incorporated, since 1992.
During her eight year tenure, the Pittsburgh native and
Carnegie Mellon graduate has used her 24 years of corporate
management experience to position SCDAA as a source of services
and support for individuals and families affected by sickle
cell disease.
Ms. Anderson was instrumental in developing and
implementing a five year strategic plan, designed to strengthen
the infrastructure of the 64 member association, promote the
association's national programs, and heighten public awareness.
Ms. Anderson is also active on several national boards or
committees, including Vice Chair, Executive Committee,
Community Health Charities, and the President's Committee on
the Employment of People with Disabilities.
Mr. Chairman and members of the subcommittee, Ms. Anderson.
----------
Wednesday, March 21, 2001.
THE SICKLE CELL DISEASE ASSOCIATION OF AMERICA
WITNESSES
LYNDA K. ANDERSON, PRESIDENT/COO, SCDAA, THE SICKLE CELL DISEASE
ASSOCIATION OF AMERICA
TAHIRA YVONNE GIVHAN
Ms. Anderson. Thank you very, very much, Congressman
Jackson. On behalf of the Sickle Cell Disease Association of
America, I want to thank you, Chairman Regula and members of
the subcommittee, for giving me this opportunity to testify.
With me today, I have Tahira Yvonne Givhan, the 2000/2001
national poster child, our junior ambassador, for the Sickle
Cell Disease Association of America. She is our star. Tahira
will be speaking with you today on the challenges that she
faces in life, because of having sickle cell anemia, an
inherited genetic disease. Before Tahira delivers her remarks,
I would like to briefly summarize the SCDAA's fiscal year 2002
appropriations request. First, we ask that $4 million be
provided to support a two part community outreach
demonstration.
Specifically, $2 million is requested from the Maternal
Child Health Block Grant. Special projects of regional and
national significance account to support the strengthening and
expansion of locally-based newborn screening follow-up
activities; and $2 million is requested from the Office of
Minority Health, or another account within the Health Resources
Services Administration, to support the strengthening and
expansion of locally-based related outreach and supportive
service efforts.
Second, we support the efforts underway at the National
Heart, Lung, and Blood Institute, to strengthen data coordination
efforts of the ten comprehensive sickle centers, and seek increased
resources for the establishment of a clinical research network.
We ask that increased funding and report language in
support of this effort be included in the fiscal year 2001
Labor HHS Education Appropriation Bill. A more detailed outline
of these requests has been submitted for the record. However,
now I would like for Tahira to tell you why, in her words,
these resources are so desperately needed.
Mr. Regula. Well, Tahira, we are happy to welcome you. I
can see why you chose her. She is a very pretty young lady.
Ms. Givhan. Thank you.
Mr. Regula. So we will be pleased to hear your testimony,
Tahira. What grade are you in?
Ms. Givhan. Fourth.
Mr. Regula. Fourth grade, and where do you go to school?
Ms. Givhan. Oak Mountain Intermediate School.
Mr. Regula. What city is that?
Ms. Givhan. Shelby County.
Mr. Regula. Well, we are pleased that you could come this
morning, so we will look forward to hearing from you.
Ms. Givhan. Thank you, Mr. Chairman and other committee
members. My name is Tahira Yvonne Givhan. I come to you on
behalf of the Sickle Cell Disease Association of America. I
have sickle anemia. It is a disease of the red blood cells. I
am inherited the gene from both my parents.
First and foremost, thank you for providing the funding for
new treatment therapies, supportive services, and newborn
testing. In fact, the doctor tested me while I was still in the
hospital, as a newborn baby. That is the law in most states,
and it is a fantastic law, because babies with sickle cell
anemia often require special care. As a result of your
investment, sickle cell anemia no longer spells doom and gloom,
the way it did years ago. The mortality rate for infants with
sickle cell anemia has decreased dramatically. Again, I thank
you.
Yes, the advances made in biomedicine in recent years are
appreciated greatly. However, more funding is badly needed to
help find a cure, so that we will no longer have to manage the
pain and suffering that comes with having this unpredictable
disease. Because I have sickle cell anemia, my cells are
sickled, making it hard for oxygen to stay in them. Sometimes,
these sickle shaped cells become sticky and thick, and can clog
small blood vessels in my body.
When this happens, I hurt. This can cause a lot of pain
anywhere in my body. When my head hurts, my parents and doctors
have to monitor me closely, to make sure that I do not have a
stroke, like many people with sickle cell anemia.
It is true that I enjoy a number of activities like other
young people my age: ballet, riding my bike, and playing on the
swing set. But during most of the days of the week, I am very
tired and in pain. At school, I do not think that my teachers
understand how difficult it is for me to keep up with the other
kids, particularly in P.E. So in addition to being in great
pain, I have to suffer the embarrassment of being different.
The challenges faced by families that have children with
sickle cell anemia are pretty serious. Therefore, the services
provided SCDAA's member organization, such as outreach, are
very important; but they need more help so that they can help
more kids like me. I believe and have faith that a cure will be
found in my lifetime, so that as we move into this new
millennium, we, too, can enjoy the American dream in its
totality. When this happens, it will just be wonderful.
Mr. Regula. Well, Tahira, you are a very persuasive
witness. [Laughter.]
Mr. Jackson.
Mr. Jackson. Mr. Chairman, let me again thank Ms. Anderson
and Tahira for their testimony. I do not have sickle cell
anemia, but I, like my father, carry the trait, as well.
I introduced elevating the Office of Research on Minority
Health at NIH to a center status last year, which fortunately
passed with the help of Mr. Bilirakis, John Lewis, Benny
Thompson, Senator Frist and Senator Kennedy in the Senate.
Sickle cell anemia just happens to be one of those diseases
at the National Institute of Health that could use better
coordination amongst all of the centers. But for the elevation
of the office to center level, the office itself did not have
the ability to even sit in the room with the other centers, to
look across the entire institute, for the purposes of trying to
arrive at a cure.
If there ever was a disease, Mr. Chairman, that is
reflective of the disparities that exist amongst those groups
who have been left behind in America, it is certainly sickle
cell anemia. Of all of the options and diseases that will be
before the Center for Research on Minority Health at NIH,
sickle cell anemia should be way on top of the list for Dr.
Ruffin, Dr. Fouchey, and Ms. Kirschstein at NIH.
I will be arguing on behalf of Tahira and other children,
as well as Americans who are similarly situated, for the
appropriate amounts at the National Institute of Health, to
reflect her desire and our desire to bring an end to this
devastating illness.
Thank you, Mr. Chairman.
Mr. Regula. Thank you.
Tahira, do you have to miss much school?
Ms. Givhan. No.
Mr. Regula. You must not, because you certainly speak very
well for a fourth grader.
Ms. Givhan. Thank you.
Mr. Regula. Thank you for coming.
Ms. Anderson. Thank you for having us.
Mr. Regula. Our next witness is Dr. John Sever, Member,
International PolioPlus Committee, Rotary International.
Wednesday, March 21, 2001.
INTERNATIONAL POLIOPLUS COMMITTEE, ROTARY INTERNATIONAL
WITNESS
DR. JOHN L. SEVER, MEMBER, INTERNATIONAL POLIOPLUS COMMITTEE, ROTARY
INTERNATIONAL
Mr. Sever. Thank you very much, Chairman Regula and
Congressman Jackson. It is a pleasure and a privilege to be
here to tell you about the International PolioPlus Program to
eradicate polio worldwide. I am a professor of pediatrics at
the Children's Hospital here in Washington and George
Washington University. I am representing Rotary International,
which I am a member of. There are 1.1 million members of Rotary
International, of which there are about 380,000 members in the
United States.
Some years ago, the Rotary founded a coalition to eradicate
polio worldwide. That includes the March of Dimes Birth Defects
Foundation, the American Academy of Pediatrics Task Force for
Child Survival and Development, and the U.S. Fund for UNICEF,
along with Rotary International. We are working to help
eradicate this disease worldwide. The goal is to complete that
eradication by the year 2005, which is just a few years ahead.
It will be only the second disease in the history of man that
has been eradicated; small pox being the other disease. So the
goal is not just to control the disease, not just to immunize
children, but to eradicate the disease completely worldwide by
the year 2005, at which point we will be able to stop
immunizing for polio, because it will no longer exist in the
world, just as we did stop for smallpox.
There has been a great deal of progress made, and the
support from this subcommittee, your support, has been very
important through the U.S. Centers for Disease Control, over
the years. That, along with Rotary International's support and
other nation's support, has really made a big difference. You
have in your material the fact that in 1988, there were over
350,000 cases a year worldwide, and today, just last year,
there were only 3,500 cases. So that is down to just one
percent of what it was in 1988.
Mr. Regula. The United States is fairly clean.
Mr. Sever. The United States has had no polio for almost 18
years now. There has been no polio. Eradication has been
complete in this hemisphere since 1991. Eradication in the
Western Pacific area was achieved two years ago, so this has
been focusing down. The only places in the world that polio
still exists is in Southeast Asia, India, Pakistan, Bangladesh,
and in Africa. So that, right now in the next five years, is
the focus to complete the eradication of this disease, so that
it will no longer happen.
The efforts can be measured in many ways. First, of course,
one can estimate the number of children who have not been
paralyzed, who would have been paralyzed, if this effort had
not taken place, and it now exceeds three million. The effort
can be measured in terms of cost savings. In the United States,
for example, although as we mentioned, we do not have any cases
of polio, we still must immunize all the children in the United
States for polio, because it could be brought in from one of
these other areas. That costs us, in this country, about $230
million a year to immunize for a disease that we do not have.
That would be, of course, saved, once the disease is
eradicated.
Worldwide immunization costs about $1.5 billion a year for
polio. Again, on a worldwide level, that would be a tremendous
savings. So both in terms of the reduction, the suffering, and
the cost, just to mention two areas, there is a tremendous
benefit for completing this job in the next few years. The U.S.
Center for Disease Control has been a great assistance. This
last year, the appropriation was for $91.4 million. When you go
to Atlanta, and besides seeing the buildings, I hope that you
will learn more about how they are providing epidemiologists
worldwide to help participate in this eradication effort.
There is a large new group in India and another group in
Africa, which are vital to identifying where polio is
continuing, and where it has to be immunized in carrying
national immunization days; plus, providing vaccines. The
Rotary is also doing this. Rotary, since 1988, has been
providing money for vaccine immunizations, as well as
volunteers. By the time this job is done, Rotary will have
provided about $500 million towards this eradication program,
from its own contributions and its own funds.
We are asking this year that the appropriation be increased
by $15 million, for a total of $106.4 million. The reason for
that is, that the price of the vaccine has gone up from about
seven cents a dose, to about 9.6 cents a dose, and because of
the tremendous amount of effort that is required now in Africa
specifically to get the job done.
Thank you.
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Mr. Regula. Well, thank you very much. I think it is great
that a service organization such as Rotary does get behind what
is obviously a very worthwhile project.
Mr. Sever. Thank you.
Mr. Jackson. Mr. Chairman, I just have one question.
Mr. Regula. Yes, Mr. Jackson?
Mr. Jackson. Let me also congratulate you, sir, for the
work that you have undertaken. To what do we owe the
substantial cost increase for the cost of the polio vaccine?
Mr. Sever. Well, basically, the costs of materials have
gone up in the last couple of years, and the large volumes that
are now being used have caused the manufacturers to have to
build additional facilities, as I understand, in order to
produce this.
For example, in India, we had an immunization date, which
is the way you would eradicate this, as we are doing in Africa.
There are 17 countries in Africa, simultaneously immunizing
their entire population of children under five years of age.
It takes enormous amounts of vaccine, and we have had to
just tremendously increase the capacities to provide this
vaccine, and to have it available. In India, for example, a few
weeks ago, they just immunized 140 million children in one day.
There is just an unbelievable effort to that, and it is an
enormous quantity of vaccine.
So unfortunately, the cost of producing the vaccine and the
cost of augmenting the facilities has come back in terms of
this increase in vaccine costs.
Mr. Jackson. Is the cost that you have requested, in terms
of the increase in the program, does it approximate the size of
the problem, in terms of our ability to curtail the disease by
administering polio vaccines, but at the same time, does it
take into account the fact that the population in many of these
areas is constantly growing and expanding?
Mr. Sever. It takes into consideration both, sir. The
population growth is important. The issues of administration
under these massive programs has to be taken into
consideration. The other countries are assisting, too. The
United States, I think, is the leadership of countries, but
Great Britain and most European countries are also helping to
try to get this job done.
The fact that we are focusing on it to get it done quickly
in the next five years is important, too, because we can then
complete the job, and it will not have to go on and on and on.
Mr. Jackson. Thank you, Mr. Chairman.
Mr. Regula. Thank you.
Our next witness is Lydia Lewis, who will be introduced by
Mr. Jackson.
Mr. Jackson. Mr. Chairman, Lydia Lewis became Executive
Director of the National Depressive and Manic-Depressive
Association in 1997.
Headquartered in my hometown of Chicago, the National DMDA
is the largest patient-directed, illness-specific organization
in the country, with nearly 400 patient-run support groups
throughout the country.
Ms. Lewis' primary responsibility has been to position
national DMDA as a leading source for information on mood
disorders, and the treatments for patients, family members,
health care professionals, the media, and others.
She holds a bachelor's degree in psychology from the State
University of New York at Buffalo. She was a charter member of
the NIH Director's Counsel of Public Representatives.
She also serves on the oversight committees of several
large NINH clinical trials, including current trials studying
the effectiveness of treatments for bi-polar disorder and the
study of treatment of adolescents with depression. One of her
proudest accomplishments has been her willingness to confront
her own life-long battle with depression.
Mr. Chairman and members of the committee, I present Ms.
Lewis.
----------
Wednesday, March 21, 2001.
NATIONAL DEPRESSIVE AND MANIC-DEPRESSIVE ASSOCIATION
WITNESS
LYDIA LEWIS, EXECUTIVE DIRECTOR, NATIONAL DEPRESSIVE AND MANIC-
DEPRESSIVE ASSOCIATION
Ms. Lewis. Thank you very much, Congressman Jackson; I
truly appreciate the introduction. Mr. Chairman Regula and
members of the subcommittee, as Congressman Jackson said, I am
Lydia Lewis. I am the Executive Director of the National
Depressive and Manic-Depressive Association. We appreciate the
opportunity to testify in support of funding for neuro-science,
behavioral science, and genetic research, through the National
Institutes of Health and the National Institute of Mental
Health. National DMDA applauds the doubling of the NIH budget,
and encourages the subcommittee to continue providing strong
leadership on this effort, which has had a significant impact
on mental health research.
While I am here today to testify on behalf of National
DMDA, I know personally what it is like to battle depression
every day, to fight the urge to end my life. It is a dreadful
way to live. I, myself, suffer from the disease, and I am not
alone. The recent global burden of disease study conducted by
the World Health Organization, the World Bank, and Harvard
University found that mental illness has long been
misunderstood. In fact, it accounts for more than 15 percent of
the burden of disease in established market economies. This is
more than the disease burden caused by all cancers combined.
More than 20 million American adults suffer from unipolar
or major depression every year, and it is the leading cause of
disability in the world today. An additional 2.3 million people
suffer from bipolar disorder. Onset is nearly always before the
age of 20, meaning more high school drop-outs, more illegal
drug and alcohol use, higher teen pregnancy rates, more teen
violence, and more adolescent suicides. An estimated 50 million
Americans experience a mental disorder in any given year, yet
only one-fourth of them actually receive mental health and
other services. Women are more than twice as likely as men to
experience depression. One out of every four American women
will experience a major depressive episode in her lifetime.
Coping with these devastating illnesses is a tragic,
exhausting, and difficult way to live. Mood disorders and other
mental illnesses kill people every day. Depression is the
leading cause of suicide. One in every five bipolar sufferers
takes his or her life; one in five. Suicide is the third
leading cause of death among fifteen to twenty-four year old
Americans. For every two homicides committed in the United
States, there are three suicides.
Despite these facts, stigmatizing mental illness is a
common occurrence. Labeling people with mental illnesscontinues
to send the message that de-valuing mental illness is acceptable.
Equally devastating is the stigma associated with the
research of mental illnesses. Research in behavioral science is
as critical as that undertaken for any other illness. Our
understanding of the brain is extremely limited, and will
remain so for decades, unless much greater financial support is
provided. Neuro-science research is also critically important
to understand the mechanisms in the brain that lead to these
illnesses. Every day, technology and science bring us further
in understanding the brain. These kinds of successes build upon
each other. Great strides are being made, but it is imperative
that the progress be maintained.
In 1999, the Surgeon General released the first-ever study
from that office on mental illness. It concluded that these
diseases are real, treatable, and affect the most vital organ
in the body, the brain. We are particularly pleased that NIMH
played a lead role in the Surgeon General's report on youth
violence. With further research into the relationship between
mental illness and violence, we are hopeful that tragedies like
the recent school shootings in California and across the
country can be prevented in the future. Research supported by
NIMH has led to a much better understanding of these illnesses.
We are learning more about their impact on other diseases, such
as Parkinson's, cardio-vascular ailments, stroke, diabetes, and
obesity. But more funding for NIMH and other research
institutions is critical to ensure that any forward momentum is
not lost.
We commend the subcommittee's past support of the National
Institutes of Health and the National Institute of Mental
Health, and your renewed commitment to full funding of mental
health research. Together, our efforts will mean real treatment
options, and an end to the stigma associated with mental
illness, lives saved, and a far more productive America.
Again, I appreciate the opportunity to testify.
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Mr. Regula. Thank you.
Mr. Jackson, do you have any questions?
Mr. Jackson. I do not have any questions, Mr. Chairman.
Mr. Regula. Thank you for coming.
Ms. Lewis. Thank you.
Mr. Regula. Our next witness will be Dr. George Hardy,
Executive Director of the Association of State and Territorial
Health Officials. Mr. Hardy, welcome.
----------
Wednesday, March 21, 2001.
ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS
WITNESS
GEORGE E. HARDY, JR., MD, MPH, EXECUTIVE DIRECTOR, ASSOCIATION OF STATE
AND TERRITORIAL HEALTH OFFICIALS
Mr. Hardy. Thank you, Mr. Chairman, Mr. Jackson, and
members of the subcommittee. I appreciate the opportunity to
appear here this morning. My name is George Hardy. I have the
privilege of serving as the Executive Director of ASTHO, the
Association of State and Territorial Health Officials.
In the last century, our nation has made tremendous strides
in improving the health of Americans. As Dr. Sever just
reminded you, we have eradicated smallpox from the globe, polio
from the Americas, and we have had substantial reduction in the
incidents of disease and death from major infectious and
chronic diseases. We also recognize that there is a lot more
that we have to do.
I would like to make the case that as a nation, we need to
continue our investment and research, but just as importantly,
we need to invest in the transfer of research findings to
public health programs. If research findings are not made
available to the public, they might just as well not have been
made.
If society is going to be the ultimate beneficiary of our
commitment to research, we need to make the same kind of
commitment to investment in programming.
CDC and HRSA provide the states with the resources to carry
out these public health programs. ASTHO urges the committee to
assure that CDC receives a total appropriation in fiscal year
2002 of $5 billion and HRSA, $6.7 billion
This morning, I will discuss only a few of the important
programs to states. You have heard about immunization, but you
are going to hear about it again. Let me tell you how important
this is.
In the last 50 years, immunization programs have produced a
95 percent decline in most childhood vaccine-preventable
diseases. Despite this, an estimated one million American two-
year-olds have not received one or more doses of vaccine that
they should have had, at that point in life.
Not only must we assure that the children are adequately
immunized, but we also need to assure that adolescents and
adults receive needed immunization services, such as influenza,
hepatitis, and pneumococcal vaccine.
We thank the members of this subcommittee for ensuring that
CDC received a down-payment last year on much-needed
immunization funding. But as the Institute of Medicine has
pointed out, additional funds are still necessary to meet the
need.
Just one example of such a need is the important challenge
of raising immunization levels among children served by WIC
programs. Specifically, we are requested $32.5 million
additional dollars for CDC's immunization infrastructure
program, and $93 million additional for domestic vaccine
purchases.
This latter figure, I know, sounds high; but it is
necessary if we are going to provide the newly-approved
pneumococcal vaccine for children. This vaccine will cost
health departments nearly $200 per child to purchase.
The preventive health and health services block grant is a
component of every state's strategy to address their own unique
health needs. ASTHO has just produced this new publication,
``Making a Difference,'' which I know you have seen, Mr.
Chairman, and it documents the impact of public health through
this program.
Every state does something different. In Ohio, for
instance, to just pick a state at random, the Health Department
has shown a marked reduction in the incidents of adverse
reactions and preventable hospital admissions, as a result of
medication errors in the elderly.
As I have said, every state has addressed its own problems.
I think that this document will convince you of the importance
of the preventative block.
Since its inception 20 years ago, funding for the
preventive block grant has been stagnant. It has not kept pace
with inflation.
It has not been adjusted for the increasing population, or
for the new public health needs that were not even known at the
time it was created, such as AIDS and West Nile Virus. We are
asking the subcommittee to provide an additional $75 million
for that block grant.
Last year, the Congress enacted the Public Health Threats
and Emergencies Act, to address bioterrorism, antimicrobial
resistance, and public health capacity. Each of these are
critically important, and we would urge the subcommittee to
fully fund the $534 million that is authorized for these
services.
Many other programs at CDC and HRSA deserve this
committee's attention. The Maternal and Child Health Block
Grant and the Ryan White Care Act, both programs at HRSA, are
critical to the states, and we support the request of $850
million for the MCH block grant.
I want to close by expressing again our appreciation to
this subcommittee for its past commitment to public health.
Your work has made a tremendous difference in the lives of
people, and we are going to need your help again this year, as
we try to advance the health of our Nation.
Thank you, Mr. Chairman.
[The information follows:]
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Mr. Regula. Well, thank you very much for your comments. I
am sure there is a great need there.
The next witness is Dr. Thomas Clemens, Professor of
Medicine and Molecular and Cell Physiology, University of
Cincinnati.
----------
Wednesday, March 21, 2001.
NATIONAL COALITION FOR OSTEOPOROSIS AND RELATED BONE DISEASES
WITNESS
DR. THOMAS L. CLEMENS, PROFESSOR OF MEDICINE AND MOLECULAR AND CELL
PHYSIOLOGY, UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE, NATIONAL
COALITION FOR OSTEOPOROSIS AND RELATED BONE DISEASES
Dr. Clemens. Thanks, Mr. Chairman and Congressman Jackson.
My name is Tom Clemens. I work at the University of
Cincinnati. I do basic research in bone biology. With me is
Charles Hall, a patient with fibrous dysplasia.
The National Coalition for Osteoporosis and Related Bone
Diseases appreciates this opportunity to present our position
on the need for continued and expanded funding for osteoporosis
and related bond disease research at the National Institutes of
Health. We also appreciate the committee's past support for the
goal of doubling the NIH budget, and last year's significant
increase.
The bone diseases represented by our coalition occur in all
populations and at all ages. They are devastating diseases,
with significant physical, psycho-social, and financial
consequences, including pain, disability, and death.
Consider, if you will, what we already know about how our
bones function. Throughout life, our bone is constantly being
remodeled through repeated cycles of bone breakdown and bone
build-up. As we age, this balance shifts in favor of bone
breakdown, rather than bone build-up. If unchecked, this
delicate balancing act goes awry, and this results in bone
disease.
Our increasing understanding of this process has led to
exciting new drug therapies, that balance out. Yet, bone
disease still has no cure, and there are many important
questions remaining unanswered.
What are the major bone diseases? One is osteoporosis, the
most prevalent bone disease in this country. It is
characterized by low bone mass and structural deterioration of
bone. Ten million Americans have osteoporosis, and 18 million
more have low bone mass, placing them at risk of the disease.
In 1995, osteoporosis was responsible for 2.5 million
physician visits; 180,000 nursing home omissions, and over
400,000 hospital admissions. The direct cost of fracture is
$13.8 billion, which should triple by the year 2040.
Paget's disease of bone is a chronic disorder that may
result in enlarged or deformed bones in one or more regions of
the skeleton. Complications may include arthritis, fractures,
bowing of the limbs, and hearing loss. Paget's affects up to
eight percent of our population over 60. That is two to three
million Americans.
Osteogenesis Imperfecta is a genetic disorder that is
typically diagnosed in infancy. Osteogenesis imperfecta causes
bones to break easily. For example, a cough or a sneeze can
break a rib; simply rolling over in bed can break a leg.
Osteogenesis Imperfecta affects an estimated 30,000 adults,
children and infants in the United States, causing as many as
several hundred broken bones in a lifetime.
I understand from Mr. Grove, Chairman Regula, that you have
actually had the opportunity to see a number of these patients
at the Institute of Child Health.
Fibrous dysplasia, which affects Mr. Hall, is a chronic
disease of the skeleton, which causes expansion of one or more
bones, due to the development of a fibrous scar within the
bone. This weakens the bone, causing pain, deformity,
disability, and fracture. At present, there are no approved
therapies for this disease.
Osteopetrosis is a disease present at birth, at which bones
are overly dense. This is due, again, to an imbalance between
bone formation and bone breakdown. Complications often begin
before the age of five, and include fractures, frequent
infections, and problems with sight and blood vessel disease.
The National Institute of Arthritis and Muscular Skeletal and
Skin Diseases, NIAMS, leads the Federal research effort on bone
disease; however, the need for trans-NIH search is vital. Bone-
related disease cuts across many research institutes at the
NIH. Given the breadth and depth of these diseases, we urge the
committee to instruct NIH to make this one of its top trans-NIH
priorities.
With the steady greying of Americans, now is the time to
find solutions to these dehabilitating diseases, in order to
alleviate the stress that will be placed on the Medicare system
in the future.
Vast opportunities still exit to expand our current
knowledge base. Initiatives that may serve as springboards to
further research include: basic research, funded by the NIH;
and clinical trials with power-thyroid hormone, or PTH, the
newest front-line treatment for osteoporosis.
One form of PTH has just been submitted to the FDA for
approval. Researchers still do not really know how it functions
at the cellular level.
While osteoporosis was once thought to be a woman's
disease, it is now an important issue among men. An estimated
one-third of hip fractures, worldwide, occur in men, including
the one recently sustained by President Ronald Reagan. A major
study on how the disease affects men is currently underway and
supported by the NIH. In the area of osteogenesis imperfecta,
researchers are exploring the effectiveness of a drug that
appears to increase bone marrow density and decrease bone loss.
Finally, a new clinical center for patients with fibrous
dysplasia was recently established at the NIH, and has proved
to be a resource for physicians and patients around the
country, while furthering research on this crippling disease.
Mr. Chairman, the research community sincerely appreciates
the committee's efforts over the years to ensure continued
strength of the NIH research program. The high value that we
continue to place on biomedical research will lead to the
prevention of disease, reduce disability, and decrease the
staggering health care costs associated with bone and other
diseases.
Just let me say one more thing before I finish, and that
concerns the timing of our request. With the completion of the
human genome project, researchers right now are poised to make
new discoveries and identify new gene targets. This is going to
be absolutely essential, so the timing of our request is
critical.
Thank you, Mr. Chairman.
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Mr. Regula. Do you deal with brittle bones?
Mr. Clemens. Yes, and the one disease that I did mention,
osteopetrosis, is called marble bone disease. Osteogenesis
imperfecta is also associated with brittle bones, and is called
actually Brittle Bone Disease.
Mr. Regula. That is a very difficult challenge.
Are there any questions, Mr. Jackson?
Mr. Jackson. Mr. Chairman, just by virtue of the fact that
NIAMS is an institute at NIH, and they are already engaged in
trans-NIH research on many of the diseases that you indicated,
is there a specific funding request for any of the diseases
that you mentioned, that should be covered, above and beyond
what the committee and the President have already made a
commitment to do? I am not so sure that I actually heard that
in your testimony.
Mr. Clemens. We would recommend a 16.5 percent increase for
NIAMS; but I wanted to stress the trans-NIH funding; because
there are institutes, for example, child health and the cancer
institutes, where these bone diseases are also funded. So we
would like to recommend the 6.5 increase, with the trans-NIH
funding for that. That is not over and above 16.5 percent.
Mr. Regula. Thank you very much.
Our next witness is Lawrence Pizzi, Volunteer, North
American Brain Tumor Coalition.
----------
Wednesday, March 21, 2001
NORTH AMERICAN BRAIN TUMOR COALITION
WITNESS
LAWRENCE PIZZI, VOLUNTEER, NORTH AMERICAN BRAIN TUMOR COALITION
Mr. Pizzi. Good afternoon, Mr. Chairman. I am going to
follow suit with many of my predecessors, and tell you that
although I was born overseas, my first and earliest memories
are Kent, Ohio. [Laughter.]
Mr. Regula. You are getting close.
Mr. Pizzi. I knew I had to come up with something.
Mr. Regula. Well, Chicago and Ohio have done well today.
Mr. Pizzi. My name is Larry Pizzi. It is my privilege to
appear today as a representative of the North American Brain
Tumor Coalition, a network of 12 charitable organizations that
raise funds for brain tumor research, and provide information
and support to individuals with brain tumors, their families,
and their friends.
We corroborate in advocacy to increase brain tumor
research. We also work to guarantee that every brain tumor
patient has access to the best possible health care.
I am also the Executive Director of one of the coalition's
founding member organizations, and the only member of the
coalition not represented by one of the states on this
committee. I am from Massachusetts.
Most importantly, though, I am the father of Timothy
Lawrence Pizzi, a child diagnosed with a brain tumor in 1989.
He lived nearly seven years, before dying at the age of 12.
Mr. Regula. This was your son?
Mr. Pizzi. Yes, my son.
Mr. Regula. He was born with the tumor?
Mr. Pizzi. He was diagnosed at age six with a tumor that he
probably had since birth. He died at age 12. He and thousands
like him, children and adults, are the reason that my testimony
today is a privilege, and I thank you.
Brain tumors are a unique disease and present special
challenges for all that they touch. Brain tumors are not a
single disease. Instead, there are at least 126 types of
central nervous system tumors. It is difficult to treat brain
tumors, not only because of their diversity, but because of the
unique biology of the brain.
I am sure that you can understand how it is possible to
remove a lung, a breast, or prostate that is affected by
cancer; but we cannot remove the brain. Treatment strategies
that are successful with other cancers cannot be used to treat
brain tumors.
Moreover, brain tumors affect the organ that make us who we
are. They are a disease not only of the body, but also of the
soul. They are a disease of the quality of life.
A recent Government study accurately defined a brain
tumor's impact as mental impairment, seizures, and paralysis
that affect the very core of a person, and have a demoralizing
effect on loved ones.
Added to these burdens is the knowledge that for most brain
tumors, adequate treatment is not available. In children, even
if they do survive the devastating impact of the treatment, it
often leaves them with permanent damage. However, these are
exciting times, and there is hope for progress.
I would simply echo those who have come before me, and ask
that we continue to fund the National Institutes of Health in
such a way that we essentially double the research budget by
the year 2003. We join the other patient organizations in
commending this committee for its role in that progress, and we
would ask that you continue it.
Brain tumor research suffers from a lack of trained
clinical investigators. Good funding is going to be very
important to continue attract them.
Mr. Regula. Is there any one institution that is focusing
on this, that you are aware of?
Mr. Pizzi. That is my next point. We have been urging for a
number of years corroboration between the two institutes at the
National Institutes of Health, that have responsibility for
brain tumors, the NINDS and NCI. That is the National Institute
of Neurological Disorders and Stroke and the National Cancer
Institute.
I am very glad to say that over the last year, we have seen
much progress in that area, resulting in this document by a
progress review group, that was carried out jointly bythe NINDS
and the NCI, and advocates in the extra-mural community.
I am here today to ask you and your committee to ensure
that this progress review group document, which represents a
true corroboration between Government, the private sector, and
the advocacy sector, not become a document on a shelf.
These organizations, the NCI and the NINDS, have worked
very well together to produce a national strategy for attacking
this disease. We have a couple of specific requests.
One is that we enhance brain tumor research through
continuing the corroboration that this document represents. The
two institutes should strengthen their mechanisms for
coordination and corroboration among extra-mural researchers.
The written version of my testimony contains the details of how
we would like this accomplished.
They should organize and fund a series of inter-
disciplinary meetings, of researchers that would focus on the
subjects of brain tumor biology. They, along with the Center
for Scientific Review, should make sure that study sections, or
the people who look at the grant requests coming up from the
field, saying yes, we should fund this or no, we should not,
have the right expertise to evaluate brain tumor grants.
Currently, they do not.
Mr. Regula. You do not think they are capable of making
judgments on the allocation of the resource money?
Mr. Pizzi. Brain tumors are highly specialized. Our
experience is that the specialists who make up the brain tumor
community are not adequately represented on those.
I will close with this point. In addition, there is the
recently established NCI-NINDS Neuro-oncology Branch. They see
this as great progress, because it represents the two
institutions. We would like to see that branch continue, to not
only work intermurally in Bethesda, but to be sort of the focal
point for the corroboration.
I would like to tell you that my son was very close to a
very prominent brain tumor researcher. His name was Dr. Mark
Israel. One day shortly before my son died, knowing that he
would die, he called Mark on the telephone, and asked him the
question that he would always love to ask him, ``Mark, are
still looking for a cure?'' Mark, of course, told him that he
was. Timothy said to him, ``Now would be a good time.''
It did not work for Tim, or thousands of others, since he
died five years ago. He became part of one statistic that I
will leave you with. Brain tumors are the leading cause of
cancer deaths in children under the age of 20, now surpassing
acute lymphoblastic leukemia, and are the third leading cause
of cancer deaths in young adults, ages 20 to 39.
We applaud the dedication of this subcommittee to advancing
biomedical research. We look forward to working with you to
support brain tumor research at a time when advances, we
believe, are truly going to be possible, and to make a time
when the Timothys of this world will have a much brighter
future.
I thank you.
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Mr. Regula. Thank you.
What are the choices, since you cannot use chemicals or
chemotherapy?
Mr. Pizzi. Brain tumors are resistent, generally, to
chemotherapy, because of the nature of the biology of the
brain. Radiation is a very common treatment; but, of course, it
does a lot of damage to normal, healthy brain tissue.
So we have a case where the treatment can leave the patient
cured or in remission, but with so many deficits. Nearly 80
percent of adults who have brain tumors or are treated for them
are unable to go back to work, even though they are still
alive.
Children who are treated for brain tumors live the rest of
their lives with cognitive deficits. So it is just the nature
of where it is, Mr. Chairman. It is truly a unique organ of the
body. There are 126 kinds of them. There is no other cancer
that has that many sub-sets of a disease.
Mr. Regula. It puts pressure on the brain.
Mr. Pizzi. Automatically, and that, of course, is a major
problem.
Mr. Regula. I had a friend that died that way.
Thank you very much.
Mr. Pizzi. Thank you very much for your time.
Our next witness is Ken Moss, Friends of Cancer Research.
Mr. Moss?
----------
Wednesday, March 21, 2001
FRIENDS OF CANCER RESEARCH
WITNESS
DR. KEN MOSS, FRIENDS OF CANCER RESEARCH
Ms. Segal. Good afternoon, Mr. Chairman, I am Ellen Segal
of Friends of Cancer Research. I am pleased to introduce to you
Dr. Ken Moss. He is from your home state of Ohio, from
Cleveland. He is an endothesiologist, and he also teaches at
Case Western.
Dr. Moss and his wife Anita are going to put a human face
on this disease, and talk about their daughter Elisa. You will
hear from Dr. Moss.
Dr. Moss.
Dr. Moss. Thank you.
Chairman Regula and members of the subcommittee, thank you
for the opportunity to testify today.
I come before you not as a physician, but as a father of a
beautiful and talented 17 year old, who passed away last
October from cancer.
I took this photo on Elisa's high school graduation, almost
four months before she died. She looked exactly the same way on
that fateful day in October. In fact, hours before she died,
she stopped in front of the mirror on the way out the door to
the doctor's office, telling her mother that she was going to
put on makeup, so that no one would be able to tell that, ``I
am a cancer patient.''
Elisa was gifted and mature beyond her years. Almost
everyone she met liked her. Over 900 people attended her
funeral. Classmates flew home from college from as far away as
California, because Elisa meant that much to them.
It is impossible in five minutes to tell you of all the
anguish, fear and frustration that we felt as we watched
helplessly as cancer slowly took her.
While returning from a New Year's cruise in January of
1998, my daughter noticed pain in her thigh. I did not think
anything of it; however, the pain persisted. Within a few
weeks, my wife arranged for a MRI. A mass was found and quickly
biopsied.
``I am sorry, but your daughter has cancer.'' No statement
will strike more terror into a parent than that. Even worse,
Elisa had a rare, highly malignant tumor. The prognosis was a
20 percent five year survival.
As a parent, I was devastated; but as a doctor, I simply
could not accept it. We took her to Memorial Sloan Kettering
for a second opinion. They recommended high dose chemotherapy,
surgical excision, and a bone marrow transplant.
Throughout the chemotherapy that caused extreme illness,
loss of her hair, and most importantly, forced her to remain at
home and stop going to school, Elisa fought back. She never
gave up and she never complained.
During each of the 12 surgical procedures that she had in
the two years that followed her diagnosis, she always remained
optimistic, and she was an inspiration to everyone who knew
her.
In August, 1998, Elisa underwent a stem cell transplant.
Yet, six months later, she relapsed, with a tumor in her lung.
After a biopsy confirmed the worst, a big debate ensured about
what to do. Traditional medicine had failed her, so we examined
experimental protocols at the National Cancer Institute.
One study in particular had promise, and Elisa, who had
always played an active role in her treatment, agreed. This
began a period of four months of commuting to Bethesda with
Elisa. But the home run that we had hoped run was not to be,
and by August 1, 1999, it was clear to investigators that Elisa
was not responding and, in fact, her tumors were doubling, both
in size and in number, each month.
I brought Elisa back home to the Cleveland Clinic, and her
doctor sat me down and told me that she had less than three
months to live, and that her only chance was more chemotherapy,
to hopefully shrink the tumors and buy her more time. To me,
this was insanity, doing the same thing again, and expecting a
different result.
I knew that her only hope was to target the cancer cells by
other means, such as attacking the tumors' blood supply. My
family and I had already read all the literature. We were
knowledgeable about the tremendous advances that were being
made with different agents.
There were so many promising treatments on the horizon; if
only we had the time to wait for the studies to be carried out;
time for new drugs to come to market. But we did not, and Elisa
had only three months to live.
Elisa's doctors at the Cleveland Clinic accepted my
suggestion that we try a radically different approach that was
only vaguely described in one person and in animal studies. The
treatment which we modified constantly over the next 13 months
significantly slowed her tumor growth. Not only did Elisa not
die, she went with us on a 10 day Christmas cruise, and had a
ball.
In March, Elisa returned to high school and completed her
senior year. She went to prom and lived as normally as she
could, despite the fact that twice a week, in our family room,
I would hook her up to an IV, and administer the experimental
treatment.
She graduated with highest honors, and was accepted to Case
Western Reserve University, where she intended to get a
combined degree in nutrition and biochemistry.
Sadly, her time ran out before the treatment protocol that
we were using could be fine-tuned. Elisa was content to live
with her cancer. She was hopeful that we could convert it to a
chronic disease.
Elisa's dream can become a reality if Congress and the
White House live up to the five year commitment to double the
NIH budget. If the Government falters on the commitment, at a
time of great excitement and optimism amongst cancer
researchers, the momentum will be lost. It is also essential to
fund NCI's bypass budget request, which is a comprehensive
national plan for cancer research.
There is hope in the near future for effective treatment
alternatives, and promising laboratory research awaits clinical
studies, such as those underway at the NCI. No single treatment
will effectively control cancer. Combinations of different
treatments will be necessary. Costly clinical studies of
treatment combinations must be started.
Elisa did not die because she had incurable cancer. My
daughter died because we did not know how to control it.
A week before she died, she said her goodbyes. She made one
request to each member of her family. She requested that my
son, Jordan, name his first-born child after her. She requested
that my wife, Anita, visit her grave every day, for the first
year.
To me, she asked that I ensure that her death would not be
in vain; that something positive would result from it. It is
for this reason that I come before you today. Please do not
allow Elisa's legacy to die.
Thank you.
[The information follows:]
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Mr. Regula. We will try. Thank you for coming.
Our next witness will be Michaelle Wormley, Executive
Director of Women Opting for More Affordable Housing Now, Inc.
----------
Wednesday, March 21, 2001.
WOMEN OPTING FOR MORE AFFORDABLE HOUSING NOW, INC.
WITNESSES
MICHAELLE WORMLEY, EXECUTIVE DIRECTOR OF WOMEN OPTING FOR MORE
AFFORDABLE HOUSING NOW, INC.
JOANNE KANE, EXECUTIVE DIRECTOR OF THE MCAULEY INSTITUTE
Ms. Wormley. Good afternoon, Mr. Chairman and members of
the subcommittee. You have my written statement. I will just
provide you with some of the highlights.
I am Michaelle Wormley, the Executive Director of Women
Opting for More Affordable Housing Now, WOMAN, Incorporated. We
are a Southeast Texas non-profit organization, that creates
affordable, livable transitional housing, and supportive
services for women living in abusive relationships. We are
asking for at least $25 million for fiscal year 2002, for a
housing assistance program authorized under the Violence
Against Women Act last year.
WOMAN, Inc. grew out of a networking group of nine battered
women's shelters and service providers in a 13 county area,
including Houston, Dallas, and Beaumont, Texas. Our long-term
goal, since we were founded in 1993, has been developing
transitional housing facilities at each of the nine locations
represented in the consortium.
Each sponsor provides comprehensive social services and
property management, while WOMAN, Inc. may finance, own,
maintain, operate and sell the properties it develops in order
to provide the most cost-effective project that is affordable
to woman earning 50 percent or less of the medium income.
I am accompanied today by JoAnne Kane, Executive Director
of the McAuley Institute. McAuley was founded by the Sisters of
Mercy in 1983, and is the only national faith-based housing
organization that focuses its resources on low income women and
families.
McAuley has worked closely with WOMAN, Inc. since 1993,
providing both technical assistance and financial services.
Many of the women who participate in housing programs and
related services provided by the community-based groups like
WOMAN, Inc. are survivors of domestic violence.
As housing providers, the dilemma that we saw was that
families, having begun to stabilize their lives in a shelter
program had only one choice when seeking affordable housing;
that of returning to their batterers.
Our vision was to provide survivors more viable options for
restoring their lives. That vision was honored by the Fannie
Mae Foundation with the maximum Awards of Excellence in May of
1999, and recognition of our Destiny Village Project in
Pasadena, Texas. Destiny Village is a 30 unit apartment
complex, which provides supported housing to families leaving
domestic violence.
Over the past several years, McAuley, along with a
coalition of 200 groups representing domestic violence and
sexual assault survivors have strived to re-authorize the
Violence Against Women Act with the Housing Assistance Program.
With the October, 2000 Enactment of VAWA 2000, our goal was
partially realized. VAWA housing assistance would provide a
bridge, up to eighteen months, to help survivors secure a
stable, secure environment for themselves and their children.
The new law requires that the housing assistance must be
needed to prevent homelessness, and may be used for rent,
utilities, security deposits, or other costs of relocation.
Support services to enable survivors to obtain permanent
housing, and to aid their integration into a community,
including transportation, counseling, child care services, case
management, and employment counseling could be supported with
grant funds.
VAWA enjoyed strong bipartisan support, and the Congress
clearly intended to create and fund a viable housing assistance
program under VAWA.
We fully expect the program to be extended this year as
part of the Child Abuse Prevention and Treatment Act, for which
the current authorization is five years, and expires this year.
The need for this program is critical. According to the
U.S. Conference of Mayors 1999 survey of 26 cities, domestic
violence was listed as the fifth leading cause of homelessness.
The Texas Department of Human Services figures indicate
that for the fiscal ending 1998, 3,796 adults were denied
shelter, due to lack of space. A conservative estimate from
HUD's homeless office is that nine percent of all clients
serviced came directly from a domestic violence situation.
An informal poll of domestic service providers nationwide,
conducted over the last two months about a national coalition
against domestic violence, the number one funding need
identified by shelter based programs was for transitional
housing for battered women.
The importance of housing assistance to families fleeing
abusive situations cannot be overstated. Short-term housing aid
and targeted supportive services can help survivors bridge the
gap between financial and emotional dependency, and productive,
healthy, and life-sustaining environments for themselves and
their children. We ask that you provide $25 million for VAWA
housing assistance for the coming year.
JoAnne, did you want to speak?
Ms. Kane. The experience of WOMAN, Inc. is duplicated
across the country, both as a direct response to the woman
fleeing violence, and an example of successful programs,
created by local women leaders to deal with some of our
nation's most intractable problems.
These women leaders project a solely pathological
assessment, which looks at violence alone as the problem. They
craft multi-faceted programs that combine human development and
community development, family health andcommunity building
strategies.
The care-givers are often finding themselves in the same
situation as the women, knowing that housing is the one
solution, and yet finding that the opportunities for women
decline daily. There are 5.4 million worse case housing needs
in this country, and 60 percent are women.
So the appropriation is needed, a system and a practical
system is ready to respond, and their are women for whom the
opportunity is not just a home of their own, but an opportunity
to leave family violence behind forever.
Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
Do the habitat programs help?
Ms. Wormley. They are a critical response to the need.
However, again, in trying to assure stability for the mothers
and the children, transitional housing is very critical.
Mr. Regula. Thank you very much.
Our next witness is Jerold Goldberg, Dean, Case Western
Reserve, School of Dentistry. Welcome to the panel.
----------
Wednesday, March 21, 2001.
HEALTH PROFESSIONS AND NURSING EDUCATION COALITION [HPNEC]
WITNESS
JEROLD GOLDBERG, D.M.D., DEAN, CASE WESTERN RESERVE UNIVERSITY SCHOOL
OF DENTISTRY, TESTIFYING ON BEHALF OF THE HEALTH PROFESSIONS AND
NURSING EDUCATION COALITION [HPNEC]
Mr. Goldberg. Mr. Chairman, I am Jerry Goldberg, Dean of
the Case Western Reserve University School of Dentistry. I am
testifying today on behalf of the Health Professions and
Nursing Education Coalition [HPNEC].
This is an informal alliance of over 40 organizations,
dedicated to ensure that Title 7 and 8 programs continue to
help educate the Nation's health care personnel.
These programs improve the accessibility, quality, and
racial and ethnic diversity of the health care work force. In
addition to providing unique and essential training and
education opportunities, these programs help meet the health
care delivery needs of under-served areas in this country. At
times, they serve as the only source of health care in many
rural and disadvantaged communities.
Additionally, the graduates of Bureau of Health Profession-
funded programs are three to ten times more likely than average
graduates to participate in medically under-served communities.
These programs graduate two to five times more minority and
disadvantaged students.
As the Nation's health care delivery system rapidly changes
and makes dramatic changes, the Bureau of Health Professions
has identified the following five priorities, to ensure that
all providers are prepared to meet the challenges of the health
care in the 21st Century. They are: geriatrics, genetics,
diversity, and informatics.
HPNEC has determined that these programs require $550
million to educate and train the health care work force that
addresses these priorities.
As part of the two year effort to reach this goal, HPNEC
recommends at least $440 million dollars for Title 7 and 8 in
fiscal year 2002. These figures do not include funding for the
Childrens Hospital's Graduate Medical Education Program, and
are now separate from Title 7 and 8 funding.
The programs are organized in the following categories:
minority and disadvantaged health professions; primary care
medicine and dentistry; interdisciplinary, community-based
linkages; health professions work force information and
analysis; public health work force development; Nurse Education
Act; and student financial assistance.
A serious defect in our health care system is the lack of
dental care for low income populations and those in under-
served areas. With funding from Title 7, institutions are able
to provide oral health to these under-served populations.
Dentists who have benefitted from advanced training in
general dentistry and pediatric dentistry consistently refer
fewer patients to specialists, which is especially important in
rural and under-served urban areas, where logistics and
financial barriers can make specialized care unobtainable.
The Bureau of Health Professions in HRSA provides threeyear
grants to start expanded programs and to expand programs, after which
time, these programs must be self-sufficient. Eighty-seven percent of
the dentists who go through these programs remain in primary care
practice.
Members of HPNEC are concerned that the Administration has
severely cut or even eliminated portions of Title 7 and 8
funding. It states in the health profession section of the
budget blueprint that ``Today a physician shortage no longer
exists. Moreover, the Federal role is questionable in this
area, given that these professions are well paid, and that
market forces are much more likely to influence and determine
supply.''
We contend that typical market forces do not eliminate work
force shortages in under-served areas, and that their effect on
skyrocketing costs of living has directly contributed to the
kind of health care professionals in these regions. HPNEC has
provided a letter to the President, outlining this position.
We appreciate the subcommittee's support in the past. We
look to you again to support these programs and their essential
role in the health care system. Thank you for accepting this
testimony.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for bringing this to our attention.
Our next witness is Dr. Frankie Roman, Medical Director,
Center for Sleep Disorders, at Doctors Hospital in Massillon,
Ohio. We are happy to welcome you, my next door neighbor,
almost.
Dr. Roman. For a second, Mr. Chairman, I thought you were
avoiding your neighbor. [Laughter.]
----------
Wednesday, March 21, 2001.
NATIONAL SLEEP FOUNDATION
WITNESS
FRANKIE ROMAN, M.D., MEDICAL DIRECTOR, CENTER FOR SLEEP DISORDERS,
NATIONAL SLEEP FOUNDATION
Dr. Roman. Good afternoon, Mr. Chairman and Congressional
staff members. Thank you for inviting me to present testimony
this morning, or this afternoon, on behalf of the National
Sleep Foundation.
We have submitted written testimony to the official record,
and I would like to use my time to address some of the major
points regarding how sleep disorders, sleep deprivation, and
fatigue impact the Nation's health and safety.
As the Chairman mentioned, I am based in Massillon, Ohio. I
drive through Navarro, Ohio, his home town every day. I just
want to make my Ohio connection clear.
The National Sleep Foundation is an independent non-profit
organization that works with thousands of sleep experts,
patients, and drowsy driving victims throughout the country, to
prevent health and safety problems, related to fatigue and
untreated sleep disorders.
The Foundation's interest today in the subcommittee's work
is based on the National Sleep Foundation's relationship with
the Center for Disease Control and Prevention, and specifically
with the National Center for Injury Prevention and Control.
The NSF today is asking the subcommittee to consider
providing an additional $1.5 million to the center's fiscal
year 2002 funding, to address sleep deprivation and fatigue-
related injuries.
Sleep represents a third of every person's life, and has a
tremendous impact on how we function, perform, and think during
the other two-thirds. Unfortunately, that is the first thing we
sacrifice. We give up sleep to attend all these Congressional
hearings and Congressional fund raisers later on in the
evening.
Too many of us forget that lack of adequate, restful
slumber has serious consequences at home, in the work place, at
school, and on the highway. Members of Congress are not immune
to this. If you recall, Mr. Chairman, I did an informal survey
a few years ago, with the help of your office. We found that
seven percent of the Congressional members fall asleep during
these Congressional hearings.
Mr. Regula. Maybe it has got something to do with the
witnesses.
Dr. Roman. Well, hopefully it does not.
The numbers were worse for the Congressional staff members,
so I am not even going to mention that, just for them.
It just shows that the ill effects of sleep deprivation are
suffered by all, including members of Congress. This is
something that touches each and every person in this country.
Tragically, drowsy driving claims more than 1,500 lives,
and accounts for at least 100,000 crashes in the UnitedStates,
every year. The sad thing is that these incidents are preventable. Just
this past week, Mr. Chairman, I saw a school bus driver from our
community, who fell asleep at the wheel, and the kids are complaining
about how the bus is wagging.
I have seen many police officers, I have actually seen some
of your Congressional members, I have seen elected officials
from the school and the Government in our community; and so I
do not put a face or a name today before you. However, I ask
you, the next time you go to your community, look around and
you will see that this is an issue that affects each and every
one of us.
Many of the groups before you, too, would benefit from my
request today, or what the National Sleep Foundation is trying
to accomplish through the CDC.
Fatigue or sleep deprivation should be considered an
impairment like alcohol and drugs. New research shows that a
person who has been awake for 24 consecutive hours demonstrates
the same impairment in judgment and reaction time, as an adult
who is legally drunk. Today, it is unacceptable to drive or
work under the influence of drugs and alcohol. Fatigue should
fall under the same category.
The National Sleep Foundation has worked with volunteers
like myself for the next decade to raise awareness and minimize
fatigue-related injuries. While public awareness is desperately
needed, a strong Federal partner with the expertise and the
ability to disseminate, test, and improve education, training
and injury prevention programs to communities like ours in
Stark County, Ohio, is crucial to attacking these problems.
We feel that the CDC is our partner, and should help the
NSF and public health officials address these problems.
We have data telling us that lack of sleep affects the
Nation on many different levels, from the airline pilot, and I
have several pilots of that nature, to the child in the
classroom, I receive many with a court order coming to see me;
and from the Amish. Surprisingly, even though they have a
simple life style, they are identifying sleep disorders as a
problem in their day-to-day lives.
This research is absolutely no good if we cannot translate
it into education and injury prevention programs for the
general public. Public education, physician and police
training, school-based programs and work place prevention
programs are all desperately needed.
We believe that the CDC can and should play a vital role,
working with the sleep community to address these problems by
developing a sleep awareness plan that would set national
priorities around sleep issues and public health and safety.
This proposed sleep awareness program would allow the CDC and
other Federal agencies to develop and distribute accurate
medically sound information in programs to local communities.
This information, coupled with training for those involved
with public health and safety at the state level, will begin to
turn the tide of injuries, health problems, and costs
associated with sleepiness and sleep disorders, which I see on
a daily basis.
I thank you, Mr. Chairman, for your time. Again, we wish
that the subcommittee would consider increasing the overall
budget for the center by $1.5 million, to allow the center to
act as a coordinating body for the development and
implementation of this five year sleep awareness plan.
Thank you for your consideration in this request. I would
be glad to answer any questions that you may have.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. It seems to me that you are talking about two
different things, disorders and deprivation. Deprivation is
lifestyle.
Dr. Roman. Yes, but we consider it a disorder, also,
because many of the sleep disorders cause sleep deprivation.
Only through education and awareness will people realize that
it is just not lifestyle, and that there are other things going
on.
Mr. Regula. Do you try to treat physical causes, or just
try to treat the habits of people; that they just do not get
enough sleep, they do not go to bed on time, and so on.
Dr. Roman. We do both, Mr. Chairman.
Mr. Regula. Are there certain physical causes that people
do not sleep well, and is that something you treat?
Dr. Roman. Yes, the most common one that we see is sleep
apnea. That is people who snore and stop breathing in their
sleep. Most of their manifestation is, I do not get enough
sleep, or I feel tried when I wake up. These are people who
fall asleep in different social situations, including driving
or at work, or even on the toilet seat.
Mr. Regula. Well, I suppose our societal lifestyle has
something to do with it, the demands are so great.
Dr. Roman. Unfortunately, the first thing that we all
sacrifice is sleep, to get in all the activities, social,
professional, and personal, that we would like. What we
aretrying to educate the public is, this is a major mistake.
Mr. Regula. Is there any magic number? I see different
numbers. You should have six hours, seven hours, eight hours.
Would that not depend a little bit on the physiology on the
individual?
Dr. Roman. Yes, the average is around eight hours. But
there are some people who require less sleep, and some that
require more. You cannot train yourself to sleep less. That is
a myth; where you can say, I can get by with only four hours.
What we do as a society, most Americans, we are chronically
sleep deprived, and on the weekends, we make up, we sleep in;
which, unfortunately, makes us start off the next week in a
bind.
For example, next week, which is National Sleep Awareness
Week, and our clock shifts forward, there is a seven percent
increase in accidents that Monday. It does not matter if you
spring forward or fall back with our clock, but there is a
seven percent increase. So I strongly recommend that no one
drive next Monday.
Mr. Regula. You should stay home from work; is that it?
[Laughter.]
Well, you apparently have got an ally in our President. He
seems to have good habits about going to bed early, and that
will be helpful.
Dr. Roman. He also takes naps, which we strongly recommend.
Unfortunately, it is very un-American to take naps.
Mr. Regula. I thinking about one, myself, if I can get
through this list. [Laughter.]
Dr. Roman. I thank you for your time, Mr. Chairman. I am
available in our community, as I am your neighbor. I will
always be available to you. Thank you very much.
Mr. Regula. Well, thank you for coming.
Next is Deborah Neale, a member of the Ohio Chapter
Executive Committee of the Ohio State Public Affairs Committee.
----------
Wednesday, March 21, 2001.
OHIO CHAPTER EXECUTIVE COMMITTEE OF THE OHIO STATE PUBLIC AFFAIRS
COMMITTEE
WITNESS
DEBORAH NEAL, MEMBER, OHIO CHAPTER EXECUTIVE COMMITTEE OF THE OHIO
STATE PUBLIC AFFAIRS COMMITTEE
Ms. Neal. Thank you, Mr. Chairman.
Good afternoon, I am Debbie Neal, a long time volunteer of
the March of Dimes. I also bring you greetings from our former
State Senator Grace Drake, who has just agreed to be on our
committee in Cleveland, Ohio.
As you know, the March of Dimes is a national voluntary
health agency, founded in 1938 by President Roosevelt, to find
a cure for polio. Today, the three million foundation
volunteers and 1,600 staff members in every state, the District
of Columbia, and Puerto Rico, work to improve the health of
infants and children, by preventing birth defects and infant
mortality.
I am here today seeking the prioritization of funds to
improve and health and well being of mothers, infants, and
children, through research, prevention of birth defects, and
developmental disabilities, and improved access to care. I am
not here to lobby for funds for the March of Dimes, as less
than one percent of the Foundation's funding comes from Federal
sources.
The Foundation supports continuing the five year effort to
double the funding. We are especially interested in three
issues within the National Institutes of Health.
First, the National Institute for Child Health and Human
Development should have the resources to expand research on
birth defects and developmental biology, allowing for testing
of new treatments for autism, and further research on Fragile
X, which is the most common inherited cause of mental
retardation.
Secondly, we recommend increased funding for the National
Human Genome Research Institute, to allow scientists to develop
the next generation of research tools, and thereby accelerate
an understanding of genomics.
Third, other activities at NIH strongly supported by the
Foundation include work being done by the National Center on
Minority Health and Disparities; advancement of treatment
options for sickle cell disease; and extra-mural research
through the Pediatric Research Initiative.
As you know, Mr. Chairman, last year, the Children's Health
Act of 2000 created a new center on birth defects and
developmental disabilities at CDC, bringing the number of
centers that make up the CEC to seven. Support in Congress for
this new center is indicative of the importance that members
place on research and prevention activities related to birth
defects.
The new center begins operations in mid-April, April 15th,
and we encourage the subcommittee to commit the resources
needed to ensure a successful launch.
Currently, three-quarters of the states monitor the
incidents of birth defects. However, the systems vary
considerably. CDC is working with states to standardize
datacollection through 26 cooperative agreements, lasting three years
each. However, funds are not adequate to support all the states seeking
assistance, including our own state of Ohio.
The March of Dimes recommends adding $2 million to CDC's
state-based birth defects surveillance program. This CDC also
supports eight regional birth defects research and prevention
centers, where groundbreaking work on spina bifida, heart
defects, Downs Syndrome, and other serious, life-threatening
conditions present at birth are underway.
Increased funding would allow additional data collection to
study genetic and environmental causes of birth defects. The
March of Dimes recommends adding $8 million to the budget for
these eight centers.
Developmental disabilities, monitoring and research are
also important, and the Foundation supports CDC's plan to
create five regional research centers to study developmental
disabilities, such as autism, cerebral palsy, mental
retardation, and hearing and vision deficits. The funding
needed is $5 million.
The new Center on Birth Defects and Developmental
Disabilities will administer the folic acid education campaign
and newborn screening program. The current folic acid education
campaign has been inadequate, and should be funded at a greater
level of $5 million for 2002, with an estimate by 2006. This
life-saving intervention is needed to reduce the number of
babies born with neural tube defects.
Newborn screening for metabolic diseases and functional
disorders such as PKU, sickle cell disease, and hearing
impairment is a great advance in preventative medicine. To
support newborn screening, the foundation recommends an
increase, so that CDC can provide states the technical
assistance needed to ensure that babies who test positive for
these conditions receive appropriate care.
Finally, we would like to focus your attention on two
programs, administered by the Health Resources and Services
Administration, that improve access to health care for mothers
and children.
The Maternal and Child Health Block Grant compliments
Medicaid and the Children's Health Insurance Program. It is no
wonder we call it CHIP. That is easier to say. This program
targets service to under-served populations. The foundation
recommends funding at the authorized level of $850 million.
Secondly, community health centers are an essential source
of obstetric and pediatric care, and the foundation supports
$175 million in new funds, to increase both the number of
centers, and improve the scope of services offered.
Thank you for allowing me to testify today.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Was it the March of Dimes started to eradicate
polio?
Ms. Neal. It was.
Mr. Regula. So you heard the success story of that?
Ms. Neal. It is. In fact, our friend, Pat Sweeney, has
always said, it should change its name from the March of Dimes
to the March of Quarters, because of inflation. [Laughter.]
Mr. Regula. Right, but it was a tremendous success story.
Ms. Neal. Well, it is fascinating to listen to the doctor
talk about eradication worldwide. I mean, it is in our
lifetimes that this has happened.
Mr. Regula. I believe he said that they vaccinated 107,000,
I believe.
Ms. Neal. Yes, at one time.
Mr. Regula. No, that was million, 170 million.
That is great progress to make those achievements. We hope
we can have the same success with birth defects.
Ms. Neal. One of the reasons that I have chosen to be a
volunteer with March of Dimes for so many years is because they
do accomplish a lot of real concrete success stories.
Mr. Regula. Well, thank you for coming.
Ms. Neal. Thank you.
Mr. Regula. Next is Dr. Amy Lee, Assistant Professor of
Community Medicine, from Northern Ohio.
----------
Wednesday, March 21, 2001.
FRIENDS OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION
WITNESS
AMY LEE, MD, MPH, MBA, FRIENDS OF THE HEALTH RESOURCES AND SERVICES
ADMINISTRATION
Dr. Lee. Actually, besides your wonderful support to my
academic institution, I have a brother who lives in Stark
County, and my real estate agent works with your son, David, at
Cutler GMA. That is my Ohio connection.
Mr. Regula. My goodness.
Dr. Lee. I am honored to be here today to testify on behalf
of the Friends of the Health Resources and Services
Administration or HRSA.
The Friends of HRSA is an advocacy coalition of 125
national organizations, and it represents millions of public
health and health care professionals, academicians such as
myself, and consumers.
HRSA programs assure that all Americans have access to
basic health care services. In Ohio, in fact, three fourths of
our public health funding comes from Federal sources, and HRSA
plays a major role in this support.
HRSA is a health safety net for nearly 43 million
Americans, who lack health insurance; 49 million Americans who
live in areas that have little access to primary health care
services; and also African American babies who are 2.4 times
more likely than their white counterparts to die before their
first birthday.
The Agency's overriding goal is to provide 100 percent
access to health care, with zero disparities. The Friends of
HRSA feel the Agency requires a funding level of at least $6.7
billion in order to achieve this goal.
HRSA funding goes where the needs exists. Although programs
are geared towards health care access, I would just like to
highlight two programs, and mention several others.
The first program is the new community access program. It
allows communities to build partnerships among health care
providers to deliver a broader range of health services to
uninsured and under-served residents. Cincinnati actually
received a CAP grant, and was one of the highest grant
applications.
This program coordinates some 50 organizations in this area
through strategies to improve care, including the
implementation of regional disease, management protocols for
asthma, depression, diabetes and hypertension.
The Friends are very concerned that the Administration's
budget blueprint recommends eliminating this program of
coordinated service delivery. This is an innovative program
that is not duplicated anywhere else.
The next program I would like to highlight is the health
professions programs, which assure adequate national work
force, despite projected nationwide shortages of nurses,
pharmacists, and other professionals. Actually, Dr. Goldberg
speak on behalf of this program, as well.
Graduates of these programs are three to ten times more
likely to practice in under-served areas. In addition, they are
two to five times more likely to be minorities. The Friends are
also concerned that cuts in these programs, which are proposed
in the Administration's budget blueprint will impact this
poorly.
These programs provide up-front incentives for dozens of
types of health professionals, not only physicians, but mental
health, dentists, and also public health professionals, as
well.
Market forces will continue to drive shortages and mal-
distribution in many of these sectors, potentially leaving
health centers under-staffed, without the support of health
professions programs.
Also, it is clear for the need for other HRSA programs, as
well. The Maternal and Child Health Block Grant provided funds
for the Cleveland Healthy Start Program, and they saw a 40
percent in infant mortality, as a result.
I really did not need to look any further than my local
newspaper, the Akron Beacon Journal, to find other sources of
need. On February 20th, the Akron Beacon Journal reported ``HIV
stalks careless men.'' It reported that HIV is increasing in
numbers in young people and heterosexuals.
HRSA, next to Medicaid, provides the largest source of
funding for AIDS programs, for low income and under-insured
Americans.
Over the weekend, actually, they ran a series of Ohioans
spreading out, and blacks flee to suburbia. This told of folks
who were going to suburban areas and rural areas to stay and to
live there. Of course, there will be more need for programs
such as the programs provided by HRSA to provide health care
services.
I would like to submit these three articles for the record,
as well.
Mr. Regula. Without objection.
[The referenced articles follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Dr. Lee. As you can see, HRSA programs are all about access
to health care for Americans. We are really, because if we have
a toothache or if we get sick, we know where to go, and we will
get taken care of. For millions of these Americans, it is not
that easy.
I would like to close with a story from a HRSA-funded
vision specialty clinic; actually from your district in Wayne
County in Wooster. On one occasion, a four year old boy was
taken in by one of the Head Start Clinic staff, because they
thought he might have problems seeing. They found, on exam,
that he was functionally blind.
Because of the actions of the crack staff, this boy had
glasses in three days. After he put the glasses on, the doctors
said, he passed the smile test, because when they put the
glasses on, the boy had a huge grin. For the next few days, the
days said that he just looked at things and people that he had
never really seen before, because he had these glasses, and due
to the services of this HRSA specialty care clinic.
I do not think it is by accident that we have heard a
number of public witnesses here that have spoken on behalf of
HRSA programs, because HRSA offers that link between the
services and the people that need it the most.
Thank you for this opportunity for me to speak on behalf of
the Friends of HRSA. I welcome any questions.
Mr. Regula. Well, do you, in your role as Professor of
Community Medicine, work with the physicians in training there?
Dr. Lee. I work with a few. Actually, I am mostly an
Administrator. I direct the master public health program, which
is a partnership program of five public institutions there.
I am also involved in public health activities through the
Ohio Public Health Association. I am President this year, as
well. I am a little involved in the medical student training.
Mr. Regula. But the public health programs would be
delivered by physicians and/or nurses, I assume?
Dr. Lee. Actually, the master public health program, it
could be physicians, but also nurses, health care
administrators, for them to better provide health care services
to communities, as opposed to individuals.
Mr. Regula. I assume the community health centers would be
something where you would have a direct involvement.
Dr. Lee. Actually, I sat on the board for the one in Akron,
and because of a lot of other responsibilities, I had to give
that up. But I was very much involved in that community health
center for awhile.
Mr. Regula. Are you using the new center up there, that you
bring in people for lectures?
Dr. Lee. Oh, that center has not been built, yet.
Mr. Regula. You have not got it built?
Dr. Lee. No, no, the ground has not been broken, yet.
Mr. Regula. Oh, my.
Dr. Lee. They are still making the plans.
Mr. Regula. Well, at least you have the money.
Dr. Lee. Yes, yes, thanks to you. [Laughter.]
Mr. Regula. Okay, thank you for coming.
Thank you for coming. Our witness is doctor James Pearsol.
----------
Wednesday, March 21, 2001.
CENTER FOR DISEASE CONTROL AND PREVENTION (CDC) COALITION
WITNESS
JAMES A. PEARSOL, BA, MED, CHIEF, OFFICE OF POLICY AND LEADERSHIP, OHIO
DEPARTMENT OF HEALTH
Mr. Pearsol. Good afternoon, Mr. Chairman and Members of
the Subcommittee. You may be a Cleveland Indians fan. If you
are, then maybe you know Jimmy Person, who has quite a baseball
player and quite a character. I am not a baseball player, but I
probably qualify as a character.
I am honored to be here today to testify on behalf of the
CDC Coalition. The CDC Coalition is a nonpartisan association
with more than 100 hundred groups committed to strengthening
the Nation's prevention programs. Coalition members groups
represent millions of public health workers, researchers,
educators, and citizens served by CDC Coalition programs.
I would like to welcome the Chairman into his new position.
In addition, overseeing the funding for Public Health Service
and to thank you for the work that you will do in the
forthcoming year on this difficult bill. The CDC Coalition is
the Nation's prevention agency that is putting health research
into practice.
Public health prevention is about two things. The what of
health prevention is preventing adverse health outcomes and the
how are the tools of the trades including programs,
surveillance, and best practices. Prevention translates into
lives saved and pain and suffering avoided, health costs
avoided, quality of life improved, use of best health
practices, and use of credible health information.
In the best professional judgement of the CDC Coalition,
CDC will require funding of a least $5 billion to adequately
fulfill its mission for fiscal year 2002.
Mr. Regula. Do you work directly with CDC?
Mr. Pearsol. Yes. We receive, again, probably $40 million
of our budget, part of the three-fourths of Federal funding at
the Ohio Department of Health, and pass that on in large
measure to local health and community departments.
Mr. Regula. The funding is channeled through CDC.
Mr. Pearsol. Correct.
Mr. Regula. The Federal portion.
Mr. Pearsol. That is correct.
Mr. Regula. You in turn work with local public health
agencies in the communities around Ohio.
Mr. Pearsol. That is correct.
Mr. Regula. The State County Board of Health would be
working directly with to you.
Mr. Pearsol. I work directly for them, Bill Franks and his
Board, the city, Bob Patteson, and Mayor Watkins.
Mr. Regula. Go ahead.
Mr. Pearsol. Thank you. Health prevention is like auto
maintenance. It is not appreciated until it fails. It is not
much fun when it fails. In any maintenance of prevention
ignored is guaranteed to lead to failure. CDC makes Public
Works in Ohio, and I will give you some examples. Chronic
diseases are Ohio's quiet killer. Five diseases account for 70
percent of Ohio's deaths. In fact, heart disease, 91 deaths
each day, cancer, 68 deaths each day, stroke, 18 deaths each
day, lung disease, 15 deaths each day, and diabetes, nine
deaths each day.
The CDC Center for Chronic Disease Prevention and Health
Promotion supports programs that combat this chronic set of
diseases. The impact on the elderly is profound and about 80
percent of seniors have at least one chronic condition and 50
percent have two or more. We know that breast and cervical
cancer, prostate, lung, and colon rectal cancers can be avoided
through early detection.
The CDC supports programs like these and other chronic
illness such as diabetes. Nearly 16 million Americans have
diabetes and the largest increases are among adults 30 to 39 in
age. CDC supports state and territorial diabetes control
programs that attack this problem.
Health disparities persist in all of these disease that I
talk about in Ohio. This CDC's REACH program that is racial and
ethnic approaches to community health address serious
disparities and infant mortality, breast and cervical cancer,
HIV and AIDS, etc. In Ohio, infant mortality rates for African
American are twice those of whites.
One of Ohio's Public Health Service success stories is
childhood immunizations. In 1994, only about half of our two
year old had been immunized by 2001 and 78 percent had been
immunized, which is a 55 percent increase. This was possible
through the availability of low cost vaccine from CDC. Injuries
and their prevention is crucial.
Each day an average of 9,000 U.S. workers sustained
disabling injuries, 17 died from work related injuries, and 137
died from work related illnesses. Finally, the preventive help
block grant is the key to flexible funding at the local level
were local program can match solutions to demand in the local
community.
The how of CDC is cease surveillance. This is a lot like an
air traffic control system. It is the disease tracking control
system. It is a basic monitoring system that detects early
warning signs. The National Electronic Disease surveillance
system created Ohio's early warning system for disease
outbreaks. The Epidemic Intelligence Service Officer Corps has
supported many outbreak investigations in Ohio and including TB
outbreak in Columbus, Typhoid outbreak in Cincinnati, Listeria
in northwest Ohio; part of a National outbreak,
Cryptosporidiosis in a Delaware county swimming pool, and E.
coli in Medina county fair grounds water system.
In terms of capacities and skills, the CDC Coalition
supports full funding for the provisions authorized in the
Pubic Health threat emergency act sponsored by representative
Burns Stewpack. This concluded my prepared remarks. I would be
happy to answer any questions.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you work any with the schools as part of an
education program for preventive medicine?
Mr. Pearsol. Yes. We work directly school program with
nursing staff and the Public Health teachers. In order to get
the message to the community.
Mr. Regula. There are a lot of gains that could be made in
preventive medicine to achieve good health, that is to develop
programs of preventive medicine to alert people.
Mr. Pearsol. Yes, that is right. We believe this is the
key. Ohioans smoke more are more obese, exercise less, and eat
fewer fruits and vegetables. Those are behaviors that can
change the kinds of chronic diseases that I am mentioned that
kill Ohioans and others in Americans in this country.
Mr. Regula. Is it an education process?
Mr. Pearsol. Yes, education is part of the process. It is
changing the behaviors and repeating the message.
Mr. Regula. Thank you.
Mr. Pearsol. Thank you, Mr. Chairman.
Mr. Regula. Our next witness is Gerald Slavet.
Ms. Hurley-Wales. It is Slavet.
Mr. Regula. I am intrigued by ``From the Top.'' Is that
Ringling Brothers?
Mr. Hurley-Wales. No, it is a radio program.
Mr. Regula. Oh, where is it?
Mr. Hurley-Wales. Actually, in your area, it is on WCLV in
Cleveland.
Mr. Regula. What kind of a program is it?
Mr. Hurley-Wales. Well, I am happy to answer that.
Mr. Regula. I guess you are going to tell us.
Mr. Hurley-Wales. Right, I will tell you all about it.
Mr. Regula. Okay.
----------
Wednesday, March 21, 2001.
GERALD SLAVET EDUCATION PERFORMANCES FOUNDATION
WITNESS
JENNIFER HURLEY-WALES, EXECUTIVE VICE PRESIDENT, GERALD SLAVET
EDUCATION PERFORMANCES FOUNDATION
Ms. Hurley-Wales. My name is Jennifer Hurley-Wales. I am
here to testify on behalf of Gerald Slavet of the Education
Performances Foundation. Gerald is out of the country today. We
were very appreciative to have this opportunity to appear
before you and the Subcommittee.
I am the Executive Vice President of our foundation and co-
founder of our flagship project ``From the Top.'' Since its
launch in 1998, ``From the Top'' radio program has brought into
the foreground the exceptional achievements of pre-collegiality
classical musicians. It helped build the self esteem of the
young participants, and provided role models for 100 to 1,000
young people across the United States.
The mission of ``From the Top'' is to celebrate and
encourage the development of youth through music. The project
is designed to demystify classical music making it more
accessible to young audiences and adults. ``From the Top''
believes that young people that can play Mozart's Clarinet
Concerto are just as cool as those who dunk basketballs.
We know those who play that kind of music are usually
strong students and that is why we celebrate young classical
musicians in the same way that their athletic schoolmates are--
as heroes.
Early involvement with classical music plays a key role in
the development of children's intellects, which is important
for the new economy that relies on math, science, and
analytical skills.
We believe that ``From the Top's'' is entertaining and
accessible and national radio program will lead to a public
conversation at the grass roots level. Perhaps this will help
influence public opinion and policy about the value of arts
education.
``From the Top's'' weekly radio series taped before a live
audience, features America's most exceptional 9- to 18-year-old
classical musicians and performance and interviews. Now
broadcast on 215 station nationwide, the show has a projected
listenership of 700,000 people each week.
A passionate listenership I should say as demonstrated by
the daily flood of positive e-mails we continue to receive.
Mr. Regula. Do you go nationwide?
Ms. Hurley-Wales. We are on 215 stations nationwide.
Mr. Regula. Produced in Cleveland?
Ms. Hurley-Wales. It was produced in Boston.
Mr. Regula. OK.
Ms. Hurley-Wales. ``From the Top'' is considered today the
most listened to classical music program on public radio.
Tapings take place before family audiences in Boston at New
England Conservatory's Jordan Hall and in halls across the
country including Carnegie Hall in New York and the Kennedy
Center in Washington. In fact, we will be here next week.
The extraordinary popularity and success of ``From the
Top'' radio series has led to the creation of three additional
components. ``From the Top'' television specials are in
development for production for PBS. They will feature host
Christopher O'Riley, performances and documentary style
profiles of five exceptional young musicians and ensembles.
``From the Top.org'' is the only site on the Internet that
provides a complete suite of services and community for young
people who are passionate about music. The site is an
interactive forum for kids, teachers, and parents to discuss,
present, and research all matters that relate to music.
``From the Top's'' newest initiative, Sound Waves education
project addresses the urgent need to bring cultural
missionaries into our communities through curricular materials
linked to the radio shows, teacher training workshops, and
cultural leadership training for young musicians.
This Sound Wave project builds on ``From the Top's''
greatest asset and the power of the young performer as a role
model for other kids. Thanks to the interest and leadership of
Congressman Joe Moakley, and the support of this Subcommittee,
our foundation has received funding from the U.S. Department of
Education in the past, including a $510,000 grant for this
fiscal year.
``From the Top'' would not be in existence without the U.S.
DOE funding. Please know that we are aware of the importance in
improving our funding and we mounted a comprehensive
development effort to that effect. We appreciate the support of
this Subcommittee and we now respectfully request that you
extend your commitment to young people and the arts by
providing a $1.25 million grant to Education Performances
Foundation to continue support for this innovative program.
This grant would allow us to further develop and implement
our cultural leadership training and expand the reach of
educational efforts through school, community, and Internet-
based programs. Your continued support would allow the
overwhelmingly positive impact of ``From the Top'' to continue
and multiply for the greater mission of our project to be
reached. Thank you.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. I thought that I left the arts when
I left Interior. The next witness is Joseph E. Pizzorno,
President Emeritus of Bastyr University in Seattle, Washington.
----------
Wednesday, March 21, 2001.
BASTYR UNIVERSITY
WITNESS
JOSEPH E. PIZZORNO, JR., PRESIDENT EMERITUS, BASTYR UNIVERSITY IN
SEATTLE, WASHINGTON
Mr. Regula. Do you know my friend Sled Gordon?
Mr. Pizzorno. Actually, I have talked to him several times.
Mr. Regula. We worked together on Interior matters.
Mr. Pizzorno. Great. You said Washington like a true
native. You must have spent some time with him.
Mr. Regula. We spent quite a bit of time together. He was
Chairman and I was Chairman of house, parks, and forests. We
also took care of the flagship in your part of the world. You
are in Seattle.
Mr. Pizzorno. Yes.
Mr. Regula. OK. We look forward from hearing from you.
Mr. Pizzorno. Thank you, Mr. Chairman. My name is Joseph
Pizzorno. I am a licensed naturopathic physician in the state
of Washington. I am also the founding President of Bastyr
University. The first fully credited institution of natural
medicine in the United States.
I am also a member of the Seattle County Board of Health.
The Chair of special interest groups on Alternative Medicine
for the American Public Health Association. I have also been
appointed to the White House Commission on Complementary and
Alternative Medicine Policy. This was created by Congress to
advise Congress on how to integrate natural medicine into the
health care system.
While I am very active in several of these organizations,
and have 25 years of leadership in natural medicine, education,
research, and health policy innovation, I am not here
representing any particular organization.
I am here because I believe that the most pervasive and
silently accepted crisis in America today is ill health of our
people. We have a health care system that is oriented towards
disease treatment and symptom relief, but does relative little
to actually restoring and promoting people's health.
Every decade, for the past 50 years, the incidence of
chronic and degenerative disease has increased in virtually
every age group in the past 50 years. The message that I am
presenting to you today is somewhat different from the message
you have heard earlier today.
Our current health care system is excellent in many ways,
such as acute conditions and emergency care, but it is not
particularly effective in restoring and promoting health.
Health promotion is the area in which natural medicine is most
effective.
My written testimony addresses several areas and defines:
What is Complementary in Alternative Medicine? How popular is
CAM? Why is it important in heath care? Who are the CAM
professionals? What state of the research in CAM? What are the
critical issues that determine if the full benefits of CAM will
be experienced by the American people. Finally, I present
specific recommendations to the Subcommittee.
What is CAM? It is something that is know by many names.
Natural medicine, alternative medicine, integrative medicine,
and complementary medicine. It seems that our government is now
calling it CAM. I will use CAM in my further address.
When many people think about CAM, they think about it as
simply substituting natural therapies for drugs and surgery.
That is not what natural medicine is about. It is about
philosophical approach to heath care fundamentally difference
from that of the conventional medicine.
It is about health promotion rather than disease treatment,
about correcting the underlying causes of ill health rather
than system relief. It is about improvement in function rather
than waiting for end stage pathology that requires heroic
intervention. It is about education, healthy lifestyles, self
care, and natural health products rather than dependence on
medical doctors.
It is about supporting the body's own healing processes
rather than turning to drugs to support or replace by systems.
It is about a powerful belief in the inherent ability of the
body to heal if just given a chance. These concepts of healing
change the way in which we think about and provide health care.
Why are these concepts important to health care? Americans
are experiencing unpresitant burden of ill health and disease
worsening disease trends, appallingly high incidence of
treatment side effects and out of control health care costs.
There are a lot of statistic in my written testimony.
Of the 191 countries that maintain health statistics, the
United States rant seventy second in health status according to
the World Heath Organization. According to Christopher Muray,
M.D., Director of WHO's Global Program on Evidence for Health
Policy.
Basically, you die earlier and spend more time disabled if
you are an American rather than a member of most advanced
countries. One of the key differences between health care in
the United States and most of the rest of the world, especially
those ranking higher in health statistics, is significantly
higher healthier life styles and in several countries such as
number two ranked Australia, and much greater use of CAM in
natural health care products.
In fact, in both European countries, ranking above the
United States in health care statistics, the lead prescription
drugs are herbal medicines and not synthetic chemicals. CAM is
most effective precisely in those area weakest in conventional
medicine.
How popular is CAM? 42 percent of Americans now seek the
services of natural medicine practitioners. There were 629
million visits in natural medicine practitioners in 1997, which
was more than primary medical doctors for primary care.
What can I recommend to this committee? Currently, the
primary mechanism for Federal funding in CAM research is
through the NIH National Center for CAM research. It receives
less than one percent of the NIH total budget and that is
inadequate to meet the need of the mission.
The state of CAM research is widely misunderstood. It is
easily dismissed as having no evidence. In fact, there is
tremendous amount of evidence supporting the natural medicine.
The textbook of natural medicine 10,000 citations of peer
review scientific literature documenting the authenticity of
these kinds of interventions.
I would like to leave you with one recommendation. We have
experience tremendous benefits in our country form having
invest a lot of resources in conventional medicine research. We
have invested less than one half of one percent in research
into natural medicine. I believe that we can experience the
same kind of benefits if we engage in more natural medicine and
reap the benefits of the centuries long traditions of healing.
Thank you.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Peterson must be delayed
arriving. I take one more and hopefully he will get here. Mr.
Akhter. I have a meeting with the Secretary of Education. If
you can cut it short, that would be helpful.
----------
Wednesday, March 21, 2001.
AMERICAN PUBLIC HEALTH ASSOCIATION
WITNESS
MOHAMMAD AKHTER, EXECUTIVE DIRECTOR, AMERICAN PUBLIC HEALTH ASSOCIATION
Mr. Akhter. Thank you, Mr. Chairman. My name is Mohammad
Akhter. I am the Executive Director of the American Public
Health Association. We have 55,000 members and they are primary
concerned with the health of the American people. I am not here
to testify and support particular agency, particular program or
special group of people, but just the American people.
Mr. Regula. You have heard the testimony. Will your
testimony be similar to what we have heard.
Mr Akhter. No. It is very specific. Let me point out to you
three or four areas we think the major emphasis should be
really help the American people be healthy and happier for the
future.
First, there are health disparities among our Americans. We
have made tremendous progress in life expectancy, immunization,
and other arenas. I have been health commissioner in
Washington, DC. I have been state health director for the state
of Missouri. We have done wonderful work. However, some of
minority do not enjoy the same health status.
The number of minorities is increasing. By 2050, there will
be 50 percent of all people of racial ethnic descent. We cannot
have a strong Nation if some of our people our suffering this
disproportionately from heart disease and cancer. For example,
the infant mortality rate is twice as high for the African
American than it is for the average American.
Similarly, the death rate from the diabetes is twice as
high for Hispanics as it is for rest of the country. Last year,
Congress passed a bill and created a center in the NIH for
minority health. Mr. Chairman, we respectfully request that the
center be fully funded so it can get its work going. In
addition, we are asking that you fund the agency for health
care research and quality so that research can be taken to the
people at large to be able to help people.
Secondly, Mr. Chairman, these were the issues that are very
near and dear to most Americans. The second most important
problem among our communities is the substance abuse problem.
Many of the social and public health problems have root cause
is the substance abuse.
President has put some additional money in the budget for
substance abuse treatment. We hope that the Subcommittee will
look at this carefully. We will push that forward.
The third area is our seniors. 80 percent of them have one
chronic condition and 50 percent have two or more. They become
utterly disabled and have to go to nursing home or need more
medical care. HCFA has started a new program were they have
combined the company assessment with health promotion disease
prevention and treatment. We can keep people healthier in their
own homes. Not only improve theirquality of life, but also save
some money.
Finally, Mr. Chairman, last year, the Congress passes a
bill to deal with the bad terrorism to repair our Nation. The
responsibility for this was placed in the Center for Disease
Control in Atlanta. It is a problem today, as it was last year.
We need to fund that completely so that we can have our
communities prepared and our people protected.
Lastly, Mr. Chairman, like the economy, disease is also
become global. Now the hoof mouth disease. A disease can come
at any time. We have the best scientist in the world. We need
to make them available to other countries so that they can
contain the disease at a local level. The Office of
International Health, CDC, NIH where they have these experts,
that those programs be funded so that the programs can be
available to other countries so we do need to fight the
diseases once its inside of our borders.
Mr. Chairman, I appreciate very much the opportunity to
testify before you. I would be glad to answer any questions.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for your testimony. You are
absolutely right. Announce prevention. It is worth a pound of
cures, they always say. Thank you for being here.
Our next witness is Marianne Comegys. I appreciate the
patients of all of you. Somebody has to be last. Francine makes
out the list so do not hold me responsible. [Laughter.]
----------
Wednesday, March 21, 2001.
MEDICAL LIBRARY ASSOCIATION AND THE ASSOCIATION OF ACADEMIC HEALTH
SCIENCES LIBRARIES
WITNESS
MARIANNE COMEGYS, CHAIR, MLA GOVERNMENT RELATIONS COMMITTEE, MEDICAL
LIBRARY ASSOCIATION AND THE ASSOCIATION OF ACADEMIC HEALTH SCIENCES
LIBRARIES
Ms. Comegys. I am Marianne Comegys, Associate Professor at
Louisiana State University Health Science Library in
Shreveport, Louisiana.
I am pleased to testify on behalf of the Medical Library
Association and the Association of Academic Health Sciences
Libraries regarding fiscal year 2002 budget for the National
Library of Medicine.
MLA is a professional organization representing 1200
institutions and 4,000 individuals involved in the management
and dissemination of biomedical information.
AAHSI is compromised of the directors of libraries of 142
accredited U.S. and Canadian medical schools. The NLM is the
world's largest medical library with 5.8 million items through
National network of regional libraries. MLM ensures that health
professionals and the public have access to health prevention
and treatment.
Mr. Regula. OK. You have sold me. Where do you get your
funding? What does it come through.
Ms. Comegys. It comes through NIH. The NLM is one of the
agencies within NIH.
Mr. Regula. Your effort would be to get more funding for
NIH.
Ms. Comegys. Right, through the NLM.
Mr. Regula. So that can give you more money.
Ms. Comegys. Specifically, to the NLM as well.
Mr. Regula. You would like that to be mentioned in the
report.
Ms. Comegys. Right.
Mr. Regula. I got the message. You will have to wrap up in
a minute or two.
Ms. Comegys. Okay, I will.
I will mention that recognizing the invaluable role that
NLM plays in our health care delivery system, NLM also joins
with ad hoc for medical research funding, and recommends a 16.5
percent increase for NLM in the NIH in fiscal year 2002.
Many of our programs today, that the other witnesses have
testified to, and one of the important issues that I will just
sort of mention and sort of just regard this today since you
are in a hurry, is that we provide, as the medical library
community, the information resources necessary for those.
Mr. Regula. Who uses your services, doctors?
Ms. Comegys. The public, the health care physicians, and
right now, there is a big push for consumer health.
Mr. Regula. Well, if I wanted to use your services as a
layman, where would I go?
Ms. Comegys. You can go now to the public libraries; you
can go to the medical libraries.
But what we are doing now and what the National Library of
Medicine has done is emphasize the consumer, and what wehave
provided for you, Mr. Chairman, is easy access to this information
through user-friendly databases.
Mr. Regula. Here comes my pinch hitters. Now you have go
lots of time. [Laughter.]
Mr. Peterson [assuming chair]. He said you had lots of
time, so take it.
Ms. Comegys. Well, okay, I will start over. Do I still have
that five minutes?
On behalf of the Medical Library Community, I thank the
subcommittee for the leadership in securing a 15 percent
increase for NLM in fiscal year 2001. With respect to the
library's budget for next year, I will address four issues:
NLM's basic services outreach and telemedicine activities,
PUBMED Central and the clinical trials database, and a need for
a new library building.
It is a tribute to NLML that the demand for its services
continues to steadily increase each year. There are more than
250 million Internet searches annually on the Medicine
database.
Mr. Chairman, NLM is a national treasure. I can tell you
that without NLM, our Nation's medical libraries would be
unable to provide the type of information services that our
Nation's health care providers, educators, researchers, and
patients have come to expect.
NLM's outreach programs are designed to educate medical
librarians, health care professionals and the public about NLM
services. The need for enhanced outreach activities has grown
in recent years, following the library's decision to provide
free access to its Medicine databases.
Mr. Chairman, we applaud the success of NLM's outreach
initiatives, and look forward to continuing our work with them
on these important programs. Telemedicine also continues to
hold great promise for dramatically increasing the delivery of
health care to under-served communities. NLM has sponsored over
50 telemedicine related projects in recent years.
Introduced in 2000, PUBMED Central is an on-line collection
of live science articles, which evolved from an electronic
publishing concept, initially proposed by former NIH director,
Dr. Harold Varmus. This new on-line resource will significantly
increase access to biomedical information, and we encourage the
subcommittee to continue to support its development.
I also want to comment on a new NLM service. It is the
clinical trials database. This service is free, and it logs
more than two million hits a month. It is an invaluable
resource, which lists 5,000 Federal and privately-funded trials
for serious or life-threatening diseases.
In order for NLM to continue its mission, a few facility is
urgently needed. Over the past two decades, the library has
assumed several new responsibilities, particularly in the areas
of biotechnology, high performance computing, and consumer
health. As a result, the library has had tremendous growth in
its basic functions.
An increase in the volume of biomedical information, as
well as library personnel, has resulted in a serious shortage
of library space. The medical library community is pleased that
Congress last year appropriated the necessary architectural and
engineering funds for facility expansion at NLM.
We encourage the subcommittee to continue to provide the
resources necessary to acquire a new facility, and to support
the library's information programs.
Thank you for the opportunity to present the view of the
medical library community.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Peterson. Who all has access to the library.
Ms. Comegys. To the databases of the libraries?
Mr. Peterson. Yes.
Ms. Comegys. Everyone, from the physician to the researcher
to the consumer; and one of the pushes that the National
Library of Medicine has had for the last few years, and it has
actually come the demand of the consumer, is that they know
more about themselves and their health, and where to find this
type of information.
So Medline, which is a database of references and articles,
now is free, on the web. It is easily accessible amd the user-
friendly version is called Medline-Plus.
Mr. Peterson. Medline-Plus.com?
Ms. Comegys. Well, Medline-Plus is actually through NIH
NLM, and then I think Medline-Plus is a database that lists 450
different health topics.
Within that database, there is also dictionaries. There are
consumer health links to other information on specific
diseases. There is drug information. There is information on
physicians within each territory. There is also, as I
mentioned, the clinical trials database, and that is also quite
accessible for anyone.
So you, as a patient, or you, as a family member of someone
who has a serious or life threatening disease, could go in,
look on the clinical trials database, which is on theweb, which
is free, and see which clinical trials are available right now, which
are those that will be available.
Then you, as an informed patient now, or informed family
member, can go to your physician and say, you know, this is
something that I think I would be interested in and want to
participate in. It gives you all of the criteria listed, as
well.
So one of the pushes for NLM is the consumer and the
consumer health, along with the human genome project which, of
course, is for the researcher, and it is that enormous DNA data
sequencing information, of course, which all the researchers in
the U.S. and worldwide are so excited about. So we are from the
researcher, as well as to the consumer.
Mr. Peterson. If I was to inform my constituents on how
they could utilize this, what should I tell them?
Ms. Comegys. You can actually tell them, in Pennsylvania,
they can go to their public libraries and have access to it.
You can actually tell them to look on the Internet, just to
search at home under National Library of Medicine. Within that
website, it gives you all of the databases that I have
described, plus others that they can have access to, free of
charge.
I can get you the website information. That is something
that more and more people utilize, the Med-line databases. As I
mentioned in my report, I think it mentioned so many million
hits. Thirty percent of that is actually from the public, and
that is probably increasing every day.
Mr. Peterson. The rest is doctors, hospitals.
Ms. Comegys. Researchers, health care professionals, and
medical students.
Mr. Peterson. If you could give us a short paper on that.
Ms. Comegys. I will do that.
Mr. Peterson. We may bog down the system.
Ms. Comegys. Well, that is great. Do you know, the National
Library of Medicine has sort of looked at those statistics, and
they have never been down. They have continued to keep the web
site.
That is good, because they were actually surprised at the
increase that has come about from that database. That is why
they have gone to more and more of the consumer-based database.
We, in the medical library community, work with the
National Library of Medicine, through regional medical
libraries. We go out, through grants from NLM, and train the
public librarians on how to search for this information. We
train the health care professionals on how to search it. We
have grants to train the public health professionals on how to
search, and how to help the patient, so that it is not just the
patient out there, trying to search it with not as much
knowledge as maybe they needed. But actually, it is quite user
friendly. You could get on there today, and find out all sorts
of information.
Mr. Peterson. I shall do that.
Ms. Comegys. The other thing is that I want to mention
that, it is an accurate up to date databases. One of the
concerns is that I think is with all the medical literature out
there on the web. How accurate, reliable or up to date is the
information. When you come to our databases, that is what you
are getting is good information.
Mr. Peterson. I wonder if real physicians use that often.
Ms. Comegys. Yes, that is one of the other projects within
the outreach projects with the NLM. Many of the grants are
given to the regional medical library groups. There are eight
regional library groups and through those groups, the grants
are distributed to the local areas. The push for the rural and
the medically undeserved areas.
Telemedicine also comes in now to also help within those
areas. Those in those areas that are medically undeserved have
no less health information than those in the large cities. This
is real important to us as well.
Mr. Peterson. How does your telemedicine project work?
Ms. Comegys. They all work quite differently. You can have
telemedicine where it is the consultation from a small town
physician who is sending visual images. We can do this now
because of the technology. The high bandwidth and the wheel
time video imaging that is available to us now.
Small town physician can actually send these visuals images
to the specialist in the larger city. The specialist in the
large city can work on diagnosis and treatment. The patient
would not have to travel to that large facility and that city.
On a personal level right now in Louisiana at the Louisiana
State University, we have a telemedicine program that we are
working with the prisoners at a correctional institution in
Louisiana.
Our physicians at LSU are looking at information at the
prison for those physicians there and then we are diagnosing
and sending treatment information back to them so that they do
not have to transport those prisoners to Shreveport or any
other major facility.
It can be used whether is it consultations with the
physician and a patient. There is a lot of home health
telemedicine projects. You can use it for continuing education
with the physician and the student, who many of our students
are in rural areas in Louisiana. Louisiana has a lot of rural
areas. The patient themselves sort through some telemedicine
projects and having access to the electronic resources.
Mr. Peterson. Thank you very much.
Ms. Comegys. Thank you.
Thursday, March 22, 2001.
MEMBER OF CONGRESS
WITNESS
HON. LOUIS STOKES, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO
Mr. Regula. We'll get started. I see we have many
interested people again. I think it's great that you're here. A
lot of you are going to a lot of trouble to be here to testify
for your cause, and that's what this country's all about. I
know that it's time and money that you have to do, but you're
not only helping your cause, you're helping a lot of others who
are going to follow along. Really, it's a very generous thing
for each of you to come and bring to our attention the
importance of something that's close to your heart.
This Committee does have a lot of challenges, obviously.
This is our sixth day of public witnesses. We have the former
chairman of this Committee with us this morning, Mr. Lou Stokes
from Cleveland. How many years did you chair this, Lou?
Mr. Stokes. About as long as the committee, Mr. Chairman,
24 years.
Mr. Regula. Twenty-four years. I need you as a consultant.
I've been on it for about 24 days.
Mr. Stokes. You'll do fine, Mr. Chairman.
Mr. Regula. Lou's out practicing law in Cleveland, Ohio. He
did a lot of good things, not only here, but the other
committees, and we're happy that you're here today.
Just a few of the rules. We have the boxes here which are
timekeepers. I hate to do it, but we have to. We have about 28
today, and we've had 28 most every--this is the sixth day. I
think it's indicative of the great interest that the public has
in this Committee, is the fact that we've had so many, and then
on top of that, we had to have a lottery to decide who would
get to be even a public witness, because the requests are far
more than we can accommodate. But it's great that you bring
these things to our attention.
The boxes will be green and then it goes to amber, which
means you've got a minute to wrap up, and then the red light
goes on and the buzzer. So we regret it has to be that way, but
we'll do the best we can to get all the evidence in.
I see Nancy has arrived. Would you like to introduce your
former Chairman?
Mrs. Pelosi. It would be an honor.
Mr. Regula. Okay. I don't know whether to call you Chairman
or former Congressman or lawyer. You have a selection of
titles, Lou, but I like to call you best of all friend. That's
the one I like.
Mr. Stokes. And that's something that means a great deal to
me, Mr. Chairman, the friendship that you and I share, and the
friendship you shared also with my late brother, Carl, with
whom you served in Ohio.
Mr. Regula. That's right. Lou's brother Carl was the first
African American mayor of a major city in the United States, he
was mayor of Cleveland. I sat beside him in the State House of
Representatives, and we became very good friends. In fact, he
endorsed me. [Laughter.]
And he's a Democrat in Canton District. So see, Steny,
there's an opportunity for you. [Laughter.]
Mr. Hoyer. You never can tell.
Mr. Regula. I think, Nancy, you came close once. You were
out there, weren't you, at that meeting?
Mrs. Pelosi. Yes, Mr. Chairman, I remember it well. And so
do you. [Laughter.]
Mr. Regula. Okay, well, Mrs. Pelosi, will you introduce our
first witness this morning?
Mrs. Pelosi. Mr. Chairman, this is a very great honor, as I
know that any one of my colleagues would attest to. As you
indicated in your opening remarks, this is almost a family
affair for all of us, for Steny, for Jesse, because when Lou
comes to the Committee, he not only comes personally, but he
brings a great tradition with him.
You talked about Carl, and I have my connection, too, my
brother, Thomas D'Alessandro was a very close friend of Carl.
They were both mayors in that very difficult time in our
country's history, both young mayors. And they had a very, very
close personal bond.
I always used to say to Lou when I came here, I one day
would love to meet your mother, she has to be the greatest mom
in the world to have produced two great sons. Now the
courthouse is--is it this Saturday?
Mr. Stokes. It was this past Sunday.
Mrs. Pelosi. This past Sunday, it was dedicated in Ohio in
honor of her in her name. So with all of that personal and
political history, I'm pleased to welcome our former colleague,
Lou Stokes, behind whom and under whose leadership it was a
pleasure to serve here and in other committees in the Congress.
Congressman served in the Congress for 30 years, my friends,
for those younger people here who don't know, 30 years, 1969 to
1999. He spent many of those years as a member of this
Subcommittee.
He's currently senior counsel of the law firm Squire,
Saunders and Dempsey, and is a member of the faculty of Case
Western Reserve University, senior visiting scholar at the
Mandel School of Applied Social Sciences. Congressman Stokes is
also a member of the board of advisors for the Trust for
America's Health, which brings him here today. He will describe
what it is, so I won't take any time to do that.
But Congressman Stokes and the Trust for America's Health
have shown great leadership in the effort to improve our
Nation's response to environmental health hazards. As Iwelcome
him, I want to say that in welcoming Lou Stokes to this Committee, I am
welcoming the best that America has to offer.
Our chairman, Mr. Stokes.
Mr. Hoyer. Mr. Chairman?
Mr. Regula. Mr. Hoyer.
Mr. Hoyer. Thank you. I want to join Nancy's remarks.
Before you got here, Nancy, I indicated to our audience that I
had the great privilege and honor of sitting next to Lou for
many years as he served on this Committee. He and his brother
and family have been giants on behalf of so many different
issues.
But clearly, every young African American child in America
can have an extraordinary role model in Lou Stokes. As I sat
next to him, as you know, Mr. Chairman, you didn't serve on
this Committee, so you didn't have the privilege of seeing him,
but whether it's the historically black colleges dealing with
higher education, or it was in TRIO, or it was in primary and
secondary education programs, or whether it was dealing with
employees at NIH who were aspiring to be treated on the basis
of their character, their talent and their contribution rather
than the color of their skin, Lou Stokes has been and continues
to be a giant on behalf of all Americans.
I want to join Nancy in welcoming him to this Committee.
His leadership was a powerful, it was a quiet leadership, a
leadership of conscience and of character, not of bluster and
power, which made it even more powerful because of that. And
Lou, all of us who know you are honored to be your friend and
honored to have served with you. I join Nancy and Ralph and
Jesse in welcoming you to the Committee.
Mr. Regula. Mr. Jackson.
Mr. Jackson. Thank you, Mr. Chairman.
Let me just say that we run the danger this morning with
all of the accolades that we could bestow upon Mr. Stokes, of
the kind things that all of us who have had the opportunity to
work with him, who have witnessed him from afar, and those of
us who for the very brief tenures that we've been in the
institution have had the great opportunity and privilege of
working with Mr. Stokes, we run the danger this morning of our
accolades being much longer than your testimony. [Laughter.]
When I first came to this Committee, I came really as the
successor to Lou Stokes. Many of the programs that I champion
and argue for on this Committee were programs that Lou Stokes
one, authored as a member of this institution, shepherded the
legislation through the process, and then, on this Committee,
fought to make sure that those programs were fully funded.
The outstanding work that his family has done, his brother
as mayor of Cleveland, the Congressman himself here in the
United States institution, there are very few people who have
earned the respect of both sides of the aisle like Congressman
Lou Stokes.
I remember when he announced his retirement, and many of us
went to the Floor essentially to say goodbye to Mr. Stokes, the
outpouring from both sides of the aisle was nothing less than
astounding. I've seen other members of Congress who served the
same amount of time in the institution, and literally within 15
or 20 minutes, whatever accolades were being bestowed upon
them, essentially the special order was essentially over. We
could have spent the entire day, maybe even the entire week,
talking about the contributions that Lou Stokes has made to
this Nation.
I'm indeed honored that you're before our Committee, and
I'm equally as honored to have the great privilege of trying my
very best to follow in my footsteps on the Committee. I'm very
grateful, Mr. Stokes.
Mr. Stokes. Thank you.
Mrs. Pelosi. This isn't about Mr. Stokes' contribution to
this Committee, but it's important to note that he was the
chair of the Ethics Committee, he was the chair of the
Intelligence Committee, and all that that implies in terms of
the changes. As the Ranking on Intelligence now, I can speak to
all that he has done to, as far as diversity is concerned in
that community as well. He has pioneered so many fronts, he's
the all American boy. We could again take all day to talk about
him.
Mr. Jackson. I believe he was also lead investigator on the
assassination of Martin Luther King, Jr., lead investigator on
the assassination of John F. Kennedy, as well. So for those of
you who are here, it's really a great privilege and a great
honor for those are here and are very unfamiliar with our
Committee to be in the presence of Mr. Stokes.
Thank you, Mr. Chairman.
Mr. Regula. Well, it's not only that, you go to Cleveland,
every other street is a Stokes Boulevard. [Laughter.]
And the Stokes VA clinic, and I don't know, is there
anything left to name up there? Between you and Carl and your
mother, I guess you skipped the Terminal Tower. But you've done
well. Lou, we're happy to welcome you.
Mr. Stokes. Mr. Chairman and Mr. Hoyer, Mrs. Pelosi and Mr.
Jackson, I'm indeed overwhelmed.
Mr. Regula. And we have a new member down here, Mr.
Sherwood.
Mr. Stokes. Mr. Sherwood.
Mr. Regula. He's the newest member of our Subcommittee.
Mr. Stokes. Greetings, Mr. Sherwood.
Obviously I'm overwhelmed, your kindness and your kind
remarks this morning have indeed overwhelmed me. It's difficult
to even say to you what it meant to walk back into this room
where I spent 24 of the 30 years that I served on the
Appropriations Committee. It is a part of my life, and I
suppose will always remain a part of my life, as will the
personal friendships I had with each one of you.
We've spoken, Mr. Chairman, of the great friendship you
had, not only with me but with my brother, Carl, with whom you
served. And Mr. Hoyer, I remember even you were out in Ohio
when my daughter was running for judgeship out there, and you
shared that experience with us. She's still on the bench, and
enjoying it, thanks to you and others.
Mrs. Pelosi, as you mentioned, your brother and my brother
were mayors at the same time, and they were great friends. You
enjoyed a special relationship also with my brother Carl.
And Mr. Jackson, in your case, your father, Rev. Jesse
Jackson, was highly instrumental when Dr. King came to
Cleveland and walked the streets of Cleveland, to register
voters in a way that they were able to elect Carl Stokes as
mayor of Cleveland and set history. Your father was one of the
young lieutenants that Dr. King brought with him. And your
father over the years was a part of everything that Carl and I
did in that city.
It was a great honor for me to counsel with you about the
fact that when I was leaving here, that this would be a great
subcommittee for you to get on. I hear such wonderful things
about what you're doing in terms of carrying on the work that I
endeavored to do over the years.
Mr. Chairman, I'm indeed honored to be here this morning.
Mr. Chairman and members of the subcommittee, I'm currently
serving on the board of a new public health organization called
the Trust for America's Health. A former chairman of this
Committee, John Porter, and Governor Lowell Weicker are also on
this board.
The Trust's mission is to put prevention back into the
fight against chronic diseases. I serve on the Pew
Environmental and Health Commission, located at Johns Hopkins
Hospital. Based on the Commission's recommendation, the Trust's
first initiative is to fight for the creation of a nationwide
health tracking network to track chronic diseases. Today,
chronic diseases such as cancer, asthma, leukemia, birth
defects and Parkinsons kill four out of five Americans. More
than a third of our population, 100 million women, children and
men suffer from chronic diseases. These diseases annually cost
our country $325 billion.
Yet there is no national system to track these killer
diseases. Our Federal and State agencies only coordinate
tracking infectious diseases: polio, typhoid and yellow fever,
diseases that a national tracking system helped to eradicate.
Chairman Regula, let me give you some examples from our
home State of Ohio. Even though asthma attacks are the number
one cause of school absenteeism, and asthma has increased 75
percent between 1980 and 1994, Ohio does not track this
disease. Ohio does not track cerebral palsy, autism and mental
retardation, even though the National Academy of Sciences
estimates that 25 percent of these diseases in children are
caused by environmental factors.
Although birth defects are the leading cause of infant
mortality, Ohio does not have a birth defects registry. Even
though multiple sclerosis has increased by about 20 percent
between 1986 and 1995, Ohio does not track this disease. And
unfortunately, Ohio is not unusual, it is the norm.
To fill this void, the Pew Commission proposed a nationwide
health tracking network. The network involves three basic
features. The first feature establishes and coordinates local,
State, and Federal health agencies to collect vital data. This
data becomes part of a national system to track and monitor
priority chronic diseases and potentially related environmental
factors.
The second is an early warning system that would identify
environmental health threats in their earliest stages and give
public health officials valuable data about health risks, such
as lead poisoning. This network would be similar to the
existing system that informs communities about infectious
disease outbreaks.
The final piece consists of enhancing and coordinating
local, State and Federal health officials into rapid response
teams to quickly investigate clusters and outbreaks. The
response system would include regional programs to investigate
local health problems and centers at our universities to assist
with research and data analysis. The network would provide our
doctors and hospitals, public health officials and communities,
with data on patterns and possible environmental factors to
enable them to form preventive strategies.
Currently, chronic diseases cost our country $325 billion
annually and are expected to reach $1 trillion in 15 years.
These medical costs could be reduced significantly if we had
data to prevent the onset of these diseases. The network has
estimated the cost at about $275 million, or less than $1 for
every man, woman and child in America. This investment is
necessary now to stem the crushing medical costs to our
country.
This subcommittee and the Administration have rightfully
doubled the investment in NIH. But we need to fund a network to
give our NIH scientists the data they need. As a Nation, we can
track birds and people with West Nile virus and the ebola virus
on another continent. But we still can't track asthma.
In the fiscal year 2001 budget, this subcommittee asked the
CDC to research developing a network and expects the CDC to
present the findings during this year. Now I am asking this
subcommittee to finish what you have already begun. Please make
the investment in this basic public health tracking tool. Only
with your help can we pull our health tracking system into the
21st century and win the war against chronic diseases that
cause so much human suffering.
I thank you for the privilege of testifying.
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Mr. Regula. Thank you. Lou, where would you think we should
put this kind of a record keeping, data collecting, in NIH or
CDC or HHS?
Mr. Stokes. I would think probably, Mr. Chairman, that CDC
ought to be the appropriate agency here. And as I said, in the
2001 budget, the subcommittee asked CDC to look into this
matter and report back to the subcommittee. I would think that
they would probably be the correct one, the Centers for Disease
Control.
Mr. Regula. Right. Questions? Mrs. Pelosi.
Mrs. Pelosi. Just a comment, Mr. Chairman. I thank--it's
music to our ears to hear the maestro sing this song. Because
this is such an important issue and you've worked on it so many
years, Mr. Stokes.
I just want to call the Chairman's attention, this subject
came up, whether it was yesterday or the day before, when we
were talking about the Sugar Law Guild Center, where they
talked about tracking, and especially in minority communities,
which are disproportionately affected by some of this, and the
tracking will give us the data to verify that.
But again, this was the only hearing that we had in this
Committee, was on this subject, environmental health, and the
issue of tracking was very, very important in that, the asthma,
and how it affects children especially, is really a
responsibility we have to get to the bottom of.
So there's a connection to all of this. The non-profit
community is playing a very major role, and with the prestige
of Mr. Stokes, I'm sure we're going to find an answer to this.
Thank you, Mr. Chairman. Thank you, Mr. Stokes.
Mr. Stokes. Thank you very much.
Mr. Regula. I checked with the staff, of course, as you
know, the bill didn't get finished until December, early
December or late November. Anyway, we don't have a report back
yet, but we anticipate that coming this year, the response to
the Committee's action.
Mr. Stokes. Good.
Mr. Regula. Any other questions?
If not, thank you, Lou. We're happy to welcome you back
here.
Mr. Stokes. Thank you so much.
Mr. Regula. It's a great idea.
----------
Thursday, March 22, 2001.
SAFER FOUNDATION
WITNESS
DIANE WILLIAMS, PRESIDENT AND CEO, SAFER FOUNDATION
Mr. Regula. We'll move on. Next, Mr. Jackson will introduce
Diane Williams.
Mr. Jackson. Mr. Chairman, as President of the Safer
Foundation, a position she has held for four years, Diane
Williams heads the Nation's leading non-profit provider of
social services, education and job opportunities, exclusively
targeting ex-offenders. Ms. Williams' association with Safer
began in the 1970s as a volunteer, then serving on the agency's
board of directors and as the vice president for development
and strategic initiatives.
Before she began her tenure at Safer, Ms. Williams was
marketing director for the enhanced business unit at Ameritech,
and she has held executive positions at AT&T and Rockwell
International. Ms. Williams is an accomplished speaker in the
areas of criminal justice policy, community corrections
strategy, as well as prevention and basic education programming
for adult and juvenile ex-offenders.
She has been profiled in the Chicago Tribune, Chicago Sun
Times, and her televised appearances include talk shows aired
on CBS, NBC and WGN. In 1994, Diane was named the best and
brightest among business executives by Dollars and Sense
Magazine. Ms. Williams earned an MBA from Northwestern
University and serves as an adjunct professor in marketing at
Aurora College.
Mr. Chairman and members of the Subcommittee, I present Ms.
Diane Williams.
Ms. Williams. Thank you, Congressman Jackson and Mr.
Chairman, for allowing me to present the Safer Foundation to
you today. You heard a long list of things that I've done, and
this that I do today and throughout my time at the Safer
Foundation is the most important work that I've done in my
career. So you scare me to death when I come here and present
this subject today.
The Safer Foundation is a not-for-profit organization that
works to reduce recidivism by supporting the efforts of former
offenders to become productive, law-abiding members of their
communities. We provide a full spectrum of services, including
education, employment and case management.
Established in 1972, with facilities in Chicago, Rock
Island, Illinois and Davenport, Iowa, Safer has placed clients
in over 40,000 jobs and is the largest community based provider
of employment services for ex-offenders in this country. The
Nation's prison population you know is on the rise. Over
600,000 men, women and youth are released from institutions
each year.
When ex-offenders come out of the correction system, they
often have a variety of needs, as does the community have a
variety of needs around helping them to re-integrate into
society. All too often, many ex-offenders do not secure
permanent, unsubsidized employment, because they lack
occupational skills, have little or no job hunting experience,
or find that many employers refuse to hire those with criminal
records. Without a strong support system in place, all too
often ex-offenders fall back into the criminal subculture. They
do what they know how to do best.
The re-entry partnerships initiative begun in 1999 is a
Federal demonstration that assists eight States in confronting
the challenges presented by the return of offenders from prison
to the community. Funded through the Department of Justice, the
Department of Labor and the Department of Health and Human
Services, re-entry partnerships include identification of the
appropriate re-entry offender population, surveillance and
monitoring, community based support resources, and coordination
between the criminal justice system and the employment, social
services and treatment systems.
The Safer Foundation respectfully requests that the
subcommittee continue to support and to expand this important
initiative.
Safer is also committed to bridging the gaps that preclude
the ex-offender population from successfully living in the
community. We do that by providing, as we said, employment
services geared to make successful job placements. We have
employment specialists who work with our clients to complete
job applications, to train them on how to behave inthe
interview process, but even more importantly, to train them on how to
behave in the job once achieved, so that they might not only be placed
in employment, but retain that employment for a long, successful period
of time.
We have focused lots of our efforts on what we call a
lifeguard position, which supports that client around those
issues that arise while working sometimes or often for the
first time when you're working, how you interact with your
supervisor, how to work with other people and how to keep up
your commitment as a team member in that work environment.
The one on one relationship provided by our job developers
is critical as we transition or assist to transition people
into the mainstream. In addition to offering job training and
placement, Safer also offers education programs. Current
research indicates that the more education an offender has, the
less likely they are to return to prison. Our youth empowerment
program is one of Safer's most effective education programs,
both in terms of helping clients earn their GEDs and also in
reducing recidivism.
Sixteen to 21 year olds are referred by probation and
parole officers, or word of mouth, and are placed in this
program which is designed to help students continue their
education and training after Safer. Rather than provide
traditional classroom instruction, which we know has been a
failure for the clients that we serve, we offer an approach
that's considered peer tutoring, or in today's more appropriate
terminology, cooperative education. We started it before there
was such a term as cooperative education.
In addition to learning basic skills to prepare for taking
the GED, these youthful ex-offenders learn problem solving
skills that are needed to succeed in the world of work and
community, increase their level of confidence in their ability
to learn and to make and sustain constructive life changes. Of
the over 300 students that have participated in our youth
empowerment program, 81 percent complete the program. And their
academic progress increased 12.5 percent from pre to post GED
readiness. This is the equivalent of three grade levels in an
eight week period of time.
Of the students who finish the program, 50 percent passed
the GED exam the first time they took it, a pass rate well
above the State average, and actually the norm that the country
averages. Nearly 200 of the students who completed the training
were placed in either higher education, vocational training or
jobs, and 95 percent completed at least 30 days retention in
their placements.
Perhaps most significantly, our three year recidivism rate
for the youth empowerment program is only 21.4 percent, less
than half of the Illinois juvenile rate of 51 percent for the
same period.
We are in the process of building a program on the south
side of Chicago because three out of the four students that
apply for our program today are denied access to the program.
We are asking your support in continuing that project that
Congressman Jackson was very instrumental in helping us to
start this year. Thank you.
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Mr. Regula. Thank you.
How far out do you reach? Do you go beyond Illinois?
Ms. Williams. We've gone into Illinois and Iowa, have not
gone beyond those two States today. It is interesting that you
ask that question, Mr. Chairman, because a number of other
folks are asking us about coming to States where they serve.
Mr. Regula. I think I heard you say that among juveniles,
the recidivism rate is 51 percent?
Ms. Williams. In the State of Illinois, for the 16 to 21
year old age group, that's correct.
Mr. Regula. I suspect it's even higher--I was on the Ohio
Crime Commission, and at that time it was 75 percent in the
adult population. That's tragic.
Ms. Williams. It is tragic. On the adult side, we have in
Illinois, it's almost 50 percent. Our recidivism rate for the
adult population that we serve is 17 percent. So we do help
people.
Mr. Regula. The ones you serve are at 17 percent?
Ms. Williams. That's correct.
Mr. Regula. Those that are outside the system, it's
probably much higher.
Ms. Williams. That's correct.
Mr. Regula. Any other questions? Yes, Mr. Kennedy.
Mr. Kennedy. Yes, Mr. Chairman, I want to commend the good
work that's being done, just say, we have a permanent prison
class in this country right now, 2 million people in jail.
These people are going to have to come out. And the thought
that we as a Nation have not come to grips with what that's
going to mean, I mean, these are people with a record. They're
going to be living in our society, trying to get jobs, trying
to get re-integrated. I mean, we're going to pay the price as a
Nation if we don't come up with a better solution than we have
now for helping them re-integrated into the community.
And every one of those people that you're saving is also, I
would venture to say, many families who might otherwise be
victimized by this person that you're saving, a lot of
heartache and grief. So I think you're doing more than our own
criminal justice system is doing to help keep our communities
safer. And I want to thank you for the good work you're doing.
Ms. Williams. Thank you very much.
Mr. Regula. Thank you.
----------
Thursday, March 22, 2001.
MARYLAND STATE DEPARTMENT OF EDUCATION
WITNESS
NANCY S. GRASMICK, MARYLAND STATE SUPERINTENDENT OF SCHOOLS, MARYLAND
STATE DEPARTMENT OF EDUCATION
Mr. Regula. Our next witness, Mr. Hoyer will introduce Dr.
Nancy Grasmick.
Mr. Hoyer. Thank you very much, Mr. Chairman.
While Dr. Grasmick is coming forward, I'll start to
introduce her. Dr. Grasmick has been superintendent of schools
in Maryland since 1991, for over a decade. Nancy, are you the
longest serving superintendent in the United States now?
Ms. Grasmick. There's one other that's longer.
Mr. Hoyer. Dr. Grasmick is a graduate of Johns Hopkins
University, Towson and of Gallaudet. So she has a very broad
background and a lot of ways to communicate with people, and
does so extraordinarily well on behalf of children and on
behalf of families.
I'm not objective when it comes to Dr. Grasmick, I must
say, because Judy, my wife Judy and Nancy were at Towson
together, and graduated together and worked together throughout
their professional careers and frankly, until Judy died. Dr.
Grasmick has received too many awards, Mr. Chairman, for me to
articulate. But if you read her resume, she has been cited as
one of Maryland's most outstanding leaders, one of the Nation's
most outstanding educators, has been cited, as I say, both by
National and State organizations for her work and leadership in
education.
She has been the superintendent, which is, by the way,
selected by our board, under two governors. She is the only
person that I know of that was the secretary of two departments
at the same time in the State of Maryland. She was with
Juvenile Family--what was the name of it, Nancy?
Ms. Grasmick. The Office for Children, Youth and Families.
Mr. Hoyer. The Office of Children, Youth and Families,
which we have a similar one, as well as the superintendent of
schools, an extraordinarily accomplishment. She has been
recognized by her peers throughout the Nation as somebody who
has brought a commitment to quality education and to
accountability, which is being discussed, properly so, so
widely.
So I'm pleased on behalf of all the Committee to welcome
Dr. Grasmick to our Committee, and look forward to her
testimony.
Ms. Grasmick. Thank you. Thank you, Mr. Hoyer. It's really
an honor to be here and testify before you, Mr. Chairman, and
members of the Committee.
It is also an honor to perpetuate the vision of an
extraordinary woman, Judy Hoyer, who was such a champion and
pioneer for young children in the State of Maryland. In her
honor, and because of her incredible work, we have created in
the State of Maryland a concept known as the Judy Center.
As you begin your work on the fiscal year 2002 budget, I'm
asking that you give consideration to nationally replicating
this incredible collaborative full service program for all of
America's young children. What is a Judy Center? It is a
comprehensive early childhood education program, which is
coupled with family support services for children birth through
six years of age and their families. It is either located in a
public school or located in a facility in close proximity to an
elementary school.
Currently in the State of Maryland, our Judy Centers are
serving over 4,400 of these young children. Over the years,
Government has been dedicated to generating program after
program, wonderful programs, for young children and their
families. However, these programs have been generated in a
piece-meal fashion where they are scattered across communities,
where space is sometimes the primary consideration of where
they will be located.
Often citizens do not know of the existence of these
services and they don't have the capability to access them.
Imagine needing three or four different services for your
child, but you don't have transportation to even get to one
service. It can be a daunting task, and sometimes the
conclusion is, it's easier not to participate than to try to
figure out how to access these services.
This is the wonderful part of the Judy Centers. We take the
best part of Government, all of the helpful services being
generated, and make them accessible to families. This is cost
effective, it provides services to our citizens, but in
addition to that, it provides for cost avoidance. In the State
of Maryland, we are spending more than $328 million a year of
State and Federal funding to help children catch up as they
matriculate through their school career.
We're all aware of the current brain research talking about
the potential for learning that young children have. In
Maryland, we've created a kindergarten work sampling system,
and we have concluded that 40 percent of the children entering
kindergarten in the State of Maryland are not ready to learn as
we've defined it as a national goal. These Judy Centers offer
full day, full year services, including kindergarten, pre-
kindergarten, therapeutic nurseries, special education
services, infant and toddler programs, before and after school
child care, Head Start, Family Support Centers, Healthy
Families, parent involvement programs, community health
programs. It builds a continuum of education and support
services from birth through school entry.
Thirteen of our 24 jurisdictions in the State of Maryland
currently have Judy Centers. We anticipate the expansion very
soon. Why do these centers work? In addition to the reasons
I've already cited, they are results oriented, strong
accountability for outcomes, program accreditation is a
requirement for all of the programs contained in these centers.
Family support services are required. Project coordination and
case management services are essential.
Finally, it brings together a whole community of
professionals. And I would say that all of us in this room know
that education is the bridge to opportunity. The Judy Centers
help young children and their families take those first steps
on that bridge.
Thank you.
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Mr. Regula. Thank you. That's a wonderful legacy for Judy
Hoyer.
A couple of questions. Can you use Title I or do you use
Head Start money to finance these? How do you handle that?
Ms. Grasmick. We cobble together a lot of the dollars that
we receive. Yes, we do use Head Start monies for a portion of
this, and yes, we do use some of our Title I funding for a
portion of this. Certainly we do that. But it's all of the
collateral services that make these so special that often are
not funded.
Mr. Regula. Do you use volunteers at all, medical personnel
or consultants?
Ms. Grasmick. We have medical personnel, we have the
presence of higher education in terms of doing professional
development for the individuals who work in these centers. So
there's a K-16 relationship, as well as social workers, health
professionals, etc.
Mr. Regula. Another aside. Do you do testing in the
Maryland system?
Ms. Grasmick. We certainly do, throughout the school career
of children. I'm proud to say in quality counts, which is the
national assessment of all 50 States, Maryland was rated number
one with a score of 98 for its assessment accountability and
standards.
Mr. Regula. Questions?
Mr. Hoyer. She's terrific, isn't she? [Laughter.]
Obviously I'm not very subjective on this issue, Mr.
Chairman, I admit to that. But I know those of my colleagues
who have served on this Committee for some time, Nita Lowey and
I particularly, talking about comprehensive schools, and in Dr.
Grasmick's testimony, this is not necessarily a program that
costs more money. What it seeks to do, we have at the Federal
and State levels a lot of programs that all of us have
sponsored or supported, that have a multiplicity of parents who
are all very proud of those programs.
The problem that Judy had and that others have at the local
level is looking sort of at this array of programs that are
designed to help Mary Jane or Johnny Brown. But the complexity
of getting from HHS, Department of Education, Department of
Transportation, Department of Agriculture, HUD and other
agencies who have resources available to help children learn
better and to help their families be more functional and
therefore have the family unit and the child ready to learn and
learning well, is a challenge.
I will be introducing in the next couple of weeks the Full
Service Community Schools Act of 2001. I put $500,000 in this
bill about five years ago, for the purposes of having a study
done by HHS and the Department of Education on how to better do
this. They came out with a report, we didn't implement it as
quickly as we could.
The Governor and Judy, the present Governor, who was then
county executive of Prince George's County, and Governor
Schaffer, then our Governor, very close to Dr. Grasmick, and
Judy put together a similar center in Prince George's County,
Mr. Chairman, and that has served as the model for this program
that Dr. Grasmick and Governor Glendenning put together. In
fact, it was Governor Glendenning's suggestion to name these
the Judy Centers, which he thought was much more family
friendly than the actual title of the bill, which was the
Judith B. Hoyer Early Child Care and Education Act.
But Dr. Grasmick, I want to thank you so very much for the
leadership and commitment that you have shown in making sure
not just that this program works, but that we are effectively
reaching out to every child, and that like President Bush says,
we cannot afford to leave a child behind.
Thank you for being here, and thank you for your
leadership.
Ms. Grasmick. Thank you, Congressman.
Mr. Regula. Mrs. Pelosi.
Mrs. Pelosi. Mr. Chairman, I know usually you don't want us
to have too many comments, but very briefly, I want to join
Congressman Hoyer in welcoming Dr. Grasmick. Her reputation in
Maryland is well established for a long time. As Steny pointed
out in his opening remarks, her qualifications are exquisite.
But I just want to thank you for this model, which as
anyone who knew and loved Judy would know how much this means
to her. I want to thank you and Mr. Hoyer for your leadership
on this. Your successful implementation of it serves as a model
to the rest of the country. For that we're all grateful. Thank
you.
Ms. Grasmick. Thank you.
Mr. Regula. Thank you for being here.
We have a motion to adjourn on the Floor. If everybody
could go over and get back quickly. I think Mr. Jackson--Mr.
Peterson will do one other one until you get back and introduce
your witness. I think, Mr. Hoyer, you have some, too.
Mr. Hoyer. I'll go vote.
Mr. Regula. So we will do one, then we'll go to yours, Mr.
Jackson.
----------
Thursday, March 22, 2001.
MINORITY HEALTH PROFESSIONS SCHOOLS
WITNESS
RONNY B. LANCASTER, MBA, J.D., PRESIDENT, ASSOCIATION OF MINORITY
HEALTH PROFESSIONS SCHOOLS
Mr. Regula. Okay, we'll get started. Mr. Jackson, if you'd
like to introduce your guest today, Mr. Ronny Lancaster.
Mr. Jackson. Thank you, Mr. Chairman.
Mr. Chairman, thank you for the opportunity to introduce
Ronny Lancaster. Mr. Lancaster is the Senior Vice President for
Management and Policy at the Morehouse School of Medicine, and
the President of the Association of Minority Health Professions
Schools. Mr. Chairman, the Association of Minority Health
Professions Schools is comprised of the Nation's 12
historically black medical, dental, pharmacy and veterinary
schools. Combined, these institutions have graduated 50 percent
of all African American physicians and dentists, 60 percent of
all African American pharmacists, and 75 percent of all African
American veterinarians.
Mr. Chairman, working closely with the Association in the
106th Congress, we were successful in passing legislation
establishing the National Center for Minority Health and Health
Disparities at the NIH. Following the passage of this
legislation, this subcommittee included a line item
appropriation of $130 million in fiscal year 2001. Mr.
Chairman, members of the subcommittee, I want to thank Mr.
Lancaster and the Association of Minority Health Professions
Schools for their commitment to improving the health status of
all Americans, and I look forward to working with Mr.
Lancaster.
Mr. Lancaster, welcome to the subcommittee.
Mr. Lancaster. Thank you, Mr. Jackson.
Thank you, Mr. Chairman, and good morning to you and
members of the subcommittee and to Mr. Jackson.
Mr. Chairman, it's an honor to appear before the
subcommittee this morning, and thank you for the opportunity.
It is an honor to be introduced by any member of Congress, and
a privilege to be introduced by Congressman Jackson, a member
not only of this subcommittee, but a member who has
distinguished himself in that in just a second term he has
successfully sponsored legislation which leads to the
improvement of lives for millions of Americans in our
association and the Nation. We owe Mr. Jackson and his
colleagues a debt of gratitude for their hard work, their
vision and their commitment in accomplishing this most
important objective.
Our association also welcomes you, Mr. Chairman, and we
look forward to a long association during your tenure as Chair.
We ask that the record reflect our deep appreciation to
Chairman John Porter who led this subcommittee with
distinction.
Mr. Chairman, before beginning my formal testimony, I'd
like the opportunity, very briefly, to introduce the gentleman
to my left, your right. This is Dr. John E. Maupin, President
of Meharry Medical College. It will be my privilege to hand
over the gavel as president of this association to Dr. Maupin
in about two weeks.
Mr. Chairman, you may know, and interestingly, Mrs. Pelosi
mentioned in introducing Mr. Stokes, she referred simply to
difficult days in our Nation's history. We, I think, all
recognize that our history has been punctuated by glorious
moments, and yet simultaneously, unfortunately, there have been
difficult times. Meharry Medical College stands alone with
Howard University School of Medicine as only two universities
in this Nation where for almost eight decades, these were the
only medical schools in the country where African American and
other students were allowed to go for medical education. So it
is a privilege to introduce Dr. Maupin, and again a privilege
to hand the gavel to him.
Mr. Chairman, I'm here this morning to ask the support of
the subcommittee for three areas. These include support for the
continuation of the doubling effort for the National Institutes
of Health, support for the Title III program which is
administered by the U.S. Department of Education, and finally,
support for a group of programs administered by the Health
Resources and Services Administration, HRSA, collectively
referred to as Health Professions Programs.
To go through these, just a word about each of these
quickly, Mr. Chairman. Support for the doubling of the
appropriation to support the National Institutes of Health is
nearly universal. We add our voice to that chorus. The National
Institutes of Health has done a magnificent job in leading the
world in scientific inquiry and discovery, leading in turn to
the improved health status of many Americans.
Regrettably, despite the success, NIH has not done as good
a job focusing on the important subject of minority health and
health disparities. Now, thanks to the leadership of Mr.
Jackson and Congressman Charlie Norwood, and the strong support
of Republican and Democratic leaders in both chambers, we now
have at NIH a new national center for minority health and
health disparities charged with examining these very important
issues.
So we support a 16 percent increase for NIH and request
also a funding level of $200 million for this new center, to
enable it to conduct the important work for which it has been
charged.
Secondly, Mr. Chairman, with respect to the Title III
program, this program is authorized by Title III of the Higher
Education Act, commonly referred to as Title III, and its
purpose simply is to strengthen historically black graduate
institutions by establishing and strengthening program
development offices, helping to initiate endowment campaigns at
those institutions, strengthening information technology
programs and finally, strengthening their library capacity.
And finally, Mr. Chairman, I will say also, we are very
appreciative to this subcommittee for their very strong support
of this program last year, and we request support again in this
program at the level of $60 million.
Finally, in the area of health professions, we ask your
support for the group of programs collectively referred to as
Health Professions, programs such as the Health Careers
Opportunities Program, HCOP, which encourages minority and
underprivileged youth to consider careers in health
professions, another program, Scholarships for Disadvantaged
Students, which makes it possible for these students, frankly,
to receive an education. And finally, Centers of Excellence
programs, which seeks to support a level of excellence at each
of our institutions.
These programs, Mr. Chairman, collectively, without
exaggeration, are the difference at our institutions between
the doors being open and closed.
So in closing, Mr. Chairman, once again I'd like to thank
Mr. Porter for his leadership in the past. I'd like to thank
Mr. Jackson for the privilege of introducing me this morning.
And finally, thank you, Mr. Chairman, for the privilege of
appearing this morning. Welcome, and we look forward to working
with you during your tenure.
[The information follows:]
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Mr. Regula. Thank you.
How many institutions do you represent?
Mr. Lancaster. There are nine institutions, Mr. Chairman,
with twelve graduate programs at these nine institutions. These
institutions are located throughout the country.
Mr. Regula. Are these exclusively African Americans, or do
you have a mixture of student body?
Mr. Lancaster. They all have a history in the African
American tradition, that is to say, they are HBCUs. But, it's
really important to emphasize that each of our institutions
admit a wide range of students. My institution, for example,
the Morehouse School of Medicine, 80 percent are African
American students, approximately 10 percent are Hispanic and 10
percent are white.
Mr. Regula. Okay, thank you.
Mr. Jackson, questions?
Thank you for coming.
Mr. Lancaster. Thank you, Mr. Chairman.
----------
Thursday, March 22, 2001.
SOCIETY FOR INVESTIGATIVE DERMATOLOGY
WITNESSES
LUIS A. DIAZ, M.D., PRESIDENT, THE SOCIETY FOR INVESTIGATIVE
DERMATOLOGY; CHAIRMAN, DEPARTMENT OF DERMATOLOGY, UNIVERSITY OF
NORTH CAROLINA AT CHAPEL HILL
DANIELLE CURTIS
DAVID ZARET
Mr. Regula. Next is Dr. Luis Diaz, The Society for
Investigative Dermatology and Chairman of the Department of
Dermatology, University of North Carolina, and accompanied by
Danielle Curtis and David Zaret.
Dr. Diaz. Thank you, Mr. Chairman, subcommittee members.
On behalf of the Society for Investigative Dermatology, the
thousands of patients with skin diseases and myself, I wish to
thank you, Mr. Chairman, for this opportunity to testify before
your Committee. I am Luis Diaz, President of the Society for
Investigative Dermatology, a dermatologist dedicated to patient
care, skin research and training of dermatologists and
scientists. I work at the University of North Carolina.
On my left is Danielle Curtis, a patient suffering with
vertiligo, an autoimmune disease in which the immune system
destroys the pigment of the cells. On my right is Mr. David
Zaret, a patient suffering from a disease named anthivulgaris,
an autoimmune disease in which the immune system destroys the
skin on the lining of the oral cavity. These diseases were
lethal until the decade of the 1950s.
Complications of treatment of these diseases are serious.
You can imagine the problems that Danielle and David are
suffering every day of their lives.
The mission of the Society for Investigative Dermatology is
to support research in skin diseases, and to facilitate the
training of physicians and scientists of the future. We believe
that scientific research on skin diseases is the best approach
to bring hope and assistance to millions of Americans of all
ages, gender and ethnicity that are currently suffering from
these ailments. Through research, we wish to enhance our
knowledge in prevention, diagnosis and treatment of skin
diseases.
We have four suggestions which are also advocated by the
American Academy of Dermatology, representing all U.S.
dermatologists, and the Coalition of Patient Advocates for Skin
Disease Research, which is composed of 24 organizations
concerned with skin diseases. One, our Society is deeply
grateful to the members of this Committee for our efforts to
double the funding of NIH over five years. We support the
proposal of the Ad Hoc Group for Medical Research Funding,
which calls for a 16.5 percent increase in funding for NIH in
fiscal year 2002 and specifically for the National Institute of
Arthritis, Musculoskeletal and Skin Diseases, NIAMS.
Last year, Congress passed and the President signed a bill
which included a major section regarding clinical research and
loan repayment provisions for young trainees interested in
biomedical research. The pool of physician scientists is
decreasing at an alarming rate in all fields of medicine, and
in dermatology. We request that this Committee provide the
appropriate level of funding for this new, important
legislative initiative.
You would be surprised, Mr. Chairman, the information
regarding total cost to society of a skin disease is not
updated since 1979. Information about incidence, prevalence,
mortality and disability, along with the economic cost is
unavailable. Also unavailable is information about loss of
economic productivity and activities that are foregone as a
result of disease.
A number of Federal agencies collect information about
these matters. We believe a workshop developed under the
auspices of the NIAMS and including representatives of all
various agencies to identify existing information sources on
the causes and scope of skin diseases, and to recommend
strategies to developing new information sources would be very
valuable. Such a workshop would be useful to NIAMS for its own
planning purposes, it would be useful to the field of
dermatology for its use in planning for future research,
manpower and service needs. And it would be very helpful to the
volunteer organizations in informing their constituencies on
patients, for raising funds from the public for research.
If the committee is interested, we would be pleased to work
with your staff regarding bill report language in that regard.
Thank you very much for giving me the opportunity. I am
pleased to answer any questions you may have, Mr. Chairman.
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Mr. Regula. Thank you. Any questions?
Thank you for coming. I see you're headquartered in
Cleveland, is that right? Or the Society is.
Dr. Diaz. In Cleveland, yes.
Mr. Regula. How many members do you have nationwide?
Dr. Diaz. Three thousand.
Mr. Regula. Mostly physicians that treat?
Dr. Diaz. Physicians and scientists working in research in
dermatology.
Mr. Regula. So you get help from NIH?
Dr. Diaz. We get help from NIH, yes.
Mr. Regula. Okay. Thank you for coming.
Dr. Diaz. Thank you very much, Mr. Chairman.
----------
Thursday, March 22, 2001.
RETT SYNDROME ASSOCIATION
WITNESSES
KATHY HUNTER, FOUNDER AND PRESIDENT, INTERNATIONAL RETT SYNDROME
ASSOCIATION
CHERYL DUNIGAN
Mr. Regula. Next, Mr. Hoyer will introduce Kathy Hunter.
Mr. Hoyer. Thank you very much, Mr. Chairman. I also
understand she's joined by Dr. Dunigan.
Mr. Chairman, some years ago, Kathy, when did we do this,
1985?
Ms. Hunter. In 1986.
Mr. Hoyer. In 1986, I spoke with Chairman Natcher, and we
had some testimony about a disease, an affliction that I had no
knowledge of. But I knew a wonderful, and still know, a
wonderful young woman named Christy. And she and I went to
church together.
She at that point in time, I presume, was about seven or
eight years of age. For the first 18 months of her life, she
developed normally, 16, 20 months, developed normally. And then
for some unknown reason, her neurological development not only
stopped, but it went back. And to this day, she has not
progressed much beyond the age of a 14 or 15 month old. Her
body has developed, obviously. She is still a good friend, and
I see her in church from time to time, not as often as she used
to come.
She's a wonderful young woman. She was afflicted with what
we now know is Rett Syndrome. It is a syndrome that affects
young women at that age. The tragedy of course is that it
afflicts a normally growing child that parents have related to
for the first few months of life, thinking that their child was
going to develop fully and normally.
We put $500,000, we didn't earmark it, but we put in, we
asked NIH to look at this. And both Johns Hopkins and Baylor
undertook to look at this syndrome and have now developed,
identified and we are making progress.
Kathy Hunter has a child as well with Rett Syndrome, and
founded an organization to spur research and development, and
parents getting together and talking to one another and making
it easier to cope and to understand and work on behalf of these
afflicted young children. She has done an extraordinary job, as
so many citizens who take unto themselves the personal
responsibility to make a difference. She and her husband have
made an extraordinary difference, and I am pleased to be her
friend and to welcome her to this Committee. She is one of
those advocates on behalf of health of her own child, but on
behalf of thousands and thousands of other children and
parents, and of our society.
John Kennedy once said, in talking about some children with
disabilities that although these children were the victims of
fate, they would not be the victims of our neglect. And
certainly, Kathy Hunter has not neglected these children. Thank
you, Kathy, for all you've done.
Thank you, Mr. Chairman.
Ms. Hunter. We're so appreciative for your leadership and
your advocacy and support and that of the Committee over the
years.
Julia Roberts has just become our national spokesperson,
and we made a film that's now showing on Discovery Health.
Mr. Hoyer. Kathy, if you could tell her that I would
certainly be open to working closely with her as well----
[Laughter.]
Mr. Hoyer. I love seeing you, I want you to know that, I
don't want her as an alternative. But you could bring her to
testify next time.
Ms. Hunter. It would be very helpful to have a pretty
woman, but we're also very happy to have your support.
Mr. Hoyer. Thank you.
Ms. Hunter. Thank you for this opportunity to convey the
importance of increased funding to the National Institutes of
Health to accelerate research on the cause, treatment and cure
for neurological disorders. The International Rett Syndrome
Association joins the biomedical community's efforts to double
the NIH budget by fiscal year 2003 and stands by the request
for a $3.4 billion increase for NIH in fiscal year 2002.
The impact and burden of neurological diseases cannot be
emphasized enough. As I have for the last 16 years, I come
before this Committee to talk about the Rett Syndrome story.
It's the tale of a unique and puzzling brain disorder which
doesn't show its face until the child is about a year old,
andhas achieved normal developmental milestones, and then a frightening
mental and physical deterioration follows.
Rett Syndrome robs its victims of the ability to walk,
speak, and use their hands purposefully. It renders children
incapable of performing the simplest acts of daily living
without total assistance from others. Though rarely fatal, Rett
Syndrome follows a tragic and irreversible course leaving its
victims permanently impaired for life.
Pearl Buck said, ``We learn as much from sorrow as from
joy, as much from illness as from health, as much from handicap
as from advantage and indeed, perhaps more.'' And this is true.
Parents learn many good lessons in their journey with Rett
Syndrome, but our children's suffering does not begin to
balance the knowledge or insight gained from the terrible
tragedy of Rett Syndrome.
My daughter with Rett Syndrome is 27 years old. She's as
tall as my heart.
Think of what it would be like to realize that your child
will never grow up like her brothers or sisters, and imagine
what it's like to provide the kind of care and support required
for an infant, but for a lifetime. But I'm not here to tell you
just about the bad news about Rett Syndrome. I'm here to share
some marvelous news, and that is that last year when I was
here, I told you about the dedication and triumph that led to
the miraculous discovery of the gene for Rett Syndrome. Located
on the X chromosome, this gene produces part of a switch that
shuts off the production of proteins. When these are not shut
off when they should be, the protein over-production causes
nervous system deterioration which you see in Rett Syndrome.
This finding is the first incidence of a human disease
caused by defects in a protein whose function it is to silence
other genes. So in a way, Rett Syndrome is the little disease
that could.
The gene discovery will help us better understand the
disease process in Rett Syndrome and will likely lead to
treatments. Because brain development continues long after
birth and symptoms of Rett Syndrome do not develop for several
months, there's a window of opportunity during infancy in which
we might be able to intervene to prevent further damage,
something we never thought possible before. In fact, clinical
trials based on the gene discovery are already underway.
One of the most thrilling pieces of news is the recent
development, just in the last two weeks, of two animal models
which mimic Rett Syndrome. These mouse models will allow drug
experimentation which may mitigate the damage or improve
function, and will permit post-mortem studies at all stages of
development. Even more exciting, researchers will be able to
study the effects of the mutation in animals who have not yet
developed clinical symptoms. These studies could answer many
questions about the cascading effect of the mutation in the
brain and throughout the body, both before and after birth. The
understanding of these basic molecular changes greatly improves
our understanding of finding prevention and treatment
strategies.
Studies of the mouse have already shown that the genetic
defect is in effect not only during brain development before
birth, but has a critical prolonged effect even after birth.
Since it's easier to treat newborns than to correct defects in
embryonic development, this gives us hope and promise for
future treatments.
Since the first time I came before this Committee, we have
come such a long way. I told you, now I'm wearing reading
glasses and I brought my grandchild with me. So back in 1986,
when NIH funding began, it was a study of a rare and little
understood disorder. It was a pretty risky venture. Work had to
start at the beginning, because this was a disorder that had
nothing more than a name.
Before the gene discovery diagnosing Rett Syndrome before
the age of four or five years was often difficult. Today, we
have a new genetic test to improve the speed and accuracy of
early diagnosis, and people don't have to wait like I did until
my daughter was 10 years old, and also to screen prenatally in
families who already have a child with Rett Syndrome.
Another significant result is the discovery that Rett
Syndrome is not limited to females, as previously thought. It's
now known that while rare, males can have Rett Syndrome, they
die before birth or shortly after birth. So the mutation could
play a major role in non-specific mental retardation in both
males and females. The finding of the MECP2 mutation appears
also in people who do not have Rett Syndrome and this knowledge
leads us to know that it's responsible for milder forms of
mental retardation, and may account for a large number, about
65 percent of people who have mental retardation and have no
known diagnosis for it.
So this rare, little-known disorder that came to your
attention some 16 years ago may have a profound effect that
lasts far beyond Rett Syndrome. The biggest news in this story
is not about Rett Syndrome, it's about those thousands and
thousands of people who fall into that category, the 65 percent
of unknown causes for mental retardation.
So we urge you to increase funding that will bring about a
better tomorrow and a brighter future for people with
neurological disorders. Thank you.
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[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Hoyer. I want to again thank you. The bad news is that
this syndrome exists. The good news is, as Kathy indicated,
that we've had recently some extraordinary progress.
I would say to my friend, Don Sherwood, and Patrick
Kennedy, who are both spending their first few days on this
Committee, it is an extraordinary opportunity to assist both
individuals but more importantly, millions of people in the
United States and around the world. Dr. Rett is from
Switzerland, right?
Ms. Hunter. Austria.
Mr. Hoyer. Austria, excuse me. From Austria. He was the
first medical doctor to identify this, but NIH grants to
Hopkins and Baylor have been really the spur that has led to
the discoveries. So it is a good news story as well that we are
on the brink, hopefully, of possibly prevention and perhaps
even amelioration.
Thank you, Kathy. Doctor, thank you.
Thank you, Mr. Chairman.
Mr. Regula. Thank you. Thank you for coming.
----------
Thursday, March 22, 2001.
AMERICAN ACADEMY OF FAMILY PHYSICIANS
WITNESS
JAMES C. MARTIN, M.D., BOARD MEMBER, AMERICAN ACADEMY OF FAMILY
PHYSICIANS
Mr. Regula. Next we have our colleague from San Antonio,
Texas, Mr. Charles Gonzalez, who's going to introduce Dr. James
Martin. Welcome, Mr. Gonzalez.
Mr. Gonzalez. Thank you, Mr. Chairman.
Good morning, Mr. Chairman, members of the Committee. It is
a distinct pleasure, of course, to be introducing someone who
will be testifying here this morning who is from San Antonio.
It's Jim Martin, and as I said, he is from San Antonio, and
he's here representing the American Academy of Family
Physicians, AAFP.
After 20 years of private practice, Dr. Martin now serves
as program director for the Family Residency Program at Santa
Rosa Health Care in San Antonio. He is also a clinical
professor with the University of Texas Health Science Center in
San Antonio. Dr. Martin has been a member of the AAFP since
1976, and currently serves on the board of directors. The AAFP
represents more than 88,000, I believe it may be closer to, or
surpasses now, 90,000 family physicians, family practice
residents and medical students nationwide.
Health profession training programs are vital in the effort
to train more family doctors, especially in medically under-
served communities, much like my district, San Antonio, Texas.
What determines the effectiveness of a Congress is how well
informed are its members. So to Dr. Martin and all other
witnesses that will be testifying today, I commend them. And as
a member of Congress, and even on behalf of this Committee, the
important role that you play to inform us in making the
decisions that better serve our constituents.
And with that, it's a great pleasure to introduce Dr. Jim
Martin of San Antonio.
Dr. Martin. I would like to address three specific funding
issues with you this morning. The first is family medicine
training under Section 747 of the Public Health Safety Act. The
second is the Agency for Health Care Research and Quality, and
the third are the rural public health programs which you now
sponsor.
Before doing that, the Academy has asked me to thank this
Subcommittee for its incredible support for these programs
through the years. We especially appreciate your recognition
last year of the need to enhance the program by additional
funding in fiscal year 2001. The Academy now asks you to also
provide appropriate support for Section 47 by $158 million, $96
million of which will go to family medicine training.
That becomes very important to us, especially at a time
when the Administration budget blueprint suggests that cuts
should occur in these programs. The rationale of the cuts is
based on the presupposition that there already are enough
primary care family physicians, and that the market should be
able to regulate the supply itself. The realities of health
care in American would suggest otherwise, which I would like to
state to you.
First of all, there is a shortage of primary care and
family physicians in America. The Institute of Medicine, the
Council on Graduate Medical Education, and other entities have
long advocated that we have a balanced physician work force, 50
percent primary care physicians, 50 percent subspecialists. By
the most conservative number that I could find, America is
short 20,000 family physicians.
And the markets have not helped us here, in that the number
of students interested in primary care specialties have
decreased over the last four years, and we suspect in the
national residence and matching program that will come out
today that that trend will still continue, with a decreased
interest on the part of medical students.
There is good news. Your Title VII funds have been
effective. The Graham Policy Center has shown very clearly that
students who are in medical schools receiving Title VII funding
are more likely to go into primary care, they're more likely to
go into family medicine, they're more likely to practice in
rural areas, and as Congressman Gonzalez said, they're more
likely to practice in the primary care health profession
shortage areas, or HPSAs, which I will shorten it to at this
point.
A very intriguing study by the Graham Policy Centerlooked
at the HPSAs across the country. There are 3,000 counties in the United
States, 800 of which now are primary care HPSAs. If we take the general
internists, general pediatricians and the obstetrician gynecologists
out of this mix, there become another 176 counties that are HPSA
designated.
If we remove the family physicians, that number goes to
almost 1,500. The conclusion is that family physicians are
responsible for the health care infrastructure of half of the
counties in the United States, and we don't have enough of
them.
Very briefly, I would also ask you to continue to support
the ARHQ programs. We have worked very carefully with them. We
especially appreciate what ARHQ brings to the table in its
research at the practice level. We also appreciate their
commitment to addressing some of the quality and health safety
issues that we now are all concerned about.
For the second the Subcommittee recognized that the
research that's being done here is taking the new discoveries
of the NIH and other basic biomedical technology and
translating that into how we take better care of our patients
at the doctor patient level, and we think this is some
important.
And finally, I ask you also to continue to support the
National Health Care Service, your State offices of rural
health, for the work that they do.
That concludes my remarks. I'd be happy to respond to any
questions that you might have.
[The information follows:]
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Mr. Regula. I agree with you, there's a real shortage. But
how do you overcome the fact that here comes a student with a
huge debt for education, and obviously, the specialists have
better earning power than the family practice. I don't know if
we can address that simply by saying we want more members in
family practice.
Dr. Martin. Well, they are issues that need to be
addressed. I think that there are individuals out there who
want to be what family doctors and the primary care physicians
do. I think it's important for the medical schools to go back
and look at their admitting policies and try to identify those,
what shall I say, more altruistic individuals who are willing
to take on jobs where they are not paid as well, and where
their work hours are much longer than some of their
subspecialty colleagues.
Mr. Regula. Do you think Medicare's reimbursement rates
tilts this table a little bit?
Dr. Martin. They're certainly not helpful, especially for
those in the rural or the inner city areas, like Congressman
Gonzalez has.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. On the Medicare reimbursement, though, for the
residency it tilts it, clearly. The subsidies are enormous for
specialties. We should like to get some specific
recommendations from you in terms of what we can pass on to our
colleagues, because the reimbursement for these residencies,
we're all paying for that. The Medicare program is subsidizing
these people getting a specialty.
So that's all money that's taxpayer money that's going to
help educate someone to get higher earning power, and if it's
the need of this country to have primary care physicians, we
ought to reverse that policy, especially given the fact there's
a shortage of graduate medical education dollars. We ought to
point it, if we do have a shortage, towards those primary care
professions.
Dr. Martin. May I respond to Mr. Kennedy? We agree very
much that needs to be addressed. As I stated earlier, there
needs to be a balance. Obviously, we need many subspecialists.
But we also need an appropriate number of primary care, and
specifically family physicians. I hope that the work force
policies will really look at that graduate medical education
funding, and make sure the funds go to where this country needs
it.
Mr. Hoyer. I just want to make an observation. You have an
extraordinarily effective member of Congress who has presented
you to this Committee. His dad was a giant, as you know, in
this institution. I am struck by the fact that his personality
is different from his father's, but his father was and he is
extraordinarily effective and popular and respected in this
institution. I'm sure you probably know that, but I wanted to
reiterate. He does a great job.
Mr. Gonzalez. Thank you, Steny.
Mr. Regula. Thank you. Thank you for bringing the doctor.
I think you make a good point, Mr. Kennedy, we slant the
table.
Mr. Kennedy. In terms of budget cutting, there's always a
fight for those of us who represent prime graduate medical
education programs. And we're fighting for the dollars. But if
there are going to be cuts, let's make sure that the funding
goes to support our priorities.
Mr. Hoyer. If Mr. Kennedy will yield, I am very confident
that because Mr. Regula is such an effective leader of this
Committee, that our 302(b) allocation will be sufficient to
fund all the priorities that this Nation ought to be investing
in. [Laughter.]
Mr. Regula. Take down his words. [Laughter.]
----------
Thursday, March 22, 2001.
OHIO STATE UNIVERSITY COLLEGE OF LAW
WITNESS
GREGORY H. WILLIAMS, DEAN OF THE OHIO STATE UNIVERSITY COLLEGE OF LAW
Mr. Regula. Okay, Mr. Hoyer, you're going to introduce Greg
Williams.
Mr. Hoyer. Dr. Williams, the Dean of the----
Mr. Regula. I'm trying to figure this one out. It's an Ohio
State University Law School Dean, and we go to Maryland to get
him introduced.
Mr. Hoyer. Well, it's not so surprising, because of course,
Dr. Britt Kerwin was the President of the University of
Maryland College Park for many years, until stolen away in the
dead of night by Ohio State.
But I frankly think that we're sort of a twofer here. I
don't think it was lost on the folks that put together their
spokesperson that he was from Ohio State. Not that they would
be that cynical, understand. [Laughter.]
I understand that.
Mr. Regula. Trained in Maryland, learned well.
Mr. Hoyer. Dean, we welcome you to this Committee.
Mr. Chairman, I suppose the reason that I'm doing this is
that I had been a proponent last year of a program that was
authorized in 1998. The Dean is going to talk about it. But the
effort is to, we talk about diversity, we talk about reaching
out to people, and to include the legal profession, the medical
profession, other professions, so that we do have a diversity,
not just so that we have diversity for diversity's sake, but
diversity so that we will have expertise and experience in
various different cohorts of our population. It's an
extraordinarily important effort.
And so I suppose it's for that reason that I am doing this.
But Dean, we welcome you to discuss this Thurgood Marshall
program, Thurgood Marshall, of course, a son of Maryland as
well. That may be another reason, Mr. Chairman, that I'm
involved in this. But in any event, Ohio State, as you know,
one of the great institutions of this country. And I might say,
Dr. Kerwin, I teased, you didn't steal him at all, he chose to
go there.
But in my opinion, one of the finest educational leaders in
our country. We were very, very sorry to lose him. He is an
extraordinary talent, as you know, Dean, and I know a delight
to work with as well.
Thank you, Mr. Chairman.
Mr. Williams. Thank you, Mr. Hoyer, and thank you, Mr.
Chairman, for being here. I appreciate the opportunity, and Mr.
Hoyer, you're right, Dr. Kerwin is truly outstanding and we are
very fortunate to have him at Ohio State.
As indicated, I am Dean of the Ohio State University
College of Law. It's a real pleasure to be here. I want to
thank you, Mr. Hoyer, for your support of Thurgood Marshall
Educational Opportunity Program. It's been very important, and
we appreciate that support.
Actually, it's certainly consistent with things you've done
in the past and things you've supported. You may not remember,
but our meeting goes back many years ago. Thirty years ago, you
and I served on the national membership committee of the Young
Democratic Clubs of America.
Mr. Hoyer. How could I forget?
Mr. Williams. Thank you. So it's a real pleasure to be here
today. I'm speaking as past president of the Association of
American Law Schools, as well as Dean of the Ohio State
University College of Law, and for Martha Barnett, the
President of the American Bar Association, who unfortunately is
not able to be here.
But more importantly, actually, I'm speaking as a legal
educator with 25 years experience working with the CLEO
program, which I'm sure you know administers the Thurgood
Marshall program. For almost a quarter of a century, I
personally have recruited law students to this program,
minority, disadvantaged students, and have worked with them to
develop their legal careers. In 1999, I served as the first
African American male president of the Association of American
Law Schools, and my theme as president of the association of
American Law Schools was enhancing diversity in the legal
profession. I spent a lot of time working with law schools
around the country talking about the issues that the Committee
is concerned about.
As you know, Congress has authorized the Thurgood Marshal
program in the Higher Education Act Amendments of 1998, and the
program is designed to increase the number of low income,
minority and disadvantaged persons in the legal profession. The
Marshall program is administered through the Council on Legal
Education Opportunity, which is a non-profit organization
supported by the American Bar Association, as well as the
Association of American Law Schools and a number of other
groups.
The CLEO program was established in 1968 to make it
possible for economically and culturally disadvantaged students
to enter and successfully complete law school. Since that time,
over 6,000, over 6,000 students have gone through the CLEO
program. I have personally seen many of these students, in
fact, I've taught in the CLEO programs in Iowa and Ohio and
Wisconsin and other places. And of all the students that I've
seen go through the program in the last 25 years, I can't
recall more than two that did not successfully complete the
program.
So it is a program that truly has made a difference. In
fact, I think there are three members of Congress presently
serving who went through the CLEO program. It's a program that
has truly made a difference. The CLEO training program as
funded by the Marshall program has been so successful that many
States have tried to emulate it. Chairman Regula, as you may
know, Chief Justice Moyer, of the Supreme Court of Ohio, has
developed a program to develop a CLEO type program in the State
of Ohio to complement the national efforts that are ongoing,
and Chief Justice Moyer, of course, has provided greater
leadership on this issue.
By opening the doors of opportunity to more minority and
disadvantaged students, the Marshall program will help to
ensure that the legal profession reflects the diversity of the
population that it serves. The social justice system that
represents the population that it serves is a critical
component to maintaining public trust and confidence in the
justice system.
A recent ABA report called Public Perceptions of the
Justice System found that almost half of all Americans believe
that the justice system treats minorities different than
whites. A significant contributor to this perception is a
society that's nearly 30 percent persons of color, yet minority
representation in the legal profession is less than 10 percent.
One key to remedy this crisis in confidence, in my view, in the
justice system is to increase the number of minorities serving
as lawyers, judges, prosecutors, public defenders and
legislators.
Over the past five years, minority law enrollment has
increased only four-tenths of 1 percent, the smallest increase
in the past 20 years. In 1999, the total number ofminority law
graduates in the United States dropped for the first time since 1985.
With the minority population growing in the United States and the law
school enrollment increasing only at four-tenths of 1 percent, minority
representation in the legal profession looks bleak.
Currently, minority representation in other areas actually
is much higher, including accounting and economics, engineering
and medicine. All of those are higher in representation of
minorities than the legal profession.
Increasing diversity in the legal profession has multiple
advantages even beyond the public trust and confidence. Within
an educational setting, there's been a number of studies
recently, for instance, one done at Harvard and the University
of Michigan that found that it really made a difference when
the classes were diverse in terms of the experience that the
students were going to be able to get in law school. And of
course, what we find is most of the, not most, but many of the
graduates who go through the CLEO program and minority students
are in fact going out to serve those communities that need
service the most.
It appears that my time is finished, but I would urge you
to seriously consider funding the Thurgood Marshall program. It
is a program that has truly made a difference in this country
and deserves your continued support. And I thank you very much.
[Editor's Note.--Prepared statement to be kept as part of
committee files.]
Mr. Regula. You make a very good point.
Any other questions?
Well, thank you for coming. We have a vote on the rule on
tornado shelters and two suspensions and a possible motion to
adjourn. I don't know why anyone would want to adjourn.
[Recess.]
Mr. Regula. We have a vote coming up very soon. Let us see
if we can take one more witness before we have to vote.
----------
Thursday, March 22, 2001.
COALITION OF ACADEMIC HEALTH CENTERS
WITNESS
DONALD C. HARRISON, SENIOR VICE PRESIDENT AND PROVOST FOR HEALTH
AFFAIRS, UNIVERSITY OF CINCINNATI
Dr. Harrison. Good morning, Mr. Chairman and members of the
subcommittee. Mr. Chairman, your good friend, Bill Keating, who
has visited me a number of times, sends his regards.
My name is Dr. Donald Harrison. I am the Senior Vice
President and Provost for Health Affairs at the University of
Cincinnati.
I am also a practicing cardiologist and I served as
National President of the American Heart Association and Vice
President of the American College of Cardiology. I was Chief of
Cardiology for 20 years.
I am here on behalf of a coalition of 20 academic health
centers across the nation to highlight issues of concern to all
academic health centers in the United States.
We are the institutions that conduct a significant portion
of extramural, biomedical and behavioral research funded
through the National Institutes of Health.
I would like to thank all of the members of this
subcommittee for the outstanding support to NIH over the past
several years. These additional funds have clearly had
significant impact on the cause, prevention and the treatment
of health problems, which afflict the citizens of our nation
and the world.
A few of these merit mention. First, the life expectancy of
our citizens has increased by more than 20 years since the1930s
to reach 76 years for males and 80 years for females for a child born
today.
Secondly, the adjusted death rate from heart disease and
heart attacks has been reduced by 40 percent in the past 25
years.
Thirdly, our ever-increasing elderly citizens live much
more active lives, thanks to artificial joint replacement,
pacemakers and medications which prevent osteoporosis and the
treatment of breast and prostate cancer and the control of
diabetes.
On the other hand, the advances in the future, which can be
developed from the human genome project, will dwarf our past
accomplishments.
I am here today to seek your support for further enhancing
this extraordinary partnership that has been established with
great foresight over the years between the academic
institutions and the Federal government.
For the fiscal year 2002, we urge you to provide a
$3,400,000,000 increase for the NIH, which is a little more
than 16 percent. Such an increase will bring the Agency's
budget to $23,700,000,000 and keep on track to double the NIH
budget by fiscal year 2003.
I will repeat a statistic that I am sure you all are very
aware of. The NIH currently funds fewer than four of every ten
approved research grants. For this reason, I urge you to
continue your efforts to double the NIH budget by 2003.
We are really just at the dawn of the biomedical
revolution. This increased funding will keep our world
preeminence in medical innovation. It will also fuel our
country's economic growth and development.
Universities and other research institutions bear the cost
for conducting NIH research that are not supported by the
Federal research dollars. In fact, all institutions, both
public and private, provide part of the research expense for
their institutions.
Let me raise a major concern regarding the state of
extramural research facilities and laboratories. For the past
two years the NIH has included $75,000,000 in extramural
research facilities and laboratories.
For the past two years the NIH has included $75,000,000 in
extramural construction funding through the National Center for
Research Resources. It is vitally important that institutions
have the facilities and equipment to exploit research
opportunities and utilize the increased projected grant
funding.
Exciting developments in genomics, molecular biology and
neuroscience, cancer and many other fields require these kinds
of laboratories and instrumentation. Even the best minds cannot
compensate for outdated equipment and facilities. New
technology is expensive, but it is important for the
advancement of science.
That National Science Foundation, in a study in 1998 on the
status of scientific and engineering research facilities in the
United States colleges and universities found that there was
$11,500,000,000 in deferred research construction and repairs
needed.
I urge the subcommittee to provide the funding level of
$250,000,000 for extramural research construction in the year
2002.
A second significant concern of academic medical centers is
the increased cost of research institutions for complying with
research related Federal regulations. While extramural
researchers have always been subject to Federal research
regulations, the increasing number of research administration
imposed on institutions has resulted in escalated costs.
Let me stress that researchers are not opposed to providing
these safeguards and do not question the necessity of the
measures. But we believe that the Federal government and the
Federal Research Institution should help us fund the cost of
these regulations.
Finally, I would ask the committee to consider $50,000,000
to go to the Agency for Health Care Research and Quality to
reduce medical errors. This is a major problem.
Mr. Chairman, the polls reflect the fact that the American
public strongly supports Federal investment in biomedical
research. Each of these institutions mentioned will increase
the productivity of this relationship.
Best wishes to you and good health to all Members of the
Committee.
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Mr. Regula. We accept that.
Mr. Hoyer. Mr. Chairman, I know you are trying to go vote,
but Dr. Harrison mentioned that the average life expectancy of
a child born today was 76 for males and 80 for females.
Mr. William Hazeltine, whom you may know, who was one of
the leaders in the mapping of the human genome, spoke to our
bipartisan retreat.
He indicated--and he was speaking to the younger members,
not me, because my grandchildren perhaps fall in this category.
He said he believes that the average life expectancy of the
children of the younger Members, Patrick's age, would be 100
and that the life expectancy of our grandchildren would be 120,
which obviously will be confronting us with extraordinary
challenges as well. But it is amazing.
Dr. Harrison. That is a wonderful goal.
Mr. Kennedy. Mr. Chairman, that means when I get to be
Chairman I get to be there for a while.
Mr. Regula. That is right.
Mr. Hoyer. He didn't say the rest of us were going to die
real soon, however.
Mr. Regula. The committee will be suspended for
approximately 20 minutes.
[Recess.]
Mr. Regula. We will reconvene the committee. Our next
witness is Dr. Charles Schuster, Professor of Psychiatry and
Behavioral Neuroscience, Wayne State University College of
Medicine. Welcome.
----------
Thursday, March 22, 2001.
COLLEGE ON PROBLEMS OF DRUG DEPENDENCE, INC.
WITNESS
CHARLES R. SCHUSTER, PROFESSOR OF PSYCHIATRY AND BEHAVIORAL
NEUROSCIENCE, WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Dr. Schuster. Thank you very much. First of all, let me ask
permission to change my written testimony from ``good morning''
to ``good afternoon.''
Mr. Regula. Or ``good evening.''
Dr. Schuster. I am here today representing not only myself
as a drug abuse research scientist and treatment provider, but
as well I serve as the President of the College on Problems of
Drug Dependence.
The college has been in existence since 1929 and is the
oldest and largest scientific society devoted to the study of
addictions. It has over 600 members and about 1,000 people come
to our annual scientific meeting.
The membership is comprised of a broad array of scientists,
from molecular biologists through criminologists, policy
analysts, and sociologists, et cetera, concerned with the range
of problems that drug abuse is involved with.
I would like to first of all today, on behalf of the
college, thank this committee for their support of the NIH in
general in terms of the doubling of its budget, and
specifically for its support of the National Institute on Drug
Abuse and appeal to you for continuing this support for it
obviously is one of the nation's most important problems.
On the way here today I came across a recent report from
Constant Horgan of Brandeis, which states that substance abuse,
is the nation's top health problem, causing more deaths,
illness and disabilities than any other preventable health
problem today.
I am not going to burden you with statistics about that
because we are all aware of the tragedies associated with it.
What I would like to say is that the National Institute on
Drug Abuse is a governmental organization that is very
important, not only to the members of the College, but as well
to our society in general, because it supports the overwhelming
majority of scientific research on the complex problems
associated with drug abuse and dependence.
This research has already paid off in a number of ways in
terms of the development of effective prevention and treatment
interventions, which are already being utilized. However, a
great deal more is in the pipeline.
We are at a time when advances are occurring very, very
rapidly. In my written testimony I said that we were studying
the long-term effects of methamphetamine or speed on the brain
and that definitive evidence would be soon forthcoming.
Well, in the weeks between the time I wrote this and the
time I am coming here a report has come out definitely
corroborating the fact that methamphetamine causes the same
kind of brain damage in humans that has been reported in
laboratory animals for many, many years. So, this is a very
rapidly emerging field.
My own group is now studying MDMA or Ecstasy in terms of
the effects of it on the brain. One of the things we are very
interested in and is of the utmost importance to us to
understand if we are going to be able to effectively treat the
problem of drug abuse is what happens in the brain when people
move from casual, experimental drug use to regular drug use and
finally to compulsive drug use, which is what characterizes
addiction. What is going on in the brain there?
We now have the techniques to PET scanning, functional MRI
and magnetic resin spectroscopy to study these kinds of things
in living human beings and animals. Rapid advances are being
made in this area today.
In addition, NIDA's research has been responsible for a
variety of behavioral interventions to help people cope with
the behavioral changes that they have to make when they
transition from being active drug users to a drug abstinent
state.
These are very effective procedures that are now being
utilized across the United States and I think are making a real
difference.
One of the areas that I am personally involved in that I
think is very exciting is the so-called National Drug Abuse
Treatment Clinical Trials network. This is a new program at
NIDA, which is designed to bridge the gap between
academicresearchers, which is myself, and community treatment programs.
It is true in all branches of medicine that there is a gap,
but it is particularly large in the area of the treatment of
drug abuse.
NIDA has now established a network of 14 regional training
and research centers. These are academic centers spread out
across the United States, each one of which has gone out into
their community and established a collaborative relationship
with community treatment programs where research has never gone
on.
Now, what we are doing is taking new treatment
interventions which have been shown under rigidly controlled
clinical trials to be effective or efficacious, as we call it.
We are then looking at them in community treatment programs to
find out if they are useful in the real world. If they are
useful, how can we better get other community treatment
programs that are not part of the CTN to adopt their use.
This is the goal of this project. Although there are 14 of
these centers around the United States linked up with about 100
treatment programs, I think the National Institute on Drug
Abuse is very much interested in expanding this.
Mr. Regula. Are all addictions centered in the brain?
Dr. Schuster. Yes.
Mr. Regula. What does the body do, send a message that they
want to smoke or that they want a shot, to the brain?
Dr. Schuster. The message begins in the brain. We have
studies now in which we can take individuals who are chronic
drug users, we put them into a machine called a Functional MRI
and we provoke them to crave drugs by giving them cues that
have in the past been associated with their drug use.
We can delineate the regions of the brain that are
activated when they see these cues and they report an
overwhelming urge to get the drug.
Mr. Regula. So, part of drug therapy would be to change
patterns of the things that trigger?
Dr. Schuster. Absolutely. This is can be done in a couple
of ways. First of all, we are looking for medications that may
decrease craving. We are also looking for behavioral and
psychological interventions that may alter that. Great progress
has really been made because we understand the mechanisms now.
[The information follows:]
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Mr. Regula. Very interesting.
Mr. Kennedy.
Mr. Kennedy. I wanted to get into the whole idea of this
being behavioral and biological. We, obviously, need to fund
more research in the area of how the genome and how we can
intervene earlier. Because to wait until people get to be
addicts is just a waste of time.
I think it is probably very useful for us to advance the
concept that the brain is part of the body and mental health is
overall health so that we don't have insurance companies
treating people differently for mental health issues that are
chronic like drug and substance abuse any different from asthma
or diabetes or anything like that.
We need to get this bill passed in this Congress, hopefully
the Domenici Parity Bill and the Roukema bill on this side will
pass, because that is the best thing we can do in my view right
now, to get more treatment to people out there.
Dr. Schuster. I would also like to comment on the fact that
one of the problems that we have with the treatment of drug
addiction is the fact that many of the people that we see also
have concomitant mental health problems, other psychiatric
disorders. It is very common.
Yet, because of the separation in the funding streams, it
is oftentimes very difficult for us to provide both services in
the same site. As a consequence of this, when you take
somebody, as somebody said earlier today, they don't have a
car. They have to take three buses. You refer them to a
psychiatrist or a mental health clinic on the other side of
town and they don't get there.
We really have to work on trying to mainstream these so
that we can provide these kinds of services in the same venue,
so to speak.
Mr. Kennedy. That is my point, Mr. Chairman, about the
schools for the kids because it is a non-threatening
environment. It is not some substance abuse treatment center,
some mental health place that has all kinds of stigmas laden
with it. You can treat people collocated.
As you said, a lot of this is behavioral and it is mental
health. We need to identify these kids who are predisposed,
either through sociological factors, their parents, they have
trouble at home, their parents are addicts or what have you,
and address it early on.
Mr. Regula. Thank you for coming.
Dr. Schuster. Could I have ten seconds? Research has shown
that if we could ensure the children learn to read in the first
grade, if they become positively engaged in school that is the
most effective prevention intervention we could have.
Mr. Regula. Good point. We have the whole gamut here.Thank
you.
Mr. Steve Wilhide, President of the Southern Ohio Health
Service Network.
Thursday, March 22, 2001.
NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, INC.
WITNESS
STEVE WILHIDE, PRESIDENT, SOUTHERN OHIO HEALTH SERVICE NETWORK
Mr. Wilhide. Thank you, Mr. Chairman. Mr. Chairman and
members of the subcommittee, I want to thank you for the
opportunity to be here today. I am President and CEO of the
Southern Ohio Health Services Network, which is a rural
community health center. I am speaking on behalf of the
National Association of Community Health Centers regarding
funding for the Consolidated Health Center Program within the
Department of Health and Human Services. I would like to thank
this committee for your increases that have enabled us to serve
millions more people nationwide in our community health
centers. We appreciate your commitment to this program and
appreciate your consideration of expanding the program so we
can serve millions more.
Southern Ohio Health Services Network is a Federally
supported community health center founded in 1976. I was
brought there as the first Executive Director. Our first year's
budget was $49,000. It was an Appalachian Regional Commission
grant and $200,000 from the Department of Health and Human
Services to provide direct care.
Today, approaching our 25th anniversary, we have a budget
of approximately $17,000,000 of which about 20 percent comes
from a Federal grant and we serve approximately 50,000 people
who had one or more visits for one or more services last year.
We have over 50 physicians, dentists, nurse practitioners,
social workers, and clinical psychologists.
Mr. Regula. Do you have volunteers?
Mr. Wilhide. We have volunteers. We have a volunteer
physician who is retired that I met through my church who
volunteers. We have a nurse who is retired and volunteers and
we have a volunteer board that is very, very active. I will be
getting back to my board meeting this afternoon.
Nationwide, health centers serve 11 million people, 4.6
million of whom have no health insurance.
We applaud President Bush's call to double the number of
patients served by health centers and to double the number of
sites. We would urge Congress to appropriate $175,000,000 more
in order to achieve that goal.
I think it is important to understand that community health
centers are locally controlled and operated entities. The
boards of those health centers, the majority of whom are
consumers of the care, determine what health care needs are
prioritized and then hold me accountable for reporting back to
them as to what progress we are making toward clinical outcome
goals.
So, the board, each year, sets forth a list of clinical
priorities, whether they want to decrease the risk of diabetics
who have foot problems or what have you. We report to the board
on our progress.
Back in 1977 and 1978 two of our counties had the highest
infant mortality rates in the State of Ohio, higher than many
Third World countries. The board felt this was unacceptable. We
targeted that program. We were able to receive a Maternal and
Child Health grant in addition to our Federal dollars and other
dollars. We worked with the entire community, public health
departments, and community action programs with outreach, the
Grads Program which targets pregnant teenagers to keep them in
school.
Mr. Regula. Did that include nutrition help?
Mr. Wilhide. Absolutely. We also have the WIC Program that
we operate. We were able to integrate all these services into
one comprehensive approach. Because as many people have
indicated before, it is not a medical problem, it is not a
psychological problem, it is total integration that makes up
the human being.
So, we actually were able to recruit, through the National
Service Corps, and we would not have gotten these doctors had
we not, pediatricians and obstetricians, gynecologists. The
first pediatrician ever to serve in Brown County just retired a
few months ago.
I am please to report today that our infant mortality rates
are below State average in those two counties and 82 percent of
women are getting first trimester prenatal care compared to
about 58 percent before we started the campaign. Again, it was
a combination of education, nutrition, socialwork, and
psychology, integrated together into one setting.
In addition to being responsive to local health care needs,
community health centers have proven to be effective and
efficient over the years. They provide their comprehensive
services at an average cost of about $350 per person per year.
That is obviously less than $1 per person served.
They are having many studies to show their cost
effectiveness in reducing hospitalization, reducing unnecessary
emergency room utilization, higher child immunizations. My own
program has a 93 percent immunization rate of two-year-olds.
That is considerably above the State average.
So, again, I think we are not a medical model. We are a
comprehensive model with a variety of services based upon the
needs of our own individual communities.
Last year the National Association of Community Health
Centers surveyed 100 health centers and found that those health
centers could serve 50 percent more people if funding was
available.
In order to do this we are going to have to establish new
sites in new locations and expand existing services in present
locations.
By way of example, in Adams County, which you may not be
familiar with, which fortunately now is only the second poorest
county in the State, I think Perry County is first; we opened a
23,500 square foot mall-type service facility and closed two
aging facilities that were inadequate. We have in that facility
the only psychiatrist in the county, a clinical pharmacy,
internal medicine, the WIC Program, social work. There is a
significant increase in the numbers of elderly served and
dental. We have gone from three dental operatories to nine and
the appointment books are full right now.
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Mr. Regula. I am sure they are.
Thank you for coming. I think those community health
centers do great work.
Mr. Donald Price, President of the Society for
Neuroscience.
----------
Thursday, March 22, 2001.
SOCIETY FOR NEUROSCIENCE
WITNESS
DONALD L. PRICE, PRESIDENT
Dr. Price. Good afternoon. My name is Don Price. I am a
Professor of Neurology, Pathology and Neuroscience at Johns
Hopkins and present President of the Society for Neuroscience.
The Society for Neuroscience has about 28,000 members and
its major commitment is to basic and clinical neuroscience. We
are obviously very grateful for the support that we have gotten
in the past and that biomedical research has gotten in the
possibility.
So, with that as a background, I want to depart from those
remarks and give you an example of a human disease where really
extraordinary progress has been made. That is Alzheimer's
disease, which is the most common cause of dementia in late
life.
I think we are now on the threshold of coming up with
therapeutic targets which could prevent this disease. What I
would like to do, because you heard for example, an elegant
discussion of the problem of rats. I would like to explain how
that happens.
The first thing that happened with Alzheimer's was to
define it as a disease. The second thing was to look at the
brain and find that there were very unusual deposits called
ambyloid in the brain tissue. Then, the gene that encoded the
protein that gave rise to ambyloid was identified. It turns out
that it was like this pen. It is a protein thatlooks like this
and the ambyloid component is imbedded in it.
So, somehow abnormal scissors, enzymes, leave that peptide
out and it becomes deposited in the brain of an Alzheimer's
patient and causes the disease.
Over the past few years we have identified mutations in
that gene that are linked to the human disease. I brought two
specimens, one from my grandson and the other from my
administrative assistant. It is not hard to tell which is the
Alzheimer mouse versus the other.
But basically, what you can do is you can take the mutant
human gene, put it in the mouse and the mouse will come up with
the disease. It is now possible to use these mutant mice to
test mechanisms and therapies. It represents the kind of
advance that I think we are going to see over the next decade
for Parkinson's disease, for Rett syndrome where the gene has
now been identified, and so forth.
It really represents an extraordinary step forward in terms
of trying to treat disorders which, when I was neurology
resident and a clinician, one really didn't want to diagnose
because the news was so bad for the family.
It is now possible to knock out the genes that make these
scissor-like clips. It turns out when you knock those genes out
in mice, the mice look perfectly well. What that tells you is
that you could then give this mouse an inhibitor of that
cleavage product, that enzyme, and this would not happen. The
mouse would not get Alzheimer's disease. If it works in mice,
it should work in humans.
To emphasize the point that was made before about
prevention, if one comes up with a small molecule that can get
into the brain that can inhibit these enzyme activities that
cleave this ambyloid protein, one could potentially completely
prevent a disease like Alzheimer's.
I think the same story is going to be translated to Lou
Gehrig's disease and many of the other devastating neurological
diseases. When genes are identified for psychiatric diseases,
we are going to be able to do the same kinds of things.
So, really, that is how the NIH monies are being invested.
I think they are critical if we are going to improve the health
of our population.
Thank you very much.
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Mr. Regula. Thank you.
Are there questions?
I have just one. Does Alzheimer's have a pattern of onset
that you would start this treatment once you identified it? You
would not do it in a healthy person, I assume.
Dr. Price. No. I think it would depend. I mean Alzheimer's
disease clearly starts much earlier than the first obvious
clinical sign. If you had a very safe drug, you could start it
early. The earliest case of Alzheimer's that I know of is a
young person who had a gene lesion who got it at 16 years of
age. So, it can occur from 16 to late 80s. But it usually has a
very indolent course.
So, to answer your question directly, if you had a safe
therapy, then one might treat patients prospectively.
Mr. Regula. I understand there is some genetic pattern,
that it is inherited.
Dr. Price. That is right. It is really the identification
of those genes that has allowed this kind of research to go
forward. That is what we are going to see, I think, in
psychiatry in the next decade.
Mr. Regula. Well, thank you for coming.
Dr. Price. Thanks very much.
Mr. Regula. Dr. Robert Felter, Chairman of Pediatrics and
Medical Director, Tod Children's Hospital in Youngstown.
I am happy to welcome you.
----------
Thursday, March 22, 2001.
NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS
WITNESS
ROBERT A. FELTER, CHAIRMAN OF PEDIATRICS AND MEDICAL DIRECTOR, TOD
CHILDREN'S HOSPITAL, YOUNGSTOWN, OHIO
Dr. Felter. Good afternoon. My name is Robert Felter. I am
a pediatric emergency physician and currently Chairman of
Pediatrics and Medical Director of Tod Children's Hospital in
Youngstown, Ohio.
Thank you for the opportunity to testify on behalf of the
National Association of Children's Hospitals. Mr. Chairman, I
especially want to thank you and the members of your committee
and your colleagues very much for last year's appropriation off
$235,000,000 for Graduate Medical Education or GME Programs for
the nation's nearly 60 pediatric teaching hospitals.
You enacted this funding at a time when it was critically
needed by hospitals all across the country. Your 2001
appropriation is a major step toward fulfilling the Congress's
authorization of the $285,000,000 needed to provide equitable
Federal support for our GME Programs.
In today's increasingly price competitive health care
marketplace, Medicare has become the only major reliable source
of GME support. Teaching hospitals absolutely rely on it to
remain competitive. But children's hospitals qualify for
virtually no Federal GME support from Medicare because we care
for children.
On the average, one of our hospitals receives less than one
half of one percent of the GME support which other teaching
hospitals receive through Medicare. That creates a huge gap in
Federal support for children's hospitals. According to the
Lewin Group, it amounts to about $285,000,000 annually.
It puts at risk not only our hospitals, but also the future
of our entire pediatric workforce and health care for all
children. Here is why: On the average our hospitals consist of
less than one percent of all hospitals, but we train nearly 30
percent of all pediatricians, nearly 50 percent of all
pediatric specialists and almost all pediatric emergency
specialists such as myself.
We are also the major pipeline for future pediatric
research. We also serve all children, regardless of economic
need, from the furthest rural to the nearest inner city
neighborhoods. We provide personal, compassionate care combined
with state-of-the-art medical treatment.
Mr. Chairman, as we discussed in your office last week, you
know that this affects my own hospital very much. We provide
more than 30 pediatric sub-specialists and highly specialized
programs such as our pediatric in-patient cancer unit. We serve
all children. More than 60 percent of our care at Tod
Children's goes to children who are assisted by Medicaid or
have no insurance.
We also train 27 medical residents each year. The majority
of them go into practice in the Youngstown area or in Ohio.
Mr. Regula. You got some financial support for that program
out of this committee this current year; right?
Dr. Felter. Yes, we got $200,000 for Tod and we will get a
little over $1,000,000 this year from the increased finances.
Again, it costs us about $200,000,000.
As you know, Youngstown is an economically depressed
community, which makes it difficult for us to attract and
retain strong clinical talent. The loss of our GME Program
would seriously affect Youngstown's pediatric workforce. We
face the potential for that loss right now. We spend more than
$2,000,000, our hospital does, just on the direct cost of the
program.
We face increasing pressures to eliminate either that
training program or other programs. Frankly, without strong
Federal funding through Children's Hospital GME program, the
future of our training program is in jeopardy. That in turn
puts into jeopardy the long-term future of our children's
hospital and the health of our community.
With such a major impact on small institutions such as Tod
Children's Hospital, you can image the impact of this funding
on much larger institutions in their regions such as Children's
Hospital in Boston or Los Angeles, which train hundreds of
residents.
Please take the next step to close the gap by appropriating
full funding this year. It is vital for the future of our
pediatric workforce and the healthcare of all children.
Thank you again for your past support. We appreciate very
much your consideration of our request today for fulfillment of
equitable GME support for children's hospitals.
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Mr. Peterson [assuming chair]. I didn't really hear most of
your testimony, but I didn't really need to. I am very familiar
with Pennsylvania's Pittsburgh Children's Hospital and CHOP in
Philadelphia. I call them miracle hospitals, because that is
really what you do. We send our very sickest children to you
and you do miracles.
I totally support, personally, and I am just speaking for
one person, of closing that gap. If there is any part of our
teaching system that should not have been shortchanged, it is
our kids.
Dr. Felter. Thank you very much. I appreciate the support.
Mr. Peterson. Are there any questions?
Thank you very much.
Next we will hear from Stephen Bartels, President of the
American Association for Geriatric Psychiatry. We welcome you.
Please proceed.
----------
Thursday, March 22, 2001.
AMERICAN ASSOCIATION FOR GERIATRIC PSYCHIATRY
WITNESS
STEPHEN BARTELS, PRESIDENT
Dr. Bartels. Mr. Chairman and members of the subcommittee I
am Dr. Stephen Bartels, President of the American Association
for Geriatric Psychiatry. AAGP is a professional membership
organization dedicated to promoting the mental health and well
being of older Americans and improving the care of those with
late life mental disorders.
Mr. Chairman, I join many of those other witnesses here
today in thanking the subcommittee for its continued strong
support for increased funding for the National Institutes of
Health over the last several years.
However, I am here today to convey the serious concern
shared by researchers, clinicians and consumers that there
exists a critical disparity between Federally funded research
on mental health and aging and mental health needs of older
Americans.
Mr. Chairman, as we have already heard today, the U.S.
Census projects that numbers of Americans over age 65 will
increase dramatically over the coming decades.
However, despite recent significant increases in
appropriations for research in mental health, the proportion of
new NIH funds for research on older persons has actually gone
down and is woefully inadequate to deal with the impending
crisis of mental health in older Americans.
With the Baby Boom generation nearing retirement, the
number of older Americans experiencing mental health problems
is certain to increase in the future. By the year 2010, there
will be approximately 40 million people in the United States
over the age of 65. Over 20 percent of those people will
experience mental disorders.
Current and projected economic costs of mental disorders of
aging alone are staggering. Depression is an example of a
common problem among older persons. Approximately 30 percent of
older persons in primary care settings have significant
symptoms of depression. Depression is associated with greater
health care costs, poor health care outcomes and increased
morbidity and mortality.
Older adults have the highest suicide rate of any age
group. AAGP would like to call to the subcommittee's attention
the fact that recent increases in the National Institute of
Mental Health and the Center for Mental Health Services have
not been reflected in new research funding on mental health in
aging.
For example, while total research grants awarded by NIMH
increased 59 percent in 1995 to the year 2000, NIMH grants for
aging research increased at half that rate over the same
period. In fact, between 1999 into the year 2000, the actual
amount of new funding for aging grants by NIMH declined.
I brought this diagram here to show that the proportion of
total NIMH newly funded research devoted to aging declined from
an average of eight percent in 1995 down to six percent in the
year 2000. It is juxtaposed against significant increases that
this committee has approved for NIMH over the last several
years.
I have also taken the liberty to bring this other diagram
that shows the increasing numbers of people who are elderly
that are projected to come, the associated health care
expenditures. This large increase is showing the number of
people with mental disorders as opposed to younger people and
this is the NIMH funded research at the current rate, which is
quite low.
Now, Mr. Chairman, the research that this committee has
funded shows definitely that treatment works for many mental
health problems in older persons. However, if current trends in
funding for aging and mental health continue at NIMH and CMHS,
we will dramatically fall short of the need for continued
developments and our understanding of the causes of mental
health problems in older people and the development of
effective prevention and treatment.
Improving the treatment of late life mental problems will
benefit not only the elderly, but also the current Baby Boomer
generation whose lives are often profoundly affected by those
of their parents who comprise an unprecedented challenge to the
future of mental health services in America.
In short, Mr. Chairman, this is not simply a concern for
our nation's elderly. Under-funding research on mental health
in aging is a problem for those of us with parents afflicted
with mental disorders and for the future of those of us who
will reach retirement age in the next two decades.
Based on our assessment of the current need and future
challenges of late life mental disorders, we submit the
following three recommendations for consideration:
One, the current rate of funding for aging grants at NIMH
and CMHS is inadequate. Funding of aging research grants by
these agencies should be increased by approximately three times
the current funding level, to be commensurate with the current
need. Two, infrastructures within NIMH and CMHS are needed to
support the development of initiatives in aging research,
including the creating of positions with these agencies
dedicated to promoting, maintaining and monitoring research on
mental health in aging. Three, the establishment of grant
review committees with specific expertise in reviewing research
proposals on mental health in aging. In conclusion, we are
dramatically under-investing in research on mental health in
aging at a time when the NIMH and CMHS budgets have seen
significant increases. The projected economic impact of the
aging Baby Boom generation on Medicare and Social Security
systems is well known.
But there is another challenge that has not received
attention. We can expect an unprecedented explosion in the
number of people over age 65 with potentially disabling mental
disorders.
I would like to thank you for allowing me to submit this
testimony today. We will be happy to answer any questions.
Mr. Peterson. In your research, are you tracking some of
the mental health drugs that our seniors have been on for
decades?
Dr. Bartels. Yes.
Mr. Peterson. I would like to just raise one. I have a
personal experience. My mother had depression problems all of
her life. I don't remember when she would not go into the lows
and the highs. She was never doctored until the last two or
three decades. I do not think we doctored it much when I was a
child.
But she was on a drug called Vivactil for maybe 25 or 30
years. I had a younger brother who over a period of time had to
get the doctors that prescribed that to reconsider that drug.
He had done some research. He was always unsuccessful. I guess
I kind of hold myself responsible that I didn't give him more
assistance, but I certainly didn't hamper him.
Recently, she had a health problem where she broke her hip
and was temporarily in a nursing home for rehab. The doctor
there quickly agreed with my brother that she ought to be off
that drug.
My mother could not carry on a conversation with me for
three years. My mother can carry unlimited conversation today
after six months. I just find that a tragedy that she was
deprived of the ability to communicate. She knew my name. She
always knew me. She expressed love for her children, but she
could not communicate.
She is actually gaining. We were blaming it all on
Alzheimer's. She is actually gaining the ability to have a
conversation with her children.
In discussing this with nurses, they feel there are a
number of mental health drugs over long periods of time that
have actually harmed people's ability to think and carry on a
conversation.
Do we monitor them long term?
Dr. Bartels. Well, not well enough. I think part of that
has to do with health services research in pharmacoepidemiology
and look at precisely this: co-prescriptions, old medications
that have bad side effects that do impair cognition.
The good news is that there are new medications which have
minimal side effects that enhance functioning. We know, for
example, like your mother had a hip fracture, that untreated
depression actually results in worse health care outcomes.
Those people do not get better as fast and they are more likely
to die.
So, untreated depression, untreated disorders without the
state-of-the-art medications is actually a tragedy.
Mr. Peterson. Well, I guess in Pennsylvania where they had
the PACE Program where they really know what everybody is on
and she was in the PACE Program. I have been going to talk to
them because I have worked with them for years at the State
level.
How many people are still on that drug? I personal think it
is a bad drug.
Dr. Bartels. I think there are newer and better drugs that
are out there and that is part of the research that we are
hoping to focus on, looks at those medications, treatment and
services that will make a difference for people like your
mother.
Mr. Peterson. Of course, I am one who thinks we rely too
much on drugs today. There are wonderful drugs. I am not
against new drugs.
Dr. Bartels. There are very effective non-pharmacologic
interventions also that we are doing research on.
Mr. Peterson. There are so many seniors. I tour home health
agencies. Five, six, seven, eight, nine or ten drugs, I am just
amazed how many drugs our seniors are on and the complications
of them. Are we studying that, too?
Dr. Bartels. We are. Our group at Dartmouth is doing just
those sorts of studies right now.
Mr. Peterson. Do you have any questions?
The gentleman from Rhode Island.
Mr. Kennedy. I agree, Mr. Chairman. The fact of the matter
is seniors are over-utilizing the health care system for many
reasons, because they are depressed or they are not getting
connections. So, they use the Medicare system as a way to get,
you know, some attention and whatever that makes up for lack of
proper love and so forth from their family or the losses that
they have suffered.
If you would establish a kind of program that was a
practicum of how to identify depression among seniors, I mean
if you had limited resources and I am not talking about the
research angle and increasing science, which I agree with you
on, but just out there right now, what would be your kind of
vision of what a program would look like?
Dr. Bartels. I think there are several things. First of
all, you are exactly right that we know from health services
research that there is increased health services utilization,
emergency room visits, hospitalizations, et cetera, with
untreated depression.
I think the place to go is where seniors are, which is to
say that because of the stigma of mental illness, they are less
likely to go to specialty care providers. So that primary care
physician offices, educating primary care physicians to better
identify and use state-of-the-art treatments is a place to go,
senior citizens centers as well as senior housing.
Some of the innovative programs that we have actually
looked at and a number of us have researched, I think, are the
places to look at.
Mr. Kennedy. I would love to have you share what some of
your findings have been in those areas because I would like to
get those things back in my community because I know there are
too many seniors who are suffering needlessly. People think,
oh, that is just part of being old.
Dr. Bartels. I would be delighted to talk with you in
details about some of these programs.
Mr. Kennedy. That would be great. Thanks very much.
Mr. Peterson. Thank you.
We are trying to accommodate people who have plane
reservation problems. We are next going to hear from Dr. Felix
Okojie, Vice President, Research and Strategic Initiatives,
Jackson State University.
If you have a similar problem, let us know. We will try to
accommodate you.
Please proceed.
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Thursday, March 22, 2001.
JACKSON STATE UNIVERSITY
WITNESS
FELIX OKOJIE, VICE PRESIDENT, RESEARCH AND STRATEGIC INITIATIVES
Dr. Okojie. Mr. Chairman, distinguished members of the
subcommittee, I am Felix Okojie, Vice President for Research
and Strategic Initiatives at Jackson State University. I want
to thank you members of the committee for giving me the
opportunity to appear before you today as you consider the
fiscal year 2002 funding year priorities for this subcommittee.
First of all, I would like to be on record with this
committee for the extraordinary and strategic efforts for
putting significant amounts of dollars in agencies like NIH and
the education in that has helped historically Black colleges
and universities across this country to contribute
significantly to the health and other problems of the citizens
of this country.
As a result of the efforts of this committee, I would like
to speak very briefly to how Jackson State University in
Jackson, Mississippi has benefitted and continues to benefit
from the efforts of this committee.
There are two initiatives that the university is very much
interested in that we think, because of the resources that have
already been invested at the university by Federal agencies as
a result of the appropriations from this committee, can even
further enhance the critical goal that we have.
There is a study going on right now in Jackson called The
Jackson House Study, which is an epidemiological,
cardiovascular disease study by the largest CVD study for
African-Americans in this country. Within that we also have a
major cancer study going on at the medical school.
Jackson State University recently developed an
epidemiological institute where CVD and things like prostate
cancer will be the major focus.
Jackson State University is at the forefront in trying to
help to meet some of the disparity, particularly in the area of
cities in Mississippi and this country.
One of the initiatives we would like to highlight is the
establishment of a minority Rural and Urban Health and Wellness
Center. The impetus for this center is as a result of the
critical mass of the human resource and intellectual capital
that has been harnessed over the years to do a lot of disparity
studies in collaboration with institutes like NIH and CDC.
Information out of these studies can be disseminated both
in the rural and urban areas of the State as well as across
different parts of this country. So, the Health and Wellness
Center would take advantage of this synergy and the
intellectual capital to capitalize and to disseminate
significant information on both disparities as it relates to
those common issues that afflict minority populations in
Mississippi and in other parts of this country.
I ask this committee that sufficient funding be provided in
the health facilities account of the HHS section of the
Education Appropriations bill to support projects such as this
that Jackson State is proposing.
The other major project is a project called the Mississippi
e-Center at Jackson State University. This is a center that we
would like the committee to be aware of. Again, this center is
designed to create some more outreach efforts through the use
of technology to reach urban and rural areas in Mississippi, as
well as providing some new and innovative ideas that can help
service some of the needs across this country by using
research, e-technology programming and e-service opportunities
to meet the needs of minorities in this country as well as
major aspects of people in this country.
Mr. Chairman, thank you for this opportunity. I will take
any questions.
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Mr. Peterson. Thank you very much. I guess we have no
questions.
Next, we will call on Dorothy Hill, President of the
American Psychiatric Nurses Association. Please proceed.
----------
Thursday, March 22, 2001.
AMERICAN PSYCHIATRIC NURSES ASSOCIATION
WITNESS
DOROTHY HILL, PRESIDENT
Ms. Hill. Mr. Chairman, my name is Dottie Hill and I am
Vice President of Patient Care at Arcadia Hospital in Bangor,
Maine. I am here today as President of the American Psychiatric
Nurses Association, or APNA. Thank you for providing me with
the opportunity to outline APNA's funding priorities for fiscal
year 2002.
Founded in 1987, APNA is comprised of approximately 4,000
psychiatric nurses representing every State in the nation. Our
mission is to advance psychiatric and mental health nursing
practice, improve mental health care for culturally diverse
individuals, families, groups and communities and to help shape
mental health care policy.
Before moving on, I would like to quickly review some
startling statistics to demonstrate the impact mental illness
has on our country. One out of every five children has a mental
health disorder. Two-thirds of our nation's seniors living in
nursing homes have a mental health disorder.
Although 80 percent of those with depression can be
effectively treated, only one out of three receives appropriate
treatment.
The economic burden related to mental illness is staggering
with the total estimated cost for mental health disorders in
1994 at approximately $204,000,000,000. I would like to
reiterate that mental illnesses are biological, medical
illnesses.
First APNA is seeking increased Federal support for
psychiatric nursing research. Psychiatric nurses have been and
will continue to be an integral part of our nation's research
community.
With this in mind, APNA would like to commend this
subcommittee and in particular, Congresswoman DeLauro for the
fiscal year 2001 appropriations measure that led to a joint
NINR and NIH mentorship program for psychiatric nurse
researchers. The program will support the development of expert
psychiatric mental health nurse researchers in the area of
measuring outcomes in the care of psychiatric patients.
APNA is extremely excited about this program and wishes to
acknowledge the tremendous work done by Dr. Patricia Grady,
Director of NINR, and Dr. Steven Hyman, Director of NIMH, and
the staff at both institutions.
In addition to supporting the nurse researcher mentorship
program, strong Federal support is needed in order to build our
nation's research capacity by ensuring an adequate supply of
nurse researchers.
As a result, we would ask the committee to include nurse
researchers in any research-related loan repayment program so
that we can attract the most promising students into
psychiatric nursing research.
We would also like to take a moment to note our concern
that current NIH and NINR funding does not fully reflect the
broad range of psychiatric nursing research. With the grant
funding focused on issues such as violence and substance abuse,
while these issues are very important, we would like to extend
this research portfolio.
In all, APNA is seeking $144,000,000 for NINR and at least
a 16.5 percent increase for NIMH.
APNA's second priority relates to the nursing shortage our
country now faces. I am sure you folks have heard a lot about
that. In order to address this serious problem, APNA and other
members of the health professions and nursing education
coalition recommend at least $440,000,000 in fiscal year 2002
overall funding for Title VII and Title VIII of the Public
Health Service Act.
These figures do not include funding for the children's
hospitals Graduate Medical Education Program, an amount
separate from Title VII and Title VIII funding.
Within the health professions programs, APNA is joined by
other members of the nursing community in seeking a minimum
increase of $25,000,000 within Title VIII.
Further, we are seeking an additional $10,000,000 for 2002
for the Nursing Education Loan Repayment Program. Equally
important, APNA is advocating for an improved data collection
to learn even more about our nursing workforce.
Finally, APNA would like to ask for the committee's helpto
ensure that recent reforms related to the use of seclusion and
restraint include the expertise of our nation's psychiatric nurses. We
are concerned that new policies could overlook our nation's psychiatric
nurses in a way that could negatively impact patient and staff safety.
Safety in nursing work environments is crucial with the
impending nursing shortage.
Thank you very much for providing me with the opportunity
to present our funding priorities. I would be happy to answer
any questions.
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Mr. Peterson. The last county medical society that I met
with shared with me that 40 to 50 percent of their patients
needed mental health treatment. That has not been historic; has
it?
Ms. Hill. It actually has been historic, but I don't think
we have discovered or admitted or understood that until more
recently with some of the advances that we are finding, that
people have described before this community in terms of being
able to look in people's brains and understanding that many of
what we heretofore thought were maybe disorders of aging or
just adulthood or disorders related to stress actually had a
biological and medical basis.
The more we understand that, the more we are beginning to
diagnose and hopefully treat those illnesses.
Mr. Peterson. But you don't think that is an uncommon
figure?
Ms. Hill. No, I do not.
Mr. Peterson. Do psych nurses basically work in psych
units? I have a lot of small rural hospitals. They don't all
have psych units. But if they don't have a psych unit, would
they hire a psychiatric nurse?
Ms. Hill. Eighty percent of our psychiatric nurses are
functioning in hospitals, but not in small rural hospitals. If
there is not a psychiatric unit in a hospital, it would be very
hard to find a psychiatric nurse.
Mr. Peterson. They are basically in where the units are?
Ms. Hill. Right.
Mr. Peterson. You kept using the term ``mental health
nursing research.'' I don't quite understand that term.
Ms. Hill. Well, in the past most of the nursing research
that has been done has not been funded. Psychiatric nursing,
mental health nursing research has not been funded or it has
been under-funded.
We have had some great success in the last year getting
some dollars put towards nursing research for psychiatric
nursing. That is what we are asking about. Much of the funding
has gone to much broader nursing research that does not relate
to psychiatry.
Mr. Peterson. Is that separated from psychiatric research
in general? I guess that is the question maybe I should have
asked. Why is it separate who the provider is, whether it is a
nurse or a doctor?
Ms. Hill. Again, nursing research has a specific body of
knowledge all its own which relates to how patient care
influences how patient care influences people to get better. It
is a different science.
Mr. Peterson. Do you think we need to get a little bit
drastic, maybe, in our future budgets about dealing with the
nursing shortage in general, beyond psychiatric, I mean just in
general. Are we approaching, in your view, a huge crisis?
Ms. Hill. A drastic crisis.
Mr. Peterson. I have young nurses in my district, who, now
that we are basically Bachelor's degree nurses, who found that
they can go to school one more year and be anything they want.
That is a foundation for other careers. So, what we thought was
maybe the right direction now allows them to just move on.
Several are going to be accountants, CPAs. That is not exactly
what you would think a nurse would go to.
But because of what they found on the floor in their first
two or three years in practice, they are just moving on. They
are going to night school and they are going to move on and
leave the nursing profession.
If it is like that across the country, we are really in
trouble.
Ms. Hill. That is right.
Mr. Peterson. We are always looking for projects or pilots
that we can do across this country. I think we really need to
put our thinking caps on to discover how we can get people into
nursing quickly.
Ms. Hill. I agree.
Mr. Peterson. I look forward to your advice.
Ms. Hill. Thank you.
Mr. Peterson. Dr. Robert Schwartz, Professor and Chairman,
Department of Family Medicine and Community Health, University
of Miami, School of Medicine.
Good afternoon and welcome.
----------
Thursday, March 22, 2001.
ORGANIZATIONS OF ACADEMIC FAMILY MEDICINE
WITNESS
ROBERT SCHWARTZ, PROFESSOR AND CHAIR, DEPARTMENT OF FAMILY MEDICINE AND
COMMUNITY HEALTH, UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
Dr. Schwartz. Thank you. It is an honor and a privilege to
be here. As you mentioned, I am Professor and Chair of the
Department of Family Medicine and Community Health at the
University of Miami School of Medicine. I am also a member of
the board and legislative chair of the Society of Teachers of
Family Medicine.
I have been a practicing physician and teacher for more
than 20 years. I thank you for the opportunity to be able to
talk on behalf of the organizations of academic family medicine
today.
I am here to discuss two programs under the purview of this
committee: The Family Practice Training Programs under Title
VII of the Health Services Act; and the Agency for Health Care
Research and Quality, also known as AHRQ.
Both of these programs address real and important needs in
our society. These programs are not sexy. They do not have a
natural and sympathetic constituency. What they do have is a
proven ability to make positive changes in our nation's health
care and in our patient's lives.
These are programs this committee supported well in the
last funding cycle. We are asking for that support again this
year.
We ask in addition that the funding for the Primary Care
Medicine and Dentistry Cluster of Title VII be increased
$158,000,000. This would allow for $96,000,000 for family
practice training programs.
Currently, the Federally funded educational system
reinforces the sub-specialization of the physician workforce.
The President's budget blueprint says that the nation has too
many doctors. We respectfully disagree.
What we are experiencing is a surplus of specialists. We do
have a shortage of doctors, primary care physicians and doctors
who care for families.
Title VII programs are designed to counter this market bias
and support development of the primary care physician
workforce. These are the only Federal programs that explicitly
fund the infrastructure to produce physicians who will address
Congressional stipulated goals. They will help deliver health
care to under-served populations. They will bring health care
professionals to rural areas and will improve geographic mal-
distribution of the physician workforce.
We are excited because now we have new data. Federal
funding through Title VII of Family Medicine Department's pre-
doctoral programs and faculty development has made a
difference. A current study shows that these three types of
grants really do make a difference in producing more family
physicians and more primary care doctors.
Pre-doctoral and department development grants made a
difference in producing more primary care doctors serving in
rural areas and more doctors serving in primary care health
professional areas, also known as HPSAs.
Sustained funding during the years of medical school
training had more positive impact than intermittent funding.
Another recent study data show that without family physicians
over 1,000 additional counties would qualify for this
designation as a HPSA.
This compares to an additional 176 counties that would meet
the criteria if all internists, pediatricians and obstetricians
in aggregate were withdrawn. These funds must be maintained and
increased to help our nation's service needs.
I would like to share one of the main success stories
created by Title VII funding. Dr. Joyce Lawrence is a young
African-American woman who grew up in Liberty City, one of the
poorest communities in South Florida and even in the country.
She was able to gain entrance to the University of Arizona
School of Medicine and early in her training was exposed to a
Title VII-funded pre-doctoral family medicine. This had an
enormous impact on her future.
Dr. Lawrence graduated, returned to Miami, determined that
she was going to do something for the community in which she
grew up. She gained a position in our residency program,
supported through the years again by Title VII dollars and
successfully completed her three-year post-graduate training.
Dr. Lawrence was recently hired as the medical director for
a privately-funded school health initiative to put health care
back into the Miami-Dade County school system, one of the
largest public school systems in the country, one with limited
health care access for its predominately minority and under-
served community.
This is a real success story, but only one of many made
possible by sustained Title VII funding for academic family
medicine in the country.
Mr. Chairman, the other program I am testifying on today is
funding for AHRQ. We also appreciate the increased funding
provided this past year. However, we support a budget
allocation of $400,000,000 for fiscal year 2002. This includes
funding for patient safety, translating research into practice,
outcomes research and 350 new investigator-initiated grants.
Why? Just like Title VII programs, the research conducted
through AHRQ is critical to responding to national health care
needs. While our country has dramatically increased investment
in basic medical science research through NIH programs, there
has been little support to answer questions of major concern to
many America's and their family physicians.
Nor has there been adequate effort to develop the clinical
applications in primary care from this new basic science
knowledge. We applaud the investment in NIH, but we feel
strongly that an increase in funding for AHRQ will dramatically
enhance the ability of the recent resources to maximize
research in primary care.
As a practicing family doctor, I need to know how the rapid
advances in new pharmacological products, information,
technology, gene therapy, and diagnostic techniques are
applicable to the care of my patients.
In addition, we need to know the risks of these new
treatments and techniques. AHRQ is the only Federal agency to
support this.
Thank you, Mr. Chairman.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Peterson. Thank you, Dr. Schwartz.
Let me ask the first question. What do you consider primary
care?
Dr. Schwartz. Well, that is a good question and obviously,
it is a controversial one.
Mr. Peterson. It shouldn't be.
Dr. Schwartz. It shouldn't be. A family doctor is a
physician who has been trained to take care of the entire
family. They do pediatrics. They do adult medicine. Many of
them still do obstetrics and gynecology. They specialize in
geriatrics. Behavioral medicine is a very important component
of the family medicine programs.
It is really the broadest physician that exists in the
United States and it is the perfect physician for rural areas
and urban centers. The interesting thing is that the majority
of the care to poor and minority populations, the under-served,
takes place in academic or residency training programs
throughout the country.
Mr. Peterson. I always considered family physicians
internists. OB-GYN, I know that is one lot, too. But I don't
understand it because OB-GYNs are many women's primary doctor.
And you mentioned pediatrician. Who should I have included in
that? Anybody else?
Dr. Schwartz. Primary care is usually all of those that you
mentioned. But family physicians consider themselves the real
primary care physician because we really do the broad range of
services where many families go to one physician and then, if
they have a problem, they are referred to somebody else and a
third and a fourth.
One of the things that we hold up most importantly is
continuity of care, seeing the same physician year after year,
understanding patient's problems and understanding them within
the context of family. Those are some of the things that
unfortunately modern medicine has pushed aside.
We have really created so many sub-specialties, I hear all
the time of people being grateful for having a family physician
who really knows the entire family.
Mr. Peterson. In the rural setting, if I did not look at
their license, I would not know an internist from a family
physician because they practice almost the same. Most people
don't know the difference.
Dr. Schwartz. No. That is true.
Mr. Peterson. Where are we at today in the percentage
coming through the primary care specialty? Do you know what the
numbers are nationally? I don't.
Dr. Schwartz. Well, you are going to hear in the news very
soon that today was the match results and unfortunately family
medicine training programs did not do as well as they have done
in the past. That is a significant problem. It has improved
dramatically in the last decade, but as has been mentioned
today, there are many pressures that push students into sub-
specialty medicine. Salaries are much higher in diagnostic
radiology.
Loan repayment is an enormous issue. Students are coming
out with $90,000 or $100,000 indebtedness. Those are clearly
forces that push people away from doing family medicine.
Mr. Peterson. A decade or more ago in State government I
chaired health and welfare. I got the attention of our nine
medical schools by proposing legislation that would have made
those who go into primary care residencies less costly than
those who chose the other.
The medical schools were all in my office within a week
discussing this issue. Now, what I was able to do was-we
changed the numbers in Pennsylvania. I have not watched them
since I left five years ago. But we changed the numbers and
primary care residencies grew in Pennsylvania because of that
action and that fear that we were going to do something to
penalize them.
Of course, some of the bigger schools went back into
primary care because they needed the doctors themselves, just
to fill their own slots.
Now, I guess I would be for loading some incentives. We
have to somehow change this. Everett Koop was the one who
brought me to the issue years ago. We don't have that kind of a
voice any more. He talked about this issue a lot.
I don't think people realize where we are headed.
Dr. Schwartz. I think you are right. I think it is an
extraordinary problem in terms of people understanding that
primary care physicians are essential in health care.
Many of the problems that were discussed today in terms of
the research, et cetera, can only really be handled on the
front line. There is less hospitalization than ever before
because of the cost of hospitalization. Well, where is that
care going to take place but in the community?
You also mentioned the issue of medications. I feel very
strongly that our communities and patients are over-medicated.
One of the reasons we need money in AHRQ is because outcomes
research needs to occur in the community. A lot of the things
that we empirically know as physicians need resources to be
funded.
Mr. Peterson. Come to me privately with you are ideas about
what we talked about. We are running short of time here today.
I would love to talk to you for an hour. Sometime contact me, I
will be glad to work with you.
Dr. Schwartz. Thank you very much, sir.
Mr. Peterson. Next, we are going to hear out of order
Patricia Underwood, the First Vice President of the American
Nurses Association.
If you have a flight problem, let us know.
Welcome. Please proceed.
----------
Thursday, March 22, 2001.
AMERICAN NURSES ASSOCIATION
WITNESS
PATRICIA W. UNDERWOOD, FIRST VICE-PRESIDENT
Ms. Underwood. Good afternoon. Mr. Chairman and members of
the subcommittee, I am Patricia Underwood, the First Vice
President of the American Nurses Association, the only full
service professional organization representing the nation's 2.7
million registered nurses.
This afternoon I will address funding for nursing education
and research. The American Nurses Association believes that our
shared goal of ensuring the nation of an adequate supply of
well-educated nurses will reaffirm the need for increasing
funding for these programs.
Mr. Chairman, as you know, there is a shortage of nurses,
particularly due to a mal-distribution of nurses and their
unwillingness to work in dissatisfying and unsafe environments.
An even more critical shortage of nurses is coming due to a
lack of young people entering the nursing profession.
Due to an aging workforce, the average age of the working
nurse is 43.3 years, and also due to nurses leaving the
profession because of increasingly stressful, non-supportive
working environments.
This shortage will mean that patients in hospitals and
long-term care may not get the frequent checks that they need
to ensure quality of care, prevent complications and thereby
increase hospital stays and increase mortality.
This shortage will also mean that there will be not enough
nurses to care for our vulnerable population such as children,
the elderly or those with mental health problems. It will mean
that there will not be enough nurses to promote health in our
inner city environments and in the rural areas of our nation.
There are several things that can be done right now to
begin to increase the supply of nurses and to create the
environments that will attract and retain nurses.
ANA is encouraged by President Bush's budget blueprint that
recommends focusing on resources, on grants that address
current health care workforce challenges such as the nursing
shortage.
Now, the first thing that we can do is to support the
expansion of programs under the Nurse Education Act
reauthorized under Title VIII of the Health Professional Act of
1998. It provides for competitive grants to schools of nursing
to strengthen nurse education. Unfortunately, lack of funding
within the current NEA has kept the Health Services
Administration from funding programs such as scholarships for
disadvantaged students.
The HRSA Division of Nursing reports that it will not even
hold a competitive grant cycle for nurse stipend and pre-entry
programs for this year due to lack of funds.
The American Nurses Association supports a $25,000,000
increase to a total of $103,700,000 for NEA.
Secondly, we need to find ways to increase the number of
nursing faculty because the average age of the nursing faculty
is 55 years. If we are going to be able to increase the number
of nurses, we have to have the faculty to education them.
Preparation at the Masters level could be increased through
NEA by expanding the current loan repayment program. Fifty
percent of all applications made for loan repayment, however,
are denied due to a lack of funds.
ANA supports increasing the funding for this repayment
program to $10,000,000 for fiscal year 2002.
Preparation of faculty at the doctoral level could also be
increased to some degree through pre- and post-doctoral
training grants provided by the National Institute for Nursing
Research.
Currently, we need to look at funding to ameliorate the
shortage. We need to look at issues that address the nurses
working environment.
Research shows that health facilities catering to nursing
needs are like magnets and can draw nurses to them. It is
interesting, ANA has data that clearly indicates that when you
have appropriate nurse staffing in acute care settings, there
is a decrease in hospital-acquired infections, a decrease in
patient falls, a decrease in pressure sores, a decrease in
lengths of stay and an increase in patient satisfaction, all of
which increase recovery and decrease the cost of health care.
Appropriate staffing also increases nurse satisfaction with
the care that they provide. Further, research has shown very
clearly that the ability of nurses to have decision-making
authority at the bedside and throughout the organization is one
factor that enables hospitals to attract and retain nurses.
Increased funding for the National Institute for Nursing
Research so that research to find models to retain nurses and
identify interventions that are able to achieve the desired
health outcomes with the lowest cost is essential.
Nursing research helps attract talented people into the
profession and provides nurses with an opportunity to conduct
research that makes a difference in the lives of patients.
Mr. Chairman, we thank you for your support of nursing
education and research. You have the opportunity to act in a
way that will truly influence the health of our nation.
Thank you. I would be happy to answer questions.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Peterson. I would just like to run an issue by you.
Last year when a group of nursing school people were visiting
me, I urged them to come back and give us some ideas on how to
deal with the nursing shortage.
Two weeks ago they came to my office and gave me a
proposal, asking for a little money. It was the following: This
major nursing school from a major university in Pennsylvania is
going to couple with a group of hospitals and also with a group
of LPN programs and it will be a two-year nursing degree
utilizing LPNs with a certain amount of floor experience.
I would be interested in your reaction to that. That is
sort of a difference in the trend. We have been phasing out of
the two- and three-year programs that have provided a lot of
our nurses to all four-year Bachelor degrees.
Are we in a position where we may have to reverse that?
Ms. Underwood. I do not personally agree with reversing
that. The problem is, when you think about the shortage, many
times people think, okay, let's get more bodies in there to
give care.
The reason this shortage that we are heading for, and it is
going to peak around 2010, is that we have an increasing
demand, because of the increasing acuity in the health care
system throughout the country, we have a demand for an increase
in nurses with more knowledge and experience.
It is those very nurses that have more knowledge and
experience would are going to be retiring and moving out of the
system. So, just increasing the number of new people coming in
is not going to help that. One of the things that I think is a
much more attractive model that a number of State have been
using, is to really encourage nurses who have their associate
degree, their two-year programs, to make the articulation
between the two-year and the four-year and the articulation
actually between the LPN and the two-year and four-year much
more smooth and to really get those people in and facilitate
their moving up in terms of the nursing education.
But just having more people educated is not enough if we
don't change the working environments to keep people.
You mentioned to another speaker about the people who are
preparing for nursing and then going into other fields. While
nursing is great, we need to keep them in nursing.
Mr. Peterson. But I think something has happened that I
didn't anticipate. I didn't realize a Bachelor degree nurse
could go to school for one more year and go to almost any
career that she wants. That is something I think we have to
look at.
I guess a lot of my hospital administrators and nursing
home administrators would argue with your theory. I personally
think we need to do what you want to do and do what this
university wants to do.
We can discuss that another day, but I think the problem is
large enough that if we did all of the above, we are still
going to be in trouble.
Ms. Underwood. One important point that I think you did
make and it came through: This is not a situation that nurses
can solve by themselves, even if we are totally united as a
profession.
We really need to work with all of you and with the public
and with the physicians and with the hospitals to address the
issue.
Mr. Peterson. Thank you.
Mr. Regula [resuming chair]. Our next witness is Dr.
William Harmon, Transplant Physician and Director of Pediatric
Nephrology, Children's Hospital, Boston.
We are happy to welcome you.
----------
Thursday, March 22, 2001.
AMERICAN SOCIETY OF TRANSPLANTATION
WITNESS
WILLIAM E. HARMON, TRANSPLANT PHYSICIAN AND DIRECTOR OF PEDIATRIC
NEPHROLOGY, CHILDRENS HOSPITAL, BOSTON, MASSACHUSETTS
Dr. Harmon. Mr. Chairman, thank you for the opportunity to
present testimony on behalf of the American Society of
Transplantation. I am William Harmon, a transplant physician
and Director of Pediatric Nephrology at Children's Hospital in
Boston and Secretary-Treasurer and Chairman of the Public
Policy Committee of the American Society of Transplantation.
The AST, which is a professional organization that has no
governmental support, was established in 1982. Our membership
which now numbers more than 1,600 is comprised of physicians,
surgeons and scientists engaged in the research and practice of
transplantation medicine, surgery and immunobiology.
The AST is the largest professional transplant organization
in the United States and represents the majority of
professionals in the field of transplantation.
Today, there are more than 75,000 Americans whose names are
on the organ transplant waiting list. During the next hour,
four new names will be added to that list. By the time I get
home to Boston this evening, at least 15 individuals will have
died because the wait for a transplant was just too long.
These patients awaiting transplantation represent a cross-
section of our society. They are mothers and fathers who
provide for their families. They are community and business
leaders. And they are children who should havetheir entire
lives ahead of them.
We have made great strides in the past four decades of
transplantation and we have developed extraordinary medical and
surgical procedures to provide transplants to people with
catastrophic organ failure. But the very success of these
procedures has expanded the pool of candidates much faster than
the supply of available donors.
We simply don't have enough organs to transplant. The organ
transplant waiting list has increased in size by approximately
380 percent in the last ten years while the number of available
donors has changed very little.
Each year the AST identifies the shortage of available
donors as the number one problem in the field of
transplantation. The Society is particularly pleased to see
that Secretary Thompson was very quick to emphasize the need
for enhancing organ donation in the United States.
Support for organ donation is only half the battle. The
other critical issue is ensuring the long-term survival and
function of the transplanted organ. Over the last 40 years,
transplantation of solid organs has moved from an experimental
to an accepted therapy with approximately 22,000 transplants
performed in the United States annually.
The short-term success of this procedure has improved
greatly over the last few years with recipients now enjoying
more than 90 percent survival at one year. Most of this success
can be attributed to research in immunosuppression that is
being funded by Federal appropriations.
Our better understanding of immunity and the body's
response to foreign proteins has led to countless breakthroughs
in many areas of medical science.
The AST believes that now at the dawn of a new millennium
we are on the threshold of many important scientific
breakthroughs in the area of transplantation research. These
include new insights into the immune mechanisms of rejection,
the induction of total tolerance transplant organs, the
immunologic response to animal organs and tissues, so-called
Xenographs, and even bold new experiments in tissue engineering
and organ development.
As one example, two years ago NIAID, NIDDK and the Juvenile
Diabetes Foundation collaborated in the formation of the Immune
Tolerance Network, which is dedicated to the rapid development
and deployment of novel clinical trials in the broad areas of
organ transplantation and autoimmune diseases.
Already new trials have begun and important scientific data
are being collected by the ITN.
AST strongly urges the subcommittee to continue its
leadership in the area of biomedical research and to provide at
least a 16 percent increase in funding for the NIH in fiscal
year 2002.
The AST supports the level of increase for NIAID and HLBI
and NIDDK.
To truly translate the promises of scientific discovery
into better health for all Americans, the President, Congress,
and the American people must continue the commitment to
significant, sustained growth in funding for the NIH.
Clinical and basic transplantation funding at the NIH must
be increased. In particular, we recommend to Congress that the
NIH give consideration to high priority initiatives of NIAID
and HLBI and NIDDK, which I have provided to you in written
testimony.
The fruits of current research have produced many important
successes in the field of transplantation. Ever more precise
and powerful transplant immunosuppressive drugs have greatly
increased both patient and graft survival. However, despite
today's success, virtually all the transplanted organs will
eventually be lost.
Many challenges lie ahead of us, including the
understanding of preexisting and concomitant illnesses such as
cardiovascular disease, hypertension, infection, hepatitis,
bone disease, diabetes and malignancies.
In addition, the therapeutic strategies to induce donor-
specific tolerance hold promise. The strategies to overcome
Xenogenetic barriers have begun. Expansion of these programs,
as well as others I have provided, will ultimately enable
transplant physicians, surgeons and scientists to provide
patients with a successful transplant for a failed organ for
their entire natural lifetime.
Therefore, I end my remarks here today by repeating AST's
request that this subcommittee and Congress stay on track to
double NIH's research budget by the year 2003 and permit these
high priorities and initiatives to move forward.
Thank you very much.
Mr. Regula. Thank you. As I understand it, there is a
nationwide compilation of the people who have need of a
transplant so that you have to take your turn.
Dr. Harmon. Yes. Every patient who is on the transplant
list is known by what is known as the Organ Procurement and
Transplant Network, which is funded through the NOTA
legislation which was enacted in 1987.
We track every patient and every donor so we know who is
coming up. There are 75,000 of them waiting right now.
Mr. Regula. I know. My secretary in the committee I
previously chaired is waiting on lungs. I think she is number
two or three at Johns Hopkins.
I explored Pittsburgh and they said, well, the order of
succession is the same no matter where you go because it is a
nationwide program.
Dr. Harmon. It is a national program.
Mr. Regula. You are doing a lot of great work, though. I
know my colleague, Floyd Spence, is a wonderful example of the
success. He had a lung replacement maybe ten years ago.
Well, thank you for coming.
Dr. Harmon. Thank you very much.
Mr. Regula. The next witness is Dorothy Mann, Board Member
AIDS Alliance for Children, Youth and Families.
----------
Thursday, March 22, 2001.
AIDS ALLIANCE FOR CHILDREN, YOUTH AND FAMILIES
WITNESS
DOROTHY MANN, BOARD MEMBER
Ms. Mann. Good afternoon, Mr. Chairman. My name is Dorothy
Mann. I am a Board member of the AIDS Alliance for Children,
Youth and Families, a national organization addressing the
needs of children, youth and families who are living with,
affected by or at risk for HIV and AIDS. It is my honor also to
serve on the CDC's HIV STD Prevention Advisory Committee.
I am also the Executive Director of the Family Planning
Council in Philadelphia, serving over 120,000 Title X funded
family planning clients. We also provide a range of community-
based HIV and STD prevention, screening and treatment services.
Mr. Chairman, I am here today because our nation is
becoming complacent about AIDS. How many new HIV infections do
you think we have in this country every year? In 2001, 40,000
people will become newly infected with HIV. Half of these
infections will occur in people under 25.
That means 100 people in this country will become infected
with HIV today and again tomorrow. Can we prevent HIV from
infecting 40,000 people in America? Yes. But it will take
bolder leadership, increased funding and smarter allocation of
resources.
The Ryan White Care Act, which was reauthorized by Congress
in the year 2000, is the most critical Federal program
dedicated to people living with HIV and AIDS.
Today I will focus on Title IV of the Care Act, which
provides funding for medical care, social services and access
to research for children, youth, women and families. Simply
put, Title IV is a success story. It has enabled communities to
respond quickly and efficiently to the HIV epidemic.
Since the science became clear about the role of AZT in
reducing mother-to-child HIV transmission, Title IV grantees,
including my own, have played a major role in the remarkable
steady decline in the number of infants born with HIV in this
country.
CDC estimates that fewer than 200 infants were born with
HIV last year. But even one baby born with this disease is too
many. As the number of HIV-infected women of childbearing age
rises, reducing perionatal transmission becomes more
challenging and expensive.
Despite the successes of Title IV, currently funded at
$65,000,000, much more needs to be done.
The President's budget calls for a four percent increase in
discretionary spending. But with 40,000 new infections each
year, we need to increase spending on Federal AIDS programs
much more than four percent or people will die.
If funding for the Federal AIDS program does not keep pace,
individuals, families and entire communities across the country
will continue to be decimated by this terrible disease.
The AIDS Alliance recommends a total funding of $83,000,000
for Title IV for fiscal year 2002. This is a 28 percent
increase over 2001, which is the same rate we received this
year.
As you know, the Congressional Black Caucus Minority AIDS
initiative has provided critical increase in Federal AIDS
programs reflecting the disproportionate impact of HIV and AIDS
on communities of color. Eighty-four percent of the clients
served by Title IV are people of color.
AIDS Alliance would be happy to provide additional
information to this committee as you consider the Congressional
Black Caucus funding for 2002.
It goes without saying that HIV is spread from an infected
person to an uninfected person. Thus far we have focused HIV
prevention efforts almost exclusively on uninfected people. We
have largely ignored those who are already infected.
Mounting evidence suggests that as people with HIV are
living longer and more active lives, they are more likely to
engage in unprotected sex. Let me be clear. I am not advocating
laws or policies that criminalize or stigmatize HIV-positive
people or their behavior.
I am talking about interventions that help HIV-positive
people reduce their risk behavior and protect their uninfected
partners.
What can be done? We must work to break down the walls
between HIV prevention and care programs. As you appropriate
funding to agencies such as HRSA, CDC, and SMSA, you must
encourage coordination to the greatest extent possible to
reduce barriers between these agencies and between prevention
and care.
It is estimated that CDC needs an additional $300 million
each year to implement their new strategic plan to reduce HIV
new infections to 20,000. Scientific evidence should be the
basis for HIV infection policies.
We know, for example, that needle exchange programs work
and do not increase drug use. Yet, we still have Federal
restrictions on their funding. We need to take politics out of
science.
Let me leave you with a final thought: Reversing the
nation's growing complacency about AIDS is a daunting task, but
we must do more, much more, than simply prevent an escalation
in the rate of new infections.
It is intolerable. If we had 40,000 American casualties in
a war, would we find that acceptable? I hardly think so. We
have to do more because if we don't, it will only get worse.
Thank you.
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Mr. Regula. Our next witness is Emily Sheketoff, Executive
Director, American Library Association.
----------
Thursday, March 22, 2001.
AMERICAN LIBRARY ASSOCIATION
WITNESS
EMILY SHEKETOFF, EXECUTIVE DIRECTOR
Ms. Sheketoff. Thank you, Chairman Regula.
We wish to thank you for your support for our libraries in
the past. We look forward to working with you on behalf of
America's libraries in your first year as Chairman of this
subcommittee.
I know that you are familiar with libraries, as a result of
your experiences as a teacher, and as the father of a librarian
at Western Reserve in Hudson, Ohio.
I would like to talk to you about the crucial benefits that
Federal support brings to the libraries.
Mr. Regula. You did not know that my wife started the
National First Ladies Library.
Ms. Sheketoff. Yes, sir, and I have a terrific magazine
article with a good picture of that for you. [Laughter.]
So I tried hard. On Federal support for libraries, we would
like to talk about two key National goals: outreach to those
for whom libraries service requires extra effort or special
materials, such as individuals with disabilities; and
mechanisms to identify, preserve, and share library and
information resources across institutional or governmental
boundaries through technology.
The library community is capable of astonishing creativity
and expertise in support of National goals such as revitalizing
the economy, having children start school ready to learn, and
developing literate, informed adults.
Oftentimes, one of the few sources of funding for
innovation available to libraries is Federal funding. It is
estimated that library programs generate from three to four
dollars for every Federal dollar invested.
Mr. Chairman, our new President has said on many occasions,
``We must leave no child behind.'' I can tell you that
America's libraries believe that we must lead no reader behind.
That is why we feel so strongly that library programs need
additional Federal funding.
We need to ensure equitable access and participation of our
Nation's readers to library activities and opportunities in
their communities. We need to support our libraries continuing
efforts to keep pace with the rapidly changing information
technology environment.
We need to recognize the important contributions that
libraries make to the social, civic, and educational health of
their communities. Like many schools, libraries often service
as the hubs of their communities, and provide important
services, training in technology, and opportunities for life
long learning, particularly in traditionally under-served
areas.
Recently, the library community corroborated on developing
a draft for the reauthorization of the Library Services and
Technology Act, which will expire in fiscal year 2002. We are
seeking to increase the authorization level to $500 million. As
you know, this represents a significant expansion in the
Federal Government's commitment to the support of our Nation's
libraries.
Today, we request your support for fiscal year 2002 of a
down-payment of $350 million for library programs authorized
under LSTA. With this increase, more libraries could expand
their services to include technology training and literacy
programs that enable students to achieve the success and
education, and programs for families, who may not have not used
libraries before.
Library programs for young children encourage pre-reading
skills and develop a love for reading.
Mr. Regula. We will have to wrap it up. I am going to have
to go vote here. You are preaching to the choir.
Ms. Sheketoff. Great, well, I just wanted to give you an
example in Ohio. In this year, Ohio received $5.5 million. If
the state distribution was increased to $350 million, Ohio
would get about $11 million. This would enable Ohio to complete
the school library connections to the statewide Ohio network.
In 1999, the libraries of Ohio requested $7.5 million in
LSTA funding, but received only $2.9 million. So you see, the
need is great and the funds available can stretch only so far.
We are also asking that this subcommittee support education
Title 6, the Block Grant that goes to libraries, at least at
the $400 million level.
As you know, school library materials are only one option
of this block grant. Unfortunately, less and less of the funds
are used for school library materials. As a result, many school
libraries have old, outdated, and inaccurate material on their
shelves.
Research shows that a good library media program in the
school is an excellent predictor of student achievement. In
summary, an increase in LSTA funding to $350 million would
allow more of the 16,000 libraries to begin to provide Internet
training and information access services to families, adult
learners, the small business sector, and the communities who
need them.
Thank you very much, Mr. Chairman.
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Mr. Regula. Thank you, and they are very important. I
understand that. We, of course, have constraints on what we
have available.
Ms. Sheketoff. With a real dedication to education, the
library component is really critical.
Mr. Regula. Well, we hope that we get enough adequate
funding from OMB.
Thank you for coming today. I regret that I have to get
over to there and vote or we will run out of time.
Ms. Sheketoff. Thank you, Mr. Chairman.
Mr. Regula. The committee will be in recess for about 10
minutes.
[Recess.]
Mr. Regula. We will reconvene.
Our next witness is Mr. Richard Kase.
----------
Thursday, March 22, 2001.
ARTHRITIS FOUNDATION NORTHEAST OHIO CHAPTER
WITNESS
RICHARD D. KASE, CHAIRMAN, CANTON OHIO ADVISORY BOARD, ARTHRITIS
FOUNDATION NORTHEAST OHIO CHAPTER
Mr. Kase. Good afternoon, Mr. Chairman and members of the
subcommittee, which are few and far between at this stage of
the game.
Mr. Regula. Yes, that is true.
Mr. Kase. It is truly an honor to speak to you, one of
Canton's favorite sons.
I want to thank you for the opportunity to speak today
about how Congress can continue to play an important role in
helping improve the quality of life for the 43 million
Americans living with arthritis, including the 300,000 children
living with the disease.
Specifically, I would like to thank the subcommittee for
its leadership in supporting funding increases to support
arthritis research at the National Institute of Arthritis, and
musculoskeletal skeletal and skin diseases and the Centers for
Disease Control and Prevention's Arthritis Program.
As I said, my name is Richard Kase. I am from Canton, Ohio.
I am a business man and a volunteer. I am here today in my role
with Arthritis Foundation of Northeast Ohio as the Volunteer
Chair of the Canton Area Advisory Board.
I am also one of the 43 million Americans living with this
painful and oftentimes debilitating disease. I was first
diagnosed with osteoarthritis in 1992, at the age of 40.
Due to osteoarthritis, I have had five knee operations and
one back surgery. While osteoarthritis limits my daily
activities, simply climbing stairs is extremely painful.
I consider myself fortunate. For today, there is new hope
for the millions of Americans with arthritis. We have new, more
effective therapies to prevent pain and disability, thanks to
the Federal investment in research.
With the CDC's arthritis program, we are reaching out and
empowering millions of Americans to help them take steps to
improve their quality of life.
Mr. Chairman, 95,000 persons living in Ohio's 16th
Congressional District have arthritis. One of those individuals
is Tiffany Kenyan.
Tiffany was diagnosed with juvenile rheumatoid arthritis at
the age of four. Every day is a challenge, as she faces the
pain, physical disabilities, and psychological trauma brought
on by the disease.
Now a teenager, Tiffany has been unable to do many of the
activities that most of her friends take for granted. However,
thanks to new therapies, early diagnosis in the treatment and
the support of family, she plans golf, dances, and swims when
possible. She may have arthritis, but it does not have her.
Like me, Tiffany has been a beneficiary of the research
investments in the National Institutes of Health by this
subcommittee. Our lives have been made better, thanks to a new
generation of treatments and therapies, for the many serious
forms of the disease.
Ongoing growth in the NIH budget will provide the National
Institute for Arthritis and Musculoskeletal and Skin Diseases
the resources to support critical research ranging from
osteoarthritis to lupus to juvenile rheumatoid arthritis.
To meet this pressing national need, the Foundation urges
the members of the subcommittee to continue the doubling of the
NIH budget, within five years, and provide $462 million, as
part of the NIH's fiscal year 2002 appropriations for NIAMs.
With this in mind, the Arthritis Foundation strongly
believes this investment must be matched with a similar
investment in public health programs, designed to ensure that
all Americans benefit from our new understandings about the
disease, effective self-management strategies, and improved
treatment options.
As a person with arthritis, I am proud that Congress has
recognized the importance of this national effort by
establishing and funding the National Arthritis Action Plan,
which is a public health strategy.
This innovative public health strategy is being implemented
by the CDC, in partnership with state health departments across
America. The Arthritis Foundation, and its 55 state-based
chapters.
Among our goals are improving the scientific information
base on arthritis; researching how we can better prevent
arthritis; and encouraging more individuals with arthritis to
seek early diagnosis and treatment, to reduce pain and
disability.
Due to this subcommittee's support and leadership, the CDC
was provided with $12 million as part of the fiscal year 2001
budget, to move forward with this vision. To date, 37 states
have been awarded funds to begin executing the plan.
Based on the enthusiasm of our state partners, the
Foundation's commitment to invest its resources, and the
pressing need to address the growing public health problems
associated with arthritis, we strongly encourage the members of
the subcommittee to provide the CDC with $24.5 million, as part
of the fiscal year 2002 budget, to help establish state-based
arthritis programs in all states in territories.
This modest investment will help us meet the challenge of
arthritis, and lead to a day when arthritis is no longer the
leading cause of disability in the U.S., for individuals 18
years of age and older.
It will help lead to a day when arthritis no longer costs
our economy $82.5 billion a year in medical care and related
expenses, including lost productivity.
Congressman Regula, for generations, we have labored under
the many myths surrounding arthritis. Arthritis was an
inevitable part of the aging process. There were no effective
treatment options, apart from taking a few aspirin.
Exercise was harmful for individuals with arthritis.
Children do not get arthritis was another myth. It cannot be
prevented.
Today, we stand ready with the necessary tools, expertise
and energy, to shatter these myths, and capitalize on the
fruits of our research to help improve the lives of Americans
living with arthritis.
On behalf of the 43 million Americans living with
arthritis, I appreciate the opportunity to speak to you today,
and urge the members of the subcommittee to help us win the war
against arthritis by supporting funding for these critical
Federal Programs.
It has been a pleasure and honor to testify to you today on
behalf of all of the arthritis victims. Thank you.
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Mr. Regula. You are saying that there have been some very
substantial progress, though?
Mr. Kase. There has been tremendous progress, relative to
new drugs that have reached the market; great progress relative
to public awareness and prevention.
Mr. Regula. Do the drugs just relieve the pain, or do they
actually affect some degree of cure or change?
Mr. Kase. It is really a supplement to other non-steroidal
drugs, just to relieve the pain. I, for one, have been on
Vioxx, which is a new medication. You take one a day, as
opposed to the 12 Advil that I was taking every day.
Mr. Regula. I see Vioxx advertised. Does it work pretty
effectively?
Mr. Kase. For me, it has worked very well. For some people,
it does not work quite as well, and it has some side effects
for other individuals. But for me, it was a very good drug, and
is a very good drug.
Mr. Regula. Thank you for coming. I know it is a
substantial trip here from Canton, Ohio.
Mr. Kase. But to come to see you, Congressman, it was well
worth it. [Laughter.]
Mr. Regula. You had better reserve judgment until we get
the bill out and see.
Mr. Kase. Well, we will talk about that back in
Canton.Thank you. [Laughter.]
Mr. Regula. Well, we are going to do what we can for all of
these things. It depends what we have available in the
allocation of funds, which is beyond our control.
Our next witness is Dr. Paul Mintz, Professor of Pathology
and Internal Medicine, University of Virginia Health System.
----------
Thursday, March 22, 2001.
AMERICAN ASSOCIATION OF BLOOD BANKS
WITNESS
PAUL MINTZ, M.D., PROFESSOR OF PATHOLOGY AND INTERNAL MEDICINE,
UNIVERSITY OF VIRGINIA HEALTH SYSTEM; AMERICAN ASSOCIATION OF BLOOD
BANKS
Dr. Mintz. Good afternoon, Mr. Chairman. I appreciate the
opportunity very much to come here today.
I am Professor of Pathology and Internal Medicine at the
University of Virginia. Today, I am speaking to you on behalf
of the American Association of Blood Banks, the professional
society for approximately 8,000 individuals involved in blood
banking and transfusion medicine; and about 2,000 institutional
members, including community blood centers, the American Red
Cross, and hospital-based services.
Mr. Regula. I understand they are having trouble getting
people to donate. Is that true?
Dr. Mintz. That is true, sir. There really has been
intermittent blood shortages. Of course, fewer and fewer people
are eligible to donate, as restrictions are put into place.
Mr. Regula. Yes, well, mad cow disease has put a six month
waiting period on anyone in England, as I understand it.
Dr. Mintz. It is anyone who actually has lived in England,
between 1980 and 1996, for six months, cannot be a blood donor,
indefinitely, in the United States.
Mr. Regula. Indefinitely?
Dr. Mintz. That is correct. That actually is also going to
apply now in France, for people who have been in France for 10
years or Portugal for 10 years, based on a new recommendation.
So there are fewer and fewer eligible blood donors in this
country; that is correct.
AABB has long recognized the critical role of the National
Institutes of Health, and especially the National Heart, Lung,
and Blood Institute, and other public health agencies that they
have played in ensuring that patients have access to the best
possible transfusion therapies.
In fact, today, the Nation's blood supply is safer than it
has ever been. Each year, over 26 million units of blood are
transfused into millions of individuals. With enhanced Federal
support for research, transfusion medicine promises new
lifesaving therapies, as well as an even safer blood supply.
We strongly encourage to support the following research
initiatives. First, ongoing Federal support for blood supply
data is needed. Blood safety and availability are inseparable
requirements for ensuring optimal patient care.
The safest possible blood component cannot benefit the
patient if it is not readily available. The number and duration
of seasonal blood shortages are increasing. An aging population
and more complex medical procedures have resulted in an
increasing demand for blood.
In order to predict and prepare for possible shortages, we
need reliable data regarding both collection and utilization of
all types of blood components.
In 1996, recognizing the significant need for blood supply
data, the AABB founded the National Blood Data Resource Center,
the NBDRC. In prior years, NHLBI had funded this data
collection. However, when this Federal funding ceased, there
was a clear vacuum in public and private support for national
blood data collection.
The AABB is very proud of the fine work that the NBDRC has
produced, including its important biennial nationwide blood
collection and utilization survey. In fiscal year 2000, the
NHLBI agreed to fund the collection of certain monthly supply
statistics. Unfortunately, ongoing support from the NHLBI for
blood supply data is not continuing in fiscal year 2001.
The AABB is very concerned that so long as no specific
Federal agency is responsible for supporting critical data
collection regarding the blood supply, we will not be able to
generate necessary long-term information.
Policymakers, including Congress, cannot make sound
decisions affecting patients lives, absent reliable data.
Therefore, the AABB strongly urges Congress to designate an
appropriate office within the Public Health Service, to be
responsible for Federal support of blood supply data
collection. In addition, Congress should appropriate sufficient
dollars to support long-term efforts, like those of the
National Blood Data Resource Center, to collect,analyze, and
distribute data about the Nation's blood supply.
In short, we need to know who is donating the blood, what
kind of components are being collected, and where it is going.
Then we can plan responsibly regarding donor selection
criteria, and patient initiatives.
Mr. Regula. I assume you work with the American Red Cross,
since they seem to take the lead.
Dr. Mintz. Yes, that is correct. The American Red Cross is
responsible for about half the blood collection in this
country, and then other community blood centers are responsible
for the other half. We, in the AABB, actually work with all of
these centers.
A second initiative that I would like to suggest is
research regarding non-infectious risks of transfusion. The
AABB urges the subcommittee to support additional Federal
efforts to enhance the safety of blood transfusion.
In recent decades, the United States invested significantly
in reducing transfusion risks associated with infectious
diseases, as you well know. This investment has paid off
dramatically.
When I first taught medical students in 1979, I told them
there was one percent risk of acquiring what is not hepatitis C
from a blood transfusion. That risk is now about one in a
million. The same kind of statistics apply to HIV. The risk of
acquiring such an infection from a blood transfusion has
actually been reduced about 10,000 fold in the last 20 years.
Mr. Regula. So you have better control.
Dr. Mintz. We have better testing, better donor screening,
and also viral inactivation of many blood components.
Mr. Regula. How do we help?
Dr. Mintz. Actually, I think that right now, Federal
funding should be directed toward non-infectious risks. There
is actually about a 100 fold increase in risk of patient who is
receiving a blood transfusion right now, getting the wrong
unit, than there is of getting an infection.
There has not been an investment in the processes to assure
appropriate safeguards in getting the right unit to the right
patient.
Mr. Regula. Where would that investment be; CDC, NIH?
Dr. Mintz. I think it would be in developing a clinical
trials network, that would emphasize research in the non-
infectious risks of transfusion, including providing processes
to get the right unit to the right patient, and other non-
infectious risks, such as immuno-modulation.
Mr. Regula. Well, thank you, and we will put your testimony
in the record.
Dr. Mintz. Thank you very much.
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Mr. Regula. We have two young ladies here, and one of them
from my district. They are in the Presidential classroom, and
this is the real world, young ladies.
What we are doing in here will touch your lives, because we
do all the research on medical, and something that is
discovered over the next many months and years may save your
life.
Likewise, we do education. Of course, I am sure that is
important to both of you. So we are happy to welcome you. As
soon as we get finished up here, we will go back and get a
picture with you in the office.
Okay, next we have Kathryn Peppe, President of the
Association of Maternal and Child Health Programs.
----------
Thursday, March 22, 2001.
ASSOCIATION OF MATERNAL AND CHILD HEALTH PROGRAMS
WITNESS
KATHRYN PEPPE, PRESIDENT, ASSOCIATION OF MATERNAL AND CHILD HEALTH
PROGRAMS
Ms. Peppe. Thank you, Mr. Chairman. I am Kathy Peppe,
President of Association of Maternal and Child and Health
Programs. I am also the Chief of the Division of Family and
Community Health Services at the Ohio Department of Health.
That is Ohio's maternal and health program.
Thank you for the opportunity to testify today. We at the
Association of Maternal Child and Health Programs really
appreciate the subcommittee's interest and support of Maternal
and Child Health Services Block Grant, and all of the programs
that are supported with that funding source in our states.
For over 65 years, programs authorized under Title 5 of the
Social Security Act, the Maternal and Child Health Programs
Block Grant, have helped fulfill our Nation's strong commitment
to improving the health of all mothers and children. Title 5 is
the foundation of our Nation's public health system.
It continues today to watch over and promote the health of
mothers, children, and youth, while serving as a safety net
program for all of our country's high risk and most vulnerable
residents.
State maternal and child health programs funded by the
Block Grant have demonstrated their ability to adapt through
decades of change.
We have had to respond to the emergence of new diseases,
the discovery of new vaccines and treatment methods, and the
changing health care financing and delivery systems across the
country. Yet Congress has remained committed to this public
health program, because we have been accountable for what we
have been doing.
We have provided proven preventive health programs with
demonstrated and measurable results. Grants to the State Health
Departments are used to help locally-determined needs that are
consistent with the national healthy people goals for fiscal
year 2010 or 2000, so on.
This includes reducing maternal and infant mortality,
helping children with disabilities function to their full
potential, and educating children and adolescents about how to
reduce risky behaviors and learn healthy lifestyles.
The Maternal and Child Health Block Grant encompasses lots
more than just moms and babies. Children with special health
care needs and teenagers are a major focus for our programs.
Maternal and Child Health Programs ultimately address the
health needs of families. The flexibility of the Block Grant
gives us the chance to develop innovative programs and services
that go beyond health care needs to address individual specific
needs and help people access needed health care services.
Last year, Congress raised the authorization level for the
Title 5 Program to $850 million. While funding for other public
health programs has been expanded over the past five years,
Title 5's funding has remained relatively flat in the past
decade. So the increased authorization was desperately needed
and comes at an ideal time for us in states.
The MCH programs have just completed a five year needs
assessment. As a result, all of the states and territories are
poised to move forward to address their unmet health needs, as
soon as additional funding is appropriated.
Each state knows precisely how it would allocate its
resources to meet the priority needs for maternal and child
health populations. In Ohio, we could use additional funds to
expand our child and family health services clinic programs.
These are clinics that provide primary health care for pregnant
women, child and infants, who otherwise would go without health
care.
We could implement a statewide system of child fatality
review. We could offer additional children with special health
care needs access to the services of specialists around the
state. We could put preventive dental sealants on the teeth of
more children to reduce cavities.
I want to share with you a couple of stories about real
people, who we have touched in Ohio. Anna is someone who is
from Stark County, your home. She is a pregnant 31 year old
woman with a history of premature delivery, closely spaced
pregnancies, and late entry into prenatal care; plus asthma,
tobacco use, drug use, homelessness, and three of her four
children are in permanent placement.
Fortunately, Ohio's Title 5 Program had what Anna needed.
The Ohio Infant Mortality Reduction Initiative paired a trained
outreach worker from the local neighborhood, where these high
risk, low income pregnant women, who are either uninsured or
under-insured.
The outreach worker helped this mom, and subsequently her
baby, get into care and stay in care, as well as meet other
basic needs. Thanks to the outreach program, Anna has her own
apartment today. She has completed parenting classes and
attends substance abuse treatment programs.
The best news is that she delivered a healthy beautiful and
drug free baby girl, she regained custody of one of her other
children.
This is a victory for Ohio. In its recent needs assessment,
Ohio Title 5 Program identified the reduction of infant
mortality, particularly for those with disabilities, as one of
our top 10 health issues.
It is an excellent example of how assessment of local needs
can translate into effective programs. Let me just close by
saying that we are urging you to remember the faces of people
who are actually touched by block grants in the states and
their stories like Anna's.
There are hundreds of thousands of other stories that we
could share with you similar to these. Please fully fund the
Title 5 Program at $850 million.
Mr. Regula. It sounds like you are having a lot of success
and that is what we like to hear on these programs.
Ms. Peppe. Yes, thank you. I would be happy to answer any
questions.
Mr. Regula. Thank you.
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Mr. Regula. Our next witness is Carl Suter, Director of
Vocational Rehabilitation Programs, Council of State
Administrators; welcome.
----------
Thursday, March 22, 2001.
COUNCIL OF STATE ADMINISTRATORS OF VOCATIONAL REHABILITATION
WITNESS
CARL SUTER, DIRECTOR, COUNCIL OF STATE ADMINISTRATORS OF VOCATIONAL
REHABILITATION
Mr. Suter. Good afternoon, Mr. Chairman, I am Carl Suter. I
am the Director of the Illinois Rehabilitation Agency of
Vocation Rehabilitation Services.
I also am a member of the Council of State Administrators
of Vocational Rehabilitation. We are a Federal and State
partnership, and have been a partnership for over 80 years in
helping individuals with disabilities become employed.
The Rehabilitation Act and the Vocational Rehabilitation
Program is the cornerstone of our Nation's commitment to
serving individuals with disabilities and helping them to
become employed.
Our program, every year, get thousands of folks into jobs.
One of the things that I am here to tell you today, is that
even though I know Congress had intended in the past to give
our program cost of living increases every year, states like
Ohio and Illinois are not receiving those cost of living
increases.
For example, in Illinois, we received less than one-half of
one percent of an increase for cost of living.
Mr. Regula. Do you think that other states are getting it,
and you are not; or is it across the board?
Mr. Suter. Well, because of the way the formula works, in
Illinois and Ohio, the formula has had an adverse impact on us
being able to get what the COLA, the overall COLA that you had
for the program. In Illinois, we got less than one-half of one
percent. I think that Ohio got less than two percent of an
increase.
This comes at a time in which, when you would look at Louis
Harris pole and other National surveys, we know that 70 percent
of people of disabilities are not employed. Yet, two thirds of
those wish to work. Individuals between the ages of 18 and 60
are not working, and yet they want to work.
Our program has many pressures on it. The special education
program, is a great program, a sister program, that helps many
youths with disabilities get great services. Now as those youth
begin to come to adulthood, and they come to vocational
rehabilitation, that adds additional pressures to our program
to serve them.
I would like to tell you about one youth in Illinois to
kind of illustrate this point. Rick is a young man with Down's
Syndrome in the Chicago area. We started working with him when
he was a junior in high school. We helped him get a job after
school and on weekends.
When Rick graduated last summer, he told us that he did not
want to sit at home, like some of his friends were going to be
doing. He wanted to work. He wanted a real job.
He did not want to have to get $550 each month from SSI. He
wanted to work. We got Rick a job working in a hospital. He is
earning over $9 an hour. He is getting full benefits.
There are thousands of Ricks in this country. They want to
work, and they turn to vocational rehabilitation services for
the kinds of training technology that they need.
There are many pressures on our program. The Olmstead
decision is another one, where folks are coming out of
institutions and now into the community. Not only do they want
to live independently; they want to work.
With TANF, we have had great success in this country in
getting folks off of TANF. But what is left now is the hard
core of that population. Many of those, in fact, have
disabilities and they are coming to us for vocational
rehabilitation services.
We have enough funds to only serve one in twenty eligible
individuals with disabilities; one in twenty. Yet, the data
shows that there are thousands and thousands, hundreds of
thousands of folks who need our services.
The Rehabilitation Services Administration tells us that in
fiscal year 1999, we spent $2.2 billion on services for this
population. We serve nationally over 1.2 million people and got
230,000 of those folks into competitive jobs.
Sir, let me leave you with one recommendation. Our Council
of State Administrators of Vocational Rehabilitation would like
for us to be able to have an increase that will allow us to
serve these hundreds of thousands of folks who come to us.
We are asking for a 10 percent increase in funding, about
6.5 percent over the regular CPI that we would normally
bereceiving. That equates to about $240 million.
Mr. Regula. Well, you really have two problems. You need to
change the formula, because I think it penalizes Illinois and
Ohio; and secondly, of course, to get more money into the
program.
Mr. Suter. Right.
Mr. Regula. Thank you for coming.
Mr. Suter. Thank you very much.
Mr. Regula. I know that it is a good program. I am familiar
with it back home.
Mr. Suter. Thank you.
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Mr. Regula. Our next witness is Steve Korn, President of
National Council of Social Security Management Associations.
----------
Thursday, March 22, 2001.
NATIONAL COUNCIL OF SOCIAL SECURITY MANAGEMENT ASSOCIATIONS, INC.
WITNESS
STEVE KORN, PRESIDENT, NATIONAL COUNCIL OF SOCIAL SECURITY MANAGEMENT
ASSOCIATIONS, INC.
Mr. Korn. Chairman Regula, my name is Steve Korn and I am
here as President of the National Council of Social Security
Management Associations, an organization of over 3,000 managers
and supervisors who work in SSA's field offices and telephone
centers.
Thank you for giving me the opportunity to come before you
today to talk about the budget needs of the Social Security
Administration, from the perspective of the front-line managers
and supervisors who are directly responsible for delivering
service to the American public.
Over the past two decades, SSA has witnessed a dramatic
reduction in staff. For example, the local Canton, Ohio field
office lost seven positions just in the past six years.
In addition, over the past five years, supervisory staff in
SSA's local field offices and telephone centers have been
reduced by more than 1,000 positions. Accommodations of
dramatic reductions in both overall and supervisory staff, has
resulted in a critical situation whereby the level and quality
of service provided to the public is in severe jeopardy.
A little over a year ago, the Bipartisan Social Security
Advisory Board warned of the need to bolster resources in the
Social Security field offices. The board found that staff
resources in offices all over the country have declined to the
point where their ability to provide quality service to the
community is threatened. The board reaffirmed these findings in
an updated report issued earlier this month.
To better quantify the findings of the Social Security
Advisory Board, our organization conducted a survey of field
office management throughout the country. The responses which
were received from managers in over 50 percent of all field
offices confirm that services were below acceptable levels in
three critical areas: telephone service, the quality of work
products, and in employee training.
They also found that customer waiting times are increasing.
A copy of these findings has been sent to this committee, as
well as to each Congressional office.
While the statistics of the results are revealing, I
thought it was interesting to share a couple of the more than
64 pages of comments that we received from these front-line
managers.
For example, regarding telephone service, a manager in the
Chicago region, which includes the State of Ohio writes the
following: ``We need more incoming lines. However, we do not
have the staff to cover the additional lines.''
Another manager offered this chilling story. A physician
contacted us in response to a representative pay issue. He
wrote the manager saying he was on hold for over an hour.
Fortunately, he had a speaker phone, which enabled him to
take care of his patients while waiting for us to answer.
Hedisconnected the call before we ever spoke to him. In his letter he
stated, ``You call me from now on, because I will never contact Social
Security again.'' I wish I could tell you that this was simply an
isolated incident, but unfortunately, it really is not.
Another Chicago region manager wrote, ``As we take the SSA
measures to the community, we have generated more work for the
staff. We say we are ambassadors of the agency, and cultivate
good relationships with neighborhood. We then make our public
wait longer to be served, and have insufficient staff to
validate what we went out preached.''
Another manager writes, ``Quality has suffered here to a
great extent as the result of the loss of front-line
supervisors. These were the people with the hands-on
experience. They reviewed the work. They addressed individual
employee shortcomings. They saw to the technical needs of the
employees. Now they are gone.''
If these current service delivery and quality problems were
not bad enough, Social Security will face additional challenges
over the coming decade, as the large baby boom generation
begins to file for disability and retirement benefits, at the
same time that the agency faces its own wave of retirements.
For example, Quinzella Hobbs, who is the manager of the
Canton Field Office, reports that right now, 29 percent of her
staff has both the age and required years of services to retire
today. It generally takes replacement hires three years to
become fully productive.
In the face of these current and future challenges, NCSSA
recommends the following. First, SSA's budget should reflect
the immediate need to increase front-line staffing in SSA's
field offices by 5,000 full-time equivalents, a 17.5 percent
increase.
Second, SSA's field offices and telephone centers should be
allowed to fill front-line supervisory positions, based on the
need to maintain adequate levels of quality training and
customer service.
Third, SSA's administrative budget should be removed from
the discretionary spending caps, along with SSA's program
budget, allowing Congress to allocate sufficient funds to SSA,
based on demonstrated service needs.
As an independent agency, in accordance with Section 104(b)
of the Social Security Act, Social Security submitted its own
fiscal year 2000 budget to this committee. Social Security
requested $8.11 billion, which is $438 million more than was
requested by the new Administration.
The additional funds will allow SSA to begin to address
many of the problems identified. For example, new employees can
be hired now, so they can be trained and up to speed before we
lose our experienced employees. Certainly, we would urge you to
support this higher level of funding.
Mr. Chairman, I thank you again for inviting my testimony.
I am certainly happy to answer any questions that you might
have.
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Mr. Regula. Well, thank you, and I am aware of some of the
problems because, of course, we look to our local Social
Security Office to help with constituent problems. I have hired
a couple of your people away. That is probably one of the
reasons that you have a shortage. [Laughter.]
They are good people, and they are well trained. It works
out well for us. But we are aware of the problem, and we, of
course, have the report that was submitted. Thank you for
coming. Where are you located?
Mr. Korn. I am located in Vallejo, California, Northern
California. Again, the problems we face are very similar to
what is faced in your state.
Mr. Regula. Is automation helping you?
Mr. Korn. Automation is essential. Quite honestly, without
automation, we would be much worse. The problem is, there is
not enough automation out there to address the problems.
Mr. Regula. Somebody has to put the material in to
automate.
Mr. Korn. And there has to be people to use what is out
there. So it is a combination. It is not one answer.
Mr. Regula. Well, thanks for coming; you have made a long
trip here.
Mr. Korn. Yes, I have.
Mr. Regula. We appreciate it.
Mr. Korn. I am happy to do it.
Mr. Regula. Do not be too distressed that we do not have
other committee members here. You have got the most important
people here, and that is the staff.
Mr. Korn. That is absolute true, and we have the Chairman.
Thank you very much.
Mr. Regula. You are welcome.
Our next witness is Mr. John Black, General Counsel,
National High School Federation.
----------
Thursday, March 22, 2001.
NATIONAL HIGH SCHOOL FEDERATION
WITNESS
JOHN BLACK, GENERAL COUNSEL, NATIONAL HIGH SCHOOL FEDERATION
Mr. Black. Thank you. Good afternoon, and I appreciate the
opportunity to give the keynote address here today.
Actually, Dr. Martin and I are both from Indiana. Given the
success, or lack thereof, of the Indiana University basketball
team, I guess we are just having one of those weeks.
Mr. Regula. Well, your former coach was from my district.
Mr. Black. Oh, really?
Mr. Regula. Yes, we keep chairs away up there. [Laughter.]
Please continue.
Mr. Black. Well, I am here on behalf of the National High
School Federation, which is an organization comprised of all 50
state associations and the District of Columbia, and one of the
members is Clara Mascara in Ohio High School Athletic
Association.
We have approximately seven million young people who play
under the rules that we write each year in 17 sports. One of
them is right here, and maybe both of them. We have got a
couple of high school athletes there.
We have a concern that is coming up. It factors into the
idea that a lot of teachers who used to be coaches are going on
to other things; either they are getting tired of coaching or
they run for Congress.
So we wind up with a situation where instead of having
experienced educators providing coaching to young people, we
wind up, particularly at the lower level, the JV and freshmen
and sophomore teams and in middle schools, with a lot parents
and a lot of volunteers from the community, who may know
something about ``Xs and Os,'' but are not necessarily
experienced in the teaching skills that help them instill what
we like to think of are some of the advantages of participation
in inter-scholastic activities.
The CDC has pointed lately very much at childhood obesity,
and Health and Human Services has talked a lot about the
benefits of extra-curricular participation, in terms of staying
in school, better grades, lower team pregnancies, lower
incidents of drug use.
So we think we are doing a good thing. It costs about three
percent of the total budget for education to take care of
athletics and extra-curricular activities. However, we are
winding up with all these coaches who really need to have a
little bit of extra help, in terms of how to take advantage of
what we call the teachable moments that come in the course of
teaching.
We have a program that has worked for about 10 years. It is
the Coaches Education Program. It is very inexpensive. It costs
about $40 per person. It is focused on people who are not
trained educators.
Our concern is that although we are giving it to about
25,000 people a year, that is only a drop in the bucket. We
have got an awful lot more coaches out there, and there is a
very high turnover.
So we are thinking that it might make some sense to try a
model program, where we make it available, and particularly
available to inner city in situations, where the $40 to come as
a volunteer coach may seem as a real impediment.
We would like to try that on an experimental basis in a
couple of states, to just see if it works and see if it helps.
Mr. Regula. Have you put your suggestion in your statement?
Mr. Black. We have.
Mr. Regula. We will get a chance to look at it.
Mr. Black. Okay.
Mr. Regula. And we appreciate your being here.
Mr. Black. Thank you very much.
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Mr. Regula. All right, our last witness today is Dr.
William Martin, President and CEO of Indiana University Health
Care, and President of the American Thoracic Society, and Board
Member of the American Lung Association. Tell us your story.
----------
Thursday, March 22, 2001.
THE AMERICAN LUNG ASSOCIATION AND THE AMERICAN THORACIC SOCIETY
WITNESS
WILLIAM J. MARTIN, II, MD, THE AMERICAN LUNG ASSOCIATION AND THE
AMERICAN THORACIC SOCIETY
Dr. Martin. Well, I realize that I am the last witness of
the last day. I would first like to thank you and your members.
This is our only chance to put forth the story for our patients
and the scientific community, and we thank you very much for
this opportunity.
I am a pulmonary and critical care physician at Indian
University and, as you noted, President of the American
Thoracic Society and a Board Member of the American Lung
Association.
In my brief time before you today, I would like to raise
three issues. The first is the rapidly disappearing physician
scientist. That is not simply physician scientists in lung
disease, but in all of health related science.
Physician scientists are essential to the research
enterprise, because they link bench research to the patient's
bedside. However, fewer and fewer physicians are devoting their
time and talents to research.
There are several mechanisms at NIH that they could use to
address these problems, but perhaps most importantly, Congress
needs to address why physicians choose not to pursue science.
Invariably, this is because of the overwhelming debt from
medical school, which you have earlier today, that can average
anywhere from $75,000 to $150,000.
Physicians with large debts often leave their research
careers behind, and pursue private practice, where debts can be
more easily paid off. The next generation of physician
scientists should not be selected on the basis of whether or
not they have debts from medical school.
Last year, Congress passed legislation that provided debt
relief for physicians who do clinical research. We would
request that Congress support expansion of this program to
include all areas of biomedical science.
If enacted, Congress would ensure that the quality of the
scientist, and not his or her financial background, would
determine the next generation of physician scientists.
Mr. Regula. Was this debt relief on student loans, Federal
supported loans?
Dr. Martin. Yes, it is for medical school. It was part of
an omnibus package last year. This was specifically the
Clinical Research Enhancement Act.
The second issue that I wish to bring to your attention is
that of chronic obstructed pulmonary disease, or COPD. COPD is
a collection of airway disorders, including emphysema, that are
progressive and fatal.
An estimated 16 million Americans have COPD, and another 16
million Americans are undiagnosed. COPD affects twice as many
Americans as diabetes, and is the Nation's fourth leading cause
of death.
In the April issue of ``Scientific American,'' which I was
just reading on my way here, it is noted that the mortality
rate for heart disease and stroke for the past 20 years has
declined by more than 50 percent. In contrast, in this same
article, the mortality for COPD has increased by 34 percent.
Surprisingly, little is known about how COPD develops.
Genetics may provide important clues. We know that of all long-
term smokers, only 15 percent develop COPD. This is something
that shows that some people are disposed to the disease.
We also do not fully understand the role of genetics in
other types of airway diseases, such as asthma. More research
into COPD will likely help us understand why certain people
with asthma also develop progressive and irreversible disease.
In approximately two weeks, April 4th, an important
document will be released by NHLBI and the World Health
Organization called GOLD, that provides for the world community
what can be done for COPD.
We need break-through research to understand why people
develop COPD and to effectively reduce the morbidity and
mortality associated with airway diseases.
The third issue is tuberculosis. Tuberculosis is an
airborne infection that primarily affects the lungs, but can
also affect other body parts, such as the brain, kidneys, and
spine.
TB is spread by coughing and sneezing. There are over
18,000 active cases of tuberculosis in the United States. The
Institute of Medicine recently published a report that
documents the cycles of attention and progress toward
tuberculosis elimination, followed by periods of insufficient
funding, and the re-emergence of TB.
The IOM report provides the U.S. with a road map of
recommendations on how to eliminate TB in the U.S. The American
Lung Association and the American Thoracic Society endorse the
IOM report and its recommendations.
Representatives Brown, Morella, and Waxman will soon
introduce legislation to give NIH and CDC the authority and
resources to implement the IOM report.
Thank you.
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Mr. Regula. Well, thank you. This shows a connection
between the lungs and the heart. I am not sure how this is
different from just an ordinary heart problem.
Dr. Martin. I am sorry, in reference to COPD?
Mr. Regula. Yes.
Dr. Martin. Well, with COPD, although people with advanced
COPD develop heart failure, and it is a complication, the vast
majority of people with COPD die a slow respiratory death.
Mr. Regula. Then it obviously would be connected with
smoking?
Dr. Martin. It is, and I think it does not always engender
public support, when you consider a disease like COPD as being
self-inflicted.
Mr. Regula. Yes.
Dr. Martin. But I would argue that every patient that I
have ever taken care of with COPD acquired the addition to
cigarettes when they were an adolescent, and typically under
the age of 15.
Mr. Regula. So that is the time to try to deal with the
problem.
Dr. Martin. Absolutely.
Mr. Regula. I think you are right. It grieves me, when I
drive past a high school, and I see these kids out there.
Dr. Martin. Yes.
Mr. Regula. You girls see that in your schools, do you not,
and you wonder, why would you want to start? I do not know.
Well, good luck to you.
Dr. Martin. Thank you very much.
Mr. Regula. Thank you, and we are sure glad to see you
today.
Dr. Martin. I bet. [Laughter.]
Mr. Regula. The hearing is adjourned.
Tuesday, March 27, 2001.
TESTIMONY OF MEMBERS OF CONGRESS
VARIOUS PROGRAMS AND PROJECTS
WITNESS
HON. JOSEPH CROWLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
YORK
Mr. Regula. Our first witness this morning is Mr. Joseph
Crowley from the State of New York, who has some interest in
various programs and projects. We try to limit you to five
minutes. Good morning.
Mr. Hoyer. Good morning, Mr. Chairman. I want to welcome
the distinguished representative from the State of New York,
Mr. Crowley. He's one of our outstanding members.
Mr. Crowley. I thank Chairman Regula and my good friend,
Mr. Hoyer, but also the Ranking Member, Mr. Obey, for granting
me this opportunity to testify before the Subcommittee on
Labor, Health and Human Services and Education Appropriations,
to discuss some of my key priorities.
To best communicate the needs of my district, I would like
to present my remarks in three specific parts. They are
educational priorities, strengthening of public health
infrastructure and improving the quality of life for the people
of Queens and the Bronx in New York.
Regarding education, I believe it is imperative that our
society continue to invest in our children and in our public
schools. I recently conducted a study of the schools in my
Congressional district that documented how almost every child
in the public school system is being taught in classrooms that
are nearly 100 percent over capacity. Unfortunately, this
situation is all too common in school districts throughout New
York City, and unfortunately more so throughout our Nation.
In these types of environments, the teacher's ability to
teach becomes seriously altered. For these reasons, old
teaching methods and techniques do not always prepare young
teachers for real life situations that occur in inner city
school classrooms every day. As a response, the City University
of New York has launched a teacher empowerment zone, which is a
major effort to improve teacher training programs.
The program would create virtual classrooms with teachers
teaching students to observe during the course of their study,
in addition to other traditional learning tools. A student
enrolled in the teaching program would have the opportunity to
monitor a real classroom with the use of digital technology and
at the end of the class period, engage in a dialogue with the
teacher of the class to discuss the events that have occurred.
One of the sites of the program would be at LaGuardia
Community College, part of the City University of New York
system. This school is centrally located at a transit hub that
links Queens, the most ethnically diverse borough in the City
of New York, with the world's center of finance, commerce and
of arts. The College provides access to higher education and
serves New Yorkers of all backgrounds, ages and means. For its
part in the teacher empowerment zone, LaGuardia Community
College has launched a major campus-wide initiative to expand
the educational use of digital technology and is prepared to
focus particular attention on the interlocking issues of
technology in instruction and assessment.
For this project, I am requesting $2.8 million. This money
would be used to improve the infrastructure and provide the
faculty development needed to advance this initiative.
Additionally, funding would be used to improve and expand
classroom connectivity, create links to local secondary
schools, upgrade available software and enhance professional
development programs. This is a worthwhile and creative program
that deserves Federal assistance.
To continue to build on our children's potential, I am also
seeking assistance for the Queensborough Public Library to
expand its Jackson Heights Queens branch. The Queensborough
Public Library has the highest circulation of any library
system in the United States, and spends more money per capita
on books than any other major urban library system in our
country.
The funding I seek will not only expand the Jackson Heights
branch, but will also provide greater access of materials to
patrons, provide resources for new children's programs, and
allow for more computers, offering free access to the
electronic information.
Furthermore, there is one more additional educational
program I would like to touch on that I did not include in my
prepared remarks. The Taft Institute at Queens College, which
is also my alma mater, the Taft Institute was founded in 1961
to honor Ohio Senator Robert Taft's exemplary record of public
service and political courage. The Taft Institute is a non-
partisan enterprise dedicated to promoting informed citizen
participation in the United States and around the world.
In 1996, the Taft Institute chose Queens College of the
City University of New York as the site of its national
headquarters. This institute strives to reverse the mounting
trend of citizen apathy and cynicism. Its programs reflect the
conviction that true democracy requires that each new
generation of citizens be committed to civic involvement. At a
time when the high water mark of political involvement, the
simple act of casting a ballot, scarcely reaches 50 percent,
the need for such a program should be self-evident. Yet the
unexamined, often unspoken premise persists that active
citizenship will somehow emerge spontaneously in adulthood
without prior learning or experience.
The Taft Institute takes the opposite view. Responsible
citizenship must be fostered from the earliest age. To thisend,
the Institute has created a program of professional development to
inspire and empower the teachers who will help to shape America's
political future.
Funding for Taft Institute programs comes from both public
and private sources. While private sector funding has
significantly increased in recent years, the Institute seeks
new sources of support to continue and expand the innovative
civic education programs essential to our country. Among its
distinguished fellows would be our Speaker, Dennis Hastert,
just to name one.
I hope that we can work together for this important
program, and I am therefore reaching out to this Congress and
this Committee for $300,000 for this important institute.
With regard to the health concerns of New Yorkers and all
Americans, I want to inform the Committee that last Thursday, I
sent a letter to President Bush requesting at least $25 million
for the Centers for Disease Control. These funds would be used
to monitor, detect and combat West Nile encephalitis, a disease
that originated in my Congressional district, but has since
spread throughout the eastern seaboard.
I was pleased to be joined by 43 other Northeastern members
of Congress in this effort to ensure that adequate attention
and resources are provided to combating this mosquito-borne
virus.
Additionally, I will be asking the Committee to provide the
needed resources to combat sexually transmitted diseases
including HIV and AIDS. Here I urge a two-pronged attack, one
globally based and one locally based. On the prevention side, I
would appreciate if the Committee would highlight the need for
funding of microbicide testing. Microbicides would fill a gap
in the range of prevention tools because they are woman
controlled and could protect against various STDs, not just
HIV. These user controlled products that kill or inactivate the
bacteria in viruses that cause STDs and HIV-AIDS are the only
hope to prevent the transmission for many women overseas and
even some here in our own country.
Locally, I seek funding for an innovative program in my
district to combat sexually transmitted disease, including HIV-
AIDS in the often overlooked minority community. While the rate
of HIV-AIDS infections is decreasing in the white population,
it has drastically increased in the African American and Latino
populations.
Finally, as the representative of the middle and working
class districts in northwestern Queens and the southeastern
Bronx, I would like to discuss some specific needs of my
constituents. Among these needs are for the young adults of
Queens and the Bronx. Therefore, I am working to secure vital
dollars for additional computers for a job training center at
the Queens Bridge Homes, America's largest public housing unit.
In these uncertain economic times, these dollars are needed now
more than ever to assure the support and strength of this job
training and skill providing site.
Oftentimes, public housing is seen as a trap of despair,
but Queens Bridge is different. It has been successful in
utilizing the full potential of residents to keep it safe and
full of promise. I hope to build on the existing job training
and educational center at Queens Bridge, so as to harness all
the abilities of the people of this community.
For my older constituents, I am working for two senior
centers in my district that are in need of assistance. First,
the Sunnyside Community Services Senior Center in Sunnyside,
Queens, which seeks capital project funding to make their
center both disability accessible and more senior friendly.
While my office is working with them and the city and the State
of New York for funding, a shortfall is expected, and I hope
this Congress will be able to provide some funding for this
important senior center.
Additionally, I will be championing the cause of the
seniors of North Flushing Senior Center, a center as familiar
to Representative Lowey as it is to myself. Last year, a
funding shortfall almost caused havoc at this important
community organization. I hope that working together, we can
ensure that meals are always provided and the good works of
that institution will continue well into the future.
There are a great many other needs in my community and
throughout our global community for assistance. I thank you,
Chairman Regula, for your time, and my good friend, Steny
Hoyer, for being here and taking the time to listen to some of
my priorities.
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Mr. Regula. Thank you. Quick question. The superintendent
of New York, I heard him speak at a seminar, sounds like an
impressive regime that he's installed. What do you think?
Mr. Crowley. In terms of?
Mr. Regula. The New York City school system. Is it Mr.
Levy?
Mr. Crowley. The chancellor. Yes, I think he's an
impressive individual, and someone who has been able to work
with not only both sides of the aisle, so to speak, but really
work within all the different communities of New York. The one
thing that he's been grappling with and we've all been
grappling with has been class size, and the problem with school
modernization and overcrowding, the lack thereof in schools.
In my district particularly, we're faced with the fact that
the average school age is 50 years of age, and one out of every
two schools is 75 years or older.
Mr. Regula. He mentioned it.
Mr. Crowley. These are real problems. In Queens County, we
expect to be between 30,000 and 50,000 seats shy by the year
2007. So forget about a school building, there's not actually a
seat for these young people to sit in. That's a real crisis
that we're facing in the New York city public school system.
But Chancellor Levy is doing all he can.
Mr. Regula. Sounds like an interesting approach. Mr. Hoyer?
Mr. Hoyer. I have no questions, I'd like to thank
Congressman Crowley for obviously a very thoughtful
presentation, dealing with a number of different areas of
critical concern to his district, and frankly, to the country.
Mr. Crowley. Thank you. Thank you both.
Mr. Regula. We'll give you the forms, if you don't have
them, to make a formal request.
Mr. Crowley. Thank you very much.
----------
Tuesday, March 27, 2001.
EDUCATIONAL AND HEALTHCARE PROGRAMS
WITNESS
HON. BILL PASCRELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
JERSEY
Mr. Regula. Our next will be Mr. Pascrell of New Jersey,
Education and Health. Summarize as much as you can. We have a
long list today.
Mr. Pascrell. Mr. Chairman, thanks for extending the
courtesy to us, and members of this great Committee. Just a
week ago, I was here with Thelma Thiel, if you remember, the
President of the Hepatitis Foundation, and you were so kind to
her, and I thank you for that.
Today I want to talk about two subjects, education and
health care, if I may. As a former teacher, I know the impact
that large classroom sizes have on student performance. The
quality of our children's education is largely dependent upon a
strong teaching work force.
According to the United States Department of Education, the
Nation will need 1 million new teachers by the year 2010.
Similar to what's happening to teachers is happening to nurses
in America, as you well know. The looming shortage is already
creating problems for school districts across the country.
Even in advance of the peak of the shortage, school
administrators are already reporting tremendous difficulties in
recruiting qualified teachers. We can't get science and math
teachers, they're moving into other areas that are obviously,
will put more money in their pocket, to be very honest with
you.
While this is certainly a national problem, New Jersey, Mr.
Chairman, particularly is plagued by the mass exodus of
qualified teachers who are retiring. We rank among the top five
States in the Nation for projected growth, however, in the
student population.
The number of high school graduates in the State is
expected to increase by 25 percent in the year 2008. That's not
a long way off. Mr. Chairman, the numbers do not tell the whole
story here. Unless the new members of the teaching force are
well educated, well prepared and unless current teachers'
knowledge and skills are updated and honed, our Nation's need
for quality educators will not be met.
A compelling and growing body of research shows that the
single greatest determinant of student achievement is teacher
quality. New and experienced teachers alike are educating an
increasingly diverse population with many different languages
and cultural backgrounds.
Mr. Regula. If I could interrupt you there. If you had a
priority choice between more pay, upgrading skills versus
reducing classroom size, assuming you can't do both, which
would you opt for?
Mr. Pascrell. Qualified teachers.
Mr. Regula. That's my inclination, too, that that's number
one, is to have qualified teachers.
Mr. Pascrell. I can recommend a book, and I don't want to
take more time, Mr. Chairman, you've been more than fair with
me, but the book, Thomas Jefferson's Children, excellent book
on education, provides reforms that are succinct and we can all
understand. I recommend it.
Mr. Regula. Thank you.
Mr. Pascrell. Schools of education must meet the needs of
this diverse student population and the needs of our
technologically advancing world. That's why we wired our
schools. The university in my district has been working on this
problem. Montclair State University, 90 years in business, has
built a nationally recognized teacher education program.
Currently, Montclair graduates approximately 300 teacher
candidates a year. It also turns away hundreds of qualified
students each year, because of an acute shortage of space at
the university.
To alleviate this problem and to help the State and the
entire Nation create more teachers, Montclair State is building
a $45 million center for teacher preparation and technology.
State of the art, authentic, not money thrown to the wind. The
new center will allow the university to increase the number of
teacher candidates it graduates each year by 60 percent. It
will also allow the university to increase the number of
masters degrees it awards to teachers already in the field, a
critical component of teacher retention.
While increasing in number of teachers, the center for
teacher preparation and technology will make certain these
teachers are competent in incorporating instructional
technology into their teaching. This center will include
interactive distance education equipment, wireless technology,
full internet access and applications and hardware to keep
track of student progress more effectively. This is supported
bipartisanly, Mr. Chairman.
Montclair State will receive $5 million from the State of
New Jersey. It is asking Congress for $5 million to complete
this critical project. And the rest of the money will be raised
by the University itself.
There are numerous pieces of legislation that call for an
increase of teachers in the coming years. I believe, Mr.
Chairman, this is a good project. I ask the Committee to take a
look at it. Ask me any questions if you will. I think it's
worthy, because it goes to the very heart of what we're talking
about in education.
The second project is a 21st Century institute for medical
rehabilitation research. During the last cycle, my colleagues,
Frelinghuysen, Payne, Rothman and Andrews and I asked this
Committee for $3.9 million. Congress provided $775,000 of that
amount. I'm here today to ask for the remaining funds, Mr.
Chairman.
This Committee has long recognized the extraordinary value
and promise of medical research. You have demonstrated that
time and time again with your support for increases in funding
to NIH. All Americans should be grateful for this action as you
are bringing all of us new hope for key breakthroughs in
medicine and treatment.
Up until now, this area has not seen the kinds of increases
that many others have enjoyed and the need remains substantial
in the area of rehabilitation medicine and research. One of the
premier institutions in the country in the rehabilitation
research field is in my district, the Kessler Medical
Rehabilitation Research and Education Corporation, and the
Kessler Rehab Hospital are widely regarded as leaders
nationally in rehab medicine, treatment and research. Much more
can and must be done to accelerate and build on the work which
is already underway.
So several years ago, the Kessler organization decided to
create a new and unique effort in the United States. This was
it, this was pro forma for the rest of what has happened since.
Last year, your Subcommittee recommended funding for this
effort. I'm deeply grateful, Kessler is deeply grateful.
One area of rehab that I am particularly involved in, and
interested in, we've done work in other areas, is the traumatic
brain injury. We now have a registration list which is very
critical. Kessler is dealing with this problem, Mr. Chairman.
Two million Americans experience a traumatic brain injury every
year. Two million. About half of these cases result in at least
short term disability.
Eighty thousand people sustain severe brain injuries,
leading to long term disability. Most people with a brain
injury must experience some type of rehab in order to function
in their daily lives. So Mr. Chairman, to make a long story
short, I ask for these two projects, and I think they're worthy
projects, and I've come to the right Committee.
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Mr. Regula. Well, we'll probably get a better estimate of
that later in the year. [Laughter.]
Thank you. Is Kessler tied with NIH in any way?
Mr. Pascrell. Yes, much of the dollars comes from NIH. It's
probably the premier institution in the country.
Mr. Regula. So it works with them?
Mr. Pascrell. A lot of breakthroughs, Mr. Chairman.
Mr. Regula. Your education institution that you mentioned,
is that a State university?
Mr. Pascrell. Yes. Montclair State University is a State
university.
Mr. Regula. Mr. Hoyer.
Mr. Hoyer. No questions. Thank you.
Mr. Regula. Thank you for coming.
Mr. Pascrell. Thank you, Mr. Chairman.
----------
Tuesday, March 27, 2001.
NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL
WITNESS
HON. MICHAEL HONDA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Honda, we're ready for you. Glad you came.
Mr. Hoyer. Mr. Chairman, as you know, Mr. Honda is one of
our newer members, but a very experienced member, a
distinguished member of the general assembly in California, and
does an outstanding job.
Mr. Honda. Does that mean I get a raise?
Mr. Regula. Do you take any responsibility for the rolling
blackouts?
Mr. Honda. No, not yet. I take the responsibility of
helping, though.
Mr. Regula. It's a tough issue out there.
Mr. Honda. Yes, it is. Not to be funny, though, there may
be light at the end of the tunnel.
Mr. Chairman, thank you very much for allowing me to
testify here. I want to thank Mr. Hoyer for acknowledging my
presence also.
Distinguished members of the Subcommittee, thank you for
this opportunity to testify today. I'm here to respectfully
request your assistance on a very important initiative that
affects millions of Americans. Specifically, I'm asking you to
consider an additional $1.5 million for the National Center for
Injury Prevention and Control at the Centers for Disease
Control and Prevention, to address a very important topic,
sleep deprivation and fatigue related injury.
I think many people smile when they hear the term sleep and
fatigue, because they probably just pooh-pooh it and say that
it's something that doesn't seem to be very important.
Mr. Regula. We had a public witness, an M.D., that spoke at
length about that, runs a couple of clinics back in Ohio.
Mr. Honda. Right.
Mr. Regula. So it is, and I think the NIH has done some
work, is doing work on the impact.
Mr. Honda. Right. We just need to do more work in the
public domain to sort of raise the issue. I appreciate this
opportunity.
Sleep represents a third of every person's life. It has a
tremendous impact on how we live, function, perform, and think
during the other two-thirds of our lives. Lack of adequate,
restful sleep has serious consequences at home, in the
workplace, at school and on the highway. Untreated sleep
disorders, of which there are more than 80, and sleep
deprivation contributes to injuries, impaired work
productivity, academic performance, reduced quality of life,
poor health and even death.
As a teacher, a school principal and school board member, I
have seen sleep deprivation as a growing problem for high
school students, the largest at-risk group for fall-asleep car
crashes, as well as being a factor in causing car accidents for
parents, transportation workers, police officers and medical
residents.
According to the National Sleep Foundation, the direct or
indirect cost to the United States economy due to sleep
disorders and sleep deprivation are estimated to exceed $100
billion each year. As someone with a sleep disorder myself, I
know these problems all too well. I am one of the approximately
40 million Americans who suffers from chronic sleep disorder. I
was diagnosed with obstructive sleep apnea, which is a very
common sleep and breathing disorder that affects at least 12
million Americans.
Each time a person with sleep apnea stops breathing,
sometimes up to 400 times a night in severe cases, and I was
one of them, the brain awakens the person just enough to get
them breathing again. What I learned is that when you stop
breathing, the chemistry of your blood changes, and it clicks
off in your brain to say, wake up, dummy, wake up.
That's when you hear folks just gasping for breath in the
middle of the night, and then they continue to sleep. This
allows them to go into deep sleep, what they call REM, where
they get that rest, but they continue to appear to be sleeping,
to get their rest, but they don't get that deep rest.
This not only affects the quality of a person's sleep and
daytime functioning, but it leads to very serious health
problems. Untreated sleep apnea has been linked to
hypertension, cardiovascular disease, diabetes, depression,
memory problems, obesity and other serious problems.
I am very lucky, because unlike most undiagnosed Americans
with sleep disorders, I have a nationally recognized physician,
Dr. William DeMent, who was able to treat my sleep disorders.
And the diagnosis and proper sleep treatment definitely has
improved the quality of my life immeasurably. I say, Mr.
Chairman, that it's a malady that can be cured overnight.
While public awareness is desperately needed, a strong
Federal partner with expertise and ability to disseminate
tested and proven education training and injury prevention
programs to communities throughout the Nation is needed even
more. The CDC can help us address the comprehensive and complex
health and safety problems related to sleep issues by
developing a sleep awareness action plan that would set
national priorities around sleep issues in public health and
safety.
This five year sleep awareness action plan would develop
the evaluative research including daily collection through the
National Center for Injury Prevention and Control and others at
the CDC. The research would include an attempt to validate or
improve existing surveys and survey methodologies regarding how
sleep deprivation problems are related to the on the job
injuries, highway crashes and other medical conditions, such as
diabetes, heart disease, cancer and obesity.
The data from this research will allow the CDC to devote
accurate educational material and model prevention and health
promotion programs to provide to States as they address these
important issues. This information will begin to turn the tide
of injuries, health programs and costs associated with
sleepiness and sleep disorders.
So as I sit here today, I'm happy to report that I am
feeling fine. But I want all of you to know that it has taken
hard work with my doctor, reprioritizing with my family and my
life. I hope that you all take the time you need to get the
quality sleep you need every night. As a new member of
Congress, I am quickly learning that our schedules are so
packed and our days are so long that you are probably not
getting all the sleep that you need, but getting sufficient
sleep should not be optional.
I just want to close by thanking you for the opportunity to
testify today, and I look forward to working with the group and
providing myself as a personal testimony to the issue of sleep
disorders and fatigue, as it relates not only to adults and
sleep disorders, but also fatigue as it relates to young people
who are coming to a point where, especially seniors that are
coming to graduation. We see too many youngsters who fall
asleep at the wheel because of fatigue. It doesn't have to be
disorders, it's just our attitude toward sleep and sleep
deprivation.
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Mr. Regula. I think you're suggesting that CDC needs to do
a major public information campaign to make people aware that
this is a problem that's curable.
Mr. Honda. That's correct. Succinctly put, Mr. Chairman.
We're looking for support of $1.5 million.
Mr. Regula. We're going to be visiting there next week, so
it will be a good question for us to raise.
Mr. Hoyer, questions?
Mr. Hoyer. No, I have no questions. Thank you, Mr. Honda.
Mr. Regula. Thank you for coming.
Mr. Honda. Thank you, Mr. Chairman.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. ROBERT FILNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Filner.
Mr. Hoyer. I pledge to Mr. Filner that I will read every
sentence of your statement.
Mr. Filner. I just want you to give me the money.
[Laughter.]
Mr. Regula. Welcome, Mr. Filner.
Mr. Filner. Thank you, Mr. Chairman. And we all appreciate
your--and the staff and as many members as possible--sitting
through and listening to all these requests. We do appreciate
it and thank you so much.
I bring forward to you two proposals that are important to
my district, my constituency, but I think also serve as models
for broader application to similar situations in other parts of
our Nation. First is a $3.9 million appropriation for Paradise
Valley Hospital to create what is called a complementary
medical center, and therefore address health needs of a
minority population that is often overlooked. Your Committee
provided about $700,000 for this center in the last
appropriation. This would allow them to actually set up and
begin services in this complementary medical center.
It would be a unique showcase of how public and private
health care enterprise can cooperate, because it would provide
needed specialty care to an under-served community which then
could be replicated throughout the country. What we have in
Paradise Hospital is the only community hospital in our county.
It serves not only the whole county, but it is located in the
fourth poorest city in California, National City, one of the
cities I represent. In fact, the thirteenth poorest city in the
Nation.
And it is truly a safety net provider, but has not been
able to provide the kind of complementary health care that
wealthier medical centers can.
Mr. Regula. Is this a non-profit or a city facility, or
State?
Mr. Filner. It's a non-profit hospital, but it's a private
hospital. It's in the Adventist medical chain of facilities.
As I said, the complementary nature or the complementary
medical techniques have been available to wealthier
communities, but have never really been given in a holistic way
or in a very comprehensive way to disadvantaged populations.
What we have in mind here is to showcase that when these
services are provided to even poorer communities, they will
have a very much enhanced medical care and in fact save us, of
course, as a Nation, money in the long run.
So again, you have provided some startup money for this in
the last appropriation cycle. The money that I would ask for
now would allow them to actually set up the center.
In my second request, I am joined by my colleague,
Congresswoman Susan Davis from San Diego. We are asking that
the senior community center of San Diego be funded for a
demonstration program, $250,000 for Title IV of the Older
Americans Act, to establish a demonstration project entitled
Health Promotion/Harm Reduction.
What this is for is seniors, a growing number of seniors,
who have emotional or mental health problems, to help them
before they get more seriously ill or in fact, thrown out on
the street into homelessness. The only organization in San
Diego to provide at-risk seniors is the senior community
centers. They have shown in an 18 month test that if they
provide intensive case management services in conjunction with
nutrition services, the self-reliance of this population is
greatly increased.
So with just $250,000, they think they can in fact decrease
emergency medical interventions, reduce medical costs to our
community, get early treatment of illness and thus allow
seniors to have an independent and healthy lifestyle.
These are two areas, again, for San Diego, mainly in poor
communities for a population that is under-served, as you well
know.
Mr. Regula. Is the senior unit a private, non-profit?
Mr. Filner. It's a non-profit also.
Mr. Regula. It's not operated by your senior groups?
Mr. Filner. It's not operated by the city government. It's
a private non-profit.
Again, these services, we believe of course not only will
help our specific population, but serve as good models for
other places in the country.
So that's what I have before you, Mr. Chairman. I thank you
for the time.
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Mr. Regula. Thank you for bringing this to our attention.
----------
Tuesday, March 27, 2001.
IMPACT AID AND CROHN'S AND LYME DISEASE
WITNESS
HON. SUE W. KELLY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
YORK
Mr. Regula. The next witness is Representative
Congresswoman Sue Kelly from New York. Sue, on Impact Aid,
Crohn's and Lyme Disease.
Ms. Kelly. That's a polyglot, isn't it?
Mr. Regula. You have quite a list.
Ms. Kelly. I brought this map, because I want to show you
this map. This map shows you the area, actually, of West Point.
And this little tiny strip, this little tiny strip outlined in
red right there, this all belongs in one township. This little
tiny strip of land, which represents about not quite 7 percent
of all of the land in this----
Mr. Regula. It's the Hudson River, I assume.
Ms. Kelly. This is the Hudson River. Right there, bounded
by the Hudson River, that's all the land that this township has
that they can use for any kind of tax purposes at all to
support the school system. This is the most highly impacted
school system in the Nation, here at West Point.
Mr. Regula. Is that all West Point?
Ms. Kelly. This is all West Point.
Mr. Regula. How many acres would be in that?
Ms. Kelly. West Point? I don't know. I should know. I'm the
Vice Chairman of the West Point Board, I should know, but I
don't. [Laughter.]
But the thing I'm trying to point out here is that these
people can't grow. This is mountain in here. So they have
mountainous areas in here, they have the river over here.
Mr. Regula. Is that a school district?
Ms. Kelly. There is a school district here, and the
students who are taught in grade school on the Point come out
into this school district for their high school.
Mr. Regula. So the Point doesn't operate a high school?
Ms. Kelly. It doesn't operate a high school, a junior high,
high school. They come out into this district for their high
school.
Mr. Regula. That would be all the personnel that operate
it.
Ms. Kelly. All the civilian and military personnel. And
remember, this is an active base as well. All those people send
their kids out here into this little area to this high school.
Years ago, this high school was properly funded. And I'm
talking about Section 8002. This is the most highly impacted
district in the Nation. We've got to have our Impact Aid.
Because years ago, we can get a copy of that for you if you
want. Years ago, this was fully funded and we had enough
funding coming in there to help the school district. When I was
elected, that school district was teaching social studies out
of a book that stopped at the Vietnam War. That was six years
ago.
These kids had very old books, they had teachers that were
leaving, their teachers hadn't had any advanced training, the
school buildings themselves were in terrible shape. And this
school district was a threatened school district. There it is,
sandwiched between the Point, the river and mountains. They
can't grow, they've got nothing to tax. They need our help.
We've got to have that money that we had, at least what we
had last year if not more. We really do need an increase. But
since we've been working----
Mr. Regula. Does that go out by formula?
Ms. Kelly. Yes, it goes out by formula. I'm just trying to
locate it and see.
Mr. Regula. Does it depend on the per capital wealth of the
district as to how much they get?
Ms. Kelly. You can imagine, if it's a military base, you
know the state of what the military gets paid.
Mr. Regula. On the portion that they tax. Do you use real
estate taxes in New York for schools?
Ms. Kelly. We use real estate taxes for schools, but
there's no place to tax. This is very, there's only so much of
that land you can use, because people live there, too. There's
housing.
Mr. Regula. What I'm getting at is, the Impact Aid is
predicated on the amount of available tax revenues within a
district. So Impact Aid would vary from place to place
depending on the wealth of the district that's involved. What
you're saying is you need more, either change the formula or
more money to this district.
Ms. Kelly. I need more money in this district. We need a
better formula for taking--now, there's 8002, which is land
based, and I'm talking about land based right now, because----
Mr. Regula. Staff tells me you went from 32 million to 40
million last year. So apparently we do control in the Committee
the macro amount that goes to each of the districts.
Ms. Kelly. You do, yes, absolutely.
Mr. Regula. That's what I was trying to determine, is it
formula, and the answer is no. It's just a judgment call.
Ms. Kelly. Well, correct me if I'm wrong, sir, but I think
perhaps there is a formula for one part of this. It's the per
capita student part that has a formula. Then the part I'm
talking about does not.
Mr. Regula. Kind of an enrichment.
Ms. Kelly. It is something to make up for the fact that the
land was taken by the Federal Government. The Point didn't used
to be that large. But for one reason or another, during the
various wars, they've added land in because they need it for
training. And as they've added land in, endingit for training,
they've eaten into the township.
Mr. Regula. Does the Point train any other than cadets? Do
they have other training facilities there? You mentioned that
it was more than just a military academy.
Ms. Kelly. It's an active Army base as well.
Mr. Regula. That's what I'm saying, do they train troops
there?
Ms. Kelly. I don't know if we train--we train specified
things. They run mountaineering courses, they do some other
things. Plus they have some, if I remember correctly, I know we
have a mint there, there's a number of Federal activities that
are going on at the Point and a lot of people working there and
living there on the Point.
The thing is, what we got last year wasn't even 50 percent
of what basically we are entitled to under what we were
promised when the Point's land was taken, when the Point took
our land. So from an Impact Aid standpoint, we really, I really
need to help these people. Because what's happened, because we
got that increase, we now have teachers who are coming back
into the district. We are training the teachers, we have bought
new books, there's a social worker to help the kids, which
we've never had before, and we really need not only that, but
the school has a new roof over part of it, so that now they can
use that part of the school. It was really raining in.
So it's not money gone to waste. It's good money, we need
to do it. And we really need to have a full funding. I'll take
50 percent, that's $62 million, but it's the second step of a
promise that we have made in the past to this school district.
And Impact Aid all across the Nation needs our help. But this
is the most highly impacted district in the Nation.
I want to go quickly to a couple of other things that I
have on the ticket here. Because we can talk further if you'd
like about the Impact Aid. I want to talk about Crohn's
disease. Crohn's disease is an inflammatory bowel disease.
Mr. Regula. We had some public witnesses on that. Not here
today, but in the past couple of weeks.
Ms. Kelly. It encompasses a whole group of diseases.
There's about a million people in the United States who have
this disease. It is economically and physically debilitating
for people. I know about that, because my daughter has Crohn's
disease.
Mr. Regula. You're asking for more money on research on
this?
Ms. Kelly. I want you to designate more money to research.
I know you can't tag it that way, but I'd like report language
that really strongly recommends NIH do something to put more
money into research for Crohn's. It's on the increase, and it
is very debilitating. People who have Crohn's disease have the
option of losing a part of their intestine or sometimes all of
their intestine. The disease can come from your mouth to your
anus.
It blocks off your ability to allow food to get through
your gut, and then what happens is you go, what happens to a
lot of people with Crohn's disease is they get sick, they have
an operation and they lose a piece of something. They are fine
for a while, they get sick, they have an operation, they lose
another piece of something. Pretty soon, there's not much left
between their mouth and their anus, and they live with a
feeding tube if they live at all.
It's a very serious disease, it's on the increase, and we
are paying very little attention to the people who have Crohn's
disease. We need to give them some hope and we need to do some
research. I hope that you will think about putting some strong
report language in about that.
Mr. Regula. We will have NIH before us, and your concern is
that we just get more money into research to try to find cures.
Ms. Kelly. There are some interesting ideas about cures.
Dr. Crohn actually lived in my district before he died. And he
is the person who identified this disease that was killing
people and no one knew what it was. But from his
identification, from that point onward, there's been very
little attention paid to it. It's one of these diseases that
people just simply don't pay a lot of attention to.
Just like Lyme disease, which is the other thing that
brought me here today. I could talk about a couple of other
things, like juvenile diabetes and so forth. But Lyme disease,
the epicenter of Lyme is in my district. So I'm here for three
causes: Impact Aid, which I care ardently about; Crohn's
disease, which is in my family; and Lyme disease, which I have
had. We are in the epicenter of it, we need to have----
Mr. Regula. Is this the deer----
Ms. Kelly. Deer ticks, yes. And we have some ideas about
what we can do to stop the transmission of Lyme. We need money
for research. We have come up with a vaccine that works, but it
doesn't work on people over 60 or under 10, as far as I know,
from what their research has shown. So we can't vaccinate our
very young. And it's a debilitating disease. Many people are
left permanently disabled because of Lyme disease.
So from a long range standpoint, it's a very expensive
disease.
Mr. Regula. It's tick-borne, and the deer is the host?
Ms. Kelly. The deer are a host for the tick. The tick is
actually the host of the spirochete that causes the disease.
There is now three identified diseases, but it's only the deer
tick I'm talking about. There's also the reketsial diseases
that are borne by dog ticks. That's the Rocky Mountain spotted
fever and so on. We have cases of Rocky Mountain spotted fever
that have been on Long Island last year. It used to be only in
the Rocky Mountains. Now that is spreading.
We need research on tick-borne diseases, both reketsial
diseases and the spirochete diseases, because we don't
understand completely how to stop them. And they are walking
right straight through our Nation.
I'm chairman of the Lyme Disease Caucus. We have a number
of people, I've had several of our colleagues come up to me on
the Floor saying, let me get on your caucus, my wife just got
Lyme disease, because it is very prevalent in the midwest, it's
prevalent on the coast and in the mountainous areas and the
Rocky Mountains and out in California and Oregon and
Washington. But it's most prevalent, and the epicenter is in
the northeast. We need your help.
Mr. Regula. I remember you telling me about it. It doesn't
seem to have impacted in Ohio yet, but it will probably get
there.
Ms. Kelly. That's perhaps because the doctors don't know
how to identify it. One of the biggest problems we have is that
doctors don't understand what they're looking at. They know
they have a disease and they can treat it with a broadspectrum,
heavy duty antibiotic, and sometimes if it's a mild case, it will knock
it out. And they think, well, didn't quite identify it, but I got it.
So the patient is better.
Part of what we need to do is use this money for educating
the doctors and the other part for doing the research needed to
stop the disease itself. We can do it.
Thank you.
[The information follows:]
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Mr. Regula. Thank you.
Mr. Sherwood.
Mr. Sherwood. What's the name of the school district?
Ms. Kelly. The name of the school district is Highland
Falls School District.
Mr. Sherwood. What's the annual budget?
Ms. Kelly. I don't know if I have it. I'll have to get back
to you, because I don't remember.
Mr. Sherwood. Do you have the cost per student per year?
Ms. Kelly. I can give you a cost per student per year. I
can also give you a per student, how much the Impact Aid means.
We're talking about over a million dollars to this school
district. And if we don't get it, that school district will
fold.
Mr. Sherwood. You mentioned $62 million.
Ms. Kelly. Because this is what we've been asking for. This
is the second step in what we had asked for originally and got
started on. And a ten year program to bring the section 8002
funding into its full funding level. And that's only 50 percent
that I'm asking for.
Mr. Sherwood. But did you use the term $62 million?
Ms. Kelly. I did, yes. We need to have the funding next
year. We need to have the funding next year at $62 million,
because this is what the school district has got to have.
Mr. Sherwood. You mean that's their total budget or what
you're asking for under Impact Aid?
Ms. Kelly. No, this is for the total Impact Aid. Our school
district gets a piece of that. But what we haven't had is 50
percent funding. We need to get it fully funded. Any one of us
who represents an impacted district knows full well that
without that funding, we're going to go down the tubes with
these school districts. Since we have a President who's
dedicated to education, we want to fund these schools. We need
to.
Mr. Sherwood. But doesn't the State of New York fund their
participation in your school district on the wealth effect? In
other words, the smaller your tax base, the higher percent you
get from the State? That's the way it works in Pennsylvania.
Ms. Kelly. We get some aid that way, but we have not gotten
the school building aid that we needed. There's just not enough
money to--we have New York City, as you know, that eats up the
majority of our funding for our education budget. So we have
not had that much. The people in this town, if you look at
their income, this is not a wealthy town. It's a very, very--I
hesitate to say low income, but it's lower middle income folks
who live there. These people are people who are living on
Government salaries because they work for West Point, they're
the people who are the teachers at West Point or they're
working on the base, and these are guys and women who are, you
know, they're taking Government salaries. They don't have a lot
of resources. And they don't have the money to put into the
school itself, and there are not a lot of wealthy people who
live in the surrounding area to put taxes in.
Mr. Sherwood. Is there a local elected school board that
makes the financial decisions?
Ms. Kelly. We do have a local elected school board that
makes those decisions, yes.
Mr. Sherwood. Thank you, Mr. Chairman.
Mr. Regula. Mr. Cunningham, any questions?
Mr. Cunningham. Mr. Chairman, thank you. I'd just make a
comment. I've worked with Ms. Kelly even when I was chairman of
the Education Subcommittee on Authorization. I went to that
area. Matter of fact, if you haven't made a trip to, West Point
itself is underfunded, the military academy, compared to the
other academies. If you look at the area around, she's not
exaggerating. Impact Aid is critical to her particular
district, more so than I think a lot of districts. Maybe not so
much as mine----
[Laughter.]
Mr. Cunningham [continuing]. But it is important. Having
visited the area, it is, Impact Aid is very important to that
area.
Ms. Kelly. I thank you. Mr. Cunningham has worked very
carefully with me, because he has been there, he's driven
through the trailer parks that these people live in, and he
knows full well that it's very important for us to get----
Mr. Regula. The trailer parks are on the West Point campus?
Ms. Kelly. Not on the campus, sir, but they're outside in
Highland Falls. That's where these folks can afford to live.
Mr. Regula. Thank you for coming.
----------
Tuesday, March 27, 2001.
IMPACT AID
WITNESS
HON. MARK STEVEN KIRK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Regula. Mr. Kirk from the State of Illinois, Impact
Aid. We've heard that subject discussed here.
Mr. Kirk. Thank you, Mr. Chairman. I'm here to basically
underscore the point. I sit here as the successor to John
Porter, so I with some trepidation testify before this
Committee.
Mr. Regula. You have Great Lakes, then, don't you?
Mr. Kirk. I do. And I used to be sitting on the seats in
the back row there very recently. So to be here is a real
honor.
For me, in our Congressional district, as far as the United
States military in the midwest, we're about it. But boy, are we
it. If you join the United States Navy, you're coming to the
Tenth----
Mr. Regula. I spent some time in Great Lakes. Very familiar
with it.
Mr. Kirk. And now that all naval training is being
concentrated there--well, we didn't steal it, we bought if fair
and square. For us, now, at Great Lakes, we expect the recruit
population will go from 50,000 to 70,000 in the coming four
years. So as a member of the military family, it is only
growing in our district.
Mr. Regula. Is that the only one giving boot camp now?
Mr. Kirk. That's it.
Mr. Regula. For the whole USA?
Mr. Kirk. For the surface fleet, right.
With me is the actual superintendent of the district, 187
school district, Dr. Patricia Pickles. Mr. Chairman, with your
permission, if I could have Dr. Pickles join me up here.
Mr. Regula. Okay.
Mr. Kirk. I actually stand in awe of Dr. Pickles and what
she went through. As the Impact Aid situation worsened about
four years ago, this Subcommittee rescued the program, and
specifically district 187. We were looking at scenarios in
which we would have to close down schools in north Chicago and
send, bus the students to schools in surrounding school
districts, which would have made no sense, because we had a
perfectly functioning good school infrastructure there.
But the structure of education funding did not allow us to
meet the needs of the students. In our 187 school district,
several others were approaching over 30 percent of the students
coming from military housing. So this program is essential for
our very survival, and will become increasingly essential. As
Great Lakes expands its impact on all of the surrounding school
districts will grow.
I have a detailed statement, which with your permission----
Mr. Regula. All the statements will be part of the record.
Mr. Kirk. I would just like to underscore a couple of key
points. The military family that we know, I just left the fleet
last year, so for me, I'm coming straight out of that
environment. My last tour was in Operation Northern Watch. For
us, we have seen, Charlie Muscow is a great academician at
Northwestern University, who studies the cultural divide
emerging between the active duty military and the civilian
world, it's really expanding. And we see that in the kids.
For us, we are expecting that about 50 percent of the
recruits coming into today's military are from military
families. So the children of the men and women who protect us
today will be the people who protect our children tomorrow.
With all of this concern about military pay, health care,
housing and benefits, I would suggest we add one key component.
And that is Impact Aid for military education.
I made this point very forcefully with Secretary Rumsfeld,
who is actually also the Congressman from our district. He
represented our district in the 1960s. And with Secretary
Paige, who made a very forceful statement in favor of Impact
Aid before the House Budget Committee. That's the key point
that I want to make, that these young leaders in these impacted
schools will most likely be the military personnel of the
future. That point needs to be made to support this program.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Does Great Lakes impact on a number of school
districts?
Mr. Kirk. It does. For us it's North Chicago, Waukegan,
Highland Park, Glen View, Lake Forest.
Mr. Regula. And they all get a piece of the Impact Aid,
then?
Mr. Kirk. They do, but let me hand it over to Patricia. She
has one of the, probably the most heavily impacted districts in
the country.
Ms. Pickles. Most of the students do attend North Chicago
Public Schools, district 187, 35 percent of our student
population----
Mr. Regula. Thirty-five percent of your student population
is military?
Ms. Pickles. Thirty-five percent.
Mr. Regula. So Impact Aid is an important part of your
budget?
Ms. Pickles. Very important part. Over 72 percent of our
student population qualifies for free and reduced meals. With
that 35 percent, more than 200 of those students are identified
as needing special needs, so they need special education, which
is an additional burden in terms of cost. And as the
Congressman stated, almost 10 years ago, our district almost
dissolved because we didn't have the funds to support them due
to the Federal presence.
So we dearly need Impact Aid.
Mr. Regula. All right, thank you. I know it's a tough
situation, you heard Ms. Kelly.
Mr. Kirk. As you all know, Chairman Porter spent a lot of
time on this. It was no accident. And for us, I would expect
that the size of the military under this Administration will
grow. It's already growing in my district, so it's under those
concerns that we look forward to supporting your legislation
and supporting the program.
Mr. Regula. Thank you.
Mr. Kirk. Thank you.
Mr. Cunningham. Mr. Chairman, could I ask one real quick
question on it? San Diego does have a lot of military, as well
as important in Impact Aid. You alluded to, as far as the
special education, we have a hospital called Balboa there. Many
times, military families seek orders that are close to those
hospitals, because of their children and special education. Is
that one of the reasons that military families are drawn there,
because of the medical facility?
Mr. Kirk. Yes, we are not only home to the Great Lakes
Naval Hospital, we're also home to the North Chicago VA Medical
Center, which, if you look at the morbidity and mortality
statistics among DOD and military related health care
facilities, is one of the best in the country. The taxpayers
spent about $110 million there to bring that facility up to the
state of the art. And that is an enormous attractive factor.
What we've seen now, and it's just like, I just got off
Dakani so I know the attractiveness of San Diego. But
similarly, in northern Illinois, people like to, when they
leave the service, remain with us. And it's because of those
services.
Mr. Cunningham. I know my sister-in-law just testified
before the committees in charge of special education in San
Diego City. I think it would be good to do a study on the
relationship of military families, special education and Impact
Aid, how it really affects the entire community.
Mr. Kirk. Right.
Mr. Cunningham. Because the original intent is to make sure
that it didn't, with Native Americans or the military, and it
does. So it's an area in which I think all of us, Republicans
and Democrats, support. I don't see why we can't help. I don't
know if we can help as much with budget, but I think we could
do that.
I was sworn in at Glen View Naval Air Station and I coached
football at Insdale. So I'm very familiar with the area.
Mr. Kirk. Gosh. Well, Mr. Chairman, as you know, since the
military most likely will be growing, this program is one of
the pieces of glue that allowed the community to welcome the
military family and expansion in our districts. If expansion of
Great Lakes means bankrupting the local school districts, we've
got a problem on our hands.
So thank you.
Mr. Regula. Thank you. Mr. Sherwood, any questions?
Mr. Sherwood. No, thank you.
----------
Tuesday, March 27, 2001.
HEALTH PROJECTS
WITNESS
HON. LYNN WOOLSEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Next is Mrs. Woolsey from California. Any park
issues today?
Mrs. Woolsey. No park issues today, no, but there will be
in the future, I can assure you.
Mr. Regula. I'm quite sure.
Mrs. Woolsey. Speaking of Impact Aid, that affects Park
Service personnel also.
Mr. Regula. True.
Mrs. Woolsey. Thank you, Mr. Regula, for hearing me again,
and thank you, members of the Committee, for giving me the
opportunity to talk about five excellent education and health
projects in my Congressional district.
Some of you, well, you, Mr. Regula, Mr. Chairman, you heard
my constituent, Dr. Sushma Taylor testify last week about
Center Point, a non-profit comprehensive drug and alcohol
treatment center. Center Point is one of a very few full
service drug and alcohol treatment centers that provides
comprehensive social, educational, vocational, medical,
psychological, housing and rehab service.
Mr. Regula. Do they take patients from all over the country
or just in California?
Mrs. Woolsey. Mainly in California, but I'm sure that they
do tradeoffs with other areas in the country.
Mr. Regula. But is it a private non-profit?
Mrs. Woolsey. Private non-profit.
Mr. Regula. Thank you.
Mrs. Woolsey. But there's local funding, Federal funding,
State funding involved. That's why again, I'm supporting their
request for $1.8 million to purchase and equip an additional
rehab center, and $1.5 million for their successful adolescent
residential treatment program.
Next, I'm very proud that I represent the only public four
year university, Sonoma State University, serving the large six
county region north of the San Francisco Bay. On behalf of
Sonoma State University, I'm asking for $1 million for lab
equipment for their masters program in computer and engineering
sciences. I'm also requesting for them $1 million for their
lifelong learning institute, which offers programs specifically
tailored to the interests and needs of the North Bay senior
population.
The third request I have is an exciting new program in my
district for Dominican University, a private university that
serves minorities, women in great proportions and has one of
the best diversities of any private institution that I know of
in at least the North Bay, but probably in many parts of the
country.
What they have is, they're trying to develop a training and
lifelong learning center to address the current shortage of
math and science teachers, and to meet the need for health
professionals in the Bay region and around the Nation. We don't
have a number for their request at this moment, they came in with a
huge number that would have wiped out all the rest of my requests, so
we're asking them to come back with something else, and I'll provide
that when I write my requests to you.
Mr. Regula. If you have multiple requests, it would be
helpful if you sort of prioritize them, because obviously we're
not going to have enough funding to do everything everybody
would like.
Mrs. Woolsey. And Mr. Chairman----
Mr. Regula. So if we had your priorities, it would be
helpful.
Mrs. Woolsey. I appreciate that, and I am willing to do
that. I also know that what we ask for we don't always get all
of, but I sort of feel that if we get our nose under the tent
and you see how well these programs work, then the next year we
can build on that.
One of the programs that we've had experience with in that
regard is Yosemite National Institute, an institute that
conducts institutionally rigorous hands-on environmental
science programs in my district and elsewhere. One of
Yosemite's highest priorities is to make these programs
available to low income minority communities, those who
traditionally have little access to quality, science-based
education programs.
That's why I support their request, Mr. Chairman, for $1
million to develop more outreach programs for this population.
I'm also requesting, and behind me I have a whole group of
people who came and met with me this morning, and I was already
prepared to come here and they asked could they come with me,
so they're back there. I'm requesting $2 million for the Sonoma
County Health Care Information Network. It's a network that
integrates local health information in order to improve the
quality of local health care.
Mr. Chairman, the Sixth District of California is a leader
in meeting the health and education needs of the 21st century,
and that's because I've been able to work with them and to get
the support from our Federal Government and from your Committee
to give them the help they need to be successful. So I thank
you very much, and I thank the Subcommittee.
I look forward to working with you. I will prioritize these
requests.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. I know that you did get some help
last year.
Mrs. Woolsey. I did. You've been good. And I appreciate
your work.
Mr. Regula. We'll see. Thank you.
----------
Tuesday, March 27, 2001.
NATIONAL CENTER FOR SOCIAL WORK RESEARCH WITHIN NIH
WITNESS
HON. ASA HUTCHINSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ARKANSAS
Mr. Regula. Okay, Mr. Hutchinson from the great State of
Arkansas. You're interested in the National Center for Social
Work Research with NIH.
Mr. Hutchinson. That's correct, Mr. Chairman, and thank you
for this opportunity to present the case for this. This is
legislation I'm sponsoring with Congressman Rodriquez. It would
create the national center for social work research within----
Mr. Regula. So it's a new regulation you would hope to get?
Mr. Hutchinson. That's correct, it's new authorization.
Even though the authorization has not yet passed, I wanted to
alert you to the fact that we have introduced this legislation,
we'll be asking for support for funding it. And this is within
the National Institutes of Health, but they do some social work
research, but it's not organized toward a national center.
Presently, there is limited funding available through NIH, but
this would emphasize the importance and urgency of research on
social problems from child abuse to juvenile violence. It would
give researchers more guidance, it would change the hard data
into effective policy recommendations.
Funding appropriated to a national center for social work
research would be used for grants to universities and other
non-profit organizations to support ongoing research, national
coordination and dissemination efforts and to cooperate with
legislators of Government, every level.
I think a national center is needed to address some very
important issues. As a father of four and new grandfather, I am
concerned about the next generation. And some questions that
could be asked, why does our system not work better to prevent
violence in our schools? Why has there been a increase in child
abuse today over 50 years ago? Is there a reason for the
occurrences of child abuse being on the rise? Are there
societal pressures on parents that didn't exist even 10 years
ago?
What can we do to help these families? I don't have the
answers to those questions. And I think that that is the reason
this is needed, and I daresay with great respect for this panel
that you might not have the answers to all of those questions.
So social workers are the professionals who can give us
insight into those areas. I was struck by a recent Rand health
study on youth violence, which stated that ``to devise better
programs, researchers need more information.'' Our Nation's
young people are increasingly affected by violence, both as to
its perpetrators and its victims. Many violence prevention
programs aim to reverse this trend but few of them have been
properly evaluated and even fewer have been shown to work.
We need to learn what causes young people to become
violent. Such information could provide the tools for
legislators to make better policy decisions and aid parents,
teachers and counselors in providing better care for these
young people.
Just this month, there's been two school shootings that
we're all aware of in California, which has reminded us of the
many dangers of ignoring children's needs. The alarming
sequence of school shootings from Jonesboro, Arkansas, to
Paducah, Kentucky, to Littleton, Colorado and scores of others
cry out for a response. We find ourselves searching for answers
that do not come easily, and we have to research the solutions,
analyze them for our families, our community schools and
interaction between the peers.
To do that most effectively, they've got to have an
understanding of the factors that lead to these tragedies,
information social workers are compiling right now. But today's
resources are limited. Policy makers lack the information that
is needed, information that the social workers have. And the
national center will provide this critical link.
I can think of no one better qualified or in a better
situation to evaluate this great need than the social workers
who work with these children on a daily basis. It makes sense
to put them to work on these public policy decisions. Social
workers are problem solvers. They work to solve problems
dealing with people's counseling needs, health care needs,
treatment of mental and emotional disorders. So they are
uniquely qualified to do research into this particular area.
As the Subcommittee considers the fiscal year 2002 Labor
and Education Appropriations Act, I respectfully request and
encourage you to consider funding for a national center for
social work research, ideally to be funded at our authorization
level that's requested, but whatever that you believe fits
within your budget, the highest level possible, I think it
would be well deserving.
Let me conclude with this. I'm a conservative, and
sometimes conservatives don't jump into the social work arena.
But whenever you look at the President's initiative on using
faith based organizations, when you look at the arena of child
abuse, when you look at juvenile violent crime, whenever you
look at our investment in cancer research and things that are
causing people to die, is it not incumbent upon us as
conservatives to say, we ought to invest in research in the
very societal problems that lead us this direction, and that
give us this heartache in society.
So I don't think we should neglect this area of community,
of family, of what we can do as policy makers. And this would
coordinate it, rather than just being out there all over the
globe, we need to put it in a focused fashion in the National
Institutes of Health, tell them to elevate this to a higher
priority, because we need some help in solving these problems.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. And your bill does that, I assume?
Mr. Hutchinson. That's exactly what the bill does.
Mr. Regula. Questions? Mr. Cunningham.
Mr. Cunningham. Asa, my wife drug me to an event this
weekend. Remember Peter Yarrow? Peter Yarrow is a good friend
of David Obey as well, Peter, Paul and Mary. Maybe you remember
that name.
Mr. Hutchinson. That I remember. [Laughter.]
Mr. Cunningham. He was, I thought, well, this guy is a left
wing anti-military guy and I didn't want to go. But I'll tell
you what, he's got a program called Don't Laugh at Me for
children, and it is fantastic. I think he's a fantastic
individual. I've got the tape and the things, I'll let you look
to it. It may be something that we can get a copy for you. But
it talks about the very things you're doing. I was 100 percent
sold, once I saw the program.
Mr. Hutchinson. Good. And you're a wise man to go where
your wife leads you. [Laughter.]
Mr. Regula. Thank you. As I assume, you want to pull
information that's being developed in many disparate sources
into once center, so there's a focus of it, which then would be
able to communicate this out to the public?
Mr. Hutchinson. Absolutely. To coordinate what is going on
out there, to beef it up, to analyze it a little bit more,to
get the information to the people who are making the decisions,
to give us more hard data as the Rand study indicated.
Again, cancer research would be a good example of that,
women's health issues, you know, once you coordinate it, it
gets more focused and directed. We need to do this in the
social work arena.
Mr. Regula. Have you presented your bill to the authorizers
yet?
Mr. Hutchinson. Oh, absolutely. And Congressman Fred Upton
is, I believe, going to put a package together or children's
health bill, or a public health bill.
Mr. Regula. This is the Education and Work Force Committee,
then?
Mr. Hutchinson. Correct. So this would be a component, I
believe, of what they will do----
Mr. Regula. Oh, part of the Commerce Committee, Energy and
Commerce.
Mr. Hutchinson. Yes. But we have worked with them and I'm
very hopeful that this will move forward.
Mr. Regula. Okay, well, thanks for coming this morning.
Mr. Hutchinson. Thank you.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS AND PROJECTS
WITNESS
HON. JOE BACA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Baca, various programs and projects, from
California. Welcome.
Mr. Baca. Thank you very much, Mr. Chairman, for granting
me an opportunity to discuss the importance of education and
social issues and needs of the 42nd Congressional district.
As you are aware, and my colleagues, I am deeply honored to
testify before you. I believe that this Subcommittee handles
some of the most important issues facing our Nation, and
especially my district. I have submitted a more detailed
written statement of my actual requests.
Mr. Regula. It will be made a part of the record,
obviously.
Mr. Baca. Thank you.
Education is a top priority for my district, for myself,
and has been since I served in the legislature in California
and continues to be here. I share with you in my belief that
every student should have an opportunity that he or she should
be whatever they want to be. As the President indicated, that
no child should be left behind, that means having good quality
education, encouraging students to stay in school, to go to
college, to graduate from school. Many of the appropriations
requests I am submitting for reading instruction, mentoring,
teaching training, are designed to address these goals,
including student retention, crucial issues in my district.
Health issues is one important priority in my district.
I've submitted to the Subcommittee venues in Congress seeking
for funding for drug and alcohol treatment for youth age 12 to
17. Sometimes we forget that a lot of our youth in that area
are not receiving the funding especially as it pertains to
drugs and alcohol. It's important we put our top priority into
supporting individuals. I've supported this legislation in the
State legislature. I hope that we can support that kind of
legislation to really address teenage drinking and alcohol,
especially as it pertains to a lot of us and the effects it has
in our schools, especially what's going on, too, as we look at
what's going on.
Expanding the Healthy Family programs in California to
include indigent adults, supporting health care for seniors and
children, fighting against breast cancer, license plate funding
program, supporting prostate cancer, diabetes research and
treatments are also important priorities, which require Federal
funds which I am requesting this year. Specifically, I am also
requesting funding for San Bernardino Community College
district, in my district, we're multi-campus, providing KVCR
television station owned by the district for $21 million for
digital conversion and expansion of operations, studio space,
for $35 million to $42 million for moving the KVCR facility to
a more desirable location.
Last year you granted me $1.7 million to obtain for distant
learning. This is very important, especially as we see
community colleges right now. Most of our students are going to
community colleges, they can't into four year institutions. And
KVCR, through its digital program, is doing a lot more of the
outreach and providing educational services. We need to make
sure they continue to provide an opportunity, especially as we
look at students right now that are trying to get into our four
year institutions and can't get in to our State colleges and
universities. This is an avenue that can be done through KVCR
telecommunications in providing not only classes that they can
take and outreach, but also assuring that we provide the
facilities. I think this is very important for our area as
well.
I'm also requesting $500,000 for Fontana Unified School
District for subsequently retrofitting an ADA improvement to
the civic auditorium, a facility that is utilized by hundreds
and thousands of students in the City of Fontana, purchased a
building in 1985, this is high priority funding and
retrofitting which I think is very important for us. While also
the capacity to the city, it has capacity only of 1,000 but we
need to continue to improve and provide subsequent retrofitting
for that area.
I'm also requesting $3 million for the City of Ranch
Cucamonga, which I share along with Dreier and Miller that were
surrounded in that area to design and construct a new senior
citizen center that provides 25 to 30 square feet. The city is
providing matching funds of $2 million for land and ongoing
maintenance and operation cost.
For the City of San Bernardino, I'm requesting $1.5 million
for the city to support job training for the city on one stop
career center. This request is strongly supported by the civic
and business groups in my district, along with Congressman
Lewis.
Mr. Chair, I have many other projects that I've outlined
specifically, the California University at San Bernardino, San
Bernardino County Superintendent of Instruction Schools, San
Bernardino County Unified School District, the University of
California at Riverside, with an incubator that's important to
our area, as we look at providing jobs and getting
universities. It's the only university in that area that is
supported not only by myself, Ken Calvert, Mary Bono, Miller
and also Congressman Lewis support the project for funding in
that area, even though it's not in my district, but it's the
only university within that area, and I think it's our
responsibility to provide assistance to them.
These are but a few of the many projects that I have
submitted requests for you. You have specific details on the
others, Mr. Chairman. I thank you for giving me the opportunity
to come before you. I know it is a long list and a wish list of
many areas. But I believe it's important that I represent my
district, submit those requests and whatever possible can be
funded, I would appreciate very much if the Committee would be
able to look at some of the important projects to improve the
quality of life, education and health in our area.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Questions?
Thank you for coming. You do have a substantial list.
Mr. Baca. Thank you, Mr. Chair. I look forward to your
continued support, and I'm not shy. [Laughter.]
----------
Tuesday, March 27, 2001.
CLOSE UP FOUNDATION AND PROJECTS
WITNESS
HON. DONALD M. PAYNE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW JERSEY
Mr. Regula. Mr. Payne, New Jersey.
I'm sorry, Don, I got you out of order here.
Mr. Payne. Well, I may not get an extra program, then.
[Laughter.]
Mr. Regula. Pretty high price you're asking.
Mr. Payne. Thank you. It's certainly a pleasure to be here,
Chairman Regula. Let me just start by saying that our city of
Newark, New Jersey is really on the rebound, it's coming back.
We had a civil disorder in 1967 that really is the dividing
point as we look at history in Newark. And because of support
that we've gotten from your Committee, we've been going in the
right direction over the last decade.
Mr. Regula. Are you getting a new airport there, or a lot
of pretty major----
Mr. Payne. Yes, pretty major, the road construction funding
has just made it, actually, it's the third largest airport now,
it's overtaken Kennedy and JFK, I mean, JFK and the other New
York air, LaGuardia.
Mr. Regula. Is it a hub at this point for any of the
airlines?
Mr. Payne. Yes, Continental, which has gained a lot of
strength and health now, and is doing an excellent job to
overseas, South America.
Mr. Regula. We left out of there for the----
Mr. Payne. That's right, it's a great place. So anyone
who's traveling, at least come through Newark. We have a little
city tax on it, you know.
But it's great to be here. I'll be brief. We have some
health projects, the Emergency Medical Services demonstration
project, the Children's Health Care Services and Outreach
Center, and Babyland Family Services. What the coordinated
Emergency Medical Services demonstration project is, it's a
project to bring together transportation and emergency services
in older cities. This is a very vital need. So we have, we're
asking for $5 million to help with this demonstration project.
Of course, the details are in the packets.
The second one is the Newark Children's Health Care Service
and Outreach Center. It's to positively impact on the health of
Newark's children through the development of a coordinated
health care system that will allow the city to bring health
care services to the community. Through the centralization of
services, we believe that we can increase access to an array of
health and social service needs to Newark's citizens. We ask
for $2.5 million for that.
And thirdly, the Babyland Family Services is a major non-
profit child and family service organization, providing
comprehensive child care and family development services to
1,500 at-risk children and their families annually. Babyland is
seeking additional funding to establish the technological
linkages to nurture the educational development of almost 700
children, provide computer training for 2000 parents, teachers
and entry level professionals. We're asking $2 million there.
Just quickly, at the UMDMJ, we have a series of programs
that we're asking. One is elimination of health disparity, and
they have a very well focused program. We're asking for $5
million over a five year period. There is also a cancer
institute center, the Dean and Betty Gallow Prostate Cancer
Center. Dean Gallow is a former member of this Subcommittee,
unfortunately passed away from prostate cancer. His widow,
Betty Gallow, has been carrying the work on that Dean started.
So we're asking for $10 million to assist in that project,
which has become extremely successful.
I'll conclude there, but there is one national program that
I am making a request for, Mr. Chairman, it's the Close Up
Foundation, civic education fellowship program. As you know,
the Close Up Foundation is a civic educational program that
brings students from around the country to our Nation's capital
to study about government. It's been around for quite a while.
As you know, we need all the help we can get in civic
education and responsibility. We see what's happening at our
high schools and elementary schools in our country. As a former
teacher and coach, I didn't coach in the Army, but I coached in
high school, we really see the need for these kinds of
programs, bringing youngsters to our Nation's capital,
stressing civic education, which I think is missing in a lot of
our school systems.
So with that, we'll submit our full text and I appreciate,
like I said before, the previous support and look for continued
support.
[The information follows:]
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Mr. Regula. Thank you. Questions?
Mr. Cunningham. Don, the Close Up Program, that's not the
one that recently had controversy with Reverend Jackson, is it?
Mr. Payne. No, not to my knowledge, no. It's really a
program that has a lot of support from business, but we do need
to have our Federal support. But to my knowledge, this is not
that program.
Mr. Cunningham. Okay, thank you, Don.
Mr. Payne. Thank you very much.
Mr. Regula. Thank you for coming.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. ROBERT SCOTT, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH
OF VIRGINIA
Mr. Regula. Mr. Scott, from the great State of Virginia.
Mr. Scott. Thank you, Mr. Chairman and members of the
Committee. I appreciate the opportunity to speak with you
today.
To save time, Mr. Chairman, you have the testimony and I
want to just speak very briefly on two projects, the Massey
Cancer Center at the Medical College of Virginia, and the
Achievable Dream Program in Newport News, Virginia.
The Massey Cancer Center, Mr. Chairman, is a building, a
$26 million project. We're requesting $2.8 million from
appropriations. The board of directors will be raising $10
million to $15 million.
Mr. Regula. Is this a private non-profit?
Mr. Scott. I'm sorry?
Mr. Regula. Is it a private, non-profit school?
Mr. Scott. The Medical College of Virginia is a State
college. It's part of the Virginia Commonwealth University.
Mr. Regula. Right.
Mr. Scott. It's a $26 million program. The board of
directors will be raising $10 million to $15 million, and we
have received previous requests of $1.2 million, and we hope to
receive the remaining $2.8 million to complete the project. The
center is one of 59 national cancer institute programs, and
it's an excellent program, Mr. Chairman, and I would hope that
staff will read the details on it, and it's one that we're very
much interested in. They have an outreach program going into
the rural areas where they've had a significant impact on
incidence of cancer and success in treating cancer from the
Medical College of Virginia, going out into rural areas.
The Achievable Dream Program is an education program
consisting of teaching at-risk students at an elementary and
middle school. Basically they have as kind of a hook, you come
in and play tennis in the afternoon during the summer,
education in the morning, then they go into the full year-round
session. It's basically an inner city school. They have extra
curricular and character building activities.
They have shown that the program works. Their test scores
are at or above the city average, and we have some areas where
there are very high income students, very low income students.
These low income students are at or above, in some cases way
above, the city average. They receive significant support from
the community, an average of about $1,800 per student. We're
asking for $1.5 million from funds for the improvement of
education so that we can start an early childhood center for
three to four year olds. The earlier you start, the much better
you can do.
This is a very successful program, and we hope we can have
your continued support.
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Mr. Regula. Questions? Mr. Cunningham.
Mr. Cunningham. Bobby, we have a teaching hospital in San
Diego for medicine, and it's just about to fold. With the HMOs,
California is a leader in HMOs, yes, we do need HMO reform. But
are you having those similar problems with the teaching
hospitals and the training of doctors? A, the number that are
requesting medical school has gone down, secondly, that they're
having trouble funding it.
Mr. Scott. A significant portion of the patient load is
Medicaid, Medicare. So the reduced reimbursements are squeezing
all of the hospitals, particularly the teaching hospitals,
because they're open to everybody. So anybody that comes in,
they're going to deal with. It's a major strain.
Mr. Cunningham. I think across the Nation we're having
trouble, and we're going to have trouble having good doctors, I
think, in the future, unless we attend to it.
Thank you.
Mr. Scott. Thank you.
----------
Tuesday, March 27, 2001.
CLEVELAND BOTANICAL GARDEN (PROJECT)
WITNESS
HON. STEPHANIE TUBBS-JONES, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF OHIO
Mr. Regula. Next, from the great, great State of Ohio,
Stephanie Tubbs-Jones. Stephanie, you're going to speak on
behalf of the Cleveland Botanical Garden.
Ms. Tubbs-Jones. That's correct. If you'll allow me to
stray for just a moment, I want to bring you greetings from my
predecessor, the Honorable Congressman Louis Stokes.
Mr. Regula. He was here in person last week.
Ms. Tubbs-Jones. Oh, really? Did he tell you about us
naming a post office after his mom, and how great it was? Well,
doggone it, I'll have to tell him he preempted me.
Mr. Regula. About everything I see in Cleveland has been
named after him. We're running out of streets.
Ms. Tubbs-Jones. I think so. [Laughter.]
I'm just trying to hold my name out there. I can't get the
streets and the buildings, but I'm doing okay.
Mr. Chairman, thank you very, very much for the opportunity
to present this morning. I'm here on behalf of the Cleveland
Botanical Gardens. This is our fiscal year 2002 request, to
secure $1 million in Federal funds to enable the Cleveland
Botanical Garden to develop interactive ecological exhibits and
educational materials for students from kindergarten through
12th grade and their families.
You have all this information in your packet. I thinklast
year when I presented, you had the opportunity to taste right from
downtown salsa, which is a salsa that is produced by the students who
grow tomatoes at this facility and surrounding facilities. What the
botanical gardens has attempted to do is let young people in
Cleveland's school districts and surrounding school districts have an
understanding of ecology, an understanding of preserving the
environment.
So in this next step, we've already begun the funding of a
glass house, but what the next step will allow us to build, two
ecological systems, one like that exists in Costa Rica, where
you have high ground properties, where people will be able to
come through and interact with the activities, similar to
probably some of the rainforest and other areas. But the other
areas have focused on the lowlands, and we're going to focus in
on the highlands.
I could be very detailed in my presentation, but I know you
don't want me to be, so I will not. But I come here to say that
this is a project that's very important to my Congressional
district, but also important to the region and the area and the
State of Ohio. I appreciate all the support that you gave me
last year, and in my second term as now a sophomore member of
Congress, no longer a freshwoman, I'm here to say I need your
help again, and any additional information that I can supply
you, I'll be glad to do so, and I thank you for the opportunity
to be heard.
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Mr. Regula. I think I got a note that they're doing long
distance learning from there.
Ms. Tubbs-Jones. That's correct. In fact, the director of
the program would be here, but he's in Costa Rica, because
we're doing exchange programs with children from Ohio and
children from Costa Rica. It's a pretty exciting opportunity
and a collaboration between Case Western Reserve University,
the Botanical Gardens and the University of Costa Rica.
Mr. Regula. Questions?
You got some support for this last year, I believe.
Ms. Tubbs-Jones. Yes, sir, and if I didn't say it, I
thought I did, thank you for last year's support, and I'm back
again. Anything else you can give me, I'd appreciate it.
Mr. Regula. I'm not surprised. [Laughter.]
----------
Tuesday, March 27, 2001.
LUPUS RESEARCH AND CAREGIVERS AND PROJECTS
WITNESS
HON. CARRIE P. MEEK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
FLORIDA
Mr. Regula. Our next guest is Carrie Meek from Florida.
Carrie, we're glad to have you, an also a member of our Full
Committee.
Mrs. Meek. Thank you, Chairman Regula, and all my friends
on this Committee. I'm pleased to be here today.
It's regarding a program in which I'm very, very interested
and very concerned. I want to testify this morning on my
highest funding priorities for fiscal year 2002. I understand
you have a very awesome responsibility and you don't have the
resources that you really need to meet some of these
responsibilities. But we'll have to do the best we can.
There are some issues that I'm interested in, and I know
the time is limited, so I want to submit the rest of my
testimony for the record.
Mr. Regula. Without objection.
Mrs. Meek. My number one priority, Mr. Chairman, is
increased funding for lupus. Each of you is aware of this
disease, we've been before your subcommittee for many years.
And thank God, it was authorized last year, through Chairman
Bilirakis' committee. It was a very long fight. It is something
that I come before this Subcommittee to ask you, now that it's
authorized, will you please fund it to the point that we can
stop the killing and the maiming of this disease of young
women?
I'd like to request $30 million for the Centers for Disease
Control to fund a grant program authorized under Title V,
Subtitle B of Public Law 106-505. It's the Public Health
Improvement Act of 2000, for treatment and support services for
lupus patients and their families. This is a little bit
different from the rest of the things you've been doing for us.
Through the years, you have each year provided some funding for
lupus. Now we're asking you to provide funding to support the
lupus patients, in that they have a very, very hard time with
their physical bodies being naturally undermined by this
disease.
I also request $25 million in additional research funding
over and above the enacted 2001 level on the Title V, to enable
the National Institutes of Arthritis, Musculoskeletal, and Skin
Diseases, you call it NIAMS, to conduct expanded research to
understand the causes and to find a cure for lupus. First of
all, there is no cure for lupus. The treatment for lupus many
times is just as harmful to the patient as is the lupus itself.
The third thing is, if you continue the research, sooner or
later you will get to the cause and a cure for this disease.
Now, it's very important to me that we find a cure for
lupus, and find a cure for the suffering that people go
through. My sister died of lupus, a lot of young women die of
lupus in their child bearing years. I've been urging the Congress to
direct NIAMS and NIH to mount an all-out campaign against lupus.
Now, rest assured that this is not to say that they have
not been working hard on this. Except that they need more
resources to do the support service, they need more
researchers, more resources to do the research as well.
Now, this is a killer. It's an autoimmune disease and it
kills more people than HIV-AIDS and most of the other
autoimmune diseases. It's really significant for women to focus
on this disease, because about 1.4 million Americans have some
form of lupus, and most of them are women. Many of these
victims, if you've ever seen anyone or talked to anyone with
lupus, the pain is very debilitating. The women aren't even
able to hold their own children.
Suffice it to say, Mr. Chairman and members of the
Committee, I'm asking for $30 million for the Centers for
Disease Control to fund a grant program which will support
lupus patients. I'm requesting $25 million in additional
research funding. That's going to NIAMS, which is a part of the
National Institutes of Health. These groups have done an
outstanding job, and if anyone can beat this diseases, it's
those two.
The most discouraging thing is that the family members
suffer so from this particular disease.
My second priority, Mr. Chairman, is a demonstration
project to develop and test HIV-AIDS prevention, a media
campaign. We brought it before the Committee last year, they
thought it was a good idea, but they didn't fund it. What we'd
like to do is a demonstration project to develop and test on
HIV-AIDS. We know that the media program has worked with
cigarettes. It has worked with HIV. But I'm requesting this
now, and you know the drug program has worked. Every time you
see one of those very well thought out drug programs regarding
children, you will see that it's very, very effective.
I'm requesting $10 million for the Centers for Disease
Control and Prevention to develop and implement a grass roots
minority HIV-AIDS prevention media campaign. That would be
modeled after the $185 million the Congress spent on anti-drug
media programs for the National Office of Drug Control. Funding
for it would be used to develop and test the effectiveness of
the HIV-AIDS prevention media campaign in 20 United States
counties with the greatest number of minority HIV infections.
I won't prolong that. Each of you is aware of the
propensity of HIV-AIDS to kill and to maim the population.
Third, Mr. Chairman and members, $15 million to fund the
Higher Education Demonstration Projects, which will ensure
equal opportunities for individuals with learning disabilities.
Now, you all have heard of learning disabilities in youngsters
from K-12. And a lot is done for them. Very little is done for
youngsters who get out of high school and go to college and
have learning disabilities.
And to say that means that they need support as well as the
younger persons do. It's one that shows you that you'd be
surprised that a number of youngsters who go to college with
learning disabilities, they don't read very well, most of them
are very bright students. But they have these learning
disabilities, and the teachers are not really capable of being
able to understand how to teach these young people, nor do they
understand what these learning disabilities are.
So I'm urging the Committee to include $15 million to fund
the grant program currently authorized. We were able to get
this program authorized about two years ago here in the
Congress through the Labor HHS Committee, and we were able to
get it funded at $5 million for the entire country. But think
of all the students who are enrolled in institutions of higher
education who need these services and cannot get them.
So as I understand it, each year a million dollars has been
placed in that program to take care of some of the needs. I'm
sure you realize that $1 million more each year certainly would
not put that program where it should be.
What this does, it identifies college students with
learning disabilities and develops effective techniques for
teaching these students. I think it's very fair that we think
of the fact that we are really developing our students, and
just because they have a learning disability doesn't mean that
they're not bright. I think if you note, Einstein was learning
disabled. That just gives you one example of the kind of
student you're dealing with with learning disabilities. They're
very bright students.
University professors have found the research that has
developed as a result of this program has been very helpful,
helping them to teach students in higher education.
My next one, Mr. Chairman, I listed them all for the
Committee to look at, increased funding for community health
centers. I support an increase in funding for the consolidated
health centers program by at least $175 million for fiscal year
2002 in order to provide an inexpensive way to get high
quality, affordable primary health care to under-served
communities.
Now, just take my State of Florida. There are 2.5 million
people who have no regular source of primary care. Most of
these people are in urban inner city areas like my home
community in Miami, and in isolated rural areas. They do need
better health care. And of course, the community health care
centers is one that can provide that kind of help to people.
The last one has to do with please increase funding for
graduate medical education for pediatric hospitals to $285
million, the fully authorized level. You say, well, Carrie,
that's really asking for a lot. You made a good start in your
funding for pediatric graduate medical education the last time.
But this is one of the areas of health care which has been
overlooked for a very long time. We should take the next step
by moving as quickly as possible toward funding at the fully
authorized level.
And I want to thank the Chairman and the members of the
Committee for your patience in listening to the list of things
I've brought before you. I'm sure that you will look at them in
such a way as will meet the needs of the people of this
country. I think of all the things we deal with here in the
Congress, health is one of our most important ones, and I thank
the Committee for having me appear before you.
[The information follows:]
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Mr. Regula. Thank you.
Questions? Thank you, Carrie. Did you get that building
down there that we had a couple of years ago and name it after
the President, the college?
Mrs. Meek. No, you wanted to name it after me, that's why
they didn't build it, I think.
Mr. Regula. Did they build it?
Mrs. Meek. Yes, they did.
Mr. Regula. They didn't name it after you, though?
Mrs. Meek. No, they did not.
Mr. Regula. Well, we'll have to----
Mrs. Meek. We'll have to take the money back, Mr. Regula.
[Laughter.]
Mr. Regula. Has it been named yet?
Mrs. Meek. No, not yet.
Mr. Regula. Maybe we can address that problem.
Mrs. Meek. All right, thank you so much.
----------
Tuesday, March 27, 2001.
MEDICARE AND HEALTH CARE FINANCING ADMINISTRATION
WITNESS
HON. PETE STARK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Stark from California.
Mr. Stark. Thank you, Mr. Chairman. Do you have any
leftover buildings in the 13th Congressional District in
Northern California? Maybe Duke and I could work something out.
Mr. Regula. No money.
Mr. Stark. No money, okay. [Laughter.]
Well, if I were just to build the sign that goes over the
door, could I contribute that?
Thank you for giving me the opportunity to address you this
morning, Mr. Chairman, members. I hope you'll take my complete
statement for the record, and just let me summarize it for you.
As the Chair recalls, for 10 years, I guess, I chaired the
health subcommittee of the Ways and Means Committee. It has
since been chaired both by Mr. Chairman Thomas and now Mrs.
Johnson. I believe we are all in accord on this, and we have
all had our disagreements with HCFA. Under the 10 years that I
chaired the Committee HCFA was under Republican, under a
Republican Administration, it's been under a Democratic
Administration when Mr. Thomas was there. The reports have been
late, we've had complaints from doctors and hospitals, you've
all had complaints in your Congressional districts.
But the truth is, in all of that time, we have been able to
say, as we speak to people across the country, that they're
operating the Medicare operation a couple of hundred billion
dollars a year with a 2 percent overhead. There's not an
insurance company in the world, Blue Cross and Kaiser maybe
come to 12 percent, that could operate on 2 percent. And some
of the more expensive insurance companies that are doing the
same thing, 14, 18 percent. And it's these same insurance
companies, Blue Cross, that do a preponderance of the work
under the supervision of HCFA for distributing these payments.
Think about this. Today, Medicare beneficiaries will make a
million physician visits. This is not just hospitals. This is
going to the doctor. A million visits. And Medicare will
process more than 3 million claims today and spend a billion
bucks. That's what we're doing every day. And we're doing this
on their share of the budget, about $2.2 billion for program
management.
The graph will show, Mr. Chairman, that this is in real
dollars, the dotted line down here, and it's only in the past
year that we've gotten up to 1993 expenditures.
Now, what's wrong? Their computer system doesn't work. They
haven't gotten up to the full time employee level that they
were 10 years ago. We have been starving them. And since 1996,
we gave 700 new legislative provisions for them to administer.
Now, you can say we're cockeyed for doing that. My point is
that we all do that. This is a Congressional mandate, and it's
been under both parties and under both Administrations.
The money, although you get scored for it, comes out of the
trust fund. So those of us who want to protect the trust fund
realize, but let me just tell you this. That it was in 1996
that we came out with this, or we didn't come out, we got this
14 percent of what we were spending. Again, let's say it's $2
billion a year. Twenty-eight billion of that was spent
incorrectly. Now, some of the incorrect payments were fraud and
abuse, and some were just mistakes, just filled out the form
wrong, paid the check wrong, whatever we did. We were throwing
away, if you will, in the 20s of billions of year.
They have cut that, because of legislative provisions we
mandated, to 6.8 percent. They have cut that in half. So they
have saved $12 billion in six years by addressing the fraud
provisions which we forced on them.
Now, what I'm telling you, they're doing this, and they're
still only spending $2 billion a year for administration, and
the results of what they're doing have saved us $12 billion. So
I'm just here saying, could we double their budget over a
period of years and get them up to say, 4 percent of benefit
spending. I don't know how much a new computer system is going
to cost. It's in the dark ages. But you and I know that the
phone company can find everybody, and our credit card people,
Visa and Master Charge are more efficient than HCFA, and
they're spending more to collect money from us.
So that's my plea. I'll be glad to try and answer any
questions. This is one of our better managed bureaucracies.
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Mr. Regula. Has mechanization helped, the computers and
record keeping?
Mr. Stark. Of course. And they're behind the curve. There's
no question that mistakes were made, I'm trying to think of how
many years ago it was, Mr. Chairman, they decided to do eight
different computer programs around the country, because they
felt they had to give eight different people a chance to bid on
the work. How do you have eight different systems?
Mr. Regula. Do they still have more than one system?
Mr. Stark. They have more than one. Because historically,
when Medicare came into being, it was, the billing part of it
was turned over mostly to Blue Cross people around the country.
So every are has a different billing system. Because they have
a different person, we actually contract out the majority of
the work to people called intermediaries. We've got to change
that. This is the 21st century.
Mr. Regula. Are you saying change the contracting out, or
changing the coordination?
Mr. Stark. Changing the coordination, changing the method.
There's a whole lot of modernization. But they've got to have
the equipment and the personnel to do it.
And I have great faith in Governor Thompson, a good
administrator in my natal State of Wisconsin. But we've had
good administrators right along. It's one of the biggest
bureaucracies, as you know.
Mr. Regula. It's a Herculean task.
Mr. Stark. It is. And we can't starve them at the same time
we're forcing more work down on them. As I say, I don't think
we can find either a budgetary fight or a partisan fight on
this issue. I know we don't get scored for the savings out of
the fraud and abuse as opposed to directly. But it's there, and
as I say, these are----
Mr. Regula. Do the intermediaries pick up fraud?
Mr. Stark. They will trigger investigations, because
they're the ones who can understand patterns. But each
intermediary, the problem is, has a different way of judging.
In other words, certain screening tests, that would call for
surgery or certain screening tests that would call for more
clinical tests could differ. One area of the country might pay
for bone marrow and another might not. Don't ask me why. This
is just the historical way they have done this.
So there's a lot we can accomplish. But for us to begin to
proceed more rapidly, which we should do, is going to take
people and--the sheer volume, the complexity of all the
different medical procedures. And one of these days, we're
probably going to get into pharmaceuticals, and that's just
going to add another whole bunch of words and numbers and
procedures that you and I wouldn't be able to spell or
understand, but we would end up paying for.
Mr. Regula. That's an enormous challenge.
Mr. Stark. Yes. If you could find, as you push these
numbers around, some there, I think that you will find the
Republican Administration, the Democratic minority will move to
help in any way we can.
Mr. Regula. Pretty much a bipartisan issue.
Mr. Stark. I believe so, Mr. Chairman. I certainly don't--
all I can tell you is that in the past years, the current chair
and the now chair of the full Committee have supported efforts
to see that HCFA gets better funding.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. I talked with Governor Thompson about this
problem the other night. It's very real and we have to address
it. We find that all over the Government, that our computer
systems are not anywhere near up to date with the work we're
trying to accomplish. And it costs us money in unusual ways,
because of that.
Mr. Stark. If the gentleman would yield, and this is the
poster child of the type of operation that can save from
computerization, because of the huge volume of small claims and
forms that have to be filled out. As I say, we're all excited
that Governor Thompson can do a good job over there, but I
think we've got to give him the resources.
Mr. Sherwood. I agree.
Mr. Stark. I thank the gentleman for his concern.
Mr. Regula. Thank you.
Mr. Stark. I thank you for the opportunity to present the
case here today, and I hope you can find a few dollars to help
out this group.
Thank you very much, Mr. Chairman.
Mr. Regula. Thank you.
----------
Tuesday, March 27, 2001.
CONGREGATE AND HOME-DELIVERED-MEALS PROGRAM
WITNESS
HON. CHRISTOPHER SHAYS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CONNECTICUT
Mr. Regula. Mr. Boehner.
Mr. Boehner. I'll yield to my colleague who's in the middle
of a hearing.
Mr. Regula. Oh, all right, Mr. Shays, congregate and home
delivered meals program.
Mr. Shays. Thank you. He yielded on the agreement I'd be 30
seconds. I thank him very much.
Mr. Chairman, just to make you aware of the fact that our
congregate meal and our home delivered meals has been somewhat
static, and there hasn't been a sense of--
Mr. Regula. Static in reimbursement, static in numbers?
Mr. Shays. Funding, except in terms of adding a little bit
to the congregate last year. But the bottom line is, I'm asking
if you would restore $43 million to put $43 million into the
congregate meal program to bring it to a total of $421 million,
which would bring it to the funding level of 1995.
The only point I want to make to you is that there have
been unused funds in the congregate meal that have been unused
by agencies, and they have built up a level of spending now so
those unused funds from past years have been used up, and
you're going to start to see around the country some
significant deficits. Just an alert to you that you may need to
take a look at it.
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Mr. Regula. Don't we get a lot of volunteers involved in
this operation?
Mr. Shays. Yes, it's great. You get a lot of volunteers,
but this pays for the meals. You get a lot of volunteers who
come to the congregate sites, a lot of volunteers who do the
home delivered meals. It's a cost effective program.
Mr. Regula. Do they get reimbursed mileage, because they
drive their automobiles?
Mr. Shays. I'm not even sure of that, sir. We just had a
challenge in our district because what we found is they had
built up to levels using past funds. They built up their
spending level above the annual appropriations that exist. So
the States made up the difference in Connecticut. But I suspect
you may be having a problem around the country that will start
to surface as people use past funds for present operations.
Mr. Regula. Well, and of course, more seniors, too.
Mr. Sherwood?
Mr. Sherwood. No questions.
Mr. Regula. Well, thanks.
Mr. Shays. Thank you, and I thank my colleague for
yielding.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS
WITNESS
HON. JOHN A. BOEHNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
OHIO
Mr. Regula. Mr. Boehner.
Mr. Boehner. Hello, Mr. Chairman. I'm glad to be here this
morning.
Mr. Regula. What will you be doing to our budget over there
in your committee?
Mr. Boehner. We'll be working very closely with you. Good
morning and thanks for the opportunity to be here. Let me say
hello to my friend and the newest member of your Committee, Mr.
Sherwood. It's nice to see that you're here.
And I appreciate the job that you all have in terms of
trying to decide how to allocate the biggest chunk of the
Appropriations Committee. It is a difficult choice. I'm here
today as chairman of the Education and Work Force Committee to
really outline our priorities. I think the President has done a
good job in his proposal on education, which is embodied in a
bill that we introduced last week, H.R. 1. And the effort there
is to close the achievement gap that exists between
disadvantaged students and their peers, and to work with States
to improve the schools to be the best in the world.
I could talk about the President's education proposal, but
you all understand it fairly clearly. More flexibility in terms
of consolidating programs, in allowing schools to have more
flexibility over how to use those resources in their schools.
Secondly, actually doing a better job of targeting the
money to the schools who need it the most. And thirdly, putting
into place a new reading program that is absolutely essential.
Because if children can't read, they're not going to learn.
We know that the early childhood reading program, and the
President's proposal, will do a lot to improve reading scores,
and we think, learning.
Now, money is not the only issue here. We've spent $130
billion since 1965 on well intentioned, well meaning education
programs. The fact is, we've gotten almost no results for the
money we've invested. And what we need is a system of
accountability and rededication of the Federal Government's
commitment to helping those students who would otherwise fall
through the cracks.
Let me point out three issues that I think are most
important on the education side. They're outlined in the
authorization levels in our bill, H.R. 1, which is in effect
the President's proposal. A $461 million increase in Title I,
$320 million for the President's State assessment initiative
for grades 3 through 8 in reading and math and thirdly, $975
million for the President's reading first and early reading
program.
When you look at what we're attempting to do over there in
terms of providing for more accountability and more
flexibility, we believe that, and targeting, targeting the
money to these children who most need it, these three programs
that we've outlined here are the core of making this work.
I'd also ask that you find the resources to increase
funding for IDEA. This Committee has done a marvelous job the
last five years in increasing IDEA funding. The President's
calling for increased funds, and I know that every member of
Congress listens to what I listen to when I go home from every
one of my school districts. And that's that IDEA needs more
money.
You should be aware that part of the President's request
for his reading program and the early childhood reading program
will in effect help with IDEA issues in local districts. That's
because there are an awful lot of students that end up in IDEA
because they can't read. To the extent we can solve this
reading problem or address this reading problem, both the early
childhood reading and the K-3 reading program, I think we'll
take a big step in helping these school districts with their
IDEA money issues.
Secondly, in this area, the President has also asked for a
billion dollar increase in Pell Grants. We all understand the
need to continue the effort to increase the Pell Grants, to
help those children, again, at the bottom of the economic
ladder, who without that effort would never be able to attend
post secondary education programs. And I think that again,
you're getting a lot of requests, but I think we all understand
the importance of the Pell Grant program.
Let me switch gears and talk about the other side of my
committee, and that would be the labor side. I support the
President's plan to level fund the Department of Labor,
especially in our enforcement areas. In the past, the DOL has
had the habit of administering the Nation's labor and
employment laws beyond what I believe the scope of what
Congress intended. And I think taxpayers savings will arise
from effectively protecting workers by properly enforcing
important labor and employment laws.
I would ask that you support the efforts of the Department
of Labor's inspector general to better protect workers benefit
funds and reduce waste, fraud and abuse that continues to exist
there.
So I thank you for the opportunity to be here and look
forward to answering any questions that you might have.
[The information follows:]
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Mr. Regula. One of the components of the President's
program is testing.
Mr. Boehner. Correct.
Mr. Regula. Do you anticipate that the Federal Government
will fund these tests, even though the States develop them?
Mr. Boehner. What the President proposed is that we, the
Federal Government, assist the States in developing their
tests. Under his proposal and under H.R. 1, the States will
determine what tests to use in their States.
Mr. Regula. I understand that.
Mr. Boehner. But the actual implementation of it is left to
the States. Now, this bill is going through committee here in
the next month or month and a half. Whether we get into funds
for the actual implementation of the test is yet to unclear.
But Mr. Chairman, I think you understand that in virtually
every school district in America, there's testing that goes on
every year.
Mr. Regula. Oh, yes.
Mr. Boehner. And under the President's proposal, some
States are already testing in every grade, reading and math.
Others may be doing other tests. But frankly, I'm not so sure
that when it's all said and done there's any additional testing
that's going to result from the President's proposal. I believe
that the requirement that we'll have in our bill, that we have
annual assessments in reading and math in grades three through
eight may in fact replace some other testing that's already
being done.
Mr. Regula. Staff just advised me, apparently the budget
resolution withholds a $1.25 billion from this Committee,
unless we appropriate a commensurate increase for special ed.
Well, obviously that's going to squeeze what we have to do some
of these other things that are embodied in your bill.
Mr. Boehner. Sounds like a big issue between the
Appropriations Committee and the Budget Committee.
Mr. Regula. I've noticed that there's some discussion of
that. You're going to be involved, too, because you're going to
bring to us through authorization programs that cost money.
Mr. Boehner. I'm confident that when the budget resolution
gets through the House and the Senate and we come to
conference, that all of these issues will be ironed out to our
satisfaction, as they always are.
Mr. Regula. That there will be adequate funding.
Mr. Boehner. I'm convinced that there will be adequate
funding. Even though the President has called for an overall
increase in discretionary funding of about 4 percent, it is
going to put pressure on all of you to make serious decisions
about what needs to be funded.
Mr. Regula. True. Very true.
Mr. Boehner. But I think it's obvious from all the national
polling that we see that education is the number one issue in
the country. The President called for it during his campaign.
He has devoted serious time to this over the last several
months.
And as we get the bill through our Committee and the Floor,
and the Senate does theirs, I do expect that we will have a
bill signed into law prior to your bill, your appropriations
bill, being on the Floor. I would expect that Mr. Miller and I,
the Ranking Democrat on the Committee, we expect to work
closely with you as we move through this process.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Mr. Chairman, I have great faith in your
ability to work those things out.
Mr. Boehner. So do I.
Mr. Sherwood. But the assessment issue I think is so
important. Because parents and students deserve to know where
they stand in relation to other schools. I think our education
establishment has tried to push that on the back burner,
because they don't want the comparison and they worry about
teaching towards the test and those sorts of things.
Well, I think our college board tests and so forth have
told us that if the test is well designed, there are tests that
work. I like the President's proposal to bring assessment
forward, testing forward.
Mr. Boehner. Well, Mr. Sherwood, as a former school board
member, you understand better than most, well, the Chairman's a
former member of the education establishment, I might add, but
the annual assessments really are important, because there's a
big secret out there. The big secret is that about half of our
kids just are not learning.
Now, we've lost a generation of students in our country. We
can keep looking the other way, and act like it doesn't exist.
We can continue to allow the disease of low expectations to
continue. But the people that get hurt the most are the people
at the low end of the economic ladder in our country, the most
disadvantaged of our children are the ones who are trapped and
who will never succeed without an education.
And although we've done all types of well intentioned
programs out of here, the fact is that we need to start asking
for results. And one of the issues that, and Mr. Miller and I
are in much more agreement than most of you would ever guess
about the direction of this bill, because the money needs to
get to those students who most need it.
Those schools in inner city neighborhoods and rural
communities, they've got bigger problems. They need the extra
funds in order to ensure that those kids get a decent
education. But without the testing, without the bright light of
truth being shone on what's happening in some of our buildings,
I don't think we'll ever get there. Because there's a certain
amount that we can do in terms of the Federal Government.
But when you put the bright light on what's happening in
these schools, it will energize communities, businesses,
parents to get out of their easy chairs, get away from their TV
and find out what in the world is happening in our schools.
That is just as important as the change in direction that we're
going to be proposing the next couple of months.
Mr. Sherwood. Expectations are the key.
Mr. Regula. Accountability.
Mr. Boehner. That's it. We'll have plenty of time to talk
about it as the year goes on.
Mr. Regula. I think we'll hear from you in the future.
Mr. Boehner. Thank you.
----------
Tuesday, March 27, 2001.
HEALTH RESEARCH PROGRAMS
WITNESS
HON. CHRIS SMITH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
JERSEY
Mr. Regula. Mr. Smith, Chris, health research programs.
Mr. Smith. Thank you very much.
Mr. Chairman and members of the Committee, thank you for
this opportunity to appear before the Committee. I would ask
that my full statement be made a part of the record, Mr.
Chairman.
Thank you. Let me just say on last Congress, I formed,
along with Congressman Ed Markey a caucus that now comprises
131 members and continues to grow in the area of Alzheimer's
research. As all of us know, and many of us have had family
members who have suffered the devastating impact of that
disease, as we all know, it's not terminal, but it devastates
not only the patient but also the family and especially the
primary caregiver, who often, it turns out to be, is the
spouse, raising serious questions about respite care.
But the bottom line is that right now, there are about 4
million people who have Alzheimer's and many more thousands,
tens of thousands, who are in the process of developing this
devastating disease. It's estimated by the year 2050, 14
million people, today's baby boomers, will have Alzheimer's
disease in those who are moving into that age category. So it's
a ballooning epidemic, that if we don't marry up the necessary
resources in research and trying to get to the cause and
hopefully to solve it, to reverse it in those who have it and
prevent it in those who do not have it, we're talking about a
major----
Mr. Regula. Chris, I'm curious. Is this prevalent in other
countries in somewhat the same degree that we have it?
Mr. Smith. It's a very good question. Increasingly, it's
recognized that Alzheimer's is a disease of aging. So where you
have an aging population, and many of our developing countries,
people simply don't make it into their 60s or 70s. It's
estimated that anyone who's 85 or older, one out of every two,
are in some part, one degree or another into Alzheimer's
disease. So it is a function, to some extent, of our aging.
Mr. Regula. It has parameters of degrees of severity, I
assume, from what you are saying.
Mr. Smith. Yes, there are. It's a progressive disease that
gets progressively worse as the dementia and the plaques and
everything else in the brain form.
Mr. Regula. Then in turn have impact on the physical well
being of the individual, is that correct?
Mr. Smith. That's correct. It may not lead to, like we see
with some diseases, a breakdown where the kidneys don't
function. It doesn't do that. But it leads to an overall
deterioration of the patient. They're not as viable. They
certainly are not interacting.
But primarily, if they exist and get worse and worse and
worse, they very often just sit in a chair and do very little.
They don't recognize family members. And the impact on the
family members, because I've known so many of them, sometimes
it's much harder for them, for a husband or wife to go spend
time with their family member and they don't even recognize
them.
So we're asking on behalf of our coalition, of our caucus,
for a $200 million increase to really declare war on this.
There have been a number of very promising studies that have
been done. They're all in one stage or another, and it seems to
me that this is something we can lick if we again have enough
resources.
The second, if I could, because I know we--it's not a vote.
The second is in the area of autism. I've been involved in the
autism issue since elected to Congress 21 years ago. On and
off, I always thought CDC-NIH were doing what they could do,
inquiries that I would make over the years, particularly in the
1980s, suggested that yes, we're doing what we can.
Three years ago, in one of my major cities, Brick Township,
we discovered that there may be a cluster of autistic children.
There seemed to be an elevated number, perhaps as much as
double what the national average was expected to be, which is
one out of every 500 children.
We asked CDC to come in, we asked other people from ATSDR
to come in and do a study. They did. They found out that indeed
there was a four per thousand, a doubling of instances of
autistic children in that area. From my contacts since and
during that process, I have been astonished as to what we don't
know about autism and how we have almost been frozen in time
over the last 20 years doing very little to mitigate this
disease.
We don't know what causes it, we don't even know what the
prevalence of this terrible disease is, the reporting that goes
on in State after State is passive. Most States don't have a
clue.
To remedy that, last year I introduced legislation that
became Title I in Mike Bilirakis' bill of the Centers of
Excellence to get at the prevalence issue, but also to begin
looking at what can we do, what triggers autism. We all know
families who have had autistic children who are into their
second and going into their third year, all of a sudden, bingo,
their child can't communicate. And this developmental disorder,
for whatever the trigger is, becomes very compulsive and again,
they start down a course of expenses and tragedy, even though
they love their children desperately, it is a heartbreak like
few heartbreaks one can experience.
We're asking for a very modest $5 million to try to, in
addition to what's already been allocated, to try to, it would
be for the Center for Birth Defects and Development
Disabilities at CDC. We've scoped it out, we think it's a good
idea. We ask you to take a look at it. More needs to be done
without a doubt. New Jersey has taken the lead. We don't know
why there seems to be an elevated number in New Jersey. If
there is one. There may be no cluster. There may be a problem
that is going on everywhere else, it's just been below the
radar screen.
And I would hope that you could take a look at this as
well.
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Mr. Regula. Mr. Sherwood.
Mr. Sherwood. No questions, Mr. Chairman.
Mr. Regula. Well, I'm sure, Chris, both of these require
attention. I think NIH is working on them, and as you know,
there's been a commitment to double their budget over a five
year period. And I assume the groups contact them, because they
do allocate resources at NIH. We don't try to dictate just
where they should do their work.
Mr. Smith. I do understand that, and I think they have
realized maybe belatedly, because they have such a full plate,
just that this has been underfunded in the past and this is a
problem overseas as well. In Poland, for example, I've been
working with a group that's, they don't know how to deal with
it. Some of our people, Johnson and Johnson has been active in
this. There seems to be a gross under-reporting of these cases
as well over there. I'm sure as we get into the surveillance
and the prevalence issue, we're going to find that there's so
much more that we don't know. The numbers are higher, and I say
that as a tragedy.
Just one final point. We have formed a caucus, Mike Doyle
and I formed it this year, we have 101 members, and that's
growing as well, to deal with the issue of autism. I know
you'll be very sympathetic, and I look forward to working with
you.
Mr. Regula. Thank you for coming.
Mr. Smith. Thank you, Mr. Chairman, Mr. Sherwood.
Mr. Regula. We'll recess until 2:00 o'clock this afternoon.
[Recess.]
----------
Afternoon Session
Mr. Regula. Well, Wes, you are number one.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. WES WATKINS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
OKLAHOMA
Mr. Watkins. First, let me say congratulations, Mr.
Chairman to you, after many years of serving in the Interior.
Well, you are still in the Interior, but you are just not the
Chair over there. I appreciate the opportunity, and I
appreciate all your work over all the years on the various
committees, and especially Interior, and now as Chair of the
Subcommittee on Labor and HHS.
Mr. Chairman, you know, you have probably heard me over the
years talk about our needs in the rural and economically
depressed areas of the southeast Oklahoma quadrant. I have 21
counties in my district, and all of them are rural, and also
the Tulsa area, which is doing well economically, and the big
Oklahoma City metropolitan area. I have got a nick that goes in
between, and then all of the southeast part.
Mr. Regula. They do not have any oil, do they?
Mr. Watkins. They have very little on the far west side.
That touches very little of my overall district.
But one thing that has not touched us is the fact that we
have been left behind economically speaking, with all the
manufacturing. I do not have a Fortune 500 company in my
district. I have got some timber in one area that is
warehoused, but I do not have big, huge manufacturing.
I am a product of out-migration. When I was growing up, my
family had to leave three times to go to California and search
for jobs. That is what made the burning imprint on my life
about going into public life, in order to try to build the
economy and build jobs. As I have told people before, I am not
in politics as an end, but politics as a vehicle.
We are trying to change that. We have done some good, and
we have still got a long way to go. The per capita income in my
district is about 60 percent of the national average; not the
top, but it is about 60 percent of the out-migration.
Like I said, we have been doing some good. We have had to
do a lot of things on our economic infrastructure. One of the
things also that has happened to us is we have been passed by
the high technology, the information technology, in that rural
area of the state of Oklahoma. The big cities, again, are doing
well.
What I am trying to do, I am working with Career Tech.
Career Tech is the state vocational technical education system
all across the state of Oklahoma. I am working with them trying
to work through the hub and provide the high tech potential in
that area. We call it REVTECH.
Last year, the committee provided $921,000. I am asking
this year, Mr. Chairman, and I hope you will be able to help
us, for about $1.25 million to help work with the State
Department of Career Tech. That would allow us, in a lot of
those different areas, to be able to provide the necessary
wiring, the technology, et cetera, to be able to attract more
people.
For instance, I work with an industry that is up around
Tulsa, but not in my district. They said they could hire 500
more people if they could find trained people. Well, I have got
500 people, but they are scattered throughout my area, if I can
get them all together.
So that is the one request that we have up at the top of
the list. The other is the fact that for many years, I have
worked on international trade. The reason for my commitment and
dedication to international trade is the fact for every $1
billion of increase in trade, you actually produce about 20,000
jobs. So it makes a lot of sense.
Mr. Chairman, I know your background is in rural areas, and
some of it is in agriculture. I think, if I recall, you were
out on the farm there.
We are not going to save rural America just with
agriculture alone. I say that with two degrees in agriculture.
I love agriculture. But we have got to have off-farm jobs some
way to be able to survive or to be able to re-build our small
communities.
We are working also on the international trade aspect of it
at Oklahoma State University, our land grant university there.
This committee helped last year with $320,000. I am asking, if
you could, give us $750,000, or as close to that as you
possibly can.
The other thing that you worked with me on last year on the
committee was Fragile X, and I am just asking for language as
to the help on working with that. That is one of the things
that has come along, that has dealt with the retarded. They
have made some very scientific breakthroughs, and I have got
some language in there for that.
The other request, and I have had several others, but this
other one is the one new one. It is the Seminole Junior
College, or Seminole College. They have got dormitories, but
there is some renovation that needs to take place there, if
they are going to be able to continue to use them. I am trying
to figure out how we can get that done.
I have said to community there that I would do my best to
try to help them with some renovation some way, if we possibly
could. So that would be a big help to that community.
Mr. Regula. Is that BIA operated?
Mr. Watkins. No, it is not, but there are a large number of
Native Americans there. In fact, Mr. Chairman, and you probably
know this from your work with the Interior, Oklahoma has got
the highest percentage of Native Americans of any state in the
nation. In fact, close to 22 percent are in Oklahoma.
Mr. Regula. Okay, we will look at them.
Mr. Watkins. If you could help me, sir, I would appreciate
it very, very much. This is a committee that I felt like there
are some things there that maybe you could help us. I really
would appreciate it.
Mr. Regula. It will depend a lot on what we have available
to work with.
Mr. Watkins. Being on the Budget Committee, I am trying to
do my best to let you have as much as we possibly can.
Mr. Regula. We look forward to that, Wes.
Mr. Watkins. We will keep pushing for it.
Thank you, Mr. Chairman.
Mr. Regula. Thank you.
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Mr. Regula. Ms. Mink, I see you have various programs, too.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS
WITNESS
HON. PATSY T. MINK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
HAWAII
Mrs. Mink. I brought a very modest list. [Laughter.]
Thank you, Mr. Chairman. I do not know how long my voice is
going to last, so may I just ask unanimous consent that my
testimony be inserted in the record.
Mr. Regula. Yes, all the testimony will be included in the
record.
Mrs. Mink. I also brought with me a letter which 85 members
have signed with respect to the ovarian cancer research. I
believe you are familiar with my annual trek to this committee,
urging that more funds be committed to this research.
Mr. Regula. That would be through the NIH.
Mrs. Mink. Yes, that is correct. I remember when I started
this campaign for funding for research in this area, that the
NIH was only spending $7 million. Today, it is up around $70
million, but we need a lot more.
It is a very tragic situation where the situation of our
research has not come to a point where an early detection test
has been found. I believe they are close to it, but until we
can find a satisfactory detection for ovarian cancer, we are
going to continue to lose many, many thousands of young women.
A lot of the women who come down with this are in their mid-to-
late 30s. It is very, very tragic.
About 23,000 women are diagnosed each year. Most of them
are in their late stages, where they cannot be saved. So the
mortality every year is about 14,000, which is the highest in
the reproductive illnesses.
So I think it really takes a determined effort on the part
of this committee to recognize the enormous situation that
women are in today.
There are no symptoms for ovarian cancer, usually, that the
doctors can detect by physical examination or by pain or other
kinds of things. So unless we have a test, it is not going to
be possible to save these lives. So the research is really
very, very critical.
My bill that I have circulated in the House with about 115
co-sponsors asks for a $150 million commitment. I hope that
this committee will find the necessary funds to make that
possible.
The other institute which I feel needs to have real
attention is the National Eye Institute. We are not aware of
how many people in America suffer from eye diseases. We need to
spend more money on research, money to determine why these
illnesses occur, and what can be done to alleviate this
condition.
Some of it has to do with diabetes and other kinds of
related illnesses. But the NEI, which is a separate institute,
the National Eye Institute, is currently funded at $510
million. This year, I am hoping that you will be ableto go up
to $604 million for this institute.
Last year, we had put in a bill asking for the funding to
be doubled in at least five years, and we are marching steadily
ahead. So I hope that the progress that we have gained in the
last several years will not be stayed in any way, and that we
will continue.
The last item is one that relates to education funding. We
are really absolutely transfixed on the fact that our young
people are killing each other in our schools for almost no
understandable reason. A lot of them are from middle class
neighborhoods, coming from well stationed families, without any
clear evidences of problems in their homes.
The Speaker, Mr. Hastert, established a task force last
year on school violence. I was fortunate enough to serve on
that. Most of us had various approaches to it. But the one
thing that we agreed on was the necessity for having additional
staff put into our schools, particularly in the intermediate
years.
We do not want to call them counsellors, because they
already have categories for those people. We do not want to
call them social workers or whatever. So we came up with the
title, school-based resource staff.
The schools could then pick whatever kind of personnel they
felt suited for their particular school situation. But what we
want to do is to get a ratio of one of these resource staff
people per every 250 students.
That is still a high ratio, but we think that is a starting
point. In order to get there, Mr. Chairman, we have a target of
100,000 additional school-based personnel. I hope you will come
up with the funding necessary to support it.
Mr. Regula. Would you contemplate 100 percent of that being
Federally financed?
Mrs. Mink. Yes, 100 percent; it is like 100,000 teachers,
to phase them in. But the target is 250 to one ratio,
ultimately.
Some schools already have that. So they would not be
getting into this particular fund. But for those school
districts that do not have these extra personnel to take care
of handling the students, this is not the chore of the
curriculum-type person or the vice principal, who has to do
administrative work, or worry about discipline and those kinds
of things.
This is a school personnel individual that is there solely
and exclusively to deal with the students, so they can go to
someone with their problems; or if they hear something about
someone making some outrageous statements or threats, they can
go to this individual, without the fear of peer pressure and so
forth. They can go to this individual and tell us staff person
what they heard, and let the staff person decide to what level
that should be taken.
We think that this is a position that the Federal
Government can take very, very easily. Our task force that the
Speaker appointed unanimously agreed that this is a step that
must be taken.
So I thank you very much for your consideration.
Mr. Regula. Thank you for coming, Patsy.
[The information follows:]
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Mr. Regula. Next is Billy Tauzin from the great state of
Louisiana. Boy, you are just getting warmed up down there on
your celebrating, are you not?
Mr. Tauzin. Lent time is a time for rest.
Mr. Regula. So you are resting now, is that it? [Laughter.]
Mr. Tauzin. We are paying for our sins.
Mr. Regula. Well, you need more than 40 days.
Mr. Tauzin. Actually, 40 is a good start.
----------
Tuesday, March 27, 2001.
VARIOUS PROGRAMS
WITNESS
HON. BILLY TAUZIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
LOUISIANA
Mr. Tauzin. Mr. Chairman, thanks for having me. I bring to
you today a young friend of mine who has been before the
committee for three years now. His name is Keith Andrus. He is
a ninth grade student, and he happens to be the son of my
office manager, Rachel Andrus. She and her husband, Ron, are
here with me. He is also afflicted with Friedreich's Ataxia.
Now Friedreich's Ataxia and Usher Syndrome are very rare
disorders which occur in rural medically under-served Cajun
populations at a rate of 2.5 times the national average. It is
genetically, apparently, connected and, as a result, the Cajun
population in my state have severe incidents of this particular
disorder.
It is rare. It is degenerative. It severely diminishes the
physical abilities, and ends up confining patients to
wheelchairs by their late teens.
The quality of life is heavily comprised and, sadly,
because of heart problems, life expectancy is shortened to 37
years. Currently, Mr. Chairman, there is no treatment and no
cure. Keith stands as an example of courage, in the face of
that kind of a statement: no treatment, no cures.
By the way, there are many people across America who face
this disorder. There is a young family in Ohio, in Struthers,
Ohio. They are a very closely knit family with a mom and dad
and three kids. One of the twin boys has Friedreich's Ataxia.
That is in your own home state, just asan example.
But across America, families like them watch their children
grow up knowing that so far, there is no treatment and no cure.
We are trying to do something about that. I am pleased to
tell you that your subcommittee established at home in
Louisiana the Center for Acadiana Genetics and Hereditary
Health Care. It was established through a health care outreach
grant. It is administered through the Health Resources and
Services Administration.
For three years, you have helped fund this center. By the
way, it is heavily supported at home. Over 50 percent of its
support comes from state and voluntary contributions. We are
asking your support for the $1.5 million of Federal funding to
keep the center open.
Mr. Regula. It was $921,000 last year?
Mr. Tauzin. Right, and the center, Mr. Chairman, links the
School of Medicine, the Biomedical Center, the hospitals, the
rural clinics, and a strong telecommunications network to
provide urgently needed health services, information, and
education regarding these kinds of genetic diseases.
By the way, this is, of course, not the only disease that
is genetically connected. Through the work of the center, in
connection with other genetic research done around the country,
we are learning and discovering much more about Usher Syndrome
and diseases like diabetes, cancer, heart disease, Alzheimer's,
Parkinson's and other psychiatric disorders.
But here is this kid and his hope, literally, lies with
you. Will we find a cure; will we find a treatment in time?
Mr. Regula. Well, we have done a lot with genetics.
Mr. Tauzin. We are doing an awful lot.
The work that your committee has done is supported at NIH.
We, at Energy Commerce, have jurisdiction over at NIH. I want
to thank you from the bottom of my heart for the commitment
that you have made to NIH.
Mr. Regula. You did the authorizing in your committee.
Mr. Tauzin. So we are connected here, Mr. Chairman. We will
continue to be connected in this vital effort.
But the bottom line is that we can not stop this kind of an
effort. This kind of an effort may lead to a day when I can
bring Keith here and say, guess what, we have found a cure; we
have found a treatment in time for him and in time for others
like him, and families like him.
Mr. Regula. It seems to me that the potential lies in the
genetic research that they are doing today.
Mr. Tauzin. In fact, at one of the hearings, Mr. Chairman,
we heard that work being done in a completely different area
yielded some very exciting information that may, in fact, touch
upon Friedreich's Ataxia one day.
The neat thing about the work being done in all these
different areas is that with the human genome completed, we are
going to be able to tie some of that work together and discover
how one has application on the other.
My plea to you today is not for a large sum. I am not
asking for half a billion dollars or hundreds of millions of
dollars, just $1.5 million to keep literally hope alive for
this young man and others like him.
I lay it again at your feet and ask you humbly to take it
seriously, and to keep this thing alive for him.
Mr. Regula. Well, we have a lot of challenges on this
committee, as you can fully understand. A lot of what we can do
is dependent on funding. We are doing some wonderful things in
research, and we hope that this will be one of them.
Mr. Tauzin. Oh, I have no doubt that it is. Keith will tell
you that he has no doubt. With the advances we are finding, he
has no doubt that we are going to find it in time. His family
has no doubt. I just want to commend him for his personal
courage, and for his family's courage.
Mr. Regula. Does he go to school here in Washington?
Mr. Tauzin. He is here in school.
Go ahead and say hello, Keith. What school do you go to?
Mr. Andrus. Woodson High School
Mr. Regula. Is it in D.C.?
Mr. Andrus. In Virginia.
Mr. Regula. In Virginia; that is Fairfax County, probably.
Mr. Tauzin. Keith is already having great difficulty
walking. As a result, he can not carry hot liquids or liquids,
because of health reasons. Every year that Keith has come, the
committee has been able to see how the disease is wrecking his
frame and hurting his chances for a good healthy, long life.
Mr. Regula. Keith, we will make every effort to help the
NIH find a cure. Thanks for coming.
Mr. Tauzin. Thank you, Mr. Chairman.
Thank you all.
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Mr. Regula. Yes, Mr. Stupak, you are just in time.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. BART STUPAK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MICHIGAN
Mr. Stupak. Thank you, Mr. Chairman, Nancy; thanks for
giving me the call and saying, come on over in a hurry. I was
just down the hall, and I made it. [Laughter.]
We have a number of requests for the committee's
consideration, today, Mr. Chairman. First, let me start with
Operation Uplink. This involves technological assistance to the
Upper Peninsula of Michigan. What we are looking for is $2.5
million to fund an initiative to comprehensively design and
advance an information-based infrastructure in the Upper
Peninsula.
What we are really saying is this. Northern Michigan
University, Michigan Technological University, Bay de Noc
Community College, Marquette General Regional Hospital, our
regional libraries, economic development, and local government
would like to get linked up. In doing that, we want to look at
certain factors which are unique to the Upper Peninsula.
If we could get a well-designed telecommunications
infrastructure, we would have the opportunity to level the
playing field between rural areas, like my district, and the
urban areas.
Mr. Regula. Would this require fiberoptics, or what type of
link are you contemplating?
Mr. Stupak. With the technology clusters that we are
talking about, and this last mile of connections that theyare
talking about, it would be better than the fiberoptics. We have some
fiberoptics around Marquette and the rest of the Upper Peninsula. We
are talking about high speed Internet, broad band access, things like
this.
In my district, even with this great economy that had been
going for the last few years, the Upper Peninsula still had 5.8
percent unemployment. In Michigan Tech, where part of this is,
it is around 10 to 12 unemployment.
What we are saying is, in order to compete and to really
get our future going, we really would like to have this UP
uplink program going.
If you take a look at it, Mr. Chairman, it is not much
different than what we did. I have introduced legislation in
the past to bring electricity, to bring telephones, to bring
those services to rural America.
This is one region of the country that is geographically
unique. We have always had a problem with high unemployment, at
5.8 percent, while the rest of Michigan was 3.6 percent. I said
some parts, in the winter months, like on the eastern end of
the Upper Peninsula, unemployment is 30 percent.
Now when the ice leaves the lakes, as you know, come
summertime, they would have virtually no unemployment; but for
four or five months out of the year, we are at 30 percent
unemployment. What do you do on those cold winter nights? If we
had the technology, I think there are a lot of things that we
could do and can do.
That is where we would like to go with that opportunity. It
is $2.5 million. I would hope that you would take a look at
that request.
The next one is for our gerontological studies, basically
for senior citizens. Again, this is at Northern Michigan
University, the Upper Peninsula. Our population is about 12
percent senior citizens. On the western end, again, we just did
a study in Kohebic, in Ougan Counties, and it is 25 to 30
percent of older population that is 65 and older.
While we would like to use the center for research,
education, community service in rural Michigan, that is related
to older individuals and the aging process. It would be the
knowledge of the aging process and the aging network, and its
service provisions apply information as a mechanism to enhance
the lives of people who reside in rural communities like
Michigan's upper peninsula.
This would be worked out in Northern Michigan. Again, these
two programs almost go hand in hand.
Thirdly, Mr. Chairman, Northwestern Michigan College, you
helped them out last year. This is in Traverse City. Again,
they want to operate a life-long learning center on the West
Bay Campus.
The senior citizen center is there. It is a waterfront
area. The lifelong learning center would be the hub for
participatory learning for faculty, staff, and students at
Northwestern Michigan Community College in Grand Traverse
County.
As you know, Mr. Chairman, this is probably one of the
fastest growing areas of Michigan. Retirees leave the auto
plants in southern Michigan and they come up to my district to
retire.
Traverse City and Northwestern Michigan have been a leader
in trying to provide senior programs. Again, this would go with
Northwestern Michigan College in Traverse City.
Last, but not least, the Olympic Scholarship is a program
that we have been here a couple of times, advocating for in the
last two years. You have funded it, which has helped out many
athletes. Athletes train at our four Olympic Centers in
Marquette, Michigan; Lake Placid, New York; Colorado Spring,
Colorado; and outside San Diego, California.
These athletes, most of them are young people. They are in
sports such as speed skating, boxing, Greco-Roman wrestling,
many of the Nordic sports.
There are no scholarships for them. But they are willing to
train. They take money out of their own pockets. They go all
over the nation, doing training, competing. They go to Europe,
where they get some help.
At the same time, many of these people would also like a
degree. Even if you won the gold medal in Greco-Roman
wrestling, I do not know how you could make that into some kind
of an economic benefit for the rest of your life, or speed
skating.
Even though we may win the gold medal, like some of the
athletes that came out of Marquette, a couple of Olympics ago,
and we may win the speed skating, there is no career in that.
There is nothing.
So where they are putting in all the hours, we think we
should have an Olympic education training center, as Northern
Michigan and these others are, and let them go to school, give
them a scholarship, let them train.
The boxers start at 5:00 in the morning. I have been up
there talking to them many times. Many of them come from inner
cities. Many of them come from poor backgrounds. They are
there, and if it was not for the Olympic scholarships, not only
could they not probably participate and train and work for the
Olympics, but at the same time, they are getting a quality
education.
So the Olympic scholarships have been a great advantage to
the four sites throughout this country. I hope you would fund
it again.
That is a quick overview. Like I said, I literally ran down
here, and I think I ran through my report, too. But it is all
here, and it is 15 pages. I am not going to read it. But if you
have any questions on any of these three programs, that I have
outlined, I would be happy to answer any questions.
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Mr. Regula. Okay, thank you; are there any questions?
[No response.]
Mr. Regula. Thank you.
The Olympic Center is named after your son, I believe.
Mr. Stupak. Yes, that is true, and I thank the committee
for that courtesy that they have shown us. Thank you.
Mr. Regula. Thank you.
Next is Representative Danny Davis.
----------
Tuesday, March 27, 2001.
CONSOLIDATED HEALTH CENTERS
WITNESS
HON. DANNY DAVIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Davis. Thank you very much, Mr. Chairman and members of
the subcommittee. I am pleased to provide the subcommittee with
testimony in support of the urgent need to increase funding by
$250 million for the Consolidated Health Centers Program; that
is community, migrant, homeless, and public housing health
centers, to at least $1.419 billion for fiscal year 2002. I
realize that this committee has been very supportive of the
community health center program in the past. In fact, members
on both sides of the aisle of this committee have united to
advance this program. It is a true testament of the integral
role health centers play in the delivery of health care for
this nation.
I appreciate the committee's support last year of our
request for a $150 million increase. Unfortunately, the $150
million increase has only enabled health centers to serve 10
percent of the Nation's 43 million uninsured people. With the
uninsured population continuing to grow at a rate of over
100,000 individuals per month, it is estimated that the
uninsured population will reach over 53 million by 2007.
There is no question that much more needs to be done to
expand health center services to reach more uninsured people,
and to continue to provide quality care to existing health
center patients.
I applause President Bush's recent call to double the
number of patients served by community health centers, enabling
millions more to have access to the most basic health care.
In fact, the President's budget has recommended a modest
increase of $124 million for the health center program. I
believe that is a good start, but because of the demand for
health care and the rise in the number of uninsured, I believe
we will need to raise that number to $250 million.
With an additional $250 million, health centers will be
able to serve and expand facilities in rural and urban
communities, and see an additional 700 patients.
Our nation is still divided when it comes to health care;
that is, those who have and those who have not. I have had the
good fortune to work directly with and in community health
centers, prior to running for public office.
It has been my testament and my goodwill to see that there
is no other group of centers or programs in the nation that has
been able to provide the kind of access to health care that
these centers have given.
So, Mr. Chairman, I would urge that we seriously look at
increasing by $250 million, so that all of the uninsured people
in this country, who would then benefit, would come out of the
uninsured, to the serviced area.
I thank you, Mr. Chairman. It has been a pleasure to be
here.
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Mr. Regula. They use a lot of volunteers, am I correct, in
the community health centers?
Mr. Davis. Well, they used to. Volunteerism in this country
is not quite what it used to be. They use volunteers. But these
centers basically started out of the old OEO programs. They
were put in urban and rural communities where nothing hardly
was there.
Many of them have become the centerpieces for economic
development in those communities, as well, and they are the
biggest thing there. They provide not only health care, but
they have provided employment opportunities, business and
economic development opportunities, and they are pretty much
considered to be community-owned. People feel really good about
them.
Mr. Regula. I am sure that is true. We have one in our
area.
Are there any questions?
[No response.]
Mr. Davis. Thank you very much, Mr. Chairman and members of
the committee.
Mr. Regula. Thank you.
Next is my colleague from Ohio, Mr. Kucinich.
----------
Tuesday, March 27, 2001.
UNITED STATES HOUSE OF REPRESENTATIVES
WITNESS
HON. DENNIS KUCINICH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
OHIO
Mr. Kucinich. Good afternoon, Mr. Chairman.
Mr. Regula. Dennis, we are happy to welcome you.
Mr. Kucinich. It is my pleasure to be in front of your
subcommittee. I appreciate it very much. Good afternoon to my
colleagues; I appreciate the chance to be in front in your
committee. With the permission of the Chair, I will begin
whenever it is appropriate.
Mr. Regula. Go ahead.
Mr. Kucinich. Thank you very much for the opportunity to
appear before the committee. I am urging the committee to
prevent the use of Federal funds for prolonging the public
comment period of the final Medical Privacy Standards.
Last month, a new 30-day comment period was opened on the
standards mandated by the Health Insurance Portability and
Accountability Act, and several industries are lobbying to
extend the period even further.
These regulations are long overdue. When Congress passed
HIPAA in 1996 with strong bipartisan support, it required HHS
to promulgate rules by August 23rd, 1999, if Congress did not
legislate. During HHS' work on the regulations, Congress and
other interested parties articulated their views.
In September, 1997, the Secretary of HHS submitted a health
privacy report to Congress and testified before the Senate
Committee on Labor and Human Resources. Several bills were
introduced.
The proposed rule was published in November, 1999. Industry
and consumer groups asked for the comment period to be
extended, and HHS pushed the deadline back by 45 days.
The rule generated extraordinary feedback; 52,000 comments.
Clearly, the health care and insurance industries have had
ample opportunity to make their voices heard, and have done so.
Now the industry groups seeks to weaken the medical privacy
law by delaying the rule's implementation. The rule already
allows health plans two years to comply, and gives small plans
an additional year beyond that deadline. These groups do not
have a leg to stand on in lobbying for continued delay.
They have had plenty of input into the regulations, have
known for five years that the regulation was forthcoming, and
now have another two to three years to meet the deadline.
By not implementing the rule, not only are the medical
privacy of patients put at risk, but so is the privacy of their
Social Security numbers, the privacy of their financial
information, their ability to maintain health coverage, and
even keep a job. That is really the core of this.
Here are some examples of abuses that have occurred because
of the lack of medical privacy laws. Last December, Terry
Sergeant, a North Carolina resident, was fired from her job,
after being diagnosed with an expensive genetic disorder.
Three weeks before being fired, she was given a positive
review at work and a raise. She suspects her self-insured
employer found out about her condition and fired her to avoid
the medical expense.
A truck driver in Atlanta was fired from his job after his
employer learned that he had previously sought treatment for a
drinking problem.
A California woman requested that her pharmacy not disclose
her prescription information to her husband, from whom she had
separated. When he contacted the pharmacy, he received a copy
of all of her prescription records, and then gave them to the
rest of the family, her friends, the Department of Motor
Vehicles and others, claiming she was a drug addict and a
danger to her children.
A banker who served on his county's health board cross-
referenced his customer accounts with patient information, and
then called the mortgages of anyone with cancer.
The University of Michigan Medical Center inadvertently put
several thousand patient records on public Internet sites for
two months in 1999. Only when a student searching for
information about a doctor found links to private patient
records with numbers, job status, medical treatments and other
information was the problem discovered. It goes on and on and
on, Mr. Chairman. I will submit, with the Chair's permission,
all of this testimony.
But what it comes down to is that the implementation of the
Medical Privacy Rules on April 14th ought to be strongly
considered. Americans long ago asked Congress to respond to the
threat of vulnerable privacy records, and many have already
suffered from abuse of private information made public.
This committee can ensure that these protections go into
effect if you prohibit the use of funds in this bill to delay
the implementation of the medical privacy regulations any
longer.
I am here presenting this in my capacity as the Chair of
the Progressive Caucus. I thank the Chair for his indulgence
and I thank the members. Thank you.
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Mr. Regula. Are there any questions?
[No response.]
Mr. Regula. Thank you.
Mr. Kucinich. Thank you and good afternoon.
Mr. Regula. Do we have any other members here? Don Young is
the next one on the list.
Mr. Kucinich. Mr. Chairman, in concluding, I am just going
to submit all of this record, if the Chair would accept it.
Mr. Regula. Oh, yes, all statements are part of the record.
Ms. Pelosi. Would the Chair yield?
Mr. Regula. Yes, certainly.
Ms. Pelosi. Mr. Chairman, I do not know whether you saw it
last night, but on TV on PBS, they had a special presentation.
What it consisted of, largely, is something of interest to the
committee. It was about environmental health.
What it was, it was the release of documents from the
chemical industry, as to what they knew and when they knew it,
about danger to workers in the work place, and communities
surrounding these factories.
Last year, as I have mentioned a couple of times in our
hearings, under Chairman Porter's leadership, we had a hearing
on environmental health. Scientists came and talked about the
need for bio-monitoring to monitor what people are breathing
and drinking in the water, from chemicals in the environment.
It was a very important hearing. In fact, I have been on
the committee, and others who have been on it longer, do not
recall us ever having a hearing on a single subject. Usually,
we have hearings of this kind.
So that hearing, plus the funding and the generosity of
this committee to fund the CDC over the last four years to
increase the funding of the environmental health project, have
taken us a long way down the road to having an understanding of
the connection between health or disease and chemicals in the
atmosphere or in the water.
I would commend Moyer's show to the Chairman's attention,
and to all of our colleague's attention. Certainly, we want to
have a balanced approach as to how we go forward. We do not
want to do anything that is not science-based. But certainly,
on behalf of our children's health, we really do not know what
risk we are putting children at.
Of course, because they are younger and developing, they
are impacted more directly and more negatively than older
people.
Mr. Regula. Well, it seems to me, we have had an EPA for
many years, and we have all these agencies. Would they not have
a vast body of knowledge about these types of hazards?
Ms. Pelosi. You would think so. In the testing that is
done, you know, they will test the air, they will test the
water, and they will test this or that. But this is the work
that we are doing now to see what to monitor in human beings.
Because of the generosity of this committee over the past
few years, the CDC is in a much better position to do some of
the monitoring, which I think you have heard in one of the
points that Mr. Stokes made, when he was here, on the
environmental health issue that he is working and that
monitoring.
Then we see that children have higher incidences of asthma,
because of the atmosphere in which they live and that the
connection between the environment and health is a direct one.
The committee has taken the lead on this. I think it would be
interesting to see some more evidence on that.
Mr. Regula. What conclusions did Moyer reach, or what
recommendations, if any?
Ms. Pelosi. Well, the whole point was that we have to have
data. We have to have a ground truth on the basis of which we
go forward. Even the chemical industry admitted in their own
statements that we really do not know what some of the risks
are to these. Even though they have set out to make some tests,
they have not done them, yet.
Again, this is information that would be useful to the
committee. The committee has to have a scientific basis and
data on which to make judgments. This is another piece of
information that I think would be useful to the committee, as
it balances its decisions.
Mr. Regula. Where did you see this?
Ms. Pelosi. It was on PBS, and it was called ``Trade
Secrets.'' Basically, what it was, a lot of the chemical
industries, over the past 40 years, have known the danger that
their chemicals have posed to the public, but have kept that
information from the public.
Indeed, in their own documentation, they show how, when
they were going to go to NOISH, which is the science part. OSHA
is the work place safety and NOISH is the scientific research
part of it.
They said, well we cannot deny if they ask us, but we will
not volunteer the information, even though NOISH had put out a
call for all information regarding some of these chemicals in
the atmosphere. So it is interesting.
Mr. Peterson [assuming chair]. I think the situation with
liability that we have, I know ladder companies, and this is on
the whole safety side, were hesitant to improve the ladder,
because they admit then that the ladder was not as strong and
safe as it could have been with the new improvements, and they
were instantly liable, if anybody got hurt on the old ladder,
so they never put the new structure out or changed it.
I have a feeling that companies, as they improve their
processes, realize that they have come up with a new process
that is better than how they were doing it, but instantly are
liable to the trial lawyers for cases, because they have now
improved the process. They have found out how to reduce it. I
mean, I really think this thing cuts both ways.
Ms. Pelosi. I say we have to balance that. You bring up an
interesting point. When I say this was a trade secret, all of
this was largely a presentation of their own documents, of the
documents of the chemical industry that are now public.
One of the things that does not relate to workman's comp or
anything like that is, for example, hair spray, and what is
involved in aerosol hair spray. If you have it in the work
place, you have some protection in liability, because of
workman's comp and this or that.
But once that is proven to be a danger to the general
public, then it is a different dynamic, if you were to be sued
or something like that. So they have, in this case, even more
reason to keep the information secret, not because of what it
meant in terms of work place, but what it meant in terms of the
general public.
I see that one of our colleagues has arrived. Again, this
would be a good committee, because we have the CDC. We have the
NIH. We have the science at NOISH. We have the scientific
institutions, as part of our dynamics.
We do not want to proceed on a notion or emotion. We want
to proceed on the basis of science. This is a very valuable
contribution, in terms of avoiding the science.
We have a different responsibility, I think. But we do have
responsibility for balance, and I look forward to working with
you on that.
Thank you, Mr. Chairman.
Mr. Regula [resuming chair]. Thank you, Nancy.
We have a health care task force group. The first speaker
in that group will be our friend from Ohio, again, Mr.
Kucinich, and I believe Ms. Christenson is here, also.
Ms. Pelosi. Mr. Chairman, I am sorry, I did realize Mr.
Kucinich was coming forward again, or I would not have
continued.
Mr. Regula. No, that is all right. I think it is a real
problem.
Ms. Pelosi. For everything that I have said, it is more so
in minority communities and disadvantaged communities, because
that is where a lot of these chemicals are.
Thank you, Mr. Chairman.
Mr. Regula. Thank you.
Representative Kucinich.
----------
Tuesday, March 27, 2001.
HEALTH CARE INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
WITNESS
HON. DENNIS KUCINICH, CHAIR, CONGRESSIONAL PROGRESSIVE CAUCUS HEALTH
CARE TASK FORCE
Mr. Kucinich. Mr. Chairman, it is a pleasure to be a part
of your committee once again. I thank you very much for the
chance to appear, and to Ms. Pelosi. I saw that two hour
program. We will have a chance to chat about it soon; thank
you. I am here on behalf of the Congressional Progressive
Caucus, of which I am the Chair, and to address some issues
that I know this committee is very concerned about.
America is home to the most advanced medical research
facilities and scientists in the world. In part, that is
because this committee has provided funding and guidance to
achieve it.
I am pleased that so many of my colleagues have supported
doubling the budget at the National Institute of Health. I
think we all appreciate the priority of finding therapies and
cures for diseases and other ailments to improve public health;
but America is home to irony, as well.
For example, the United States ranks 25th among other
nations in infant mortality rates, which is twice the rate of
Singapore, which has the lowest rate. These statistics reflect
the gross failure of our health system to provide access to
adequate prenatal care.
Every day, 410 babies are born to mothers who receive late
or no prenatal care, according to the National Center for
Health Statistics. African American infants are more than twice
as likely as white infants to die before their first birthday.
Among others, the United States ranks 20th in maternal
mortality levels. According to the World Health Organization,
half of these could be prevented through early diagnosis and
appropriate medical care of pregnancy complications.
For a country with advanced medical technology, it is
unfortunate that mothers and infants do not have access to
basic preventive health care. This example illustrates the
broader point that this committee must also fund programs to
get cures that we pay for to the people who need them, prevent
disease, and ensure a minimum level of health care to every
American.
The AIDS crisis in our country requires a comprehensive
strategy, meaning prevention therapy and research for a cure.
Up to 900,000 Americans are now infected with HIV, and half of
this population is under the age of 25.
This committee, I hope, will be able to fund the following
programs at the Centers for Disease Control to prevent
infection and provide care for those who are infected:
prevention activities that depend on CDC funds given to local
health departments; HIV Prevention Community Planning Groups,
and the Substance Abuse Prevention and Treatment Block Grant.
The minority HIV/AIDS Initiative works on both prevention
and providing care resources in communities of color, where the
major of new AIDS cases occur.
In order to provide care for those infected with HIV, the
Ryan White CARE Act and the Housing Opportunities for People
with AIDS Program support a range of services. This coordinated
group of programs is crucial to dealing with the HIV virus, and
all should be fully funded.
The Progressive Caucus is also asking that the committee
raise its funding level of support to programs under the Health
Resources and Services Division that are critical to maintain a
skilled health work force.
They have a number of other recommendations here, which I
would ask the Chair and the committee to please give their
thoughtful consideration to. As any of the health programs we
are talking about, the solution needs to be comprehensive.
Besides research and development of therapies, we must
train doctors and nurses in new therapies, for us to have
medical professionals serve in shortage areas of the country.
This strategy must also include educating people about how
to take care of their own health, and exercise preventive
strategies. Prevention is the best medicine.
Mr. Chairman, the committee has been a leader in providing
for health advances in our country. I ask it to continue to be
a leader by funding initiatives to make health advances
accessible to all Americans.
I thank the Chair, and thanks to all the members for your
time.
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Mr. Regula. Thank you.
Representative Christensen.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL BLACK CAUCUS HEALTH CARE TASK FORCE
WITNESS
HON. DONNA M. CHRISTIAN-CHRISTENSEN, A DELEGATE FROM THE U.S. VIRGIN
ISLANDS, CHAIR, CONGRESSIONAL BLACK HEALTH CARE TASK FORCE
Ms. Christensen. Thank you. Good afternoon, Mr. Chairman
and members of the subcommittee. It is a pleasure to be here.
Mr. Chairman, I want to begin by congratulating you on your
assumption of the Chair of this new subcommittee. As Chair of
the Interior Subcommittees for several years, my constituents
have been the beneficiary of your leadership.
Of course, the territories are a part of the health dilemma
that we are going to discuss this afternoon. It is one which is
defined by grave disparities in health care status.
The subcommittee has my full testimony. I am going to
summarize and also clarify a few points in it, if I might.
First, the funding, including my request in the CBC and HIV
and AIDS minority initiative, is not intended just for African
Americans, but for all communities of color. It also extends to
people living in our rural areas.
Second, the request is additional to and not intended to
supplant or take away from any other Department of Health and
Human Services funding. Indeed, we are requesting that the
department's budget be fully funded, at least at the 2001
level.
Third, the request, which includes our HIV and AIDS
initiative, is for $1 billion for fiscal year 2002, and
hopefully for subsequent years through 2006.
Fourth, while they do not come under the jurisdiction of
this subcommittee, we have included in our overall agenda,
universal coverage in the full lifting in the cap on Medicaid
for the territories. We hope for your support, as well as the
support of other subcommittee members on this initiative.
My testimony here today, however, is on the state of
African American health in this country, and what I think it
will take to adequately address it.
In any discussion on the health of people of African
descent in the United States, it is important that it be framed
in the context of what is called the Slave Health Deficit; 400
years of health care, deferred or denied, a deficit that has
never been made up.
Even at the dawn of this new century and millennium,
African Americans have the lowest life expectancy of any other
population group in this country, and the gap has widened,
actually, since 1985.
Today, hundreds of African Americans will die from
preventable diseases. This number is increased over the last 20
years. Deaths from heart disease are 38 percent higher in black
males and 68 percent higher in black females.
In recent years, our death rate due to stroke was about 75
percent higher than in our white counterparts. The prevalence
of diabetes in African Americans is almost 70 percent higher
than in whites; and with less access to care, African Americans
suffer more amputations, blindness and kidney failure.
The infant mortality gap has widened since 1985, and ours
is twice that of our white counterparts. Over 50 percent of all
new HIV infections annually are in African Americans, and we
make up 45 percent of all AIDS cases, and we are only about 13
percent of the total population.
An African American male is almost eight times as likely to
have AIDS as his white counterpart, and for women, that is
about twenty times more likely.
Mr. Chairman, our health agenda in the request to the
subcommittee makes an attempt to address the causes of
disparities. The facts that I have just recited just barely
scratch the surface.
Twenty-three percent of African Americans are uninsured.
Many have Medicaid; but recent studies have called into
question the quality of care, and in particular, for HIV/AIDS,
that Medicaid recipients have received.
Much current research has demonstrated that even with
insurance, and when other factors are equal, African Americans
and particularly women experience clear discrimination in their
receipt of health care services.
On the other hands, when language, ethnicity, and culture
are the same or similar, research shows better rapport and,
therefore, better compliance and outcomes.
Mental health services are severely lacking for American
Americans at all ages. Put simply, according to our Surgeon
General, Dr. David Satcher, the U.S. mental health system is
not well equipped to meet the needs of racial and ethnic
minority populations.
All of these and other factors conspire to create the
disparities that exist for African Americans, as well as other
people of color. They form the basis for our request.
As discussed briefly in the full testimony, they are:
allotting full funding for the new Center for Minority and
Disparity Health Research at NIH, as well as having the other
offices of minority health in the agencies funded.
The $1 billion request would provide the following:
increase health providers of color; provide adequate staff for
our medically under-served areas; enhance the ability of our
providers to practice their art and to provide for ethnics and
diversity training in our health profession schools, and
collect important health data.
These are provisions of the Minority and Disparity
Education Act of 2000. It would increase and provide culturally
and linguistically sensitive mental health services in
communities of color; adequately fund the community health
centers, which are the nexus of health care for our
communities; provide adequate health services for inmates in
correctional facilities; provide adequate outreach and funding
for immunization programs; continue and expandthe CDC minority
AIDS initiative.
Mr. Chairman, in 1998, the Congressional Black Caucus,
joined by community organizations and health advocates from
around the country, called on Secretary Donna Shalala to
declare a state of emergency for HIV and AIDS in the African
American community and other communities of color.
What we achieved was a declaration of a severe and ongoing
crisis; and to have, first $156 million in 1999; $249 million
in 2000; and this year, $350 million targeted to communities of
color.
This initiative, which needs to be expanded, has been
effective, and it has been affected across all communities of
color. However, we made one mistake; we should have called for
a state of emergency in the overall health of African Americans
and other people of color.
It is this emergency, that for the health of African
Americans and for people of color, across all of the diseases,
which is the emergency that truly exists.
With the full funding of the request before you today,
which this country today has the resources to do, we can begin
to respond appropriately to the crisis that exists in health
care for our communities today. Under your leadership, this
country can make the moral and political commitment to
guarantee access to medical care as a fundamental right to all
of its people.
I thank you, Mr. Chairman and subcommittee members, for the
opportunity to testify. I will be happy to answer any
questions.
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Ms. Pelosi. I just have a brief question.
Mr. Regula. Yes, go ahead.
Ms. Pelosi. I was so impressed by the very important
testimony that our colleague has presented. It stands on its
own, and her credentials are well known to us.
But I would like her to put on the record her credentials
as a health professional, and all that she brings to this
testimony today, Mr. Chairman. We are so proud of her.
Ms. Christensen. I should have said that I chair the Health
Braintrust of the Congressional Black Caucus. I am a family
physician, and have been in practice for 21 years in the Virgin
Islands, also. I was a public health official in the Virgin
Islands for many of those years.
Mr. Regula. Well, that is a vanishing group, the family
physicians.
Ms. Christensen. Yes, and that is the pearl of American
health.
Mr. Regula. I agree with you. I felt strongly that we
should encourage more family physicians. You cannot just take
one area of a human being, and not be sensitive to the whole
person.
Ms. Christensen. I suspect that it will come back.
Mr. Regula. Probably economics are driving it, as much as
anything. With the high costs that students have, they feel
like the specialties pay better.
Ms. Christensen. Well, they do. That is another area that
has to be addressed, in terms of the reimbursement. I know that
HCFA is going to be under much scrutiny this year. Hopefully,
some of those issues will be addressed.
Mr. Regula. Well, it is great what you did. Were you in a
smaller community?
Ms. Christensen. I practiced in the Virgin Islands. I was
always able to make house calls, for most of practice. The
island that I practice on has between 50,000 and 60,000 people.
Mr. Regula. There are others besides you there, I hope?
Ms. Christensen. Yes. [Laughter.]
Mr. Regula. That would keep you busy.
Well, thank you for bringing this to our attention.
Ms. Christensen. You are welcome. Thank you, again, for the
opportunity to testify.
Mr. Regula. Next, we have our friend from Alaska.
----------
Tuesday, March 27, 2001.
CLOSE UP FOUNDATION
WITNESS
HON. DON YOUNG, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ALASKA
Mr. Young. I have a very short statement that I will read
in its entirety, primarily because the staffer wrote it, and
this is the first time she ever wrote anything for me.
Mr. Regula. I thought you were going to say that it was the
first time you ever asked for any.
Mr. Young. No, not really. [Laughter.]
I will say, Mr. Chairman and members of the committee, I
would suggest, as we have new members on this committee that
have not been involved in the Close Up Program, and that is
what I am here today to talk about.
The Ellender Fellowship Program is a critical component in
Close Up's educational program to educate our Nation's young
people about how our Federal system of Government works, and
their rights and responsibilities as citizens.
Congress created the Allen J. Ellender Program in 1972, out
of a belief that our Nation was at a critical juncture in
ensuring that the next generation of Americans would share in
the values and beliefs of the preceding generations, who forged
our democratic form of government.
By the way, Mr. Chairman and members of the committee, 1972
was the first year that I ran for this job.
I believe that we must ensure the present generation of
young Americans is committed to the ideals of active
citizenship, service to the community, and loyalty to country,
that are the foundation of our democratic system of government.
We must be dedicated to educating young people about civic
virtue and teaching them about their place in our democracy.
Our national heritage includes an unwavering belief in the
importance of each and every citizen to the success and health
of our democracy. The Close Up Foundation has embraced this
belief and made it an integral part of its mission to educate
young people.
Close Up is dedicated to the principle that the poorest
among our Nation's young people should have an opportunity to
come to Washington to gain first-hand experience in how our
Government works.
The Close Up Foundation utilizes the Ellender Fellowship
Program to reach out to student populations that are among the
most economically needy and under-served. The Ellender
Fellowship recipients include students from our Native
American, immigrant, rural and inner city communities.
As the State of Alaska's sole representative in the House,
I have had the privilege to meet with numerous students from
Alaska, visiting Washington as part of the Close Up's civic
education program.
Mr. Chairman and members of the committee, we have had
11,000, since the beginning of this program, from Alaska, that
have come to participate in this good program.
For students in rural Alaska, Washington, D.C. is far
removed from their everyday lives, and is a place that operates
in a way that they may not fully understand. Many of these
students do not have access to C-Span, so they have never seen
Congress in action.
Close Up recognizes that their geographic isolation does
not mean they play less of a role in the future of our country.
I believe that we should be highly supportive of programs
that successfully aid young people in becoming well-rounded,
informed, and active citizens.
The Allen J. Ellender Fellowship Program provides teachers
and economically disadvantaged students with a unique
opportunity to travel to Washington, and learn first-hand about
Government.
A health democracy depends upon the participation of its
citizens. This critical education program deserves our full
attention and our full support.
In closing, I would ask the subcommittee to recognize the
critically needed work of the Close Up Foundation through
continued and increased funding of the Allen J. Ellender
Fellowship Program.
I want to thank you, Mr. Chairman and members of the
subcommittee. As I said, this is a short statement. I wouldbe
willing to answer any questions. Again, I want to stress, there are
11,000 Alaskan students who have participated in this program.
Thank you, Mr. Chairman.
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Mr. Regula. Are there any questions?
The Ellender Fellowship or Foundation provides money for
students to participate, who otherwise would not be able to?
Mr. Young. That is the primary purpose of this program, to
have those people in from the rural areas and impoverished
area; and believe me, we still have them in Alaska, to come to
Washington, D.C.
We do have other schools that do participate in this in
here, from a more influential group of people. However, we are
a long ways away, and it has been very good for the State of
Alaska.
Mr. Regula. Is Ellender just confined to Alaska?
Mr. Young. No, it is nationwide; it is huge. Alaska has
participated in it. I have helped raise money in the private
sector for this program.
Mr. Regula. Well, you have had 11,000 over what period of
time?
Mr. Young. Since 1972.
Mr. Regula. Given your population base, that is still a
lot.
Mr. Young. Yes, that is a lot of them; and if we had the
same population, same ratio, it would be over 250,000 in
California. We really do participate in this program.
Mr. Regula. Yes, they do.
Well, thank you for coming today.
Mr. Young. I am pleased to see that my two new members did
not ask me any questions. I was not sure that I could answer
them.
But thank you, Mr. Chairman, and congratulations to you.
Mr. Porter sat in that chair for many years, and I know you
will do a wonderful job.
Mr. Regula. He did a great job when he was here.
Mr. Young. And you will do equally as well.
Thank you very much.
Next is Mr. Fattah from Pennsylvania.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL BLACK CAUCUS EDUCATIONAL BRAIN TRUST
WITNESSES
HON. CHAKA FATTAH, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH
OF PENNSYLVANIA, ON BEHALF OF REP. MAJOR OWEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK, CHAIR, CONGRESSIONAL BLACK
CAUCUS EDUCATIONAL BRAIN TRUST
HON. RUBEN E. HINOJOSA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS, CONGRESSIONAL HISPANIC CAUCUS
Mr. Fattah. Thank you, Mr. Chairman. If you do not mind, I
have asked my good friend, Congressman Hinojosa, to join me,
because we share a similar interest, and we could expedite the
committee's work.
Mr. Regula. That is fine.
Mr. Fattah. Let me thank you for allowing me to pitch hit
for Congressman Major Owens, who was scheduled to provide this
testimony, and is unable to do so. I am going to let my written
testimony stand for the record.
I would like to thank the Chairman, because of his
tremendous interest in a variety of matters, relative to
education. I am not going to belabor any of the points that
need to be made.
I would also like to welcome my two colleagues from
Pennsylvania, Congressman Peterson and Sherwood, who have
served with me before in the State Senate, and worked on
education-related matters. We have a lot of mutual interests.
Let me say on behalf of the Congressional Black Caucus, the
Caucus has laid out a number of positions, which are
articulated in the written testimony about the need for this
committee's continued support.
This committee really has been in the vanguard of pushing
for a set of programs and initiatives that have helped hundreds
of thousands of young people live up to their potential, pursue
an adequate education, and to go on to higher education.
There is an emphasis, obviously, on the Pell Grant and the
Trio Programs and, most particularly, the Gear Up Program,
which is close to my heart.
I want to thank the committee for its support over the last
three cycles for its support for Gear Up, which I authored and
moved through the House, with a lot of help from a lot of
different people. It is now helping over one million young
people in our country.
Mr. Regula. You introduced me to it, when we were down at
St. Petersburg.
Mr. Fattah. That is right, and it is a tremendous program.
It is doing very, very well.
But I know that this subcommittee will have an allocation,
and you have some very difficult decisions to make. I respect
whatever deliberations and outcomes there will be from the
result of that. There are a lot of choices from Head Start on
through in the education pipeline, to help move young people
and their families.
However, in terms of the Congressional Black Caucus and the
Hispanic Caucus, we represent constituencies that these
programs impact most acutely, and they are very important, too.
So we just want to urge you to do all that you can do.
I would also say that I am very concerned, and I will
betestifying before the House Education Committee tomorrow, about the
whole question of how to encourage states to do more themselves to give
disadvantaged and poor communities, both in urban and rural areas, an
equal educational opportunity.
Part of the problem is that the Federal Government is
trying to help make up the deficit that is the result of a lack
of full support from our state governments in the poor
communities in those states. We need to work more as a Congress
to try to encourage states to treat both our rural school
districts and urban school districts in a way in which young
people will get a fair and an equal opportunity.
I know that we cannot legislate outcomes, but I think that
we could do more to encourage states not to have poor children,
who are already disadvantaged, made more disadvantaged by the
way that they create their funding cycles and dispense
curriculums around the state.
Nancy Pelosi, in the great State of California, knows that
there is a major litigation going on there in which young
people in Compton High have little or no opportunity to take AP
courses; and young people at Berkeley High have more than 25 AP
courses to choose from.
It just creates a circumstance in which not every young
person can pursue, within their own potential, what God-given
talents they have.
So I just think, Mr. Chairman, that your committee will
make a lot of tough decisions about allocations and
programmatic thrusts.
We can also do more by encouraging these states to take
their children, and to give not just the wealthy, middle class
suburban youngsters every opportunity, but to also make sure
that those who are impoverished, who live in rural and urban
communities in their states, to have the same opportunity to
have quality teachers in the classroom, good facilities, and an
adequate curriculum to prepare them.
So thank you, Mr. Chairman.
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Mr. Regula. I think it is a universal thing. Ohio is going
through the same type of lawsuit, involving Appalachia.
Mr. Fattah. Yes.
Mr. Regula. Mr. Hinojosa.
Mr. Hinojosa. Thank you very much, Mr. Chairman.
On behalf of the Congressional Hispanic Caucus, CHC, I want
to thank you and the members of the Appropriations Committee
for allowing Chaka and me to come before you and discuss the
educational needs of the African American children, Hispanic
children, and all minority children in the United States.
I want to preface my remarks by saying that I have only
served four years in Congress. As I start my fifth year, I want
to say that it has been a real pleasure for me to collaborate
with Chaka Fattah.
Both of us serve on the Education Committee, and we are
well informed and certainly committed to work on trying to help
children graduate from high school and go on to higher
education.
It is no doubt that two caucuses, the Black Caucus and
Hispanic Caucus, working together, are beginning to really make
a difference in bringing to the forefront the importance of
educating children early: Early Start, Head Start, Gear Up, K-
12 programs that are exemplary in helping students graduate
from high school, and then of course bringing a great deal of
attention to the work that is being done by HSIs and HBCUs.
All of this is to say that some of the senior members of
committees that I serve on in Education have commented that
never before have they seen the collaborative work being done
by the Black Caucus and the Hispanic Caucuses.
So I thank you for this opportunity. As you know, the
Census Bureau projects that by the year 2030, Hispanic children
will represent 25 percent of the total student population.
Census figures already indicate that Hispanics have become the
Nation's largest minority.
In my area, the largest county that I represent, Hidalgo
County, has grown to 88 percent in population.
Mr. Regula. Where is that located in Texas?
Mr. Hinojosa. It is south of San Antonio, 250 miles.
Hidalgo County is on the Texas border region, between
Brownsville and Laredo, an area that is the third fastest MSA
in the country. It is an area that in my own district, it has
grown by 50 percent over the last 10 years.
Mr. Regula. That would be southwest then; am I correct?
Mr. Hinojosa. We are considered the Southwest. Texas is so
spread out that I am 850 miles from west Texas and El Paso. I
am 650 miles from Dallas. It is an area that is just growing by
leaps and bounds.
Mr. Regula. Where do you fly to go home?
Mr. Hinojosa. I fly Houston, and then Houston to McAllen.
It takes me seven hours.
Mr. Regula. But you are not on the Gulf of Mexico, though?
Mr. Hinojosa. No, I am approximately an hour. Solomon Ortiz
represents the coastal area from Brownsville to Corpus
Christie; and I run parallel with him, from McAllen to San
Antonio; Rodriguez is parallel with mine, from Rio Grande City
to San Antonio. Then the fourth one would be Henry Bonilla from
Laredo to San Antonio.
All that area has grown so much that we are going to get
two new Congressional Districts in that area.
Mr. Fattah. They are taking those from Pennsylvania, right?
[Laughter.]
Mr. Regula. They are both going to be Republican; is that
right?
Mr. Fattah. We will see. [Laughter.]
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Mr. Regula. Are there any questions from the members?
[No response.]
Mr. Hinojosa. I want to say that the amounts that are in my
prepared material have some very specific numbers that we are
asking, as the Congressional Hispanic Caucus, on the
Appropriation funding that we are asking.
For example, on Title 1, we are asking for a level of
funding of $24 billion. If you ask why it is that much, the
reason is that we are not serving all of the eligible children.
So what we did is, we took the number that are eligible and
multiplied it, because it is a formula-funded program, and it
would take $24 billion to serve all those that are qualified
and eligible.
The Caucus also is suggesting a funding level of $508
million for Title 7 of the ESEA. Another figure that is very
important to us is the request for $500 million for adult
continuation programs.
Mr. Regula. That is a pretty hefty increase that you are
proposing.
Mr. Hinojosa. We are, simply because this is the time that
President Bush is saying that education is the foremost
important issue. If we are going to do what he says, and not
leave any child behind, then it is going to take getting up to
the funding level that will reach all the children, and not
just a few.
If you look at some of the programs, such as Gear Up, and
you will see that we are asking for an amount that will take us
into the next funding level, so that they would be getting,
what is that number, Chaka?
Mr. Fattah. $495 million.
Mr. Hinojosa. Yes, $495 million.
Mr. Fattah. Right.
Mr. Hinojosa. Again, I am not trying to exaggerate when I
say that when you are only serving 38 percent of the children
who are eligible in head start; when we are serving only a
small number who qualify for Gear Up; when you take a look at
the under-funding that has occurred in the last 10 years for
HSIs, Hispanic Serving Institutions, where we were getting only
$10 million in help, and we took that number from $10 million
to $28 million, just think about this.
There are 203 Hispanic Serving Institutions, and over three
million Hispanic college students. So this is just to say that
we have neglected many of these exemplary programs. All we are
asking is that you take a good look at these programs, because
they are the ones who are going to help our students graduate
from high school, go on to colleges, and become professions. In
fact, some of them may become Congressmen.
Mr. Fattah. Thank you, Mr. Chairman.
Mr. Regula. I think Henry Bonilla went through the Trio
Program.
Mr. Fattah. Yes.
Mr. Regula. Is the state pulling its share?
Mr. Hinojosa. We are challenging them, I guarantee you. We
are challenging the State of Texas to do their share.
Mr. Regula. Are there any questions?
Mr. Sherwood.
Mr. Sherwood. I would just like to suggest to the gentleman
from Texas that he take good care of those two Congressional
seats, because we might want them back some day. [Laughter.]
Ms. Pelosi. Mr. Chairman, I would like to commend these two
gentlemen. They have worked so hard on the education issues on
their committee and with Mr. Fattah here on the Appropriations
Committee. Mr. Hinjosa will do a lot for the economic
development of his area on the Banking Committee, which has
some important jurisdiction, down there for economic
development.
But when they talk about Gear Up, the work on the
authorizing side is so important to us here, both for the
Hispanic servicing institutions and the Historical Black
colleges and universities, that have been such a tremendous
resource to us.
So for all of the K-12 preschool and the rest and higher
education, thank you for making it, I do not want to say
easier, but for helping our community give this such a high
priority. I am pleased to work with you in these areas.
Mr. Fattah. Thank you, Mr. Chairman, for giving us the
time, and we look forward to working with you. I am sorry that
I am off the House Education Committee. However, I am happy to
be on the Appropriations Committee.
Mr. Regula. I believe you made a worthwhile change.
Next is Mr. Underwood from Guam. I used to see you in the
Interior.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL ASIAN PACIFIC AMERICAN CAUCUS HEALTH CARE TASK FORCE
WITNESS
HON. BOB UNDERWOOD, A UNITED STATES DELEGATE FROM GUAM AND CHAIR,
CONGRESSIONAL ASIAN PACIFIC AMERICAN CAUCUS HEALTH CARE TASK FORCE
Mr. Underwood. Mr. Chairman, it is always a pleasure to
appear in front of you, begging for more money in various
capacities.
Mr. Regula. And you are pretty good at it. [Laughter.]
Mr. Underwood. Well, thank you, Mr. Chairman and members of
the committee, for the opportunity to present the concerns of
the Asian and Pacific Island Caucus on some major health issues
concerns.
You may already know, Mr. Chairman, that the Asian and
Pacific Island is the most diverse ethical and racial group in
the country, comprised of both immigrant populations and
indigenous populations of Pacific Islanders.
It also is the most heterogenous community. What you may
not know is that Asian and Pacific Islander communities are
severely hampered by a lack of accurate demographic data to
monitor and enforce civil rights, laws, and ensure equal access
to Federal programs, and in particular, health care. This lack
of meaningful data makes it difficult to track health treads,
identify problems areas and solutions, and enforce civil
rights.
This problem has been attempted to be resolved by the
Office of Management and Budget back in 1997, when it made a
significant change to the standards for maintaining, collecting
and presenting Federal data on race and ethnicity.
This chain separated Asians from Native Hawaiians and other
Pacific Islanders, and allowed respondents to designate more
than one racial ethnic category. We hope that this effort will
provide more accurate data.
In addition, to this particular issue, the 1990 Census also
reported that about 35 percent of Asian and Pacific Islanders
live in linguistically-isolated household, in which none of the
individuals ages 14 or over spoke any English very well.
In 1997, the Census reported the rate of persons with
limited English proficiency grew to 40 percent for Asian and
Pacific Islanders Americans, and over 60 percent for Southeast
Asian Americans.
The absence or severe lack of culturally and
linguistically-assessable services leads to the gross under-
utilization of health care services, misdiagnosis and treatment
of disease, chronic illness and needless suffering.
It also contributes to Asian and Pacific Islanders seeking
treatment at a much later more progressed state of illness,
which is not only costlier to treat, but is often preventable
with earlier detection.
Asian and Pacific Islanders are often mislabeled as the
model minority with few health is social problems. This label
is a myth and a gross myth representation of the community,
which is very diverse.
Within this population alone, there exits divergent social
economic achievement rates, among euthenics and racial diverse
cultures.
Recent data from various institutions and Government
agencies, including the Department of Heath and Human Services
and the Census, revealed for example the following disparities.
Compared to the total U.S. population, disproportionate
numbers of minority Americans lack health insurance; about 24
percent of Asian and Pacific Islanders Americans. Asian and
Pacific Islander Americans continue to experience the highest
rate of tuberculosis and hepatitis B in this country.
Approximately one half of all woman who give birth to
Hepatitis B carrier infants in the U.S. were foreign-born Asian
woman. Liver cancer, which is usually caused by exposure to
Hepatitis B virus, disproportionately effects the Asian
Americans. Filipinos have the second poorest five year survival
rates for colon and rectal cancers of all U.S. ethnic groups.
Cancer is reported as the leading cause of death in nearly
all Pacific Island jurisdiction. In Guam, lung cancer accounts
for one-third of all recorded deaths. Native Hawaiians have the
second highest mortality rate in the National due to lung
cancer.
Cervical cancer is a significant problem in Korean and
American women, and it affects Vietnamese American women at a
rate five times higher than white women. Breast cancer
incidents in Japanese American women is approaching that of
white women.
Moreover, some studies indicate that approximately 79
percent of Asian-born Asian American women have a greater
proportion of tumors larger than one centimeter at diagnosis.
Breast and cervical cancer rates for Marshallese Islander are
five times and 75 times higher respectably for rates for all
U.S. women.
Native Hawaiian woman have the highest incidents of
mortality rates of endometrial cancers of all U.S. woman.
Diabetes affects tomorrow's indigenous people of Guam and
Commonwealth of the northern Marianas Islands at five times the
National average. Infant mortality rates in the U.S. insular
areas of American Samoa, Guam and Siena more than double the
National average.
Finally, in my home island of Guam, there has been a recent
and significant incidence of suicide, and particularly teen
suicides, fostered by contacts through suicide packs over the
Internet.
Last week, the Guam Department of Mental Health and
Substance reported that about 95 percent of the admissions into
the children's unit of the Guam Memorial Hospital are related
to suicide intentions.
In response to all of this, we have listed five listed
budgetary priorities, including a funding increase of $12
million additional for the Office of Minority Health and the
Department of Health and Human Services for the REACH
initiative in the Center for Disease Control.
This is currently funded at $35 million. In fiscal year
2000, the CDC was able to fund only 32 grants, which works in
collaboration with OMH and other appropriate Federal agencies,
to intensify efforts to eliminate health disparities. However,
a funding increase is requested to allow communities to apply
for REACH initiative grants.
For the National Center for Minority Health and Health
Disparities in the NIH, we are asking again for additional
funding for the minority ADIS initiative, which was funded in
2001 at $350 million, which is an increase of $100 million over
fiscal year 2000. However, the 2001 funding fell short of the
original funding request of approximately $540 million.
Finally, in fiscal year 2001, SAMSA's minority fellowship
program received nearly $2 million over the fiscal year level,
for a total of $3 million.
A $2 million increase is again requested for fiscal year
2002, to help address the critical needs to enhance the quality
and effectiveness of the provision of health and mental health
services to community of colors by increasing numbers of well-
trained professionals.
It is very critically important to understand that the
context of the provision of health care services in minority
communities is affected by cultural linguistic factors and the
lack of, in many instances, trained personnel.
I believe that it should be our strong commitment as a
Nation to help bridge this gap for the provision of health
services, so that we can reduce the disparities, some of which
I have outlined here today.
Again, I want to thank you, Mr. Chairman, as always. I do
not know what other subcommittee you are going to go to next,
but I always enjoy appearing in front of you. Thank you very
much.
[The information follows:]
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Mr. Regula. I am sure you will have a request, whatever
subcommittee it is. [Laughter.]
Mr. Rodriguez.
----------
Tuesday, March 27, 2001.
CONGRESSIONAL HISPANIC CAUCUS HEALTH CARE TASK FORCE
WITNESS
HON. CIRO RODRIGUEZ, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS AND CHAIR, CONGRESSIONAL HISPANIC CAUCUS HEALTH CARE TASK
FORCE
Mr. Rodriguez. Mr. Chairman, let me first of all apologize
for being a little bit late. As the Chairman of the Hispanic
Caucus and member of the VA committee, we had an opportunity to
provide some testimony on health, and you will have an
opportunity to vote on those bills this afternoon on the VA,
which is also very critical for a lot of Hispanic veterans that
are out there.
But I want to thank you for allowing us the opportunity, as
Chairman of the Task Force on Health with the Hispanic Caucus,
that has 18 members of the 21 Hispanic members of the Congress,
to be here before you.
Hispanics continue to experiences barriers in the areas of
health care insurance. I want to briefly just mention to you
that out of 44 million uninsured Americans in this country,
one-quarter of those, or 11 million, are Hispanics.
These are individuals that are working. In fact, out of
those 11 million that are Hispanics that are uninsured, 9
million are working individuals, that despite the fact that in
this country, if you are working for a small company, if you
are not working for a major corporation, if you are not working
for Government, you do not have access to insurance.
Yet, you are not poor enough to qualify for Medicaid; you
are not old enough to qualify for Medicare; and you find
yourself without any access to insurance. So the importance of
the CHIPS Program is critical, and so we want to be supportive
of those efforts and encourage the importance of continuing to
fund those efforts in that area.
The importance of access to health care is one of the
things that is lacking in the Hispanic community, and one of
the areas that impacts us the most.
To address the growing problems, and one which is a
negative impact on local health disparities in our local
communities, it is important that we continue to move forward
in those efforts.
Our community health centers that provide a vital safety
net for Hispanics and other minorities throughout this country
need to continue to be funded. Seventy percent of those served
by the community health centers are minority. Sixty-six percent
of them live in poverty.
The request from our efforts, from the Hispanic Caucus, is
that we fund them at $250 million above the current funding
levels for the community health centers.
President Bush has promised to provide $3.6 billion, over
five years, to build additional 1,200 community health centers.
We request a $250 million increase. It would put us on the
right track to meet the President's needs in this specific
area. So we ask for your serious consideration.
Hispanics also account for 20 percent of the new AIDS
cases. As we look at the issue of AIDS, we see the new data
that is there and it looks like we are making some inroads but
despite, it is hitting disproporionately a lot of the low
income areas.
Despite the fact that Hispanics represent 12.5 percent of
the population, we represent 20 percent of HIV cases. So we ask
for your help and your support in that specific area and
request full funding at the level of $539.4 million for year
2002 for the Minority AIDS Initiative to promote capacity
building for minority-based organizations.
The U.S. Census 2000 shows that Hispanics make up 12.5
percent as I indicated. One of the basic ways of dealing with
AIDS is to make sure we have those community-based programs.
With the Hispanic community, we have not been able to organize
those. We have been lagging behind in resources to fight the
issue of AIDS and we need those resources to make sure we
establish those community-based organizations to reach out to
those pockets that are out there.
In the area of diabetes, it strikes Hispanics--especially
Mexican Americans and Puerto Ricans--at a disproportionate
rate. In addition, growing evidence shows that Type II diabetes
and adult onset diabetes increasingly strikes Hispanic
children. We are learning more about the relationships. The
beauty of this is we have a lot of new research where we can
identify those specific areas with young people, with children.
We have been able to identify a large number, but now we have
to do something about that. We need to move forward.
We ask for increased support of $100 million for Hispanic
focus on diabetes prevention and treatment. These activities
include targeting geographic areas throughout this country that
need to be targeted.
It doesn't do any good to identify those kids--we are doing
it--and not do anything about it. Part of that is the education
that goes along with that. So we ask for your help, assistance
and your efforts.
In the area of mental health and substance abuse, one of
the areas that we have neglected as a country and where people
have fallen through the cracks, as indicated earlier by my
friend, is we are finding a lot of young people. When they
first came to tell me we were having a large number of suicides
among young ladies of Mexican-American descent, I told them I
don't believe it, show me the research. Sure enough, they came
to me and it is startling to see the rates of suicides among
young Hispanics as well as alcohol and drug abuse. So it
becomes important that we look at that area of mental health
and substance abuse, and that we provide some resources.
President Bush's budget includes an initiative to double
NIH funds for 2003. While the Hispanic caucus supports
increasing research funding levels, it is important to find
ways to encourage Hispanic focused research. The key is toalso
look at specific research that targets Hispanic populations with a
clear understanding that with what we face, we can then deliver
culturally competence.
There is example after example and one example that comes
to me, which I have been sharing, when we talk about competency
and culturally relevant, when this person was told she was
positive. When you tell them in positive, then you think
everything is okay and sure enough this person later on had a
child and contracted AIDS. So there is a need and we should not
take things for granted. We need to reach out and make sure
people understand, especially when we deal with issues of
mental health and the competency and cultural relevancy of
reaching out to those individuals.
We had another case of mental health with a person in a
State hospital in San Antonio who would go out and walk and
walk, walk and stop, walk and stop and walk and stop and people
would try to stop her. She would get angry and throw a fit. She
was actually doing her rosary. She would walk so many steps and
would stop and keep on. People didn't understand that.
It is important to recognize the importance of cultural
competency, language proficiency and what it means. We are
going to ask for some funding in that specific area of $3
million. If you want specifics on the funding, I would look
forward to meeting with you to provide some of those
statistics.
The budget also proposes reduced funding to the health
professionals which provide training grants to institutions to
increase the number of under represented health professions.
This is a serious mistake. Right now, every agency in the
Federal Government is expecting to retire one-third of our
people. We were just told in the GAO report on the military
that of 50 percent, 65,000 employees, we are going to retire
32,000 of them, almost half.
There is a need for us to invest in apprenticeships. It is
important for us to invest in those individuals and make sure
that we have good quality professionals.
In the area of access to health care, there is a nursing
shortage in this country and this is not the time to cut back
on these programs. The budget estimates of $125 million for
community access programs provides grants to communities,
hospital and community health centers that serve uninsured
youngsters and is key. Please look at that funding, especially
in terms of the apprenticeship programs and providing the
health professions the assistance that is needed.
We need to go beyond that. We need to make sure we have
those qualified professionals out there, those individuals that
can be culturally competent and have access to the training
that is important and needed.
According to the Department of Health and Human Services,
there are 3,000 medically under served communities. So we need
these grants.
Thank you for the time and the opportunity to address the
subcommittee on the Congressional Hispanic Caucus priorities
and we look forward to working with you.
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Mr. Regula. The community health centers have served a very
worthwhile role and I hope we can increase those because I
think it catches a lot of people who are uninsured and probably
not able to get medical care.
Mr. Rodriguez. Yes, sir. In fact, 67 percent are uninsured
in that category and 70 percent are minority.
Mr. Regula. Questions?
Ms. Pelosi. I want to thank the two gentlemen for their
excellent testimony and Mr. Underwood for his leadership in the
Asian Pacific Islander Caucus and Mr. Rodriguez who has been
working on this for such a long time. Last year, he was able to
get $1.7 million for minority health research and outreach. We
are hoping that money will be coming very soon to help in
getting a handle on what these needs are.
I wanted to bring Congresswoman Christensen in on this as
well. As you testified earlier, we are blessed that the former
Chair of the Interior Committee is now in the Health seat
because he understands the needs of the territories better than
anyone.
Mr. Regula. I have had a lot of assistance from Mr.
Underwood.
Thank you both for your interest.
Our next witness is Ms. Ros-Lehtinen from Florida.
----------
Tuesday, March 27, 2001.
CLOSE UP FOUNDATION
WITNESS
HON. ILEANA ROS-LEHTINEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF FLORIDA
Ms. Ros-Lehtinen. We are so thankful to have such a strong
organization nationally and in all of our districts.
Thank you, Mr. Chairman and members of the subcommittee. We
are pleased to submit my testimony in support of the Close Up
Foundation's Allen J. Ellender Fellowship Program.
During my time in Congress, I have been a strong supporter
of Close Up and its civic education programs. As a former
educator, I believe the Close Up Foundation Civic Education
Program is a valuable weapon in our arsenal to combat
disaffection with government among our young people.
The Allen J. Ellender Fellowships are vital in reaching out
to a diverse group of young people, specifically those in need
of financial assistance so that we can enable them to
participate in Close Up's unique civic education program.
Without the Ellender Fellowship Program, the Close Up
Foundation would be unable to reach students who are perhaps
more in need of having their importance to our democracy
validated.
The only criterion for a student to receive an Ellender
Fellowship is an income eligibility requirement and student
recipients of these fellowships are among the neediest students
in our educational system. Impressively, the overwhelming
majority of Ellender Fellowship recipients participate in local
fundraising activities throughout the year to cover the full
cost of the program.
The foundation also has special programs to reach students
who are recent immigrants to the United States. As a member
from Florida, one of the most culturally diverse States in our
Nation, I can personally attest to the growing positive
influence that these immigrants have had upon the cultural
fabric of our Nation and the great contributions that they make
every day to our country. They too need to be educated about
their adopted homeland and specifically about how our
government and our democratic form of government works. Close
Up also outreaches to students in our rural towns and urban
communities who are beneficiaries of Ellender Fellowship
assistance.
I understand the subcommittee faces an extremely difficult
task in trying to prioritize what programs to fund and at what
levels, but I ask you to consider the grave need for civil
education programs, and particularly for programs that reach
our disadvantaged youth.
The Close Up Foundation uses the relatively small
appropriations that it receives for the Ellender Fellowship
Program as seed money around which educators and students
expand their local Close Up programs. I ask that the
subcommittee demonstrate its support for Close Up's civic
education program by not only maintaining the current $1.5
million funding level for the Allen J. Ellender Fellowship
Program but by increasing the funding level. This would send an
important signal that we in Congress believe that citizenship
education is as important to being a well-rounded individual as
knowing math, science and literature. It would be a great
investment in the strength and well being of our democracy.
I thank the Chairman and I thank the members and the staff.
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Mr. Regula. Do you think these young people go back home
and take the message of things they learn here in the Close Up
Program back to their colleagues?
Ms. Ros-Lehtinen. I think so. At least that has been the
case in our district office. We encourage them to participate,
they come to our district office, put in their time there as
well, and go back to their areas, whether they are working in
Washington or in the district office and really make it work.
They demonstrate that this is a great country where we are
given all kinds of opportunities.
I thank you for funding it and we hope to be there with
even a little more this year.
Mr. Regula. Next we have a panel of Mr. Hayworth and Mr.
Edward on Impact Aid. We heard from some of our colleagues
earlier making a pretty powerful case. I will let Mr. Sherwood
take this one.
Mr. Sherwood [assuming chair]. Gentlemen.
----------
Tuesday, March 27, 2001.
IMPACT AID
WITNESS
HON. J.D. HAYWORTH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ARIZONA
Mr. Hayworth. Let me thank the gentleman from Pennsylvania.
It is good to see him in the Chair but my joy at seeing him
there is eclipsed by the temporary departure of the full
Chairman of the Subcommittee who is all too aware of the
challenges we confront.
I would note for the record that a number of my
constituents join me in this chamber here today for this
testimony who could offer very eloquent testimony as to just
how important this program is. On behalf of all the members of
the Impact Aid Coalition, I want to thank you and members of
the subcommittee for affording us this opportunity to address
what we consider to be a very, very important issue, an issue
of critical importance, impact aid.
Impact aid is a Federal education program that provides
funding to more than 1,500 school districts connected in some
way to the Federal Government, whether by an Indian
reservation, a military installation, or the designation of
Federal land. Traditionally, property sales and personal income
taxes account for a large portion of the average school
district's annual budget but impact aid schools educate
students whose parents may live on nontaxable Federal property,
shop at stores that do not generate taxes, work on nontaxable
Federal land, or do not pay taxes in their States of residence.
School districts could also receive impact aid if some or all
of their property was taken off the tax rolls by the Federal
Government.
As one of the Co-Chairs of the Impact Aid Coalition, I am
honored to be here to fight for this important program and I am
so pleased the gentleman from Texas, Mr. Edwards, joins me in
this endeavor. The Coalition will be sending you a letter
requesting your support for its goals of securing $1.19 billion
in funding for the Impact Aid Program for fiscal year 2002.
While this is an increase of approximately 19 percent over last
year's funding level, Mr. Chairman, it is important to note
that the amount the Federal Government actually owes impact aid
schools for basic support and Federal property payments is more
than $2 billion.
Increasing impact aid funding to $1.19 billion will be an
important step toward fully funding this program which
currently receives less than half of its authorized funding.
As you may know, the Sixth District of Arizona, which I am
honored to represent, is the most federally impacted
congressional district in the country. My district alone
receives nearly $100 million in impact aid funds. Without these
funds, thousands of my young constituents would simply not be
educated, constituents who join me today in this hearing room.
My district is unique because it has the largest Native
American population in the 48 contiguous States, nearly 1 out
of every 4 of my constituents is a Native
American.Approximately 50 percent of the land mass in my district is
tribal land. Many Native American reservations face staggering
unemployment rates and other devastating economic conditions. For many
children on these reservations, education is their only hope to escape
a life of poverty.
I am sure you are aware of the Federal Government's treaty
obligations to our sovereign Indian tribes and nations. Part of
these obligations includes educating these children. It was
part of the treaty trust obligation. Without impact aid, the
Federal Government cannot live up to those aforementioned
treaty obligations. Therefore, I wholeheartedly support the
Coalition's goal of securing $1.19 billion for this important
program.
You know that I am ever critical of wasteful and
unnecessary government bureaucracy. Therefore, I am
particularly pleased to support impact aid as funds in this
program are provided directly to the local school districts for
general operating expenses. The use of impact aid funds is
determined by locally elected school boards. As you know, the
money appropriated by Congress is sent by electronic financial
transaction directly to the financial institution of the
eligible school district. There is no administrative cost
associated with the program.
I am also a strong critic of wasteful spending and the
inappropriate use of Federal tax dollars that is seen from time
to time here in our Nation's Capitol. I am completely committed
to maintaining a balanced budget. However, because impact aid
services military families and Indian tribes, my colleagues
understand this full well. It is an unequivocal Federal
responsibility.
Through a robust impact aid program, we can demonstrate our
commitment to those children who would otherwise be shut out
from most educational opportunities. By funding impact aid, at
$1.19 billion for fiscal year 2001, we can fulfill our
responsibility of providing these educational opportunities to
each of our Nation's students.
Again, thank you, Mr. Chairman, and members of the
subcommittee for inviting members of the Impact Aid Coalition
here today to voice our opinions, to be joined by our
constituents. I would be happy to remain here to answer any
questions you might have.
Thank you very much.
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Mr. Sherwood. Thank you very much.
Now we will hear from the gentleman from Texas.
----------
Tuesday, March 27, 2001.
WITNESS
HON. CHET EDWARDS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS, ON BEHALF OF THE IMPACT AID PANEL
Mr. Edwards. It is an honor for me to join my colleague,
J.D., to speak on behalf of the bipartisan 127 House member
Impact Aid Coalition.
To most Americans, the term impact aid may not mean
anything but to 13 million American children, it means the
difference between receiving a quality education and a mediocre
or poor education.
With the Chairman's approval, I would like to submit my
written testimony and would like to do something a bit
different if I could, and then give back some of my five
minutes of time.
I would like to put a human face on the statistics behind
those 13 million Americans impacted directly by this education
program.
This comes from a Washington Post article of March 14, a
story of one military family. Let me read several excerpts. The
first is a letter from an Army Soldier, Randy Roddy who was in
Saudi Arabia at the time his son was about to have his second
birthday. This is what he wrote to that son. ``As your second
birthday rolls around and it is apparent that we will not be
able to spend it together, I find it important to write you and
tell you some things you need to know. Someday perhaps you will
be able to pull out this letter and comprehend.''
He then goes on to say, ``I must start by telling you how
proud I am to have you as my son. You never cease to amaze me
when I see you on a video cassette. Because of events in this
world of ours that are bigger than either you or me, I have not
been able to share these last five months with you.''
The article goes on to talk about Mr. Roddy's spouse. It
said, meanwhile at Ft. Bliss in the Texas desert, Lisa had her
own struggles raising their child, working a receptionist job
to supplement their pay, soothing the fragile emotions of
several dozen wives whose husbands served in Randy's command.
``They look to me,'' she said, ``as a troop commander's wife. I
helped deliver two babies, I helped when someone's car was
repossessed. One wife tried to kill herself and her three
children and called me.'' The articles goes on and says, ``You
don't just join the Army, the whole family does.''
It talks about Mr. Roddy's four-year-old child, a little
girl, who lost all of her hair because of being distraught when
her father was deployed to Korea on a company tour for a year.
The reason I mention the story of the Roddy family is it is
clear we underpay our military soldiers and their families, all
of our troops from all services. It is clear to our Military
Construction Subcommittee that 60 percent of our military
families live in housing that does not meet basic DOD
standards.
The reason I mention that is it seems to me if we can't pay
our military soldiers and their families what they deserve, if
we ask them to live in substandard housing, if we ask their
families to spend month upon month away from loved ones serving
our country, risking their lives for you, me and our families,
the very least we should do as a country for these families is
to say to them while you are serving your country and risking
your life, we are going to ensure that your children will
receive a quality education.
I think the story of the Roddy family tells the story of
the importance of impact aid. Whether it is Native American
children or children of military families, amidst the many
important competing priorities that you must set, I hope this
subcommittee would once again remember the importance of
funding adequately the Impact Aid Program. I would like to look
at Mrs. Roddy who will be before our Military Construction
Subcommittee in a few weeks and say, despite all of the
difficulties and perhaps some of the things we ask you to
sacrifice, we will see that your children receive a quality
education.
That has happened in the past, Mr. Chairman, because of the
members of this subcommittee and we respectfully ask, on behalf
of the Coalition and these 13 million children for whom we
speak, that you please continue that leadership effort and
support fully funding for impact aid.
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Mr. Sherwood. Thank you both very much for your exceptional
and compelling testimony.
Two years ago at a readiness hearing in Italy with our
distinguished late chairman of the Readiness Committee, Mr.
Bateman, I was talking with some military personnel there and
made almost the same statement you did. When our brave young
men and women are defending us around the world, the least we
can do is see there is a good education for their children.
In all these areas where the Federal Government, by treaty
or law, has denied these school districts of revenue that would
normally be there, we have to step up to the plate, so we will
take a strong look at it.
Mr. Hayworth. One note. We should point out that though my
friend from Texas concentrated on military dependents and I
talked about some of the challenges facing tribes, these
concerns are not mutually exclusive. If you take a look at
those who answer the call to military service, tribal members,
Native Americans, more than any other group, answer the call to
military service. So there is a connected interrelationship
here. I would appreciate the committee taking that into
account.
I commend my friend from Texas for very eloquent testimony
about what is faced by military dependents. You can see on the
faces of my constituents here and they could offer very
profound testimony from their real life experience.
I appreciate your hearing us and the Chair's indulgence for
this time this afternoon.
Mr. Sherwood. The gentleman from New York, Mr. Fossella.
----------
Tuesday, March 27, 2001.
JUVENILE DIABETES RESEARCH
WITNESS
HON. VITO J. FOSSELLA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW YORK
Mr. Fossella. Thank you for providing me the opportunity to
testify today.
I would like to thank you and this committee for continuing
the effort to double the budget of the National Institute of
Health by the year 2003. Since being elected to Congress, I
have been a strong supporter of meaningful funding for the
National Institute of Health, and I applaud the President's
recent announcement that he will seek increased funding for
life-saving medical research at the NIH.
I would pause to thank publicly all those dedicated
professionals employed by the NIH and all health care
professionals publicly and privately who dedicate their lives
to try to improve the human condition.
Politics is a lot of things to a lot of people but one
thing we can agree upon is that we can all work together to
improve the human condition. We have seen it time and time
again where illnesses we thought could never be solved have led
individuals to lead better lives. As far as I am concerned, our
best days are ahead.
Of special concern to me is meaningful funding for the
National Institute of Diabetes and Digestive and Kidney
Diseases for fiscal year 2002. Finding a cure for Type I
diabetes is absolutely doable and with congressional support,
it will happen. No one in my parents' generation ever imagined
a human being would travel in space, let alone land on the moon
but on May 25, 1961, President Kennedy stood before a joint
session of Congress to declare it ``time for a great new
American enterprise.'' Then in 1969, what seemed impossible
became reality.
I believe we are now in a time of a great American
enterprise, a time when we are closer than ever before to not
only helping the millions who currently suffer from the
insidious condition of diabetes but laying the foundation for
future generations to live their lives free of this disease.
It is not just a health issue, it happens to be an economic
one as well. Diabetes happens to be a very costly disease to
our Nation and accounts for approximately $105 billion in
direct and indirect health care costs. One out of ten health
care dollars overall are spent on individuals with this
disease.
I understand the World Health Organization estimates there
are 125 million people worldwide with diabetes. This number has
increased 15 percent in the last 10 years and is actually
expected to double by the year 2005. In the U.S., the CDC
refers to diabetes as ``a major public health threat of
epidemic proportions.''
Ten million people in our Nation have already been
diagnosed with diabetes while an estimated 6 million have
diabetes but are undiagnosed. To put that in prospective,
onaverage, there is an estimated 23,000 people diagnosed and another
14,000 undiagnosed in every congressional district across the country.
More important than the costs are the lives this disease
takes. Each year, 193,000 people die from complications from
this disease. That is one every three minutes. Clearly a cure
must be found and I believe it will be.
Great and promising strides have recently been made in
funding a cure for Type I diabetes. The contributions must
continue and with your assistance, I am confident a cure will
be discovered during our lifetime.
Researchers are collaborating on many new treatments and
others on the identification of the genetic components of
diabetes. One of these promising treatments is known as the
Edmonton Protocol for Eyelet Cell Transplantation. This is a
process where insulin-producing cells called eyelet cells are
removed from the pancreas and transplanted to a diabetic
patient. The success rate has been extremely encouraging.
The researchers in Edmonton, Canada have announced they
were successful in transplanting the insulin producing eyelet
cells into a number of men and women with Type I diabetes
resulting in the discontinued use of insulin injections which
is the scourge of millions who suffer from it. To date, more
than 16 men and women have received this transplant and 100
percent remain off insulin entirely.
Researchers are further studying this transplantation
without the need of the dreaded immunosuppressant drugs. The
Edmonton Protocol has given the diabetic community great hope
for a cure. Clinical trials of this extraordinary
transplantation will be taking place and are taking place here
in the United States. The procedure may not be helpful to
children because it requires the use of the immunosuppressant
drugs I mentioned before. Children's fragile bodies simply
cannot withstand these very strong drugs.
It is my hope that continued research with your support and
members of this committee and indeed all of Congress, will soon
enable more adults and even children to utilize eyelet
transplantation. Our support is crucial to capitalize on the
success of eyelet cell transplantation and to shorten the
timeline to cure that we know is within our grasp.
Mr. Chairman, you have been a leading advocate in this in
playing an important role in encouraging increased research of
diabetes and particularly Type I diabetes. Last year, Congress
and the White House approved a 60 percent increase, the largest
ever in juvenile diabetes research funding at the NIH. This
increased funding will allow researchers to explore new
opportunities to cure diabetes.
It is my hope that Congress remains committed to helping to
find a cure for diabetes. The time is now, the cure is within
our grasp. It is not just the individuals, it is the families
that are affected adversely, the 18-month-olds, the two-year-
olds that have to live and forever live until a cure is found
with the six to eight times a day of pin pricks and two, three
and four injections. All we would like to do is help them live
a normal and healthy life.
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Mr. Regula [resuming chair]. I understand. I have had some
families from my district visit with me and I know the
difficulty it creates for everyone involved. We do hope we can
get a cure. It would be a wonderful thing to get a breakthrough
on that.
I know NIH is pursuing research very aggressively,
especially using cell process as you described. That would be a
wonderful thing if we could. We will do all we can.
Mr. Fossella. Thank you, sir.
Mr. Regula. Mr. Wu, you get the honor of being the last one
today.
----------
Tuesday, March 27, 2001.
PROJECTS
WITNESS
HON. DAVID WU, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OREGON
Mr. Wu. Thank you.
I thank you for the opportunity to testify before the
subcommittee today. As you prepare the fiscal year 2002
appropriations bills, I would like to bring to your attention
several projects from my congressional district that I think
are worthy of national attention.
I am seeking $2.5 million from the Fund for the improvement
of post-secondary education to support the Mark O. Hatfield
School of Government at Portland State University. It is named
in honor of Oregon's most prominent and distinguished national
leaders and has been a solid academic center for the
advancement of education and research about public service.
The money will be used to fund faculty and staff and
support students at the school and the various research
institutions such as the Institute for Tribal Government which
the larger committee helped fund last year.
Among the activities that will be funded is advanced
education for elected and appointed officials at all levels of
government, including those at non-profit organizations and
other public institutions.
In addition, funds will be used to increase the awareness
of the importance of public service and to foster among young
Americans greater recognition of the role of public service in
the development of United States and to promote public service
as a career choice.
There is an extensive history of Federal funding for the
Hatfield School of Government. Congress approved funding for
the school in fiscal year 1999 and 2000 and last year as I
noted funding was approved for the Institute of Tribal
Government, an institution unique in the 50 States to study and
support tribal governments.
The second project I would like to mention briefly is a
million dollar request from the Fund for the Improvement of
Education for the Portland Metropolitan Partnership. We talk a
lot about improving primary and secondary teaching but without
strong leadership from the top, I don't believe that progress
is possible. This program at Portland State University is aimed
at providing that kind of leadership within schools.
Third, I am seeking $2 million from the Administration on
Aging for Oregon Health Sciences University for the second
phase of the Center for Healthy Aging. The subcommittee
supported the first phase of this project with a $1 million
appropriation in fiscal year 2000. This demonstration project
promotes health and prolonged independence by coaching
participants and connecting them with resources to bring about
positive changes in health behaviors and status.
Here I would like to go off the written track a bit by
mentioning that Oregon is among that handful of States thathas
really innovated in helping older Americans achieve and maintain
independence for longer periods of time. This not only gives older
Americans their choice of lifestyles because I think many would prefer
to stay as independent as long as possible, but in addition, it helps
save the Federal Government money because if we don't have to
institutionalize people, it is a significant savings. The Center on
Health Aging's purpose is disseminate a clinical model which works both
for older Americans and for our public purse. It is a worthwhile
project this committee has seen fit to fund in the past.
About two weeks ago, this subcommittee heard from Dr.
Grover Bagby, the Director of the Oregon Cancer Center at OHSU.
Dr. Bagby addressed the growing shortage of nurses faced by
academic as well as rural health centers. The baby boom
generation has provided its share of nurses and as a result, we
will be facing large scale retirements soon. OHSU is expecting
that 45 percent of the nursing faculty will retire within four
years and because of this, we are attempting to alleviate the
nursing shortage through the Laboratory for Teaching Technology
application and innovation in nursing at OHSU. I am requesting
$1.9 million from the Health Resources and Services
Administration, Rural Health Outreach Grant Account.
Without the teaching nurses at OHSU, we do not expect to be
able to get nurses into the rural parts of the State nearly as
effectively as we otherwise could.
Finally, I hope you will be able to support a small portion
of the Columbia River Estuary Research Program through the Fund
for the Improvement of Post Secondary Education. We are seeking
funding to train scientists, students and faculty for this
program. Last year, the subcommittee supported the program
through an appropriation to establish certificate and graduate
degree programs in environmental information technology. We are
seeking to continue that programmatic development and training.
I might add I became familiar with this program several
years ago as a private citizen. It is an amazing public/private
partnership where this research institution has basically gone
to the mouth of the Columbia River, one of the major estuaries
of the U.S. west or anywhere in America, and by studying the
currents, studying temperature, salinity, water density and
flows, by being able to predict where things wind up, these
folks are better able to help ships navigate the Columbia
River, help salmon smelts navigate downstream to get out to the
ocean, help predict where pollutants will wind up.
There is an obvious hardware component of this program but
there is a very important human and training component to this
program. That is where we are seeking help from this
subcommittee. It is a well leveraged and well worthwhile
program.
I thank the committee for its attention to these programs
of importance to Oregon and am ready to answer any questions
you may have.
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Mr. Regula. Thank you. Sounds like you have some
interesting projects.
Is the School of Government at Portland something like what
they have at Harvard with the Kennedy School?
Mr. Wu. In essence, it is our northwest version of the
Kennedy School, yes, or the midwest version of the Hubert
Humphrey School or the LBJ School.
Mr. Regula. The aging project sounds interesting. You are
trying to help older people stay independent for a longer
period of time?
Mr. Wu. That is an important goal. Perhaps that is a
primary goal along with helping them to stay healthier longer.
Mr. Regula. That goes along with it. You can't be
independent if you are not healthy.
Mr. Wu. That is right. And at a fixed health status, if you
will. We want to help people stay healthier but at one fixed
health status, if you are able to coach the individual and also
bring together community resources to focus on the individual,
if the individual can reach out to the resources and bring
community resources to bear, at the same health status that
person might be tempted to go into an institution whereas if
you bring the services together in the right way and empower
the individual.
Mr. Regula. You make the community more friendly to
independence?
Mr. Wu. Yes.
Mr. Regula. Do you involve the family? A lot of times this
would take education of families for support members. Does the
program involve family members too?
Mr. Wu. Absolutely. In this program there is a very strong
educational component for the family and I should say outside
of this program in the general model, there is the availability
for some State funding of family members so that family members
can take more time away from other things and be more
appropriate and more effective caregivers to fellow family
members.
Mr. Regula. Sounds like a very worthwhile program.
Mr. Wu. It is something that had a bit of room to run in a
few other States and no where has it gone as far as it has
especially in the Klamath Valley part of the State of Oregon.
If we can make this model effective and try to replicate it
elsewhere, I have heard academicians from around the country
discuss how this would make people happier by keeping them
independent but be a major cost savings to the Federal
Government.
Mr. Regula. I think that is absolutely right on both
counts.
Do you have Klamath Valley?
Mr. Wu. No, I do not. It is Mr. Walden's good fortune to
have the Klamath Basin.
Mr. Regula. It would be further east.
Mr. Wu. A bit to the east and to the south.
Mr. Regula. Do you have the city?
Mr. Wu. Most of my congressional district is rural but I
also have the urban core of Portland, the financial district,
the most urban parts of Portland through the high tech suburbs
but two-thirds or three-quarters of my congressional district
is actually forestland or agricultural land.
Mr. Regula. What corps or cattle?
Mr. Wu. Not much in the way of cattle but we have a lot of
orchards, a lot of nursery stock as it became too costly to run
nurseries in southern California, a lot of the nursery folks
came up to my neck of the woods, and hazelnuts or filberts as
we prefer to call them in the northwest and I think some of the
best wines in America.
Mr. Regula. You must have a somewhat temperature climate
there?
Mr. Wu. Yes. It is a temperate climate more like the
Mendocino coast or the burgundy kind of climates in Europe. We
are so far north that our vinters have the challenge of highly
variable growing seasons. That creates both the best of times
and the worst of times as agriculture tends to do.
Mr. Regula. Thank you for coming.
The committee is adjourned until 10:00 a.m. tomorrow.
Tuesday, April 3, 2001.
McKINNEY EDUCATION FOR HOMELESS CHILDREN AND YOUTH
WITNESS
HON. JUDY BIGGERT, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Regula. I call the committee to order.
We have four panelists. You are not the ones that were
scheduled for Panel 1, but we have four of you, so I am just
going to go ahead and then as the others come in, we will use
them on Panel 2 or Panel 3. I would be interested to hear what
you have to say, and I know these are tough issues.
We will start out with you Mrs. Biggert. Try to stick to 5
minutes, if possible.
Mrs. Biggert. Thank you, Mr. Chairman and distinguished
members of the subcommittee, who aren't here, but I will say
hello to them anyway.
Mr. Regula. This is not unusual. That is why I get the
extra pay.
Mrs. Biggert. I am sure they will join you as time goes on.
As the Republican cochair for the Congressional Women's
Caucus, I am pleased to have the opportunity for our members to
testify today. Every year this forum has provided the caucus an
opportunity to come together as a bipartisan group to discuss
issues affecting women throughout the United States. And I
would like to thank you again for extending us the opportunity
for this year.
Today I would like to express any support for the McKinney
Education for Homeless Children and Youth, the EHCY program,
and I respectfully request the subcommittee to appropriate
$70,000,000 for this program in fiscal year 2002. Children
represent one of the fastest growing segments of the homeless
population. In fact, an estimated 1,000,000 children and youth
will experience homelessness this year, a situation that will
have devastating impact on their educational advancement.
Because of their unstable situation, these children face
significant hurdles in obtaining an education. Studies show
that homeless children have four times the rate of delayed
development, are twice as likely to repeat a grade, and are
more susceptible to homelessness as adults. EHCY removes these
obstacles to education for homeless children and has made a
real difference in the lives of many children and families.
Yet, appropriations for the McKinney Education Program, the
only Federal education program targeted to these children, have
not kept up with demand for services or inflation.
Despite the increase in homelessness, Congress did not
increase the funding for this program at all from 1995 until
2000. When Congress did finally increase the funding in 2001,
it appropriated $35,000,000 for the program an increase of just
$6,200,000. The lack of adequate funding for this program has
been a major barrier to educating homeless children and youth.
According to a recent national survey, in 1997 States were only
able to serve 37 percent of school-aged children identified to
be in this difficult situation.
Compounding the problem is the poor collection of data on
homeless children. States often do not have the resources to
conduct the necessary assessments, and the lack of a uniform
method of data collection has resulted in unreliable national
data and the possible underreporting of homeless children.
Earlier this month the subcommittee heard testimony from
Lois Ferguson on behalf of the National Coalition for the
Homeless. She gave emotional testimony about her experiences
with homelessness and how the EHCY program had benefited her
family. EHCY can make a real difference in many more lives, but
only if the funding is there.
I understand and appreciate the enormous budget constraints
under which this subcommittee is working. However, I believe
there is no better time than now to renew and strengthen
Congress' financial commitment to helping provide homeless
children with access to a quality education. I ask that you
match the $70,000,000 that the Senate Health, Education, Labor,
and Pensions Committee has recommended for the program in
fiscal year 2002. By doing so, you will be reaching out to
homeless children, helping to ensure that they don't lose out
on what is guaranteed for all our children, a free public
education. You also will be meeting President Bush's call to
leave no child behind.
Thank you very much for allowing me to testify today.
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Mr. Regula. Do you think the faith-based, if that program
does develop, would be one group that might offer some services
for these children?
Mrs. Biggert. I think that is one way to address it. But
what really concerns me is getting them back into a school
system immediately and no red tape. And I think that the amount
of money to do that, to have help financially for the
ombudsman, and then the awareness that they know they can go to
a school right away. And spreading $70,000,000 even over 50
States doesn't go very far.
Mr. Regula. I notice you are close to Chicago. They have
had some enlightened programs in their school system. Has the
Chicago system done anything innovative in providing these
services?
Mrs. Biggert. What we did in Illinois--and, in fact, I have
introduced the homeless education bill, which is in the
reauthorization of the K-through-12 program, and that is the
model that we use for that program. So Illinois has a very
great model for all the States in the education of children,
and it is working very well there. And even, in fact, just a
couple of weeks ago one of my schools, you would not think
would have homeless children in it, it really worked out a
program for a couple of kids that were homeless and didn't know
where to go were enrolled in school; and they had the ombudsman
that was provided in this program.
So it really is working there. It was brought to my
attention from other States, saying why can't we have the same
kind of program.
Mr. Regula. I guess it takes local initiative, because we
had $35,000,000 last year, which obviously is not enough.
Mrs. Biggert. Well, you know, for the homeless centers just
to be able to provide not only for education, but to be able to
provide for all the homeless and particularly the children.
Mr. Regula. I am sure it is a severe problem.
----------
Tuesday, April 3, 2001.
THE WELLNESS OF WOMEN
WITNESS
HON. JUANITA MILLENDER-McDONALD, A REPRESENTATIVE IN CONGRESS FROM THE
STATE OF CALIFORNIA
Mr. Regula. Mrs. McDonald.
Ms. Millender-McDonald. Thank you, Mr. Chairman, and good
morning to you.
Mr. Chairman, as the co-chair of the Women's Caucus, I am
proud to come this morning. And we thank you for the
opportunity to come before you this morning to again lay out
our agenda for women and women's health. I am proud to have the
women who have come this morning as a strong showing of
advocacy for women across this country, especially the women
who know of the myriad of health issues and problems that we
see.
I have testified in the past, Mr. Chairman, before you and
others, on the need for us to look at the National Bone Marrow
Program, telemedicine, breast, cervical, and lung cancers,
fibroid tumors and other critical health issues. I was very
pleased and very happy to have sat in the audience when the
President mentioned his increase in funding in his budget for
NIH.
I respectfully request then that the 16.5 percent that the
NIH is requesting for the various outlines of health issues
that I will talk to this morning really be put in the budget,
that is, $3,400,000,000 for NIH so that we can see some
improvement in women's health. We have chosen for our theme
this 107th Congress ``The Wellness of Women,'' and we certainly
want, in our efforts and others' efforts, to promote and
preserve women's health.
As you know, heart disease is the number one killer for
American women. Studies suggest that women are more likely than
men to die from a heart attack, and women who recover from a
heart attack are more likely than men to have a stroke or
another heart attack. In fact, 44 percent of women die within a
year following a heart attack compared to 27 percent of men.
CDC is asking for $50 million to expand community education
programs in 35 States for cardiovascular health programs.
Another illness, Mr. Chairman, is that of cancer. It is the
second leading killer of American women claiming 43,900 women
in 1997. So early detection coupled with improved treatments
has led to a decline in breast cancer rates, as well as
cervical cancer, if women do get Pap smear tests. However, lung
cancer has become the number one killer for women in terms of
cancer in the cancer category, so we are asking, as well as the
CDC, for the National Breast, Cervical, and Lung Cancer the
Early Detection Program in the amount of $210,000,000 so that
we can try to grapple with this whole notion of women and lung
cancer, as well as cervical and breast cancers.
Another disease that is really crippling women is that of
lupus. Lupus affects one out of every 185 Americans. Although
lupus can occur at any age and in either sex, 90percent of the
victims with lupus are women. During the child-bearing years, lupus
strikes women 10 to 15 times more frequently than men. And so we are
asking for again, the NIH appropriation for lupus at $55,200,000.
We are also--and the final thing that I would like to
address is diabetes, the fourth leading cause of death in
African American, Native Americans and Hispanic women, the
sixth leading cause in Asian women and the seventh leading
cause in white women. An estimated 16,000,000 Americans have
diabetes, but only 10,600,000 cases are diagnosed, of which
4,200,000 are women. Left untreated, diabetes can lead to
severe vision loss, heart disease, stroke, kidney disease, and
amputation of the lower limbs.
The current NIH appropriation earmarked for diabetes is
only 65 percent of the funding necessary. Therefore, I am
asking for 1,500,000,000, which is 100 percent of the funding
needed to address this single most costly disease in America.
Mr. Chairman I was really thrown aback when I went to one
of the clinics in my district to find that young African
American women, ages 25 to 35, are really being crippled with
visual impairments due to diabetes because they do not have
health insurance. And so we are asking for this increased
funding for education programs, for research, and for treatment
of women.
We know that women now are making up 52 percent of the
heads of households; there must be a wellness among women for
them to continue to be sometimes the only breadwinner for our
children.
Thank you, Mr. Chairman.
Mr. Regula. Thank you. I might mention to you, we did go to
the Centers for Disease Control yesterday, nine of the
committee members and the staff. It was a very interesting day,
and they mentioned some of the things that you just brought
out.
Ms. Millender-McDonald. Thank you.
Mr. Regula. I think one of the problems in diabetes is that
people don't know they have it until their vision and some of
the things you just mentioned becomes evident of it.
Ms. Millender-McDonald. I will be following them. And thank
you so much; the CDC and NIH I will be working with them, so I
do thank you.
Mr. Regula. They do a nice job. We will be hard-pressed to
do all the things that we need to do----
Ms. Millender-McDonald. I know that is right.
Mr. Regula [continuing]. With what is allocated to us, but
we are going to give it a try.
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Tuesday, April 3, 2001.
WOMEN IN SMALL BUSINESSES
WITNESS
HON. SHELLEY MOORE CAPITO, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF WEST VIRGINIA
Mr. Regula. Mrs. Capito.
Ms. Capito. Thank you, Mr. Chairman, for allowing me to
come here today and give you some brief and very general
testimony.
Wellness of women--I am the Vice Chair of the Women's
Caucus--I am talking more wellness of women in terms of their
economic wellness. In recent years women have made great
strides in the workplace, especially as entrepreneurs. Between
the years of 1987 and 1997 the number of women-owned businesses
has increased 89 percent, and today there are more than
8,500,000 small business owners in the United States that are
women, and many in West Virginia, my home State.
The small business has been and always will be the key to
the American dream, especially for women and other minorities.
But erecting and ignoring government barriers that hinder their
success will slow their creation of and stifle their growth. In
February of this year, six of my constituents received Small
Business Administration loans; three of those business owners
were women. Although they were very happy to receive the
financial support, they probably would have been happier if the
government would remove some of the unnecessary regulations
that prevent them from doing such things as offering expanded
health insurance policies to their employees or creating new
jobs, all things that could be done with the costs that they
expend jumping through the hoops of government bureaucracy.
Women need to have better access for financing, for they
are small businesses. As leaders entrusted with this
responsibility, we need to be vigilant and recognize these
needless barriers that burden our small businesses. So we have
to be aware that we need to not tolerate the unnecessary
obstacles that prevent women and minorities from the American
dream. I can't help but wonder how many more women or minority
entrepreneurs we could have if we made starting and running a
small business a little bit easier.
So today I would like to ask that we work together to
preserve and extend the ideas of the American dream, and let's
send this message that the true entrepreneurial spirit is
available to them.
Thank you for letting me make this general statement. I
appreciate you listening.
Mr. Regula. Thank you.
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Mr. Regula. I read a comment the other day that--I think it
was Germany's czar for production said, if his country had used
women as effectively as the United States, it could have had a
pretty substantial impact on their ability to fight World War
II. He recognized--fortunately, belatedly--that women are
very--and I think that was a unique phenomenon in the United
States, the impact of the women on the war effort. Rosie the
Riveter truly was a very great part of it.
And the point you make is well taken that the role has
expanded. When I came here there were 18 in the House, now we
have how many?
Mrs. Biggert. Sixty-one.
Mr. Regula. There was one in the Senate. Now there are
nine.
Ms. Capito. Watch out.
Mr. Regula. None on the Court and now we have two, of
course.
I was startled to sit with a lady the other day who had
three or four stars, which is kind of unique too. Times have
changed, fortunately for the better.
Stephanie, you are on the third panel, but I will just take
Louise and then we will come to you.
----------
Tuesday, April 3, 2001.
NIH OFFICE OF RESEARCH ON WOMEN'S HEALTH
WITNESS
HON. LOUISE M. SLAUGHTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF NEW YORK
Mr. Regula. Mrs. Slaughter.
Ms. Slaughter. Thank you, Mr. Chairman. Good morning to you
and Ms. DeLauro.
I guess, in view of this conversation, it is probably good
to point out this is Equal Pay Day, and women in the United
States are still only paid 78 cents to the male dollar. So we
are making some progress, but it is going pretty slow there.
And we have contributed a great deal; we do want to be
recognized.
I do appreciate the opportunity to testify before the
subcommittee on issues that are important to the Women's
Caucus. As a Vice Chair of the caucus, I speak on behalf of all
my colleagues when I say that we look forward to continuing our
excellent working relationship with this subcommittee under
your leadership.
I would like to highlight briefly two issues that are
extremely important to the health of American women. The first
is women's health research at the National Institutes of Health
and particularly the efforts of the NIH's Office of Research on
Women's Health.
This is a tiny office with a monumental mission. It has a
threefold mandate to, one, strengthen, develop, and increase
research into diseases, disorders, and conditions that affect
women, determine gaps in knowledge about such conditions and
diseases, and establish a research agenda for NIH for the
future directions in women's health research;
Second, to ensure that women are included as participants
in NIH-supported research; and
Third, to develop opportunities and support for
recruitment, retention, reentry and advancement of women in
biomedical careers.
Under the leadership of Dr. Vivian Pinn, this office has
made major inroads on all of these issues. Its progress is
hampered, however, by a lack of resources. Over the past 4
years they have received paltry budget increases, especially
given the fact that Congress is working to double the NIH
budget. For fiscal year 2000, NIH received a budget increase of
14 percent, but the ORWH budget was increased less than 4
percent. It is currently carrying out its mission with a
$22,000,000 budget and, by contrast, the new Center for
Minority Health and Health Disparities is funded at
$132,000,000 for fiscal year 2001 and the Office of AIDS
Research at $48,200,000.
Last year I organized a letter from 22 women Members to
Acting Director Ruth Kirschstein asking her to increase the
budget. It is my understanding that she has requested a
respectable budget increase for the Office of Research on
Women's Health for fiscal year 2002. I hope the subcommittee
will not only fund this request fully, but include language in
the accompanying report encouraging the future permanent
director to maintain this commitment. And that is a very
important step.
I would like to turn now to the other issue on my agenda,
which is environmental health. The interplay between an
individual's genetic predisposition to disease and the
environment is not well understood. The evidence is clear and
accumulating daily, however, that the by-products of our
technology are linked to illness and that women are especially
susceptible to these environmental health-related problems.
There are many reasons for that, the makeup of a woman's
body containing more fatty tissue, more exposure to household
chemicals, and the like. You may have seen or heard Bill
Moyers' recent report, titled ``Trade Secrets.'' Mr. Moyers
detailed the fact that the chemical industry has kept
confidential documents over the past 50 years about adverse
health effects of workplace chemical exposures on their
employees.
In addition, a recent CDC report showed that all Americans
have traces of pesticides, metals, and plasticizers in our
blood and urine. What does this mean for our health? We don't
know. However, the chemical industry has also provided great
benefits to society through industrial and technical
advancement. It is a question of benefit versus risk, but we
need to at least understand the risk to make an assessment.
I urge the subcommittee to provide increased funding for
the National Institute of Environmental Health Sciences to
enhance the research on environmental causes of disease so that
we may improve the public health of America. This investment
will save the lives and health of people who today suffer
needlessly because we lack the scientific data to understand
the effect of environment of exposures on human health.
Mr. Chairman, I would like to note that I am proud to have
recently introduced H.R. 183, the Women's Health Environmental
Research Centers Act, a bill that will enhance scientific
research in women's health and the environment and will fill a
gap in the NIEHS research agenda by targeting resources to
women's environmental health. NIEHS fully supports the
initiative, and I would very much like to work with you, Mr.
Chairman, on empowering the agency to create these research
centers.
Again, thank you very much for the opportunity to address
you on these important issues.
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Mr. Regula. Thank you.
I might mention that at CDC they have one section on
environmental health generally. An interesting footnote, they
said they could take a sample of your blood and tell you all
the various components how much arsenic is in it, how much all
the various metals. Ms. DeLauro was there.
You want to go ahead and ask some questions or comments.
Ms. Slaughter. They can tell you almost everything from a
drop of blood, including all the diseases that you have had as
a child. It is a remarkable fluid that we have here. As former
microbiologist, I am very fond of it.
Mr. Regula. I like a good supply myself.
Ms. DeLauro. I will just briefly comment to Mrs. Slaughter
it was a really fascinating what the CDC is doing--I was there
with the group yesterday--particularly in this area and what we
could do by way of tracking illnesses and so forth and dealing
with genetic predispositions. So your words are well taken.
Ms. Slaughter. Three to 4 percent of breast cancer in women
is genetically linked; the rest of it must be environmental. So
we need to study this very closely.
Mr. Regula. Staff advises me that we are probably getting a
larger allocation on the women's health issues.
Ms. Slaughter. Thank you. I am so happy to hear that. Thank
you very much.
Mr. Regula. Mrs. Lowey.
Mrs. Lowey. Thank you, Mr. Chairman. I personally want to
thank you and thank the entire Women's Caucus. This is always
the highlight of the presentations for us.
And I want to particularly associate myself with your
comments on environmental health. To date, they really haven't
done enough work in that area. And I feel there so strongly the
mapping we have done in New York, the coincidences between high
rates in particular areas--not only New York, San Francisco,
around the country. I think this is something that we have to
continue looking at. I have always been interested in the work
of Stephanie Coburn and the connections of her research with
cancer. So I want to thank you and the entire Caucus for your
presentations.
Ms. DeLauro. I can explain it to my colleagues; I have to
leave at 10:30.
Pay Equity Day it is, and there is a press conference about
the Paycheck Fairness Act, which, as my colleagues know, is a
piece of legislation most of them are on for pay equity for
women; and we are going to do that over on the Senate side this
morning.
But I just wanted to say, this is an unbelievable
committee. When I first came, it was a 15-member committee. In
terms of the representation for women, there are three
Democratic members, there were two Republican members. I can go
back and think about when it was Mrs. Pelosi, Mrs. Lowey, and
myself, and Helen Bentley on the other side--a feisty,
wonderful woman.
But I think, Mr. Chairman, in terms of focus of this
committee and where it goes and what it does not only on just
women's health and those issues, but broadly, with the
portfolio that exists in the committee, that I think women have
made a difference; and the women members who come before this
committee every single year talk about issues that face this
Nation broadly and, I think, make a remarkable contribution to
what is being done.
Just one additional thing: When I first came here, it was
only 10 years ago, I worked with women here who were courageous
in charting the waters for the NIH, doing clinical trials for
women and for minorities, and for there to be an Office of
Women's Health at HHS; and because of the tenacity of the women
who served in this body longer than 10 years ago--I look at
people like Louise, Nita was here, it is people like Pat
Schroeder and Barbara Kennelly and Nancy Johnson who charted
the way--Connie Morella.
Thank you, Mr. Chairman. I apologize to my colleagues for
interrupting your testimony.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman.
I understand from my colleagues, Nita Lowey and
RosaDeLauro, that they both have meetings at 10:30. This makes my
arrival just right, so I can carry on for them when they leave. So I
just want to thank you guys and say again, like Rosa said, this is a
great committee and I really look forward to working on it.
On the pay equity, we had a wonderful press conference and
committee hearing up in Rhode Island about 2 weeks ago. The
response was overwhelming. My local newspaper carried it front
page, the whole story. My colleagues in the State legislature
are pressing for it; they say they are not going to go for a
budget that doesn't include it within State payroll. So it is
not just equal pay, but pay equity, that there is a point
system for jobs so that, you know, given experience and the
duties of the job, that is going to be the criterion by which
people are paid, not a set, you know, number of jobs that are
set up.
So anyway, thank you, Mr. Chairman. Thank you, my
colleagues.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you, Mr. Chairman. I am looking forward
to listening to my esteemed colleagues and helping them work on
this very important program. Thank you.
Mr. Regula. Well, thank all of you on the first panel. And
I just want to tell you, if my wife and daughter were here,
they would be cheering you on.
Ms. Slaughter. I am sure you will, as well.
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Tuesday, April 3, 2001.
NORTHEAST OHIO NEIGHBORHOOD HEALTH CENTERS
WITNESS
HON. STEPHANIE TUBBS JONES, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF OHIO
Mr. Regula. Our next panel. We have the three--oh, here is
Connie. Don't wait. We will go ahead. Is Connie on panel 4?
That is all right. Okay. It is very informal here.
Okay, we will take them in the order I have them here. But
you were here early, so we will start with you, Stephanie.
Mrs. Jones. I appreciate you giving me the opportunity to
plead.
Mr. Chairman, the Congressional Black Caucus is holding
election reform hearings somewhere in this building. I am
trying to get over there to all my colleagues.
Good morning. Just for the record I would like to add to
the names of some people who have been working in the past on
the issue of women's health: Mary Rose Oakar, as well as my
predecessor, Louis Stokes. I got that in.
I appreciate your extending time for me to relate some of
the very urgent concerns of the 11th Congressional District
regarding the provision of health care at federally qualified
community health centers.
Northeast Ohio Neighborhood Health Centers is located in
the heart of Cleveland and serves some of the most impoverished
neighborhoods in the city. As in most large cities, large
hospital health care providers have been migrating out of the
inner city. The end result of this migration is many more
uninsured for our health care centers to serve. The majority of
constituents served by these centers live under 100 percent of
the Federal poverty line. Many of these people are now working
but remain uninsured because their jobs do not provide health
benefits.
The rollout of Ohio's SCHIP has helped. SCHIP covers
children who live at up to 200 percent of Federal poverty
level. Moreover, the State of Ohio has expanded coverage to
adults living at 100 percent of the Federal poverty level.
The Northeast Ohio Neighborhood Centers have experienced an
increase of almost 10 percent in the uninsured patient base in
the last year, partially due to hospital closings. NEON is not
the only provider that has suffered immensely from managed care
in our city.
Approximately one-half of NEON's 35,000 patients are
children. Approximately 28,000 of those 35,000 patients live
under 100 percent of the poverty level. Many of them have
mental health or drug and alcohol problems as well as diabetes,
hypertension, cancer or high-risk pregnancies, as well as other
health issues that often parallel living in poverty.
Twenty-three physicians and six dentists logged more than
115,000 encounters in the year 2000. NEON provides
transportation, translation and counseling to encourage and
empower patients.
Despite the hospital closings, managed care and numerous
other earth tremors in the health care system, NEON's
community-based system of five health care center sites is
still open and providing care.
I will skip over only to say that the neighborhood health
centers need additional support for them to continue to be able
to provide care.
In my district we lost two large hospitals in this control
of the health care delivery system; and only on Sunday, in the
Plain Dealer newspaper, it was reported that many of the
hospitals are diverting patients. They close down their EMS
center, their emergency room; and, therefore, the EMS trucks
have to go to the next hospital, the next hospital. That has a
significant impact on the delivery of health care.
Very quickly, we would like to have $600,000 to do MIS
upgrades or information management upgrades, as well as we seek
$3,800,000 in addition to the MIS for many of the facilities
that NEON operates. The facilities are old, and they are in
need of renovation to be able to continue to provide care.
I thank my colleagues and the Women's Caucus for giving me
the opportunity to be heard today. I would ask this committee
to keep in mind the desperate need of community health centers
in our Nation and the need for them to provide care. I submit
my testimony for the record.
Also, let me not forget, there--I should say that,
incidently, Mr. Chairman, you may also know that there is a
center comparable in your community in Massillon.
Mr. Regula. I am very aware of it. They reminded me several
times.
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Tuesday, April 3, 2001.
VARIOUS PROGRAMS
WITNESS
HON. CONNIE MORELLA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MARYLAND
Mr. Regula. I think what we will do is do the panel and
then questions, because we have a pretty full schedule here to
get through today. So, Connie, you are next.
Mrs. Morella. Thank you, Mr. Chairman.
I want to begin by congratulating you on the chairmanship
of what I consider one of the most important subcommittees of
the Appropriations Committee and thank you for extending to us
this opportunity to testify before you. And, Ms. DeLauro, I am
wearing my red for Equal Pay Day.
Mr. Regula. Isn't there equal pay in the Congress?
Mrs. Morella. Well, it is--actually, I would say it is one
of the few places where we are pretty close to equal pay, but
in so many other areas that is not the case.
Among my top priorities is the continuation of our
commitment to double the budget for the National Institutes of
Health, and we are on the right track. We are in year number 4
of the 5-year plan. The President has called for
$23,100,000,000, which is a 13.8 percent increase. To keep on
track, we could use $23,700,000,000.
Let me jump around to a couple of other issues that are
important to all of us and indeed to me.
Since 1990, I have been the sponsor of legislation to
address women and AIDS issues. Women are the fastest-growing
group of people with HIV, with low-income women and women of
color being hit the hardest by the epidemic. AIDS is the
leading cause of death in young African American women.
We particularly urge your support for the development of a
microbicide to prevent the transmission of HIV and sexually
transmitted diseases at a level of $75,000,000. Currently, less
than 1 percent of the budget for HIV and AIDS-related research
at the National Institutes of Health is being spent on
microbicide research. Actually, I would like to see the
important work of the Office of AIDS Research quickly converted
into a proactive, strategic plan for microbicide research and
development that has the active involvement and support of NIH
and institute leadership. Much progress has been made, but more
needs to be done.
You know, microbicides, I remember many years ago when I
first introduced legislation I couldn't pronounce microbicide,
but it is so critically important to making sure that we don't
have HIV and AIDS and sexually transmitted diseases. It is like
a vaginal solution that has nothing to do with a spermicide, so
it is not a birth control method; and, boy, what a difference
this would make in the world.
I would like to jump to breast cancer. Mr. Chairman, as you
know, women continue to face a one in eight chance of
developing breast cancer during their lifetime. More than
2,600,000 women are currently living with breast cancer. This
year alone more than 183,000 women will be diagnosed with
breast cancer, and 41,000 women will die of the disease.
This subcommittee has clearly demonstrated its commitment
to breast cancer research. We urge you to continue this
momentum in this fiscal year 2002. On behalf of all the women
who live in fear of the disease, we urge the subcommittee to
continue its strong commitment.
And, Mr. Chairman, although it is not a widely known fact,
tuberculosis is the biggest infectious killer of young women in
the world. In fact, TB kills more women worldwide than all
other causes of maternal mortality combined. Currently, an
estimated one-third of the world's population, including 15
million people in the United States, are infected with the TB
bacteria; and due to its infectious nature TB can't be stopped
at national borders. So it is important to control TB in the
United States, and it is impossible to control it until we
control it worldwide. I urge support for an annual investment
of $528,000,000 for the Centers for Disease Control in its
efforts to eliminate TB. Of course, there is that multiple-
drug-resistent strain of TB that is so dangerous.
The Violence Against Women Act is a very important
priority. We reauthorized it, added some new programs. Now I
respectfully request that the funding become a priority for
this subcommittee; and I am requesting that the shelters under
the FVPSA, which is the Family Violence Prevention Act, be
funded at their authorized level of $175,000,000 for fiscal
year 2002.
Also, transitional housing that Asa Hutchinson and Bill
McCollum helped to put into that bill, the transitional housing
program to be funded at its original and one-time authorization
level of $25,000,000.
Rape prevention and education to be funded at its full
authorization level of $80,000,000 for fiscal year 2002.
Several other programs I have mentioned in the testimony
that I am submitting but are, very briefly, the Women in
Apprenticeships and Nontraditional Employment Act, I introduced
that many years ago, it has been working well on $1,000,000, to
continue it. The Campus-Based Child Care Program, which is
working to allow low-income women to have some assistance with
child care on college campuses. What a great way to get them
off of welfare and into the work world.
That being said, you are very kind and gracious, you and
the members of this subcommittee, Mr. Sherwood, and I see Ms.
Pelosi is here. We had Ms. Lowey, Ms. DeLauro and Mr. Kennedy
listening to us and hope that you will be able to accommodate
these.
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Tuesday, April 3, 2001.
PREVENTION OF DOMESTIC VIOLENCE
WITNESS
HON. SHELLEY BERKLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEVADA
Mr. Regula. Could you all stay when you finish the panel?
Then we will take the questions. Because we are on a pretty
tight schedule to get through all the other witnesses.
Ms. Berkley.
Ms. Berkley. I am delighted to have an opportunity to
testify before this subcommittee which enjoys a wonderful
reputation for tackling issues of major importance to women and
children and families in our Nation and has been instrumental
in improving the quality of life for millions of American
families that, prior to your interest and actions, had little
hope for their futures or the futures of their children.
I want to thank you for allowing me to speak today in
support of increased funding for programs to prevent domestic
violence. Crimes of domestic violence have devastating
consequences for women personally, as well as for their
families and for society as a whole. In my district of southern
Nevada, I have visited shelters for battered women and talked
with law enforcement officers, counselors and community
leaders. I had an opportunity to do a drive-along with the
police when they were doing their domestic violence shift, and
I have seen firsthand the horrible effects domestic violence
can have on a community. That is why today I ask you to
continue efforts to prevent domestic violence by fully funding
domestic violence grant programs within the Department of
Health and Human Services.
These programs, which include grants for rape prevention
and education, community intervention and prevention
organizations, as well as the National Domestic Violence
Hotline, are vital to the fight against domestic violence.
Of particular importance, however, is funding that supports
shelters for battered women. These shelters are often the only
source of protection and relief for women who are fleeing from
a violent situation.
Women across the country need the services that domestic
violence programs provide; and, again, I urge you to fully fund
these programs.
I have had an opportunity to tour all of the domestic
crisis shelters in southern Nevada in my district, from the
ones where people are going just for a very temporary 24-hour
situation to get them out of their house, get their children
out of the house, to the more complex situations where, when I
went to visit the shelters, they blindfolded me and drove me
there because these are places that are so secret that the
perpetrator of the violence cannot find his family and continue
to perpetuate the crime against his family.
Most of these women, when I sit down and speak to them,
they tell me how desperate they are to have a place to go not
only for themselves but particularly for their children. Many
women are stuck in a violent situation because theydon't have
anyplace to go, and they endure incredible violence in their homes
because they are afraid to be without an income, without a roof over
their heads, without shelter for their children.
If we can provide this tool for them to get out of those
situations, they can break this dependency and codependency
that they have on the perpetrator of the violence and begin to
get the counseling they need and break out of the situation and
be able to take care of not only themselves but their children
as well. Many times, it is just a shelter to house them until
they can get on their feet. But if we don't provide this they
will end up back in the abusive situation.
When I was practicing law I spent a good deal of my pro
bono time trying to help these women get out of the situation,
provide them with low-cost divorces. But it wasn't--it was the
dependency, it was the emotional damage, it was the
psychological fear that they had of breaking that tie and
getting out of their home and feeling that without that home
they would be destitute and on the streets. And for many of
these women they endure incredible pain and incredible violence
just so their children aren't out in the streets.
Again, I want to thank you very much, but unless we fully
fund these domestic crisis shelters we are going to have this
problem in perpetuity; and the cost to society is far more
extensive if we don't spend the money to fully fund these
shelters and these programs than if we don't.
Mr. Regula. Thank you.
Are you familiar with Parents Anonymous? It is--at least in
Ohio they are pretty active where they--it is like single
mothers can go and talk to each other and get help. It is a
support group and somewhat goes to what you are discussing
here.
Ms. Berkley. There are many programs available, but in the
final analysis, if the women has to go back to that violent
environment, she is never going to break the cycle.
Mr. Regula. Very true.
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Mr. Kennedy. Mr. Chairman, these grants also help us
identify those children, because the National Institutes of
Mental Health have developed an absolute correlation between
children from families with domestic violence and drug abuse,
cognitive delay in learning and further violence within the
family among these children. This is absolutely a determinative
in terms of the cycle of violence. So these grants have another
effect of allowing us to try to address the needs of these
children along with their mothers in many cases.
So I look forward to working with you on making sure that
we get some training for these kids, too, when they face these
situations. A couple of States have done very well by these
grants to get the whole families involved.
Thank you, Mr. Chairman.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Well, the testimony is very compelling; and
we have all in our private lives seen examples. If there is
anything that we can do, such as these grants, to put that
behind us, we are certainly on the right track. Thank you.
Mr. Regula. Ms. Pelosi.
Ms. Pelosi. Mr. Chairman, while I was listening to the very
excellent testimony of Representative Berkley, especially
toward the end when she was talking about her own experience
doing pro bono work, I was reminded of our work together when
we were on Commerce, Justice, State together. We were able to--
I had worked with Senator Cohen, others in the Senate and
this--not Senator Cohen, others in the Senate on the Republican
side where we tried to make--for women to have legal
assistance. They were testing the income of the spouse.
So we had an amendment in our Commerce, Justice bill for
legal assistance that would say that the income of the spouse
would not be counted against the woman when she tried to get
some legal assistance, some legal aid. Which made a very--as
you well know, you graciously did pro bono work, but everyone
is not able to avail themselves of that. So that made it a
difference, too.
But this has been a fight for a while in the Congress to
get as much as possible for these grants. It is one of the
proudest moments that we have, when the Women's Caucus comes
before us with this array of issues that are so important; and
we have been able to make a substantial difference in many
areas of health, Mr. Chairman. Everybody understands that this
is a tricky issue, because everyone is uncomfortable with it
and all the more reason we have the maximum resources to do it.
So I am glad the Women's Caucus has made this a priority.
Mr. Regula. As you pointed out, you and I have been
champions of legal services in Commerce, State because that is
one way that women can get help that otherwise just wouldn't be
available.
Tuesday, April 3, 2001.
COMMUNITY HEALTH CENTERS
WITNESS
HON. LORETTA SANCHEZ, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mrs. Sanchez.
Ms. Sanchez. Thank you, Mr. Chairman, and congratulations
on your chairmanship. Thank you to the entire subcommittee for
allowing us to come before you to testify today.
I would lend my voice to many of the issues that--probably
all of the issues that these women are going to talk to today,
but in particular I want to take a couple of minutes to talk
about increasing the funding for community health centers. We
would like to see an increase in the amount of $250,000,000.
I will tell you, it is some of best money that we can
spend, because this directly affects areas that are usually low
income, as parts of my district are. It is about putting health
care readily accessible to people there, because they either
don't have transportation or they do not have an ability to get
off work or they have children they have got to take care of or
they have to bring the children with them.
What happens when you don't have community health clinics
is that people don't go and see a doctor. When they do go and
see the doctor, it is with a very chronic problem already when
they walk through the front door. Where is it that they go?
They don't go to a clinic. They go to an emergency hospital
where they know it is the highest cost of delivery in the
entire health care system.
So when we are able to put these community clinics in areas
where people can come, they can come with their kids, they can
walk, they are readily available, they are open on Saturdays
and Sundays, and they can get preventative medicine. They can
work on issues of nutrition for diabetes, for example, where
the Latino community has about five times the amount of
diabetes in our community than anybody else in the United
States, and that is simply because of nutrition. There are
problems that we have that become very expensive if we don't
get access to health in a meaningful way to people in lower
income areas.
One of the things that has happened in my district and why
I feel so strongly about this is that we are now seeing what we
call back room clinics in pharmacies. So if you go to an
independent pharmacy or you go to a drugstore that doesn't even
have a pharmacy there in my area and you need something, you
need medication for your kid, your kid is sick, what is
happening is that these people are taking them into the back
room, somebody who is not even a doctor is analyzing what is
wrong with this kid and giving them drugs that are either
coming in, brought across the border from Mexico--and we have
had, just in the last 6 months, an 18-month-old baby girl and a
15-year-old boy die because of illegal drugs, prescription
drugs coming from someplace else being given to these kids. And
these parents are--this is the kind of health care that they
think they can afford.
So the more that we can do to put in neighborhood clinics
the better it will be for all of us in the long run. We don't
need to lose these kids simply because parents are doing the
best that they think they can do in a system that is pretty
much ignoring them.
And I am talking about working people. I am talking about
people who have taxes taken out of their paychecks. I am
talking about people who pay taxes when they go and they buy
everything at the store. These are people who are low income
and need the access to health care.
So I would hope that you would really consider increasing
the amount towards the community health care centers.
Mr. Regula. Thank you.
Any questions?
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Tuesday, April 3, 2001.
TRANSITIONAL HOUSING
WITNESS
HON. JANICE D. SCHAKOWSKY, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF ILLINOIS
Mr. Regula. Our next witness is Mrs. Schakowsky, the
successor to my great friend, Sid Yates.
Ms. Schakowsky. As I was going to say, Mr. Chairman, though
you and I don't know each other very well, I feel very warmly
toward you because of the great relationship that you had and
the things Sid Yates said about you, so thank you very much.
Mr. Regula. I still miss him. He used to call me after I
was gone to tell me how to run the committee.
Ms. Schakowsky. Well, I wanted to also talk about violence
against women and the needs for transitional housing, and I am
so glad that Connie Morella spoke to you about it. Shelly
Berkeley talked about the need for shelters.
I wanted to particularly emphasize the $25,000,000 for
transitional housing that was authorized in the Victims of
Trafficking and Violence Protection Act of 2000. So I am hoping
that that money now can be appropriated.
The Department of Justice has identified 960,000 women
annually who report having been abused by their husbands and
boyfriends, but we know that number is really just the tip of
the iceberg. The first comprehensive national health survey of
American women conducted by the Commonwealth Foundation says
that 3.9 million American women actually experience abuse by an
intimate partner each year, 3.9 million.
Hundreds of these women, hopefully thousands, are able to
get out of those situations, but they have few financial
resources and often have no place to go. Lack of affordable
housing and long waiting lists for assisted housing mean that
many women and their children are forced to choose between
abuse at home or on the streets.
While we absolutely need more money for shelters because
they are filled to capacity right now, we know that, in fact,
50 percent of homeless women and children--that is, 50 percent
of the families, the women and children who are homeless right
now are fleeing abuse. So the connection between housing and
abuse is overwhelming.
Housing can prevent domestic violence and mitigate its
effects. Shelters provide immediate safety to battered women
and their children and help women gain control over their lives
and get on their feet. A stable, sustainable home base is
crucial for women who have left a situation of domestic
violence. While dealing with the trauma of abuse, they are also
learning new job skills, participating in educational programs,
working full-time jobs or searching for adequate child care in
order to gain receive sufficiency. Transitional housing
resources and services provide a continuum between those first
emergency shelters and independent living and so those
transitional housing dollars are very important.
According to estimates by the McAuley Institute,
$25,000,000 in funding for transitional housing would provide
assistance to at least 2,700 families. We must be supportive of
individuals who are escaping violence and seeking to better
their lives.
In closing, let me reiterate my appreciation to the
subcommittee and restate my strong support for providing safe
transitional housing assistance to women and children fleeing
domestic violence. Thank you.
Let me just, on a personal note, mention that my last visit
to this committee last year I was sitting next to Loretta
Sanchez. Actually, it was sort of depressing because she was
talking about being in the first Head Start class and how
important it was, and I was there to talk about being the
first--teaching the first Head Start class. I thought, oh, my
word, the difference here. But I am so happy that so many of us
are here today talking about domestic violence and the
importance of providing the support for women seeking to flee
that.
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Mr. Regula. We hope that in Head Start we can maybe improve
on it and make it a little more of an educational experience,
rather than just warehousing of kids. That tends to be the
characteristic of it, and I think you will miss a great
opportunity in Head Start to not do more on the education side
of it. I have never figured out quite why it was in the welfare
department and not in the education department.
Ms. Schakowsky. Head Start has been a wonderfully
successful program.
Mr. Kennedy. Mr. Chairman, on the Head Start, the thing
that the teachers say is most important is the social and
emotional development of the child. That is what gives them the
cognitive advantage over those kids that haven't gone through
Head Start. So it is not so much that they are learning their
ABCs, but they are in an environment that starts to make it
conducive to learning down the road. So it is kind of an
interesting thing. But it is not the cognitive development so
much at Head Start, which is what we think it is, but it is the
social and emotional development, which I might add is lacking
in our other primary education, which we need to work on.
Ms. Schakowsky. I agree. I didn't want to step on my own
message, though. I wanted to be sure that I am focusing here on
the $25,000,000 for the transitional housing.
Mr. Regula. This committee has a broad jurisdiction.
Any other questions? Thank you very much.
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Tuesday, April 3, 2001.
ENFORCEMENT OF WORK PLACE PROTECTIONS
WITNESS
HON. HILDA SOLIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mrs. Solis.
Ms. Solis. Thank you, Mr. Chairman and members. It is a
pleasure to be here for the first time to speak before your
subcommittee; and I want to add my comments also, along with
those that have been made by previous members, regarding health
care research and the whole issue of domestic violence.
Just as kind of a footnote there, in my own district I was
successful in getting one shelter established in Los Angeles
County in the area that I represented. It is a really sad
situation when you think about all the animal shelters that
exist in my district.
When you put a price at where you value human life and what
have you, we only were able to get funding for one shelter. So
much more is sorely needed.
I would hope that this committee would strongly take a good
look at how we can enhance partnerships, both public and
private, with law enforcement, so we can have both permanent
shelters for those and transitional.
Our problem in our district is that we have many women who
are faced with this issue of domestic violence, and with that
bring their children. In cases for Latinos, for example, you
are talking about 4 or 5 siblings, children that come along
with that one woman, who is looking for a place to go and
possibly a warm meal, a roof over her head, but also the
opportunity to find employment. So I would hope that this will
be a priority for this coming session.
But my remarks, I would like to focus in on the issue of
enforcement of Federal wage and overtime laws by the Department
of Labor. As you go through in crafting the Labor-HHS funding
budget for fiscal year 2002, I would like to urge the committee
to allocate sufficient funds for the enforcement of workplace
protections.
This issue is very critically important to women, not just
in my district, but in many corners of our country,
particularly in those areas where you find an enormous number
of low skilled workers, women in particular, who are working,
as an example, in the garment industry.
My district has a very high proportion of individuals who
work in the garment industry. Unfortunately, a few years ago it
was discovered there was a sweatshop in the City of El Monte,
which I happen to represent. There were 72 women, Thai women,
that were held hostage there, many for 7 years. They did not
mention though, however, in those news articles, there were
many Latino women also working there day in and day out and
were forced to work under very harsh conditions and were not
given minimum wage, were not given overtime, were actually
placed in a warehouse setting where they were pretty much
locked in and could not leave the compound as it was later
viewed by the public.
I would hope that we could do as much as we can to help to
provide information to the workforce, but particularly women
that tend to be attracted to this particular type of industry,
because it is a problem, not only in California, but along the
border and other parts of the country, where I believe we need
to do more to provide those protections for women and their
children, because we also know there are many children working
in it these factories as well.
Because of a lack of resources in the past few years and
also on the part of our local municipalities that may not have
enough funding to follow through on code enforcement to really
go through and find out if, for example, a true small business
is actually working legitimately and that they are paying for
their licenses and what have you. We are finding there has been
a cutback in these areas, and obviously that leads to more
abuse.
So I would hope that this committee would take a strong
look at protecting the rights of women in the workplace as we
work towards pay equity. We also have to work towards a place,
an environment, where they can work and be treated with
dignity, and that they are fully aware of their rights when
they are at the workplace, and that the employer also plays a
meaningful role in providing that kind of information as well.
This year we are going to be working on trying to elevate
the minimum wage. In the State of California, we happen to have
a higher minimum wage than here at the Federal level, and I
hope we can work in partnership to bring some equity. That
isn't to say where I would like to see it. I would like to see
it much more higher, but at least it is a start. I would hope
we can venture into those discussions.
I would like to thank you for the opportunity to speak to
you today.
Mr. Regula. Thank you. We will bring this issue up with
Mrs. Chao when she testifies, because it would be her
department responsibility.
Questions.
Ms. Pelosi. No questions.
[The information follows:]
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Tuesday, April 3, 2001.
SCHOOL-BASED LATINO MENTAL HEALTH SERVICES
WITNESS
HON. GRACE F. NAPOLITANO, A MEMBER OF CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Thank you very much. Our next witness is Mrs.
Napolitano. Am I saying it right?
Ms. Napolitano. You are very right on, sir.
Good morning, and thank you so much for the opportunity you
have given the Women's Caucus to come before you and bring the
issues that all of us feel are important. I associate myself
with the remarks at every turn.
One of the reasons, Mr. Chairman and members, that I am
here, is because there is an issue that has been identified in
the last 2 years dealing with youth mental health crisis in
this country. Recent incidents in school shootings only add
more urgency to that particular matter, and that is the reason
why I am here, again, to respectfully request you continue
support for the school-based Latino mental health services
program in my an area. It is a pilot we begun.
Let me provide some disturbing facts that illustrate, and I
am sure you heard them before, but I just need to get them to
you again, the depth of the crisis for young Latinos in the
country.
Today, nearly one in three Latino adolescents has seriously
considered suicide. This is the highest rate for any racial or
ethnic group in the whole country. Additionally, they also lead
their peers in the rates of alcohol and drug abuse, teen
pregnancy, and self-reported gun handling.
These statistics are all more alarming when one considers
that fewer prevention and treatment services reach young
Latinos than any other racial or ethnic group. This is a report
that came to us in 1999 with the state of Hispanic girls
through the National Alliance for Hispanic Health, a
conglomerate of groups that provide mental health services for
Latino groups. This is in spite of the fact that Hispanic girls
now represent the largest minority of girls in the country, and
are expected to remain so for the next 50 years.
Last year this subcommittee gratefully took a major and
laudable step when it directed SAMHSA to provide $680,000
through the programs of national and regional significance
activity, center for the mental health services, to begin
addressing the mental health need of Latino adolescents through
innovative school-based mental health services in our area.
What we have done is we have taken the nonprofit mental
health care provider and all other mental health advisers and
have gone to the schools, setting the program actually in three
middle schools and a high school, to give the direct services.
The funding does not go to the State, does not go to the
county, but goes directly to the providers and the schools
where the most need is.
Now I am asking, I am urging and I am begging the
subcommittee to give this fledgling pilot program an
opportunity to make a difference in the lives of these young
women and many others. School administrators, teachers,
community mental health providers, and parents, and, most
importantly, young Latinos believe this program is urgently
needed.
This subcommittee and Congress has begun to provide
national leadership in dealing with this crisis and in finding
appropriate solutions. Our aim as a society should be to help
these young girls reach their true potential and allow them to
make positive contributions to their communities, to their
State and to their Nation. Failure to do so may condemn a
generation of young girls to lives that are significantly less
hopeful and productive than they deserve.
Again, I respectfully request the subcommittee to continue
providing this program at the same level of funding as last
year, and hopefully this program will provide a way for
duplication throughout other areas where it may be so
desperately needed at this point.
Thank you again for the consideration, and look forward to
answering any questions you may have.
Mr. Regula. Thank you. Questions.
Mr. Kennedy. Yes, Mr. Chairman.
I applaud you for your work on this. I have been working
with the chairman to address this issue. Would you kind of
explain further how the schools end up being a non-stigma
environment so the kids can get the help in the schools, rather
than in some mental health counseling outside, which would
certainly be so loaded with stigma, and of course explain the
culture, the Latino culture, so that it really oppresses people
with this mental health issue. We think we have got a stigma.
Imagine what it is for the Latino culture.
Ms. Napolitano. It is a tremendously important area to be
able to provide the service in the school itself. Understanding
that my Latino friends and relatives and my peers and everybody
else, they consider it an area that you don't go. You don't
talk about it, you don't bring it up. Especially in the male
Latino, you just don't admit that you have a mental problem.
The stigma is they don't know the difference between a
mental health issue and a mental disease issue. Part of what
has happened in our society, and the Latino society
specifically, is this has carried on to the family, you are not
allowed to admit you have a mental problem or a mental health
issue that can be dealt with, that you can talk out.
So the idea is to have it in the schools where the peer
pressure is. These teachers can be a part of it. The parents
will be a part of it. This is not just a school thatis going to
be involved. It is a whole community effort by bringing all the players
in at the school to deal with the issue.
The classrooms are going to be set up so that they can go
to specific rooms to deal with it, and there will be classes
given to others that do not have the same problem of dealing
with mental health issues, but rather to understand that it is
not a stigma, but rather an idea for them to identify, in their
own mind, how they can deal with pressures and those kind of
issues.
Mr. Kennedy. Thank you very much.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Ms. Napolitano. Thank you.
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Tuesday, April 3, 2001.
ON BEHALF OF CHILDREN WITH MENTAL ILLNESS AND HIV/AIDS
WITNESS:
HON. SHEILA JACKSON-LEE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS
Mr. Regula. Okay. Ms. Jackson-Lee.
Ms. Jackson-Lee. Thank you very much, Mr. Chairman. It is
nice to see you, and thank all the members for being here on a
Tuesday morning. Might I associate myself with all of my fellow
colleagues from the Women's Caucus and their different issues.
Might I particularly associate myself with my colleague sitting
next to me on the issue of mental health.
I have offered, over the last two sessions, the Omnibus
Give a Kid a Chance Mental Health Bill, that deals with
providing more resources for children that are dealing with
mental health concerns. I would like to give you what you may
already know very quickly, and then focus in particular on the
concerns that I have.
Mr. Chairman, I think you may be aware that 13.7 million
children in this country have diagnosable mental health
disorder, yet less than 20 percent of them receive treatment.
The White House and U.S. Surgeon General have recognized mental
health needs to be a national priority in this Nation's debate
about comprehensive health care.
I have found that at least 1 in 5 children, adolescents,
have a diagnosable mental, emotional or behavorial problem that
may lead to school failure, substance abuse, violence or
suicide. However, 75 to 80 percent of these children do not
receive the services.
According to a 1999 report of the U.S. Surgeon General for
young people 15 to 24 years old, suicide is the third leading
cause of death behind intentional injury and homicide. In
particular, in the African American community, the U.S. Surgeon
General has found that the rate of suicides among African
American youth has increased 100 percent in the last decade.
Black male youth, ages 10 to 14, have shown the largest
increase in suicide rates since 1980 compared to other youth
groups by sex and ethnicity, increasing 276 percent. Almost 12
young people between the ages of 15 and 24 die every day by
suicide.
When we speak about another selective group in the study of
gay male and lesbian youth suicide, the U.S. Department of
Health and Human Services found lesbian and gay youth are two
to six times more likely to attempt suicide than other youth
and account for up to 30 percent of all completed teen
suicides.
I interact with such a group, family group, in Houston,
working with these young people in particular, trying to make
adults available to be engaged in their lives. You see it
firsthand because, as my colleague said, they are intimidated,
they don't know where to turn for information. They are
different, whether they are Latino, whether they are African
American, whether they are different by way of a lifestyle,
whether they are different by way of their particular religious
background.
Mr. Regula. Do you think they recognize that they have a
need?
Ms. Jackson-Lee. No, Mr. Chairman. I think, as my colleague
has said, sometimes it is culturally different, sometimes there
is a cultural difference. If I take my community, the African
American community, very heavily based in religious beliefs, it
is well-known that you are directed toward your Savior, and, if
you are not grounded in that, then you are not directed
anywhere. It is a stigma in the community, and I would argue,
not having firsthand experience to the gay and lesbian
teenager, but as I have been told by groups that advocate for
them, they particularly are isolated because they are
different. So I think what it is is that I don't know what I
have, I am confused, but no one will understand me.
So I think that this whole concept of having services,
whether it is in the schools, which I support, whether it is in
community-based health clinics, which I support, because I want
parents to be able to feel free who are not able to access the
private sector for psychiatric or counseling service, to have
the access to do this.
This is not a conversation about guns, Mr. Chairman. I know
it is well known, my position, but I think over the last 48
hours, we have saw some studies that were shocking aboutteenage
boys being able to have access to guns or bring guns to school. So we
know that our children suffer from gun violence. Handgun Control
reports that in 1996, more than 1,300 children, aged 10 to 19,
committed suicide with firearms.
What I would like to get at is the intervening act factor,
to be able to help these young people before they get to that
point.
With the high number of uninsured young people, Texas has
the second highest rate of uninsured children in the Nation
with over 25 percent, there are programs that you support that
I would like to ask for increased support.
The National Mental Health Association has a children's
mental health services program that provides grants to public
entities for comprehensive community-based mental health
services for children with serious emotional disturbances.
These grants go to direct services that include diagnostic,
evaluation services, outpatient services at schools, at home,
and in the clinic, and day treatment. I would like to see that
funded and provided additional funding.
In addition, I would like to see parity for alcohol and
drug addiction treatment for young people and their families. I
emphasize their families, Mr. Chairman. I think that is an
excellent combination, because many times the adults in the
home, whoever is the supervising adult, a grandmother maybe,
are as much in need of service as might be the child.
I met with these individuals through the National Mental
Health Association, and I had grandmothers raising 15-year-olds
who already had a child and already tried to attempt to commit
suicide 2 or 3 times, a little girl 15 years old. And to see
the grandmother who was not that old to have to confront the
needs of this 15-year-old, they both needed to be in
counseling.
The Children Mental Services Health Program only serves now
34,000 children, so I ask the committee to authorize $93
million for that. The Safe Schools Health Student Initiative is
another program of the Children's Mental Health Services
Program, and I would ask for $78 million involved in that
program.
Quickly, Mr. Chairman, I want to move from mental health
and focus briefly only on children as victims of HIV-AIDS. I
know this may have been previously discussed.
I support a particular community organization called the
Donald R. Watkins Memorial Fund, which has seen its dollars cut
drastically. It is estimated that 800,000 to 900,000 Americans
are living with HIV and every year another 40,000 become
infected.
I happen to come from a community in Houston that at the
time of the issuance or the establishment of the Ryan White
treatment dollars, we were 13th in the Nation of HIV infected.
That was about 1991-92. My particular community has not
decreased as much as we would like, and we find a large number
of our young people infected with HIV-AIDS. In fact, we find a
large number of African American's infected, and particularly
children.
So I would ask to receive a total additional amount, I
believe this is $4 million during FY 2000, and even more during
FY 2001. Let me get this amount into the record. I am asking
for an increase for $89 million for Title I, $45 million for
Title II, $46 for Title III, $19 million for Title IV, so
Houston will receive additional funds, as well as the Nation,
and I am particularly asking for direct grants for Donald R.
White Memorial Foundation for $500,000 for their special
services dealing with children and young people.
I will conclude, because my statistics may be a little
long, to simply say that Andy Williams in California,
Columbine, we can all talk about guns, we can talk about taking
guns away from children, but these children are disturbed. And
as I followed this, I had a hearing in my district with Senator
Wellstone. It is amazing. First of all, what we do is we put
most of them in a juvenile justice system, because we don't
have any place to put them.
The parents don't know what to do. The parents don't
intervene soon enough. If we had just known, or Andy Williams
had somewhere to go to talk about this bullying or maybe talk
to the children about character issues. And I think mental
health, if we can destigmatize it and ensure that children feel
free--it is just like coming to a counselor or going to Burger
King or McDonald's, to be able to express your feelings, we
might not have all of these painful situations that are
happening in our community.
I am with these children, I talk to the gay and lesbian
youth, it is really an emotional situation when you speak to
them. No one cares about them.
I just think we can do better. I know how we are fighting,
when I say fighting, I know the difficulty of appropriators. I
appreciate all of you very much. But this has gotten to be a
crisis in our Nation, not taking care of our children who are
disturbed and resulting in adults who are dysfunctional.
So I would appreciate very much your indulgence. I conclude
by simply saying I had an amendment on underserved populations
in the last Congress, and this is what this is all about, many
underserved populations, because they are not getting some of
the services that they need.
Mr. Regula. I think you are suggesting that there ought to
be counselors available somewhere for this disturbed youth to
go.
Ms. Jackson-Lee. Somewhere, and it can be either theschool-
based efforts, that I support enthusiastically, and then there are
these community-based mental health clinics that, because they are in
the community, they can be called any manner of names. Whether they
have to be called mental health clinics, they become familiar.
The National Mental Health Association has interfaced with
this structure, where they put them in the community and the
parent, the guardian, whoever it is, can go with the child, and
it may be down the block, or it may be just a few blocks away,
or maybe connected to the school, or it may be connected to
some community-based group. But what it does is it allows the
families to come without stigma and also not go very far away.
When you hear the word ``psychiatrist'' or do you have to go to
a doctor's office, these are community-based entities that may
be helpful. I think they are in only 34 States right now.
Mr. Regula. Could they be part of the community health
centers? We have had testimony here about the importance of
those.
Ms. Jackson-Lee. That is part of the effort of the National
Mental Health Association. We would like to see more funding so
they could be in more states.
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Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman. This is not social
science; this is not soft science. We have the Surgeon General
just come out with his report on children's mental health. This
is part of the health. The brain is like any other organ. It is
like diabetes, asthma, it is a chronic illness, it needs to be
treated regularly.
We have one in five children, according to the Surgeon
General's report and as Ms. Jackson-Lee pointed out, who have
severe emotional mental illness, and the schools are one of the
primary places to capture them, because that is obviously a
non-stigma environment.
In addition to that, as Ms. Jackson-Lee pointed out, the
community health centers are good places. But what we also need
to do is train the primary care physicians to identify
depression and mental illness. You would be surprised how many
regular primary care general physicians do not know how to
identify this, and therefore it goes undetected.
You also, being a member of Commerce-Justice-State, the
Office of Juvenile Justice and Deliquency Prevention, the
juvenile crime rate is going up. What is the surprise?
We know through sociological studies that parents are
spending one-third less time with children today than they did
just a couple of decades ago. If you don't think that comes
with a price, when you have two parents working or it is a
single-parent family, where that child doesn't see the parent
until the end of the night and the child has to be put to bed,
this is a significant cost to our society. We need to bring the
families together somehow, and hopefully these kinds of
programs will help do it. I just wanted to pass that along.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Mr. Regula. Mrs. Pelosi.
Ms. Pelosi. Mr. Chairman, I just want to associate myself
with Mr. Kennedy's remarks. We have to have parity in terms of
mental health and what other people call other health issues. I
particularly want to commend both of our witnesses for their
focus on the School-Based Mental Health Initiative, and also
Congresswoman's Jackson-Lee's testimony about HIV-AIDS, and I
want to say that thanks to both of our witnesses and many women
here this morning, we were able to send a letter to President
Bush on March 29 signed by 153 members in a bipartisan fashion
to talk about the AIDS epidemic.
I think that at some point we will have the opportunity to
meet with the President on this subject, and the subject of
young people and HIV-AIDS, which is certainly an important
component of it. We are optimistic we can meet with the
President.
Good work on these issues. Mr. Chairman, the testimony that
people bring in for a few minutes is important to us. This is
like the tippy-tippy-tip of the iceberg of the work that they
do in that regard. Thanks to both of you.
Mr. Regula. I would be curious, since the Secretary of
Education is from your town, did you have anything in the
school system there, any counseling, that would be accessible
to students in a disturbed state?
Ms. Jackson-Lee. We were beginning to make some progress on
school-based health clinics. In those health clinics we had
individuals who could stand in for counselors. When I say that,
nurses who were trained, et cetera, they could go right in the
school.
They are slowly but surely--in fact, we argued in the
present legislative session in Texas for more funding for
school-based clinics. But we, too, I would say the Secretary of
Education is very open to this, but we too need more growth in
those areas.
I will also I guess acknowledge that we have been--I will
knock on some wood here-- fairly fortunate in Houston, but
again, I don't take any special pride, because violence breaks
out anywhere and everywhere. So it is just that it is something
that we need to make great strides on.
Might I just say on the hearing that I had in Houston, the
juvenile justice officials came forward and noted
whatCongressman Pelosi noted and Congressman Kennedy noted, is that we
don't know what to do with these children. They said you are sending
them to us because we are the only physical plant they can be housed.
You would think they would say bring them on or we are
prepared to do it, but they were the ones pleading with us,
find us more mental health services because you are sending us
children who we can't treat, we can only house them.
Mr. Kennedy. Mr. Chairman, if I could, these kids who end
up in our juvenile justice system, you have 95 percent or
higher that come from abusive homes. This is, like, the
correlation is too great. We know which kids are high risk. We
ought to intervene earlier. These kids, by the time they end up
in the juvenile justice system, the parents know, the teachers
know, the schools know, for us to let them slip through its
cracks itself is criminal.
On the Elementary and Secondary Education Act with the
Education Secretary, this might be a good issue for us to try
to include somewhere in the Elementary and Secondary Education
Act, because it is so fundamental to the child's education.
Mr. Regula. We will have an opportunity when the Secretary
of Education is before us to talk about that, and probably one
of the things that teacher education should include is some
course or so that would, because the teacher would be a very
good person to identify disturbed children early.
Ms. Napolitano. They are with them a major portion of the
time, and they can tell when the student is beginning to act up
or the grades are beginning to fall.
Mr. Chairman, I have a mental health hospital in my area
and have been involved for many years at the adult level. We
have also different clinics from the Mental Health Association
that I have been involved with through the years.
They deal with really mostly the disease more than the
illness. I think it is time we began to add substance to the
local provision of services by giving some assistance to the
families, as my colleague was saying, for mental health
services.
What we are attempting to do is begin to show that the
partnership between the county and the State, adding additional
services, maybe not even in funding, but services, whether it
is personnel or whether it is a locale, so that we can expand
on the delivery of the service at the local level.
You are right. The correlation of the children, the
neglected one, the at-risk kids, all has a bearing, and we all
know those areas. So if we can target the areas and begin to
work with the community to be able to deal with the child, we
will be successful. That is what I am attempting to do, along
with my colleague.
Mr. Regula. Thank you both for coming. It is a significant
problem you have identified. We will do what we can.
Ms. Jackson-Lee. Mr. Chairman, may I ask a procedural
question on the time that members have to have requests in?
Mr. Regula. The 27th of April.
Ms. Jackson-Lee. It has not passed. Someone had given me a
date that caused migraine indigestion.
Mr. Regula. My experience in Interior is some requests may
not be timely, but they still get to the chairman.
Ms. Jackson-Lee. I am trying to meet your rules and
regulations. So you are saying April 27th?
Mr. Regula. That is correct.
Ms. Jackson-Lee. Thank you, Mr. Chairman.
----------
Tuesday, April 3, 2001.
RE: PROJECTS
WITNESSES
HON. BRAD SHERMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Sherman.
Mr. Sherman. Mr. Chairman, it is interesting to appear
before you in a new capacity. I want to thank the members of
the subcommittee for being here. I have had a number of
projects in my district that I think will interest the
subcommittee.
The first--I guess it works better when you turn the
microphone on.
The first is a request for $500,000 to help build the new
Guadalupe Community Center in the poorest part of my district.
It is a program run by Catholic Charities of Los Angeles. The
building program will cost $1.5 million. Private charities will
come through with one-third of that amount, the City of Los
Angeles roughly a third, and I am asking the Federal Government
to provide the final third.
The center serves 900,000 individuals from low income
families, 84 percent of its clients are Hispanic. It provides
emergency food, clothing, case management, senior nutrition,
welfare to work services, a youth mentoring program. Due to
immigration, there is a substantial additional need. The center
needs to expand so it can provide English as a second language
and computer and math skills. That is the first project on my
list, is a request for half a million dollars for the Guadalupe
center.
The next two projects are so important that I am
bringingthem to the subcommittee's attention, even though 80 percent of
the project is outside my district. The projects will take place
primarily in Elton Gallegly's district. He and I share Ventura County.
He can't be here today. He is counting on my eloquence to explain the
programs.
The first is a preventive health care program for the
people of Ventura County. This is an outreach program to
provide preventative health so we don't have people showing up
at emergency rooms. The county has had a drop of roughly 20,000
people in the number who are in Medicaid, but then there has
been a 20,000 increase in the number who were on Medicaid and
now have no insurance at all.
This is an innovative program to provide cost-effective
preventive medical services. Some $9 million is being provided
by the county, and we need $5 million of Federal funds,
slightly more than a third, Federal funds for this program.
The next of the two Ventura County projects that are
primarily outside my district is a Center for Mental Health
Services grant request dealing with mental health services for
those in prison, in transition to being released and rejoining
society. This program has already received $900,000 in Federal
support for start-up, and the State has granted $1.6 million.
It is an innovative program to provide a full range of
mental health services to those in prison. There has been a
significant reduction in recidivism from those who get this
kind of treatment, and this is, I think, an ideal pilot study
to show the importance of this treatment to other county prison
facilities.
The next project I am seeking $2.75 million for a child
care center in Newbury Park. This will go an along with some
local funds. The total budget is $3 million. We are also
seeking in roughly the same area funds for a senior adult
center expansion.
Finally, for a YMCA that will be focusing much of its
attention on the low income people of the region, providing
social services. Roughly half the money there is being provided
by local government and local charities, and we are seeking the
other half from the Federal Government.
Mr. Regula. Thank you. Things haven't changed too much
since Interior.
Mr. Sherman. I do have many things on the list, but I did
put them in what I think is a reasonable order. As I say, the
first one is a $500,000 project.
Mr. Regula. Questions.
Mr. Honda.
----------
Tuesday, April 3, 2001.
RE: EDUCATIONAL PROGRAMS
WITNESS
HON. MIKE HONDA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Honda. Good morning, Mr. Chairman. I think the last
time I was before you we were talking about sleep or fatigue;
is that correct?
Mr. Regula. Right.
Mr. Honda. I just want to thank the Chair and the
distinguished members for the opportunity to present my
testimony today.
I have submitted a full written testimony for the record,
but today I would like to focus on increasing school
construction, recruiting 100,000 new teachers over the next 7
years, increasing Pell grants, as well as fully funding special
education.
If we are going to judge teachers, Mr. Chairman, and
students by test scores, then Congress must fund programs that
encourage improvement, growth within education, and we must
demonstrate a commitment and respect and confidence in students
by providing safe, permanent classrooms that are not crumbling.
Nearly 80 percent of Americans support providing Federal
funding for school repair and modernization, yet the
President's budget eliminates $1.2 billion the Congress
approved last year for school renovation and cuts another $433
million in unspecified programs.
It would take nearly $112 billion to bring public and
elementary and secondary schools to adequate condition.
Thisfunding would help renovate up to 14,000 needy public schools and
serve around 14 million students. I urge the committee to spend the
$24.8 billion over the next 2 years in new tax credit bonds to renovate
up to 6,000 schools.
If we want students to learn more at a faster rate, then we
need to reduce class size to enable teachers to teach
efficiently. We also need to provide the teachers with the best
training in order for them to provide the best instruction, and
in order to attract and train teachers for both high need
schools and underserved teaching topics, such as math and
science, Congress should increase compensation for qualified
teachers.
According to the National Center for Education statistics,
elementary and secondary school enrollment will grow from 52.2
million in 1997 to 54 million in 2006, requiring new schools
and new teachers. Research has also shown that students in
smaller classes and grades K-3 learn fundamental schools better
and continue to perform well even after returning to larger
classes after third grade.
I urge the committee to continue to recruit 300,000 new
teachers over the next 7 years in order to reduce class size
averages in the early grades. I also encourage the $1 in new
funding in 2002 and $18.4 billion over the next 10 years to
provide up to $5,000 in supplemental pay to fully qualified
teachers in high poverty schools or those in need of
improvement under Title I.
I request an increase of $600 in the maximum Pell grant,
for a total of $4,350. I also ask that Congress fully fund
special education in order to free up general fund money to
allow schools to spend their money where it is most needed.
By failing to meet these needs, Mr. Chairman, in the
education system, we are failing to meet the needs of every
single American. If we truly expect our schools to meet the
challenges of greater accountability and higher achievement,
then we as Congress need to ensure that we continue to fund the
initiatives that we have put forward. Congress, as well as
schools, need to be held accountable for their actions, and
accountability is a two-way street.
I just want to close by talking about accountability, and I
guess student achievement.
We know that we have made mandates, such as PL 94-142,
which is requiring the pursuit of special education
identification of youngsters. Since we are at 13 to 15 percent
funding level, where we said we would be funding them at 40
percent, this ties up, as you well know, a lot of the local
funds that school districts are trying to use, as they try to
meet the mandates. So we have created a mandate without the
full funding.
As a school principal of two schools, identifying
youngsters, I know this is a big struggle between parents who
want youngsters to be identified and seek the special help and
school districts in their inability to fully fund it all. If we
really want to help our local schools, then we should fully
fund special education so they can free up their local money to
do the things that they could do more efficiently at the local
level.
Mr. Regula. Thank you. Questions?
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Pelosi. Mr. Chairman, since many of our witnesses today
are senior Members of Congress, and Mr. Honda is a freshman, he
alluded to his experience as a school principal, but, for the
record, I wanted him to tell you how he knows of what he speaks
as a very distinguished record as an administrator and a
teacher in the San Jose area.
Mr. Honda. Thank you, Ms. Pelosi.
Mr. Chairman, I have spent over 15 years as an
administrator in a K-8 school in South Central San Jose, and I
know that we tell our parents what their rights are, and a lot
of times, in the community I worked with, we had to be their
advocates in order to be able to identify these youngsters.
Many times school districts are so strapped that they are
hesitant to go all the way, because they have to look at their
bottom line. We put them in this situation that is untenable
for both the districts and we frustrate our parents because
they want the best for their youngsters, as do the schools.
In other sections of our valley, parents do know their
rights and they bring lawyers with them to the school
districts. That creates, again, another situation where it is
untenable for both sides. So if we solve this problem, we will
solve the problem not only for the poor neighborhoods, who
where administrators need to be the advocates of the
youngsters, and also the well-to-do neighborhoods, where
parents have the wherewithal to bring attorneys with them, and
we can solve that problem by fully funding a mandate that we
have put forward a few years ago.
Ms. Pelosi. Mr. Chairman, our witness also brings
impressive academic credentials from graduate studies at
Stanford University in education.
Mr. Honda. I get it.
Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Mr. Honda, as a 20-year school board member,
I have great respect for your credentials as a principal and
know how important that is. IDEA is something that we have to
step up to, because we have created the mandate, but not put
the funding with it. So I certainly agree with you on that, and
the Pell grants, and a lot of your presentation.
But when you talk about the Federal Government providing
100,000 new teachers or reducing the student-teacher ratio,
doesn't that go against what you said earlier, that if we
provide the IDEA funds, then the districts have the right to
run, the ability to run their own deal?
I am very pro-education then and I agree with you, but I
think there are things we can do from Washington and things we
shouldn't try to do from Washington.
Mr. Honda. I agree with you, Mr. Sherwood. I was aschool
board member for over 9 years in San Jose unified. I understand how
budgets are dealt with. You are caught in the middle really as a school
board, isn't that correct? At the Federal Government level, you know,
the 100,000 teachers was an effort by the Federal Government to help
reduce class sizes in many classrooms across the country. I think that
is a good role for the Federal Government to do, to encourage the
reduction of class size, and also to find funds to be able to
compensate teachers who are teaching in high need areas and who are
teaching in subject matters that are subject matters that we need, like
math and science.
Now, today we are talking about accountability, and if we
are talking about accountability, then we have to also be
accountable by fulfilling our obligation and fully funding that
mandate. We are also talking about student achievement.
Now, student achievement is obtained by having time on
task, and the way we attain time on task in our role can be to
help reduction of class size and encourage that, and we can
fully help the local school districts if we fund fully special
education. That frees up an incredible amount of monies that
can be reinvested in reduction of class sizes and hiring new
teachers. But when we do that, Mr. Sherwood, you know when we
reduce class sizes, we create a need for more teachers. So we
need to help support that effort and do just our part so until
they get on their feet.
The other thing is when we create more teachers, we need
the classrooms when we reduce class size. If we don't do those
two things, in addition to in our effort to reduce class size
and to increase student achievement, if we don't help in the
construction of new classrooms, providing new teachers, then we
are only going one-third of the way.
The other way we can help the local school districts is to
free up the local money so they can reinvest that in those
areas also. So we need to help school districts be able to
provide new construction or modernize by putting up the $25
billion for the tax credit, because at the local level, when we
create a bond indebtedness, we are in there for 30 years,
right? If we come up with a tax credit against the interest on
the principal, that reduces the local effort by 10, sometimes
15 or 20 years, and that is a big impact that is not really
well seen by the general public. But we do know that, because
we have been involved in that kind of dynamics of budgeting.
So the Federal Government has a very unique role, but a
very important role, to help attain accountability, student
achievement, by helping the local classroom achieve that time
on task by creating, hiring more teachers in those needed areas
and providing the funds to create more classrooms or modernize
classrooms.
Mr. Sherwood. We agree and we disagree.
Mr. Regula. Thank you, Mr. Honda.
Mr. Honda. I am trying to give a macro-picture along with
the details.
Mr. Regula. Thank you.
Mr. Honda. Thank you very much. Let me close, Mr. Chairman,
by reiterating what some of the other folks said. I do think we
need to start looking at more brain research. That is one area
we haven't paid a lot of attention to. Youngsters do come with
developing minds and brains. If we look at minds as one set, we
have to look at the brain and its development in the process of
education.
The last comment is we are getting close to senior prom,
graduation, and you know as well as I do that we see tragedy in
our newspapers about youngsters dying behind the wheels, not
because of drugs, not because of alcohol, but because of
fatigue. I would just like to reiterate if there is some way we
can admonish our schools to talk to our youngsters about taking
care of themselves and not get overly tired so that they avoid
those tragedies.
Thank you, Mr. Chairman.
Mr. Regula. Good point. Mr. Bereuter.
----------
Tuesday, April 3, 2001.
APPROPRIATION FOR THE UNIVERSITY OF NEBRASKA--LINCOLN AND FUNDING FOR
THE CLOSE UP FOUNDATION
WITNESS
HON. DOUG BEREUTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEBRASKA
Mr. Bereuter. Mr. Chairman, Ms. Pelosi, Mr. Sherwood,
members, thank you for letting me testify today. May I observe
the Chairman loose, unusually rested and tan, and I am not
quite sure how he did it, but I know how he got his tan,
because I was with him.
I am here to testify, Mr. Chairman, and members of the
subcommittee, on two items, an appropriation for the University
of Nebraska--Lincoln, and funding of the Close Up Foundation.
The first item is the Great Plains Software Technology
Initiative. A substantial amount of detail is given about this
program. It is, in some ways, a unique program, but I think it
is replicable across the whole country. It takes a look at the
importance of information technology, attempts oh to help our
students cope with it; to use it well as a building block for
their future.
The program at the University is the result of an $18
million grant from one of our alumni, a challenge grant, and
this would provide an opportunity for some internship programs
as these students in their educational experience in this
honors program implement the curriculum with industry applying
what they are learning in the process as they approach the
junior and senior year. This will provide an opportunity for
additional students, but, most importantly, it helps develop
further the curriculum which is replicablearound the country.
It is an important initiative. I took a look at the whole
range of proposals from the University of Nebraska systems,
including this campus, which is in my district, and decided
this was the one that I thought had the greatest opportunity
for replicability around the country for its application.
Secondly, I want to speak about the Close Up Foundation, as
I usually do. They have a request for $1.5 million, which is
almost below the area where you observe it. But I think it is
an important testimony to the corporate world that provides
most of the funds for the fellowships for low income students
that the Federal Government and the Congress, specifically,
thinks this is an important program.
When I first came here, Nebraska was one of only seven
States that did not participate, although I was speaking to
teachers and student groups, and today Steve Janger, the
president and founder, tells me that we have the highest
participation rate on a per-capita basis in the country. I just
spent about 45 minutes this morning speaking to students from
my district.
It is, in my judgment, the most outstanding citizen
education program that brings people to Washington of any age
group, and this happens to be a course focused than our high
school juniors and seniors. I, along with Mr. Roemer, I
believe, who also takes a lead on helping the Close Up
Foundation, interested in making sure that this program which
focuses on the Federal Government, a national program, is not
block granted, that it maintains its separate identity through
the authorization process, where Mrs. Landrieu is working in
the Senate and where various House Members are taking a lead to
make sure the Close Up Foundation's programs continue.
Mr. Chairman, thank you very much for listening to my
request. I would be happy to answer any questions you may have.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Thank you.
Mr. Regula. Thank you.
Mr. Dreier. This is a switch. I am usually on the other
side of the table with you.
----------
Tuesday, April 3, 2001.
RE: DIABETES RESEARCH
WITNESS
HON. DAVID DREIER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Dreier. It is very nice to be here.
Mr. Chairman, let me begin by extending very hearty
congratulations to Mr. Sherwood on his recent appointment to
this very important committee, and obviously the great
intelligence that all of you had in placing him on your
subcommittee.
I want to congratulate you also, because I have spent the
last 30 minutes or so listening to the testimony, and you have
very important work with which you deal, and this is the first
time I have been before this subcommittee, and I appreciate it.
It is interesting, if 10 days ago someone had said to me
that I was going to be testifying on diabetes funding before
Ralph and his subcommittee, I would have said, well, that is
interesting, but I was--really would be a little skeptical
about it.
A week ago Sunday night, many people watched something that
took place in the area that I am privileged to represent, the
Academy Awards, and I happened to see an old friend of mine, a
guy called Doug Wick, accept the Oscar for the best motion
picture. He produced Gladiator.
Doug and I had been friends for 25 years, but, quite
frankly, we had lost contact, and I have been very good friends
with his parents, whom I mentioned to you the other day,
Charles Wick, who is director of the U.S. Information Agency in
the Reagan Administration, and Doug's mother, who was the
chairman of the Reagan inaugurals in the 1980s, and I
maintained contact with them, but frankly had not been in touch
with Doug.
But when Doug won this academy award, I decided to call him
and congratulate him, and we had a nice chat, and he informed
me that his daughter, Tessa, had 3 years ago--she is now 10--3
years ago had been diagnosed with juvenile diabetes, and he
asked that I come before you to strongly support the funding
that has been provided, and I am very happy that the President
has doubled the budget for NIH, and we have also had a
significant increase I know for diabetes funding, due in large
part to your efforts, and I want to encourage that.
What I would like to do is I would like to just read
highlights of a letter that Lucy and Doug Wick's daughter,
Tessa, wrote recently to a number of people, encouraging
support for diabetes funding. I have a longer version which I
would like to put in the record.
Mr. Regula. Without objection.
Mr. Dreier. As I said, she has politics in her veins with
her grandparents, so she has a much longer version, but I am
going to take the somewhat briefer version. I was rather moved
by this.
I haven't even met Tessa. I look forward to meeting her.But
Doug encouraged me to be here, so let me just share this with you.
``January 15th, 1998, was a day I will never forget. It was
the worst day of my life. I was at school in second grade when
right before lunch my parents rushed through the door and told
my teacher I would have to leave. I could tell by the look on
their faces that they were not taking me to Disneyland.
Instead, they drove me to the UCLA hospital.
``When I got to the hospital, the doctors told me I had
diabetes. They said that I would have to get 2 or 3 shots every
single day. I was used to maybe 1 shot every year. And there
was more bad news. I was going to have to prick my finger 4 or
5 times a day and put a drop of blood into a little computer. I
was going to have to do this before every meal, before bed, and
maybe even in the middle of the night. So far, according to my
sister's calculations, I have had to prick myself or inject
myself with insulin over 4,500 times, and I have had diabetes
for a year and a half.
``And then there was this creepy information about what I
could eat. For instance, everyone likes to trade food at lunch,
but unless I want to have an extra shot, which is usually
never, I have to stay away from cheesecake, slurpies and
cookies. I don't know if you are a big lunch trader, but I am,
and take it from me, what is the use of trading food if you
can't win any of the good stuff?
``Sometimes I try and remember what it was like to just eat
whatever I wanted without taking a shot of insulin. I try and
remember all the nights that I could just go to sleep without
worrying about having a seizure in the middle of the night and
making my mom wake up at 2 in the morning to check my blood
sugar just in case.
``The last 2 summers I have gone to diabetes camp. The
first day the camp director stood up and said, will anybody
here with diabetes please raise your hands? And every single
kid and all the staff members raised their hands. I couldn't
believe it. Then the director said, I guess anybody here with
diabetes will be the normal ones, and everyone clapped.
``I like feeling normal at camp. But where I really wanted
to feel normal is at home, at school, and with my friends, and
that is only going to happen one way, and that way is to find a
cure. So please support diabetes funding and help us find a
cure.
``Thank you very much, Tessa Wick.''
Obviously no one could say it any more eloquently than
Tessa did in this letter, Mr. Chairman. But I just want to
congratulate you and encourage you to proceed with funding for
this very important effort to find a cure for diabetes.
Mr. Regula. Thank you. I have a young lady in my district
whose parents brought her to visit with me in the office, an
identical situation. You really reach out to these young
people. We hope to find something. We are going to commit as
much in the way of resources as we can to this.
Mr. Dreier. Thank you very much. I will convey that word to
the Wicks for you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Give my best to Charles. He did a terrific job
at USIA. I worked with him. Of course, Mrs. Wick was active
with the Ford Theater.
Mr. Dreier. Right. She still is.
Mr. Regula. She still is. That is a great program there.
Mr. Sherwood.
Mr. Sherwood. It is bad enough with adult onset diabetes,
but to think a child is looking forward to their whole life
with this insidious disease, tell your young lady that her
testimony was very compelling and we will pay attention.
Mr. Dreier. Thank you very much, Don. I will try to be as
nice to you all when you come before the Rules Committee as you
have been to me today.
Mr. Regula. We will keep that promise in hand.
Mr. Dreier. I said I will try.
Mr. Regula. Okay, Mr. Roemer.
Mr. Roemer. Thank you, Mr. Chairman. Congratulations again
on your ascension to the most important, in my estimation, of
many of the important subcommittee chairmanships. As a member
of the education committee, we look to you to fund many of our
suggestions, but also to work in a bipartisan way with you on
cooperative projects.
Mr. Regula. We await your bill with interest.
Mr. Roemer. We are working in a bipartisan way to try to
report an ESEA bill to you. Congratulations to Mr. Sherwood on
his elevation to this important committee.
I ask unanimous consent to have my entire statement entered
into the record.
Mr. Regula. Without objection.
----------
Tuesday, April 3, 2001.
RE: TRANSITION TO TEACHING
WITNESS
HON. TIM ROEMER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF INDIANA
Mr. Roemer. My good friend, Mr. Dreier, talked about the
Academy Awards. One of the parts that you may have seen, if you
watched, Mr. Chairman, was that they wanted to keep the
testimony as short as possible. I am sure you are looking for
some of that in your time here. They were going to award a high
definition television to those people that kept their testimony
short. While I don't pretend to be any Julia Roberts, I might
have more success between the two gentleman here in the room if
I was for the three or four actual projects that I am going to
ask your cooperation for.
I will try to keep my testimony short, although I don't
certainly have the----
Mr. Regula. You won't get a television, but you will get
our appreciation.
Mr. Roemer. Okay. I will try to get the appreciation and
the support for my projects.
Certainly the Preventing Child Neglect and Delinquency
Program with the University of Notre Dame is important. The Ivy
Tech College Machine Tool Training Apprenticeship Program,
where we are trying to train more people in manufacturing jobs
is very important in my district as we go through some rough
layoffs.
As Mr. Bereuter testified about the importance of the Close
Up Program, that is a program that I have been involved in for
my 10 years here in Congress. Steve Janger does a great job
running that program, and they bring a host of minority
students into Washington, D.C. for civic education. I hope you
will continue to show your strong support for that.
I am testifying here for a program that we started last
year for the first time, Transition to Teaching. We provided in
the appropriation billion dollars 31 million for this
appropriation, and I would encourage your subcommittee to fund
it once again.
Imagine, Mr. Chairman, if you have a 17-year-old son or
daughter, sending them to school, and you are going to try to
encourage your son or daughter to maybe take an honors class in
physics and go to Ohio State University. And that physics
teacher is not certified in physics, but certified in physical
education.
Imagine if you have a second grader going to school and
they are having difficulty reading, and we are having a teacher
who is not certified in teaching reading in their first year
who is not comfortable with the format, the subject matter or
the inclusion of technology into the curriculum. Many of our
first year teachers are in that position.
We are going to have to hire 2 million new teachers in the
next 10 years, many of which will fall into the situations that
I have just outlined for you, in the second grade or as juniors
in high school.
We have this transition to teaching program that follows up
on the very, very successful troops to teachers program that
was instigated in 1994. We brought people from the military
into the teaching profession. Many of them were trained in
science and technology and math. Eighty three percent of them
are still teaching in high need areas, in high need schools,
and now we have followed on with the transition to teaching
program where we are rewarding universities and not-for-
positive profits to train the next generation of teachers in
math, science, technology areas, to come into our schools in
mid-career, at 45 or 50 years old, and teach in these subject
matters in high need areas. This is a program that is going to
work very well, that is hopefully going to address some of our
need for the 2 million new teachers, although it is not the
silver bullet by itself, and I hope you will continue to fund
this program.
Thank you for the testimony today.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. I assume that there will be
hopefully a lot of military retirees that will participate.
Mr. Roemer. There will be some, Mr. Chairman. That has
actually slowed down since 1994, with some of the attrition and
some of the military people leaving now. We are doing
everything we can to try to keep some of those people and
retain them, and we are looking outside the military to follow
up on the troops to teachers with this transition to teaching
program.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Thank you.
Mr. Roemer. Thank you. Thank you, Mr. Chairman.
----------
Tuesday, April 3, 2001
FUNDING REQUESTS FOR EDUCATION, LABOR, AND HHS PROGRAMS
WITNESS
HON. MAXINE WATERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Ms. Waters.
Ms. Waters. Good morning. Thank you very much, Mr. Chairman
and members, for sitting in those seats for the hours that you
have to sit to hear all of the testimony that comes before this
committee and a particular thanks for the time that you are
giving to all of the Members today. I am delighted to be here.
I will go into a few of my requests. Mine are not as program
specific as they are general in nature, and I have broken them
down into the three areas that you have oversight
responsibility for: Education, health and human services, and
the labor issues.
Mr. Regula. We will put your entire statement in the
record.
Ms. Waters. Thank you very much. On education I am hopeful
that this Congress will be known as the Education Congress. We
have all talked a lot about education, and there is some
confusion about how much increase we are going to have in this
education budget. I certainly hope that it is in the
neighborhood of 11 percent or more rather than the 4 or 5
percent I keep hearing alluded to.
Under education, educational technology is very important.
This includes programs such as the Technology Literacy
Challenge Fund. There is a digital divide, and if we are to
prepare young people for the future, particularly in some of
the poor communities, we must make sure that they have access
to computers and new technology. So I think that we should not
have any cuts in that area.
Teacher training is extremely important. I was at a teacher
training program this past weekend that was done by my local
school district where they have the teachers, the
administrators and the parents all together, and teacher
training, mastering English for many of the immigrant students
and students who are coming from other places, and I thought it
was very, very effective. We have got to put money into teacher
training programs.
School modernization. Without a doubt we have schools that
are falling apart. The air conditioning does not work, the
heating systems are broken, graffiti on walls, the toilets not
working. And so I think again if we are to be the Education
Congress, we have got to make sure that we modernize our
schools and buy some new schools because we have expanding
populations that cannot accommodate the growth in many of these
areas.
After school programs such as the 21st Century Learning
Centers, very important. Many of our schools could help out
with the problems of the entire community if they had after
school programs, programs that gave additional support to what
is going on in the classrooms during the day, and I think we
have talked about that a lot and we have these facilities that
are sitting there and we should put them to good use.
Let me move on to Health and Human Services. Numerous
studies have demonstrated that minorities are
disproportionately impacted by a variety of health problems.
The National Institutes of Health is collaborating on 12 5-year
projects to research how social and environmental factors
contribute to the desperate health problems of racial and
ethnic minorities.
Cardiovascular disease, the death rate in 1998 for African
Americans attributable to heart disease was 136.3 per 100,000
people compared to 95.1 per 100,000 for others. In cancer the
Centers for Disease Control are currently allocated 174,000 for
breast and cervical cancer screening. African American women
have the highest death rate from cervical cancer. African
American women have breast cancer rate similar to other women
but die at greater numbers from preventable disease. Women
should not be dying from breast cancer, but we need to have
more research in those areas.
You have heard probably a lot about AIDS. The Congressional
Black Caucus has spent a lot of time on creating additional
funding in this category of AIDS because of the alarming
increases in HIV and AIDS in the African American community. I
would ask this committee to pay special attention to that
funding and the special category that we worked so hard for to
help build capacity in minority communities, in poor
communities that don't have the capability of dealing with
outreach and prevention and all of that.
Mr. Regula. We were at the CDC yesterday, Centers for
Disease Control, and they made emphasis on that very point that
you are making.
Ms. Waters. Thank you so very much. It is extremely
important. I won't go into the death rates. I will talk about
diabetes that has been mentioned here a lot today. I want to
tell you that I am watching too many people lose limbs and die
from diabetes. They are cutting off arms and--well, feet and
legs in particular, and people are going blind from diabetes.
We need a lot of money in prevention and outreach so people can
understand the symptoms of this disease and how to care for
themselves. People are dying at a very early age.
Mr. Regula. They made a good point yesterday that a lot of
times people don't recognize it early enough and the impact on
the body is already pretty progressive before it is recognized.
Ms. Waters. That is right, Mr. Chairman. They refer to it
as the silent killer because by the time many people get there,
their bodies are already overcome by all that goes along with
it and we need health care prevention for all of America,
everywhere.
Mr. Regula. I agree with that.
Ms. Waters. So we don't learn until, you know, after we get
50 and things start falling apart. Then we get very conscious
about our health. But I sure would have liked to have known a
lot of this when I was a lot younger.
In education also I wanted to mention Head Start. I worked
in Head Start when Head Start first was originated. I was the
supervisor parent involved in voluntary services, and of course
I learned a lot about how parents and communities can be in
control of the children's educational destiny. There is not a
lot that I need to say about Head Start. I think everybody
recognizes that it is a wonderful program that needs full
funding, and to the degree we do that we have prepared children
for school and they are prepared to read, et cetera.
In labor, I want to mention Job Corps. Job Corps is very
important and they really have done a very good job. I am
concerned that we still have Job Corps programs that don't have
the residential component. That is extremely important when you
take these kids into Job Corps. If, for example, in Los
Angeles, where we have a big Job Corps program, some of them
have to go back to their communities at night, we lose them, or
the influence of the community is so great that in one program
they change clothes. For example, they wear one set of clothes
while they are in the Job Corps, but when they go back to their
communities they have to wear another set of clothes to
identify with the neighborhoods that they come from. We would
like to see more residential facilities associated so that by
the time they transition out, they are into jobs, they are
going to live on their own so they don't have to go back to
those communities.
The veterans employment and training I can't say enough
about that. I have a program in my district. This is very
important because they take the homeless veterans off the
street, and they have a program that is designed to get them
back into the main stream and they live in this facility while
they are being trained and they are doing jobs. And many of
them go on from there again to have their own homes and to live
a full life and off the street and using their talent.
And so these are just some of the things that I wanted to
quickly mention in the short period of time that we have here
today, and I appreciate your attention to these matters.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Mr. Regula. I would like to visit with you on Head Start,
but I will catch you on the floor.
Ms. Waters. That is my favorite subject any time.
Mr. Regula. I would like to talk with you about it and see
how you suggest ways to making it even more effective. But I
will find you there. We have one more witness.
Ms. Waters. Thank you.
----------
Tuesday, April 3, 2001.
FUNDING REQUESTS FOR FAR ROCKAWAY PENINSULA PROGRAMS IN QUEENS, NEW
YORK
WITNESS
HON. GREGORY W. MEEKS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW YORK
Mr. Regula. Mr. Meeks.
Mr. Meeks. Thank you, Mr. Chairman. I ask unanimous consent
for my statement to be in the record in its entirety.
Mr. Regula. Without objection.
Mr. Meeks. Mr. Chairman, Mr. Sherwood, I thank you for this
opportunity to present testimony to you today. And I will be
succinct. Let me first, I come to talk about a specific program
within my district. And we are asking for a mere $2 million
earmarked to the Joseph P. Addabbo Family Health Care Center.
Mr. Regula. I knew Joe well, good man.
Mr. Meeks. He was a great man who did a lot in the
community that I now represent, and this particular health care
center we named after him because he really started it while he
was here in Congress. And it deals with the part of the
district that is probably the most isolated part of New York
City, of all of New York City. It is a peninsula that is about
24 miles outside of downtown Manhattan. And many individuals
who have to live on that peninsula, they are subject to just
the services that are there. They don't have access to what we
call the mainland, which is the other part of New York City,
and that is just how difficult it is because of the
transportation to the mainland if you happen to live on the
peninsula.
As you may know, the Joseph P. Addabbo Family Health Care
Center is a private, nonprofit, federally funded community
health center that was established in 1987 to provide
comprehensive health services to the poor and medically
indigent and or medically underserved residents of the Rockaway
peninsula. The Rockaway peninsula ranked 14th among the 58
neighborhoods in the city for severe health-related problems in
1995 and 1996, the years for which the most recent data is
available, with the rate of preventable hospital admissions
more than 50 percent above the city average in 1996. This is an
area home to the sickest and poorest segments of all of New
York City, and this project that we are talking about is a
joint project. It is a joint health and educational project
that we are looking to develop on the peninsula.
The Joseph P. Addabbo Family Health Care Center
participated in a Robert Wood Johnson-funded needs assessment
in the peninsula's low income communities. This project was
designed to identify primary health care needs. As a result of
this assessment, Far Rockaway has been designated a health
crisis area by the Health Systems Agency of New York City.
Another important aspect of the health profile of the
Rockaway peninsula is a greater portion of its residents are
children, with 38 percent of the population below 20 years of
age. The large number of children and the high level of risk
factors present in the community warrant particular attention
to the needs of the children and young adolescents. Twenty-nine
percent of the children live below the poverty level. Academic
achievement levels in schools range near the bottom, with 54
percent of the students reading below their grade level and 44
scoring below their grade level in mathematics.
There is also a high incidence of pregnancy among
teenagers. In fact, it is 14.5 percent higher than all of the
Borough of Queens, and New York City's average is only 8
percent. And most of these are young adults between the ages of
15 and 18 years old. The AIDS rate has been growing much faster
than the growth rate increase of 82 percent from 1990 to 1991.
Now this project is something that is a conglomerative. We
have several different parts of the community that are engaged
in helping this, and what we are trying to do is to get our
Federal portion of it funded. For example, the New York City
Housing Authority has invested $1.5 million into the project.
The New York City Council has put in $1.1 million for it. The
New York State Assembly has put in $500,000. The Borough
President of Queens has put $2 million. York College, a local
college within the district, is putting $500,000 into this. And
the College of Aeronautics is putting another $500,000 in this.
So this becomes for the peninsula a mass educational and health
care facility that will cover some 104,000 people that
currently live on the peninsula who are isolated from other
parts of the city. So we just come asking to bring in our
Federal share and ask for whatever consideration this committee
could give us in getting an earmark of $2 million.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Sherwood.
Mr. Sherwood. Thank you very much.
Mr. Regula. Mr. Addabbo was a senior member of
Appropriations.
Mr. Meeks. He was.
Mr. Regula. And he and I went to Tokyo. I had forgotten. It
was quite a while ago. He is not living anymore?
Mr. Meeks. No, he is not. He passed away. His family is
still very involved in this and through all of his good work we
have named this for him.
Mr. Regula. You have what was his district or portions of
it?
Mr. Meeks. Most of it is what he used to represent. He was
my Congressman.
Mr. Regula. Thank you for bringing this.
The subcommittee is adjourned.
Tuesday, May 22, 2001.
EDUCATION
WITNESS
LISA GRAHAM KEEGAN, CHIEF EXECUTIVE OFFICER, EDUCATION LEADERS COUNCIL
Mr. Regula. Well, we'll get started. We have a number of
witnesses this morning, and we need to keep moving, so that
everyone has an opportunity to be heard and some time for
questions. Our first witness, Bishop Conway, is not here yet,
so I think we'll go to Lisa Keegan, the Chief Executive
Officer, Education Leaders Council. Mr. Obey, would you like to
make any comments here?
Mr. Obey. Thank you, Mr. Chairman. I think we might as well
get started. We're more interested in hearing what they have to
say than what I have to say.
Mr. Regula. Okay. Well, we're happy to welcome you. As you
know, we have a five-minute rule, so if you'll summarize it
will be helpful.
Ms. Keegan. I'll do that. Thank you very much, Mr.
Chairman. As you said, my name's Lisa Keegan. I am the Chief
Executive Officer of the Education Leader's Council. We are a
group of reform minded State school chiefs, State board
members. We have governors who are members, and we have
superintendents, teachers who are members.
Our organization believes that reform is necessary in
American education, and we have been engaged in that in our
States. We believe that most of this will happen in the States.
And we appreciate the opportunity to discuss with the Congress
the direction that you're going to take in your budget and in
the education bills before you.
Our organization believes that in fact it is instruction
that makes the difference for kids. It is not externals. What
matters in a classroom is dependent on high expectation and
instruction of a child. And we see going about that in a number
of ways, many of which are very innovative in the States. But
we do think it's our responsibility to educate the kids, and
we're not looking for excuses or external situations to be
solved.
We don't believe class size is the answer, we don't believe
that wealth issues are the answer, we don't believe color of
children has anything to do with ability to learn. We feel very
strongly that instruction is the answer and the classroom is
where this has to happen.
I want to talk a little bit about the proposals that have
been made on the House budget. I realize many of them have
reform components. Oftentimes those of us who talk about
reform, it's happening here and we're listening to it, are
characterized as not being interested in children or because we
want to have a change, that's seen as very hostile.
At the Council we try to remain very disciplined in our
focus on a few things. One is that our appropriations from the
Congress and in the States needs to be focused on the needs of
kids and not on the bureaucracies that serve them. They need to
as much as possible go directly to the classroom and to the
needs of the instruction leader, who is the teacher, usually.
Secondly, that oftentimes means that those resources will
have to be changed in terms of formula. Where they are needed
is in the classroom. Where they are often lobbied for is
outside of the classroom, because organizations for education
tend to be interested in organizations outside of the
classroom. We believe that's problematic.
Thirdly, we would like to see that the Congress, in pushing
some majorly important ideas, will seek not to strangle so much
with regulation but rather to support movement in the direction
of strong instruction, strong assessments and product and
result for students. We do believe it's absolutely essential to
have assessments. You may find our opinion quite different than
a lot of the education organizations. We make no apologies for
assessments. We are about the business of assessing in our
States. We think it's critically important.
We think it's fabulous that the President has proposed $320
million in his budget to assist States with their testing
programs. However, we also hope that most States are already
about this business already. It's critically important to know
where our kids are.
We do take issue with much that's been said about the cost
of assessment. We listened to a number of statements from the
National Association of State Boards of Education saying that
the cost was $7 billion for testing. That assumes about $125
per student, which we think is nonsense. In our States, where
we are running testing programs, the State of Virginia has a
very extensive budget that costs $4 per year. They are not
testing annually. If they did that, that would double, but it
would not be anywhere near this $125 that's being bandied
about.
In Massachusetts, which exceeds the President's proposal in
terms of the frequency of testing and the depth of that
testing, their costs are $14 per child. In Arizona, they are
about $10 per child. So I would keep that in mind. The exercise
ought to be strong but narrow focus on assessment and let the
States go beyond if they want to. We feel it's very important
to let them determine sort of the extent to which they're going
to test, beyond reading and writing and mathematics that's
being asked for, which we think is necessary, particularly to
prove Title I.
We are pleased with the increases to Title I. We think that
money should follow students into programs that work for them.
That has always been our bottom line. We recognize the desire
to try to hold everybody harmless and make sure we're funding
everybody last year the way we were, or this year the way we
were last year because of political reasons. We would encourage
you to let that money follow kids. Kids and parents will find
successful programs and those programs should prosper because
of it.
We do support the money for teacher quality. We think it's
very important to keep that flexible. There are a number of
very, very innovative teacher quality programs going on,
depending on the needs of States. Our States, our member
States, have everything from Troops to Teachers to the teacher
advancement programs, all sorts of innovative programs.
We also hope you will continue support for choice. Our
organization is a strong believer in school choice. We think
all options that work for kids ought to be made available to
them. And as State school chiefs, we support that. You find
that might be unusual from time to time, coming from State
school chiefs. We believe any school that's working well for a
child is one worth investigation as to whether or not they'll
be able to go there, and we're pleased that that discussion is
ongoing in the Congress.
Thank you very much, Mr. Chairman.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Did you have any input with the authorizing
committee on the bill that's on the Floor this week? And if so,
have you looked at it and do you agree with most of it?
Ms. Keegan. Mr. Chairman, we have had input on that bill,
which we appreciate. We like very much the President's original
No Child Left Behind idea. We feel it's had to be compromised,
we understand that. We support very much the emphasis on
assessment. We would like to see that simplified a little bit,
so that the States are looking at gain of all kids and that we
don't make it so complicated that it fails in its
implementation.
We would like to see some of the amendments on flexibility
and choice come on. It's very important for the members to
recognize that any time there's a program, we have a
requirement then to staff that program in our departments of
education with X number of people, and it makes it very
difficult to focus when you have to be maintaining dozens of
different programs. We would like to be able to focus on our
standards and assessment programs.
Mr. Regula. Mr. Obey.
Mr. Obey. As you know, the President has proposed under his
plan that NAEP be used as a second check on the annual
assessments. However, the bill before the House today allows
States to use other tests that might not be as rigorous as
NAEP. With which position do you agree, the President or the
bill as it's before the House today?
Ms. Keegan. Mr. Chairman and Representative Obey, we are
fans of the NAEP test at the Education Leaders Council. We use
it. We believe it is strong. We understand the concern that you
could slide into a situation where you are sort of mandating a
national tests that States have a discomfort with. Our concern
is that we know the NAEP well, we understand it, we think the
standards are rigorous. We would not look forward to having a
requirement for a test that was not in line with our own
standards.
So any language that allows for an alternative, which we
understand the need for, we hope will maintain the same kind of
rigor that is present in the NAEP. We are big supporters of
OERE, OERI and the research arm in the Department and of NAGBE,
which sponsors the NAEP tests. It's something all of us have a
great deal of confidence in right now.
Mr. Obey. You prefer the NAEP, rather than some substitute
as a second check?
Ms. Keegan. Mr. Chairman, Mr. Obey, we prefer the NAEP in
our organization. That does not mean that we don't understand
there could be a need for something down the road. So all I'm
saying is, to the extent there's going to be an alternative, we
would like for that to be extremely tight in its language. I
think we all have reason to be quite confident in the NAEP.
Most of us are using its statistics right now when we talk
about how the country is doing.
So if we had to decide between one or the other, the NAEP
or any series of tests that might not be of the same quality,
we would go just with the NAEP.
Mr. Regula. Mr. Jackson.
Mr. Jackson. I have no questions, Mr. Chairman.
Mr. Regula. One last question. We're going to have an
amendment on the education bill on the President's suggestion
on vouchers, or if the school is failing, the children have a
choice. How does your group feel about that? The language was
in the President's original bill.
Ms. Keegan. Correct. Mr. Chairman, we support that. We
don't believe any child should be in a school that's failing.
There are options available for these children. We believe the
first priority is to have a child in the classroom with a
teacher that's going to move that child. We realize these are
difficult decisions for lots of people, but for us, it's an
easy decision. We want that child educated and in any way we
can find to do that, we will be supportive of.
Mr. Regula. Do you like the Troops to Teachers program?
Ms. Keegan. Mr. Chairman, we do. Most of our States are
using it. We've had a great deal of success with it. When I was
the chief in Arizona, we had great success with that program
and Teach for America, and any number of alternative entryways
into teaching.
Mr. Regula. I'm curious, you take this retiree from the
military, did you require that they go back to school and go
through the hoops to get certification that you normally have
to do?
Ms. Keegan. Mr. Chairman, no, and that's what's interesting
about these alternative programs. They do go through
preparation in instruction and classroom management. There are
some tests to determine content knowledge. That's similar to
Teach for America, another project that brings in very young
graduates and puts them in inner city schools, which has been
very successful.
We believe there are several ways to prepare very strong
teachers and make them qualified. There does have to be an
instruction, but probably not the traditional route.
Mr. Regula. Well, thank you very much.
Mr. Jackson.
Mr. Jackson. I think I do have a question, just one. At
least as I understand the nature of our education system in the
country, we have, based upon the way our country has evolved,
50 separate and unequal States, 3,068 separate and unequal
counties, and at least as many separate and unequal cities.
Many States derive their revenue from agricultural economy,
others derive them from a service based economy, others derive
them from an industrial based economy, which only exacerbates
the nature of that inequality.
So for the 53 million children in public schools across the
country who find themselves in the 85,000 separate and unequal
schools in the 15,000 separate and unequal school districts,
I'm wondering how your programs overcome those limitations, and
how the vast majority of those children who find themselves in
those unequal schools are reached?
Ms. Keegan. Mr. Chairman, Representative Jackson, we think
this is a huge concern. In fact, it's a concern that a lot of
people don't like to address. That is the fact that public
education in its traditional form segregates by wealth, because
it relies on a property tax base and a boundary by which to
serve children. So it doesn't so much keep children within a
neighborhood as it keeps other children out.
We believe that the solutions to this need to be generated
by the State, but that they ought to be generated by coming up
with funding formulas wherein money follows students, into
school that work for them, that funding probably ought to be
more generated by shared taxes rather than just local property
taxes. And as you know, there is a wealth of political fallout
when you start to talk about changing district basis for
education.
So it is a local-State issue, it is very difficult. I think
there are 25 States right now, Representatives, thatare engaged
in a sort of Supreme Court argument over this very issue. It's
something that our organization has been involved in at the State level
and will continue to be, because we think there's a moral imperative.
Mr. Jackson. Does your organization believe that every
child deserves the right to an equal, high quality education?
Ms. Keegan. Mr. Chairman, Representative Jackson, yes, sir.
Mr. Jackson. Is there any way for us to guarantee that
every child gets such a right without the idea of education as
a fundamental right being part of our constitution?
Ms. Keegan. Mr. Chairman, Representative Jackson, I'm not
quite sure that it isn't at least a moral imperative as part of
what we do. Obviously that has not been part of the
constitution overall. It has been part of implementation in
every State. I don't see that changing. I think most people are
dedicated to that ideal. We have tripped ourselves up in its
implementation, we believe, and we just have to address that
without pointing fingers at why that happened.
Mr. Jackson. I thank you. Thank you, Mr. Chairman.
Mr. Regula. Mr. Obey.
Mr. Obey. Mr. Chairman, I just can't help but observe, it's
very interesting that the bill before the House today would
withhold education funding from States if children are not
tested annually. For instance, if Wisconsin decided to test on
math in odd numbered grades, and decided to test on reading in
even numbered grades, money would be withheld from the State
for exercising that judgment.
But money would not be withheld from States if they have
outrageous differences in the dollars per child in say, Maple
School District in my district versus Maple Bluff, where they
spend almost twice as much money. I find that an interesting
focus on the hole in the doughnut.
Mr. Regula. I think our witness would agree with you, but
we're going to have to move on.
----------
Tuesday, May 22, 2001.
LIHEAP
WITNESS
THE MOST REVEREND EDWIN M. CONWAY, AUXILIARY BISHOP OF THE ARCHDIOCESE
OF CHICAGO
Mr. Regula. We're pleased to call Bishop Conway, the Bishop
of the Archdiocese of Chicago. Mr. Jackson, I understand you'll
introduce our guest.
Mr. Jackson. Thank you, Mr. Chairman.
Mr. Obey. Where is Chicago? [Laughter.]
Mr. Jackson. Somewhere sandwiched between Ohio and
Wisconsin.
Mr. Regula. It's the new home of the Boeing Company.
Mr. Jackson. When our bill comes before the Committee, I
want both of you to remember that.
Mr. Regula. I said it's the new home of the Boeing Company.
Mr. Jackson. Yes, sir, it certainly is.
Mr. Chairman, I am honored today to introduce the Most
Reverend Edwin M. Conway, who was ordained a priest on May 6th,
1960, and ordained a bishop on March 20th, 1995. Currently,
Bishop Conway serves as the Episcopal Vicar for Vicariate
Number Two of the Archdiocese, which includes supervision of 63
parishes on the north and northwest side of Cook County,
Illinois.
Bishop Conway serves as the liaison for the Health Affairs
Office of the Archdiocese, which oversees 23 Catholic health
care centers and long term health care facilities of the
Archdiocese. He has served as an associate pastor and in
various roles of service and management within the Catholic
Charities system and the Archdiocese of Chicago.
Bishop Conway was the administrator of Catholic Charities
from 1980 through 1997, and served as the director for the
Archdiocese of Chicago and was a member of the Cardinal's
Cabinet from 1985 through 1997. Bishop Conway holds a masters
degree in theology and a masters degree in social work from
Loyola University in Chicago. Mr. Chairman, and members of the
Subcommittee, I present to you Bishop Conway.
Bishop Conway. Thank you.
Mr. Regula. Thank you. We're happy to welcome you, and look
forward to your comments. Your testimony will be made part of
the record.
Bishop Conway. Good morning, Chairman Regula and thank you,
Mr. Jackson, for the invitation to come and also for your
introduction this morning. And good morning also to the members
of the Committee that are here before us.
We have written testimony, I'd like to submit that and just
spend briefly, some four or five minutes here discussing some
of the high points of that testimony.
Thank you for the invitation to speak to you this morning
regarding the Low Income Home Energy Assistance Program,
LIHEAP. I am an Auxiliary Bishop from the Archdiocese of
Chicago. Cardinal George was asked, as the Archbishop of
Chicago, to come and testify this morning. Fortunately
orunfortunately, he has been called to Rome for a Consistory of the
Cardinals along with Pope John Paul II and has asked me to speak on his
behalf for the Archdiocese of Chicago.
As you will see from my resume, I've spent more than 30
years with the Catholic Charities of the Archdiocese of
Chicago. Many of those years I spent as its administrator.
Thus, I speak from my own experience as well as a bishop in
Chicago which oversees some 67 parishes, serving multi-ethnic
and multi-racial communities. The Archdiocese of Chicago has
377 parishes, with approximately three-quarters of a million
active parishioners.
This morning I wish to speak to you specifically about the
Low Income Home Energy Assistance Program. I fervently urge you
to appropriate at least $2.3 billion in core funding for the
LIHEAP program for the fiscal year 2002. The overall totals,
you recall, last year were $2.3 billion and were made available
to all the States in order to help low income families with
home energy problems. Illinois received approximately $132
million and it was supplemented by an additional $65 million in
State grants. This money came from various sources within State
supplemental low income assistance funds.
The program in Chicago was administered through the
Community Economic Development Association of Cook County,
which serves the household of elderly disabled and others who
are disconnected or meet the poverty guidelines. In Illinois,
approximately 775,00 households are eligible for low income
below this level. Currently, Peoples Gas in Chicago records
approximately 25,000 elderly and disabled with heating bills
that are significantly or substantially past due.
I point this out as it comes time when gas prices have more
than doubled. The energy bills will not return to the 2000 year
level in the foreseeable future, which gives us an example of
the Archdiocese itself, which purchases gas at approximately 60
percent less value from NICOR and Peoples Gas in Chicago. Based
upon that usage, however, of the present and past heating
seasons, an additional $8 million will be required of the
Archdiocese in payments in the year to come.
This will severely decrease the amount of discretionary
dollars that the parishes and pastors will have to distribute
to poor clients who are experiencing eminent shut-off of the
utilities. I point out that in the week prior to April 4th, the
deadline for gas shut-off in Chicago, the Archdiocese of
Chicago Catholic Charities received more than 300 requests for
energy assistance over the past several months. They have
received more than 500 requests regarding utility assistance.
The average bill for heating in Illinois in the area of
Chicago is $1,500. The State assistance LIHEAP program is $495.
This amount is less than one-third of the energy bill going to
assist elderly and the vulnerable poor.
The Bishops of Illinois have talked about the right to
housing for families and their children, and they have sought
to estimate the number of households in which families will be
experiencing no heat. I therefore strongly believe, and I have
been informed by the Catholic Charities of the United States,
that the situation nationally, especially in some of the colder
States, is also parallel to Illinois.
I stress the fact that unless the amount is restored to at
least last year's level, more than 50,000 households in the
Chicago area will be ineligible this coming year if the current
grant remains the same. The facts in this instance are very
clear, the dramatic increases in home energy costs, lack of
corresponding increases in salaries and income, results
certainly and assuredly that families will be unable to meet
their bills.
Therefore, we implore this Committee to fund LIHEAP for the
year 2002 at at least equal to the amounts in the resources
that were available to the States for the last winter, or $2.3
billion. And since even this amount may not be adequate to meet
the needs of low income families living on the edge of
homelessness, we would strongly encourage an appropriate
increase over this level in the overall funding.
We hope at the very least that if this amount remains as
introduced by the Administration, the $300 million be also
allocated in an appropriate basis to each State. We know that
our brothers and sisters in California have been publicly and
visibly shown to have utility problems. We are seeking some
sort of the same recognition in Illinois and among our Chicago
citizens, who rely on this program to continue to survive.
Thank you, Mr. Chairman. And thank you to the members of
the Committee for receiving testimony this morning.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. Bishop Conway, I don't know if you're aware of
it, but Chairman Regula is a member of what is known as the
College of Cardinals in the Congress.
Bishop Conway. Which means?
Mr. Obey. I thank you for reminding him that he doesn't
belong to the only College of Cardinals.
Mr. Regula. I didn't get summoned to Rome, though.
[Laughter.]
Mr. Obey. Let me simply ask one question. In your
statement, you referred to the need for funding LIHEAP at last
year's level of $2.3 billion. I believe what that refers to is
that $1.7 billion was made available in the regular 2000
appropriation, plus an additional $556 million was available in
carry-over funds, for a total of $2.256 billion.
I think it's important for the Committee to understand that
if we adopt the President's fiscal year 2002 request, which is
$1.7 billion, composed of $1.4 billion in core funds and
$300,000 in contingency funds, that States would see a 25
percent reduction in the actual amount of deliverable aid next
winter.
How many people did you say that would not be served in
Illinois?
Bishop Conway. In Illinois, we think there will be at least
50,000 households in the Chicago-land area that will not be.
And also we know that probably the $2.3 billion is inadequate.
It certainly is what we would like you to achieve, but even
more is needed if we're going to match the increasing energy
bills.
Mr. Obey. I certainly agree with that. Thank you, Mr.
Chairman.
Mr. Regula. Mr. Jackson.
Mr. Jackson. Mr. Chairman, I did have a question, but the
Bishop spoke to it in his remarks. My district, the Second
District of Illinois, receives $12 million of that $76 million
in the LIHEAP program. The next closest district receives some
$4 million.
So I'm very well aware of the benefit that LIHEAP provides,
and I think the Bishop's testimony and his extended remarks,
when we begin to negotiate over our bill, I certainly hope that
the Committee will take into account that there are a number of
communities, particularly those who suffer in Chicago winters,
who are in desperate need of this program, and any efforts to
under-fund the program can only create the kind of misery
amongst some Americans that none of us would want in a Chicago
winter.
So I'm certainly hoping, Mr. Chairman, that you'll be
sensitive and the Committee will be sensitive to the Bishop's
remarks. Thank you, Mr. Chairman.
Mr. Regula. I might say, I think there will be a
supplemental emergency appropriation. It will include money for
LIHEAP. I know that's in the planning stage. I'm not sure how
much yet. But there will be.
Mrs. DeLauro.
Mrs. DeLauro. I'm delighted to hear that the Chairman
thinks there will be a supplemental appropriation. We weren't
sure that that was going to be the case. Clearly, LIHEAP is a
lifeline for people in our communities where we have tough
winters, and those that have tough summers as well, as we've
seen in the past. And we need to continue the past efforts with
regard to LIHEAP, especially now given the kinds of crises that
people are facing in their lives with energy.
Thank you.
Mr. Regula. As I understand it, you just deal with Chicago?
Bishop Conway. That's correct.
Mr. Regula. How about the outlying areas? Is that part of
another----
Bishop Conway. It's a different diocese.
Mr. Regula. Configuration?
Bishop Conway. Yes, different diocese. However, we are in
communication and we have a statewide organization. The
Illinois Catholic Conference, that deals with issues. It's
fundamentally the same. In fact, some of the rural areas
outside Chicago, which are more devastated economically, are
really concerned about facing this.
Mr. Regula. Does your diocese administer this program, or
just work with individuals to apply for it?
Bishop Conway. Yes, it works with the county to distribute
the funds.
Mr. Regula. What's the policy, pretty much, of the gas
companies? Do they shut off if they don't get paid?
Bishop Conway. Well, this has been a very sensitive point.
We've gone through several public manifestations and
demonstrations about this. And currently, it's in abeyance
until it is handled in a much better way. There were two due
dates set and at both times the gas companies gave a reprieve
until some further discussion was done by the local
municipalities, county government and hopefully the Federal
Government.
Mr. Regula. Do you think most people know that this is
available and take advantage of it? Because otherwise they
could be in a real crisis situation.
Bishop Conway. I think most people become aware of it and
maybe they're not aware of it at first glance, where they
certainly begin to come to the point of having their gas turned
off or collaterally through some other arrangement with the
social service agency they become aware of this and apply for
it.
Mr. Regula. I assume the gas company would let them know.
Bishop Conway. They do.
Mr. Regula. They have an interest, too.
Bishop Conway. Right.
Mr. Regula. Well, thank you very much for coming and
testifying this morning.
Bishop Conway. Thank you.
----------
Tuesday, May 22, 2001.
WOMEN'S HEALTH
WITNESS
CAROLYN M. MAZURE, CHAIR, WOMEN'S HEALTH RESEARCH COALITION
Mr. Regula. I think Mrs. DeLauro, we'll move then to
Carolyn Mazure, the Chair of the Women's Health Research
Coalition. You'll be introduced by Mrs. DeLauro.
Mrs. DeLauro. Good morning. Mr. Chairman, let me just say
thank you to you and to my colleagues. It's such a pleasure to
welcome to the Committee a woman whose work I truly do admire
greatly, and of whom I'm tremendously proud to count as one of
my constituents. Dr. Carolyn Mazure is a professor of
psychiatry at the Yale University School of Medicine, the
principal investigator for the Donohue Women's Health
Investigator Program at Yale. I might add that that is the
largest university-wide women's health research program in the
United States.
Dr. Mazure is a national leader in the field of women's
health, conducting research on women and tobacco dependence,
post-traumatic stress disorder in determining predictors of
depression and psychosis. She serves on the board of the
Society of Women's Health Research and in addition to that, she
really has been a leader in bringing the work of research on
women's health into the community, to look at how we actually
try to improve the health and the lives of women across their
entire life span.
So it's a great honor for me to welcome Dr. Mazure and to
be able to say to the Committee, this is someone who really
does have an unbelievable grasp of what is happening out there
with regard to women's health and research and look forward to
her comments on the budget for the next fiscal year, and say
thank you to you for spending some time with us, Doctor.
Mr. Regula. Thank you. Your entire statement will be put in
the record, and we'll appreciate your summarizing.
Ms. Mazure. Thank you. First, thank you, Congresswoman
DeLauro, for your very kind words of introduction. It's very
much appreciated. Mr. Chairman and other members of the
Committee, I appreciate the opportunity to speak with you
today.
For the record, I am Dr. Carolyn Mazure, with the academic
affiliations as noted by Congresswoman DeLauro. I'm testifying
today in my capacity as the chair of the Women's Health
Research Coalition, which was created by the Society for
Women's Health Research two and a half years ago.
The Coalition has nearly 200 members committed to advancing
women's health research. Most of these members really include
national leaders in scientific and medical investigations and
in academic institutions throughout the country, and also does
include people from voluntary health organizations as well as
pharmaceutical and biotech companies, again, to the larger
issue of trying to make transfer of information possible across
these different constituencies.
To begin, let me first emphasize that we strongly support
the goal of improving the health and the health care of all
individuals through newly discovered research based information
that can be incorporated into medical practice and also
incorporated into personal practice. But there are at least
three reasons for a special focus on women's health and on
understanding what are referred to as sex-specific factors in
health and disease.
First, women historically have been under-represented as
subjects of scientific research for a variety of reasons. And
when women have been included, even to this day, sex-specific
analyses of health data have not traditionally been conducted.
A recent GAO report coming out in 2000 also confirmed that
finding.
Second, age adjusted indicators of both health status and
also of service utilization continue to show that women have
more acute medical problems and higher hospitalization rates,
even when you exclude hospitalizations due to childbirth.
Finally, there are large gaps in our scientific knowledge
about disorders and conditions that either affect women solely
or predominantly or differently. For all these reasons, we ask
the Congress to play a pivotal role in advancing research on
the health of women, research that we believe will make a
difference in women's lives and in so doing, will benefit every
person in the country.
That's what brings me to why I am testifying here today.
The Coalition is seeking the Subcommittee's support on four
major priorities. First, we join with others who have appeared
before this Committee to advocate for a $3.4 billion or 6.5
increase in the NIH budget for fiscal year 2002. However,
importantly, as the NIH grows to meet the great need for
medical research in many areas of health, we ask for your
support in ensuring that there be at least comparable increase
directed towards women's health research within that pot of
money. There is too much work to be done, as detailed in the
written statement that I'm providing, not to ensure such
funding.
Second, we ask that the various offices, advisors and
coordinators throughout the Department of Health and Human
Services, those individuals who enhance the Department's focus
on women's health research, be funded at least to the
Administration's recommended levels. In particular, we strongly
support the $50 million request in the President's budget for
the Office of Research on Women's Health, which is, as you
know, based within the NIH, and the $27 million request for the
Office of Women's Health in the Office of the Secretary.
These are significant increases that need to be maintained,
but I want to point out also that other women's health
representatives in SAMHSA and CDC and FDA andelsewhere also
need strong support to carry out their missions.
Third, within the $50 million for the Office of Research on
Women's Health, that is the office with NIH, we ask for your
strong support in creating women's health research centers, as
recommended in the Administration's proposed budget. We believe
these should be well funded interdisciplinary, peer reviewed
centers, which collectively cover a wide range of critical sex
and gender based health research issues.
Such centers would provide an effective mechanism for
operationalizing a strategy in women's health that would pursue
a research agenda that's been designed by the Office of
Research on Women's Health. This strategy is used, that is the
strategy of centers, is used in cancer research, it's used in
asthma research. Surely we can do it in a field of research
that will directly affect so many of our citizens. With this
funding, the entire field of sex and gender based research can
move into a new era.
Finally, we ask for your support in maintaining and
expanding the BIRCWH program, which is sponsored by the Office
of Research on Women's Health, again as recommended in the
President's budget. BIRCWH, which stands for Building
Interdisciplinary Careers in Women's Health, is training the
next generation of women's health researchers. It is strongly
supported by the institutes within NIH and by the community.
NIH plans to issue a request for applications to generate a new
round of these centers, but the Office of Research on Women's
Health must have the $50 million appropriation to create them.
Just last month, the Institute of Medicine issued a
landmark report called Exploring the Biological Contributions
to Health Research: Does Sex Matter? The results were
unequivocal with regard to the incredible scientific
opportunity in studying sex differences with regard to health.
This Subcommittee and the Department of Health and Human
Services routinely does turn to the IOM for advice on major
questions related to medical research and practice because the
IOM provides objective, scientific analysis.
The report makes it clear that sex is a critical variable
in understanding biology at the cellular level, and remains so
through early development, puberty, adulthood and old age. We
hope that the Committee will support the priorities I've
outlined above to begin the process of implementing the IOM's
fundamental conclusion that sex matters.
Mr. Chairman, Committee, the Women's Health Research
Coalition stands ready to work with the Subcommittee to advance
research on women's health and sex-specific factors in health
and disease and thus build a better future for all Americans.
Thank you for this opportunity to testify.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. No questions.
Mr. Regula. Mr. Jackson.
Mr. Jackson. No questions, Mr. Chairman.
Mr. Regula. Mrs. DeLauro.
Mrs. DeLauro. No questions. I think Dr. Mazure just laid
out a mission for all of us, and the kind of first-rate work
that is done that we have seen and see the results of, I think
just continues to let us know that we need to focus in this
area, because of what the results have been, and where we might
go. Thank you for your great work.
Mr. Regula. I'm curious, obviously, the life expectancy of
women is substantially higher than men. Shouldn't the focus be
perhaps on both men's and women's health issues? For some
reason it's just been women's health out at NIH. It would seem
to me that it ought to be a little broader. What would be your
observation?
Ms. Mazure. I think that's a very important point. The way
in which we really see it is, I think several points are
embedded in the answer. One is that historically, women have
not been the subjects of research. So we have a bit of
scientific catch-up to do. Secondarily, in the new science and
the way in which we're approaching women's health, we're very
interested in what's referred to as sex-specific differences.
And by looking at differences between women and men in
reference to all forms of illness and all forms of disease
prevention, we really are discovering as much about men's
health as women's health. So I think the broad field of women's
health really advances health knowledge in all areas for
everyone.
I also do think that in reference to the issue that you
raised where men tend to live on average a shorter length of
life than women, living longer doesn't always necessarily mean
living better. It often is associated with higher rates of
chronic disease, cancer, dementias, cardiovascular illness.
Nevertheless, I think we have to do better at communicating
information about health to men so that men are in a position
to take better care of their own health.
Mr. Regula. Thank you. We appreciate your being here.
----------
Tuesday, May 22, 2001.
SMALL SCHOOLS
WITNESS
TOM VANDER ARK, EXECUTIVE DIRECTOR OF EDUCATION, BILL AND MELINDA GATES
FOUNDATION
Mr. Regula. Our next witness today is Mr. Tom Vander Ark,
who's the Executive Director of Education for the Bill and
Melinda Gates Foundation, to talk about small schools. We're
pleased to welcome you, Mr. Vander Ark.
Mr. Vander Ark. Thank you, Mr. Chairman, members of the
Committee. It's a pleasure to be with you today.
I'm Tom Vander Ark, I'm the Executive Director for
Education for the Bill and Melinda Gates Foundation in Seattle.
There's been a great deal of attention paid to elementary
schools in particular in education reform in the last decade,
and very little paid to high schools, which is surprising,
because American high schools work well for relatively few
students. Unfortunately, that's most true for economically
disadvantaged students and students of color.
But today there are hundreds of schools that are bucking
that trend. They're public schools, charter schools, private
schools, urban, rural, they're suburban schools, but they all
have one thing in common: they're small. After 40 years of
consolidation, about two-thirds of American students now go to
high schools larger than 1,000 students. As former Governor Jim
Hunt said, we've made a terrible mistake in America. And we
think it's time to reverse that mistake.
There are decades of research, and especially a plethora of
research in the last five years that small schools make a
difference. It's interesting to note that there's very more
conclusive research on small schools than there is on small
class size. And yet small class size is a top of mind issue for
teachers and parents.
What we know from the research is that small schools
improve attendance, achievement, motivation, graduation rates,
it results in higher college attendance rates, school safety
and school climate are improved, there's better parent and
community involvement and better staff satisfaction.
Mr. Regula. I'm sorry to interrupt you, would you define
small school? You're talking about it as a term. If we had some
definition it would be a little easier to relate to your
testimony.
Mr. Vander Ark. The research is inconclusive on that front.
We generally say about 400 students, or less than 100 students
per grade. So if it's a 6-12 school, it might be 600 students.
But it's less than 100 students per grade.
Mr. Regula. Would that be, would you define it as a small
school in terms of a building, could it be one school district
with a lot of small units?
Mr. Vander Ark. Absolutely. I'll give you an example. The
Julia Richman High School in the East Side of Manhattan, in the
early 1990s, was one of three dozen large comprehensive high
schools in New York City that had graduation rates of less than
25 percent. Let's think about that for a minute. This is a
school that serves economically disadvantaged students,
primarily students of color. They had a graduation rate of less
than 25 percent.
Today that center, it's now called the Julia Richman
Education Complex, that complex now has four small focused high
schools, a K-8 school, a school for autistic children and a day
care center. So there's about 1,600 students on that campus.
All four of those high schools have graduation rates between 90
and 95 percent and college attendance rates of the same. All of
the students in that school share the amenities of a large
school, gymnasiums, auditorium, performing arts center, and a
library.
All of these schools, and the hundreds of great small
schools in New York, in Chicago, in the Bay Area, all operate
on the same per pupil allocation as large schools. So the
notion that they're less efficient is absolutely not true. For
the same money, we can get the benefits that I described
earlier.
Why is this important to us? It's become a focus of our
work because high schools are the largest, the least efficient
and least effective and the most intractable schools in our
system. We've developed a two-pronged approach of starting new
small high schools and trying to help transform big bad schools
into a multiplex of good small schools.
But changing an American tradition is far from easy. The
Gates Foundation and a number of other private philanthropies
have contributed considerable resources to this daunting
challenge. But it's going to take multi-sector collaboration to
effect real change at scale.
There's a growing consensus that our high schools aren't
working, especially for most economically disadvantaged
students. And there's fortunately a growing consensus about the
attributes of schools that work for all students. We feel
strongly that it's time to address this important injustice in
our schools and to promote real design, so that all of our
schools work for all of our kids.
Thank you for the opportunity to testify.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
Isn't it true that the research shows that student
performance is superior in high schools that are smaller than
800 students as opposed to larger?
Mr. Vander Ark. No question.
Mr. Obey. I find it interesting and frustrating that last
year this Committee worked to increase the appropriation to
assist school districts to explore the opportunity to create
smaller schools, especially at the high school level. We
increased funding for that program from $45 million to $125
million. But, the bill which is on the floor today eliminates
this specific authorization for small schools.
I find that distressing because I think that small schools
are absolutely critical at the high school level if we're going
to improve not just academic behavior but social behavior as
well. I congratulate the organization that you are running for
its emphasis on the problem.
Just one other point. It's my understanding, Mr. Chairman,
that in Florida, Governor Bush and the legislature have passed
legislation requiring that all new high schools that are built
be of the smaller variety. I wish that nationally we would get
the same message as we're getting from the kid brother in
Florida. [Laughter.]
I also would note that I've seen a number of comments which
suggest that small high schools are more costly per student. My
understanding is that while they may have a higher cost per
student, that they are less costly per graduate, indicating
that there is a higher level of performance that pays off
economically as well as academically.
Mr. Vander Ark. Mr. Chairman and Mr. Obey, our findings are
that the hundreds of small schools that exist today generally
operate on the same per pupil allocation. I would argue, as Ms.
Keegan did earlier, that we do need to address the inequities
in our funding system. This is true especially in our major
cities. I would agree that we need funding that's needs based
and that follows the students.
That's a different but related issue to this one. I think
the important point here is, there are hundreds of great
schools doing a great job for the same per pupil allocation.
Now, two related issues on capital costs. Some would argue that
it costs more in terms of capital construction per pupil for a
small school. That may be true if you want to adorn it with all
the amenities that we traditionally think of on a secondary
campus. But clearly, there's opportunity, as Julia Richman and
many others illustrate, for a number of schools to share a
campus facility with the traditional accoutrements of an
American high school.
The second issue is that there is a transaction cost, a
transformation or a redesign cost to transform a big,
comprehensive school into a multiplex of small schools. It's
not capital cost, it is primarily time and resources for the
staff to rethink the way their schools are designed, to be
trained to teach in small teams, to serve as advisors for
students. And that's what the bulk of our funds pay for, is
that redesign effort.
Mr. Obey. Thank you, Mr. Chairman.
Mr. Regula. Mr. Obey, you and I both went to the Aspen
seminar. As I recall, Dr. Levy from the New York City system
was pointing their system in that direction. Is my recollection
similar to yours?
Mr. Obey. He certainly indicated that he wanted to, in the
remarks that he gave to the conference.
Mr. Vander Ark. I can address that, Mr. Chairman and Mr.
Obey. The Gates Foundation, Carnegie and the Open Society
Institute have helped to support a major initiative with New
York City and New Visions for Public Schools in an effort to
both start new small schools and to attempt to transform 12 to
15 of the worst large high schools in New York into small
schools, small, a multiplex of small schools much as I've
described.
Mr. Regula. Do athletics get in the way?
Mr. Vander Ark. Absolutely. This is dangerous and
politically radioactive work, largely because high schools work
today for elite athletes and for the top 10 percent of our
students. Those are vocal and influential parents. So it is
clearly an issue.
I'll mention the Julia Richman story. The students from
those four high schools play together on interscholastic teams.
They compete, they mix teams and compete internally on
intramural teams. So again, that's a great model of how you can
have your elite sports, if that's what a community desires, but
have very small focused coherent programs where every child
gets the attention they deserve.
Mr. Obey. Mr. Chairman, I guess I would observe that it
would be interesting to compare headline size for a high school
that wins a conference football championship versus a high
school that produces an unusually large number of national
merit scholars.
Mr. Regula. I agree with you completely. I live on a farm.
At the end of my driveway is an old red brick one room school
that was closed about 50 years ago. I've said many times, I
have three children, I would have been absolutely delighted had
they gone there. Because they would have had eight grades eight
times, provided there was a good teacher. That's always a
caveat that goes all the way througheducation. We're into a
consolidated school, and I see some real problems.
I'm curious, how does your foundation practically, how do
you try to encourage this trend, probably to discourage
consolidations or big schools and at the same time encourage
some deconsolidation, if you will?
Mr. Vander Ark. Well, Mr. Chairman, I'll give you an
example of the work that we just initiated in Colorado with
Governor Owens' office. First of all, we're helping to create a
statewide foundation to create a network of technology focused
high schools in the most economically disadvantaged
neighborhoods in Colorado.
Secondly, we're working with the State accountability
system, so that every high school that's labeled as under-
performing in their State becomes eligible for the program that
we've designed, that will actually supplement the State aid to
failing schools. So they get a small amount of money from the
State and then if they can demonstrate to us some sense of
leadership and initiative, we'll supplement that with
additional money, with outside consulting help and some clear
direction on what they ought to do.
Mr. Regula. You've obviously worked with the New York
system and from what I remember of Dr. Levy's comments it's
working pretty well in terms of, as compared to what it had
been before.
Mr. Obey. I'm sorry, I didn't hear you.
Mr. Regula. I said, I think Dr. Levy indicated in his
testimony to us in that seminar that their decentralization was
working fairly effectively for students.
Mr. Obey. He thought it was. He also mentioned that there
were a considerable number of critics after him, as you
indicated. But I think he'll outlast them.
Mr. Regula. Chicago's done--I'm sorry Mr. Jackson isn't
here--Chicago's done some pretty innovative things. I met with
their superintendent, and at least I was under the impression
that they were doing what you're suggesting. Is that accurate?
Mr. Vander Ark. Mr. Chairman, that's accurate. Pat Walsley,
who is now the dean at the University of Washington, recently
authored a study called Small Schools Great Strides, which
chronicles the success of the roughly 150 small schools in
Chicago. So they've certainly recognized that size matters, and
that good teaching most frequently happens in small schools,
where teachers can work together, where they can hold each
other accountable, and where they can hold students
accountable. You can create an authoritative environment in a
small school that's virtually impossible to create in a large
school.
Mr. Regula. Did you get an opportunity to testify in the
authorizing committee? They were doing a bill that we have on
the Floor now.
Mr. Vander Ark. Mr. Chairman, as a foundation we don't
advocate for particular appropriations or bills. So no, I
didn't.
Mr. Regula. Well, from what you're saying, Mr. Obey, the
ability of this Committee to support a small school program
would be inhibited by the lack of authorization in the new
bill.
Mr. Obey. Well, what I'm saying is that the authorization
bill repeals the specific authorization. We have, in the past,
on this Committee found ways, by using general authorizations,
to accomplish purposes that are constructive, and I hope that
we can find that in this instance as well. I think it's a
strange argument that some people make--that no effort is
required on the part of the Federal Government because the
Gates Foundation is involved. That seems to say, let cousin
Johnny do it, rather than me, when we all ought to be working
on it together.
Mr. Regula. Well, thank you for coming. I'm in total
agreement with what you're saying. I've been seven years in
public education and on the State school board. I think this
trend of bigness is better is just being demonstrated as not
the right way to go. Have you developed any paper on this
subject, to support what you've presented this morning? Of
course we have your testimony. Is there anything additional to
that?
Mr. Vander Ark. Mr. Chairman, we have several articles on
this subject. My testimony includes references to a number of
the research studies that have been published in the last four
or five years. I'd also call your attention to the Dropout
Commission that made their report on January, Commission on the
Senior Year, which made their report in February, the American
Youth Policy Forum, which published their report earlier this
year, the Education Trust, all of those organizations have come
out very strongly in favor of small schools, and all of those
reports cite many of the same pieces of research that are noted
in my testimony.
Mr. Regula. What you're saying is that in the thoughtful
establishment, this is the direction that the research is
taking?
Mr. Vander Ark. There's very strong momentum among people
that are looking at data. Unfortunately, that conversation has
not reached most local school districts.
Mr. Regula. I think we'll need to be creative.
Mr. Obey. Well, I think that's allowed in the democratic
system. [Laughter.]
Mr. Regula. Thank you very much for coming. I commend you
for your work, and I hope you have ever greater success.
Mr. Vander Ark. Thank you.
Mr. Regula. Because I think it's absolutely the right way
to go.
----------
Tuesday, May 22, 2001.
NIH
WITNESS
ERIC S. LANDER, CHAIR, JOINT STEERING COMMITTEE FOR PUBLIC POLICY
Mr. Regula. I understand, Dr. Lander, you're on a tight
schedule. So we'll give you an opportunity to be heard at this
moment.
Mr. Lander. Thank you very much, Mr. Chairman.
Mr. Regula. Your testimony will be in the record and we'll
welcome a summary.
Mr. Lander. Great. Mr. Chairman, members of the
Subcommittee, thank you for inviting me here this morning to
testify. My name is Eric Lander, I'm a professor of biology at
the Massachusetts Institute of Technology and the Director of
the Whitehead Institute/MIT Center for Genome Research. I'm
here today representing the Joint Steering Committee for Public
Policy, which is a coalition of scientific research societies
that jointly represents about 25,000 research scientists
nationwide and globally.
My own scientific research is related to the Human Genome
Project. Our own center at the Whitehead Institute was the
largest of the contributors to the recent sequencing of the
human genome, and in addition, we work on trying to apply this
knowledge to dissect the basis of human diseases, the causes of
cancer and diabetes and heart disease.
The scientific community is tremendously grateful for the
support of this Committee and of the Congress in increasing the
funding for the National Institutes of Health over the past
several years. The additional funding is having a major impact
on the pace of biomedical research, and it's been responsible
for much of the remarkable scientific progress that we read
about on a daily basis.
I'm here today to ask you to continue increasing that
support toward the goal of doubling the NIH budget. Given your
own history of support for biomedical research, I take it for
granted that you consider funding the NIH to be a tremendously
important investment in our children's future. And I take it
for granted that you know that millions of Americans suffer
from Alzheimer's disease and arthritis and cancer and chronic
lung diseases and diabetes and heart disease. And I take it for
granted that you know that such diseases pose an incalculable
burden of pain and hardship on its victims and their families,
as well as a financial burden estimated approaching $1 trillion
annually.
But this alone would not be enough to justify substantial
increases now. Substantial increases now can only be justified
if two things hold. First, that there really are extraordinary
and urgent new opportunities that justify additional
investment. And two, that there's confidence that additional
investment can be used well.
And you have every right to demand answer to those
questions, and I want to provide them. Number one, what are
these new opportunities and what's so urgent them anyway? Mr.
Chairman, there is an extraordinary revolution now underway.
The revolution is most apparent in such landmarks as the Human
Genome Project, which has given us the parts list for human
medicine, the inventory of 30,000 or 40,000 human genes. This
is having a dramatic effect on medicine. It's the equivalent of
being able, for the first time, to have a look under the hood
of the car to see what's wrong.
One of the most uncomfortable facts about medicine in the
20th century is that for most diseases, including heart
disease, diabetes, hypertension, depression and schizophrenia,
we have had no clue what the actual cause is, the molecular
mechanism of the disease. So we've been shooting in the dark.
We've mostly been treating symptoms. Sometimes we get it right,
but often it's a matter of luck.
In the past decade, we've begun to see real progress on
discovering the mechanisms, the causes of disease. Let me give
you an example of what happens when we know the mechanism. Ten
days ago the FDA granted swift approval to a new cancer drug,
Gleevec, directed against a kind of leukemia called Chronic
Myelogenous Leukemia. It was a new kind of cancer drug: it is
non-toxic and taken orally. Of 53 patients who had failed
conventional therapy and were expected to die of their disease,
53 had remissions. Moreover, the drug is now turning out to be
effective against other cancers for which it wasn't even
designed, including a kind of stomach cancer.
Some people call this a miracle, and in many ways, it is.
But it's no accident. It resulted from a dogged effort to
understand the cause, the mechanism of leukemia. First, the
recognition that two chromosomes were consistently rearranged
in this cancer. Then the discovery that a novel gene caused by
this chromosome rearrangement produced an errant protein locked
in the on position.
Then the proof that this protein, this errant protein, was
absolutely essential for the cancer cells to grow. All this was
the product of NIH funded research, through the foresight of
this Congress. Once the mechanism was known, talented chemists
in the pharmaceutical industry stepped in and created a drug to
block this errant protein, and without side effects.
Mr. Chairman, it's the difference between trying to fix a
car when you have no idea what's wrong and between trying to
fix a car when you can look under the hood. And this is not an
isolated story. Ten years ago we had no idea what the mechanism
was of Alzheimer's disease. Since then, we've been able to look
under the hood and find key causative mechanisms. And it's led
to an explosion in drug development.
I believe that we will see drugs emerge that can prevent
Alzheimer's disease before symptoms occur, that is, prevention
of diseases, rather than dealing with the devastating
consequences. This could only happen by knowingthe mechanism.
Similar stories have emerged for Parkinson's disease and
other diseases. We're standing on the threshold of what I think
is the greatest revolution in the history of medicine. We're
now set to work out the mechanisms underlying most common
diseases that afflict people. And it's an audacious program to
imagine that this could happen, but I believe it will happen in
the next one to two decades.
But it's going to take major and increased investment now.
I think the investments were justified. We finally have the
tools to lay bare the secrets of disease, and I think we'd be
failing the American people in general and our children in
particular if we didn't seize the opportunity. If we delay
investment today, we delay understanding, we delay therapies
and cures. I think this is a very special moment in history and
we need to seize it.
Number two, how can this Congress be sure that the
increased investment is being used widely? That is, how can you
monitor the progress?
Some years ago, this Congress passed the Government
Performance and Results Act, GPRA. What performance and results
should you be monitoring?
Well, the development of new drugs and therapies that
stemmed from NIH is one such measure. But it's a long term
measure, because it can take a decade or more for understanding
to translate to therapy.
Instead, I would urge you to focus on the discovery of
mechanisms. Keep a scorecard of how we're doing at discovering
the mechanisms. That's the key, because you can feel confident
that if we reveal the molecular mechanisms, it will unlock the
prodigious energies of industry and academia to fashion
therapies and cures. In this way, you can be sure that the
investments are reaping dividends.
You can also look at new initiatives at NIH, such as the
newly established NIH Center for Minority Health, which is a
sign that we're working together to ensure that biomedical
research benefits all Americans.
Number three, finally, Mr. Chairman, I know it's not the
purview of this Committee, but I would like to add that for all
of this to succeed, we need increased investment in other areas
of science as well. Increased investment in biomedical research
will not reap its full potential unless we have corresponding
investment in physics, chemistry, computational science, etc.
These allied disciplines are absolutely essential. For example,
for figuring out what protein shapes and functions are about,
or for developing non-invasive imaging to speed clinical trials
through the study of early markers of disease.
The President's budget for biomedical research is very
encouraging. But I'm deeply concerned that the budget for other
sciences is neglecting key investments.
In summary, this is no ordinary time. The science of the
last century has now brought us to an extraordinary threshold
of understanding the basis of disease, and it is time for
extraordinary investment to reap those benefits.
Thank you for your consideration, and I'd be glad to answer
your questions.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. Well, I want to thank you very much for your
statement. It's not the first time that I've heard you, but I'm
very happy that you focused on our obligations beyond NIH. I've
said this before, but I'll say it again very frankly. There is
a member of the Subcommittee that was prepared to vote for at
least the President's budget on NIH. It's become the holy
picture item in the health budget. We all pose for political
holy pictures by stumbling toward the nearest microphone to say
how much we're dedicated to NIH research.
The problem is two-fold, as I see it. First of all, this
big investment in NIH, according to the budget, will stop after
2004. Because then the budget estimates don't contain the 15
percent increases any more, the increases drop to low single
digit levels, accurately reflecting what will be available in
the budget as this tax cut that's being passed continues to
drive everything else off the table.
The other problem that we have, as you have indicated, is
that if all we do is fund NIH and don't deal with NSF and some
of the other seed corn agencies, we are going to cut the plant
off at its roots. The flowers may look pretty for a few days,
but they won't last that long, at least not in the health we'd
like to see them.
This isn't really a question. It's just a statement of
philosophy. I think that we have a once in a generation
opportunity, now that we have surpluses instead of deficits. We
have a choice to make between tossing almost all of those
surpluses at the private sector in the form of individualized
realizations of happiness through tax cuts, or we can try to
reserve a major part of those surpluses, I would hope by far
the largest part, to finally enhance the quality of public
services and the strength of public investments that must by
nature be a collective enterprise rather than an individual
enterprise.
I think we're about to blow the biggest chance we've had in
a generation to really make a difference, not just for medical
research, but in a number of other areas as well. I thank you
for focusing not just on NIH, but also on the other near
orphans in the scientific community, given the squeeze that we
have on those agencies.
Mr. Lander. Thank you. We can't deliver on the promise
without a full picture of the support it will take.
Mr. Regula. Thank you for a thought provoking testimony.
Mr. Lander. Thank you, Mr. Chairman.
----------
Tuesday, May 22, 2001.
TEACHERS
WITNESS
C. EMILY FEISTRITZER, PRESIDENT, NATIONAL CENTER FOR EDUCATION
INFORMATION
Mr. Regula. Our next witness is Emily Feistritzer,
President of the National Center for Education Information.
Your testimony will be made part of the record, we welcome your
comments.
Ms. Feistritzer. Thank you, Mr. Chairman. I'm the President
of the National Center for Education Information, which is a
private, non-partisan research organization in Washington. I
started the National Center for Education Information just to
fill what I thought was a gap of a need for collecting,
analyzing and reporting objective and unbiased information. So
we really don't take a position on these matters, but we take
great pride in the kind of data that we've been able to make
available.
I thought I was going to follow the gentleman from the
Gates Foundation and I wanted so much to do that, because so
many things he said fit right into this changing market for
teaching and alternative routes for bringing people into
teaching.
But I wanted to share with you, before I get into my
statement, in a book that we do called Alternative Teacher
Certification: A State by State Analysis, which I will make
available to the entire Committee, in the introduction we have
a section on schools in the nature of how schools are organized
in this country. One of the bulleted items states that at the
high school level, only 3 percent of all secondary schools in
this country enroll 1,500 or more students, and yet they
account for 33 percent of all enrollment. It just reinforces
what Mr. Vander Ark said. Forty-one percent of schools enroll
fewer than 400 students, and yet account for only 18 percent of
all students.
So we're really talking about a relatively small number of
schools throughout this country that enroll the proportion of
all the students who are enrolled in schools. This is very much
related to the whole issue of teacher supply and demand, which
is the topic that I was asked to speak with you about. We've
all heard that we're going to need to 2.2 million additional
teachers in the next decade. You could have a whole hearing
with probably 25 witnesses to just debate what that actually
means.
But the fact of the matter is, the demand for teachers is
increasing, not decreasing. But it's actually not increasing
everywhere. The demand for teachers is really isolated in
certain regions of the country, namely large inner cities and
in outlying rural areas of the country. And in certain subject
matter areas, such as science, mathematics and special
education.
We find that actually, the Nation nationally is turning out
enough people to teach. The colleges and universities that
prepare teachers in this country are producing roughly 200,000
brand new, never taught before teachers each year, and that's
more than enough actually. The problem is most of the people
who are coming through colleges of education fully qualified to
teach don't want to teach where the demand for teachers is
greatest. Undergraduate teacher education programs historically
have turned out young white females who do not want to teach in
large inner cities and who do not want to move actually very
far away from home.
Now, what we find also is that in the National Center for
Education Statistics data from baccalaureate and beyond
studies, that about 60 percent of baccalaureate degree
recipients who are fully qualified to teach are not teaching
the following year, and only about 53 percent of them are not
teaching five years out. So we have a production of teachers in
this country that is great enough to meet the demand. The
problem is that the production of teachers is not satisfying
the demand, because the demand is, as I said earlier, isolated
and quite specific to geographic regions and to specific
subject areas.
That's why this new movement toward States developing
alternative routes for recruiting, training and licensing
teachers makes so much sense. Because not only have alternative
routes evolved since the mid-1980s and grown rapidly since the
mid-1990s, it is because not only are they meeting the demand
for additional teachers in specific areas of the country, they
are also meeting the demand created by the supply of people who
are stepping forward to want to teach who do not fit the
traditional definition of a teacher, which is a high school
student going to go college and majoring in education.
We find that there are huge numbers of what I call non-
traditional candidates for teaching, people who already have a
bachelor's degree, usually in a field other than education,
many of whom have life experience, some of whom have been in
other careers and retired, who really do want to teach. And
they really do want to teach in areas of the country where the
demand for teachers is greatest. And alternate routes are being
developed all over the country to specifically recruit these
people to teach in these ares of the country where the demand
is greatest.
And the Federal Government, in its infinite wisdom, has
been through the authorizing language and through this
appropriation moving in the direction of providing some much
needed support of the development of these types of programs.
I see that my formal time is up, so I'll stop here.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I'm curious, is the multiplicity of
requirements, and it varies from State to State for
certification, is somewhat of a barrier to the people you
characterize perhaps who have had other careers and would like
to teach, but suddenly they're faced with going back and taking
a couple of years of how-to courses, is that a problem?
Ms. Feistritzer. I think it is a problem. You can't ask
people who have finished their degrees, in some cases masters
degrees and some cases professional and even more advanced
degrees, to give up employment and go back to college and pay
tuition to take courses required for certification and may or
may not be able to find a job.
So that is a problem. That's why the alternate routes that
are designed specifically to attract this population of people
and are developed to train that population of people to teach
in the very schools that most traditionally trained teachers
don't want to teach in make an awful lot of sense, and are
being met with a tremendous amount of enthusiasm from mid-
career changers and military personnel and so on.
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
As you know, last year we were able to provide $34 million
in the budget for non-traditional teacher recruitment
activities. And $31 million of that was based on the
Transition-to-Teaching Initiative. What's your evaluation of
that program?
Ms. Feistritzer. I have testified before the authorizing
subcommittee, and I'm very much in favor of that. I think that
the States really do need financial support in developing these
programs. Most of the programs that are springing up around the
country are really on the backs of the participants in the
program. They can be very costly to the individual who's trying
to get a credential to teach. So I think the transitions to
teach program, in the current budget, is an excellent program.
My only caution, I was around during the block grant era of
Chapter II in the early 1980s. I saw a lot of really good
programs, like teacher centers and teacher corps really get
lost in the block grants. And I think that, I have a problem
with turning all of this money over to the States to do with as
they will. I would hope that there would be some guidelines
that these monies be used for such things as the design and
implementation of alternative certification routes, for
example. Because I'm not sure the States will wind up using it
for that if they can get away with using it for something else.
Mr. Obey. How about the Teach for America model?
Ms. Feistritzer. Teach for America is really a recruitment
effort for recent college graduates to make a two year
commitment to teaching. I like Teach for America a lot. I like
Troops to Teachers an awful lot. But those two programs are
specifically recruitment efforts for specific populations of
people.
The alternative teacher certification arena is much broader
and much bigger and encompasses a whole lot more people and has
more potential, I think, for bringing in wider audiences of
people in a way that fits with the current bureaucracy of
American education, which is not likely to change in our
lifetimes.
Mr. Obey. I would just have to say that in light of your
other comments about block grants, that I'm fascinated. One
thing that fascinates me is that there are a number of people
in Congress and out who will criticize the degree of
educational attainment of students in the country. And they
will say, we just aren't doing very well at all. So their
answer is to turn even more authority over to the people who
already have the lion's share over running schools, namely the
local school boards.
I don't think my district is much different than anybody
else's, local school boards make 95 percent of the decisions
about how kids get educated and where they get educated, who
they get educated by and where resources go. It's always
fascinated me that the Federal Government, which really is only
nibbling around the edges in terms of the financial support it
gives education, somehow gets the blame for the lack of
performance in schools that are largely governed by local
school districts.
I think you have to conclude that that judgment is not
based on evidence, but it's based more on ideology or
philosophy.
Thank you, Mr. Chairman.
Mr. Regula. Has there been any movement on the part of
States to remodel their requirements for certification to make
it easier for these transition type of individuals?
Ms. Feistritzer. We survey the State departments of teacher
ed and certification every year. And the results of that are
published here. There's been a lot of movement in that
direction.
I am more encouraged, I've been covering and around
education all my life, I'm a third generation educator. And I'm
actually more optimistic than I think I've been throughout my
life about the future of the teaching profession for this
single reason, that the population of people who are stepping
up to the plate sincerely wanting to teach is radically
changing, positively.
And the States and even the institutions of higher
education are being, I think, very positively responsive to
using it as an opportunity to design some really good,
sensible, not a whole lot of courses and riff-raff, but really
sensible, field based mentor companion teacher preparation
program for life experienced adults. Forty-one States now say
they are doing such a thing, but they need a lot of support.
Mr. Regula. Has the NEA and/or the AFT been a help or
hindrance, or are they neutral on this whole effort?
Ms. Feistritzer. The NEA and the AFT both, to their credit,
have been back in the early 1980s, rather silent on the issue
and increasingly open to the development of good new
alternative teacher preparation programs. They've not gone as
far as sitting here before you, calling for $1.2 billion for
them.
But they have been increasingly, I think, open to the
development of collaborative alternative teacher preparation.
Mr. Regula. That's a positive note.
Thank you for coming.
Ms. Feistritzer. Thank you.
Tuesday, May 22, 2001.
STUDENT FINANCIAL AID
WITNESS
BRIAN FITZGERALD, STAFF DIRECTOR, ADVISORY COMMITTEE ON STUDENT
FINANCIAL ASSISTANCE
Mr. Regula. Brian Fitzgerald, Director, Advisory Committee
on Student Financial Assistance. Your statement will be made
part of the record, you may summarize, please.
Mr. Fitzgerald. Thank you, Mr. Chairman, Mr. Obey, for the
opportunity to present an overview of the Advisory Committee's
most recent report entitled Access Denied: Restoring the
Nation's Commitment to Equal Educational Opportunity, a copy of
which is in your materials today.
For the record, my name is Brian Fitzgerald, I'm staff
director of the Advisory Committee. I will deliver testimony on
behalf of Dr. Juliet Garcia, who is President of the University
of Texas-Brownsville and Chairperson of the Advisory Committee.
She is ill today and apologizes for not being able to be here
herself.
Our committee was authorized by Congress in the Higher Ed
amendments of 1986, to provide expert, independent, objective
advice to Congress and the Secretary on Federal student
financial aid policy issues. The committee's most important
legislative charge is to make recommendations that maintain
access to post-secondary education for low income students.
Over two years ago, the committee began a comprehensive
examination of the condition of access, that is the opportunity
to attain a baccalaureate degree. At three public meetings
devoted exclusively to access, the committee was informed by
testimony of dozens of students, college administrators and
scholars about the financial as well as the academic, social
and cultural dimensions of access.
Emanating from those activities and a parallel two year
study, the Access Denied report marshals the most authoritative
data to pinpoint the access problem and its causes. The report
documents the wide gap between available aid, including loans,
and college costs for low income students. This gap, known as
unmet need, is $3,200 a year at two year public colleges and
$3,800 a year at four year public colleges. Significant enough
to lower the rate at which low income students enter college,
attend four year institutions and attain a bachelor's degree.
More than 30 years ago, the Federal Government entered into
a partnership with States and higher education institutions to
ensure that all Americans could have access to a college
education without regard to their economic means. As a result,
tens of millions of Americans who otherwise would not have had
access to college have attended and earned associate's and
bachelor's degrees. This highly successful effort increased the
rate at which Americans enter college to record levels, which
has fueled this Nation's economic growth.
Unfortunately, the post-secondary participation of low
income students continues to lag far behind that of their
middle and upper income peers. Large differences in college
entry rates persist, with gaps as wide as three decades ago.
In addition, a recent U.S. Department of Education study
indicated that low income students who graduate high school at
least marginally qualified, enroll in four year institutions at
half the rate of their comparably qualified high income peers.
Equally troubling, only 6 percent of low SES students earn a
bachelor's degree, as compared to 40 percent of high SES
students. These facts have major implications not only for the
lifetime earnings of low income students, but it also robs the
Nation of hundreds of billions of dollars a year in gross
domestic product.
Yet the challenges that face low income students today in
gaining access to college will worsen considerably as a result
of impending demographic forces. Rivaling the size of the baby
boom generation, the projected national growth of college age
population by 2015 exceeds 16 percent or about 5 million, with
at least 1.6 million additional students enrolling in college,
many of whom will be low income. Thus, even if college costs
continue to grow no more rapidly than family income, these
demographic changes will greatly increase the gross amount of
financial aid required to ensure access.
Unfortunately, financial barriers are higher now in
constant dollars than they were three decades ago. The unmet
need gap facing low income students has reached unprecedented
levels, once again, $3,200 and $3,800 respectively at two year
and four year public institutions. This includes all work and
loan.
Given these levels of unmet need, the failure to close the
participation and completion gaps is not surprising. Unmet need
is forcing low income students to choose levels of enrollment
and financing alternatives not conducive to academic success,
persistence and ultimately degree completion.
One often hears the argument that poor academic preparation
is the primary reason for low income students' lack of access.
That is simply not true. Inadequate financial aid, that is the
unmet need gap, often prevents the most highly qualified low
income youth from attending college at all. In fact, the lowest
achieving high income students attend college with the same
frequency as the highest achieving poor students.
If my committee members could leave you with only one
message today, it would be this. The inability of tens of
thousands of academically prepared low income students to
enroll in a four year institution, attend full time and earn a
bachelor's degree is the result of unmet need just as it was 30
years ago, and portends no narrowing of participation gaps,
even in the long run. No matter how strong the Nation's
commitment to academic preparation, no matter how quickly
academic preparation advances, no progress can be made toward
improving access without increases in need based grant
assistance starting with the Pell Grant program.
Thank you, Mr. Chairman and Mr. Obey. I would be happy to
respond to any questions you have.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. I have just one.
On the Pell Grants, which would you think would be more
effective, have a larger amount the first year with a
decreasing amount the second, third and fourth year, or have a
flat amount for four years as part of a Pell Grant program? And
some of the colleges have indicated they have to end up picking
up the difference where it drops off in the second, third and
fourth year. Do you have an opinion on this, which would be the
better way to do it?
Mr. Fitzgerald. Mr. Chairman, we looked not only at the
ability of students to enter college, but the most important
thing is that students must be enabled to persist and obtain a
degree of their choosing. We feel that giving higher grants in
the first year or first two years may have a slight impact on
the number of students enrolling, that is to say, it may
increase. We are very concerned that it may actually harm
persistence, and put colleges in a position, and many of them
serving the lowest income students will not be able to do this,
but put colleges in a position where they have to make up the
difference.
Mr. Regula. So you'd prefer a flat amount for four years?
Mr. Fitzgerald. That is correct, Mr. Chairman.
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
I would simply note that, the reason why low-income
students don't attend college in the numbers that we would like
them to is very easy to understand, when you recognize that in
1975 the Pell Grant maximum award, as a percentage of the cost
of going to college, was 84 percent, and today it's 39 percent.
I don't think it takes a rocket scientist in order to figure
out that that's a major reason why much smaller numbers of low-
income people attend college than would be the case if we
really, truly had equal access to education.
This country is great at myths. We always talk about equal
justice under the law, and liberty and justice for all in the
pledge of allegiance. But when you take a look at performance,
if our words were to match what we're actually doing, the
pledge of allegiance would be amended so we say that we're
providing liberty and justice for almost everybody, but not for
all.
That's all, Mr. Chairman.
Mr. Regula. There have been some allegations that college
tuition tracks with whatever we do with Pell Grants. Any
validity to that? When you look at the numbers, it would appear
that might be the case.
Mr. Fitzgerald. Mr. Chairman, although our report does not
specifically deal with college costs, I think there's been a
good deal of emphasis on college costs recently. We've examined
that very carefully. We find no relationship whatsoever to the
level of Pell Grants and college costs.
Congress created a commission on college costs to look at
that. The fact of the matter is, the number of Pell Grant
recipients is a relatively small number, it's a minority among
students enrolled in college. So if Pell were driving college
costs, you would be, for example, I believe you are on the
board of trustees at Mount Union----
Mr. Regula. Right.
Mr. Fitzgerald. I was just look at the data, I don't know
what the enrolment is, I'm sort of backing into it. But there
are three times as many loans as grants, as Pell Grants, at the
college. If Pell were driving tuition at your college, you
would be in effect taxing non-Pell Grant recipients when they
are no better off as a result of rising Pell Grants.
In fact, the majority of students attend public
institutions, about 80 percent of all students. Those tuitions
are set by a public governance process unrelated to levels of
Federal and often unfortunately, State aid. And in key States,
California, Massachusetts, Virginia, tuitions have declined, 20
percent in Virginia in 1999-2000.
So frankly, I think the concern about college costs is
actually, the jawboning, if you will, has led college leaders
to look very carefully at that and frankly make a very
concerted effort to even lower tuition. That is going to
change, though, with the decline in State subsidies.
Mr. Regula. Yes, we're having that in Ohio because of the
budget constraints.
Mr. Kennedy.
Mr. Kennedy. All the talk about Pell makes me very proud to
come from Rhode Island. And of course, Pell didn't pioneer the
Pell Grant without understanding the importance of what it
meant to my State and all the institutions of higher learning
in my State.
I know from hearing from them, having gone to a number of
graduations this past weekend and talked to the boards of
directors at the different public institutions, they're all
very concerned about what's coming down the road in terms of
funding for higher education and assistance from the Federal
Government. So I welcome your concerns and advocacy on behalf
of financial aid to students. We certainly need it now more
than ever, because as we all know, higher education is the key
to opportunities for the future.
So thank you.
Mr. Regula. Mr. Obey.
Mr. Obey. Mr. Fitzgerald, I'd just like you to repeat one
sentence that you uttered earlier. You said the lowest
achieving high-income students attend college at the same rate
as the highest achieving low-income students?
Mr. Fitzgerald. That's correct, Mr. Obey. It's 78 percent
of the highest achieving low-income students go to college, and
77 percent of the lowest-achieving high income students. The
inescapable conclusion is that money matters.
Mr. Obey. You bet. Thank you, Mr. Chairman.
Mr. Regula. You made your point very effectively.
----------
Tuesday, May 22, 2001.
EDUCATION
WITNESSES
PETER HORTON, ACTOR, THE CREATIVE COALITION AND COMMITTEE FOR EDUCATION
FUNDING
CAROLYN HENRICH, PRESIDENT, COMMITTEE FOR EDUCATION FUNDING
Mr. Regula. Mr. Peter Horton, from the Creative Coalition
and Committee for Education Funding. You're accompanied by
Carolyn Henrich, President of the Committee for Education
Funding.
We're happy to welcome you, your testimony will be made
part of the record, and we'll welcome your comments.
Mr. Horton. Thank you very much. Good morning, Mr. Chairman
and Congressman Obey, members of the panel.
On behalf of the Creative Commission and the Committee for
Education Funding, I would like to thank you for letting us
speak on such an important topic. I think all of us in this
room would agree that education of our children is a foundation
stone, if not the cornerstone, for building and maintaining a
healthy and prosperous society.
My name is Peter Horton, as you stated. I am an actor,
director, writer in the film and television business, as you
also stated. This is Carolyn Henrich, President of the
Committee for Education Funding.
Mr. Chairman, I think I'm going to take your advice and not
read my full written statement into the record. I can feel the
room slowly wilting as we go along here, and with the exception
of a couple of points, facts, I would like to share, I will
then take another tack.
One of the facts in my written statement is that the
Federal investment in education has actually declined as a
share of the Federal budget from 2.5 percent in 1980 to 2.1
percent today, which means that we are spending only two cents
of every Federal dollar on education. Now, the groups that I am
representing today are advocating a five cent expenditure,
which certainly to me seems reasonable, at least.
There's just a couple other quick facts. At the elementary
and secondary level, enrollments are projected to set new
records every year, reaching over 54 million by the year 2006.
Over the next decade, college enrollments are expected to
continue to grow another 11 percent, with one in five students
coming from families below the poverty line. And then the last
one, which truly shocked me, which is that 30 percent of our
students live in poverty in this country, in this Nation.
Mr. Regula. Thirty percent in the public schools live in
poverty, is that correct?
Mr. Horton. Yes, sir. It's shocking.
Mr. Regula. It is.
Mr. Horton. I think what I would like to do for the balance
of my time, if you don't mind, is really speak to you from my
heart. If I can, I would like to try and explain to you why I'm
so passionate about this issue, why I think it's so important
that you provide adequate funding for education in this
country. I went to public school my whole adolescence and
childhood. My sister Ann is a school teacher. One of my heroes
growing up was a woman named Jo Egger Lundquist, who is an
extraordinary educator up in the northwest, who believes that
teaching is not a profession but a calling, which I believe and
concur with completely.
But most importantly, what's affected me the most on this
issue is I recently became a father for the first time. As you
know, becoming a father for the first time changes your whole
outlook on things, your whole perspective on the world. I am
facing a situation in Los Angeles where, for me to get adequate
education for my daughter, I have to be willing and able to
spend $15,000 a year for her grammar school education, and
$10,000 for kindergarten.
Now, there's a significant portion of this country that
makes $10,000 to $15,000 a year in salary, and an even larger
group that's making more than that but still can't afford that
kind of expenditure for education. I don't know what we tell
them. I don't know how we explain that to their children.
My family and I spend a lot of time in a small community in
California called Cambria. It has 5,000 students and the public
school there is so overcrowded that a lot of the classroom work
has to be done in the halls of that school. Now, recently a
number of, or two education bond measures were up for a vote in
that community, and both failed. Now, this is a community where
neighbors know each other, they know the children that they're
voting against. I don't know how to explain to those children
why they still have to use the hallway as their classroom.
Now, you are the only body in this country that has the
ability to set a national standard of education for this
country, a bar if you will, under which no student, not my
daughter, not any student, will fall. We're spending two cents
on a dollar. It used to be two and a half cents, it's now two
cents. We need at least five cents.
And that's not just my opinion. As I'm sure you know, polls
indicate a vast majority of Americans feel like spending five
cents on education is something they can support
wholeheartedly, in fact are asking you to do something about
that. I mean, we are the wealthiest country in this planet. And
we're going through one of the most prosperous times in our
history. We can afford five cents. We can afford the nickel.
Thank you for your time.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Obey.
Mr. Obey. Thank you for your testimony. I think you're
right. I would put it another way, I don't think we can afford
not to provide that nickel.
I would just note two things. My wife started out at the
time she married me, as a speech therapist. She used to work
with kids in a hall closet, because that's all that the school
system provided, in one of the schools that she taught. I never
dreamed that 30 years later, you'd still have the same
conditions. I was silly enough to believe in the improvability
of a society on a consistent basis and in so many ways I've
been proven wrong.
The other point I would simply make is that you indicated
that we've actually seen investments in education going down as
a percentage of our national budget. I would point out that
we've seen our investments in everything go down as a
percentage of our national income. If you take a look at all of
the dollars that the Appropriations Committee can provide in
the budget this year, and if you compare that to what we were
spending in 1980, this country was spending 5.2 percent of our
total national income in 1980 on all domestic initiatives of
the Federal Government except for entitlements. That's not
counting programs like Social Security.
Today we are at 3.4 percent of our total national income.
And within five years, under the budget that Congress has just
adopted, we will be down to 2.8 percent of our total national
income. We are shortchanging education. We are shortchanging
science. We are shortchanging health care. We're shortchanging
environmental cleanup. We're shortchanging all of those
collective enterprises that represent the fundamental
responsibilities of people to each other in this society.
And that's what makes this budget this year so incredibly
frustrating.
Mr. Horton. I would say also, I think the way we treat our
children as a Nation is sort of the canary in the cave. It's
our best indicator of our integrity as a Nation. I would say,
our best focus right now, our most necessary focus right now is
to make that statement as a Nation, that our children are worth
at least five cents on the dollar, and the rest up to you.
Mr. Obey. Well, again, all I will say is that over the last
five years we've had an average annual increase in federal
education appropriations of about 13 percent.
Mr. Horton. Yes.
Mr. Obey. This year, the President's budget cuts that rate
of increase in half when you compare apples to apples, program
delivery versus program delivery by academic year. Some
progress. Thank you.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you. It seems to me that the big
challenge we have as a Nation is to get these facts that you've
just mentioned out and in the public consciousness. But not
only that, there has to be a will, because we know more today
than we ever have in our history about brain development and
the impact of violence on children long term in terms of their
learning. We know all these things, and yet we are treating our
kids worse than they've ever been treated in the history of the
Nation.
So even during times of the Depression, kids were,
according to historians and child development specialists, were
essentially treated better because of the nature of family and
attentiveness to children than they are today. It says
something about the fact that it isn't just simply knowing
more. We as a society believe that if we just had more
information that would do it. It's not enough. It's a culture
of change that has to take place for us to embrace this
increase.
So all I can say is that it takes a fundamental political
change of heart. I think those that have advocated a reduction
in Government spending insofar as the collective enterprises
that Mr. Obey was talking about have been doing so by
denigrating government and tearing down our public institutions
and saying that you can't be trusted, politicians can't be
trusted, our whole democracy is failing you, the public. And if
you say that enough, people will believe it. And what they have
come to believe is that that's true. Unfortunately, when they
believe that that's true, there isn't the confidence to support
these programs, and the public will to support these programs.
So we need to change the ethic in this country that looks
upon government and political leaders as the lowest form of
life, and start changing the civic ethic in this country in
terms of public institutions. So I can just say, I
wholeheartedly appreciate what you're saying, and I do agree
that we're becoming two separate societies as a result.
What comes to mind is John Kenneth Galbraith's book,
Private Wealth, Public Squalor. We're going to have a lot of
people that have the wealth, and then we're not going to have
any infrastructure in this country that everyone can share.
It's not going to be a pretty sight, we're going to become a
banana republic of sorts, an oligarchy, which is essentially
what we're becoming now.
So I think the disparity in income and wealth has never
been greater in our country's history. It's an absolute
travesty that we don't have public policy that reflects a newer
view of where investments need to be made in education, because
that is clearly the correlation between a good education and a
person's ability to get a good job. It'sjust so direct. So how
we can not look at that as a civil right, and if you deny that person a
good public education, essentially they should be able to sue under the
Fourteenth Amendment for denial of their civil rights.
So I'm in agreement with you and I hope that you're
successful in helping us change the public culture in terms of
this. And certainly I acknowledge the fact that Hollywood has a
great deal of influence in shaping our culture to the degree
that folks like yourself can take a leadership role. I think
that's really constructive and I appreciate it, and I really
applaud your efforts.
Mr. Horton. Thank you. I think one last brief thing. From
the beginning of civilization, there's been a balancing act
between the need of the community, the good of the community,
the good of the individual. A healthy society has a very even
balance. I think you here in Washington set that tone.
Mr. Regula. I appreciate your testimony. I have to say, I
read a disturbing article over the weekend from the Los Angeles
Times. The headline is, after spending $2 billion, Kansas City
schools get worse. A judge in Kansas City, Missouri ordered the
schools to spend a lot more money. And he ordered the State
government to come up with the money. They did spend the $2
billion, on top of everything else. And their scores are down
now. Admittedly they didn't do well. It says, 900 top of the
line computers, an Olympic size swimming pool, with six diving
boards, I don't know exactly how that makes you a better
scholar, padded wrestling room, etc., etc.
I think we have to be careful, and I support more funding,
but I think we also need to say what works. Because it's
obvious that in Kansas City, $2 billion did not improve. In
fact, they're going to take the system away, apparently, and
turn it over to the State and/or the mayor. It says the new
approach, back to the basics. I would hope this Committee has
time after we've finished our regular hearings to have some
oversight on what really works. How do we make sure the money
we do spent causes an improvement in the system and the
education of young people?
I think that's part of the challenge.
Mr. Horton. I agree with that. I clearly agree with that. I
think, though, if you go back to Jo Egger Lundquist's statement
that teaching is a calling, I think it's important.
Mr. Regula. That's true.
Mr. Horton. And I think we have to start treating teachers
with that respect. I think yes, in any endeavor, there is going
to be anecdotal evidence that says, this didn't work over here.
And maybe that anecdotal evidence is a good reason to take a
look at the system, try and make sure that we're functioning
well in that system.
Mr. Regula. Leadership, it says in Kansas City they've had
20 superintendents in 30 years. That tells you a lot right
there.
Mr. Horton. There you go. There's the problem. But I don't
think that means we should not fund it.
Mr. Regula. Oh, no. No, I'm more interested in how we can
make sure our funding gets results, and that's exactly what
you're saying, that's what all of us here want.
Just as an aside, you have many credits as an actor. I see
you were in the Into Thin Air, Death on Everest.
Mr. Horton. I was.
Mr. Regula. Did they film that there or here?
Mr. Horton. I wish we could say we braved the elements and
went all the way to Tibet, but we did it in Austria, which is
sort of like Tibet but not really. [Laughter.]
Mr. Horton. I think the food in Tibet would probably be
better, actually, than it was in Austria.
Mr. Regula. Very interesting. This was a TV series?
Mr. Horton. A TV film, yes.
Mr. Regula. That was a takeoff on the book?
Mr. Horton. Yes.
Mr. Regula. I read the book.
Mr. Horton. The book was terrific. Better than the TV show,
I have to admit. [Laughter.]
Mr. Regula. Thank you for coming and for your interest.
Tuesday, May 22, 2001.
DEPARTMENT OF LABOR BUDGET
WITNESS
RICHARD TRUMKA, SECRETARY-TREASURER, AFL-CIO
Mr. Regula. Our next witness will be Mr. Richard Trumka,
the Secretary-Treasurer of the AFL-CIO, on labor issues. Thank
you for coming. We'll put your testimony in the record, and you
can summarize for us.
Mr. Trumka. Thank you very much, Mr. Chairman. I'll do just
that.
Mr. Chairman, Congressman Obey, Congressman Kennedy, on
behalf of the 13 and a half million working women of the AFL-
CIO, I appreciate the opportunity to address some of the
concerns the President's fiscal year 2002 budget raises for
working families. Of particular interest and importance are
proposals for key worker protection, work development and
international labor programs. Those are the three that I'll
focus on.
Many of these programs, in our opinion, are already
inadequate to fully protect the rights of working people here
at home. Program cuts and flat funding will dilute these
protections even further, with the impact harshest for the very
workers who need most of the protections.
If current economic weakening persists or worsens, these
effects will be magnified. For workers in the global economy,
program cuts undermine our capacity to promote workers' rights
and fight child labor and other abuses, efforts central to
ensuring that trade improves the living standards for all,
rather than undermines the protections for America's working
families. We ask you to bear all these concerns in mind as you
consider the President's proposal for 2002.
And I'll briefly talk about three of those areas. Worker
protection. For 2002, the President proposes flat funding for
the Employment Services Administration, which enforces the
Nation's wage and hour laws, and for OSHA. These translate out
into a $6 million cut in ESA and an $11.5 million cut in OSHA.
We think this is the wrong approach.
Violations of basic wage and hour requirements remain
pervasive, especially in low wage industries. In the poultry
industry, for example, a DOL survey in 2000 found wage and hour
violations in virtually every surveyed establishment. Similar
problems exist in garment manufacturing, where one DOL survey
found violations in two-thirds of establishments in Los
Angeles, agriculture and industrial laundries and many other
traditional low wage industries.
They even exist among workers in the modern economy, such
as Silicon Valley immigrant workers who assemble circuit boards
at home on a piece rate basis. The President's ESA funding
proposals threaten the Department of Labor's oversight of
working conditions and enforcement of work protections for all
of these workers.
Proposed funding levels for OSHA also threaten that
agency's capacity to ensure workplace safety and health by
cutting 94 full time staff positions, two-thirds of which come
from enforcement, and by reducing funding for standard setting
and worker safety training. In sum, the funding proposals for
key worker protection programs concern us greatly. At a time
when a Nation can afford to do so much, we should be investing
more, not less, in protecting workers' rights.
In job training, Mr. Chairman, the fiscal year 2002 budget
would cut over $500 million in training and employment
services, including reductions in adult, youth and dislocated
worker programs, the latter having been targeted for a 13
percent reduction. Ironically, the President proposes to boost
funding for the unemployment insurance system to handle an
expected increase in claimants at the same time that he wants
to cut back on retraining and reemployment programs that would
help the unemployed return to work.
We're also deeply troubled by the proposal to eliminate
national funding for incumbent worker training. It's
unrealistic to expect State and local programs to pick this up,
this funding slack up, unless the needs of other workers,
including the unemployed and the disadvantaged, are to be
sacrificed. On the international labor program side, the
President's proposals for DOL international labor programs in
2002 is $71.6 million. That's less than half of the 2001 budget
of $148 million.
It's especially ironic that the President is calling for
such steep cuts at the same time that he is trumpeting those
programs as the preferable alternative to trade agreement
provisos as the mechanism for ensuring international labor
rights.
The cuts proposed by the President would seriously,
seriously reduce the Nation's capacity to combat child labor
around the world, to provide child laborers with basic
educational opportunities, to support workplace HIV and AIDS
programs targeted at youth, to promote the ILO declarations of
the fundamental principles and rights of work and promote
workers' rights around the world.
Mr. Chairman, we believe these cuts are misguided and will
undermine the efforts of American workers to compete in the
global economy. We ask this Subcommittee and the full Committee
to keep the needs of working families in mind during your
budget deliberations and to fund adequately the important
worker protection, job training and international labor
programs on which many families in this country so deeply
depend.
Thank you, Mr. Chairman.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Your testimony is timely, we have
the Secretary of Labor this afternoon before this Committee.
Mr. Obey.
Mr. Obey. Thank you, Mr. Chairman.
Mr. Trumka, I would simply make one observation and ask one
question. In this tax bill that's working its way through the
Congress, the cost of providing tax cuts over the next 10 years
to persons making more than $200,000 a year--the cost of
refusing to limit the size of their tax cuts to about $7,500
just from the rate cut alone--is about $280 billion over 10
years. We're going to toss that kind of money at them. Yet,
we're being told that we have to cut the Dislocated Workers'
Program appropriation by 13 percent and international labor
programs by 50 percent.
Would you explain what these international labor programs
do? Would you explain how they work and would you explain why
they're needed? I find it interesting that an Administration
that is about to ask Congress for additional authority in the
trade area is making a 50 percent cut in the program that is
meant to cushion the blow of globalization on American workers
because of their increasing vulnerability to products that are
produced with either slave labor or child labor. Would you
explain why these programs are not trinkets and why they are
crucial to the average working person?
Mr. Trumka. In short, the answer to that question is, these
programs allow us to identify the most outrageous actions that
take place around the world, whether it's child labor, whether
it's forced labor, and allow us to correct them in one form or
another. To not correct them causes American employees and
American employers to compete with products in the global
market that are made and subsidized and actually reward this
type of child, prison, convict labor or forced labor.
The other things allow us to monitor work places, for
instance, to find out abroad who is complying with their labor
laws and who isn't. We have tried for a significant amount of
time to get workers' rights as part of every trade agreement,
because it's our belief that workers' rights should be elevated
to the same level as intellectual property rights. We've been
unsuccessful to date.
Each and every time we're told that we should look to
another forum. And the forum that is always pointed to is the
UNDILO. This cut actually slashes in half the program and takes
any resemblance of seriousness that that claim can make away.
No one, if this budget is passed with this type of funding, no
one can seriously say to an American worker, you should go
elsewhere to protect your rights, you should go elsewhere to
look for help for a Mexican worker or Chilean worker or
Brazilian worker, you should go elsewhere. Because this flies
in the face of that argument.
Then when you look at things like AIDS and HIV, all of
those affect us on a moral basis and on an economic basis. The
spread of AIDS-HIV has been a horrible thing that all of us
want to eliminate. And we tried that, particularly with you,
and particularly in some of the African nations, it's a very
serious problem. But it's growing elsewhere. This would hamper
our ability to do that.
The other thing this would do is, we were successful in
getting a few people, 17 I believe, around the world to work in
embassies to identify outrageous workers rights and to promote
workers rights in those areas, so that they could increase
their standard of living, so that laws were either enforced, or
if they were inadequate, we as a person in the global economy
could say they were inadequate, change the laws so those
workers have a real chance to participate in the global
economy.
All of those programs directly impact people here, whether
it's in the Trade Bill directly with TAA assistance, whether
it's competing with child labor, whether it's competing with
people at forced labor, whether it's competing with Colombians
who have workers truly assassinated. In one of the coal mines
of Colombia, the president and vice president of the local
union were being bussed from the home to the work site. The bus
was stopped, they were taken off the bus and both of them were
assassinated, shot directly in the head as a message to
everybody else that if workers stand up for their rights, this
is the fate that befalls you. We're forced to compete against a
society that uses that threat to lower their prices and to
avoid any resemblance of honest, fair treatment and dignity in
workers.
Mr. Obey. I think that's an eloquent statement. I think it
will be a cold day in hell before the average worker in this
country will be willing to support further trade agreements, so
long as he sees programs like this that are meant to provide
them barely minimal protection being shredded by their own
government.
Mr. Trumka. We would very much like to be able to support
those trade agreements. But we would like for those trade
agreements to be fair to workers on both sides of the border.
And when we're told to go to the ILO, and then first of all, we
don't adopt here at home any of the ILO standards that protect
workers and then the meager funding that there is is slashed in
half, I think it speaks forcefully to the American worker
about, is that truly an avenue, or is that just a convenient
way to deflect us.
This truly highlights and makes it irrefutable that that
avenue is a means to deflect us, not to protect our rights.
Mr. Obey. Thank you, Mr. Chairman.
Mr. Regula. Thank you. Thank you for coming.
Just off the record, you were in mining, did you work in
the mines?
Mr. Trumka. Yes, I did, seven and a half years.
Mr. Regula. Open pit or what type?
Mr. Trumka. Deep mines in southwestern Pennsylvania. And
Mr. Chairman, it's been my experience, when there's a downturn
in the economy that the first place that employers,
particularly mining employers, attempt to cut is in the health
and safety area.
Mr. Regula. Yes.
Mr. Trumka. If you look at the last time, we had a downturn
in both of our States.
Mr. Regula. Right.
Mr. Trumka. You saw that the downturn was preceded by a
rash of belt line fires, people being killed, people being
crippled and lost production facilities. At a time when our
country needs as much energy as we can get, I think that's the
wrong thing for us to be advocating.
Mr. Regula. I was curious, my dad was a farmer, but he was
also involved in a drift mine. I used to go back in there, and
the closest I ever got to a pony was that animal that pulled
the cars out to dumping tipple. So that's kind of a dangerous
business, when you get right down to it, the point that you
make. And I see, in China they've trapped a large group of
miners. There's always that threat.
Mr. Trumka. It's horrible what's happening, the lack of
mine safety in China, the lack of safety in the workplace in
China.
Mr. Regula. Do you get any opportunity to communicate to
countries like the Chinese, some decent standards and ideas on
safety?
Mr. Trumka. It's difficult, because as you well know, the
representatives that they send to all the international events
that are supposed to be worker representatives are really not
worker representatives. So we talk to them about health and
safety. We have American companies that attempted to go over
there one time and create mining, but they've never caught on
to the notion that the value of a human life was more important
than a pound of coal.
Mr. Regula. Well, thank you very much for your testimony.
----------
Tuesday, May 22, 2001.
COMMUNITY HEALTH CENTERS
WITNESS
PATRICIA DIETCH, PRESIDENT AND CEO, DELAWARE VALLEY COMMUNITY HEALTH,
INC.
Mr. Regula. Patricia Dietch, President and CEO, Delaware
Valley Community Health. Thank you for coming. Your statement
will be put in the record, we'll appreciate your observations.
Ms. Dietch. Thank you, Mr. Chairman, Mr. Obey. I'm Patty
Dietch, I'm as you said, President and CEO of Delaware Valley
Community Health in Philadelphia, Pennsylvania. I'm happy to be
here today to represent the National Association of Community
Health Centers and the millions of patients who get their
medical care in health centers across the country.
I want to start by thanking Congress and this Committee for
your past support and let you know how much it's appreciated,
that the past increases that have been awarded to community
health centers have not gone unnoticed by those of us who try
to keep them going and those of us who work in them and by our
community boards and the patients who get their care there.
I'd like to take a moment to tell you about how some of
those past increases are used, from our experience. In 1999,
Congress awarded a $94 million increase for community health
centers. My organization applied for and received an expansion
grant. And we moved into a suburban, actually an affluent
suburban county, a suburban county of Philadelphia that has,
their county seat is an old industrial town that has a lot of
poverty pockets, economically depressed, because most of the
industry had left the town. We identified a group of mostly
minority low income patients who had very poor health status
indicators and little or no access to health care.
So we received this grant, and we projected that we would
approximately serve about 1,600 patients. In the first year
alone, we had 2,200 patients, over 7,000 medical visits. These
are people who are working poor, who work in service jobs, in
restaurants and landscaping, temporary construction jobs, 7-11,
people who work but work in low paying jobs where they don't
have employer sponsored health care plans. As a matter of fact,
83 percent of the people who come to the center do not have
health insurance.
These people, because they haven't received medical care in
a long time, some of them 10 years, are very expensive to work
up and treat. They require a lot of diagnostic tests, they have
multiple problems that when you first get them, it takes a lot
to get them managed, people who would have probably waited
until they got catastrophic illnesses and went to the emergency
room. So this center, by everyone's measure, has been a
success. I think that you'll see opportunities for that all
over the country.
So far this year, there's 100 applications that have been
received to expand health center sites, and almost 500 that
have been submitted to add services to existing sites. Even the
$150 million increase that we received last year, only half of
these applications could be funded with that increase. And this
year, we're starting in a new position for us, the President
has made health centers a priority, and both President Bush and
Health and Human Services Secretary Thompson have been very
supportive of community health centers. The President has
pledged to double the number of patients served by health
centers over the next five years. And also, he has called to
increase the number of new sites by 1,200 in 2006.
Last year, health centers served over 11 million. Forty-two
percent of them have no health insurance. Although already,
health centers are the most efficient and effective providers
in the country, serving each patient for just over $1 a day.
When I learned that statistic, I did my own health center and
we're actually below that. So I was pretty proud of that.
In order to double the number of patients served over the
next five years, NACHC has calculated that next year, health
centers would have to serve an additional 1.65 million
patients. If you add that up, that's a cost of $175 million
increase. I understand that this is an ambitious goal that the
President has set, and we're ready to meet it, how and ever we
can.
We continue to see an increasing number of
uninsuredpatients in our health centers. In my organization in the last
five years, the percentage of uninsured has grown from 11 percent to 43
percent, just since 1996. And now with the spotlight placed on the
program by the President, I expect we will see more uninsured patients
finding health centers and increasing our patient loads.
Mr. Chairman and Mr. Obey, I work at health centers because
I'm really committed to serving those less fortunate and to
ensure that all people have access to high quality primary
health care, and they really receive it at health centers. I
think it's unparalleled, the kind of care that they get. We're
extremely pleased with the President's call to double the
number of patients seen in health centers in the next five
years, but it's going to be difficult to achieve if the
funding, the dollars say that even this year we're going to
need $175 million just to start to get there over the five
years.
So that's what we're here to say, is that we appreciate
your support and it's been greatly appreciated by the millions
of people and those of us who keep these centers open every
day. Thank you.
[The justification follows:]
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Mr. Regula. I think they are great programs.
Mr. Obey.
Mr. Obey. You say that the President has made funding of
community health centers a high priority. I'd like to examine
that statement a little bit.
Last year, as you know, we provided an $150 million
increase. Even with that, only half the applications were
funded. Now the Administration is proposing an increase, not of
$150 million as we had last year, but $124 million.
I told the story in this Committee a week ago about a woman
I met about two months ago who was not fortunate enough to live
in an area where they had centers. I went to announce the
creation of a dental clinic in this four-county low-income
area. I met a young woman who was on Medicaid. Only about half
the dentists in those four counties would even take Medicaid
patients. And those who did take Medicaid patients would take
no new ones.
She had a child who needed to have the braces removed from
his teeth. She looked for a long period to try to find a single
dentist who would take those braces off. After calling 30 of
them, she could find not a one. So she held the kid down while
the father took the braces off with a pair of pliers.
How many more health centers could be provided, and how
many more people could be provided service, if the President's
budget this year provided the same dollar increase that we had
in the budget last year, namely $150 million rather than $124
million that's in the President's budget?
Ms. Dietch. Well, I'm not sure I can do this math in my
head, but $175 million would be 1.6 million additional
patients. So a little over a million more patients for $150
million, 1.2.
Mr. Obey. We have 40 million Americans without health
insurance. At that rate, it will take about 40 years before we
can get them covered by health centers, right?
Ms. Dietch. That's true.
Mr. Obey. Probably every member of this Committee and this
Subcommittee will be pushing up daisies at that point, Mr.
Chairman.
Mr. Regula. Yes, probably.
Mr. Obey. Thank you.
Mr. Regula. Thank you for coming. I'm curious, is your pin
of significance to community health centers? I sort of thought
it might be, given the configuration?
Ms. Dietch. No, I'd like to tell you that it is, but it was
really just a gift from someone where I left a former job, and
she bought it in a department store. It didn't come from
Colombia, I probably should make up a better story. But it's
really true.
Mr. Regula. It indicates people helping people, and our
reliance on each other.
Ms. Dietch. Yes, and they're multicultural.
Mr. Regula. That's very much what a community health center
is.
Ms. Dietch. Absolutely.
Mr. Regula. A lot of volunteers, people helping people.
Ms. Dietch. Actually, and a lot of usages of other Federal
programs. My organization participates with the Senior
Reemployment, the Older Americans Act, we have seniors who are
trying to re-enter the work force come to us as volunteers,
we've hired a couple of them, AmeriCorps, I mean, we utilize a
lot of people.
Mr. Regula. I think it's a great program. I hope we can do
more.
Ms. Dietch. Thank you.
----------
Tuesday, May 22, 2001.
PUBLIC HEALTH
WITNESS
ANTHONY ROBBINS, M.D., CHAIR, DEPARTMENT OF FAMILY MEDICINE AND
COMMUNITY HEALTH, TUFTS UNIVERSITY SCHOOL OF MEDICINE
Mr. Regula. Dr. Anthony Robbins, you get the blue ribbon
for patience this morning. I'm sorry we couldn't get to you
sooner, but as you can tell, there was a lot of testimony.
You're the Chairman of the Department of Family Medicine
and Community Health--where, it doesn't tell me.
Dr. Robbins. I'm sorry. It's at Tufts University in Boston,
Massachusetts.
Mr. Regula. Okay. And you want to talk about public health.
Dr. Robbins. I'd like to talk about public health. I spent
most of my career in public health, in government, State and
Federal. Actually before I go to the core of my statement,
perhaps I could just say to you how sad it is to be in front of
this Committee without Silvio Conte here. He was a great
advocate for public health and we miss him.
The President's budget that you're considering today is
problematic for efforts to improve the health of Americans. I
want to make just two key points and then a lot of the
illustrations are in my written testimony and we can go to
those questions if you'd like.
Expansion at NIH has great merit. But to expand NIH alone
is shortsighted public policy. It's already clear that many
Americans are not in a position to benefit from scientific
advances in medicine and public health. The budget will
increase the likelihood that under-served citizens, the
elderly, the needy, and rural Americans will never benefit
fully from NIH research.
As we saw last week with the introduction of this new
leukemia drug, when we rely on commercial firms to exploit
research results borne of Government investment, lifesaving
products may be beyond the financial reach of many Americans.
Investment at NIH must be balanced with full drug coverage
under Medicare and expansion of health programs to help the
under-served.
And that point really refers particular to the programs of
HRSA and to the programs of the Substance Abuse and Mental
Health Services Administration. That's point one.
The second point refers to how public health works in our
Federal system, where protecting the health of the public is
principally in the domain of States. But we have wisely built
federal programs that now provide the critical glue that holds
State public health efforts together. Any weakening of the
Federal public health programs will be far more damaging than
the reduced Federal budget numbers might indicate. State and
city programs will not be able to provide adequate protection
for their people against tuberculosis, lead poisoning, or
asthma, for example. We in New England, where we've been
dealing with the West Nile virus problem will probably not have
the resources we need.
If you look at the history of this, since the Michael
Debakey Commission on Heart Disease, Cancer and Stroke reported
in 1965 that the benefits of biomedical research were not
reaching all Americans, the gulf between investment and
research and the application of the results has actually
widened. Since that time, there is a wide body of evidence that
early detection and intervention can reduce the burden of
illness and disability on our aging population. As a
consequence of our failure to assure the broad distribution of
health advances produced by NIH research, many Americans,
particularly the poor, those who live in rural areas, and the
elderly, become sick and disabled and die unnecessarily.
Two health agencies of the Department of Health and Human
Services, HRSA and SAMHSA, define their mission in terms of
improving health and services for under-served Americans. To
the life saving programs of these two agencies the President's
budget would inflict serious damage. Then in the written
testimony I describe what happens in the community access
program and the rural health program, the Bureau of Health
Professions, Maternal and Child Health Block Grant and Ryan
White, poison centers and the mental health grants to
communities.
I follow a witness who has spoken about the increase of
10.6 percent for the community and migrant health centers. And
the President is to be commended for that. But that represents
only a small part of the overall HRSA budget which would
decline overall, including the increase for health centers, by
10.4 percent.
At SAMHSA, the targeted capacity program to which a small
amount of money has been added isn't growing nearly rapidly
enough. The agency itself estimated that 2.9 million people are
left out in terms of getting services from this program, from
these targeted areas. Yet the budget would cover 17,000 new
people or only .06 percent of what the agency says is needed.
Now, let me go to the Centers for Disease Control and sort
out the constitutional issue that States retain the prime
responsibility for protecting and improving the health of their
people. State health departments delegate some of their
responsibility to city and local health departments. I used to,
when I was a State health officer, first in Vermont and then in
Colorado, I was always reminding the Feds, as we called them,
that we in the States have the prime responsibility.
But in truth, in modern society, threats to health have
outgrown the capacity of State and local health departments to
respond without Federal help. Pathogens and toxic chemicals
cross borders. People cross borders. And public health
responses must as well. The Federal Government has responded
very well historically, with important assistance, help in
gathering data and surveillance, laboratory supportto stay
ahead of threats to health, and would help building capacity and
purchasing power, and help developing new programs where the science
has made it possible.
The Centers for Disease Control and Prevention have grown
to become the critical Federal public health assistance
program. Yet CDC's overall programs are being cut back in a
number of areas. The chronic disease and health promotion
program would be cut back by $174 million in the proposed
budget, cutting back on cervical and breast cancer screening,
heart disease and stroke, the diabetes program and many others.
There's new technology that is finally letting us look at
environmental hazards by seeing how people are exposed. Yet the
Center for Environmental Health would see a diminution in its
budget.
Vaccine purchases, which have become a very important part
of Federal assistance to States, I guess it goes up a little
bit, but the fact is that the cost of vaccines to vaccinate one
child fully will almost double next year because of the
addition of a wonderful new vaccine that comes out of NIH
research. The pneumococcal vaccine, which is effective against
one of the major causes of meningitis, and the blood borne
pneumococcal infections in infants, costs a lot of money. And
the new budget does not incorporate enough funding to continue
to cover the same number of kids with these vaccine purchases.
I mentioned asthma, where we have a national epidemic and
where in fact we're finally getting a handle on it, and yet
that program is cut back. And finally, the Prevention and
Health Services block grant is reduced.
I urge you, and maybe this is another one of those cases
where creativity will be needed, but I urge an expansion in the
health programs in the rest of the Department of Health and
Human Services, especially CDC, HRSA and SAMHSA, comparable to
that that has been proposed by the President for the National
Institutes of Health.
Let me conclude with a story. About 25 years ago, I was a
brash young State health officer, State health commissioner in
Vermont. I joked with the head of our appropriations committee
in the State house of representatives, and I told him that the
budget that he was proposing for me, that there wasn't a heck
of a lot I was going to be able to do about a variety of
avoidable problems, and that I might just have to sit back and
name the outbreaks and epidemics after the members of the
committee.
Now, Em Hebard was really very supportive and used my joke,
I guess, to help bring the budget up to a reasonable level. I
guess I would conclude by hoping that you can do as well by my
colleagues in the Public Health Service and for the people of
the country. Thank you.
[The justification follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do we get to pick our disease?
Dr. Robbins. Oh, I guess so. [Laughter.]
Mr. Obey. Tony, good to see you. Just a couple of
questions.
First of all, would you expand on what this new PCV
vaccine? Would you give us a little more information about what
would happen in terms of numbers of kids who would actually be
covered by all the vaccines they need if we stuck to the
President's budget? How many kids are going to be left out?
Dr. Robbins. Well, I can only, I can guess----
Mr. Obey. Why is it important?
Dr. Robbins. Let me go back to the vaccine, because this is
a very good story. We have had in the last 20 years three major
vaccine successes. All the other vaccines are older than that.
But first there was the hepatitis B vaccine and now hepatitis A
vaccines. These were developed out of research efforts and
brought to market and included in the universal vaccine
programs.
The most magnificent success was the hemophilus influenza B
vaccine, where essentially this disease, which was the most
common form of meningitis in children, virtually disappeared in
this country. Now we're succeeding similarly in the rest of the
world.
The most common remaining cause of meningitis in young
children is streptococcal pneumoniei, the organism that causes
pneumococcal meningitis. And interestingly enough, the old
vaccine that was effective in adults has been around for a long
time. It was developed many, many years ago and the technical
advance was producing something that would make it immunogenic,
would produce an immune response in children.
When that was done, they then had to produce a vaccine that
covered seven different strains of pneumococci. And in doing
that, this became a very expensive vaccine, sufficiently
expensive so that I'm told that next year's price, this vaccine
will cost as much as all the other vaccines together have been
costing under the CDC purchase program.
That meant in effect, if you were just going to keep the
same number of children protected you were going to have to
double the allocation. I think, if I remember the numbers, it's
up by $73 million or about a third of the increase that would
be needed to keep pace with immunization.
CDC provides by bulk purchases, by making contracts with
the vaccine manufacturers, I believe it's 11 States, 6 in New
England plus 5 others that buy all of their vaccines for all of
their children, and then the other States which buy a smaller
number for the under-served, for the uninsured. This has become
critical to every immunization program in the country.
These programs are essentially surveillance, so you know
where you've got the disease and you know how good the coverage
is, organization so that you make sure that everyone is coming
into health centers and health plans to be immunized, and the
support of certain personnel and the purchase of vaccines.
They've been magnificently successful.
Mr. Obey. Thank you. I noticed in public polling, Mr.
Chairman, that there's a strange gap in the public
understanding of the Public Health Service and the public
health agencies. When you use the term public health, what
many, many Americans think you're talking about is health care
delivered to the poor--Government health care for poor people.
They don't realize that what the public health service does is
to try to protect the health of the entire American population
from serious diseases.
I think if we could just find a way to make that change in
people's heads it would be a whale of a lot easier to get
support for some of these programs.
Dr. Robbins. I'm even reminded that when you go into
building one of NIH that the plaque on the wall describing the
mission of the institutes includes public health. It is not
simply to produce products and advances for the medical care
system. That's the problem for the under-served and the poor.
As we get new advances, it makes it to us, they make it to us
middle class people. But without the HRSA program, without the
kind of emphasis on screening and advances for diabetes
treatment that CDC is pushing so effectively now, this doesn't
make it to the under-served portions of the population.
Mr. Obey. Thank you.
Mr. Regula. Thank you, and we appreciate your patience.
Very worthwhile information.
The subcommittee will be in recess until 2:00 o'clock.
Dr. Robbins. I should thank the staff, because I've been
where you are, and you stuck it out, too.
[The following statements were submitted for the record:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
W I T N E S S E S
----------
Page
Acosta, Daniel, Jr............................................... 1738
Akhter, Mohammad................................................. 291
Albino, Dr. J.E.................................................. 49
Albright, Ann.................................................... 1542
Alexander, Dr. Richard........................................... 1750
Amundson, S.J.................................................... 1288
Anderson, L.K.................................................... 132
Baca, Hon. Joe................................................... 693
Bartels, Stephen................................................. 451
Bass, Patricia................................................... 1354
Bellermann, P.R.W................................................ 1476
Bereuter, Hon. Doug.............................................. 976
Berkley, Hon. Shelley............................................ 916
Biggert, Hon. Judy............................................... 885
Black, John...................................................... 606
Boehner, Hon. J.A................................................ 752
Brown, D.L....................................................... 1294
Bumpers, Betty...............................................1733, 1819
Bye, Dr. R.E., Jr................................................ 1397
Capito, Hon. S.M................................................. 894
Capuano, Hon. R.E............................................1570, 1832
Carter, Warrick.................................................. 73
Chambers, D.A.................................................... 94
Christian-Christensen, Hon. D.M.................................. 811
Clayton, Hon. Eva................................................ 1847
Clemens, Dr. T.L................................................. 173
Comegys, Marianne................................................ 302
Conway, The Most Reverend E.M.................................... 1025
Courtice, Dr. T.B................................................ 61
Crawford, L.H.................................................... 1726
Crowley, Hon. Joseph............................................. 631
Curtis, Danielle................................................. 361
Davis, Hon. Danny................................................ 792
Denison, Donna................................................... 1627
Diaz, L.A........................................................ 361
Dietch, Patricia................................................. 1178
Dreier, Hon. David............................................... 982
Dunigan, Cheryl.................................................. 371
Dutchman, Richard................................................ 1726
Edwards, Hon. Chet............................................... 866
Einhorn, L.H..................................................... 1234
Enna, S.J........................................................ 1490
Epp, J.G.....................................................1732, 1839
Epstein, S.H..................................................... 1263
Fasig, L.G...................................................1282, 1698
Fattah, Hon. Chaka............................................... 830
Feistritzer, C.E................................................. 1082
Felter, R.A...................................................... 441
Filner, Hon. Robert.............................................. 650
Fisher, Lucy..................................................... 1233
Fitzgerald, Brian................................................ 1093
Fossella, Hon. V.J............................................... 870
Frank, Irwin..................................................... 1220
Frelinger, J.A................................................... 1359
Friedlander, Michael............................................. 1368
Fulcher, Juley................................................... 1644
Gallegly, Hon. Elton............................................. 1870
Garcia, Dr. Juliet............................................... 1096
Gelenter, R.H.................................................... 1762
Givhan, T.Y...................................................... 132
Goldberg, Jerold................................................. 214
Grasmick, N.S.................................................... 338
Greene, S.M...................................................... 1577
Hardy, G.E., Jr.................................................. 161
Harmon, W.E...................................................... 528
Harrison, D.C.................................................... 396
Hasselmo, Nils................................................... 1384
Hayworth, Hon. J.D............................................... 862
Held, Marilyn.................................................... 85
Hennenfent, Mike................................................. 1753
Henrich, Carolyn................................................. 1150
Hill, Dorothy.................................................... 490
Hinojosa, Hon. R.E............................................... 830
Hinton, Dr. Philip............................................... 1598
Honda, Hon. Michael............................................645, 967
Hooley, Hon. Darlene............................................. 1861
Horton, Peter.................................................... 1150
Hunter, Kathy.................................................... 371
Hurley-Wales, Jennifer........................................... 271
Hutchinson, Dr. R.A.............................................. 1726
Hutchinson, Hon. Asa............................................. 680
Jackson-Lee, Hon. Sheila......................................... 937
Jacobs, Phil..................................................... 121
James, Sharpe.................................................... 1346
Jenkins, Dr. Renee............................................... 1
Jones, Hon. S.T.................................................. 902
Kalabokes, Vicki................................................. 1765
Kane, Joanne..................................................... 202
Karlin, H.R...................................................... 1268
Kasdin, Neisen................................................... 1344
Kase, R.D........................................................ 553
Keegan, L.G...................................................... 1009
Kelley, C.M...................................................... 1775
Kelly, Hon. S.W.................................................. 654
King, Hon. Peter................................................. 1858
Kirk, Hon. M.S................................................... 663
Klose, Kevin..................................................... 1813
Knappenberger, P.H., Jr.......................................... 1517
Kobor, Pat....................................................... 1317
Korn, Steve...................................................... 595
Krahn, Gloria.................................................... 1376
Kucinich, Hon. Dennis..........................................799, 807
Kukic, Dr. Stevan................................................ 37
Lancaster, R.B................................................... 350
Lander, E.S...................................................... 1073
Larson, Patricia................................................. 1642
Lee, Amy......................................................... 247
Leon, M.L........................................................ 108
Lewis, Lydia..................................................... 151
Luke, G.G........................................................ 1726
Mabee, M.S....................................................... 1455
Maloney, Hon. C.B................................................ 1853
Mann, Dorothy.................................................... 530
Martin, J.C...................................................... 380
Martin, W.J., II................................................. 618
Masten, Sue...................................................... 1422
Mazure, Dr. C.M..............................................1042, 1682
Meek, Hon. C.P................................................... 728
Meeks, Hon. G.W.................................................. 1000
Millender-McDonald, Hon. Juanita................................. 889
Mink, Hon. P.T................................................... 771
Mintz, Paul...................................................... 561
Monsky, S.L...................................................... 1595
Morella, Hon. Connie............................................. 909
Mosena, David.................................................... 1437
Moss, Dr. Ken.................................................... 195
Moss, Myla....................................................... 1726
Napolitano, Hon. G.F............................................. 933
Neal, Deborah.................................................... 235
Nunes, Carolyn................................................... 15
Nyeholt, James................................................... 1211
Nyeholt, Margaret................................................ 1211
O'Toole, Patrice................................................. 1636
Okojie, Felix.................................................... 467
Owens, Hon. M.R..............................................1840, 1864
Palone, Hon. Frank, Jr........................................... 1834
Pascrell, Hon. Bill.............................................. 639
Payne, Hon. D.M.................................................. 701
Pearsol, J.A..................................................... 260
Peck, S.B........................................................ 1215
Peppe, Kathryn................................................... 572
Perez, D.P....................................................... 1499
Petrovic, Jennifer...........................................1535, 1800
Pierson, Carol................................................... 1741
Pizzi, Lawrence.................................................. 184
Pizzorno, J.E., Jr............................................... 281
Pribyl, John..................................................... 1608
Price, D.L....................................................... 430
Pryce, Hon. Deborah..........................................1851, 1868
Randall, Allison................................................. 1644
Randell, Llyce...............................................1790, 1804
Reynolds, Ronna.................................................. 1272
Ritcher, M.K..................................................... 1427
Robbins, Anthony................................................. 1187
Rodriguez, Hon. Ciro............................................. 852
Roemer, Hon. Tim................................................. 988
Roman, Frankie................................................... 224
Ros-Lehtinen, Hon. Ileana........................................ 859
Rothmam, Hon. S.R................................................ 1844
Ruth, Betty...................................................... 1611
Salzberg, J.P.................................................... 1230
Sanchez, Hon. Loretta.........................................920, 1860
Schakowsky, Hon. J.D............................................. 924
Schlender, J.H................................................... 1364
Schuster, C.R.................................................... 408
Schwartz, Robert................................................. 501
Scott, Hon. Robert............................................... 711
Sever, Dr. J.L................................................... 135
Shannon, Jacqueline.............................................. 1581
Sharpe, A.L...................................................... 1317
Shays, Hon. Christopher.......................................... 749
Shaeffer, Les.................................................... 1271
Sheketoff, Emily................................................. 541
Sherman, Hon. Brad............................................... 966
Silver, H.J...................................................... 1310
Slaughter, Hon. L.M.............................................. 896
Slavet, Gerald................................................... 274
Smith, Hon. Chris................................................ 759
Smokler, Irving.................................................. 1504
Solis, Hon. Hilda................................................ 928
Stark, Hon. Pete................................................. 738
Stevens, Christine............................................... 1615
Stokes, Hon. Louis............................................... 315
Stupak, Hon. Bart................................................ 785
Suter, Carl...................................................... 585
Tate, Richard.................................................... 1611
Tauzin, Hon. Billy............................................... 776
Teter, Harry..................................................... 1440
Thiebe, E.A...................................................... 1754
Tilman, David.................................................... 1562
Torre, Robert.................................................... 1688
Trumka, Richard.................................................. 1164
Tubbs-Jones, Hon. Stephanie....................................719, 902
Underwood, Hon. Bob.............................................. 844
Underwood, P.W................................................... 515
Valachovic, Dr. Richard.......................................... 1726
Van Zelst, T.W................................................... 1707
Vander Ark, Tom.................................................. 1054
Waters, Hon. Maxine.............................................. 994
Watkins, Hon. Wes................................................ 764
Watkins, J.H..................................................... 1824
Waxman, Dr. F.J.................................................. 1810
Weinberg, Myrl................................................... 1333
Weisman, R.S.................................................1479, 1794
Wick, Douglas.................................................... 1233
Wilhide, Steve................................................... 419
Williams, Christine.............................................. 1431
Williams, Diane.................................................. 328
Williams, G.H.................................................... 393
Wolff, Liesel.................................................... 1631
Wood, J.O........................................................ 1305
Woolsey, Hon. Lynn............................................... 673
Wooten, C.D...................................................... 1717
Wooten, R.E...................................................... 1717
Wormley, Michaelle............................................... 202
Wu, Hon. David................................................... 876
Young, Hon. Don.................................................. 825
Zaret, David..................................................... 361
ORGANIZATIONAL INDEX
----------
Volume 7B
Page
Advisory Committee on Student Financial Assistance............... 1093
Adler Planetarium and Astronomy Museum........................... 1517
The Ad Hoc Group for Medical Research Funding.................... 1523
AFL-CIO.......................................................... 1164
AIDS Alliance for Children, Youth and Families................... 530
Air Force Sergeants Association.................................. 1712
Alachua County, Florida, Board of County Commissioners........... 1351
American Academy of Family Physicians............................ 380
American Academy of Pediatrics................................... 1
American Academy of Physician Assistants......................... 1339
American Association of Blood Banks.............................. 561
American Association for Geriatric Psychiatry.................... 451
The American Association of Immunologists........................ 1359
American Association of Nurse Anesthetists....................... 94
American Association of Poison Control Centers................... 1479
Amercian Association of Poison Control Centers................... 1794
American Association of University Affiliated Programs for
Persons with Developmental Disabilities........................ 1376
The American Cancer Society...................................... 1431
The American Chemical Society.................................... 1798
The American Chemical Society.................................... 1483
American College of Cardiology................................... 1529
American Dental Education Association............................ 1721
American Dental Hygienists' Association.......................... 1215
American Diabetes Association.................................... 1542
The American Gas Association..................................... 1292
American Gastroenterological Association......................... 1449
American Indian Higher Education Consortium...................... 1410
American Library Association..................................... 541
The American Lung Association and the American Thoracic Society.. 618
American Museum of Natural History............................... 1400
American Nurses Association...................................... 515
American Psychiatric Nurses Association.......................... 490
American Psychological Association............................... 1602
American Public Health Association............................... 291
American Public Power Association................................ 1521
American Trauma Society.......................................... 1440
American Urological Association, Inc............................. 1220
American Society of Clinical Oncology............................ 1234
American Society of Hematology................................... 1694
American Society for Microbiology (CDC).......................... 1444
American Society for Microbiology (NIH).......................... 1770
American Society for Pharmacology and Experimental Therapeutics.. 1490
American Society for the Prevention of Cruelty to Animals........ 1551
American Society for RSD/CRPS.................................... 1732
American Society for RSD/CRPS.................................... 1839
The American Society of Transplant Surgeons...................... 1572
American Society of Transplantation.............................. 528
Archdiocese of Chicago........................................... 1025
Arthritis Foundation Northeast Ohio Chapter...................... 553
The Association of America's Public Television Stations.......... 1621
Association of American Universities............................. 1384
The Association of Independent Research Institutes............... 1539
Association of Maternal and Child Health Programs................ 572
Association of Medical School Pediatric Department Chairs........ 1462
The Association of Minority Health Professions Schools........... 350
Association of State and Territorial Health Officials............ 161
Association of Women's Health, Obstetric and Neonatal Nurses..... 1485
Bastyr University................................................ 281
Bill and Melinda Gates Foundation................................ 1056
The Bushnell Center for the Performing Arts...................... 1272
California School of Professional Psychology..................... 49
Canavan Research Foundation...................................... 1268
Center for Disease Control and Prevention (CDC) Coalition........ 260
The Center for Victims of Torture and the National Consortium of
Torture Treatment Programs..................................... 1230
The Children's Heart Foundation.................................. 1238
CJD Voice........................................................ 1717
Coalition for Advancement of Health Through Behavioral and Social
Science Research............................................... 1317
Coalition of Academic Health Centers............................. 396
Coalition on Federal Funding of Vocational Rehabilitation........ 1507
Coalition for Health Funding..................................... 1455
Coalition for Health Services Research........................... 1676
Coalition for International Education............................ 1299
Coalition of Northeastern Governors.............................. 1420
College of Problems of Drug Dependence, Inc...................... 408
Columbia College................................................. 73
Communities Advocating Emergency AIDS Relief Coalition........... 1354
Community Medical Centers........................................ 1598
Consortium of Social Science Associations........................ 1310
Council of State Administrators of Vocational Rehabilitation..... 585
Creative Commission and the Committee for Education Funding...... 1150
Developmental Disability Research Centers Association............ 1368
Doris Day Animal League.......................................... 1288
Education Leaders Council........................................ 1009
Every Child By Two: Carter/Bumpers Campaign for Early
Immunization................................................... 1733
Every Child By Two: Carter/Bumpers Campaign for Early
Immunization................................................... 1819
The Federation of Behavioral, Psychological, and Cognitive
Sciences....................................................... 1636
Florida State University......................................... 1397
The Foundation for Ichthyosis and Related Skin Types, Inc........ 1587
Friends of Cancer Research....................................... 195
Friends of CDC................................................... 121
Friends of the Health Resources and Services Administration...... 247
Friends of NICHD Coalition...................................1282, 1698
FSH Society, Inc................................................. 1499
Gerald Slavet Education Performances Foundation.................. 271
Great Lakes Indian Fish and Wildlife Commission.................. 1364
Hackensack University Medical Center............................. 1688
Health Professions and Nursing Education Coalition............... 214
Humane Society of the United States.............................. 1555
Infectious Diseases Society of America........................... 1200
International PolioPlus Committee, Rotary International.......... 135
International Rett Syndrome Association.......................... 371
Jackson State University......................................... 467
Joint Steering Committee for Public Policy....................... 1073
LPA.............................................................. 1468
March of Dimes Birth Defects Foundation.......................... 235
Maryland State Department of Education........................... 338
Medical Library Association and the Association of Academic
Health Sciences Libraries...................................... 302
The Mended Hearts, Inc........................................... 1762
Miami Beach, Florida, the City of................................ 1344
Minann, Inc...................................................... 1707
Minnesota Senior Corps Association............................... 1608
Motion Picture and Television Fund............................... 1562
Museum of Science and Industry................................... 1437
National Alliance to End Homelessness............................ 1780
National Alliance for the Mentally Ill........................... 1581
National Alliance of State and Territorial AIDS Directors........ 1511
The National Alopecia Areata Foundation.......................... 1765
National Association of Anorexia Nervosa and Associated Disorders 1727
National Association of Children's Hospitals..................... 441
National Association of Community Health Centers, Inc. (Southern
Ohio).......................................................... 419
National Association of Community Health Centers, Inc. (Delaware
Valley)........................................................ 1178
National Association of County and City Health Officials......... 1294
The National Association of Developmental Disabilities Councils.. 1326
National Association of Foster Grandparent Program Directors..... 1824
The National Association of Home Builders........................ 1388
National Center for Education Information........................ 1082
National Center for Injury Prevention and Control................ 645
National Center for Learning Disabilities........................ 37
National Coalition Against Domestic Violence..................... 1644
National Coalition for Heart and Stroke Research................. 1305
National Coalition for Osteoporosis and Related Bone Diseases.... 173
National Congress of American Indians............................ 1422
National Council of Social Security Management Associations, Inc. 595
National Depressive and Manic-Depressive Association............. 151
National Federation of Community Broadcasters.................... 1741
National Foundation for Ectodermal Dysplasias.................... 1427
National Head Start Association.................................. 1577
National Health Council.......................................... 1333
National Hemophilia Foundation................................... 1277
National High School Federation.................................. 606
National Marfan Foundation....................................... 1745
National Minority AIDS Council................................... 108
National Minority Public Broadcasting Consortia.................. 1591
The National MPS Society......................................... 1271
The National Multiple Sclerosis Society.......................... 1391
The National Neurofibromatosis Foundation, Inc................... 1476
National Psoriasis Foundation.................................... 1323
National Public Radio............................................ 1785
National Public Radio............................................ 1813
National Rural Health Association................................ 1567
National Senior Service Corps.................................... 1611
National Sleep Foundation........................................ 224
The National Treasury Employees Union............................ 1775
National Youth Leadership Institute.............................. 1225
The National Youth Sports Program................................ 1754
The NephCure Foundation.......................................... 1504
Newark, New Jersey, the City of.................................. 1346
North American Brian Tumor Coalition............................. 184
Ohio State University College of Law............................. 393
Ohio Wesleyan University......................................... 61
Oklahoma State Experimental Program to Stimulate Competitive
Research....................................................... 1810
One Voice Against Cancer......................................... 1415
Organizations of Academic Family Medicine........................ 501
People for the Ethical Treatment of Animals...................... 1631
Population Association of America................................ 1558
Preparing for an Aging Society................................... 1251
Prostatitis Foundation........................................... 1750
Safer Foundation................................................. 328
San Diego Unified School District................................ 15
Scleroderma Research Foundation.................................. 1595
The Sickle Cell Disease Association of America................... 132
Society for Animal Protective Legislation........................ 1615
The Society of Gynecologic Oncologists........................... 1207
The Society for Investigative Dermatology........................ 361
Society for Neuroscience......................................... 430
The Society of Toxicology........................................ 1738
St. John Health System, Detroit.................................. 85
The Trust for America's Health................................... 317
United Fresh Fruit and Vegetable Association..................... 1627
Women's Health Research Coalition............................1042, 1682
Women Opting for More Affordable Housing Now, Inc................ 202